Thoracic Spine Disorders — MCQs
The compression fracture is commonest in
How is the degree of deformity in scoliosis calculated?
A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?
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?
A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
A man presents with back pain following a road traffic accident (RTA). There is no history of neurological deficit. An X-ray of the spine is done. What is the diagnosis based on the image?
Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?
What is the earliest X-ray sign observed in spinal tuberculosis?
Pott's spine is most common at which specific region of the spine?
Undertaker's fracture is seen at the level of cervical vertebra:
Thoracic Spine Disorders Indian Medical PG Practice Questions and MCQs
Question 1: The compression fracture is commonest in
- A. Upper thoracic spine
- B. Cervical spine
- C. Lumbosacral region
- D. Lower thoracic spine (Correct Answer)
Explanation: ***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 2: How is the degree of deformity in scoliosis calculated?
- A. Hamburger method
- B. Haldane method
- C. Milwaukee method
- D. Cobb's method (Correct Answer)
Explanation: ***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.
Question 3: A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?
- A. Osteoporosis (Correct Answer)
- B. Spondylodiscitis
- C. Pott's spine
- D. Spondylolisthesis
Explanation: ***Osteoporosis*** - The X-ray shows diffuse **osteopenia** (reduced bone density) and **vertebral compression fractures**, particularly visible in the lateral view, which are characteristic findings in elderly patients with osteoporosis and chronic backache. - The vertebral bodies appear **demineralized** and some exhibit a loss of height, suggesting collapse due to weakened bone structure. *Spondylodiscitis* - This condition involves **inflammation of the vertebral body and adjacent intervertebral disc**, typically showing **erosions** of the vertebral endplates and **narrowing of the disc space** on X-ray, which are not clearly evident here as the primary issue. - While it can cause back pain, the dominant finding on this X-ray is widespread bone density loss and fractures, rather than localized infection-related changes. *Pott's spine* - Pott's spine (**tuberculous spondylitis**) is a form of osteomyelitis that causes **destruction of vertebral bodies** and adjacent discs, often leading to a **gibbus deformity** (sharp posterior angulation of the spine). - The X-ray does not show extensive vertebral destruction, paraspinal abscess formation, or typical kyphotic deformity associated with Pott's spine. *Spondylolisthesis* - Spondylolisthesis is characterized by the **forward slippage of one vertebral body over another**, often due to a defect in the pars interarticularis. - While there may be some degenerative changes, there is no clear evidence of significant anterior translation of a vertebral body on the lateral X-ray that would indicate spondylolisthesis.
Question 4: 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?
- A. Meningocele
- B. Kyphosis (Correct Answer)
- C. Meningomyelocele
- D. Lordosis
Explanation: ***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.
Question 5: A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
- A. Bohler's Angle
- B. Ferguson's Angle
- C. Cobb's Angle (Correct Answer)
- D. Pauwels' Angle
Explanation: **Cobb's Angle** - **Cobb's angle** is the primary method for measuring the severity of **scoliosis** on radiographs. - It is measured by drawing lines parallel to the superior endplate of the most tilted superior vertebra and the inferior endplate of the most tilted inferior vertebra of the curve; the angle between these two lines (or their perpendiculars) is the Cobb angle. *Bohler's Angle* - **Bohler's angle** is used in the assessment of **calcaneus fractures** and is measured on a lateral foot radiograph. - A decrease in this angle is indicative of a calcaneal fracture. *Ferguson's Angle* - **Ferguson's angle**, also known as the lumbosacral angle, measures the inclination of the sacrum relative to the horizontal in the standing position. - It is primarily used in the assessment of **spondylolisthesis** and other lumbosacral conditions. *Pauwels' Angle* - **Pauwels' angle** is used to classify **femoral neck fractures** based on the angle of the fracture line relative to the horizontal. - It helps determine the severity and stability of femoral neck fractures, guiding treatment decisions.
Question 6: A man presents with back pain following a road traffic accident (RTA). There is no history of neurological deficit. An X-ray of the spine is done. What is the diagnosis based on the image?
- A. Spinous process fracture (Correct Answer)
- B. Chance fracture
- C. Compression fracture
- D. Fracture of base of vertebrae
Explanation: ***Spinous process fracture*** - The X-ray image reveals a **fracture of the spinous process** of one of the cervical vertebrae, characterized by a visible discontinuity or separation of this posterior bony projection. - This type of fracture, often caused by direct trauma or forceful hyperextension/hyperflexion, typically presents with localized back pain but often **without neurological deficit** as the spinal canal generally remains intact. *Chance fracture* - A **Chance fracture** (or seatbelt fracture) is a horizontal fracture of a vertebral body, usually in the thoracolumbar region, often caused by distractional forces (e.g., flexion over a seatbelt). - It involves all three columns of the spine (anterior, middle, and posterior) and is not seen in the cervical spine X-ray provided. *Compression fracture* - A **compression fracture** is characterized by the collapse of the vertebral body, often resulting in a wedge shape. - This typically appears as reduced height of the anterior vertebral body on an X-ray, which is not the primary finding in the image. *Fracture of base of vertebrae* - A **fracture at the base of the vertebrae** is a non-specific term; specific vertebral fractures are categorized based on the part of the vertebra affected (e.g., vertebral body, pedicle, lamina, spinous process). - The image distinctly shows a fracture in the **spinous process**, not the main body or base of the vertebra.
Question 7: Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?
- A. Two (Correct Answer)
- B. Three
- C. Four
- D. Five
Explanation: ***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.
Question 8: What is the earliest X-ray sign observed in spinal tuberculosis?
- A. Gibbus
- B. Narrowing of disc space (Correct Answer)
- C. Paravertebral shadow
- D. Endplate erosion
Explanation: ***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.
Question 9: Pott's spine is most common at which specific region of the spine?
- A. Sacral
- B. Cervical
- C. Lumbosacral
- D. Thoracolumbar (T12-L1) (Correct Answer)
Explanation: **Thoracolumbar (T12-L1)** - The **thoracolumbar junction (T12-L1)** is the most common site for Pott's spine due to its biomechanical stress and vascular supply, making it a frequent location for spinal tuberculosis. - This region is susceptible to **compression fractures** and bone destruction, leading to kyphotic deformity (gibbus) in advanced cases. *Sacral* - While spinal tuberculosis can affect any part of the spine, the **sacral region** is considerably less common than the thoracolumbar junction. - Infections in the sacrum are often associated with other pelvic involvement or direct extension from adjacent sites. *Cervical* - Tuberculosis of the **cervical spine** can occur but is not as frequent as in the thoracolumbar region. - Clinical manifestations can include **neck stiffness, dysphagia**, and neurological deficits affecting the upper limbs. *Lumbosacral* - The **lumbosacral region** (L5-S1) can be affected by Pott's spine, but it is less common than the thoracolumbar junction. - Involvement here can lead to specific neurological symptoms like **foot drop** or radicular pain in the lower extremities.
Question 10: Undertaker's fracture is seen at the level of cervical vertebra:
- A. C5-C6
- B. C6-C7 (Correct Answer)
- C. C3-C4
- D. C1-C2
Explanation: **C6-C7** - An **undertaker's fracture** is a post-mortem injury typically seen in cases of hanging, resulting from the neck's hyperextension. - It commonly affects the lower cervical spine, most frequently at the **C6-C7 level**, due to the biomechanics of the forces involved. *C5-C6* - While cervical fractures can occur at various levels, **C5-C6** is less common for an undertaker's fracture specifically. - This level is more frequently associated with **cervical spondylosis** or traumatic injuries from falls. *C3-C4* - Fractures at the **C3-C4 level** can be life-threatening as they are close to the phrenic nerve origin, but they are not characteristic of "undertaker's fracture." - Injuries at this level are less common in the specific context of post-mortem hyperextension. *C1-C2* - Fractures of **C1 (atlas) and C2 (axis)**, such as a Jefferson fracture or hangman's fracture, are distinct and result from different mechanisms. - They are not typically referred to as "undertaker's fracture," which implies a specific post-mortem injury pattern.
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