3.8 of 74 Ratings
A 49-year-old-male that is a current pack-per-day smoker underwent a lumbar L3-S1 posterior spinal fusion for severe multilevel spinal stenosis. The patient has a history of diabetes mellitus and a body mass index (BMI) of 37. Perioperatively the patient received 900 mg of clindamycin every 8 hours, which continued for 24 hours post-operatively. Intraoperatively two drains were placed, one subfascial and one suprafascial. Post-operatively there was a large volume of drainage that necessitated drains for 5 days before removal. At the patient's 5-week post-operative follow-up he was found to have a surgical site infection. Which factor is most related to developing the surgical site infection?
Subfascial drain placement
Vancomycin powder applied to wound at the time of closure
Wound drains present beyond perioperative antibiotic coverage
Increased drain output
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Which factor has been associated with worse patient-reported outcomes for those undergoing surgical correction of adult spinal deformity?
Lack of patient reported allergies
Preoperative Oswestry Disability Index scores
Preoperative sagittal vertical axis >+5 cm
Figures A and B are anteroposterior and lateral standing stereoradiographic images of a 55-year-old male with chronic back pain and gait abnormality. Surgical correction of which parameter will be most important for improving his health-related quality of life (HRQOL) scores?
Apical vertebral rotation
C7 sagittal vertical axis
Coronal cobb angle
Coronal plumb line
What is the incidence of major complications following adult spinal deformity surgery?
Which of the following figures show an asterisk that correctly quantifies the amount of sagittal imbalance?
A 53-year-old woman is seen in the adult spine clinic for long-standing back pain. History reveals she had untreated scoliosis as a child. Her current radiographs are shown in Figures A and B. Due to discomfort with ADLs and progressive pain, surgical intervention is planned. Which of the following factors would increase her risk of nonunion?
An anterior thoracoabdominal approach
Preoperative Cobb angle of 60 degrees
Age greater than 35 years
A posterior midline approach
Positive sagittal balance < 5 cm
In patients with adult scoliosis requiring long thoracolumbar fusions, which of the following is the major advantage of extending the fusion to the sacrum as opposed to ending at L5.
Improved function outcomes
Decreased pseudoarthosis rates
Decreased major medical complications
Improved correction and maintenance of sagittal balance
Improved curve correction in the coronal plane
In adult patients with scoliosis, severity of symptoms correlates with which of the following variables?
Magnitude of coronal Cobb angle
Number of spine levels involved in the deformity
Level of the apex of the curve
A 66-year-old female presents to your clinic complaining of back pain, difficulty standing-up straight, weakness in her legs, and neurogenic claudication. On upright thoracolumbar radiographs, there is a 75 degree thoracolumbar curve with the apex at L2, and the C7 plumb line falls 12 cm anterior to the posterosuperior corner of S1. Aside from a decompression of the stenotic levels, which of the following choices will lead to the MOST reliable decrease in overall disability?
Ensuring the lumbar lordosis is within 15 degrees of the pelvic incidence
Decreasing the cobb angle to less than 25 degrees
Correcting the sagittal vertical axis to +3 cm from neutral
Increasing the pelvic tilt to greater than 20 degrees
Stopping the fusion at L5