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Thoracolumbar Spine & Deformity MCQs

Practice Set 37 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 721

Topic: Thoracolumbar Spine & Deformity

A 16-year-old male gymnast complains of chronic lower back pain. Radiographs show a grade I spondylolisthesis at L5-S1. What radiographic spinopelvic parameter is most strongly correlated with the risk of progression in isthmic spondylolisthesis?

. Lumbar lordosis
. Sacral slope
. Pelvic tilt
. Pelvic incidence
. Sacrofemoral angle

Correct Answer & Explanation

. Pelvic incidence

Explanation

Pelvic incidence (PI) is a fixed morphologic parameter determined by the sum of Pelvic Tilt and Sacral Slope. A high pelvic incidence strongly correlates with an increased risk of progression in isthmic spondylolisthesis due to elevated shear forces at the lumbosacral junction.

Question 722

Topic: Thoracolumbar Spine & Deformity

A 35-year-old construction worker sustains an L1 fracture with 50% canal compromise and 25 degrees of kyphosis after a fall. Neurologic exam is normal. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, how many points are assigned specifically for the burst morphology of this fracture?

. 1 point
. 2 points
. 3 points
. 4 points
. 5 points

Correct Answer & Explanation

. 2 points

Explanation

Under the TLICS system, fracture morphology is scored as follows: compression = 1 point, burst = 2 points, translation/rotation = 3 points, and distraction = 4 points. Therefore, a burst fracture morphology contributes 2 points.

Question 723

Topic: Thoracolumbar Spine & Deformity

A 15-year-old boy presents with a progressive thoracic kyphosis of 55 degrees. Imaging is evaluated for Scheuermann's kyphosis.

To meet the classic Sorensen criteria, what is the minimum degree of anterior wedging required in each of three consecutive vertebrae?

. 3 degrees
. 5 degrees
. 10 degrees
. 15 degrees
. 20 degrees

Correct Answer & Explanation

. 5 degrees

Explanation

The Sorensen criteria for diagnosing Scheuermann's disease require anterior wedging of at least 5 degrees in 3 or more consecutive vertebrae. This is accompanied by an overall thoracic kyphosis typically greater than 45 degrees.

Question 724

Topic: Thoracolumbar Spine & Deformity



A 15-year-old male gymnast presents with mechanical low back pain. Radiographs reveal a Grade 1 slip at L5-S1. What is the anatomic location of the defect causing this specific type of spondylolisthesis?

. Pedicle
. Pars interarticularis
. Facet joint
. Lamina
. Spinous process

Correct Answer & Explanation

. Pars interarticularis

Explanation

Isthmic spondylolisthesis (Wiltse Type II) is caused by a defect or stress fracture in the pars interarticularis. It is most commonly seen in young athletes who undergo repetitive lumbar hyperextension.

Question 725

Topic: Thoracolumbar Spine & Deformity

When evaluating an adult patient for spinal deformity correction, achieving spinopelvic harmony is a primary goal. To minimize the risk of adjacent segment disease and mechanical failure, the lumbar lordosis (LL) should ideally be matched to within 10 degrees of which specific pelvic parameter?

. Pelvic tilt (PT)
. Sacral slope (SS)
. Pelvic incidence (PI)
. Sagittal vertical axis (SVA)
. T1 pelvic angle (TPA)

Correct Answer & Explanation

. Pelvic incidence (PI)

Explanation

Pelvic incidence (PI) is a fixed morphological parameter unique to each individual. Achieving a PI-LL mismatch of less than 10 degrees is a critical goal in adult spinal deformity surgery to restore proper sagittal balance.

Question 726

Topic: Thoracolumbar Spine & Deformity



A 22-year-old man was wearing a lap belt during a head-on collision. Radiographs demonstrate a flexion-distraction injury (Chance fracture) through the L2 vertebral body and posterior elements. Which of the following concomitant injuries must be carefully ruled out?

. Aortic dissection
. Diaphragmatic rupture
. Hollow viscus intra-abdominal injury
. Renal artery thrombosis
. Pelvic ring disruption

Correct Answer & Explanation

. Hollow viscus intra-abdominal injury

Explanation

Chance fractures are flexion-distraction injuries highly associated with lap-belt use. Up to 50% of patients with this fracture pattern have concomitant intra-abdominal injuries, particularly hollow viscus rupture.

Question 727

Topic: Thoracolumbar Spine & Deformity

When evaluating a 68-year-old female for adult spinal deformity, which of the following postoperative spinopelvic parameters is most closely correlated with achieving a satisfactory health-related quality of life (HRQOL) score?

. Pelvic tilt (PT) greater than 30 degrees
. Pelvic incidence minus lumbar lordosis (PI-LL) mismatch of less than 10 degrees
. Sacral slope less than 20 degrees
. Sagittal vertical axis (SVA) greater than 10 cm
. Thoracic kyphosis greater than 50 degrees

Correct Answer & Explanation

. Pelvic incidence minus lumbar lordosis (PI-LL) mismatch of less than 10 degrees

Explanation

The SRS-Schwab classification of adult spinal deformity emphasizes three sagittal modifiers that correlate with HRQOL. A successful surgical realignment aims for an SVA < 5 cm, PT < 20 degrees, and a PI-LL mismatch of less than 10 degrees.

Question 728

Topic: Thoracolumbar Spine & Deformity

A 24-year-old woman is involved in a high-speed motor vehicle collision while wearing only a lap belt.

Radiographs and CT scans reveal a transverse fracture through the L2 vertebral body, pedicles, and spinous process (Chance fracture). Which of the following associated injuries is most critical to rule out?

. Aortic transection
. Renal artery thrombosis
. Hollow viscous intra-abdominal injury
. Diaphragmatic rupture
. Pelvic ring disruption

Correct Answer & Explanation

. Hollow viscous intra-abdominal injury

Explanation

Chance fractures (flexion-distraction injuries) are frequently associated with lap-belt use and carry a high rate (up to 50%) of concomitant hollow viscus intra-abdominal injuries, particularly bowel perforations.

Question 729

Topic: Thoracolumbar Spine & Deformity

A 14-year-old competitive gymnast presents with persistent lower back pain unresponsive to 6 months of physical therapy and bracing. Radiographs demonstrate a Grade II L5-S1 isthmic spondylolisthesis. She is neurologically intact. Surgical intervention is planned. Which of the following procedures is considered the most appropriate standard of care?

. L5 laminectomy without fusion
. L5-S1 anterior lumbar interbody fusion (ALIF) alone
. L5-S1 posterolateral instrumented fusion in situ
. L5-S1 posterior interbody fusion with complete anatomic reduction
. Pars interarticularis repair using pedicle screws and laminar hooks

Correct Answer & Explanation

. L5-S1 posterolateral instrumented fusion in situ

Explanation

For pediatric patients with symptomatic low-grade (Grade I or II) isthmic spondylolisthesis failing conservative care, L5-S1 posterolateral instrumented fusion in situ yields excellent outcomes. Complete reduction is unnecessary and increases the risk of L5 nerve root injury.

Question 730

Topic: Thoracolumbar Spine & Deformity

A 25-year-old male falls from a ladder.

CT imaging shows a T12 burst fracture with 30% canal compromise. MRI confirms that the posterior ligamentous complex (PLC) is fully intact. The patient has normal motor and sensory exams in his lower extremities. What is his Thoracolumbar Injury Classification and Severity (TLICS) score, and what is the recommended treatment?

. TLICS Score 2; nonoperative management with a TLSO brace
. TLICS Score 4; operative management
. TLICS Score 5; operative management
. TLICS Score 7; nonoperative management with a TLSO brace
. TLICS Score 8; operative management

Correct Answer & Explanation

. TLICS Score 2; nonoperative management with a TLSO brace

Explanation

The TLICS score assigns points for morphology (burst = 2), PLC integrity (intact = 0), and neurologic status (intact = 0). A total score of 2 indicates that nonoperative management with bracing is the standard of care.

Question 731

Topic: Thoracolumbar Spine & Deformity

A 68-year-old woman undergoes corrective surgery for flatback syndrome. To achieve optimal sagittal balance and minimize compensatory mechanisms, her postoperative lumbar lordosis (LL) should be matched to within 10 degrees of which of the following spinopelvic parameters?

. Pelvic tilt (PT)
. Sacral slope (SS)
. Pelvic incidence (PI)
. Thoracic kyphosis (TK)
. Sagittal vertical axis (SVA)

Correct Answer & Explanation

. Pelvic incidence (PI)

Explanation

To maintain proper sagittal balance, postoperative lumbar lordosis (LL) should match the patient's fixed pelvic incidence (PI) within 10 degrees (PI = LL +/- 10 degrees). This minimizes compensatory mechanisms and improves clinical outcomes.

Question 732

Topic: Thoracolumbar Spine & Deformity

A 32-year-old male construction worker has a symptomatic Grade II isthmic spondylolisthesis at L5-S1. He complains of severe bilateral leg pain. Which nerve root is most likely being compressed, and at what anatomical location?

. L4 root in the lateral recess
. L5 root in the neural foramen
. S1 root in the lateral recess
. S1 root in the neural foramen
. L5 root in the central canal

Correct Answer & Explanation

. L5 root in the neural foramen

Explanation

In L5-S1 isthmic spondylolisthesis, the L5 exiting nerve root is most commonly compressed in the neural foramen. Compression is typically caused by the hypertrophic fibrocartilage (Gill nodule) at the pars interarticularis defect.

Question 733

Topic: Thoracolumbar Spine & Deformity

In the preoperative planning for adult spinal deformity correction, achieving a harmonious sagittal profile is a primary goal. Which of the following formulas correctly describes the relationship between the pelvic parameters?

. Pelvic Incidence (PI) = Pelvic Tilt (PT) + Sacral Slope (SS)
. Pelvic Tilt (PT) = Pelvic Incidence (PI) + Sacral Slope (SS)
. Sacral Slope (SS) = Pelvic Incidence (PI) + Pelvic Tilt (PT)
. Pelvic Incidence (PI) = Pelvic Tilt (PT) - Sacral Slope (SS)
. Sacral Slope (SS) = Pelvic Tilt (PT) - Pelvic Incidence (PI)

Correct Answer & Explanation

. Pelvic Incidence (PI) = Pelvic Tilt (PT) + Sacral Slope (SS)

Explanation

Pelvic Incidence (PI) is a fixed anatomical parameter defined as the sum of Pelvic Tilt (PT) and Sacral Slope (SS). Surgical correction aims to restore the Lumbar Lordosis (LL) to within 10 degrees of the patient's fixed Pelvic Incidence (PI-LL mismatch < 10 degrees).

Question 734

Topic: Thoracolumbar Spine & Deformity

A 35-year-old male falls from a roof. Review the provided imaging.

When calculating the Thoracolumbar Injury Classification and Severity (TLICS) score to determine the need for operative stabilization, which MRI finding is given the most weight?

. Anterior wedge compression height loss > 50%
. Posterior ligamentous complex (PLC) disruption
. Number of anterior column fracture fragments
. Presence of Schmorl's nodes
. Degree of local kyphosis less than 10 degrees

Correct Answer & Explanation

. Posterior ligamentous complex (PLC) disruption

Explanation

In the TLICS system, disruption of the posterior ligamentous complex (PLC) is assigned 3 points, which is the highest individual score for morphology/ligament status. A total TLICS score > 4 indicates operative management.

Question 735

Topic: Thoracolumbar Spine & Deformity

A 35-year-old woman falls from a horse and sustains a T12 burst fracture. She is neurologically intact. MRI demonstrates that the posterior ligamentous complex (PLC) is intact. Loss of vertebral body height is 30%, and local kyphosis is 15 degrees. Based on the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

. Anterior corpectomy and fusion
. Posterior short-segment pedicle screw fixation
. Thoracolumbosacral orthosis (TLSO) brace
. Kyphoplasty
. Posterior laminectomy alone

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) brace

Explanation

The patient's TLICS score is 2 (2 points for burst morphology, 0 for intact neurology, 0 for intact PLC). A TLICS score less than 4 is an indication for non-operative management, typically with a TLSO brace.

Question 736

Topic: Thoracolumbar Spine & Deformity

A 35-year-old man falls from a roof and sustains a T12 burst fracture. Neurologic examination reveals normal strength and sensation in the lower extremities (ASIA E). CT and MRI show 40% loss of anterior vertebral height, 15% canal compromise, and an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the recommended treatment?

. Posterior spinal fusion T10-L2
. Anterior corpectomy and fusion T12
. Short segment posterior fixation T11-L1
. Conservative management with a thoracolumbosacral orthosis (TLSO)
. Posterior laminectomy and fusion T11-L1

Correct Answer & Explanation

. Conservative management with a thoracolumbosacral orthosis (TLSO)

Explanation

The TLICS score for this patient is 2 (Morphology: burst = 2, Neurologic status: intact = 0, PLC: intact = 0). A score of 3 or less is an indication for non-operative management, typically with a TLSO.

Question 737

Topic: Thoracolumbar Spine & Deformity

A 30-year-old man falls from a roof and sustains a T12 burst fracture. He is neurologically intact, and MRI confirms an intact posterior ligamentous complex. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his score and recommended management?

. Score 2, Non-operative management
. Score 4, Operative management
. Score 5, Operative management
. Score 3, Non-operative management
. Score 7, Operative management

Correct Answer & Explanation

. Score 2, Non-operative management

Explanation

The TLICS score assigns 2 points for a burst fracture, 0 points for intact neurology, and 0 points for an intact PLC. A total score of 2 is an indication for non-operative management.

Question 738

Topic: Thoracolumbar Spine & Deformity

A 20-year-old man is brought to the trauma bay after sustaining a C5 burst fracture resulting in complete quadriplegia. He is noted to have a blood pressure of 80/50 mmHg, a heart rate of 50 bpm, and warm, flushed extremities. What is the primary pathophysiological mechanism for his hemodynamic state?

. Loss of sympathetic tone from the T1-L2 level
. Massive concealed acute blood loss
. Loss of somatic reflex arcs below the injury
. Cardiac tamponade causing obstructive shock
. Systemic inflammatory response syndrome

Correct Answer & Explanation

. Loss of sympathetic tone from the T1-L2 level

Explanation

The patient is experiencing neurogenic shock, caused by the loss of sympathetic outflow originating from T1-L2. This results in unopposed vagal tone, leading to the classic presentation of hypotension, bradycardia, and warm extremities.

Question 739

Topic: Thoracolumbar Spine & Deformity

A 14-year-old gymnast has persistent back pain and radicular leg pain due to a Grade II L5-S1 isthmic spondylolisthesis. She has failed 6 months of conservative management including bracing and physical therapy. What is the most appropriate surgical intervention?

. Direct pars repair with wiring
. L5-S1 anterior lumbar interbody fusion only
. L5-S1 posterior instrumented fusion
. L5 laminectomy without fusion
. Continuation of non-operative observation

Correct Answer & Explanation

. L5-S1 posterior instrumented fusion

Explanation

In adolescents with a symptomatic Grade II isthmic spondylolisthesis that fails conservative treatment, posterior or transforaminal instrumented fusion is the standard of care. Pars repair is generally reserved for Grade 0 or I slips without disc degeneration.

Question 740

Topic: Thoracolumbar Spine & Deformity

A 30-year-old man falls from a 10-foot ladder. CT reveals an L1 burst fracture with 40% canal compromise. MRI shows an intact posterior ligamentous complex (PLC). Neurologic exam is completely normal. What is his Thoracolumbar Injury Classification and Severity (TLICS) score, and what is the recommended treatment?

. TLICS 2; nonoperative management
. TLICS 4; nonoperative management
. TLICS 4; operative management
. TLICS 5; operative management
. TLICS 7; operative management

Correct Answer & Explanation

. TLICS 2; nonoperative management

Explanation

The TLICS score for this patient is 2: 2 points for burst fracture morphology, 0 points for an intact PLC, and 0 points for normal neurologic status. A total score of 3 or less indicates nonoperative management, typically with a rigid orthosis or early mobilization.

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