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OITE Review Book > Spine > Flashcards

Spine Flashcards

1
Q

C5

A

Delt, biceps

lateral shoulder/arm sensation

biceps reflex

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2
Q

C6

A

bracioradialis, ECRL

thumb sensation

brachioradialis reflex

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3
Q

C7

A

triceps, FCR

long finger sensation

triceps reflex

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4
Q

C8

A

FDS

small finger sensation

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5
Q

T1

A

interossei

medial elbow sensation

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6
Q

L2/L3

A

iliopsoas, hip adductors

anterior and medial thigh sensation

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7
Q

L4

A

quad, TA

anterior knee, medial leg sensation

patellar reflex

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8
Q

L5

A

EHL, TA, TP, hamstrings, glutei

lateral leg, dorsal foot senation

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9
Q

S1

A

GSC, peroneals

posterior leg sensation

achilles reflex

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10
Q

S2

A

FHL/FDL

plantar foot sensation

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11
Q

S3/S4

A

bowel/bladder

perianal sensation

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12
Q

Spinal cord normally extends to…

A

L2.

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13
Q

Anterior cervical spine approach complications

A

recurrent laryngeal nerve –> hoarseness

sympathetic nerves –> Horner’s syndrome

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14
Q

ALIF spine approach complications

A

superior hypogastric plexus –> retrograde ejaculation/infertility

sympathetic trunk –> anhidrosis; one leg feels cold, increased temp of extremity

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15
Q

Lateral LIF spine approach complications

A

ilioinguinal nerve: travels with round ligament/spermatic cord

iliohypogastric nerve

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16
Q

Which images best show acute SCI?

A

STIR

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17
Q

Central cord syndrome is usually due to an…

A

hyperextension injury.

Lateral corticospinal tracts of the upper extremities are more central –> UE more affected than LE.

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18
Q

Anterior cord syndrome

A

Injury to anterior spinal artery which supplies anterior 2/3 of cord.

-loss of motor (corticospinal tract) & pain/temp sensation (spinothalamic tract) but preserved proprioception/vibration (dorsal columns)

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19
Q

Brown-Sequard

A

cord hemitransection

  • loss of ipsilateral motor and proprioception/vibration
  • loss of contralateral pain/temp senesation
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20
Q

After SCI, distended bowel or bladder will stimulate…

A

autonomic dysreflexia –> HTN, sweating, piloerection, facial flushing, HA, blurred vision, stuffy nose.

Tx: catheterization, disimpaction, treat HTN

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21
Q

What area has highest potential for neuro improvement after SCI?

A

lumbar (conus medullaris)

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22
Q

ASIA classification

A

Grade A: complete; no motor or sensory below level
Grade B: incomplete; sensory preserved, no motor
Grade C: incomplete; more than half the muscles involved have grade < 3 strength
Grade D: more than half the muscles involved have >/= 3 strength
Grade E: normal

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23
Q

The Wiltse approach is between…

A

the longissimus and multifidus muscles.

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24
Q

Disc herniations will resorb over time via…

A

phagocytosis by macrophages.

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25
If patient is symptomatic after discectomy, obtain...
MRI w/ gadolinium to differentiate between fibrosis (contrast enhancing) vs recurrent disc herniation (non-enhancing).
26
Compared to primary discectomy, revision discectomy has...
similar outcomes.
27
DISH
- associated with DM - non-marginal syndesmophytes (flowing ossification) - disc space NOT involved - most commonly affects right side of thoracic spine
28
Ankylosis spondylitis
- HLA-B27 - sacroiliitis and enthesitis - marginal syndesmophytes - vertebral scalloping - disc space ossified - kyphotic deformity (chin on chest) --> tx w/ C7-T1 posterior osteotomy/fusion ***THA w/ AS is at increased risk of anterior dislocation bc of relative hyperextension of the hip (even after posterior approach)
29
Most important atlantoaxial stabilizer
transverse ligament
30
What indicates disruption of transverse ligament
>6.9 mm of combined lateral mass overhang (rule of spence)
31
What is an unstable ADI?
> 3.5 mm in adults | > 5 mm in peds
32
SAC (or PADI) associated with increased risk of neuro injury
< 13 mm
33
Treatment of Type I and III odontoid fractures
C-collar
34
Treatment of type II odontoid
young pt, small displacement: c-collar old pt, large displacement: posterior C1-2 fusion **aberrant vertebral artery is a contraindication to C1-2 transarticular screws
35
Normal C2 osteology
Basilar synchondrosis fuses between 3-6 years of age. 2ndary ossification center fuses at 12 years of age; failure to close --> os odontoideum
36
Hangman's fracture
bilateral C2 pars fx --> spondylolisthesis of C2 on C3 *usually non-operative (rigid cervical collar)
37
Normal facet anatomy
superior facet is anterior to inferior facet
38
A unilateral facet dislocation will show...
25% listhesis vs bilateral facet dislocation with 50%.
39
W/ cervical spine facet fx-dislocation, there is highest risk for...
vertebral artery injury.
40
Halo pin should be placed...
1 cm above the lateral 1/3 of the orbit at the equator of the skull to avoid the supraorbital nerve.
41
Cranial nerve 6 (abducens nerve)
palsy of lateral rectus --> loss of lateral gaze --> diplopia
42
Transporting a child on a standard adult backboard will...
flex the neck due to large occiput in children.
43
Contraindication to posterior only decompression/fusion for cervical spinal stenosis is...
fixed C2-C7 kyphosis > 13 degrees.
44
Treatment of OPLL w/ adequate cervical lordosis
posterior laminoplasty or laminenctomy w/ fusion (avoid going anteriorly due to high risk of durotomy)
45
Tx of symptomatic pseudoarthrosis after ACDF
posterior instrumented fusion.
46
If you suspect recurrent laryngeal nerve palsy after ACDF...
perform direct laryngoscopy to confirm and evaluate extent of injury.
47
In RA, atlantoaxial subluxation results from...
pannus formationo at the atlantodental joint compromising the transverse ligament.
48
Indications for posterior C1-2 decompression and fusion in RA
ADI > 10 mm or PADI/SAC < 14 mm
49
Treatment of basilar invagination w/ cervical myelopathy in RA
posterior occiput-C2 decompression and fusion
50
lamina fracture is associated with...
traumatic dural tear.
51
Chance fracture
flexion-distraction injury **associated with GI injury **generally unstable and require decompression/stabilization regardless of neuro function
52
Compression of the cauda equina leads to...
lower motor neuron symptoms. *Neurogenic bladder --> urinary retention leads to overflow incontinence **Needs to be decompressed within 48 hours.
53
Degenerative spondylolisthesis typically occurs at...
L4-L5
54
Isthmic spondylolisthesis typically occurs at...
L5-S1 (pars defect).
55
What structure is at risk with reduction of L5-S1 spondylolisthesis
L5 nerve root
56
Main risk for slip progression is...
age.
57
What is the greatest risk factor for complication w/ adult deformity surgery?
age > 60
58
In general, correct the sagittal alignment of adult deformity by...
changing lumbar lordosis.
59
For back pain, compared to lumbar fusion, cognitive behavioral therapy...
provides equivalent outcomes.
60
UMN symptoms
spastic paresis, hyperreflexia, babinski
61
LMN symptoms
flaccid paralysis, hyporeflexia, muscle atrophy, fasciculations
62
Spondylodiskitis
disc space narrowing and endplate erosion are common with pyogenic osteomyelitis but not with tuberculosis or neoplasm
63
Best imaging for osteo/epidural abscess
MRI w/ and w/o gadolinium. Give abx w/o biopsy if positive blood cultures. Otherwise, IR guided biopsy first then abx.
64
Surgery for osteomyelitis/epidural abscess usually requires...
anterior decompression and fusion +/- posterior instrumented fusion because the infection often involves the vertebral body and disc (anterior structures).
65
Pott's disease
spinal tuberculosis severe focal spinal kyphosis, acid-fast bacilli
66
Earliest xray finding of pediatric diskitis
loss of lumbar lordosis

OITE Review Book (10 decks)

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