Spondy and Stenosis

Question 1

Spondylolisthesis due to congenital anomaly of the upper sacrum or L5 neural arch, leading to displacement

Answer 1

Type I Wiltse classification

dysplastic

Question 2

Spondylolisthesis due to spondylolysis

Answer 2

Type II (isthmic) Wiltse classification

Question 3

3 subtypes of Type II (isthmic) Wiltse classification

Answer 3

A. a stress (fatigue) fracture of the partes interarticularii
B. an elongated, but intact, partes interarticularii
C. an acute fracture of the partes interarticularii (rare)

Question 4

pseudospondylolisthesis; due to long-standing degenerative disease of the facet and discovertebral joints with no separation of the partes interarticularii

Answer 4

Type III (degenerative) 
Wiltse classification

Question 5

Spondylolisthesis due to a fracture of the neural arch in any place except the partes interarticularii

Answer 5

Type IV (traumatic) Wiltse classification

Question 6

Spondylolisthesis due to generalized bone disease

Answer 6

Type V (pathologic Wiltse classification

Question 7

easiest imaging modality for Spondylolisthesis

Answer 7

Plain film x-ray

Question 8

Meyerding’s grading system

Answer 8

Grade I = 1 – <25% 
Grade II = 25 – 50% 
Grade III = 50 – 75% 
Grade IV = 75 – 100% 
Grade V = >100% (spondyloptosis)

Question 9

Inverted Napoleon’s Hat Sign

Answer 9

Grade V (>100%) spondy

Question 10

Spondylolysis is most common at

Answer 10

L5 (82%)

2nd m/c at L4

Question 11

Spinal canal and neural foraminal narrowing, secondary to multifactorial degenerative changes

Answer 11

Acquired Spinal Stenosis

Question 12

stenosis is more common in males in what spinal region?

Answer 12

cervical

Question 13

The four ‘F’s’ of a degenerative spondylolisthesis

Answer 13

Female
Four (L4)
Forty (above 40 yoa)
Fat

Question 14

Signs/Symptoms of cervical spinal stenosis:

Answer 14

• spastic paraesis
• “myelopathic hand” (upper extremity radiculopathy) or heaviness in arms
• Gait disturbance, loss of position and vibration sense
• Chronic neck pain

Question 15

Signs/Symptoms of lumbar spinal stenosis:

Answer 15

• Chronic lower back pain
• Bilateral lower extremity pain/paresthesia/weakness
• Flexion relieves S/S in 80% of cases
• Exacerbated by prolonged standing and walking
• Degree of spinal stenosis does not always correlate with symptoms

Question 16

Sagittal central canal measurement in spinal stenosis

Answer 16

Stenosis C/S = <13 mm

Stenosis L/S = <10-12 mm

Question 17

the posterior aspect of the trefoil (cause of posterolateral narrowing) is due to a combination of

Answer 17

facet arthrosis and ligamentum flavum hypertrophy

Question 18

are formed in a degenerated facet joint

Answer 18

Synovial facet cyst

Question 19

Posterolateral to the thecal sac, of cysts are found in the?

Answer 19

Lumbar spine (70-80% at L4-L5)

Question 20

Synovial facet cysts creates an ___________ extending from the facet into either the spinal canal, lateral recess, neural foramen, or extraforaminal space

Answer 20

extra-dural mass

Question 21

the gold standard for imaging facet cysts

Answer 21

MR (Bright on T2, dark on T1)