Spine Disorders Practice Questions

Q: What is the most common cause of endplate destruction with reduction of the intervertebral disc space on X-ray?

Tuberculosis. **Explanation:** The hallmark of **Infective Spondylodiscitis**, most commonly caused by **Tuberculosis (Pott’s Spine)**, is the destruction of the intervertebral disc space. In TB spine, the infection typically starts in the paradiscal area of the vertebral body. Because the disc receives its nutrition via diffusion through the vertebral endplates, the infection easily crosses the disc space to involve the adjacent vertebra. Proteolytic enzymes (in pyogenic) or the slow destruction of endplates (in TB) lead to **narrowing of the disc space** and subsequent **endplate erosion**. **Analysis of Incorrect Options:** * **Metastasis (D) & Lymphoma (A):** These are malignancies. Malignant cells typically spread via the Batson’s venous plexus to the vertebral body. Crucially, tumor cells do not cross the fibrocartilage of the intervertebral disc. Therefore, in malignancy, the **disc space is characteristically preserved**, which is a key radiological differentiator from infection. * **Eosinophilic Granuloma (C):** This typically causes "Vertebra Plana" (Calvé disease), where there is a uniform collapse of a single vertebral body (pancake vertebra) while the disc spaces above and below remain completely normal. **NEET-PG High-Yield Pearls:** * **Earliest sign of TB Spine on X-ray:** Rarefaction/blurring of the paradiscal vertebral margins. * **Most common site for TB Spine:** Thoracolumbar junction (D12-L1). * **Cold Abscess:** A hallmark of TB spine; it lacks the typical signs of inflammation (heat/redness). * **Rule of Thumb:** If the disc space is **reduced**, think **Infection** (TB/Pyogenic). If the disc space is **preserved**, think **Malignancy** (Metastasis/Myeloma).

Q: What condition is the given test used for?

Prolapsed intervertebral disc. ***Prolapsed intervertebral disc*** - The **Straight Leg Raise (SLR)** or **Lasègue's test** shown in the image is specifically designed to detect **lumbar disc herniation** by stretching the **sciatic nerve**. - A positive test occurs when leg elevation between **30-70 degrees** reproduces **radicular pain** down the leg, indicating **nerve root compression** from disc prolapse. *Ankle injury* - Ankle injuries are assessed using tests like the **anterior drawer test** or **talar tilt test**, which involve manipulating the ankle joint directly. - The SLR test does not evaluate **ankle ligaments** or **joint stability** and would not be relevant for ankle pathology. *Hip injury* - Hip pathology is evaluated using tests like **FABER test**, **Thomas test**, or **Trendelenburg test** that assess hip joint mobility and stability. - The straight leg position in SLR does not stress the **hip joint** or reproduce typical hip pain patterns. *None of the above* - This option is incorrect as the **SLR test** is a well-established orthopedic examination specifically for **lumbar radiculopathy**. - The test has high sensitivity for detecting **L4-L5** and **L5-S1** disc herniations when positive.

Q: The Hong Kong operation is performed for which condition?

Tuberculosis of the spine. **Explanation:** The **Hong Kong operation** is a landmark surgical procedure specifically designed for the management of **Tuberculosis of the spine (Pott’s disease)**. **Why Option A is correct:** Developed by Hodgson and Stock in 1956, the Hong Kong operation involves a **radical anterior debridement** of the necrotic bone and tuberculous debris, followed by an **anterior interbody fusion** using an autologous bone graft (usually from the rib or iliac crest). The rationale is that since TB spine primarily affects the anterior column (vertebral bodies), an anterior approach allows direct access to the lesion, ensures complete clearance of the cold abscess, and provides better stability through grafting, leading to faster healing and prevention of kyphosis. **Why other options are incorrect:** * **Options B & C:** While Tuberculosis of the hip and knee are common extra-axial sites, they are managed via joint-specific procedures like Girdlestone arthroplasty (for hip) or arthrodesis/synovectomy. The term "Hong Kong operation" is strictly reserved for spinal intervention. * **Option D:** Chronic osteomyelitis of long bones typically requires sequestrectomy and saucerization, not the specific radical anterior approach and fusion defined by the Hong Kong technique. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The Hong Kong operation remains the classic surgical reference for Pott’s spine with neurological deficit or progressive kyphosis. * **Approach:** It is an **Anterior Approach** (Transthoracic, Retroperitoneal, or Transperitoneal depending on the level). * **Indication:** Indicated when there is a poor response to AKT, persistent neurological deficit, or severe spinal instability. * **Most common site of TB Spine:** Lower Thoracic and Upper Lumbar vertebrae.

Q: Which of the following is NOT a clinical sign of Pott's spine?

Loss of deep tendon reflexes. Pott’s spine (Tuberculous Spondylitis) is a chronic granulomatous infection that primarily affects the vertebral bodies [1]. The correct answer is **Loss of deep tendon reflexes** because Pott’s spine typically results in an **Upper Motor Neuron (UMN)** type of paralysis (Pott’s paraplegia) rather than a Lower Motor Neuron (LMN) lesion. 1. **Why "Loss of deep tendon reflexes" is the correct answer:** In Pott’s spine, spinal cord compression occurs due to abscess, granulation tissue, or bony sequestration. Since the compression usually occurs at the thoracic or cervical levels (above the level of the conus medullaris), it results in **spastic paralysis**. This is characterized by **exaggerated (brisk) deep tendon reflexes** and an extensor plantar response (Babinski sign), not a loss of reflexes. 2. **Analysis of Incorrect Options:** * **Tenderness:** This is the most common early clinical sign. Localized "cold" tenderness over the affected spinous processes is a hallmark of the disease [1]. * **Sensory loss:** As the disease progresses and causes cord compression, patients often experience sensory deficits (hypoesthesia or anesthesia) below the level of the lesion [2]. * **Paravertebral muscle spasm:** This is a protective mechanism where the body attempts to splint the painful, infected segment, leading to restricted spinal movements and a characteristic "stiff" gait [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Lower Thoracic and Upper Lumbar vertebrae. * **Earliest radiological sign:** Reduction/narrowing of the intervertebral disc space [2]. * **Paradoxical Breathing:** Seen in cervical Pott's spine due to phrenic nerve involvement. * **Deformity:** Kyphosis (Gibbus) is common due to anterior wedging of collapsed vertebrae [2]. * **Cold Abscess:** A collection of caseous material that lacks the classic signs of inflammation (heat/redness) [2].

Q: A 62-year-old man presents to the emergency department with severe pain in his lower back, left buttock, and the posterolateral aspect of his left leg. The pain began acutely after he lifted his 8-year-old granddaughter into the back of a truck, and he describes it as "shooting" in nature. He is curled into a fetal position, which he states relieves the pain. Attempts to extend the man's spine markedly exacerbate the pain. Further examination reveals foot drop with weakness of the anterior tibial, posterior tibial, and peroneal muscles. Sensory loss is demonstrated over the anterior shin and dorsal foot. These findings suggest a radiculopathy at which of the following cord levels?

L5. ### Explanation **1. Why L5 is Correct:** The patient presents with classic signs of **L5 radiculopathy**, most commonly caused by a posterolateral disc herniation at the **L4-L5 level**. The clinical findings are diagnostic: * **Motor Deficit:** The L5 nerve root supplies the **tibialis anterior** (dorsiflexion), **tibialis posterior** (inversion), and **peroneal muscles** (eversion). Weakness in these leads to **foot drop**. * **Sensory Deficit:** The L5 dermatome covers the **anterolateral leg (shin)** and the **dorsum of the foot**, including the first web space. * **Clinical Presentation:** The "shooting" pain (sciatica) and relief in the fetal position (flexion opens the neural foramina) are characteristic of nerve root compression. **2. Why Other Options are Incorrect:** * **A (C7):** This is a cervical nerve root. Compression would cause pain radiating down the arm to the middle finger, weakness in triceps/wrist extensors, and loss of the triceps reflex. * **C (S3):** S3 involvement typically presents with "saddle anesthesia" and bladder/bowel dysfunction (part of Cauda Equina Syndrome), rather than isolated foot drop. * **D (T9):** Thoracic radiculopathy causes band-like pain around the mid-abdomen/umbilicus and does not affect lower limb motor function. **3. NEET-PG High-Yield Pearls:** * **L4 Root:** Weakness in Quadriceps, diminished **Knee jerk** reflex, sensory loss over medial malleolus. * **L5 Root:** Weakness in **Extensor Hallucis Longus (EHL)** and foot dorsiflexion. **No specific reflex** is associated with L5. * **S1 Root:** Weakness in plantar flexion (Gastrocnemius), diminished **Ankle jerk** reflex, sensory loss over the lateral border of the foot. * **Rule of Thumb:** A disc herniation usually affects the **traversing** (lower) root. For example, an L4-L5 disc prolapse affects the L5 nerve root.

Q: All of the following are red flag signs of back pain except?

Age between 35-50 years. **Explanation:** In clinical orthopaedics, **"Red Flags"** are specific clinical indicators that suggest back pain may be caused by a serious underlying pathology (such as malignancy, infection, or cauda equina syndrome) rather than simple mechanical strain. **Why Option D is the Correct Answer:** Age between **35–50 years** is considered the "safe zone" for mechanical back pain. Red flags regarding age typically include patients **younger than 20 years** (suggesting congenital issues or spondylolisthesis) or **older than 50–55 years** (suggesting malignancy or osteoporotic fractures). Therefore, being in the 35–50 age bracket is not a red flag. **Analysis of Incorrect Options (Red Flags):** * **A. Previous history of malignancy:** This is a major red flag for **spinal metastasis**, especially if the pain is non-mechanical (worse at rest/night). * **B. Previous history of steroid use:** Long-term corticosteroid use leads to secondary osteoporosis, significantly increasing the risk of **vertebral compression fractures**, even with minimal trauma. * **C. Saddle anaesthesia:** This refers to sensory loss in the perineal region and is a pathognomonic sign of **Cauda Equina Syndrome**, a surgical emergency. **Clinical Pearls for NEET-PG:** * **TUNA FISH Mnemonic for Red Flags:** **T**rauma, **U**nexplained weight loss, **N**eurological deficits, **A**ge (>50 or <20), **F**ever, **I**ntravenous drug use, **S**teroid use, **H**istory of cancer. * **Night Pain:** Pain that prevents sleep is a classic indicator of spinal tumors or infections (like Pott’s disease). * **Bladder/Bowel Dysfunction:** Urinary retention or fecal incontinence in a back pain patient requires immediate MRI to rule out cord compression.

Q: What is ozonolysis used for?

Disc bulge. **Explanation:** **Ozonolysis** (also known as **Ozone Discectomy** or **Ozonucleolysis**) is a minimally invasive percutaneous procedure used primarily for the management of symptomatic **contained lumbar disc herniations (Disc Bulge)** that have failed conservative treatment. **Why it is correct:** The procedure involves injecting a medical ozone-oxygen ($O_3/O_2$) mixture directly into the nucleus pulposus. Ozone causes the oxidation of proteoglycans (glycosaminoglycans) within the disc, leading to the release of water and subsequent dehydration of the nucleus. This reduces the intradiscal pressure, causes the disc bulge to shrink, and alleviates mechanical compression on the nerve roots. Additionally, ozone has anti-inflammatory properties, inhibiting pro-inflammatory cytokines and prostaglandins. **Why other options are incorrect:** * **Early Meniscal Tear/Cyst:** These are intra-articular pathologies of the knee. Management typically involves conservative therapy or arthroscopic repair/debridement. Ozone is not a standard treatment for structural meniscal lesions. * **Sequestered Disc:** This refers to a "free fragment" where the disc material has lost continuity with the parent disc. Ozonolysis is ineffective here because the ozone cannot be contained within the disc space to reduce pressure, and it cannot "dissolve" a detached fragment outside the annulus. **High-Yield Facts for NEET-PG:** * **Indication:** Best for contained disc herniation (bulge/protrusion) with radiculopathy. * **Contraindication:** Sequestered disc, calcified disc, or significant neurological deficit (cauda equina syndrome). * **Mechanism:** Proteoglycan degradation $\rightarrow$ Disc shrinkage $\rightarrow$ Decompression. * **Advantage:** Outpatient procedure, no "failed back surgery syndrome," and minimal complications compared to open discectomy.

Question 1

What is the most common cause of endplate destruction with reduction of the intervertebral disc space on X-ray?

Accepted Answer

Tuberculosis

Answer

Lymphoma

Answer

Eosinophilic granuloma

Answer

Metastasis

Question 2

What condition is the given test used for?

Accepted Answer

Prolapsed intervertebral disc

Answer

Ankle injury

Answer

Hip injury

Answer

None of the above

Question 3

A 23-year-old woman presents with back pain. Radiographic examination reveals a condition affecting her vertebral column. Her history includes polio and muscular dystrophy. Which of the following vertebral column conditions is most likely present in this patient?

Accepted Answer

Scoliosis

Answer

Lordosis

Answer

Kyphosis

Answer

Spina bifida

Question 4

The Hong Kong operation is performed for which condition?

Accepted Answer

Tuberculosis of the spine

Answer

Tuberculosis of the hip

Answer

Tuberculosis of the knee

Answer

Chronic osteomyelitis

Question 5

What is the most common site of ossification of the posterior longitudinal ligament (OPLL)?

Accepted Answer

Cervical spine

Answer

Thoracic spine

Answer

Lumbar spine

Answer

Sacrum

Question 6

Which of the following is NOT a clinical sign of Pott's spine?

Accepted Answer

Loss of deep tendon reflexes

Answer

Tenderness

Answer

Sensory loss

Answer

Paravertebral muscle spasm

Question 7

Which statement is true regarding Hangman's fracture?

Accepted Answer

Union almost always occurs

Answer

High post-admission mortality

Answer

Most common axis fracture

Answer

Surgical treatment is necessary

Question 8

A 62-year-old man presents to the emergency department with severe pain in his lower back, left buttock, and the posterolateral aspect of his left leg. The pain began acutely after he lifted his 8-year-old granddaughter into the back of a truck, and he describes it as "shooting" in nature. He is curled into a fetal position, which he states relieves the pain. Attempts to extend the man's spine markedly exacerbate the pain. Further examination reveals foot drop with weakness of the anterior tibial, posterior tibial, and peroneal muscles. Sensory loss is demonstrated over the anterior shin and dorsal foot. These findings suggest a radiculopathy at which of the following cord levels?

Accepted Answer

L5

Answer

C7

Answer

S3

Answer

T9

Question 9

All of the following are red flag signs of back pain except?

Accepted Answer

Age between 35-50 years

Answer

Previous history of malignancy

Answer

Previous history of steroid use

Answer

Saddle anaesthesia

Question 10

What is ozonolysis used for?

Accepted Answer

Disc bulge

Answer

Early meniscal tear

Answer

Early meniscal cyst

Answer

Sequestered disc

Spine Disorders — MCQs

Spine Disorders — MCQs

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