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Ravi Board/OITE Prep > Spine > Flashcards

Spine Flashcards

1
Q

uni vs bilateral facet dislocations

A

uni is 25% sublux; bL is 50%; more likely to have SC injury with bilat; uni has monoradiculopathy that improves with traction

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2
Q

if intubated and facet dislocation

A

MRI first then reduction - need to check for herniated disk - this would require ant and post approach

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3
Q

epidural abscess and neuro comrpomise - what is prognosis

A

with prompt decompression - only 18 % of pts with abscess recover; on 23% with paralysis recover

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4
Q

indications for surgery in epidural abscess

A

neuro sx; vertebral instability or deformity; no resolution after 6 wks IV abx; MRI showing>50% thecal sac compression; or depressed immune response

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5
Q

hyperreflexia and surgery for myelopathy

A

not an absolute indiciation if all else is asympomatic

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6
Q

pedicle diametere t-spine

A

largest at T1 and T12; smalles at T4 -T6

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7
Q

pedicle diameter T12 vs L1

A

T12 is bigger

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8
Q

peds discitis timeline

A

loss of lordosis is first sign before any xray findings

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9
Q

xray changes in peds discitis

A

diskc space narrowing at 1 week; endplate changes at 1-3weeks; sawtooth erosions at 4 weeks.; scalloping of endplates is with long standing infections

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10
Q

tx of peds spondy

A

if grade 4 (>50% slip) L4-Sacrum fuson

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11
Q

C7 affected motor function

A

triceps; wrist flexion

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12
Q

biceps weakness is what radiculopathy

A

C5 or C6

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13
Q

what structures are disrupted in facet dislocation

A

flexion-distraction injury - posterior structures are typically damaged

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14
Q

fusion of C2

A

dens to body at 6years; tip of dens to rest of dens at 12

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15
Q

use of Halo vest

A

for upper C-spine injuries - to control rotation

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16
Q

normal T-spine kyphosis

A

T20-T50

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17
Q

hypoglossal nerve injury lateralality

A

if left side injured; tongue deviates to left

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18
Q

def of brown-sequard injury

A

ipsilateral motor deficit; contralateral pain and sensory loss

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19
Q

steps for awake facet dislocation

A

if change in neuro status - closed reduce followed by MRI followed by surgery - mri helps determine approach

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20
Q

PADI and recovery with atlantoaxial sublux

A

if PADI > 10mm then there is chance of recovery; > 13mm Is best chance for recovery; < 14 is reason to operate

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21
Q

hallmarks of Anky Spondy

A

bilat sacroilitis; +/- uveitis; + HLA b27; typically has neg RF titer

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22
Q

when to do pars repair vs fusion

A

if L4 or higher; L5 is fusion

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23
Q

sx of Juvenile Anky Spondy

A

Enthesitis; kyphosis; SI; stifness; LE inflammatory arthritis; decreased chest expansion and UVEITIS - NOT uretheritis

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24
Q

what skeletal maturity system correlates with scoliosis progression

A

Tanner-Whitehouse RUS - use radius, ulnar epiphysis and 1-3-5 metacarpal epiphysis to determine skeletal age

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25
what tracts are injured in central cord
latearl corticospinal tracts
26
Atlanto-dens interval
normal is < 3mm in adults, < 5mm in kids; if > 7mm then concern for rupture tectorial membrane, transverse and alar ligaments
27
asymmetric abdominal reflexes
MRI for syrinx or tumor in kids - even if curve is small
28
single rod tx
for thoracic kyphosis - can do anterior single rod; but higher rate of pseudo arthrosis if T5-T12 is > 40 degrees
29
if revising ACDF for non union whats the tx
PSF - has higher complications, more pain and EBL but still has HIGHER chance of fusion
30
steroids for sci
NOPE - no clear benefit; possible increased risk
31
PT for congen muscular torticolis
stretches - lateral tilt away from affected side; roll chin Towards affected side
32
ASIA A vs B
A has no motor or sensory; B has sensory but no motor
33
risk of adjacent segment disease in lumbar
age over 60; multi level fusion; ending at L1-3; or fusion with adjacent laminectomy
34
components of TLICS scoreing
injury morphology (compression vs rotation vs distraction); neuro status; and PLL integrity
35
mxn of lateral mass fracture separation
hyperextenson; lateral compression and rotation - C6 is most common -then 5; 7; 4; 3
36
whats tspine curve needs MRI in AIS
LEFT CURVE - gets MRI
37
risk of progression based AIS curve sizze
if > 25 deg before skeletal maturity; if > 50 T spine after maturity; if > 40 L-spine after maturity - both will progress at 1-2 deg per year
38
safe zone for occiput screws
in a triangle made by 2cm lateral to EOP; 2cm inferior to EOP
39
collagen type in discs
central is type 2; peripheral annulus is type 1
40
burst with retropulsion - surgical tx
anterior decompression with strut graft
41
risk of cervical laminoplasty
c5 palsy
42
c spine in Klippel-Feil
fused c-spine at birth; limited neck motion
43
tx of revision disc herniation
revision microdiscectomy
44
accuracy of needle biopsy for discitis
70% but needed prior to empiric abx
45
chance fracture assoc with
bowel injury
46
what is chance frx
compresison anterior; distraction posterior
47
approach for far lateral disc herniation
between multifidus and longissimus
48
when can you brace
skeletally immature (risser 0-1-2) 25-40 deg
49
measuring sagittal balance
center of C7 body plumb line and distance to post superior corner of S1
50
when does jeffereson frx need surgery
if TAL is also out - needs c1-2 fusion
51
before fixation of jeffersion frx you need
CT Angio
52
role of SSEP
provide direct info about posterior columns; indirect about anterior columns and NO info on nerve roots
53
tceMEP
provide info on anterior and lateral corticospinal motor tracts; spinal nerve roots; peripheral nerves; and plexus
54
most common complicaiton after adult spinal deformity
instrumentation failure
55
angle cut off for acdf vs psf for cspine stenosis
10 deg rigid kyphosis means go anterior
56
rf for pseuodarthrosis in spine
smoking; kyphosis >20; positive sagittal balance > 5cm; pre existing hip OA, > 55 years, and thoracoabdominal approach
57
tx for spont atlantoaxial rotatory instability
soft collar for 1 week; then halter traction and meds for 3 weeks; thenhalo traction; last is c1-2 fusion
58
SCM in Atalnotaxial rotatory displacement vs congen torticolis
SCM is spastic on SAME side of chin in AARD vs opposite side in congenital torticolis
59
spurling sign test
rotate head and tilt head to AFFECTED SIDE
60
halo anterior pin placement
1cm above orbital rim on lateral two thirds
61
most common complication of halo pins
loosening of pins
62
mortality after VCF
at 2 years close to hip fractures
63
tx of impending pars defect
bracing with LSO
64
mc radic after Post cervical decompression
C5 motor radiculopathy presenting 4 hrs to 6 days post-op
65
Ankyspody and THA risk is higher of
anterior dislocation - even with posterior approach
66
peds epidural abscess - tx
straight to IV abx - no biopsy or aspiration needed in peds population
67
fusion of anky spondy C-spine injuries
long construct bc of osteoporosis and stiff spine
68
when can you establish SCI complete vs incomplete
only after BC reflex is BACK
69
pelvic incidence equation
sum of tilt and slope
70
what risser stage correlates with linear growth most
risser 0 coveres the first two thirds of pubertal growth spurt
71
imaging for peds spondy if xrays are neg
SPECT scan for sondylolysis or pars defect
72
risk factors for post-op tspine decompresison after lumbar surgery
age over 55; pre and post-op sagittal imbalance and smaller lordosis
73
disc changes with age
less water; less large proteoglycans; incr KS to CS ratio; increase in neovascularization at annulus
74
most common complication of thoracic endoscopic surgery
intercostal neuralgia
75
non op tx of Scheuermans
if 50-74 deg can use extnsion brace or TLSO if apex is below T7
76
non op of cervical myelopathy - what predicts better outcome
increased transverse cord area > 70mm2
77
tspine disc herniation tx
if no neuro sx - PT; majority are between T8-12
78
goals of adult spinal deformit
SVA to within 5cm of neutral, ensure pelvic tilt is < 20 deg; and lordosis is withint 9 deg of Pelvic incidence - amount of coronal correction does not correlate to outcomes
79
c-spine facet orientation
superior facet is anterior to inferior; and beomce more posterolateral facing as you go down

Ravi Board/OITE Prep (9 decks)

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