Exam 1: General Surgery Part 5

Question 1

Scoliosis surgery is considered in all children with progressive curves greater than ____ to ____ degrees.

Answer 1

40 to 50 degrees

Question 2

Define Scoliosis

Answer 2

Lateral deviation of the normal vertical spine greater than 10 degrees

Classifications are used clinically

Question 3

Define Kyphosis

Answer 3

(Humpbacked) posterior angulation of the spine

Question 4

Define Lordosis

Answer 4

(Bent backward) anterior angulation of the spine

Question 5

Differentiate primary and secondary curves

Answer 5

• Primary curves: appear early and most frequently in thoracic and lumbar regions
• Secondary curves: (compensatory) develop above or below the primary curve and evolve to maintain alignment

Question 6

What method is most commonly used to measure the magnitude of the curve from anteroposterior radiographs?

Answer 6

Cobb Method

AP xrays are used to determine the curve

Question 7

What is congenital scoliosis caused by?

Answer 7

Spinal anomaly caused by failure of formation and segmentation that results in scoliosis or kyphosis (Hemivertebra is the most common cause)

Question 8

Are bracing/casting effective for congenital scoliosis?

Answer 8

No

Question 9

What are the surgical options for congenital scoliosis?

Answer 9

• Fusion
• Convex hemiepiphysiodesis
• Hemivertebra excision
• Growing rods
• Vertical expandable prosthetic titanium rib (VEPTR)

Question 10

Infantile scoliosis occurs b/w what age?

Answer 10

Occurs b/w birth - 3 years old

Question 11

Bracing for infantile scoliosis is considered when spine reaches ____ degrees

Answer 11

30 degrees

Question 12

Treatment for infantile scoliosis starts as early as ____ months

Answer 12

4-5 months

Question 13

Juvenile scoliosis is diagnosed b/w ____ and ____ years

Answer 13

4-10 years

Question 14

Juvenile scoliosis represents ____ % of idiopathic scoliosis

Answer 14

10-15%

Question 15

What percentage of juvenile idiopathic scoliosis has an underlying spinal condition (i.e., Arnold Chiari Malformation)

Answer 15

20%

Question 16

Juvenile Scoliosis > ____ degrees will require surgical intervention

Answer 16

30 degrees

Question 17

Adolescent Idiopathic Scoliosis occurs after age ____.

Answer 17

10 years

Question 18

Adolescent Scoliosis may have ____ impairment disproportionate to the severity of their scoliosis.

Answer 18

Pulmonary Impairment

Question 19

Does bracing decrease curve progression in adolescent scoliosis?

Answer 19

• Bracing will decrease curve progression
• BUT bracing is associated with worse PFT results at the time of surgery.

Question 20

What is neuromuscular scoliosis caused by?

Answer 20

• Caused by disorders of the brain, spinal cord, and muscular system
• Pts have deteriorating muscle function and mechanical distortion.

Question 21

How does scoliosis affect the lungs?

Answer 21

↑ Restrictive lung defects

Question 22

What problems can arise long term if scoliosis is untreated?

Answer 22

• Hypoxemia
• Hypercarbia
• Recurrent infections
• Pulmonary hypertension

Question 23

What is the most significant predictor of impaired respiratory function for a scoliosis patient?

Answer 23

• The number of vertebrae affected
• Degree of thoracic curve

Question 24

Scoliosis Surgery Anesthetic Management

Answer 24

• SSEP (Somatosensory evoked potentials)
• MEP (Motor evoked potentials)
• EMG (Electromyography)
• Evoked potentials
• Lost of IV Pumps
• Eye lubrication - prone for a LONG time
• Bite block
• Foley Cath (long surgery)
• A-line
• 2 PIV
• Type and cross

Question 25

Define SSEP

Answer 25

Monitored from a peripheral nerve through dorsal column of spinal cord to somatosensory cortex. (Proprioception/Vibration) **Posterior/sensory spinal tract** ## Footnote Measures brain activity in response to sensory stimulation.

Question 26

Define MEP

Answer 26

Monitored from a peripheral muscle through corticospinal tract to motor cortex **Anterior/motor spinal tract** ## Footnote Measures muscle activity in response to motor cortex stimulation.

Question 27

Define EMG

Answer 27

Direct nerve root monitoring (commonly during pedicle screw placement) ## Footnote Measures the electrical activity of muscles at rest and during contraction, used to diagnose muscle and nerve disorders.

Question 28

Evoked potential monitoring is affected by these factors.

Answer 28

* Neural injury * VA * Muscle relaxants * Hypercbia * Hypoxia * Hypotension * Hypothermia

Question 29

How does scoliosis affect end-expiration and end-inspiration on the concave side? How does scoliosis affect end-expiration and end-inspiration on the convex side?

Answer 29

Main effect of sculiosis on respiratory function is machaninical

Question 30

Which scoliosis is associated with the highest amount of blood loss? What TXA doses for each?

Answer 30

**Neuromuscular scoliosis has the highest blood loss** TXA Idiopathic: 50mg/kg TXA Neuromuscular: 100mg/kg