No evidence of association with HLA-B27Associated with HLA-B8 (common in patients with DISH and diabetes)
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A 39-year-old male falls off his bicycle and complains of neck pain and tingling in his fingers. Trauma series radiographs are seen in Figures A and B. Which of the following is likely to be true?
Examination would likely reveal a short neck, low posterior hairline and limited neck motion.
Serum human leukocyte antigen B27 is likely to be positive.
He is likely to be of Japanese descent.
The disease is defined by flowing ossification of the anterior longitudinal ligament at 4 consecutive levels.
Rheumatoid factor is likely to be positive.
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A 48-year-old man is brought in by emergency services after falling down a flight of stairs. He complains of weakness in both hands. Examination reveals weak grip bilaterally. Injury CT scans are shown in Figure A. What is the most appropriate treatment option?
Hard cervical orthosis
Immobilization in cervico-thoraco-lumbo-sacral orthosis
Anterior decompression and fusion of C4-C7
Posterior decompression and fusion of C5-C6
Posterior decompression and fusion of C3-T2
Which of the following is the greatest risk factor for a paradoxical embolus from a venous air embolus (VAE) when performing complex cervical spine deformity operations in the beach-chair position?
Nitrous oxide anesthesia
Persistent foramen ovale (PFO)
All of the following are characteristics of juvenile ankylosing spondylitis EXCEPT?
A patient with ankylosing spondylitis and a hip flexion contracture undergoes uneventful right total hip replacement using a Kocher (posterior) approach. This patient is at increased risk for which of the following complications post-operatively?
Posterior hip dislocation
Anterior hip dislocation
A 75-year-old man presents to your office complaining of inability to lift his head and look ahead. He states that initially he was unable to turn his head sideways, and that this progressed to his current state. A clinical photo is provided in Fig A. Radiographs of his cervical spine and lumbar spine are provided in Figure B and C. What is the most appropriate management?
Anterior osteotomy, anterior decompression and fusion
Halo traction for 6 weeks only
Posterior fusion in situ
Anterior osteotomy, posterior instrumentation
Posterior extension osteotomy, then posterior fusion and instrumentation
A 61-year-old man with ankylosing spondylitis falls and hits his forehead while getting out of the shower. On arrival to the emergency room he complained of neck pain, but his neurologic exam is normal. A CT scan shows a nondisplaced extension-type fracture of the lower cervical spine and no evidence of epidural hematoma. He is treated with a cervical orthosis and admitted for pain management. Seven hours later he reports increasing paresthesias in his upper and lower extremities. Examination now shows weakness in his upper and lower extremities, including 3+/5 ankle dorsal and ankle plantar flexion. An MRI scan is performed emergently and is shown in Figure A . What is the most appropriate next step in management.
Methylprednisolone at 30 mg/kg over 1st hour followed by 5.4 mg/kg/hr drip for 23 hours
Repeat MRI in twelve hours with serial neurologic exam
Anterior cervical fusion
Posterior cervical laminectomy
Posterior cervical laminectomy and fusion with instrumentation
A 32-year-old man presents with low back and hip pain that has been gradually worsening over the past year. He reports the symptoms are worse in the morning. Radiographs are shown in Figure A. Laboratory studies show a positive HLA-B27. What additional finding will help confirm the diagnosis?
Positive Rheumatoid Factor
Elevated urine phosphoethanolamine
A 69-year-old man falls on the ice. On arrival to the emergency room he is found to have a 2 cm laceration on the back of his head. He complains of neck pain, but is oriented to place and time and his neurologic exam is normal. Cervical and lumbar radiographs are shown in Figures A-C. What is the next most appropriate step in treatment?
Obtain flexion-extension radiographs
Obtain a CT scan of the lumbar spine
Obtain a CT scan of the cervical spine
Obtain a technetium bone scan
Treat with soft collar and discharge patient to home
A 45-year-old man with ankylosing spondylitis presents with fixed sagittal imbalance and difficulty with horizontal gaze. His kyphotic deformity is localized to the thoracolumbar spine. Which of the following procedures allows the most correction in the sagittal plane at a single level without having to resect the intevertebral disc?
Pedicle subtraction osteotomy (PSO)
Vertebral column resection (VCR)
Single-level opening wedge osteotomy
Multi-level opening wedge osteotomies