Spine SAQ

Question 1

why the thoracolumber fracture is Potentially devastating?

Answer 1

• narrow canal
• precarious blood supply
• fulcrum of motion at thoracolumbar spine

Question 2

Why thoracic spine from T2 to T10 has increased stiffness ?

Answer 2

due to

• increased rigidity by articulation with ribs
• ribs articulate with sternum, adding secondary stability
• facet joints oriented in coronal plane
• disks are thin increasing stiffness and rotational stability
• kyphosis concentrates axial load on anterior column

Question 3

What Are the thoracic approaches?

Answer 3

midline posterior approach

• indicated only when spinal cord compression is posterior

costotransverse

• can be open or thoracosopic

transthoracic

Question 4

Signs of instability TL injury?

Answer 4

injury to middle column

• as evidenced by widening of interpedicular distance on AP radiograph
• loss of height of posterior cortex of vertebral bod

disruption of posterior ligament complex combined with anterior and middle column involvement

Question 5

conditions where PLC is clearly ruptured?

Answer 5

• widening of interspinous distance
• progressive kyphosis with nonoperative treatment
• facet diastasis

Question 6

What is a chronic posttraumatic syndromes after spinal cord injury?

Answer 6

• Syringomyelia
• microcystic myelomalacia
• Archnoiditis
• deafferentation pain

Question 7

What is the advantages of early Decompression and stabilizing the spine, fracture

Answer 7

• Allows early patient mobilization to prevent system complications
• Improved neurological recovery after spinal cord injury specially patient with incomplete spinal cord injury
• Reduce hospital stay
• Improve rehab

Question 8

Define Adolescent Idiopathic Scoliosis

Answer 8

Defined as idiopathic scoliosis in children 10 to 18 yrs

• most common type of scoliosis

Question 9

What is The Epidemiology Of Adolescent Idiopathic Scoliosis

Answer 9

incidence of 3% for curves between 10 to 20°

incidence of 0.3% for curves > 30°

10:1 female to male ratio for curves > 30°

• 1:1 male to female ratio for small curves
• right thoracic curve most common
• left thoracic curves are rare and indicate an MRI to rule out cyst or syrinx

Question 10

What is the natural history of Adolescent Idiopathic Scoliosis

Answer 10

• increased incidence of acute and chronic pain in adults if left untreated
• curves > 90° are associated with cardiopulmonary dysfunction, early death, pain, and decreased self image

Question 11

What are The risk factors for progression Of Adolescent Idiopathic Scoliosis

Answer 11

curve magnitude

before skeletal maturity

• > 25° before skeletal maturity will continue to progress

after skeletal maturity

• > 50° thoracic curve will progress 1-2° / year
• > 40° lumbar curve will progress 1-2° / year

remaining skeletal growth

younger age

• < 12 years at presentation

Tanner stage (< 3 for females)

Risser Stage (0-1)

• Risser 0 covers the first 2/3rd of the pubertal growth spurt
• correlates with the greatest velocity of skeletal linear growth

open triradiate cartilage

peak growth velocity

• is the best predictor of curve progression

1. in females it occurs just before menarche and before Risser 1 (girls usually reach skeletal maturity 1.5 yrs after menarche)
2. most closely correlates with the Tanner-Whitehouse III RUS method of skeletal maturity determination

• if curve is >30° before peak height velocity there is a strong likelihood of the need for surgery

curve type

• thoracic more likely to progress than lumber
• double curves more likely to progress than single curves

Question 12

What do you look for radiographiclly In AIS?

Answer 12

• Cobb angle
• Spinal balance
• Stable zone
• Stable vertebrae
• neutral vertebrae
• end vertebrae
• apical vertebrae
• clavicle angle