Spine- Steinmann

Question 1

What are the sensory checks for neurological levels C5-C8, T1, L3, T4, L3-L5 and S1?

Answer 1

Sensory:
C5 Deltoid Region
C6 Thumb, Index
C7 Middle Finger
C8 Small Finger
T1  Inner Arm
L3  Over Sartorius Muscle
L4  Medial Ankle
L5  Great Toe Web Space
S1  Lateral Foot

Question 2

**What can you do to reverse complete spinal cord injury that causes the person to be paralyzed? What is the time limit for this and recovery?

Answer 2

reduce immediately!!!

within 2 hours to get complete recovery

Question 3

What should be obtained when you have a pt with tenderness and a considerable mechanism of injury?

Answer 3

CT of the tender area

Question 4

What is instability of the spine?

Answer 4

Inability to perform normal structural functions under physiologic loads–> likely to injury nerve root or cause deformity

Suggests:

• Risk of injury to neural elements
• Risk deformity
• Risk of pain

Question 5

What is the best treatment for discogenic low back pain?

Answer 5

conservative for at least 9 month

avoid behaviors that could irritate it, anti-inflammatory (NSAIDS), PT or exercise

Question 6

*What is caudal equina syndrome?

Answer 6

-massive rupture of the disc into the canal occluding all the sacral nerve roots.

• loss of bowel and bladder function
• saddle anesthesia
• perianal numbness bilaterally

emergency –> to OR

Question 7

*pt in a significant tc with unexplained neuro deficit and X-rays are negative. what’s the next appropriate imaging?

Answer 7

MRI=better for neuro injuries

Question 8

*70 yo with chronic low back pain, worse with walking. pain with standing and better with sitting or using a walker and leaning forward. what is the most likely diagnosis?

Answer 8

lumbar spinal stenosis

Question 9

*19 yo football player (lineman) w/ low back pain. pain on and off over the past year, progressively worse, esp when blocking. Extension provokes most pain and pt has associated hamstring spasticity . what is the most likely diagnosis?

Answer 9

isthmic spondylolesthesis

more common in gymnasts and lineman.

also associated with hamstring spasms

Question 10

*41 yo ortho doc with LBP radiating down leg after doing squats at the gym. Initially, numbness and tingling down medial and dorsal aspect of foot, later noticed unable to extend big toe. foot drop with diminished perianal pinprick. Large L4-5 disc herniation on MRI. What should you do?

Answer 10

acute foot drop + perianal sensory loss–> cauda equina

emergent surgery

Question 11

*What’s the minimal spinal curvature degree to diagnose spinal scoliosis?

Answer 11

> 10 degrees in a coronal plane