clinical correlations

Question 1

What is the most common spinal deformity

Answer 1

scoliosis

Question 2

What population does scoliosis most often affect

Answer 2

pre-pubescent girls

Question 3

What are the causes of scoliosis

Answer 3

idiopathic
congenital (wedge shaped segment)
short leg
neuromuscular (cerebral palsy, muscular dystrophy)
degenerative (osteoporosis)

Question 4

What is the primary curve vs secondary in scoliosis

Answer 4

primary is the way you initially bend and the secondary curve is the compensatory bend

Question 5

In scoliosis which way do the spinous processes rotate

Answer 5

towards the center of the curve

Question 6

What is the treatment for scoliosis

Answer 6

bracing and internal fixation

Question 7

What can cause compression fractures

Answer 7

trauma. or because of previous condition- osteoporosis and neoplastic metastasis

Question 8

Which area of the vertebral column is most prone to dislocation

Answer 8

cervical vertebrae

Question 9

Which segment of cervical vertebra is most prone to dislocation

Answer 9

CV6

Question 10

What is the fracture nature of CV1 Atlas

Answer 10

the occipital condyles push down with force and the lateral masses of atlas are pushed laterally- forcing arches to fracture.

Question 11

Describe fractures of CV2

Answer 11

~40% cervical fractures
hangmans fracture
and forceful hyperextension resulting in bilateral fracture though pars interarticularis

Question 12

Describe the fracture of dens- odontoid process

Answer 12

complete fracture results in avascular necrosis
does not impinge on the cord if transverse ligament is attached but there is slight added tension of cord on posterior arch

Question 13

Describe problems of rupturing transverse ligament of atlas

Answer 13

atlas moves freely in AP direction- so the spinal cord gets pinched between dens and posterior arch- quadriplegia or death

Question 14

what ligament is missing or relaxed in downs syndrome

Answer 14

transverse ligament of atlas

Question 15

What happens if you rupture alar ligaments

Answer 15

increased rotation of skull and CV1 on CV2 ~30 degrees unilaterally.
can be caused by increased flexion with rotation of the skull

Question 16

What is spondylolysis

Answer 16

defect in the pars interarticularis

Question 17

spondylolisthesis

Answer 17

bilateral spondylolysis. vertebral column above fractures shifts forward

Question 18

Spina bifida occulta

Answer 18

neural arch defect at LV5 or SV1
can be complete or partial- usually spinous process is absent
tuft of hair on skin can indicate area of defect

Question 19

what happens with degeneration of articular cartilage (Osteoarthritis)

Answer 19

inflammation and bone spur formation (osteophyte) which leads to a narrowing of the intervertebral foramina and impinges spinal nn

Question 20

Radiculopathy

Answer 20

pain distributed along path of a dermatome

Question 21

Spinal stenosis

Answer 21

Narrowing of the spinal canal and or intervertebral foramen

Question 22

What are the two procedures for radiculopathy

Answer 22

laminectomy and foramintomy- enlarge intervertebral foramina

Question 23

What happens with osteoarthritis of the zygopophyseal joints

Answer 23

narrowing of intervertebral foramina

Question 24

What causes injury to the anterior longitudinal lig

Answer 24

rapid hyperextension like in whip lash injuries

Question 25

Describe progression of ankylosing spondylitis

Answer 25

``` inflammation of sacroiliac and all spinal ligaments osteophytic bone growth into the log the spine fuses and so no arm swing most common in 30-50 yr old men HLA B27 marker "bamboo" spine ```

Question 26

What is a ruptured disk? Herniated disk?

Answer 26

ruptured is tearing annulus fibrosis | herniated is tearing annulus fibrosis AND protrusion of nucleus pulposus

Question 27

Where do most herniated disks occur

Answer 27

posterolaterally and impinge nerves | in the lumbar L4-S1 regions where the bodies are greatest so flexion has greatest overall excursion

Question 28

Acute pain from intervertebral disk suggests what

Answer 28

tear in annulus fibrosis

Question 29

regional inflammation around intervertebral disk suggests what

Answer 29

herniated nucleus

Question 30

Chronic pain associated with disk herniation suggests what?

Answer 30

compression of spinal nerve root- continuous low grade depolarization that results in patient "feeling" pain in the receptive field of the compressed n

Question 31

Herniations affect which spinal nerves

Answer 31

in cervical region same level spinal nn | in lumbar regions affect spinal n one or more segments lower than disk level

Question 32

what are signs of interference in the supply of blood provided by segmental arteries?

Answer 32

paresthesia and/or paraplegia

Question 33

Describe the location of lumbar puncture

Answer 33

suarachnoid space ofund between ligamentum flavum as patient flexes placed between LV3 and LV4 or LV4 and LV5

Question 34

location of spinal tap in neonate

Answer 34

LV4-LV5 because spinal cord is almost full length of column

Question 35

Describe location of epidural anesthetic

Answer 35

through sacral hiatus into sacral canal to deliver anesthesia to the surface of cauda equina to remove pelvic pain without removing motor function because that occurs in higher cord levels.