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Flashcards in Goldstien List spine Deck (26)
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1

Risk factors for surgical site infection in spine surgery (13)

  • Age > 60
  • Smoking
  • Diabetes
  • Obesity
  • EtOH abuse
  • Steroid use
  • Trauma patients
  • Previous surgical infection
  • Previous spinal surgery
  • Pre-op hospitalization > 1 week
  • Surgery > 5 hours (#1)
  • Blood loss > 1 litre
  • Posterior spinal surgery

2

Biochemical changes in aging discs

  • Decreased water
  • Decreased proteoglycan
  • Decreased chondroitin sulfate
  • Increased collagen
  • Increased keratin sulfate

3

Anterior cervical spine landmarks (6)

  • Angle of the mandible C1/2
  • Hyoid bone C3
  • Superior thyroid cartilage C4/5
  • Inferior thyroid cartilage C5/6
  • Cricoid cartilage C6
  • Carotid tubercle C6

4

Complications of anterior cervical spine surgery (8)

  • Neurologic injury
  • Pseudarthrosis
  • Airway compromise
  • Recurrent laryngeal nerve injury (dysphonia)
  • Dysphagia
  • Esophageal injury
  • Graft dislodgement
  • Stroke (carotid artery compression)

5

Risk factors for airway complications in cervical spine surgery (3)

  • Surgical time > 5 hours
  • Blood loss > 300 mL
  • Multilevel surgery at/above C3/4

6

Risk factors for prolonged dysphagia after anterior cervical spine surgery (3)

  • Female
  • Revision surgery
  • Multilevel surgery

7

Clinical syndromes associated with cervical spondylosis (4)

  • Myelopathy
  • Axial neck pain
  • Radiculopathy
  • Combination
  • (M.A.R.C.)

8

XR findings of cervical spondylosis (5)

  • Facet hypertrophy
  • Loss of disc height
  • Loss of cervical lordosis
  • Osteophytes
  • Subchondral sclerosis/cysts
  • (F.L.L.O.S.)

9

MRI findings of cervical spondylosis (5)

  • Soft disc herniations
  • Foraminal stenosis (uncovertebral joint spurs)
  • Decreased SAC
  • Myelomalacia
  • Ligamentum flavum hypertrophy
  • (Front → back)

10

Surgical options for cervical spondylosis (5)

  • Anterior cervical discectomy and fusion
  • Cervical disc arthroplasty
  • Posterior keyhole laminoforaminotomy
  • Laminoplasty
  • Posterior cervical laminectomy and fusion
  • (Front → back)

11

Indications for surgical intervention in cervical spondylosis (5)

  • Myelopathy
  • Radiculopathy unresponsive to treatment
  • SAC ≤ 13 mm with myelomalacia in an asymptomatic patient
  • Intractable neck pain with1 or 2 level disease

12

Indications for cervical laminoplasty (3)

  • Preserved cervical lordosis
  • Multilevel anterior compression
  • Ossification of the posterior longitudinal ligament)

13

Complications of cervical laminoplasty (3)

  • Decreased range of motion
  • Axial neck pain
  • Kyphosis

14

Causes of cervical Myelopathy

  • Congenital stenosis
  • Ossification of the posterior longitudinal ligament
  • Acquired stenosis (spondylosis, tumor, infection)
  • Loss of cervical lordosis
  • (C.O.A.L.)

15

Clinical findings of cervical Myelopathy (6)

  • Upper extremity clumsiness
  • Myelopathy hand
  • Sensory abnormalities
  • Upper motor neuron findings
  • Bowel/bladder dysfunction
  • Gait abnormalities (broad-based gait)
  • (Upper → lower)

16

Ranawat classification of cervical myelopathy (4)

  • Class I: pain, no neurologic deficit
  • Class II: subjective weakness, hyperreflexia, dysesthesias
  • Class IIIA: objective weakness, long tract signs, ambulatory
  • Class IIIB: objective weakness, long tract signs, nonambulatory

17

Nurick myelopathy scale (5)

  • Grade 0: nerve root signs, no cord involvement
  • Grade I: nerve root signs, cord involvement, normal gait
  • Grade II: nerve root signs, cord involvement, mild gait abnormality
  • Grade III: nerve root signs, cord involvement, severe gait abnormality
  • Grade IV: nerve root signs, cord involvement, gait only with assistance

18

Imaging findings of cervical myelopathy (4)

  • Sagittal canal diameter ≤ 13 mm
  • Pavlov’s (Torg’s) ratio < 0.8 (canal:vertebral body width)
  • Cord flattening on MRI
  • Myelomalacia (↓ signal on T1 and ↑ signal on T2)

19

Types of clinical course of cervical myelopathy (Clark & Robinson) (3)

  • Stable (75%)
  • Slow, steady decline (20%)
  • Rapid decline (5%)

20

Factors in decision-making process for surgical treatment of cervical myelopathy (4)

  • Location of compression
  • Alignment of the spine
  • Number of involved levels
  • Nature of compression (soft tissue vs. bone)

21

Indications for cervical disc arthroplasty (5)

  • Patient < 65 years of age
  • MRI findings consistent with disc degeneration or herniation
  • Radiculopathy or myelopathy
  • Involvement of 1-3 segments
  • Failure of 6 weeks of nonoperative management 

22

Contraindications to cervical disc arthroplasty (10)

  • -       AS, RA, OPLL, DISH
  • -       IDDM
  • -       Osteoporosis
  • -       Obesity
  • -       Pregnancy
  • -       Neck Pain without Objective Evidence
  • -       Cervical Instability
  • -       Previous ALIF
  • -       Previous INFECTION
  • Previous FRACTURE

23

Risk factors for cervical spine involvement in rheumatoid arthritis (5)

  • Mutilating arthritis
  • Males
  • Longer duration of disease
  • Seropositive disease
  • Steroid treatment
  • (M.M.L.S.)

24

Patterns of rheumatoid arthritis involvement in the cervical spine (4)

  • Atlantoaxial instability (#1 - 50-80%)
  • Basilar invagination (#2 - 40%)
  • Subaxial instability (20%)
  • Combination (#3)

25

Indications for surgical intervention in rheumatoid atlantoaxial instability (6)

Absolute (3)

  • SAC ≤ 13 mm on flexion XR
  • Cord < 6 mm on flexion MRI
  • Ranawat IIIA/B myelopathy

Relative (3)

  • Progressive instability
  • Intractable pain
  • AADI ≥ 10 mm on flexion XR

26

Methods of posterior C1-2 fixation (3)

  • Posterior wiring techniques (Brooks, Gallie)
  • Transarticular screws (Magerl)
  • Posterior screw/rod fixation (Harms technique – C1 lateral mass, C2 pedicle)