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Alexey Ortho Flashcards > Spine > Flashcards

Spine Flashcards

1
Q

SPORT trial outcome for degenerative spondylolisthesis

A

For degenerative spondylolisthesis:
Decompression WITH fusion - 80% satisfactory outcomes
Decompression WITH fusion - Standard of care
Instrumentation - Better fusion rates, but no better outcomes and higher re-operation rates
Decompression WITHOUT fusion - 70% satisfactory outcomes

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2
Q

What is the most common level for Degenerative Spondylolisthesis vs. Isthmic Spondylolisthesis

A 
Degenerative = L4/5
Isthmic = L5/S1
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3
Q

How to draw Pelvic Incidence

A

Line 1: Center of S1 endplate to center of femoral heads
Line 2: Line perpendicular to the center of the S1 endplate

Pelvic incidence = Pelvic tilt + Sacral slope
Pelvic incidence is independant of the position of the pelvis

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4
Q

How to draw Sacral slope

A

Line 1: Parallel to S1 endplate

Lene 2: Horizontal line

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5
Q

How to draw Pelvic tilt

A

Line 1: Center of the S1 endplate to the center of the femoral heads
Line 2: Vertical line through the femoral heads

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6
Q

Yearly rate of curve progression in Adult Idiopathic Scoliosis (Thoracic / Thoracolumbar / Lumbar)

A 
Thoracic = 1 degree per year for curves > 50 degrees
Thoracolumbar = 0.5 degrees per year
Lumbar = 0.25 degrees per year

Note: Degenerative scoliosis more likely to progress than Idiopathic Adult

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7
Q

Wiltse Classification of Spondylolisthesis

A 
1 = Dysplastic
2 = Isthmic
3 = Degenerative
4 = Traumatic (post-traumatic)
5 = Pathologic
6 = Surgical (post-surgical)
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8
Q

Radiographic parameters to aim for in correction of Adult Scoliosis

A

Saggital vertical axis within 50mm of the L5/S1 disc

Pelvic tilt less than 25 degrees

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9
Q

Diagnostic criteria for Scheuermann’s Kyphosis

A
  1. Kyphosis >45 degrees (norm = 40)
  2. > 5 degrees wedging at 3 or more adjacent vertebra
  3. > 30 degrees Thiraco-Lumbar kyphosis (norm = 0)
    (from Sorensen 1964)
Other features:
Schmorl's nodes
Irregular and flat vertebral endplates
Increased AP diameter of Apical vertebra
Narrow disc spaces
Spondylosis in adults

More than 80, operatey

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10
Q

Central cord syndrome - What tract is affected, what is clinically weak?

A

Lateral Corticospinal tract
Upper limb weakness > Lower limb weakness
Distal weakness > Proximal weakness (Fingers > Shoulder)

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11
Q

Differential diagnoses for Myelopathy

A 
Stroke
Ageing
Amyotrophic Lateral Sclerosis
Multiple Sclerosis
Movement disorder
Vitamin B12 deficiency
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12
Q

Simple argorithm for Cervical decompression

A

1 to 2 levels = Anterior alone ok
3+ levels + >10 degrees Kyphosis = A and P
3+ levels + <10 degrees Kyphosis = Posterior alone ok

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13
Q

Definition of spinal shock

A

Temporary physiological stage of the acutely traumatized spinal cord, manifested by the transient absence of reflexive function caudal to the spinal cord injury.

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14
Q

In what clinical situation is an MRI not necessary with bifacet / unifacet C-spine dislocation / listhesis prior to attempt at reduction

A

Complete spinal cord injury - nothing to lose, just go ahead and reduce it.

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15
Q

Ankylosing spondylitis Non-Orthopaedic manifestations

A 
Anterior Uveitis (20-40%)
Aortitis
Aortic regurgitation
Aortic calcification
Pulmonary fibrosis

Aortic calcification is a relative contraindication to thoracic kyphosis correction

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16
Q

Ankylosing spondylitis skeletal manifestations

A

Setonegative (RF -ve) spondyloarthropathy

Enthesitis
Sacroiliitis
Klebsiella pneumoniae synovitis
Spinal kyphosis
Arthritis
Spinal ankylosis
Costovertebral joint ankylosis (loss of chest expansion)
Hip FFD
17
Q

Indications for surgery in spine infection

A

NBACK

Neurology
Biopsy
Abscess
Continued symptoms despite ABs
Kyphosis
18
Q

Numbers to know in atlantoaxial subluxation

A

Related to Rheumatoid neck mostly.

ADI >3mm = abnormal
ADI >7mm = severe
ADI >10mm = high risk or paralysis

PADI / SAD <14mm = neural compression

19
Q

What is the CervicoMedullary angle

A

Angle between anterior line of brainstem and anterior line of spinal cord at the Ocipito-Cervical junction

Less than 135 degrees = high rate / risk if myeolopathy

Usually relevant in Rheumatoid c-spine

20
Q

What is the slip angle in spondylolisthesis?

A

Line 1: along posterior sacrum
Line 2: perpendicular to Line 1
Line 3: along inferior border or slipped vertebra

Slip angle between Line 2 and Line 3

> 30 degrees = high risk of progression

21
Q

Risk factors for non-union of Type 2 dens fractures

A 
Displacement > 5 mm
Distraction > 2 mm
Posterior displacement
Angulation >11 degrees
Comminution
Reverse oblique pattern
Age >40
Delayed presentation
22
Q

What are the components of the Posterior Ligamentous Complex of the spine?

A

SUPRAspinous ligaments
INTERspinous ligaments
Ligamentum flavum
Facet joint capsules

23
Q

Posterior cord syndrome. What’s gone, what’s left, what’s the cause?

A

Gone: vibration and proprioception
Intact: motor (can have bladder issues)
Cause: Tabes dorsalis, friedreich ataxia, AIDS, multiple sclerosis, cervical myelopathy

24
Q

Anterior cord syndrome. What’s gone, what’s left, what’s the cause?

A

Gone: motor, pain, temperature (urinary retention)
Intact: proprioception
Cause: anterior spinal artery infarct, disc herniation, radiation

25
Q

Central cord syndrome. What’s gone, what’s left, what’s the cause?

A

Gone: motor weakness (arms > legs)
Intact: sensation
Cause: syrinx, tumor, cervical spondylosis

26
Q

How are pelvic incidence and lumbar lordosis related?

A

Lumbar lordosis should be Pelvic Incidence +/- 9 degrees

This is relevant for planning deformity correction

27
Q

Non-Structural causes of scoliosis?

A

CHIPS

Compensatory (LLD)
Hysterical
Irritative (Tumor, infection)
Postural
Sciatic (Nerve root)
28
Q

Structural causes of scoliosis?

A

NIC NAOMI

Neuromuscular
Idiopathic
Congenital

Neurofibromatosis
Achondroplasia
Osteogenesis Imperfecta
Marfan's
Irradiation
29
Q

Neuromuscular causes of scoliosis

A

Myopathic (Muscular dystrophy, Polio, SMA)
Neuropathic (CP, Syrinx, Spina bifida)
Mixed (NSMNs)

30
Q

3 types of idiopathic scoliosis

A

Infantile (5%) ( < 4 yo )
Juvenile (15%) ( 4 to 10 yo )
Adolescent (80%) ( > 10 yo )

31
Q

What is the indication for surgery in congenital scoliosis

A

Progression

> 4-6 degrees per year

It is better to operate early to fuse the segment than wait too long and not be able to achieve correction.

32
Q

What is the RVAD angle of Mehta

A

In Early-Onset (infantile) scoliosis (Not congenital)

Angle between inferior endplate of vertebra and its rib, subtract from the same angle of the other rib.

If < 20 degree difference, then 90% chance of spontaneous recovery
If > 20 degree difference, then likely to need surgery

33
Q

What is a Phase 2 rib?

A

In Early-Onset (infantile) scoliosis (Not congenital)

On an AP X-ray:
Phase 1: rib head does not overlap vertebra
Phase 2: rib head overlaps vertebra

Phase 2 = high chance of needing surgery

34
Q

What is the difference between degenerative and isthmic spondylolisthesis?

A 
Degenerative = no pars defect
Isthmic = pars defect

Degenerative can be due to:
Facet degeneration, horizontal orientation, disc degeneration or ligamentous laxity

Isthmic is due to microtrauma

35
Q

Indications for spondylolisthesis fusion

A

Failure of non-op after 6 months
Neurologic deficit progression
Instability (slip progression)
Cauda equina

36
Q

In adult spinal deformity, what are the indications to extend fusion to S1 (not stop at L5)?

A 
C7 plumb line not restored
Sacral slope not restored
Any disease of L5/S1
- disc
- spondy
- facet arthropathy
Prior L5/S1 laminectomy

Alexey Ortho Flashcards (21 decks)

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