Spine Flashcards
(MSK) 9. The following MRI features favour spinal mets fracture rather than an osteoporotic collapse: (T/F)
(a) Convex posterior border of the vertebral body.
(b) Diffuse paraspinal mass.
(c) Abnormal signal in the neural arch.
(d) Low signal intensity band on T1W MRI.
(e) Areas of normal marrow signal vertebral body.
Answer:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Diffuse paraspinal mass is not helpful in differentiating between metastatic and osteoporotic collapse. However focal paraspinal mass is seen more frequently with metastatic collapse. Low signal intensity band on T1WI and T2WI is more common in osteoporotic collapse (93%) than in metastatic collapse (44%). Spared normal marrow signal in a vertebral body is highly suggestive of osteoporotic collapse.
(MSK) 20. Which of the following are correct regarding musculoskeletal trauma. (T/F)
(a) Sternal fracture an indirect sign of thoracic spine injury
(b) Atlanto-occipital dislocation is prequently fatal
(c) Laceration of the dura is commonly associated with lumbar spine fracture
(d) A scapholunate angle of more than 80% is suggestive of scapholunate dissociation
(e) Epiphyseal plate fracture (Salter-Harris type I) are common in nonaccidental injury in children.
Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Laceration of the dura is not associated with lumbar spine fracture. It is more common in patients with a burst fracture that is associated with neurological deficit and laminae fracture. The epiphyseal plate injuries are rarely encountered in non-accidental trauma.
(MSK) 21. Which of the following are correct with regards to the cervical spine: (T/F)
(a) For the erect lateral view of the cervical spine the central beam is directed horizontally to the centre of C3 vertebra.
(b) The space between the odontoid process and the anterior arch of the atlas (atlanto-dens interval) should not exceed 3 mm in adults
(c) A Jefferson fracture is unstable
(d) A swimmer’s view can be used for better demonstration of the C1/C2 junction.
(e) A hangman’s fracture is usually secondary to a hyper-flexion injury
Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
For the erect lateral view the central beam is directed to the centre of C4. A swimmer’s view is used for better visualization of C7/C8/T1. Hangman’s fracture is secondary to hyperextension resulting in bilateral fractures of pedicles of C2. It is unstable injury and accounts for 4-7% of all spinal fractures.
- Regarding diffuse idiopathic skeletal hyperostosis which of the following are correct: (T/F)
(a) Sacroiliac joints are usually involved when the lumbar spine is.
(b) Highest incidence in the 3rd to 5th decades.
(c) Most commonly involves the cervical spine.
(d) Extraspinal ligamentous hyperostosis is a feature.
(e) In the thoracic spine the hyperostoticchanges are more prominent on the right.
Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Diffuse idiopathic skeletal hyperostosis is a common condition characterised by bone proliferation at sites of tendinous and ligamentous insertion of the spine affecting elderly individuals.It commonly affects the elderly more than 50years of age with a slight male predominance. It most commonly involves the lower thoracic spine. Sacroiliac joints are not involved. However, the appearance of spine may be similar to ankylosing spondylitis.
- Which of the following are correct regarding trauma of the neck? (T/F)
(a) The most common site of vertebral artery injury in blunt trauma to the neck is at the C5/C6 level.
(b) Multiple levels are involved in 20% of fractures of the cervical spine.
(c) In blunt neck trauma, dissection of the extracranial carotid artery is asymptomatic in 10% of cases.
(d) Fracture of the odontoid peg most commonly involves the tip.
(e) Barium swallow has poor sensitivity for pharyngoesophageal injury is blunt neck trauma.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Vertebral artery injury is usually due to stretching and occurs most frequently at the C1-C2 level. Vertebral artery injuries are more common than carotid artery injuries in blunt neck trauma. Dissection of the extracranial carotid artery is asymptomatic at presentation in 50% of the cases. Diagnosis may be delayed.
- Which of the following are correct regarding Klippel-Feil syndrome? (T/F)
(a) Vertebral fusion involves the bodies and neural arches.
(b) Coarctation is a feature.
(c) It is associated with Sprengel’s shoulder deformity.
(d) Conductive hearing loss is a feature.
(e) Lymphoedema is a feature.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Klippel Feil syndrome is also associated with syringomyelia, platybasia, clubfoot, hemivertebrae and congenitally heart diseases. Vertebral fusion may involve the craniovertebral junction and cervicothoracic junctions.
- Which of the following are correct regarding fractures of the cervical spine? (T/F)
(a) Flexion teardrop fractures involve the superior endplate of the vertebral body.
(b) Hangman’s fracture is a bilateral fracture of the neural arches of C2.
(c) Unilateral interfacet joint dislocation is a stable injury.
(d) Clay shoveler’s fracture is stable.
(e) In bilateral interfacetal dislocation, there is anterior translocation of the involved vertebra by at least 50% of the diameter of the subjacent vertebrae.
Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Flexion teardrop fractures involve avulsion of the anterior inferior corner, usually of the C2 vertebral body with displacement of the involved vertebral body into the spinal column. There is destruction of all soft tissue structures with an associated acute anterior cervical cord syndrome.
