non-traumatic spine

QUESTIONS 16 Non-traumatic spinal disorders - I

Multiple Choice Questions
Multiple True-False

1) Os odontoideum
a) is called dystopic when the ossicle moves with the anterior arch of C1
b) the tip of the odontoid process maintains some continuity with the body of C2
c) most likely results from trauma
d) may be associated with Klippel–Feil syndrome
e) can be treated with odontoid screw fixation

2) Syringomyelia
a) involves dilatation of the central ependymal-lined spinal cord canal
b) is present in 90% of patients with Chiari I
c) may be explained by the hydrodynamic theory introduced by Williams
d) is observed in 10% of cases after significant spinal cord trauma
e) light touch, vibration and joint position sense are affected

3) Surgical treatment of cervical rheumatoid arthritis
a) the transoral approach is now decreasingly used
b) cranial settling is an indication for occipito-atlantal fusion
c) asymptomatic patients should be treated conservatively regardless of the atlanto-dental interval
d) the Gallie method is superior to C1/C2 transarticular screw in atlanto-axial fusion
e) MEPs and SSEPs changes are indications for atlantoaxial fusion

4) Physical examination findings in cervical radiculopathy
a) C6 radiculopathy may result in weakness in elbow extension
b) C8 radiculopathy may affect the triceps reflex
c) upper plexus avulsion may mimic C5 radiculopathy
d) C7 radiculopathy should be differentiated from thoracic outlet syndrome
e) T1 radiculopathy results in weakness in finger abduction

5) Thoracic outlet syndrome
a) often presents with neck pain
b) patients have atrophy of the thenar eminence
c) produces numbness in the medial half of the fourth finger
d) has reduced amplitude ulnar sensory potentials in neurophysiology studies
e) transaxillary surgical rib resection is no superior to supraclavicular neuroplasty

6) Treatment of low back pain
a) physiotherapy can improve disability 5-10%
b) randomised trails showed significant improvement after use of TENS machines
c) posterior lumbar interbody fusion with pedicle screws offers early stability
d) anterior lumbar interbody fusion can produce permanent retrograde ejaculation
e) randomised trials have shown that artificial lumbar discs produce better results than pedicle screw fixation

7) Spondylolisthesis
a) has higher incidence in young athletes
b) is more likely to progress in males rather than in females
c) grades I and II should be treated surgically in children and adolescents
d) when is grade III and has slip angle more than 55% should be treated surgically
e) a randomised trial showed similar outcome between surgical and conservative management groups

8) Intradural/extramedullary tumours
a) schwannomas usually originate from motor nerves
b) compared to schwannomas, neurofibromas are more likely to undergo malignant transformation
c) meningiomas are 8 times more common in females rather than in males
d) the recurrence rate of totally excised meningiomas is 15% at 10 years
e) nerve sheath tumours are usually surgically curable

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