Cervical Spine MCQs

A 78-year-old man is involved in a low-speed motor vehicle collision. CT scan of the cervical spine reveals a displaced Type II odontoid fracture. Which of the following factors is most strongly associated with nonunion if treated conservatively with a halo vest?

A 60-year-old woman with a 20-year history of rheumatoid arthritis requires elective total hip arthroplasty. Flexion-extension cervical radiographs reveal an anterior atlantodens interval (ADI) of 8 mm. She is neurologically intact. What is the most appropriate management regarding her cervical spine prior to hip surgery?

A 25-year-old man is involved in a motor vehicle collision and sustains an isolated Jefferson (C1 ring) fracture. The 'Rule of Spence' on an open-mouth odontoid radiograph evaluates the combined overhang of the C1 lateral masses on C2. Overhang greater than what measurement suggests a rupture of the transverse atlantal ligament?

A 72-year-old woman complains of deteriorating handwriting, clumsiness in her hands, and unsteadiness when walking in the dark. On examination, rapidly flicking the distal phalanx of her middle finger into flexion causes a reflex flexion of her thumb and index finger. What is the name of this clinical sign?

An 80-year-old male trips and falls, striking his chin. CT of the cervical spine shows a fracture through the base of the odontoid process extending down into the cancellous body of C2. According to the Anderson and D'Alonzo classification, what type of fracture is this, and what is the typical initial treatment for a neurologically intact elderly patient?

The off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical discectomy and fusion (ACDF) has been associated with a significantly increased risk of which of the following life-threatening postoperative complications?

A 78-year-old man sustains a Type II odontoid fracture with 5 mm of posterior displacement after a fall. He is neurologically intact. Non-operative management with a halo vest is being considered. Compared to rigid cervical collar immobilization, halo vest placement in this specific patient population is associated with a significantly higher risk of:

An 82-year-old man sustains a Type II odontoid fracture after a fall from standing. He is neurologically intact but has severe neck pain. He has multiple comorbidities including severe COPD. What is the most appropriate management?

A 55-year-old woman with a 20-year history of rheumatoid arthritis presents with neck pain and occipital headaches. Flexion-extension radiographs reveal an anterior atlantodental interval (ADI) of 11 mm. What is the most appropriate definitive management?

A 78-year-old woman falls from a standing height and sustains a Type II odontoid fracture. She has a history of severe osteoporosis and COPD. Her neurologic exam is normal. What is the most appropriate initial management?

During an anterior cervical discectomy and fusion (ACDF), a right-sided approach is chosen. Which of the following statements regarding the recurrent laryngeal nerve (RLN) is most accurate?

An 84-year-old woman presents with severe neck pain after a low-energy fall from a standing height. CT imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. She is neurologically intact. What is the most appropriate management?

Half of all cervical spine rotation occurs at the atlantoaxial (C1-C2) articulation. Which of the following ligaments is the primary restraint to anterior translation of the atlas on the axis?

A 25-year-old professional javelin thrower presents with medial elbow pain. Valgus stress testing is positive at 30 degrees of elbow flexion. Which structure is the primary restraint to valgus instability in this position?

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

During an anterior cervical discectomy and fusion (ACDF), excessive lateral dissection over the longus colli muscle places the vertebral artery at risk. At which cervical level does the vertebral artery most commonly enter the transverse foramen?

An 82-year-old man presents with a Type II odontoid fracture after a ground-level fall. He has severe COPD and coronary artery disease. He is neurologically intact. What is the most appropriate initial management considering his age and fracture type?

An 85-year-old man sustains a Type II odontoid fracture with 3 mm of posterior displacement. He has multiple medical comorbidities, including severe COPD and coronary artery disease. What is the most appropriate initial management?

A 55-year-old man presents with progressive clumsiness in his hands and a broad-based gait. Imaging reveals continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6, occupying 65% of the canal. His cervical alignment is lordotic. What is the preferred surgical approach?

A 78-year-old man with severe COPD sustains a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. Compared to surgical intervention, nonoperative management with a rigid cervical collar in this patient demographic is associated with a higher rate of which of the following?