Surgery B - spinal injuries

Question 1

what is an odontoid fracture?

Answer 1

the peg of bone is broken

Question 2

type 1 odontoid fracture

Answer 2

just the tip of the bone is broken

Question 3

type 2 odontoid fracture

Answer 3

most comm type

peg broken at base

Question 4

type 3 odontoid fracture

Answer 4

bone broken below base of peg

Question 5

58 y/o male IVDU

• pc: chest infection
• pmh: T2DM

starts complaining of severe back pain on walking.

possible differentials

Answer 5

• discitis
• mechanical back pain
• cauda equina
• metastatic disease

Question 6

causative organism of discitis?

Answer 6

• staph aureus G+ve cocci
• pseudomonas in IV drug abuse
• streptococcus in chest infections

Question 7

58 y/o with discitis given IV antibiotics.

however patient is getting worsening back pain with rigors and has bi-lateral decreased sensation and power in L3-L4

next step?

Answer 7

• IV antibiotics not working
• patient needs urgent repeat MRI
• to look for compressive epidural abscess

Question 8

NICE red flags for back pain

Answer 8

• bilateral sciatica
• severe progressive bilateral neurological deficit in legs
• impaired urinary flow
• loss of rectal fullness
• saddle anaesthesia

Question 9

patient with bilateral decreased sensation in L4/L5, with new ‘saddle anaesthesia’ and trouble passing urine.

what is the differential and what would you do next?

Answer 9

• cauda equina syndrome?

- urgent referral to on-call orthopaedics

Question 10

pathophysiology of vertebral disc degeneration

Answer 10

• loss of proteoglycan & collagen and degradation
• fall in osmotic pressure
• disc doesn’t behave hydrostatically under load
• loose height and fluid more rapidly
• stress concentration along end plates and annulus