Surgery

Question 1

TLIF

Answer 1

Transforaminal Interbody Lumbar Fusion

Question 2

Describe pedicle screw start points in T/L spine

Answer 2

T-spine
midpoint of Transverse process and lateral pars
(note: midpoint in height, but you can also follow the superior aspect down to get to the same point - see image)
Mid T spine
Junction of midpoint of transverse process and lateral 1/3 of superior articular process
Distal T
Junction of transverse process and lateral pars
Lumbar
Junction of midpoint of transverse process and 2mm lateral to pars (lateral aspect of facet joint / mamillary process / lateral pars)

Question 3

How do these lesions affect disc space?
TB spondylodiskitis
Pyogenic spondylodiskitis
Tumor

Answer 3

TB spondylodiskitis = No early disk involvement
Pyogenic spondylodiskitis = Involves the disk space
Tumor = Spares the disk space

Question 4

What is a syrinx?
What is a syringomyelia?

Answer 4

L5-S1
L4-L5 is second most common

Question 5

Name the following vertebral levels by land marks

Answer 5

C2-3: Mandible
C3: Hyoid
C4-5: thyroid
C6: Cricoid
C7: vertberal prominence
T3: Spine of scapula
T8: nipples
T10: xiphoid
L4: bifurcation of aorta
S1: Bifurcation of iliacs

Question 6

Describe pelvic incidence:

Answer 6

Pelvic Incidence = pelvic tilt + sacral slope
Angle formed by:
a line from the center of the femoral head to the middle of the S1 end plate
a line perpendicular to the S1 endplate

Question 7

Name 5 complications with anterior approach to the cervical spine

Answer 7

Postoperative C5 palsy incidence
Recurrent laryngeal nerve injury
Hardware failure and migration
Postlaminectomy kyphosisPostoperative axial neck pain
Vertebral artery injury
Esophageal Injury
Dysphagia & alteration in speech

Question 8

Name 6 surgical options for degenerative

Answer 8

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)

Question 9

מה הם הגורימים המשפעים על ההחלטה באיזו גישה תבצע את הניתוח

Answer 9

Anterior only (ACDF): gold standard for 1-2 level disease
Posterior only: <13 degrees kyphosis
Some say <10 degrees but definitely <13 degrees
Anterior + Posterior: rigid kyphosis >10 degrees and multilevel disease (>2 levels)
Kyphosis >13 degrees is an absolute contraindication to any posteriorly only decompression

Question 10

3 Indications for PLIF in spondylolisthesis

Answer 10

Severe slip
Neurologic compromise
Saggital imbalance

Question 11

What is defined as instability on flex-ex radiographs

Answer 11

Instability: >3.5mm of motion between flexion and extension views

Question 12

6 dangers in retroperitoneal approach to lumbar spine?

Answer 12

-Sympathetic chain: lateral aspect of vertebral body
-Genitofemoral nerve: anterior surface of psoas muscle attached to fascia
-Segmental lumbar arteries & veins: Branches from aorta
-Aorta: Bifurcates at L4
-Ureter: lies between psoas fascia and peritoneum
-Superior hypogastric plexus: Injury leads to retrograde ejaculation

Question 13

PLIF

Answer 13

Posterior Lumbar Interbody Fusion

Question 14

ALIF

Answer 14

ALIF – Anterior Lumbar Interbody Fusion