Cervical Spine MCQs

An 82-year-old man falls from a standing height and presents with neck pain.

Imaging reveals a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. He has a history of severe chronic obstructive pulmonary disease (COPD) and coronary artery disease. What is the most appropriate initial management?

An 84-year-old frail female is evaluated after a mechanical fall at her nursing home. She complains of high neck pain but is neurologically intact.

A CT scan of the cervical spine reveals a Type II odontoid fracture with 3 mm of posterior displacement. She has severe COPD, congestive heart failure, and osteoporosis, making her a prohibitive surgical risk. What is the most appropriate management?

A 78-year-old man presents with neck pain after a low-speed motor vehicle collision. CT scan shows a displaced Type II odontoid fracture. He has a history of severe COPD and ischemic heart disease. What is the most appropriate management?

An 84-year-old man sustains a Type II odontoid fracture after a ground-level fall. He has a history of COPD and mild heart failure. Which of the following management strategies is associated with the highest rate of major complications and mortality in this specific patient population?

An 82-year-old male falls from a standing height. He has severe neck pain but a normal neurologic examination. CT scan reveals a Type II odontoid fracture with 2 mm of posterior displacement. Comorbidities include severe COPD, diabetes mellitus, and severe osteoporosis. Which of the following treatments provides the best balance of safety and efficacy for this specific patient?

A 78-year-old man presents with neck pain after a ground-level fall. CT scan reveals a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. He has a history of severe COPD, congestive heart failure, and coronary artery disease. What is the most appropriate management?

An 82-year-old woman with a history of severe osteoporosis and multiple medical comorbidities presents after a low-speed motor vehicle collision. She reports severe upper neck pain. She is neurologically intact.

A cervical CT scan reveals a Type II odontoid fracture with 3 mm of posterior displacement. What is the most appropriate initial management for this patient?

An 82-year-old woman with a medical history of severe severe chronic obstructive pulmonary disease and recent myocardial infarction falls from standing height. She complains of isolated neck pain. A CT scan of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. She is neurologically intact. What is the most appropriate definitive management?

An 82-year-old male with a history of severe COPD and ischemic heart disease presents with neck pain after a low-speed motor vehicle collision. CT scan demonstrates a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. Which of the following is the most appropriate initial management for this patient?

An 84-year-old man is brought to the emergency department after a ground-level fall. He complains of severe neck pain but denies any numbness, tingling, or weakness in his extremities. His medical history is significant for severe chronic obstructive pulmonary disease (COPD), coronary artery disease with a previous myocardial infarction, and poorly controlled diabetes mellitus. Neurological examination is completely intact. A CT scan of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. What is the most appropriate management for this patient?

A 45-year-old man undergoes an anterior cervical discectomy and fusion (ACDF) at C5-C6 through a right-sided, transverse cervical approach. On postoperative day 1, he is noted to have severe hoarseness and coughing when attempting to drink thin liquids. Laryngoscopy confirms unilateral vocal cord paralysis. The injured structure responsible for this complication typically courses in which of the following anatomic locations?

A 22-year-old collegiate baseball pitcher reports medial elbow pain during the late cocking and early acceleration phases of throwing. MRI confirms a partial-thickness tear of the medial ulnar collateral ligament (MUCL). Which bundle of the MUCL is the primary restraint to valgus stress at the elbow during these specific phases of the throwing motion?

During an anterior cervical discectomy and fusion (ACDF), excessive lateral bone removal using a burr puts the vertebral artery at significant risk. The vertebral artery typically enters the transverse foramen first at which cervical level?

A 19-year-old collegiate baseball pitcher undergoes reconstruction of the ulnar collateral ligament (UCL) of the elbow. Which bundle of the UCL is considered the primary restraint to valgus stress between 30 and 120 degrees of elbow flexion?

During a multi-level anterior cervical discectomy and fusion (ACDF), lateral dissection places the vertebral artery at risk. In normal cervical anatomy, the vertebral artery typically enters the foramen transversarium at which cervical vertebral level?

During a right-sided anterior cervical discectomy and fusion (ACDF) at C5-C6, the surgeon carefully mobilizes the visceral structures to avoid nerve injury. Which of the following anatomic characteristics makes the recurrent laryngeal nerve more susceptible to injury on the right compared to the left?

A 45-year-old patient presents with neck pain and occipital headaches after a motor vehicle collision. Flexion-extension radiographs of the cervical spine demonstrate an atlantodental interval (ADI) of 4 mm. An MRI is obtained to evaluate the ligamentous structures. The alar ligaments primarily prevent which of the following movements?

A 45-year-old female with long-standing rheumatoid arthritis presents with suboccipital neck pain and new-onset clumsiness in her hands. Dynamic cervical radiographs and a subsequent MRI reveal marked atlantoaxial instability and pannus formation. In evaluating the stability of the atlantoaxial joint, the alar ligaments serve as the primary restraints to which specific motion?

A 22-year-old collegiate baseball pitcher reports medial elbow pain during the late cocking and early acceleration phases of throwing. On examination, he has localized tenderness slightly distal to the medial epicondyle and a positive moving valgus stress test. An MRI of the elbow (Figure 8) demonstrates a full-thickness tear of the ulnar collateral ligament (UCL). Which of the following components represents the primary restraint to valgus stress at the elbow between 30 and 120 degrees of flexion?

When evaluating an upper cervical spine MRI for atlantoaxial instability, the integrity of the transverse ligament is the primary focus. This ligament firmly attaches to which of the following osseous landmarks?