Cervical Spine MCQs

An 82-year-old man with multiple medical comorbidities including severe COPD and ischemic heart disease falls from a standing height. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the most appropriate definitive management?

An 82-year-old man sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact. Which of the following stabilization methods is associated with the highest risk of severe morbidity and mortality in this specific patient population?

An 82-year-old woman falls from a standing height and presents with severe neck pain. Radiographs reveal a Type II odontoid fracture with 3 mm of posterior displacement. She has a history of severe COPD and ischemic heart disease. What is the most appropriate non-operative management for this patient?

A 75-year-old woman suffers a Type II odontoid fracture after a ground-level fall. The fracture is displaced 3 mm posteriorly. She has severe medical comorbidities, including advanced COPD and heart failure. What is the most appropriate management?

A 12-year-old boy with Down syndrome is being evaluated for participation in the Special Olympics. Flexion-extension cervical radiographs show an atlantodens interval (ADI) of 6 mm. He is completely asymptomatic and his neurologic examination is normal. What is the most appropriate recommendation?

An 82-year-old man falls from a standing height and sustains a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. Given his age and significant medical comorbidities, what is the most appropriate initial management considering the high nonunion rate?

A 26-year-old man presents after a diving accident. He is awake, alert, and cooperative. He complains of severe neck pain and has right-sided upper extremity weakness (C6 distribution). Radiographs reveal a right unilateral facet dislocation at C5-C6. What is the most appropriate initial management?

A 58-year-old man of East Asian descent presents with progressive clumsiness in his hands, hyperreflexia, and gait instability. Radiographs and MRI show continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6, causing severe multilevel cord compression. His cervical alignment is lordotic. What is the most appropriate surgical intervention?

An 82-year-old man with advanced dementia and severe chronic obstructive pulmonary disease presents after a ground-level fall. CT scan reveals a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. What is the recommended initial management?

An 82-year-old man falls from a standing height and sustains a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact but has severe neck pain. He has a history of severe COPD, ischemic heart disease, and osteoporosis. What is the most appropriate initial management?

A 22-year-old collegiate baseball pitcher complains of medial elbow pain during the late cocking phase of throwing. The moving valgus stress test is positive. Which specific ligamentous structure is the primary restraint to valgus stress at the elbow between 30 and 90 degrees of flexion?

A 21-year-old collegiate pitcher reports medial elbow pain and decreased throwing velocity. The "moving valgus stress test" is positive. What structure is the primary restraint to valgus stress at the elbow during the late cocking phase of throwing?

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is frequently used off-label in anterior cervical discectomy and fusion (ACDF). This specific application is strongly associated with which of the following complications?

During an anterior cervical discectomy and fusion (ACDF), the longus colli muscles are elevated to define the lateral margins. Overzealous lateral dissection and retraction past the longus colli places which structure at immediate risk?

During an anterior cervical discectomy and fusion (ACDF), aggressive lateral dissection places the vertebral artery at risk. In standard human anatomy, the vertebral artery typically enters the transverse foramen at which cervical level?

A 7-year-old boy with Down syndrome undergoes routine cervical spine screening radiographs. Flexion-extension views reveal an Atlanto-Dens Interval (ADI) of 9 mm. He is neurologically intact and asymptomatic. What is the recommended management?

An anterior cervical discectomy and fusion (ACDF) is planned at the C6-C7 level. A right-sided approach is historically considered to have a higher risk of recurrent laryngeal nerve (RLN) injury compared to a left-sided approach due to which anatomical variant?

An 80-year-old man sustains a Type II odontoid fracture after a ground-level fall. Displacement is 2 mm. He has severe medical comorbidities. What is the most appropriate management?

An 82-year-old man presents with neck pain after a low-energy fall. CT demonstrates a Type II odontoid fracture with 2 mm of posterior displacement.

He has no neurologic deficits and has significant cardiac comorbidities. What is the most appropriate management?

A 35-year-old construction worker presents with lower neck pain after forcefully lifting a heavy load. Plain radiographs show an avulsion fracture of the spinous process of C7.

There are no neurologic deficits. What is the most appropriate management?