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Spine Flashcards

1
Q

proximal extent of fusion for Scheurmans

A

span the whole deformity

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2
Q

what is sagittal vertical axis

A

plumb line from C7 to fall BEHIND hips and within 4-5cm of posterior corner of S1

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3
Q

relationship of pelvic incidence to lumbar lordosis

A

generally PI is within 10 deg of lumbar lordosis

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4
Q

TLSO is most effective for which curves

A

those with apex BELOW t7

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5
Q

delay in diagnosis of 3 column spine injuries in pts with anklyosed spine

A

up to 19% of cases

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6
Q

tx of frx dislocation of spine

A

posterior reduction, stabilization 2 levels above and below

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7
Q

risk factors for PJK

A

adv age, 360 fusions; fusion to sacrum; upper instrumentation ending at T1-T3

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8
Q

trigger EMG thresholds

A

< 4-6mA means intact with neural structure; > 10 is safe; 9-10 is pedicle breach

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9
Q

what is effect of inhaled anesthetic vs IV anesthetic on neuromonitoring

A

inhaled dampens neuro physio signals

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10
Q

what is benefit of recombinant PTH for vertebral frx

A

reduced by 65%

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11
Q

effect of bisphos on vertebral frx

A

reduces by 50-70%

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12
Q

m/c complication of transpsoas lumbar instrumentation

A

thigh pain and psoas weakness

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13
Q

osteoporosis has what gene associated

A

COL1A1

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14
Q

ideal candidate for non-op for spineinfection

A

mssa; < 65y; no neuro sx; lumbar abscess location (vs other spine)

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15
Q

complication of bmp usage in PLIF

A

HO causing compression of neural elements

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16
Q

open vs tubular diskectomy for HNP

A

same outcome, same complication and revision surgery risk

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17
Q

highest risk for lumbosacral plexus during lateral approach

A

at l4-l5 - LS plexus lives b/w TP and vertebral body at in psoas at L4-5

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18
Q

baseline failure rate for non-op spine infection and risk factors for failure

A

IVDA, DM, > 65 y; CRP >115; WBC >12 or S. Aureus

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19
Q

tx of non frx with anky spondy

A

PSF even if non displaced

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20
Q

MIS vs Open TLIF Fusion rate

A

similar fusion rate; lower complication; shorter hospital stays

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21
Q

SINS criteria for instability - lower risk if

A

blastic; non-junctional (outside of C7-T2); no collapse even with 50% vt involvement;

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22
Q

what is chance fracture mechanism

A

distraction injury - look for tranverse pedicle fracture on axial CT

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23
Q

pelvic tilt in setting of lumbar lordosis

A

generally should be Less than 20; increased PT can indicate the amount of compensation to stand up straight

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24
Q

which growth factors are implicated in spinal stenosis

A

TNF - alpha; IL 1; MMP

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25
Q

rate of dysphagia in ACDF

A

up to 12 % of at 1 year

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26
Q

Wiltse approach

A

between the paraspinals (multifidus and longissimus) lands on the facet joints

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27
Q

dorsal spinal columns transmit

A

proprioception; vibration; deep touch

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28
Q

lateral spinothalamic trasmitts

A

pain and temp

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29
Q

halo for dens frx in eldery

A

higher risk of dysphagia

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30
Q

what deformity influences adult deformity patients to choose surgery

A

CORONAL plane deformity

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31
Q

MIS diskectomy associated with

A

increased rate of dural tear, overal complication rate is similar

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32
Q

sequestrectomy vs complete diskectomy

A

Sequestrectomy has higher recurrence rate but similar surgical time; complication, blood loss and LOS

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33
Q

ACDF vs posterior foraminotomy

A

similar function and outcome - but Posterior has higher rate of recurrence at SAME level and higher post-op neck pain

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34
Q

potential nerve palsy after c-spine surgery

A

C5 - 70% recover by 6 months but can occur up to 1 year after surgery- no treatment. Just reassure

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35
Q

how to reduce risk of c5 nerve palsy

A

prophylactic c4-5 foraminotomy; and neuromonitoring

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36
Q

recurrent vs superior laryngeal nerve injury

A

Recurrent nn innervates all muscles EXCEPT cricothyroid and will lead to hoarseness if injured; Sup. Nn is for cricothyroid and leads to voice fatigue and lost high pitch if injured

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37
Q

decompression of a burst fracture

A

best done via anterior approach; indirect decompression via posterior distraction is good but NOT AS GOOD

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38
Q

aorta bifurcates at which vertebral level

A

L4

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39
Q

multilevel interbody implant in osteoporotic spine

A

can increase the risk of subsidence

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40
Q

bmp 2 for spine fusion is cost effective when

A

considering lost wages and productivity; do NOT use in tumor fusions

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41
Q

tx of jumped facets in obtunded patient

A

OR for reduction followed by MRI to evaluate

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42
Q

smith pete osteotomy requires

A

anterior spine flexibility

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43
Q

sacralization of L5 vs Lumbarization of S1

A

up to 15% for L5 and 3-7% for S1

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44
Q

Bertolotti syndrome

A

L5 TP articulates with Sacrum - 5% and can cause LBP in young adults

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45
Q

what is functional spine unit

A

vt above and below; the disk; the paired facet joints

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46
Q

which facet is main compressor in lumbar radicu

A

SUPERIOR facet of the lower vertebrate

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47
Q

right vs left acdf

A

left side has a more predictable course of recurrenty larygneal - on right its variable under the subclavian artery often in surgical field

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48
Q

injury to superior laryngeal nn can lead to

A

loss of aspiration prevention via mucous sensory reflex

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49
Q

acdf landmarks

A

circoid MEMBRANE is C5-6; cricoid cartilage is c4-5; hyoid bone is c3 and angle of mandible is c2

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50
Q

TP facet relationship in lumbar spine

A

TP is in line with lower face

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51
Q

order of spinal muscles medial to lateral

A

interspinalis, multifidus, longissimus; iliocostalis

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52
Q

during lateral spine approach what do you do to hips and knees

A

Flex - to relax the iliopsoas

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53
Q

safest spot in acdf for vertebral artery

A

superior endplate at the uncinate process

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54
Q

ponticulus posticus

A

anatomic variant of vert artery for c1 - 15% of people

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55
Q

most important measurement for avoiding vert artery in C2 instrumentation

A

width of inferior surface of isthmus in C2

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56
Q

which t-spine has narrowest pedicle

A

T5

57
Q

pedicle/TP relationship in T spine

A

midline TP is midline pedicle in THORACIC Spine

58
Q

pedicle angles in L spine

A

start at 12 deg and increase to 30 deg by L5

59
Q

internal carotid artery and c1 lateral mass

A

within 1mm of exit of c1-2 articular screw or c1 lateral mass

60
Q

calf atrophy denotes which radic

A

chronic l5 neuropathy or S1

61
Q

Reflexes

A

C5-biceps; C6-BR; C7- triceps;

62
Q

l4 vs l5 foot sensation

A

L4 is MEDIAL foot; L5 is dorsal/lateral foot; S1 is pure lateral and plantar

63
Q

hoffman test accuracy for myelopathy

A

sensitive but NOT specific

64
Q

traslaminar vs transforaminal esi

A

TF works better and for longer but might require multiple injections

65
Q

emg vs mri sensitivity vs specificity for radic

A

mri is more sensitive; EMG is more specific (bc motor unit changes can take up to 21 days)

66
Q

T1PA iis what

A

angle from center of T1 to femoral head and to midpooint of sacrum < 14 is goal

67
Q

coronal plumb line

A

line down C7 and midline sacrum - distance should be < 4cm

68
Q

chin brow vertical angle

A

normal is -10 to +20

69
Q

risk for pjk

A

360 fusion; fusion to sacrum;

70
Q

indications for surgery in burst frx

A

neuro compromise; OR PLC disruption; canal compromise without symptoms or kyphosis is NOT a reason; and is NOT associated with chronic pain

71
Q

smith pete osteotomy gives how much correction

A

10 deg;

72
Q

complications and HRQOL for spinal deformity surgery

A

despite complicatons; most are temporary so don_t afect HRQOL; complications lower the 2 year HRQOL

73
Q

bracing reduces AIS surgery by

A

50% with at least 12 hours a day

74
Q

risk factors for persistent symptoms after myelopathy surgery

A

motor grade < or = 2; lost pain sensationa; multisegment disease including c5

75
Q

posterior laminoplasty vs acdf

A

posterior has more infection risk and more neck pain

76
Q

acdf placed steroid

A

can reduce dysphagia without causing increase in pseuoarthrosis or infection; no change in pain

77
Q

epidural abscess with NO neuro sx - should you operate?

A

IF > 65; DM; or MRSA then YES

78
Q

zero profile acdf plate does what

A

reduced short term and long term dysphagia withOUT change in fusion rate

79
Q

cage vs graft in acdf

A

no difference in adjacent segment disease

80
Q

risk factor for adjacent seg disease in acdf

A

women and smoker

81
Q

delayed surgery for central cord syndrome

A

reduced mortality

82
Q

indirect interbody decompression is how much

A

10-20%; putting the cage in anterior 1/3 disk space is good for restoring angle wihtout compromising the distraction

83
Q

what is at risk with c1-2 screws

A

either lateral mass at c1 or transarticular c1-2 screws can result in injury to internal carotid

84
Q

SINS scoreing

A

< 6 is stable, 7-12 is pending instability; 13 and up is unstable

85
Q

what is neurogenic shock

A

c- or t- spine injuries leading to lost Autonomics; look for hypotension with BRADY cardia - tx is to give pressors (phenyl; epi; dopa/dobutamine); atropine for HR;

86
Q

when to give steroids after acute spine injury

A

for 24 hours IF started within 3 hours

87
Q

which sci has highest potential for neuro recovery

A

conus medullaries

88
Q

alert patient with cs-pine jumped facet or perch what next

A

traction and reduce - do NOT sedate; MRI AFTER

89
Q

which 3-column TL injury is MOST unstable

A

translation/rotation - most likely assoc. with complete SC injury

90
Q

flexion distraction TL injury involves which columns

A

middle and posterior - NOT anterior

91
Q

what is floating lateral mass and tx

A

cervical spine frx of lamina and Ipsilateral pedicle - do a 2 level ACDF -these are unstable

92
Q

halo for subaxial c-spine injuries is

A

POOR immobilization - better for C1-2 injuries

93
Q

what is predictive of myelopathy severity

A

transverse area of SC

94
Q

age over 80 with spinal stenosis - what is outcome of Surgery

A

better outcomes compard to non-op

95
Q

complication of stereotactic radiation

A

compression fracture

96
Q

contraindication to c1-2 articular screw

A

aberrant vertebral artyery

97
Q

for suspected c-spine injury first imaging of chocie

A

CT - NOT cspine xray

98
Q

biggest risk with cervical corpectomy

A

midline migration of vertebral artery causing iatrogenic injury

99
Q

risk factor for adjacent segment disease

A

lami next to a fusion

100
Q

strongest reccomendation for treating osteoporotic VCF

A

AGAINST vertebroplasty

101
Q

VCF on MRI has what feature

A

Low T1 and high signal on STIR

102
Q

what is measurement is correlated to high grade spondylisthesis

A

Pelvic incidence - NOT slip angle or percentage; not sacral slope

103
Q

where is superior hypogastric plexus in relation to spine

A

at level of L5-S1

104
Q

sympathetic chain location in anterior spine

A

medial to psoas border behind the great vessels

105
Q

lumbar disc replacement vs fusion

A

increased pt satisfaction at 2 years for LDR

106
Q

treatment for far lateral disc herniations

A

extraforaminal diskectomy

107
Q

which nerves are at risk during transpsoas l4-5 approach

A

ilioinguinal and iliohypogastric - sit b/w int/ext obliques above iliac crest

108
Q

what Is r/f for highest complication in spinal deformity surgery

A

age >60

109
Q

moA denosumab

A

blocks osteoCLASTS - dmAB binds to RANKL (from osteoblasts) blocking its activiation of osteoclasts

110
Q

cervical stenosis involving 3 or more levels

A

check to see if alignment allows for posterior decompression-fusion

111
Q

which frx have higher risk of vert artery injury

A

highest with basical skull frx; OC dissocitaion or frx in HYPER ostotic spine; also if they invovle transverse foramen

112
Q

moA of gabapentin

A

binds to pre-synapse Ca channels and prevents neurotransmitter release

113
Q

DISH spine and SI joints

A

they are SPARED - it_s a non-inflammatory condition - associated with DM - track A1c

114
Q

spinal stenosis neuro exam

A

sx only when walking; neuro sx should be absent while sitting

115
Q

athetoid cerebral palsy seen with

A

kernicterus and jaudince - look for early cervical spine disease, disc degen

116
Q

displaced odontoid fractures - first step

A

always reduce - then OR

117
Q

unstable peds os odontoideum tx

A

c1-2 fusion

118
Q

tspine disc herniation ct appearance

A

often have calcifications

119
Q

children under 2 with spine frx what is NAT rate

A

40% are due to non-accidental trauma

120
Q

percentage of multiple myeloma with vcf

A

up to70% get vcf

121
Q

intra-op monitoring - which is most SPECIFIC for sc injury

A

Transcranial MEP is most specific; SSEP are NOT as Sn/Sp

122
Q

intra-op EMG used for

A

nerve root injury - ie during screw placement

123
Q

risk of adjacent segment disease with wrong needle placement

A

increased risk for adjacent segment disease

124
Q

Rha pre-op spine imaging -what is needed

A

flex/extension c-spine xray

125
Q

osteotomy of choice during long curves

A

smith pete - ie during schuermans

126
Q

intra-op tx to prevent PJK in lumbar fusions

A

in long lumbar fusions; augmenting the level ABOVE the fusion can help acute PJK from VCF - by using vertebroplasty

127
Q

when can you return to high intensity exercise after diskectomy

A

4 weeks is safe

128
Q

which mri findings in myelopathy mean poor prognosis

A

low t1 signal; high t2 signal

129
Q

timing of bone scan for VCF

A

wait at least 7-10 days; in acute phase it can lead to false negative

130
Q

what changes in pelvis to accomdate positive sagittal balance

A

pelvic retroversion

131
Q

if patient still septic after epidural abscess drainage then what next

A

MRI entire spine for skip lesions; even if psoas abscess present

132
Q

first step in bilatearl disc herniation if obtunded

A

get MRI to make sure disk isnt herniated - this would require an anterior approach

133
Q

PADI limit for surgery in RhA

A

if less than 13

134
Q

composition of obturator nerve

A

L1-3

135
Q

sciatic vs femoral nn contributions

A

Sciatic - L4,L5,S1; Femoral L3-4 - therfore L4 goes to BOTH

136
Q

after bisphos tx is maxed out what next for VCF prevention

A

add teraparatide

137
Q

in order to correct saggital balance in previous fusion you need

A

fusion to pelvis with PSO - smith pete requires OPEN disc space

138
Q

where does recurrent laryngeal nerve run

A

between tracheoesopahgeal interval

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