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ABOS PART ONE > Spine Chapter > Flashcards

Spine Chapter Flashcards

1
Q

“canal expansive laminoplasty”

A

for the millipede MRI, but contraindicated in a FIXED kyphosis

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2
Q

in cervical stenosis this canal diam is at risk for neuro issues later

A

sagittal diam

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3
Q

indications for stabilization of the RA spine

A

instability, pain, neuro deficit, PADI

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4
Q

effect of PSF on anterior cord compression in RA

A

the pannus of RA that causes cord compression usually goes away with PSF

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5
Q

second most common cervical spine pathology in RA

A

basilar invagination

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6
Q

normal soft tissue shadows on cervical spine films

A

6mm @ C2, 20mm @ C6

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7
Q

long-term outcomes in complete SCI

A

80% get one nerve root level back, 20% get 2

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8
Q

contraindications to steroid use in SCI

A

more than 8 hrs from injury, pregnant, diabetic, infections, penetrating injury

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9
Q

surgical mgmt of spinal GSW

A

only if there is progressive neuro deficit, or intracanal bullet below T12

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10
Q

most sensitive test for HNP

A

positive contralateral SLR

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11
Q

bilateral sacroiliitis, decreased chest wall excursion

A

ankylosing spondylitis, with a + HLA-B27

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12
Q

after 6 wks of nonop for mostly leg pain

A

can consider epidural injections

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13
Q

after 6 wks of nonop for mostly back pain

A

appropriate to image at this point

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14
Q

who had higher recurrence rate in the SPORT trial, with regard to structural aspects of HNP

A

those with massive posterior annulus loss, or noncontained defects

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15
Q

surgical mgmt of epidural fibrosis

A

this does not do well with exploration

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16
Q

surgical mgmt of discogenic back pain

A

Shen says don’t operate on these people

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17
Q

surgical mgmt of lumbar segmental instability

A

posterolateral fusion

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18
Q

effect of alendronate on spinal fusion rates in animals

A

this nitrogenous bisphophonate decreases fusion rates

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19
Q

indications for fusion in spinal stenosis

A

removal of more than 1 facet, pars defects, symptomatic radiographic instability, degenerative or isthmic spondy/scoli

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20
Q

what does the SPORT trial tell us about the outcomes of spinal stenosis mgmt

A

that at 4 years, both nonop and op groups are improved. However, those that were operated on did better

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21
Q

imaging for spondy

A

SPECT

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22
Q

natural history of unilateral pars defects

A

almost never progress

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23
Q

this is the sacral slope plus the pelvic tilt

A

the pelvic incidence, which is an anatomic constant

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24
Q

spondy and restriction of activities

A

even if asymptomatic, grade 2 slips need to stop activity

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25
indications to repair a pars defect
if associated with a 10% slip in a young pt or at L4 or above
26
this condition has nonmarginal osteophytes
DISH
27
how does AS affect spinal alignment
can result in fixed kyphotic deformity, creates sagittal imbalance
28
scoli and pregnancy
no correlation bt curve progression and issues with pregnancy
29
highest risk of scoli curve progression (i assume in an adult)
right-sided thoracic curve >50*
30
this is the strongest predictor of disability in adult scoli
sagittal imbalance
31
indications for surgical mgmt of adult scoli
More than 50* in pt younger than 30, chronic pain in an older pt, or a progressive curve (watch for increasing spinal stenosis or decreasing lung functions)
32
fusion of an adult scoli (not sure about peds) down to L5 is associated with
progressive sagittal imbalance and L5-S1 disc degeneration
33
when anterior fusion is added for kyphotic deformities
if it doesn't correct to less than 55* on hyperextension
34
bisphosphonate use in compression fxs
their use decreases incidence 65% at year 1, 40% at year 3
35
choice of bone graft vs PMMA in anterior strut creation for metastatic spine cancer
if they'll live more than 6 mos, they get bone
36
vertebra plana
EG
37
how much of sacral roots can you take during chordoma resxn and expect normal function
1/2
38
60% of polyostotic fibrous dysplasia pts will have this
spine dz
39
this is the first finding in disciitis
loss of lumbar lordosis
40
this infection in the spine typically spares the discs
TB
41
signal changes on GAD MRI in the spine
pus lights up, CSF stays dark
42
outcomes of revision LDH surgery in comparison to primary
equal
43
regardless of age, these myelopathic patients do best with nonop
those with a transverse cord area more than 70mm2
44
4 risk factors for pseudoarthrosis in adult scoli surgery
positive sagittal balance greater than 5cm, age >55, anterior approach, kyphosis greater than 20*
45
this is a structuralcontraindication to C1-C2 transarticular screws
abherrent vertebral artery
46
bracing for AIS curves
those curves from 25-40* in immature (risser 0-2). Those with an apex below T7 are best candidates
47
these C1 fxs can be treated in a collar
if the transverse ligament is intact, (i.e. combined lateral mass distance less than 8.1mm) you can nonop these
48
main complication of the transpsoas lateral approach
dorsal root ganglion injury
49
ramifications of surgical delay in cauda equina more than 48 hrs
60% will have chronic bowel and bladder issues; other stuff comes back
50
comparison of interbody fusions with standard
there is more blood loss, more restoration of the neuroforaminal height, and probably more adjacent segment degeneration (30%). Other outcomes, including fusion rates, are similar
51
4 risk factors for development of proximal junctional kyphosis
if the PI > lumbar lordosis, instrumentation to the pelvis or sacrum, in kyphosis if you don't bypass the 1st lordotic segment, or if the sagittal plumb line is >4cm forward
52
decision tree for surgery in cervical myelopathy
laminectomy alone is nearly never the answer. if there are 1-2 levels, go anterior. If there are 3+ levels, depends on the kyphosis. If more than 10*, just do PSF
53
this is a relative indication to treat a stable burst surgically
polytrauma
54
how pelvic incidence relates to the spine when standing
should be the amount of lordosis in the lumbar spine
55
pt can't stand upright without flexing at the knees, crouching
sagittal imbalance
56
non-instrumented fusion
pseudoarthrosis
57
MIS spine compared to standard open procedures
shorter hospital stays, MAYBE slightly higher dural tear rate, but essentially the outcomes, complications, and revision rates are all the same bt the two groups
58
troubleshooting intraop monitoring
check hypotension, temperature, inhaled agents, and check leads before doing anything with the hardware or the correction.
59
wake-up testing
doesn't seem to be useful, takes too long and doesn't tell you what component is causing the issue
60
complication rate in wiltse
40%, most commonly iliopsoas weakness
61
incidence of thigh pain in wiltse approach
100%, but transient
62
bony overgrowth leading to nerve compression after BMP use more common with this technique
PLIF
63
frequency of dysphagia after ACDF
70% at 2 weeks, but only 15% at one year
64
difficult ambulation that improves with sitting
neurogenic claudication from spinal stenosis
65
main complication of percutaneous instrumentation of spine
hardware failure, since you can't put in any graft for a fusion
66
main benefit of percutaneous instrumentation of the spine
less blood loss
67
why blood loss in ankylosing spondy pts is a concern
they can develop epidural hematomas more easily than non-AS
68
how is PTH useful in osteoporosis
it increases osteoblastic bone formation, decreases osteoblastic apoptosis, and decreases vertebral osteoporotic fxs 40-60%
69
risk factors for proximal junctional kyphosis in degenerative scoli pts
360 fusions, advanced age (65+), ending at T1-T3, and extending to the sacrum (below L2?)
70
need for additional surgery in revision PJK
50% will end up with adjacent segment degeneration and need another operation
71
EMG testing of pedicle screws
less than 4mA is touching neural tissue, 8-10mA is out of a pedicle, more than 15mA has 98% probability of being in a pedicle
72
thoracic TB MRI findings
spares the disc, has anterior soft tissue signal
73
TLIF vs PLIF
these have the same fusion rates, same surgical time, same length of stay, and same volume of disc removed. However, the TLIF has less blood loss and spares the paraspinal musculature
74
when steroids are the right answer in non-trauma spine
in tumor if there is cord compression
75
main complication of spine surgery for tumor
infection
76
why AS fxs are a big deal
60% neuro deficit, and increased mortality for up to 2 years (worse than hip fx supposedly)
77
indication for MRI in facet dislocation
everyone gets one after reduction, whether it was successful or not. Obtunded pts will get one before AND after. Awake pts just after...
78
aorta bifurcates at the
anterior aspect of L4
79
what else does cauda equina have besides bowel/bladder, saddle anesthesia
motor weakness, or other lower motor neuron signs
80
decision tree for adult scoli
if under 50 you are treating coronal plane deformity, if over 50 you are treating chronic pain and disability
81
smith peterson osteotomies in the spine require this to be effective
anterior column flexibility
82
ACDF vs posterior foraminotomy
equal pain relief and functional outcome. ACDF has higher risk of adjacent level dz, posterior foraminotomy has more neck pain and same-level dz.
83
landmark for C6
cricoid
84
landmark for C3
hyoid
85
landmark for C4
upper border of thyroid cartilage
86
landmark for C5
lower border of thyroid cartilage

ABOS PART ONE (11 decks)

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