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Thoracolumbar Spine & Deformity MCQs

Practice Set 10 of 49

This practice set contains high-yield board review questions covering key concepts in Thoracolumbar Spine & Deformity. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 181

Topic: Thoracolumbar Spine & Deformity

Which of the following figures most closely approximates the prevalence of defects in the L5 pars interarticularis in a newborn:

. Less than 1%
. 3%
. 5%
. 10%
. 15%

Correct Answer & Explanation

. 5%

Explanation

Pars interarticularis defects are not found in newborns, whereas the incidence is 5% in patients who are in the first grade. It remains close to this figure throughout later life.

Question 182

Topic: Thoracolumbar Spine & Deformity

A 15-year-old male presents with persistent low back pain due to a grade II L5-S1 isthmic spondylolisthesis. Conservative management with physical therapy and bracing has failed over the past 6 months. What is the most appropriate surgical treatment?

. L5-S1 anterior lumbar interbody fusion
. L5-S1 posterior in situ posterolateral fusion
. L5-S1 posterior reduction and interbody fusion
. L4-S1 posterior instrumented fusion
. Pars interarticularis repair

Correct Answer & Explanation

. L5-S1 posterior in situ posterolateral fusion

Explanation

Posterior in situ posterolateral fusion is the gold standard for symptomatic, low-grade (Grade 1 and 2) isthmic spondylolisthesis that fails conservative care. Pars repair is typically reserved for younger patients with a pars defect but no significant slip (Grade 0).

Question 183

Topic: Thoracolumbar Spine & Deformity

Scoliosis in Marfan syndrome is characterized by which of the following:

. Scoliosis curves are more likely to begin in the juvenile period.
. There is an increased likelihood of left thoracic curves.
. Brace treatment is more likely to be successful because of the flexibility.
. Patients are less likely to have back pain.
. C urves are more likely to be stable in adulthood.

Correct Answer & Explanation

. Scoliosis curves are more likely to begin in the juvenile period.

Explanation

Scoliosis curves are much more likely to begin in the juvenile period than idiopathic scoliosis. There is no significant difference in the likelihood of left thoracic curves in Marfan syndrome. Brace treatment is less likely to be successful in Marfan syndrome than in idiopathic scoliosis. Marfan patients with scoliosis are more likely to have back pain. Marfan curves are more likely to progress in adulthood.

Question 184

Topic: Thoracolumbar Spine & Deformity

Scoliosis in osteogenesis imperfecta is characterized by which of the following:

. Scoliosis is due primarily to vertebral fractures.
. Scoliosis is due primarily to ligamentous laxity.
. Scoliosis is due primarily to associated neurologic problems.
. Scoliosis usually responds to brace treatment.
. Scoliosis rarely impairs quality of life.

Correct Answer & Explanation

. Scoliosis is due primarily to ligamentous laxity.

Explanation

Scoliosis in osteogenesis imperfecta (OI) is due primarily to ligamentous laxity. Scoliosis in OI is due primarily to ligamentous laxity, not bony fractures. There is no association between brainstem impression and scoliosis. Scoliosis in OI rarely responds to brace treatment. Scoliosis, when present in OI, is a major impairment of quality of life.

Question 185

Topic: Thoracolumbar Spine & Deformity
Which of the following is true regarding brace treatment for Scheuermann kyphosis?
. The Milwaukee brace is not indicated.
. Permanent correction is usually obtainable.
. Bracing is effective in curves over 75°.
. Bracing is ineffective in curves having an apex at or above T8.
. The brace should be worn for 1 year after starting brace treatment.

Correct Answer & Explanation

. Permanent correction is usually obtainable.

Explanation

Brace treatment is effective for Scheuermann kyphosis. Unlike idiopathic scoliosis, permanent correction of the deformity is the goal. The Milwaukee brace is often indicated. Brace treatment is ineffective for curves over 74°. The brace should be worn until skeletal maturity.

Question 186

Topic: Thoracolumbar Spine & Deformity
Which of the following is true regarding brace treatment for Scheuermann kyphosis?
. The Milwaukee brace is not indicated.
. Permanent improvement is usually obtainable if compliant.
. Bracing is effective in curves over 75°.
. Bracing is ineffective in curves having an apex at or above T8.
. The brace should be worn for 1 year after starting brace treatment.

Correct Answer & Explanation

. Permanent improvement is usually obtainable if compliant.

Explanation

Brace treatment is effective for Scheuermann kyphosis. Unlike idiopathic scoliosis, permanent improvement of the deformity is the goal. The Milwaukee brace is often indicated. Brace treatment is ineffective for curves over 74°. The brace should be worn until skeletal maturity.

Question 187

Topic: Thoracolumbar Spine & Deformity

Which of the following statements is true regarding scoliosis in cerebral palsy (C P):

. Scoliosis is most common in hemiplegic C P because of muscle imbalance.
. A thoracolumbosacral orthosis is usually successful in halting curve progression.
. Scoliotic curves over 50° are likely to worsen even if the children are mature.
. Surgery for scoliosis will prolong life expectancy.
. The surgical complication rate is lower in C P than idiopathic scoliosis.

Correct Answer & Explanation

. Scoliotic curves over 50° are likely to worsen even if the children are mature.

Explanation

Curves greater than 50° usually progress. Scoliosis is most common in totally involved C P patients. Scoliosis is rare in patients with hemiplegia. Braces rarely halt curves in CP. Surgery has no proven effect on prolonging life expectancy. The complication rate is higher in CP.

Question 188

Topic: Thoracolumbar Spine & Deformity

A patient with neurofibromatosis and a 55° scoliosis may be treated with a posterior fusion and instrumentation alone in which of the following situations:

. He has a kyphosis of 75°.
. He is also undergoing multilevel laminectomy for tumor.
. He has a prior pseudarthrosis.
. He has a kyphosis of 35°.
. He has a bone age of 9.

Correct Answer & Explanation

. He has a kyphosis of 35°.

Explanation

He has a kyphosis of 35°. This degree of kyphosis increases the risk of pseudarthrosis with posterior fusion alone. The laminectomy increases the risk of pseudarthrosis. Anterior fusion should be added when there is a history of pseudarthrosis. A 9-year-old boy has a high risk of crankshift phenomenon with posterior fusion alone.

Question 189

Topic: Thoracolumbar Spine & Deformity

Which of the following statements is true regarding school screening for scoliosis:

. The American Academy of Orthopaedic Surgeons (AAOS) no longer recommends it.
. The AAOS recommends screening each year.
. The AAOS recommends screening boys and girls at age 9.
. The AAOS recommends screening boys and girls at age 11.
. The AAOS recommends screening only boys at age 16.

Correct Answer & Explanation

. The AAOS recommends screening boys and girls at age 11.

Explanation

All children should be screened at age 11. The AAOS still recommends school screening for scoliosis. The AAOS recognizes that yearly screening is counterproductive. Screening at age 9 is too early.. Screening at age 16 is too late.

Question 190

Topic: Thoracolumbar Spine & Deformity

Which of the following features is true of congenital scoliosis but not infantile idiopathic scoliosis:

. Bracing has been shown to decrease progression.
. The age of onset is before 3 years old.
. The thoracic curve may be convex to either the left side or the right in either curve type.
. The rib-vertebral angle difference predicts the risk of worsening.
. Vertebrae are abnormally formed from birth.

Correct Answer & Explanation

. Vertebrae are abnormally formed from birth.

Explanation

In congenital scoliosis, the vertebrae are abnormally formed from birth. The vertebrae are normal at birth in infantile idiopathic scoliosis. Age of onset is before age 3 in both types of scoliosis. The thoracic curve may be convex to the left slide or the right side in either curve type. In infantile idiopathic scoliosis, it is most commonly convex to the left. The rib-vertebral angle difference (angle between the apical vertebral endplate and the rib on the convexity minus the rib on the concavity) greater than 20° predicts an increased risk of worsening in infantile idiopathic scoliosis but not in congenital scoliosis. Bracing has not been shown to affect infantile idiopathic scoliosis.

Question 191

Topic: Thoracolumbar Spine & Deformity

Scoliosis in Marfan syndrome, as compared to idiopathic scoliosis, is characterized by which of the following:

. Scoliosis curves are more likely to begin in the juvenile period.
. There is an increased likelihood of left thoracic curves.
. Brace treatment is more likely to be successful because of the flexibility.
. Patients are less likely to have back pain.
. C urves are more likely to be stable in adulthood.

Correct Answer & Explanation

. Scoliosis curves are more likely to begin in the juvenile period.

Explanation

Scoliosis curves are much more likely to begin in the juvenile period than idiopathic scoliosis. There is no significant difference in the likelihood of left thoracic curves in Marfan syndrome. Brace treatment is less likely to be successful in Marfan syndrome than in idiopathic scoliosis. Marfan patients with scoliosis are more likely to have back pain. Marfan curves are more likely to progress in adulthood.

Question 192

Topic: Thoracolumbar Spine & Deformity

Scoliosis in osteogenesis imperfecta is characterized by which of the following:

. Scoliosis which is due primarily to vertebral fractures.
. Scoliosis is due primarily to ligamentous laxity.
. Scoliosis is due primarily to associated neurologic problems.
. Scoliosis usually responds to brace treatment.
. Scoliosis rarely impairs quality of life.

Correct Answer & Explanation

. Scoliosis is due primarily to ligamentous laxity.

Explanation

Scoliosis in osteogenesis imperfecta (OI) is due primarily to ligamentous laxity. Scoliosis in OI is due primarily to ligamentous laxity, not bony fractures. There is no association between brainstem impression and scoliosis. Scoliosis in OI rarely responds to brace treatment. Scoliosis, when present in OI, is a major impairment of quality of life.

Question 193

Topic: Thoracolumbar Spine & Deformity

A 16-year-old gymnast presents with severe mechanical back pain. Radiographs show a grade II isthmic spondylolisthesis at L5-S1. Non-operative management has failed after 6 months. What is the most appropriate surgical treatment?

. L5-S1 anterior lumbar interbody fusion only
. L5 laminectomy without fusion
. L5-S1 posterior lateral fusion with instrumentation
. In situ fusion of L4-L5
. Pars repair using a lag screw

Correct Answer & Explanation

. L5-S1 posterior lateral fusion with instrumentation

Explanation

For a symptomatic grade II isthmic spondylolisthesis failing conservative care, an L5-S1 posterolateral fusion with pedicle screw instrumentation is the standard procedure. Direct pars repair is generally reserved for younger patients with pars defects but no significant slip (Grade 0 or very mild Grade I).

Question 194

Topic: Thoracolumbar Spine & Deformity

The following skeletal feature helps to establish a diagnostic level of major skeletal involvement in Marfan syndrome:

. Hyperextensible knees
. Atlantoaxial subluxation
. Standing height over 2 m
. Increased thoracic kyphosis
. Pectus carinatum

Correct Answer & Explanation

. Pectus carinatum

Explanation

Pectus carinatum has a high diagnostic value for Marfan syndrome. Hyperextension of the knees is not common in patients with Marfan syndrome. This skeletal feature is seen in many other conditions; therefore, it has low diagnostic specificity. Atlantoaxial subluxation is rare in Marfan syndrome, but is common in some of the skeletal dysplasias. Although patients with Marfan syndrome are generally tall, height is too nonspecific to be a helpful diagnostic criterion. Kyphosis is not a skeletal diagnostic criterion.

Question 195

Topic: Thoracolumbar Spine & Deformity

All of these findings are features of patients with Scheuermann kyphosis, except:

. Vertebral wedging
. Endplate irregularity
. Schmorl nodes
. Truncal obesity
. Back pain

Correct Answer & Explanation

. Truncal obesity

Explanation

Obesity is not any more common in patients with Scheuermann kyphosis than in the general population. Vertebral wedging is a common feature of Scheuermann kyphosis. Endplate irregularity is a common feature of Scheuermann kyphosis. Schmorl nodes are a manifestation of the disordered behavior of the vertebral endplates under load. Back pain is common in Scheuermann kyphosis.

Question 196

Topic: Thoracolumbar Spine & Deformity
A 7-year-old boy with a history of multiple café-au-lait spots and axillary freckling presents with a rapidly progressive spinal deformity. Anteroposterior and lateral radiographs demonstrate a short-segment, sharply angulated thoracic curve. Which of the following is the most likely diagnosis?
. Idiopathic scoliosis
. Congenital scoliosis
. Dystrophic neurofibromatosis scoliosis
. Non-dystrophic neurofibromatosis scoliosis
. Marfan syndrome scoliosis

Correct Answer & Explanation

. Dystrophic neurofibromatosis scoliosis

Explanation

Dystrophic scoliosis in Neurofibromatosis type 1 typically presents as a short-segment, sharply angulated curve with severe vertebral wedging, spindling of transverse processes, and rib penciling. It is prone to rapid progression and often requires early surgical stabilization with combined anterior and posterior fusion.

Question 197

Topic: Thoracolumbar Spine & Deformity

The most common osseous abnormality in neurofibromatosis 1 (NF1) is:

. Congenital tibial dysplasia
. Scoliosis
. Valgus deformity of the ankle
. Macrodactyly
. Dysplasia of posterior cranial fossa

Correct Answer & Explanation

. Scoliosis

Explanation

Of the many orthopedic manifestations of neurofibromatosis 1 (NF1), including kyphoscoliosis, lordoscoliosis, spondylolisthesis, congenital tibial dysplasia, segmental hypertrophy, cystic bone lesions, and subperiostial bone proliferation, scoliosis is the most common.

Question 198

Topic: Thoracolumbar Spine & Deformity

Which of the following clinical features distinguishes homocystinuria from Marfan syndrome:

. Lens dislocation
. Scoliosis
. Chest wall abnormalities
. Tall stature
. Delayed intellectual development

Correct Answer & Explanation

. Delayed intellectual development

Explanation

Patients with Marfan syndrome do not typically have defects in intellectual functioning, while patients with homocystinuria typically do show signs of delayed intellectual development. Patients with Marfan syndrome and homocystinuria both develop lens dislocations, scoliosis, chest wall abnormalities, and tall stature.

Question 199

Topic: Thoracolumbar Spine & Deformity

Which of the following features differentiates Marfan syndrome from Ehlers-Danlos syndrome (EDS):

. Joint hypermobility
. Scoliosis
. Lens dislocation
. Vascular problems
. Joint dislocations

Correct Answer & Explanation

. Lens dislocation

Explanation

Patients with Ehlers-Danlos syndrome (EDS) and Marfan syndrome may have joint hypermobility, scoliosis, vascular problems, and recurrent joint instability. Patients with Marfan syndrome also develop lens dislocations, and while some patients with EDS exhibit eye problems, it is related to ocular globe fragility. Lens dislocation is not a feature of EDS.

Question 200

Topic: Thoracolumbar Spine & Deformity

A 35-year-old male falls from a ladder and sustains an L2 burst fracture. Imaging shows 40% canal compromise. He is neurologically intact, and MRI confirms an intact posterior ligamentous complex. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is his total score and the generally recommended management?

. Score 2; Non-operative management
. Score 4; Operative management
. Score 5; Operative management
. Score 7; Operative management
. Score 1; Non-operative management

Correct Answer & Explanation

. Score 2; Non-operative management

Explanation

Under the TLICS system, a burst fracture scores 2 points, intact neurological status is 0 points, and an intact posterior ligamentous complex is 0 points, resulting in a total score of 2. A score of 3 or less is an indication for non-operative management.

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