Cervical Spine MCQs

A 45-year-old woman undergoes an anterior cervical discectomy and fusion at C6-C7. Postoperatively, she is noted to have unilateral ptosis, miosis, and anhidrosis on the surgical side. Which structure was most likely injured during the surgical exposure?

A 30-year-old man sustains an axial loading injury, resulting in a Jefferson burst fracture of C1. Which radiographic measurement on the open-mouth odontoid view best indicates a rupture of the transverse atlantal ligament?

An 82-year-old previously independent male presents with a displaced Type II odontoid fracture after a fall. Considering the morbidity associated with various treatments in the elderly, what is generally the most appropriate definitive management?

A 55-year-old woman undergoes a multilevel anterior cervical discectomy and fusion (ACDF) using recombinant human bone morphogenetic protein-2 (rhBMP-2). Postoperatively, she develops severe dysphagia and respiratory distress. This complication is most directly related to which of the following?

An 82-year-old woman sustains a Type II odontoid fracture after a ground-level fall. She has multiple medical comorbidities, severe osteoporosis, and is minimally displaced. What is the most appropriate management strategy with the lowest associated mortality?

During a right anterior cervical discectomy and fusion (ACDF) at C6-C7, the recurrent laryngeal nerve is at greater risk than on the left side. Which anatomical characteristic explains this increased vulnerability?

During an anterior cervical discectomy and fusion (ACDF), aggressive lateral dissection over the uncinate process risks iatrogenic injury to the vertebral artery. At which cervical level does the vertebral artery most commonly enter the transverse foramen?

Which portion of the medial ulnar collateral ligament complex is the primary restraint to valgus stress at the elbow during the late cocking phase of throwing?

During an anterior cervical discectomy and fusion (ACDF), self-retaining retractors are placed. Which anatomical structure is at greatest risk of injury leading to Horner's syndrome if the longus colli muscles are retracted too far laterally?

During an anterior cervical discectomy and fusion (ACDF), excessive lateral dissection risks injury to the vertebral artery. At which cervical level does the vertebral artery typically enter the transverse foramen?

During an anterior cervical discectomy and fusion (ACDF), excessive lateral dissection carries the risk of vertebral artery injury. At which cervical level does the vertebral artery typically enter the transverse foramen from the neck?

A 38-year-old male is involved in a high-speed collision. Imaging reveals a fracture through the bilateral pars interarticularis of C2 with 4 mm of anterior translation of C2 on C3 and no severe angulation (Levine-Edwards Type II). What is the preferred initial management?

A neurologically intact 34-year-old male presents after a motor vehicle collision with a bilateral C5-C6 facet dislocation. An urgent MRI reveals a massive, extruded herniated disc behind the C5 vertebral body. What is the most appropriate next step in management?

An 82-year-old male with severe COPD, chronic kidney disease, and congestive heart failure sustains a Type II odontoid fracture with 2 mm of posterior displacement after a ground-level fall. He is neurologically intact. What is the most appropriate management strategy for this frail patient?

A 55-year-old male presents with progressive cervical myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). On a lateral neutral cervical radiograph, the OPLL mass crosses the K-line. What is the most appropriate surgical approach?

A 78-year-old man presents with severe neck pain following a ground-level fall. Imaging reveals a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. What is the most appropriate definitive management?

A 72-year-old man presents with an isolated Type II odontoid fracture after a ground-level fall. Anterior odontoid screw fixation is being considered. Which of the following is an absolute contraindication to this specific procedure?

An 82-year-old man presents with neck pain after a low-speed motor vehicle collision. CT scan of the cervical spine demonstrates a displaced Type II odontoid fracture. He is neurologically intact but has significant medical comorbidities. Which of the following is the most appropriate initial management?

A 35-year-old man presents to the emergency department after a high-speed motor vehicle collision. He complains of severe neck pain and exhibits bilateral upper extremity weakness (deltoids and biceps 3/5, triceps 4/5) with normal lower extremity strength. Radiographs demonstrate a 50% anterior translation of C5 on C6. The patient is awake, alert, and cooperative. What is the most appropriate next step in management?

A 25-year-old man is brought to the trauma bay after a diving accident. He is awake, alert, and cooperative. Neurologic examination is entirely normal. Plain radiographs and CT scans demonstrate a unilateral C5-C6 facet dislocation with approximately 25% anterior translation of C5 on C6. What is the most appropriate next step in management?