cervical spine

Question 1

neck pain, myelopathy, DM, IVDU

Answer 1

check for epidural abscess

Question 2

presentation cervical myelopathy

Answer 2

gait instability, bilateral numbness tingling, difficulty buttoning shirts

Question 3

tests for cervical myelopathy

Answer 3

grip and release test, Hoffman’s sign, clonus, babinski, toe to heel gait

Question 4

JOA classification

Answer 4

JOA 4 (4 wheels) - wheelchair bound, needs ADL assistance
JOA14 - mild ambulatory, functioning

Question 5

if patient has lumbar spinal stenosis + myelopathy symptoms then what

Answer 5

get cervical MRI

Question 6

buzzword: asymmetric periventricular plaques

Answer 6

MS

Question 7

Outcome of cervical myelopathy predicted by

Answer 7

severity of symptoms at treatment, older age, smoking, preop comorbidities, T2 intensity, transverse area of spinal cord

Question 8

cervical myelopathy natural history

Answer 8

stepwise progression and deterioration

Question 9

Cervical myelopathy, when to go anterior?

Answer 9

if >10 degrees kyphosis bc cord is draped over anterior vertebrae or only 1 or 2 levels of compression

Question 10

when to back up ACDF

Answer 10

3 or more levels, then need posterior

Question 11

T/F: T12 pedicle is bigger than L1

Answer 11

T

Question 12

indication for cervical disc replacement

Answer 12

single and 2 level cervical disc disease with minimum facet disease
clinical outcomes equivalent to ACDF, reduced reoperation rate, reduced adjacent level disease

Question 13

T/F: Vance powder decreases infection in posterior cervical surgery

Answer 13

true

Question 14

why does c5 palsy occur

Answer 14

any surgery that shifts the cord posterior stretches the nerve, treatment is observation and reassurance

Question 15

atlantoaxial subluxation can present with what:

Answer 15

occipital headaches due to compression of occipital branch of C2

Question 16

ADI greater than ? and SAC/PADI ? are indication for surgery

Answer 16

ADI >10
PADI/SAC <14
treat with C1/2 fusion

Question 17

how to treat basilar invagination

Answer 17

occiput to cervical fusion, indication is progressive cranial migration

Question 18

mechanism of etanercept

Answer 18

TNFA antagonist

Question 19

abatacept

Answer 19

MHC receptor antagonist

Question 20

Disc

NP/Annulus collagen

Answer 20

annulus type 1
NP type 2 collagen (high water content)
blood supply is avascular, nutrition through pores in endplates

Question 21

C6/7 disc gets what

Answer 21

C7 nerve root bc nerve root is above C7 body

Question 22

what percent cervical radiculopathy resolve with nonop

Answer 22

75-90%

Question 23

indication for surgery for cervical radiculopathy

Answer 23

persistent and disabling pain fro 6-12 weeks, failed nonop

Question 24

lumbar sympathetic chain injury

Answer 24

leg is warm and dry

Question 25

what percent of patients get dysphagia after anterior cervical surgery

Answer 25

50%

Question 26

hypoglossal nerve injury

Answer 26

if injured tongue deviates to side of injury

Question 27

cervical spine adjacent segment disease

Answer 27

1.6 to 4.2 percent per year

Question 28

neural tube Neural crest notocord

Answer 28

NC: peripheral nervous system, spinal ganglia, sympathetic trunk NT: spinal cord notochord: vertebral bodies and discs

Question 29

Asia classification

Answer 29

``` A: complete, no motor or sensory B: No motor, sensory only (B barely anything) C: 50% of muscles less than grade 3 D: 50% of muscles more than grade 3 E: normal ```

Question 30

AS vs DISH

Answer 30

AS: HLAB27, bilateral sacroilitis, marginal osteophyte DISH: flowing candle wax, preservation of disc space, associated w/diabetes, non marginal osteophyte

Question 31

blood flow to dens

Answer 31

apex - internal carotid | base - vertebral artery

Question 32

treatment Type 1 and 3 odontoid fx

Answer 32

orthosis or halo

Question 33

type 2 treatment

Answer 33

young w/risk factor and displaced get operative, if not displaced get halo >50 never halo, put in soft collar, ok for surgery if needed

Question 34

risk factor for nonunion odontoid fx

Answer 34

``` age >50 >6mm displacement treatment delay diabetes fracture comminution posterior angulation >10 degrees ```

Question 35

sum of lateral mass displacement

Answer 35

if sum of lateral mass displacement is >8.1mm then a transverse ligament rupture is assured and the injury pattern is considered unstable

Question 36

ADI

Answer 36

<3mm normal in adult (<5mm normal in child) 3-5 injury to traverse ligament >5 injury to transverse/apical/alar ligaments

Question 37

powers ratio

Answer 37

used to diagnose occipitocervical dislocation (C-D)/(A-B) normal =1

Question 38

who gets a halo

Answer 38

unstable type 2 atlas (Jefferson fracture) type 2 odontoid fractures (in young w/o nonunion RF) Type 2/3 hangman fx

Question 39

what percent of spinal cord injury patients have MDD

Answer 39

11%

Question 40

Which is not an upper motor neuron sign - Fasciculations - Spasticity - Muscle Weakness - Exagerated deep tendon reflexes - sustained clonus

Answer 40

- Fasciculations Weakness is upper and lower

Question 41

what level can you repair pars defect vs fuse

Answer 41

L4 and above can be repaired, L5/s1 needs fusion

Question 42

when is TLSO indicated in adolescent idiopathic scoli

Answer 42

25-40 degrees, apex below T7, skeletally immature, riser 023 curves <25 can be observed >40 degrees do not respond well to bracing

Question 43

functional electrical stimulation is used in Rehab for spinal cord injury and has greatest effect on:

Answer 43

skeletal muscle

Question 44

curve progression

Answer 44

magnitude of curve at time of peak height velocity is most prognostic sign in relationship to surgery more than 70% of curves that measure more than 30 degrees att his time are likely to reach surgical range

Question 45

what is klippel feil

Answer 45

congenital cervical fusion of the cerivcal vertebra with low posterior hairline and short neck and limited neck motion if fusion is above C3 should not participate in contact sports

Question 46

surgery vs nonop for lumbar stenosis

Answer 46

At 4 years, surgical management is expected to result in more improvement in pain, function, satisfaction than nonoperative management.

Question 47

A 2-year-old child falls down a flight of stairs and is found to have spinal cord injury without radiographic abnormality (SCIWORA). What is the most important predictor of her neurologic outcome

Answer 47

severity of initial neurologic injury

Question 48

aging disc

Answer 48

decrease in water decrease in large aggregated proteoglycans increase in degradative enzyme activity decrease in nutritional transport increase in keratin sulfate to chondroitin sulfate ratio

Question 49

In patients with incomplete spinal cord injuries what is the most important prognostic variable relating to neurologic recovery?

Answer 49

severity of neurologic deficit

Question 50

What is the most powerful preoperative prognostic factor for clinical outcomes with surgical treatment of lumbar stenosis

Answer 50

comorbid medial conditions

Question 51

Patients with symptomatic spinal stenosis treated with surgical decompression compared to those treated nonoperatively have what clinical outcomes.

Answer 51

improved clinical outcomes in pain and function at 4 years

Question 52

Lhermitte maneuver

Answer 52

provocative maneuver flexing neck used in the diagnosis of cervical myelopathy. When it is positive the patient will complain of electric shock-like sensations that radiate down the spine and into the extremities.

Question 53

In adult patients with scoliosis, severity of symptoms correlates with which of the following variables?

Answer 53

sagittal imbalance