Spine Flashcards
In the absence of trauma and “red-flag” signs, plain radiographs are not required unless …….
symptoms have persisted longer than 4 to 6 weeks
Cervical spondylosis most commonly occurs at
C5 - C6
Cervical nerve roots exit …………….their corresponding vertebrae (e.g., C5 exits at the C4-C5 neural foramen). Consequently, disc
herniation at C5-C6 involves the ……… nerve root.
Cervical nerve roots exit above their corresponding vertebrae (e.g., C5 exits at the C4-C5 neural foramen). Consequently, disc
herniation at C5-C6 involves the C6 nerve root.
The natural history of cervical spondylotic myelopathy is characterized by ?
stepwise deterioration in symptomatology followed by a period of stability.
What percentage of asymptomatic patients older than 40 years demonstrate a herniated nucleus
pulposus or foraminal stenosis?
25%
operative indications of Cervical spondylosis?
Operative indications include myelopathy with motor/gait impairment and radiculopathy with persistent disabling pain that
has failed nonoperative measures.
Anterior cervical discectomy and fusion complications include
recurrent laryngeal nerve injury, dysphagia, airway obstruction, nonunion, and adjacent segment disease
when is canal expansive laminoplasty used and when is it absolutely contraindicated?
Canal-expansive laminoplasty is used for multilevel spondylosis, congenital cervical stenosis, and ossification of the posterior longitudinal ligament. It is contraindicated in the setting of fixed
kyphosis.
what is the pavlov/Torg ratio?
The relationship between the diameter of the spinal canal and the corresponding vertebral body. The Torg ratio is calculated through radiographical or MRI measurement by dividing the sagittal diameter of the canal by the diameter of the vertebral body. <0.8 is abnormal and risk of neurological involvement.
what diameter of cervical spinal canal puts patient at increased risk and what is the absolute stenosis value?
13mm
10mm
Rheumatoid spondylitis most commonly presents as an occipital headache due to compression of ?
greater occipital branch of C2.
what is the cause of rheumatological spondylitis and what conditions result from this?
Progressive cervical instability secondary to pannus formation and erosion of the joints and capsular structures occurs in up to 90% of patients. This can manifest as (1) atlantoaxial instability, (2) cranial settling (basilar invagination), and (3) subaxial
subluxation.
Atlantoaxial subluxation is most common. A posterior atlantodens interval (ADI) l……………………mm is associated with an increased
risk of neurologic injury and usually requires surgical treatment.
Atlantoaxial subluxation is most common. A posterior atlantodens interval (ADI) less than 14 mm is associated with an increased
risk of neurologic injury and usually requires surgical treatment.
what is the Magerl technique? Harms technique?
Transarticular screw fixation (Magerl) across C1-C2
The Harms technique of stabilizing C1–C2 using fixation of the C1 lateral mass and the C2 pedicle with polyaxial screws and rods
reduced risk of vertebral artery injury in Harms technique.
Ranawat classification?
1, subjective symptoms
2 subjective symptoms with weakness
3 objective signs and weakness
a ambulatory
b non ambulatory (surgery less successful but still considered)
Always obtain ………………………. before elective surgery in patients with rheumatoid arthritis.
Always obtain flexion/extension films before elective surgery in patients with rheumatoid arthritis.
AS patient with neck pain …always think of ?
?cervical spine fracture
Spinal shock is over when
bulbocavernosus reflex returns.
what is neurogenic shock?
Neurogenic shock is secondary to loss of sympathetic tone and can be recognized by relative bradycardia.
Central cord syndrome?
most common, affecting elderly patients with a spondylotic cervical spine. It presents as motor and sensory loss greater in the upper than the lower extremity. Independent ambulation is regained in approximately half of
elderly patients and almost always in young patients.
Anterior cord syndrome?
second most common and has the worst prognosis. It presents as greater motor loss in the legs
than in the arms, with dorsal columns spared
Brown-Séquard syndrome ?
Brown-Séquard syndrome presents as motor weakness on the side of injury and contralateral loss of pain and temperature. It
has the best prognosis.
Autonomic dysreflexia?
syndrome of uncontrolled sympathetic nervous output occurring in patients with a spinal cord injury above T6. It presents as hypertension, pupillary dilation, headache, pallor, and reflex bradycardia. Treat with urinary catheterization, fecal
disimpaction, antihypertensives, and atropine in severe cases
Most thoracic herniated discs are treated nonsurgically.
• Indications for surgery include?
progressive thoracic myelopathy and persistent unremitting radicular pain.
Thoracic HNP is typically treated via an …………………………… approach for midline or central herniations. Anterior discectomy and hemicorpectomy are performed as needed. A ……………………………..is used for a lateral herniation.
Thoracic HNP is typically treated via an anterior transthoracic approach for midline or central herniations. Anterior discectomy and hemicorpectomy are performed as needed. A transpedicular
approach is used for a lateral herniation.
Posterior approach and laminectomy are contraindicated because?
an inability to retract the spinal cord and high rate of neurologic injury.
Back pain predominant
• Worse with flexion → ………………………………………………• Worse with extension → ………………………………………….
Leg pain predominant
Worse with flexion → ……………………………….
• Worse with extension → ……………………………………
Back pain predominant • Worse with flexion → discogenic back pain • Worse with extension → spondylolisthesis or facet arthropathy
• Leg pain predominant • Worse with flexion → lumbar disc disease
• Worse with extension → spinal stenosis
Most herniations are? why?
posterolateral (where the posterior longitudinal ligament is the weakest) and may present as back pain and nerve root pain/sciatica involving the lower nerve root at that level (L5 at
the L4-L5 level)
Far lateral herniation or foraminal stenosis involves the
exiting nerve root (L4 at the L4-5 level).