T-spine

Question 1

What is found in the anterior column of the thoracolumbar region?

Answer 1

• ALL

- Anterior 2/3rds of body

Question 2

What is found in the middle column of the thoracolumbar region?

Answer 2

• Posterior 1/3rd of body

- Posterior longitudinal ligament

Question 3

What is found in the posterior column of thoracolumbar region?

Answer 3

• Posterior ligaments

- Vertebral arches

Question 4

What type of fracture in the thoracolumbar region is stable?

Answer 4

Through one column

Question 5

How can a two column fracture through the thoracolumbar region be stable?

Answer 5

• Depending on the extent of the fracture

Question 6

What is required in a 3 column thoracolumbar fracture?

Answer 6

• Internal fixation

Question 7

What is the mechanism of a compression fracture in the thoracic spine?

Answer 7

• Flexion force collapses the anterior vertebral body

Question 8

What posture contributes to and is a result of compression fractures?

Answer 8

• Kyphosis
• Axial forces create flexion force
• Crushed bodies create kyphotic posture

Question 9

What shape do the vertebral bodies take on in a compression fracture?

Answer 9

Wedge shaped

Question 10

How can a compression fracture be stable?

Answer 10

• If the fracture is only through the anterior body

Question 11

Who is most at risk for compression fractures?

Answer 11

• Caucasian, post-menopausal women

Question 12

What is the treatment for a compression fracture?

Answer 12

• Cement injected into a painful fractured vertebral body

Vertebroblasty

Question 13

How quickly do vertebroblasties provide pain relief and restoration of mobility?

Answer 13

Within 48 hours

Question 14

What type of movement is prevented with a vertebroblasty?

Answer 14

• Fracture movement

Question 15

What is the success rate of vertebroblasty?

Answer 15

73 - 90 %

Question 16

Does vertebroblasty correct vertebral deformities?

Answer 16

No, but it does prevent further collapse

Question 17

Through what structures is the needle passed through in a vertebroblasty?

Answer 17

• Pedicle and vertebral body

Question 18

What is the difference between a kyphoplasty and a vertebroblasty?

Answer 18

• Corrects deformity and relieves pain and restores mobility

Question 19

When must a kyphoplasty be performed?

Answer 19

When the fracture is acute.

Question 20

What is the procedure of a kyphoplasty?

Answer 20

• Patient recumbent
• Balloon inserted into vertebral body and inflated
• Balloon removed, and cavity filled with bone cement

Question 21

What are the 3 scoliosis types?

Answer 21

• Infantile
• Juvenile
• Adolescent

Question 22

At what age does infantile scoliosis occur?

Answer 22

< 3 yo

Question 23

How does infantile scoliosis resolve?

Answer 23

Spontaneously

Question 24

What age groups are affected by Juvenile scoliosis? What gender is more effected?

Answer 24

• 3 - 10 yo

- Girls > Boys

Question 25

At what age does adolescent scoliosis occur?

Answer 25

- 10 yo to skeletal maturity

Question 26

How more likely are girls to develop adolescent scoliosis than boys?

Answer 26

7Xs more.

Question 27

What event does adolescent scoliosis typically coincide with?

Answer 27

- Growth spurts

Question 28

What type of scoliosis is at particular risk for progression?

Answer 28

Juvenile

Question 29

When does progression halt in adolescent scoliosis? What else ends here?

Answer 29

- Ends at skeletal maturity | - Conservative treatment no longer affective

Question 30

How the curves of scoliosis named?

Answer 30

For the location and side of the apex as viewed clinically from behind.

Question 31

Can there be multiple apexes in a scoliotic spine?

Answer 31

- Yes

Question 32

What is the Cobb angle?

Answer 32

- Standard AP view with equalized leg lengths - Draw lines from the most tilted inferior and superior vertebraes - Drop perpendiculars off the lines, and measure the angle

Question 33

What is the measurement error in a Cobb angle?

Answer 33

< 10 degrees

Question 34

How is the Cobb Angle documented? (besides the degrees)

Answer 34

Which vertebrae were used to calculate

Question 35

What is the pedicle method of scoliosis measurement?

Answer 35

- Drop a plumb line down the middle of the vertebrae | - Measure position of pedicles against the midline from 0 to 4+

Question 36

Where are the pedicles positioned in 0, 1+, 2+, 3+, and 4+?

Answer 36

``` 0: Normally 1+: Slightly off-center 2+: One pedicle almost obscured 3+: Pedicle at midline 4+: Pedicle past midline ```

Question 37

What 3 ways are the vertebrae deformed in scoliosis?

Answer 37

- Wedge shaped body - Shorter pedicles and laminae on the concave side - Deformed spinous process

Question 38

What 2 ways are the ribs deformed in scoliosis?

Answer 38

- Deformed on both sides | - Rotation causes rib hump on convex side

Question 39

How is scoliosis "corrected"?

Answer 39

- Stretch concave | - Strengthen convex