All are true about isthmic spondylolisthesis, except?
D)
Cord syndromes from best prognosis to worst?
D)
49- What is the most common spinal anomaly in congenital scoliosis?
D)
13-29%
Complete spinal cord injury, C7 level, what do you expect?
D)
Patient has low back pain and claudication, also found to have hyperreflexia and ataxia. Lumbar spine MRI show severe stenosis. What to do next?
MRI c and T spine r/o myelopathy bc of the hyperreflexia
68- Patient presents 2 months after a fall and neck and shoulder pain. Has forearm numbness, weak wrist flexion and weak elbow extension. Also has weak triceps reflex. Which root?
A)
Picture of C4-C5 anterolisthesis post-trauma. Right arm pain. What do you expect?
a) Lateral shoulder numbness and arm flexor weakness
b) Shoulder shrug weakness and supraclavicular numbness
A)
It will compress nerve root below ( C5)
Regarding C1-C2 instability, what is true?
C)
Normally when rotating the neck the ipsilateral facet joint subluxates posteriorly while the contralateral subluxates anteriorly, while in instability the ispilateral rotates and the contralateral stays put.
C1-2 rotation is more than 50
Describe Powers ratio. A= Anterior arch of Ca, B = Basion, C = posterior arch of C1, O = Opisthion.
C)
All are true about spine infections, except?
C)
WBC olnly elevated 55%
Staph 60% time
What is true about pseudosubluxation in pediatric c-spine?
A)
Most common C2-3
If step at spinous process: true subluxation
6 year-old kid with 3 days of atlanto-axial rotatory subluxation. What is the next step?
a) NSAIDs + soft collar
b) Dynamic CT
c) Static CT
A vs B
NSAID's + collar: management if < 7 days
Gold standard for Dx is Dynamic CT
Pelvic incidence, what is true
A)
PI increases during adolescence
What is not a negative prognostic factor in bracing for AIS? ?
C)
4 poor prognosis factors for bracing in AIS
Poor in brace correction
Hypokyphosis
Male
obese
Noncompliant
Central cord syndrome (on sagittal MRI), which are weaker?
C)
Brown Sequard – what are the findings
Ipsilateral propioception vibration motor
Contralateral Temperature + pain
Ipsilateral Temperature and pain at affected level 2 levels below
Patient presents with cervicomedullary syndrome after a trauma. Which is false?
D)
Can affect pons - C4
All of the following are true regarding Gadolinium MRI of the spine except? (REPEAT 2010)
C)
Epidural fibrosis lights up
In a patient who has been diagnosed with Charcot of the spine, all are true except:
B)
Regarding thoracic disc herniation at T8-T9 what is true REPEAT
C)
Costotransversectomy is best approach: resect rib head over affected disc (T9 in this case)
Patient has a C7 level spinal cord injury, what will be his physical exam findings?
B)
Regarding anatomy of spinal cord, all are true except REPEAT
C)
Lateral corticospinal: main volunatary control. Upper extemity more central which is why you get upper >lower motor deficits in central cord
What is true regarding L5 nerve root injury when treating high-grade spondylolisthesis?
a) Occurs in 30% of cases
b) Increased strain on the nerve with increased slip reduction
c) Increased risk of nerve root injury with increased translation of the vertebra
d) Decreased risk if pedicle screws in L4 and not L5
If all of the except answer is D
Ais true: from JAAOS artcle
B/C: also true
The use of a cross-link in spine surgery aids in what way? REPEAT
B)
When using a VEPTR, all of the following are possible complications except? REPEAT
D)
VEPTR: acnhored on ribs on concave side of scoliosis to provide distraction
Regarding spinal stenosis, which is false?
a) Degenerative spondylolisthesis is most common at L5-S1
b) The L5 superior facet can cause lateral recess stenosis
A)
Most common L4-L5
Regarding isthmic spondylolisthesis, which is true?
B)
A 14yo male is post-op from a posterior spinal instrumented fusion for adolescent idiopathic scoliosis. All blood loss was meticulously replaced by the anesthetist in the OR. He has a hemovac and foley in place. He is oliguric in PACU and for 24 hours post-op despite IV at maintenance and with replacement. What is the cause of his oliguria?
C)
Regarding a quadriplegic with preserved C7 function, what is true about their functional status?
C)
You are shown a lateral C-spine x-ray. There is no obvious fracture except slight impaction of anterosuperior cortex of C5 vertebral body. There is 25% anterolisthesis of C4 on 5. What is true about this injury?
D)
A 12yo female presents with several months of back pain, which is limiting her ability to participate in sports. After a complete history and physical exam, what is the most appropriate initial investigation?
B)
Spect CT is most senitive
Which of the following is associated with an increased risk of complications with halo treatment?
B)
Halo ideal
0.5 cm prox to eyebrow
Above pinna below equator
Ring not >1cm away from head
What nerve root(s) in adult L5-S1 isthimic spondylolisthesis will be affected?
D)
the exiting nerve root bc of compressed foramen
A 5yo female with congenital scoliosis, L5 fully segmented hemivertebrae with 50 degree LS angle. What is the best treatment?
D)
Cannot do hemiepiphysiodesis because of the kyphosis
One month following an L1 burst fracture with 60% canal stenosis, a patient presents with new onset numbness and weakness to both legs. What is the optimal treatment?
B)
If height loss significant and not below conus need to come from the front to put a cage
A patient with an osteoid osteoma of the C5 lamina is seen in clinic. She has been refractory to non-op treatment. What is the next step?
B)
A patient with an osteoid osteoma of the C5 lamina is seen in clinic. She has been refractory to non-op treatment. What is the next step?
D)
During the posterior approach to the spine, the thecal sac can be retracted?
B)
One month following an L1 burst fracture with 60% canal stenosis, a patient presents with new onset numbness and weakness to both legs. What is the optimal treatment?
B)
A patient with an osteoid osteoma of the C5 lamina is seen in clinic. She has been refractory to non-op treatment. What is the next step?
C)
A patient sustains a gunshot wound to the right side of the neck. He develops a Brown-Sequard syndrome. Which of the following is true regarding his neurologic deficits?
D)
Brown sequard
Motor function is disrupted on the side of injury, while pain and temperature are affected on the contralateral side.
90% will recover ability to walk
12 year-old kid with Duchenne Muscular Dystrophy, 35-degree scoliosis, 55% FVC. What should you do?
B)
For duchenne surgery at 20-30 degrees to preserve pulmonary fct
All of the following spine conditions are seen in achondroplasia EXCEPT?
B)
A patient with bilateral L5 spondylolysis who has failed non-op treatment (including brace). All are reasons to perform repair of pars defect (ex. with pedicle screws, sublaminar hooks or wires) EXCEPT?
D)
Repair of pars defect from L1 to L4 not L5/s1
Need intact disc t level of slip
Regarding the anterior approach to the cervical spine, all of the following are true EXCEPT?
B)
It is the sympathetic not parasympathetic that is at risk
All of the following are correct landmarks for inserting an L3 pedicle screw EXCEPT?
D)
All of the following are true regarding somatosensory evoked potentials (SSEP), EXCEPT? Double check old question on previous exams for wording.
B)
SSEP not live bc measurements are averaged for extraction of background
Iv anesthetics affect MOTOR potentials
4 factors that affect SSEP
Halogenated agents
Nitrous oxide
hypothermia
Hypotension
SSEP do not monitor what part of spine
Anterior column: motor aspect
Regarding the anterior approach to the thoracic spine, all of the following are true EXCEPT?
C)
To access the disk is the rib below ie 12th
All of the following syndromes have atlanto-occipital instability EXCEPT:
B)
All of the following conditions are associated with C-spine instability EXCEPT:
D)
What is the rubrospinal column?
D)
Shown Lateral C spine X ray with 2 lines drawn. One from Basion to C1 posterior arc line, the other from opision to dens. Each point was labeled. Basion B, C1 Spinolaminar line= C, Opision= O, Apex of Dens= A. Basically the question was what is Power’s ratio?
Basion to posterior arch C1 = a
Opision to anterior arch C1 = b
Power's ratio: A/B
If >1: anterior dislocation
if < 1: posterior dislocation
In the spinal cord, all of the following statements are true EXCEPT?
A)
drosal tract = ass first so sacral to cervical from central to periphery
54 y.o. lady with 12 years low back pain sees you for first time. Normal neuro exam. Xrays shown- show about 50% to 60% was grade 3 to me L5 on S1 isthmic Spondylolithesis. What you do?
a) Follow up PRN
b) Close follow up in 3 month with repeat XR
c) In situ fusion
d) Decompression and fusion
B?
Guy with tumor at about T9- shown MRI, now with cord compression and symptoms- all are reasonable except? Was kyphotic segment keep in mind
B)
Since kyphosis will lead to further instability
The recurrent laryngeal nerve is a branch from?
B)
Middle age lady with 2 days neck pain, now with new onset neuro deficits- SHOWN Sagittal MRI of C spine. Fluid collection post aspect of cord- causing impingement. Also minimal disc bulge at about C5-6. What you do?
B)
Which nerve is at risk when taking graft from PSIS?
B)
Injury to neck- now C6 paraplegic. All will work except?
A)
Finger flexion is c8
What is cause of C1-2 and basilar invag in pt with RA?
B)
Posterosuperosuperior most common endplate that is displaces
Burst fx of spine. All true, except?
A)
Fracture of middle/anterior column leads to widening of interpedicular space
All indications to perform PLIF or TLIF except?
A)
Regarding burst fractures, all the following are true except?
C)
Most common cause of post-op spine infection?
A)
Which one is true regarding isthmic spondy?
B)
Spine associations, all except?
A)
Associated with spondylolisthesis:
Spina bifida occulta
pars elongation
Scheurmann disease
Thoracic hyperkyphosis
SCIWORA, what is true?
C)
Age usually <8
25% have delayed presentation
Most common location sciwora
c spine
You are shown a lateral C-spine xray showing retrolisthesis of about 25% C5 on What is the most likely diagnosis?
a) Unilateral facet dislocation
b) Bilateral perched facets
A)
Bilateral causes 50%
Patient presents with cervical myelopathy and upper motor neuron signs. All of the following are UMN signs except?
B)
The jaw jerk reflex or the masseter reflex is a stretch reflex used to test the status of a patient's trigeminal nerve (CN V). It is pronounced in patients with UMN lesions
All of the following associations are right except?
D)
A patient has a high (T4) spine injury (I think this had a radiograph with burst fx). Which of the following do you expect to find?
C)
Juvenile Idiopathic scoliosis. What percent have intraspinal pathology?
C)
Name 3 indications for MRI in scoliosis
Atypical curve patterns: left thoracic, short angular,no lordosis, no rotation, congenital)
Patient <10 with curve >20
Abnormal neuro exam
Reason to brace congenital scoliosis
C)
What exercises do you not give to spinal stenosis? (Repeat from previous years)
B)
Extension narrows canal
All of the following are true with vertebral burst fractures EXCEPT:
C)
What carries the worst prognosis in RA c-spine disease?
C)
has higher association with neuro injuries
Regarding the ASIA classification of spinal cord injuries, Which is True?
B)
In burst fractures with spinal canal compromise what is most likely to happen with fracture healing?
C)
Remodells and bone resorbs
Which of the following is LEAST useful in assessment for LBP? - I think this should be lumbar spinal stenosis
a) Stress Test (treadmill test)
b) Physical Exam
c) SF-36/Oswestry- Patient administered questionnaires
d) MRI
B or C
The stress test has been definately proven to be effective
MRi is also useful
A 36 y.o. male comes to your office with chief complaint of LBP. 1 week previous he picked up his 5 y.o. child and the pain began. He has been unable to return to work since that time. He reports the pain as being localized to buttock, posterior thigh. Your exam reveals spasm in the lumbar paraspinal muscles, but no neurologic deficits. What is the next step in the management of this patient?
B)
Regarding Halo traction and pins. Which of the following increases the risk of complications?
A)
12 year old with 70° kyphosis from T4-12. Which is best treatment option?
B)
this is scheuermann's kyphosis
Treat with milwakee brace 60-80 degrees
observation if <60 degrees
Normal kyphosis is 20-40 degrees
Which function is served by adding cross links to bars in spine surgery?
B)
Dalhouse:What position is maximized lumbar spinal canal.
a) flexion
b) extension
A)
All of the following are UMN injury signs EXCEPT (Dalhousie asks which of the following IS seen with UMN lesion, same answers provided):
C)
fasciculations are LMN
What is the most common neurologic injury associated with this fracture? (PICTURE given of a T5 burst fracture with retropulsion in canal of 50%)
A)
A young female with a C5-6 fracture-dislocation who is a complete quadriplegic is put in traction and she reduces anatomically. She had maxillary and mandibular fractures. You are called to see her later because she develops a decreased level of consciousness, tinnitus, dysphagia, diplopia, nystagmus and difficulty swallowing. What is the cause?
G)
From vertebral artery occlusion
Mot common location for degenerative spondy
L4-5
What is true regarding SCIWORA
A)
Regarding the spine, all are true except
a) inferior facet of L4 causes lateral recess stenosis at L4/5
b) Pars pathology causes isthmic spondylolysis
Degenerative spondylolithesis most common at L5-S1
Wiltse paramedial approach best for far lateral discectomy
C)
Degenerative spondy most common at L4/5
Acute axial load to spine, what fails first
C)
MRI and Gad for spine. All are true except
B)
Thoracic Outlet syndrome all true except
D)
Worse with abduction and ER: wright's manouver
Adson: neck hyperextended, head tutned toward affected sign...deep breath and hold >>>>>decrease subclavian pulse
Thoracic outlet is associated with
B)
compression is to middle scalene
Associated with lowered scapula
Which of the following is true regarding thoracic outlet syndrome?
C)
Cmpression is btw middle scalene and scm
More common in females: 3.5x
Brachial plexus injury, all true EXCEPT—
D)
Horners is associated with avulsion of T1 (preganglionic) and interruption of sympathetic ganglion
31M with a 10-year history of dialysis. Given a CT scan of C-spine which showed end plate erosion, MRI shows dark adjacent vertebral bodies. What is the most likely diagnosis:
A)
Renal spondyloarthopathy: can mimick infection
The absence of high intensity signal helps eliminate infectious process
Patient with low back pain s/p diskectomy 6 months ago. Most likely diagnosis
B)
Open Odontoid growth plate (osteochondrosis of odontoid)
C)
Odontoid ossifies at age 3
Odontoid fuses at age 12
22-year-old female with neck pain. No neurology. Systemically well. Xrays show an expansile lytic lesion in the anterior vertebral body extending into the pedicle. This is most likely (Dalhousie has shorter question- benign vertebral lesion in 22 yo female spine?)
D)
the others are typically in the posterior elements
What does not happen with growing rods for congenital scoliosis
D)
the others are the main complications of growing rod/veptr
A five-year-old boy is brought to the physician because of documented progression of infantile idiopathic scoliosis that was noted at three months of age. The patient's spinal deformity has worsened despite cast and brace treatment, and the parents are now considering surgical treatment, specifically growing-rod surgery. The patient's general health and neurological status are found to be normal on physical examination. The overall complication rate of the growing-rod surgical procedure is likely increased by:
A)
if growing rod subfascial: premature fusion
If growing rod above fascia: skin breakdown
What increases the intraforaminal space in the lumbar spine?
Dahhousie has “lying, sitting, or standing?
B)
5 yo with congenital scoliosis has a fully segmented L5 hemivertebra with 50 degree sacral angle. What is true about the surgical treatment?
A)
resection if <5 and curve >40
or if l5 hemivertebrae: bc it causes pelvic obliquity
L5-S1 (Dalhousie has L4-5) left sided anterior retroperitoneal approach. Cannot mobilize the aorta b/c of a branch of iliac vein. Which branch:
D)
iliolumbar: l4/l5
middle sacral vein: l5/sw1
Regarding thoracolumbar spine:
A)
because at the level of conus
15M w/ back pain x1yr. Has isthmic spondylolisthesis w/ 60% slip of L5 on S1. Did not respond to physio and lumbosacral bracing. No neurology. What is the next step in treatment?
D)
D wrong: because usually need L4-S1
When doing an anterior thoracotomy to the thoracic spine, all are correct EXCEPT:
E)
VEPTR complication in all except—
B)
You are doing a left sided retroperitoneal approach to L4-L5 and you see a vein crossing the L5 vertebral body and you can’t mobilize the aorta because of this vein. Which vein would this be:
C)
at L5/S1 its the middle sacral artery
Sacral sparing: has voluntary anal contraction
Spinal cord injury 72 hrs later with complete transection at T8 with bulbocavernosus back and no return of function below the level, the following is correct:
E)
If bulbocavernosus absent then its spinal shock
From 2007: Spinal stenosis, best outcomes with surgery in:
D)
Most common complication of lateral mass plating is?
C)
Frankel Grade correct:
D)
Full T8 spinal cord injury, complete neurological injury, reason to fix posterior:
A)
Halo applied, with regards to motion allowed
B)
Halo most common nerve injury
Supraorbital: just medial to the safe zone
What is true about the disc in spine anatomy?
A)
Nucleus type 2
Annulis Type 1
Disk is usually avascular
Highest disc pressure in lumbar spine in what position:
B)
Lowest if supine
Highest if sitting and flexed forward
What percentage of people with mechanical back pain and NO sciatic will get better WITHOUT treatment? Ottawa: Acute disabling back pain without sciatica. What is the chance of a full functional recovery without treatment?
B)
90% resolves within one year
Patient with Ank Spond and C-spine fracture, all true EXCEPT:
A)
Postion of maximal size of lumbar spinal canal:
B)
Regarding lower cervical injuries which of the following is not true?
C)
Calgary: Which of the following is the C6 nerve root most responsible for.
C)
A 40 y old Japanese female has OPLL and recent myelopathy. It is C3-C6 with normal lordosis and no listhesis. Rx:
B)
What is contraindication to post Cervical approach:
C)
More than 10-13 degrees
The following are true about central cord except?
Causes bladder dysfunction (Ottawa)
B)
Autonomic dysfunction in spinal cord injury, what is true?
A)
more common with high thoracic injuries
usually 2-3 months after
Caused by sympathetic dysfucntion
CAUSED BY BLADDER DISTENSION 75%
Most common cause of U/E Charcot joint is?
B)
With regards to spinal stenosis, which is true?
A)
Spinal stenosis, best outcomes with surgery in:
A)
Most common complication of lateral mass plating is?
D)
- If you disrupt axons and endoneurium, which injury is it?
C)
neurontmesis: disupt axin and ndoneurium
Axonotmesis: axon and myelin sheet disruption: endoneurium intact
Neuropraxia: focal demyelination azons
What is true of the anterior approach to the cervical spine?
B)
sympathetic at risk
division omohyoid increases exposure
Unilateral facet dislocation and nerve compression, which is true?
A)
D could also be the answer depending on how its frased
Halo application, all true EXCEPT: (Ottawa: What increase rate of halo complications?
C)
in kids should have 32 lb of torque: divide by number of pins
PSIS Bone Graft, loss of sensation to buttock and pain, what nerve injured?
A)
cluneal arise from posterior branch of lower lumbar roots
L5 root compression has what?
D)
L5 gives SGN >>>weak abductors>>>>trendelenberg
Retroperitoneal approach to spine, L5/S1 disc, vein in way, which is it?
A)
You give the poor guy retrograde ejaculation b/c you suck at exposing the spine from the anterior approach, what is the nerve causing this part of?
D)
All are correct about SSEP in spine surgery EXCEPT (wording off, hard to recall):
D)
What is a predictor of poor outcome after lumbar stenosis surgery?
A)
this is from a astudy
other factors
Depression
Disorder affecting walking ability
Scoliosis
Patient with onset shoulder pain radiating to neck and down arm, now with deltoid and triceps weakness, most likely Dx is what:
C)
look up parsonage turner syndrome
Picture of a patient with c spine injury and C5 retrolisthesis (C4 was anterior 2-3 mm and C6 was anterior 2-3mm), what physical exam would you expect?
C)
nerve roots exit above in cervical spine
What will you see with L5 compression?
D)
Patient presents with neck and right upper extremity pain. Radiographs show a lytic, expansile lesion at the uncovertebral joint involving the C5/6 joint. What is the most likely clinical exam finding?
D)
C6 affected
exits above
ASIA classification:
D)
One year following discetomy and patient develops back pain. Which one is true regarding imaging with MRI gadolinium?
B)
With regards to an elderly patient with a T spine compression fracture, except
B)
The degree of correction achieved with cervical osteotomy in chin-on-chest deformity is approx?
A)
Chin on chest: ank spond
Cervical extesion osteotomy: at c7 t1 because avoid Vert
Atlantoocciptal dissociation is diagnosed by
C)
Harris rule of 12
if tip basion >12mm from dens: dissociation
If bassion >12mm anterior to line ging up posterior aspect of dens: dissociation
A 45 yo man hurt his back 1 week ago while playing with his kid. He is still unable to work and c/o pain radiating to his buttock and posterior thigh. Examination reveals tender paraspinal muscles but is it otherwise unremarkable. He is otherwise healthy. What is the next step in his management?
C)
. A 40 yo guy presents with back and leg pain. It is worse when he sneezes and has a positive SLR at 30o, Lasègue's sign (positive SLR) and Bowstring sign. He also has decreased patellar reflex and decreased thigh extension with knee flexion. What level is affect?
A)
SLR: L4-s1
Knee flexion (sciatic nerve): L4-s1
Patellar reflex: L4
With regard to spinal cord injuries
D)
82 yo man with type II DM, comes with falls and leg weakness/giving way, able to WB with leg in full extension, no pain, has full knee flexion power, 45 degree extension lag, no knee reflex on that side, normal ankle reflexes bilaterally, no sensory loss, what is it
C)
No patellar refelx: L4
Also weak quads: Femoral nerve
Woman with spinal stenosis and degenerative spondylolisthesis, all OK except:
D)
because of listhesis
Intermediate result of disc replacement for 1 level disease
C)
risk of adjacent level disease: 30%
What is chief presenting complaint in adult scoliosis
hump
A)
42 year old RA female with VMO (vertical migration of the odontoid), arm numbness, myelopathy symptoms. SAC = 12 and flex-ex views show an irreducible deformity. How do you proceed?
A)
C6 quad. What muscle is least likely to work
D)
C6: wrist extensors
Percentage of adjacent level disease after artificial disc replacement at 10 years
A)
Regarding retrospective reviews of C-Spine surgery looking at adverse intra-op events which is true
C)
Wound healing after spine surgery is most affected by
B)
Independent risk factos
use 2 residents
Prbc
Obesity
High grade spondylolisthesis (grade 3) with regards to PLIF (? EXCEPT question, PLIF means posterior construct)
D)
Repeat: young man fall and T8 paraplegic no other significant injury had DPL was negative, in ER get 2 litre of RL no effect BP 90/40 and HR 50 what’s the reason:
D)
hypotension and low HR: Neurogenic sho
repeat on treatment of guy with symphysis disruption and vertical Denis 2 sacral fracture. rx:
A)
L1 burst # 1 month ago with 60% canal compromise with fragment compressing conus, now progressing neurologic symptoms:
B)
becasue of neuro deficits
LIST THE CORD SYNDROMES From best to Worse in Prognsosis:
Brown Sequard,
Root,
Central,
Anterior,
Complete
Ankylosing Spondylitis, all are true except:
B)
sacroiliitis usually first
The advantages of dynamic plating during ACDF surgery in the C-Spine are?
A)
Which is the least helpful in diagnosing spinal stenosis:
C)
Complete quad (no sacral sparing, Bulbocavernosus intact) with shoulder abduction 5/5, elbow flexion 4/5, wrist extension (0/5), all levels below 0. Sensory to shoulder intact.
A)
Repeat most common problem with all occipital hardware
D)
Use of stiffer (rigid) instrumentation in any spinal fusion results in which of the following to the fusion mass?
C)
More rigid: stronger fusion mass
Lumbar spinal stenosis, worst prognostic factor for function post-op (except)?
A)
C6 tetrapalegic. Most likely non-functional muscle:
C)
FDS is C8
Strongest Occipitocervical instrumentation
A)
Best is combilation of midline and lateral screws
lateral screw: better for rotation
Midline screws: longer screw
Picture: x-ray of cervical spine shows 25% listhesis of C4 on C5. Likely diagnosis:
a) Bilateral perched
b) Unilateral facet fracture dislocation
B)
20 yr-old in MVA polytrauma and intubated. X-ray and CT show C3-C4 listhesis with bilateral jumped facets. No obvious fractures seen. You are asked to state what makes the reduction difficult.
C)
lower in c spine is more difficult
All of the following factors influence the choice of approach (anterior or posterior) in Cervical Myelopathy Surgery, Except?
E)
A man gets burst fracture at L1 with 60% canal compromise. Treated conservatively and returns after one month with progressive leg numbness and weakness. Most appropriate management?
D)
need anterior to do corpectomy
. You are presented with a sagittal MRI of the c-spine of some old dude who fell and hit his head and now has neurological symptoms. It shows cord compression with some intense signal in the center of the cord. How will this patient present on exam?
A)
In a patient with a disk herniation but NO cauda equina, when is it appropriate to excise the disk?
C)
3 mm displaced odontoid fracture Type 2. Neuro intact. Undisplaced Fracture of posterior arch C1. All are possible treatments EXCEPT
A)
cannot do wiring because of posterior arch fracture
Biomechanically which is strongest for Occipital-Cervical instrumentation?
D)
Thoracic outlet syndrome repeat
D)
worse in men
btw scm and middle scalene
XRay of C3-4 trauma, 25% anterior displacement with what seemed like rotational malalignment of upper segment. Most likely:
C)
bilateral perch is 50%
20 yr-old dude in MVA polytrauma and intubated. X-ray and CT show C3-C4 listhesis with bilateral jumped facets. No obvious fractures seen. You are asked to state what makes the reduction difficult?
D)
The following increase the risk of neurological deterioration in vertebral pyogenic osteomyelitis EXCEPT?
C)
A recent study about injections for lumbar spinal stenosis revealed?
B)
Regarding type 2 odontoid fractures, which is true:
B)
42 year old female RA with VMO (vertical migration of odontoid), arm numbness, myelopathy symtoms. SAC = 12 and flex-ex views show an irreducible deformity. How do you proceed?
D)
30 yr-old guy 6 months post L4-L5 diskectomy. He did well but he now returns with neuro symptoms after lifting something heavy. You are given an MRI with a large, non-enhancing goombah at the level of the L4-L5 disc. What is it?
D)
because of non enhancing part
Landmarks in the c-spine. All are true EXCEPT?
D)
lower border mandible c2-3
Hyoid: c3
Thyroid cartilage: c4-c5
Cricoid: C6
Carotid tubercle: C6
All are poor prognostic indicators of recovery after whiplash injury EXCEPT:
A)
X-Ray of lumbar spine fused as well as fused SI joints. (looked like pic of AS, complete with central line of ossification (supraspinous and interspinous ligaments) and marginal syndesmophytes). What is true of this patient?
