Cervical Spine MCQs

A 60-year-old Asian male presents with progressive cervical myelopathy. Imaging demonstrates continuous multi-level ossification of the posterior longitudinal ligament (OPLL) from C3-C6. Cervical lordosis is preserved, and the K-line is positive. Which procedure provides adequate decompression while minimizing the risk of a dural tear?

A 64-year-old man has severe cervical spondylotic myelopathy due to continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. He has a neutral cervical alignment. Which of the following is the most appropriate surgical approach to decompress the spinal cord?

A 50-year-old man of East Asian descent presents with progressive hand clumsiness and broad-based gait. CT demonstrates a continuous, dense bony mass along the posterior aspect of the C3 to C6 vertebral bodies. MRI shows significant anterior spinal cord compression, but sagittal alignment is lordotic. What is the most appropriate surgical option?

An 82-year-old woman falls from a standing height. CT imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. She has no neurologic deficits but has a history of congestive heart failure and severe COPD. What is the most appropriate management?

A 30-year-old man dives into a shallow pool and sustains a burst fracture of C1 (Jefferson fracture). On the open-mouth odontoid radiograph, the sum of the lateral mass displacement of C1 over C2 is measured at 8 mm. What does this finding indicate?

An 82-year-old man presents with neck pain after a ground-level fall. CT scan reveals a Type II odontoid fracture with 2 mm of posterior displacement. He has a history of severe COPD, ischemic heart disease, and osteoporosis. Neurologic examination is completely normal. What is the most appropriate initial management?

A 32-year-old man is involved in a motor vehicle accident. He complains of right-sided arm pain and exhibits weakness in elbow flexion and wrist extension. Radiographs demonstrate an anterolisthesis of C5 on C6 of approximately 25%. What is the most likely diagnosis?

Which of the following radiographic measurements on a lateral cervical spine film is most indicative of an atlanto-occipital dissociation?

An 82-year-old male presents with severe neck pain following a ground-level fall. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact but has multiple medical comorbidities, including severe COPD and congestive heart failure. What is the most appropriate initial management?

An 82-year-old male with severe COPD and ischemic heart disease falls from a standing height. Imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the most appropriate management for this patient?

A 28-year-old female sustains a burst fracture of the C1 ring (Jefferson fracture) after a shallow water diving accident. An AP open-mouth odontoid radiograph reveals lateral displacement of the C1 lateral masses relative to the C2 articular facets. According to the Rule of Spence, a combined overhang greater than what value strongly suggests a transverse ligament rupture?

An 82-year-old man falls from standing and sustains a Type II odontoid fracture with 3 mm of posterior displacement. His neurologic examination is completely normal. What is the most appropriate management?

A 22-year-old diver hits his head on the bottom of a pool. Radiographs reveal a burst fracture of the C1 ring (Jefferson fracture). An open-mouth odontoid view shows an asymmetric overhang of the C1 lateral masses on C2 totaling 8 mm. This finding indicates disruption of which critical stabilizing structure?

Which of the following surgical factors is considered the strongest independent risk factor for the development of adjacent segment disease requiring surgery after an anterior cervical discectomy and fusion (ACDF)?

A 35-year-old male is brought to the trauma bay after a high-speed motor vehicle collision. He is awake, alert, and cooperative. Imaging reveals a bilateral cervical facet dislocation at C5-C6. Neurologic exam reveals 3/5 strength in the bilateral upper extremities and intact sensation. According to current guidelines, what is the most appropriate immediate step in management?

An 84-year-old female with multiple medical comorbidities sustains a Type II odontoid fracture with 3 mm of posterior displacement following a low-energy fall. She is neurologically intact. What is the most appropriate initial management?

A 21-year-old collegiate baseball pitcher presents with chronic medial elbow pain that is worse during the late cocking and early acceleration phases of throwing. MRI demonstrates a high-grade partial tear of the ulnar collateral ligament (UCL). He has failed 4 months of conservative management and is opting for reconstruction. Which specific structure provides the primary restraint to valgus stress at the elbow between 30 and 120 degrees of flexion?

The 'SAFE' interval in anterior cervical discectomy and fusion (ACDF) refers to the safe surgical corridor between which two anatomical structures?

A 45-year-old woman undergoes an anterior cervical discectomy and fusion (ACDF) at C5-C6. During the exposure, the surgeon dissects laterally along the uncinate process. Which of the following structures is at greatest risk of iatrogenic injury if lateral dissection extends excessively beyond the uncinate process at this level?

A 45-year-old woman undergoes an anterior cervical discectomy and fusion (ACDF) at the C6-C7 level via a right-sided transverse incision. Postoperatively, she is noted to have profound hoarseness. The affected nerve is more susceptible to injury on the right side compared to the left due to which of the following anatomical characteristics?