1 What is spinal arthrodesis? Spinal arthrodesis is defined as osseous union (fusion) between adjacent vertebrae due to surgical intervention. During surgery, adjacent bone surfaces are decorticated and graft material is applied to promote bone growth between adjacent vertebrae. Spinal instrumentation or external immobilization may be utilized to limit motion at the surgical site and enhance fusion. Spinal arthrodesis procedures are broadly categorized by location as…

General principles 1 What is spinal decompression surgery? Spinal decompression is a general term that refers to a range of surgical procedures that are performed to relieve symptoms due to compression of the spinal cord and/or nerve roots. Spinal decompression may be accomplished using direct and/or indirect methods and is often performed in conjunction with spinal implants and/or spinal fusion. 2 Explain what is meant by…

1 What types of adverse events are encountered in the early postoperative period following spinal procedures? In the postoperative period, adverse events (AEs) may involve the surgical site or arise due to systemic or medically related causes. Surgical site AEs include those related to the surgical approach, neural decompression, spinal instrumentation, bone graft site, wound healing, and wound infection. Systemic or medically related AEs include events…

1 What is intraoperative neurophysiologic monitoring? Intraoperative neurophysiologic monitoring refers to the various neurophysiologic techniques used to assess functional integrity of the nervous system during surgical procedures that place these structures at risk. 2 What neurologic structures are at risk during spinal surgery? Spinal cord and/or nerve roots at the surgical site Spinal cord and/or peripheral nervous system structures remote from the surgical site, including spinal…

1 What are some key areas of focus in relation to perioperative anesthetic management of spinal surgery patients? 1. Preanesthetic patient risk assessment and optimization for surgery 2. Assessment of procedure-specific risk factors 3. Identification of a potentially difficult airway, cervical instability, or spinal cord compression 4. Hemodynamic monitoring requirements 5. Intraoperative neurophysiologic monitoring and anesthetic agent selection 6. Intraoperative positioning 7. Maintenance of normothermia 8.…

1 What are some factors which influence complication rates associated with spinal procedures? Type of procedure Whether elective or emergency Chronologic age of the patient General health status of the patient and medical comorbidities Institution where surgery is performed 2 What are some examples of types of elective spinal procedures that are associated with a relatively low risk of complications and perioperative morbidity? When performed in…

1 What are some critical factors that determine the outcome of a spinal procedure? Critical factors that determine whether a spinal procedure is a success or failure include: Surgical indications Surgical procedure (type and invasiveness) Surgical technique Timing of surgery Patient psychosocial factors Medical comorbidities Biologic factors It is critical to perform the appropriate surgical procedure for the correct indications with technical proficiency at the appropriate…

1 What is a spinal orthosis? A spinal orthosis is a device that provides support or restricts motion of the spine. Spinal orthoses may also be prescribed to treat spinal deformities such as scoliosis. All orthoses are force systems that act on body segments. The forces that an orthosis generates are limited by the tolerance of the skin and subcutaneous tissue. 2 List some common indications…

General considerations 1 What specialists perform diagnostic and therapeutic spinal injections? A diverse community of physicians from many specialties perform spinal injections including anesthesiologists, physiatrists, interventional radiologists, neurologists, and spine surgeons. 2 What is the preferred setting for performing spinal injections? The preferred setting for both diagnostic and therapeutic spinal injections is the sterile environment of an outpatient/ambulatory surgery suite or hospital operating room. Fluoroscopy is…

Thoracic spine 1 What etiologies are included in the differential diagnosis of patients who present for initial assessment and management of symptoms attributed to the thoracic spine in an outpatient setting? Diagnosis of patients referred for evaluation of thoracic spine conditions is not always straightforward. Thoracic spine pain may arise from a variety of sources including thoracic and cervical spinal structures, chest wall structures, as well…

1 What etiologies are included in the differential diagnosis of patients who present for initial assessment and management of symptoms attributed to the cervical spine in an outpatient setting? The most common cervical diagnoses in patients who present for initial evaluation for nonsurgical management in an outpatient clinic or office setting include axial neck pain, radiculopathy, and myelopathy. These conditions may present singly or in combination.…

1 What nuclear medicine studies play a role in the evaluation of spinal pathology? The technetium-99m ( 99m Tc) bone scan has demonstrated utility in the evaluation of osseous lesions. Positron emission tomography (PET) with 18 F-fluoro-2-deoxy-2D-glucose (FDG) has shown utility in diagnosis of spinal metastatic disease, infection, and bone marrow abnormalities, while 18 F-sodium fluoride (NaF) PET has shown utility in the assessment of skeletal…

1 What is computed tomography? Computed tomography (CT) is a noninvasive imaging technology that generates detailed cross-sectional images using a computer and rotating x-ray emitter. The CT scanner is a circular, rotating frame with an x-ray emitter mounted on one side and x-ray detectors mounted on the opposite side. As the patient lies on a mechanical table, which moves through the CT gantry, the scanner rotates…

1 What is magnetic resonance imaging (MRI)? Magnetic resonance imaging (MRI) is a noninvasive imaging technology that uses magnetic fields and radiofrequency (RF) current to generate three-dimensional anatomical images without the use of ionizing radiation. The components of an MRI system include the main magnet, gradient coils, a RF coil, a computer system, and a patient table that passes through a horizontal tube (bore) running through…

General 1 What features distinguish screen-film radiography (SFR) versus computed radiography (CR) versus digital radiography (DR)? Screen-film radiography (SFR), also known as conventional or film-based radiography, utilizes a light-sensitive silver halide–coated film placed within a cassette containing two intensifying screens, which is placed behind the patient to be imaged and exposed to an x-ray beam. Radiographic contrast is dependent on differential attenuation of x-rays as they…

1 What are the major objectives of spinal imaging tests? Common reasons to order spinal imaging studies are to: 1. Rule out serious spinal pathology, such as tumor or infection. 2. Screen the spinal column for injuries following trauma. 3. Identify and assess spinal cord and/or nerve root compression. 4. Identify and evaluate spinal instabilities and deformities. 5. Create a topographic map to guide surgical intervention.…