Spine Disorders Practice Questions

Q: The material used in vertebroplasty is -

Polymethyl methacrylate. ***Polymethyl methacrylate*** - **Polymethyl methacrylate (PMMA)** is a commonly used **bone cement** in vertebroplasty due to its biocompatibility and mechanical properties. - PMMA rapidly polymerizes in situ, providing **structural support** and **stabilization** to the fractured vertebral body. *Polyethyl methacrylate* - **Polyethyl methacrylate** is another acrylic polymer, but it is less commonly used as a bone cement in vertebroplasty compared to PMMA. - It might have different handling characteristics or mechanical strength than PMMA, making it less ideal for this specific procedure. *Isomethyl methacrylate* - **Isomethyl methacrylate** is not a standard or recognized bone cement used in vertebroplasty. - The prefix "iso-" indicates an isomer, but this specific compound is not typically employed in medical procedures like vertebroplasty. *Isoethyl methacrylate* - **Isoethyl methacrylate** is also not a recognized or standard material used for bone cement in vertebroplasty. - Similar to isomethyl methacrylate, it is not a widely adopted or suitable material for providing structural support in vertebral fractures.

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

3 columns. ***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.

Q: Pseudoclaudication is caused by:

Lumbar canal stenosis. ***Lumbar canal stenosis*** - **Pseudoclaudication**, also known as **neurogenic claudication**, is a classic symptom of **lumbar spinal stenosis**. - This condition involves narrowing of the **spinal canal**, which compresses the **nerve roots** and causes pain, numbness, or weakness in the legs during walking. *Aortic aneurysm* - An **aortic aneurysm** is a localized **dilation of the aorta** and typically causes symptoms due to **rupture**, **compression of adjacent structures**, or **thromboembolism**. - It does not directly cause gait-dependent leg symptoms that characterize pseudoclaudication. *Peripheral vascular disease* - **Peripheral vascular disease (PVD)** causes **vascular claudication**, which is characterized by reproducible muscle pain with exercise due to **ischemia**. - Unlike pseudoclaudication, PVD pain is typically relieved by **rest** and is less affected by posture. *Spinal cord compression* - While **spinal cord compression** can cause neurological deficits, it typically presents with **upper motor neuron signs** (e.g., hyperreflexia, spasticity) below the level of compression. - These symptoms are usually more constant and severe than the intermittent, posture-related symptoms of pseudoclaudication, which primarily affects nerve roots.

Q: Which of the following is least likely to be associated with progressive congenital scoliosis?

Wedge vertebra. ***Wedge vertebra*** - A **wedge vertebra** is a less severe form of vertebral anomaly compared to a hemivertebra, characterized by incomplete formation of the vertebral body on one side. - While it can cause scoliosis, it is significantly **less likely to progress** rapidly or severely compared to anomalies that involve complete lack of formation or fusion. *Hemivertebra* - A **hemivertebra** is a fully unsegmented vertebral body fused to one side of the adjacent segments, leading to a profound congenital deformity and a powerful growth plate on the opposite side. - This imbalance causes a **high likelihood of progression** in congenital scoliosis due to differential growth. *Unilateral unsegmented vertebra with bar* - This anomaly involves a **failure of segmentation** on one side of a vertebral body, creating a "bar" that inhibits growth on that side, while the other side grows normally. - The unrestricted growth on one side coupled with restricted growth on the other creates a significant imbalance, leading to a **high potential for progressive scoliosis**. *Block vertebra* - A **block vertebra** results from a complete failure of segmentation between two or more vertebral bodies along both sides. - While it causes a reduction in vertebral height and potentially some stiffness, it generally leads to **little or no progressive scoliosis** because the growth inhibition is symmetric and balanced on both sides of the spine.

Q: A 45-year-old patient presents with chronic lower back pain. X-ray shows anterior displacement of a vertebral body. What is the likely diagnosis?

Spondylolisthesis. ***Spondylolisthesis*** - This condition involves the **anterior displacement** (slipping forward) of one vertebral body over the one below it, which perfectly matches the X-ray finding. - It often causes **chronic lower back pain**, especially in active individuals or those with degenerative changes. *Spondylosis* - Refers to **degenerative changes** in the spine, including **osteophytes** and **disc space narrowing**, but typically does not involve anterior vertebral displacement. - While it can cause chronic back pain, the specific X-ray finding points away from isolated spondylosis. *Compression fracture* - Involves a **collapse of the vertebral body**, usually due to trauma or osteoporosis, leading to a **decreased vertebral height**. - It does not present as an anterior displacement of an entire vertebral body. *Osteoporosis* - This is a condition of **decreased bone density**, making bones fragile and prone to fractures (e.g., compression fractures), but it does not directly cause anterior vertebral displacement. - While osteoporosis can be an underlying factor for some spinal conditions, it is not the direct diagnosis for the described X-ray finding.

Q: A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?

Cobb's Angle. **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.

Q: A 60-year-old woman with a history of chronic back pain presents with acute-onset sharp pain radiating down the right leg. She also reports numbness and tingling in the foot. What is the best next step in management?

MRI of the spine. ### MRI of the spine - The patient's symptoms of acute-onset sharp pain radiating down the right leg with numbness and tingling strongly suggest **radiculopathy**, likely due to **nerve root compression** from a herniated disc, stenosis, or other pathology [1]. - An **MRI of the spine** is the **most sensitive and specific imaging modality** to visualize soft tissue structures like intervertebral discs, nerve roots, and the spinal cord, allowing for accurate diagnosis and guiding further management. *Bed rest* - While historically recommended, **prolonged bed rest** is generally discouraged for acute low back pain and radiculopathy as it can lead to deconditioning and delayed recovery [2]. - **Modified activity** and early mobilization are often preferred over strict bed rest, even for severe pain [2]. *X-ray of the spine* - An **X-ray of the spine** can identify bony abnormalities like fractures, severe degenerative changes, or spondylolisthesis, but it **cannot visualize soft tissue structures** that are typically responsible for radicular symptoms, such as herniated discs or nerve root compression. - Therefore, it is not the best initial imaging choice for pinpointing the cause of the patient's neurological symptoms. *Physical therapy* - **Physical therapy** is an important component of long-term management for back pain and radiculopathy, focusing on exercises, stretching, and education to improve function and reduce pain. - However, in the setting of **acute, severe radicular symptoms** with numbness and tingling, it is crucial to first establish a definitive diagnosis through imaging to rule out more serious compression and guide appropriate therapeutic interventions.

Q: A 50-year-old male presents with chronic low back pain and has failed 6 weeks of basic conservative management, including rest, NSAIDs, and physical therapy. MRI shows disc herniation at L5-S1 with radiculopathy. There are no features of cauda equina syndrome or progressive neurological deficits. What is the next best step in management?

Epidural steroid injection. ***Epidural steroid injection*** - This is the appropriate **next step** after failed basic conservative management (6 weeks of rest, NSAIDs, PT) for **disc herniation with radiculopathy**, as it targets inflammation at the nerve root level. - **ESI** can provide significant pain relief and improve function, allowing better engagement in rehabilitation before considering surgical options. *Acupuncture* - While acupuncture may provide some **adjunctive benefit** for chronic pain, it is not considered standard next-line therapy for symptomatic disc herniation with radiculopathy. - There is **limited evidence** supporting its effectiveness in resolving nerve compression or significant radicular symptoms compared to epidural steroid injection. *NSAIDs* - **NSAIDs** were already part of the initial conservative management that failed over 6 weeks. - Continuing the same approach that has proven **ineffective** is not appropriate; escalation to more targeted therapy is indicated. *Surgical decompression* - Surgery is typically reserved for patients who have failed **epidural steroid injections** or have progressive neurological deficits, cauda equina syndrome, or intractable pain. - Since there are **no progressive neurological deficits** or cauda equina features, less invasive interventional options should be tried first.

Q: Which of the following is not a typical symptom of a lumbar disc herniation?

Saddle anesthesia. ***Saddle anesthesia*** - While a severe complication, **saddle anesthesia** is indicative of **cauda equina syndrome**, a medical emergency, and not a typical, isolated symptom of a simple lumbar disc herniation. - It suggests **compression of multiple nerve roots** in the lumbosacral region, beyond what is usually seen with a single disc herniation. *Positive straight leg raise test* - This is a common and reliable physical exam finding in patients with **lumbar disc herniation**, indicating nerve root irritation. - It elicits radiating pain down the leg when the affected leg is raised between 30 and 70 degrees. *Radicular leg pain* - **Radicular pain**, often described as sharp, shooting pain down the leg, is the hallmark symptom of a lumbar disc herniation as it signifies **nerve root compression**. - The pain typically follows a **dermatomal pattern**, corresponding to the specific nerve root involved. *Weakness in foot dorsiflexion* - Weakness in **foot dorsiflexion** (commonly affecting the **L4 or L5 nerve roots**) is a frequently observed neurological deficit in lumber disc herniation. - This can be assessed through manual muscle testing and is a sign of **motor nerve root compression**.

Q: A 50-year-old male with a history of chronic low back pain presents with new-onset bowel and bladder incontinence. What is the next best step in management?

Urgent MRI of the spine. ***Urgent MRI of the spine*** - The new onset of **bowel and bladder incontinence** in a patient with chronic low back pain is highly suggestive of **cauda equina syndrome**. This is a surgical emergency. - An **urgent MRI** is crucial to confirm the diagnosis and identify the level of compression, guiding immediate surgical decompression to prevent permanent neurological deficits. *Conservative management with NSAIDs* - This approach is appropriate for routine, uncomplicated low back pain, but it is entirely inadequate for a **neurological emergency** like potential cauda equina syndrome. - Delaying definitive diagnosis and treatment in such cases can lead to irreversible neurological damage, including chronic incontinence and paralysis. *Bed rest* - While bed rest might be recommended for acute exacerbations of certain types of back pain, it is not a primary treatment for neurologic emergencies and will not resolve the underlying compression causing **cauda equina syndrome**. - Prolonged bed rest can also lead to complications like deconditioning and venous thromboembolism, and it would waste critical time for diagnosis and intervention. *Physical therapy* - Physical therapy is a cornerstone of management for chronic low back pain and for rehabilitation after an acute event once stability is achieved. - However, in cases of suspected **cauda equina syndrome**, physical therapy is contraindicated as an initial step because it does not address the acute spinal cord or nerve root compression and may worsen the condition or delay necessary surgical intervention.

Question 1

The material used in vertebroplasty is -

Accepted Answer

Polymethyl methacrylate

Answer

Polyethyl methacrylate

Answer

Isomethyl methacrylate

Answer

Isoethyl methacrylate

Question 2

Dennis stability concept is based on which of the following?

Accepted Answer

3 columns

Answer

4 columns

Answer

5 columns

Answer

2 columns

Question 3

Pseudoclaudication is caused by:

Accepted Answer

Lumbar canal stenosis

Answer

Aortic aneurysm

Answer

Peripheral vascular disease

Answer

Spinal cord compression

Question 4

Which of the following is least likely to be associated with progressive congenital scoliosis?

Accepted Answer

Wedge vertebra

Answer

Hemivertebra

Answer

Unilateral unsegmented vertebra with bar

Answer

Block vertebra

Question 5

A 45-year-old patient presents with chronic lower back pain. X-ray shows anterior displacement of a vertebral body. What is the likely diagnosis?

Accepted Answer

Spondylolisthesis

Answer

Spondylosis

Answer

Compression fracture

Answer

Osteoporosis

Question 6

A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?

Accepted Answer

Cobb's Angle

Answer

Bohler's Angle

Answer

Ferguson's Angle

Answer

Pauwels' Angle

Question 7

A 60-year-old woman with a history of chronic back pain presents with acute-onset sharp pain radiating down the right leg. She also reports numbness and tingling in the foot. What is the best next step in management?

Accepted Answer

MRI of the spine

Answer

Bed rest

Answer

X-ray of the spine

Answer

Physical therapy

Question 8

A 50-year-old male presents with chronic low back pain and has failed 6 weeks of basic conservative management, including rest, NSAIDs, and physical therapy. MRI shows disc herniation at L5-S1 with radiculopathy. There are no features of cauda equina syndrome or progressive neurological deficits. What is the next best step in management?

Accepted Answer

Epidural steroid injection

Answer

Surgical decompression

Answer

Acupuncture

Answer

NSAIDs

Question 9

Which of the following is not a typical symptom of a lumbar disc herniation?

Accepted Answer

Saddle anesthesia

Answer

Positive straight leg raise test

Answer

Radicular leg pain

Answer

Weakness in foot dorsiflexion

Question 10

A 50-year-old male with a history of chronic low back pain presents with new-onset bowel and bladder incontinence. What is the next best step in management?

Accepted Answer

Urgent MRI of the spine

Answer

Conservative management with NSAIDs

Answer

Bed rest

Answer

Physical therapy

Spine Disorders — MCQs

Spine Disorders — MCQs

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