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121 Cards in this Set

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SECTION 7: SPINE
SECTION 7: SPINE
62. Anatomy of the Spine
62. Anatomy of the Spine
All vertebrae have three primary ossification centers: the ________ (anterior vertebral body), the ________ ________ (posterior elements, pedicles, and a small portion of the anterior vertebra), and a ________ element (anterior part of lateral mass, transverse process, or rib).
All vertebrae have three primary ossification centers: the centrum (anterior vertebral body), the neural arch (posterior elements, pedicles, and a small portion of the anterior vertebra), and a costal element (anterior part of lateral mass, transverse process, or rib).
The most aggressive congenital scoliosis combines failures of ________ and failures of ________ and is associated with a hemivertebra on one side and an unsegmented bar on the other.
The most aggressive congenital scoliosis combines failures of segmentation and failures of formation and is associated with a hemivertebra on one side and an unsegmented bar on the other.
A particular arrangement of ________ ligaments forms the transverse apical alar ligament complex at the C1-2 articulation. The ________ ________ ligament runs horizontally behind the dens and is the major stabilizer. It is crossed (hence cruciate) anteriorly by the vertically oriented ________ ligament. Finally, a paired set of obliquely oriented ________ ligaments adds additional support to the articulation.
A particular arrangement of three ligaments forms the transverse apical alar ligament complex at the C1-2 articulation. The transverse atlantal ligament runs horizontally behind the dens and is the major stabilizer. It is crossed (hence cruciate) anteriorly by the vertically oriented apical ligament. Finally, a paired set of obliquely oriented alar ligaments adds additional support to the articulation.
The disk consists of a fibrous outer anulus fibrosus with ________ oriented collagen __ molecules, and a softer, crabmeat-consistency nucleus pulposus, which cushions force with predominantly type __ collagen molecules.
The disk consists of a fibrous outer anulus fibrosus with obliquely oriented collagen I molecules, and a softer, crabmeat-consistency nucleus pulposus, which cushions force with predominantly type II collagen molecules.
The superior tip of the ________ articulating process is a major offending structure in lumbar foraminal stenosis.
The superior tip of the inferior articulating process is a major offending structure in lumbar foraminal stenosis.
The ________ and ________ laryngeal nerves are particularly at risk for injury during the anterior cervical approach. Injury may lead to temporary or permanent vocal cord paralysis.
The recurrent and superior laryngeal nerves are particularly at risk for injury during the anterior cervical approach. Injury may lead to temporary or permanent vocal cord paralysis.
In the thoracic spine on the left, usually around ____, is the large segmental artery of ________, which can cause cord infarction if injured.
In the thoracic spine on the left, usually around T8, is the large segmental artery of Adamkiewicz, which can cause cord infarction if injured.
The lumbar plexus runs through the posterior two thirds and around the _______ muscle laterally, with the ________ nerve directly anterior to the muscle.
The lumbar plexus runs through the posterior two thirds and around the psoas muscle laterally, with the genitofemoral nerve directly anterior to the muscle.
The lumbar pedicle screw starting point is at the intersection of two lines, one drawn medial to lateral through the midpoint of the ____, the other superior to inferior on the lateral edge of the ____ ________.
The lumbar pedicle screw starting point is at the intersection of two lines, one drawn medial to lateral through the midpoint of the TP, the other superior to inferior on the lateral edge of the pars interarticularis.
The internal carotid artery lies anteriorly within ___ mm of the ideal exit point of a bicortical C1 lateral mass screw or C1-2 transarticular screw.
The internal carotid artery lies anteriorly within 1 mm of the ideal exit point of a bicortical C1 lateral mass screw or C1-2 transarticular screw.
63. Physical Examination of the Spine
63. Physical Examination of the Spine
A positive ________-_____ _____ test is highly sensitive for ipsilateral nerve root compression.
A positive straight-leg raise test is highly sensitive for ipsilateral nerve root compression.
A positive crossed straight-leg raise test is highly specific for contralateral ________ ________ ________.
A positive crossed straight-leg raise test is highly specific for contralateral herniated nucleus pulposus.
Percussive tenderness on the spinous process is sensitive for acute/subacute ________ ________.
Percussive tenderness on the spinous process is sensitive for acute/subacute vertebral fracture.
A positive ________ test is highly specific for ipsilateral cervical root compression.
A positive Spurling test is highly specific for ipsilateral cervical root compression.
Three positive ________ signs out of five correlates with nonorganic disease. a. Superficial tenderness b. Simulation c. Overreaction d. Regional disturbances e. Distraction
Three positive Waddell signs out of five correlates with nonorganic disease. a. Superficial tenderness b. Simulation c. Overreaction d. Regional disturbances e. Distraction
An abnormal ________ ________ test is sensitive (nonspecific) for myelopathy.
An abnormal tandem gait test is sensitive (nonspecific) for myelopathy.
Reflexes can be tested for cervical roots ____, ____, and ____ and for lumbosacral roots ___ and ___.
Reflexes can be tested for cervical roots C5, C6, and C7 and for lumbosacral roots L4 and S1.
Thoracic sensory levels are T4 (________ line) and T10 (________).
Thoracic sensory levels are T4 (nipple line) and T10 (umbilicus).
Manual muscle strength grading: __/5 strength is significant weakness but maintains antigravity.
Manual muscle strength grading: 3/5 strength is significant weakness but maintains antigravity.
Pathologic reflexes (positive ________ or ________, sustained ________) are sensitive for myelopathy.
Pathologic reflexes (positive Hoffman or Babinski, sustained clonus) are sensitive for myelopathy.
64. Imaging of the Spine
64. Imaging of the Spine
Plain radiographs create a two-dimensional view, and two ________ images are required to adequately visualize the examined structures.
Plain radiographs create a two-dimensional view, and two orthogonal images are required to adequately visualize the examined structures.
___ radiographs are preferred to ___ views when evaluating patients with scoliosis because they minimize the amount of radiation absorbed by vital organ systems.
PA radiographs are preferred to AP views when evaluating patients with scoliosis because they minimize the amount of radiation absorbed by vital organ systems.
________ materials absorb more radiation and are ________ on radiographs than less dense structures.
Dense materials absorb more radiation and are brighter on radiographs than less dense structures.
________ ___ provides faster acquisition of images than previous technology.
Helical CT provides faster acquisition of images than previous technology.
CT ___________ is useful for evaluating neural structures in patients with contraindications to MRI, such as those with pacemakers.
CT myelography is useful for evaluating neural structures in patients with contraindications to MRI, such as those with pacemakers.
_____ is useful for evaluating soft tissues, including disks, nerves, and the spinal cord, and for diagnosing disk herniations, spinal stenosis, and acute or subacute fractures.
MRI is useful for evaluating soft tissues, including disks, nerves, and the spinal cord, and for diagnosing disk herniations, spinal stenosis, and acute or subacute fractures.
_____ findings must be correlated with patient symptoms because multiple studies have reported positive MRI scans in asymptomatic patients.
MRI findings must be correlated with patient symptoms because multiple studies have reported positive MRI scans in asymptomatic patients.
Intravenous gadolinium contrast is useful in MRI of patients with ________, ________, and previous surgery.
Intravenous gadolinium contrast is useful in MRI of patients with tumors, infections, and previous surgery.
Nuclear medicine studies have different imaging characteristics, depending on the type of ________ used.
Nuclear medicine studies have different imaging characteristics, depending on the type of radionuclide used.
________ ________ studies can be performed in conjunction with cross-sectional imaging such as CT or MRI to provide more detailed studies.
Nuclear medicine studies can be performed in conjunction with cross-sectional imaging such as CT or MRI to provide more detailed studies.
65. Nonsurgical Treatment and Diagnostics in Spinal Disorders
65. Nonsurgical Treatment and Diagnostics in Spinal Disorders
Spinal manipulation is defined as a controlled passive force that takes the joint past physiologic motion, causing joint ________.
Spinal manipulation is defined as a controlled passive force that takes the joint past physiologic motion, causing joint cavitation.
Spinal manipulation is at least as effective for short-term relief of acute back pain as other nonsurgical treatment, but it is not recommended in ________ or ________.
Spinal manipulation is at least as effective for short-term relief of acute back pain as other nonsurgical treatment, but it is not recommended in radiculopathy or myelopathy.
Physical therapy is based on mobilization and ________- or ________-based exercises.
Physical therapy is based on mobilization and flexion- or extension-based exercises.
Transforaminal ESIs have shown efficacy, especially in ________ disk herniations.
Transforaminal ESIs have shown efficacy, especially in lateral disk herniations.
Facet joints are innervated by the ________ branch of the dorsal ramus after it exits the neuroforamen above and at the level of the facet.
Facet joints are innervated by the medial branch of the dorsal ramus after it exits the neuroforamen above and at the level of the facet.
Manual compression, the ________ test, and a host of other tests have been found to have no diagnostic value in the diagnosis of SI pain.
Manual compression, the Patrick test, and a host of other tests have been found to have no diagnostic value in the diagnosis of SI pain.
EMG is used to evaluate the motor unit at rest for spontaneous muscle activity, which, when present, indicates ________ instability or ________ injury.
EMG is used to evaluate the motor unit at rest for spontaneous muscle activity, which, when present, indicates membrane instability or neuronal injury.
Abnormality on EMG in _____ separate muscles sharing the same nerve root but innervated by different peripheral nerves is suggestive of radiculopathy.
Abnormality on EMG in two separate muscles sharing the same nerve root but innervated by different peripheral nerves is suggestive of radiculopathy.
EMG lacks ________ but is ________ in the diagnosis of radiculopathy.
EMG lacks sensitivity but is specific in the diagnosis of radiculopathy.
________ entails pressurizing the disk with a non-noxious fluid in an attempt to stimulate nerve endings in injured disks.
Diskography entails pressurizing the disk with a non-noxious fluid in an attempt to stimulate nerve endings in injured disks.
66. Adult Spinal Deformity
66. Adult Spinal Deformity
ASD is defined as a rotatory and lateral spinal curve > ___° in a skeletally mature person.
ASD is defined as a rotatory and lateral spinal curve >10° in a skeletally mature person.
From ___% to ___% of the population has a curve greater than 10°.
From 1.4% to 12% of the population has a curve greater than 10°.
_____ and ____ pain are common symptoms in patients with ASD.
Back and leg pain are common symptoms in patients with ASD.
Unlike the classic pattern of neurogenic claudication, patients with scoliosis and stenosis do not obtain relief with sitting or ________ ________.
Unlike the classic pattern of neurogenic claudication, patients with scoliosis and stenosis do not obtain relief with sitting or forward flexion.
Curve progression is likely, especially in patients with ________ curves or when preexisting ________ is seen on radiographs.
Curve progression is likely, especially in patients with thoracic curves or when preexisting rotation is seen on radiographs.
AP and lateral _____-________ views should be obtained for complete evaluation. Measurements should include ________ ________ to assess magnitude of all curves, ______ plumb line to assess for ________ imbalance, and center sacral vertical line to identify ________ malalignment.
AP and lateral long-cassette views should be obtained for complete evaluation. Measurements should include Cobb angles to assess magnitude of all curves, C7 plumb line to assess for sagittal imbalance, and center sacral vertical line to identify coronal malalignment.
CT myelography is most useful for assessing stenosis and bony anatomy, as ________ makes interpretation of MRI scans difficult.
CT myelography is most useful for assessing stenosis and bony anatomy, as rotation makes interpretation of MRI scans difficult.
Nonsurgical management is the first treatment of choice and remains the mainstay of treatment in those patients in whom surgery is ________.
Nonsurgical management is the first treatment of choice and remains the mainstay of treatment in those patients in whom surgery is contraindicated.
Correction of these deformities often necessitates ________ ________ and ________ surgeries, either staged or performed on the same day. Combined surgeries can result in longer surgeries, higher complication rates, and more overall medical stress to the patient. Careful preoperative planning for the approach, correction of deformity via ________, and medical optimization are critical.
Correction of these deformities often necessitates combined anterior and posterior surgeries, either staged or performed on the same day. Combined surgeries can result in longer surgeries, higher complication rates, and more overall medical stress to the patient. Careful preoperative planning for the approach, correction of deformity via osteotomies, and medical optimization are critical.
Achievement of ________ ________, ________ of pain, and a ________ ________ are the primary goals of surgery.
Achievement of spinal balance, relief of pain, and a solid arthrodesis are the primary goals of surgery.
67. Infections of the Spine
67. Infections of the Spine
The most common presenting symptom of a postoperative spinal infection is _____, although its onset may be delayed.
The most common presenting symptom of a postoperative spinal infection is pain, although its onset may be delayed.
Most postoperative spinal infections are ________ ________, but laboratory and imaging studies also may be useful for confirming this diagnosis.
Most postoperative spinal infections are clinically evident, but laboratory and imaging studies also may be useful for confirming this diagnosis.
The mainstay of treatment of postoperative infections is ________ ________ and ________ in conjunction with an appropriate course of antibiotics.
The mainstay of treatment of postoperative infections is surgical irrigation and débridement in conjunction with an appropriate course of antibiotics.
With ________ spinal infections, pathologic organisms usually emanate from the ________ _____ ________ into the relatively avascular disk space before spreading to adjacent vertebral bodies.
With hematogenous spinal infections, pathologic organisms usually emanate from the vascular end plates into the relatively avascular disk space before spreading to adjacent vertebral bodies.
Most patients with diskitis can be treated successfully with ________ and ________, but surgical intervention is indicated for infections recalcitrant to nonsurgical management or those resulting in any type of ________ deficit or ________ deformity.
Most patients with diskitis can be treated successfully with immobilization and antibiotics, but surgical intervention is indicated for infections recalcitrant to nonsurgical management or those resulting in any type of neurologic deficit or progressive deformity.
________ infections may be caused by tuberculosis, fungal species, or other atypical organisms.
Granulomatous infections may be caused by tuberculosis, fungal species, or other atypical organisms.
Because of the indolent nature of granulomatous diseases, patients with these infections may already exhibit significant destruction of the vertebral column and ________ kyphosis at the time of the diagnosis.
Because of the indolent nature of granulomatous diseases, patients with these infections may already exhibit significant destruction of the vertebral column and focal kyphosis at the time of the diagnosis.
________ directed at the causative pathogen is the most effective treatment of granulomatous diseases.
Pharmacotherapy directed at the causative pathogen is the most effective treatment of granulomatous diseases.
Epidural abscesses are associated with a high risk of neurologic compromise secondary to direct compression of the neural elements, as well as an associated ________ injury caused by the infection itself.
Epidural abscesses are associated with a high risk of neurologic compromise secondary to direct compression of the neural elements, as well as an associated ischemic injury caused by the infection itself.
With few exceptions, epidural infections should be treated surgically with ________ with or without ________, followed by local wound care and an adequate course of antibiotic therapy.
With few exceptions, epidural infections should be treated surgically with decompression with or without fusion, followed by local wound care and an adequate course of antibiotic therapy.
68. Spinal Trauma
68. Spinal Trauma
Patients with ankylosing spondylitis have increased risk of spinal fractures with minor trauma and can experience neurologic deterioration secondary to ________ ________.
Patients with ankylosing spondylitis have increased risk of spinal fractures with minor trauma and can experience neurologic deterioration secondary to epidural hematoma.
Noncontiguous spine injuries can occur in up to __% of patients and are common in the presence of head injury, upper cervical injury, and cervicothoracic injury.
Noncontiguous spine injuries can occur in up to 24% of patients and are common in the presence of head injury, upper cervical injury, and cervicothoracic injury.
________-________ syndrome has the best prognosis for ambulation, ________ ________ syndrome has a variable recovery, and ________ ________ syndrome has the worst prognosis.
Brown-Séquard syndrome has the best prognosis for ambulation, central cord syndrome has a variable recovery, and anterior cord syndrome has the worst prognosis.
In patients with SCI, hypotension (systolic blood pressure < _____ mm Hg) should be avoided and mean arterial blood pressure at ____ to _____ mm Hg should be maintained to prevent secondary SCI.
In patients with SCI, hypotension (systolic blood pressure <90 mm Hg) should be avoided and mean arterial blood pressure at 85 to 90 mm Hg should be maintained to prevent secondary SCI.
According to the third national acute spinal cord injury study (NASCIS III), if the time from injury to treatment is less than ___ hours, the protocol is a ____-mg/kg bolus of methylprednisolone followed by ____ mg/kg/h for 23 hours. If the time from injury is between ____ and ____ hours, the infusion is continued at ____ mg/kg/h for an additional 23 hours (48 hours total).
According to the third national acute spinal cord injury study (NASCIS III), if the time from injury to treatment is less than 3 hours, the protocol is a 30-mg/kg bolus of methylprednisolone followed by 5.4 mg/kg/h for 23 hours. If the time from injury is between 3 and 8 hours, the infusion is continued at 5.4 mg/kg/h for an additional 23 hours (48 hours total).
In C1 fractures, if both lateral masses are significantly displaced and > ___ mm of combined lateral overhang is present, it is likely that the transverse ligament is disrupted.
In C1 fractures, if both lateral masses are significantly displaced and >7 mm of combined lateral overhang is present, it is likely that the transverse ligament is disrupted.
An intact ________ ________ ________ should be considered a prerequisite for nonsurgical care of a burst fracture.
An intact posterior ligamentous complex should be considered a prerequisite for nonsurgical care of a burst fracture.
Type 2A ________ fractures (traumatic spondylolisthesis) exhibit flexion with little translation and can overdistract with minimal force; ________ should be avoided when this fracture pattern is recognized.
Type 2A hangman’s fractures (traumatic spondylolisthesis) exhibit flexion with little translation and can overdistract with minimal force; traction should be avoided when this fracture pattern is recognized.
Abdominal visceral injuries are commonly (____%) associated with ________-________ injuries in the thoracolumbar spine.
Abdominal visceral injuries are commonly (50%) associated with flexion-distraction injuries in the thoracolumbar spine.
Most lower lumbar spine fractures can be treated nonsurgically with ________ results.
Most lower lumbar spine fractures can be treated nonsurgically with excellent results.
69. Degenerative Conditions of the Cervical Spine
69. Degenerative Conditions of the Cervical Spine
Cervical Radiculopathy
Cervical Radiculopathy
Cervical nerve roots exist above their corresponding numbered pedicles. (C6 exists between ___ and ___.)
Cervical nerve roots exist above their corresponding numbered pedicles. (C6 exists between C5 and C6.)
Nonsurgical treatment should be attempted for the vast majority of patients with cervical radiculopathy. Many forms of nonsurgical treatment relieve the pain but may not alter the ________ ________ of the disease.
Nonsurgical treatment should be attempted for the vast majority of patients with cervical radiculopathy. Many forms of nonsurgical treatment relieve the pain but may not alter the natural history of the disease.
Surgical management provides excellent and predictable outcomes in patients with ________ ________ dysfunction or failure to improve despite time and nonsurgical treatment. Either an anterior or a posterior approach can be selected in the appropriate circumstances, understanding that neither is perfect and each carries its own set of pros and cons.
Surgical management provides excellent and predictable outcomes in patients with progressive neurologic dysfunction or failure to improve despite time and nonsurgical treatment. Either an anterior or a posterior approach can be selected in the appropriate circumstances, understanding that neither is perfect and each carries its own set of pros and cons.
Complications associated with ACDF include ________ ________ and ________ problems.
Complications associated with ACDF include persistent speech and swallowing problems.
Cervical Myelopathy
Cervical Myelopathy
Cervical myelopathy is typically a ________ disorder.
Cervical myelopathy is typically a surgical disorder.
Early treatment, before the onset of permanent ________ ______, is recommended.
Early treatment, before the onset of permanent cord injury, is recommended.
An anterior approach is indicated in patients with myelopathy arising from ____ or ____ disk segments.
An anterior approach is indicated in patients with myelopathy arising from one or two disk segments.
Laminoplasty is indicated in patients with multilevel involvement (______ or _____ disk spaces).
Laminoplasty is indicated in patients with multilevel involvement (three or more disk spaces).
A combined anterior-posterior approach is indicated in patients with ________ ________ and ________, or those with postlaminectomy kyphosis.
A combined anterior-posterior approach is indicated in patients with multilevel stenosis and kyphosis, or those with postlaminectomy kyphosis.
The surgical procedure chosen must be tailored to the patient’s specific pattern of stenosis, comorbidities, and symptoms. Strict adherence to a ________ ________ protocol should be avoided.
The surgical procedure chosen must be tailored to the patient’s specific pattern of stenosis, comorbidities, and symptoms. Strict adherence to a blind algorithmic protocol should be avoided.
70. Lumbar Degenerative Disease and Low Back Pain
70. Lumbar Degenerative Disease and Low Back Pain
Up to ____% of patients will experience low back pain at some point their lifetime, and it usually resolves in a matter of weeks. The mainstay for treatment of acute low back pain is nonsurgical.
Up to 85% of patients will experience low back pain at some point their lifetime, and it usually resolves in a matter of weeks. The mainstay for treatment of acute low back pain is nonsurgical.
The vast majority (____%) of symptomatic LDHs improve with nonsurgical management.
The vast majority (90%) of symptomatic LDHs improve with nonsurgical management.
A paracentral disk herniation will affect the traversing nerve root, not the exiting nerve root. For example, an L4-5 left paracentral HNP will result in an ___ radiculopathy, not an ___ radiculopathy.
A paracentral disk herniation will affect the traversing nerve root, not the exiting nerve root. For example, an L4-5 left paracentral HNP will result in an L5 radiculopathy, not an L4 radiculopathy.
An intraforaminal or extraforaminal HNP will affect the exiting root. For example, a far lateral HNP at ___-__ will result in an ___ radiculopathy.
An intraforaminal or extraforaminal HNP will affect the exiting root. For example, a far lateral HNP at L3-4 will result in an L3 radiculopathy.
The absolute indicators for surgical management of LDH are ________ ________ and a ________ ________ ________. Both are rare.
The absolute indicators for surgical management of LDH are cauda equina and a progressive neurologic deficit. Both are rare.
Lumbar spinal stenosis is typically associated with ________. The differential diagnosis includes hip ________, vascular disease, and peripheral neuropathy.
Lumbar spinal stenosis is typically associated with exertion. The differential diagnosis includes hip pathology, vascular disease, and peripheral neuropathy.
The five main types of spondylolisthesis are ________, ________, ________, ________, and ________.
The five main types of spondylolisthesis are degenerative, isthmic, traumatic, dysplastic, and iatrogenic.
In situ ________ L5-S1 fusion is indicated for children and adolescents with a low-grade spondylolisthesis.
In situ posterolateral L5-S1 fusion is indicated for children and adolescents with a low-grade spondylolisthesis.
A ________ repair is indicated for persistently symptomatic patients with spondylosis, minimal DDD, no slippage, and no discogenic component to their pain.
A pars repair is indicated for persistently symptomatic patients with spondylosis, minimal DDD, no slippage, and no discogenic component to their pain.
71. Osteoporosis of the Spine and Vertebral Compression Fractures
71. Osteoporosis of the Spine and Vertebral Compression Fractures
_____s are the most common fragility fractures in the elderly.
VCFs are the most common fragility fractures in the elderly.
____ _____ to ____ ____ of these VCFs become symptomatic enough to require medical care.
One fourth to one third of these VCFs become symptomatic enough to require medical care.
A ___% reduction in predicted forced vital capacity of the lung can be expected for each thoracic VCF.
A 9% reduction in predicted forced vital capacity of the lung can be expected for each thoracic VCF.
Medical ________ and ________ need to be involved early on in the management of these patients.
Medical specialists and therapists need to be involved early on in the management of these patients.
Although the pain of a VCF is usually localized, radicular pain can occur with nerve root ________.
Although the pain of a VCF is usually localized, radicular pain can occur with nerve root irritation.
Thoracic VCFs are usually _____-_______, whereas lumbar VCFs tend to be ________.
Thoracic VCFs are usually wedge-shaped, whereas lumbar VCFs tend to be biconcave.
An ____ or ____ ______ is used to diagnose a radiographically ambiguous but clinically suspected VCF.
An MRI or bone scan is used to diagnose a radiographically ambiguous but clinically suspected VCF.
There are two main categories of antiosteoporotic drugs: ________ and ________.
There are two main categories of antiosteoporotic drugs: anticatabolic and anabolic.
________ and ________ are highly effective minimally invasive surgical treatments of VCFs.
Vertebroplasty and kyphoplasty are highly effective minimally invasive surgical treatments of VCFs.
The rate of clinically significant complications with vertebroplasty or kyphoplasty is ________.
The rate of clinically significant complications with vertebroplasty or kyphoplasty is minimal.
72. Inflammatory Arthritides of the Spine
72. Inflammatory Arthritides of the Spine
In RA, anterior ADI > ____ mm is considered abnormal; however, the posterior ADI has more prognostic value. An anterior ADI > ___ to ____ mm or posterior ADI < ____ mm is associated with an increased risk of neurologic injury and usually requires surgery.
In RA, anterior ADI >3.5 mm is considered abnormal; however, the posterior ADI has more prognostic value. An anterior ADI >9 to 10 mm or posterior ADI <14 mm is associated with an increased risk of neurologic injury and usually requires surgery.
In RA, surgical intervention should be attempted before the onset of Ranawat class ____ myelopathy because neurologic improvement is limited once the condition reaches this degree of severity.
In RA, surgical intervention should be attempted before the onset of Ranawat class IIIB myelopathy because neurologic improvement is limited once the condition reaches this degree of severity.
Patients with ankylosing spondylitis have decreased ________ ________ relative to other people.
Patients with ankylosing spondylitis have decreased chest expansion relative to other people.
Any patient with ankylosing spondylitis who presents with a sudden onset of back or neck pain must be worked up for a fracture. Rapid neurologic deterioration can occur as a result of ________ instability or ________ formation.
Any patient with ankylosing spondylitis who presents with a sudden onset of back or neck pain must be worked up for a fracture. Rapid neurologic deterioration can occur as a result of spinal instability or hematoma formation.
The earliest radiographic sign of ankylosing spondylitis is ________ on the ________ side of the ________ joint. Ankylosing spondylitis has a predilection for bilateral ________ and marginal thin-flowing ________, leading to the characteristic ________ ________ appearance.
The earliest radiographic sign of ankylosing spondylitis is erosion on the iliac side of the sacroiliac joint. Ankylosing spondylitis has a predilection for bilateral sacroiliitis and marginal thin-flowing syndesmophytes, leading to the characteristic bamboo spine appearance.
Approximately ____% of patients with psoriatic arthritis develop a spondyloarthropathy. Medical treatment is similar to that for patients with RA. Surgical indications are similar to those for patients with RA who have cervical disease or ankylosing spondylitis and a kyphotic deformity.
Approximately 10% of patients with psoriatic arthritis develop a spondyloarthropathy. Medical treatment is similar to that for patients with RA. Surgical indications are similar to those for patients with RA who have cervical disease or ankylosing spondylitis and a kyphotic deformity.
Asymmetric sacroiliitis and nonmarginal syndesmophytes differentiate ________ syndrome from ________ ________.
Asymmetric sacroiliitis and nonmarginal syndesmophytes differentiate Reiter syndrome from ankylosing spondylitis.
In contrast to ankylosing spondylitis, ________ is characterized by large, nonmarginal syndesmophytes with involvement of at least four contiguous vertebral bodies, and there is no involvement of the sacroiliac joints.
In contrast to ankylosing spondylitis, DISH is characterized by large, nonmarginal syndesmophytes with involvement of at least four contiguous vertebral bodies, and there is no involvement of the sacroiliac joints.