Thoracolumbar Spine & Deformity MCQs

A 62-year-old woman is planning to undergo reconstructive surgery for adult spinal deformity. Preoperative measurements show her pelvic incidence (PI) is 60 degrees. To achieve optimal sagittal balance postoperatively, what should her target lumbar lordosis (LL) ideally be?

A 28-year-old construction worker falls from a scaffolding, sustaining an L1 burst fracture. He is neurologically intact. Upright radiographs show 20 degrees of local kyphosis, and CT shows 40% canal compromise. The posterior ligamentous complex is intact on MRI. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate treatment?

Which of the following fixed spinopelvic radiographic parameters is most strongly associated with the severity and progression risk of an isthmic spondylolisthesis in a pediatric patient?

A 10-month-old infant presents with a left-sided thoracic curve measuring 30 degrees. The diagnosis of infantile idiopathic scoliosis is suspected. Which of the following radiographic parameters is most predictive of whether this curve will progress or spontaneously resolve?

A 14-year-old gymnast presents with chronic low back pain exacerbated by extension. Radiographs show an L5-S1 isthmic spondylolisthesis with 25% slip (Grade 1). She has failed 6 months of conservative management. What is the most appropriate surgical treatment?

In the evaluation of typical adolescent idiopathic scoliosis (AIS), which of the following is commonly observed regarding the sagittal profile of the thoracic spine?

An 8-month-old boy is diagnosed with infantile idiopathic scoliosis with a left-sided thoracic curve measuring 25 degrees. The rib-vertebral angle difference (RVAD) of Mehta is 12 degrees. What is the most likely natural history of this curve?

A 14-year-old female gymnast presents with progressive low back pain. Radiographs demonstrate a grade II isthmic spondylolisthesis at L5-S1. She has failed 6 months of conservative management (rest, bracing, physical therapy), and her pain significantly limits her activities of daily living. Neurologic examination is entirely normal. What is the most appropriate surgical treatment?

When placing lumbar pedicle screws, accurate identification of the starting point is critical to avoid nerve root injury. The medial border of the lumbar pedicle correlates with which anatomic landmark on the posterior elements?

To properly place a lumbar pedicle screw, the surgeon must identify the correct starting point to avoid neurological injury. Anatomically, the standard starting point is defined by the intersection of the:

A 13-year-old gymnast presents with chronic lower back pain. Radiographs reveal an isthmic spondylolisthesis at L5-S1 with 60% forward translation (Meyerding Grade III). She has failed 6 months of physical therapy. What is the most appropriate surgical management?

A 5-year-old boy presents with a 40-degree left thoracic scoliosis. MRI reveals a syrinx extending from T4 to T10. Which of the following curve characteristics most strongly suggested the presence of an underlying neural axis abnormality?

A 14-year-old girl with adolescent idiopathic scoliosis has a major thoracic curve of 55 degrees. On the lateral radiograph, her thoracic kyphosis is measured at +15 degrees. According to the Lenke classification, what is her sagittal modifier?

A 6-month-old infant is diagnosed with infantile idiopathic scoliosis with a 25-degree left thoracic curve. The rib-vertebral angle difference (RVAD) of Mehta is measured at 25 degrees. What is the expected natural history of this condition?

An extensively porous-coated, cylindrically fully coated diaphyseal engaging stem is used in revision hip arthroplasty. To achieve predictable long-term biologic fixation (osseointegration), what is the minimum required distance of diaphyseal scratch fit?

A 24-year-old male is involved in a high-speed motor vehicle collision while wearing only a lap belt. Radiographs and CT show a transverse fracture through the L1 spinous process, pedicles, and vertebral body. Which of the following associated injuries must be highly suspected and ruled out?

In a 60-year-old patient with adult de novo degenerative lumbar scoliosis, which of the following radiographic findings is most predictive of rapid curve progression?

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following combinations automatically meets the threshold (score >= 5) for operative intervention?

A 68-year-old man presents with progressive stooped posture and low back pain. Radiographic analysis reveals a significant mismatch between pelvic incidence and lumbar lordosis. Which of the following compensatory mechanisms allows this patient to maintain horizontal gaze and an upright stance despite a positive sagittal vertical axis?