6. Spine MCQs

A 55-year-old male undergoes an uncomplicated 8-hour posterior instrumented lumbar fusion for adult degenerative scoliosis in the prone position. He experiences a 1.5 L estimated blood loss. On postoperative day 1, he complains of painless, bilateral visual loss. Pupillary reflexes are sluggish. What is the most likely etiology?

A 45-year-old female presents with persistent, severe axial neck pain one year after an anterior cervical discectomy and fusion (ACDF) at C5-C7. Flexion-extension radiographs and a thin-cut CT scan demonstrate a clear pseudarthrosis at the C6-C7 level with loosening of the anterior hardware. She is neurologically intact. What is the most reliable surgical option to achieve solid fusion in this patient?

A 70-year-old male presents with bilateral lower extremity pain and cramping that worsens with walking and prolonged standing, but improves when he leans forward over a shopping cart. Examination reveals normal peripheral pulses. In differentiating this condition from vascular claudication, which of the following activities is classically better tolerated by this patient?

An 8-year-old female presents with a 2-week history of torticollis and neck pain following a severe upper respiratory tract infection. Radiographs are consistent with atlantoaxial rotatory subluxation (Grisel's syndrome). Neurologic examination is normal. What is the most appropriate initial management?

A 40-year-old male presents with low back pain and unilateral radicular pain in the right S1 distribution. He undergoes a right L5-S1 microdiscectomy. Postoperatively, his radicular pain is completely resolved, but three weeks later, he develops excruciating, recurrent right leg pain. MRI with gadolinium shows a rim-enhancing fluid collection in the epidural space at the operative site. What is the most likely diagnosis?

A 45-year-old male presents after a motor vehicle accident with an L1 burst fracture. Neurological examination is completely normal. CT and MRI show a burst fracture with retropulsion, intact posterior ligamentous complex, and no epidural hematoma. What is his Thoracolumbar Injury Classification and Severity (TLICS) score, and what is the recommended management?

A 70-year-old male with a known history of Diffuse Idiopathic Skeletal Hyperostosis (DISH) presents with severe back pain after a minor fall. Initial plain radiographs of the spine appear largely unchanged from prior exams, showing flowing anterior osteophytes. What is the most appropriate next step in management?

A 45-year-old male presents with right leg pain, numbness over the dorsum of the foot, and weakness in great toe extension. MRI reveals a right-sided far-lateral (extraforaminal) disc herniation at L4-L5. Which nerve root is most likely compressed?

A 55-year-old male with progressive gait clumsiness is diagnosed with cervical myelopathy secondary to Ossification of the Posterior Longitudinal Ligament (OPLL). The 'K-line' on his cervical lateral radiograph is plotted, and the OPLL mass crosses anterior to the K-line (K-line negative). Which surgical approach is most biomechanically appropriate?

A 60-year-old diabetic patient presents with back pain, fever, and new-onset bowel and bladder incontinence. MRI reveals a large lumbar spinal epidural abscess with severe thecal sac compression. He is hemodynamically stable. What is the most appropriate next step in management?

A 45-year-old male with long-standing Ankylosing Spondylitis sustains an extension-distraction injury of the cervical spine through the C5-C6 disc space. Upon arrival, he is neurologically intact, but 4 hours later he develops progressive quadriplegia. What is the most likely cause of his neurological deterioration?

A 15-year-old male presents with cosmetic concerns regarding a rounded upper back. Lateral thoracic spine radiographs demonstrate a thoracic kyphosis of 55 degrees. To meet the strict radiographic criteria for Sorensen's definition of Scheuermann's disease, there must be anterior wedging of at least 5 degrees in how many consecutive vertebrae?

In a patient presenting with L4-L5 degenerative spondylolisthesis, which facet joint orientation is most strongly associated with the pathogenesis of this condition?

A 65-year-old Asian male presents with progressive cervical myelopathy secondary to Ossification of the Posterior Longitudinal Ligament (OPLL). Which of the following radiographic parameters is most strongly associated with a poor clinical outcome if he is treated with a posterior cervical laminoplasty?

A 45-year-old male presents with acute urinary retention, saddle anesthesia, and bilateral lower extremity weakness secondary to a massive L4-L5 disc herniation. Regarding the surgical management of Cauda Equina Syndrome (CES), which clinical factor has the strongest correlation with the long-term recovery of bladder function?

In the Thoracolumbar Injury Classification and Severity (TLICS) score, how many points are assigned to a frank disruption of the posterior ligamentous complex (PLC), and what is the surgical implication if a patient's total score is 5?

A 14-year-old gymnast presents with 3 months of activity-related low back pain. Radiographs are normal. MRI of the lumbar spine reveals hyperintensity on STIR imaging in the L5 pars interarticularis bilaterally, without a visible fracture line on T1-weighted images. What is the most appropriate initial management?

A 68-year-old man presents with bilateral leg pain when walking. Which of the following findings in his history or physical examination most strongly points to neurogenic claudication secondary to lumbar spinal stenosis rather than vascular claudication?