6. Spine MCQs

A 68-year-old man presents with progressive difficulty buttoning his shirts and a wide-based, unsteady gait. He denies neck pain but notes occasional shock-like sensations radiating down his spine with neck flexion. On physical examination, tapping the distal phalanx of the middle finger results in spontaneous flexion of the thumb and index finger. Which of the following examination findings is considered the most specific for his likely diagnosis?

A 35-year-old male presents after a high-speed motor vehicle collision. Radiographs show a traumatic spondylolisthesis of the axis with severe angulation and minimal translation. The fracture line is oblique. According to the Levine and Edwards classification (Type IIA), what is the most critical management principle during initial stabilization?

A 65-year-old male with type II diabetes presents with progressive stiffness of his thoracic and lumbar spine. Radiographs demonstrate flowing ossification along the anterolateral aspect of four contiguous vertebral bodies. The sacroiliac joints are preserved, and disc heights are relatively normal. What is the most common metabolic abnormality associated with this condition?

A 30-year-old male is evaluated in the trauma bay following a high-speed motor vehicle collision. Cervical spine imaging demonstrates a traumatic spondylolisthesis of the axis (Hangman's fracture). The C2-C3 disc space is widened posteriorly with severe angulation, but there is minimal anterior translation of C2 on C3. This injury pattern is classified as a Levine and Edwards Type IIA fracture. Which of the following interventions is strictly contraindicated in the acute management of this fracture?

A 68-year-old male presents with bilateral lower extremity pain, heaviness, and cramping that occurs reliably after walking two blocks. The patient's history is evaluated to differentiate between neurogenic claudication (due to lumbar spinal stenosis) and vascular claudication (due to peripheral arterial disease). Which of the following findings most specifically suggests neurogenic claudication?

A 65-year-old male presents with worsening hand clumsiness, frequent dropping of objects, and a broad-based, unsteady gait. On examination, he has a positive Hoffmann sign and hyperreflexia in his lower extremities. An MRI of the cervical spine reveals severe canal stenosis at C4-C5 and C5-C6. Which of the following MRI findings is considered the most specific indicator of a poor prognosis for neurologic recovery following surgical decompression?

A 22-year-old male dives into shallow water and strikes his head. Imaging reveals a C5 burst fracture with significant canal compromise. On neurologic examination, he has absent motor function in the bilateral upper extremities distal to C5 and absent motor function in the lower extremities. He has no sensation to pinprick or light touch below C5, but he has intact perianal sensation and voluntary anal sphincter contraction. What is his American Spinal Injury Association (ASIA) Impairment Scale grade?

A 25-year-old male presents after a motor vehicle collision. Imaging reveals a traumatic spondylolisthesis of the axis.

Radiographs show a fracture through the pars interarticularis of C2 with severe angulation and minimal translation, without facet dislocation. Applying axial traction causes the fracture gap to widen. Based on the Levine and Edwards classification, what is the most appropriate management?

A 16-year-old gymnast complains of chronic low back pain exacerbated by extension. Radiographs and subsequent MRI show a unilateral pars interarticularis defect at L5 without evidence of spondylolisthesis.

She has failed 6 months of structured conservative management including bracing and physical therapy. She strongly wishes to return to competitive gymnastics. What is the most appropriate surgical intervention?

A 45-year-old male presents with severe, radiating leg pain. An MRI of the lumbar spine is obtained.

Imaging demonstrates a 'far lateral' (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely to be directly compressed by this specific type of herniation?

A 68-year-old male presents with progressive hand clumsiness and gait imbalance over the past year. Examination reveals a positive Hoffmann sign bilaterally and hyperreflexia in the lower extremities. MRI of the cervical spine demonstrates severe spinal canal stenosis at C4-C5 and C5-C6. Which of the following specific MRI findings in the spinal cord is most strongly associated with a poor prognosis for neurologic recovery following surgical decompression?

A 75-year-old male with severe neurogenic claudication secondary to multilevel lumbar spinal stenosis is considering surgical intervention after failing 6 months of conservative treatment. Which of the following preoperative clinical features is most predictive of a highly successful outcome following a lumbar laminectomy and decompression?

A 65-year-old male presents with deteriorating hand dexterity and gait imbalance. On physical examination, tapping the distal brachioradialis tendon results in diminished reflex elbow flexion, but elicits spontaneous flexion of the ipsilateral fingers. This physical exam finding localizes the spinal cord pathology to which of the following levels?

A 28-year-old male falls from a height and sustains a thoracolumbar spinal fracture. A CT scan confirms a burst fracture at L1. According to the Denis three-column theory of spinal stability, a burst fracture is characterized by the biomechanical failure of which columns under an axial load?

A 55-year-old diabetic male presents with back pain, fever, and progressive bilateral lower extremity weakness. MRI reveals a spinal epidural abscess compressing the thoracic spinal cord. What is the most common causative organism?

A 72-year-old male presents with worsening hand clumsiness, frequent falls, and a broad-based gait. Physical examination reveals a positive Hoffmann sign bilaterally.

An MRI of the cervical spine is obtained. Which of the following MRI signal characteristics within the spinal cord is most strongly associated with a poor prognosis for neurologic recovery following surgical decompression?

A 68-year-old male complains of bilateral posterior leg pain when walking. You are attempting to differentiate neurogenic claudication (due to lumbar spinal stenosis) from vascular claudication. Which of the following is most characteristic of neurogenic claudication?

A 68-year-old male presents with worsening hand clumsiness, frequent falls, and a broad-based shuffling gait. Examination reveals hyperreflexia and a positive Hoffmann's sign bilaterally.

MRI demonstrates severe multilevel cervical stenosis from C3 to C6 with intramedullary T2 signal hyperintensity. Standing radiographs show a rigid, 25-degree cervical kyphotic deformity. What is the most appropriate surgical approach?

A 40-year-old male construction worker falls 15 feet from scaffolding. He is neurologically entirely intact. CT imaging of the spine reveals a burst fracture of L1 with 40% retropulsion into the spinal canal and 15 degrees of regional kyphosis. MRI reveals an intact posterior ligamentous complex (PLC). Using the Thoracolumbar Injury Classification and Severity Score (TLICS), what is his calculated score and the recommended treatment approach?