Cervical Spine MCQs

A 50-year-old woman undergoes a C5-C6 anterior cervical discectomy and fusion via a right-sided approach. Postoperatively, she has a hoarse voice, and direct laryngoscopy confirms unilateral vocal cord paralysis. The nerve most likely injured in this approach courses between which two anatomic structures?

A 55-year-old man undergoes a straightforward C3-C6 anterior cervical discectomy and fusion (ACDF). Three hours postoperatively in the PACU, he develops rapidly progressive quadriparesis and difficulty breathing. His drain output is minimal, but his neck is visibly swollen. What is the most appropriate next step in management?

An 82-year-old woman sustains a Type II odontoid fracture after a fall. She is neurologically intact. Her past medical history is significant for severe COPD and congestive heart failure. Which of the following treatments is associated with the lowest morbidity and mortality for this patient?

An 82-year-old woman with severe COPD and heart failure falls and sustains a Type II odontoid fracture with 2 mm of displacement. What is the most appropriate initial management considering her comorbidities?

A healthy, active 75-year-old man falls and sustains a Type II odontoid fracture with 3 mm of displacement. He is neurologically intact. What is the most appropriate management that provides the highest union rate and lowest morbidity?

A 75-year-old male sustains a Type II odontoid fracture with 3 mm of posterior displacement following a low-energy fall. He is neurologically intact. Which of the following is the most appropriate initial management?

During an anterior cervical discectomy and fusion (ACDF) at C6-C7, the surgeon uses electrocautery near the lateral border of the longus colli muscle. Postoperatively, the patient develops ipsilateral ptosis and miosis. Injury to which of the following structures is most likely responsible?

A 25-year-old male sustains a Type IIa Hangman's fracture following a motor vehicle collision. Radiographs show severe anterior angulation of C2 on C3 without significant translation. What is the most appropriate non-operative management?

What is the primary advantage of cervical disc arthroplasty over anterior cervical discectomy and fusion (ACDF) based on long-term randomized trials?

A 6-year-old child presents with torticollis 10 days after an upper respiratory infection. Dynamic CT scan reveals C1-C2 rotatory subluxation with 4 mm of anterior displacement of C1 on C2. According to the Fielding and Hawkins classification, what type is this and what is the status of the transverse ligament?

A 78-year-old male sustains a Type II odontoid fracture after a ground-level fall. He has no neurologic deficits but has a history of severe COPD and congestive heart failure. Which of the following treatments is associated with the highest morbidity and mortality in this specific patient population?

A 62-year-old male undergoes an anterior cervical discectomy and fusion (ACDF). The surgeon chooses a right-sided approach to the lower cervical spine. To avoid postoperative hoarseness, the surgeon must be mindful of the recurrent laryngeal nerve (RLN). Which of the following best describes its anatomic course on the right side compared to the left?

A 65-year-old female with long-standing rheumatoid arthritis presents with progressive clumsiness in her hands and difficulty walking. Flexion-extension radiographs reveal an anterior atlantodental interval (ADI) of 11 mm. What is the most critical parameter to evaluate on imaging to determine her risk of impending severe neurologic deficit?

A surgeon plans to use recombinant human bone morphogenetic protein-2 (rhBMP-2) off-label during an anterior cervical discectomy and fusion (ACDF). The patient should be counseled about a significantly increased risk of which of the following complications compared to autograft?

An 82-year-old male with severe COPD and congestive heart failure falls from standing height. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the recommended management strategy that balances fracture care with the lowest morbidity and mortality for this specific patient?

An 82-year-old female presents with a Type II odontoid fracture displaced by 4 mm posteriorly after a ground-level fall. She has significant medical comorbidities. What is the most appropriate management?

During an anterior cervical discectomy and fusion (ACDF) at C5-C6, the surgeon utilizes a right-sided approach. Postoperatively, the patient has a hoarse voice but normal swallowing. Injury to which of the following nerves is the most likely cause?

When performing an anterior cervical discectomy and fusion (ACDF), knowledge of the vertebral artery's course is crucial. Moving from proximal to distal, the vertebral artery typically first enters the foramen transversarium at which cervical level?

The alar ligaments play a critical role in stabilizing the craniocervical junction. What is their primary biomechanical function?

A patient with advanced rheumatoid arthritis presents with myelopathic symptoms. Flexion-extension radiographs show significant atlantoaxial instability. Which ligament, primarily responsible for limiting axial rotation and lateral bending between the occiput and the axis, is most likely compromised?