w Adult Spine 201
Self-Assessment Examination 201
2015
AAOS
Yowr Sorefor Lifelong Orthopaedic learig
,1 - MMFigures MM1 MMand MM2 MMare MMCT MMscans MMobtained MMfrom MMa MM68-year-old MMman MMwho MMhas MMhad
MMprogressive MMneck MMpain MMand MMstiffness, MMworsening MMgait MMimbalance, MMupper MMextremity MMweakness,
MMearly MMmuscle MMfatigue, MMdifficulty MMwith MMfine MMmotor MMcontrol, MMand MMdifficulty MMwith MMactivities MMof MMdaily
MMliving MMover MMthe MMpast MMfew MMyears. MMOn MMphysical MMexamination, MMhe MMhas MMa MMwide MMbased MMstiff MMlegged
MMgait, MMgeneralized MMupper MMextremity MMweakness, MMdense MMsensory MMloss MMin MMthe MMupper MMand MMlower
MMextremities, MMand MMmarkedly MMbrisk MMreflexes. MMWhat MMis MMthe MMmost MMappropriate MMtreatment MMfor MMthis
MMpatient?
Figure MM1 Figure MM2
A. Observation
B. Cervical MMepidural MMinjections
C. Multilevel MManterior MMcervical MMdecompression MMand MMfusion
D. Posterior MMcervical MMlaminoplasties MMfrom MMC3-6
Correct MManswer: MMD
This MMpatient MMhas MMprogressive MMmyelopathy MMsecondary MMto MMossification MMof MMthe MMposterior MMlongitudinal
MMligament. MMDiagnostic MMimaging MMreveals MMmultilevel MMcervical MMcord MMcompression MMfrom MMC4-6. MMThe
MMpatient MMhas MMmaintained MMreasonable MMcervical MMlordosis. MMA MMposterior MMprocedure MMsuch MMas MMmultilevel
MMlaminoplasty MMdecompresses MMthe MMspine, MMis MMmotion MMpreserving, MMand MMhas MMa MMlow MMcomplication MMrate.
MMObservation MMand MMcervical MMepidural MMinjections MMare MMnot MMviable MMoptions MMin MMpatients MMwith
MMprogressive MM MMmyelopathy. MMAnterior MMcervical MMdecompression, MMincluding MMcorpectomy, MMis MMan MMoption;
MMhowever, MManterior MMprocedures MMhave MMan MMincreased MMrisk MMof MMcomplications MMsuch MMas MMdural MMtear MMor
MMcerebrospinal MMfluid MMleak. MMThe MMaxial MMCT MMimage MMshows MMa MM"double MMlayer" M M
MMsign, MMwhich MMis MMconsistent MMwith MMdural MMossification MMand MMincreases MMthe MMrisk MMof MMdural MMinjury MMwith
MManterior MMdecompression.
2 - MMWhen MMcompared MMwith MMposterior MMdecompression MMand MMfusion, MMthe MMaddition MMof MMan MMinterbody
, fusion MMfor MMthe MMtreatment MMof MM MMdegenerative MMspondylolisthesis MMand MMstenosis MMhas MMbeen MMshown
MM
to M M
MM
A. result MMin MMincreased MMpatient MMfunctional MMoutcome MMscores.
B. reduce MMthe MMincidence MMof MMsymptomatic MMpseudarthrosis.
, C. increase MMthe MMlength MMof MMhospital MMstay.
D. increase MMhospital MMcosts.
Correct MManswer: MMD
The MMuse MMof MMan MMinterbody MMgraft MMhas MMbeen MMshown MMto MMincrease MMhospital MMcosts. MMGottschalk
MMand MMassociates MMfound MMno MMchange MMin MMOswestry MMDisability MMIndex MM(ODI) MMor MM36-Item MMShort-
Form MMHealth MMSurvey MM(SF-36) MMscores MMwhen MMcomparing MMpatients MMfused MMusing MMeither MMposterior
MMfusion MMor MMtransforaminal MMinterbody MMfusion. MMThey MMalso MMfound MMno MMchange MMin MMfusion MMrates
MMat MM3 MM years MMafter MMsurgery. MMCarreon MMand MMassociates MMshowed MMsome MMthat MMusing MMa MMposterior
MMplace MMinterbody MMtransforaminal MMlumbar MMinterbody MMfusion MM(TLIF) MMor MMposterior MMlumbar
MMinterbody MMfusion MM(PLIF) MMdid MMresult MMin MMimproved MMODI MMand MMSF-6D MMscores MMbut MMdid MMnot
MMresult MMin MMany MMchange MMin MMEuroQol MMfive MMdimensions MMquestionnaire MM(EQ-5D) MMscores. MMUsing
MMthe MMEQ-5D MMdata, MMthey MMestimated MMthat MMthe MMuse MMof MMan MMinterbody MMgraft MMbecomes MMcost
MMprohibitive MMif MMthe MMcharges MMexceed MM$1,570 MMabove MMthe MMcost MMof MMa MMposterior MMfusion. MMThe
MMuse MMof MMan MMinterbody MMcage MMhas MMnot MMbeen MMshown MMto MMincrease MMhospital MMstay.
3 - MMFigures MM1 MMand MM2 MMare MMMRI MMimages MMobtained MMfrom MMa MM22-year-old MMman MMwho MMfell MMfrom MMa MM2-
story MMbuilding. MMOn MMexamination, MMhe MMhas MMdiminished MMrectal MMtone MMand MMurinary MMretention. MMIf MMsurgical
MMstabilization MMis MMelected, MMwhat MMis MMthe MMmost MMbiomechanically MMstable MMoption?
Figure MM1 Figure MM2
A. Sacral MMplating
B. Iliosacral MMscrews
C. Iliosacral MMscrews MMand MMlumbopelvic MMfixation
D. External MMfixation
Self-Assessment Examination 201
2015
AAOS
Yowr Sorefor Lifelong Orthopaedic learig
,1 - MMFigures MM1 MMand MM2 MMare MMCT MMscans MMobtained MMfrom MMa MM68-year-old MMman MMwho MMhas MMhad
MMprogressive MMneck MMpain MMand MMstiffness, MMworsening MMgait MMimbalance, MMupper MMextremity MMweakness,
MMearly MMmuscle MMfatigue, MMdifficulty MMwith MMfine MMmotor MMcontrol, MMand MMdifficulty MMwith MMactivities MMof MMdaily
MMliving MMover MMthe MMpast MMfew MMyears. MMOn MMphysical MMexamination, MMhe MMhas MMa MMwide MMbased MMstiff MMlegged
MMgait, MMgeneralized MMupper MMextremity MMweakness, MMdense MMsensory MMloss MMin MMthe MMupper MMand MMlower
MMextremities, MMand MMmarkedly MMbrisk MMreflexes. MMWhat MMis MMthe MMmost MMappropriate MMtreatment MMfor MMthis
MMpatient?
Figure MM1 Figure MM2
A. Observation
B. Cervical MMepidural MMinjections
C. Multilevel MManterior MMcervical MMdecompression MMand MMfusion
D. Posterior MMcervical MMlaminoplasties MMfrom MMC3-6
Correct MManswer: MMD
This MMpatient MMhas MMprogressive MMmyelopathy MMsecondary MMto MMossification MMof MMthe MMposterior MMlongitudinal
MMligament. MMDiagnostic MMimaging MMreveals MMmultilevel MMcervical MMcord MMcompression MMfrom MMC4-6. MMThe
MMpatient MMhas MMmaintained MMreasonable MMcervical MMlordosis. MMA MMposterior MMprocedure MMsuch MMas MMmultilevel
MMlaminoplasty MMdecompresses MMthe MMspine, MMis MMmotion MMpreserving, MMand MMhas MMa MMlow MMcomplication MMrate.
MMObservation MMand MMcervical MMepidural MMinjections MMare MMnot MMviable MMoptions MMin MMpatients MMwith
MMprogressive MM MMmyelopathy. MMAnterior MMcervical MMdecompression, MMincluding MMcorpectomy, MMis MMan MMoption;
MMhowever, MManterior MMprocedures MMhave MMan MMincreased MMrisk MMof MMcomplications MMsuch MMas MMdural MMtear MMor
MMcerebrospinal MMfluid MMleak. MMThe MMaxial MMCT MMimage MMshows MMa MM"double MMlayer" M M
MMsign, MMwhich MMis MMconsistent MMwith MMdural MMossification MMand MMincreases MMthe MMrisk MMof MMdural MMinjury MMwith
MManterior MMdecompression.
2 - MMWhen MMcompared MMwith MMposterior MMdecompression MMand MMfusion, MMthe MMaddition MMof MMan MMinterbody
, fusion MMfor MMthe MMtreatment MMof MM MMdegenerative MMspondylolisthesis MMand MMstenosis MMhas MMbeen MMshown
MM
to M M
MM
A. result MMin MMincreased MMpatient MMfunctional MMoutcome MMscores.
B. reduce MMthe MMincidence MMof MMsymptomatic MMpseudarthrosis.
, C. increase MMthe MMlength MMof MMhospital MMstay.
D. increase MMhospital MMcosts.
Correct MManswer: MMD
The MMuse MMof MMan MMinterbody MMgraft MMhas MMbeen MMshown MMto MMincrease MMhospital MMcosts. MMGottschalk
MMand MMassociates MMfound MMno MMchange MMin MMOswestry MMDisability MMIndex MM(ODI) MMor MM36-Item MMShort-
Form MMHealth MMSurvey MM(SF-36) MMscores MMwhen MMcomparing MMpatients MMfused MMusing MMeither MMposterior
MMfusion MMor MMtransforaminal MMinterbody MMfusion. MMThey MMalso MMfound MMno MMchange MMin MMfusion MMrates
MMat MM3 MM years MMafter MMsurgery. MMCarreon MMand MMassociates MMshowed MMsome MMthat MMusing MMa MMposterior
MMplace MMinterbody MMtransforaminal MMlumbar MMinterbody MMfusion MM(TLIF) MMor MMposterior MMlumbar
MMinterbody MMfusion MM(PLIF) MMdid MMresult MMin MMimproved MMODI MMand MMSF-6D MMscores MMbut MMdid MMnot
MMresult MMin MMany MMchange MMin MMEuroQol MMfive MMdimensions MMquestionnaire MM(EQ-5D) MMscores. MMUsing
MMthe MMEQ-5D MMdata, MMthey MMestimated MMthat MMthe MMuse MMof MMan MMinterbody MMgraft MMbecomes MMcost
MMprohibitive MMif MMthe MMcharges MMexceed MM$1,570 MMabove MMthe MMcost MMof MMa MMposterior MMfusion. MMThe
MMuse MMof MMan MMinterbody MMcage MMhas MMnot MMbeen MMshown MMto MMincrease MMhospital MMstay.
3 - MMFigures MM1 MMand MM2 MMare MMMRI MMimages MMobtained MMfrom MMa MM22-year-old MMman MMwho MMfell MMfrom MMa MM2-
story MMbuilding. MMOn MMexamination, MMhe MMhas MMdiminished MMrectal MMtone MMand MMurinary MMretention. MMIf MMsurgical
MMstabilization MMis MMelected, MMwhat MMis MMthe MMmost MMbiomechanically MMstable MMoption?
Figure MM1 Figure MM2
A. Sacral MMplating
B. Iliosacral MMscrews
C. Iliosacral MMscrews MMand MMlumbopelvic MMfixation
D. External MMfixation
