Spine Trauma Imaging — MCQs

10 questions

Not a radiological feature of Ankylosing spondylitis

Regarding Hangman's fracture, which of the following statements are correct? 1) Fracture of either pedicles or lamina of C2 cervical vertebra 2) Bilateral in nature

Teardrop fracture of lower cervical spine implies -

A 35-year-old male presents to the emergency department following a high-speed motor vehicle accident. He complains of severe lower back pain but denies any loss of consciousness or abdominal pain. A lateral X-ray of the lumbar spine is obtained, as shown in the image. The image reveals a horizontal fracture through the vertebral body, extending through the posterior elements. Based on the clinical presentation and imaging findings, what is the most likely diagnosis?

Jefferson fracture is -

Undertaker's fracture is seen at the level of cervical vertebra:

Which of the following statements about Hangman's fracture is correct?

Dennis stability concept is based on which of the following?

A man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?

Q10

What is the investigation of choice in a patient with traumatic paraplegia?

Spine Trauma Imaging Indian Medical PG Practice Questions and MCQs

Question 1: Not a radiological feature of Ankylosing spondylitis

A. Romanus sign
B. Fish mouth vertebrae (Correct Answer)
C. Trolley track sign
D. Dagger sign

Explanation: **Fish mouth vertebrae** - **Fish mouth vertebrae**, characterized by concave vertebral bodies, are typically seen in conditions like **osteoporosis** or **sickle cell anemia**, resulting from vertebral compression or infarction. - This appearance is not a characteristic radiological feature of **ankylosing spondylitis**, which primarily involves fusion and ossification of spinal ligaments. *Romanus sign* - The **Romanus sign** refers to erosions at the anterior and posterior corners of the vertebral bodies, an early and characteristic radiological feature of **ankylosing spondylitis**. - These erosions eventually lead to squaring of the vertebrae. *Trolley track sign* - The **trolley track sign** is a classic late-stage radiological finding in **ankylosing spondylitis**, indicating ossification of the interspinous and supraspinous ligaments, and the facet joint capsules. - This results in three parallel lines visible on an anteroposterior spinal radiograph. *Dagger sign* - The **dagger sign** is another characteristic radiological feature of **ankylosing spondylitis**, representing ossification of the supraspinous and interspinous ligaments. - It appears as a single central radiopaque line on an anteroposterior spinal radiograph.

Question 2: Regarding Hangman's fracture, which of the following statements are correct? 1) Fracture of either pedicles or lamina of C2 cervical vertebra 2) Bilateral in nature

A. Both are false
B. 2 is true, 1 is false
C. 1 is true, 2 is false
D. Both are true (Correct Answer)

Explanation: ***Both are true*** - A **Hangman's fracture** is specifically a fracture through the **pedicles** (or pars interarticularis) of the **C2 vertebra**, which can also involve the lamina. - This fracture is inherently **bilateral** across both pedicles, classifying it as a spondylolisthesis of C2 on C3. *Both are false* - This option is incorrect because both presented statements are accurate descriptions of a Hangman's fracture. - The definition and typical presentation of this fracture align with both points. *1 is true, 2 is false* - This is incorrect because the fracture of the C2 pedicles/lamina is indeed the hallmark (statement 1), but the bilateral nature across the pedicles is also a defining characteristic, making statement 2 true as well. - A Hangman's fracture is a **traumatic spondylolisthesis** of C2 on C3 due to bilateral pedicle fractures. *2 is true, 1 is false* - This is incorrect because statement 1 accurately defines the location of the fracture at the **C2 pedicles/lamina**. - While it is **bilateral**, the primary anatomical location in C2 is foundational to the diagnosis.

Question 3: Teardrop fracture of lower cervical spine implies -

A. Wedge compression fracture
B. Axial compression fractures
C. Flexion-rotation injury with failure of anterior body
D. Flexion compression failure of body (Correct Answer)

Explanation: ***Flexion compression failure of body*** - A **teardrop fracture** of the lower cervical spine is typically caused by a **flexion-compression mechanism**, leading to a fracture of the anteroinferior vertebral body. - This results in a small, triangular fragment (the "teardrop") separated from the main vertebral body, often associated with **cervical instability** and potential neurological deficits. *Wedge compression fracture* - A **wedge compression fracture** primarily involves anterior vertebral body collapse due to **axial loading** and flexion, but without the distinct separation of an anteroinferior fragment characteristic of a teardrop. - While it involves compression, it lacks the specific force vector and resulting fragment morphology seen in a teardrop fracture. *Axial compression fractures* - **Axial compression fractures** (e.g., burst fractures) typically result from a force directly along the spinal axis, causing the vertebral body to **explode outwards** and potentially into the spinal canal. - These fractures show widening of the interpedicular distance and posterior element involvement, which are not primary features of a simple teardrop fracture. *Flexion-rotation injury with failure of anterior body* - A **flexion-rotation injury** often leads to more complex patterns, such as **facet dislocation** or unilateral/bilateral interfacetal dislocation. - While it can involve anterior vertebral body failure, the primary mechanism of a classical teardrop fracture is **pure flexion-compression**, not significant rotation.

Question 4: A 35-year-old male presents to the emergency department following a high-speed motor vehicle accident. He complains of severe lower back pain but denies any loss of consciousness or abdominal pain. A lateral X-ray of the lumbar spine is obtained, as shown in the image. The image reveals a horizontal fracture through the vertebral body, extending through the posterior elements. Based on the clinical presentation and imaging findings, what is the most likely diagnosis?

A. Burst fracture
B. Compression fracture
C. Chance fracture (Correct Answer)
D. Spondylolisthesis

Explanation: ***Chance fracture*** - A **chance fracture** is characterized by a **horizontal fracture** through the entire vertebral body and posterior elements, including the neural arch, typically caused by a **flexion-distraction mechanism** in accidents like those involving seatbelts (lap belt only), consistent with the high-speed motor vehicle accident scenario. - The image distinctly shows a fracture line traversing the vertebral body and extending into the posterior elements, which is the hallmark of this type of injury. *Burst fracture* - A **burst fracture** involves a comminuted fracture of the vertebral body with **retropulsion of bone fragments** into the spinal canal due to axial loading, which is not clearly depicted here. - While it can result from high-impact trauma, the characteristic horizontal disruption of both anterior and posterior segments points away from a solely compressive mechanism. *Compression fracture* - A **compression fracture** primarily involves the **anterior wedging** or collapse of the vertebral body, resulting from only axial compression forces without significant involvement of the posterior elements. - The presented image shows a fracture extending through the posterior elements, which is not typical for a simple compression fracture. *Spondylolisthesis* - **Spondylolisthesis** is the **anterior slippage of one vertebral body over another**, often due to pars interarticularis defects (spondylolysis) or degenerative changes. - This condition involves vertebral displacement, not a fresh fracture line across the body and posterior elements as seen in the image.

Question 5: Jefferson fracture is -

A. Fracture of any cervical vertebra
B. Fracture of axis
C. Fracture of spinous process of C7
D. Fracture of atlas (Correct Answer)

Explanation: ***Fracture of atlas*** - A **Jefferson fracture** specifically refers to a **burst fracture** of the **C1 vertebra (atlas)**, caused by a compressive force on the head. - This type of fracture often involves **four separate fractures** within the anterior and posterior arches of the atlas. *Fracture of any cervical vertebra* - This is a too broad a statement; while the atlas is a cervical vertebra, a Jefferson fracture is a specific type affecting only C1. - Cervical spine fractures can involve various vertebrae (C1-C7) and different fracture patterns, not all of which are Jefferson fractures. *Fracture of axis* - The **axis** is the **C2 vertebra**, and its characteristic fractures include a **dens fracture** or a **hangman's fracture**, which involve different mechanisms and anatomical locations than a Jefferson fracture. - Injury to C2 can cause different neurological deficits compared to C1. *Fracture of spinous process of C7* - A fracture of the spinous process of C7 is known as a **clay-shoveler's fracture** and is typically an avulsion injury, not a burst fracture from axial compression. - This type of fracture usually results from forceful neck flexion, leading to avulsion of the spinous process.

Question 6: 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.

Question 7: Which of the following statements about Hangman's fracture is correct?

A. Odontoid fractures are more common than Hangman's fractures.
B. Surgical treatment is rarely necessary.
C. High post-admission mortality is uncommon.
D. Most cases heal well without surgery. (Correct Answer)

Explanation: **Most cases heal well without surgery.** * A **Hangman's fracture** is a fracture of both pedicles of the **axis (C2)** vertebra, typically caused by hyperextension and distraction. * Despite being a severe injury, most stable Hangman's fractures (Type I and some Type II) can be managed non-surgically with **halo immobilization** and achieve good healing outcomes. *Odontoid fractures are more common than Hangman's fractures.* * **Odontoid fractures** (fractures of the dens of C2) are actually more common than Hangman's fractures. * Odontoid fractures constitute about **10-15% of all cervical spine fractures**, whereas Hangman's fractures are less frequent. *Surgical treatment is rarely necessary.* * While many stable Hangman's fractures heal non-surgically, **surgical treatment is often necessary** for unstable fractures, such as most Type IIA and Type III fractures, or failed non-operative management. * Unstable fractures involve significant **displacement**, angular deformity, or compromise of the spinal canal, warranting surgical stabilization. *High post-admission mortality is uncommon.* * Hangman's fractures, especially unstable types, can be associated with significant **spinal cord injury** and instability. * Therefore, a **high post-admission mortality** can occur, particularly in severe cases or those with associated injuries, making this statement incorrect.

Question 8: Dennis stability concept is based on which of the following?

A. 4 columns
B. 3 columns (Correct Answer)
C. 5 columns
D. 2 columns

Explanation: ***3 columns*** - The **Denis classification** system for spinal stability divides the vertebra into three conceptual columns: **anterior**, **middle**, and **posterior**. - This three-column model helps in assessing the **stability of spinal fractures** and guiding treatment decisions. *4 columns* - The four-column concept is **not standard** for Denis classification; it would overcomplicate the established three-column model. - Adding a fourth column lacks the **clinical utility** and widespread acceptance of the Denis system. *5 columns* - A five-column system is **not recognized** in the standard Denis classification of spinal stability. - Such a detailed breakdown would be **excessive** and not provide additional practical information for assessing stability. *2 columns* - The two-column concept, often seen in older classifications like **Holdsworth classification**, predates Denis's work and was found to be **less comprehensive** for assessing spinal stability. - It does not account for the critical stabilizing role of the **middle column** in spinal fractures.

Question 9: A man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?

A. MRI
B. CECT
C. NCCT (Correct Answer)
D. X-ray

Explanation: ***NCCT*** - **Non-contrast Computed Tomography (NCCT)** of the head is the **investigation of choice** for acute head trauma due to its rapid acquisition, wide availability, and excellent sensitivity for detecting acute hemorrhage, fractures, and mass effects. - It rapidly identifies life-threatening conditions such as **epidural, subdural, and intracerebral hemorrhages**, which require immediate intervention. *MRI* - **MRI** is superior for detecting subtle brain tissue injuries, diffuse axonal injury, and non-hemorrhagic lesions but is generally **not the first-line investigation** in acute trauma due to longer scan times, limited availability in the emergency setting, and inability to detect acute hemorrhage as clearly as CT. - Its use is typically reserved for follow-up studies or when CT findings are inconclusive or specific soft tissue detail is required. *CECT* - **Contrast-enhanced CT (CECT)** of the head is reserved for specific indications like evaluating vascular lesions (e.g., aneurysms, arteriovenous malformations) or tumors, which are generally **not the primary concern** in the initial assessment of acute head trauma. - Administering contrast agents can delay imaging, may pose risks to patients with renal impairment or allergies, and does not significantly improve the detection of acute traumatic hemorrhage compared to NCCT. *X-ray* - **X-rays** of the skull are useful for detecting **skull fractures**, but they provide **limited information** regarding intracranial injuries or soft tissue damage, which are critical in head trauma. - They have largely been superseded by CT scans, which offer a more comprehensive view of both bony structures and intracranial contents.

Question 10: What is the investigation of choice in a patient with traumatic paraplegia?

A. Myelography
B. CT scan
C. MRI scan (Correct Answer)
D. Plain X-ray

Explanation: ***MRI scan*** - An **MRI scan** provides superior imaging of **soft tissues**, including the spinal cord, nerves, and ligaments, which are crucial for assessing damage in **traumatic paraplegia**. - It is essential for detecting **spinal cord compression**, hemorrhage, edema, and ligamentous injuries that may not be visible on other imaging modalities. *Plain X-ray* - A **plain X-ray** primarily visualizes bony structures and can detect major **fractures or dislocations** but offers limited information about the spinal cord or soft tissue damage. - It may miss subtle bony injuries and provides no information on **spinal cord integrity**, which is critical in paraplegia. *Myelography* - **Myelography** involves injecting contrast dye into the spinal canal and then performing X-rays or CT scans, which is an **invasive procedure** with potential risks. - While it can demonstrate **spinal cord compression** indirectly, it has largely been replaced by MRI due to its invasiveness and MRI's direct visualization capabilities. *CT scan* - A **CT scan** is excellent for evaluating **bony injuries**, such as vertebral fractures and alignment, with good detail. - However, it is less effective than MRI for directly visualizing the **spinal cord itself** and assessing soft tissue damage, which is paramount in paraplegia.

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