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ABOS PART ONE > Spine Chapter > Flashcards

Spine Chapter Flashcards

1
Q

“canal expansive laminoplasty”

A

for the millipede MRI, but contraindicated in a FIXED kyphosis

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2
Q

in cervical stenosis this canal diam is at risk for neuro issues later

A

sagittal diam

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3
Q

indications for stabilization of the RA spine

A

instability, pain, neuro deficit, PADI

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4
Q

effect of PSF on anterior cord compression in RA

A

the pannus of RA that causes cord compression usually goes away with PSF

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5
Q

second most common cervical spine pathology in RA

A

basilar invagination

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6
Q

normal soft tissue shadows on cervical spine films

A

6mm @ C2, 20mm @ C6

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7
Q

long-term outcomes in complete SCI

A

80% get one nerve root level back, 20% get 2

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8
Q

contraindications to steroid use in SCI

A

more than 8 hrs from injury, pregnant, diabetic, infections, penetrating injury

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9
Q

surgical mgmt of spinal GSW

A

only if there is progressive neuro deficit, or intracanal bullet below T12

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10
Q

most sensitive test for HNP

A

positive contralateral SLR

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11
Q

bilateral sacroiliitis, decreased chest wall excursion

A

ankylosing spondylitis, with a + HLA-B27

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12
Q

after 6 wks of nonop for mostly leg pain

A

can consider epidural injections

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13
Q

after 6 wks of nonop for mostly back pain

A

appropriate to image at this point

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14
Q

who had higher recurrence rate in the SPORT trial, with regard to structural aspects of HNP

A

those with massive posterior annulus loss, or noncontained defects

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15
Q

surgical mgmt of epidural fibrosis

A

this does not do well with exploration

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16
Q

surgical mgmt of discogenic back pain

A

Shen says don’t operate on these people

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17
Q

surgical mgmt of lumbar segmental instability

A

posterolateral fusion

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18
Q

effect of alendronate on spinal fusion rates in animals

A

this nitrogenous bisphophonate decreases fusion rates

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19
Q

indications for fusion in spinal stenosis

A

removal of more than 1 facet, pars defects, symptomatic radiographic instability, degenerative or isthmic spondy/scoli

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20
Q

what does the SPORT trial tell us about the outcomes of spinal stenosis mgmt

A

that at 4 years, both nonop and op groups are improved. However, those that were operated on did better

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21
Q

imaging for spondy

A

SPECT

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22
Q

natural history of unilateral pars defects

A

almost never progress

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23
Q

this is the sacral slope plus the pelvic tilt

A

the pelvic incidence, which is an anatomic constant

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24
Q

spondy and restriction of activities

A

even if asymptomatic, grade 2 slips need to stop activity

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25
Q

indications to repair a pars defect

A

if associated with a 10% slip in a young pt or at L4 or above

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26
Q

this condition has nonmarginal osteophytes

A

DISH

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27
Q

how does AS affect spinal alignment

A

can result in fixed kyphotic deformity, creates sagittal imbalance

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28
Q

scoli and pregnancy

A

no correlation bt curve progression and issues with pregnancy

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29
Q

highest risk of scoli curve progression (i assume in an adult)

A

right-sided thoracic curve >50*

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30
Q

this is the strongest predictor of disability in adult scoli

A

sagittal imbalance

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31
Q

indications for surgical mgmt of adult scoli

A

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)

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32
Q

fusion of an adult scoli (not sure about peds) down to L5 is associated with

A

progressive sagittal imbalance and L5-S1 disc degeneration

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33
Q

when anterior fusion is added for kyphotic deformities

A

if it doesn’t correct to less than 55* on hyperextension

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34
Q

bisphosphonate use in compression fxs

A

their use decreases incidence 65% at year 1, 40% at year 3

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35
Q

choice of bone graft vs PMMA in anterior strut creation for metastatic spine cancer

A

if they’ll live more than 6 mos, they get bone

36
Q

vertebra plana

A

EG

37
Q

how much of sacral roots can you take during chordoma resxn and expect normal function

A

1/2

38
Q

60% of polyostotic fibrous dysplasia pts will have this

A

spine dz

39
Q

this is the first finding in disciitis

A

loss of lumbar lordosis

40
Q

this infection in the spine typically spares the discs

A

TB

41
Q

signal changes on GAD MRI in the spine

A

pus lights up, CSF stays dark

42
Q

outcomes of revision LDH surgery in comparison to primary

A

equal

43
Q

regardless of age, these myelopathic patients do best with nonop

A

those with a transverse cord area more than 70mm2

44
Q

4 risk factors for pseudoarthrosis in adult scoli surgery

A

positive sagittal balance greater than 5cm, age >55, anterior approach, kyphosis greater than 20*

45
Q

this is a structuralcontraindication to C1-C2 transarticular screws

A

abherrent vertebral artery

46
Q

bracing for AIS curves

A

those curves from 25-40* in immature (risser 0-2). Those with an apex below T7 are best candidates

47
Q

these C1 fxs can be treated in a collar

A

if the transverse ligament is intact, (i.e. combined lateral mass distance less than 8.1mm) you can nonop these

48
Q

main complication of the transpsoas lateral approach

A

dorsal root ganglion injury

49
Q

ramifications of surgical delay in cauda equina more than 48 hrs

A

60% will have chronic bowel and bladder issues; other stuff comes back

50
Q

comparison of interbody fusions with standard

A

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

51
Q

4 risk factors for development of proximal junctional kyphosis

A

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

52
Q

decision tree for surgery in cervical myelopathy

A

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

53
Q

this is a relative indication to treat a stable burst surgically

A

polytrauma

54
Q

how pelvic incidence relates to the spine when standing

A

should be the amount of lordosis in the lumbar spine

55
Q

pt can’t stand upright without flexing at the knees, crouching

A

sagittal imbalance

56
Q

non-instrumented fusion

A

pseudoarthrosis

57
Q

MIS spine compared to standard open procedures

A

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

58
Q

troubleshooting intraop monitoring

A

check hypotension, temperature, inhaled agents, and check leads before doing anything with the hardware or the correction.

59
Q

wake-up testing

A

doesn’t seem to be useful, takes too long and doesn’t tell you what component is causing the issue

60
Q

complication rate in wiltse

A

40%, most commonly iliopsoas weakness

61
Q

incidence of thigh pain in wiltse approach

A

100%, but transient

62
Q

bony overgrowth leading to nerve compression after BMP use more common with this technique

A

PLIF

63
Q

frequency of dysphagia after ACDF

A

70% at 2 weeks, but only 15% at one year

64
Q

difficult ambulation that improves with sitting

A

neurogenic claudication from spinal stenosis

65
Q

main complication of percutaneous instrumentation of spine

A

hardware failure, since you can’t put in any graft for a fusion

66
Q

main benefit of percutaneous instrumentation of the spine

A

less blood loss

67
Q

why blood loss in ankylosing spondy pts is a concern

A

they can develop epidural hematomas more easily than non-AS

68
Q

how is PTH useful in osteoporosis

A

it increases osteoblastic bone formation, decreases osteoblastic apoptosis, and decreases vertebral osteoporotic fxs 40-60%

69
Q

risk factors for proximal junctional kyphosis in degenerative scoli pts

A

360 fusions, advanced age (65+), ending at T1-T3, and extending to the sacrum (below L2?)

70
Q

need for additional surgery in revision PJK

A

50% will end up with adjacent segment degeneration and need another operation

71
Q

EMG testing of pedicle screws

A

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

72
Q

thoracic TB MRI findings

A

spares the disc, has anterior soft tissue signal

73
Q

TLIF vs PLIF

A

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

74
Q

when steroids are the right answer in non-trauma spine

A

in tumor if there is cord compression

75
Q

main complication of spine surgery for tumor

A

infection

76
Q

why AS fxs are a big deal

A

60% neuro deficit, and increased mortality for up to 2 years (worse than hip fx supposedly)

77
Q

indication for MRI in facet dislocation

A

everyone gets one after reduction, whether it was successful or not. Obtunded pts will get one before AND after. Awake pts just after…

78
Q

aorta bifurcates at the

A

anterior aspect of L4

79
Q

what else does cauda equina have besides bowel/bladder, saddle anesthesia

A

motor weakness, or other lower motor neuron signs

80
Q

decision tree for adult scoli

A

if under 50 you are treating coronal plane deformity, if over 50 you are treating chronic pain and disability

81
Q

smith peterson osteotomies in the spine require this to be effective

A

anterior column flexibility

82
Q

ACDF vs posterior foraminotomy

A

equal pain relief and functional outcome. ACDF has higher risk of adjacent level dz, posterior foraminotomy has more neck pain and same-level dz.

83
Q

landmark for C6

A

cricoid

84
Q

landmark for C3

A

hyoid

85
Q

landmark for C4

A

upper border of thyroid cartilage

86
Q

landmark for C5

A

lower border of thyroid cartilage

ABOS PART ONE (11 decks)

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