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INRC > Spine > Flashcards

Spine Flashcards

1
Q

What is the Hufschmidt grade?

A

Clinical symptom grading of spondylolisthesis

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2
Q

What are the types of lumbar canal stenosis?

A

Central, lateral and foraminal

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3
Q

What % of disc herniation are in the thoracic spine?

A

1% (mostly T11/12)

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4
Q

Between which levels can a thoracic disc prolapse cause Horner’s syndrome?

A

T2-5

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5
Q

What are the approaches to a thoracic disc prolapse?

A 
Anterior (transthoracic)
Posterior lateral (transpedicular, costotransversectomy, lateral extracavitatory approach)
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6
Q

What investigation should all patients with a thoracic disc have prior to surgery?

A

CT scan!! As likely calcified.

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7
Q

What are the stages of degenerative disc disease?

A

Dysfunction - poor biomechanics resulting in pain
Instability - aberrant motion
Re-Stabilisation - fusion to immobilise the area

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8
Q

Which nerve is thought to cause discogenic pain?

A

Sinoverterbral nerve

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9
Q

What is the equation for momentum?

A

Momentum = force X distance

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10
Q

What is IAR?

A

Incidence of angular rotation

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11
Q

What aspect of a screw governs the pull out strength?

A

The thread depth

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12
Q

What aspect of a screw governs the screw fracture strength?

A

The inner diameter

The screw fracture strength is proportional to the diameter cubed

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13
Q

What is the definition of the functional spinal unit?

A

The two vertebral bodies, intervening disc and facet joints

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14
Q

What is normal Sagittal balance?

A

Centre of C2 runs to the anterior T7, middle of T12 and posterior L3 and ?S1

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15
Q

How are fractures classified with AO classification?

A

A - Anterior
B - Posterior
C - Anterior and Posterior
These are each subdivided into 1-3

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16
Q

How do you classify occipital-cervical dislocation?

A

A - Head forward
B - Head vertical displacement
C - Head backwards

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17
Q

How can you measure occipito-cervical dislocation

A 
Powers ratio
BDI
CCI (Condylar gap) >2mm
BAI
X-line
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18
Q

What is the classification of occipital condyle fractures?

A

Anderson:
1 - Comminuted condyle
2 - Extension of skull base fracture
3 - Avulsions of the condyle

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19
Q

What is the rule of spence?

A

Overhang of the C1 over C2 >7mm when combined suggests transverse ligament injury

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20
Q

How do you manage Jefferson fractures?

A

Transverse ligament intact - Halo

Transverse ligament not intact - Surgery

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21
Q

What is C1 osteosynthesis?

A

Bilateral C1 lateral mass screws with a connector between the screws to treat Jefferson’s fractures

22
Q

What fractures occur of C2?

A 
Peg fractures (Anderson D'Alonzo classification)
Hangman's (Effendi classification)
Ring fractures
23
Q

What is the Effendi classification?

A

1 - C2/3 disc intact with only C2 pars fracture

2 -

24
Q

What does the bulbocavernous reflex tell you?

A

Lack of supra spinal input to the sacral outflow is suggestive of a complete spinal injury

25
Q

What are the Canadian c-spine rules?

A

Image if:

1) >65 years
2) Dangerous mechanism
3) Parasthesia in extremities

26
Q

Which fracture should not be placed into traction?

A

Occipital-cervical dislocation

Hangmann’s type 2A

27
Q

How can a burst fracture be diagnosed on AP X-Ray?

A

Widening of the interpedicular distance.

28
Q

What are the types of spondylolisthesis?

A 
Degenerative - due to facet degenerative changes
Isthmic - has bilateral pars defects
Traumatic
Congenital
2 more
29
Q

What is the management of Chordoma / chrondrosarcoma of the spine?

A

Total enbloc resection

30
Q

How do you calculate prognosis in patients with spinal metastasis?

A 
Tokuhashi score: 
General condition
Number of extra spinal bone mets
Number of bone mets
Visceral mets
Primary site of cancer
Spine cord involvement
Total is 15; If 9 surgery, 6-9 unclear
31
Q

What is the most likely diagnosis of an extramedullary intradural tumour?

A 
Meningioma / haemangiopericytoma
Schwannomas
Neurofibromas (need to sacrifice the nerve root)
Ependymoma (myxopapillary)
Cavernoma
Mets etc
Dermoid
32
Q

What is the diagnosis of an intramedullary intradural spinal tumour?

A

Low grade astrocytoma
Ependymoma (homogenous enhancement, arachnoid capping cysts or syrinx associated)
Subependymoma
Haemangioblastoma (florid contrast enhancement with large syrinx - get an angiogram!)
Vasculitis/ Demyelinating lesion / Sacroid

33
Q

Where are spinal haemangiocytomas?

A

Subpial

34
Q

What are the symptoms associated with Chiari malformation?

A

Cough headache
Lower cranial nerve dysfunction
Dysphagia
Limb symptoms associated with syrinx

35
Q

What is platybasia?

A

When the angle of the Clivus in flattened >120 degress

36
Q

What is the pB-C2 line?

A

A line drawn through the odontoid tip from the ventral dura perpendicular to a second line drawn from the basion to the inferoposterior aspect of C-2 vertebral body.If the peg is >9mm behind this line then basilar invagination exits

37
Q

What is the classification of Basilar Invagination?

A

Goel classification:

1) Reducible - Unstable with tip of peg above chamberlain, McRae & wackheim’s line - need posterior reduction and C1/2 fixation
2) Irreducible - need to have odontoid peg resection (transoral) plus posterior fixation

38
Q

How can bone mineral density be estimated from CT?

A

BMD (mg/ml) = 0.78 X Hounsfield unit

39
Q

What are the contraindications to vertebroplasty?

A

Coronal split fracture
Vertebra planum
Posterior wall breach

40
Q

Why is the risk of cement extrusion less with kyphoplasty?

A

As the balloon creates a cavity which is filled with low pressure cement

41
Q

What proportion to the population suffer from RA?

A

1%

42
Q

What is the aetiology of instability in the spine with RA patients?

A

Immune complex deposition causes ligamentous laxity and instability. This leads to pannus formation and neurological compression

43
Q

What is the difference between basilar invagination and cranial settling?

A

Basilar invagination has C1/2 instability I.e. C1 is in the normal position; with Cranial settling the C1/2 and normal and the whole complex has migrated cranially

44
Q

What is the differential diagnosis of an intradural spinal lesion (extra / intramedullary)?

A 
Meningioma
Schwannoma
Neurofibroma
Chordoma
Myxopapillary ependymoma
45
Q

What are the radiological features of a solitary fibrous tumour?

A

Look it up

46
Q

What are the radiological features of a benign vs malignant peripheral nerve sheath tumour?

A

Look it up

47
Q

What is the differential diagnosis of an intradural lesion at the conus?

A 
Myxopapillary ependymoma
Paraganglioma
Cavernoma
Dermoids
Lipoma
Dermoid
48
Q

What is the differential of an intramedullary spinal lesion?

A

Low grade astrocytomas
Ependymoma (usually central and homogeneous)
Subependymoma
Haemangioblastoma (pial location on the surface of the cord)
Caveroma
Inflammatory lesion

49
Q

What are the radiological features of a spinal haemangioblastoma?

A

Haemangioblastomas are associated with large syrinxes

!! Get an angiogram !! Take the feeders

50
Q

What are the general principles of spinal intramedullary surgery?

A 
Adequate laminectomy
Large durotomy
Adequate myelotomy
Surgical plane better centrally at the edges and worse at the poles
Debulk with CUSA
Water tight dural closure

Laminoplasty for children

51
Q

When would you do a posterior foraminotomy / discectomy?

A

Soft discs affecting the root unilaterally

Best if sequestered

INRC (7 decks)

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