6. Spine MCQs

According to the Spine Patient Outcomes Research Trial (SPORT) for degenerative spondylolisthesis, which of the following statements is true regarding outcomes of surgical versus non-operative treatment?

A 55-year-old man presents with severe lower back pain and low-grade fevers. MRI shows L4-L5 discitis and osteomyelitis without a significant epidural abscess. He is neurologically intact, and three sets of blood cultures are negative. What is the most appropriate next step?

A 14-year-old girl is undergoing a posterior spinal fusion for adolescent idiopathic scoliosis. During deformity correction, the neuromonitoring technician reports a sudden, sustained 80% decrease in motor evoked potentials (MEPs) in the bilateral lower extremities, while somatosensory evoked potentials (SSEPs) remain at baseline. A wake-up test confirms the patient cannot move her lower extremities. Which of the following anatomic structures is most likely compromised?

A 10-month-old infant presents with a left-sided thoracic curve measuring 35 degrees. Supine radiographs demonstrate a rib-vertebra angle difference (RVAD) of 25 degrees at the apical vertebra. Furthermore, the rib head on the concave side overlaps the apical vertebral body. What is the most appropriate management for this patient?

A 68-year-old woman presents with severe flatback deformity and sagittal imbalance following a prior lumbar fusion from L3 to S1. Her pelvic incidence (PI) is 55 degrees. Standing full-length radiographs reveal a current lumbar lordosis (LL) of 15 degrees and a sagittal vertical axis (SVA) of +12 cm. To achieve optimal sagittal balance, what should be the target postoperative lumbar lordosis?

A 22-year-old restrained driver is involved in a high-speed motor vehicle collision. Radiographs and CT of the thoracolumbar spine demonstrate a flexion-distraction injury (Chance fracture) through the L2 vertebral body and posterior elements. Which of the following associated injuries must be highly suspected?

A 15-year-old male with a history of back pain presents with bilateral lower extremity radicular pain. Radiographs reveal a Grade IV isthmic spondylolisthesis at L5-S1. During surgical reduction and fusion, the patient is at highest risk for iatrogenic injury to which of the following nerve roots?

A 60-year-old woman with a 20-year history of severe rheumatoid arthritis presents with neck pain and progressive clumsiness in her hands. Which of the following radiographic parameters is the most reliable predictor of impending neurologic compromise and paralysis?

A 55-year-old man undergoes a complex 10-level posterior spinal fusion for adult spinal deformity. The surgery lasts 11 hours with an estimated blood loss of 3.5 liters. On postoperative day 1, he complains of painless, profound bilateral vision loss. Pupillary reflexes are sluggish. What is the most likely etiology of this complication?

A 28-year-old man falls from a height and sustains a Type II odontoid fracture. The fracture line slopes from anterior-inferior to posterior-superior. Intact transverse ligament is noted on MRI. Which of the following makes this patient a poor candidate for an anterior odontoid screw?

A 45-year-old man with acute severe low back pain and bilateral sciatica presents to the emergency department. He reports difficulty urinating. Which of the following post-void residual (PVR) bladder volumes is most indicative of cauda equina syndrome?

A 15-year-old boy presents with progressive mid-back pain and a rounded posture. Lateral radiographs of the thoracic spine demonstrate anterior wedging of T7, T8, and T9. According to Sorensen's criteria for classic Scheuermann's kyphosis, what is the minimum degree of anterior wedging required in these consecutive vertebrae?

A 50-year-old man presents with left arm pain radiating to his thumb and index finger. Examination demonstrates weakness in wrist extension and a diminished brachioradialis reflex. Which cervical nerve root is most likely compressed?

A 3-year-old boy is evaluated for congenital scoliosis. Radiographs demonstrate a unilateral unsegmented bar on the left spanning T5 to T8, with a contralateral fully segmented hemivertebra at T6. What is the natural history of this specific spinal anomaly if left untreated?

A 16-year-old male gymnast complains of insidious onset, mechanical lower back pain. Radiographs are normal. A T2-weighted STIR MRI of the lumbar spine reveals bilateral high signal intensity in the L5 pars interarticularis. There is no spondylolisthesis. What is the most appropriate initial management?

A 40-year-old woman undergoes an anterior cervical discectomy and fusion (ACDF) for C5-C6 spondylosis. Postoperatively, she is noted to have a new-onset unilateral vocal cord paralysis and a hoarse voice. Injury to the recurrent laryngeal nerve is suspected. Which surgical approach and anatomical relationship most likely contributed to this injury?

A 65-year-old woman with adult spinal deformity is planning for surgery. Her pelvic incidence (PI) is 60 degrees. To minimize the risk of adjacent segment disease and mechanical failure, her postoperative lumbar lordosis (LL) should be targeted closest to what value?

A 58-year-old man undergoes a C3-C6 cervical laminectomy and posterior spinal fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops profound weakness in bilateral shoulder abduction and elbow flexion, with no sensory changes. What is the most likely etiology of this new deficit?

A 6-year-old boy undergoes a posterior spinal fusion without anterior fusion for a severe progressing thoracic scoliosis. Over the next four years, he develops progressive rotational deformity and lordosis despite a solid posterior fusion mass. What is the primary cause of this phenomenon?

A 35-year-old woman falls from a height and sustains a T12 burst fracture. She is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is her total score and the recommended management?