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6. Spine MCQs

Practice Set 15 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 281

Topic: 6. Spine

Which of the following is true regarding the normal anatomical alignment of the thoracic spine?

. The normal thoracic kyphosis ranges from 10 to 40 degrees with the apex at T4
. The thoracic spine is highly flexible compared to the lumbar spine
. The normal kyphosis ranges from 20 to 50 degrees with the apex typically between T6 and T8
. The thoracic facet joints are oriented primarily in the sagittal plane
. Thoracic kyphosis decreases naturally with age

Correct Answer & Explanation

. The normal kyphosis ranges from 20 to 50 degrees with the apex typically between T6 and T8

Explanation

Normal thoracic kyphosis ranges from 20 to 50 degrees (measured as the Cobb angle from T2 to T12) with its apex typically located between the T6 and T8 levels. Unlike lumbar lordosis, thoracic kyphosis naturally increases with age.

Question 282

Topic: 6. Spine

Clinical symptoms of lumbar spinal stenosis usually correlate with a canal anteroposterior diameter of less than:

. 20 mm
. 15 mm
. 10 mm
. 5 mm
. There is no correlation.

Correct Answer & Explanation

. 10 mm

Explanation

The clinical syndrome of lumbar stenosis correlates with a measured anteroposterior diameter of the dural sac of less than 10 mm.

Question 283

Topic: 6. Spine

Which of the following is the most commonly fractured location along the thoracolumbar axis:

. The cervicothoracic junction
. The mid-thoracic region
. The thoracolumbar region
. The lumbar region
. The lumbosacral junction

Correct Answer & Explanation

. The thoracolumbar region

Explanation

Up to 60% of spinal injuries occur between the T11 and L1 segments. The rigid thoracic rib cage and coronal orientation of the facets permit lateral bending and rotation but little flexion and extension. The facet joints then transition caudally to a more sagittal orientation in the lumbar spine, allowing increased flexion/extension but limiting lateral motion. These factors create a stress concentration at the thoracolumbar junction, which is demonstrated by the high incidence of injury at the T11 to L1 segments.

Question 284

Topic: 6. Spine

A 26-year-old man who was involved in a motor vehicle accident is found to have a T12 compression fracture on plain radiography without evidence of posterior extrusion. The likelihood of finding another fracture in the spinal axis with further evaluation is:

. Highly remote, these fractures are usually isolated
. 10% to 15%
. 50% to 75%
. A low thoracic fracture is almost always associated with another fracture in the spine.
. The incidence of noncontiguous-associated fractures in the spine is not known.

Correct Answer & Explanation

. 10% to 15%

Explanation

A thorough workup in these patients is essential; approximately 10% to 15% of patients will have noncontiguous injuries located elsewhere in the spine.

Question 285

Topic: 6. Spine

Based on the three-column model of spinal stability, an unstable spinal injury is defined as:

. An injury that disrupts no less than all three columns
. Disruption of any of the three columns is considered unstable.
. Disruption of more than one column
. Disruption of all three columns plus neurological injury
. The three-column model of injury is not a reliable marker of instability.

Correct Answer & Explanation

. Disruption of more than one column

Explanation

The three-column spine consists of the anterior, middle, and posterior columns. In this widely used classification system, the middle column is the key to instability. If the middle column is disrupted, in addition to either the anterior or posterior columns, then instability results.

Question 286

Topic: 6. Spine

Burst fractures of the vertebral body require prompt evaluation because:

. Although burst fractures of the vertebral body are stable injuries, neurologic deterioration is likely.
. Burst fractures of the vertebral body involve two-column injury and are unstable.
. Burst fractures of the vertebral body are extremely painful to the patient.
. Burst fractures of the vertebral body are commonly associated with other noncontiguous fractures.
. Burst fractures of the vertebral body often result in spinal shock.

Correct Answer & Explanation

. Burst fractures of the vertebral body involve two-column injury and are unstable.

Explanation

When the middle column is involved in a compression injury, it is classified as a burst fracture. This involves axial load on the spine, with or without a flexion component, and retropulsion of the posterosuperior vertebral body into the spinal canal, thus requiring prompt medical attention. Neurologic deficit is variable and is related to the severity of the initial injury and location of the fracture, and only loosely related to the percent of canal compromise.

Question 287

Topic: 6. Spine
Compression fractures of the spine, although typically considered a one-column injury, can be unstable. Findings at time of presentation suggestive of an unstable fracture include:
. Pain out of proportion to the physical examination
. Radiographic findings of more than one compression fracture
. Initial kyphosis greater than 20° to 30°
. Loss of less than 50% of anterior vertebral body height

Correct Answer & Explanation

. Initial kyphosis greater than 20° to 30°

Explanation

Compression fractures are inherently stable and may be treated with extension bracing or casting. If, however, the flexion injury is severe enough, damage to the posterior ligaments can result and the injury becomes unstable. Criteria for this instability were developed by McAfee and include more than 20° to 30° of initial kyphosis or more than 50% loss of anterior vertebral height, applicable to both compression and burst fractures.

Question 288

Topic: 6. Spine
Which of the following is the most important factor responsible for a decreasing proportion of patients with complete paraplegia after sustaining a spinal cord injury today compared with four decades ago?
. Improvements in rehabilitative measures
. Advances in operative techniques and instrumentation
. New and novel medication therapy
. Higher patient motivation and participation in therapy and rehabilitation
. Better initial triage, resuscitation, and clinical management of patients

Correct Answer & Explanation

. Better initial triage, resuscitation, and clinical management of patients

Explanation

Improvements in the initial triage, resuscitation, and clinical management of spinal cord-injured patients are likely responsible for a decreasing proportion of patients with complete paraplegia. Currently, approximately 45% of spinal cord-injured patients have a complete injury, as opposed to two-thirds four decades ago.

Question 289

Topic: 6. Spine

Based on the current consensus on treatment of acute spinal cord injury, intravenous steroid treatment is considered to have potential benefit if begun within how many hours of original injury:

. 3
. 5
. 8
. 12
. 24

Correct Answer & Explanation

. 8

Explanation

The results of the National Acute Spinal Cord Injury Study II (NASC IS II) demonstrated significant motor and sensory improvement in patients who were treated within 8 hours of injury with a methylprednisolone bolus of 30 mg/kg, followed by an infusion of 5.4 mg/kg per hour for 24 hours.

Question 290

Topic: 6. Spine
A 73-year-old woman with a history of cervical stenosis who sustained a fall at home yesterday is now complaining of clumsy fingers and weakness in her hands. She denies any difficulty with ambulation or bowel and bladder dysfunction. She most likely has:
. Bilateral cervical radiculopathy
. Exacerbation of cervical stenosis
. Anterior cord syndrome
. Posterior cord syndrome
. Central cord syndrome

Correct Answer & Explanation

. Central cord syndrome

Explanation

The most common incomplete spinal cord injury syndrome is most likely central cord syndrome. Central cord syndrome often occurs as a result of a pinching of the spinal cord in elderly patients who have a narrowed spinal canal as the result of degenerative spondylosis. It is a pattern of disproportionately severe upper extremity motor and sensory changes as compared to lower extremity findings.

Question 291

Topic: 6. Spine

A 27-year-old man was involved in a motor vehicle accident. He was resuscitated at the scene but was noted to have a prolonged hypotensive period. Upon arrival at the medical center, he is noted to be paraplegic but radiographic evaluation does not demonstrate any fracture or soft tissue abnormality. Which of the following is the most likely diagnosis:

. Occult fracture with retropulsion into the cord
. Contusion of the cord at a high thoracic level
. Spinal shock
. Spinal cord ischemic injury at the low thoracic watershed zone
. Conversion disorder

Correct Answer & Explanation

. Spinal cord ischemic injury at the low thoracic watershed zone

Explanation

A watershed zone refers to an area that is supplied purely by end arteries. Therefore, during periods of hypoperfusion, it is the most likely region to sustain an ischemic injury. In the spinal cord, this region lies in the T7-T9 region as it is a watershed zone between the rostral anterior spinal artery distribution and the caudal dominant lumbar segmental artery.

Question 292

Topic: 6. Spine

The watershed zone of the spinal cord most closely correlates with which region of the spinal cord:

. C 5-C 7
. T4-T6
. T7-T9
. T11-L1
. L3-L5

Correct Answer & Explanation

. T7-T9

Explanation

A watershed zone refers to an area that is supplied purely by end arteries. Therefore, during periods of hypoperfusion, it is the most likely region to sustain an ischemic injury. In the spinal cord, this region lies in the T7-T9 region as it is a watershed zone between the rostral anterior spinal artery distribution and the caudal dominant lumbar segmental artery.

Question 293

Topic: 6. Spine
Which of the following is the most common source of infection in vertebral osteomyelitis?
. Trauma
. Iatrogenic
. Hematogenous spread
. Spontaneous
. Unknown mechanism

Correct Answer & Explanation

. Hematogenous spread

Explanation

Hematogenous seeding from another primary source is the most common causative agent. Hematogenous spread of infections is believed to affect the spine via septic emboli in the endarteriolar circulation of segmental spinal arteries at the vertebral endplates. The majority of cases of pyogenic spondylitis begin in the subchondral, metaphyseal region of the anterior subligamentous portion of the vertebral body—the portion with the greatest arterial supply and the most anastomoses.

Question 294

Topic: 6. Spine

Which of the following is the most common location of vertebral osteomyelitis along the spinal axis:

. C raniocervical junction
. Thoracic spine
. Lumbar spine
. Sacral spine
. C ervical spine

Correct Answer & Explanation

. Lumbar spine

Explanation

Lumbar spine is the most common region of the spine affected by hematogenous spread of organisms leading to osteomyelitis followed by the thoracic spine.

Question 295

Topic: 6. Spine

Neurogenic shock is defined as:

. Decreased cardiac output due to increased parasympathetic tone
. Severe volume depletion leading to hypotension
. Widespread gram-negative septicemia with hypoperfusion
. Loss of sympathetic tone and widespread vasodilation
. Increased cardiac output due to decreased parasympathetic tone

Correct Answer & Explanation

. Loss of sympathetic tone and widespread vasodilation

Explanation

Neurogenic shock is a unique hemodynamic alteration in patients with spinal cord injuries who have their sympathetic outflow disrupted in addition to the interruption of the motor and sensory pathways. The loss of sympathetic tone to the heart and peripheral vasculature leads to bradycardia and hypotension.

Question 296

Topic: 6. Spine

The normal range of thoracic kyphosis is:

. 0° to 10°
. 5° to 20°
. 20° to 50°
. 35° to 50°
. 40° to 60°

Correct Answer & Explanation

. 20° to 50°

Explanation

The normal range of thoracic kyphosis is 20° to 50°. The mean in normal adults is 35°. The normal range of lumbar lordosis is 40° to 80°. The mean in normal adults is approximately 60°. The spine is usually straight in the sagittal plane between T10 and L2. The majority of lumbar lordosis occurs between L4 and S1.

Question 297

Topic: 6. Spine

The normal range of lumbar lordosis is:

. 0° to 10°
. 10° to 20°
. 20° to 50°
. 40° to 80°
. 60° to 90°

Correct Answer & Explanation

. 40° to 80°

Explanation

The normal range of thoracic kyphosis is 20° to 50°. The mean in normal adults is 35°. The normal range of lumbar lordosis is 40° to 80°. The mean in normal adults is approximately 60°. The spine is usually straight in the sagittal plane between T10 and L2. The majority of lumbar lordosis occurs between L4 and S1.

Question 298

Topic: Thoracolumbar Spine & Deformity

A 45-year-old falls from a height and sustains an L1 burst fracture. MRI demonstrates an intact posterior ligamentous complex (PLC) and the patient has no neurologic deficit. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the patient's score and recommended management?

. TLICS 2, non-operative management
. TLICS 4, non-operative management
. TLICS 5, operative management
. TLICS 3, non-operative management
. TLICS 7, operative management

Correct Answer & Explanation

. TLICS 2, non-operative management

Explanation

The TLICS system assigns 2 points for a burst fracture morphology, 0 points for an intact PLC, and 0 points for an intact neurologic status, totaling 2 points. A score of 3 or less is an indication for non-operative management.

Question 299

Topic: Thoracolumbar Spine & Deformity

A 30-year-old involved in a motor vehicle accident sustains a flexion-distraction injury (Chance fracture) at L2. Which of the following concomitant injuries is most highly associated with this fracture pattern?

. Aortic transection
. Gastrointestinal tract injury
. Splenic rupture
. Bladder rupture
. Renal avulsion

Correct Answer & Explanation

. Gastrointestinal tract injury

Explanation

Chance fractures are caused by a flexion-distraction mechanism, commonly associated with lap seatbelts. They have a high association (up to 40-50%) with intra-abdominal injuries, particularly hollow viscus and mesenteric tears.

Question 300

Topic: 6. Spine

A 55-year-old man presents with bilateral leg pain and fatigue. During history and physical examination, which of the following findings most reliably differentiates neurogenic claudication from vascular claudication?

. Pain relief with standing
. Diminished distal pulses
. Pain relief with lumbar flexion
. Exacerbation of pain with cycling
. Presence of stocking-glove numbness

Correct Answer & Explanation

. Pain relief with lumbar flexion

Explanation

Neurogenic claudication is hallmark for lumbar spinal stenosis and classically improves with lumbar flexion (e.g., sitting, leaning forward, or cycling). Vascular claudication is related to muscle ischemia during activity and does not improve strictly with postural changes like spine flexion.

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