Spine Disorders Practice Questions

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**.

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: Whiplash injury is a tear of which ligament?

Post. longitudinal ligament. ***Post. longitudinal ligament*** - Whiplash injury, often caused by **hyperextension-hyperflexion** of the cervical spine, commonly results in a tear of the **posterior longitudinal ligament**. - This ligament is crucial for stabilizing the spine and preventing **hyperflexion**, making it vulnerable during sudden, forceful movements. *Ligamenta flava* - The **ligamenta flava** are located on the posterior aspect of the vertebral canal and are primarily composed of elastic tissue, providing flexibility. - While they can be injured in severe trauma, they are less commonly implicated in typical whiplash compared to the **posterior longitudinal ligament**. *Anterior longitudinal ligament* - The **anterior longitudinal ligament** is primarily involved in preventing **hyperextension** of the spine. - While it can be injured in whiplash, the hyperextension phase typically stresses this ligament, but the hyperflexion rebound phase is more damaging to posterior structures. *Supraspinal ligament* - The **supraspinal ligament** connects the tips of the spinous processes and primarily limits **flexion** of the spine. - While it can be strained during whiplash, it is not the primary ligament commonly torn in typical whiplash injuries, which often involve deeper spinal ligaments.

Q: Most common cause of kyphotic deformity ?

Osteoporosis. ***Osteoporosis*** - **Osteoporosis** leads to vertebral compression fractures, particularly in the thoracic spine, which causes a gradual collapse of the vertebral bodies and an increase in the kyphotic curve. - This condition is very common, especially in **postmenopausal women** and the elderly, making it the most frequent cause of kyphotic deformity. *Trauma* - While significant **spinal trauma** can lead to kyphotic deformities, it is generally less common than the gradual kyphosis resulting from osteoporosis. - Traumatic kyphosis usually results from severe injuries leading to **vertebral body collapse** or neurological deficits. *Ankylosing spondylitis* - **Ankylosing spondylitis** can cause severe kyphosis, often referred to as a "bamboo spine," due to chronic inflammation and fusion of the vertebrae. - However, it is a less prevalent condition compared to **osteoporosis-related kyphosis**. *Rickets* - **Rickets**, a childhood bone disorder caused by **vitamin D deficiency**, can lead to bone deformities including kyphosis due to softened bones. - While a cause in children, its prevalence is lower than osteoporosis globally as a cause of kyphosis and it primarily affects a different age group.

Q: Anterolateral decompression is primarily indicated for

Spinal tuberculosis (Pott's disease). ***Spinal tuberculosis (Pott's disease)*** - **Anterolateral decompression** is crucial for **Pott's disease** to remove infected bone and pus, relieve pressure on the spinal cord, and facilitate fusion. - This approach allows direct access to the anterior spinal column, which is commonly affected by the destructive process of **tuberculosis**. *Spinal metastasis* - While spinal metastasis can cause compression, **anterolateral decompression** is less common as a primary approach; often, surgical treatment involves posterior decompression, stabilization, and adjuvant therapies like radiation. - The goal is often **pain management** and neurological preservation in the context of advanced disease. *Lumbar disc herniation* - **Lumbar disc herniation** is typically addressed by posterior approaches like **microdiscectomy** or laminectomy, which directly access the posterior aspect of the disc. - **Anterolateral decompression** is generally not indicated as the primary treatment for standard disc herniations. *Ankylosing spondylitis* - Surgical intervention in **ankylosing spondylitis** is usually reserved for severe kyphosis or spinal fractures, employing osteotomies and stabilization techniques, often through posterior approaches. - **Anterolateral decompression** is not a standard procedure for the typical manifestations or complications of **ankylosing spondylitis**.

Q: How is the degree of deformity in scoliosis calculated?

Cobb's method. ***Cobb's method*** - This is the **standard radiographic measurement** used to assess the severity of spinal curvature in scoliosis. - It involves drawing lines along the **most tilted vertebrae** at the ends of the curve and measuring the angle formed by their intersection. *Hamburger method* - This is not a recognized method for calculating the degree of deformity in scoliosis. - There is **no established medical or orthopedic technique** bearing this name for scoliosis assessment. *Haldane method* - This method is primarily used in **biochemistry** to describe **enzyme kinetics** and is unrelated to scoliosis measurement. - It describes the relationship between reaction rates and reactant concentrations in biological systems. *Milwaukee method* - The **Milwaukee brace** is a historical type of orthotic device used to treat scoliosis, but it is not a method for calculating the degree of deformity. - While it is associated with scoliosis treatment, it does not involve the measurement of the curve itself.

Q: What is the most common movement force involved in fractures of the spine?

Compression. ***Compression*** - **Axial compression** due to falls from a height or direct impact is the most frequent mechanism leading to vertebral body fractures, such as **compression fractures**. - These forces typically crush the vertebral body, often without significant displacement of bone fragments. *Flexion* - While often present in spinal fractures, pure **flexion forces** alone are less common than compression as the primary force. - Flexion forces are most frequently involved in **wedge fractures** and **flexion-distraction injuries**, where they are often combined with compression or distraction. *Extension* - **Extension injuries** are relatively rare and usually occur in specific scenarios like being struck in the chin or in elderly patients with **ankylosing spondylitis**. - These forces can lead to fractures of the posterior elements or **hyperextension injuries** of the anterior spinal column. *Lateral Rotation* - **Rotational forces**, especially when combined with flexion or extension, can cause unstable fracture patterns like **fracture-dislocations**. - However, isolated **lateral rotation** as the primary injury mechanism is much less common than axial compression.

Q: Return of the bulbocavernosus reflex in spinal shock is

Sign of recovery from spinal shock. ***Sign of recovery from spinal shock*** - The return of the **bulbocavernosus reflex (BCR)** is the earliest clinical sign indicating the end of the spinal shock phase. - Its presence signifies that the suppressed **spinal cord segments** below the injury have regained some reflex activity. *Results in loss of all spinal reflexes* - During **spinal shock**, there is indeed a temporary loss of **all spinal reflexes** below the level of injury, but the question refers to the _return_ of the reflex. - The absence of all reflexes is characteristic _of_ spinal shock, not its resolution. *May preserve some reflex activity but not this one* - This statement is incorrect; **spinal shock** is defined by a complete or near-complete lack of **reflex activity** below the lesion. - If some reflex activity were preserved, the patient would not be considered to be in the full phase of spinal shock. *Indicates some recovery of spinal function, but is not the earliest sign of recovery* - The return of the **bulbocavernosus reflex** is, in fact, considered the **earliest reliable clinical sign** that spinal shock is resolving. - Other signs of functional recovery, such as motor or sensory return, typically follow the return of this specific reflex.

Q: What is the most common site of spinal tuberculosis?

T10-L1. ***T10-L1*** - The **thoracolumbar junction** (T10-L1) is the most common site for spinal tuberculosis (Pott's disease) due to its high vascularity and mechanical stress. - This region is particularly susceptible to hematogenous spread of *Mycobacterium tuberculosis*. *C7-T1* - While cervical spine involvement can occur, the **C7-T1 region** is less frequently affected by spinal tuberculosis than the thoracolumbar junction. - Tuberculosis in the cervical spine poses a higher risk for neurological deficits due to the smaller canal diameter. *T1-T5* - The mid-thoracic region (T1-T5) is less common for spinal tuberculosis compared to the thoracolumbar area. - Lesions in this area can still cause significant deformity (gibbus) and potential neurological compromise. *T10-L2* - This option is very close to the correct answer, but **T10-L1** specifically represents the peak incidence within the thoracolumbar region. - Including L2 slightly extends the range, but the highest concentration of cases is typically observed at the junction itself.

Q: Which of the following sites is least common for intervertebral disc prolapse?

T3 - T4. ***T3 - T4*** - Intervertebral disc prolapse is **rare in the thoracic spine** (T2-T12) due to the limited mobility and strong rib cage support. - The T3-T4 level is particularly uncommon as it is located in the **mid-thoracic region**, which experiences less mechanical stress than the thoracolumbar junction. *L4 - L5* - This is one of the **most common sites** for lumbar disc prolapse, accounting for a significant percentage of cases. - The L4-L5 disc is subjected to **considerable mechanical stress** and movement during daily activities. *L5 - S1* - The L5-S1 disc is also a **very common site** for prolapse, frequently second only to L4-L5. - This level experiences high **compressive and rotational forces** due to its position at the base of the lumbar spine. *C6 - C7* - This is the **most common site for cervical disc prolapse**, especially in cases of cervical radiculopathy. - The C6-C7 segment experiences significant **flexion-extension and rotational movements**, predisposing it to disc degeneration and herniation.

Question 1

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

Question 2

Block vertebrae are seen in which condition?

Accepted Answer

Klippel-Feil syndrome

Answer

Pagets disease

Answer

Leukemia

Answer

TB

Question 3

Whiplash injury is a tear of which ligament?

Accepted Answer

Post. longitudinal ligament

Answer

Ligamenta flava

Answer

Supraspinal ligament

Answer

Anterior longitudinal ligament

Question 4

Most common cause of kyphotic deformity ?

Accepted Answer

Osteoporosis

Answer

Trauma

Answer

Ankylosing spondylitis

Answer

Rickets

Question 5

Anterolateral decompression is primarily indicated for

Accepted Answer

Spinal tuberculosis (Pott's disease)

Answer

Lumbar disc herniation

Answer

Ankylosing spondylitis

Answer

Spinal metastasis

Question 6

How is the degree of deformity in scoliosis calculated?

Accepted Answer

Cobb's method

Answer

Hamburger method

Answer

Haldane method

Answer

Milwaukee method

Question 7

What is the most common movement force involved in fractures of the spine?

Accepted Answer

Compression

Answer

Extension

Answer

Flexion

Answer

Lateral Rotation

Question 8

Return of the bulbocavernosus reflex in spinal shock is

Accepted Answer

Sign of recovery from spinal shock

Answer

Results in loss of all spinal reflexes

Answer

May preserve some reflex activity but not this one

Answer

Indicates some recovery of spinal function, but is not the earliest sign of recovery

Question 9

What is the most common site of spinal tuberculosis?

Accepted Answer

T10-L1

Answer

C7-T1

Answer

T1-T5

Answer

T10-L2

Question 10

Which of the following sites is least common for intervertebral disc prolapse?

Accepted Answer

T3 - T4

Answer

L4 - L5

Answer

L5 - S1

Answer

C6 - C7

Spine Disorders — MCQs

Spine Disorders — MCQs

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