Practice Set 3 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.
Which of the following pathophysiologic mechanisms best describes Grisel's syndrome?
. Atlantoaxial subluxation secondary to inflammatory retropharyngeal hyperemia
A 45-year-old patient presents with neck pain radiating down the right arm. Examination shows weakness in triceps extension and wrist flexion, with numbness isolated to the middle finger. Which nerve root is most likely compressed?
. C7
Which radiographic finding is essential to confirm the diagnosis of Diffuse Idiopathic Skeletal Hyperostosis (DISH) according to Resnick's criteria?
. Flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies
In the Levine-Edwards classification of traumatic spondylolisthesis of the axis (Hangman's fracture), a Type IIA fracture is characterized by which of the following?
. Fracture with severe angulation and minimal translation
A 55-year-old male with long-standing ankylosing spondylitis presents after a minor fall with neck pain but intact neurology. CT reveals a fracture through the C5-C6 disc space extending into the posterior elements. What is the most appropriate definitive management?
. Long-segment posterior instrumented fusion
An 80-year-old male with severe cervical spondylotic myelopathy has multi-level compression from C3 to C6 predominantly due to ossification of the posterior longitudinal ligament (OPLL). Radiographs show a fixed, rigid kyphotic deformity of 15 degrees. Which surgical approach is generally indicated?
. Anterior cervical corpectomy and fusion
Which radiographic finding best differentiates an os odontoideum from an acute Type II odontoid fracture?
. Hypertrophy of the anterior arch of C1 with a rounded, sclerotic margin of the ossicle
In a patient with severe rheumatoid arthritis, what measurement of the anterior atlantodens interval (ADI) is generally considered an absolute indication for surgical stabilization, even if the patient is asymptomatic?
. > 9 mm
A trauma patient presents with complete loss of motor and sensory function below T4 following a motorcycle accident. The bulbocavernosus reflex is absent. Which of the following statements regarding the patient's prognosis is most accurate?
. Prognosis for neurologic recovery cannot be accurately determined until the bulbocavernosus reflex returns.
A 65-year-old man with cervical spondylotic myelopathy exhibits a positive inverted supinator reflex on examination. This abnormal reflex is characterized by a diminished brachioradialis response accompanied by which of the following simultaneous actions?
. Finger flexion
According to the Sorensen criteria, classic Scheuermann's kyphosis is defined radiographically by a thoracic kyphosis greater than 40 degrees accompanied by which of the following?
. Anterior wedging of at least 5 degrees in 3 consecutive vertebrae
A 7-year-old child presents with torticollis and severe neck stiffness one week after undergoing an adenotonsillectomy. Radiographs demonstrate atlantoaxial subluxation without evidence of trauma. What is the most likely diagnosis?
. Grisel's syndrome
According to the Levine-Edwards classification, a Type II Hangman's fracture (traumatic spondylolisthesis of the axis) is generated by which specific mechanism of injury?
. Hyperextension followed by severe axial loading and flexion
When evaluating a Jefferson burst fracture on an AP open-mouth radiograph, what combined lateral mass overhang measurement (Rule of Spence) is historically used to indicate a high probability of transverse ligament rupture?
. > 6.9 mm
A 45-year-old man presents with sharp, radiating neck pain. Neurological examination reveals weakness in triceps extension, a diminished triceps reflex, and numbness over the dorsal aspect of the middle finger. Which cervical nerve root is most likely compressed?
. C7
A 55-year-old male with a long history of Ankylosing Spondylitis suffers a mechanical fall from a standing height. He complains of moderate lower neck pain. Initial plain radiographs of the cervical spine appear unremarkable. What is the most appropriate next step in management?
. Obtain a CT scan of the cervical spine
During an anterior cervical discectomy and fusion (ACDF), the surgeon retracts the longus colli muscles laterally to expose the vertebral bodies. Vigorous or prolonged lateral retraction of this muscle places which of the following structures at highest risk of injury?
. Cervical sympathetic chain
In a 5-year-old trauma patient, a lateral cervical spine radiograph shows apparent anterior subluxation of C2 on C3. To differentiate physiologic pseudosubluxation from true traumatic injury, which radiographic line should be drawn to assess the alignment of the posterior arches?
. Swischuk's line
A 70-year-old male with type 2 diabetes presents with neck stiffness. Radiographs show flowing ossification along the anterolateral aspect of the cervical spine. To meet Resnick's strict radiographic criteria for Diffuse Idiopathic Skeletal Hyperostosis (DISH), how many contiguous vertebral bodies must be involved?
. Four
Ossification of the posterior longitudinal ligament (OPLL) is a progressive condition that can lead to severe cervical myelopathy. Which of the following demographic groups has the highest prevalence of OPLL?
. Asian males over 50 years of age