Thoracolumbar Spine & Deformity MCQs

A 35-year-old roofer falls 15 feet, sustaining an L1 burst fracture. On physical examination in the emergency department, his neurological examination is completely intact (ASIA E). A CT scan and MRI demonstrate 30% loss of anterior vertebral body height, 15 degrees of focal kyphosis, retropulsion of bone into the spinal canal narrowing it by 20%, and an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and the recommended management?

A 30-year-old construction worker falls from scaffolding. A CT of the lumbar spine reveals an L1 burst fracture with 40% loss of anterior vertebral body height and 30% canal compromise. The posterior elements are intact. He is neurologically intact (ASIA E), and a subsequent MRI confirms an intact posterior ligamentous complex (PLC). Using the Thoracolumbar Injury Classification and Severity (TLICS) system, what is his total score and the generally recommended treatment?

A 14-year-old elite female gymnast presents with progressive, activity-limiting lower back pain and tight hamstrings. Radiographs reveal a Grade II isthmic spondylolisthesis at L5-S1. Despite 6 months of comprehensive conservative management including rest, bracing, and targeted physical therapy, her pain remains debilitating. What is the most appropriate surgical intervention?

A 15-year-old boy presents with progressive mid-back pain and a noticeable cosmetic deformity. Standing lateral radiographs demonstrate a thoracic kyphosis of 80 degrees. Radiographic criteria (Sorensen's criteria) for typical Scheuermann's kyphosis includes anterior wedging of at least:

A 68-year-old woman presents with progressive severe mechanical low back pain, early satiety, and an inability to stand upright for more than 10 minutes without supporting herself on a walker (flatback syndrome). Standing full-length radiographs are obtained. Her pelvic incidence (PI) is 60 degrees, and her pelvic tilt (PT) is 35 degrees. To achieve optimal sagittal spinopelvic balance during a planned multi-level adult spinal deformity reconstruction, the postoperative goal for her lumbar lordosis (LL) should be approximately:

A 16-year-old elite male gymnast presents with a 9-month history of mechanical low back pain that has not improved despite rigorous non-operative management, including bracing, physical therapy, and rest. Imaging reveals an L4 bilateral isthmic spondylolysis with no measurable spondylolisthesis. An MRI shows healthy, well-hydrated discs at L3-L4, L4-L5, and L5-S1. What is the most appropriate surgical treatment?

A 16-year-old elite gymnast presents with a 3-month history of insidious-onset, activity-related lower back pain that worsens with lumbar extension. Neurological examination is unremarkable. Plain standing anterior-posterior, lateral, and oblique radiographs demonstrate no obvious pars interarticularis defect or spondylolisthesis. What is the most appropriate next imaging modality to evaluate for an acute or active spondylolysis?

A 35-year-old male falls from a 15-foot ladder and sustains an L1 burst fracture. His neurological examination is completely normal (ASIA E). A CT scan shows 45% canal compromise and 20 degrees of local kyphosis. An MRI confirms an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is the most appropriate management?

A 14-year-old female gymnast complains of persistent mechanical low back pain for 6 months. Radiographs demonstrate a Grade II L5-S1 isthmic spondylolisthesis. Non-operative management, including bracing, physical therapy, and activity modification, has failed. She is now scheduled for an in situ posterolateral L5-S1 fusion. Which of the following slip parameters is most associated with a high risk of progression and nonunion?

A 65-year-old woman presents with severe mechanical back pain and an inability to stand upright. Standing full-length spine radiographs reveal a pelvic incidence (PI) of 60 degrees and a sacral slope (SS) of 20 degrees. What is her pelvic tilt (PT), and what is the optimal target for her postoperative lumbar lordosis (LL) to restore sagittal balance?

A 40-year-old male falls from a height of 10 feet. Neurological examination is completely normal (Grade E). CT of the spine (Figure 5) shows an L1 burst fracture with 40% loss of anterior body height, 20 degrees of kyphosis, and 30% canal compromise. MRI demonstrates an intact posterior ligamentous complex (PLC). Using the Thoracolumbar Injury Classification and Severity (TLICS) score, what is this patient's score and the recommended management?

A 68-year-old woman presents with severe low back pain and a progressive forward-leaning posture. Standing full-length spinal radiographs reveal a pelvic incidence (PI) of 60 degrees, a pelvic tilt (PT) of 35 degrees, and a lumbar lordosis (LL) of 25 degrees. To optimally correct her sagittal imbalance during surgical reconstruction, what is the primary realignment goal regarding these spinopelvic parameters?

Which of the following radiographic parameters is considered the gold standard for quantifying global sagittal alignment on a standing 36-inch lateral radiograph?

A 14-year-old female gymnast presents with a 1-year history of unrelenting low back pain exacerbated by extension maneuvers. Radiographs demonstrate a Grade II isthmic spondylolisthesis at L5-S1. She has failed 6 months of comprehensive conservative management, including Boston bracing, physical therapy, and strict activity modification. Which of the following is the most appropriate surgical intervention?

In the preoperative planning for a 62-year-old woman undergoing corrective surgery for adult degenerative scoliosis and sagittal imbalance, analyzing spino-pelvic parameters is critical. To minimize the risk of mechanical failure, proximal junctional kyphosis, and adjacent segment disease, the postoperative lumbar lordosis (LL) should ideally be matched to the patient's pelvic incidence (PI) within what range?

A 35-year-old woman is involved in a motor vehicle collision and sustains a burst fracture of L1. Her neurological examination demonstrates full strength and normal sensation in her bilateral lower extremities (ASIA E). An MRI is obtained which definitively demonstrates disruption of the posterior ligamentous complex (PLC). Based on the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

Figure 11 shows a lateral radiograph of a 14-year-old female gymnast with chronic, mechanical low back pain. Radiographs reveal a Grade II isthmic spondylolisthesis at L5-S1. She has failed 6 months of physical therapy, activity modification, and bracing. Which of the following is the most appropriate surgical treatment?

A 35-year-old male falls 10 feet from a ladder and sustains an L1 burst fracture. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). Based on the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and the generally recommended treatment?

A 16-year-old female gymnast complains of 6 months of persistent lower back pain that is worsened with spinal extension. She has failed physical therapy and bracing. Upright lateral radiographs demonstrate a Grade I isthmic spondylolisthesis at L5-S1. What is the most appropriate surgical intervention?