6. Spine MCQs

A 45-year-old male presents to the emergency department with acute lower back pain and bilateral leg numbness. The resident suspects Cauda Equina Syndrome (CES). Which of the following clinical findings has the highest positive predictive value for confirming CES requiring urgent surgical decompression?

According to the Spine Patient Outcomes Research Trial (SPORT) evaluating the treatment of degenerative spondylolisthesis with spinal stenosis, what was the primary conclusion comparing surgical to non-operative management at the 4-year follow-up?

A 15-year-old male presents with postural deformity. Radiographs reveal a thoracic kyphosis of 75 degrees. To officially diagnose Scheuermann's kyphosis using Sorensen's criteria, the lateral radiograph must demonstrate which of the following?

A 50-year-old male with a known history of advanced ankylosing spondylitis presents to the emergency department with severe neck pain after a minor low-speed motor vehicle collision. Standard anteroposterior and lateral cervical radiographs show no obvious fracture. What is the most appropriate next step in management?

When placing a standard anatomic lumbar pedicle screw at the L4 level, what is the most widely accepted surface landmark for the starting point?

An adult patient with sagittal imbalance is scheduled for spinal deformity correction. The measured Pelvic Incidence (PI) is 60 degrees. According to the SRS-Schwab adult spinal deformity classification, which of the following is the target Lumbar Lordosis (LL) to minimize the risk of mechanical failure and adjacent segment disease?

A 45-year-old male presents with severe radicular leg pain. MRI demonstrates a large, exclusively extraforaminal (far lateral) disc herniation at the L4-L5 level. Which nerve root is most likely compressed by this specific pathology?

A 35-year-old male presents after falling from a 10-foot roof. He is neurologically intact. CT of the lumbar spine demonstrates an L1 burst fracture with 30% canal compromise. MRI confirms an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

A 68-year-old male with long-standing ankylosing spondylitis presents with severe neck pain after a minor fall. Initial plain radiographs are difficult to interpret due to extensive ossification. Neurological examination reveals rapidly progressive quadriparesis. What is the most likely etiology of his acute neurological decline?

A 55-year-old male with poorly controlled diabetes presents with severe back pain, fevers, and acute bilateral lower extremity weakness. MRI reveals a ventral spinal epidural abscess spanning L2-L4 with severe thecal sac compression. Blood cultures are pending. What is the most appropriate next step in management?

In a patient with rheumatoid arthritis presenting with cervical myelopathy due to atlantoaxial subluxation, which of the following radiographic parameters is the most reliable predictor of postoperative neurologic recovery?

A 25-year-old male is brought to the emergency department after a motor vehicle collision. He is awake, alert, and fully cooperative. Neurological examination is completely normal (ASIA E). Cervical spine radiographs reveal a bilateral facet dislocation at C5-C6. What is the most appropriate next step in management?

During a posterior spinal fusion for adolescent idiopathic scoliosis, the neuromonitoring technician reports a sudden bilateral loss of motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs). The surgeon halts the correction maneuver. What is the most appropriate initial action by the anesthesia team?

A 16-year-old male presents with thoracic back pain and a rigid kyphotic deformity. Lateral radiographs demonstrate anterior wedging of the T7, T8, and T9 vertebral bodies. What is the minimum degree of wedging required in each of these adjacent vertebrae to confirm the diagnosis of classic Scheuermann's disease?

A 12-year-old female presents with a high-grade (Meyerding Grade IV) L5-S1 isthmic spondylolisthesis. She has severe hamstring tightness and an abnormal gait, but is neurologically intact. During surgical intervention, an attempt is made to fully reduce the spondylolisthesis prior to fusion. Which nerve root is at the greatest risk of injury during this reduction maneuver?

An adult patient with severe sagittal imbalance secondary to flatback syndrome is evaluated for corrective surgery. On standing lateral radiographs, the patient's lumbar lordosis is significantly reduced. What is the primary pelvic compensatory mechanism the patient will use to maintain an upright posture and keep their gaze horizontal?

A 30-year-old male sustains a traumatic spondylolisthesis of the axis (Hangman's fracture) following a motor vehicle accident. Radiographs reveal marked angulation of C2 on C3 with minimal translation. This is classified as a Levine-Edwards Type IIA fracture. Which of the following treatments is absolutely contraindicated?

A 55-year-old male of Asian descent presents with progressive clumsiness in his hands and broad-based gait. Cervical spine MRI shows severe multi-level ventral cord compression secondary to Ossification of the Posterior Longitudinal Ligament (OPLL). A lateral cervical radiograph demonstrates that the OPLL mass crosses the K-line (a "K-line negative" cervical spine). What is the surgical implication of this finding?

A 22-year-old male restrained rear-seat passenger is involved in a head-on collision. He presents with severe thoracolumbar back pain. CT of the spine reveals a T12 flexion-distraction injury (Chance fracture) extending through the pedicles and posterior elements. Which of the following injuries is most highly associated with this specific fracture pattern?