Spine Surgery
What you must understand
Know spinal anatomy, instability criteria (Denis three-column, TLICS), and the difference between stable and unstable injuries. Understand degenerative conditions - disc herniation, stenosis, spondylolisthesis - and their natural history versus surgical indications. Be fluent in red flags (fever, night pain, weight loss, bowel/bladder dysfunction, progressive neurologic deficit) that mandate urgent imaging. Know cauda equina syndrome as a surgical emergency. Understand deformity (scoliosis, kyphosis) and its classification, plus principles of fusion, decompression, and instrumentation.
Traps in questions
- Cauda equina syndrome: bilateral leg pain, saddle anesthesia, urinary retention - requires urgent MRI and decompression; timing affects outcome.
- Cervical myelopathy signs: gait disturbance, hand clumsiness, hyperreflexia, positive Hoffmann and Babinski.
- Thoracolumbar junction (T11–L1) is the most common fracture site due to transition from rigid to mobile segments.
- Not all disc herniations need surgery - most resolve; surgery is for refractory radiculopathy or progressive deficit.
Worked example
A patient with L4–L5 disc herniation and L5 radiculopathy: motor deficit in great-toe extension and sensory loss over the dorsum of the foot. If the deficit is progressive or pain refractory after 6–8 weeks of conservative care, discectomy is indicated.
Exam strategy
Always ask: is there instability, neurologic compromise, or infection/malignancy? These drive urgency.