need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

NBME 18 Answers

nbme18/Block 1/Question#15 (reveal difficulty score)
A 34-year-old man has a herniated lumbar ...
D (Lamina) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +1  upvote downvote
submitted by โˆ—azibird(279)
get full access to all contentpick a username

A laminectomy removes the lamina and spinous process. The lamina is the posterior bridging segment (D). The lateral bridging segment is the pedicle (B).

However, I don't understand how you could access the herniated disc from this angle, the spinal cord would be in the way! Can someone explain?

https://www.mayoclinic.org/tests-procedures/laminectomy/about/pac-20394533

get full access to all contentpick a username
scrambledeggs  Take a look at the section labeled Laminotomy and Discectomy. https://eorthopod.com/lumbar-discectomy/ +7
coby219  "Intervertebral disc (nucleus pulposus) herniates posterolaterally through annulus fibrosus (outer ring) into central canal due to thin posterior longitudinal ligament and thicker anterior longitudinal ligament along midline of vertebral bodies. Nerve affected is usually below the level of herniation." - first aid 19 p455 +5
chj7  Adding to coby219, after knowing herniation most commonly occurs posterolaterally, we would most likely choose between B and D. The only reasonable choice from a surgical perspective would be D b/c we would most likely be entering the patient's vertebrae from the back (thus, B would be harder to access). +1
freemanpeng  Question stem said" laminectomy". I just ingored it and kept struggling between lamina(D) and pedicle(B)...... So, it's not about neurosurgery; it's just basic anatomy! +1



Must-See Comments from nbme18

feliperamirez on He is medically qualified to drive
anechakfspb on Tubular atrophy
aneurysmclip on Endothelial nitric oxide synthase production
azibird on 24,25-Dihydroxycholecalciferol
famylife on Increased transcription of HMG-CoA reductase
match95 on Plasmid loss
apurva on Antineoplastic
cbreland on Basement Membranes
match95 on Proximal tubule: isotonic; Macula densa: ...
sugaplum on Abnormal migration of endoderm from the ...
amirmullick3 on Myelofibrosis
merpaperple on Primary spermatocyte
wishmewell on Alpha-synuclein
namira on Greening reaction on blood agar

search for anything NEW!