Spine

Question 1

What is appearance of hemangioma on spine CT?

Answer 1

vertical striations in vertebral body

Question 2

What is ASIA Grade A spinal cord injury?

Answer 2

No sensory or motor function

Question 3

What did SPORT trial show with regards to spinal stenosis?

Answer 3

Spinal stenosis treated with surgery had greater improvement in pain and function than patients treated nonsurgically

Question 4

What is appearance of osteochondroma on spine CT and pathology slides

Answer 4

CT: sessile bony mass in posterior elements
Path: benign cartilage cap w/ benign bone elements

Question 5

What artery can you injury with C1 screws?

Answer 5

vertebral artery

Question 6

What spine conditions are associated with HLA B27 (2)?

Answer 6

Scheuermann kyphosis, ankylosing spondylitis

Question 7

What is the next step in workup for a patient who had I&D of lumbar epidural abscess and IV abx but continues to worsen clinically?

Answer 7

MRI thoracic and cervical spine to identify skip lesions

Question 8

What is characteristic symptom of lumbar stenosis and what is treatment?

Answer 8

Neurogenic claudication

Laminectomy

Question 9

What 2 types of congenital scoliosis have the lowest risk of progression?

Answer 9

Block and wedge vertebrae

Question 10

What nerve root provides sensation to the thumb?

Answer 10

C6

Question 11

What are anterior ADI, posterior ADI, and spinal canal diameter cutoffs for surgery in RA?

Answer 11

anterior ADI: > 6 mm
posterior ADI: < 13 mm
spinal canal diameter: <13 mm

Question 12

What approach should be used for an extraforaminal hernation?

Answer 12

Wiltse approach - far lateral muscle sparing approach

Question 13

What nerve roots contribute to the obturator, femoral and sciatic nerves?

Answer 13

obturator: L1, L2, L3
femoral: L3, L4
sciatic: L4, L5, S1

Question 14

What is typical clinical presentation of DISH patient who fractures? What is treatment?

Answer 14

Severe pain with minor trauma. Long segment posterior fusion

Question 14

What is management of a thoracic spine fracture of all 3 columns in someone with ankylosis spondylitis?

Answer 14

Posterior spinal fusion

Question 14

What is treatment for someone who s/p ACDF and then goes on to later have myelopathy and cord signal change at same level?

Answer 14

posterior decompression

Question 14

What test should be ordered for patients with history of gastric bypass undergoing spinal fusion?

Answer 14

DEXA

Question 15

What is treatment of stable burst fractures without neurologic deficit? What have studies shown about nonop vs. operative treatment?

Answer 15

bracing; nonop treatment has less pain and better functional outcomes

Question 16

What is treatment for patient with ankylosis spondylitis who sustains a c-spine fx?

Answer 16

posterior cervical instrumented fusion

Question 17

When is surgery indicated in thoracic disc herniations?

Answer 17

frank or progressive myelopathy

Question 17

What test should be done before a disc replacement is performed?

Answer 17

DEXA scan

Question 18

What is the most common reason for reoperation after surgery for adult spinal deformity?

Answer 18

pseudoarthrosis

Question 19

What angle best correlates with overall sagital alignment? How do you measure it?

Answer 19

Pelvic incidence - one line from femoral head to center of S1 endplate, another line perpendicular to S1

Question 20

What is treatment for a floating lateral mass fracture?

Answer 20

two level fusion (can be anterior or posterior)

Question 21

What is treatment for cervical myelopathy in someone who is a smoker?

Answer 21

laminoplasty (want to avoid fusion)

Question 22

What 3 factors predict a poor postop outcome for patients with cervical spondylotic myelopathy (CSM)?

Answer 22

low intramedullary signal on T1 MRI, clonus, spasticity

Question 23

What is next step in patient with vertebral osteomyelitis who has a negative CT guided biopsy?

Answer 23

Obtain a second CT guided biopsy

Question 24

What do xrays look like for patients with osteopetrosis? What is the mutation?

Answer 24

significant sclerosis (bone within a bone appearance); chloride 7 (CLCN7) gene

Question 25

How does giant cell tumor appear on CT scan? What is a reasonable nonsurgical option if patient wants to avoid surgery?

Answer 25

Lytic lesion; denosumab

Question 26

What diagnosis has disordered appearance of bone with multiple intersecting lines on histology? What is the treatment?

Answer 26

Paget's disease; bisphosphonates

Question 27

Which nerve root is affected in lumbar spondylisthesis?

Answer 27

exiting nerve root (e.g. L5 in an L5-S1 spondylisthesis)

Question 28

When should you allow a football player return to play when he sustains a cervical herniated disc?

Answer 28

No symptoms and negative neurologic exam

Question 29

How long do you extend the fusion in Scheuermann's kyphosis?

Answer 29

just past the first lordotic disc space

Question 30

What nerve innervates the intervertebral disc?

Answer 30

sinu-vertebral nerve

Question 31

What timeframe do you want to perform cervical decompression in acute SCI?

Answer 31

within 24 hours

Question 32

What are the treatment thresholds in the TLICS scoring system?

Answer 32

0-3: nonop 4: surgeon's decision 5 or greater: operative

Question 33

What amplitude change in SSEPs is indicative of an intraoperative spinal cord injury?

Answer 33

over 50%

Question 34

What is prognosis for someone who undergoes surgery for cauda equina syndrome?

Answer 34

improvement in pain and sensory symptoms but urinary symptoms and sexual dysfunction may persist

Question 35

What imaging should you get for someone who is diagnosed with Klippel-Feil syndrome on AP/lateral cervical xrays?

Answer 35

flexion/extension views to look for atlantoaxial instability

Question 36

What is treatment of a displaced dens fracture in an elderly person with pectus carinatum?

Answer 36

Posterior C1-2 fusion Screw contraindicated due to rounded chest Halo vest contraindicated due to age

Question 37

What are some differences between presentation of DISH and ankylosing spondylitis?

Answer 37

DISH - older people, no pain, ossification of ALL AS - younger people, painful, SI joint erosion

Question 38

What is a common complication after spinal deformity surgery? What factors (3) increase the risk of reoperation?

Answer 38

PJK older patients, excessive postop lumbar lordosis, larger corrections

Question 39

What lumbar level has the highest rate of nerve injury for a LLIF through a transpsoas approach? What nerve is injured?

Answer 39

L4-5, femoral nerve

Question 40

What are difference in outcomes for pedicle screw fixation without fusion vs. fusion for patient w/ burst fracture?

Answer 40

less blood loss and OR time for pedicle screw fixation alone and no difference in long term outcomes

Question 41

What complication occurs with a double screw construct for odontoid fixation in elderly patients?

Answer 41

higher rates of cutout than single screw

Question 42

What does the Torg-Pavlov ratio measure? What is the commonly used threshold?

Answer 42

cervical stenosis; <0.8

Question 43

What intraoperative strategy can be used to decrease risk of pedicle screw failure in osteoporotic patient?

Answer 43

augmenting screw with PMMA cement

Question 44

What nerve root palsy is most common in cervical spine surgery? What muscles are affected?

Answer 44

C5; deltoid and biceps

Question 45

How do you interpret SINS (Spinal Instability Neoplastic Score)?

Answer 45

0-6 = stable 7-12= potentially stable 13 or greater= unstable

Question 46

What is considered a significant change in motor evoked potentials and somatosensory evoked potentials during neuromonitoring (in terms of latency and amplitude)

Answer 46

10% increase in latency 50% increase in amplitude

Question 47

An MIS LLIF at what level has the highest risk of nerve injury to the lumbar plexus?

Answer 47

L4-5

Question 48

What vascular structure is at risk of being injured with C1 lateral mass screws? How should you angle your screws to avoid this?

Answer 48

internal carotid artery; 10 degrees medial

Question 49

What is the effect of injecting local corticosteroid after a multi level ACDF

Answer 49

lower dysphagia rates

Question 50

What part of spine is BMP contraindicated in in spine surgery? Why?

Answer 50

anterior cervical spine; higher risk of death due to soft tissue swelling

Question 51

What is an advantage of lumbopelvic fixation over iliosacral screws for U-type sacral fxs?

Answer 51

Immediate weight bearing and more likely to discharge home w/ lumbopelvic fixation

Question 52

What additional imaging test should you get for a thoracic herniated disc and why?

Answer 52

CT thoracic spine; thoracic herniated discs often calcify which can alter your surgical approach

Question 53

What are differences in outcomes between posterior foraminotomy and ACDF and cervical herniated disc?

Answer 53

higher incidence of postsurgical neck and recurrence of radiculopathy w/ foraminotomy

Question 54

What two complications are more common with transperitoneal approach compared to retroperitoneal approach for ALIFs?

Answer 54

retrograde ejaculation, ileus

Question 55

What is the most common nerve root palsy after cervical laminoplasty?

Answer 55

C5

Question 56

What treatment is associated with vertebral fracture in a patient with a metaplastic lesion in vertebral body?

Answer 56

radiation

Question 57

What is prevalence of cervical spine degenerative changes in adult population?

Answer 57

50-60% of people

Question 58

What associated injury has been shown to have the largest impact on quality of life scores in a young male with a sacral fracture?

Answer 58

neurologic injury