Cervical Spine MCQs

A 62-year-old female with long-standing rheumatoid arthritis presents with neck pain and mild upper extremity clumsiness. Lateral flexion-extension radiographs of the cervical spine demonstrate atlantoaxial subluxation (AAS). Which of the following radiographic measurements is widely considered an absolute indication for surgical stabilization?

In a patient with severe rheumatoid arthritis, which of the following cervical spine radiographic measurements is the most reliable predictor of impending neurologic deficit?

A 65-year-old male presents with deteriorating handwriting, frequent tripping, and hyperreflexia in all extremities. The Hoffmann sign is positive bilaterally. Which surgical approach is most appropriate for a patient with 4-level cervical spondylotic myelopathy, neutral sagittal alignment, and no significant neck pain?

A 65-year-old female with long-standing rheumatoid arthritis presents with neck pain and mild hand clumsiness. Flexion-extension radiographs reveal 8 mm of atlantoaxial instability. What is the most critical radiographic parameter to evaluate her risk of impending neurologic deterioration?

A 45-year-old male sustains a burst fracture of the atlas (Jefferson fracture). Which of the following radiographic findings dictates the need for rigid stabilization (e.g., halo-vest or surgery) due to transverse ligament rupture?

A 45-year-old male presents after a diving accident. Radiographs reveal a C1 burst fracture. An open mouth odontoid view demonstrates lateral displacement of the C1 lateral masses. A displacement greater than 6.9 mm indicates rupture of which of the following structures?

A 25-year-old male presents to the emergency department after a diving accident. He is awake, alert, and cooperative. Examination reveals weakness in his hands and intrinsic muscles, but intact lower extremity function. Imaging shows a bilateral C6-C7 jumped facet. What is the most appropriate next step in management?

A 5-year-old child presents with short-trunk dwarfism, significant genu valgum, and normal intelligence. Radiographs reveal platyspondyly and hypoplasia of the odontoid process. Urine testing shows elevated keratan sulfate. Which enzyme is most likely deficient?

A 6-year-old boy presents with a disproportionately short trunk, severe coxa vara, and an abnormal waddling gait. Cervical spine radiographs reveal odontoid hypoplasia. Genetic testing would most likely reveal a mutation affecting which of the following?

A 7-year-old girl with short stature, corneal clouding, and normal intelligence presents for evaluation. Radiographs show severe platyspondyly and hypoplasia of the odontoid. She is found to be deficient in which of the following enzymes?

A 6-year-old boy presents with short stature, severe genu valgum, and corneal clouding, but displays normal intelligence. Radiographs reveal generalized platyspondyly and marked odontoid hypoplasia. Which of the following is the specific enzyme deficient in this patient's condition?

A 6-year-old girl with Morquio syndrome (MPS IV) presents with progressive weakness and clumsiness in her hands. Cervical spine flexion-extension radiographs demonstrate severe atlantoaxial instability. What is the primary anatomic cause of this instability in Morquio syndrome?

A 6-year-old child presents with severe disproportionate short-trunk dwarfism, knock-knees, and normal intelligence. Radiographs reveal platyspondyly and odontoid hypoplasia. Laboratory analysis confirms a diagnosis of Morquio syndrome (MPS IV). Which of the following is the deficient enzyme in Type A of this disorder?

A 6-year-old girl presents with short-trunk dwarfism, severe genu valgum, and generalized joint hyperlaxity. She has normal intelligence but exhibits corneal clouding. Cervical spine radiographs reveal odontoid hypoplasia with significant atlantoaxial instability.

Which of the following glycosaminoglycans abnormally accumulates in this patient's specific syndrome?

In a patient with advanced rheumatoid arthritis evaluating the cervical spine, which radiographic parameter indicates the highest risk for progressive neurologic deficit and dictates the need for surgical stabilization?

A 60-year-old woman with long-standing rheumatoid arthritis presents with new-onset myelopathy. Flexion-extension cervical radiographs reveal an atlantodental interval (ADI) of 10 mm. Which ligament's failure is primarily responsible for this radiographic finding?

In patients with mucopolysaccharidoses (MPS), upper cervical instability is a well-documented risk. The pathogenesis of odontoid hypoplasia and subsequent atlantoaxial instability in Morquio syndrome (MPS IV) is primarily due to the accumulation of which of the following?

A 6-year-old child presents with extreme ligamentous laxity, short stature, and progressive severe kyphoscoliosis. Urine analysis reveals elevated levels of keratan sulfate. Radiographs demonstrate universal platyspondyly with anterior central beaking. Which of the following is an absolute surgical indication in this disorder?

A 25-year-old male sustains a traumatic spondylolisthesis of the axis (Hangman's fracture) following an MVC. Imaging shows a bilateral pars fracture with 4 mm of translation and 15 degrees of angulation. According to the Levine and Edwards classification, what is the most appropriate initial management?

Both Multiple Epiphyseal Dysplasia (Fairbank type) and Pseudoachondroplasia can be caused by mutations in the Cartilage Oligomeric Matrix Protein (COMP) gene. Which of the following clinical or radiographic features best distinguishes Pseudoachondroplasia from Multiple Epiphyseal Dysplasia?