Spine Disorders Practice Questions

Q: What should be the most likely diagnosis of this 65-year-old lady who presents with backache?

Spondylolisthesis. ***Spondylolisthesis*** - As a 65-year-old, she is at risk for degenerative spondylolisthesis, which typically occurs at **L4-L5** and is more common in women. - This condition involves the **forward slippage** of one vertebral body over another, often causing back pain due to instability and potential nerve root compression. *Osteoporotic fracture* - While common in older women, an osteoporotic fracture would typically present with **acute, severe pain** after a minor trauma or spontaneously, unlike generalized backache. - A fracture usually implies a **sudden collapse** of the vertebral body, often visible on imaging as a wedge or compression fracture. *Spondylolysis* - This is a defect or stress fracture in the **pars interarticularis**, more common in younger athletes and typically affecting L5. - While it can cause back pain, it usually precedes spondylolisthesis and is less likely to be the primary diagnosis for a new presentation of backache in a 65-year-old woman. *Discitis* - Discitis is an **infection of the intervertebral disc**, which would typically present with severe, localized back pain often accompanied by **fever**, chills, and elevated inflammatory markers. - This presentation is inconsistent with a general complaint of backache in an afebrile patient without other systemic symptoms of infection.

Q: Ankle reflex is affected in prolapsed intervertebral disc at what level?

L5 - S1. ***L5 - S1*** - The **ankle reflex** (Achilles reflex) is primarily mediated by the **S1 nerve root**. [1] - A prolapsed intervertebral disc at the L5-S1 level would compress the **S1 nerve root**, leading to an altered or absent ankle jerk reflex. [1] *L3 - L4* - A herniation at this level typically affects the **L4 nerve root**, which may impact the **patellar reflex** (knee jerk reflex), not the ankle reflex. - Compression at L3-L4 often presents with quadriceps weakness and sensory deficits along the medial thigh and leg. *L4 - L5* - Prolapse at this level most commonly compresses the **L5 nerve root**, resulting in weakness in foot dorsiflexion ("foot drop") and sensory loss over the dorsum of the foot. - The L5 nerve root is not the primary mediator of the ankle reflex. *S1 - S2* - While the S1 nerve root primarily mediates the ankle reflex, significant disc herniation specifically between S1 and S2 is less common. - S1-S2 disc prolapse typically affects the **S2 nerve root**, which can lead to weakness in toe flexion and sensory loss along the posterior aspect of the leg and sole of the foot, rather than directly impacting the ankle reflex.

Q: What type of fracture is associated with seat belt injuries?

Chance fracture. ***Chance fracture*** - A **Chance fracture** is a **horizontal fracture** of a vertebral body, commonly occurring at the thoracolumbar junction (T12-L2) due to hyperflexion and distraction forces, characteristic of seat belt injuries. - The classic mechanism involves **flexion over a lap belt**, causing the anterior column to compress and the posterior and middle columns to experience tensile failure. *Tear drop fracture* - A **teardrop fracture** is typically caused by severe flexion and axial compression, resulting in a triangular fragment from the **anterior inferior corner of a vertebral body**. - While serious, they are often associated with **diving accidents** or severe hyperextension, rather than the specific mechanism of a seat belt injury. *Wedge fracture* - A **wedge fracture** is a type of compression fracture where the vertebral body collapses anteriorly, forming a wedge shape. - These are common in **osteoporosis** or high-energy axial compression, but the seat belt mechanism involves a more complex combination of flexion and distraction, leading to a Chance fracture. *Whiplash injury* - **Whiplash** refers to a soft tissue injury (ligaments, muscles, discs) in the neck caused by a rapid hyperextension-hyperflexion motion, commonly seen in **rear-end car collisions**. - It is primarily a **soft tissue injury** and not a bone fracture, although severe whiplash can sometimes be associated with minor fractures, this is not its primary definition or common association.

Q: What is the management for the most dangerous type of odontoid fracture according to the Anderson and D'Alonzo classification?

Type II - screw fixation. **Type II - screw fixation** - **Type II odontoid fractures** are considered the most dangerous due to their location at the base of the dens, which has a **poor blood supply**, leading to a high rate of non-union. - **Screw fixation** (anterior odontoid screw fixation) is often preferred for Type II fractures to achieve stable internal fixation and promote healing. *Type I - immobilization in rigid collar* - **Type I odontoid fractures** are stable fractures of the tip of the dens, usually managed with a **rigid cervical collar** due to their excellent prognosis and low risk of instability. - This type does not represent the most dangerous category and typically heals well with conservative management. *Type III - halo vest immobilization* - **Type III odontoid fractures** involve the body of the axis and are generally more stable than Type II fractures due to a larger cancellous bone surface for healing. - While a **halo-vest immobilization** can be used, Type III fractures often have good healing potential and are not considered the most dangerous type. *Type III - immobilization in rigid collar* - Although some stable Type III fractures might be managed with rigid collar, it's not the primary or universal treatment, and this type is not the most dangerous. - More unstable Type III fractures might require **halo-vest immobilization** or surgical intervention, but the inherent instability and non-union risk of Type II make it the most critical.

Q: Hangman's fracture is the fracture involving which cervical vertebra?

C2. ***C2*** - A **Hangman's fracture** specifically refers to a fracture of the **pars interarticularis of the second cervical vertebra (C2)**, also known as the axis. - This type of fracture is typically caused by extreme **hyperextension** and distraction injuries, historically associated with judicial hanging. *C1* - The first cervical vertebra, C1 (atlas), is involved in a **Jefferson fracture**, which is a burst fracture resulting from an axial load. - A Jefferson fracture involves fractures of the anterior and posterior arches of C1, distinguishing it from a Hangman's fracture. *C3* - Fractures of C3 are less common than C1 or C2 and are typically associated with higher energy trauma causing a **flexion-distraction injury**. - These fractures can involve the vertebral body or posterior elements but are not specifically termed a Hangman's fracture. *C4* - Fractures of the fourth cervical vertebra (C4) can occur due to various mechanisms, including flexion, extension, or compression. - While significant, C4 fractures do not carry the specific designation of a Hangman's fracture, which is reserved for C2.

Q: Craniocervical junction abnormalities are seen in all of the following except:

Ankylosing spondylitis. ***Ankylosing spondylitis*** - While ankylosing spondylitis primarily affects the **axial skeleton**, prominent craniocervical junction abnormalities are **less common** compared to other conditions listed. - The disease typically involves progressive **fusion of the sacroiliac joints** and spine, and while cervical involvement can occur, it usually doesn't lead to the severe instability or malformations seen in the other options at the craniocervical junction. *Rheumatoid arthritis* - **Rheumatoid arthritis** can lead to significant **craniocervical junction abnormalities**, including **atlantoaxial subluxation**. - This occurs due to inflammation and destruction of ligaments and joints in the upper cervical spine, particularly the **odontoid process**. *Odontoid dysgenesis* - **Odontoid dysgenesis** refers to congenital abnormalities in the development of the **odontoid process** (dens) of the axis (C2). - This can result in an unstable craniocervical junction and increased risk of **spinal cord compression**. *Basilar invagination* - **Basilar invagination** is a condition where the **odontoid process** protrudes abnormally high into the foramen magnum. - This can be congenital or acquired, and it significantly impacts the **craniocervical junction**, potentially causing brainstem or cerebellar compression.

Q: Schober's sign is for :

Flexion of lumbar spine. ***Flexion of lumbar spine*** - **Schober's test** measures the degree of **lumbar spine flexion**, indicating the mobility of the lower back. - A limited increase in the marked distance during lumbar flexion suggests reduced spinal mobility, often seen in conditions like **ankylosing spondylitis**. *Chest expansion* - While important in assessing conditions affecting the spine like ankylosing spondylitis, chest expansion is typically measured using a **tape measure** around the chest, not Schober's sign. - Reduced chest expansion indicates **costovertebral** and **costosternal joint involvement**. *Pain with motion of hip* - Hip joint pathology is assessed through specific range of motion tests and palpation, independent of Schober's test. - Pain during hip motion could indicate conditions like **osteoarthritis** or **hip impingement**. *Neck pain and stiffness* - Neck pain and stiffness are assessed through cervical spine range of motion tests, such as flexion, extension, and rotation. - Schober's test specifically evaluates lumbar spine mobility, not the cervical spine.

Q: What is a common symptom of lumbar canal stenosis?

Neurogenic claudication. ***Neurogenic claudication*** - This is the hallmark symptom of lumbar canal stenosis, characterized by **leg pain, numbness, or weakness** that is induced by walking or standing and relieved by sitting or leaning forward. - The narrow spinal canal compresses nerve roots, leading to these symptoms, often described as a **"shopping cart sign"** where patients lean over to alleviate pain. *Lower back pain* - While lumbar canal stenosis can cause lower back pain, it is a very **non-specific symptom** and not the primary defining characteristic of the condition. - Many conditions, including muscle strains or disc herniations, can cause lower back pain, making it an insufficient standalone indicator. *Numbness in the legs* - Numbness in the legs can occur as part of **neurogenic claudication** in lumbar canal stenosis, but it is typically accompanied by pain and/or weakness and follows a pattern related to activity. - Numbness alone can also be a symptom of various other neurological conditions or peripheral neuropathies, making it too broad a descriptor. *Weakness in the legs* - Leg weakness can be a component of **neurogenic claudication** in lumbar canal stenosis, often appearing after walking or standing for some time. - However, isolated leg weakness without other classic claudication features can also indicate conditions like stroke, multiple sclerosis, or nerve damage from other causes.

Q: Test used for prolapsed lumbar intervertebral disc is?

Lasegue test. ***Lasegue test*** - The **Lasegue test**, also known as the **straight leg raise test**, is a primary diagnostic test for **lumbar disc herniation** causing **sciatic nerve root compression**. - It elicits radiating pain down the leg when the affected leg is passively raised, due to stretching the **sciatic nerve**. *Active straight leg raising test* - This test is primarily used to assess for **sacroiliac joint dysfunction** or **lumbar instability**, not disc prolapse. - The patient actively lifts their leg, and the examiner assesses for pain or instability in the pelvic region. *Thomas test* - The **Thomas test** is used to determine the presence of a **hip flexion contracture**. - It involves assessing the ability of the hip to extend fully when the contralateral hip is flexed to the chest. *Apley's grinding test* - **Apley's grinding test** is a specific maneuver used to detect **meniscal injuries** in the knee joint. - It involves compressing and rotating the tibia on the femur while the patient is prone.

Question 1

What should be the most likely diagnosis of this 65-year-old lady who presents with backache?

Accepted Answer

Spondylolisthesis

Answer

Osteoporotic fracture

Answer

Spondylolysis

Answer

Discitis

Question 2

Which of the following statements about the management of Pott's paraplegia is incorrect?

Accepted Answer

Decompression via anterolateral approach is most preferred

Answer

Chemotherapy is the mainstay of conservative management

Answer

Paraplegia not improving with conservative treatment even after 3 - 6 months is an indication for surgical intervention.

Answer

Posterior fusion and instrumentation can be used to manage the condition.

Question 3

Ankle reflex is affected in prolapsed intervertebral disc at what level?

Accepted Answer

L5 - S1

Answer

L3 - L4

Answer

L4 - L5

Answer

S1 - S2

Question 4

What type of fracture is associated with seat belt injuries?

Accepted Answer

Chance fracture

Answer

Tear drop fracture

Answer

Wedge fracture

Answer

Whiplash injury

Question 5

What is the management for the most dangerous type of odontoid fracture according to the Anderson and D'Alonzo classification?

Accepted Answer

Type II - screw fixation

Answer

Type I - immobilization in rigid collar

Answer

Type III - immobilization in rigid collar

Answer

Type III - halo vest immobilization

Question 6

Hangman's fracture is the fracture involving which cervical vertebra?

Accepted Answer

C2

Answer

C1

Answer

C3

Answer

C4

Question 7

Craniocervical junction abnormalities are seen in all of the following except:

Accepted Answer

Ankylosing spondylitis

Answer

Odontoid dysgenesis

Answer

Basilar invagination

Answer

Rheumatoid arthritis

Question 8

Schober's sign is for :

Accepted Answer

Flexion of lumbar spine

Answer

Chest expansion

Answer

Pain with motion of hip

Answer

Neck pain and stiffness

Question 9

What is a common symptom of lumbar canal stenosis?

Accepted Answer

Neurogenic claudication

Answer

Lower back pain

Answer

Numbness in the legs

Answer

Weakness in the legs

Question 10

Test used for prolapsed lumbar intervertebral disc is?

Accepted Answer

Lasegue test

Answer

Active straight leg raising test

Answer

Thomas test

Answer

Apley's grinding test

Spine Disorders — MCQs

Spine Disorders — MCQs

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