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A 72-year-old patient fell from standing height approximately 10 days ago. The patient's neck pain continued to worsen over the last 10 days but has not experienced any associated arm pain or weakness, nor any loss of dexterity. Figure A is her CT scan of the cervical spine during the office visit. Surgical treatment is recommended, but the patient prefers to avoid surgery. The patient is at an increased risk of which of the following complications with nonoperative treatment as opposed to operative treatment?
Vertebral artery occlusion
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An active 79-year-old male fell from standing height and noticed immediate neck pain. Examination in the emergency department reveals 5/5 motor in bilateral upper and lower extremities. Current imaging is shown in Figures A-C. The patient undergoes treatment that included closed reduction under anesthesia immediately followed by a posterior C1-2 fusion utilizing lateral mass screws at C1 and pedicle screws at C2. Which of the following statements is true regarding this treatment approach?
It will increase the rate of nonunion compared to nonoperative treatment.
It will increase the rate of dysphasia compared to treatment in a halo immobilization.
It will decrease mortality compared to nonoperative treatment.
It has a decreased fusion rate compared to an anterior surgical approach
It will lead to a lower SF-36 score.
An 85-year-old man presents with newly-recognized neck pain after an uneventful fall 4 weeks ago in the dementia unit at the nursing home where he resides. He is on apixaban for atrial fibrillation and Dilantin for seizures. Additionally, he has a history of pulmonary lobectomy for small cell lung carcinoma, pulmonary hypertension, and aortic stenosis. There are no neurologic deficits noted on examination but he does have clear discomfort with neck motion. Current imaging is shown in Figures A-C. What is the best next step in treatment?
Halo vest immobilization
Posterior cervical arthrodesis
A 45-year old male is involved in a motor vehicle accident and presents to the emergency room with complaints of neck pain. Physical exam shows he is an ASIA E. An open-mouth cervical radiograph is shown in Figure A. A sagittal CT scan is shown in Figure B. A CT axial angiogram is shown in Figure C. Which of the following treatment options is contraindicated in this patient?
Anterior screw osteosynthesis with single cannulated screw
Anterior screw osteosynthesis with two cannulated screws
C1-C2 transarticular screws
Posterior C1-C2 wiring with autograft
An 72-year-old man falls down the stairs and strikes his forehead. He presents to the emergency room with neck pain and a normal neurological exam. He is an active smoker. His past medical history includes chronic obstructive pulmonary disease, atrial fibrillation, and insulin-dependent diabetes mellitus. Coronal and sagittal images from a CT scan of his cervical spine are shown in Figure A. Which treatment option is most appropriate?
A young boy is involved in a motor vehicle accident and presents with neck pain. A CT scan is performed and is negative for fractures. Based on the presence of the ossification center shown in Figure A, what is the most likely age bracket of this patient.
< 1 years of age
1-3 years of age
3-6 years of age
8-10 years of age
> 12 years of age
A 67-year-old male smoker was involved in a motor vehicle accident and presents with neck pain. On initial presentation his neurologic exam was intact. Injury films are shown in Figure A and B. The patient was evaluated and surgical treatment was recommended. The patient left the hospital against medical advice. Seven months later he returns with continued neck pain. His current neurologic exam shows no deficits. A current CT scan and MRI is performed and shown in Figure C and D. What is the most appropriate treatment at this time?
Physical therapy and NSAIDS
Hard Cervical Orthosis
Anterior screw osteosynthesis
Posterior C1-C2 fusion
In Figures A-E, which of the following fracture patterns is at greatest risk for nonunion with nonoperative treatment?
In elderly patients with type II odontoid fractures, which of the following treatment modalities has the highest morbidity and mortality?
Hard cervical collar
Posterior cervical stabilization
Soft cervical orthosis
In patients who are neurologically intact, all of the following cervical spine injuries can be appropriately managed with external immobilization in a rigid cervical orthosis EXCEPT
A 42-year-old diabetic male smoker presents with neck pain and several contusions on his left side after crashing his motorcycle 2 hours prior. He was helmeted at the time of the accident. He currently denies any pain or weakness. On examination of his spine, there is pain with limited motion of his neck. The motor examination does not reveal any upper or lower extremity weakness and there are no sensory deficits. The patient is placed in a rigid C-collar and undergoes imaging. Figure A is the current CT scan. The patient is eventually cleared for surgery and undergoes the treatment depicted in Figure B two days later. What is associated with this treatment?
Greater loss of motion compared to posterior fixation
Increased rate of infection compared to posterior fixation
Acceptable reduction regardless of fracture morphology
High likelihood of successful fracture union with few treatment complications
Increased risk of nonunion due to 48-hour delay to fixation
A 65-year-old diabetic male with a 30-pack-year smoking history and COPD presents to the ED with severe axial neck pain after a fall from standing while attempting to use the restroom in the middle of the night. He is neurologically intact and denies any radicular symptoms. Figures A through D are the current radiographs and CT scans. What is the most appropriate management at this time?
Continued immobilization in a semi-rigid cervical orthosis for 6 to 8 weeks
Reduction and posterior instrumented C1-C2 fusion
Open reduction and internal fixation of the odontoid process with an anterior odontoid screw
Resection of the odontoid process through a transoral approach
Reduction with Gardner-Wells tong traction and 6 weeks of skeletal traction
A 37-year-old male was involved in a motorcycle accident. He is neurologically intact. A coronal and sagittal CT scan is shown in Figure A. What is the most appropriate management?
Anterior odontoid screw fixation
Transoral anterior odontoid resection
Cervical immobilization for 6-8 week in an external orthosis
Treatment in a soft cervical orthosis for two weeks followed by range of motion exercises
A 36-year-old male falls while intoxicated two weeks ago and has had persistent neck pain ever since. For unclear reasons he did not seek medical attention. He now reports persistent neck pain, but denies symptoms in his upper and lower extremities. On physical exam he has Grade 5 motor strength in his upper and lower extremities, normal reflexes, and his sensory exam is normal. A CT scan is shown in Figure A. All of the following place this patient at an increased risk of nonunion EXCEPT:
Fracture gap of 2 mm
Posterior displacement of > 5mm
Delay in treatment of 2 weeks
Age < 40 years