Spine Disorders Practice Questions

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: Which of the following is NOT true about ankylosing spondylitis?

90% of patients are HLA-B27 positive.. Ankylosing Spondylitis (AS) is a chronic inflammatory seronegative spondyloarthropathy primarily affecting the axial skeleton. **Explanation of the Correct Answer:** Option **C** is the incorrect statement (and thus the correct answer) because while there is a strong association between HLA-B27 and AS, the prevalence varies by ethnicity. In the Indian population and globally, approximately **90-95% of patients** with AS carry the HLA-B27 gene; however, the presence of the gene is **not diagnostic** on its own, as only 5% of HLA-B27 positive individuals actually develop the disease. In the context of NEET-PG, the "90%" figure is often used as a distractor because while true for the patient population, the diagnosis is primarily clinical and radiological (Modified New York Criteria). **Analysis of Other Options:** * **A. Gender:** AS shows a strong male predilection, traditionally cited as a **3:1 male-to-female ratio**. * **B. Age of Onset:** It typically presents in young adults, usually **late teens to the 3rd decade (20-30 years)**. Presentation after age 40 is rare. * **D. Bamboo Spine:** This is a classic late-stage radiographic finding caused by **syndesmophytes** (marginal ossification of the annulus fibrosus) and diffuse paraspinal ligamentous calcification, giving the spine a fused, rigid appearance. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Symmetrical **Sacroiliitis** (best seen on MRI as bone marrow edema). * **Schober’s Test:** Used to clinically assess restricted lumbar flexion. * **Extra-articular manifestation:** **Acute Anterior Uveitis** is the most common. * **Radiology:** Look for "Dagger sign" (ossification of supraspinous/interspinous ligaments) and "Romanus lesions" (shiny corners of vertebrae). * **Treatment:** NSAIDs are the first-line; TNF-alpha inhibitors (e.g., Etanercept) are used for refractory cases.

Q: What is the first sign of tuberculosis of the spine?

Narrowing of intervertebral space. **Explanation:** **1. Why the correct answer is right:** In Tuberculosis of the spine (Pott’s disease), the infection typically begins in the **paradiscal region** (the area of the vertebral body adjacent to the disc). The tubercle bacilli reach this area via the arterial supply. The infection then spreads across the disc space to the adjacent vertebra. The **narrowing of the intervertebral disc space** is the earliest radiological sign because the disc is deprived of its nutrition (which it receives via diffusion from the vertebral endplates) and is subsequently destroyed by the proteolytic enzymes released during the inflammatory process. This loss of disc height often precedes visible bone destruction on a plain X-ray. **2. Why the incorrect options are wrong:** * **B. Rarefaction of vertebral bodies:** While rarefaction (demineralization/osteopenia) occurs as the disease progresses due to hyperemia and bone destruction, it is a secondary feature that follows the initial disc space narrowing. * **C. Destruction of laminae:** TB spine primarily involves the anterior column (vertebral bodies). Involvement of the posterior elements (laminae, pedicles, spines) is rare and occurs much later in the disease course. * **D. Fusion of spinous processes:** This is not a sign of active TB. In the healing phase, bony ankylosis may occur, but it typically involves the vertebral bodies, not the spinous processes. **Clinical Pearls for NEET-PG:** * **Most common site:** Thoracolumbar junction (D12-L1). * **Earliest symptom:** Back pain and stiffness (protective muscle spasm). * **Earliest radiological sign:** Narrowing of the disc space. * **Cold Abscess:** A hallmark of TB spine; it is "cold" because it lacks the classic signs of acute inflammation (heat, redness). * **Pott’s Paraplegia:** The most serious complication; the earliest sign is the loss of vibration sense.

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 may cause metastatic tumors causing spinal cord compression except?

Meningioma. **Explanation:** The core concept here is the distinction between **metastatic (secondary)** tumors and **primary** tumors of the spine. **Why Meningioma is the correct answer:** A **Meningioma** is a **primary, typically benign tumor** arising from the arachnoid cap cells of the meninges. While it is a common cause of spinal cord compression (specifically in the intradural-extramedullary compartment), it is **not a metastatic tumor**. It originates within the spinal canal rather than spreading there from a distant primary organ. **Why the other options are incorrect:** Metastatic disease is the most common malignancy of the spine. The most frequent primary sources that metastasize to the spinal column (causing epidural cord compression) include: * **Lung Carcinoma (Option A):** The most common source of spinal metastases in men. * **Breast Carcinoma (Option B):** The most common source of spinal metastases in women. * **Lymphoma (Option C):** A common systemic malignancy that can involve the vertebral column or the epidural space, leading to cord compression. * *Other common sources include Prostate, Kidney (RCC), and Thyroid (mnemonic: "Lead Kettle" - PB-KTL).* **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of spinal metastasis:** Thoracic spine (~70%), followed by the lumbar spine. * **Compartment check:** Meningiomas and Schwannomas are the most common **Intradural-Extramedullary** tumors. * **Red Flag:** New-onset back pain in an elderly patient with a history of weight loss or smoking should always be investigated for spinal metastasis. * **Investigation of Choice:** MRI is the gold standard for diagnosing spinal cord compression.

Question 1

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 2

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 3

A 17-year-old boy presents with chronic low back pain and stiffness for the past 8 months. He denies any gastrointestinal or genital infections. His temperature is 98.6 F. Laboratory investigations show normal ESR and negative RA factor. X-ray films of the vertebral column show flattening of the lumbar curve and subchondral bone erosion involving the sacroiliac joints. What is the most likely diagnosis?

Accepted Answer

Ankylosing spondylitis

Answer

Degenerative joint disease

Answer

Reiter syndrome

Answer

Seronegative rheumatoid arthritis

Question 4

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 5

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 6

Which of the following is NOT true about ankylosing spondylitis?

Accepted Answer

90% of patients are HLA-B27 positive.

Answer

Affects males more commonly than females.

Answer

Typically presents in the 30-40 year age group.

Answer

Radiographic findings may include a 'bamboo spine'.

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

What is the first sign of tuberculosis of the spine?

Accepted Answer

Narrowing of intervertebral space

Answer

Rarefaction of vertebral bodies

Answer

Destruction of laminae

Answer

Fusion of spinous processes

Question 9

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 10

All of the following may cause metastatic tumors causing spinal cord compression except?

Accepted Answer

Meningioma

Answer

Lung carcinoma

Answer

Breast carcinoma

Answer

Lymphoma

Spine Disorders — MCQs

Spine Disorders — MCQs

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