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Flashcards in Spine Deck (367)
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1

Safe zone for occipital screw placement

 

Triangular region created by connecting 2 dots 2cm lateral to the external occipital protuberance, and a point 2 cm inferior to it

Point B on the pictures

2

Slip angle greater than what degree is associated with greater risk of progression?

>50 degrees

3

6 things to do if a neuro alert during scoliosis surgery

  1. check equipment
  2. check blood pressure >90mmHg
  3. check Hgb
  4. reverse or lessen correction
  5. wake up test
  6. remove implants if spine stable

4

Risks of postoperative spinal infection

Longer OR time

Immunocompromised state

Increased blood loss (decreases circulating Abx)

Poor nutritional status

Obesity (BMI >35kg/m^2)

Use of instrumentation or OR microscope

Prior spinal surgery or local radiation

Longer constructs or more extensive procedures

Tobacco or alcohol use

Multiple trauma

5

Anklylosing spondylitis trauma

What must you do?

CT scan of spine

Often skip fractures

6

Fieldig Classification of AARD

Type I:

Unilateral facet subluxation with intact transverse ligament

Type II:

Unilateral facet subluxation with 3-5mm of anterior displacement (injured TL)

Type III:

Bilateral anterior facet displacement of >5mm

High risk of neuro compromise

Type IV:

Posterior displacement of Atlas (C1)

7

Safe zone for halo application (anterior pins)?

Lateral 1/3 of eyebrow, below the equator (site D in figure)

Avoids supraorbital and supratrochlear nerves

8

In facet dislocation, what must you do after successful reduction and why?

MRI - to look for disc herniation

9

What age does the secondary ossification center of the dens fuse with the rest of C2?

~12 years

10

Normal range of kyphosis in mid-thorcic spine (T5-12)

20-50 degrees

11

Power's Ratio

Basion to posterior arch/Opisthion to anterior arch

Normal is 1

Abnormal: occipito-atlantal instability

12

Three types of Diastematomyelia?

1. boney

2. fibrous

3. cartilaginous

13

Why do you have to use a paediatric spinal board for paediatrics?  What age do you have to use it until?

To compensate for large head

Paediatric boards have an occipital cutout to compensate for this

Use until 8 years

14

Name 6 surgical options for degenerative spondy:

Laminoplasty

Laminectomy no fusion

Laminectomy UNinstrumented fusion

Laminectomy + instrumented fusion

(all of the above ± PLIF/ALIF/TLIF)

Dynamic stabilization (see pic)

Lumbar interspinous spacers (prevents extension)

 

15

Treatment algorithm for AARD

Acute

  • Soft collar, anti-inflammatories, exercise program

Acute >1 week

  • Head halter traction and bracing

Subluxation > 1month

  • halo traction and bracing

Subluation > 3 months, late diagnosis or neuro deficits

  • Posterior C1-2 fusion

16

If a patient presents with a cervical rotational deformity what injury should you think of?

Unilateral facet dislocation

17

Disc herniations at the following levels with affect which nerve root?

1.C2-C3
2.C7-T1
3.T4-T5
4.L2-L3
5.L5-S1 

 

 

1 - C3
2 - C8
3 - T4
4 - L3
5 - S1

18

Interpret:

 

a) ADI < 3 mm

b) ADI between 3 and 5 mm

c) ADI > 5 mm

 

 

a) Normal

b) Transverse Ligament Rupture

c) Transverse Ligament and Alar Ligaments Ruptured

19

Most common locations for pseudoarthrosis in adult spinal deformity?

L5-S1

Thoracolumbar junction

(so any junctional area)

20

 

Why is discography not so good?

 

It causes accelerated disc degeneration and loss of height.

21

What are the components of TLICS and what score means surgery?

  1. Morphology
  2. Neurologic injury
  3. Status of PLC

 

5 or more get OR

22

 

What type of vertebral malformation is most likely to cause a progressive congenital scoliosis?

 

Unsegmented bar with a contralateral hemivertebrae

 

Tx. is PSIF with resection of vertebrea

23

Components of PLC?

Supraspinous ligament

Interspinous ligament

Facet capsule

Ligamentum flavum

24

Complications of vertebroplasty/kyphoplasty

Cement extravasation

Cement Embolism

new fracture

neurologic compromise

25

How to improve outcomes (arthrodesis) in fusion for spondy?

Pedicle screws

Interbody fusion

Non-smokers (major risk for pseudoarthrosis)

26

 

Rate of tandem stenosis for patients with lumbar or cervical stenosis?

 

20%, so image other area if symptoms aren't clear

27

5 conditions resulting in Atlanto Axial Instability?

  1. Downs
  2. RA
  3. Dens Fracture
  4. Atlas Fracture
  5. Transverse Ligament Rupture

28

Outcomes of SPORT trial with respect to degenerative scoli

Surgical intervention > non surgical at 2 years and 4 years

No difference in surgical method used

Patients with predominantly leg pain did the best

29

Pelvic incidence

Pelvic tilt

Sacral slope

Which are position dependent?

Pelvic tilt and sacral slope are position dependent

pelvic incidence does not change after skeletal maturity

30

 

What is abnormal structure in congenital muscular torticullis?

 

Tight SCM