Cervical Spine MCQs

A 60-year-old female with long-standing, poorly controlled rheumatoid arthritis presents with progressive neck pain, clumsiness in her hands, and hyperreflexia in all four extremities. Flexion-extension radiographs demonstrate an atlanto-dens interval (ADI) of 9 mm. What is the primary pathophysiological cause of this specific upper cervical instability?

A 6-year-old child with normal intelligence presents with short stature, corneal clouding, and severe genu valgum. Radiographs reveal atlantoaxial instability and platyspondyly with central anterior beaking of the vertebral bodies. What accumulated substance is expected in the urine?

A 5-year-old child with normal intelligence presents with short trunk dwarfism, severe genu valgum, and a barrel chest. Radiographs reveal severe platyspondyly with anterior central beaking of the vertebrae and marked hypoplasia of the odontoid. What enzyme is most likely deficient in this patient?

During an anterior cervical discectomy and fusion (ACDF) at C5-C6 using a left-sided approach, a retractor is placed medially to protect the visceral structures. Which nerve is most at risk of neuropraxia due to prolonged retractor compression?

A computerized tomography (C T) scan of the neck reveals an atlantoaxial rotatory displacement with 6 mm of anterior translation. The most likely associated anatomic defect is:

A 25-year-old male is involved in a motor vehicle accident and sustains a burst fracture of the C1 ring (Jefferson fracture). Which radiographic finding best indicates incompetence of the transverse atlantal ligament?

According to the Rule of Spence, an open-mouth odontoid radiograph showing total lateral overhang of the C1 lateral masses on C2 of greater than 6.9 mm indicates a rupture of which structure?

A 45-year-old sustains a Hangman's fracture demonstrating severe angulation but minimal translation, classified as an Effendi/Levine-Edwards Type IIa. What is the appropriate initial management strategy?

A 72-year-old female presents after a low-energy fall, landing on her head. She complains of severe neck pain. Radiographs show a fracture through the base of the odontoid process, extending into the body of C2, with significant anterior displacement of the odontoid fragment relative to C2. She has no neurological deficits. Given her age and fracture pattern, what is the most appropriate definitive management strategy?

An 80-year-old female sustains a low-energy fall from a standing height. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. She is neurologically intact. Which of the following is the most appropriate initial management?

An 82-year-old female presents with severe neck pain following a ground-level fall. Imaging reveals a Type II odontoid fracture with 3 mm of posterior displacement. She is neurologically intact but has severe medical comorbidities (ASA class IV). What is the most appropriate management?

An 82-year-old male with a history of COPD and osteoporosis sustains a Type II odontoid fracture after a ground-level fall. He complains of severe neck pain but remains neurologically intact. When considering treatment, which of the following management options is associated with the highest risk of mortality and severe complications in this specific patient demographic?

An 82-year-old male sustains a Type II odontoid fracture. He has severe medical comorbidities making surgery high risk. If treated non-operatively with a rigid cervical collar, which factor is most highly associated with an increased risk of non-union?

During an anterior cervical discectomy and fusion (ACDF) via a right-sided approach, the surgeon carefully mobilizes the midline structures. Which of the following nerves is at higher risk of injury during a right-sided lower cervical approach compared to a left-sided approach?

A 48-year-old male undergoes an anterior cervical discectomy and fusion (ACDF) for a C5-C6 bilateral facet dislocation. Postoperatively, he develops hoarseness and difficulty swallowing. Which of the following complications is most likely responsible for his symptoms, and what is its typical management?

A 30-year-old male sustains a burst fracture of the atlas (Jefferson fracture) after a diving accident. On the open-mouth odontoid radiograph, the combined overhang of the C1 lateral masses on C2 is measured at 8 mm. What does this measurement indicate regarding the integrity of the stabilizing ligaments?

An 82-year-old male presents with severe neck pain following a ground-level fall. Imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. He has multiple severe medical comorbidities, including advanced COPD and congestive heart failure. Based on current literature for this specific demographic, what is the most appropriate initial management?

A 35-year-old male is evaluated after being struck by a high-speed vehicle. Lateral cervical spine radiographs are obtained to evaluate for craniocervical junction injury. Which of the following radiographic measurements is most sensitive for diagnosing atlanto-occipital dissociation (AOD)?

A 35-year-old male is involved in a high-speed motor vehicle collision. Cervical spine imaging reveals a C1 ring fracture. Open-mouth odontoid view demonstrates lateral displacement of the C1 lateral masses relative to C2. According to the Rule of Spence, what combined lateral overhang measurement strongly suggests a ruptured transverse ligament?