6. Spine MCQs

A 65-year-old male with a long-standing history of ankylosing spondylitis presents with localized, progressive lower thoracic back pain after a minor fall 3 months ago. He has no neurologic deficits. Plain radiographs demonstrate a radiolucent gap involving the intervertebral disc space and adjacent endplates at T11-T12, with surrounding sclerosis. CT confirms a pseudoarthrosis at this level. What is the most appropriate management?

A 3-year-old female is referred for an asymptomatic progressive spinal deformity. Radiographs demonstrate a fully segmented hemivertebra at L2, resulting in a 35-degree scoliotic curve. Given the natural history of this specific anomaly, what is the most appropriate management?

A 68-year-old male presents with bilateral leg pain and heaviness that occurs after walking 2 blocks. During a stationary bicycle test, he experiences significant leg cramping and pain when pedaling in an extended spine posture. However, his symptoms persist even when he leans completely forward over the handlebars while continuing to pedal. What is the most likely diagnosis?

A 13-year-old female gymnast presents with persistent lower back pain for 6 months. Lateral radiographs show a grade 1 isthmic spondylolisthesis at L5-S1. MRI demonstrates bilateral pars defects with prominent marrow edema on STIR sequences, but no central canal stenosis. She has failed 6 weeks of rest and NSAIDs. What is the most appropriate next step in management?

A 45-year-old male presents with right-sided neck pain radiating down his arm to his middle finger. He notes weakness in triceps extension and an absent triceps reflex. A Spurling test reproduces his symptoms. Which cervical nerve root is most likely compressed, and between which two vertebrae does this nerve exit?

A 65-year-old male with known cervical spondylosis sustains a hyperextension injury. He presents with bilateral upper extremity weakness (motor strength 2/5 in the hands) and mild lower extremity weakness (motor strength 4/5). MRI reveals severe multi-level cervical stenosis, worse at C4-C5, with intramedullary T2 hyperintensity. According to recent AOSpine guidelines, what is the recommended timing for surgical decompression?

A 6-year-old child with Down syndrome is evaluated for neck pain. Radiographs show an anterior atlantodental interval (ADI) of 6 mm. What is the most reliable radiographic predictor for the development of neurologic deficit in this patient?

A 45-year-old man presents with acute onset of severe anterior thigh pain, weakness in knee extension, and a diminished patellar reflex. MRI of the lumbar spine reveals a far-lateral extraforaminal disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 32-year-old female is involved in a motor vehicle accident and sustains a Levine-Edwards Type IIA traumatic spondylolisthesis of the axis (Hangman's fracture). The fracture shows severe angulation with minimal translation. What is the most appropriate initial management?

A 72-year-old man with a history of cervical spondylosis presents with severe bilateral upper extremity weakness and numbness after a hyperextension injury. His lower extremity strength is only mildly diminished, and he retains bowel and bladder control. Which of the following tracts is most centrally located and responsible for the disproportionate upper extremity weakness?

A surgeon considers using recombinant human bone morphogenetic protein-2 (rhBMP-2) to augment a spinal fusion. In which of the following scenarios is the use of rhBMP-2 associated with the highest risk of life-threatening complications, prompting an FDA warning?

A 15-year-old male presents with postural thoracic back pain and a prominent thoracic kyphosis. Radiographs are obtained to evaluate for Scheuermann's disease. According to the Sorensen criteria, what radiographic finding is required to confirm the diagnosis?

A 14-year-old female with an L5-S1 Meyerding Grade IV isthmic spondylolisthesis undergoes posterior spinal fusion with instrumental reduction. Postoperatively, she is noted to have a new foot drop and weakness in great toe extension. Injury to which of the following structures is the most likely cause?

A 55-year-old woman with a 20-year history of severe rheumatoid arthritis complains of neck pain, occipital headache, and subjective bilateral hand clumsiness. Which of the following radiographic measurements is most indicative of basilar invagination (cranial settling) in this patient?

A 16-year-old gymnast presents with 3 weeks of focal lower back pain exacerbated by extension. Plain radiographs of the lumbar spine are normal. What is the most appropriate next imaging modality to diagnose an acute pars interarticularis stress reaction while minimizing radiation exposure?

A neurologically intact 40-year-old male sustains an L1 burst fracture after a fall. MRI confirms that the posterior ligamentous complex (PLC) is completely intact. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is his total score and the recommended management?

An 84-year-old female presents with a Type II odontoid fracture with 3 mm of posterior displacement following a low-energy ground-level fall. She is neurologically intact. Which of the following management strategies is generally contraindicated in this specific demographic due to high associated morbidity and mortality?

A 55-year-old Asian male presents with severe cervical myelopathy. Imaging reveals continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. The K-line, drawn from the midpoints of the spinal canal at C2 and C7 on a neutral lateral radiograph, does not cross the peak of the OPLL (K-line negative). What is the significance of this finding regarding surgical planning?

A 60-year-old diabetic male presents with a 3-day history of escalating lower back pain, fever, bilateral lower extremity weakness (grade 3/5), and new-onset urinary retention. MRI reveals a ventral epidural abscess spanning L2 to L4 with severe cauda equina compression. What is the most appropriate next step in management?

When evaluating a patient with a spinal metastatic lesion, the Spinal Instability Neoplastic Score (SINS) is utilized to assess the need for surgical stabilization. Which of the following radiographic or clinical findings contributes the highest point value (4 points) to the SINS calculation?