Spine Disorders Practice Questions

Q: A 40-year-old male sustains spinal injury after an accident. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is:

Central cord syndrome. ***Central cord syndrome*** - This syndrome is characterized by **greater motor weakness** in the **upper extremities** than in the lower extremities, along with varying degrees of sensory loss. **Sacral sparing** (preserved perineal sensation and voluntary anal contraction) is also a classic feature. - It often results from **hyperextension injuries** of the cervical spine, leading to damage predominantly in the central gray matter and surrounding white matter. *Complete spinal cord injury* - This involves a total loss of **motor and sensory function** below the level of the injury, including the sacral segments. - The presence of **sacral sensations** in the patient rules out a complete spinal cord injury. *Posterior cord syndrome* - This syndrome affects the **dorsal columns**, resulting in a loss of **proprioception**, **vibration sense**, and **fine touch** below the level of injury. - Motor function and pain/temperature sensation are typically preserved, which does not match the described motor weakness. *Anterior cord syndrome* - This involves damage to the **anterior two-thirds of the spinal cord**, leading to a loss of **motor function** (corticospinal tracts) and **pain and temperature sensation** (spinothalamic tracts) below the injury. - However, **proprioception** and **vibration sense** (dorsal columns) are typically preserved, and sacral sparing of sensation is not a characteristic feature, nor is greater lower limb power. [1]

Q: Subluxation of atlanto-axial joint is seen in all except:

Gout. ***Gout*** - **Atlanto-axial subluxation** is generally not a recognized complication of gout. - Gout primarily affects **peripheral joints** due to uric acid crystal deposition, rarely causing spinal instability. *Odontoid dysgenesis* - This condition involves a developmental abnormality of the **odontoid process**, which can lead to instability and **atlanto-axial subluxation**. - A malformed or hypoplastic odontoid is inherently less stable, increasing the risk of C1-C2 displacement. *Ankylosing spondylitis* - **Atlanto-axial subluxation** can occur in advanced stages, particularly due to inflammatory changes affecting ligaments and joints of the cervical spine. - While predominantly affecting the thoracolumbar spine and sacroiliac joints, cervical involvement can lead to instability. *Rheumatoid arthritis* - **Atlanto-axial subluxation** is a well-known and serious complication, often caused by inflammation and erosion of the transverse ligament and articular facets. - Chronic synovitis * weakens the supporting structures, leading to C1-C2 instability and potential neurological compromise.

Q: The most common site of involvement of spinal TB in children is at which of the following level?

Lower thoracic vertebra. ***Lower thoracic vertebra*** - The **lower thoracic spine (T8–T12)** is the most common site for spinal tuberculosis (Pott's disease) in children and adults due to its high vascularity and mechanical stress. - Involvement at this level often leads to severe **kyphosis** and neurological deficits like **paraplegia** as the disease progresses. *Cervical vertebra* - While cervical spinal TB can occur, it is relatively **less common** than thoracic involvement. - Lesions here are more likely to cause **neurological symptoms** with upper limb involvement or respiratory compromise due to phrenic nerve irritation. *Upper thoracic vertebra* - Involvement of the upper thoracic spine is **less frequent** compared to the lower thoracic segments. - Though possible, the upper thoracic region is not considered the **predominant site** for initial lesion development. *Mid thoracic vertebra* - The mid-thoracic region (e.g., T4-T7) is less frequently affected by spinal TB compared to the **thoracolumbar junction** or lower thoracic area. - This area has a relatively **stable mechanical load** compared to the junctional segments.

Q: Most common site of extrapulmonary TB -

Spine. ***Spine*** - The **spine**, particularly the **thoracic and lumbar regions**, is the most frequent site for **extrapulmonary tuberculosis (TB)**, known as Pott's disease. - This form of TB can cause **vertebral collapse**, kyphosis, and neurological deficits due to spinal cord compression. *Shoulder* - While TB can affect almost any joint, the **shoulder** is a less common site for extrapulmonary TB compared to the spine. - TB arthritis of the shoulder typically presents with **monoarticular pain** and swelling, often with limited range of motion. *Knee* - **Tuberculosis of the knee joint** is relatively uncommon but can occur, usually presenting as **monoarticular arthritis**. - It often leads to **chronic pain**, swelling, and functional limitation, which can be difficult to diagnose without specific investigations. *Hip* - **Hip joint involvement** in extrapulmonary TB is also less common than spinal involvement but more frequent than shoulder or knee involvement. - TB of the hip can cause **pain**, limping, and restricted movement, often mimicking other forms of arthritis.

Q: True regarding Hangman's fracture is:

Bilateral fractures of pars interarticularis of C2. ***Bilateral fractures of pars interarticularis of C2*** - A **Hangman's fracture** specifically refers to a **traumatic spondylolysis** of the C2 vertebral body, involving bilateral fractures through the **pars interarticularis** or pedicles of the axis. - This injury is typically caused by a forceful **hyperextension-distraction** mechanism, often associated with rapid deceleration trauma. *Whiplash injury* - A **whiplash injury** is a general term for a range of neck injuries caused by sudden, forceful back-and-forth movement of the head. - While it can result in various soft tissue damage and ligamentous injuries, it is not a specific fracture type like a Hangman's fracture. *Odontoid process fracture of C2* - An **odontoid fracture** involves the **dens**, a superior projection from the C2 vertebral body, and is distinct from a Hangman's fracture. - Odontoid fractures are classified into three types (I, II, III) based on the location of the fracture line and typically result from flexion or extension forces on the neck. *Fracture of hyoid bone* - The **hyoid bone** is located in the neck above the larynx and is typically fractured due to direct trauma to the neck, often associated with manual strangulation or hanging. - A hyoid fracture is entirely unrelated to injuries of the cervical spine or C2 vertebra.

Q: Jefferson's fracture is:

Fracture of Atlas. ***Fracture of Atlas*** - A **Jefferson's fracture** specifically refers to a burst fracture of the **C1 vertebra** (atlas). - This type of fracture often results from an **axial loading injury** to the head, transmitting force through the occipital condyles to the C1 lateral masses. *Avulsion fracture of C7* - An **avulsion fracture of C7** is commonly known as a **clay-shoveler's fracture**, which is distinct from a Jefferson's fracture. - It typically results from **sudden powerful neck flexion** or muscle contraction, causing a spinous process to be pulled away. *Fracture of Axis* - The **axis (C2 vertebra)** is involved in fractures such as a **hangman's fracture**, which is a bilateral pedicle fracture. - While C2 fractures are also cervical spine injuries, they are anatomically and mechanistically different from C1 fractures. *Due to fracture of traumatic spondylolisthesis of C2 over C3* - **Traumatic spondylolisthesis of C2 over C3** describes a type of fracture-dislocation, often involving the pedicles of C2. - This specific injury is generally associated with different forces and bone involvement than a burst fracture of the C1 ring.

Q: A building contractor suddenly complains of lower backache which increases on bending down. He has:

Disc prolapse. ***Disc prolapse*** - A building contractor's occupation involves frequent **bending and lifting**, which are common mechanisms leading to a **disc prolapse** [2], [3]. - Pain that **increases on bending down** is a classic symptom of disc prolapse, as this movement puts increased pressure on the affected intervertebral disc [2], [3]. *Fibrositis* - **Fibrositis** (now more commonly referred to as **fibromyalgia**) is characterized by widespread musculoskeletal pain, fatigue, and tender points [1]. - It does not typically present with pain exacerbated specifically by **bending down** in the way described for a localized backache. *Tuberculosis of spine* - **Tuberculosis of the spine (Pott's disease)** is a chronic infection that presents with more insidious symptoms like constitutional symptoms (fever, weight loss) and progressive neurological deficits [4]. - The sudden onset of backache and its exacerbation with bending are not typical primary symptoms, which often include bone destruction and **vertebral collapse** [4]. *Renal colic* - **Renal colic** is characterized by severe, spasmodic pain in the flank, often radiating to the groin, typically caused by kidney stones. - The pain is usually unrelated to movement and is not typically described as a "lower backache" that increases specifically with **bending down**.

Q: Removal of vertebral disc can be done by all these approaches except:

Laminoplasty. ***Laminoplasty*** - **Laminoplasty** is a procedure that *expands the spinal canal* by reshaping and repositioning the lamina, rather than removing it, to relieve pressure on the spinal cord. - Unlike disc removal techniques, it aims to *preserve the posterior spinal elements* and maintain spinal stability. *Hemilaminectomy* - A **hemilaminectomy** involves the *partial removal of a lamina on one side* of the vertebra. - This approach allows access to the spinal canal to remove disc material or decompress nerve roots. *Laminotomy* - **Laminotomy** is a procedure where a *small opening is made in the lamina* to access the spinal canal. - This minimal removal of bone is often sufficient for **microdiscectomy**, allowing for the removal of herniated disc fragments. *Laminectomy* - A **laminectomy** involves the *complete removal of the lamina* of one or more vertebrae. - This wider exposure is used for more extensive decompression, such as for **spinal stenosis** or larger disc herniations.

Q: Burst fracture of spine is a type of:

Compression injury. ***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.

Q: Most common type of spinal injury is:

Flexion injury. **Flexion injury** - **Flexion injuries** are the most common type of spinal injury, particularly affecting the **cervical spine**. - These injuries often result from forceful forward bending of the spine, such as in **whiplash** or falls, leading to vertebral body compression or ligamentous tears. *Compression injury* - While **compression injuries** can occur, they are generally less common than flexion injuries across all spinal segments. - They primarily involve an axial load being applied to the spine, leading to **vertebral body fractures**. *Rotation injury* - **Rotation injuries** are relatively uncommon and often occur in combination with other forces, such as flexion or extension. - These injuries involve twisting of the spine, which can lead to **ligamentous damage** or **facet joint dislocation**. *Extension injury* - **Extension injuries** occur when the spine is forcefully bent backward, often seen in hyperextension trauma. - They are less common than flexion injuries and can result in **posterior element fractures** or **ligamentous avulsions**.

Question 1

A 40-year-old male sustains spinal injury after an accident. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is:

Accepted Answer

Central cord syndrome

Answer

Complete spinal cord injury.

Answer

Posterior cord syndrome

Answer

Anterior cord syndrome

Question 2

Subluxation of atlanto-axial joint is seen in all except:

Accepted Answer

Gout

Answer

Odontoid dysgenesis

Answer

Ankylosing spondylitis

Answer

Rheumatoid arthritis

Question 3

The most common site of involvement of spinal TB in children is at which of the following level?

Accepted Answer

Lower thoracic vertebra

Answer

Cervical vertebra

Answer

Upper thoracic vertebra

Answer

Mid thoracic vertebra

Question 4

Most common site of extrapulmonary TB -

Accepted Answer

Spine

Answer

Shoulder

Answer

Knee

Answer

Hip

Question 5

True regarding Hangman's fracture is:

Accepted Answer

Bilateral fractures of pars interarticularis of C2

Answer

Whiplash injury

Answer

Odontoid process fracture of C2

Answer

Fracture of hyoid bone

Question 6

Jefferson's fracture is:

Accepted Answer

Fracture of Atlas

Answer

Avulsion fracture of C7

Answer

Fracture of Axis

Answer

Due to fracture of traumatic spondylolisthesis of C2 over C3

Question 7

A building contractor suddenly complains of lower backache which increases on bending down. He has:

Accepted Answer

Disc prolapse

Answer

Fibrositis

Answer

Tuberculosis of spine

Answer

Renal colic

Question 8

Removal of vertebral disc can be done by all these approaches except:

Accepted Answer

Laminoplasty

Answer

Hemilaminectomy

Answer

Laminotomy

Answer

Laminectomy

Question 9

Burst fracture of spine is a type of:

Accepted Answer

Compression injury

Answer

Extension injury

Answer

Rotation injury

Answer

Flexion injury

Question 10

Most common type of spinal injury is:

Accepted Answer

Flexion injury

Answer

Compression injury

Answer

Rotation injury

Answer

Extension injury

Spine Disorders — MCQs

Spine Disorders — MCQs

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