Menu

6. Spine MCQs

Practice Set 124 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2461

Topic: 6. Spine
A 45-year-old woman awakens with the acute onset of burning left shoulder pain that radiates toward the axilla. She denies any history of trauma. On examination, she is unable to abduct her arm but has full passive shoulder motion. Her sensation is intact. Cervical spine examination reveals full range of motion and a negative Spurling’s test. Radiographs and MRI studies are normal for the cervical spine and shoulder. What is the most likely diagnosis?
. Cervical C6-7 radiculopathy
. Impingement
. Rotator cuff tear
. Brachial neuritis
. Adhesive capsulitis

Correct Answer & Explanation

. Brachial neuritis

Explanation

DISCUSSION: The definition of brachial neuritis or Parsonage-Turner syndrome is a rare disorder of unknown etiology that causes pain or weakness of the shoulder and upper extremity. The loss of active motion excludes cervical C6-7 radiculopathy and impingement. A normal MRI scan and full passive motion exclude a rotator cuff tear and adhesive capsulitis, respectively. REFERENCES: Misamore GW, Lehman DE: Parsonage-Turner syndrome (acute brachial neuritis). J Bone Joint Surg Am 1996;78:1405-1408. McCarty EC, Tsairis P, Warren RF: Brachial neuritis. Clin Orthop Relat Res 1999;368:37-43.

Question 2462

Topic: 6. Spine

A 38-year-old man reports right upper extremity pain that radiates from his neck to his anterior arm, dorsoradial forearm, and into the index finger. Examination reveals weakness of the biceps muscle group and loss of his brachioradialis reflex on that side. At which level is he most likely to have a right-sided cervical disk protrusion on an MRI scan? Review Topic 1 C4-C5 2 C5-C6 3 C6-C7

. C6 vertebral body
. Far lateral C6-C7

Correct Answer & Explanation

. C6 vertebral body

Explanation

The patient has a typical right C6 radiculopathy based on his history and physical examination. A posterolateral disk protrusion at the C5-C6 level is mostly likely to cause a C6 radiculopathy because the C6 nerve roots exit just above the C6 pedicle and therefore would be compressed by a right-sided C5-C6 disk protrusion. In contrast to the lumbar spine, far lateral disk protrusions are not typically described in the cervical spine.

Question 2463

Topic: 6. Spine

A 72-year-old female is undergoing preoperative planning for a total hip arthroplasty. She has a history of a multisegmental lumbar spinal fusion from L2 to the sacrum, resulting in a 'flatback' deformity and a stiff spine. How should the surgeon adjust the positioning of the acetabular component to minimize the risk of dislocation?

. Target increased acetabular anteversion and increased inclination
. Target decreased acetabular anteversion and decreased inclination
. Orient the cup precisely parallel to the transverse acetabular ligament
. Target normal 'safe zone' parameters and utilize a dual-mobility bearing exclusively
. Target increased retroversion and increased inclination

Correct Answer & Explanation

. Target increased acetabular anteversion and increased inclination

Explanation

Patients with a stiff, fused spine and flatback deformity lack the normal ability to posteriorly tilt their pelvis when moving from a standing to a sitting position. Normally, this posterior pelvic tilt dynamically increases acetabular anteversion to accommodate hip flexion. Because this patient cannot tilt her pelvis, she is at a high risk for anterior bony impingement and subsequent posterior dislocation when sitting. To compensate for the stiff spine, the surgeon should implant the cup in greater baseline anteversion and inclination.

Question 2464

Topic: 6. Spine

A 72-year-old male with ankylosing spondylitis and a completely fused lumbopelvic spine is planned for a total hip arthroplasty. His spine is fused in a flattened position, resulting in fixed pelvic retroversion. How does this rigid spinopelvic state alter the risk of dislocation, and what intraoperative adjustment should be considered?

. Increased risk of anterior dislocation in extension; cup should be placed in less anteversion
. Increased risk of posterior dislocation in flexion; cup should be placed in more anteversion
. Increased risk of anterior dislocation in flexion; cup should be placed in more anteversion
. Increased risk of posterior dislocation in extension; cup should be placed in less anteversion
. The risk is unchanged; target standard safe zone parameters

Correct Answer & Explanation

. Increased risk of anterior dislocation in extension; cup should be placed in less anteversion

Explanation

In a stiff spine with fixed pelvic retroversion, the pelvis cannot anteriorly tilt when standing, leaving the acetabulum relatively uncovered anteriorly. This creates a high risk of anterior impingement and dislocation in extension, requiring the cup to be placed in less anteversion than standard.

Question 2465

Topic: 6. Spine
What is the most common adverse postoperative complication of laminoplasty for multilevel cervical spondylotic myelopathy?
. Loss of cervical range of motion
. Inadvertent closure of the laminoplasty postoperatively
. Progressive cervical kyphosis
. C5 nerve root palsy
. Inadequate decompression of the spinal cord

Correct Answer & Explanation

. Loss of cervical range of motion

Explanation

DISCUSSION: A 30% to 50% loss of cervical range of motion is reported postoperatively in most patients following cervical laminoplasty. Inadvertent closure of the laminoplasty does occur but is rare. Laminoplasty is advocated in lieu of laminectomy to prevent progressive kyphosis and can effectively decompress the spinal cord. C5 nerve root palsies are a poorly understood but rare complication of surgical decompression for cervical spondylotic myelopathy. REFERENCES: Emery SE: Cervical spondylotic myelopathy: Diagnosis and treatment. J Am Acad Orthop Surg 2001;9:376-388. Edwards CC II, Riew KD, Anderson PA, et al: Cervical myelopathy: Current diagnostic and treatment strategies. Spine J 2003;3:68-81.

Question 2466

Topic: 6. Spine

A 7-year-old girl with a known diagnosis of neurofibromatosis has neck pain and deformity. She has been wearing a soft cervical collar for the past 2 months with mild relief of her symptoms. An MRI scan shows several small neurofibromas on the left side of the cervical spine near the foramina at C6 and 7. A lateral cervical spine radiograph is shown in Figure 34. What is the most appropriate management? Review Topic

. Anterior and posterior spinal fusion
. Anterior spinal fusion
. In situ posterior fusion
. Halo traction correction and posterior fusion
. Continued soft cervical collar treatment

Correct Answer & Explanation

. Anterior and posterior spinal fusion

Explanation

With a diagnosis of neurofibromatosis and severe kyphosis, anterior and posterior treatment is needed to achieve correction and fusion. In situ fusion has a high failure rate with the kyphotic deformity and even with traction, correction of the kyphosis is not expected. Anterior treatment alone may achieve correction, but in neurofibromatosis only circumferential treatment has been shown to provide longterm stability.

Question 2467

Topic: Cervical Spine

What is the standard interval for placement of an anterolateral portal in ankle arthroscopy?

. Peroneus brevis to peroneus longus
. Peroneus tertius to extensor hallucis longus
. Peroneus tertius to superficial peroneal nerve
. Extensor hallucis longus to deep peroneal nerve
. Extensor hallucis longus to extensor digitorum longus

Correct Answer & Explanation

. Peroneus brevis to peroneus longus

Explanation

As with arthroscopy of the knee, the anterolateral (AL) portal is the primary diagnostic portal used for initial placement of the arthroscope. The AL portal is made 5 mm below the joint line just lateral to the extensor tendons. The lateral cutaneous branch of the superficial peroneal nerve lies near this portal region. From this approach, one can visualize the anteromedial (AM), anterocentral (AC), and most of the AL areas of the tibiotalar joint. With the addition of laterally based external distraction instrumentation, the surgeon can usually advance the arthroscope posterocentrally and posterolaterally to visualize most of the articulation and the structures in the central and posterior compartments: the intraarticular aspects and synovium of the distal tibiofibular syndesmosis, the posterior tibiofibular ligament, the transverse ligament, and the synovial plicae that overlie the transverse ligament.

Question 2468

Topic: 6. Spine
  • Radiographs of the cervical spine of a 73-year-old man who fell down stairs reveal cervical spondylosis without evidence of fracture or dislocation. MRI and CT scans are consistent with the plain radiographs. After 72 hours, neurologic evaluation reveals intact sensation; however, weakness of the upper extremities is greater than that of the lower extremities. What is the most likely diagnosis?
. Central cord syndrome
. Anterior cord syndrome
. Posterior cord syndrome
. Brown-Sequard syndrome
. Cervical nerve root injury

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome is the correct answer. Common in the older patient, sacral sparing, upper extremity involvement greater than the lower extremity. Functional recovery expected in 75% of patients. 2-Anterior cord syndrome complete motor deficit; trunk and lowerextremity deep pressure and proprioceptive preserved. 3-Posterior cord syndrome is rare with loss of deep pressure, deep pain, and proprioception. 4-Brown-Sequard syndrome-Uncommon-Ipsilateral motor deficit, contralateral pain and temperature deficit. 5-Cervical nerve root injury- functional impairment of the cervical spine. Symptoms are often acute and severe, dependent on the level of the lesion. An infraforaminal protrusion may compress only the spinal root ganglion resulting in severe brachialgia with paresthesia and numbness but with little or no motor involvement.

Question 2469

Topic: 6. Spine
If a laminectomy for spinal stenosis is performed, which of the following is an indication for concomitant arthrodesis at that level?
. Prior laminectomy at an adjacent level
. Ten degrees of degenerative scoliosis
. Removal of 25% of each facet joint at surgery
. Degenerative spondylolisthesis at the level of the laminectomy
. Foraminal stenosis at the level of the laminectomy

Correct Answer & Explanation

. Degenerative spondylolisthesis at the level of the laminectomy

Explanation

DISCUSSION: A prospective randomized study of patients with degenerative spondylolisthesis and spinal stenosis by Herkowitz and Kurz showed significantly improved clinical outcomes in patients who also received a lumbar arthrodesis. Patients with a laminectomy at an adjacent level do not have improved outcomes with an arthrodesis. Minimal lumbar scoliosis does not require arthrodesis. Arthrodesis is indicated in cases where there is removal of more than 50% of the facets bilaterally but not with an associated foraminal stenosis. REFERENCES: Herkowitz HN, Kurz LT: Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991;73:802-807. Garfin SR, Rauschning W: Spinal stenosis. Instr Course Lect 2001;50:145-152.

Question 2470

Topic: 6. Spine
A 53-year-old man reports acute, severe left shoulder pain after undergoing abdominal surgery 10 days ago. Initial management, consisting of anti-inflammatory drugs, physical therapy, and a subacromial injection of corticosteroid, fails to provide relief. Reexamination of the shoulder 2 months after the onset of symptoms reveals atrophy of the infraspinous and supraspinous fossa and profound weakness of active abduction and external rotation. His neck is supple with a full range of motion. Plain radiographs and an MRI scan of the shoulder are normal. What diagnostic study should be performed next in the evaluation of this patient?
. Shoulder arthrography
. MRI of the cervical spine
. CT of the head
. Technetium Tc 99m bone scan
. Electromyography and nerve conduction velocity studies

Correct Answer & Explanation

. Electromyography and nerve conduction velocity studies

Explanation

DISCUSSION: Suprascapular nerve palsy is a fairly uncommon yet well-known cause of shoulder pain and weakness. A variety of causes have been described, including compression by a ganglion cyst, an anomalous or thickened superior transverse scapular ligament, a humeral and scapular fracture, and traction or kinking of the nerve in the suprascapular notch. In this patient, the injury is most likely caused by traction or compression of the nerve in the suprascapular notch as the result of positioning during abdominal surgery; therefore, the studies of choice are electromyography and nerve conduction velocity studies. While MRI of the cervical spine may be of some value in ruling out a radiculopathy, the clinical history does not support such a cause for this condition. REFERENCES: Rengachary SS, Neff JP, Singer PA, Brackett CE: Suprascapular entrapment neuropathy: A clinical, anatomical, and comparative study. Part 1: Clinical study. Neurosurgery 1979;5:441-446. Rengachary SS, Burr D, Lucas S, Hassanein KM, Mohn MP, Matzke H: Suprascapular entrapment neuropathy: A clinical, anatomical and comparative study. Part 2: Anatomical study. Neurosurgery 1979;5:447-451. Bigliani LU, Dalsey RM, McCann PD, April EW: An anatomical study of the suprascapular nerve. Arthoscopy 1990;6:301-305.

Question 2471

Topic: Cervical Spine
The space available for the cord is an important determinant in neurologic recovery. Recent analysis suggests that the most reliable radiographic predictor for neurologic recovery after surgery in patients with rheumatoid arthritis and paralysis is a preoperative
. anterior atlanto-odontoid interval of less than 9 mm.
. anterior atlanto-odontoid interval of greater than 9 mm.
. posterior atlanto-odontoid interval of greater than 10 mm.
. posterior atlanto-odontoid interval of greater than 12 mm.
. posterior atlanto-odontoid interval of greater than 14 mm.

Correct Answer & Explanation

. posterior atlanto-odontoid interval of greater than 10 mm.

Explanation

DISCUSSION: Boden and associates’ recent article presents significant evidence that patients with rheumatoid arthritis, neurologic deterioration, and C1-2 instability are more likely to improve after surgery if the posterior atlanto-odontoid interval is greater than 10 mm preoperatively. The accepted safe range for the posterior atlanto-odontoid interval is 14 mm. This measurement is believed to better represent the space available for the cord than the anterior atlanto-odontoid interval. REFERENCES: Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 273-279. Boden SD, Dodge LD, Bohlman HH, Rechtine GR: Rheumatoid arthritis of the cervical spine: A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 1993;75:1282-1297. Wattenmaker I, Concepcion M, Hibberd P, Lipson S: Upper airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis. J Bone Joint Surg Am 1994;76:360-365.

Question 2472

Topic: 6. Spine

A 66-year-old female presents to your clinic complaining of back pain, difficulty standing-up straight, weakness in her legs, and neurogenic claudication. On upright thoracolumbar radiographs, there is a 75 degree thoracolumbar curve with the apex at L2, and the C7 plumb line falls 12 cm anterior to the posterosuperior corner of S1. Aside from a decompression of the stenotic levels, which of the following choices will lead to the MOST reliable decrease in overall disability? Review Topic

. Ensuring the lumbar lordosis is within 15 degrees of the pelvic incidence
. Decreasing the cobb angle to less than 25 degrees
. Correcting the sagittal vertical axis to +3 cm from neutral
. Increasing the pelvic tilt to greater than 20 degrees
. Stopping the fusion at L5

Correct Answer & Explanation

. Ensuring the lumbar lordosis is within 15 degrees of the pelvic incidence

Explanation

This patient has a spinal deformity in both the coronal and sagittal planes. Among the options given, correction of the sagittal vertical axis (SVA) to +3 cm is the most reliable predictor of clinical improvement.Spinal malalignment in Adult Spinal Deformity (ASD) challenges balance mechanisms used for maintenance of an upright posture to achieve the basic human needs of preserving level visual gaze and retaining the head over the pelvis. Severe malalignment can result in greater muscular effort and energy expenditure to maintain the erect posture as well as use of compensatory mechanisms. As such, surgical correction of these deformities are aimed at achieving proper spinopelvic alignment.Glassman et al. performed a multi-center retrospective study of 298 adults with spinal deformity. Regardless of operative (129 patients) or non-operative care (172 patients) a positive sagittal balance was the found to be the most reliable predictor of clinical symptoms in both patient groups.Schwab et al. published a current concepts review on operative management for adult spinal deformities and identified three major goals of surgery: (1) Correct the SVA towithin 5 cm of neutral, (2) Ensure the pelvic tilt is less than 20 degrees, (3) Ensure the lumbar lordosis is within 9 degrees of the pelvic incidence.Illustration A demonstrates how to measure the SVA. Illustration B depicts the realignment objectives in the saggital plane as described by Schwab et al.Incorrect

Question 2473

Topic: 6. Spine
An obtunded 80-year-old man was found alone in his apartment after an apparent fall. A CT scan performed in the emergency department shows that he has an extensile injury of an ankylosed cervical spine. The fracture extends across the ossified C5-C6 disk space and into the lamina of C5. There is 1.5 cm of widening between the C5 and C6 vertebrae anteriorly. The patient's family asks you about the long-term impact of the fracture on his functional capacity and survival. You advise them that patients with fractures of the cervical spine with ankylosing conditions have
. An unknown prognosis until they can participate in an examination.
. Higher rates of neurologic deficit and mortality than other same-age people.
. Higher rates of neurologic deficit than other same-age people, but comparable mortality rates.
. Similar rates of neurologic deficit and mortality as other same-age people.

Correct Answer & Explanation

. Higher rates of neurologic deficit and mortality than other same-age people.

Explanation

DISCUSSION: Several studies have found that rates of neurologic deficit and mortality are higher for patients with ankylosing spondylitis and a spinal fracture than for age-matched controls. The 2011 work of Schoenfeld and associates, which directly compared patients with cervical fractures in ankylosed spines to age- and sex-matched controls who also had cervical fractures but no ankylosing condition, demonstrated that those with ankylosing spondylitis were at elevated risk for mortality for up to 2 years after sustaining a fracture. In a study by Westerveld and associates, the rate of neurologic deficit among patients with ankylosing spondylitis and a spinal fracture was 57.1% compared to 12.6% among controls. RECOMMENDED READINGS: Westerveld LA, van Bemmel JC, Dhert WJ, Oner FC, Verlaan JJ. Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2014 May 1;14(5):729-40. doi: 10.1016/j.spinee.2013.06.038. Epub 2013 Aug 27. PubMed PMID: 23992936. Schoenfeld AJ, Harris MB, McGuire KJ, Warholic N, Wood KB, Bono CM. Mortality in elderly patients with hyperostotic disease of the cervical spine after fracture: an age- and sex-matched study. Spine J. 2011 Apr;11(4):257-64. doi: 10.1016/j.spinee.2011.01.018. Epub 2011 Mar 5. PubMed PMID: 21377938.

Question 2474

Topic: 6. Spine
A corset-type brace may help reduce symptoms during an episode of acute low back pain as the result of
. decreased intervertebral motion in the sagittal plane.
. decreased intervertebral motion in the coronal plane.
. decreased intervertebral motion in the axial plane.
. decreased intradiskal pressure.
. increased intradiskal temperature.

Correct Answer & Explanation

. decreased intradiskal pressure.

Explanation

DISCUSSION: Although there is no significant alteration in motion with a corset, studies have shown a decrease in intradiskal pressure. REFERENCES: Nachemson A, Morris JM: In vivo measurements of intradiscal pressure: Discometry, a method for determination of pressure in the low lumbar disc. J Bone Joint Surg Am 1964;46:1077-1092. Axelsson P, Johnsson R, Stromqvist B: Effect of lumbar orthosis on intervertebral mobility: A roentgen stereophotogrammetric analysis. Spine 1992;17:678-681.

Question 2475

Topic: 6. Spine
Which is the best initial study for the diagnostic evaluation of diskogenic low back pain?
. MRI
. Diskography
. CT-diskography
. Radiography
. CT

Correct Answer & Explanation

. Radiography

Explanation

Radiography is the best initial study for the evaluation of diskogenic low back pain. The normal degenerative process can be evaluated. Vacuum phenomenon may be found within the disk space. Other possible sources for back pain should also be evaluated. The other tests may be beneficial but represent later imaging options.

Question 2476

Topic: 6. Spine
Figure 81 is a lateral thoracic spine radiograph of a 76-year-old man with a history of ankylosing spondylitis who falls and strikes his back. He has moderate thoracic discomfort. An initial examination does not reveal neurologic deficits. He is discharged home that day, but returns 3 days later with profound weakness in his legs. Which imaging study should have been obtained at his initial presentation?
. Plain radiographs of the lumbar spine
. Anteroposterior radiograph of the pelvis
. CT scan of the thoracic spine
. MRI of the brain

Correct Answer & Explanation

. CT scan of the thoracic spine

Explanation

Patients with ankylosing spondylitis are at high risk for occult vertebral fractures that are not readily detectable on radiographs. The treating surgeon must have a high suspicion for fractures in these patients and pursue further imaging of the spine with CT and (often) MRI. Even among patients who are neurologically intact, fracture displacement and neurologic deterioration can occur if fractures are not recognized early and appropriately stabilized.

Question 2477

Topic: 6. Spine
A 47-year-old man has left-sided motor weakness in the extensor digitorum longus and extensor hallucis longus, sensory loss in the lateral calf and dorsal foot, and no discernible reflex loss.
. Figure 72a Figure 72b
. Figure 72c Figure 72d
. Figure 72e Figure 72f
. Figure 72g Figure 72h

Correct Answer & Explanation

. Figure 72g Figure 72h

Explanation

Figures 72c and 72d show T1 MR images of a far lateral disk herniation at the L4-L5 level. This would affect the exiting or L4 nerve root. Radicular symptoms would occur at the L4 level. Figures 72g and 72h show the T1 MR images of a central lateral disk herniation at the L4-L5 level. This would affect the traversing or L5 nerve root. Radicular symptoms would occur at the L5 level. The patient's symptoms (extensor digitorum longus and extensor hallucis longus weakness) correspond to L5 radiculopathy.

Question 2478

Topic: 6. Spine
A patient who underwent an L4-L5 hemilaminotomy and partial diskectomy for radiculopathy 8 weeks ago now reports increasing low back pain without neurologic symptoms. A sagittal T2-weighted MRI scan is shown in Figure 13a, and a contrast-enhanced T1-weighted MRI scan is shown in Figure 13b. What is the most appropriate management for the patient’s symptoms?
. Physical therapy
. CT-guided needle biopsy and IV antibiotics
. Revision laminotomy and diskectomy
. L4-L5 anterior debridement and fusion
. Open repair of the L4-L5 pseudomeningocele

Correct Answer & Explanation

. Physical therapy

Explanation

DISCUSSION: The MRI scans show Modic changes in the L4-L5 vertebral bodies due to spondylosis. There is no increased fluid signal or enhancement in the L4-L5 disk to suggest infection or any other pathologic process. Therefore, the patient’s pain should be treated with a course of physical therapy and rehabilitation. There is no infection; therefore, IV antibiotics and debridement are not indicated. Similarly, a pseudomeningocele is not present. A revision diskectomy is useful for recurrent radiculopathy but would not be helpful for degenerative low back pain. REFERENCES: Spivak JM, Connolly PJ (eds): Orthopaedic Knowledge Update: Spine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2006, pp 319-329. Shen FH, Samartzis D, Andersson GBJ: Nonsurgical management of acute and chronic low back pain. J Am Acad Orthop Surg 2006;14:477-487.

Question 2479

Topic: Thoracolumbar Spine & Deformity
When comparing the overall outcomes of surgical versus nonsurgical treatment of stable thoracolumbar burst fractures in patients without neurologic injury, 5 years following injury, the principle differences lie in:
. fracture kyphosis.
. reduction of retropulsed bone.
. pain reduction.
. incidence of complications.
. return to work.

Correct Answer & Explanation

. return to work.

Explanation

DISCUSSION: When patients are compared at 5 years follow-up, there are no statistically significant differences between the two groups with respect to kyphosis, the degree of retropulsed bone resorption, pain and function levels, or the ability to return to work. Nonsurgical management of stable neurologically intact burst fractures has a very low incidence of complications. REFERENCES: Wood K, Butterman G, Mehbod A, et al: Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: A prospective, randomized study. J Bone Joint Surg Am 2003;85:773-781. Shen WJ, Liu TJ, Shen YS: Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 2001;26:1038-1045.

Question 2480

Topic: 6. Spine
Figure 21 shows the tomogram of a 26-year-old woman who sustained an axial load injury to her neck in a fall off a horse. What ligament is injured?
. Anterior longitudinal
. Posterior longitudinal
. Alar
. Apical
. Transverse

Correct Answer & Explanation

. Transverse

Explanation

DISCUSSION: Levine and Edwards, in their description of the classic C1 burst (Jefferson) fracture, noted that spread of the lateral masses of more than 7 mm is indicative of a transverse ligament rupture. Long-term C1-C2 instability, however, has not been described with this fracture pattern. Although long-term traction followed by halo vest immobilization has been described as the best technique for achieving an ideal result, treatment of this injury remains somewhat controversial. REFERENCES: Levine AM, Edwards CC: Fractures of the atlas. J Bone Joint Surg Am 1991;73:680-691. Kurz LT: Fractures of the first cervical vertebra, in Clark CR (ed): The Cervical Spine, ed 3. Philadelphia, PA, Lippincott Raven, 1998, pp 409-413.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page