Spine Disorders Practice Questions

Q: Condition in which there is anterior or posterior displacement of a vertebra in relation to the vertebrae below:

Spondylolisthesis. ***Spondylolisthesis*** - This term specifically refers to the **slippage** (anterior or posterior displacement) of one vertebra relative to an adjacent one. - It often results from conditions like **spondylolysis** (a defect in the pars interarticularis) or degenerative changes. *Spondylitis* - This condition involves **inflammation of the vertebrae**, often seen in diseases like ankylosing spondylitis. - While it can cause pain and stiffness, it does not primarily describe the displacement of one vertebra over another. *Spondylolysis* - This refers to a **defect or stress fracture in the pars interarticularis** of a vertebra. - It is a common *cause* of spondylolisthesis, but not the slippage itself. *Spondylosis* - This is a general term for **degenerative changes** in the spine, including osteoarthritis of the spinal joints and disc degeneration. - It describes age-related wear and tear, not the direct displacement of a vertebra.

Q: Most common site of disc prolapse in lumbar spine is

L5-S1. ***L5-S1*** - The **L5-S1 intervertebral disc** is the most common site for disc prolapse in the lumbar spine. - This is due to the significant **biomechanical stresses** at the lumbosacral junction, including axial loading and rotational forces, which make it susceptible to herniation. *L4-5* - While **L4-5** is a common site for disc prolapse, it is less frequent than L5-S1. - Disc herniation at L4-5 typically affects the **L5 nerve root**. *L3-4* - Disc prolapse at **L3-4** is relatively uncommon compared to the lower lumbar segments. - A herniation at this level would typically impinge on the **L4 nerve root**. *L2-3* - **L2-3** disc prolapse is a rare occurrence in the lumbar spine. - Symptoms would involve the **L3 nerve root**, affecting motor function of the quadriceps and sensation in the medial thigh.

Q: All of the following are true about fracture of the atlas vertebra, except -

Quadriplegia is seen in 80% cases. ***Quadriplegia is seen in 80% cases*** - This statement is incorrect; **neurological deficits** such as quadriplegia are **uncommon** in atlas fractures (Jefferson fractures) because the fracture fragments tend to spread outwards, decompressing the spinal cord. - While significant trauma can lead to neurological injury, the classic Jefferson fracture mechanism often spares the spinal cord from direct compression. *Atlantooccipital fusion may sometimes be needed* - **Atlanto-occipital fusion** (craniovertebral fusion) is a surgical option reserved for **unstable atlas fractures** or those associated with significant ligamentous injury. - It aims to provide **stability** to the craniocervical junction, preventing further neurological damage, especially if non-operative measures fail. *Jefferson fracture is the most common type* - The **Jefferson fracture** is indeed the **most common type of atlas fracture**, characterized by a burst fracture of the C1 ring. - It typically results from an **axial load** to the head, such as a diving accident, leading to fractures of both anterior and posterior arches. *CT scans should be done for diagnosis* - **CT scans** are the **gold standard** for diagnosing atlas fractures due to their superior ability to visualize bone and detect subtle fractures of the C1 ring. - They provide detailed three-dimensional images that are crucial for assessing the **fracture pattern**, displacement, and involvement of adjacent structures.

Q: Unstable spine injury occurs in

Flexion-rotation injury. ***Flexion-rotation injury*** - This type of injury is particularly unstable because it involves forces that disrupt both the **anterior and posterior columns** of the spine, leading to significant ligamentous and bony damage. - The combined flexion and rotation can shear or fracture vertebral bodies and dislocate facets, compromising the **spinal canal** and leading to neurological deficits. *Flexion injury* - Pure flexion injuries, such as **wedge fractures**, primarily affect the anterior column and are often stable, especially if the posterior elements remain intact. - While powerful flexion can cause significant damage, the rotational component is key to the inherent **instability** associated with spinal column disruption. *Compression injury* - Compression injuries typically result in **burst fractures** or wedge fractures, which are often considered stable if the posterior ligamentous complex is intact and there is no significant vertebral body retropulsion into the spinal canal. - The primary force is axial, which can cause comminution but does not necessarily disrupt the **three-column integrity** in a way that directly leads to gross instability as comprehensively as a flexion-rotation injury. *Extensor injury* - Extension injuries, often occurring in whiplash or hyperextension, can cause fractures of the posterior elements (e.g., **spinous processes**, laminae) or disc herniation. - While potentially damaging, especially to the spinal cord, they do not typically create the same degree of structural **instability** across all three spinal columns as a flexion-rotation injury.

Q: Most common orthopaedic manifestation of Neurofibromatosis is:

Scoliosis. ***Scoliosis*** - **Scoliosis** is the most frequent and debilitating orthopedic manifestation of **neurofibromatosis type 1 (NF1)**, affecting approximately *25%* of patients. - It often presents as a **dystrophic curve**, characterized by sharp, short-segment, and rapidly progressive curves that can lead to significant spinal deformities. *Atlanto-axial instability* - While **atlanto-axial instability** can occur in NF1, particularly due to dural ectasia or bony abnormalities, it is a **less common** orthopedic manifestation compared to scoliosis. - It typically requires specific diagnostic imaging and may present with neurological symptoms, but it is not the most prevalent. *Sphenoid dysplasia* - **Sphenoid dysplasia** is a characteristic bony lesion in NF1, often resulting in **orbital pulsatile exophthalmos** due to the absence or hypoplasia of the greater wing of the sphenoid bone. - While diagnostic for NF1, it is a Craniofacial manifestation rather than affecting the Musculoskeletal system *Pseudoarthrosis of the tibia and thinning of the cortex of long bones* - **Pseudoarthrosis of the tibia**, particularly **congenital tibial pseudoarthrosis**, is a significant but **less common** complication of NF1, occurring in about *5%* of patients. - **Thinning of the cortex of long bones** can also occur, contributing to a risk of fractures, but these are not as frequent as scoliosis.

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: 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: 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: 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.

Question 1

Condition in which there is anterior or posterior displacement of a vertebra in relation to the vertebrae below:

Accepted Answer

Spondylolisthesis

Answer

Spondylitis

Answer

Spondylolysis

Answer

Spondylosis

Question 2

A 47-year-old man awakens with low back pain after a weekend of gardening. He recalls no specific incident of trauma and has never had back pain before. There is no radiation of the pain and no disturbance of normal bowel or bladder function. The ROM of the low back is painful and restricted in all planes, and there is paraspinal tenderness from L2 to L5 on the right. Scoliosis and kyphosis are absent. Findings on straight-leg-raising test are negative, reflexes are active and equal, and the patient can walk on his heels and toes. Findings on x-rays of the lumbar spine are normal. Which is the best treatment?

Accepted Answer

Bed rest for 48 hours, anti-inflammatory agents, heat to the low back, and nonnarcotic analgesics

Answer

Immediate magnetic resonance image (MRI) for the lumbar spine

Answer

Bed rest for 7-10 days, heat to the lower back, anti-inflammatory agents, muscle relaxants, and analgesics

Answer

Hospitalization for pelvic traction, physical therapy, anti-inflammatory agents, intramuscularly analgesics, and muscle relaxants

Question 3

Most common site of disc prolapse in lumbar spine is

Accepted Answer

L5-S1

Answer

L4-5

Answer

L3-4

Answer

L2-3

Question 4

All of the following are true about fracture of the atlas vertebra, except -

Accepted Answer

Quadriplegia is seen in 80% cases

Answer

Atlantooccipital fusion may sometimes be needed

Answer

Jefferson fracture is the most common type

Answer

CT scans should be done for diagnosis

Question 5

Unstable spine injury occurs in

Accepted Answer

Flexion-rotation injury

Answer

Flexion injury

Answer

Compression injury

Answer

Extensor injury

Question 6

Most common orthopaedic manifestation of Neurofibromatosis is:

Accepted Answer

Scoliosis

Answer

Atlanto- axial instability

Answer

Sphenoid dysplasia

Answer

Pseudoarthrosis of tibia and thinning of cortex of long bones

Question 7

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

Accepted Answer

Gout

Answer

Odontoid dysgenesis

Answer

Ankylosing spondylitis

Answer

Rheumatoid arthritis

Question 8

Most common site of extrapulmonary TB -

Accepted Answer

Spine

Answer

Shoulder

Answer

Knee

Answer

Hip

Question 9

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 10

Burst fracture of spine is a type of:

Accepted Answer

Compression injury

Answer

Extension injury

Answer

Rotation injury

Answer

Flexion injury

Spine Disorders — MCQs

Spine Disorders — MCQs

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