Spine Disorders Practice Questions

Q: What is the earliest X-ray sign observed in spinal tuberculosis?

Narrowing of disc space. ***Narrowing of disc space*** - This is the **earliest radiographic finding** in spinal tuberculosis on plain X-ray, typically appearing within the first few weeks to months of infection. - Tuberculous spondylitis begins in the **anterior subchondral region** near the vertebral endplates, leading to early involvement of the intervertebral disc. - The infection spreads from the vertebral body to the adjacent disc, causing **disc space narrowing** along with endplate irregularities as initial manifestations. - Unlike pyogenic spondylitis, TB shows **relatively preserved** disc space initially, but narrowing is still the earliest visible change. *Endplate erosion* - **Endplate erosion** occurs concurrently with or shortly after disc space narrowing as the tuberculous infection destroys the subchondral bone. - Both findings appear early in the disease course and are often seen together on X-ray. - This represents active bone destruction at the vertebral margins. *Paravertebral shadow* - The **paravertebral abscess** is a characteristic and important finding in spinal tuberculosis, but it develops **later** in the disease course. - It forms as a secondary phenomenon when the infection spreads beyond the vertebral body, with caseous material and pus collecting along the paravertebral ligaments. - While highly suggestive of TB when present, it is not the earliest radiographic sign. *Gibbus* - A **gibbus deformity** is a **late complication** resulting from vertebral body collapse and subsequent angular kyphosis. - It indicates extensive vertebral destruction and significant structural compromise. - This is a clinical and radiographic sign of advanced disease, not an early finding.

Q: Which finding is MOST specific for pseudoclaudication?

Leaning forward reduces the pain.. ***Leaning forward reduces the pain.*** - Leaning forward, as when pushing a shopping cart, widens the **spinal canal**, reducing compression on nerves and alleviating pain in **pseudoclaudication** (neurogenic claudication) [1]. - This position increases the available space for the **spinal cord** and **nerve roots**, which are typically compressed in spinal stenosis [1]. *Pain decreases when walking uphill.* - Walking uphill often worsens **pseudoclaudication** because it can increase lumbar lordosis, further constricting the spinal canal and compressing nerve roots. - In contrast, a decrease in pain when walking uphill would be more characteristic of **vascular claudication** due to improved blood flow against gravity. *Pulses are typically normal in pseudoclaudication.* - While it is true that pulses are typically normal in pseudoclaudication, this is a **negative finding** used to *differentiate* it from vascular claudication, rather than a *specific positive sign* of pseudoclaudication itself. - Normal pulses indicate that the primary issue is not due to vascular compromise, but it doesn't describe the specific mechanism of neurogenic pain relief. *Pain decreases when sitting down* - While sitting down generally relieves pain in **pseudoclaudication** by reducing lumbar lordosis and gravitational load on the spine, it is a less specific indicator than leaning forward. - The act of sitting may also relieve pain in other conditions like general low back pain or muscle fatigue, whereas the forward lean directly targets the spinal canal narrowing.

Q: The most common site for spinal trauma across all mechanisms of injury in the general population is

Cervical spine. ***Cervical spine*** - The **cervical spine** is the **most flexible** part of the vertebral column with a wide range of motion, making it highly susceptible to injury from various mechanisms, including falls, motor vehicle accidents, and diving accidents. - Its anatomical position at the base of the skull directly supporting the head makes it vulnerable to **acceleration-deceleration forces** and impacts. *Thoracic spine* - The **thoracic spine** is relatively **stable and rigid** due to its attachment to the rib cage, which provides significant protection against trauma. - Injuries to the thoracic spine are less frequent compared to the cervical spine, often requiring **high-energy forces**. *Lumbar spine* - The **lumbar spine** is also a common site for trauma, particularly in flexion-distraction injuries, but it is generally **less frequently injured** than the cervical spine across all mechanisms. - While flexible, its larger vertebral bodies and strong musculature provide more stability than the cervical region. *Sacral spine* - The **sacral spine**, being fused and part of the pelvic ring, is **well-protected** and less prone to isolated traumatic injury compared to the mobile segments of the spine. - Injuries to the sacrum often occur in conjunction with pelvic fractures due to **high-impact trauma**.

Q: A 30-year-old male presents with low back pain and neurological symptoms. Based on these findings, what is the most likely diagnosis?

Prolapsed inter-vertebral disc. ### Prolapsed inter-vertebral disc - A **prolapsed or herniated disc** can directly compress spinal nerves or the spinal cord, leading to a variety of neurological symptoms [1]. - This condition is a common cause of **acute low back pain** with radiating leg pain (**sciatica**) and potential weakness or sensory changes in dermatomal distributions [1]. *Spondylolysis* - This refers to a **stress fracture in the pars interarticularis** of a vertebra, often asymptomatic or causing localized back pain. - While it can be a precursor to spondylolisthesis, **spondylolysis itself does not typically cause neurological symptoms** unless there is associated mechanical instability leading to nerve compression. *Spondylosis* - This is a general term for **age-related degenerative changes** in the spine, including disc degeneration, osteophyte formation, and facet joint arthritis [2]. - While severe spondylosis can lead to spinal stenosis and neurological symptoms, the primary presentation is usually **chronic back pain and stiffness**, rather than acute neurological deficits. *Spondylolisthesis* - This condition involves the **forward slippage of one vertebra over another**, often due to bilateral pars fractures (spondylolysis). - While it can cause back pain and, in severe cases, neurological symptoms due to nerve root compression, **prolapsed intervertebral disc is a more common and direct cause** of acute low back pain with neurological symptoms [1].

Q: A right-sided disc herniation at the L5-S1 level typically may cause:

Low back pain and right-sided sciatica. ***Low back pain and right-sided sciatica*** - A right-sided disc herniation at the L5-S1 level typically compresses the **S1 nerve root** on the right side. - This compression leads to **sciatica**, which presents as radiating pain along the S1 dermatome (back of the leg and sole of the foot), often accompanied by localized **low back pain**. *Weakness of dorsiflexion of the right foot* - **Dorsiflexion weakness** is primarily associated with compression of the **L4 or L5 nerve roots**, not S1. - The muscles responsible for dorsiflexion (e.g., tibialis anterior) are predominantly innervated by L4 and L5. *Normal ankle jerk reflex* - The **ankle jerk reflex** is mediated by the **S1 nerve root**. - Therefore, compression of the S1 nerve root would typically lead to a **diminished or absent ankle jerk reflex**, not a normal one. *Diminished sensation over the medial aspect of the foot* - **Diminished sensation** over the **medial aspect of the foot** corresponds to the **L4 dermatome**. - A herniation at L5-S1 primarily affects the S1 dermatome, which involves the **lateral aspect of the foot** and sole.

Q: All are true about Klippel-Feil syndrome EXCEPT:

Bilateral shortening of sternocleidomastoid. ***Bilateral shortening of sternocleidomastoid*** - While Klippel-Feil syndrome affects neck mobility, **shortening of the sternocleidomastoid** muscles is not a diagnostic feature and would typically be associated with congenital torticollis rather than Klippel-Feil syndrome directly. - The primary characteristic of Klippel-Feil is the **fusion of cervical vertebrae**, leading to a classic triad of symptoms. *Bilateral neck webbing* - **Neck webbing**, also known as pterygium colli, can be a feature of Klippel-Feil syndrome, contributing to the appearance of a short neck. - This is often a result of abnormal skin folds and can be associated with other genetic syndromes as well. *Low hair line* - A **low posterior hairline** is one of the classic triad of symptoms associated with Klippel-Feil syndrome, indicating a short neck. - This clinical sign helps in the physical examination diagnosis of the condition. *Restriction of neck movements* - Due to the **fusion of cervical vertebrae**, patients with Klippel-Feil syndrome commonly experience significant **restriction of neck movements**. - This reduced range of motion is a cardinal symptom and part of the classic triad.

Q: What type of spinal injury is characterized by vertical fragmentation of the vertebrae due to axial loading?

Burst fracture. ***Burst fracture*** - A **burst fracture** results from severe axial loading, causing the vertebral body to **fragment vertically**. - Fragments can retropulse into the **spinal canal**, potentially leading to neurological deficits. *Compression fracture* - A **compression fracture** typically occurs from flexion or axial loading, causing the **anterior portion of the vertebral body to collapse** but without significant fragmentation or retropulsion. - The posterior wall of the vertebra usually remains intact, making it relatively stable. *Flexion-rotation injury* - This type of injury involves forces that combine **flexion and rotation**, often causing significant ligamentous and bony disruption, including facet joint dislocation or fracture-dislocation. - It does not primarily lead to vertical fragmentation but rather rotational instability and dislocation. *Extension injury* - An **extension injury** occurs when the spine is forced into excessive extension, often damaging the posterior elements of the vertebrae or causing anterior disc or ligamentous avulsion. - It contrasts with axial loading and fragmentation, typically affecting the posterior vertebral structures.

Question 1

What is the earliest X-ray sign observed in spinal tuberculosis?

Accepted Answer

Narrowing of disc space

Answer

Gibbus

Answer

Paravertebral shadow

Answer

Endplate erosion

Question 2

Which finding is MOST specific for pseudoclaudication?

Accepted Answer

Leaning forward reduces the pain.

Answer

Pain decreases when walking uphill.

Answer

Pulses are typically normal in pseudoclaudication.

Answer

Pain decreases when sitting down

Question 3

The most common site for spinal trauma across all mechanisms of injury in the general population is

Accepted Answer

Cervical spine

Answer

Thoracic spine

Answer

Lumbar spine

Answer

Sacral spine

Question 4

A 30-year-old male presents with low back pain and neurological symptoms. Based on these findings, what is the most likely diagnosis?

Accepted Answer

Prolapsed inter-vertebral disc

Answer

Spondylolysis

Answer

Spondylosis

Answer

Spondylolisthesis

Question 5

A right-sided disc herniation at the L5-S1 level typically may cause:

Accepted Answer

Low back pain and right-sided sciatica

Answer

Normal ankle jerk reflex.

Answer

Weakness of dorsiflexion of the right foot.

Answer

Diminished sensation over the medial aspect of the foot.

Question 6

All are true about Klippel-Feil syndrome EXCEPT:

Accepted Answer

Bilateral shortening of sternocleidomastoid

Answer

Bilateral neck webbing

Answer

Low hair line

Answer

Restriction of neck movements

Question 7

What type of spinal injury is characterized by vertical fragmentation of the vertebrae due to axial loading?

Accepted Answer

Burst fracture

Answer

Compression fracture

Answer

Flexion-rotation injury

Answer

Extension injury

Spine Disorders — MCQs

Spine Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?