26-8. Lumbar Laminectomy for Discectomy with Spinal Fixation

How many vertebrae comprise the vertebral column in a normal adult?
a) 24
b) 26
c) 33
d) 30

c) 33

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Into how many regions are the vertebrae of the adult vertebral column divided?
a) 3
b) 4
c) 5
d) 6

c) 5

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What are the five regions of the vertebral column from superior to inferior?
a) Lumbar, cervical, thoracic, sacral, coccygeal
b) Cervical, thoracic, lumbar, sacral, coccygeal
c) Thoracic, cervical, lumbar, sacral, coccygeal
d) Sacral, coccygeal, lumbar, thoracic, cervical

b) Cervical, thoracic, lumbar, sacral, coccygeal

How many bones are in the cervical region of the vertebral column?
a) 5
b) 7
c) 12
d) 33

b) 7

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What is the name of the first cervical vertebra (C1) and what is its primary function?
a) Axis; allows rotation of the head
b) Atlas; supports the skull
c) Sacrum; supports pelvic girdle
d) Coccyx; muscle attachment

b) Atlas; supports the skull

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What is the second cervical vertebra (C2) called and what does it allow?
a) Atlas; supports the skull
b) Sacrum; fusion of vertebrae
c) Axis; allows rotation, flexion, and extension of the head
d) Coccyx; muscle attachment

c) Axis; allows rotation, flexion, and extension of the head

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How many bones are in the thoracic region and what is their role?
a) 7; support the skull
b) 12; main support for the thorax and articulation with ribs
c) 5; provide trunk flexibility
d) 4; muscle attachment

b) 12; main support for the thorax and articulation with ribs

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How many lumbar vertebrae are there and what are their two main functions?
a) 12; articulation with ribs and support of thorax
b) 7; support skull and neck movement
c) 5; support body weight and allow trunk flexibility
d) 4; muscle attachment

c) 5; support body weight and allow trunk flexibility

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What forms the sacrum and what is it considered part of?
a) Five fused bones; pelvic girdle
b) Four fused bones; axial skeleton
c) Seven individual bones; cervical spine
d) Twelve bones; thoracic cage

a) Five fused bones; pelvic girdle

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How many vertebrae form the coccyx and what is its function?
a) Five fused vertebrae; support skull
b) Four fused vertebrae; attachment for hip and pelvic muscles
c) Seven individual bones; neck support
d) Twelve bones; rib articulation

b) Four fused vertebrae; attachment for hip and pelvic muscles

What part of a vertebra is located anteriorly?
a) Neural arch
b) Spinous process
c) Body or centrum
d) Transverse process

c) Body or centrum

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What structure is formed posteriorly by the neural arch in a vertebra?
a) Intervertebral disc
b) Vertebral foramen (opening for the spinal cord)
c) Pedicle
d) Vertebral body

b) Vertebral foramen (opening for the spinal cord)

What are the lateral extensions of the pedicles called?
a) Spinous processes
b) Transverse processes
c) Neural arches
d) Facets

b) Transverse processes

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What is the function of the facets on the vertebrae?
a) Protect the spinal cord
b) Support muscle attachment
c) Provide articulating surfaces between vertebrae
d) Connect vertebrae to ribs

c) Provide articulating surfaces between vertebrae

What is an osteophyte commonly known as?
a) A cartilage tear
b) A bony spur
c) A ligament strain
d) A nerve sheath

b) A bony spur

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What can happen if osteophytes form within the spinal canal?
a) Increased flexibility of the spine
b) Compression of the spinal cord
c) Decreased bone density
d) Improved nerve conduction

b) Compression of the spinal cord

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What is the medical term for the formation of osteophytes causing spinal issues?
a) Scoliosis
b) Spondylosis
c) Spina bifida
d) Osteoporosis

b) Spondylosis

Which lumbar intervertebral spaces are most commonly affected by problems?
a) L1–L2 and L2–L3
b) L3–L4 and L4–L5
c) L4–L5 and L5–S1
d) L5–S1 and S1–S2

c) L4–L5 and L5–S1

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What is lumbar spondylosis?
a) Forward displacement of a vertebral body
b) Advanced lumbar disc disease
c) Constriction of the spinal canal
d) Inflammation of the lumbar muscles

b) Advanced lumbar disc disease

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What condition is characterized by advanced constriction of the spinal canal caused by spondylosis?
a) Lumbar stenosis
b) Lumbar spondylolisthesis
c) Lumbar scoliosis
d) Lumbar disc herniation

a) Lumbar stenosis

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What is lumbar spondylolisthesis?
a) Compression of the spinal cord
b) Forward displacement of the upper vertebral body on the lower vertebral body
c) Degeneration of intervertebral discs
d) Narrowing of the neural foramina

b) Forward displacement of the upper vertebral body on the lower vertebral body

What surgical approaches are used for spinal cord tumor removal and to provide exposure for pain control infusion pumps, cordotomy, and rhizotomy?
a) Discectomy and fusion
b) Laminectomy or hemilaminotomy
c) Foraminotomy and microdiscectomy
d) Vertebroplasty and kyphoplasty

b) Laminectomy or hemilaminotomy

What does surgical treatment for lumbar, thoracic, and cervical disc degeneration typically involve?
a) Injection of corticosteroids into the disc
b) Removing the degenerated disc and fusing the joint when necessary
c) Physical therapy and bracing
d) Only pain medication management

b) Removing the degenerated disc and fusing the joint when necessary

What is the purpose of performing a laminectomy for discectomy?
a) To fuse vertebrae for spinal stability
b) To decompress a nerve root impinged by an extruded disc fragment
c) To inject medication into the spinal canal
d) To remove vertebral bone for tumor access

b) To decompress a nerve root impinged by an extruded disc fragment

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Which region of the spine is most often affected by nerve root impingement due to disc extrusion because of its weight-bearing function?
a) Cervical
b) Thoracic
c) Lower lumbar
d) Sacral

c) Lower lumbar

What type of incision is used to approach the affected spinal levels posteriorly?
a) Transverse incision with a #15 blade
b) Midline or paramedian incision with a #10 blade on a #3 handle
c) Lateral incision with a scalpel
d) Oblique incision with electrocautery

b) Midline or paramedian incision with a #10 blade on a #3 handle

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Which instrument is used to separate the paraspinous muscles from the spinous processes and laminae?
a) Periosteal elevator or osteotome
b) Scalpel
c) Kerrison rongeur
d) Pituitary rongeur

a) Periosteal elevator or osteotome

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What is packed around the margins to assist with hemostasis and blunt dissection during muscle separation?
a) Ray-Tec sponges folded lengthwise
b) Cotton balls
c) Gauze pads
d) Sterile towels

a) Ray-Tec sponges folded lengthwise

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What type of instrument is placed to provide exposure after muscles are reflected?
a) Retractor
b) Scalpel
c) Curette
d) Forceps

a) Retractor

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Which retractors are examples commonly used for exposure in lumbar spine surgery?
a) Adson-Beckman, Martin-Meyerding, Taylor, angled Gelpi
b) Weitlaner, Senn, Richardson
c) Deaver, Army-Navy, Ragnell
d) Balfour, Bookwalter, Omni-Tract

a) Adson-Beckman, Martin-Meyerding, Taylor, angled Gelpi

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What anatomical structures are removed using rongeurs during the laminectomy?
a) Spinous process, ligamentum flavum, margin of lamina, medial margin of adjacent facet
b) Vertebral body and intervertebral disc
c) Transverse processes only
d) Spinal cord and dura mater

a) Spinous process, ligamentum flavum, margin of lamina, medial margin of adjacent facet

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After removing bone with Kerrison rongeur, what is retracted medially with a nerve root retractor?
a) Dura and nerve root
b) Spinal cord
c) Paraspinous muscles
d) Ligamentum flavum

a) Dura and nerve root

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What should the CST do with bone fragments removed during laminectomy?
a) Discard immediately
b) Save in a small basin to be packed into the surgical wound for osteogenesis
c) Send to pathology
d) Use to fashion implants

b) Save in a small basin to be packed into the surgical wound for osteogenesis

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What instrument is used to remove extruded fragments of disc material?
a) Pituitary rongeurs
b) Kerrison rongeurs
c) Curettes
d) Osteotomes

a) Pituitary rongeurs

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If removing a spinal tumor, which instruments are used for blunt and sharp dissection?
a) Metzenbaum scissors and periosteal elevator
b) Kerrison rongeur and curette
c) Scalpel and bone saw
d) Pituitary rongeur and curette

a) Metzenbaum scissors and periosteal elevator

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What should the CST do with disc fragments removed during the procedure?
a) Discard immediately
b) Place into sterile specimen container to be sent to pathology
c) Save for grafting
d) Use for implant shaping

b) Place into sterile specimen container to be sent to pathology

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What instrument is used in the intervertebral disc space to remove all remaining disc fragments?
a) Curettes
b) Pituitary rongeur
c) Kerrison rongeur
d) Osteotome

a) Curettes

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What vital structures must the surgeon take care not to injure when removing disc fragments?
a) Aorta and vena cava
b) Spinal cord and nerve roots
c) Esophagus and trachea
d) Jugular vein and carotid artery

a) Aorta and vena cava

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What may be performed if the spine is destabilized following laminectomy?
a) Fusion of the vertebrae
b) Complete removal of vertebrae
c) Spinal cord stimulation
d) Laminectomy extension

a) Fusion of the vertebrae

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Where is bone graft typically taken from for spinal fusion?
a) Iliac crest of the patient or homogenous banked bone
b) Rib cage
c) Femur
d) Tibia

a) Iliac crest of the patient or homogenous banked bone

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How is fusion achieved during spinal fusion surgery?
a) By placing bone graft struts in and along the intervertebral spaces after curettage
b) By removing the vertebrae completely
c) By implanting a prosthetic disc only
d) By using only metal screws and plates without bone graft

a) By placing bone graft struts in and along the intervertebral spaces after curettage

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What devices may be used for stability if bone grafting alone is insufficient?
a) Rods, cages, plates, and screws
b) External braces only
c) None, patient immobilization only
d) Bone cement

a) Rods, cages, plates, and screws

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What is typically placed in the wound before closure to aid in drainage?
a) Hemovac drains
b) Jackson-Pratt drains
c) Penrose drains
d) Foley catheter

a) Hemovac drains

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What type of suture is used to approximate the paraspinous muscles during closure?
a) Heavy-gauge polyglactin suture
b) Monofilament nylon
c) Silk
d) Chromic gut

a) Heavy-gauge polyglactin suture

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What materials are commonly used to close the skin after spinal surgery?
a) Monofilament nylon or stainless-steel staples
b) Chromic gut sutures
c) Silk sutures
d) Vicryl sutures only

a) Monofilament nylon or stainless-steel staples