Spine Flashcards
uni vs bilateral facet dislocations
uni is 25% sublux; bL is 50%; more likely to have SC injury with bilat; uni has monoradiculopathy that improves with traction
if intubated and facet dislocation
MRI first then reduction - need to check for herniated disk - this would require ant and post approach
epidural abscess and neuro comrpomise - what is prognosis
with prompt decompression - only 18 % of pts with abscess recover; on 23% with paralysis recover
indications for surgery in epidural abscess
neuro sx; vertebral instability or deformity; no resolution after 6 wks IV abx; MRI showing>50% thecal sac compression; or depressed immune response
hyperreflexia and surgery for myelopathy
not an absolute indiciation if all else is asympomatic
pedicle diametere t-spine
largest at T1 and T12; smalles at T4 -T6
pedicle diameter T12 vs L1
T12 is bigger
peds discitis timeline
loss of lordosis is first sign before any xray findings
xray changes in peds discitis
diskc space narrowing at 1 week; endplate changes at 1-3weeks; sawtooth erosions at 4 weeks.; scalloping of endplates is with long standing infections
tx of peds spondy
if grade 4 (>50% slip) L4-Sacrum fuson
C7 affected motor function
triceps; wrist flexion
biceps weakness is what radiculopathy
C5 or C6
what structures are disrupted in facet dislocation
flexion-distraction injury - posterior structures are typically damaged
fusion of C2
dens to body at 6years; tip of dens to rest of dens at 12
use of Halo vest
for upper C-spine injuries - to control rotation
normal T-spine kyphosis
T20-T50
hypoglossal nerve injury lateralality
if left side injured; tongue deviates to left
def of brown-sequard injury
ipsilateral motor deficit; contralateral pain and sensory loss
steps for awake facet dislocation
if change in neuro status - closed reduce followed by MRI followed by surgery - mri helps determine approach
PADI and recovery with atlantoaxial sublux
if PADI > 10mm then there is chance of recovery; > 13mm Is best chance for recovery; < 14 is reason to operate
hallmarks of Anky Spondy
bilat sacroilitis; +/- uveitis; + HLA b27; typically has neg RF titer
when to do pars repair vs fusion
if L4 or higher; L5 is fusion
sx of Juvenile Anky Spondy
Enthesitis; kyphosis; SI; stifness; LE inflammatory arthritis; decreased chest expansion and UVEITIS - NOT uretheritis
what skeletal maturity system correlates with scoliosis progression
Tanner-Whitehouse RUS - use radius, ulnar epiphysis and 1-3-5 metacarpal epiphysis to determine skeletal age
what tracts are injured in central cord
latearl corticospinal tracts
Atlanto-dens interval
normal is < 3mm in adults, < 5mm in kids; if > 7mm then concern for rupture tectorial membrane, transverse and alar ligaments
asymmetric abdominal reflexes
MRI for syrinx or tumor in kids - even if curve is small
single rod tx
for thoracic kyphosis - can do anterior single rod; but higher rate of pseudo arthrosis if T5-T12 is > 40 degrees
if revising ACDF for non union whats the tx
PSF - has higher complications, more pain and EBL but still has HIGHER chance of fusion
steroids for sci
NOPE - no clear benefit; possible increased risk
PT for congen muscular torticolis
stretches - lateral tilt away from affected side; roll chin Towards affected side
ASIA A vs B
A has no motor or sensory; B has sensory but no motor
risk of adjacent segment disease in lumbar
age over 60; multi level fusion; ending at L1-3; or fusion with adjacent laminectomy
components of TLICS scoreing
injury morphology (compression vs rotation vs distraction); neuro status; and PLL integrity
mxn of lateral mass fracture separation
hyperextenson; lateral compression and rotation - C6 is most common -then 5; 7; 4; 3
whats tspine curve needs MRI in AIS
LEFT CURVE - gets MRI
risk of progression based AIS curve sizze
if > 25 deg before skeletal maturity; if > 50 T spine after maturity; if > 40 L-spine after maturity - both will progress at 1-2 deg per year
safe zone for occiput screws
in a triangle made by 2cm lateral to EOP; 2cm inferior to EOP
collagen type in discs
central is type 2; peripheral annulus is type 1
burst with retropulsion - surgical tx
anterior decompression with strut graft
risk of cervical laminoplasty
c5 palsy
c spine in Klippel-Feil
fused c-spine at birth; limited neck motion
tx of revision disc herniation
revision microdiscectomy
accuracy of needle biopsy for discitis
70% but needed prior to empiric abx
chance fracture assoc with
bowel injury
what is chance frx
compresison anterior; distraction posterior
approach for far lateral disc herniation
between multifidus and longissimus
when can you brace
skeletally immature (risser 0-1-2) 25-40 deg
measuring sagittal balance
center of C7 body plumb line and distance to post superior corner of S1
when does jeffereson frx need surgery
if TAL is also out - needs c1-2 fusion
before fixation of jeffersion frx you need
CT Angio
role of SSEP
provide direct info about posterior columns; indirect about anterior columns and NO info on nerve roots
tceMEP
provide info on anterior and lateral corticospinal motor tracts; spinal nerve roots; peripheral nerves; and plexus
most common complicaiton after adult spinal deformity
instrumentation failure
angle cut off for acdf vs psf for cspine stenosis
10 deg rigid kyphosis means go anterior
rf for pseuodarthrosis in spine
smoking; kyphosis >20; positive sagittal balance > 5cm; pre existing hip OA, > 55 years, and thoracoabdominal approach
tx for spont atlantoaxial rotatory instability
soft collar for 1 week; then halter traction and meds for 3 weeks; thenhalo traction; last is c1-2 fusion
SCM in Atalnotaxial rotatory displacement vs congen torticolis
SCM is spastic on SAME side of chin in AARD vs opposite side in congenital torticolis
spurling sign test
rotate head and tilt head to AFFECTED SIDE
halo anterior pin placement
1cm above orbital rim on lateral two thirds
most common complication of halo pins
loosening of pins
mortality after VCF
at 2 years close to hip fractures
tx of impending pars defect
bracing with LSO
mc radic after Post cervical decompression
C5 motor radiculopathy presenting 4 hrs to 6 days post-op
Ankyspody and THA risk is higher of
anterior dislocation - even with posterior approach
peds epidural abscess - tx
straight to IV abx - no biopsy or aspiration needed in peds population
fusion of anky spondy C-spine injuries
long construct bc of osteoporosis and stiff spine
when can you establish SCI complete vs incomplete
only after BC reflex is BACK
pelvic incidence equation
sum of tilt and slope
what risser stage correlates with linear growth most
risser 0 coveres the first two thirds of pubertal growth spurt
imaging for peds spondy if xrays are neg
SPECT scan for sondylolysis or pars defect
risk factors for post-op tspine decompresison after lumbar surgery
age over 55; pre and post-op sagittal imbalance and smaller lordosis
disc changes with age
less water; less large proteoglycans; incr KS to CS ratio; increase in neovascularization at annulus
most common complication of thoracic endoscopic surgery
intercostal neuralgia
non op tx of Scheuermans
if 50-74 deg can use extnsion brace or TLSO if apex is below T7
non op of cervical myelopathy - what predicts better outcome
increased transverse cord area > 70mm2
tspine disc herniation tx
if no neuro sx - PT; majority are between T8-12
goals of adult spinal deformit
SVA to within 5cm of neutral, ensure pelvic tilt is < 20 deg; and lordosis is withint 9 deg of Pelvic incidence - amount of coronal correction does not correlate to outcomes
c-spine facet orientation
superior facet is anterior to inferior; and beomce more posterolateral facing as you go down
