Unit 4 - Surgical Management of Spine Flashcards

1
Q

natural history of scoliosis after maturity

A

70deg have cardiopulmonary sxs

50-75 deg progress 1 deg/year

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2
Q

Risser sign

A

indication of skeletal maturity using ossification of iliac crest (5 skeletally mature)

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3
Q

rib/paraspinal hump side

A

hump on same side as curve

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4
Q

syrinx

A

CSF in spinal cord

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5
Q

atypical radiographic findings in scoliosis

A

left thoracic curve, sharply angled curves, very large curve, congenital bony abnormality

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6
Q

Cobb angle

A

measurement of degree of scoliosis

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7
Q

long tract sign

A

upper motor neuron symptoms (clonus, spastisity)

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8
Q

bracing indications in scoliosis

A

variable based on risser number, at least 25 deg, sometimes just watch for progression

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9
Q

brace types

A

TLSO - for thoracic curves (boston brace)

CTLSO for double thoracic curves (milwaukee brace)

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10
Q

surgical indications for scoliosis

A

> 45 deg in adolescents
50 in mature
stiff, large kyphosis
inability to control progression with brace

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11
Q

general post-op activity after scoliosis surgery

A
possible brace (posterior approach)
walking day after surgery
no twisting or bending
no strenuous activity for 3 months
no contact sport until 6 months
activity as tolerated after 1 year
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12
Q

dysraphism

A

general term for neural tube defect

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13
Q

degrees of spina bifida

A

spina bifida occulta - no extrusion of meninges, not a clinical problem, present in 15% of population
Meningocele - saccular herniation of meninges without nerve tissue
Myelomeningocele - saccular herniation with nerve tissue, high risk of scoliosis
Rachischisis - not even skin covering nerve root and spinal cord, short life expectancy

often surgery with goal of preventing progression of deformity, when applicable
often have latex allergy

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14
Q

scheurman’s kyphosis

A
larger and more structural than postural kyphosis (hunchback), may be painful
risk of schmorls nodes
stabilizes in adulthood
>100 deg causes pulmonary restrictions
surgery if >80 deg
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15
Q

Spondolosis

A

degeneration of spine

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16
Q

spondylitis

A

inflammation of spine

17
Q

spondylolysis

A

defect in pars interarticularis
50% caused by trauma, usually hyperextension
present with acute or chronic lumbar pain
oblique view x-ray or SPECT (combo bone scan and CT)
Treatment: rest, observe, brace, surgery if sx>6 months

18
Q

spondylolisthesis

A

forward slippage of one vertebra on another
isthmic: after break in pars
surgery if grade 3 and above (50 % slippage)

19
Q

spinal compression fracture

A

compression anterior, possible distraction posterior

treatment: conservative usually

20
Q

spinal burst fracture

A

compression in anterior and middle columns

risk of neurological injury if retropulsion of bone fragments

21
Q

seatbelt/chance fracture

A

compression anterior, distraction posterior and middle
high chance of intraabdominal injury as well
ligmentous injury may need surgery, bone often doesn’t

22
Q

fracture/dislocation of spine

A

compression anterior, distraction posterior and middle, rotation shear all through
possible severe neurological involvement

23
Q

indications of cervical spine fracture

A
point tenderness, esp over spinous process
step offs
eccymosis (bruise)
new neuro symptoms
stability
24
Q

indications of surgery for herniated discs

A

severe sciatica with neurological compromise that hasn’t improved, bowel/bladder signs
~10% will require surgery

25
Q

indications/surgery for spinal stenosis

A

central canal stenosis usually due to ligamentum flavum hypertrophy
Leg pain usually > back pain
single or multi root involvement
surgery elective unless progressive neurological deficits or cauda equina syndrome
treated with injections, education, therapy, epidural