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Millers > Spine: C > Flashcards

Spine: C Flashcards

1
Q

What is the rate of tandem myelopathy/stenosis

A

20% lumbar pathology w/ cervical myelopathy

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2
Q

What are parameters for congenital cervical stenosis
What equation can be used

A

<10mm space available for the cord
Avg normal 17
Torg = B/A = <0.8 = stenosis

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3
Q

3 ways an acute cervical disc presents

A

Central cord
Acute myelopathy
Cervical radiculopathy

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4
Q

What are the 3 RA C spine manifestations

A

Basilar invagination = migration of the dens into the foramen magnum
C1-2 instability 2/2 pannus destroys the TAL
Subaxial instability (“stair step” deformity)

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5
Q

Why do patients have balance issues with cervical myelopathy

A

Posterior cord compression / posterior elements
Lose proprioception
Shuffle / stumble bc dont know where your feet are in space

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6
Q

What is Lhermitte sign

A

Flex neck causes electric shock
Myelopathy

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7
Q

What is Wartenburgs sign

A

Slightly greater abduction of the fifth digit
Weakness adducting palmar interosseous muscle
Unopposed radial innervated extensor muscles (digiti minimi, digitorum communis)

Cervical myelopathy

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8
Q

What is the Japanese Ortho Association (JOA) classification

A

Score to determine if your cervical myelopathy will improve with surgery
<14 = likely to improve
Higher score = more functional

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9
Q

What is the determining factor to determine ant vs posterior for C spine surgery

A

KYPHOSIS

> 10deg, need some anterior procedure to restore lordosis

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10
Q

If more than 3 levels C spine involved, what surgery:

If >10deg kyphosis
If <10deg kyphosis or lordotic (normal)

A

Kyphotic - anterior AND posterior

Normal - posterior alone or ant/post

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11
Q

Why should you never choose an answer with cervical laminectomy alone? (aka without fusion)

A

Post laminectomy kyphosis
Instead choose laminoplasty or lami/fusion (what you think of with fishtail from the back)

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12
Q

Surgical approach for OPLL

A

Posterior
High rate dural tear from anterior

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13
Q

What is cervical laminoplasty

A

Make a cut in the lamina that use a plate to put back together but with a gap to preserve additional cord space

Motion preserving - facets left unfused
Expands the canal
Preserves the PLC, decreasing risk of kyphosis

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14
Q

When should you choose front/back C spine surgery

A

> 3 levels ACDF (pseudo rate)
1 corpectomy (higher rates of graft displacement)
Kyphosis correction (if large enough)
Pts with high risk pseudoarthrosis (smoker, prev pseudo, inflam arthropathy)

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15
Q

Ddx for cervical myelopathy

A

Stroke
Tumor
Vit B12 def
MS - vision changes, uniL motor/sens, get MR w/ contrast (demyelin lesions, periventricular plaques)
AML (Lou Gehrig) - will have atrophy, CSF sample for dx

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16
Q

When can you return a transient quadriplegia/cord concussion to play

A

Sx: neuropraxia that resolves in mins/hrs

Return to play with sx resolve and normal MRI
CANNOT return if MRI findings stenosis

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17
Q

What congenital cervical stenosis is a CI to return to play

A

Speak Tackler’s spine
Spine straightens with trauma

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18
Q

Treat basilar invagination (RA pts)

A

Occiput - C2 fusion
- No brain stem compression
- Occiput gives you a better level arm to lengthen with than C1

Anterior + posterior - if need brain stem decompression

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19
Q

What are the ADI thresholds for AA subluxation

A

ADI = posterior aspect of the anterior atlas ring and the anterior aspect of the odontoid process

> 3.5 between flex/ext XRs = instability
10mm = surgery indication

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20
Q

What are the PADI/SAC thresholds for AA subluxation

A

PADI/SAC = distance from posterior surface of dens to anterior surface of posterior arch of atlas

<14mm = surgery indication

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21
Q

Trt AA subluxation

A

C1/2 fusion

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22
Q

What is the collagen type for annulus fibrosis vs nucleus pulposus?
What is the disc blood supply?

A

AF = T1
NP = T2
BS = avascular, diffusion

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23
Q

What level do disc herniations affect in C spine

A

Nerve exits above the level

Really no traversing roots in C spine, so herniations always affect exiting root

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24
Q

Name the following dermatomes
C3
C6
C7
C8

A

C3 = occiput
C6 = thumb
C7 = middle finger
C8 = small finger

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25
Name the motor group: C5 - T1
C5 = shoulder abduction (deltoid) C6 = elbow flexion (BR) + wrist extension (ECRL) C7 = elbow extension (triceps) + wrist flexion (FCR) C8 = finger flexion/grip (FDS) T1 = finger abduction (interossei)
26
What is the shoulder exam for patients with C spine radiculopathy
Improves with shoulder elevation / hand on head
27
What is considered instability on lateral flex/ex XRs
>3mm shift or 11deg
28
Plate vs no plate for ACDF
Plate for multi level is standard bc of high subsidence rates
29
Indications / outcome for cervical disc replacement
Young, no arthritis, single level Neck pain = relative CI Think radiculopathy or acute myelopathy Outcomes equiv to ACDF, possible decrease in adj seg dis
30
What are the soft tissue markers for the following levels: C2-6
C2 = angle mandible C3 = hyoid C4-5 = thyroid C5-6 = cricoid C6 = carotid tubercle
31
Innervation of SCM Strap muscles
SCM = CN 11 = accessory Strap = ansa cervicalis - Omohyoid - Sternothyroid - Sternohyoid
32
Contents of carotid sheath
Common carotid art IJ Vagus n
33
What is the location of screw fixation in the C spine
C1 = lateral mass C2 = pedicle > translaminar > pars C3-6 = lateral mass C7 and below = pedicle
34
RF pseudarthrosis
Smoking DM Multi level surgery Revision
35
Recurrent laryngeal nerve - Which cranial nerve - Cause - Strategy for revisions
CN X = vagus Traction injury - Left around aortic arch - Right around subclavian artery (superficial) Revision - see ENT first, approach from the same side (aka don't bag the other side nerve)
36
Cause/sx Hornerns syndrome
Over retraction of longus coli - sympathetic chain injury Ptosis, miosis, anhidrosis
37
Hypoglossal nerve injury - What nerve roots - Sx
C2-3, C3-4 Tongue deviates to SAME SIDE as injury
38
Late presentation of esophageal injury
Mediastinitis - can be 50% mortality
39
Risk factors for adjacent segment disease cervical spine
Plate <5mm from the adjacent level (aka too close) Smoking F>M
40
What side is the artery of Adamkiewicz on? Spine levels
LEFT T8-L1
41
How do you determine ASIA level
Most proximal level w/ bilateral motor >3/5 strength w/ sensory intact
42
How does neurogenic shock present
Low BP + HR Bc of loss autonomic control aka sympathetic tone
43
What is the evidence of steroids with spinal cord injury?
Not indicated - no clear benefit, real risks
44
What is the operative timeline for incomplete vs complete spinal cord injury
Incomplete - surg <12hrs, goal to stabilize to save spinal function Complete - surg <24hrs, goal to stabilize to facilitate rehab
45
Presentation for anterior cord syndrome I.e. sp emergent aortic aneurysm repair
Anterior spinal artery injury LE strength loss >> UE Lose - motor, pain and temp Keep - proprioception, vibration (dorsal column intact) WORST PROGNOSIS
46
What spinal cord syndrome has the best outcome
Brown Sequard Ipsilateral motor CL pain and temp
47
Describe DISH spine
Nonmarginal syndesmophytes Flowing candle wax XRs Older pts NO SI jt involvement Associated with DM
48
Describe disc space DISH vs ank spond
DISH - disc space preserved Ank spond - ossified
49
What is the HLA for DISH vs ank spond
DISH - HLA B8 Ank spond - HLA B27
50
Describe ank spond spine
Marginal syndesmophytes Bamboo spine, squared vertebral bodies YOUNGER pts Bilateral SI joint involvement
51
When do you decompress a spinal epidural abscess
Weakness / deficits
52
What is the C2 watershed area
Apex of dens - internal carotid Base dens - vertebral art
53
Treat the types of dens fractures
T1 - apex, nonop T2 - waist, highest rate non union <50 - Nonop = halo - Op = displaced w/ non union risk factors >50 - Non op - orthosis (NEVER halo) - Unlikely to be operative candidate T3 - body, non op
54
What restriction is placed on people with os odontoideum
CI contact sports
55
What are RF for type 2 odontoid nonunion
Older (>50) >6mm displaced **greatest RF >10deg post angulation Comminution Delayed treatment DM
56
What are the operative techniques for type 2 odontoid frx
C1-2 screw - C2 pedicle > translaminar > pars Wire w/ C1-2 transarticular screw - If aberrant vert art = ABSOLUTE NO Anterior screw - Perpendicular frx - Intact TAL - No barrel chest
57
How do you determine if a C1 fracture is operative
Sum of lateral mass displacement on open mouth >8.1mm = TAL injury = unstable Trt with occ-C2 fusion
58
Trt cervical facet dislocation
Alert/NV intact = CR -> MRI -> OR AMS/deficits = MR -> OR
59
What is the difference in operative strategy for cervical facet dislocation that can be reduced vs not
ACDF alone if reducible / unilateral Consider front back if not reducible
60
What other injuries are associated with cervical facet dislocation
Occipitocervical dissociation Transverse foramen fracture Basilar skull fracture
61
What are two subaxial C spine injuries that have anterior bone flecks? How treat differently?
Extension tear drop / avulsion = mild ext injury - Orthosis Flexion teardrop = ant frag stays with ALL, posterior frag retropulses into the canal - Ant vs ant/post fixation
62
Treat a floating lateral mass
Lamina and pedicle 2 level fusion - Post if need reduction - Anterior if already reduced
63
What fractures are good for halo
Upper cervical - controls flex/ex and rotation NOT good for subaxial spine - Poor control of lateral bend - Bell ringer phenomenon = increased subaxial motion with a halo on
64
Absolute CI for halo
Cranial frx Infx Soft tissue injury preventing pin placement <2yo
65
pins and # inch-pounds for halo pins Kids vs adults
Adults: 4 pins, 8 inch-lbs Kids: 8 - 4
66
What is safe pin placement for adults halo
Ant pin: - lateral side of orbit - 1cm above supra-orbital ride - Nerves at risk = supraorbital and supratrochlear Post pin - 180 deg from ant BOTH below the equator
67
Nerve palsy seen for halos
Abducens (CN 6) = one eye drifts centrally
68
What do SSEPs measure? Pro/con What are the alert levels?
Somatosensory evoked potentials SENSORY = dorsal column Transcranial leads read somatosensory cortex response Con: slower to respond to injury Pro: less influenced by anesthetics Alert level: - Drop 50% amplitude - Increase 10% latency
69
What do MEPs monitor? Con Alert level
Motor evoked potentials MOTOR Transcranial stim motor cortex - measure the muscle contraction Detect anterior cord injury (ischemia) Con: can be unreliable depending on anesthesia Alert - >75% decrease in amplitude (sustained)

Millers (29 decks)

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