Diagnostic Imaging, CervicoThoracic, Supine ALIF, XLIF Quiz, Biologics, iOS - NVM5 & Bendini, iGA, Spine Fundamentals, NVM5 Troubleshooting, TL Fixation, MAS Midline / TLIF
What is an example of a pathology that would not require decompression?
psudo-arthrois
Why is the Pile Driver ideal for segmental reduction
reduces rod and delivers set screw in one instrument
Tulip heads should be loaded onto MAS Guide Towers to aid with what?
reduction of the rod
Deformity into the coronal plane is defined as:
scoliosis
26. Do not thaw saline at a temperature higher than _______ degrees Fahrenheit.
102
What are two disadvantages of PEEK as a material?
D: Wear Not biocompatible
Describe Osteoconduction
"Scaffold" materials that bone cells can attach to
Describe Osteoinduction
"Signals" from proteins that recruit and direct cells to from bone
How many lock screws will the multi-load lock screw starter hold? For what use is this instrument ideal?
(8) is the max but (6) is recommended Best Used with the rocket - no tube
10. For ideal sagittal alignment, the relationship between PI and LL should be within _____ degrees
+-10 deg
What are all the BASE lordotic options offered?
- 10 deg - 15 deg - 20 deg - 25 deg - 30 deg
BASE Ti Interfixated offers ____ % more graft volume than that of Brigade Interfixated./
- 25%
33. What is the shelf life for Osteocel at -80 degrees Celsius? What is the shelf life between -45 degrees and -75 degrees Celsius?/
- 5 years - 90 days
Describe PCF
- A surgery to relieve cervical spinal cord pressure and/or myelopathy. Lamina is commonly removed after fixation is added.
Describe ACDF
- A surgery to remove a herniated or degenerative disc in the cervical area of the spine using and anterior incision through the throat area.
57. What is the crucial surgical step that makes FormaGraft® a complete biologic product, containing all three O's?/
- Add BMA to the FormaGraft prior to implantation
What are some of the most common surgical challenges present with adult spinal deformity patients?
- Alignment - Prior fusions - Poor bone quality - Rigid spines
Why does Brigade SA feature an all PEEK design versus having meal as part of the locking mechanism?
- All PEEK design provides for single step simplicity with as few instruments as possible for screw locking - Lack of pre-existing threads on the PEEK locking mechanism ensure no possibility of cross threading - The less metal that is part of the construct, the easier it is to view fusion progress on CT, MRI. and X-Rays
7. What are the four main categories of bone grafting options?
- Autograft - Allograft - Synthetic - BMP
8. List the five Biologic market segments:
- Autograft - Allograft - Sythetic - Celluar Allograft - Growth Factors
NVM5 Error - "Incomplete Stim Path"
- Check the anode ( - Check the cathode (clip or probe)
Which of the following is an associated goal that the Brigade Hyperlordotic ALIF addresses?
- Correction of coronal alignment - Restoration of Sagittal Balance - Indirect decompression - Restoration of disc Height
What are the two issues of the Helical Flange lock screws significantly reduces? How so?
- Cross Threading - head Splaying
What are 2 causes of adult scoliosis?
- Disc Degeneration / aging - Untreated AIS
MAS TLIF Modular Screw advantage
- Distraction off screw shank - visualization of the disc space - more real estate to work in - assembling screws in-situ
What degrees of lordosis is CoRoent Small Interlock Hyperlordotic available?
10 deg 15 deg 20 deg
Degenerative scoliosis is defined as a greater than ___ degree curve in the coronal plane
10 degree
The goal of the Leverage® LFS laminoplasty system is to provide safety reproducibility and ease-of-use while eliminating the most delicate steps of __________________ and ___________________ over an exposed ________________ and ____________________ lamina.
- Drilling - Screwing - spinal cord - hinged
What are causes of Erroneous EMGs Results
- False Negatives -- Neuromuscular Blocking Agents ---- Should be seeing red values but instead are seeing False Greens
ExtenSure H2 is a cortical allograft to promote midline fusion. What are some of the benefits of ExtenSure H2?
- Femoral cortical allograft - Seats securely to maintain distraction - Promotes midline fusion - Saline packaged
6. Define scoliosis and list the four main types:
- Fixed lateral curvature of the spine in the coronal plane which is >10 degrees 1. Congenital- from genetic malformation of bone 2. Neuromuscular- results from neurologic or muscular disease 3. Idiopathic- unknown cause, in young patients 4. Adult- adult onset or untreated from adolescence
55. In what shapes and sizes is FormaGraft available?/
- Granules (10cc / 20cc) - Blocks (Small / Large) - Strips (Small / Large)
Describe Laminoplasty
- Lamina is partially cut on both sides and moved to an open position to create more space for the spinal cord.
Increased stability, fusion area, and reduced potential for subsidence are benefits of ALIF Attributed to:
- Large graft footprints and apertures
2. To best achieve alignment and clinical success, the following spinopelvic parameters are recommended to be measured:
- Lumbar Lordosis - Pelvic Incidence - Pelvic Tilt - Sacral Slope - Sagittal Vertical Axis
What NuVasive products are integrated into the MAS TLIF procedural solution?
- MAS TLIF Retractor - Modular Screws - NVM5 - IPAS or ConSol
Provide at least 2 points of differentiation between RELINE and competitive systems. Why is RELINE better than all other posterior fixation systems?
- MOD and traction screws - Versatility
What are the 3 dimensions of the screw that need to be taken into consideration?
- Medial / Lateral Profile - Run on Rod - tulip Diameter
Open TLIF Benefits Include:
- Midline incision (typical) - Full exposure of anatomy - Thorough decompression and disc preparation - Relatively efficient - Conventional, familiar technique
Name the advantages of a spinous process plate fixation
- Minimal Tissue Disruption - Direct Decompression - Safe access to neural elements - fewer peri-operative complications
Open TLIF Limitations Include:
- More traumatic to patient - Destructive to supporting / adjacent anatomy - Greater chance of infection - Longer hospital stays - Longer return to normal activity
MAS TLIF's retractor advantages include:
- Multi-Directional blades - Quick connect attachment - simple + secure shank to blade attachment - customizable access for optimal visibility
List the 3 functions of the Reline Multi-functional screwdriver
- Open Polyaxial Screws - Reduction Screws - Stab and Grab Driver
19. Adjusting ___________________________ is one of the first compensatory mechanisms our body has to compensate for loss of lumbar lordosis. This is known as ______________________ the pelvis.
- PELVIC TILT - Retroverting
Consistence responses of >40mA
- Patient most likely has paralytics - Perform a Twitch Test to ensure you're above 75% 4th Twitch divided by the First - Ensure no Fade
During MAS Midline, what is the advantage of placing the cephalad shanks first prior to decompressing
- Provides Landmarks for Decompression
List the benefits of the MAS MIDLINE retractor:
- Radiolucent retractor blades - Ability to attach to a retractor arm / bed for more rigidity - Lighted - Retractor blades able to adapt to the patient specific anatomy without disrupting the posterior elements - easy transition from blade handles to retractor system
The CoRoent Small Interlock system is designed to ______________the number of steps in an ACDF procedure; maximize intraoperative _______________________ and _____________________ while helping to minimize the intraoperative ___________________.
- Reduce - Visibility - Versatility - exposure
30. How should you recommend your surgeon prepare the fusion site when using Osteocel?/]
- Remove all disc material - Use a rasp to prepare the end-plates to create bleeding bone
What is the benefit of the NuVasive 3CO Rack during osteotomies (specifically PSO or VCRs)?
- Rigid external fixation w/ direct visualization into the osteotomy site
Describe the challenges associated with traditional open TLIF/PLIF that MAS MIDLINE addresses
- Significant medial-lateral retraction - Reduces Muscle Disruption - Reduces blood-loss - Preserves neuro-vascular integrity of multifidus
MIS TLIF Limitations include:
- Steep learning curve - Increased surgical time - Limited exposure - Unfamiliar approach - Anatomical reference challenges
NVM 5 Error - During a Nerve Stim you see "1 mA"
- This means you have electrical interference or "noise" - Noise means something external is affecting the NVM 5 system
What are our NuVasive Triad Cervical Allograft interbody options and the corresponding offerings of each?
- Triad STD - Triad CC - Triad CR
BASE is available in both fixed and variable angulation bolts. True-False
- True,
What are the benefits of CoRoent Small Hyperlordotic?
- Unmatched Options to Fit Varying Patient Anatomies - Fluoro Visibility for Precision Placement - Large Fusion Aperture - Simplified Instrumentation for Ease of Use
MIS TLIF Benefits Include:
- Wiltse / paramedian approach - Less muscle stripping - Shorter hospital stay - Faster return to normal activity - Patients want "minimally invasive" procedures
Define Foraminotomy
- a decompression surgery performed to enlarge the passageway where a spinal nerve root exits the spinal canal
Define Laminectomy
- an invasive procedure in which the neural arch is removed to alleviate the pressure on the pinched nerve
Why are Osteotomies performed?
- decompress or mobilize - correct overall sagital + coronal alignment
What feature of our NuVasive® Triad Allograft promotes superior strength and allows for ready-to-use capabilities?
- harvested from one solid piece of femur - Saline packaging- Triad allograft is always ready to go (no refrigeration needed) • We offer a breakage guarantee
The Leverage LFS allows for drilling and screwing over an intact ____________________ by moving the _________________ step in the traditional procedure to the ______________ step in the Leverage LFS procedure. This provides a greater level of patient _________________ and ease-of-use while retaining all the benefits of the _______________________ laminoplasty procedure.
- lamina - last - first - safety - open door
Define Microdiscectomy ("cutting out disc")
- minimally invasive procedure in which a portion of a herniated nucleus pulpous is removed with instrument or laser
Define Facetectomy
- performed in a partial (typically medial) or a complete way - full facet removal
Describe MIS Lateral (XLIF)
- preserves posterior muscles, bones and ligaments. No retraction of posterior nerves. No access to L5-S1 and risk of potential injury to lumbar plexus.
The Affix III new design features which of the following features
- simplified locking mechanism - anatomical felxibility - grit-based surface
How do the NuVasive Adjacent Segment Fixation Systems address these challenges?
- streamline fusion mass removal - minimize tissue disruption - connects onto a variety of existing constructs - integration w/ Bendini - Armada + REL ROD CON
34. In what incidences does the equation LL = PI +
-10 have limitations?/
47. ODI (Oswestry Disability Index) scores range from 0 to 100, with the scoring indicated below: • 0-20: ___________________ • 21-40: ___________________ • 41-60: ___________________ • 61-80: ___________________ • 81-100: ___________________
0-20: Minimal disability • 21-40: Moderate Disability • 41-60: Severe Disability • 61-80: Crippling back pain • 81-100: These patients are either bed-bound or have an exaggeration of their symptoms
The height of the CoRoent Contoured is ______mm taller at the apex of the dome than the implants labeled height.
0.5 mm
How many points of contact does the pile driver have on the rod?
1 point of contact
10. What are the 3 main approach types for deformity procedures?
1) Anterior 2) Posterior 3) Anterior/posterior
2. What are the four main objectives for spinal surgery?
1) Decompress neural elements 2) Restore proper alignment 3) Stabilize with internal fixation 4) Fusion for long-term stabilization
4. Name the two key patient benefits to a Motion Preserving Procedure (TDR)?
1) Deliver pain relief 2) Maintain normal range of motion
5. What are the 3 main reasons when a spine fusion is considered necessary?
1) Diminish pain through elimination of motion between spinal segments 2) Re-establishment of spinal stability 3) Prevention of progressive spinal deformity
6. What are the 3 main tools used in a spine fusion?
1) Intervertebral implants/spacers 2) Fixation (internal brace) 3) Biologic material
40. To prevent material from becoming clogged in the Graft Funnel, ________cc of material should be driven into the tube with each pass, and repeated until is fully loaded or desired volume has been achieved./
1-2cc
Define Pathology
1. A pathology is: anatomic and physiological deviations from the normal that constitute disease or characterize a particular disease
CoRoent Small Hyperlordotic is available in what degrees of lordosis?
10 / 15 / 20 degree
Which are the only two vertebrae in the spine with their own names?
1. Atlas & Axis
How does MAS TLIF address the challenges associated with MIS TLIF
1. Avoids Steep Learning Curve - Direct visualization - Exposure defined by known anatomical landmarks 2. Retractor anchored to spine via modular pedicle screw system 3. Conventional Surgery Through a Less Disruptive Approach 4. Efficient Step-by-step technique
14. Name and define the four different types of spinal fractures
1. Burst- loss of height on both front and back sides 2. Compression- the fron of v-body breaks and less height, but the back end does not 3. Fracture dislocation- bone and soft tissue break off and move off an adjacent vertebra 4. Chance fracture- vertebra are pulled apart
4. What are the 4 main spine region names and how many vertebra are in each?
1. Cervical - 7 2. Thoracic - 12 3. Lumbar - 5 4. Sacral - 9
What are Interlock's insertion technique options?
1. Freehand 2. DTS Guided
1. Mobilize tissue off the ____ and ____ in preparation for the medial blade with cobb or bovie using the grey handle MAS TLIF Cobb 2. The ____ is used to determine the correct medial blade length 3. Using long _____, place into M/L bolt and open ____ to gain _____ exposure 4. Place long T-handle into "Tilt" bolt to ____ medial blade 5. Once the surgeon is content with their medial exposure press the "_______" release button on the inserter for the medial blade and pull straight up
1. Lamina / facet capsule 2. cobb 3. T-Handle / clockwise / medial 4. splay 5. "gold"
17. Describe four different types of cervical pathology:
1. Ossified posterior longitudinal ligament- pll of cervical spine is ossified and cause spinal cord compression 2. Rheumatoid spondylitis- damage to supporting joint surfaces (facets), ligaments, and muscles allowing for abnormal movement in cervical spine joints 3. Atlanta-axial instability- excessive movement between c1 & c2 4. Subaxial instability- occurs when erosion of the facets, discs, and interspinous ligaments of c3-C7 have slippage
2. What are two types of spine fusion procedures?
1. Posterior-lateral Fusion 2. Interbody Fusion
1. What are the three main purposes for spine fusion?
1. Prevention of progressive spinal deformity and/or maintenance of corrected deformity. 2.Re-establishment of spinal stability following disruption of structural integrity. 3. Diminish pain through elimination of motion between spinal segments.
What are the disadvantages of using fluoroscopy?
1. Radiation Exposure / 2. Tech is needed / 3. Sterile Drape / 4. Not able to see soft tissue / 5. Distorts image slightly at periphery of image
What are the advantages of using fluoroscopy?
1. Real Time Intraoperative Use / 2. Fast / 3. Easy / 4. Good images of bone / 5. Cheap (relatively)
Describe the value of the table fixation component of the MaXcess- C Retractor:
1. Reduces retractor migration and 2. Reduces tissue creep
What are the 3 CoRoent Small Interbody products that all come in the CoRoent SLP tray ("CRVIMP") cervical implant tray? What are their respective footprints?
1. Small - 14 X 11mm 2. Small Lordotic Plus - 15 X 13mm 3. Small Lordotic - 14 X 11m
5. What are the three main requirements for spine fusion?
1. Stability 2. Loading 3. Nutrient-rich Environment
Oblique Trialing: 1. Utilize ____ Technique 2. When rotating, rotate trial so the "____" and "____" markers on shaft are oriented medial and lateral with respect to the patient 3. In the ____ plane the trial needs to be past the ______ 4. In the ____ plane the trial should span the ______ 5. Release _____ following trial placement to determine appropriate size 6. _______ rotate down & ______ trial
1. insert & rotate 2. medial / lateral 3. sagittal / spinous process 4. sagittal / apophyseal ring 5. distraction 6. implant / remove
50. According to the article, Rothenfluh et. al. - Eur Spine 2014, Patients pelvic incidence-lumbar lordosis mismatch greater than 10 degrees exhibit a ________-times higher risk for undergoing revision surgery than controls if sagittal malalignment is maintained after lumbar fusion surgery.
10X
43. What is the average range of pelvic tilt? ____ to ____ degrees.
10_ to _25_ degrees
38. The delivery system can load up to _______cc of previously thawed Osteocel Pro/
10cc]
What are the Monolith cage core sizes?
12mm 14mm
List the X-CORE Mini Core Aperture options:
12mm 14mm
What is Nuvasive Power's Max Torque?
140 in/lbs
The MLX grating system (Revolver) holds ________ cc's of graft. The MLX implant can hold up to _____ cc's of graft in its central aperture
15cc 13cc
How does the Reline tulip profile compare to Solera 4.75mm?
15mm - Reline MAS Midline - 5.0 - 5.5 - 6.0 Cobalt Chrome 14.8 - Solera 4.75
List the benefits of the Reline/Precept Reduction Screws:
15mm reduction built in Good for scoli cases Degen - up to 4 levels
Monolith assembled height ranges from ______ to ______ mm.
16-55
The average distance from one uncinated process to contralateral uncinate processes is typically ______ to ______mm which is the amount of real estate the surgeon has to decompress the disc space.
18 to 22mm
With the bull dozer, how many points of contact are on the rod?
2
Describe the following X-CORE Mini Design Goals: a. Modular -
2 Core diameters 5 Endcap footprints 4 Endcap shapes
How is Osteocel Pro different from Osteocel Plus in the DBM Content:
2.5x more DBM content for increased osteoinductive potential.
52. Why do degenerative surgeons who only focus on 1 or 2 level procedures in the lumbar spine need to consider spinopelvic parameters and alignment during surgery?
2/3 OF LUMBAR LORDOSIS FOUND AT L4/5 AND L5/S1 TREAT SPONDYLOLISTHESIS POST-OP PI-LL MISMATCH 10 TIMES MORE LIKELY TO NEED ADJACENT SEGMENT DISEASE AND REVISION SURGERY - COSTLY DOWN THE ROAD, MAKE IT MORE PREDICTABLE FOR SUPERIOR CLINCIAL OUTCOMES REDUCE COST, INCREASE VALUE, PATIENT SATISFACTION
Monolith offers up to _______° of total construct lordosis/kyphosis possible.
20 deg
6. PT should be less than ______ degrees for optimal clinical outcomes.
20 degrees
59. What was the union rate of the 23 patients in this study?/
21 / 23 91.3%
Helix-R features screw angulation of ______ degrees.
25 deg
Archon features a screw cone of angulation of ______ degrees.
29 degrees
How much translation at each level will the Helix-T plate allow?
2mm
The X-CORE® Mini endcap spikes are _______ mm to maximize stability.
2mm
Explain for each of the following five indications the reasons why a surgeon would choose to use a Posterior Approach to the Cervical Spine: - Multi-level Pathology:
3+ Levels = healing rates decrease to the 80th percentile. Corpectomies of more than two vertebral bodies (three discs or more) have a high failure rate
What is the MAX RPM of Nuvasive Power?
300 RPM
How much reduction does the Bulldozer instrument provide?
30mm
12. There _____ total spinal nerve roots: a. 29 b. 30 c. 31 d. 32
31 8 cervical, 1 2 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
34. Describe the coccyx:
4 small fused vertebrae commonly referred to as the tailbone
How does the Archon-R plate compare biomechanically to conventional plates in the following motion planes: a. Flexion/Extension: b. Lateral Bending: c. Axial Rotation:
40% in flexion/extension 57% in lateral bending 65% in axial rotation
42. What is the average range of pelvic incidence? ____ to ____ degrees.
40_ to _65_ degrees
8. Normal SVA can vary slightly with age, however, a threshold of less than ____ cm is considered normal.
5 cm
What degree of lordosis is CoRoent SL & SLP?
5 degrees
Most surgeons will treat the patient from the ________ side, depending on the individual patient's anatomy. This typically allows access to the L4
5 space and increases the number of levels accessed through one incision/ A) Concave
What rod diameters does the Reline tulip accept? How does this differentiate it in the marketplace?
5.0 5.5 6.0 Most tulip heads in the competitive market can only accommodate 1 or 2 size rods.
Reline ASF connectors can connect onto what diameters of rods? Armada ASF?
5.0 - 6.0 - silver 6.35mm green Armada - 5.5-6.0
Reline's universal tulip accommodates what rod diameters?
5.0 / 5.5 / 6.0
What rod sizes and metals are available in Reline?
5.0, 5.5, 6.0 Cobalt Chrome / Titanium
Roughly what percentage of your head's flexion and extension comes from the C0-C1 joint?
50%
Roughly what percentage of your head's rotation comes from the C1-C2 joint?
50%
How much reduction does the pile driver provide?
50mm
62. By one-year postop _____ of 56 patients (______%) were fused./
51 91%
What is Nuvasive Battery life?
55 minutes straight run time
39. For best results, material should be loaded into the Graft Funnel in _____cc increments.
5cc
34. Once thawed, Osteocel is ready for use and should be used within ________ hours. /
6 hrs
For a pedicle subtraction osteotomy on a heavy adult patient which rod diameter & material would you recommend to your surgeon?
6.0 cobalt chrome
39. ______% of our lumbar lordosis is L5-S1. ____ to ____% of our lumbar lordosis is L4-S1.
60% 60-80%
52. Hydroxyapatite (HAp) and beta tric-alcium phosphate (β-TCP) comprise the mineral composition of FormaGraft. What is the ratio of each?/
60% Hydroxyapatite 40% Beta Tri-calcium
5. There are ____ cervical vertebrae. a. 5 b. 6 c. 7 d. 8
7
Multi-level cervical reconstruction corpectomy procedures can have up to a ______% incidence of failure and often require additional _____________________ fixation.
71% posterior
32. The Osteocel shipping containers will maintain the integrity of the tissue for how many hours?/
72
13. There are ___ cervical nerve roots a. 6 b. 7 c. 8 d. 9
8
51. Degenerative surgeons make up approximately what percentage of the surgeon community?
80-85%
50. FormaGraft® is made up of a mineral composition and type-1 bovine collagen. What is the ratio of each? /
88% mineral 12% collagen
The average lateral mass is _____-_____mm deep from a sagittal perspective
9-11mm
61. Complete interbody fusion with Osteocel Plus was shown in _______% of XLIF levels (______/61), with the remaining _______% being partially consolidated and progressing towards fusion at ______ months./
90.2% 55 / 61 9.8% 12 months
Paddle distractors specifically designed for the cervical spine are included with the MaXcess-C system to facilitate in accessing severely collapsed disc spaces. a. True b. False
; ; True
With Brigade SA in L4-L5 cases, start with straight screw insertion drivers into ______
A) L4
Brigade Contoured Plate design makes it ideal for:
A) L4/5
Describe how Pelvic Incidence (PI) parameters are measured
A line drawn from the center of the femoral head to the center of the S1 Endplate A line drawn from the center of the S1 endplate perpendicular to the S1 Endplate
ALIF is able to achieve improved restoration of sagittal balance due to:
A) Increased implant height options B) High degree of lordotic options C) Release of ALL
What is a "hybrid" cervical plate construct?
A combination of Variable and fixed Screws allows for a limited amount of rotational movement on the construct throughout the fusion process.
13. Define spondylolysis:
A fracture or defect in the vertebra in the pars interarticularis, commonly known as a pars defect.
Describe how Sacral Slope (SS) parameters are measured
A line drawn along the endplate of S1 A line drawn horizontally from the anterior aspect of S1
Describe how Pelvic Tilt (PT) parameters are measured
A line drawn from the center of the femoral head to the center of the S1 Endplate A line drawn from the center of the femoral head, straight vertical
Removal of all of the lamina: A) Laminectomy B) Laminotomy C) Facetectomy D) Fusion E) Microdiscectomy
A) Laminectomy
Describe the characteristics of a corpectomy procedure and under what circumstances would it be done:
A surgical procedure to remove the vertebral body in order to decompress the spinal cord. Typically utilized in trauma procedures. Positives: decompress spinal cord, restore coronal and sagittal alignment, fusion Negatives: traditional procedure is highly morbid, high blood loss, potential need for chest tube
As it progresses inferiorly from approximately the L1 level, the diameter of the psoas muscle steadily _________________________ as it is contributed to by insertions at each subsequent level.
A) Increases
What is a "translational" cervical plate construct?
A tongueand-groove design feature in the plate allows the plate length to shorten as settling occurs encouraging sharing of the axial load on both the plate and interbody throughout the fusion process
Describe how Sagittal Vertical Axis (SVA) parameters are measured
A vertical line drawn from the center of the C7 vertebral body,
Brigade SA is recommended to be placed _________ in the disc space. The Brigade screw will lag the implant into place.
A) 1-2mm Flush/Slightly proud
When estimating the length of the Brigade Contoured plate in relation to the height of the XLR graft, one should add:
A) 18mm
In a twitch test, the fourth twitch needs to be at least ________% of the first twitch
A) 75%
A true _____ image of a vertebral segment is characterized by a midline spinous process, symmetrical pedicle orientation relative to the lateral vertebral cortex, and a linear appearance of the superior endplate.
A) AP
The break of the table should be located between the greater trochanter and iliac crest to position the iliac crest _____________ the table break.
A) Above
Assembled allograft has historically been challenged by what problems?
A) Breakage
Compression of the cauda equina characterized by bilateral (both sides) leg pain, perianal anesthesia, urinary retention, and loss of rectal ton: A) Cauda Equina Syndrome B) Neuritis C) Myelopathy D) Radiculopathy
A) Cauda Equina Syndrome
What is the potential benefit of the posterior muscle sparing offered with the ALIF procedure?
A) Contributes to quicker patient recovery
Are the Brigade Interfixated screws convergent or divergent?
A) Convergent
Regarding the Triad Dual-Chamber ALIF Allograft, the _________ is designed to maintain graft integrity under lateral and torsional forces and biomechanically tested to withstand multiple impactions and reinsertions for unparalleled durability.
A) Dovetail Joint
. The lengths of the Brigade plates are measured:
A) End-to-end
The anterior lateral abdominal muscles include which of the following:
A) External oblique B) Internal oblique C) Transversus abdominus
Regarding tumors of the spine, the spine is the _______________ most common site for metastasis. A) First B) Second C) Third D) Fourth
A) First
_______________________________ is result from non-physiologic loading of the spine, e.g., motor vehicle accident, sports injury, etc. A) Fracture B) Spondylolisthesis C) Osteoporosis D) Deformity E) Tumor
A) Fracture
During implant delivery, the implant should be gently impacted and _________EMG may be used to monitor nerve activity throughout.
A) Free-Run
If psoas muscles are "___________" shaped or are laterally detached from the disc space, the segment more closely resembles L5-S1 and thus access may be challenging.
A) Helmeted B) Domed C) Tear-Drop D) None of the Above
Decompression of the spinal cord with preservation of motion segment integrity. The usual indication is cervical myelopathy due to severe central spinal canal stenosis. A) Laminoplasty B) Laminectomy C) ACDF D) PCF
A) Laminoplasty
The Brigade Plate Bender can only be used with which Brigade Plate?
A) Lordotic
The development of XLIF was led by _____________, MD, PhD, and offered as a less invasive alternative to conventional direct anterior lumbar interbody fusion and posterior transforaminal lumbar interbody fusion approaches. The technique was first introduced in the published literature in ______./
A) Luiz Pimenta; 2003
The MaXcess 4 Retractor is "Strong" because:
A) MaXcess 4 is made from 100% aluminum B) MaXcess 4 is approximately 61% stiffer than the MaXcess III C) Steel blades reduce distal blade flex D) Stronger Articulating Arm and Attachment
NVM5's advanced neuromonitoring provides proximity and directionality information about the relative position of _____ nerves to the XLIF approach through discrete-threshold responses.
A) Motor
The following regarding MaXcess 4's "Integrated Neuromonitoring" capability are true:
A) NVM5 is seamlessly integrated into the MaXcess 4 Access System leading to safer manipulation of the retractor B) Competitive retractors do not have integrated neuromonitoring C) NVM5 is the only clinically validated neuromonitoring system for a safe and reproducible lateral approach to the spine D) NVM5 provides valuable real-time information that is surgeon-driven, provides discrete thresholds, relative proximity, and directionality
______________________________ is a condition of bone pathology manifested by the loss of bone mineral.
A) Osteoblastia B) Osteomalacia C) Osteoporosis D) Osteopenia/ C) Osteoporosis
What type of lumbar procedure is done in cases where there is primarily neural impingement as well as pre-existing instability that doesn't utilize Interbody?
A) PLF B) PLIF C) TLIF D) XLIF E) ALIF/ PLF
Monitoring the lumbar plexus can be divided into four categories depending on the surgical stage: _____ occurs before the start of surgery and includes electrode placement and twitch test.
A) Patient Preparation
The ___________generally fall anteriorly and out of the way of the approach trajectory in the lateral decubitus position during realization of the retroperitoneal plane.
A) Peritoneal contents
An Anterior Access Surgeon needs to consider the following patient factors prior to performing an ALIF approach. Select which DOES NOT APPLY
A) Prior Posterior Surgery B) Body Mass Index C) Presence of Vascular disease D) Age of patient
The MaXcess 4 Retractor is "Precise" because:
A) Provides the ability to customize the exposure to meet the patient's anatomical requirements B) Tube Dilation up to only 12mm (Final dilation with retractor = approx. 14mm) C) Locks posterior blade and retracts away from the lumbar plexus D) Independent blade splay up to 20 degrees
Visualization of the ________________ is difficult to assess with certainty by preoperative imaging (e.g., MRI); the shape and location of the psoas muscle on axial MRI only infers the location of this structure, not absolute guidance as to its location.
A) Psoas
Regarding ALIF approaches, the _______ approach is by far the more common approach today.
A) Retroperitoneal
For a 2-level case, first BASE implant can be oriented how the surgeon prefers. However, the second BASE implant must be oriented in the ____________ way as the first implant to prevent potential center bolt impingement.
A) Same
Common complications regarding posterior osteotomy procedures include:
A) Significant Morbidity B) Long OR Times D) Neurological complications E) High Volume of Blood Loss
The following are all common types of posterior osteotomy procedures
A) Smith-Peterson Osteotomy (SPO) B) Pedicle Subtraction Osteotomy (PSO) C) Vertebral Column Resection (VCR)
A sequestered herniation is still within the annulus. True or False
A) True
Minimal dilation and retractor footprint of the MaXcess 4 Retractor vs. larger footprints of competitive systems helps minimize psoas trauma during an XLIF. True-False
A) True
Modulus XLIF's microporous endplate design was shown to promote new bone on-growth onto the implant surface at 4 weeks. True - False
A) True
Modulus XLIF's structure is designed to exhibit effective stiffness profile similar to that of bone. True-False
A) True
The MaXcess 4 Retractor is standard in the set in two availabilities: A "solid" style without blade splay function and the standard style with blade splay function. True-False
A) True
CoRoent ____ is our original XLIF cage, used often in early adoption, spondy cases, or smaller patients.
A) XL
4. What are two advantages of using bone as a material?
ADVANTAGES Biological- bone to bone Strength (cortical) Imaging Revisability
When awling the Brigade SA pilot holes, it is recommended to awl all 4 pilot holes prior to placing the screws.
B) False
7. What are two advantages of using cobalt-chrome as a material?
A: Biocompatibility Corrosion resistance
9. What are two advantages of PEEK as a material?
A: Imaging Strength
8. What are two advantages of using shape memory alloy as a material?
A: Changes to desires shape inside body Corrosion resistant
10. What are two advantages and disadvantages of ceramic as a material?
A: good bearing surface Low wear characteristics D: brittle (high MOE) Low impact ion strength
11. What are two advantages and disadvantages of carbon fiber reinforced polymer as a material?
A: imaging MOE close to cortical bone Availability D: Low impact ion strength Clinical documented wear debris
A thorough understanding of the anatomic complexity of the _______ and _____ is essential for performing the procedure safely
B) Lumbar Plexus; Psoas
The retroperitoneal space is covered posteriorly by the:
C) Transversalis fascia
What is Nuvasive's platform compatibility?
All TL Fixation NVM5
Cervical procedure performed from posteriorly typically involving decompression, fixation, and fusion. A) Laminoplasty B) Laminectomy C) ACDF D) PCF
D) PCF
Describe the clinical benefits for Reduction Tower:
Allows controlled segmented reduction.
Explain for each of the following five indications the reasons why a surgeon would choose to use a Posterior Approach to the Cervical Spine: - Ossification of the PLL:
As the ossified PLL grows, it compresses the spinal cord, leading to myelopathy The ossified PLL scars the dura and removal of the PLL/osteophytes can cause massive dural defects. These dural defects can cause many postoperative complications for the patient
Describe how Lumbar Lordosis (LL) parameters are measured
Angle of the Superior Endplate of L1 and the superior endplate of S1
What is meant by the term "High Riding Vert"? Why is it important for a surgeon?
Approximately 10% of the population have a high riding vert hence the C2 transverse foramen rides median or high
Describe the difference between the Archon and Helix-R screw locking mechanisms:
Archon has a rotating locking plate mechanism Helix-R uses canted coil locking mechanism
28. How much of the cryoprotectant do you want to pour off?
As much as possible
When inserting an ACR implant of 20 degrees, the surgeon should expect to also obtain 20 degrees of lordotic correction in the patient's lumbar spine (assuming no osteotomies have been performed).
B) False
6. C1 is also known as the ___
Atlas___
7. C2 is also known as the ___
Axis___
The main action of the psoas muscle is _______.
B) Hip Flexion
Using its patented _____________________________________, the NVM5 stimulates five times per second, delivering discrete, directional, and relative proximity data to the surgeon in real-time.
B) Hunting Algorithm
The psoas muscle descends anterolaterally, deep to the inguinal ligament, where it is joined by the iliacus muscle, and together they insert into the less trochanter of the femur. Together they are referred to as the _____________________ muscle.
B) Iliopsoas
Brigade Lordotic Plate design makes it ideal for:
B) L5/S1
Surgical indications include any disease requiring interbody fusion in the thoracolumbar spine above the ____ level and below approximately ____.
B) L5; T4
This pure sensory nerve provides sensation to the lateral aspect of the thigh.
B) LFCN
Removal of a portion of the lamina: A) Laminectomy B) Laminotomy C) Facetectomy D) Fusion E) Microdiscectomy
B) Laminotomy
A true _______ image of a vertebral segment is characterized by a linear appearance of the superior endplate and posterior cortex, with superimposed pedicles.
B) Lateral
Brigade ALIF Plate has two options. What are they?
B) Lordotic and Contoured
For a 1-level case, the BASE implant must be oriented cranially.
B) False
The genitofemoral nerve can reproducibly be monitored using EMG.
B) False
A patient's pelvic Incidence (PI) should be within _______ degrees of their lumbar lordosis (LL) for them to be considered in sagittal balance.
B) 10
What are all the BASE lordotic options offered?
B) 10 degrees D) 15 degrees E) 20 degrees G) 25 degrees H) 30 degrees
NuVasive's Triad ALIF 38mm Allograft features a graft volume increase of _______% vs. other femoral ALIF ring market offerings.
B) 100
Lateral approach surgery has been described since the late ____________; however, early attempts reported significant ___________ rates
B) 1990's; Complication
Brigade Lordotic Plate dimensions are:
B) 3.75mm thickness, 26mm wide
CoRoent XL-R footprint options include (Choose all that apply):
B) 34x24mm C) 38x28mm
Brigade Hyperlordotic ALIF screw trajectory is:
B) 35 degrees
At what angle do the Brigade Interfixated screws insert?
B) 45 degrees
In the case that the integrity of the ______ is compromised, an interbody spacer with integrated fixation should be considered to minimize the risk of migration of the implant.
B) ALL
The height measurement is taken from the _______ of the XL-CT implant.
B) Center
Regarding the Triad Dual-Chamber ALIF Allograft, the _________ increases overall construct rigidity and distributes impaction forces.
B) Central Strut
Which Brigade Plate has a 5 degree kyphotic bend at the superior end?
B) Contoured
What are the four main objectives for spinal surgery in the correct order? A) Align, decompress, stabilize, fusion B) Decompress, align, stabilize, fusion C) Align, decompress, fusion, stabilize D) Decompress, align, fusion, stabilize
B) Decompress, align, stabilize, fusion
. The EnVoy Graft Delivery System is an alternative method for impacting implants into the disc space.
B) False
An advantage of the XLIF procedure is that it allows surgeons to easily treat pathologies at the L5-S1 disc space. True or False
B) False
BASE bolts are only self-tapping, not self-drilling.
B) False
Brigade Hyperlordotic ALIF (ACR) is FDA on-label without supplemental posterior fixation.
B) False
CoRoent XL, XL-W & XL-XW Inserters are identical. True - False
B) False
The MaXcess 4 has the ability to visualize critical anatomical features under fluoroscopy because:
B) MaXcess 4's geometric design has cored out material allowing optimal visualization, particularly from the lateral fluoro image
The following is NOT a feature of the Triad Dual-Chamber ALIF Allograft that contribute to its strength:
B) Machined from a single piece of allograft
What are the advantages of BASE Ti over Brigade Interfixated?
B) Metal on metal locking mechanism C) Visual and tactile feedback for locking E) Anatomic contouring, superior an
The purpose of the Twitch Test is to ensure all____________________ have been cleared from the body prior to psoas traversal.
B) Muscle Relaxants /paralytics
_______________ is the only clinically validated neuromonitoring system for lateral approaches to the spine.
B) NVM5
Monitoring the lumbar plexus can be divided into four categories depending on the surgical stage: _____ occurs primarily during initial traverse through the psoas muscle.
B) Neural Mapping
Which of the following is NOT a benefit of the Nitinol Spring Locking mechanism?
B) Offers a self-stopping depth gauge when the screw is fully seated
_______ is the oldest of the lumbar interbody fusion techniques (first reported in the 1950s) that uses bilateral interbody implants. A) PLF B) PLIF C) TLIF D) XLIF E) ALIF
B) PLIF
__________________ is defined as the anatomic and physiological deviations from the normal that constitute disease or characterize a particular disease. A) Anatomy B) Pathology C) Imaging D) Biomechanics
B) Pathology
Choose the following XLIF Technique Steps in the correct order:
B) Patient Positioning & OR Setup, Anatomical Landmark Identification & Initial Incisions, Retroperitoneal Access & Approach, Transpsoas Approach, XLIF Electrode & Retractor Assembly, Access, Annulotomy & Disc Space Preparation, Implant Sizing, Implant Placement, Supplemental Fixation
With Brigade SA, in L5-S1 cases, start with straight screw insertion drivers into ______
B) S1
What is one very common form of instability where there is a slippage between vertebral bodies? A) Stenosis B) Spondylolisthesis C) Myelopathy D) Idiopathic Deformity
B) Spondylolisthesis
____________ is defined as a fracture or defect in the vertebra in the pars interarticularis. A) Stenosis B) Spondylolysis C) Osteoporosis D) Deformity E) Tumor
B) Spondylolysis
What is another term for degenerative disc disease? A) Spondylolistheis B) Spondylosis C) Myelopathy D) Radiculopathy E) Stenosis
B) Spondylosis
Most common fractures in the lumbar spine occur at: A) T11-T12 B) T12-L1 C) L1-2 D) L4-L5 E) L5-S1
B) T12-L1
________ is a procedure wherein the degenerated disc is removed (as in interbody fusion procedures), but rather than fusing across the joint, a mobile device is implanted. A) PLF B) TDR C) TLIF D) XLIF E) ALIF
B) TDR
MaXcess 4 provides "customizable access" to the disc space because:
B) The cephalad/caudal blades have independent control from the anterior/posterior blades to allow the ability of the retractor to match the anatomical shape of the disc space.
What is the locking mechanism on Brigade Standalone?
B) Threaded Taper Block
CoRoent ____ features a larger PEEK surface area designated to spread load and help resist subsidence. It is quickly becoming the most popular cage option.
B) XL-W/XL-XW
These two nerves innervate the transversus abdominis and internal oblique, with the action of abdominal contraction.
B) iliohypogastric, ilioinguinal
21. What are the components of Osteocel that send the "signal" to recruit and direct cells?
DBM
22. When does donor screening occur during Osteocel processing?
Before and after processing
The biomechanical stability provided by an MLX implant with unilateral screw fixation is comparable to a traditional TLIF cage with ____________ fixation, and an _______ cage with an anterior plate.
Bi-Lateral Pedicle Anterior Cage w/ Plate
CoRoent MP implants are designed to sit far laterally to provide what?
Bi-Lateral fusion Stability due to placement on the apophyseal ring
6. What are two advantages of using titanium as a material?
Bone growth adheres to implant surface/ strength availability
What are the 3 steps recommended prior to placing screw shanks
Burr Drill / canulator Tap
Entrance into the retroperitoneal space is indicated by a palpable loss of resistance and palpable retroperitoneal structures, including the anterior surface of the _____ process, the twelfth rib the medial wall of the ileum and the lateral surface of the psoas muscle.
C) Transverse
CoRoent ____ features integrated screws for cases where additional stability or cage migration is a concern.
C) XL-F/XL-FW
The PLL runs from C_____ to the sacrum.
C-2
What piece of equipment is used with fluoroscopy?
C-Arm - X-Ray Source - Fluorescent Screen
C_ - C_ - C_ - and C_ have fully developed lateral masses.
C1 - C3 - C4 - and C5
There is a lateral mass at C____ C____ C___ C____ C____ and a very thin lateral mass at C____.
C1 C3 C4 C5 C6-----C7
C________ has a pars and pedicle for fixation but no lateral mass.
C2
Most cervical pathologies are found between _____ and _____.
C3-C7
What are the levels typically operated on in a laminoplasty case?
C3-C7
Depending on the patient anatomy sometimes C_____ and-or C_____ "do or do not" have a fully developed ___________________________________________.
C6 C7 Lateral Mass
Why is C7 sometimes called the prominent vertebra?
C7 has the longest and most prominent spinous process in the cervical spine
The X-CORE 2 flower pattern on the core allows for up to _______ different endcap orientations.
C) 12
The Uribe anatomic study suggests that the potential approach zones at the lateral disc spaces to prevent direct nerve injury during an XLIF procedure from L1-2 to L3-4 is the middle posterior quarter of the intervertebral discs at Zone ____
C) 3
Grade 3 spondylolisthesis is defined as a ______ to ______ slip. A) 0-25% B) 25-50% C) 50-75% D) 75-100%
C) 50-75%
CoRoent XL-R offers both _______ and _______ degrees of lordosis.
C) 8, 15
Common cervical procedure performed from the front complete with discectomy, implant placement, and fixation. A) Laminoplasty B) Laminectomy C) ACDF D) PCF
C) ACDF
Location and bifurcation of ______________________is important to evaluate pre-operatively in case of anomalies or rotational deformities that result in these structures shifting laterally.
C) Aorta and Vena Cava
_____is a procedure to remove a vertebral body, usually to decompress the spinal cord. A) PLF B) PLIF C) Corpectomy D) XLIF E) ALIF
C) Corpectomy
NVM5's advanced EMG provides proximity and directionality that encourages more posterior approach corridors and avoidance of the ____________nerve anteriorly.
C) Femoral
This nerve has major contributions to the motor and sensory function of the quadriceps.
C) Femoral
While the ______ nerve is the nerve most commonly discussed with respect to lateral approach surgery, as it represents the most apparent risk of motor injury.
C) Femoral
A condition or factor that serves as a reason to perform or administer a certain medical treatment: A) Surgical complication B) Contra-indication C) Indication D) Operative intervention
C) Indication
What are back pain symptoms mainly due to? A) Radiculopathy B) Myelopathy C) Inflammation D) Cauda Equina Syndrome
C) Inflammation
. Regarding the Triad Dual-Chamber ALIF Allograft, the _________ distributes impaction load to lateral graft walls and central strut and shields the implant joint from excessive shear forces.
C) Inserter Instrumentation
The Uribe anatomic study suggests the safe zone at L4-5 is at the _____________ of the disc (Zone II & III Junction).
C) Midpoint
Monitoring the lumbar plexus can be divided into four categories depending on the surgical stage: _____ is used during subsequent dilation, retractor expansion, and discectomy with graft placement.
C) Ongoing monitoring
This _____ incision allows for digital palpation of the retroperitoneal space, anterior displacement of retroperitoneal fat and peritoneal contents, and guidance of the initial dilator through the retroperitoneal space to the border of the psoas muscle.
C) Posterolateral
______ originated as a modification of the classic PLIF procedure and is a unilateral (approach from one side only), sparing the trauma to the other side. A) PLF B) PLIF C) TLIF D) XLIF E) ALIF
C) TLIF
NVM5 delivers discrete ____________________________, enabling the surgeon to assess proximity to the nerve in the lumbar plexus.
C) Thresholds
Describe how Chin Brow Vertical Angle (CBVA) parameters are measured. What are the optimal ranges?
CBVA is measured based on the vertical plum line of the top of the brow & the angle of the face Optimal Range = - 5 & 18 deg
24. What are the tests each Osteocel lot must pass post-cryopreservation?
CELL COuNT • Confirm a minimum of 250,000 cells per cc (including MSCs and osteoprogenitor cells) • Visual cell quantification CELL VIABILITY • Confirm a minimum of 70% total viability • Dye exclusion assay CELL ACTIVITy • Verify osteogenic potential • Alkaline phosphatase assay using cell culture technique
27. In the 2006 paper by Frank Schwab, "A Clinical Impact Classification of Scoliosis in the Adult," which of the 3 coronal plane measurements did not have a clinical impact (i.e. clinically irrelevant to patient's health related quality of life)?
COBB ANGLE
Describe the clinical benefits for Adjustable Cross-Connector:
Can be placed over the top of existing tulip screws, after the construct is locked down.
5. The _______ or "horses tail" in Latin, is a bundle of spinal nerves following the termination of the spinal cord. It extends through the lumbar and sacral regions.
Cauda Equina
11. Which graft option is current available in the market to satisfy all 3 O's of bone graft formation?
Cellular Allograft - Osteocel
12. What is Osteocel?
Cellular allograft which possess autograft-like composition - Signal - - Cells - 3 mil count - Scaffold
1. The human nervous system consists of the ______ and the __
Central Nervous System_(CNS) Peripheral Nervous System (PNS)__
"iatrogenic" instability is defined as:
Cervical instability results from the destruction of the spine's load-bearing elements. This may occur as a result of the disease process itself OR may be the consequence of the surgical approach used to address it
What is the stiffest rod offered with Reline?
CoCr -6.0 Diameter
What are the available NuVasive TLIF implants?
CoRoent Large Oblique Modulus Coalesce CoRoent Anterior TLIF Ti Oblique TLIF Anterior TLIF TLX MLX
How is Osteocel Pro different from Osteocel Plus in the Handling Characteristics:
Cohesive handling properties minimize variability in interbody cage packing from scrub to scrub.
What steps does the Reline MAS ConSol Instrument Consolidate?
Combines - targeting needle - bone awl - tap into one instrument
The MaXcess Retractor has two different attachment points for the articulating arm. The anterior attachment will secure the _______blade and translate the cephalad & caudal blades ________./
D) Posterior; anteriorly
7. Name and define the four different types of stenosis described in your study materials:
Congenital- back/nek stenosis due to developmental malformations (shortened pedicles) Foraminal- narrowing of intervertebral foramen where the exiting spinal nerve can be impinged due to facet hypertrophy or loss of disc height central- narrowing of the central spinal canal due to bony hypertrophy, ossification if ligaments, anatomical displacement, or bulging discs Lateral recess- narrowing of the space within the spinal canal adjacent to the exit zone of the nerve roots
What are a few challenges a surgeon may encounter during revision surgeries?
Connecting onto an existing rod
15. Explain why Osteocel is "Consistent":
Consistent means strict quality controls at every processing step, to ensure that every single lot of O+ meets the same stringent criteria, creating reliable tissue quality every time.
4. The spinal cord tapers to an end at what is referred to as the ____.
Conus Meullaris
How are CT scan images created?
Created via Digital Geometry Processing, used to generate a three-dimensional image of the inside of the body; from a large series of two-dimensional X-Ray images- taken around a single axis of rotation
Describe the "main selling point" of the Fascial Splitter?
Creates a smooth, consistent pathway Improves rod passage Incremental value to your MAS cases
Which cervical pathology occurs when there is erosion of the facet joints, discs and interspinous ligaments of C3-C7? A) Ossified posterior longitudinal ligament B) Rheumatoid spondylitis C) Atlanto-axial instability D) Sub-axial instability
D) Sub-axial instability
Describe the benefit of "crossover plate sizing":
Crossover plate sizing in one-level to five-level configurations allows for selection of plates that match a wide variety of patient anatomies.
Describe the clinical benefits for Hinged Rod:
Customized to each patient, takes little room, is not bulky and is safe to lock down.
Describe the clinical benefits for Occipital Keel Plate:
Customizes each construct to help achieve best anatomical fit and provide stability.
With NVM5, ________________ controls stimulation from the sterile field, without delay, aiding in efficiency in the O.R.
D) Surgeon
CoRoent ____ is designed to achieve coronal correction of trapezoidal-shaped vertebral bodies from the eXtreme lateral approach.
D) XL-CT
________ procedures are an innovative approach to spine fusion accessing the spine from the side of the body instead of the front or back like traditional methods. A) ALIF B) PLIF C) TLIF D) XLIF
D) XLIF/
What are two disadvantages of using cobalt-chrome as a material?
D: Difficult to fabricate Metal hypersensitivity
Brigade Hyperlordotic ALIF offers what degree of lordotic options? (Choose all that apply)
D) 20 E) 30
When estimating the length of the Brigade Lordotic plate in relation to the height of the XLR graft, one should add:
D) 24mm
Brigade Contoured Plate dimensions are:
D) 4.0mm thickness, 26mm wide
What is the visual indicator that the screw is properly set with Brigade Standalone ALIF?
D) A black triangle is used as a visual indicator
The psoas major muscle receives innervations from the second to fourth lumbar spinal nerves as tiny intrinsic branches off the _______ nerve.
D) Femoral
Recording _________ allows for real-time assessment of nerve or nerve root integrity between the stimulus and distal muscle recording site(s).
D) Free-Run EMG
_______________________ is a procedure to stop the motion between two or more vertebrae by encouraging bone to form across the defect. A) Decompression B) Laminectomy C) Foraminotomy D) Fusion E) Microdiscectomy
D) Fusion
During a lateral approach, particularly at L4-5 the first anatomic element encountered and which can be evaluated preoperatively via radiograph (X-Ray) is the _______.
D) Iliac Crest
What are two disadvantages of using shape memory alloy as a material?
D: Not good for weight bearing Limited use right now
What are the two types of Adult Scoliosis?
Degenerative Adult Idiopathic Scoliosis (untreated)
42. What is Propel?/
Demineralized bone matrix (DBM) in reverse phase medium (RPM)]
Describe the clinical benefits for Set Screw Repeater:
Designed to reduce procedure time and complexity.
What is Diagnostic Imaging
Diagnostic Imaging is a technology that doctors use to look inside the body to help determine the causes of an injury or illness and ensure that a diagnosis is accurate.
1. Define the purpose of the NuVasive NVM5 Hunting Algorithm:
Directionality and relative ProximityThe proximal white line on all three XLIF® dilators corresponds with the distal electrode. As the dilator is rotated, the surgeon is able to match the position of the electrode (white line) with EMG responses, helping to create a multidimensional understanding of where nerves lay within the psoas muscle.
What are two and disadvantages of using titanium as a material?
Disadvantages Imagine/ permanent material
What are two disadvantages of using stainless steel as a material?
Disadvantages Imaging High MOE
What are two disadvantages of using bone as a material?
Disadvantages Prep in surgery Risk of disease transmission Availability Reproducibility
Why would a doctor use discography?
Discography or discogram is used as a diagnostic tool to determine if one of the discs in the spine is responsible for typical pain symptoms.
Explain Allograft
Donor bone •DBM: acid-treateddemineralized bone, typically mixed with a putty carrier •New category: cellular allograft:(Osteocel® Plus)
Is Reline & Precept a single or duel lead shank?
Duel
Reline MOD features a single or dual lead screw shank standard in the set?
Duel Lead
Reline shanks are single or duel lead?
Duel Lead
_______ is performed with the patient is supine (lying on back), an abdominal incision is made (location slightly variant, depending on preference of approach angle and number of levels being treated), trans- or retro-peritoneal dissection is performed to get through or behind the abdominal contents, and an interbody and fixation is placed following disc preparation. A) PLF B) PLIF C) TLIF D) XLIF E) ALIF
E) ALIF
A _______________ is a minimally invasive surgical procedure in which a portion of a herniated nucleus pulpous is removed by way of instrument or laser. A) Microdiscectomy B) Fusion C) Facetectomy D) Laminectomy E) Foraminotomy
E) Foraminotomy
The _____ muscle is a long muscle that originates from the anterolateral aspect of the lumbar vertebral bodies, transverse processes, and their intervening disc spaces.
E) Psoas
The ______ muscle is the key muscle traversed with blunt dissection (or spreading of the muscle fibers) during the XLIF approach.
E) Psoas
According to Dr. Rodgers, which of the following is NOT one of the 5 key steps for performing the XLIF procedure?
E) Shallow Docking
Initial blunt finger dissection through tissue down to facet joint helps what?
Ensure space around K-Wire is free from facia or tissue that would prevent retractor blades from being placed.
Which of the following conditions are the main reasons that lead to disc tear? A) Limited movement B) Loss of fluid C) Annular stress D) Muscle cramping E) All the above F) B & C only
F) B & C only
3. What is a bone graft used for in spine procedure?
Facilitates the body to grow new bone and fuse a section of the spine together.
12. C2 has both lateral masses and pedicles. True or False?
False
16. Osteocel cells are removed from their host donor bone, concentrated, expanded, and then recombined with cancellous chips. True or False?
False
29. If saline is unavailable to keep the Osteocel from drying out on the back table, water can be used as a substitute. True / False
False
31. When packing Osteocel, a legitimate concern is that the Osteocel could be too tightly packed for best results. True / False
False
36. If the shipping tape seal on the Osteocel® shipping box is broken it can still be returned as long as the product has not been removed from the packaging. a. True / False
False
36. Radiographs that include the femoral head are NOT necessary to calculate the parameters needed to determine global sagittal alignment. True or False?
False
Every surgical procedure needs a decompression. True or False?
False
Interlock's locking mechanism is a multi-step process. a. True b. False
False
Over-distraction and facet distraction with use of the CoRoent Small Hyperlordotic implant is never a concern. a. True b. False
False
Sagittal spinal deformity is commonly defined by increasing SVA; however, SVA alone may underestimate the severity of the deformity. True or False?
False
Spinal regions (cervical cervicothoracic thoracic thoracolumbar lumbar lumbosacral) act and operate independently and do not depend on one another for alignment. True or False?
False
TLX implant expands in posterior height - True/False
False
The Archon cervical plate features a "zero-step" locking mechanism that automatically locks upon screw insertion. a. True b. False
False
The MaXcess-C blades are not radiolucent to allow maximum visualization of the blades under fluoro during the procedure. a. True b. False
False
The domed surface of CoRoent Contoured requires the surgeon to perform more boney removal to fit the shape of the implant. a. True b. False
False
The integrated light source cannot be utilized with the handheld retractor blades. a. True b. False
False
What are the advantages of using CT Scans?
Fast & Accurate Evaluations / Great for bone & some soft tissue / Multiple Viewing options / Non-Invasive / Less expensive than MRI / OK for any implanted device
What are the advantages of using radiography?
Fast & Easy Assessment / Used for over 100 years / Good visual detail of bones / Relatively inexpensive & readily available
96. List the construct types available with Gradient Plus:
Fixed Semi-Constrained Dynamic
What is a "rigid" or "fully-constrained" cervical plate construct?
Fixed Screws are inserted at a fixed trajectory (10° at ends of plate) and remain in that trajectory once locked into the plate and throughout the fusion process.
What are the rod inserters available with Reline & Precept?
Fixed obtuse adjustable Acute obtuse adjustable
56. What is BMA?/
Fluid that is drawn from the marrow of bone in order to obtain bone-forming cells.
What type of diagnostic imaging modality allows doctors to obtain real time moving images of a patient's internal structures?
Fluororadiography
Explain why sagittal alignment is important to both an adult degenerative and deformity surgeon:
For adults - majority of lordosis in Lumbar exists at L4-S1 (40-60%) so lordotic / Sagital correction plays a role at those two levels Deformity - since it spans the entire spine
What is the primary indication for iliac fixation?
For long Posterior Constructs above L1
58. How long is the shelf life for FormaGraft? /
FormaGraft has a shelf life of 4 years.
Rotate blades __________ for placement to reduce possibility of blade catching on skin or fascia Instruct surgeon to leave screws ________ Remove ________ once screw has passed _____ cortex of VB Rotate ______ to correct position when K-wire is removed
Freely proud K-wire / Posterior Blade
44. What is Dr. Haid's opinion regarding the most common error made by spine surgeons?
GIVE PATIENT TOO LITTLE LUMBAR LORDOSIS
The MLX implant is fully expanded when a hard stop is reached and _______
deployment of the Red Button marked "expanded" on insterter
40. In Dr. Haid's case of the 33 y old nurse with multiple surgeries, for what reason does he attribute the lack of long term success and breakdown of adjacent segments?
HE DID NOT RESTORE HER LORDOSIS - POOR UNDERSTANDING OF SAGITTAL BALANCE AND SPINO-PELVIC PARAMETERS
What is Nuvasive Cleaning Instructions?
Hand wash only - do not machine wash
9. Define HRQOL:
Health Related Quality of Life
What are Reline & Precept locking mechanism? What are the benefits of this locking mechanism?
Helical Flange: - reduce cross thread - avoid head splay
Reline MOD feature what type of locking screw mechanism?
Helix Flange
What type of locking cap thread pattern does Reline utilize?
Helix Flange - Square head
What are a few pathologies that diagnostic imaging helps doctors see better?
Herniated Disc / Collapsed Disc / Stenosis / Malalignment / Spondylolisthesis - Retrolisthesis - Laterallisthesis / Scoliosis / Kyphosis / Hypolordosis / Fracture / Tumor / Infection
4. A ________ PT is indicative of pelvic retroversion. a. High b. Low
High
What are the disadvantages of using MRI?
High Cost / Patients can feel claustrophobic / Long imaging times / LOUD - 95 db / Long imaging times / Metal implants can cause artifact
Define the following: a. Hyper - or - Hypo Kypthotic b. Hyper - or - Hypo-Lordosis c. Flatback Syndrome:
Hyper- or Hypo-kyphosis Too much or too little kyphosis in thoracic spine Hyper- or Hypo-lordosis Too much or too little lordosis in lumbar spine Flatback Syndrome ↔ Hypolordosis Sagittal plane deformity Iatrogenic Causes (Harrington Rods) Fixed/fused spine
What is the purpose of the Slip-On Guides?
If the guide needs to be reattached in situ - it can be used to reduce and compress
In what situations might Interlock's centerline screw be useful?
If the individual's anatomy presents a challenge to the screw angles, aim the center screw away from the challenging anatomy to limit the screwdriver encounter to one time
What are the disadvantages of using CT Scans?
Ionizing Radiation / Multiple scans are probable / Cannot be used on pregnant women / Not much detail of spinal cord / Patient allergies to iodine contrast
When using the targeting tool to map out your incision the surgeon should make the incision between which landmarks?
Incision from the middle of the cranial spinous process - down to the middle of the caudal spinous process
Is the pile driver delivered inside or outside of the guide?
Inside the guide
4. How do spine instrumentation and bone grafts work together?
Instrumentation creates stability - while the body creates axial load - and bone graft provides a nutrient rich environment for bone to grow
How is Osteocel Pro different from Osteocel Plus in the Preparation Technique
Integrated cryoprotectant decreases number of preparation steps from 7 to 3 steps, reducing back-table preparation time and minimizing the opportunity for error.
43. Describe the benefits/strengths of Propel:/
Is easily moldable into desired shape Fits securely in voids and stays where placed Is hydrophobic Has inductive properties Can be used with MAS Graft Delivery System Has the ability to resist irrigation
Why is the Bulldozer the recommended instrument for rod normalization?
It has 2 points of contact of the rod & has 30mm of reduction capability
Describe the tactile and audible confirmation featured with the Pile Driver and how to achieve
It will become more resistant as the pile driver reduces the set screw into the tulip - and audible clicking noise will be heard to indicate the set screw is fully seated
45. What is the significance/benefit of Propel being hydrophobic?/
Its resists water / saline and will not lose its shape or composition when saline is applied to the fusion site.
12. Who is accredited with originating the idea of a "stable zone" (i.e. "Cone of Economy")?
JEAN DUBOUSSET
61. What is the function of the "Lock" icon above the left fluoro image? When would you want to have it select on or off?
KEEPS THE C-ARM FROM PORTING IN ANY NEW IMAGES WHILE YOU ARE PLACING YOUR MEASUREMENTS. KEEP ON WHILE PLACING YOUR LINES TO DETERMINE YOUR ANGLES, OFF WHEN WANT TO IMPO
What is the most common type of cervical deformity? How it is addressed?
Kyphosis addressed via an anterior surgical approach.
While the ending location can vary slightly, it typically occurs at the _____________disc space
L1-L2
45. Which segment of the spine has the highest rate of non-union pseudoarthrosis?
L5-S1
25. What are the 3 coronal plane radiographic parameters that we should be considering?
LISTHESIS COBB ANGLE GLOBAL CORONAL ALIGNMENT
41. In this same case, after using the equation LL = PI +- 10 degrees, how did the patient's LL and PI correlate? What were the values?
LL = 0 PI = 48 48 degree Mis-match
18. What is the equation relating lumbar lordosis and pelvic incidence?
LL = PI +/- 10 DEGREES
What is a laminoplasty and how does it differ from a laminectomy or fusion?
Laminoplasty is a motion preserving procedure, which is an alternative to a laminectomy and fusion or laminectomy.
What is the recommended trajectory of the caudal screws if you are looking at the pedicles in the AP position as a face of a clock
Left Side - from 3 to 9 Right Side - from 9 to 3
10. How do you change from peripheral to direct Twitch Test?
Left Side Menu => Twitch Test Periph =>Twitch Test Menu
After targeting 1mm of the anatomical landmark of the question above, what is the recommended trajectory of the cephalad screws if you are looking at the pedicles in the AP position as a face of a clock?
Left side - from 5 to 11 Right side - from 7 to 1
How does it simplify K-Wire Management?
Less instruments are introduced over the K-Wire
When tapping prior to placing cortical screw shanks, it is important to tap ______ to ______ to prevent the creation of microfractures
Line to Line
What is Nuvasive Power consistent ramp up in speed?
Linear Variable Speed
Describe Osteogenesis
Living "cells" that have the ability to form new bone
CoRoent Small Contoured comes in what footprint sizes and what degrees of lordosis?
Lordosis - 7 degrees Footprints: - 15 X 12 - 17 X 14 - 19 X 16
3. What are two factors that lead to disc tear?
Loss of fluid in the disc/ infectionor trauma
Describe the following X-CORE Mini Design Goals: b. Simple -
Low-profile Inserter Smooth and robust expanding core with a larger central aperture
Describe MIS TLIF
MIS PLIF / - stable constructs, large graft areas, minimal neural retraction, muscle and soft tissue preservation. Few surgeons are successful in early adoption, steep learning curve with increased OR times.
20. Retroverting the pelvis requires significant _______________________ energy and will eventually cause the individual tire out and lean.
MUSCULAR
What does MRI stand for?
Magnetic Resonance Imaging (MRI)
25. Why is the EasyScreen important to use during the Osteocel decanting process?
Makes decanting (pouring off the cryoprotectant) and rinsing with saline effortless. Keeps the O+ graft complete in the vial during decanting and rinsing
Describe how Cervical Lordosis (CL) parameters are measured. What are the optimal ranges:
Measured from C2 - C7 Optimal Range: 20 Degrees
How are the Precept / Reline Rods measured? Are the bulleted and Inserter Attachment ends included in the length?
Measured via Caliper No - just the area that its locked down
Rank the order of the following materials from most radiopaque to most radiolucent- Water Gas Metal Fat Bone
Metal / Bone / Water / Fat / Gas
The ______________________________ is the optimal spot for occipital bone screws; because of the thickness of bone.
Midline Keel (MedianNuchalLine)
What MUST be performed prior to using the MAS TLIF retractor to distract? Why?
Mobilize the facet joint
The _______________________ Corpectomy system is comprised of a monolithic core with modular endcaps allowing the surgeon to customize each construct to the patient's specific anatomical requirements.
Monolith
How does the MaXcess-C allow a surgeon to only expose what is necessary for a complete anterior cervical procedure?
Multiple Blade Options - to include micro blades to accommodate patient anatomy and surgeon preference.
Which diagnostic imaging modality involves injection of a contrast medium into the spine?
Myelography or Myelogram
Deterioration or disease of the spinal cord is termed: A) Cauda Equina Syndrome B) Neuritis C) Myelopathy D) Radiculopathy
Myelopathy
11. Which NuvaPlanning tool is used to intraoperative measure spinal alignment?
NUVA MAp_OR
53. _______________________ is an easy, is a simple software application for tablet and mobile devices, designed to provide quick, on-the-go measurements to determine and evaluate alignment goals and objectives.
NUVALINE
57. The BNC cable connects where on the back of the NVM5 and C-Arm?
NVM5 - CONTROL UNIT UNDERNEATH C-ARM - LOW RESOLUTION OUT PORT ON BACK
Are all helical flange designs between companies the same? Why?
No - Nuva patent applies to the squared off edge of the flange
How is Osteocel Pro different from Osteocel Plus in the Handling and Storage Requirements:
No difference in Handling / Storage Requirements
What are the advantages of using MRI?
No radiation / Clear detailed images / Great for soft tissue and spinal cord evaluation / No iodine in contrast / Detects subtle changes better than CT
5. Name and match the four stages of disc degeneration
Nuclear herniation Protruding herniation Extruding herniation Sequestered herniation
64. ______________________________ is a comprehensive software solution designed to assist healthcare professionals in viewing, storing, and measuring images, as well as simulating cases for interventional procedures, and sharing case plans.
NuvaMap
55. __________________________ is the industry's only real-time intraoperative assessment of various patient anatomical parameters through the use of a lateral fluoroscopic image. Intuitive software displays the comparison of intraoperative anatomical values to preoperative and planned patient measurements.
NuvaMap OR
17. Osteocel contains which bone forming cells?
O+ has an average of 3M cells/cc. a. 68% of those cells are true MSCs. b. 32% are mainly osteoprogenitor cells (OPC).
13. Explain why Osteocel is a "Complete" solution
O+ is complete because it has all 3 essential mechanisms for bone formation (osteoCONDUCTION, osteoINDUCTION, and osteoGENESIS)
14. Explain why Osteocel is "Physiologic":
O+ is like healthy autograft in a jar O+ can be used like autograft, since the concentration of cells and signals are physiologic (similar to what you would find in normal healthy bone). There are no dosing concerns with O+ like with InFuse (BMP).
C) Transverse Abdominus
Of the 3 superficial muscle layers dissected during the XLIF approach, choice A below represents the:
Describe the clinical benefits for Transition Rod:
Offers extra stability and extension to construct transition zone. Takes up little space
Why is it important to drive the screws to their final position prior to rod/set screw placement
Once the rods / set screws are placed - the surgeon will be unable to advance the screws any further
The MAS Midline exposure is very similar to the exposure requirements surgeons are accustomed to for traditional ________ surgeries
Open
When the PLL becomes calcified it is called:
Ossification of the Posterior Longitudinal Ligament (OPLL)
37. The MAS Graft Delivery system is designed specifically for the delivery of _________________ into the disc space in minimally disruptive NuVasive _________________________ procedures./
Osteocel - MAS PLIF
How is Osteocel Pro different from Osteocel Plus in the Cell Viability
Osteocel Pro cell viability and activity have been validated for up to six hours.
2. Define the three different types of bone density and then match them to the appropriate picture:
Osteomalacia- reduction in the physical strength of bone due to decreased mineralization of osteoid Osteopenia- done mineral density that is lower that normal peak bmd Osteoporosis- diminution in both the mineral/matrix of the bone
With the bulldozer does the reduction delivered inside or outside of the guide?
Outside
Define the following type of osteotomy and the average correction expected per level: a. PCO (Smith-Peterson/Ponte): b. PSO c. VCR::
PCO: The posterior column is resected between the facet joints at one or multiple levels PSO A V-shaped resection through the posterior elements, pedicles, and vertebral body. VCR A V-shaped resection through the posterior elements, pedicles, and vertebral body.
16. What is the mean PI?
PELVIC INCIDENCE
63. In addition to LL measurement, what other measurements can be taken with NuvaMap O.R.?
PELVIC INCIDENCE PELVIC TILT SEGMENT ANGLE THORACIC KYPHOSIS
12. What is the formula for assessing sagittal alignment?
PI=LL+-10 deg
2. Define the procedural value of monitoring during a TLIF
PLIF:/ • Percutaneous and minimally invasive pedicle preparation • Maximize restoration of height and lordosis • Navigate through soft tissue during revision
26. How is global coronal alignment measured?
PLUMLINE FROM C7 TO THE CENTER OF THE SACRUM
11. Why is spinal alignment important? What happens as the human body falls further out of alignment?
POOR ALIGNMENT EQUALS DISABILITY, MUST COMPENSATE FOR ANATOMIC DEFORMATION, HAVE A MECHANICAL DISADVANTAGE CHALLENGING BALANCE MECHANISMS THE MORE ENERGY IT TAKES THE HUMAN BODY TO BE IN AN UPRIGHT POSTURE. YOUR BODY WORKS MOST EFFICIENTLY IN THE STABLE ZONE, OUTSIDE THE STABLE ZONE HAVE PAIN BECAUSE OF THE ENERGY EXPENDED DUE TO INCREASED USAGE OF THE MUSCULATURE
In Dr. Glassman's study, Impact of Positive Sagittal Balance in Adult Spinal Deformity, it was found that a patient's severity of symptoms increased in a linear fashion with:
PROGRESSIVE POSITIVE SAGITTAL BALANCE
Symptoms of adult degenerative scoliosis include:
Pain Neurogenic claudication Isolated radiculopathy (Concave Side, Lateral Listhesis)
For X-CORE mini parallel end-caps add _____mm per end-cap to construct and ________mm per endcap for contouredlordotic /kyphotic endcap constructs.
Parallel - 1.5mm Lordotic and kyphotic endcaps - 2.5mm.
An oblique view on a radiograph allows a good view of what anatomy?
Pars Interarticularis of lamina
Explain Autograft
Patient's own bone -typically iliac crest or local defect •The traditional Gold Standard -all three "O's" naturally •Prior to Osteocel®, only graft with living cells
Describe Anterior Lumbar Interbody Fusion (ALIF)
Positive: L5-S1 access, direct visualization, excellent disc height restoration Negative: Potential vascular injury, requires access surgeon, removes ALL
The TLX inserter allows for implant placement, expansion, and ________
Post Packing / graft delivery
15. In addition to the sagittal balance of the spine, a patient's ___________________ parameters must also be considered for complete understanding of a patient's global alignment.
Pelvic
49. The study concludes that the mismatch between the _____ and _____ had the strongest direct correlation with disability and poor quality of life.
Pelvic Incidence & Lumbar Lordosis
48. Result from the relative risk analysis revealed that patients with PI-LL mismatch compared with patients with PI-LL harmony had ______ -fold greater risk of pelvic retroversion, ______ -fold greater risk of positive sagittal malalignment (SVA), and ______ -fold greater risk of severe disability.
Pelvic Retroversion - 4.2 X Positive SVA -10.9 X Severe Disability - 3.9 X
Explain for each of the following five indications the reasons why a surgeon would choose to use a Posterior Approach to the Cervical Spine: - Trauma (Fractions - Dislocations):
Persistent subluxation of cervical facets may force the use of combined (anterior-posterior) surgical approaches to realign, decompress, and fuse the unstable spine.
Describe how a surgeon would create an environment that favors fusion:
Prepare the recipient site. Anteriorly - the cartilaginous endplate of the disc space is removed and the cortical endplate lightly decorticated to expose bleeding bone. Posteriorly the cartilage of the facet joint is removed and the lateral mass and facet space are decorticated. Then surgeon selects a graft material to fill the defect.
The MLX Graft Containment Plate (GCP) is important
Prevents cage from collapsing from biologics from seeping out
9. How do you modify the max stimulation setting for XLIF mode?
Profile Setting => Test Selection Left Side => Test Screen
Describe the clinical benefits for Cobalt Chrome Rod:
Provides extra stiffness to construct.
Explain the benefit of the Helix-T translation mechanism:
Provides up to 2mm of independent translation at each level, allowing for streamlined implantation and natural anatomical settling.
What is PJK? Why does it happen?
Proximal junction sagittal Cobb Angle ≥10° relative to pre-operative measurement
44. What is a Reverse Phase Medium? What are the benefits?/
RPM is a 1. biocompatible 2.inert 3.hydrophobic 4.poloxamer carrier Allows the product to be molded to the desired shape prior to implantation Once implanted, it allows it to solidify to stay where placed and resist migration.
What are the disadvantages of using radiography?
Radiation Exposure - a. Women b. Eyes c. Multiples Times / Not good at visualizing soft tissue
What is the difference between radiopaque and radiolucent?
Radiopaque = description of material being x-ray'd that prevents or restricts x-rays to reach the film Radiolucent = description of material being x-tay's that allows more x-rays to reach the film
What is the advantage to the <12mm plate width of the Helix Mini?
Reduced retraction for easy placement.
What are the benefits of the Reline Traction screws over traditional screws? How are these benefits achieved?
Reline Traction has a duel to quad thread pitch. The quad engages the pedicle and increases the pullout strength because more threads are engaging more surface area of the cortical bone.
Define Osteotomy:
Remove bone to Decompress or mobilize and Correct overall sagittal and coronal alignment
During a MAS MIDLINE, retraction of the multifidus muscle to what anatomical landmark is recommended?
Retract to the lateral aspect of the facet
What is the recommended procedure for performing a two level MAS TLIF? How is it performed
Retractor to be applied - level by level Blades are multi-directional (left / right)
8. How can you determine from the NVM5 screen if an accessory is connected?
Right Side of the screen under neath "devices"
The Monolith end-caps are available in what footprint and lordosis options?
Round - - 14mm - 16mm Rectangle - - 15X13mm - 17 X 15mm - 17 X 14mm - 19 X 16mm Lordosis - Parallel - 7 deg - 10 deg
62. The NuvaMap O.R. red, yellow, and green PI-LL color coding is based off of what classification system?
SCHWAB-SRS
1. What are the components that make up the iGA platform?
SIMPLIFIED PREOPERATIVE PLANNING Preoperatively calculate and evaluate alignment parameters and implant integration REAL-TIME INTRAOPERATIVE ASSESSMENT Intra-operatively correct the spine and receive immediate feedback on alignment values INTUITIVE POSTOPERATIVE CONFIRMATION Postoperatively confirm the success of the procedure and effect on alignment
46. Describe the 4 steps to prepare Propel for use:/
STEP 1 - Remove from box. Using aseptic technique, peel back outer pouch, and introduce inner pouch and its contents into sterile field. STEP 2 - Peel back inner pouch to access Propel vial. Leave product in vial until ready to use. STEP 3 - Open lid, and remove Propel DBM Putty. STEP 4 - Mold Propel DBM Putty to desired shape and size, and combine with autologous bone in a 1:1 ratio as needed.
38. Axial back pain is resultant from _________________ instability.
Saggital
49. By itself, which of the three "O's" is FormaGraft?/
Scaffold only]
23. What does immunodepletion mean and how does it relate to Osteocel?
Selective immunodepletionto remove immunogeniccells and tissues
Describe best practices for loading and unloading the Nuvasive MAS Fixation Standard Guides:
Silver portion of the guide must be backed out - if its visible its unlocked -
Why is it important to leave the screws proud upon initial inserftion
So the blade is able to articulate around the shank head and ensure the retractor has mobility
What are a few applications that a doctor can use CT scans for?
Spinal Trauma / Evals for Pre-Op & Post-Op / Pain Causing Pathologies / Additional Studies (Myelogram / Angiogram / Discogram)
3. What is the difference between Stiffness & Strength?
Stiffness- a measure of the amount of deflection that a load causes in a material Strength- a measure of the maximum loss that can be placed on a material before it permanently deforms or breaks
How does 5.5mm CoCr compare to 6.0mm Ti in terms of stiffness and strength?
Stiffness: 5.5 is 76% more than 6.0 Strength 6.0 Ti is slightly stronger than 5.5 CoCr
Describe the following X-CORE Mini Design Goals: c. Versatile -
Straight and angled devices
1. What are three selection factors that a surgeon might consider when choosing an implant?
Strength, stiffness, imaging properties, cost, availability, clinical history, wear properties, biocompatibility
What does "stress-shielding" mean in terms of anterior cervical plating?
Stress-shielding as it relates to anterior plating and interbody biomechanics, means that a significant (disproportional) amount of the anatomic loads in the cervical spine are being placed onto the anterior plate and not transferred through to the interbody
47. What is FormaGraft?/
Sythetic - Scaffold Only]
At what level of your spine do your ribs start?
T1
What is the difference in water or CSF fluid color between a T1 & T2 weighted MRI image?
T1 = Black vs T2 = Light Gray or White
17. If a patient has a large PI (i.e. sacrum is parallel to the floor), how must the spine compensate to get the head to line up with the pelvis?
THE LUMBAR AND THORACIC SPINE MUST CURVE TO A GREATER DEGREE FOR THE PATIENT TO BE IN BALANCE
54. When using Nuvaline, what anatomical elements must be in view?
TL JUNCTION AND FEMORAL HEADS
27. How do you know once Osteocel Plus is thawed?/]
The cancelous chips settle to the bottom
41. What instrument is used if the Graft Funnel becomes clogged?
The Graft Removal Tool
37. Describe the surgical utilization of the Iliac Crest:
The Iliac Crest can be utilized for additional support and fixation while also hosting an ideal site for autogenous bone grafting.
What is the benefit of the Open Top Guides?
The ability to re-attached inter-operatively after the original towers have popped off.
What does "load-sharing" mean in terms of anterior cervical plating?
The anatomic loads are being more evenly distributed between the plate and interbody
What type of screw trajectory is unique to the MAS Midline exposure?
The cortical screw trajectory
Why is the domed surface of CoRoent® Contoured beneficial?
The domed design is meant to be bone sparing
The Interlock system reduces the number of steps in the ACDF procedure. a. True b. False
True
Describe how T1 Slope parameters are measured. What are the optimal ranges?:
The measure of the angle of T1 Superior End-plate & C7 Inferior Endplate Optimal Ranges = 13 - 25 deg
D) Genitofemoral
The nerve labeled A on the diagram above is the __________ nerve:
C) Femoral
The nerve labeled D on the diagram above is the __________ nerve
The Supine ALIF Retractor system features a carbon-fiber frame with dual table mounted arms and aluminum blades for both rigidity and radiolucency. True-False
True
In Dr. Shaffrey's case of the 71 year old female with neurogenic claudication and radicular leg pain, he believes the reason that the first two surgeries were not successful in the long term is because:
The patient's sagittal balance was not restored.Pelhjh
2. What is Modulus of Elasticity (MOE)?
The quantity used to characterize the stiffness of materials
Explain for each of the following five indications the reasons why a surgeon would choose to use a Posterior Approach to the Cervical Spine: - Congenital Canal Stenosis:
The spinal cord itself is approximately 10mm in diameter, thus congenital stenosis can cause relative small disc herniations and osteophytes to be difficult problems for patients
Why is the superior endplate referenced when targeting for percutaneous screw placement? What maneuver is done with the C-Arm to achieve a crisp / linear endplate
The superior endplate is used as the parallel marker to ensure the screw is on a correct trajectory. Use - tilt or rotate C-Arm Cephalad or Caudal depending upon the level
How do modular screw systems allow for improved access to disc space & optimized visualization to anatomy?
The tulip is attached in-situ, allowing visualization into the disc space and reliable screw performance
The ability to adequately access difficult pathological levels (below C6 and above C3) is a benefit of the MaXcess-C Retractor. a. True b. False
True
The Rod Inserters are designed so the heel of the guide does not enter into the guides. Why?
To ensure the rod needs to be fully seated into the tulip head
How did Traction perform in insertional torque and pullout strength compared to Osteogrip and Expedium?
Traction vs Osteogrp: 31% & 42% greater insertional torque for low & medium density bone 6% & 8% greater pullout strength for low & medium density bone Traction vs Expedium: 4% & 5% greater insertional torque for low & medium density bone 5% greater pull out strength for low density bone and the same for medium density
Which type of anterior cervical plating is most closely associated with the principles of load-sharing and Wolff's Law?
Translation
What is the best way to confirm Interlock's screws are locked into place?
Triangle laser marks within the screw hole provide visual confirmation that the screw is locked
15. True or False: The spine is the most common site of bony metastases.
True
16. Surgeons commonly use the superior uncinated process as a landmark for how far to decompress laterally during an ACDF procedure. True or False?
True
22. Due to the rigidity of the thoracic spine, the transition zones between the cervical-thoracic and thoracic-lumbar regions are prone to trauma induced injury. True or False?
True
24. Because the lumbar spine is at the base of the spine, it bears a majority of a person's upper body weight. True or False?
True
25. The lumbar vertebral bodies are kidney-shaped. True or False?
True
31. The sacrum is 5 fused vertebral segments, S1-S5. True or False?
True
33. Pelvic retroversion makes walking increasingly difficult (i.e. patient's must shuffle their feet to walk). True or False?
True
35. Osteocel is intended for single use and cannot be refrozen or sterilized before or after opening. True / False
True
37. As we age, our spine naturally becomes more and more kyphotic. True or False?
True
5. A high PT can mask the true extent of malalignment and lead to an underestimated surgical plan. a. True b. False
True
63. Age, gender, preexisting diabetes and nicotine use were not determined not to be statistically significant when associated with overall fusion rate in one or two-level cases. True / False
True
64. The authors concluded that given the fusion rate of the study without graft related complications; mesenchymal stem cell allografts provide an effective alternative especially in those patients with comorbid conditions that may pose a challenging fusion environment. True / False
True
68. NuvaMap allows a surgeon to simulate surgeries using NuVasive specific cages loaded into the software. True or False?
True
7. PI dictates the amount of LL a person needs to be in balance (+- 10 degrees). a. True b. False
True
A Caspar pin distraction system is included with the MaXcess-C® system. a. True b. False
True
According to Kornblum et. al "Biomechanical Evaluation of the Brigade Standalone Lumbar Interbody Cage," the standalone cage with integrated screws showed comparable stability to traditional ALIF contructs (interbody + plate), particularly in later bending and axial rotation. True-False
True
According to the Brigade Interfixated biomechanical testing "Expulsion Testing of the Brigade Standalone ALIF System with Screws", Brigade (referred to as "CoRoent XL SA" in the article), has a higher resistance to expulsion when compared to STALIF. True-False
True
Affix III is a great option for surgeons looking for a simple fixation system in single position surgery or to back up a decompression - True/False
True
An optional usage Fee is encouraged for use with the MaXcess-C Retractor if NuVasive implants are not utilized during the case. a. True b. False
True
Archon's integrated locking mechanism is locked with the same driver that is used to insert the bone screws. a. True b. False
True
Brigade Interfixated is ideal for surgeons that want a single approach standalone with a zero anterior profile. True-False
True
Helix Mini ACP underwent (and surpassed) the same testing procedures (bending compression & torsion tests to failure) per FDA requirements as all other cervical plates currently on the market including 2-hole per level plates. True or False?
True
Monolith PEEK, compared to titanium cages and allows for a large central and lateral graft apertures designed to help facilitate bony through-growth and fusion. True or False?
True
Nuvasive's assembled allograft can be inserted using the Envoy delivery system. True-False
True
Surgeon can utlize either a PLIF or TLIF cage placement through the MAS Midline exposure - True/False
True
The CoRoent Small Interlock Contoured features a larger graft window vs. CoRoent Small Interlock. True or False?
True
The Helix-R Canted-Coil Locking mechanism is an integrated zero-step locking mechanism that automatically locks the screw in place once it is placed. True or False?
True
The retroperitoneal approach to an ALIF is performed behind the peritoneum, and is a muscle sparing approach in which most patients go home within 24-48 hours - True-False.
True
Triad ALIF allograft is saline packaged to reduce brittleness and be ready for use right out of the package. True-False
True
Unlike any other plate on the market Archon-R is specifically indicated to be used for corpectomy following tumor or burst fracture. True or False?
True
When locking down the Brigade Plate, it is recommended to initially leave the screws proud, and then drive them to their final position using an alternating, diagonal (star) pattern. True-False
True
the PEEK composition of Monolith makes it more favorable for postoperative imaging - True / False
True
Adult AIS is a result of what? What are they're symptoms?
Untreated AIS Symptoms: Pain Neurogenic claudication Isolated radiculopathy (Concave Side, Fractional Curve)
Describe how Cervical Sagittal Vertical Axis (CSVA) parameters are measured. What are the optimal ranges:
Vertical Plum Line of C7 to Vertical Plum Line of C2 Optimal Range = CSVA < 4 cm
What is a "variable" cervical plate construct?
Variable Screws can be placed in at any angle within the preset cone of angulation (25° at ends of plate) and allow for rotational movement. The screws in this type of construct rotationally move as settling occurs during the fusion process.
Regarding deformity correction, what is the benefit of having the intraoperative flexibility of using the same tulip that will accept 5.0, 5.5, and 6.0 rods?
Versatility: The ability to provide multiple approaches (Open & MAS) for every case with few trays.
58. When would the BNC splitter be used?
WHEN C ARM TECH IS USING OVERHEAD MONITORS
How is a patient's health related quality of life (HRQOL) affected when the patient is outside the "Cone of Economy"?
When a patient's balance is outside the cone of economy, they are forced to compensate certain aspects of the spine which lead to spinal deformity and pain associated
Which of the following are positive characteristics of MIS procedures? A) Muscle and soft tissue preservation B) Decreased blood loss C) Faster recovery times D) Decreased learning curve E) All of the above F) A, B & C only
You chose: F) A) Muscle and soft tissue preservation B) Decreased blood loss C) Faster recovery times
6. Describe Wolff's Law
Wolff's law = bone will adapt to the loads under which it is placed.
What is Kambin's Trianlge
Working corridor: 1. Hypotenuse: Exiting Nerve Root: 2. Base: Superior endplate of the caudal vertebral body 3. Height: Traversing Nerve Root / Lateral aspect of the fact
Is Reline MAS Consol NVM5 Compatibile?
Yes
What is the advantage of using the MAS Midline Allograft, especially for the MAS Midline TLIF technique?
You are able to implant / deliver the graft to the entire anterior column disc space
Benefits of the Facet Tube: a. Max Dilation? b. Is there an articulating arm attachment point? c. What is the purpose of this attachment point?
a. 22mm b. Yes c. increased stability
How is CoRoent Anterior TLIF differentiated from the competition
Zero-Profile Inserter (rotated at 90 deg) Built-In Fulcrm to restore lordosis in Lumber
32. High SVA = _________ PT Low SVA = _________ PT
a. b.
What is the process of where X-rays stop or get absorbed by objects?
a. Attenuation
When are the following Compression/Distraction best used? a. The C/D Rack b. Figure 8's c. Hinged Compressor
a. C/D Rack Skipped levels and parallel compression / distraction b. Figure 8's At L5-S1, when you have crossover of the guides c. Hinged compressor Long constructs
Total number of vertebra: a. Cervical C1-C7 = b. Thoracic T1-T12 = c. Lumbar L1-L5 = d. Sacrococcygeal = ______ ______ Total Fused Vertebrae
a. Cervical C1-C7 = 7 b. Thoracic T1-T12 = 12 c. Lumbar L1-L5 = 5 d. Sacrococcygeal = 9 33 Total Fused Vertebrae
17. The curvature of the thoracic spine is _____:
a. Lordotic
23. The curvature of the lumbar spine is:
a. Lordotic
4. The curvature of the cervical spine is _________
a. Lordotic
9. What are the 3 "O's"
a. Osteoconduction: b. Osteoinduction: c. Osteogenesis:
This study found that the following spinopelvic parameters were predictive of an ODI more than 40: a. Pelvic Tilt (PT): ______ degrees or more b. SVA: ______ mm or more c. PI - LL: Mismatch of ______ degrees or more
a. Pelvic Tilt (PT): 22 deg or more b. SVA: 47 mm or more c. PI - LL: Mismatch of 11 deg or more
9. Dorsal roots, or sensory nerves, are located on the _____ side of the spinal cord.
a. Posterior
What are 6 different types of imaging modalities that doctors might use with their patients
a. Radiography b. Fluoroscopy c. Magnetic Resonance Imaging d. Computed Tomography e. Myelography f. Discography
19. Osteocel Pro builds on the scientific heritage and clinical experience of Osteocel Plus - True-False
a. True
Four common decompression techniques include:
a. anterior Cervical Discectomy b. Posterior laminectomy c. Posterior laminoplasty d. Posterior Foraminotomy
6. Define the term stenosis:
abnormal narrowing of the spinal canal or intervertebral foramen. may be attributed to degenerative or arthritic changes to the ligaments and/or facets. Can lead to compression
5. What are two advantages of using stainless steel as a material?
advantages - easy to manufacture Stiffness/strength
Describe the benefit of high degree screw angulation:
allows for flexibility in screw placement to deal with varying patient anatomies
10. Ventral roots, or motor nerves, are located on the _____ side of the spinal cord.
b. Anterior
60. When intraoperatively measuring LL with NuvaMap O.R., where must the two measurement lines be placed? (Choose all that apply) a. Superior Endplate of T12 b. Superior Endplate of L1 c. Inferior Endplate of L1 d. Inferior Endplate of L5 e. Superior Endplate of S1
b. Superior Endplate of L1 e. Superior Endplate of S1
9. What is the main difference between back pain symptoms vs. neural impingement symptoms?
back pain is caused by inflammation, neural impingemeant is due to stenosis or ddd
Full reduction is achieved when the green line is _______
buried and you can no longer see it
16. The brachial plexus is formed by which cervical nerve roots? a. C3-C7 b. C4-C7 c. C5-C8 d. C4-C8
c. C5-C8
48. FormaGraft is considered to be: a. Autograft in a jar b. Allograft c. Synthetic d. All of the above
c. Synthetic
32. Describe the cortical
cancellous composition of the sacrum:/ • Largely made up of cancellous bone with a cortical shell.
The ____________ acts as a landmark to count down the levels of the cervical spine.
dens
13. Describe how the odontoid process
dens functions with C1:/ • Connects and articulates with anterior articular process of the C1 ring as a pivot point. The combination of these two anatomical elements allows for axial rotation.
What step does the Reline MAS "Tap Dilator Combination" instrument eliminate?
initial dilator second dilator
7. Where are the NVM5 Quick Skills videos located?
https://nuvasive.app.box.com/s/3efyf5yuxplho5bsesro2fof82xh1xkz/folder/3860238065
What happens to the canal space as you proceed down the cervical spine?
it narrows
Deformity into the sagittal plane is defined as:
kyphosis
Each ____________________________________ has a facet joint above and below to help articulation.
lateral mass
The ____________________________________ is the thickest portion of bone in the posterior cervical spine.
lateral mass
4. What is degenerative disc disease?
loss of fluid in the disc reducing the ability to act as a shock absorber
Describe Posterior Lumbar Interbody Fusion (PLIF)
maximally invasive procedure done through partial or gull laminectomy. Retraction of nerve roots and cauda equina. Positive: large exposure for fusion Negative: fusion disease
What is the Wiltse Approach
muscle sparing approach by dissecting between the mutlfidus & the longisimis muscle
TLX is differentiated by the geometry of its expanded endplates, which expand up to 15 deg of lordosis in the _____ plane to maintain ______ alignment while correcting ______ alignment.
oblique coronal sagittal
Explain for each of the following five indications the reasons why a surgeon would choose to use a Posterior Approach to the Cervical Spine: - Cranial-Cervical Pathology:
one may see instability arise in the setting of trauma, congenital conditions, autoimmune conditions (rheumatoid arthritis), or iatrogenic (caused by previous surgery) conditions. Because the articulations are directly posterior to the mandible and oral cavity, anterior access is limited thus posterior being prefered
Describe Posterior Lumbar Fusion (PLF) - performed when neural impingement and
or pre-existing instability. No interbody is used, just pedicle screws./ Positive: known approach, decompression Negative: boney removal, potential nerve injury
8. Match the following terms to the appropriate definition: a. Radiculopathy b. Mylopathy c. Cauda Equina Syndrome _ ___ compression of the spinal cord producing symptoms and signs of cord dysfunction. ____ nerve irritation resulting in neurologic deficit, typically radiating pain and
or weakness in a limb. ____ compression characterized by bilateral (both sides) leg pain, perianal anesthesia, urinary retention, and loss of rectal tone./ _b ___ compression of the spinal cord producing symptoms and signs of cord dysfunction. __a__ nerve irritation resulting in neurologic deficit, typically radiating pain and/or weakness in a limb. __c__ compression characterized by bilateral (both sides) leg pain, perianal anesthesia, urinary retention, and loss of rectal tone
Nerve irritation resulting in neurologic deficit, typically radiating pain and
or weakness in a limb: A) Cauda Equina Syndrome B) Neuritis C) Myelopathy D) Radiculopathy/ D) Radiculopathy
___________________________________ is bone formation within the ligament which can cause compression to the spinal cord.
ossification
Recommended trajectory of the I-PAS III needle is ______ to the endplate at the _____ or ______ o'clock position on the pedicle
parallel 1 or 2 o'clock
When placing the MAS MIDLINE Cephalad screws, target 1mm medial with a burr to what anatomical landmark?
pars
When placing the MAS Midline Retractor blades, ensure that the "RIGHT" and "LEFT blades are placed appropriately, based on the _________
patient anatomy
The _____________________________extend posteriorly from the vertebral body. Surgeons use them for screw placement. C_______ has a pedicle C_______ has a small pedicle C_______ T______ T______ and T_______ have pedicles.
pedicle C2 C6 C7 T1 T2 T3
During tulip attachment with MAS Midline, the tulip is fully engaged when the gold button is______
popped out
What are the difference between Single vs Duel Lead threads?
single lead is only one thread vs a duel lead which is duel threads - which increases the speed of insertion
For what purpose / pathology is the Single Level Reducer best used?
single level spondy vertebral body reduction over a single level
What are the 3 types of "listthesis?
spondylolisthesis lateral-listhesis retro-listhesis
8. C3 - C7 are known as the __
sub-axial __ region.
1. In the AP plane ____ marker should be past the _____ 2. In the lateral view, the posterior and anterior markers should be spanning the ____ 3. Release all ______
superior / inferior - midline apophyseal ring retractors & inserter
What are common treatment options to reduce incidence of PJK?
tapered rods hooks at UIV cement augmentation in UIV pre-op alignment tethers at UIV+1 or UIV +2
The ________ is the pivot bone which protrudes up from the Axis into the Atlas. It provides Atlantoaxial stability
the dens
Instability is defined as:
the inability of the [cervical] spine to withstand physiologic loads resulting in pain deformity and-or injury to the neural structures
What is the benefit of the rod reduction tulip protruding through the set screw?
the tulip delivers the reduction force onto the rod - and NOT onto the set screw
Fusion is considered necessary when
to: A) Prevent progressive spinal deformity B) Re-establish spinal stability C) Diminish pain through elimination of motion D) All of the above E) B and C only / D) All of the above
The ______________________________________________________ are useful landmarks in anterior cervical decompressions because surgeons use them during discectomies or corpectomies as lateral landmarks for their dissection.
uncinate processes (UP)
Is stress-shielding favorable or unfavorable in regards to the fusion process? Why?
unfavorable because..... a significant (disproportional) amount of the anatomic loads in the cervical spine are being placed onto the anterior plate and not transferred through to the interbody
Define Transforaminal Lumbar Interbody Fusion (TLIF) -
unilateral facetectomy to expose disc space. Retracton of exiting nerve root. Insertion of interbody implant. Positive - good fusion rates Negative - not a full discectomy
What artery runs through the transverse foramen?
vertebral
_______________________ scoliosis comes from the malformation of bone
vertebral segments. A) Degenerative B) Idiopathic C) Congential D) Neuromuscular E) Adult/ C) Congential
What is "rod normalization"
when the rod is fully reduced into the tulip head and at 90 deg perpendicular
60. How many patients in this study showed evidence of graft rejection or complications associated with implantation?/
zero
18. Explain why Osteocel is "Experienced":
• 20+ peer reviewed journal publications • In clinical use since 2005• 100,000+ patients treated* • Backed by 15 years of R&D by NuVasive® and Osiris Therapeutics
14. Define plexus:
• A network of mixed spinal nerves that mostly serve the limbs
30. What is the Pars interarticularis? What is the consequence of a pars fracture?
• A region or bridge of bone that connects the lamina to the pedicles. "It is the portion of the house that connects the roof to the walls..."
17. Describe the sympathetic truck and its function:
• A series of ganglia, or nerve fibers, that are a fundamental part of the autonomic nervous system. A fundamental part that regulates the bodily functions of internal body organs. Controls flight or fight response.
19. Why is the thoracic spine stiffer compared to the cervical and lumbar regions?
• Because of the rib attachments in cervical or lumbar regions (not as mobile)
14. List the anatomical elements common on vertebral bodies C3 through C7:
• Body • Pedicles • Transverse processes and transverse foramens • Superior articular facet • Spinous process • Lamina
The CNS is comprised of what components?
• Brain • Spinal cord
3. The spinal cord is housed within which regions of the spine?
• Cervical and Thoracic regions
18. What is the name of the anatomical element where the ribs attach?
• Costal facets
Describe the design rationale benefit of the following Archon-R features: a. 3rd Screw fixation point:
• Decrease chance of screw pullout • Reduce opportunity for screw breakage • Increase rigidity of overall construct • Decrease the risk of screw subsidence
2. Define cortical bone:
• Dense hard bone, makes up outer shell of vertebrae
15. Describe the function and purpose of the uncinate processes:
• During an ACDF, surgeons use the uncinate processes as a landmark to determine how far to retract laterally for decompression.
56. Commonly compatible C-Arms with NVM5 include:
• GE OEC • PHILLIP B PULSERA • SIEMENS ARCADIA
11. Define DRG and its function:
• Houses both sensory and motor nerves (mixed spinal nerves)
Describe the design rationale benefit of the following Archon-R features: b. Optimized Plate Geometry:
• Increase distance between fixation points (an additional 3mm) • Provide for larger bone wedge to reduce pullout • Increase rigidity of overall construct • Remain no wider than currently marketed plate
1. Describe the difference between an indication and contra-indication?
• Indication: a condition or factor that serves as a reason the perform or administer a certain medical treatment • Contraindication: a reason to withhold a certain medical treatment
35. How does the angle of the sacral slope effect lumbar lordosis?
• It will affect the amount of lumbar lordosis needed to correct the patient for proper alignment.
4. What features of the IPAS III provide safe and reproducible pedicle cannulation?
• Jamshidi needle with integrated EMG monitoring • Elicits EMG values in real-time during pedicle cannulation to help minimize the chance of pedicle breaches • Integrated depth gauge • Diamond and beveled tip option
15. The lumbar plexus is formed by which lumbar nerve roots?
• L1-L4
59. What are the 3 ways to load images into NuvaMap O.R.?
• MANUALLY ENTRY WITH THE WIZARD • MANUALLY ENTRY WITHOUT THE WIZARD • AUTOMATICALLY UPLOADING FROM A USB DRIVE
9. C1 is unique because:
• No pedicles • No spinous process
11. The vertebral artery runs through C1-C7 transverse foramen. True or False?
• Only runs through C1-C6 foramen passing outside C7
3. What is the procedural value of monitoring MAS® Posterior Lumbar?
• Percutaneous and minimally invasive pedicle preparation • Dynamic EMG may help prevent pedicle breaches before they occur • Neuromonitoring that integrates seamlessly into the procedure
Describe the clinical benefits for Extra Rod Connector:
• Pre-assembled • Requires no pre-planning
5. Define the procedural value of monitoring during an anterior cervical case:
• Procedurally integrated neuromonitoring for reproducible outcomes • Can help protect against spinal cord impingement and dysphonia
5. What are the 3 main functions of spine?
• Protection • Structural Support • Flexibility/Mobility
1. Which are the primary functions of the boney spine?
• Provide a structural framework • Attachments for muscle tendons enabling motions - movement • Protection of internal organs
10. Describe the purpose of the transverse foramen:
• Provides a hole for the vertebral artery to run.
6. Define the procedural value of monitoring during a posterior cervical case:
• Real-time feedback communicated directly to the surgeon • Intraoperative confirmation of spinal cord integrity
3. Define cancellous bone:
• Soft, spongy bone that is more porous than cortical
6. What is CSF?
• Spinal Fluid
21. Which ribs do not attach anteriorly to the sternum?
• T11 and T12
36. Why is the sacral promontory relevant?
• The bone closer to the sacral promontory is usually more dense, thus when surgeons are placing a screw at S1 they will aim their trajectory towards this landmark for better screw purchase and fixation.
27. What is the apophyseal ring in the lumbar vertebral bodies?
• The outer, dense cortical bone on the vertebral body
26. How do the pedicles in the lumbar spine differ from the thoracic spine?
• They are thicker and bigger, wider
7. Why have Interbody Fusions become the standard of care for spine procedures?
• They provide better surface area, carry more of the spinal load (Wolff's Law) and are better vascularized for more biologics than posterolateral areas.
33. Describe the function of the sacrum:
• Transfers the axial load from the spine to the pelvis and legs
8. Define function of the sensory roots:
• Transmit information from the periphery to the brain
29. Define motion segment:
• Two vertebral bodies with the intervertebral disc between
Describe the design rationale benefit of the following Archon-R features: c. Larger screw design:
• Variable, fixed, self-tapping, self-drilling configurations • Provide a more robust screw design for aggressive purchase in differing bone types • Feature a tactile feedback surface that binds to the plate when the screw and plate are flush against the bone • Increase strength of screw by 1.9 times over current designs
7. Define function of the motor roots:
• Ventral roots that conduct information from the brain to the periphery
20. List and describe the anatomical elements present for each thoracic vertebrae:
• Vertebral Body • Superior Costal Facet • Transverse Costal Facet • Elongated Spinous Process • Small narrow pedicles
28. What is subsidence? How does placement of an interbody device across the apophyseal ring affect subsidence?
• When an implant sinks into the vertebral body it is resting on. There is a lower risk of subsidence if the implant spans the entire apophyseal ring.
51. What is the role of the collagen component of FormaGraft?/
•Absorbent network (BMA and proteins) •Provides flexibility and excellent handling characteristics
Explain Growth Factors
•Contain signals that promote cellular activity •Infuse® (BMP)
54. What is the role of beta tricalcium phosphate (β-TCP) in FormaGraft?/
•Faster-resorbingceramic •Provides space for new bone and vascular ingrowth
why it is important in spine fusion.
•In spine fusion: Increasing load on bone graft increases = bone will remodel itself = become stronger to resist "this" loading Decreasing load on a bone graft could lead to bone resorbing = no stimulus (load) to remodel = making the bone weaker
53. What is the role of Hydroxyapatite (HAp) in FormaGraft?/
•Longer-lasting ceramic •Provides structural matrix •Excellent visualization on radiograph
Explain Cellular Allograft
•Preserve the biologic components of living donor bone •Osteocel Plus, Trinity® Evolution™
Explain Sythetic
•Usually ceramics, sometimes combined with collagen •Bone marrow aspirate (cellular fluid) from iliac crest, pedicle, or vertebral body using a needle typically applied •Examples include: FormaGraft®, MasterGraft, Vitoss, Actifuse, Healos, chronOS
