Spondylolisthesis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Spondylolisthesis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Spondylolisthesis Indian Medical PG Question 1: A 45-year-old patient presents with chronic lower back pain. X-ray shows anterior displacement of a vertebral body. What is the likely diagnosis?
- A. Spondylosis
- B. Compression fracture
- C. Osteoporosis
- D. Spondylolisthesis (Correct Answer)
Spondylolisthesis Explanation: ***Spondylolisthesis***
- This condition involves the **anterior displacement** (slipping forward) of one vertebral body over the one below it, which perfectly matches the X-ray finding.
- It often causes **chronic lower back pain**, especially in active individuals or those with degenerative changes.
*Spondylosis*
- Refers to **degenerative changes** in the spine, including **osteophytes** and **disc space narrowing**, but typically does not involve anterior vertebral displacement.
- While it can cause chronic back pain, the specific X-ray finding points away from isolated spondylosis.
*Compression fracture*
- Involves a **collapse of the vertebral body**, usually due to trauma or osteoporosis, leading to a **decreased vertebral height**.
- It does not present as an anterior displacement of an entire vertebral body.
*Osteoporosis*
- This is a condition of **decreased bone density**, making bones fragile and prone to fractures (e.g., compression fractures), but it does not directly cause anterior vertebral displacement.
- While osteoporosis can be an underlying factor for some spinal conditions, it is not the direct diagnosis for the described X-ray finding.
Spondylolisthesis Indian Medical PG Question 2: A 35-year-old male presents to the emergency department following a high-speed motor vehicle accident. He complains of severe lower back pain but denies any loss of consciousness or abdominal pain. A lateral X-ray of the lumbar spine is obtained, as shown in the image. The image reveals a horizontal fracture through the vertebral body, extending through the posterior elements. Based on the clinical presentation and imaging findings, what is the most likely diagnosis?
- A. Burst fracture
- B. Compression fracture
- C. Chance fracture (Correct Answer)
- D. Spondylolisthesis
Spondylolisthesis Explanation: ***Chance fracture***
- A **chance fracture** is characterized by a **horizontal fracture** through the entire vertebral body and posterior elements, including the neural arch, typically caused by a **flexion-distraction mechanism** in accidents like those involving seatbelts (lap belt only), consistent with the high-speed motor vehicle accident scenario.
- The image distinctly shows a fracture line traversing the vertebral body and extending into the posterior elements, which is the hallmark of this type of injury.
*Burst fracture*
- A **burst fracture** involves a comminuted fracture of the vertebral body with **retropulsion of bone fragments** into the spinal canal due to axial loading, which is not clearly depicted here.
- While it can result from high-impact trauma, the characteristic horizontal disruption of both anterior and posterior segments points away from a solely compressive mechanism.
*Compression fracture*
- A **compression fracture** primarily involves the **anterior wedging** or collapse of the vertebral body, resulting from only axial compression forces without significant involvement of the posterior elements.
- The presented image shows a fracture extending through the posterior elements, which is not typical for a simple compression fracture.
*Spondylolisthesis*
- **Spondylolisthesis** is the **anterior slippage of one vertebral body over another**, often due to pars interarticularis defects (spondylolysis) or degenerative changes.
- This condition involves vertebral displacement, not a fresh fracture line across the body and posterior elements as seen in the image.
Spondylolisthesis Indian Medical PG Question 3: X-ray spine of a child is shown. What is the probable diagnosis?
- A. Bamboo spine
- B. Normal spine
- C. Ivory spine
- D. Rugger Jersey spine (Correct Answer)
Spondylolisthesis Explanation: ***Rugger Jersey spine***
- This X-ray image shows alternating bands of **increased density (sclerosis) at the superior and inferior endplates** with **central lucency** in the vertebral bodies, creating the characteristic "Rugger Jersey spine" appearance.
- This pattern is commonly associated with **secondary hyperparathyroidism**, most often seen in patients with **chronic renal failure**.
- The alternating bands resemble the horizontal stripes on a rugby jersey, hence the name.
*Bamboo spine*
- **Bamboo spine** is a characteristic finding in advanced **ankylosing spondylitis**, where ossification of the annulus fibrosus and anterior longitudinal ligament leads to **syndesmophytes** bridging adjacent vertebral bodies.
- This creates a smooth, continuous appearance resembling bamboo, which is not the pattern seen in this image.
*Normal spine*
- A **normal spine** would show **uniform bone density** throughout the vertebral bodies without the alternating lucent and sclerotic bands seen in this image.
- Normal vertebral bodies have homogeneous trabecular bone density without endplate sclerosis.
*Ivory spine*
- An **ivory vertebra** refers to a **homogeneously dense and enlarged** vertebral body, typically observed in conditions like **metastatic prostate cancer** (blastic metastases), **Paget's disease**, or **lymphoma**.
- This is typically a **localized finding** in a single or few vertebrae, distinct from the **generalized alternating band pattern** seen in Rugger Jersey spine.
Spondylolisthesis Indian Medical PG Question 4: Earliest investigation for diagnosis of Ankylosing spondylitis:
- A. CT scan
- B. Bone scan
- C. X-ray
- D. MRI STIR sequence (Correct Answer)
Spondylolisthesis Explanation: ***MRI STIR sequence***
- An **MRI STIR (Short Tau Inversion Recovery) sequence** is highly sensitive for detecting early inflammatory changes in the **sacroiliac joints** and spine, such as **bone marrow edema**, which is a hallmark of early ankylosing spondylitis.
- It can identify disease activity and structural changes *before* they are visible on conventional X-rays, making it the earliest diagnostic tool.
*CT scan*
- While a **CT scan** provides excellent detailed images of bone, it is not as sensitive as MRI for detecting early inflammatory changes like **bone marrow edema** in the sacroiliac joints.
- It involves significant **radiation exposure** and is typically used for more advanced structural assessment rather than early diagnosis.
*Bone scan*
- A **bone scan** (scintigraphy) shows areas of increased bone turnover but is **not specific** for ankylosing spondylitis and has lower spatial resolution compared to MRI.
- It can indicate inflammation or increased metabolic activity but cannot differentiate specific causes or provide detailed anatomical information as effectively as MRI.
*X-ray*
- **X-rays** are often the initial imaging modality due to their accessibility, but they only show **structural changes** (like erosions, sclerosis, or fusion) in the sacroiliac joints and spine at a later stage of the disease.
- Early inflammatory changes, such as **bone marrow edema**, are typically not visible on plain radiographs, leading to a delay in diagnosis compared to MRI.
Spondylolisthesis Indian Medical PG Question 5: False about fracture of vertebrae
- A. Fracture dislocation is common in flexion rotation injury
- B. Chance fracture occurs due to flexion distraction injury
- C. Wedge compression causes flexion injury
- D. Anterior longitudinal ligament runs along the posterior surface of vertebral bodies (Correct Answer)
Spondylolisthesis Explanation: ***Anterior longitudinal ligament runs along the posterior surface of vertebral bodies***
- The **anterior longitudinal ligament (ALL)** runs along the **anterior aspect** of the vertebral bodies, preventing hyperextension.
- The **posterior longitudinal ligament (PLL)** runs along the posterior surface of the vertebral bodies, within the vertebral canal.
*Fracture dislocation is common in flexion rotation injury*
- **Flexion-rotation injuries** are highly unstable and frequently lead to **fracture-dislocations** of the vertebral column.
- The combined forces cause significant disruption of both bony and ligamentous structures, increasing the likelihood of displacement.
*Chance fracture occurs due to flexion distraction injury*
- A **Chance fracture** (or seatbelt fracture) is caused by a **flexion-distraction injury**, typically seen in individuals wearing lap belts during deceleration.
- This mechanism results in a horizontal splitting of the vertebral body and posterior elements.
*Wedge compression causes flexion injury*
- A **wedge compression fracture** is the most common type of vertebral fracture and results from a **flexion injury** (hyperflexion).
- The anterior portion of the vertebral body collapses, creating a wedge shape, while the posterior column remains intact.
Spondylolisthesis Indian Medical PG Question 6: Burst fracture of spine is a type of:
- A. Extension injury
- B. Rotation injury
- C. Flexion injury
- D. Compression injury (Correct Answer)
Spondylolisthesis Explanation: ***Compression injury***
- A **burst fracture** occurs due to a high-energy axial load or significant compression force impacting the spine.
- This force causes the vertebral body to **shatter or "burst"** outwards, often into the spinal canal.
*Extension injury*
- **Extension injuries** typically result from hyperextension of the spine, such as in whiplash.
- This mechanism often leads to **posterior element fractures** or disc injuries, not the bursting of the vertebral body.
*Rotation injury*
- **Rotational injuries** involve twisting forces on the spine, which generally result in **facet joint dislocations** or **fracture-dislocations**.
- While they can cause instability, they do not primarily manifest as the compressive shattering seen in a burst fracture.
*Flexion injury*
- **Flexion injuries** are caused by forward bending forces, leading to **wedge fractures** or **flexion-distraction injuries**.
- These typically spare the posterior vertebral wall from bursting into the spinal canal, unlike burst fractures.
Spondylolisthesis Indian Medical PG Question 7: Identify the condition shown in the image:
- A. Renal osteodystrophy
- B. Spondylolisthesis
- C. Tuberculosis (TB)
- D. Spondylolysis (Correct Answer)
Spondylolisthesis Explanation: ***Spondylolysis***
* The image shows a **break in the pars interarticularis** of a vertebra, indicated by the arrow, which is characteristic of spondylolysis.
* This condition is a **stress fracture** or defect in the pars interarticularis, a bony segment connecting the superior and inferior articular facets.
*Renal osteodystrophy*
* Renal osteodystrophy refers to a spectrum of **bone abnormalities** that occur in chronic kidney disease, not a specific vertebral fracture pattern.
* It typically involves features such as **osteomalacia**, **osteitis fibrosa cystica**, or **osteoporosis**, which are not directly depicted as a fracture in this image.
*Spondylolisthesis*
* Spondylolisthesis is the **anterior slippage** of one vertebral body over another, which can be caused by bilateral spondylolysis but is not directly shown as a slip in this specific image.
* The image distinctly highlights the **fracture line** itself, rather than the displacement of the vertebral body.
*Tuberculosis (TB)*
* Spinal tuberculosis (Pott's disease) typically presents with **destruction of vertebral bodies**, disc space narrowing, and often a **paravertebral abscess**.
* The image does not show these features; instead, it demonstrates a clear **bony defect** in the pars interarticularis.
Spondylolisthesis Indian Medical PG Question 8: What should be the most likely diagnosis of this 65-year-old lady who presents with backache?
- A. Osteoporotic fracture
- B. Spondylolisthesis (Correct Answer)
- C. Spondylolysis
- D. Discitis
Spondylolisthesis Explanation: ***Spondylolisthesis***
- The lateral X-ray image reveals an **anterior displacement of one vertebral body over the one below it**, which is characteristic of spondylolisthesis.
- In a 65-year-old lady, degenerative spondylolisthesis due to **arthritic changes and instability** is a common cause of backache.
*Osteoporotic fracture*
- An osteoporotic fracture would typically show a **compression deformity** or a wedge-shaped vertebral body, which is not clearly depicted here.
- While osteoporosis is common in this age group, the primary finding on this image is vertebral slippage, not fracture.
*Spondylolysis*
- Spondylolysis is a **defect in the pars interarticularis** (a thin segment of bone connecting the superior and inferior articular facets) and is best seen on oblique views or CT.
- Although spondylolysis can *lead to* spondylolisthesis, the immediate and most striking finding on this lateral view is the slippage itself.
*Discitis*
- Discitis, an **inflammation or infection of the intervertebral disc and adjacent vertebrae**, would typically show **loss of disc height** and **endplate irregularities or erosions**.
- These features are not the predominant finding on this image, which clearly demonstrates vertebral body displacement.
Spondylolisthesis Indian Medical PG Question 9: Condition in which there is anterior or posterior displacement of a vertebra in relation to the vertebrae below:
- A. Spondylitis
- B. Spondylolisthesis (Correct Answer)
- C. Spondylolysis
- D. Spondylosis
Spondylolisthesis Explanation: ***Spondylolisthesis***
- This term specifically refers to the **slippage** (anterior or posterior displacement) of one vertebra relative to an adjacent one.
- It often results from conditions like **spondylolysis** (a defect in the pars interarticularis) or degenerative changes.
*Spondylitis*
- This condition involves **inflammation of the vertebrae**, often seen in diseases like ankylosing spondylitis.
- While it can cause pain and stiffness, it does not primarily describe the displacement of one vertebra over another.
*Spondylolysis*
- This refers to a **defect or stress fracture in the pars interarticularis** of a vertebra.
- It is a common *cause* of spondylolisthesis, but not the slippage itself.
*Spondylosis*
- This is a general term for **degenerative changes** in the spine, including osteoarthritis of the spinal joints and disc degeneration.
- It describes age-related wear and tear, not the direct displacement of a vertebra.
Spondylolisthesis Indian Medical PG Question 10: Hangman's fracture is
- A. traumatic spondylolisthesis of atlas vertebra (C1)
- B. traumatic spondylolisthesis of axis vertebra (C2) (Correct Answer)
- C. traumatic spondylolisthesis of lumbar vertebra (L1)
- D. traumatic spondylolisthesis of thoracic vertebra (T1)
Spondylolisthesis Explanation: ***traumatic spondylolisthesis of axis vertebra (C2)***
- A Hangman's fracture is a specific type of **traumatic spondylolisthesis** involving the **C2 (axis) vertebra**.
- It results from bilateral fractures of the **pars interarticularis** of C2, often due to hyperextension and distractive forces.
*traumatic spondylolisthesis of atlas vertebra (C1)*
- A fracture of the atlas (C1) is typically called a **Jefferson fracture**, not a Hangman's fracture.
- A Jefferson fracture usually involves ruptures of facets or arches, often caused by **axial loading**.
*traumatic spondylolisthesis of lumbar vertebra (L1)*
- **Spondylolisthesis** can occur in the lumbar spine, but it most commonly affects L5-S1 or L4-L5, and is usually a **fatigue fracture** not a traumatic spondylolisthesis.
- Fractures in the lumbar region have different causes and clinical implications than cervical fractures, and are not termed a Hangman's fracture.
*traumatic spondylolisthesis of thoracic vertebra (T1)*
- While traumatic spine fractures can occur in the **thoracic spine**, spondylolisthesis is much less common due to the rib cage's stabilizing effect.
- Fractures in this region are distinctly different from the characteristic C2 pars interarticularis fracture of a Hangman's fracture.
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