-
List the 4 different subtypes of neural tube defects
- Spina bifida occulta
- Myelomeningocele
- Meningocele
- Rachischisis
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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
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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
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Give 4 factors that are prognostic of neurologic deficit in patients with vertebral osteomyelitis
- Infection with SA
- RA
- Cephalad infection
- Advanced age
- DM
- Steroid
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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
- BHand chart
- Triradiate cartilage closure
- Menstruation
- Risser score
- Fusion elbow apophysis
- Tanner stage
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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
-
4 ways to assess spinal injury intra-op
- SSEP
- MEP
- Wake up test
- Continuous EMG
- Pedicle stimulation
-
List three neurologic features of a Brown Sequard syndrome. (3)
- Ipsilateral loss of motor
- Ipsilateral Loss Vibration proprioception
- Contralateral loss pain and temperature
-
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
-
What are 3 cervical spine findings in Down syndrome?
- C1-C2 instability
- Cervico-occipital instability
- Osseous anomalies: os odontoid, dentocentral synchondrosis c1)
-
What are 3 conditions that have dural ectasia?
AMEN
- Ank spond
- Marfans
- Ehler danlos
- NF-1
-
Please list the dermatomes for the following: medial knee, groin, medial calf, clavicle
- Medial knee: L3
- Groin: L1
- Medial calf: L4
- Clavicle: C4
-
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
-
Central cord syndrome
- UE > LE weakness
- UMN signs
- Sacral sparing
- Hands worse than upper limb
-
List 3 physical findings of sacral sparing in a spinal cord injury.
- Preserved voluntary anal contracture
- Preserved perianal sensation
- Great toe flexor activity intact
-
List 3 components of the Lenke classification.
- Curve location
- Sagital modifier: kyphosis angle
- Coronal modifier: location of apical vertebrae with respect to CVSL
-
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
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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
-
List 3 spinal conditions that will light up on a gadolinium enhanced MRI.
- Epidural fibrosis
- Epidural Abcess
- Discitis
- Tumor: hypervascular tissue
-
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
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Name the following Dermatomes: Nipple line, Umbilicus, Groin, medial calf
- Nipple: T4
- Umbilicus: T10
- Groin: L1
- Medial calf: L4
-
What is the formula for pelvic incidence
PI = SS + PT
-
Three reasons for the progression of congenital kyphosis
- Magnitude of cobb angle
- Amount of growth remaining
- Number of vertebrae involved
-
List 8 organ systems associated with congenital scoliosis
- anal atresia
- Tracheoesophageal fistula
- Renal abnormalities
- Cardiac abnormalities
- Auditory
- MSK: limb defects
- Repiratory: thoracic insufficiency
-
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
-
List 3 anatomic features associated with C2-3 pseudosubluxation
- Horizontally oriented facets
- Ligamentous laxity
- Wedged vertebrae
- Shallow facets
-
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
-
List 3 considerations for applying a pediatric halo safely
- More pins: 6-8
- Less torque: 2-4
- CT scan pre to assess cortical thickness
-
List 3 ways to do a posterior C1-2 fusion
- C1-C2 transarticular
- C1-C2 lateral mass/pedicle
- Gallie procedure with posterior wiring
-
List 4 risk factors for developing SMA syndrome with doing peds scoliosis surgery
- Short stature
- BMI <25
- Dual approach
- Stiff thoracic curve
-
List 4 criteria for selective throracic fusion in AIS
- Thoracic curve <40
- Tri radiate closed
- Apical translation <3cm
- COBB T/L ratio > 1.25
-
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
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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
-
3 findings of an incomplete spinal cord injury
- Voluntary anal contraction
- Perianal sensation present
- Palpable or visible muscle contraction below level
-
6 types of spondylolisthesis by etiology (Wiltse classification)?
- Dysplastic
- Isthmic
- Degenerative: elongation from multiple fractures, pars fatigue, pars acute frcture
- Traumatic
- neoplastic
-
3 radiographic or clinical signs of thoracolumbar instability?
Components of TLICS
- Mosphology
- Neuro Deficitis
- Integrity posterior discoligamentous complex
-
4 surgical indications in rheumatoid spine?
- ADI >10
- Cervicomedullary angle >135
- Basilar invagination
- Neurological deteriotion
- SAC< 14
-
3 complications of vertebroplasty?
- Neurological injury from cement extravasation into spinal canal
- Cement embolism
- Increased fracture risk at adjacent levels
-
List 4 prognosis factors for future instability in pediatric spine tuberculosis.
- Retropulsion
- Toppling
- Subluxation
- Lateral translation
-
TB spine risk of progression
- retropulsion
- subluxation
- lateral translation
- toppling
-
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
-
Name 4 radiographic risk factors for progression in infantile scoliosis
- RVAD > 20
- Phase 2 ribs
- Cobb angle >20
- Acute progression of curve
-
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
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Name 3 upper extremity and 3 lower extremity findings of cervical myelopathy.
- Upper extremityHoffman
- Inverted brachioradialis
- Hypereflexia
- Lower extremityClonus > 3 beats
- Babinski
- Hyperreflexia
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Give 5 indications to order an MRI in pediatric spine scoliosis patients
- PLANC
- Pain
- L thoracic
- Age < 9
- Neuro symptoms
- Congenital curve
-
What spinal pathology is seen in Achondroplasia (4)
- Lumbar stenosis
- Foramen magnum stenosis
- Decreased interpedicular distance from L1-L5
- Thoracic kyphosis
-
What findings are seen in Scheuermann's Kyphosis (4)
- • 3 vertebrae wedged > 5 degree
- • Disc narrowing
- • Endplate irregularity
- • Schmorl's nodes
-
Give 3 contraindications to laminoplasty in treating cervical stenosis
- Kyphosis > 11 degrees
- Signa change on MRU
- Severe axial neck pain
-
What age related changes are seen in the disc degeneration (3)
- Decrease water content
- Increased keratin sulfate/chondritin ratio
- decrease number cells
-
What factors can affect SSEP readings aside from neurologic injury? (4)
- Halogenated anesthetics
- Hypothermia
- Hypotension
- Hypoglycemia
-
4 Complications of ACDF
- Injury to recurrent laryngeal
- Dysphagia/esophageal rupture
- Non union
- Airway obstruction
-
Describe 3 C-spine deformities seen in RA
- Atlanto axial instability
- basilar invagination
- Subaxial instability
-
Give 3 ways of causing iatrogenic spondylolisthesis
- Removal bilateralpars
- 100% unilateral facetectomy
- Bilateral >50% facetectomy
-
4 things one can do to treat dural tear
- Tension free water tight closure
- Fibrin glue augment
- Consider lumbar drain
- Abx until drain removed
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