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Phase II Cards from RC > Thoracic-Lumbar > Flashcards

Thoracic-Lumbar Flashcards

1
Q

what % of patients with vertebral fracture have concurrent injuries?
what % are thoracic trauma? abdominal trauma?

A

45-83%

thorax:15-35%
abdomen: 6-15%

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2
Q

what % patients with vertebral fractures have fracture in other areas

A

14 - 48%

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3
Q

what % patients with vertebral fractures have multiple fractures and luxations along vertebrae?

A

15-20%

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4
Q

list plating methods to fix and treat spinal fracture

A
  • LCP
  • SOP
  • spinous process plating (Auburn (metal), Lubra (plastic))
  • spinal stapling and modified sequential fixation
  • nonlocking lateral vertebral body (not really performed)
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5
Q

what are concerns/disadvantages of using spinous process to treat spinal fracture

A
  • does not stabilize ventral compartments
  • not as strong
  • spinous could fracture
  • device pull out
  • ischemic necrosis
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6
Q

what are 4 proposed mechanisms of entry for FCE?

A
  • direct penetration from NP of IVD into spinal cord or vertebral vessels
  • remnant vessels within NP
  • herniation portion NP into bone marrow of vertebral body with retrograde movement FC into internal vertebral venous plexus
  • neovascularization of degenerated IVD
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7
Q

in De Rosio 2007, what % dogs with FCE have no MRI lesions?

A

21%

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8
Q

factors to implicate outcome/prognosis in FCE?

A
  • cervical/lumbar intumescences SA with greater long term debilitation than lesion of white matter C1-C6, T3-L3
  • unsuccessful recovery if MRI lesion to vertebral length ratio >/=2, also if no motor within 2 weeks
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9
Q

list surgical approaches to T-L spinal cord for treatment of IVDD

A
  • dorsal lam
  • hemilam
  • pediculectomy
  • mini-hemilam
  • IVD fenestration
  • partial lateral corpectomy
  • percutaneous discecotomy
  • endoscopic hemilam or corpectomy
  • dorsal lam with osteotomy of spinous process
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10
Q

prognosis of nerve sheath tumor of spine?

A

Dogs:
- 1997 study, MST 1419 d
- if brachial plexus DFI 7.5 mo; MST 12 months
- if spinal nerve root @ IV foramen 5 months

Cats:
- 70d in one study
- 2190d in another study

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11
Q

what MRI features has been shown association/ prognostic indicator for outcomes of IVDD?

A

T2W hyperintensity:
> 3x length L2

(20% dogs with >3x length of L2 get ambulation)

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12
Q

what are some biomarkers to ID IVDD?

A

MMP-9
CK
protein tau
glutamate
oxytocin in CSF S higher with compressive myelopathies

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13
Q

what is a cholesteatoma?

A

epidermoid cyst lined by keratinized stratified squamous epithelium

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14
Q

is a subarachnoid diverticula a cyst? how do you treat?

A

no - no epithelial lining

steroid + sx - dorsal laminectomy or hemi than fenestrate diverticulum and marsupialize

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15
Q

prevalence of degenerative myelopathy? breed over-represented? genetic factors implicated?

A

1-5%

GDS, pembroke welsh, boxer, rhodesian, husky, mini poodle, chesapeake bay

missense mutation superoxide dismutase gene (SOD1); bernese - AT transition; cats - FeLV antigens

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16
Q

describe the simpler classification of fracture of spine?

A

focuses on 3 units: IVD, vertebral body, articular processes

so:

  1. failure of IVD
  2. fracture of vertebral body alone
  3. fracture of articular processes

> 1 of the three = surgery

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17
Q

what are good and bad candidates of external coaptation for spinal fractures

A

best:
small dogs, minimal neuro dysfunction (or normal nociception), intact vertbral buttress, lack of concurrent injuries

poor:
unstable fractures, noncompliant owner, cats, noncompliant patients

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18
Q

where do extradural synovial cysts originate from?

A

zygapophyseal joint

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19
Q

difference between synovial versus ganglion cyst?

A

synovial cyst - have synovium like lining of epithelial cells

ganglion - no lining, from mucinous degeneration of articular cartilage

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20
Q

breed/signalment for cervical synovial cyst? prognosis with sx?

A

young, giant breeds

excellent prognosis

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21
Q

what are the 3 long vertebral ligaments?

A

supraspinous
dorsal longitudinal
ventral longitudinal

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22
Q

what are the 3 short vertebral ligaments?

A

interspinous
intertransverse
yellow

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23
Q

which vertebrae is anticlinal?

A

T11

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24
Q

what muscle attaches to accessory process? what lays just ventral and cranial to tendon attachement?

A

longissimus lumborum
spinal nerve and vasculature

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25
Q

what is the usual presentation for vascular disorders of spine?

A
  • usually focal deficit/asymmetrical
  • most patients not painful
  • Cinical signs usually regress within 24-72 hours.
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26
Q

list complications to dorsolateral approach to surgical treatment of TL IVDD? surgery for IVDD in general?

A

pneumothorax
hemorrhage/hematoma
transient neuromuscular dysfunction
scoliosis
worsen of neuro grade
myelomalacia
Urinary or fecal incontinence

27
Q

describe types of dorsal lam?

A

funkquista A:
- remove spinous process, laminae, articular process, 1/2 dorsal pedicle of vertebrae

funkquista B:
- just remove spinous process and laminae

modified dorsal:
- remove laminae, spinous process, caudal articular process

28
Q

what do you need to care for with drilling for dorsal lam?

A

cancellous bone not present in laminae that forms interarcuate space near the attachment of yellow ligament

29
Q

what is success rate of medical management for TL IVDD?

A

varies - 80-88% ambulatory
43-51% non ambulatory

30
Q

what are 3 emerging therapies for spinal cord injury due to TL IVDD?

A

autologous olfactory glial cell and other stem cell transplantation

N-acetylcysteine for oxidative stress

IV use polyethylene glycol (fuse severed axons)

31
Q

what are success rates of partial lateral corpectomy and percutaneous discectomy?

A

PLC - 91.4% ambulatory 6 mo. post op
- only 52.8% improved at discharge

PD - 88% (with deep pain perception)
32% without deep pain perception

32
Q

describe alternative pin placement for pin + PMMA for spin fracture? Advantages/disadvantages

A

unilateral pin more horizontal via lateral approach (between longissimus lumborum and iliocostal lumborum)

advantage: decreased dissection, easy closure

disadvantage: dont see alignment of ZPJ
(2nd exposure site)

33
Q

what is sensitivity for radiographs to detect spinal canal penetration post-op spine fracture repair? sensitivity for CT?

A

Rads: 50%

CT: 100%

34
Q

what is a hemivertebrae? what breed has higher lumbar frequency?

A

hemi - incompletely formed with wedge shape - frenchies

35
Q

what is block vertebrae?

A

ivd space doesnt form - adjacent vertebrae fused

36
Q

what is a butterfly vertebrae?

A

sagittal cleft with affected vertebral body

37
Q

where do most extrarenal nephroblastoma occur? MST?

A

T10- L2

range 4 mo - 3 years

38
Q

what % of spinal cord intermedullary tumors are primary?

A

2/3

39
Q

what are the prognosis for spinal fracture surgery?
- TL?
- LS?
- Cervical

A

If Dp negative - 5% maybe walk

TL:
- good if pain present. 80-100% older studies
- conservative upto 85%-95% (case selection)

LS:
- very good prognosis
many good long term without surgery
- if peripheral tone absent - guarded

Cervical:
- good, overall return to function 70%

40
Q

% of OSA in spine of dogs? MST for spinal OSA in dogs?

A

6.5%

MST (55-155 d)

41
Q

Met rate for spinal OSA in dogs

A

40%

42
Q

prognosis for spinal OSA in cat

A

low met rates in cats

88-518 days
(one cat sx + chemo 0 1705d)

43
Q

what 4 factors positively affect CT (noncontrast) to ID IVDD lesion?

A

mulitplanar reconstruction
chronic history of IVDH
chondrodystrophic breed
mineralized disc present

44
Q

Sensitivity for CT with contrast to ID IVDD

A

sensitivity 97% site

100% laterality

45
Q

% dogs that regain neuro function post surgery for TL IVDD (presented without DPP)?

A

43-62%

46
Q

what factors have been associated with outcome in dogs with surgical treatment of IVDD (TL)

A

old world:
- prognosis worse L3-L7 vs TL
- dog size (larger >15kg worse prognosis)
- type of herniations - protrusion worse> extra
- Frankel score

47
Q

what is the vacuum phenomenon on radiographs of spine?

A

gas radiolucency within IVD space from degeneration

48
Q

sensitivity of ID IVDD site on myelography?

A

74-98%

49
Q

what are adverse effects of myelography?

A

seizures, myelopathy, apnea, cardiac arrhythmia, meningitis, subarachnoid hemorrhage, death

50
Q

what % dogs with myelography get seizures?

A

10-21.4%

51
Q

IVD is _____ intense on T1/T2W

A

hypointense

52
Q

_____sequence can show signal void if lesion has hemorrhage

A

T2* (gradient echo)

53
Q

_____sequence helps for low-volume disc

A

STIR or T2W (FLAIR)

54
Q

what is the sensitivity of rads in ID osseous lesions for animals with spinal cord injury and spinal fracture?

A

79%
72%

55
Q

what 2 radiologic factors negatively associated with outcome?

A

degree of dislocation (100% = poor prognosis)
axis deviation of column on rads (DV?)

56
Q

disadvantages of MRI with spinal trauma?

A

manipulation to put in machine gently
contraindication = metallic fragments (generate heat and move)

57
Q

what is recurrence rate of surgery for TL IVDD?

what is recurrence rate of medically management for TL IVDD?

A

sx: 15-20%

mm: 40%

58
Q

what breeds have higher recurrence rates?

A

dachshunds

59
Q

list 3 ways to potentially limit recurrence?

A

fenestration
laser disc ablation
chemonucleolysis (collagenase, chondroitinase ABC, chymopapin)

60
Q

prognosis for cats with surgically addressed TL IVDD?

A

success rate 83%

61
Q

to classify fractures of spine, what makes dorsal, middle, and ventral compartments?

A

dorsal : spinous process, laminae, articular process, pedicles, dorsal ligament complex (supraspinous, interspinous, ZPJ joint capsule, Yellow L)

middle: dorsal longitudinal ligament, dorsal annulus f, dorsal vertebral body

ventral: rest of vertebral body, lateral/ventral annulus f., nucleus pulposus, ventral longitudinal ligament

62
Q

how many of above need unstable that need surgery?

A

at least 2

63
Q

what makes a screw-bar-pmma construct?

A

-cortical bone screws bilaterally into transverse processes, 1 cm screw and head extend ventromedially
-smooth steinmann pin contoured to form ā€œUā€
-contour pin wired to screw head using ortho wire

64
Q

proposed advantage of screw-bar-pmma construct?

A

avoid penetration of vertebral canal or transverse foramina

Phase II Cards from RC (26 decks)

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