Lumbar Spine Disorders — MCQs

10 questions

During a routine physical examination a 65-year-old male patient is tested for ease and flexibility of the movements of his lumbar region. Which of the following movements is most characteristic of the intervertebral joints in the lumbar region?

Which of the following movements is least permitted in the lumbar region of the vertebral column?

The clinical manifestations of cauda equina lesion include the following EXCEPT:

What type of neurological signs would you expect from a lesion in the cauda equina?

A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?

Scotty dog sign is seen in:

Tuberculosis of the spine commonly affects all of the following parts of the vertebra except:

Undertaker's fracture is seen at the level of cervical vertebra:

Pott's spine is most common at which specific region of the spine?

Q10

Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?

Lumbar Spine Disorders Indian Medical PG Practice Questions and MCQs

Question 1: During a routine physical examination a 65-year-old male patient is tested for ease and flexibility of the movements of his lumbar region. Which of the following movements is most characteristic of the intervertebral joints in the lumbar region?

A. Rotation
B. Circumduction
C. Lateral flexion (Correct Answer)
D. Extension

Explanation: ***Lateral flexion*** - **Lateral flexion** (side bending) is the most characteristic movement of the lumbar spine among the given options. - This movement is primarily facilitated by the **frontal plane orientation of the facet joints** in the lumbar region. - The lumbar spine allows approximately **20-30 degrees of lateral flexion** to each side. - The structure of the intervertebral discs and facet joint orientation in the lumbar region particularly favor this movement. *Rotation* - **Rotation** is the LEAST characteristic movement of the lumbar spine. - The lumbar facet joints are oriented in the **sagittal plane**, which significantly **restricts rotational movement**. - The lumbar spine allows only about **5 degrees of rotation**, much less than the thoracic or cervical regions. - Most trunk rotation actually occurs at the thoracic spine, not the lumbar region. *Circumduction* - **Circumduction** is a combined, sequential movement (flexion → lateral flexion → extension → lateral flexion) typically seen in ball-and-socket joints. - While the spine can perform these individual movements, circumduction is not considered a characteristic or distinct movement of intervertebral joints. - This term is more applicable to joints like the shoulder and hip. *Extension* - **Extension** (backward bending) is certainly possible and important in the lumbar spine. - However, it is not the MOST characteristic movement—the lumbar spine allows approximately **20-25 degrees of extension**. [1] - Flexion (forward bending, 40-60 degrees) and lateral flexion are more prominent movements in the lumbar region during functional activities.

Question 2: Which of the following movements is least permitted in the lumbar region of the vertebral column?

A. Flexion
B. Extension
C. Lateral flexion
D. Rotation (Correct Answer)

Explanation: ***Rotation*** - The **lumbar spine permits the LEAST rotation** of all movements (~5° total rotation), making this the correct answer. - The PRIMARY limiting factor is the **sagittal (near-vertical) orientation of the lumbar facet joints**, which are oriented in the coronal plane and face medially/laterally. - This facet orientation creates a **mechanical block to rotational movement**, acting like interlocking barriers. - The thick **intervertebral discs** in the lumbar region also resist torsional forces, further limiting rotation. *Flexion* - The lumbar region permits **excellent flexion** (forward bending), with approximately 50-60° of range. - The **large, wedge-shaped intervertebral discs** allow substantial anterior compression and movement. - This is one of the primary movements of the lumbar spine. *Extension* - **Extension** (backward bending) is moderately permitted in the lumbar spine, with approximately 15-20° of range. - Eventually limited by contact between **spinous processes** and the posterior ligamentous structures. - Still considerably more movement than rotation. *Lateral flexion* - **Lateral flexion** (sideways bending) is well permitted, with approximately 20° of movement to each side. - The structure of the vertebral bodies and **compressible intervertebral discs** allows good range of motion in the coronal plane. - Significantly more mobile than rotation.

Question 3: The clinical manifestations of cauda equina lesion include the following EXCEPT:

A. Saddle anesthesia
B. Radicular pain
C. Urinary retention
D. Extensor plantar reflexes (Correct Answer)

Explanation: ***Extensor plantar reflexes*** - Extensor plantar reflexes (Babinski sign) are indicative of an **upper motor neuron lesion**, typically affecting the **corticospinal tract**, not the cauda equina [4]. - The cauda equina comprises **lower motor neurons**; therefore, a lesion here would more likely result in absent or diminished deep tendon reflexes, and a flexor plantar response or no response [4]. *Saddle anesthesia* - This is a classic symptom of cauda equina syndrome, involving numbness or sensory loss in the **perineal and gluteal regions** due to compression of sacral nerve roots. - It results from damage to the **sensory fibers** of the cauda equina innervating these areas [1]. *Radicular pain* - Cauda equina syndrome often causes severe **low back pain** radiating down the legs, similar to sciatica, due to compression or irritation of the **nerve roots** [1]. - This pain can be bilateral and is a significant symptom, reflecting the involvement of multiple nerve roots [3]. *Urinary retention* - **Bladder dysfunction**, particularly urinary retention, is a critical red flag for cauda equina syndrome, caused by damage to the **sacral nerve roots** responsible for bladder control [2], [3]. - It signifies significant neurological compromise affecting **autonomic function** [2].

Question 4: What type of neurological signs would you expect from a lesion in the cauda equina?

A. Normal reflexes
B. Flaccid paralysis
C. Muscle atrophy
D. Lower motor neuron signs (Correct Answer)

Explanation: ***Lower motor neuron signs*** - A lesion in the **cauda equina** affects the spinal nerve roots after they've left the spinal cord, which are part of the **peripheral nervous system**. [2] - Therefore, it presents with classic features of **lower motor neuron (LMN) damage**, including muscle weakness, absent or reduced reflexes, and flaccid paralysis. [1] *Normal reflexes* - This would be an unexpected finding; **hyporeflexia or areflexia** are typical due to damage to the reflex arc within the LMN fibers. [1] - **Normal reflexes** often suggest an intact LMN pathway, which is not the case with cauda equina compression. *Flaccid paralysis* - While **flaccid paralysis** is indeed a sign of lower motor neuron damage and occurs with cauda equina lesions, it is a specific symptom rather than the encompassing neurological category. [1] - **Lower motor neuron signs** is a broader and more accurate description of the overall clinical picture. *Muscle atrophy* - **Muscle atrophy** is a chronic sign of lower motor neuron damage due to denervation, and while it will develop over time with a cauda equina lesion, it is usually not an initial acute finding. [1] - The question asks for expected neurological signs, and a more immediate and overarching description is **Lower motor neuron signs**.

Question 5: 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.

Question 6: Scotty dog sign is seen in:

A. Spondylolysis (Correct Answer)
B. Fracture femur
C. Sarcoidosis
D. Osteosarcoma

Explanation: ***Spondylolysis*** - The **Scotty dog sign** is a classic radiographic finding on an **oblique lumbar spine X-ray** indicating a defect in the pars interarticularis. - This defect, known as **spondylolysis**, causes the "neck" of the Scotty dog to appear broken or wearing a collar. *Fracture femur* - **Femur fractures** are typically identified by discontinuity of the cortical bone and soft tissue swelling, often visualized on **AP and lateral views of the thigh/hip**. - No specific "Scotty dog" appearance is associated with femur fractures, as this sign relates to the **lumbar spine**. *Sarcoidosis* - **Sarcoidosis** is a multi-system inflammatory disease primarily affecting the lungs and lymph nodes, with characteristic **non-caseating granulomas**. - Radiological findings typically include **hilar lymphadenopathy** and pulmonary infiltrates, not a bony defect like the Scotty dog sign. *Osteosarcoma* - **Osteosarcoma** is a primary malignant bone tumor often presenting with a **sunburst pattern** or **Codman triangle** on X-ray. - It primarily affects the metaphysis of long bones and does not produce the specific bony defect seen in the pars interarticularis.

Question 7: Tuberculosis of the spine commonly affects all of the following parts of the vertebra except:

A. Lamina
B. Body
C. Spinous process (Correct Answer)
D. Pedicle

Explanation: ***Spinous process*** - **Tuberculosis of the spine (Pott's disease)** typically affects the anterior columns of the vertebrae, primarily the vertebral bodies, due to their rich vascular supply. - The **spinous process** (posterior element) is rarely involved in tuberculosis because it has a relatively poor blood supply compared to the vertebral body. *Lamina* - The **lamina**, part of the vertebral arch (posterior element), is also less commonly affected by tuberculous spondylitis compared to the vertebral body. - While possible in advanced or disseminated disease, initial involvement is usually anterior. *Body* - The **vertebral body** is the most commonly affected part of the vertebra in tuberculosis of the spine. - This is due to its abundant blood supply, allowing for easy hematogenous spread of the *Mycobacterium tuberculosis* bacteria. *Pedicle* - The **pedicle** connects the vertebral body to the lamina and is considered an anterior element, albeit less frequently involved than the vertebral body itself. - Involvement of the pedicle tends to occur via direct extension from an affected vertebral body or disk space.

Question 8: Undertaker's fracture is seen at the level of cervical vertebra:

A. C5-C6
B. C6-C7 (Correct Answer)
C. C3-C4
D. C1-C2

Explanation: **C6-C7** - An **undertaker's fracture** is a post-mortem injury typically seen in cases of hanging, resulting from the neck's hyperextension. - It commonly affects the lower cervical spine, most frequently at the **C6-C7 level**, due to the biomechanics of the forces involved. *C5-C6* - While cervical fractures can occur at various levels, **C5-C6** is less common for an undertaker's fracture specifically. - This level is more frequently associated with **cervical spondylosis** or traumatic injuries from falls. *C3-C4* - Fractures at the **C3-C4 level** can be life-threatening as they are close to the phrenic nerve origin, but they are not characteristic of "undertaker's fracture." - Injuries at this level are less common in the specific context of post-mortem hyperextension. *C1-C2* - Fractures of **C1 (atlas) and C2 (axis)**, such as a Jefferson fracture or hangman's fracture, are distinct and result from different mechanisms. - They are not typically referred to as "undertaker's fracture," which implies a specific post-mortem injury pattern.

Question 9: Pott's spine is most common at which specific region of the spine?

A. Sacral
B. Cervical
C. Lumbosacral
D. Thoracolumbar (T12-L1) (Correct Answer)

Explanation: **Thoracolumbar (T12-L1)** - The **thoracolumbar junction (T12-L1)** is the most common site for Pott's spine due to its biomechanical stress and vascular supply, making it a frequent location for spinal tuberculosis. - This region is susceptible to **compression fractures** and bone destruction, leading to kyphotic deformity (gibbus) in advanced cases. *Sacral* - While spinal tuberculosis can affect any part of the spine, the **sacral region** is considerably less common than the thoracolumbar junction. - Infections in the sacrum are often associated with other pelvic involvement or direct extension from adjacent sites. *Cervical* - Tuberculosis of the **cervical spine** can occur but is not as frequent as in the thoracolumbar region. - Clinical manifestations can include **neck stiffness, dysphagia**, and neurological deficits affecting the upper limbs. *Lumbosacral* - The **lumbosacral region** (L5-S1) can be affected by Pott's spine, but it is less common than the thoracolumbar junction. - Involvement here can lead to specific neurological symptoms like **foot drop** or radicular pain in the lower extremities.

Question 10: Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?

A. Five
B. Four
C. Three
D. Two (Correct Answer)

Explanation: ***Two*** - The Holdsworth classification system, developed in 1963, simplifies the spine into two principal columns: the **anterior column** and the posterior column. - This system primarily focuses on the **stability** of the fracture based on the integrity of these two columns, particularly the posterior ligamentous complex. *Three* - The **Denis classification** system, a more widely used and detailed system, divides the spine into **three columns**: anterior, middle, and posterior. - This three-column model provides a more nuanced understanding of fracture stability and neurological compromise. *Four* - While other, more complex classification systems exist for spinal fractures, none are based on exactly four columns. - The concept of four columns is not a recognized standard in spinal fracture classification. *Five* - There is no established spinal fracture classification system that utilizes five columns to describe the injury pattern. - Such a classification would be overly complex and not clinically practical for rapid assessment.

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