Spine 2016

Question 1

7. In a well-designed prospective randomized study that provides level II evidence in favor of surgical treatment for the injury shown in Video 7, the primary outcome measure is the neck disability index (NDI) score, which shows an improvement of 5.5 points on a scale of 100 for patients treated with surgery (vs those who received nonsurgical treatment). This difference is statistically significant with a P value of 0.0001. The magnitude of difference and the P value suggests this difference
8. is highly significant and should change treatment patterns in favor of surgery.
9. is irrelevant because the study has only level II evidence.
10. may or may not be a clinically important difference.
11. does not reflect the number of patients enrolled in the study.
12. has been miscalculated.

Answer 1

3. may or may not be a clinically important difference.

RECOMMENDED READINGS

Vaccaro AR, Kepler CK, Kopjar B, Chapman J, Shaffrey C, Arnold P, Gokaslan Z, Brodke D, France J, Dekutoski M, Sasso R, Yoon ST, Bono C, Harrop J, Fehlings MG. Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture. J Bone Joint Surg Am. 2013 Apr 17;95(8):729-35. doi: 10.2106/JBJS.K.01636. PubMed PMID: 23595072.

Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J. 2009 Oct;9(10):802-8. doi: 10.1016/j. spinee.2009.06.002. Epub 2009 Jul 25. PubMed PMID: 19632904.

Question 2

19. Figure 19 is the sagittal CT scan of a 57-year-old woman with symptomatic cervical myelopathy. The single factor favoring an anterior approach is
20. a congenitally narrow spinal canal.
21. multiple levels of pathology.
22. kyphotic spinal alignment.
23. degenerative disk disease.
24. cervical spondylolisthesis.

Answer 2

3. kyphotic spinal alignment.

RECOMMENDED READINGS

Lebl DR, Bono CM. Update on the Diagnosis and Management of Cervical Spondylotic Myelopathy. J Am Acad Orthop Surg. 2015 Nov;23(11):648-60. doi: 10.5435/JAAOS-D-14-00250. Review. PubMed PMID: 26498584.

Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Nov-Dec;9(6):376-88. Review. PubMed PMID: 11767723.

Question 3

27. Video 27 is the CT scan of a neurologically intact patient who refuses surgical treatment for the injury shown, instead opting for treatment with a brace. Evidence-based medicine suggests that if this injury is treated with a brace rather than surgery, the result will be
28. painful kyphosis, which will necessitate future surgery.
29. better in the long term.
30. better sagittal alignment.
31. quicker recovery.
32. an outcome comparable to surgery.

Answer 3

5. an outcome comparable to surgery.

RECOMMENDED READINGS

Bailey CS, Urquhart JC, Dvorak MF, Nadeau M, Boyd MC, Thomas KC, Kwon BK, Gurr KR, Bailey SI, Fisher CG. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J. 2014 Nov 1;14(11):2557-64. doi: 10.1016/j.spinee.2013.10.017. Epub 2013 Oct 31. PubMed PMID: 24184649.

Alcalá-Cerra G, Paternina-Caicedo AJ, Díaz-Becerra C, Moscote-Salazar LR, Fernandes-Joaquim A. Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials. J Craniovertebr Junction Spine. 2014 Jan;5(1):25-32. doi: 10.4103/0974- 8237.135213. PubMed PMID: 25013344.

Question 4

35. A lateral cervical radiograph is shown in Figure 35. Which abnormal laboratory value usually is associated with these findings?
36. Rheumatoid factor (RF) or anti-citrullinated peptide/protein antibody (anti-CCP)
37. Human leukocyte antigen B27 (HLA-B27)
38. C-reactive protein (CRP)
39. Trisomy 21
40. Hemoglobin A1c (HgbA1c)

Answer 4

5. Hemoglobin A1c (HbgA1C)

RECOMMENDED READINGS

Belanger TA, Rowe DE. Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. J Am Acad Orthop Surg. 2001 Jul-Aug;9(4):258-67. Review. PubMed PMID: 11476536.

Smith LL, Burnet SP, McNeil JD. Musculoskeletal manifestations of diabetes mellitus. Br J Sports Med. 2003 Feb;37(1):30-5. Review. PubMed PMID: 12547740.

Denko CW, Malemud CJ. Body mass index and blood glucose: correlations with serum insulin, growth hormone, and insulin-like growth factor-1 levels in patients with diffuse idiopathic skeletal hyperostosis (DISH). Rheumatol Int. 2006 Feb;26(4):292-7. Epub 2005 Feb 10. PubMed PMID: 15703952.

Question 5

45. Figure 45 is the MR image of a 79-year-old woman with hypertension who has a 3-month history of bilateral buttock pain while walking more than 200 feet. An evaluation should include
46. examination of peripheral pulses.
47. electromyography and nerve conduction studies.
48. peripheral muscle biopsy.
49. a serum coagulopathy profile.
50. a CT myelogram.

Answer 5

1. examination of peripheral pulses

RECOMMENDED READINGS

Grimm BD, Blessinger BJ, Darden BV, Brigham CD, Kneisl JS, Laxer EB. Mimickers of lumbar radiculopathy. J Am Acad Orthop Surg. 2015 Jan;23(1):7-17. doi: 10.5435/JAAOS-23-01-7. PubMed PMID: 25538126.

Issack PS, Cunningham ME, Pumberger M, Hughes AP, Cammisa FP Jr. Degenerative lumbar spinal stenosis: evaluation and management. J Am Acad Orthop Surg. 2012 Aug;20(8):527-35. doi: 10.5435/ JAAOS-20-08-527. Review. PubMed PMID: 22855855.

Question 6

55. The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spine fusions greatly decreased after which event?
56. Published studies on 100% spine fusion with rhBMP-2 were redacted following an

investigation by the United States Department of Justice

2. Iliac crest bone graft (ICBG) was shown to be better than rhBMP-2
3. The Affordable Care Act (ACA) was enacted
4. The Sunshine Act was enacted
5. The original U.S. Food and Drug Administration (FDA) studies were subject to closer scrutiny

Answer 6

5. The original US FDA studies were subject to closer scrutiny

RECOMMENDED READINGS

Laine C, Guallar E, Mulrow C, Taichman DB, Cornell JE, Cotton D, Griswold ME, Localio AR, Meibohm AR, Stack CB, Williams SV, Goodman SN. Closing in on the truth about recombinant human bone morphogenetic protein-2: evidence synthesis, data sharing, peer review, and reproducible research. Ann Intern Med. 2013 Jun 18;158(12):916-8. doi: 10.7326/0003-4819-158-12-201306180-00012. PubMed PMID: 23778911.

Carragee EJ, Hurwitz EL, Weiner BK. A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J. 2011 Jun;11(6):471-91. doi: 10.1016/j.spinee.2011.04.023. Review. PubMed PMID: 21729796.

Martin BI, Lurie JD, Tosteson AN, Deyo RA, Farrokhi FR, Mirza SK. Use of bone morphogenetic protein among patients undergoing fusion for degenerative diagnoses in the United States, 2002 to 2012. Spine J. 2015 Apr 1;15(4):692-9. doi: 10.1016/j.spinee.2014.12.010. Epub 2014 Dec 15. PubMed PMID: 25523380.

Question 7

68. For patients with rheumatoid arthritis who are undergoing surgery for symptomatic cervical myelopathy, neurologic recovery after decompression is best predicted by presurgical
69. basilar invagination less than 0.3 cm.
70. subaxial subluxation less than 3.5 mm.
71. atlanto-dens interval less than 2 mm.
72. posterior atlanto-dens interval exceeding 13 mm.
73. rotatory subluxation less than 10 degrees.

Answer 7

4. posterior atlanto-dens interval exceeding 13 mm.

RECOMMENDED READINGS

Kim DH, Hilibrand AS. Rheumatoid arthritis in the cervical spine. J Am Acad Orthop Surg. 2005 Nov;13(7):463-74. Review. PubMed PMID: 16272271.

Garfin SR. Rheumatoid Arthritis of Cervical Spine Overview of Rheumatoid Spondylitis. Updated Dec 6, 2015. http://emedicine.medscape.com/article/1266195-overview (Accessed June 1, 2016).

Question 8

77. Video 77 is the CT scan of a patient who fell and hit his head. He does not have any upper or lower extremity weakness or numbness. He is ambulatory and has normal bowel and bladder function. Definitive treatment should include
78. a rigid cervical collar.
79. single-level anterior cervical diskectomy and fusion.
80. combined anterior and posterior cervical surgery with a pedicle subtraction osteotomy.
81. posterior cervical instrumentation and fusion.
82. cervical disk arthroplasty to preserve motion and prevent adjacent segment degeneration.

Answer 8

4. posterior cervical instrumentaiton and fusion

RECOMMENDED READINGS

Robinson Y, Robinson AL, Olerud C. Complications and survival after long posterior instrumentation of cervical and cervicothoracic fractures related to ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 2015 Feb 15;40(4):E227-33. doi: 10.1097/BRS.0000000000000726. PubMed PMID: 25494322.

Mathews M, Bolesta MJ. Treatment of spinal fractures in ankylosing spondylitis. Orthopedics. 2013 Sep;36(9):e1203-8. doi: 10.3928/01477447-20130821-25. PubMed PMID: 24025014.

Chaudhary SB, Hullinger H, Vives MJ. Management of acute spinal fractures in ankylosing spondylitis. ISRN Rheumatol. 2011;2011:150484. doi: 10.5402/2011/150484. Epub 2011 Jun 30. PubMed PMID: 22389792.

Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010 May 15;35(11):E458-64. doi: 10.1097/ BRS.0b013e3181cc764f. PubMed PMID: 20421858.

Question 9

94. A patient with a smoking history has pain in her legs after walking. You are trying to distinguish a vascular etiology from a neurogenic etiology. Which response is associated with a vascular etiology?
95. When walking, the pain will improve if she is leaning over a grocery cart
96. Sitting down is necessary to relieve the pain
97. Riding a bicycle does not cause any claudication
98. Standing still relieves the pain
99. Washing dishes at the sink aggravates the pain

Answer 9

4. Standing still relieves the pain

Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008 Feb 21;358(8):818-25. doi: 10.1056/NEJMcp0708097. Review. PubMed PMID: 18287604.

Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002 Jun;22(2):157-66. Review. PubMed PMID: 12524561.

Question 10

110. Based on the radiographic findings in Figures 110a through 110c, what is the most likely diagnosis?
111. Diffuse interstitial skeletal hyperostosis (DISH)
112. Ankylosing spondylitis (AS)
113. Down syndrome with C1-C2 instability
114. Rheumatoid arthritis (RA)
115. Osteomyelitis

Answer 10

2. Ankylosing spondylitis (AS)

RECOMMENDED READINGS

Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Orthopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg. 2005 Jul-Aug;13(4):267-78. PubMed PMID: 16112983.

Haroon N. Ankylosis in ankylosing spondylitis: current concepts. Clin Rheumatol. 2015 Jun;34(6):1003-7. doi: 10.1007/s10067-015-2956-4. PubMed PMID: 25935456.

Smith JA. Update on ankylosing spondylitis: current concepts in pathogenesis. Curr Allergy Asthma Rep. 2015 Jan;15(1):489. doi: 10.1007/s11882-014-0489-6. Review. PubMed PMID: 25447326.

Question 11

124. A study shows improved 1-month and 1-year survival rates for patients older than age 60 who undergo surgery for the injury shown in Video 124 vs survival for patients treated without surgery. If the study is a retrospective review and surgery was performed per surgeon preference, which type of bias is the most pressing concern?
125. Selection
126. Confirmation
127. Recall
128. Publication
129. Interviewer

Answer 11

1. Selection

RECOMMENDED READINGS

Chapman J, Smith JS, Kopjar B, Vaccaro AR, Arnold P, Shaffrey CI, Fehlings MG. The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976). 2013 Jun 1;38(13):1098-104. doi: 10.1097/BRS.0b013e31828-6f0cf. PubMed PMID: 23354104.

Guyatt G, Rennie D, Meade MO, Cook DJ. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 3rd edition. New York, NY: McGraw Hill; 2015.

Question 12

141b. Figures 141a through 141c are radiographs and an axial MRI scan. When discussing this patient’s condition, which statement is most accurate regarding the benefits and limitations associated with both surgery and continued nonsurgical care?
1. Continued nonsurgical treatment will produce the same long-term results as surgery
2. Fusion is absolutely required when considering surgery
3. Fusion should be done using bone morphogenetic protein (BMP)
4. Surgery will provide better short-term and long-term improvement
5. An instrumented fusion with pedicle screws and rods will provide a better result.

Answer 12

4. Surgery will provide better short-term and long-term improvement.

RECOMMENDED READINGS

Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul;73(6):802-8. PubMed PMID: 2071615.

Pearson AM, Lurie JD, Tosteson TD, Zhao W, Abdu WA, Weinstein JN. Who should undergo surgery for degenerative spondylolisthesis? Treatment effect predictors in SPORT. Spine (Phila Pa 1976). 2013 Oct 1;38(21):1799-811. doi: 10.1097/BRS.0b013e3182a314d0. PubMed PMID: 23846502.

Sigmundsson FG, Jönsson B, Strömqvist B. Outcome of decompression with and without fusion in spinal stenosis with degenerative spondylolisthesis in relation to preoperative pain pattern: a register study of 1,624 patients. Spine J. 2015 Apr 1;15(4):638-46. doi: 10.1016/j.spinee.2014.11.020. Epub 2014 Nov 29. PubMed PMID: 25450653.

Kepler CK, Hilibrand AS, Sayadipour A, Koerner JD, Rihn JA, Radcliff KE, Vaccaro AR, Albert TJ, Anderson DG. Clinical and radiographic degenerative spondylolisthesis (CARDS) classification. Spine J. 2015 Aug 1;15(8):1804-11. doi: 10.1016/j.spinee.2014.03.045. Epub 2014 Apr 3. PubMed PMID: 24704503.

Question 13

163. Figures 163a and 163b are the MR images of a 45-year-old woman who has neck pain that is radiating into her right shoulder and arm after 3 weeks of nonsurgical treatment. There is no neurologic deficit. What is the most appropriate treatment?
164. Anterior cervical diskectomy and fusion
165. Continued nonsurgical treatment
166. Chiropractic manipulation
167. Posterior cervical foraminotomy
168. Cervical epidural injection

Answer 13

2. Continued nonsurgical treatment.

RECOMMENDED READINGS

Ponnappan RK, Khan M, Matzon JL, Sheikh ES, Tucker BS, Pepe MD, Tjoumakaris FP, Nassr AN. Clinical Differentiation of Upper Extremity Pain Etiologies. J Am Acad Orthop Surg. 2015 Aug;23(8):492- 500. doi: 10.5435/JAAOS-D-11-00086. Epub 2015 Jun 26. PubMed PMID: 26116851.

Levine MJ, Albert TJ, Smith MD. Cervical Radiculopathy: Diagnosis and Nonoperative Management. J Am Acad Orthop Surg. 1996 Nov;4(6):305-316. PubMed PMID: 10797198.

Question 14

180. Although initial studies revealed no adverse events associated with rhBMP-2 and also demonstrated a clear benefit to its use when compared with iliac crest bone graft, what is now known about rhBMP-2?
181. It represents the best alternative to iliac crest autograft that is currently available to stimulate

bone growth

2. It is no longer available in the United States; it has been withdrawn because of the

manufacturer’s liability concerns

3. It is associated with substantial cancer risk
4. It is not permitted by the U.S. Food and Drug Administration (FDA) for off-label applications
5. It is always inappropriate for use in orthopaedic surgery.

Answer 14

1. It represents the best alternative to iliac crest autograft that is currently available to stimulate

RECOMMENDED READINGS

Laine C, Guallar E, Mulrow C, Taichman DB, Cornell JE, Cotton D, Griswold ME, Localio AR, Meibohm AR, Stack CB, Williams SV, Goodman SN. Closing in on the truth about recombinant human bone morphogenetic protein-2: evidence synthesis, data sharing, peer review, and reproducible research. Ann Intern Med. 2013 Jun 18;158(12):916-8. doi: 10.7326/0003-4819-158-12-201306180-00012. PubMed PMID: 23778911.

Carragee EJ, Hurwitz EL, Weiner BK. A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J. 2011 Jun;11(6):471-91. doi: 10.1016/j.spinee.2011.04.023. Review. PubMed PMID: 21729796.

North American Spine Coverage Committee. Recombinant Human bone morphogenic protein 2: defining appropriate coverage positions. https://www.spine.org/PolicyPractice/CoverageRecommendations/e-book#p=1 Accessed 10-26-2015.

Martin BI, Lurie JD, Tosteson AN, Deyo RA

Question 15

194. A 45-year-old patient who was involved in a motor vehicle collision sustained the injury shown in Video 194. What is the most likely mechanism of injury?
195. Distraction
196. Extension
197. Cannot determine without MR imaging
198. Compression
199. Rotational

Answer 15

4. Compression

RECOMMENDED READINGS

Langrana NA, Harten RD RD, Lin DC, Reiter MF, Lee CK. Acute thoracolumbar burst fractures: a new view of loading mechanisms. Spine (Phila Pa 1976). 2002 Mar 1;27(5):498-508. PubMed PMID: 11880835.

Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983 Nov-Dec;8(8):817-31. PubMed PMID: 6670016.

Question 16

199. Video 199 is the CT scan of a man with an open femur fracture, a subdural hematoma, and a spine injury. After the orthopaedic trauma team stabilizes the fracture and completes an examination, which finding most strongly favors spine surgery?
200. Thoracolumbar injury classification system (TLICs) score of 5 or higher
201. Presence of bilateral lower extremity weakness and loss of rectal tone
202. MRI evidence of posterior ligamentous complex disruption
203. Kyphosis angle exceeding 15 degrees
204. Increase of 5 degrees kyphosis on upright radiographs

Answer 16

2. Presence of bilateral lower extremity weakness and loss of rectal tone

RECOMMENDED READINGS

Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33. PubMed PMID: 16227897.

Joaquim AF, Daubs MD, Lawrence BD, Brodke DS, Cendes F, Tedeschi H, Patel AA. Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients. Spine J. 2013 Dec;13(12):1760-5. doi: 10.1016/j.spinee.2013.03.014. Epub 2013 Apr 18. PubMed PMID: 23602328.

Question 17

205. A patient with neurogenic claudication caused by spinal stenosis and spondylolisthesis has not responded to nonsurgical treatment. She underwent a complication-free surgery that corrected her underlying spine pathology, but she is unhappy with the outcome. Postsurgical imaging shows a well-healed fusion without junctional pathology and overall good sagittal alignment. This patient’s dissatisfaction is most likely related to
206. improved pain and disability scores.
207. smoking.
208. diabetes.
209. depression.
210. hypertension.

Answer 17

4. depression.

RECOMMENDED READINGS

Adogwa O, Parker SL, Shau DN, Mendenhall SK, Bydon A, Cheng JS, Asher AL, McGirt MJ. Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery. Spine J. 2013 May;13(5):501-6. doi: 10.1016/j.spinee.2013.01.017. Epub 2013 Feb 16. PubMed PMID: 23422730.

Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012 Mar 12;172(5):405-11. doi: 10.1001/archinternmed.2011.1662. Epub 2012 Feb 13. PubMed PMID: 22331982.

Question 18

220. In a well-designed prospective randomized study that provides level II evidence in favor of surgical treatment for the injury shown in Video 220, the primary outcome measure is the neck disability index (NDI) score, which shows an improvement of 5.5 points on a scale of 100 for patients treated with surgery (vs those who received nonsurgical treatment). This difference is statistically significant with a P value of 0.0001. The magnitude of difference and the P value suggests this difference
221. is highly significant and should change treatment patterns in favor of surgery.
222. is irrelevant because the study has only level II evidence.
223. may or may not be a clinically significant difference in outcome.
224. does not reflect the number of patients enrolled in the study.
225. has been miscalculated.

Answer 18

1. is highly significant and should change treatment patterns in favor of surgery.

RECOMMENDED READINGS

Vaccaro AR, Kepler CK, Kopjar B, Chapman J, Shaffrey C, Arnold P, Gokaslan Z, Brodke D, France J, Dekutoski M, Sasso R, Yoon ST, Bono C, Harrop J, Fehlings MG. Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture. J Bone Joint Surg Am. 2013 Apr 17;95(8):729-35. doi: 10.2106/JBJS.K.01636. PubMed PMID: 23595072.

Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J. 2009 Oct;9(10):802-8. doi: 10.1016/j. spinee.2009.06.002. Epub 2009 Jul 25. PubMed PMID: 19632904.

Gatchel RJ, Lurie JD, Mayer TG. Minimal clinically important difference. Spine (Phila Pa 1976). 2010 Sep 1;35(19):1739-43. doi: 10.1097/BRS.0b013e3181d3cfc9. PubMed PMID: 20700084.

Question 19

233. A 60-year-old man with a history of neck pain sustained an extension injury to his cervical spine after falling while riding a bicycle. The incident resulted in an incomplete spinal cord injury. An examination will most likely reveal
234. that his motor deficit is worse in the upper extremities than the lower extremities.
235. that lower extremities are affected more than upper extremities.
236. an ipsilateral deficit in motor function and a contralateral deficit in pain and temperature.
237. a loss of proprioception with preserved motor, pain, and light touch.
238. a complete loss of motor and sensory function below the level of the injury.

Answer 19

1. that his motor deficit is worse in the upper extremities than the lower extremities.

RECOMMENDED READINGS

Gupta R, Bathen ME, Smith JS, Levi AD, Bhatia NN, Steward O. Advances in the management of spinal cord injury. J Am Acad Orthop Surg. 2010 Apr;18(4):210-22. Review. PubMed PMID: 20357230.

Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. J Am Acad Orthop Surg. 2009 Dec;17(12):756-65. Review. PubMed PMID: 19948700.

Question 20

249. Two weeks after undergoing laminectomy and fusion for spinal stenosis, a patient is evaluated for a possible infection. Which laboratory test is most sensitive for identification of postsurgical infection?
250. Erythrocyte sedimentation rate (ESR)
251. C-reactive protein (CRP)
252. White blood cell count (WBC) and differential
253. Hemoglobin A1c (HgbA1c)
254. Serum albumin level

Answer 20

2. C-reactive protein (CRP)

RECOMMENDED READINGS

Radcliff KE, Neusner AD, Millhouse PW, Harrop JD, Kepler CK, Rasouli MR, Albert TJ, Vaccaro AR. What is new in the diagnosis and prevention of spine surgical site infections. Spine J. 2015 Feb 1;15(2):336-47. doi: 10.1016/j.spinee.2014.09.022. Epub 2014 Sep 28. Review. PubMed PMID: 25264181.

Kang DG, Holekamp TF, Wagner SC, Lehman RA Jr. Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review. Spine J. 2015 Apr 1;15(4):762-70. doi: 10.1016/j.spinee.2015.01.030. Epub 2015 Jan 28. Review. PubMed PMID: 25637469.