Spine Flashcards by Vejay Vakharia

What is the Hufschmidt grade?

Clinical symptom grading of spondylolisthesis

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What are the types of lumbar canal stenosis?

Central, lateral and foraminal

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What % of disc herniation are in the thoracic spine?

1% (mostly T11/12)

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

T2-5

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What are the approaches to a thoracic disc prolapse?

Anterior (transthoracic)
Posterior lateral (transpedicular, costotransversectomy, lateral extracavitatory approach)

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

CT scan!! As likely calcified.

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What are the stages of degenerative disc disease?

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

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Which nerve is thought to cause discogenic pain?

Sinoverterbral nerve

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What is the equation for momentum?

Momentum = force X distance

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What is IAR?

Incidence of angular rotation

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What aspect of a screw governs the pull out strength?

The thread depth

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What aspect of a screw governs the screw fracture strength?

The inner diameter

The screw fracture strength is proportional to the diameter cubed

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What is the definition of the functional spinal unit?

The two vertebral bodies, intervening disc and facet joints

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What is normal Sagittal balance?

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

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How are fractures classified with AO classification?

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

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How do you classify occipital-cervical dislocation?

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

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How can you measure occipito-cervical dislocation

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

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What is the classification of occipital condyle fractures?

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

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What is the rule of spence?

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

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How do you manage Jefferson fractures?

Transverse ligament intact - Halo

Transverse ligament not intact - Surgery

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What is C1 osteosynthesis?

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

What fractures occur of C2?

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

What is the Effendi classification?

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

2 -

What does the bulbocavernous reflex tell you?

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

What are the Canadian c-spine rules?

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

Which fracture should not be placed into traction?

Occipital-cervical dislocation | Hangmann's type 2A

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

Widening of the interpedicular distance.

What are the types of spondylolisthesis?

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

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

Total enbloc resection

How do you calculate prognosis in patients with spinal metastasis?

``` 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 ```

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

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

What is the diagnosis of an intramedullary intradural spinal tumour?

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

Where are spinal haemangiocytomas?

Subpial

What are the symptoms associated with Chiari malformation?

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

What is platybasia?

When the angle of the Clivus in flattened >120 degress

What is the pB-C2 line?

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

What is the classification of Basilar Invagination?

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

How can bone mineral density be estimated from CT?

BMD (mg/ml) = 0.78 X Hounsfield unit

What are the contraindications to vertebroplasty?

Coronal split fracture Vertebra planum Posterior wall breach

Why is the risk of cement extrusion less with kyphoplasty?

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

What proportion to the population suffer from RA?

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

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

What is the difference between basilar invagination and cranial settling?

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

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

``` Meningioma Schwannoma Neurofibroma Chordoma Myxopapillary ependymoma ```

What are the radiological features of a solitary fibrous tumour?

Look it up

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

Look it up

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

``` Myxopapillary ependymoma Paraganglioma Cavernoma Dermoids Lipoma Dermoid ```

What is the differential of an intramedullary spinal lesion?

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

What are the radiological features of a spinal haemangioblastoma?

Haemangioblastomas are associated with large syrinxes | !! Get an angiogram !! Take the feeders

What are the general principles of spinal intramedullary surgery?

``` 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

When would you do a posterior foraminotomy / discectomy?

Soft discs affecting the root unilaterally | Best if sequestered