Unit 4 - Surgical Management of Spine Flashcards
(25 cards)
natural history of scoliosis after maturity
70deg have cardiopulmonary sxs
50-75 deg progress 1 deg/year
Risser sign
indication of skeletal maturity using ossification of iliac crest (5 skeletally mature)
rib/paraspinal hump side
hump on same side as curve
syrinx
CSF in spinal cord
atypical radiographic findings in scoliosis
left thoracic curve, sharply angled curves, very large curve, congenital bony abnormality
Cobb angle
measurement of degree of scoliosis
long tract sign
upper motor neuron symptoms (clonus, spastisity)
bracing indications in scoliosis
variable based on risser number, at least 25 deg, sometimes just watch for progression
brace types
TLSO - for thoracic curves (boston brace)
CTLSO for double thoracic curves (milwaukee brace)
surgical indications for scoliosis
> 45 deg in adolescents
50 in mature
stiff, large kyphosis
inability to control progression with brace
general post-op activity after scoliosis surgery
possible brace (posterior approach) walking day after surgery no twisting or bending no strenuous activity for 3 months no contact sport until 6 months activity as tolerated after 1 year
dysraphism
general term for neural tube defect
degrees of spina bifida
spina bifida occulta - no extrusion of meninges, not a clinical problem, present in 15% of population
Meningocele - saccular herniation of meninges without nerve tissue
Myelomeningocele - saccular herniation with nerve tissue, high risk of scoliosis
Rachischisis - not even skin covering nerve root and spinal cord, short life expectancy
often surgery with goal of preventing progression of deformity, when applicable
often have latex allergy
scheurman’s kyphosis
larger and more structural than postural kyphosis (hunchback), may be painful risk of schmorls nodes stabilizes in adulthood >100 deg causes pulmonary restrictions surgery if >80 deg
Spondolosis
degeneration of spine
spondylitis
inflammation of spine
spondylolysis
defect in pars interarticularis
50% caused by trauma, usually hyperextension
present with acute or chronic lumbar pain
oblique view x-ray or SPECT (combo bone scan and CT)
Treatment: rest, observe, brace, surgery if sx>6 months
spondylolisthesis
forward slippage of one vertebra on another
isthmic: after break in pars
surgery if grade 3 and above (50 % slippage)
spinal compression fracture
compression anterior, possible distraction posterior
treatment: conservative usually
spinal burst fracture
compression in anterior and middle columns
risk of neurological injury if retropulsion of bone fragments
seatbelt/chance fracture
compression anterior, distraction posterior and middle
high chance of intraabdominal injury as well
ligmentous injury may need surgery, bone often doesn’t
fracture/dislocation of spine
compression anterior, distraction posterior and middle, rotation shear all through
possible severe neurological involvement
indications of cervical spine fracture
point tenderness, esp over spinous process step offs eccymosis (bruise) new neuro symptoms stability
indications of surgery for herniated discs
severe sciatica with neurological compromise that hasn’t improved, bowel/bladder signs
~10% will require surgery
