Pediatric Spine Deformities — MCQs
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?
X-ray spine of a child is shown. What is the probable diagnosis?
Beheaded Scottish terrier sign is seen in:
Omovertebral bone is associated with?
A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
Lachman's test is performed with the knee in what degree of flexion?
Fracture of the femur in young children (2-5 years) is typically treated by:
A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?
Most common type of lesion in Pott's spine:
A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?
Pediatric Spine Deformities Indian Medical PG Practice Questions and MCQs
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)
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.
Question 2: 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)
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.
Question 3: Beheaded Scottish terrier sign is seen in:
- A. Osteoporosis
- B. Spondylolysis (Correct Answer)
- C. Spondylosis
- D. Osteogenesis imperfecta
Explanation: ***Spondylolysis*** - The \"Beheaded Scottish terrier sign\" is **pathognomonic for spondylolysis**, which is a **fracture of the pars interarticularis**. - On oblique lumbar spine radiographs, the normal vertebra resembles a \"Scotty dog\" where the pars interarticularis forms the \"neck\"; when fractured, it appears \"beheaded\". - This defect occurs most commonly at **L5**, often due to repetitive stress in athletes (gymnasts, football players). - **Key distinction**: Spondylolysis is the pars fracture itself; if it progresses to anterior vertebral slippage, it becomes spondylolisthesis. *Spondylolisthesis* - This refers to **anterior displacement of one vertebra over another**, which can occur as a complication of spondylolysis. - While related to spondylolysis, the \"Beheaded Scottish terrier sign\" specifically indicates the **pars fracture** (spondylolysis), not the vertebral slippage. - Diagnosed on lateral radiographs showing vertebral step-off, not the oblique view Scotty dog sign. *Spondylosis* - Refers to **degenerative changes of the spine** including disc degeneration, osteophyte formation, and facet joint arthritis. - This is an **age-related process** and does not involve pars interarticularis fractures. - Not associated with the \"Beheaded Scottish terrier sign\". *Osteoporosis* - A systemic condition of **decreased bone mineral density** predisposing to fractures. - Does not produce the specific \"Beheaded Scottish terrier sign\" which is unique to pars interarticularis defects. *Osteogenesis imperfecta* - A **genetic collagen disorder** causing brittle bones and multiple fractures. - While it causes pathological fractures, it does not specifically manifest as the \"Beheaded Scottish terrier sign\".
Question 4: Omovertebral bone is associated with?
- A. Sprengel's deformity (Correct Answer)
- B. Hemivertebra
- C. Scoliosis
- D. Cervical rib
Explanation: ***Sprengel's deformity*** - An **omovertebral bone** is the most common associated skeletal anomaly with **Sprengel's deformity**, a congenital elevation of the scapula. - This fibrous, cartilaginous, or osseous bar connects the **superior medial border of the scapula** to the **cervical spine**. *Hemivertebra* - A **hemivertebra** is a congenital malformation where only half of a vertebral body develops, leading to a **wedge-shaped vertebra**. - While it can cause spinal deformities, it is **not directly associated** with an omovertebral bone. *Scoliosis* - **Scoliosis** is a lateral curvature of the spine, which can be congenital, neuromuscular, or idiopathic. - Although it can be secondary to or co-exist with other spinal anomalies, **scoliosis itself is not directly linked** to the presence of an omovertebral bone. *Cervical rib* - A **cervical rib** is a supernumerary rib arising from the seventh cervical vertebra, which can cause symptoms of **thoracic outlet syndrome**. - It is a distinct congenital anomaly and has **no direct association** with an omovertebral bone connecting the scapula to the spine.
Question 5: A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
- A. Bohler's Angle
- B. Ferguson's Angle
- C. Cobb's Angle (Correct Answer)
- D. Pauwels' Angle
Explanation: **Cobb's Angle** - **Cobb's angle** is the primary method for measuring the severity of **scoliosis** on radiographs. - It is measured by drawing lines parallel to the superior endplate of the most tilted superior vertebra and the inferior endplate of the most tilted inferior vertebra of the curve; the angle between these two lines (or their perpendiculars) is the Cobb angle. *Bohler's Angle* - **Bohler's angle** is used in the assessment of **calcaneus fractures** and is measured on a lateral foot radiograph. - A decrease in this angle is indicative of a calcaneal fracture. *Ferguson's Angle* - **Ferguson's angle**, also known as the lumbosacral angle, measures the inclination of the sacrum relative to the horizontal in the standing position. - It is primarily used in the assessment of **spondylolisthesis** and other lumbosacral conditions. *Pauwels' Angle* - **Pauwels' angle** is used to classify **femoral neck fractures** based on the angle of the fracture line relative to the horizontal. - It helps determine the severity and stability of femoral neck fractures, guiding treatment decisions.
Question 6: Lachman's test is performed with the knee in what degree of flexion?
- A. 5
- B. 20 (Correct Answer)
- C. 70
- D. 90
Explanation: ***20*** - The **Lachman's test** is most accurately performed with the knee in **20-30 degrees of flexion** to better isolate the **anterior cruciate ligament (ACL)**. - This neutral position allows the posterior capsule and other secondary restraints to be relaxed, making an **ACL tear** more evident during anterior translation of the tibia. *5* - Positioning the knee at only **5 degrees of flexion** is not ideal, as it may keep the **posterior capsule** under too much tension, potentially masking an **ACL injury**. - This position does not adequately relax the secondary stabilizers, which can lead to a false negative result for **ACL laxity**. *70* - At **70 degrees of flexion**, the knee is too bent to effectively assess the **ACL**. - In this position, the **menisci** and other structures can block clear anterior translation, and it is more common for other knee stability tests like the **anterior drawer test** to be performed. *90* - With the knee flexed to **90 degrees**, the **anterior drawer test** is typically performed, not the Lachman's test. - In this position, the **posterior horn of the menisci** can interfere with anterior translation, making the Lachman's test less sensitive for detecting an **ACL tear**.
Question 7: Fracture of the femur in young children (2-5 years) is typically treated by:
- A. Gallow's splint
- B. Open reduction (surgical intervention)
- C. Closed reduction & splintage (Correct Answer)
- D. Intramedullary nailing (surgical fixation)
Explanation: ***Closed reduction & splintage*** - In young children (2-5 years), **femur fractures** are often treated non-operatively with **closed reduction** and immediate application of a **hip spica cast** or other splintage. - This approach takes advantage of the excellent **bone remodeling potential** in young children, allowing for good functional outcomes. *Open reduction (surgical intervention)* - **Open reduction** is generally reserved for open fractures, - It is also indicated for fractures with associated neurovascular injury, compartment syndrome, or in older children where non-operative management has failed. *Gallow's splint* - The **Gallow's splint** (also known as Bryant's traction) involves suspending both legs vertically, and is typically used for **femur fractures in infants younger than 1 year** due to the risk of vascular compromise or compartment syndrome in older or heavier children. - It is not the primary treatment for children aged 2-5 years. *Intramedullary nailing (surgical fixation)* - **Intramedullary nailing** is a surgical option, usually considered for **femur fractures in older children** (typically 6 years and above) or adolescents. - It provides stable fixation but is generally avoided in very young children due to potential damage to the **growth plates** or complications related to implant size.
Question 8: A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?
- A. Thomas test (Correct Answer)
- B. Trendelenburgs test
- C. Telescoping test
- D. Nelaton's test
Explanation: ***Thomas test*** - The **Thomas test** is specifically designed to detect a **fixed flexion deformity of the hip**, where the hip cannot fully extend. - During the test, the patient's hip is flexed to flatten the lumbar spine, and if the contralateral leg then rises off the table, it indicates a fixed flexion deformity. *Trendelenburg's test* - The **Trendelenburg's test** assesses the strength and function of the **hip abductor muscles**, primarily the gluteus medius. - A positive result indicates weakness of the abductors on the standing leg, causing the pelvis to drop on the unsupported side, which is unrelated to fixed flexion deformity. *Nelaton's test* - **Nelaton's test** is used to determine the relative position of the **greater trochanter** in relation to the **ischial tuberosity** and **anterior superior iliac spine (ASIS)**, primarily in cases of hip dislocation or fracture. - It would not specifically identify a fixed flexion deformity of the hip joint itself. *Telescoping test* - The **telescoping test** is used to evaluate for hip instability, particularly in infants with **developmental dysplasia of the hip (DDH)**. - It involves applying axial pressure to the femur while moving the hip, assessing for abnormal movement of the femoral head within the acetabulum, and does not directly detect fixed flexion deformity.
Question 9: Most common type of lesion in Pott's spine:
- A. Posterior
- B. Central
- C. Paradiscal (Correct Answer)
- D. Anterior
Explanation: ***Paradiscal*** - **Paradiscal lesions** are the most characteristic and common type of lesion in Pott's spine (approximately 50% of cases), preferentially affecting the anterior vertebral body adjacent to the intervertebral disc [1]. - This location is rich in **vascularity**, allowing Mycobacterium tuberculosis to spread more easily and cause significant destruction of the vertebral bodies and discs [1]. - Typically results in **angular kyphosis (gibbus deformity)** due to anterior vertebral collapse. *Posterior* - **Posterior lesions** affect the posterior elements of the vertebrae including the pedicles, laminae, and spinous processes. - This is the **rarest type** of tuberculous spinal involvement. - May present with neurological deficits due to posterior encroachment on the spinal canal. *Central* - A **central lesion** in Pott's spine involves primarily the vertebral body itself, without specific early involvement of the disc space or adjacent vertebrae. - This type is less common than paradiscal lesions and typically leads to **vertebra plana** (flat vertebra) or uniform **compression fracture** rather than angular kyphosis. *Anterior* - **Anterior lesions** affect the front part of the vertebral body and can lead to a wedge-shaped collapse. - While the anterior column is frequently involved, the term "anterior" is less specific than "paradiscal" in describing the most common initial location that characteristically spreads to the intervertebral disc space. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1197-1198.
Question 10: A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?
- A. Osteoporosis (Correct Answer)
- B. Spondylodiscitis
- C. Pott's spine
- D. Spondylolisthesis
Explanation: ***Osteoporosis*** - The X-ray shows diffuse **osteopenia** (reduced bone density) and **vertebral compression fractures**, particularly visible in the lateral view, which are characteristic findings in elderly patients with osteoporosis and chronic backache. - The vertebral bodies appear **demineralized** and some exhibit a loss of height, suggesting collapse due to weakened bone structure. *Spondylodiscitis* - This condition involves **inflammation of the vertebral body and adjacent intervertebral disc**, typically showing **erosions** of the vertebral endplates and **narrowing of the disc space** on X-ray, which are not clearly evident here as the primary issue. - While it can cause back pain, the dominant finding on this X-ray is widespread bone density loss and fractures, rather than localized infection-related changes. *Pott's spine* - Pott's spine (**tuberculous spondylitis**) is a form of osteomyelitis that causes **destruction of vertebral bodies** and adjacent discs, often leading to a **gibbus deformity** (sharp posterior angulation of the spine). - The X-ray does not show extensive vertebral destruction, paraspinal abscess formation, or typical kyphotic deformity associated with Pott's spine. *Spondylolisthesis* - Spondylolisthesis is characterized by the **forward slippage of one vertebral body over another**, often due to a defect in the pars interarticularis. - While there may be some degenerative changes, there is no clear evidence of significant anterior translation of a vertebral body on the lateral X-ray that would indicate spondylolisthesis.
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