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6. Spine MCQs

Practice Set 153 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 3041

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?

Upper Extremity 2008 Practice Questions: Set 1 (Solved) - Figure 13

. Cervical C6-7 radiculopathy
. Impingement
. Rotator cuff tear
. Brachial neuritis
. Adhesive capsulitis

Correct Answer & Explanation

. Brachial neuritis

Explanation

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. Misamore GW, Lehman DE: Parsonage-Turner syndrome (acute brachial neuritis). J Bone Joint Surg Am 1996;78:1405-1408.

Question 3042

Topic: 6. Spine

In providing culturally competent care to a Muslim woman with a cervical spine injury, which of the following most accurately describes the steps a male orthopaedist should take to respect her religious beliefs during his examination?

. No one should be in the exam room except the patient and the physician.
. Another woman should be in the exam room and only the affected body part should be exposed.
. A chaperone of either gender should be in the exam room and no skin should be exposed.
. No particular steps need to be taken in this case.
. The patient's closest male relative should be in the exam room but a standard hospital gown may be used.

Correct Answer & Explanation

. Another woman should be in the exam room and only the affected body part should be exposed.

Explanation

In examining a traditional Muslim woman, a male physician should have another woman present, and the patient's husband, if possible. Only the affected limb or area needing examination should be exposed.

Question 3043

Topic: 6. Spine

A 15-year-old boy reports a 2-day history of progressive left buttock pain and severe limping. He denies any history of trauma or radiation of the pain. He has an oral temperature of 100.4 degrees F (38 degrees C). Examination reveals that the lumbar spine and left hip have unguarded motion. The abdomen is nontender. There is moderate tenderness of the left sacroiliac region with no palpable swelling. Pain is elicited when the left lower extremity is placed in the figure-4 position (FABER test). Laboratory studies show a peripheral WBC count of 11,500/mm3 (normal to 10,500/mm3) and an erythrocyte sedimentation rate of 38 mm/h (normal up to 20 mm/h). Radiographs of the pelvis, hips, and lumbar spine are normal. A nucleotide bone scan (posterior view) is shown in Figure 44. Initial management should consist of

Pediatrics Board Review 2007: High-Yield MCQs (Set 4) - Figure 18

. oral nonsteroidal anti-inflammatory drugs.
. intravenous antistaphylococcal antibiotics.
. incision and debridement of the retroperitoneal abscess.
. incision and debridement of the left sacroiliac joint.
. arthrotomy and irrigation of the left hip joint.

Correct Answer & Explanation

. intravenous antistaphylococcal antibiotics.

Explanation

The symptoms, physical findings, and laboratory studies are most consistent with a diagnosis of infectious sacroiliitis, usually caused by Staphylococcus aureus. Initial radiographs will be normal, and the diagnosis of sacroiliitis is often delayed. A technetium Tc 99m bone scan will localize the problem in 90% of patients but may occasionally give a false-negative result in early cases. If suspicion is high, a gallium scan or MRI scan may help confirm the diagnosis of sacroiliitis. Needle aspiration of the sacroiliac joint is difficult; therefore, antibiotic selection is usually empiric or based on blood cultures. Sacroiliitis that is the result of connective tissue inflammatory disease is usually bilateral and without fever or leukocytosis. The lack of hip irritability, spinal rigidity, and abdominal tenderness helps to rule out other causes of limping with fever, such as psoas abscess, diskitis, and septic hip. Aprin H, Turen C: Pyogenic sacroiliitis in children. Clin Orthop 1993;287:98-106.

Question 3044

Topic: 6. Spine

The illustration shown in Figure 19 shows a Chamberlain line. What is the most likely diagnosis?

Anatomy Board Review 2005: High-Yield MCQs (Set 2) - Figure 8

. Anterior atlanto-occipital dislocation
. Basilar invagination
. C1-C2 dislocation
. Transverse ligament injury
. Normal findings

Correct Answer & Explanation

. Basilar invagination

Explanation

Basilar invagination is best defined as vertical or compressive instability at the occiput-C1 joint. Such invaginations most commonly occur in patients with rheumatoid arthritis but also can occur secondary to trauma or tumor. A Chamberlain line is used as a method to determine basilar invagination. The odontoid tip should not be more than 5 mm above a Chamberlain line. Wiesel SW, Rothman RH: Occipito-atlantal hypermobility. Spine 1979;4:187-191.

Question 3045

Topic: 6. Spine
A 24-year-old man who was involved in a high-speed motor vehicle accident is transferred for definitive care after having been diagnosed with an acute spinal cord injury from a fracture-dislocation at C6-7. He has a complete C6 neurologic level and it is now approximately 10 hours from his injury. What is the most appropriate pharmacologic treatment at this time?
. No pharmacologic intervention is recommended at this time
. Administration of methylprednisolone with an initial bolus of 30 mg/kg followed by 5.4 mg/kg for 24 hours
. Administration of methylprednisolone with an initial bolus of 30 mg/kg followed by 5.4 mg/kg for 48 hours
. Administration of naloxone with an initial bolus of 30 mg/kg followed by 5.4 mg/kg for 24 hours
. Administration of naloxone with an initial bolus of 30 mg/kg followed by 5.4 mg/kg for 48 hours

Correct Answer & Explanation

. No pharmacologic intervention is recommended at this time

Explanation

The standard practice in the pharmacologic treatment of a spinal cord injury in the United States has been the administration of methylprednisolone with an initial bolus of 30 mg/kg followed by 5.4 mg/kg for 24 hours, in accordance with the findings of the second and third National Acute Spinal Cord Injury Studies (NASCIS). Although the studies have subsequently drawn criticism for their methodology and outcomes, it has been generally accepted that beneficial neurologic outcomes were anticipated in patients who were able to start the protocol within 8 hours of their initial injury. In this patient, who is outside the 8-hour treatment window, no studies have supported starting the methylprednisolone protocol at this time.

Question 3046

Topic: 6. Spine

A 15-year-old diver has had persistent, activity-related low back pain for the past 2 months. He denies any history of trauma. Examination reveals that the pain is localized to the lumbosacral junction, and there are no radicular symptoms. The pain is worse with back extension. Neurologic examination is normal, as are AP, lateral, and oblique radiographs of the lumbosacral spine. Further evaluation should include

. flexion and extension radiographs of the lumbosacral spine.
. diskography.
. an MRI scan of the lumbosacral spine.
. a bone scan with single proton emission computed tomography (SPECT).
. a renal ultrasound.

Correct Answer & Explanation

. a bone scan with single proton emission computed tomography (SPECT).

Explanation

Spondylolysis may develop as a stress fracture resulting from repetitive hyperextension during athletic activities. In young people, the pars interarticularis is thin, the neural arch has not yet reached maximum strength, and the intravertebral disk is less resistant to shear. While clinical symptoms may lead to the suspicion of spondylolysis, radiographic confirmation may be difficult in early cases. Plain radiographs may be negative initially, and the plain MRI scan may not offer good visualization of the pars. A bone scan with SPECT is very sensitive initially. CT scans with regular axial and reverse-gantry angled cuts may help determine the type of fracture and the course of treatment. Congeni J, McCulloch J, Swanson K: Lumbar spondylolysis: A study of natural progression in athletes. Am J Sports Med 1997;25:248-253.

Question 3047

Topic: Cervical Spine

In Figure 49, line AB connects the anterior arch of C1 to the posterior margin of the foramen magnum. Line CD connects the anterior margin of the foramen magnum to the posterior arch of C1. What is the normal ratio of displacement from CD to AB (Power's ratio)?

Anatomy Board Review 2005: High-Yield MCQs (Set 4) - Figure 13

. 0.25
. 0.5
. 1.0
. 1.5
. 2.0

Correct Answer & Explanation

. 1.0

Explanation

The ratio of displacement from CD to AB normally equals 1.0. If the ratio is greater than 1.0, an anterior atlanto-occipital dislocation may exist. Ratios slightly less than 1.0 are normal except in posterior dislocations, fractures of the odontoid process or ring of the atlas, or congenital abnormalities of the foramen magnum. In these conditions, the ratio may approach 0.7. Powers B, Miller MD, Kramer RS, et al: Traumatic anterior atlanto-occipital dislocation. Neurosurgery 1979;4:12-17.

Question 3048

Topic: 6. Spine

A 56-year-old man with a history of chronic lower back pain from lumbar spondylosis reports a 2-day history of acute incapacitating back pain. He denies any history of acute trauma, although he reports the pain starting after a coughing spell. He also reports difficulty urinating and some fecal incontinence. Examination reveals generalized lower extremity weakness, saddle paresthesia, hyporeflexia in the lower extremities, and loss of rectal tone. What is the most appropriate management at this time?

Spine Surgery 2009 Practice Questions: Set 1 (Solved) - Figure 19

. Immediate MRI of the lumbar spine
. General reassurance, anti-inflammatory drugs, and an early home exercise program
. Immediate radiographs of the lumbar spine and pain medications with 2 days of bed rest if the radiographs are normal
. Office caudal epidural steroid injection with follow-up in 1 week
. Outpatient MRI of the lumbar spine with follow-up in 1 week for test results

Correct Answer & Explanation

. Immediate MRI of the lumbar spine

Explanation

Cauda equina syndrome is a medical emergency that must be quickly diagnosed and treated to avoid long-term complications. Cauda equina syndrome typically presents with low back pain, unilateral or usually bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss. Although a number of pathologies can cause cauda equina syndrome, in a patient with a history of chronic back pain, disk pathology is the most common cause of acute onset cauda equina syndrome. Whereas radiographs may be useful in a traumatic onset of symptoms, MRI is the most appropriate study. Cauda equina syndrome should be evaluated on an emergent basis and admission for work-up is appropriate. Ahn UM, Ahn NU, Buchowski JM, et al: Cauda equina syndrome secondary to lumbar disc herniation: A meta-analysis of surgical outcomes. Spine 2000;25:1515-1522.

Question 3049

Topic: 6. Spine

Figure 45 shows the radiograph of a 2-year-old patient who has progressive lumbar scoliosis as the result of hemivertebra. Examination reveals no associated cutaneous lesions, and an MRI scan shows no associated intraspinal anomalies. Treatment should consist of

Pediatrics 2001 Practice Questions: Set 3 (Solved) - Figure 28

. hemivertebra excision.
. anterior and posterior spinal fusion with instrumentation from T4 to L4.
. convex anterior hemiepiphyseodesis.
. convex posterior hemiarthrodesis.
. an orthosis.

Correct Answer & Explanation

. hemivertebra excision.

Explanation

In a retrospective review of 10 patients treated with hemivertebra excision for hemivertebra in the levels of T12 to L3, the procedure was found to be safe and effective. The procedure provided an average curve correction of 67 degrees and was greatest in patients who were younger than age 4 years at the time of surgery. Long anterior and posterior fusion with instrumentation is not the treatment of choice at this age. Either anterior hemiepiphyseodesis or posterior hemiarthrodesis in this isolated hemivertebra setting would be inadequate. Brace treatment is ineffective in management of the primary curvature.

Question 3050

Topic: 6. Spine

Intradiskal electrothermal therapy (IDET) uses an intradiskal catheter to deliver controlled thermal energy to the inner periphery of the annulus fibrosis of a chronically painful intervertebral disk. Lumbar diskography is used diagnostically to identify the presumed pain generator to be targeted with IDET. Based on the medical literature, what can be said about the current status of IDET?

. IDET has been proven to seal annular tears in the annulus fibrosis.
. IDET restores segmental stability by shrinking collagen fibrils in the disk.
. IDET has demonstrated no significant benefit over placebo in controlled trials.
. IDET is an unsafe procedure with significant risk of permanent complications.
. IDET has demonstrated poor clinical results in all reported series to date.

Correct Answer & Explanation

. IDET has demonstrated no significant benefit over placebo in controlled trials.

Explanation

Intradiskal electrothermal therapy (IDET) initial clinical results were reported in 2000. The early case series were quite encouraging with reported therapeutic success rates of 60% to 80%. Early enthusiasm was high as IDET provided a nonsurgical treatment option for an otherwise complex and difficult clinical entity, chronic diskogenic low back pain. The actual mechanism of action was not well understood, and while the theoretic explanation made good sense, it did not hold up under laboratory testing. Soon clinical results from the field did not meet the high expectations set by the developers of the technique. Since those early case studies, a few level I evidence studies have been conducted, one by Freeman and associates and one by Pauza and associates. These randomized, placebo-controlled trials demonstrated no significant benefit of IDET over the placebo. Freeman BJ, Fraser RD, Cain CM, et al: A randomized, double-blind, controlled trial: Intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine 2005;30:2369-2377. Pauza KJ, Howell S, Dreyfuss P, et al: A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J 2004;4:27-35.

Question 3051

Topic: 6. Spine

A 2-year-old boy has complete absence of the sacrum and lower lumbar spine. What is the most likely long-term outcome if no spinal pelvic stabilization is performed?

Pediatrics 2007 Practice Questions: Set 1 (Solved) - Figure 14

. Progressive paralysis
. Neck extension contracture
. Inability to sit without using the hands for support
. Progressive hip dislocation
. Sexual dysfunction

Correct Answer & Explanation

. Inability to sit without using the hands for support

Explanation

Without stabilization, progressive kyphosis will develop between the spine and pelvis. The kyphosis progresses to the point that the child must use his or her hands to support the trunk, and therefore is unable to use his or her hands for other activities. Neck extension contracture does not usually develop. Neurologic deficit, including sexual dysfunction, is generally present at birth and static. Tachdjian MO: The spine: Congenital absence of the sacrum and lumbosacral vertebrae (lumbosacral agenesis), in Wickland EH Jr (ed): Pediatric Orthopaedics, ed 2. Philadelphia, PA, WB Saunders, 1990, vol 3, p 2228.

Question 3052

Topic: 6. Spine

Figure 35 shows the radiograph of a 44-year-old woman with rheumatoid arthritis who reports neck pain. Below what threshold number is surgical stabilization warranted for the interval shown by the arrow?

Anatomy 2008 Practice Questions: Set 3 (Solved) - Figure 13

. 8 mm
. 10 mm
. 12 mm
. 14 mm
. 16 mm

Correct Answer & Explanation

. 14 mm

Explanation

The posterior atlanto-dens interval represents the space available for the spinal cord and a distance of less than 14 mm is predictive of neurologic progression, thus warranting consideration for fusion, even in the absence of symptoms.

Question 3053

Topic: 6. Spine

A 10-year-old girl who is Risser stage 0 has back deformity associated with neurofibromatosis type 1 (NF1). She has no back pain. Examination shows multiple cafe-au-lait nevi with normal lower extremity neurologic function and reflexes. Standing radiographs of the spine show a short 50-degree right thoracic scoliosis with a kyphotic deformity of 55 degrees (apex T8). A 10-degree progression in scoliosis has occurred during the past 1 year. There is no cervical deformity. MRI shows mild dural ectasia, primarily in the upper lumbar region. Management should consist of

Pediatrics Board Review 2007: High-Yield MCQs (Set 2) - Figure 10

. observation with repeat radiographs in 6 months.
. a thoracolumbosacral orthosis (TLSO).
. in situ posterior spinal fusion without instrumentation, followed by full-time TLSO bracing.
. anterior spinal convex hemiepiphysiodesis.
. combined anterior and posterior spinal arthrodesis with instrumentation.

Correct Answer & Explanation

. combined anterior and posterior spinal arthrodesis with instrumentation.

Explanation

Scoliotic deformities in patients with NF1 are often dysplastic with short, angular curves. Posterior arthrodesis is made more difficult by the presence of kyphosis and of weak posterior elements caused by dural ectasia. Combined anterior and posterior spinal arthrodesis is generally preferred for progressive dysplastic curves to maximize deformity correction and to decrease the risk of pseudarthrosis. Anterior fusion may also prevent crankshaft phenomenon in young children. Brace treatment is not effective for large, rigid, or dysplastic curves. Kim HW, Weinstein SL: Spine update: The management of scoliosis in neurofibromatosis. Spine 1997;22:2770-2776.

Question 3054

Topic: 6. Spine

A 40-year-old woman has had sciatic pain on the left side for the past 8 weeks. She reports that the pain radiates to her posterior thigh, lateral calf, and into the dorsum of her left foot. Neurologic examination shows weakness of the left extensor hallucis longus. Axial T2-weighted MRI scans through L4-L5 are shown in Figure 14. Management should consist of

Spine Surgery Board Review 2006: High-Yield MCQs (Set 2) - Figure 10

. CT-guided needle biopsy at L4-L5.
. a bone survey.
. anterior interbody fusion.
. left L4-L5 microdiskectomy.
. left L4-L5 hemilaminectomy and partial facetectomy.

Correct Answer & Explanation

. left L4-L5 hemilaminectomy and partial facetectomy.

Explanation

The MRI scans show hypertrophy of the left L4-L5 facet joint and ligamentum flavum, with a synovial cyst. Appropriate surgical management consists of a hemilaminectomy and direct decompression of the neural elements. Fusion, in addition to the decompression, may be considered, particularly in patients with an associated spondylolisthesis. Epstein NE: Lumbar laminectomy for the resection of synovial cysts and coexisting lumbar spinal stenosis or degenerative spondylolisthesis: An outcome study. Spine 2004;29:1049-1055.

Question 3055

Topic: 6. Spine

A 45-year-old man seen in the emergency department reports a 1-week history of worsening low back pain and a progressive neurologic deficit in the S1 distribution. Examination reveals 2/5 strength in the gastrocnemius. Laboratory studies show a WBC count of 13,500/mm3 and an erythrocyte sedimentation rate of 74 mm/h. Radiographs of the lumbosacral spine show narrowing of the L5-S1 disk space, with irregularity of the end plates. A sagittal T2-weighted MRI scan is shown in Figure 8. Definitive management should consist of

Spine Surgery 2006 Practice Questions: Set 1 (Solved) - Figure 21

. physical therapy that includes a program of centralization of his leg pain.
. a thoracolumbosacral brace to include one thigh.
. L5-S1 laminectomy.
. interbody cage fusion with allograft bone.
. anterior debridement and decompression with posterior stabilization.

Correct Answer & Explanation

. anterior debridement and decompression with posterior stabilization.

Explanation

The history, physical examination, laboratory, and radiographic findings are most consistent with an infectious process. When there are signs of neurologic compromise, surgery is generally recommended. This is an anterior process, and anterior column debridement is necessary, followed by stabilization. Anterior or posterior stabilization is a reasonable option, but posterior decompression alone is unlikely to adequately reverse the process and may lead to segmental kyphosis. Frymoyer JW, Wiesel SW (eds): The Adult and Pediatric Spine, ed 3. Philadelphia, PA, Lippincott Williams and Wilkins, 2003, pp 165-189.

Question 3056

Topic: 6. Spine

The majority of severe cervical spine injuries occurring in contact sports evolve during axial loading and flexion of the cervical spine. At what minimum degree of flexion does axial loading place the cervical spine at risk during contact sports?

. 15 degrees
. 30 degrees
. 45 degrees
. 60 degrees
. 75 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

The paravertebral musculature, the intervertebral disks, and the normal lordotic curvature of the cervical spine can absorb much of the imparted energy of collision. However, when the neck is flexed approximately 30 degrees, the normal lordotic curvature is flattened and the forces applied to the vertex of the head are directed at a straight segmented column. In this situation, the cervical spine is less able to absorb the applied force. With mounting axial load, compressive deformation occurs within the intervertebral disks, causing angular deformation and buckling. The spine will fail in flexion, with resultant fracture, subluxation, or dislocation. A rotatory component added to axial compression can cause concomitant extension, rotation, and shear injury patterns. The National Football Head and Neck Injury Registry has made two recommendations to the NCAA Football Rules Committee to minimize the risk of such injuries: (1) No player should intentionally strike an opponent with the crown or top of the helmet; and (2) No player should deliberately use his helmet to butt or ram an opponent. Thomas BE, McCullen GM, Yuan HA: Cervical spine injuries in football players. J Am Acad Orthop Surg 1999;7:338-347.

Question 3057

Topic: 6. Spine

Figure 42 shows the radiograph of a patient with spinal muscular atrophy. Examination reveals good upper extremity function, and she can tie her shoes and propel a manual wheelchair. Posterior instrumentation and fusion may result in

Pediatrics Board Review 2004: High-Yield MCQs (Set 4) - Figure 2

. decreased longevity.
. worsening of sitting balance.
. worsening of pulmonary function.
. temporary loss of upper extremity function.
. poor patient or parent satisfaction.

Correct Answer & Explanation

. temporary loss of upper extremity function.

Explanation

Spinal muscular atrophy is caused by an abnormal survival motor neuron gene that prevents apoptosis of the motor nerves. Spinal fusion results in better sitting balance, stabilized or improved pulmonary function, and high parental satisfaction, but it may result in at least temporary loss of upper extremity function. Bentley G, Haddad F, Bull TM, Seingry D: The treatment of scoliosis in muscular dystrophy using modified Luque and Harrington-Luque instrumentation. J Bone Joint Surg Br 2001;83:22-28. Furumasu J, Swank SM, Brown JC, Gilgoff I, Warath S, Zeller J: Functional activities in spinal muscular atrophy patients after spinal fusion. Spine 1989;14:771-775.

Question 3058

Topic: 6. Spine

A 24-year-old man sustains the injury shown in Figures 19a through 19e in a paragliding accident. He is neurologically intact. He also sustained fractures of his left femur and right distal radius. Which of the following represents the best option for management of the spinal injury?

. Bed rest for 6 weeks, followed by mobilization in a thoracolumbosacral orthosis (TLSO) until the fracture has healed
. Immediate mobilization in a TLSO, continuing until the fracture has healed
. Anterior corpectomy with strut grafting and placement of anterior fixation
. Anterior corpectomy and strut grafting followed by posterior spinal fusion and instrumentation
. Posterior spinal fusion and instrumentation

Correct Answer & Explanation

. Posterior spinal fusion and instrumentation

Explanation

The injury pattern is that of a burst fracture at L1 contiguous with a compression fracture at T12. There is associated kyphosis and slight spondylolisthesis of T12 on L1. Treatment of this type of burst fracture in neurologically intact patients is somewhat controversial, with at least one study demonstrating equal long-term results comparing nonsurgical treatment to surgical treatment. In this study, however, body casts were used initially in the nonsurgical group. Moreover, because this patient has multiple fractures, spinal fracture stabilization should be considered to facilitate early mobilization. Surgical stabilization and fusion via a posterior approach is the best treatment option in this patient. Anterior decompression is not necessary since the patient is neurologically intact. McLain RF, Benson DR: Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 1999;24:1646-1654. 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.

Question 3059

Topic: 6. Spine

Figures 31a and 31b show the radiograph and MRI scan of an otherwise normal 3-month-old infant who has a spinal deformity. MRI reveals no intraspinal anomalies. What is the next step in management?

. Posterior spinal fusion with instrumentation
. Anterior-posterior hemiepiphysiodesis
. Brace management
. Cardiac and renal evaluation
. Hemivertebrectomy and fusion

Correct Answer & Explanation

. Cardiac and renal evaluation

Explanation

Congenital scoliosis in an infant warrants evaluation of the renal, cardiac, and neurologic systems because frequently there is concurrent pathology. Progression in this instance is possible but not certain; therefore, progression must be documented prior to any surgical intervention. Close observation with serial radiographs every 4 to 6 months is appropriate. All of the surgical options listed may be reasonable choices in the future, but cardiac evaluation is the most important issue at this time. Basu PS, Elsebaie H, Noordeen MH: Congenital spinal deformity: A comprehensive assessment at presentation. Spine 2002;27:2255-2259.

Question 3060

Topic: 6. Spine

A 23-year-old man sustains a unilateral jumped facet with an isolated cervical root injury in a motor vehicle accident. Acute reduction results in some initial improvement of his motor weakness. Over the next 48 hours, examination reveals ipsilateral loss of pain and temperature sensation in his face, limbs, and trunk, as well as nystagmus, tinnitus, and diplopia. What is the most likely etiology for these changes?

. Intracranial hemorrhage
. Epidural hematoma
. Unrecognized disk extrusion
. Delayed spinal cord hemorrhage
. Vertebral artery injury

Correct Answer & Explanation

. Vertebral artery injury

Explanation

The patient is showing signs of vertebral artery stroke. The signs of Wallenberg syndrome include those listed above, as well as contralateral loss of pain and temperature sensation throughout the body, an ipsilateral Horner's syndrome, dysphagia, and ataxia. Vertebral artery injuries are not unusual in significant cervical facet injuries. A lesion in the cervical spinal cord is not associated with these symptoms, and an intracranial hemorrhage from trauma is unlikely to present in this manner. Young PA, Young PH: Basic Clinical Neuroanatomy. Baltimore, MD, Williams and Wilkins, 1997, pp 242-243. Hauop JS, et al: The cause of neurologic deterioration after acute cervical spinal cord injury. Spine 2001;26:340-346.

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