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Cervical Spine MCQs

Practice Set 17 of 24

This practice set contains high-yield board review questions covering key concepts in Cervical Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 321

Topic: Cervical Spine

During an anterior cervical discectomy and fusion (ACDF) at C5-C6, the surgeon elevates the longus colli muscles. Injury to the sympathetic trunk in this region can cause Horner's syndrome. Where is the cervical sympathetic trunk typically located relative to the longus colli?

. Medial to the longus colli
. Lateral to the longus colli
. Anterior to the prevertebral fascia
. Between the longus colli and the vertebral body
. Within the carotid sheath

Correct Answer & Explanation

. Lateral to the longus colli

Explanation

The cervical sympathetic trunk runs vertically just lateral to the longus colli muscles, beneath the prevertebral fascia. Dissection should remain medial to the lateral borders of the longus colli to avoid Horner's syndrome.

Question 322

Topic: Cervical Spine

During an ulnar collateral ligament (UCL) reconstruction in a baseball pitcher, understanding elbow biomechanics is crucial. Which anatomical band of the UCL is the primary restraint to valgus stress between 30 and 120 degrees of elbow flexion?

. Posterior bundle
. Transverse ligament
. Anterior band of the anterior bundle
. Posterior band of the anterior bundle
. Radial collateral ligament

Correct Answer & Explanation

. Anterior band of the anterior bundle

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress. Specifically, the anterior band of the anterior bundle is tight in extension and early flexion, while the posterior band tightens in deeper flexion.

Question 323

Topic: Cervical Spine

A 20-year-old collegiate baseball pitcher reports a sudden snap and sharp medial elbow pain during a curveball pitch. Examination reveals marked pain and subjective instability with a moving valgus stress test. Which anatomical structure is most likely acutely injured?

. Anterior bundle of the ulnar collateral ligament.
. Posterior bundle of the ulnar collateral ligament.
. Transverse ligament of the elbow.
. Flexor carpi radialis origin.
. Common extensor tendon.

Correct Answer & Explanation

. Anterior bundle of the ulnar collateral ligament.

Explanation

The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow between 30 and 120 degrees of flexion. It is the structure most commonly injured during the late cocking and early acceleration phases of throwing.

Question 324

Topic: Cervical Spine

A 20-year-old collegiate baseball pitcher complains of medial elbow pain and decreased pitching velocity. The pain is most severe during the late cocking and early acceleration phases of throwing. A moving valgus stress test is positive. Which bundle of the involved ligament is the primary restraint to valgus stress at 90 degrees of elbow flexion?

. Anterior bundle of the ulnar collateral ligament
. Posterior bundle of the ulnar collateral ligament
. Transverse ligament
. Lateral ulnar collateral ligament
. Radial collateral ligament

Correct Answer & Explanation

. Anterior bundle of the ulnar collateral ligament

Explanation

The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow between 30 and 120 degrees of flexion. It is the structure most commonly injured in overhead throwing athletes.

Question 325

Topic: Cervical Spine

A 7-year-old child presents with torticollis and severe neck stiffness one week after undergoing a tonsillectomy. A CT scan confirms atlantoaxial rotatory subluxation. What is the primary pathophysiologic mechanism of this condition (Grisel's syndrome)?

. Congenital aplasia of the odontoid process
. Rupture of the transverse ligament due to minor trauma
. Hyperemia and inflammation leading to ligamentous laxity
. Ischemic necrosis of the atlas
. Facet joint osteoarthrosis

Correct Answer & Explanation

. Hyperemia and inflammation leading to ligamentous laxity

Explanation

Grisel's syndrome is a non-traumatic atlantoaxial rotatory subluxation associated with head and neck infections or recent ENT surgery. Pharyngeal inflammation causes local hyperemia, which leads to laxity of the transverse ligament and subsequent C1-C2 subluxation.

Question 326

Topic: Cervical Spine

A 30-year-old unrestrained driver sustains a traumatic spondylolisthesis of C2 with severe angulation and minimal translation (Levine-Edwards Type IIa). What is the most appropriate initial management?

. Immediate heavy longitudinal cervical traction
. Gentle reduction with extension and compression in a halo vest
. Immediate anterior cervical discectomy and fusion (ACDF)
. C1-C2 posterior instrumentation and fusion
. Application of a rigid cervical collar only

Correct Answer & Explanation

. Gentle reduction with extension and compression in a halo vest

Explanation

Type IIa Hangman's fractures involve a flexion-distraction mechanism. Axial traction is strictly contraindicated as it worsens the deformity; treatment requires gentle extension and compression, typically in a halo vest.

Question 327

Topic: Cervical Spine
A 78-year-old man sustains a fall from standing and presents with neck pain. CT scan shows a fracture through the base of the dens (odontoid process) without displacement. What is the Anderson and D'Alonzo classification and standard treatment for this patient?
. Type I; rigid cervical collar
. Type II; rigid cervical collar
. Type II; halo vest immobilization
. Type III; immediate surgical fusion
. Type III; rigid cervical collar

Correct Answer & Explanation

. Type II; rigid cervical collar

Explanation

A fracture through the base of the dens is a Type II odontoid fracture. In elderly patients, rigid cervical collar immobilization is generally preferred over halo vests due to the significant morbidity and mortality associated with halo application in this age group.

Question 328

Topic: Cervical Spine

An 82-year-old man presents with neck pain following a ground-level fall. CT scan reveals a Type II odontoid fracture with 2 mm of displacement. He has a history of severe COPD, congestive heart failure, and diabetes. What is the most appropriate definitive management?

. Halo vest immobilization for 12 weeks
. Rigid cervical collar immobilization
. Anterior odontoid screw fixation
. Posterior C1-C2 transarticular screw fixation
. Occipitocervical fusion

Correct Answer & Explanation

. Rigid cervical collar immobilization

Explanation

While surgical fixation is often favored for Type II odontoid fractures in healthy adults, this patient's severe comorbidities and age make surgery high risk. Halo immobilization is strictly contraindicated in the elderly due to severe respiratory complications, making a rigid collar the safest choice despite nonunion risks.

Question 329

Topic: Cervical Spine

A 78-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure sustains a displaced Type II odontoid fracture after a low-energy fall. He is deemed a high-risk surgical candidate. What is the most appropriate initial management?

. Halo vest immobilization
. Hard cervical collar
. Posterior C1-C2 fusion
. Anterior odontoid screw fixation
. Soft cervical collar

Correct Answer & Explanation

. Hard cervical collar

Explanation

In elderly patients who are poor surgical candidates, a hard cervical collar is the preferred initial treatment for Type II odontoid fractures. Halo vest immobilization is contraindicated in this demographic due to high rates of morbidity and mortality.

Question 330

Topic: Cervical Spine

A 48-year-old woman undergoes a right-sided C5-C6 anterior cervical discectomy and fusion (ACDF). Postoperatively, she exhibits significant hoarseness and a weak voice. Laryngoscopy confirms unilateral vocal cord paralysis. Injury to which of the following structures is responsible?

. Vagus nerve
. Superior laryngeal nerve
. Recurrent laryngeal nerve
. Sympathetic trunk
. Phrenic nerve

Correct Answer & Explanation

. Recurrent laryngeal nerve

Explanation

The recurrent laryngeal nerve innervates the majority of the intrinsic muscles of the larynx. Injury to this nerve during an ACDF results in true vocal cord paralysis, manifesting clinically as severe hoarseness and a breathy voice.

Question 331

Topic: Cervical Spine



An 82-year-old woman falls and presents with neck pain. The radiograph shows a displaced Type II odontoid fracture. She has significant medical comorbidities (Charlson Comorbidity Index of 6) and no neurologic deficit. What is the most appropriate initial management?

. Halo vest immobilization
. Hard cervical collar
. Anterior odontoid screw fixation
. Posterior C1-C2 fusion
. Occipitocervical fusion

Correct Answer & Explanation

. Hard cervical collar

Explanation

In elderly patients with severe medical comorbidities, a rigid cervical collar is the preferred initial treatment for Type II odontoid fractures. This is due to the high morbidity and mortality associated with halo vests and surgical intervention in this specific demographic.

Question 332

Topic: Cervical Spine

An 80-year-old man sustains a Type II odontoid fracture after a ground-level fall. He has a history of severe COPD and coronary artery disease, but his neurologic examination is completely normal. Which of the following treatment modalities has the highest associated mortality rate in this specific patient population?

. Rigid cervical collar
. Halo vest immobilization
. Anterior odontoid screw fixation
. Posterior C1-C2 transarticular screw fixation
. Observation alone with a soft collar

Correct Answer & Explanation

. Halo vest immobilization

Explanation

Halo vest immobilization is contraindicated in the elderly due to a high rate of severe complications, including pin tract infections, respiratory compromise, and an elevated mortality rate. A rigid cervical collar or surgical fixation is preferred depending on patient comorbidities and fracture characteristics.

Question 333

Topic: Cervical Spine

In a patient with longstanding rheumatoid arthritis, which of the following radiographic findings is the strongest indication for operative intervention to prevent irreversible neurologic damage?

. Anterior atlantodens interval (ADI) of 4 mm
. Posterior atlantodens interval (PADI) of 13 mm
. Subaxial subluxation of 2 mm
. Erosion of the odontoid peg
. C2-C3 facet arthrosis

Correct Answer & Explanation

. Posterior atlantodens interval (PADI) of 13 mm

Explanation

A posterior atlantodens interval (PADI), or space available for the cord, of less than 14 mm is a critical threshold and an absolute indication for cervical stabilization in rheumatoid arthritis patients.

Question 334

Topic: Cervical Spine

An 82-year-old frail female sustains a minimally displaced Type II odontoid fracture after a mechanical fall. What is the most appropriate initial management, considering her age and comorbidities?

. Halo vest immobilization
. Rigid cervical collar
. Anterior odontoid screw fixation
. Posterior C1-C2 transarticular screw fixation
. Occipitocervical fusion

Correct Answer & Explanation

. Rigid cervical collar

Explanation

In elderly patients (typically >80 years), halo vest immobilization carries an unacceptably high morbidity and mortality rate. A rigid cervical collar is the preferred initial management, despite a known higher risk of nonunion.

Question 335

Topic: Cervical Spine

An 82-year-old man sustains a Type II odontoid fracture after a ground-level fall. He has severe medical comorbidities, including heart failure and severe chronic obstructive pulmonary disease. What is the most appropriate initial management strategy?

. Halo vest immobilization
. Rigid cervical collar
. Anterior odontoid screw fixation
. Posterior C1-C2 fusion
. Transoral odontoid resection

Correct Answer & Explanation

. Rigid cervical collar

Explanation

Recent literature demonstrates that rigid cervical collars are an acceptable, non-inferior treatment for Type II odontoid fractures in the elderly, avoiding high surgical morbidity. Halo vest immobilization is contraindicated in this demographic due to unacceptably high mortality rates.

Question 336

Topic: Cervical Spine

A 24-year-old male is involved in a motor vehicle collision.

CT of the cervical spine shows a Type II odontoid fracture with 7 mm of posterior displacement. The patient is neurologically intact. What is the most appropriate definitive management?

. Rigid cervical collar for 12 weeks
. Halo vest immobilization
. Anterior odontoid screw fixation
. Posterior C1-C2 instrumentation and fusion
. Transoral odontoidectomy

Correct Answer & Explanation

. Posterior C1-C2 instrumentation and fusion

Explanation

Type II odontoid fractures with significant displacement (>5 mm) have a high nonunion rate with conservative management. Posterior C1-C2 fusion is indicated because posterior displacement is a relative contraindication to anterior screw placement.

Question 337

Topic: Cervical Spine

A 55-year-old woman with a 20-year history of rheumatoid arthritis presents with progressive hand clumsiness and hyperreflexia. Radiographs reveal atlantoaxial instability. Which of the following radiographic measurements is the strongest predictor of postoperative neurologic recovery?

. Anterior atlantodental interval (ADI) greater than 9 mm
. Posterior atlantodental interval (PADI) less than 14 mm
. Cervical lordosis angle
. Subaxial subluxation of 3 mm
. Ranawat line measurement of 15 mm

Correct Answer & Explanation

. Posterior atlantodental interval (PADI) less than 14 mm

Explanation

The posterior atlantodental interval (PADI) represents the true space available for the spinal cord. A PADI of less than 14 mm is an absolute indication for surgery and strongly correlates with an inability to achieve neurologic recovery.

Question 338

Topic: Cervical Spine

A 60-year-old male undergoes a C3-C6 cervical laminoplasty for multi-level ossification of the posterior longitudinal ligament (OPLL). On postoperative day three, he develops new-onset, profound weakness in shoulder abduction and elbow flexion, with no sensory deficits. What is the most likely diagnosis?

. Horner syndrome
. C5 nerve root palsy
. Recurrent laryngeal nerve injury
. Vertebral artery injury
. C8 nerve root palsy

Correct Answer & Explanation

. C5 nerve root palsy

Explanation

C5 nerve root palsy is a known complication following cervical laminectomy or laminoplasty, typically presenting 2-3 days postoperatively with deltoid and biceps weakness. It is thought to be caused by tethering of the nerve root as the spinal cord shifts posteriorly.

Question 339

Topic: Cervical Spine

A 55-year-old female with long-standing rheumatoid arthritis presents with progressive neck pain and myelopathic symptoms. Which of the following radiographic measurements is the strongest indication for surgical stabilization to prevent irreversible neurologic deficit?

. Anterior atlantodental interval (ADI) of 4 mm
. Posterior atlantodental interval (PADI) of 13 mm
. Subaxial translation of 2 mm
. Cervical lordosis of 5 degrees
. Ranawat line measurement of 16 mm

Correct Answer & Explanation

. Posterior atlantodental interval (PADI) of 13 mm

Explanation

In rheumatoid arthritis, a Posterior Atlantodental Interval (PADI) of less than 14 mm is a critical threshold that correlates strongly with an increased risk of neurologic injury and necessitates surgical intervention. The PADI provides a more accurate assessment of the true space available for the spinal cord than the ADI.

Question 340

Topic: Cervical Spine

The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical diskectomy and fusion (ACDF) has been associated with which of the following significant postoperative complications?

. High rates of pseudarthrosis
. Severe prevertebral soft tissue swelling and airway compromise
. Delayed C5 nerve root palsy
. Vertebral artery pseudoaneurysm
. Horner syndrome

Correct Answer & Explanation

. Severe prevertebral soft tissue swelling and airway compromise

Explanation

The use of rhBMP-2 in the anterior cervical spine is highly associated with exaggerated prevertebral soft tissue swelling, which can lead to life-threatening dysphagia and airway compromise. As a result, its use in routine ACDF is generally contraindicated or requires extreme caution.

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