Spine short answers

  1. List the 4 different subtypes of neural tube defects
    • Spina bifida occulta
    • Myelomeningocele
    • Meningocele
    • Rachischisis
  2. List 5 risk factors for poor healing in a type 2 odontoid fracture
    • Smoking
    • Age >50
    • Displacement >6mm
    • Angulation >10 degrees
    • Fracture comminution
    • Delayed presentation
  3. A child with a hemivertebra. What are 3 indications for being able to perform a hemiepiphysiodesis
    • Curve <40
    • Age <5
    • Single Hemi
    • Short segment: <5 levels
    • Concave growing potential: no bar
  4. Give 4 factors that are prognostic of neurologic deficit in patients with vertebral osteomyelitis
    • Infection with SA
    • RA
    • Cephalad infection
    • Advanced age
    • DM
    • Steroid
  5. An adolescent with a major right-sided thoracic curve with also a left-sided thoracolumbar curve. A - List 3 radiographic signs that would suggest that the TL curve is not compensatory but is a primary curve as well B - List 5 things that can predict skeletal age of the patient (? What are 5 ways to assess her skeletal maturity?)
    • A
    • Does not straighten on bending film: >25 degrees
    • Fixed kyphosis >20 degrees: from T10-L2
    • Cobb angle TL curve>thoracic curve

    • B
    • Hand chart
    • Triradiate cartilage closure
    • Menstruation
    • Risser score
    • Fusion elbow apophysis
    • Tanner stage
  6. A 14 year-old girl is diagnosed with adolescent idiopathic scoliosis and a right main thoracic curve. Name 3 radiologic factors that would suggest that the lumbar curve is also structural.
    • Lumbar curve > thoracic curve
    • Fixed kyphosis >20 degrees T10-L2
    • Curve >25 degrees on bending films
  7. 4 ways to assess spinal injury intra-op
    • SSEP
    • MEP
    • Wake up test
    • Continuous EMG
    • Pedicle stimulation
  8. List three neurologic features of a Brown Sequard syndrome. (3)
    • Ipsilateral loss of motor
    • Ipsilateral Loss Vibration proprioception
    • Contralateral loss pain and temperature
  9. What are 4 MRI findings of a patient with scoliosis and neurofibromatosis?
    • Peripheral schwannomas: enlarged foramina
    • Dural ectasia
    • tethered cord
    • Posteriorly scalloped verterbrae
    • Pencilling ribs
  10. What are 3 cervical spine findings in Down syndrome?
    • C1-C2 instability
    • Cervico-occipital instability
    • Osseous anomalies: os odontoid, dentocentral synchondrosis c1)
  11. What are 3 conditions that have dural ectasia?
    AMEN

    • Ank spond
    • Marfans
    • Ehler danlos
    • NF-1
  12. Please list the dermatomes for the following: medial knee, groin, medial calf, clavicle
    • Medial knee: L3
    • Groin: L1
    • Medial calf: L4
    • Clavicle: C4
  13. What are two important considerations to take into account for placing C1-C2 trans-artricular screws.
    • Location of vert
    • Location of Exiting nerve root: c2
  14. Central cord syndrome
    • UE > LE weakness
    • UMN signs
    • Sacral sparing
    • Hands worse than upper limb
  15. List 3 physical findings of sacral sparing in a spinal cord injury.
    • Preserved voluntary anal contracture
    • Preserved perianal sensation
    • Great toe flexor activity intact
  16. List 3 components of the Lenke classification.
    • Curve location
    • Sagital modifier: kyphosis angle
    • Coronal modifier: location of apical vertebrae with respect to CVSL
  17. List 11 muscle groups that are important to test for the ASIA classification and give their respective myotome level.
    • C5: elbow flexion
    • C6: wrist extension
    • C7: Elbow extension
    • C8: FInger flexion
    • T1: Finger Abduction
    • L2: Hip flexion
    • L3: Knee extensiom
    • L4: Ankle DF
    • L5: EHL DF
    • S1: Plantar flexion
    • S4/5: voluntary anal contraction
  18. Using the ASIA classification, state the myotome associated with each of the following muscle groups:A - 3rd digit DIP flexionB - wrist extensionC - long toe extensorsD - Voluntary anal control
    • A: C8
    • B: C6
    • C: L5
    • D: S4-5
  19. List 3 spinal conditions that will light up on a gadolinium enhanced MRI.
    • Epidural fibrosis
    • Epidural Abcess
    • Discitis
    • Tumor: hypervascular tissue
  20. List 4 dysplastic features seen in developmental spondylolisthesis that would indicate a risk for progression.
    • Horizontal/transverse facets
    • Incompetent posterior arch: spina bifida
    • Domed S1
    • Trapezoidal L5
    • Poorly developed pars
  21. Name the following Dermatomes: Nipple line, Umbilicus, Groin, medial calf
    • Nipple: T4
    • Umbilicus: T10
    • Groin: L1
    • Medial calf: L4
  22. What is the formula for pelvic incidence
    PI = SS + PT
  23. Three reasons for the progression of congenital kyphosis
    • Magnitude of cobb angle
    • Amount of growth remaining
    • Number of vertebrae involved
  24. List 8 organ systems associated with congenital scoliosis
    • anal atresia
    • Tracheoesophageal fistula
    • Renal abnormalities
    • Cardiac abnormalities
    • Auditory
    • MSK: limb defects
    • Repiratory: thoracic insufficiency
  25. List 3 radiographic features associated with C2-3 pseudosubluxation
    • Absence of soft tissue swelling
    • Reduction of subluxation on extension views
    • Disruption anterior spinal line <4mm
  26. List 3 anatomic features associated with C2-3 pseudosubluxation
    • Horizontally oriented facets
    • Ligamentous laxity
    • Wedged vertebrae
    • Shallow facets
  27. List 5 radiographic or clinical features suggesting an unstable C-spine injury
    • 3.5 mm translation
    • Vertebral body # >11 degrees angulation
    • 25% vertebral height loss
    • Disc space widening >1.7mm
    • SAC < 14mm
    • Evidence of cord/root damage
  28. List 3 considerations for applying a pediatric halo safely
    • More pins: 6-8
    • Less torque: 2-4
    • CT scan pre to assess cortical thickness
  29. List 3 ways to do a posterior C1-2 fusion
    • C1-C2 transarticular
    • C1-C2 lateral mass/pedicle
    • Gallie procedure with posterior wiring
  30. List 4 risk factors for developing SMA syndrome with doing peds scoliosis surgery
    • Short stature
    • BMI <25
    • Dual approach
    • Stiff thoracic curve
  31. List 4 criteria for selective throracic fusion in AIS
    • Thoracic curve <40
    • Tri radiate closed
    • Apical translation <3cm
    • COBB T/L ratio > 1.25
  32. List 4 findings in the cervical spine of a pediatric patient that can be confused with cervical spine trauma
    • Prevertebral soft tissue thickenning
    • Pseudosubluxation
    • Radiolucent synchondrosis
    • Pseudospread of the C1 lateral mass on C2 on open mouth view
  33. Patients with Ankylosing Spondylitis are known to have sacroiliitis. List 3 other clinical findings that are used for the diagnosis of Ankylosing Spondylitis
    • HLA B27
    • Uveitis
    • Enthesopathy
  34. 3 findings of an incomplete spinal cord injury
    • Voluntary anal contraction
    • Perianal sensation present
    • Palpable or visible muscle contraction below level
  35. 6 types of spondylolisthesis by etiology (Wiltse classification)?
    • Dysplastic
    • Isthmic
    • Degenerative: elongation from multiple fractures, pars fatigue, pars acute frcture
    • Traumatic
    • neoplastic
  36. 3 radiographic or clinical signs of thoracolumbar instability?
    Components of TLICS

    • Mosphology
    • Neuro Deficitis
    • Integrity posterior discoligamentous complex
  37. 4 surgical indications in rheumatoid spine?
    • ADI >10
    • Cervicomedullary angle  >135
    • Basilar invagination
    • Neurological deteriotion
    • SAC< 14
  38. 3 complications of vertebroplasty?
    • Neurological injury from cement extravasation into spinal canal 
    • Cement embolism
    • Increased fracture risk at adjacent levels
  39. List 4 prognosis factors for future instability in pediatric spine tuberculosis.
    • Retropulsion
    • Toppling
    • Subluxation
    • Lateral translation
  40. TB spine risk of progression
    • retropulsion
    • subluxation
    • lateral translation
    • toppling
  41. List 5 radiographic signs suggestive of juvenile idiopathic arthritis of the cervical spine.
    • C1-C2 intability
    • Facet ankalosys
    • C-spine kyphosis
    • Small narrow vertebral bodies and disc space narrowing
    • Hypoplastic vertebral bodies
  42. Name 4 radiographic risk factors for progression in infantile scoliosis
    • RVAD > 20
    • Phase 2 ribs
    • Cobb angle >20
    • Acute progression of curve
  43. Describe 4 standard physiologic maneuvers used in spine surgery that are neuroprotective to spinal perfusion.
    • MAP > 85
    • Hgb >100
    • Decreasing CSF with drain
    • Jackson table: adbomen hangs free under table > reduces vena cava pressure > less bleeding
  44. Name 3 upper extremity and 3 lower extremity findings of cervical myelopathy.
    • Upper extremity
    • Hoffman
    • Inverted brachioradialis
    • Hypereflexia

    • Lower extremity
    • Clonus > 3 beats
    • Babinski
    • Hyperreflexia
  45. Give 5 indications to order an MRI in pediatric spine scoliosis patients
    • PLANC
    • Pain
    • L thoracic
    • Age < 9
    • Neuro symptoms
    • Congenital curve
  46. What spinal pathology is seen in Achondroplasia (4)
    • Lumbar stenosis
    • Foramen magnum stenosis
    • Decreased interpedicular distance from L1-L5
    • Thoracic kyphosis
  47. What findings are seen in Scheuermann's Kyphosis (4)
    • • 3 vertebrae wedged > 5 degree
    • • Disc narrowing
    • • Endplate irregularity
    • • Schmorl's nodes
  48. Give 3 contraindications to laminoplasty in treating cervical stenosis
    • Kyphosis > 11 degrees
    • Signa change on MRU
    • Severe axial neck pain
  49. What age related changes are seen in the disc degeneration (3)
    • Decrease water content
    • Increased keratin sulfate/chondritin ratio
    • decrease number cells
  50. What factors can affect SSEP readings aside from neurologic injury? (4)
    • Halogenated anesthetics
    • Hypothermia
    • Hypotension
    • Hypoglycemia
  51. 4 Complications of ACDF
    • Injury to recurrent laryngeal
    • Dysphagia/esophageal rupture
    • Non union
    • Airway obstruction
  52. Describe 3 C-spine deformities seen in RA
    • Atlanto axial instability
    • basilar invagination
    • Subaxial instability
  53. Give 3 ways of causing iatrogenic spondylolisthesis
    • Removal bilateralpars
    • 100% unilateral facetectomy
    • Bilateral >50% facetectomy
  54. 4 things one can do to treat dural tear
    • Tension free water tight closure
    • Fibrin glue augment
    • Consider lumbar drain
    • Abx until drain removed
Author
egusnowski
ID
345834
Card Set
Spine short answers
Description
Spine sa
Updated