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6. Spine MCQs

Practice Set 149 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2961

Topic: 6. Spine

A 56-year-old woman sustained the fracture shown in Figures 30a and 30b in a motor vehicle accident. What mechanism is most likely responsible for the injury?

. Flexion distraction
. Vertical shear
. Extension distraction
. Flexion compression
. Axial load

Correct Answer & Explanation

. Axial load

Explanation

The CT scans show a burst fracture that results from an axial load injury. The radiographic hallmark of a burst fracture is compression of the posterior cortex of the vertebral body with retropulsion of bone into the spinal canal. AP radiographs often show widening of the interpedicular distance with a fracture of the lamina. Theiss SM: Thoracolumbar and lumbar spine trauma, in Stannard JP, Schmidt AH, Kregor PJ (eds): Surgical Treatment of Orthopaedic Trauma. New York, NY, Thieme, 2007, pp 179-207.

Question 2962

Topic: 6. Spine

A 15-year-old boy with Duchenne muscular dystrophy has a progressive scoliosis that now measures 55 degrees. He is in foster care and is no longer ambulatory. Because posterior spinal fusion with instrumentation is the recommended treatment, the patient participates in a thorough discussion of the risks and benefits of the procedure. However, he refuses the surgery. The physician should now

. obtain a court order to perform the surgery.
. follow the patient clinically.
. place the patient in a brace.
. perform the surgery with permission from the legal guardians.
. perform the surgery with the consent of two surgeons.

Correct Answer & Explanation

. follow the patient clinically.

Explanation

Traditionally, patients have been viewed as ignorant about medical matters and ill-equipped to determine what is in their best interest. This has been especially true for minors. However, recent informed consent policies are now based on the patient's right to self-determination. While most spinal surgeons would agree that spinal fusion improves pulmonary function, sitting balance, and comfort, they would also agree that this comes at considerable risk in a patient with compromised pulmonary function and ultimately, a terminal condition. With increasing frequency, young people older than age 14 years are gaining greater autonomy in decision making about their health care matters. This includes do not resuscitate orders when young patients are terminally ill, as well as in less serious situations. Surgery could be performed with the permission of the legal guardians; however, in this situation it is preferable to follow the patient clinically until he consents to surgery along with the legal guardians. Bracing is contraindicated. Reich WT (ed): Encyclopedia of Bioethics. New York, NY, Simon and Schuster, 1995, pp 1256-1265. Confidential health services for adolescents. Council on Scientific Affairs, American Medical Association. JAMA 1993;269:1420-1424.

Question 2963

Topic: 6. Spine

A 26-year-old woman who noted right-sided lumbosacral pain 10 days ago while vacuuming now reports that the pain has intensified. She denies any history of back problems. No radicular component is present, and her neurologic examination is normal. The next most appropriate step in management should consist of

Spine Surgery 2000 Practice Questions: Set 1 (Solved) - Figure 39

. a brief (2 to 3 days) period of bed rest and nonsteroidal anti-inflammatory drugs.
. bed rest for 2 weeks and nonsteroidal anti-inflamatory drugs, followed by physical therapy.
. epidural steroid injections.
. lumbar radiographs and MRI of the lumbar spine.
. electromyography.

Correct Answer & Explanation

. a brief (2 to 3 days) period of bed rest and nonsteroidal anti-inflammatory drugs.

Explanation

The initial management of a lumbar strain should consist of 2 to 3 days of bed rest when symptoms are severe, activity restrictions, and nonsteroidal anti-inflammatory drugs. It has been estimated that 60% to 80% of the adult population experiences back pain, with 2% to 5% affected yearly. Spontaneous improvement generally will occur within 4 weeks. Further study is indicated by the presence of radiculopathy, weakness, trauma, or suspicion of malignancy. Bigos S, Boyer O, Braen GR, et al: Acute low back pain in adults: Clinical practice guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD, Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December, 1994.

Question 2964

Topic: 6. Spine

Chronic anterior donor site pain following the harvest of autologous iliac crest bone graft for use during anterior cervical diskectomy and fusion is reported by approximately what percent of patients?

. Less than 1%
. 5%
. 25%
. 50%
. 75%

Correct Answer & Explanation

. 25%

Explanation

Four years after surgery, more than 90% of patients are satisfied with the cosmetic appearance of the iliac donor site scar. Approximately 25% still have pain and/or functional difficulty, including 12.7% who still report difficulty with ambulation, 11.9% difficulty with recreational activities, 7.5% with sexual intercourse, and 11.2% require pain medication for iliac donor site symptoms. Silber JS, Anderson DG, Daffner SD, et al: Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003;28:134-139.

Question 2965

Topic: Cervical Spine

The space available for the cord is an important determinant in neurologic recovery. Recent analysis suggests that the most reliable radiographic predictor for neurologic recovery after surgery in patients with rheumatoid arthritis and paralysis is a preoperative

Spine Surgery Board Review 2000: High-Yield MCQs (Set 2) - Figure 16

. anterior alanto-odontoid interval of less than 9 mm.
. anterior alanto-odontoid interval of greater than 9 mm.
. posterior alanto-odontoid interval of greater than 10 mm.
. posterior alanto-odontoid interval of greater than 12 mm.
. posterior alanto-odontoid interval of greater than 14 mm.

Correct Answer & Explanation

. posterior alanto-odontoid interval of greater than 10 mm.

Explanation

Boden and associates' recent article presents significant evidence that patients with rheumatoid arthritis, neurologic deterioration, and C1-2 instability are more likely to improve after surgery if the posterior alanto-odontoid interval is greater than 10 mm preoperatively. The accepted safe range for the posterior atlanto-odontoid interval is 14 mm. This measurement is believed to better represent the space available for the cord than the anterior alanto-odontoid interval. Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 273-279. Boden SD, Dodge LD, Bohlman HH, Rechtine GR: Rheumatoid arthritis of the cervical spine: A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 1993;75:1282-1297.

Question 2966

Topic: 6. Spine

A 2-year-old child is being evaluated for limb-length and girth discrepancy. As a newborn, the patient was large for gestational age and had hypoglycemia. Current examination shows enlargement of the entire right side of the body, including the right lower extremity and foot. The skin shows no abnormal markings, and the neurologic examination is normal. The spine appears normal. Radiographs confirm a 2-cm discrepancy in the lengths of the lower extremities. Additional imaging studies should include

Pediatrics Board Review 2007: High-Yield MCQs (Set 2) - Figure 4

. bone age of the left wrist.
. MRI of the spine.
. MRI of the brain.
. renal and abdominal ultrasonography.
. hip ultrasonography.

Correct Answer & Explanation

. renal and abdominal ultrasonography.

Explanation

The patient may have Beckwith-Wiedemann syndrome (BWS), which consists of exophthalmos, macroglossia, gigantism, visceromegaly, abdominal wall defects, and neonatal hypoglycemia. Hemihypertrophy develops in approximately 15% of patients with BWS. Patients with hemihypertrophy that is the result of BWS have a 40% chance of developing malignancies such as Wilms' tumor or hepatoblastoma; therefore, frequent ultrasound screening is recommended until about age 7 years. The absence of nevi and vascular markings helps to rule out other causes of hemihypertrophy, such as neurofibromatosis, Proteus syndrome, and Klippel-Trenaunay syndrome. Bone age estimations are not accurate at this young age but may become more useful later to help predict the timing of epiphysiodesis procedures. DeBaun MR, Tucker MA: Risk of cancer during the first four years of life in children from The Beckwith-Wiedemann Syndrome Registry. J Pediatr 1998;132:398-400. Ballock RT, Wiesner GL, Myers MT, et al: Hemihypertrophy concepts and controversies. J Bone Joint Surg Am 1997;79:1731-1738.

Question 2967

Topic: 6. Spine

A 14-year-old patient with an L3 myelomeningocele underwent anterior and posterior spinal fusion for a curve of 50 degrees. Follow-up examination 1 week after the procedure now reveals persistent drainage from the posterior wound. Results of laboratory cultures show Streptococcus viridans, Staphylococcus aureus, and Enterococcus. In addition to IV antibiotics, surgical irrigation, and debridement, management should include

. removal of all hardware.
. temporary placement of antibiotic beads.
. wound closure over drains.
. bedside dressing changes.
. a RAST test for latex allergy.

Correct Answer & Explanation

. wound closure over drains.

Explanation

The rate of wound infections has dramatically decreased with the routine use of prophylactic antibiotics. Factors known to increase the risk of infection include instrumentation, prolonged surgical time, excessive blood loss, poor perioperative nutritional status, a history of surgery, and a history of infection. The use of allograft does not result in an increased rate of infection. Adequate treatment requires early diagnosis and intervention. Temperature elevation and persistent wound drainage are highly suspicious for infection. An erythrocyte sedimentation rate and a WBC are not useful in diagnosis unless serial examinations show rising levels. Patients should be taken to the operating room where the entire wound can be reopened, irrigated, and debrided. Bone graft can be washed and replaced. Hardware should not be removed. The wound should be closed over suction drains. IV antibiotics should be given for a period of at least 10 days, followed by 6 weeks orally. Leaving the wound open to granulate with dressing changes results in prolonged hospitalization, inadequate treatment of the infection, and a poor cosmetic result. Lonstein JE: Complications of treatment, in Bradford DS, Lonstein JE, Moe JH, et al (eds): Moe's Textbook of Scoliosis and Other Spinal Deformities, ed 2. Philadelphia, Pa, WB Saunders, 1987, p 476.

Question 2968

Topic: 6. Spine

A full-term newborn has webbing at the knees, rigid clubfeet, a Buddha-like posture of the lower extremities, and no voluntary or involuntary muscle action at and below the knees. Radiographs of the spine and pelvis reveal an absence of the lumbar spine and sacrum. What maternal condition is associated with this diagnosis?

. Alcoholism
. Drug abuse
. Down syndrome
. Diabetes mellitus
. Idiopathic scoliosis

Correct Answer & Explanation

. Diabetes mellitus

Explanation

The history, physical examination, and radiographic findings are consistent with type IV sacral agenesis or caudal regression syndrome. These children are born with no lumbar spine or sacrum. The T12 vertebra is often prominent posteriorly. Popliteal webbing and knee flexion contractures are common with this diagnosis. There is a higher incidence of this diagnosis when the mother has diabetes mellitus. Maternal drug abuse and alcoholism can produce phenotypically unique children but without the findings described here. Maternal idiopathic scoliosis is not associated with caudal regression syndrome. Chan BW, Chan KS, Koide T, et al: Maternal diabetes increases the risk of caudal regression caused by retinoic acid. Diabetes 2002;51:2811-2816.

Question 2969

Topic: 6. Spine
A 3-year-old boy sustains a complete paralysis following a high thoracic spinal cord injury consistent with a SCIWORA-type injury (spinal cord injury without radiographic abnormality). Subsequent progressive spinal deformity will develop in what percent of patients with this injury?
. 10%
. 25%
. 50%
. 75%
. Greater than 75%

Correct Answer & Explanation

. Greater than 75%

Explanation

Spinal cord injury in skeletally immature patients almost always leads to the development of paralytic spinal deformity. The age at injury is the most important factor affecting the development of scoliosis. Spinal cord injury that occurs more than 1 year prior to skeletal maturity is almost always followed by the development of scoliosis. In one study, scoliosis developed in 100% of children who were younger than age 10 years at the time of spinal cord injury. Scoliosis can occur after injury at any level. Spasticity is often a contributing factor. Up to two thirds of patients who have paralytic scoliosis prior to skeletal maturity will eventually require surgery for curve control. Mayfield JK, Erkkila JC, Winter RB: Spine deformity subsequent to acquired childhood spinal cord injury. J Bone Joint Surg Am 1981;63:1401-1411. Lancourt JE, Dickson JH, Carter RE: Paralytic spinal deformity following traumatic spinal cord injury in children and adolescents. J Bone Joint Surg Am 1981;63:47-53.

Question 2970

Topic: 6. Spine

A 17-year-old high school football player is seen for follow-up after sustaining an injury 3 days ago. He reports that he tackled a player, felt numbness throughout his body, and could not move for approximately 15 seconds. A spinal cord injury protocol was initiated on the field. Evaluation in the emergency department revealed a normal neurologic examination and full painless neck motion. He states that he has no history of a similar injury. An MRI scan of the cervical spine is normal. During counseling, the patient and his family should be informed that he has sustained

. a spinal cord injury and he cannot participate in contact sports.
. no obvious injury and can return to all sports without risk of recurrence.
. no obvious injury, but he is at a high risk for breaking his neck in athletic competition.
. transient quadriplegia only, but this places him at greater risk for future spinal cord injury and he should refrain from all contact sports.
. transient quadriplegia and that there is no evidence of increased risk of permanent spinal cord injury should he return to contact sports.

Correct Answer & Explanation

. transient quadriplegia and that there is no evidence of increased risk of permanent spinal cord injury should he return to contact sports.

Explanation

The long-term effect of transient quadriplegia is unknown. Based on a history of one brief episode of transient quadriplegia and normal examination and MRI findings, the risk of permanent spinal cord injury with a return to play is low. There is a risk of recurrent episodes of transient quadriplegia after the initial episode. Morganti C, Sweeney CA, Albanese SA, et al: Return to play after cervical spine injury. Spine 2001;26:1131-1136. Odor JM, Watkins RG, Dillin WH, et al: Incidence of cervical spinal stenosis in professional and rookie football players. Am J Sports Med 1990;18:507-509. Torg JS, Naranja RJ Jr, Palov H, et al: The relationship of developmental narrowing of the cervical spinal canal to reversible and irreversible injury of the cervical spinal cord in football players. J Bone Joint Surg Am 1996;78:1308-1314.

Question 2971

Topic: 6. Spine

An Asian 45-year-old man has bilateral upper extremity dysfunction. Figure 35a shows a T2-weighted sagittal MRI scan of the cervical spine, and Figure 35b shows a T2-weighted axial MRI scan at the level of the C3 vertebral body. What is the most likely pathologic process?

. Cervical spondylosis
. Diffuse idiopathic skeletal hyperostosis (DISH)
. Ossification of the posterior longitudinal ligament (OPLL)
. Ankylosing spondylitis
. Neurofibromatosis

Correct Answer & Explanation

. Ossification of the posterior longitudinal ligament (OPLL)

Explanation

Although relatively common in people of Asian origin, OPLL has been reported in other races as well. The radiographic appearance can be variable as there are different types described, but some of the discerning characteristics are seen in these images. On the sagittal view, the bone posterior to the vertebral body extends along the entire length of C2 and C3. This is characteristic of OPLL, whereas cervical spondylosis and DISH more commonly are not confluent. Ankylosing spondylitis more commonly extends significantly into the spinal canal, and neurofibromatosis generally does not cause any bony growth. The axial view shows a large, oval bony projection into the spinal canal, a typical finding of OPLL. McAfee PC, Regan JJ, Bohlman HH: Cervical cord compression from ossification of the posterior longitudinal ligament in non-orientals. J Bone Joint Surg Br 1987;69:569-575.

Question 2972

Topic: 6. Spine

A 30-year-old man who underwent an anterior lumbar diskectomy and fusion at L4-5 and L5-S1 through an anterior retroperitoneal approach 1 month ago now reports he is unable to obtain and maintain an erection. The most likely cause of this condition is

. disruption of the sympathetic nerves during anterior lumbar exposure.
. traction on the parasympathetic nerve at the L4-5 level.
. not related to the surgical dissection.
. injury to the pudendal nerves in the anterior sacral region during dissection at the L5-S1 level.
. sexual dysfunction secondary to retrograde ejaculation.

Correct Answer & Explanation

. sexual dysfunction secondary to retrograde ejaculation.

Explanation

Sexual dysfunction is a common condition after extensive anterior lumbar surgical dissection. Erectile dysfunction usually is nonorganic but may be related to parasympathetic injury. The parasympathetic nerves are deep in the pelvis at the level of S2-3 and S3-4 and usually are not involved in the surgical field for anterior L4-5 and L5-S1 procedures. Retrograde ejaculation is the result of injury to the sympathetic chain on the anterior surface of the major vessels crossing the L4-5 level and at the L5-S1 interspace. Erectile function and orgasm are not affected by sympathetic injury. The pudendal nerve is primarily a somatic nerve and is not located in the surgical field. Flynn JC, Price CT: Sexual complications of anterior fusion of the lumbar spine. Spine 1984;9:489-492.

Question 2973

Topic: 6. Spine

A 69-year-old woman is seen in the emergency department with a bilateral C5-6 facet dislocation and complete quadriplegia after falling down a flight of stairs. After initial evaluation and treatment by the trauma service, she is moved to the intensive care unit. Examination reveals a blood pressure of 90/50 mm/Hg, a pulse rate of 50/min, a respiration rate of 12/min, and urine output of 1 mL/kg/h. Her hemodynamic status should be addressed by

. continued fluid bolus.
. methylprednisolone.
. insertion of a Swan-Ganz catheter.
. immediate intubation.
. beta blockers to decrease peripheral resistance.

Correct Answer & Explanation

. insertion of a Swan-Ganz catheter.

Explanation

The patient's heart rate is not responding to hypotension with tachycardia, as would be expected in the event of hypovolemic shock. Additionally, the adequate urine output suggests proper fluid resuscitation. Instead, she is bradycardic, possibly indicating neurogenic shock and loss of sympathetic tone to the heart. A Swan-Ganz catheter should be used to help differentiate these problems and guide appropriate fluid resuscitation and use of vasopressor agents. Hadley MN: Management of acute spinal cord injuries in an intensive care unit or other monitored setting. Neurosurgery 2002;50:S51-S57.

Question 2974

Topic: 6. Spine

A 42-year-old man sustained a burst fracture at L2 in a motor vehicle accident. Examination reveals that he is neurologically intact. Figure 18 shows a cross-sectional CT scan through the fracture. If the fracture is managed nonsurgically for the next 2 years, the retained fragments can be expected to

Spine Surgery 2006 Practice Questions: Set 3 (Solved) - Figure 3

. remain essentially unchanged in size.
. result in neurologic deterioration.
. gradually resorb and widen the spinal canal.
. potentially migrate within the spinal canal.
. increase the risk of further injury to the adjacent dural sac.

Correct Answer & Explanation

. gradually resorb and widen the spinal canal.

Explanation

Numerous articles have reported that both surgical and nonsurgical management of burst fractures are associated with resolution of impingement at long-term follow-up. If the patient is neurologically intact and appropriately treated at the time of injury, neurologic deterioration is not expected nor is there a risk of injury to the dural sac. The retained fragments can be expected to gradually resorb and widen the spinal canal. Mumford J, Weinstein JN, Spratt KF, et al: Thoracolumbar burst fractures: The clinical efficacy and outcome of nonoperative management. Spine 1993;18:955-970.

Question 2975

Topic: 6. Spine
An 82-year-old man is seen in consultation after being admitted for a fall from ground level. There was no loss of consciousness and the patient recalls striking his head and sustaining a hyperextension-type injury to the cervical spine. Examination reveals an 8-cm head laceration with only mild axial neck tenderness. He has generalized weakness throughout the upper extremities and maintained motor function of the lower extremities. There are no obvious sensory deficits, and the bulbocavernosus reflex and deep tendon reflexes are maintained. What is the most appropriate diagnosis at this time?
. Anterior cord syndrome
. Central cord syndrome
. Posterior cord syndrome
. Brown-Séquard syndrome
. Spinal shock

Correct Answer & Explanation

. Central cord syndrome

Explanation

Incomplete cord syndromes have variable neurologic findings with partial loss of sensory and/or motor function below the level of injury. Central cord syndrome is characterized by greater motor weakness in the upper extremities than in the lower extremities. The pattern of motor weakness shows greater distal involvement in the affected extremity than proximal muscle weakness.

Question 2976

Topic: 6. Spine

A 55-year-old woman with a history of untreated idiopathic scoliosis has had neurogenic claudication for the past several months. MRI reveals spinal stenosis at L2-L3, L3-L4, and L4-L5. Radiographs show a 45-degree lumbar curve from T10 to L4, with a degenerative spondylolisthesis at L4-L5. Laminectomy at the stenotic levels and stabilization of the deformity are planned. Which of the following is NOT considered an absolute indication for extending the fusion to the sacrum, rather than stopping at L5?

Spine Surgery 2006 Practice Questions: Set 1 (Solved) - Figure 18

. Advanced degenerative disk disease with facet arthrosis at L5-S1
. Decreased T2 signal in the L5-S1 disk with normal facet joints
. Previous laminectomy at L5-S1
. Fixed tilt of L5 with severe unilateral facet arthrosis
. Spondylolysis bilaterally at L5

Correct Answer & Explanation

. Fixed tilt of L5 with severe unilateral facet arthrosis

Explanation

There are several indications for extending adult scoliosis fusions to the sacrum, rather than stopping in the lower lumbar spine. These indications include posterior column deficiencies at L5-S1, such as spondylolysis and laminectomy, and deformities extending to the sacrum, such as fixed tilt of L5-S1 or sagittal imbalance. MRI signal changes in the L5-S1 disk do not preclude stopping the fusion at L5. Some surgeons use diskography or diagnostic facet blocks to evaluate the integrity of the L5-S1 level prior to stopping the fusion at L5. Long scoliosis fusions stopping at L5 have a significant risk of failure, highlighting the importance of careful selection of fusion levels. Bradford DS, Tay BK, Hu SS: Adult scoliosis: Surgical indications, operative management, complications, and outcomes. Spine 1999;24:2617-2629. Bridwell KH: Where to stop the fusion distally in adult scoliosis: L4, L5, or the sacrum? Instr Course Lect 1996;45:101-107.

Question 2977

Topic: 6. Spine

The parents of a 10-year-old boy with Down syndrome are seeking sports clearance for participation in the high jump at the Special Olympics. He is asymptomatic, and the neurologic examination is normal. The hips and patellae are clinically stable. Radiographs of the cervical spine in flexion and extension show a maximum atlanto-dens interval (ADI) of 6 mm. Based on these findings, what recommendation should be made?

. Clearance for all sports activities
. Avoidance of contact sports, high jump, and diving
. Application of a hard cervical collar during sports events
. Application of a halo vest
. Posterior atlantoaxial arthrodesis

Correct Answer & Explanation

. Avoidance of contact sports, high jump, and diving

Explanation

In approximately 15% of children with Down syndrome, atlantoaxial instability develops because of ligament laxity, making them susceptible to spinal cord injury with relatively minor trauma. The American Academy of Pediatrics recommends lateral flexion-extension views of the cervical spine in any patient with Down syndrome who wishes to participate in sports. A normal ADI is up to 4 mm. Patients with Down syndrome with an ADI of more than 5 mm should not participate in contact sports or sports with a high risk for neck injury, such as diving, gymnastics, high jump, or butterfly stroke. Cervical fusion has a very high rate of complications in patients with Down syndrome and is recommended only for patients who have myelopathic signs or symptoms. Atlantoaxial instability in Down syndrome: Subject review. American Academy of Pediatrics Committee on Sports Medicine and Fitness. Pediatrics 1995;96:151-154. Tredwell SJ, Newman DE, Lockitch G: Instability of the upper cervical spine in Down syndrome. J Pediatr Orthop 1990;10:602-606.

Question 2978

Topic: Thoracolumbar Spine & Deformity
Figure 3 shows the radiograph of an asymptomatic 10-year-old boy. Management should consist of
. physical therapy.
. restriction from contact sports.
. periodic observation, but no activity restriction.
. immobilization with a thoracolumbosacral orthosis (TLSO).
. direct surgical repair.

Correct Answer & Explanation

. periodic observation, but no activity restriction.

Explanation

Asymptomatic spondylolysis in a child or adolescent should be observed for the possible development of spondylolisthesis, but no other active intervention is needed.

Question 2979

Topic: 6. Spine
A 27-year-old woman has a bilateral C5-C6 facet dislocation and quadriparesis after being involved in a motor vehicle accident. Initial management consisted of reduction with traction, but she remains a Frankel A quadriplegic. To facilitate rehabilitation, surgical stabilization and fusion is planned. From a biomechanical point of view, which of the following techniques is the LEAST stable method of fixation?
. Anterior cervical plating with interbody bone graft
. Posterior cervical plating with lateral mass screw fixation
. Posterior sublaminar wiring
. Simple posterior interspinous wiring
. Bohlman interspinous wiring

Correct Answer & Explanation

. Simple posterior interspinous wiring

Explanation

In biomechanical studies, all posterior techniques of stabilization were found to be superior to anterior plating in flexion-distraction injuries of the cervical spine. These injuries usually have an intact anterior longitudinal ligament that allows posterior fixation to function as a tension band. Anterior plating with grafting destroys this last remaining stabilizing structure and does not allow for a tension band effect because the posterior stabilizing structures have been destroyed.

Question 2980

Topic: 6. Spine

A 28-year-old man sustained a fracture-dislocation of T8 in a motor vehicle accident 1 week ago. The injury resulted in complete paraplegia. Management should consist of

Trauma 2000 Practice Questions: Set 1 (Solved) - Figure 32

. mobilization in a kinetic therapy bed for 8 weeks.
. initiation of a steroid protocol.
. immediate laminectomy of T7, T8, and T9.
. application of a total contact orthosis.
. open reduction and posterior segmental stabilization and grafting.

Correct Answer & Explanation

. open reduction and posterior segmental stabilization and grafting.

Explanation

With a complete injury in the thoracic spinal cord, the likelihood of neurologic recovery is small. If possible, treatment should be planned to allow rapid mobilization and rehabilitation without the use of braces and their associated skin problems. The use of long segment fixation provides for rapid mobilization without having to use braces postoperatively. The use of steroid protocol is controversial and should be considered only if it can be started within 8 hours of the injury. Laminectomy is contraindicated because it will increase instability.

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