Cervical Spine MCQs

An 82-year-old male with a history of hypertension and diabetes sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact. Which of the following treatments is associated with the lowest morbidity and mortality in this specific patient demographic?

An 82-year-old male presents with a Type II odontoid fracture displaced 6 mm posteriorly following a low-energy fall. He is neurologically intact. In this specific elderly population, which of the following immobilization methods is associated with the highest rate of morbidity and mortality?

A 60-year-old woman with a 20-year history of severe rheumatoid arthritis presents with neck pain and progressive clumsiness in her hands. Which of the following radiographic parameters is the most reliable predictor of impending neurologic compromise and paralysis?

A 28-year-old man falls from a height and sustains a Type II odontoid fracture. The fracture line slopes from anterior-inferior to posterior-superior. Intact transverse ligament is noted on MRI. Which of the following makes this patient a poor candidate for an anterior odontoid screw?

A 40-year-old woman undergoes an anterior cervical discectomy and fusion (ACDF) for C5-C6 spondylosis. Postoperatively, she is noted to have a new-onset unilateral vocal cord paralysis and a hoarse voice. Injury to the recurrent laryngeal nerve is suspected. Which surgical approach and anatomical relationship most likely contributed to this injury?

An 82-year-old man sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact. Radiographs show a 3 mm posterior displacement. He has severe medical comorbidities (ASA IV). What is the most appropriate management?

An 82-year-old male with severe COPD, coronary artery disease, and prior myocardial infarction falls and sustains a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. A representative image is shown. Which of the following is the most appropriate treatment to minimize mortality while managing this fracture?

A 30-year-old male sustains a C1 burst (Jefferson) fracture. An open-mouth odontoid radiograph demonstrates lateral displacement of the C1 lateral masses. According to the Rule of Spence, what total combined overhang of the C1 lateral masses on the C2 articular facets suggests a rupture of the transverse atlantal ligament (TAL)?

An 82-year-old male presents to the emergency department after a ground-level fall. Imaging reveals a displaced Anderson D'Alonzo Type II odontoid fracture. His medical history is significant for severe COPD on home oxygen and congestive heart failure. He is neurologically intact. Which of the following is the most appropriate management strategy?

An 84-year-old male with multiple medical comorbidities sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact. Which of the following represents the most appropriate initial management strategy with the lowest risk of severe complications or mortality?

Biomechanical studies evaluating the distal tibiofibular syndesmosis have determined the relative contributions of its ligamentous components. Which of the following anatomical structures provides the greatest resistance to lateral displacement of the fibula?

An 82-year-old male presents with severe neck pain following a fall. CT demonstrates a Type II odontoid fracture with 4 mm of posterior displacement. He is neurologically intact and lives independently. What is the most significant advantage of posterior C1-C2 segmental instrumentation compared to halo-vest immobilization in this patient?

A 25-year-old man sustains a C1 ring fracture after diving into a shallow pool. An open-mouth odontoid radiograph is obtained. According to the Rule of Spence, a sum of lateral mass displacement greater than 6.9 mm strongly implies an incompetent or ruptured injury to which of the following structures?

A 25-year-old male sustains a Type IIA odontoid fracture (transverse fracture comminuted at the base) following a high-speed collision. Which of the following conditions represents an absolute contraindication to anterior odontoid screw fixation?

An 85-year-old female presents with a Type II odontoid fracture displaced 3 mm posteriorly after a ground-level fall. She has significant medical comorbidities. She is neurologically intact. What is the most appropriate initial management?

An 82-year-old female with multiple medical comorbidities including severe COPD and ischemic heart disease sustains a Type II odontoid fracture with 2 mm of posterior displacement after a mechanical fall. She is neurologically intact. Which of the following is the most appropriate initial management strategy?

During a right-sided anterior cervical discectomy and fusion (ACDF) at C6-C7, the patient develops a unilateral vocal cord paralysis. The vulnerability of the right recurrent laryngeal nerve during this approach is anatomically explained by its course looping under which of the following structures?

The off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in Anterior Cervical Discectomy and Fusion (ACDF) procedures has been strongly associated with which of the following serious postoperative complications?

A 25-year-old man dives into a shallow pool and sustains a C1 burst fracture (Jefferson fracture). An open-mouth odontoid radiograph demonstrates that the combined lateral overhang of the C1 lateral masses on C2 is 8 mm. What does this finding indicate and what is the recommended management?

An 80-year-old man sustains a Type II odontoid fracture with 6 mm of anterior displacement. He has severe medical comorbidities preventing surgery. He is treated non-operatively. Which of the following is the most significant risk factor for non-union in this patient?