physiologic loads to maintain relationships between vertebrae in such a way that there is no development of subsequent irritation to the spinal cord or its roots, and in addition there is no development of incapacitating deformity or pain.”
– ie, a stable spine is able to maintain its alignment under physiologic loads, and prevent the development of subsequent deformity, pain, or neurologic injury.
– a patient with a slap foot gait but no motor/sensory problems likely has a posterior column damage – secondary to tertiary syphllis (tabes dorsalis) or diabetes
– degenerative disc collapse is the earliest pathologic change in spinal stenosis – then leads to facet hypertrophy which narrows the canal.
– Gad enhanced MR is probably the best way to distinguish between recurrent disc versus fibrosis/scar. “at 6 months, MRI is able to detect abnormal disc material and separate it from postop fibrotic changes”.
– lower c-spine instability: White and Punjabi criteria.
2 points for: translation more than 3.5 mm
sagittal rotation more than 11 degrees
anterior elements damaged
posterior elements damaged
positive stretch test
1 point for: dangerous loads anticipated
abnormal disc narrowing
– a thoracic curve of greater than 50 degrees is likely to progress in an adult
– chemonucleosis lost its popularity due to ineffectiveness and anaphylaxis
– the patient that undergoes chymopapain injection may develop significant spasm (up to 20%) immediately afterwards – this is normal and should be managed expectantly or with steroids.
– things that suggest instability in burst fractures – neurologic involvement, greater than 50% compression, involvement of the posterior elements (moreso than just the greenstick laminar fracture), and doing a decompressive laminectomy (may fall off in kyphosis)
– flexion/axial loading injury to C5 with anteroinferior teardrop fragment and posterior interspinous widening would probably give an anterior cord syndrome – usually caused by hyperflexion with bone or disc fragments compressing the anterior spinal artery and cord.
– in ankylosing spondylitis, a c-spine fracture is at risk of epidural hematoma. It should be treated aggressively because of a high nonunion rate.
– in cervical spondylosis, disc space narrowing is the most common finding, and can lead to a loss of relative lordosis (ie, the spine becomes relatively kyphotic).
– in a C6/7 fracture dislocation, the lowest possible working root is probably C6 (coming out above C6). C7 comes out above C7, C8 comes out below C7. I’m not sure if C7 would still work if you dislocated C6 in front of C7, because you’d tend to pull on the C7 root. C6 should be okay though.
– within 24 hours of injury in a complete C6 quad – pressure sores or massive atelectasis? I think pressure sores.
– for C-spine stenosis, the normal adult is 17 mm; impingement begins at 13 mm. A space of 10 mm correlates highly with clinical myelopathy.
– Paget’s disease patients can present with significant spinal stenosis from an involved vertebrae. The tip off is if they are immobilized, their hypercalcemia may go through the roof.
– highest disc pressure is when sitting, leaning forward.
– weakness of quads and loss of knee jerk reflex – L3 or L4?
– indications to fuse an adult lumbar scoliosis to the sacrum is when the lumbar curve has a fixed lumbosacral obliquity greater than 15 degrees, loss of coronal and sagittal balance, and lumbosacral degeneration.
– fusion levels should extend to the stable vertebra, and all degenerative levels should be included in the fusion.
– most scoliotic patients develop a restrictive lung disease pattern.
– complications of halo-pelvic distraction include: loss of cervical lordosis, laceration of bowel, AVN of the odontoid, cranial nerve palsies
– pedicle screw insertion requires associated with dural tear, nerve root injury, fewer pseudarthrosis, and increased infection (maybe). It requires some removal of