Cervical Spine MCQs

During an anterior cervical discectomy and fusion (ACDF), the surgeon dissects laterally toward the uncinate processes. Extreme lateral dissection poses a risk of catastrophic injury to the vertebral artery. In the majority of the population, at what cervical level does the vertebral artery enter the foramen transversarium as it ascends toward the brain?

During an anterior cervical discectomy and fusion (ACDF) at the C5-C6 level, the surgeon develops the standard plane between the carotid sheath laterally and the trachea/esophagus medially. Which of the following specific fascial layers must be incised to enter this internervous plane?

During the late cocking and early acceleration phases of throwing, which specific component of the ulnar collateral ligament (UCL) complex of the elbow serves as the primary restraint to valgus stress?

A 21-year-old collegiate baseball pitcher is undergoing an ulnar collateral ligament (UCL) reconstruction utilizing an autograft.

Which native anatomical structure is the primary restraint to valgus stress at the elbow during the late cocking and early acceleration phases of throwing?

A 22-year-old collegiate baseball pitcher reports insidious onset of medial elbow pain and decreased pitching velocity. Physical examination reveals pain with the moving valgus stress test. An MRI confirms a high-grade partial tear of the ulnar collateral ligament (UCL). Which specific anatomic structure is the primary restraint to valgus stress at the elbow during the late cocking and early acceleration phases of throwing?

An 82-year-old woman falls from a standing height and presents with localized neck pain. She is neurologically intact. A CT scan of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. She has a history of severe COPD, osteoporosis, and congestive heart failure. What is the most appropriate definitive management?

A 72-year-old male sustains a trauma to the neck after a fall from a standing height. Radiographs and CT imaging demonstrate a Type II odontoid fracture with 6 mm of posterior displacement.

If surgical intervention is considered, which of the following findings is an absolute contraindication to anterior odontoid screw fixation?

Twelve hours following an elective C4-C5 anterior cervical discectomy and fusion (ACDF), a 55-year-old male patient suddenly develops progressive difficulty swallowing, stridor, and significant anterior neck swelling. His oxygen saturation drops to 86% on room air, and he exhibits suprasternal retractions. What is the most critical and appropriate immediate next step in management?

A 78-year-old man with a history of severe COPD, ischemic heart disease, and osteoporosis sustains a Type II odontoid fracture after a ground-level fall. Radiographs demonstrate 2 mm of posterior displacement. He is neurologically intact. What is the most appropriate initial management?

A 55-year-old female undergoes a C4-C7 Anterior Cervical Discectomy and Fusion (ACDF). Postoperatively, she develops severe and progressive dysphagia, requiring reintubation. Which of the following factors is most strongly associated with an increased risk of severe, life-threatening postoperative dysphagia and airway edema in this setting?

A 55-year-old Asian male presents with progressive hand clumsiness and gait disturbance. Examination reveals a positive Hoffmann's sign and bilateral upgoing plantars. Imaging demonstrates continuous ossification along the posterior aspect of the vertebral bodies from C3 to C6.

During preoperative planning for an anterior decompression, which of the following radiographic findings is the most significant predictor of an intraoperative dural tear?

During a revision anterior cervical discectomy and fusion (ACDF) at C6-C7 on the right side, the surgeon notes postoperative hoarseness in the patient. Indirect laryngoscopy confirms a vocal cord paralysis. Which of the following best describes the anatomical basis for the variable risk to the recurrent laryngeal nerve (RLN) during a right-sided versus left-sided anterior cervical approach?

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. He has a past medical history of severe chronic obstructive pulmonary disease (COPD) and ischemic heart disease. What is the most appropriate initial management?

An 82-year-old woman sustains a ground-level fall and complains of severe neck pain. CT scan (Figure 4) reveals a Type II odontoid fracture with 2 mm of posterior displacement. She is neurologically intact. Which of the following treatments has the highest risk of morbidity and mortality in this specific patient demographic?

During an anterior cervical discectomy and fusion (ACDF), meticulous dissection is required to avoid injury to the recurrent laryngeal nerve (RLN). Which of the following statements most accurately describes the anatomical characteristics and surgical implications of the RLN?

An 85-year-old woman with severe chronic obstructive pulmonary disease, congestive heart failure, and osteoporosis sustains a Type II odontoid fracture with 3 mm of posterior displacement after a mechanical fall. She complains of neck pain but has no neurological deficits. What is the most appropriate initial management for this patient?

A 55-year-old female with long-standing, poorly controlled rheumatoid arthritis complains of occipital headache and "electric shock" sensations radiating down her arms when she flexes her neck. Flexion-extension radiographs demonstrate atlantoaxial subluxation. Which of the following radiographic measurements indicates the highest risk for impending neurologic deficit and serves as a strong indication for surgical stabilization?

Figure 24 shows the lateral radiograph of an 84-year-old man who sustained a ground-level fall. He complains of high neck pain but is neurologically intact. CT scan confirms a Type II odontoid fracture with 1 mm of posterior displacement. If non-operative management is selected for this patient, which of the following orthoses is associated with the highest mortality rate in this specific demographic?

A 55-year-old female with a 20-year history of rheumatoid arthritis presents with severe neck pain, suboccipital headaches, and bilateral hand clumsiness. Radiographs show significant basilar invagination.

Which of the following radiographic measurements is the most accurate for diagnosing basilar invagination on a lateral cervical spine radiograph?

An 82-year-old man is evaluated in the emergency department after suffering a ground-level fall. He complains of upper neck pain without radiation. Neurologic examination is completely normal. CT imaging of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. Given the patient's age and clinical presentation, what is the most appropriate management strategy?