1. Complete the following about low back pain and radiculopathy:

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a. True or False. Bed rest beyond 4 days may be more harmful than helpful for patients with low back pain.

true

b. True or False. 60% of patients with low back pain will improve clinically within 1 month even without treatment.

false (89 to 90% will improve in 1 month even without treatment)

c. Pure radicular symptoms will include upper motor neuron (UMN) signs or lower motor neuron (LMN) signs?

LMN signs (Radiculopathy will/may show associated decreased reflexes, weakness, and atrophy.)

2. True or False. The percentage of low-risk back pain patients who will improve without treatment in 1 month’s time is

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a. 10%

false

b. 20%

false

c. 90%

true (Most low back patients will resolve and no specific diagnosis can be made in 85% despite aggressive workup.)

d. none

false

3. The nucleus pulposus is a remnant of the embryonic _____.

notocord

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4. True or False. The following may be considered a nonpathological condition:

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a. degenerated disc

false

b. protruded disc

false

c. bulging disc generalized > 50%

true (Bulging disc is circumferential symmetrical extension of the disc beyond the end plates. Incidence increases with age.)

d. herniated disc

false

e. focal bulging disc

false

5. True of False. Gas in the disc usually is a sign of

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a. disc infection

false

b. disc generation

true

c. aka v_____ d_____

vacuum disc

6. An extruded disc where the free fragment is contained by the posterior longitudinal ligament is called a _____ disc.

sequestered

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7. Give the definition of a sequestered disc.

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a. _____disc

extruded

b. that has lost _____

continuity

c. with its disc of _____

origin

d. also known as a _____ _____

free fragment

8. Provide the Modic classification.

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a. Type 1 T1W1_____ T2W1_____

↓ ↑

b. Type 2 T1W1_____ T2W1_____

↓ ↑

c. Type 3 T1W1_____ T2W1_____

↓ ↑

9. Kyphosis

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a. is measured by the _____ angle.

Cobb

b. Drawn with a line parallel to the

     i. superior end plate of the body _____ and the

above

     ii. inferior end plate of the body _____.

below

10. Scoliosis

a. is a measure of _____ of the curvature.

convexity

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b. Drawn with a line parallel to the superior end plate of the _____ body and the

uppermost

c. inferior end plate of the _____ body involved.

lowermost

d. Draw _____ to these lines

perpendicular

e. and measure the _____.

angle

11. Oswestry disability index

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a. is a scale used for _____ _____.

back pain

b. A score of _____% is essentially totally disabled.

45%

c. A functional score is in the _____.

teens

12. Signs of cauda equina syndrome include

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a. a_____

anesthesia (saddle)

b. b_____

bladder incontinence

c. c_____

continence of stool impaired

d. d_____

dolor leg pain (unilateral/bilateral)

e. l_____

leg weakness (unilateral/bilateral)

13. True or False. Cauda equina syndrome may include the following:

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a. bladder dysfunction (incontinence or retention)

true

b. Faber sign or Patrick-Faber sign (flexion abduction external rotation)

false (Positive in hip joint disease and does not exacerbate true nerve root compression.)

c. saddle anesthesia

true

d. unilateral/bilateral leg weakness/pain

true

e. fecal incontinence

true

14. Name the associated nerve root for each of the following:

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a. great toe strength

L5 and some L4

b. dorsal foot sensation

L5

c. lateral foot sensation

S1

d. medial foot sensation

L4

e. plantar foot sensation

S1

f. Achilles reflex

S1

15. For patients with low back pain, red flags for a serious underlying pathology would include signs consistent with what conditions?

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Hint: cisc

a. c_____

cauda equina syndrome

b. i_____

infection

c. s_____

spinal fracture

d. c_____

cancer

16. Electromyography (EMG) is not helpful to evaluate for myelopathy, myopathy, or nerve root dysfunction unless the symptoms have been present for at least _____ weeks.

3 to 4 (Results are variable before this time.)

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17. True or False. Regarding plain lumbosacral spine x-rays:

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a. Are recommended for routine evaluation of back pain

false

b. When indicated AP and lateral views are usually adequate

true

c. Unexpected findings occur frequently

false

d. Gonadal radiation is insignificant

false

e. Appropriate in patients who have “red flags”

true

18. True or False. Red flags include

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a. patients underage 20

true

b. patients over age 50

false (> 70)

c. drug users

true

d. diabetics

true

e. postop urinary tract patients

true

f. persistent pain for more than 1 week

false (> 4 weeks)

19. Complete the following about low back pain and radiculopathy:

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a. Signs on MRI that indicate disc degeneration include

     i. increase or decrease of signal intensity on T2-weighted imaging (T2WI)?

decrease

     ii. increase or decrease of disc height?

decrease

b. Signs on computed tomography (CT) that indicate disc herniation include

     i. increase or decrease of the normal epidural fat?

decrease

     ii. _____ of the thecal sac

indentation

c. Will CT show loss of concavity, or convexity, of the thecal sac?

convexity

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20. Other useful tests include the following:

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a. myelogram-CT. Identifies contribution to cause of pressure by _____.

bone

b. discography

     i. reliability_____

controversial

     ii. interpretation_____

equivocal

     iii. false positives_____

high

     iv. may help in cases of_____ _____if one

multiple discs

     v. produces

pain

21. List five signs of psychosocial distress in back pain, remembering that inappropriate response to any three suggests distress is present.

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Hint: ppaim

a. p_____

physical exam over reaction

b. p_____

pain on superficial palpation

c. a_____

axial loading produces pain

d. i_____

inconsistent SLR

e. m_____

motor or sensory exam inconsistent

22. Clear indications for urgent lumbar surgery include

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a. c_____ e_____ s_____

cauda equina syndrome

b. p_____ n_____ d_____

progressive neurological deficit

c. p_____ w_____

profound weakness (motor)

23. True or False. The following conservative therapy treatments have shown proven benefit for patients with back pain:

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a. epidural steroids

false

b. transcutaneous electrical nerve stimulation (TENS)

false

c. traction

false

d. oral steroids

false

e. spinal manipulation

false

f. muscle relaxants

false

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24. Is there a risk to the use of Parafon Forte? If so what is the risk?

yes; fatal hepatotoxicity

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25. True or False. Standard discectomy and microdiscectomy are of similar efficacy.

true

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26. Injection of chymopapain into herniated discs for treatment carries a significant risk of_____.

anaphylaxis

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27. The patient’s chances of returning to work if off for

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a. 6 months is_____%

50%

b. 1 year is_____%

20%

c. 2 years is_____%

<5%

28. Enumerate the changes that occur in the intervertebral disc with increasing age.

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G5 p.295:120mm

Hint: ddddisc

a. d_____

decrease disc height

b. d_____

decrease in proteoglycan content

c. d_____

desiccation (loss of hydration)

d. d_____

degeneration of mucoid

e. i_____

ingrowth of fibrous tissue

f. s_____

susceptibility to injury

g. c_____

circumferential tears of the annulus

29. Complete the following concerning the aging of a disc:

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a. What decreases?

     i. _____

proteoglycan content

     ii. _____

water

b. What increases?

     i. _____

mucoid degeneration

     ii. _____

fibrous tissue ingrowth

c. This results in

     i. _____

annular tears

     ii. _____

nucleus herniation

30. Complete the following about sagittal balance:

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a. Assessment requires a

     i. s_____

standing

     ii. l_____ and

lateral

     iii. f_____ spine x-ray.

full

b. A plumb line is drawn

     i. from the center of_____

C7

     ii. to the disc space of_____.

L5S1

     iii. Within_____

3.2 cm ±

     iv. behind the s_____ p_____ is

sacral promontory normal.

31. Typical disc herniation compresses the nerve existing_____.

below

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32. True or False. Surgical indications include

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a. cauda equina syndrome

true

b. numbness of foot

false

c. progressive symptoms

true

d. abnormal MRI

false

e. neurologic deficits

true

f. abnormal discogram

false

g. failed conservative treatment

true

h. pain when coughing

false

     i. severe radicular pain for 2 weeks

false (6 weeks)

j. severe back pain

false

33. The posterior longitudinal ligament

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a. is strongest in the_____.

midline

b. Therefore, most disc herniations occur off to _____.

one side

34. Complete the following regarding lumbar disc herniation:

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a. The occurrence of voiding dysfunction in lumbar disc herniation varies from_____to_____%.

1 to 18%

b. Concerning bladder symptoms, what is the sequence from the earliest findings?

     i. d_____ b_____ s_____

decreased bladder sensation

     ii. u_____ u_____

urinary urgency

     iii. i_____ f_____

increased frequency due to increased postvoiding residual

     iv. e_____ and i_____

enuresis (bed wetting) and incontinence are rare

c. Urinary retention with overflow incontinence is suggestive of what diagnosis?

cauda equina compression

35. What is the most sensitive sign of herniated lumbar disc?

the Lasègue sign

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36. The significance of a positive crossed straight-leg raising sign is

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a. specificity for nerve root compression of _____%

90%

b. It suggests a more_____HNP.

central

c. It may correlate with a disc_____ _____ _____ _____ of the contralateral root.

fragment within the axilla

d. Lasègue specificity for root compression is_____%.

83%

e. For crossed Lasègue it is_____%.

90%

37. Describe a positive Lasègue sign.

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a. Patient’s position is_____.

supine

b. Raise leg by the ankle until_____ _____.

pain elicited

c. Pain occurs below_____degrees.

60

d. It is positive in_____% herniated nucleus pulposus (HNP).

83%

38. Describe the following techniques to elicit indications of nerve root tension:

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a. Lasègue sign_____ _____ _____

straight leg raising (SLR)

b. Cram test_____ _____ with _____ _____

extend knee with leg raised

c. Fajersztajn sign _____ _____

crossed SLR (central disc)= 97% HNP (crossed Lasègue test)

d. femoral stretch test_____

prone, knee maximally flexed = L2, L3, L4 root lesions

e. bowstring sign_____ _____ _____ _____

flex knee after SLR, hip pain persists but sciatic pain ceases

f. sitting knee extension_____ _____

sitting SLR

39. Describe the Faber test.

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a. another name?

Patrick sign

b. perform by?

flexion abduction external rotation

c. positive in?

hip pathology

40. Complete the following regarding the Trendelenburg sign:

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a. The affected hip_____ when the patient is walking,

dips

b. which indicates the contralateral thigh adductors are _____.

weak

c. This causes the contralateral pelvis to _____,

tilt

d. which is caused by a lesion of the_____root.

L5 (Affected hip dips when walking to indicate weakness of contralateral thigh adductors, or while standing on leg with weak adductors causes pelvis to tilt contralateral to weakness [L5 lesion].)

41. Complete the following about crossed adductors sign:

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a. Crossed adductors sign is positive when knee jerk is elicited and the contralateral thigh_____ _____.

adductors contract

b. If knee jerk is

     i. hyperactive it suggests_____.

UMN lesion

     ii. hypoactive it suggests_____.

pathological spread due to nerve root irritation

42. Complete the following about Hoover’s sign:

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a. It is a test to learn if patient’s leg weakness is_____.

functional

b. Examiner places hands under patients_____.

heels

c. Patient is asked to lift each leg from the_____.

bed

d. If when lifting the normal leg the weak heel pushes_____.

down

e. we know the leg has_____

strength

f. and the alleged weakness is_____.

functional

43. For the listed lumbar disc level, what is the frequency of herniated disc syndrome?

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a. L5-S1_____%

45 to 50%

b. L4-5_____%

40 to 45%

c. L3-4_____%

3 to 10%

44. Name physical findings associated with an L5-S1 disc herniation and where pain radiates.

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a. reflex, a_____A_____

absent Achilles tendon reflexes

b. motor, g_____w_____

gastrocnemius weakness (plantar flexion)

c. sensory, decreased at l_____m_____and l_____f_____

foot

d. pain, p_____c_____

posterior aspect of calf to the ankle

45. How many vertebrae (presacral) are there in the typical human?

24

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46. Name three indicators for emergency lumbar surgery.

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Hint: ces, pmd, ip

a. ces_____

cauda equina syndrome—urinary retention or overflow incontinence, saddle anesthesia

b. pmd_____

progressive motor deficit—“foot drop”

c. ip_____

intolerable pain (urgent)

47. List potential findings for cauda equina syndrome.

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Hint: cauda s

a. c_____

can’t function sexually—sexual dysfunction

b. a_____

ankle jerks absent

c. u_____

urinary retention/incontinence

d. d_____

diminished sphincter tone

e. a_____

anesthesia of saddle area

f. s_____

strength is decreased

48. True or False. The following is classically recognized as a cause of the cauda equina syndrome:

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a. tumor

true

b. epidural spinal hematoma

true

c. free fat graft following discectomy

true

d. trauma/fracture

true

e. lumbar stenosis

false (Lumbar stenosis is a more chronic process and therefore would not classically give an acute/subacute presentation of cauda equina syndrome.)

49. True or False. In cauda equina syndrome, surgery should be performed

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a. stat

false

b. within 24 hours

false

c. within 48 hours

true

d. within 72 hours

false

e. within a week

false

50. True or False. Comparing microdiscectomy to standard discectomy for lumbar disc herniation, which of the following are true?

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a. shorter incision

true

b. shorter hospital stay

true

c. less blood loss

true

d. better efficacy

false (Efficacy has been shown to be equivalent between the two techniques.)

e. may be more difficult to retrieve large fragments

true

51. Success rate at 1 year for surgical discectomy is_____%.

85%

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52. Success rate at 1 year for chemonucleolysis (CNL) is_____%.

44 to 63%

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53. The percentage of patients of chemonucleolysis who eventually undergo surgery for unresolved symptoms is_____%.

approximately 56% at 6 months

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54. Complete the following about intradiscal procedures:

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a. What percent of lumbar disc patients considered for surgery could be candidates for intradiscal procedures?

10 to 15%

b. What is the success rate of intradiscal procedures?

37 to 75%

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55. True or False. Following discectomy:

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a. epidural steroids prior to closure have no benefit.

true

b. systemic steroids and bupivacaine may reduce hospital stay and postop narcotic requirements.

true

56. True or False. Regarding epidural free fat graft:

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a. It can cause nerve root compression.

true

b. It is believed to reduce epidural scar formation.

Opinions on whether it reduces scar formation are mixed.

c. Some believe it may increase epidural scar.

true

d. It increases the incidence of postoperative infection.

false

e. It may cause cauda equina syndrome.

true, rarely

57. Characterize complications of lumbar disc surgery.

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a. mortality_____%

0.06% (1/1800 pts)

b. superficial infection_____% usual organism_____%

1 to 5%; Staphylococcus aureus

c. deep infection_____%

< 1%

d. discitis_____%

0.5%

e. motor deficit_____%

1 to 8%

f. durotomy_____%

0.3 to 13%

g. after redo_____%

18%

h. surgical repair_____

1/1000 pts

     i. pseudomeningocele_____%

0.7 to 2%

j. recurrent disc_____%

4% (1.5% first year) 10-year follow-up

58. Complete the following about durotomy:

G7 p.449:60mm

a. What is the incidence of incidental durotomy in lumbar laminectomy?

incidence is 0.3 to 13% (increases up to 18% in reoperations)

b. Give four possible complications related to incidental durotomies

     i. C_____

CSF fistula-requiring repair in ˜10 per 10,000

     ii. p_____

pseudomeningocele 0.7 to 2%

     iii. h_____

herniation of nerve roots

     iv. i_____

increased epidural bleeding

59. What is the incidence of recurrent herniated lumbar disc?

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a. same level either side in first 10 years _____%

˜4%

b. any level over 10 years_____%

3 to 19%

c. first year same level either side

d. any different incidence depending on level

two times more common at L4-5

e. same level recurrence_____%

74%

f. different level recurrence_____%

26% had herniated disc at another level

60. Complete the following regarding the anterior longitudinal ligament:

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a. Asymptomatic perforations occur in _____% of discectomies.

12%

b. Depth of disc space is_____.

3.3 cm

c. Vascular injury produces bleeding into operative field only_____% of the time.

50%

d. Great vessel injury mortality is_____%.

37 to 67%

61. Enumerate five complications related to positioning for lumbar discectomies.

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Hint: tecup

a. t_____

tibialis anterior compartment syndrome

b. e_____

eyes pressure

c. c_____

cervical spine injury

d. u_____

ulnar nerve compression

e. p_____

peroneal nerve compression

62. True or False. Regarding unintended durotomy:

a. Normal ambulation is not considered a cause for failure of dural repair.

true

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b. Risk of a cerebrospinal fluid (CSF) leak is increased in

     i. revision surgery

true

     ii. removal of ossification of the posterior longitudinal ligament (OPLL)

true

     iii. high-speed drills

true

c. It is not considered an act of malpractice.

true

d. The use of fibrin glue to close is advantageous.

true

e. It can be due to thinned dura by longstanding stenosis.

true

63. Enumerate four signs of postoperative cauda equina syndrome (i.e., from epidural hematoma).

G7 p.452:78mm

Hint: pain

a. p_____

pain out of the ordinary

b. a_____

anesthesia of saddle area

c. i_____

inability to void

d. n_____

numerous muscle groups weak

64. True or False. Regarding the outcome of surgical treatment of lumbar herniated disc:

G7 p.452:127mm

a. 5% will be classified as having failed back syndrome.

true

b. At 1 year the surgical group had a better outcome than with conservative treatment.

true

c. The benefit persisted at 10 years.

false (Surgery group had better outcome at 1 year but benefit was no longer statistically significant at 4-year follow-up. At 10 years neither surgical nor conservative treatment group complained of sciatica or back pain.)

d. 63% had complete relief of back pain at 1 year postop.

true

e. At 5- to 10-year follow-up 86% felt improved.

true

65. True or False. The percentage of patients with L3-4 disc herniation having a past history of L4-5 or L5-S1 disc herniation is

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a. < 10%

false

b. approximately 25%

true

c. approximately 50%

false

d. 60 to 80%

false

e. almost 90%

false

66. Characterize a herniated upper lumbar disc.

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a. What is the incidence?

     i. L1-2_____%

0.28%

     ii. L2-3_____%

1.3%

     iii. L3-4%_____

3.6%

b. Most common muscle involved?

quadriceps femoris

c. Femoral stretch test_____

may be positive

d. Knee jerk_____

reduced in 50%

67. Characterize extreme lateral lumbar disc herniations.

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a. What is the incidence?

3 to 10%

b. What level is most commonly involved?

     i. L4-5_____%

60%

     ii. L3-4_____%

24%

     iii. L5-S1_____%

7%

c. Enumerate four differences compared with other common disc herniations

     i. Straight leg raising (SLR) is negative in_____%.

85 to 90%

     ii. Pain is increased by lateral bending in_____%.

75%

     iii. Pain is more_____.

severe

     iv. Extruded fragments are_____.

more frequent

68. Distinguishing features concerning far lateral disc herniation include the following:

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a. The root involved is the root_____ _____ _____ _____

exiting at that level negative

b. SLR is_____.

negative

c. Lateral bending is_____.

likely to produce pain

d. Severity of pain is_____ because _____ _____ _____ is compressed.

greater; dorsal root ganglion

e. Most common levels are_____and_____.

L4-5 and L3-4

f. Best surgical approach is_____ _____.

standard hemilaminectomy (and follow nerve laterally; perform medial facetectomy)

69. Zones in which disc herniation can occur are

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a. c_____

central

b. s_____

subarticular

c. f_____

foraminal

d. e_____

extraforaminal

70. True or False. One third of extreme lateral lumbar disc herniations are missed on initial radiologic exams.

true

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71. To test for far lateral disc what is the value of postdiscography CT scan?

may be a most sensitive test— 94%

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72. Give the incidence of surgery for herniated discs in pediatric patients.

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a. under 20 years of age_____%

less than 1%

b. under 17 years of age_____%

less than ½ of 1%

73. Characterize intradural disc herniation.

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a. What is the incidence?

0.04 to 1.1%

b. Can it be diagnosed preoperatively?

rarely

c. It is suspected at surgery because of a_____ _____.

negative exploration

d. Does it require a surgical dural opening?

rarely

74. Characterize juxta facet cysts (JFCs).

G7 p.456:50mm

a. What are the types?

     i. s_____

synovial

     ii. g_____

ganglion

b. What is the incidence?

rare (1/500 spinal CTs)

c. Key to diagnosis on myelography or post-myelogram cat scan PMCT is a p_____f_____d_____.

posterolateral filling defect

d. Is it uni-or bilateral?

may be bilateral

e. Does juxta facet cysts suggest stability or instability to the spine?

check for stability—may serve as a marker of instability

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75. Regarding failed back syndrome, the failure rate for lumbar discectomy is_____%.

8 to 25%

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76. True or False. Regarding failed back syndrome, the following is the best test for detecting residual or recurrent disc herniation:

G7 p.459:45mm

a. myelography with postmyelogram CT scan

false

b. CT scan with infusion

false

c. MRI without and with IV gadolinium

true

d. unenhanced MRI

false

77. Answer the following about arachnoiditis:

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a. What test is used to differentiate residual or recurrent disc herniation from scar tissue and adhesive arachnoiditis?

MRI without and with IV gadolinium

b. Why is it so important to differentiate? Because surgical treatment for scar has_____.

poor results for scar tissue or adhesive arachnoiditis

78. Characterize recurrent herniated disc.

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a. second herniation_____%

3 to 19%

b. 10 years same level_____%

4%

c. 1 year same level_____%

1.5%

d. second recurrence_____%

1%

79. Does it take a larger or smaller disc herniation to cause symptoms in recurrent disc? Why? Because_____ _____ prevents the nerve from moving away.

smaller; scar tissue

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80. Where does the cervical root exit in relation to the pedicle?

in close relation to the undersurface of the pedicle

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81. Complete the following table concerning cervical disc syndromes:

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Table 18.1

82. Complete the following about intervertebral disc herniation:

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a. C6-7 disc causes a C_____ radiculopathy.

C7

b. C5-6 disc causes a C_____ radiculopathy.

C6

c. It may simulate a _____.

myocardial infarction

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83. A left C6 radiculopathy can simulate an _____ _____ _____.

acute myocardial infarction

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84. C8 or T1 nerve root involvement (i.e., a C7-T1 or T1-T2 disc) may produce _____.

a partial Horner syndrome

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85. The most common scenario for patients with herniated cervical discs is that the symptoms were first noticed upon _____.

awakening in the morning (without identifiable trauma and stress)

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86. Complete the following about intervertebral disc herniation:

G7 p.461:60 Table 18.18

a. C 4-5 disc compresses C _____ root _____.

C5 root exiting

b. L 4-5 disc compresses L _____ root _____.

L5 root passin

87. Narrowing the cervical foramen mechanically is called _____ _____.

Spurling sign

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88. Complete the following about the Spurling sign:

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a. performed by

     i. examiner exerting pressure on the _____

vertex

     ii. while patient tilts head toward the _____ _____

symptomatic side

     iii. with neck _____

extended

b. reproduces _____ _____

radicular pain

c. analogous to _____

SLR for lumbar disc— a mechanical sign

89. Give the accuracy of radiological workups.

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a. MRI is _____%.

85 to 90%

b. CT myelogram is _____%.

98%

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90. True or False. To fuse or not to fuse. Fusion is beneficial to

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a. a plate reduces pseudoarthrosis

true

b. a plate reduces graft problems

true

c. a plate maintains lordosis

true

d. improve clinical outcome

false

e. improve arm pain

true

f. provide more rapid relief of arm pain

true

g. maintain foraminal height

false

h. maintain disc space height

false

     i. reduce post op kyphosis

true

j. improve fusion rate

true

91. What is the incidence of vocal cord paresis due to injury of the recurrent laryngeal nerve (RLN)?

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a. Temporary _____%

11%

b. Permanent _____%

4%

92. True or False. A good way to treat vertebral artery injury is by

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a. packing

false

b. direct suture

true

c. endovascular trapping

true

93. The rare complication of sleep-induced apnea can occur with anterior cervical discectomy and fusion (ACDF) at the level of_____.

C3-4

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94. Characterize dysphagia following ACDF.

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a. Incidence early is_____%

60%

b. At 6 months only_____%

5%

c. Most serious cause is_____

hematoma

d. Prmanent recurrent laryngeal nerve injury_____%

1.3%

95.Characterize pseudoarthrosis following ACDF. On flexion extension cervical spine x-rays

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a.movement of more than_____ mm

2

b.between the_____ _____

spinous processes

c. lack of _____ across the fusion

trabeculation

d. I _____ around the screws

lucency

e. t_____ of the screws on flexion extension films

toggling

f. n _____uniformly associated with symptoms

not

96. For patients in certain professions we prefer to do posterior cervical surgery instead of anterior.

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a. Which two professions?

speaker and singer

b. The reason is there is a _____%

5%

c. incidence of _____ _____ after anterior cervical surgery.

voice change

97. Indications for posterior keyhole laminotomy are

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a. s_____ l _____d_____

soft lateral disc

b.occupation of s_____ or s_____

singer or speaker

c. l _____- or u _____-l _____ d _____

lower- or upper-level disc

98. Matching. Match the recommended sequence of bone removal with the recommended sequence for posterior keyhole laminotomy.

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Sequence of bone removal recommended:

superior facet of the vertebra below, inferior facet of the vertebra above, lateral aspect of lamina above Recommended sequence:

a. 1st area of bone removal

b. 2nd area of bone removal

c. 3rd area of bone removal

99. The success rate of posterior keyhole laminectomy is in the range of _____ to _____%.

90 to 96

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100. Characterize thoracic disc herniation.

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a. It usually occurs below the level of

T8

b. Because many are calcified it is wise to geta _____ _____.

CT scan

101. Characterize thoracic disc herniation.

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a. The incidence is _____% of all disc herniations.

0.25 to 0.75%

b. _____% occur between ages 30 and 50.

80%

c. Historyof trauma is _____%.

25%

102. Characterize access to the thoracic spine.

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a. upper _____

sternal splitting

b. mid _____

right thoracotomy (heart not in way)

c. lower _____

left-easier to mobilize aorta than vena cava

d. thoracolumbar _____

right to avoid liver unless pathology is far on left side

e. lumbar _____

pathology is far on left side transabdominal

103. Complete the following concerning the thoracic spine and spinal cord anterior access to:

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a. lower thoracic spine

     i. use _____ side thoracotomy

left

     ii. avoid _____ _____ easier to mobilize

vena cava

     iii. _____

aorta

b. thoracolumbar spine

     i. use _____ side retroperitoneal approach

right

     ii. thereby avoiding _____

liver