Spine Chapter Flashcards
“canal expansive laminoplasty”
for the millipede MRI, but contraindicated in a FIXED kyphosis
in cervical stenosis this canal diam is at risk for neuro issues later
sagittal diam
indications for stabilization of the RA spine
instability, pain, neuro deficit, PADI
effect of PSF on anterior cord compression in RA
the pannus of RA that causes cord compression usually goes away with PSF
second most common cervical spine pathology in RA
basilar invagination
normal soft tissue shadows on cervical spine films
6mm @ C2, 20mm @ C6
long-term outcomes in complete SCI
80% get one nerve root level back, 20% get 2
contraindications to steroid use in SCI
more than 8 hrs from injury, pregnant, diabetic, infections, penetrating injury
surgical mgmt of spinal GSW
only if there is progressive neuro deficit, or intracanal bullet below T12
most sensitive test for HNP
positive contralateral SLR
bilateral sacroiliitis, decreased chest wall excursion
ankylosing spondylitis, with a + HLA-B27
after 6 wks of nonop for mostly leg pain
can consider epidural injections
after 6 wks of nonop for mostly back pain
appropriate to image at this point
who had higher recurrence rate in the SPORT trial, with regard to structural aspects of HNP
those with massive posterior annulus loss, or noncontained defects
surgical mgmt of epidural fibrosis
this does not do well with exploration
surgical mgmt of discogenic back pain
Shen says don’t operate on these people
surgical mgmt of lumbar segmental instability
posterolateral fusion
effect of alendronate on spinal fusion rates in animals
this nitrogenous bisphophonate decreases fusion rates
indications for fusion in spinal stenosis
removal of more than 1 facet, pars defects, symptomatic radiographic instability, degenerative or isthmic spondy/scoli
what does the SPORT trial tell us about the outcomes of spinal stenosis mgmt
that at 4 years, both nonop and op groups are improved. However, those that were operated on did better
imaging for spondy
SPECT
natural history of unilateral pars defects
almost never progress
this is the sacral slope plus the pelvic tilt
the pelvic incidence, which is an anatomic constant
spondy and restriction of activities
even if asymptomatic, grade 2 slips need to stop activity
indications to repair a pars defect
if associated with a 10% slip in a young pt or at L4 or above
this condition has nonmarginal osteophytes
DISH
how does AS affect spinal alignment
can result in fixed kyphotic deformity, creates sagittal imbalance
scoli and pregnancy
no correlation bt curve progression and issues with pregnancy
highest risk of scoli curve progression (i assume in an adult)
right-sided thoracic curve >50*
this is the strongest predictor of disability in adult scoli
sagittal imbalance
indications for surgical mgmt of adult scoli
More than 50* in pt younger than 30, chronic pain in an older pt, or a progressive curve (watch for increasing spinal stenosis or decreasing lung functions)
fusion of an adult scoli (not sure about peds) down to L5 is associated with
progressive sagittal imbalance and L5-S1 disc degeneration
when anterior fusion is added for kyphotic deformities
if it doesn’t correct to less than 55* on hyperextension
bisphosphonate use in compression fxs
their use decreases incidence 65% at year 1, 40% at year 3
choice of bone graft vs PMMA in anterior strut creation for metastatic spine cancer
if they’ll live more than 6 mos, they get bone
vertebra plana
EG
how much of sacral roots can you take during chordoma resxn and expect normal function
1/2
60% of polyostotic fibrous dysplasia pts will have this
spine dz
this is the first finding in disciitis
loss of lumbar lordosis
this infection in the spine typically spares the discs
TB
signal changes on GAD MRI in the spine
pus lights up, CSF stays dark
outcomes of revision LDH surgery in comparison to primary
equal
regardless of age, these myelopathic patients do best with nonop
those with a transverse cord area more than 70mm2
4 risk factors for pseudoarthrosis in adult scoli surgery
positive sagittal balance greater than 5cm, age >55, anterior approach, kyphosis greater than 20*
this is a structuralcontraindication to C1-C2 transarticular screws
abherrent vertebral artery
bracing for AIS curves
those curves from 25-40* in immature (risser 0-2). Those with an apex below T7 are best candidates
these C1 fxs can be treated in a collar
if the transverse ligament is intact, (i.e. combined lateral mass distance less than 8.1mm) you can nonop these
main complication of the transpsoas lateral approach
dorsal root ganglion injury
ramifications of surgical delay in cauda equina more than 48 hrs
60% will have chronic bowel and bladder issues; other stuff comes back
comparison of interbody fusions with standard
there is more blood loss, more restoration of the neuroforaminal height, and probably more adjacent segment degeneration (30%). Other outcomes, including fusion rates, are similar
4 risk factors for development of proximal junctional kyphosis
if the PI > lumbar lordosis, instrumentation to the pelvis or sacrum, in kyphosis if you don’t bypass the 1st lordotic segment, or if the sagittal plumb line is >4cm forward
decision tree for surgery in cervical myelopathy
laminectomy alone is nearly never the answer. if there are 1-2 levels, go anterior. If there are 3+ levels, depends on the kyphosis. If more than 10*, just do PSF
this is a relative indication to treat a stable burst surgically
polytrauma
how pelvic incidence relates to the spine when standing
should be the amount of lordosis in the lumbar spine
pt can’t stand upright without flexing at the knees, crouching
sagittal imbalance
non-instrumented fusion
pseudoarthrosis
MIS spine compared to standard open procedures
shorter hospital stays, MAYBE slightly higher dural tear rate, but essentially the outcomes, complications, and revision rates are all the same bt the two groups
troubleshooting intraop monitoring
check hypotension, temperature, inhaled agents, and check leads before doing anything with the hardware or the correction.
wake-up testing
doesn’t seem to be useful, takes too long and doesn’t tell you what component is causing the issue
complication rate in wiltse
40%, most commonly iliopsoas weakness
incidence of thigh pain in wiltse approach
100%, but transient
bony overgrowth leading to nerve compression after BMP use more common with this technique
PLIF
frequency of dysphagia after ACDF
70% at 2 weeks, but only 15% at one year
difficult ambulation that improves with sitting
neurogenic claudication from spinal stenosis
main complication of percutaneous instrumentation of spine
hardware failure, since you can’t put in any graft for a fusion
main benefit of percutaneous instrumentation of the spine
less blood loss
why blood loss in ankylosing spondy pts is a concern
they can develop epidural hematomas more easily than non-AS
how is PTH useful in osteoporosis
it increases osteoblastic bone formation, decreases osteoblastic apoptosis, and decreases vertebral osteoporotic fxs 40-60%
risk factors for proximal junctional kyphosis in degenerative scoli pts
360 fusions, advanced age (65+), ending at T1-T3, and extending to the sacrum (below L2?)
need for additional surgery in revision PJK
50% will end up with adjacent segment degeneration and need another operation
EMG testing of pedicle screws
less than 4mA is touching neural tissue, 8-10mA is out of a pedicle, more than 15mA has 98% probability of being in a pedicle
thoracic TB MRI findings
spares the disc, has anterior soft tissue signal
TLIF vs PLIF
these have the same fusion rates, same surgical time, same length of stay, and same volume of disc removed. However, the TLIF has less blood loss and spares the paraspinal musculature
when steroids are the right answer in non-trauma spine
in tumor if there is cord compression
main complication of spine surgery for tumor
infection
why AS fxs are a big deal
60% neuro deficit, and increased mortality for up to 2 years (worse than hip fx supposedly)
indication for MRI in facet dislocation
everyone gets one after reduction, whether it was successful or not. Obtunded pts will get one before AND after. Awake pts just after…
aorta bifurcates at the
anterior aspect of L4
what else does cauda equina have besides bowel/bladder, saddle anesthesia
motor weakness, or other lower motor neuron signs
decision tree for adult scoli
if under 50 you are treating coronal plane deformity, if over 50 you are treating chronic pain and disability
smith peterson osteotomies in the spine require this to be effective
anterior column flexibility
ACDF vs posterior foraminotomy
equal pain relief and functional outcome. ACDF has higher risk of adjacent level dz, posterior foraminotomy has more neck pain and same-level dz.
landmark for C6
cricoid
landmark for C3
hyoid
landmark for C4
upper border of thyroid cartilage
landmark for C5
lower border of thyroid cartilage
