Spine Disorders — MCQs

Spine Disorders Indian Medical PG Practice Questions and MCQs

Question 161: A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis?

A. Meningocele
B. Kyphosis (Correct Answer)
C. Meningomyelocele
D. Lordosis

Explanation: ***Kyphosis*** - **Kyphosis** is defined as an exaggerated posterior curvature of the **thoracic spine**, often seen in older adults due to **osteoporosis** or degenerative disc disease. - The patient's age and description of an "abnormally increased curvature of the thoracic vertebral column" directly correspond to the definition of **kyphosis**. *Meningocele* - A **meningocele** is a type of **spina bifida** where the meninges protrude through an opening in the spine, forming a sac. - This condition involves a **neural tube defect** and typically presents at birth, not as an acquired condition in a 69-year-old. *Meningomyelocele* - A **meningomyelocele** is a more severe form of **spina bifida** where the spinal cord and meninges protrude through an opening in the spine. - Like meningocele, it is a congenital birth defect and does not present as an abnormally increased spinal curvature in an elderly individual. *Lordosis* - **Lordosis** is an exaggerated anterior curvature, most commonly affecting the **lumbar spine**. - It results in an inward swayback appearance, which is the opposite of an increased posterior curvature of the thoracic spine.

Question 162: Grisel's syndrome is

A. Hexosaminidase deficiency
B. Glucosaminidase deficiency
C. L4-L5 displacement
D. Atlanto-axial joint dislocation (Correct Answer)

Explanation: ***Atlanto-axial joint dislocation*** - **Grisel's syndrome** is a non-traumatic subluxation of the **atlanto-axial joint**, often seen in children after infections of the head and neck. - The inflammation causes spasm of the surrounding musculature, leading to disrruption in normal stability of the **C1-C2 joint**. *Hexosaminidase deficiency* - This deficiency is associated with **Tay-Sachs disease** and **Sandhoff disease**, which are lysosomal storage disorders. - These conditions primarily affect **neurological development** and do not involve atlanto-axial joint dislocation. *Glucosaminidase deficiency* - This enzyme deficiency is not a recognized isolated entity causing a specific syndrome like Grisel's. - Deficiencies in related enzymes like **alpha-glucosidase** cause glycogen storage diseases (e.g., Pompe disease), which has different clinical manifestations. *L4-L5 displacement* - Displacement of the **L4-L5 vertebrae** refers to **spondylolisthesis** in the lumbar spine. - This condition is typically associated with **back pain** and neurological symptoms in the lower extremities, distinct from Grisel's syndrome affecting the neck.

Question 163: Hangman's fracture is fracture of C2

A. Spinous process
B. Dens fracture
C. Lamina
D. Pars interarticularis (Correct Answer)

Explanation: ***Pars interarticularis*** - A **hangman's fracture** is a traumatic spondylolisthesis of the axis (C2), specifically involving a fracture through the **pars interarticularis** bilaterally. - This fracture typically occurs from sudden, forceful hyperextension of the neck, often seen in car accidents or judicial hanging. *Spinous process* - A fracture of the **spinous process** (also known as a "clay shoveler's fracture") typically occurs in the lower cervical or upper thoracic spine due to hyperflexion. - This type of fracture is usually stable and does not involve the pars interarticularis of C2. *Dens fracture* - A **dens fracture** involves the odontoid process of C2, which projects superiorly and articulates with C1. - While it is a fracture of C2, it is distinct from a hangman's fracture, which involves the pars interarticularis. *Lamina* - Fractures of the **lamina** are less common isolated injuries in C2 and are not characteristic of a hangman's fracture. - The lamina forms part of the vertebral arch and encloses the spinal canal, but bilateral fractures here are not synonymous with the biomechanics of a hangman's fracture.

Question 164: Disc prolapse involving L4 nerve root typically presents with: (Repeat)

A. Weakness of hip flexion
B. Absent ankle jerk
C. Absent knee jerk (Correct Answer)
D. Weakness of hip extension

Explanation: ***Absent knee jerk*** - A disc prolapse at the **L4 level** can compress the **L4 nerve root**, which is primarily responsible for the **patellar reflex (knee jerk)**. - The knee jerk reflex tests the integrity of the **femoral nerve** and the **L2, L3, and L4 spinal segments**, making L4 compression a significant cause of its absence. *Weakness of hip flexion* - **Hip flexion** is primarily mediated by the **L1, L2, and L3 nerve roots**, affecting muscles like the **iliopsoas**. - While L4 can have some minor contribution, it is not the primary dermatome affected, making this less characteristic of an isolated L4 lesion. *Absent ankle jerk* - The **ankle jerk reflex** (Achilles reflex) is primarily mediated by the **S1 nerve root**. - An absent ankle jerk would suggest a lesion at the **S1 level**, not L4. *Weakness of hip extension* - **Hip extension** is mainly controlled by the **S1 nerve root**, innervating the **gluteus maximus**. - Weakness in hip extension would point towards an **S1 disc prolapse**, not L4.

Question 165: A previously healthy 45-yr-old labourer suddenly develops acute lower back pain with right-leg pain & weakness of dorsiflexion of the right great toe. Which of the following is true -

A. Immediate treatment should include analgesics, muscle relaxants, and back strengthening exercises.
B. If the neurological signs resolve within 2 to 3 weeks but low back pain persists, the proper treatment would include fusion of the affected lumbar vertebra.
C. The appearance of foot drop indicates early surgical intervention. (Correct Answer)
D. If the neurological signs fail to resolve within 1 week, lumbar laminectomy and excision of any herniated nucleus pulposus should be done.

Explanation: ***The appearance of foot drop indicates early surgical intervention.*** - The patient presents with **acute lower back pain**, **right-leg pain**, and **weakness of dorsiflexion of the right great toe**, which strongly suggests a herniated disc compressing the **L5 nerve root**. - **Foot drop** (inability to dorsiflex the ankle/toes) is a significant neurological deficit indicating severe nerve compression, warranting **early surgical intervention** to prevent permanent damage. *Immediate treatment should include analgesics, muscle relaxants, and back strengthening exercises.* - While **analgesics** and **muscle relaxants** are appropriate for initial pain management, **back strengthening exercises** are usually initiated after the acute pain subsides and often under physical therapy guidance, not immediately in the acute phase of severe neurological deficit. - The presence of **neurological deficits** (weakness/foot drop) indicates more than just simple back pain, suggesting a need for more aggressive management beyond conservative measures alone. *If the neurological signs resolve within 2 to 3 weeks but low back pain persists, the proper treatment would include fusion of the affected lumbar vertebra.* - **Lumbar fusion** is a major surgical procedure typically reserved for cases of **spinal instability**, severe intractable pain unresponsive to other treatments, or significant structural deformities. - It is **not indicated** if neurological signs resolve, even if low back pain persists, as persistent back pain post-resolution of neurological symptoms can often be managed with less invasive methods, including physical therapy, injections, or less extensive surgeries. *If the neurological signs fail to resolve within 1 week, lumbar laminectomy and excision of any herniated nucleus pulposus should be done.* - While persistent or worsening neurological deficits within 1-2 weeks are a strong indication for surgery, a strict 1-week timeframe for all cases of non-resolving neurological signs is **not universally applied**, especially if the symptoms are not rapidly progressing or severe. - The decision for surgery (e.g., **laminectomy** or **microdiscectomy**) depends on the severity of neurological deficits, progression of symptoms, and failure of conservative management, but typically, an acute foot drop indicating severe compression would warrant a more urgent consideration for surgery.

Question 166: Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?

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

Explanation: ***Two*** - The **Holdsworth classification** focuses on the **biomechanical stability** of the spine and divides the vertebral column into two main columns: the **anterior column** and the **posterior column**. - This classification was foundational for understanding spinal instability, particularly related to **flexion-rotation injuries**. *Three* - The **Denis classification** is based on a **three-column model** (anterior, middle, and posterior columns) and is more commonly used in current practice for describing thoracolumbar spine fractures. - While Denis expanded upon Holdsworth's ideas, Holdsworth himself only described two columns. *Four* - There is no widely recognized or primary classification system for thoracolumbar spine fractures that uses a **four-column model**. - Spinal fracture classifications primarily revolve around two- or three-column models, or more recently, morphological and neurological injury patterns (e.g., AO Spine classification). *Five* - A **five-column model** is not standard for classifying thoracolumbar spine fractures in medical literature. - Comprehensive classifications usually incorporate factors beyond just column numbers, such as injury morphology, neurological status, and integrity of the disc and ligaments.

Question 167: Jefferson fracture is -

A. Fracture of any cervical vertebra
B. Fracture of axis
C. Fracture of spinous process of C7
D. Fracture of atlas (Correct Answer)

Explanation: ***Fracture of atlas*** - A **Jefferson fracture** specifically refers to a **burst fracture** of the **C1 vertebra (atlas)**, caused by a compressive force on the head. - This type of fracture often involves **four separate fractures** within the anterior and posterior arches of the atlas. *Fracture of any cervical vertebra* - This is a too broad a statement; while the atlas is a cervical vertebra, a Jefferson fracture is a specific type affecting only C1. - Cervical spine fractures can involve various vertebrae (C1-C7) and different fracture patterns, not all of which are Jefferson fractures. *Fracture of axis* - The **axis** is the **C2 vertebra**, and its characteristic fractures include a **dens fracture** or a **hangman's fracture**, which involve different mechanisms and anatomical locations than a Jefferson fracture. - Injury to C2 can cause different neurological deficits compared to C1. *Fracture of spinous process of C7* - A fracture of the spinous process of C7 is known as a **clay-shoveler's fracture** and is typically an avulsion injury, not a burst fracture from axial compression. - This type of fracture usually results from forceful neck flexion, leading to avulsion of the spinous process.

Question 168: The compression fracture is commonest in

A. Upper thoracic spine
B. Cervical spine
C. Lumbosacral region
D. Lower thoracic spine (Correct Answer)

Explanation: ***Lower thoracic spine*** - The **thoracolumbar junction (T11-L2)** is the most common site for compression fractures due to its high biomechanical stress, transitioning from stiff thoracic spine to more flexible lumbar spine. - This area is particularly vulnerable to axial loading and flexion injuries because it's a zone of increased mobility and stress concentration. *Upper thoracic spine* - The upper thoracic spine has **rib cage support** and less mobility, making fractures here less common without significant traumatic force. - Fractures in this region often indicate a **high-energy injury** due to its inherent stability. *Cervical spine* - While cervical fractures can be serious, they typically result from **high-energy trauma** and are less commonly simple compression fractures compared to the thoracolumbar region. - The **cervical spine** is more prone to **burst fractures** or **dislocations** from flexion-distraction or extension injuries. *Lumbosacral region* - The **sacrum and coccyx** are relatively stable bone structures and are less prone to common compression fractures unless there is severe trauma or significant bone weakening (e.g., severe osteoporosis). - While lumbar compression fractures do occur, the **junctional region** between the thoracic and lumbar spine (lower thoracic/upper lumbar) is statistically more frequent.

Question 169: A patient presents with a burning sensation in the middle finger and weak triceps reflex. Which cervical disc level is most likely involved?

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

Explanation: ***C6-C7*** - Compression at the **C7 nerve root** (typically C6-C7 disc level) causes a burning sensation and paresthesia in the **middle finger**. - A **weak triceps reflex** (C7-C8 reflex) is a key indicator of C7 nerve root involvement. *C3-C4* - Compression at the C4 nerve root typically presents with neck pain radiating to the **posterior neck** and **shoulder blade**, without significant finger paresthesia or triceps reflex changes. - While it can cause sensory disturbances, these are usually referred to the shoulder and upper arm, not specifically the middle finger. *C2-C3* - Compression at the C3 nerve root primarily causes signs and symptoms in the **neck** and **occipital region**, possibly with some **headache**. - It does not typically involve motor or sensory deficits in the upper extremity, especially the triceps reflex or middle finger. *C5-C6* - Compression at the C6 nerve root (typically C5-C6 disc level) would primarily affect the **biceps reflex** and cause sensory symptoms in the **thumb** and **index finger**. - It would not typically cause a weak triceps reflex or paresthesia in the middle finger.

Question 170: Prolapsed intervertebral Disc (PID) is most common at -

A. L2-L4
B. L5-S1 (Correct Answer)
C. C5-C6
D. C2-C3

Explanation: ***L5-S1*** - The **L5-S1** disc is most frequently affected due to its location at the junction of the **lumbar spine** and the relatively immobile **sacrum**, leading to high biomechanical stress. - This level experiences significant forces during bending and lifting, making it vulnerable to **disc herniation**. *L2-L4* - While disc prolapse can occur at these levels, it is **less common** than at the lower lumbar segments like L5-S1. - The L2-L4 discs are under less mechanical stress compared to the lower lumbar and lumbosacral junctions. *C5-C6* - This level is a common site for cervical disc prolapse, but the question generally refers to the **overall most common site** for PID, which is in the lumbar region. - Cervical disc prolapse at C5-C6 typically presents with **neck pain** and **radiculopathy** affecting the upper extremities. *C2-C3* - Disc prolapse at this level is **rare** due to the relatively small range of motion and protective musculature in the upper cervical spine. - When it does occur, it can cause severe symptoms including **myelopathy** due to spinal cord compression.

Practice by Chapter

Cervical Spine Disorders

Practice Questions

Thoracic Spine Disorders

Practice Questions

Lumbar Spine Disorders

Practice Questions

Intervertebral Disc Disease

Practice Questions

Spinal Stenosis

Practice Questions

Spondylolisthesis

Practice Questions

Spinal Deformities

Practice Questions

Spinal Infections

Practice Questions

Spinal Tumors

Practice Questions

Spinal Cord Injuries

Practice Questions

Minimally Invasive Spine Surgery

Practice Questions

Rehabilitation of Spine Conditions

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free