Spine Surgery (Degenerative, Traumatic, Neoplastic, and Infectious)
What the candidate must own
Know the degenerative cascade: disc degeneration, facet arthropathy, ligamentous hypertrophy, and the resulting central canal, lateral recess, and foraminal stenosis. Be able to distinguish radiculopathy from myelopathy clinically and on imaging, and know the indications for discectomy, laminectomy, and fusion. Understand the three-column concept and the thoracolumbar injury classification and severity score for trauma, and the role of conservative versus operative management. For spinal infection, know the discitis-osteomyelitis pattern (disc and adjacent endplates), the role of biopsy and prolonged antibiotics, and the indications for surgery (instability, abscess, neurological deficit, failure of medical therapy). For spinal tumours, know the Tokuhashi and Tomita scoring systems for metastatic disease and the role of separation surgery and stereotactic radiosurgery.
Traps that appear in questions
- Assuming every disc herniation needs surgery - the majority resolve with conservative care.
- Missing red flags (fever, night pain, weight loss, bladder dysfunction, saddle anaesthesia) that change the diagnosis to infection, tumour, or cauda equina syndrome.
- Confusing discitis (disc and endplate involvement) with isolated vertebral osteomyelitis or tuberculosis (which spares the disc early).
- Forgetting that cauda equina syndrome is a surgical emergency requiring urgent decompression.
Rule of thumb
Before labelling back pain as degenerative, screen for red flags. Worked example: a patient with fever, night pain, and disc-endplate destruction on MRI has discitis-osteomyelitis; the next step is image-guided biopsy for culture before starting prolonged targeted antibiotics, with surgery reserved for instability, abscess, or neurological deficit.