Spine Disorders Practice Questions

Q: Regarding Hangman's fracture true is:

Union almost always occurs. ***Union almost always occurs*** - Hangman's fracture (bilateral pedicle fracture of C2) is generally stable due to preservation of the **atlanto-axial joint**, allowing for high rates of bony union with conservative management. - The **ligamentous integrity often remains intact**, providing stability and promoting healing. *Surgical treatment is necessary* - Most Hangman's fractures **do not require surgery** due to their inherent stability and high potential for union with non-operative treatment like a cervical collar or halo vest. - Surgical intervention is typically reserved for **unstable fractures** or those with significant displacement that fail conservative management. *High post-admission mortality* - Despite being a C2 fracture, Hangman's fracture usually has a **relatively low mortality rate** because the spinal cord is often spared from severe injury. - The primary mechanism (**hyperextension-distraction**) often decompresses the spinal canal rather than compressing it, reducing neurological deficit risk. *One of the most common axis fractures* - **Odontoid fractures** are the most common type of axis (C2) fracture, accounting for a higher percentage than Hangman's fractures. - Hangman's fractures are still significant but occur less frequently than fractures involving the **dens**.

Q: 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?

Kyphosis. ***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.

Q: Grisel's syndrome is

Atlanto-axial joint dislocation. ***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.

Q: Hangman's fracture is fracture of C2

Pars interarticularis. ***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.

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

Absent knee jerk. ***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.

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

Two. ***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.

Q: Jefferson fracture is -

Fracture of atlas. ***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.

Q: Discectomy can be performed using:

All of the options. ***All of the options*** - **Discectomy** can be performed through various surgical approaches, including open surgery, minimally invasive techniques using a microscope, and endoscopic procedures. - The choice of method depends on factors such as the **location and size of the disc herniation**, patient anatomy, and surgeon’s preference and expertise. *Open surgery* - This involves a larger incision to directly visualize and access the spinal structures and remove the **herniated disc material**. - While effective, it typically involves more muscle dissection, leading to increased **postoperative pain** and a longer recovery time compared to minimally invasive approaches. *Microscope* - **Microdiscectomy** uses a surgical microscope to provide magnified visualization of the surgical field through a smaller incision. - This minimally invasive approach reduces tissue dissection, leading to less pain, smaller scars, and **faster recovery** than traditional open surgery. *Endoscope* - **Endoscopic discectomy** utilizes a small camera (endoscope) inserted through a tiny incision, allowing the surgeon to view the surgical area on a monitor. - This is a highly minimally invasive technique that typically results in even **less tissue damage** and a quicker return to normal activities compared to microdiscectomy.

Q: The compression fracture is commonest in

Lower thoracic spine. ***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 1

Regarding Hangman's fracture true is:

Accepted Answer

Union almost always occurs

Answer

Surgical treatment is necessary

Answer

High post-admission mortality

Answer

One of the most common axis fractures

Question 2

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?

Accepted Answer

Kyphosis

Answer

Meningocele

Answer

Meningomyelocele

Answer

Lordosis

Question 3

Grisel's syndrome is

Accepted Answer

Atlanto-axial joint dislocation

Answer

Hexosaminidase deficiency

Answer

Glucosaminidase deficiency

Answer

L4-L5 displacement

Question 4

Hangman's fracture is fracture of C2

Accepted Answer

Pars interarticularis

Answer

Spinous process

Answer

Dens fracture

Answer

Lamina

Question 5

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

Accepted Answer

Absent knee jerk

Answer

Weakness of hip flexion

Answer

Absent ankle jerk

Answer

Weakness of hip extension

Question 6

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 -

Accepted Answer

The appearance of foot drop indicates early surgical intervention.

Answer

Immediate treatment should include analgesics, muscle relaxants, and back strengthening exercises.

Answer

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.

Answer

If the neurological signs fail to resolve within 1 week, lumbar laminectomy and excision of any herniated nucleus pulposus should be done.

Question 7

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

Accepted Answer

Two

Answer

Three

Answer

Four

Answer

Five

Question 8

Jefferson fracture is -

Accepted Answer

Fracture of atlas

Answer

Fracture of any cervical vertebra

Answer

Fracture of axis

Answer

Fracture of spinous process of C7

Question 9

Discectomy can be performed using:

Accepted Answer

All of the options

Answer

Open surgery

Answer

Microdiscectomy

Answer

Endoscopic approach

Question 10

The compression fracture is commonest in

Accepted Answer

Lower thoracic spine

Answer

Upper thoracic spine

Answer

Cervical spine

Answer

Lumbosacral region

Spine Disorders — MCQs

Spine Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?