Spine—Cervical Flashcards
What is the percentage of patients undergoing transoral removal of the odontoid process who required posterior fusion afterwards due to ligamentous instability?
● A. 20%
● B. 45%
● C. 75%
● D. 80%
● E. 90
C. 75%
Transoral approach for odontoidectomy is preferred if the patient is able to open mouth up to how much?
● A. 55 mm
● B. 45 mm
● C. 35 mm
● D. 25 mm
● E. 15 mm
D. 25 mm
What is the range of motion reduced after occipitocervical fusion?
● A. Flexion/extension: reduced by 30%
● B. Lateral rotation: 15 degrees is lost
● C. Lateral bending: 8 degrees is lost
● D. Flexion/extension: reduced by 20%
● E. Both A and C
E. Both A and C
What screws are used for atlanto-occipital transarticular fusion?
● A. 22 to 24 mm cannulated lag screws
● B. 24 to 28 mm cannulated lag screws
● C. 28 to 32 mm cannulated lag screws
● D. 32 to 34 mm cannulated lag screws
● E. 34 to 36 mm cannulated lag screws
C. 28 to 32 mm cannulated lag screws
All of the following are considered to be contraindications of anterior odontoid fixation?
● A. All fractures of the C2 vertebral body
● B. Disruption of transverse atlantal ligament (TAL)
● C. Large odontoid fracture gap
● D. Irreducible fracture
● E. Pathological odontoid fracture
A. All fractures of the C2 vertebral body
While drilling for placement of C2 pedicle screws, if brisk bleeding occurs after withdrawing the drill, what is the next best step?
● A. Abort procedure immediately
● B. Placement of screw at drilled site
● C. Screw placement on both sides
● D. Securing hemostasis by locating the bleed site
● E. None of the above
B. Placement of screw at drilled site
For LMS placement by Magerl method where is the entry point?
● A. 2 mm medial to midpoint
● B. 3 mm medial to midpoint
● C. 1 mm medial to midpoint
● D. 2 mm superior to midpoint
● E. 2 mm inferior to midpoint
A. 2 mm medial to midpoint
Which of the following are the anterior approaches to the cervical spine?
● A. Anterior odontoid screw
● B. For upper cervical spine (c1–c3) transoral approach including odontoidectomy
● C. For upper cervical spine (c1–c3) extrapharyngeal approach including medial extrapharyngeal approach and lateral extrapharyngeal approach
● D. For c3–c7 cervical spine, standard anterior cervical diskectomy approach is used
● E. All of the above
E. All of the above
Indications for anterior transoral odontoidectomy includes anterior extradural compression of the cervicomedullary junction as with pannus from rheumatoid arthritis, irreducible basilar invagination, tumors of c2, or infection. Following are the preoperative requirements for transoral approach except?
● A. Patient’s mouth can be opened at least up to 25 mm. If not, then other approaches like translabiomandibular should be considered
● B. For conditions resulting in malalignment or basilar invagination, cervical traction for 1 or more days is sometimes required
● C. Radiographic evaluation cervical MRI with and without contrast to define the soft tissue pathology, and CT of the craniocervical junction with sagittal and coronal reconstruction
● D. Intradural pathology is best dealt with this approach because watertight dural closure is easier and there are very low chances of postoperative meningitis in case of intradural pathology
● E. CTA should be done to assess position and involvement of the vertebral arteries. Measuring the distance between vertebral arteries provides useful information
D. Intradural pathology is best dealt with this approach because watertight dural closure is easier and there are very low chances of postoperative meningitis in case of intradural pathology
Which of the following statements are correct regarding transoral surgery?
● A. Video laryngoscope and second choice fiberoptic bronchoscopy are now the intubation methods of choice
● B. Three-point fixation with a Mayfield head holder is typically used
● C. A specialized retractor, for example, Crockard transoral retractor or a conventional Dingman retractor, is used
● D. The tubercle of the atlas can be palpated through the posterior pharynx to locate the midline and for craniocaudal orientation with infiltration of mucosa of posterior pharynx with 1% lidocaine with epinephrine
● E. A 3-cm long vertical incision is used with a working window of 20 to 25 mm between the two vertebral arteries
● F. Occipitocervical fusion or posterior c1–c2 arthrodesis is often used in case of basilar invagination or c1–c2 instability alone respectively
● G. All of the above
G. All of the above
Indications of occipitocervical fusion includes traumatic occipitoatlantal dislocation, absence of a complete arch of c1, congenital anomalies of the occipitocervical joints, upward migration of odontoid into the foramen magnum, or marked irreducible shifts of c1 or c2. The occipital screws are cortical
screws (narrow pitched) with distal blunt tip (to avoid dural injury) and have dimensions of 4.5-mm diameter or 8- to 12-mm length. Following are the options of occipitocervical fusion except?
● A. Keel plate (placed centrally over the thickest portion of the occipital bone) which is connected via rods to the cervical screws (c2 pedicle screw and c3 lateral mass screws)
● B. Occipital condyle–C1 polyaxial screws
● C. Occipital–c1 (also known as atlantooccipital) transarticular screws
● D. c1–c2 transarticular screws
● E. Looped rod wired to the occiput via wire cables placed through holes drilled in the occiput which reduces the range of motion to only 31% of normal
D. c1–c2 transarticular screws
The entry point of occipital condyle screws is 4 to 5 mm lateral to foramen magnum and 1 to 2 mm rostral to the atlantooccipital joint. Screws are 3.5-mm diameter polyaxial screws and bicortical purchase is obtained using screws of 20- to 24-
mm length. Following are the structures that are needed to be preserved while using these screws except?
● A. Hypoglossal nerve in hypoglossal canal
● B. Carotid arteries
● C. Vertebral arteries
● D. Accessory nerve
● E. Jugular bulb
D. Accessory nerve
Horizontal skin incision is given at c5–c6 level for anterior odontoid screw fixation. Indication for this procedure is a reducible odontoid type 2 fracture or type 3 fracture where fracture line is in the cephalad portion of the body of c2 in an elderly patient. Which of the following are the contraindications of this procedure?
● A. Fracture of c2 vertebral body
● B. Disruption of transverse atlantal ligament
● C. Large odontoid fracture gap
● D. Irreducible fracture
● E. Patients with short thick neck and barrel chest or pathologic odontoid fracture
● F. All of the above
F. All of the above
Indications of atlantoaxial fusion includes instability of c1–c2 joint due to incompetence of transverse atlantal ligament or because of incompetence of odontoid process, hangman’s fracture, or vertebrobasilar insufficiency. How much of head rotation is lost after c1–c2 fusion?
● A. 30%
● B. 40%
● C. 50%
● D. 60%
● E. 70%
C. 50%
Which of the following are the surgical options for c1–c2 fusion?
● A. Rigid instrumentation with c1 lateral mass and c2 pedicle screws
● B. Posterior cervical wiring and fusion
● C. Halifax clamps and fusion
● D. Odontoid compression screws
● E. Combined anterolateral and posterior bone grafting
● F. All of the above
F. All of the above
