Spine Disorders Practice Questions

Q: What is the angle shown in the image known as?

Cobb angle. ***Correct Option: Cobb angle*** - The image displays a method for measuring the angle of a spinal curvature, which is known as the **Cobb angle** - This measurement is routinely used to assess the severity of **scoliosis** by drawing lines parallel to the vertebral endplates at the extreme ends of the curve and then determining the angle between these lines - The Cobb angle is the **gold standard** for quantifying scoliosis and monitoring curve progression *Incorrect Option: Bohler angle* - The **Bohler angle** is a measurement used in the assessment of **calcaneal fractures** - It is formed by two lines drawn on a lateral foot X-ray and is not relevant to spinal deformities *Incorrect Option: Ferguson angle* - The **Ferguson angle**, also known as the lumbosacral angle, measures the angle of the sacral base relative to the horizontal - It describes the degree of **lordosis** and is not used to quantify scoliosis as depicted in the image *Incorrect Option: Baumann angle* - The **Baumann angle** is an important measurement used in pediatric orthopedics to assess the alignment of the **distal humerus** after a supracondylar fracture - It is irrelevant to spinal imaging and curvature assessment

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

Spondylolisthesis. ***Spondylolisthesis*** - The lateral X-ray image reveals an **anterior displacement of one vertebral body over the one below it**, which is characteristic of spondylolisthesis. - In a 65-year-old lady, degenerative spondylolisthesis due to **arthritic changes and instability** is a common cause of backache. *Osteoporotic fracture* - An osteoporotic fracture would typically show a **compression deformity** or a wedge-shaped vertebral body, which is not clearly depicted here. - While osteoporosis is common in this age group, the primary finding on this image is vertebral slippage, not fracture. *Spondylolysis* - Spondylolysis is a **defect in the pars interarticularis** (a thin segment of bone connecting the superior and inferior articular facets) and is best seen on oblique views or CT. - Although spondylolysis can *lead to* spondylolisthesis, the immediate and most striking finding on this lateral view is the slippage itself. *Discitis* - Discitis, an **inflammation or infection of the intervertebral disc and adjacent vertebrae**, would typically show **loss of disc height** and **endplate irregularities or erosions**. - These features are not the predominant finding on this image, which clearly demonstrates vertebral body displacement.

Q: Which of the following conditions is most commonly associated with cauda equina syndrome?

Herniated disc. ***Herniated disc*** - A **large central disc herniation**, especially at the L4-L5 or L5-S1 level, often compresses multiple nerve roots of the **cauda equina** [1]. - This compression leads to the characteristic symptoms of **saddle anesthesia**, **bowel/bladder dysfunction**, and **bilateral leg weakness**. *Trauma* - While **severe trauma** to the lumbar spine (e.g., fractures, dislocations) can cause cauda equina syndrome, it is a less common cause than disc herniation [1]. - Trauma typically involves an acute, high-energy injury, distinct from the more gradual onset seen with disc pathology. *Tumor* - **Spinal tumors**, both primary and metastatic, can compress the cauda equina, but they are relatively rare compared to disc herniations [1]. - Tumor-related cauda equina syndrome often presents with more insidious symptom progression and may include systemic symptoms or a history of malignancy. *Spinal stenosis* - **Spinal stenosis** can cause compression of nerve roots, typically leading to neurogenic claudication. - While severe stenosis can contribute to cauda equina symptoms, it generally involves diffuse narrowing over multiple levels and is less likely to cause acute, severe cauda equina syndrome than a single, large disc herniation.

Q: Vertebra Plana is associated with all of the following conditions except -

Scheurmanns Disease. ***Scheurmanns Disease*** - **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana). - It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana. *Histiocytosis X* - **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**. - This condition is common among young children and is associated with eosinophilic granuloma. *Leukemia* - **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana. - This is often seen in pediatric patients with acute lymphoblastic leukemia. *Excessive use of systemic steroids* - Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana. - This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.

Q: In which condition is the Milwaukee Brace primarily used?

Adolescent Idiopathic Scoliosis. ***Adolescent Idiopathic Scoliosis*** - The **Milwaukee Brace** is a widely recognized and historically significant orthotic device used primarily for the non-surgical management of **scoliosis**, particularly **adolescent idiopathic scoliosis**. - It works by applying corrective forces to the spine to prevent further curvature progression and often allows for some correction during growth. *Congenital Kyphosis* - **Congenital kyphosis** is a spinal deformity present at birth, often caused by vertebral malformations, which is typically managed surgically, especially if progressive. - While bracing can be attempted for mild, flexible curves, the Milwaukee Brace is not the primary or most effective treatment for its structural nature. *Scheuermann's Disease* - **Scheuermann's disease** is a form of kyphosis where wedging of the vertebrae causes a rigid, exaggerated forward curvature of the thoracic spine. - While bracing can be used to treat Scheuermann's disease, the **Milwaukee brace** is not the brace of choice. A **kyphosis-specific brace** such as a kyphosis-bifocal brace or a molded thoracolumbar sacral orthosis (TLSO) is typically preferred. *Spondylolisthesis* - **Spondylolisthesis** involves the forward slippage of one vertebra over another, often in the lumbar spine. - Management typically involves activity restriction, physical therapy, and sometimes surgical fusion, with bracing aimed at stabilizing the spine rather than correcting a lateral curve, making the Milwaukee Brace unsuitable.

Q: Adson's test is positive in -

Cervical rib. ***Cervical rib*** - **Adson's test** assesses for **thoracic outlet syndrome (TOS)**, which can be caused by a cervical rib compressing the **subclavian artery** or **brachial plexus**. - A positive test occurs when the radial pulse diminishes or disappears upon specific head and arm maneuvers, indicating neurovascular compression. *Cervical spondylosis* - This condition involves **degenerative changes** in the cervical spine, such as bone spurs and disc herniation. - While it can cause neurological symptoms, it typically does not lead to a positive Adson's test, as the compression site is different from that assessed by the test. *Cervical fracture* - A cervical fracture is a **traumatic injury** to the bones of the neck. - Adson's test is not indicated for diagnosing fractures and performing it could exacerbate the injury. *Cervical dislocation* - Cervical dislocation is a severe injury where cervical vertebrae are **displaced from their normal alignment**. - Similar to fractures, Adson's test is not appropriate for diagnosing or evaluating dislocations and carries a risk of further injury.

Q: Halopelvic traction is primarily used for correcting which specific spinal deformity?

Kyphosis. **Kyphosis** * **Halopelvic traction** is a technique specifically designed to apply sustained corrective forces to the spine, making it particularly effective in treating severe **kyphosis**, especially in young patients prior to surgical correction. * It aids in gradually stretching soft tissues and straightening the spinal curvature over time, often used in cases of congenital or severe developmental kyphosis. *Scoliosis* * While traction can be used in some spinal deformities, **scoliosis** (lateral curvature) is more commonly treated with **bracing** or **surgical fusion**, as halopelvic traction is less effective in correcting the rotational component. * Correction of scoliotic curves typically involves forces applied in multiple planes, which halopelvic traction is not ideally suited for. *Spondylolisthesis* * **Spondylolisthesis** involves the **slippage of one vertebra over another**, which is primarily managed through **stabilization** to prevent further slippage. * Halopelvic traction is not indicated as it could potentially exacerbate instability in the presence of vertebral slippage. *Spinal stenosis* * **Spinal stenosis** refers to the **narrowing of the spinal canal**, which compresses nerves and is usually treated with **decompressive surgery** or **conservative management** for pain relief. * Traction methods are generally not used for spinal stenosis as they do not address the underlying anatomical narrowing and may worsen symptoms.

Q: What is considered a poor prognostic indicator in Pott's paraplegia?

Rapid progression of neurological deficits. ***Rapid progression of neurological deficits*** - **Rapid progression** implies severe spinal cord damage occurring quickly, which is less likely to fully recover even with treatment. - This indicates a more aggressive disease process or significant compression that can lead to irreversible neurological impairment. *Healed disease* - **Healed disease** (even if paraplegia existed previously) indicates that the infection is resolved and the destructive process has stopped, allowing for potential neurological recovery or stability. - While residual neurological deficits might remain, the absence of active inflammation improves the long-term prognosis compared to ongoing damage. *Chronic disease* - **Chronic disease** in the context of Pott's paraplegia often refers to established deficits after a prolonged course, but it doesn't necessarily imply ongoing active deterioration. - The chronicity itself, without rapid progression, suggests a more stable state where the damage has already occurred, and further deterioration might be slow or absent. *Active disease* - **Active disease** means the infection is still present and causing bone destruction, which is a concern. - However, if the neurological deficits are not rapidly progressing, there is still a window for treatment to stop the disease and potentially allow for some recovery, distinguishing it from an acute, rapidly deteriorating situation.

Q: Block vertebrae are seen in which condition?

Klippel-Feil syndrome. ***Klippel-Feil syndrome*** - **Block vertebrae** are a characteristic radiographic finding in **Klippel-Feil syndrome**, resulting from the congenital fusion of two or more cervical vertebrae. - This fusion leads to a **short neck**, **low hairline**, and **restricted neck motion**. *Pagets disease* - **Paget's disease** is a chronic condition of abnormal bone remodeling, leading to enlarged and weakened bones. - While it can cause vertebral body changes, **block vertebrae** resulting from congenital fusion are not a typical feature. *Leukemia* - **Leukemia** involves uncontrolled proliferation of abnormal white blood cells, which can infiltrate bone marrow and cause lytic or blastic lesions in bones. - It does not cause **block vertebrae**, which are a developmental anomaly. *TB* - **Tuberculosis (TB) of the spine (Pott's disease)** is an infectious condition causing vertebral destruction, collapse, and kyphosis. - While TB can lead to vertebral collapse and eventual fusion during healing, the primary pathology is destructive and not the congenital fusion seen as **block vertebrae**.

Q: What is a Hangman's fracture?

Fracture dislocation of C2. ***Fracture dislocation of C2*** - A Hangman's fracture classically refers to a **bilateral fracture of the pars interarticularis of the axis (C2)**, often with an associated anterior subluxation of C2 on C3. - This injury is typically caused by **hyperextension-distraction forces**, such as those experienced in judicial hangings or motor vehicle accidents. *Subluxation of C5 over C6* - While cervical subluxations are serious, a **C5-C6 subluxation** does not specifically describe a Hangman's fracture. - This type of injury involves different vertebral levels and typically results from different mechanisms. *Fracture dislocation of ankle joint* - This option refers to an injury in the **lower limb**, completely unrelated to the cervical spine. - A Hangman's fracture is a specific type of **cervical vertebral fracture**. *Fracture of odontoid* - A fracture of the odontoid process involves the **dens (odontoid process)** of C2. - This is a distinct type of C2 fracture from a Hangman's fracture, which involves the **pars interarticularis**.

Question 1

What is the angle shown in the image known as?

Accepted Answer

Cobb angle

Answer

Bohler angle

Answer

Ferguson angle

Answer

Baumann angle

Question 2

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 3

Which of the following conditions is most commonly associated with cauda equina syndrome?

Accepted Answer

Herniated disc

Answer

Trauma

Answer

Tumor

Answer

Spinal stenosis

Question 4

Vertebra Plana is associated with all of the following conditions except -

Accepted Answer

Scheurmanns Disease

Answer

Leukemia

Answer

Excessive use of systemic steroids

Answer

Histiocytosis X

Question 5

In which condition is the Milwaukee Brace primarily used?

Accepted Answer

Adolescent Idiopathic Scoliosis

Answer

Spondylolisthesis

Answer

Scheuermann's Disease

Answer

Congenital Kyphosis

Question 6

Adson's test is positive in -

Accepted Answer

Cervical rib

Answer

Cervical spondylosis

Answer

Cervical fracture

Answer

Cervical dislocation

Question 7

Halopelvic traction is primarily used for correcting which specific spinal deformity?

Accepted Answer

Kyphosis

Answer

Spondylolisthesis

Answer

Scoliosis

Answer

Spinal stenosis

Question 8

What is considered a poor prognostic indicator in Pott's paraplegia?

Accepted Answer

Rapid progression of neurological deficits

Answer

Healed disease

Answer

Chronic disease

Answer

Active disease

Question 9

Block vertebrae are seen in which condition?

Accepted Answer

Klippel-Feil syndrome

Answer

Pagets disease

Answer

Leukemia

Answer

TB

Question 10

What is a Hangman's fracture?

Accepted Answer

Fracture dislocation of C2

Answer

Fracture dislocation of ankle joint

Answer

Fracture of odontoid

Answer

Subluxation of C5 over C6

Spine Disorders — MCQs

Spine Disorders — MCQs

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