Spine (WM) Flashcards
What are the components of the SINS Score?
What? Bone Lesion (Lytic vs Blastic) Where? 2 things Location vertically (rigid vs semi-rigid) and AP (are posterolateral elements involved) Consequence? Alignment, Collapse, Pain
What classification do you know for occipital condyle fractures?
Anderson and Montesano
Type 1 - comminuted (stable)
Type 2 - base of skull fracture with extension (stable)
Type 3 - avulsion fracture with medial condyle being pulled off (unstable).
What are the highly radiosensitive spinal mets?
Myeloma
Lymphoma
Seminoma
What does the NOMS framework stand for?
Neurologic
Oncologic
Mechanical
Systemtic
What is the radiologic threshold for deciding on compression in NOMS?
Spine Oncology Study Group Framework. Assessed on axial T2
If there’s deformation of thecal sac but no cord abutment suggest SRS
Higher grades surgery
Lower cEBRT
How do you classify C1 fractures?
Landell’s classification.
Type 1 - isolated post or anterior arch (collar)
Type 2 - burst (Jefferson fracture)
Type 3 - unilateral ant and post arch
For type 2 and 3 depends on integrity of transverse band of cruciate ligament
What classification of C2 peg fractures do you know
For Peg fractures
Anderson and Alonzo
Type 1 - avulsion from apical or alar ligaments
Type 2 - base of peg (odontoid screw, harms, transarticular screw)
Type 3 - extends into lateral mass (typically fuses well in collar)
What classification of C2 pars fractures do you know?
Levine and Edwards (modified Effendi)
Type 1 - no angulation, no anterolisthesis (non-operative)
Type 2 - vertical fracture with displacement >3mm but angulation <10 degrees (non-operative)
Type 2a - horizontal fracture with angulation ++ but not displaced (still operative)
Type 3.- total disruption of face and post elements free floating (operative)
What classification do you know for subaxial cervical spine fractures?
Morphology (compression, burst, distraction (facet perch, hyperextension), rotation/translation (facet dislocation, unstable teardrop, advance flexion compression injury)
Discoligamentous Complex (intact, indeterminate, disrupted)
Neurological status (intact, root, complete cord, incomplete cord, ongoing compression)
What classification do you know for thoracolumbar spinal injuries/
Morphology (compression, burst, translation/rotation, distraction)
Integrity of posterior ligamentous complex (intact, suspected, injured)
Neurological status (intact, root/complete cord, incomplete cord/cauda equina)
What are the most common mets to go to spine?
Breast, lung, prostate, renal, GI
Describe Canadian C spine rule
If no high risk factor (no dangerous mechanism (bicycle object, more than 3 feet, MVC high speed, Lateral rotation, <65, No deficit)
+ 1 low risk factor (simple rearend MVC, ambulatory any time, no neck pain at scene, no pain on midline c spine palpation)
+ left and right movement of cervical spine 45 degrees
Can be clinically cleared
What lateral mass screw trajectories are there?
Roy-camille - middle lateral mass, 1/3 from top, 10 degrees lateral
Magerl - 2 mm medial to midpoint, 25 degrees lateral, 45 degrees up
What weight can you apply in cervical traction?
10lbs + 5lbs per level
(Gardner Wells - pins in line with EAM 1cm above pinna, tighten till pin 1mm above indicator)
What are the options for fixing a type II anderson and alonzo fracture?
Odontoid screw
Magerl transarticular screw
Harms-Goel C1/C2 fixation
Describe how you would do C1 lateral mass screws?
Work along posterior arch
Retract C2 root down
15 degrees up, 15 degrees medial
Describe how you would do C2 pedicle screw
Entry point - 2mm lateral to midpoint of pars
Aim at top of Harris’ ring
Approx 45 degrees medial
How much rotation of cervical spine occurs at C1/2?
50%
How much cervical flexion occurs at C0/C1?
50%
What MAP target in SCI?
85-90 (multiple authors e.g. Saadeh syst review)
Describe the ASIA classification?
A - motor sensory complete
B - motor complete, sensory incomplete
C - motor incomplete <50 below level
D - motor >50% below level
E - intact
What percentage of ASIA A pateints improve at 6 months?
approx 20% improve 1 or more ASIA grades at 6 months
What are risk factors for OPLL?
Japanese
Male
Diabetes
How do you diagnosis DISH?
4 continguous level of bridging anterolateral osteophytes
What are the stages of cauda equina? (Nick Todd 2016)
CESS (Suspected) e.g. bilat radiculopathy but no signs or symptoms of lower sacral root dysfunction)
CESI (Incomplete) –> signs or symptoms of sacral root dysfunction without retention
CESR (Retention) –> retention but still some sacral root function
CESC (Complete) –> no sacral root function
What’s the rate of deterioration of cauda equina patients?
26% in first 24 hours (from medicolegal sample)
What is chance of recovery of cauda equina incomplete?
Operated within 24 hours - 90% normal bladder function
24-48 hours - 80% normal bladder function
>48 hours - 50% normal bladder function
What is the chance of cauda equina in retention having normal bladder function?
20-80% depending on study
How do you do Spurling’s test?
Extend, rotate to affected side, laterally flex and compress
What’s Lhermitte’s sign
Electric shock sensation down the spine in response to passive cervical flexion (typically MS but can be in any dorsal column pathology)
Describe two ways to distinguish MSK pain from neurological?
Local tenderness, pain on passive movement
What are the radiological appearances of vertebral body haemangioma?
CT - polka dot
MRI - high T1 and T2 as high fat and high water
Enhances with gad
(by contrast mets are usually low T1)
Describe MRI appearances of Modic change
Type 1 - high on T2 low on T1 (oedema)
Type 2 - iso or low T2, high T1 (fatty)
Type 3 - low on both (subchondral sclerosis)
What is chance of improvement after surgery for cervical or lumbar radiculopathy?
85-90% (BASS)
What is recovery after surgery for cervical spondylotic myelopathy?
70% will improve their JOA score
Average improvement is 55%
Benefit plateaus at 6 monhts, further marginal improvement at year
Describe features to distinguish spinal and vascular claudication?
Better leaning forward
Better going uphill
Better on a bicycle
No vascular features
Describe neural control of bladder function?
Detrusor relaxation - sympathetic T9-12
Detrusor contraction - parasympathetic S2,3,4
Voluntary control of sphincter - pudendal S2,3,4
Centrally - paramedian frontal, basal ganglia, rostral pons via reticulospinal tract
Describe the Meyerding classification?
0 - normal
1 - up to 25%
2 - 25-50%
3 - 50-75%
4 - up to 100 %
5 - spondyloptosis
Describe Wiltse classification for spondylolisthesis?
I Dysplastic
II Isthmic (stress fracture, elongation due to repeated microfractures, acute pars fracture)
III Degenerative
IV Traumatic
V Pathologic
What are causes of syrinx?
Craniocervical junction
Arachnoid web
Tumour
Post traumatic
Idiopathic
Tethering
What are causes of Syrinx?
Idiopathic
Secondary
- Tumour
- Chiari + craniocervical things
- Post-inflammatory
- Post-traumatic
- Post-surgical
- Cord compression with disc protrusion
- Arachnoid webs/cysts
What LP shunt valves are there?
In the SLIP study what are rates of reoperation at 4 years?
This is a study about patients with stable spondylolisthesis
Without fusion 34% reoperated and lower SF36
With fusion 14% reoperated
What are the components of modified JOA?
Motor dysfunction upper extremities (buttons, then sppoon)
Motor dysfunction lower (walking unaided, walking stairs without handrail, with ahndrail, walking aid on flat)
Senory sensory loss upper extremitities (none, mild, severe, complete)
Urinary dyfunction
