Menu

6. Spine MCQs

Practice Set 49 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 961

Topic: 6. Spine

According to the Eastern Association for the Surgery of Trauma (EAST) guidelines, what is the most appropriate modality to clinically clear the cervical spine in an obtunded, intubated adult trauma patient?

. Dynamic fluoroscopy
. High-quality axial CT scan
. Upright flexion-extension radiographs
. Somatosensory evoked potentials (SSEPs)
. Plain radiographs followed by an MRI after 48 hours

Correct Answer & Explanation

. High-quality axial CT scan

Explanation

Modern EAST guidelines state that a high-quality, negative CT scan of the cervical spine is sufficient to clear the cervical spine and safely remove the collar in obtunded adult trauma patients.

Question 962

Topic: 6. Spine

A 25-year-old male presents with bilateral jumped facets at C6-C7 following a diving accident. He is awake, alert, and cooperative, with an incomplete spinal cord injury. What is the recommended initial management step?

. Immediate open posterior reduction and fusion
. Immediate MRI to rule out disc herniation
. Closed reduction using cranial tongs and progressive traction
. Anterior cervical discectomy and fusion
. Administration of high-dose corticosteroids followed by MRI

Correct Answer & Explanation

. Closed reduction using cranial tongs and progressive traction

Explanation

In awake, alert, and cooperative patients with facet dislocations, closed reduction via cranial tong traction is safe and indicated before obtaining an MRI. An obtunded patient requires an MRI before any reduction attempt.

Question 963

Topic: Thoracolumbar Spine & Deformity

A 14-year-old gymnast complains of chronic lower back pain exacerbated by extension. Oblique lumbar radiographs demonstrate a "Scotty dog with a collar" sign. What is the underlying pathology?

. Spondyloptosis
. Spondylolysis
. Herniated nucleus pulposus
. Scheuermann's disease
. Sacroiliitis

Correct Answer & Explanation

. Spondylolysis

Explanation

The "Scotty dog with a collar" sign on oblique lumbar radiographs represents a defect or stress fracture in the pars interarticularis, known as spondylolysis.

Question 964

Topic: 6. Spine

A 45-year-old male sustains a severe flexion-distraction injury of the thoracolumbar spine with profound disruption of the posterior ligamentous complex. The anterior vertebral body is largely intact. Which classification historically best describes this bony/ligamentous injury pattern?

. Burst fracture
. Chance fracture
. Clay-shoveler's fracture
. Jefferson fracture
. Hangman's fracture

Correct Answer & Explanation

. Chance fracture

Explanation

A Chance fracture is a classic flexion-distraction injury that typically fails in tension through the posterior and middle columns, potentially extending into the anterior column either through bone or ligaments.

Question 965

Topic: Cervical Spine

What is the primary anatomical and functional advantage of performing an anterior odontoid screw fixation over a posterior C1-C2 fusion for a suitable Type II odontoid fracture?

. Higher union rate in osteoporotic bone
. Preservation of normal C1-C2 atlantoaxial rotation
. No need for postoperative immobilization
. Lower risk of dysphagia
. Better mechanical stability in reverse obliquity fractures

Correct Answer & Explanation

. Preservation of normal C1-C2 atlantoaxial rotation

Explanation

Anterior odontoid screw fixation is a motion-preserving surgery that maintains the roughly 50 degrees of normal cervical rotation that occurs at the C1-C2 atlantoaxial joint, unlike posterior C1-C2 fusion.

Question 966

Topic: Thoracolumbar Spine & Deformity

A 30-year-old male sustains a T12 burst fracture. He is neurologically intact, and the posterior ligamentous complex (PLC) is indeterminate on MRI. What is his TLICS score and recommended management?

. Score 2: Non-operative management
. Score 4: Operative or non-operative management
. Score 5: Operative management
. Score 7: Operative management
. Score 3: Non-operative management

Correct Answer & Explanation

. Score 4: Operative or non-operative management

Explanation

The Thoracolumbar Injury Classification and Severity (TLICS) score assigns 2 points for a burst fracture, 0 points for intact neurology, and 2 points for an indeterminate PLC, totaling 4 points. A score of 4 can be treated operatively or non-operatively based on surgeon preference and patient factors.

Question 967

Topic: Thoracolumbar Spine & Deformity

A 25-year-old restrained passenger in a high-speed MVC presents with a bony Chance fracture of L2. Which of the following is the most commonly associated concomitant injury?

. Aortic tear
. Hollow viscus injury
. Diaphragmatic rupture
. Splenic laceration
. Pelvic ring disruption

Correct Answer & Explanation

. Hollow viscus injury

Explanation

Chance fractures are flexion-distraction injuries commonly referred to as seatbelt injuries. They have a high association (up to 40-50%) with intra-abdominal injuries, particularly of hollow viscous organs.

Question 968

Topic: 6. Spine

An elderly patient with underlying cervical spondylosis sustains a hyperextension injury resulting in upper extremity weakness that is far greater than lower extremity weakness. What is the typical sequence of motor recovery for this condition?

. Upper extremities followed by lower extremities
. Proximal to distal with hands recovering last
. Distal to proximal with hands recovering first
. Symmetrical recovery across all extremities
. Lower extremities usually do not recover

Correct Answer & Explanation

. Upper extremities followed by lower extremities

Explanation

Central cord syndrome usually follows a hyperextension injury in a stenotic cervical spine. Recovery typically occurs in a specific pattern: lower extremity, then bowel/bladder, then proximal upper extremity, with fine motor function of the hands recovering last.

Question 969

Topic: Cervical Spine

Which of the following radiographic measurements is most reliable for diagnosing atlanto-occipital dissociation (AOD) on lateral cervical spine imaging in a polytrauma patient?

. Power's ratio greater than 1
. Basion-dental interval (BDI) greater than 10 mm on CT
. Atlanto-dens interval (ADI) greater than 3 mm
. Space available for the cord (SAC) less than 13 mm
. Wackenheim line intersecting the odontoid process

Correct Answer & Explanation

. Basion-dental interval (BDI) greater than 10 mm on CT

Explanation

The Basion-Dental Interval (BDI) and Basion-Axial Interval (BAI), known as the Harris measurements, are the most reliable indicators of AOD. A measurement greater than 10 mm on CT or 12 mm on plain films is diagnostic for atlanto-occipital dissociation.

Question 970

Topic: Thoracolumbar Spine & Deformity
A patient presents with a traumatic spondylolisthesis of the axis. CT shows severe angulation and >3mm translation, with C2-C3 facet capsules disrupted. According to Levine and Edwards, what is the classification and recommended non-operative treatment?
. Type I: Rigid cervical collar
. Type II: Halo vest immobilization in neutral
. Type IIA: Halo vest with compression
. Type IIA: Halo vest with gentle traction
. Type III: Surgical stabilization is strictly mandated

Correct Answer & Explanation

. Type IIA: Halo vest with compression

Explanation

Type IIA Hangman fractures show severe angulation with minimal translation and are caused by a flexion-distraction mechanism. Traction is contraindicated as it exacerbates the deformity; they must be treated with reduction under compression in a halo vest.

Question 971

Topic: 6. Spine

A patient with a spinal cord injury has preserved sensory function in the sacral segments S4-S5, but absolutely no motor function is preserved more than three levels below the motor level. What is their ASIA Impairment Scale grade?

. ASIA A
. ASIA B
. ASIA C
. ASIA D
. ASIA E

Correct Answer & Explanation

. ASIA B

Explanation

ASIA B indicates a sensory incomplete spinal cord injury. Sensory function (but not motor function) is preserved below the neurological level and includes the sacral segments S4-S5.

Question 972

Topic: Cervical Spine

A 40-year-old man dives into a shallow pool and sustains a C1 burst fracture. An open-mouth odontoid radiograph demonstrates a combined lateral mass overhang of 8 mm. What does this measurement critically indicate?

. Intact transverse ligament
. Rupture of the transverse ligament
. Rupture of the alar ligament
. Rupture of the apical ligament
. Intact tectorial membrane

Correct Answer & Explanation

. Rupture of the transverse ligament

Explanation

In a Jefferson fracture (C1 burst), the Rule of Spence dictates that a combined lateral mass overhang on C2 of 7 mm or more on an open-mouth view implies rupture of the transverse atlantal ligament. This indicates a highly unstable injury requiring rigid immobilization or surgical fusion.

Question 973

Topic: 6. Spine

A patient with a flexion teardrop fracture of C5 presents with complete loss of motor function, pain, and temperature sensation below the lesion, but with completely preserved proprioception and vibratory sense. What is the diagnosis?

. Central cord syndrome
. Posterior cord syndrome
. Anterior cord syndrome
. Brown-Sequard syndrome
. Cauda equina syndrome

Correct Answer & Explanation

. Anterior cord syndrome

Explanation

Anterior cord syndrome results from damage to the anterior two-thirds of the spinal cord, often via hyperflexion injuries or anterior spinal artery compromise. It causes loss of motor, pain, and temperature function, but preserves dorsal column function like proprioception and vibration.

Question 974

Topic: Cervical Spine

Which of the following is the most statistically significant risk factor for non-union in a Type II odontoid fracture treated with non-operative halo immobilization?

. Age less than 40 years
. Anterior displacement > 2 mm
. Posterior displacement > 5 mm
. Initial displacement > 5 mm
. Fracture gap < 1 mm

Correct Answer & Explanation

. Initial displacement > 5 mm

Explanation

High risk factors for non-union in Type II odontoid fractures include age greater than 50 years, initial displacement greater than 5 mm, posterior displacement, and a fracture gap greater than 1 mm.

Question 975

Topic: 6. Spine

A patient presents with localized lower cervical pain after repeatedly shoveling heavy snow. Radiographs show a displaced avulsion fracture of the C7 spinous process. What is the most appropriate management?

. Halo vest immobilization for 6 weeks
. Anterior cervical discectomy and fusion
. Posterior spinal fusion of C6-T1
. Symptomatic treatment with a soft collar as needed
. Rigid cervical orthosis for 12 weeks

Correct Answer & Explanation

. Symptomatic treatment with a soft collar as needed

Explanation

A Clay Shoveler's fracture is a stable avulsion fracture of a lower cervical or upper thoracic spinous process. It does not cause structural or neurological instability and is treated purely symptomatically.

Question 976

Topic: 6. Spine

A 20-year-old male presents with a gunshot wound to the abdomen. The bullet traverses the colon and lodges solidly in the L3 vertebral body. He is neurologically completely intact. What is the most appropriate management of the spinal injury?

. Bullet removal via lumbar laminectomy
. Intravenous antibiotics and observation of the spine
. Bullet removal via an anterior retroperitoneal approach
. Posterior spinal fusion and instrumentation
. Prophylactic application of a halo vest

Correct Answer & Explanation

. Intravenous antibiotics and observation of the spine

Explanation

Gunshot wounds to the spine associated with bowel perforation require broad-spectrum antibiotics, usually for 7-14 days. Surgical removal of the bullet is generally not indicated if the patient is neurologically intact, as surgery significantly increases the risk of complications.

Question 977

Topic: 6. Spine

According to the Denis three-column theory of the thoracolumbar spine, which anatomic structure defines the posterior limit of the middle column?

. Anterior longitudinal ligament
. Posterior half of the intervertebral disc
. Posterior longitudinal ligament
. Ligamentum flavum
. Interspinous ligament

Correct Answer & Explanation

. Posterior longitudinal ligament

Explanation

The middle column consists of the posterior half of the vertebral body, the posterior half of the annulus fibrosus, and the posterior longitudinal ligament (PLL). Disruption of the middle column is the defining characteristic of a burst fracture.

Question 978

Topic: 6. Spine

A 65-year-old male with long-standing ankylosing spondylitis sustains a low-energy fall. He complains of neck pain but is neurologically intact. Standard lateral plain radiographs are very difficult to interpret due to marked cervicothoracic deformity. What is the next most appropriate step?

. Reassurance and discharge with physical therapy
. CT scan of the entire cervical and upper thoracic spine
. Flexion-extension plain radiographs
. Dynamic fluoroscopy under mild sedation
. Soft cervical collar for 2 weeks followed by re-evaluation

Correct Answer & Explanation

. CT scan of the entire cervical and upper thoracic spine

Explanation

Patients with ankylosing spondylitis are at extremely high risk for highly unstable, occult fractures even after minor trauma. CT or MRI is mandatory because plain radiographs are notoriously unreliable in these patients due to baseline deformity and severe ossification.

Question 979

Topic: 6. Spine

A 25-year-old male is involved in a high-speed motor vehicle collision. Lateral cervical spine radiographs reveal a basion-dens interval of 14 mm. What is the most appropriate definitive management?

. Halo vest immobilization
. Hard cervical collar for 12 weeks
. Occipitocervical fusion
. C1-C2 transarticular screws
. Anterior cervical discectomy and fusion

Correct Answer & Explanation

. Occipitocervical fusion

Explanation

A basion-dens interval greater than 12 mm indicates atlanto-occipital dissociation (AOD). This represents a highly unstable craniocervical injury requiring definitive surgical stabilization with occipitocervical fusion.

Question 980

Topic: 6. Spine

A 32-year-old woman is evaluated after a motor vehicle collision. Radiographs show a traumatic spondylolisthesis of the axis with 4 mm of translation and 12 degrees of angulation. Which mechanism of injury is most likely responsible for this fracture pattern?

. Hyperflexion and compression
. Hyperextension and axial loading
. Lateral bending
. Hyperextension and distraction
. Rotational shear

Correct Answer & Explanation

. Hyperextension and axial loading

Explanation

Traumatic spondylolisthesis of the axis (Hangman's fracture) is typically caused by hyperextension and axial loading. The described pattern is a Levine-Edwards Type II fracture, which involves translation and angulation.

Test Yourself

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

On this Page