Cervical Spine MCQs

An 80-year-old female sustains a Type II odontoid fracture after a ground-level fall. Her family prefers conservative management over surgery due to her severe cardiac comorbidities. Which of the following is the strongest risk factor for non-union of a Type II odontoid fracture treated with a rigid cervical collar?

A 7-year-old boy presents with torticollis and severe neck stiffness 2 weeks after an uncomplicated adenotonsillectomy. He is afebrile but has persistent pain, holding his head tilted to the right and rotated to the left. Neurological examination is completely normal. Radiographs demonstrate an asymmetric atlantodental interval. What is the most likely diagnosis?

A 5-year-old boy with Down syndrome presents with neck pain and torticollis following a minor fall. Neurological examination is completely normal. Open-mouth odontoid radiographs reveal an atlanto-dens interval (ADI) of 6 mm. What is the most appropriate initial management?

In a patient with longstanding rheumatoid arthritis and neck pain, which of the following is the most reliable radiographic predictor of impending neurologic deficit requiring surgical stabilization?

Which specific portion of the ulnar collateral ligament (UCL) complex of the elbow serves as the primary restraint to valgus stress from 30 to 120 degrees of flexion, and what is its anatomic ulnar insertion?

A 80-year-old male with a history of severe COPD and ischemic heart disease presents after a mechanical fall with neck pain. A CT scan of the cervical spine demonstrates a Type II odontoid fracture with 2 mm of displacement. What is the most appropriate initial management strategy for this patient?

A 25-year-old male sustains an axial load injury to his cervical spine. Open-mouth odontoid radiographs reveal a combined lateral overhang of the C1 lateral masses on C2 of 8.1 mm. According to the Rule of Spence, this specific measurement indicates the disruption of which of the following structures?

A 65-year-old male is involved in a high-speed MVC and sustains a burst fracture of the C1 ring (Jefferson fracture). Open-mouth odontoid radiographs demonstrate lateral displacement of the C1 lateral masses. A total combined overhang of the C1 lateral masses on C2 greater than what threshold implies an incompetent transverse ligament (Rule of Spence)?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain that occurs during the late cocking and early acceleration phases of pitching. On examination, he has pain with the milking maneuver and a positive moving valgus stress test. MRI confirms a full-thickness midsubstance tear of the anterior bundle of the ulnar collateral ligament (UCL). If surgical reconstruction is chosen, which structure is considered the primary isometric restraint to valgus stress at the elbow?

During ulnar collateral ligament (UCL) reconstruction of the elbow in an overhead throwing athlete, the graft is tensioned to recreate the primary valgus stabilizer. Which specific portion of the UCL complex is the primary restraint to valgus stress at 90 degrees of elbow flexion?

A 20-year-old collegiate pitcher undergoes ulnar collateral ligament (UCL) reconstruction utilizing an ipsilateral palmaris longus autograft. Which specific component of the native UCL complex is the primary restraint to valgus stress at 90 degrees of elbow flexion?

A 5-year-old girl presents with torticollis following a mild upper respiratory infection. Radiographs show rotatory subluxation of the atlantoaxial joint. What is the most common underlying mechanism for this specific condition (Grisel's syndrome)?

A 5-year-old child presents to the emergency department after a high-speed motor vehicle collision. Lateral cervical spine radiographs show 3 mm of anterior translation of C2 on C3. Swischuk's line is drawn and passes 1 mm anterior to the posterior arch of C3. What is the correct interpretation?

An 80-year-old female presents after a ground-level fall with severe neck pain. CT scan reveals a Type II odontoid fracture with 6 mm of posterior displacement. She has a history of severe COPD and ischemic heart disease. What is the most appropriate definitive management?

A 48-year-old female undergoes a right-sided anterior cervical discectomy and fusion (ACDF) at C6-C7. Post-operatively, she complains of significant hoarseness. Direct laryngoscopy confirms a unilateral paralyzed vocal cord. Injury to which of the following structures is most likely responsible?

During an anterior cervical discectomy and fusion (ACDF) at C5-C6 using a right-sided approach, the patient develops postoperative hoarseness. Which anatomical feature explains why the recurrent laryngeal nerve is more susceptible to injury on the right side compared to the left during this approach?

A 7-year-old child presents with torticollis and severe neck stiffness one week after undergoing a routine tonsillectomy. The child holds their head tilted to the right and rotated to the left. Cervical spine radiographs and a subsequent CT scan demonstrate anterior displacement and rotation of the atlas on the axis without evidence of trauma. What is the most likely diagnosis?

A 35-year-old male dives into a shallow pool and sustains an axial loading injury to his neck. AP open-mouth odontoid radiographs reveal a combined lateral mass overhang of C1 on C2 measuring 8.5 mm. According to the Rule of Spence, this specific radiographic finding suggests rupture of which ligamentous structure?

A 55-year-old female with a history of rheumatoid arthritis presents with neck pain and paresthesias in her hands. Flexion-extension radiographs of the cervical spine demonstrate an atlanto-dens interval (ADI) of 8 mm. Which of the following is the most appropriate management?