6. Spine MCQs

A 60-year-old man with poorly controlled diabetes mellitus presents with worsening back pain and low-grade fevers for 1 week. Over the past 24 hours, he developed progressive bilateral leg weakness and urinary retention. MRI reveals a massive ventral fluid collection from L2 to L4 causing severe compression of the cauda equina, consistent with a spinal epidural abscess. What is the most common causative organism isolated in this condition?

A 52-year-old man presents with sharp neck pain radiating down his right arm. Physical examination reveals weakness in active elbow extension and wrist flexion. He also reports decreased sensation isolated to the dorsum of his middle finger. Which cervical nerve root is most likely compressed?

A 65-year-old man with cervical spondylotic myelopathy exhibits a positive Hoffmann sign on physical examination. The presence of this physical sign indicates abnormal function primarily involving which of the following descending pathways?

A 68-year-old woman complains of bilateral buttock, thigh, and calf pain that occurs after walking three blocks. The pain is rapidly relieved when she sits down or leans forward over a shopping cart. Physical examination reveals normal pedal pulses. What is the primary anatomical explanation for the relief she experiences when leaning forward?

A 45-year-old male presents with right arm pain and weakness. Physical examination reveals weakness in wrist flexion and finger extension, diminished sensation over the dorsal middle finger, and an absent triceps reflex. Which cervical nerve root is most likely compressed?

A 65-year-old female presents with neurogenic claudication and lower back pain. Radiographs reveal a grade I L4-L5 degenerative spondylolisthesis. Which of the following anatomical features is most characteristic of degenerative spondylolisthesis compared to isthmic spondylolisthesis?

A 72-year-old male complains of an insidious onset of bilateral buttock and posterior thigh pain that worsens after walking two blocks or standing for 15 minutes.

He notices immediate relief when he sits down on a bench or leans forward onto his grocery shopping cart. What physical examination finding is most characteristic of this patient's underlying condition?

A 42-year-old male presents with severe lower back pain, bilateral sciatica, and new-onset urinary retention (post-void residual greater than 500 mL). MRI confirms a massive L4-L5 central disc herniation. Current literature suggests that surgical decompression is ideally performed within what timeframe to maximize the chance of urologic recovery?

A 72-year-old male with known cervical spondylosis is involved in a hyperextension motor vehicle accident. He presents with bilateral upper extremity weakness (hands worse than arms) and relative sparing of lower extremity strength. What is the classic anatomic explanation for this specific pattern of weakness?

A 45-year-old male presents to the emergency department with acute onset of severe bilateral sciatica, saddle anesthesia, and urinary retention with overflow incontinence following heavy lifting. An urgent MRI reveals a massive L4-L5 disc extrusion causing central canal stenosis and compression of the cauda equina. Surgical decompression should ideally be performed within what time frame to maximize the probability of neurological recovery, particularly bladder and bowel function?

A 65-year-old male presents with bilateral hand clumsiness, gait instability, and frequent falls. Physical examination reveals hyperreflexia in all four extremities, a positive Hoffman sign bilaterally, and an unsteady, broad-based gait. He requires the use of a cane at all times to ambulate safely, but he is not restricted to a wheelchair. What is his Nurick classification grade for cervical spondylotic myelopathy?

A 32-year-old female falls from a height. CT of the lumbar spine reveals an L1 burst fracture. There is splaying of the spinous processes on the AP radiograph. MRI confirms disruption of the posterior ligamentous complex (PLC). Neurological examination is completely normal. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is her total score and the recommended management?

A 45-year-old male presents after a motor vehicle accident with neck pain. Imaging shows a unilateral facet dislocation at C5-C6.

What is the most common neurologic deficit associated with this injury if a radiculopathy is present?

A 65-year-old male presents with neurogenic claudication. He reports pain radiating down both legs when walking, which is relieved by leaning forward on a shopping cart. MRI shows severe spinal stenosis at L4-L5. Which ligament thickens and contributes significantly to the dorsal compression of the thecal sac in this condition?

A 62-year-old male undergoes a C4-C6 posterior laminectomy and fusion for cervical spondylotic myelopathy.

Postoperatively, he develops isolated deltoid and biceps weakness (3/5) but denies new sensory loss or leg weakness. What is the most likely etiology of this specific postoperative complication?

A 55-year-old male presents with severe right anterior thigh pain and weakness in knee extension. MRI shows a far lateral (extraforaminal) disc herniation at L3-L4.

Which nerve root is primarily compressed in this scenario?

A 60-year-old male presents with progressively worsening clumsy hands and an unsteady, broad-based gait. Physical examination reveals a positive Hoffmann sign bilaterally and hyperreflexia in the lower extremities. Radiographs and MRI demonstrate Ossification of the Posterior Longitudinal Ligament (OPLL) extending continuously from C3 to C6. The 'K-line' (a line connecting the midpoints of the spinal canal at C2 and C7) is evaluated, and the OPLL mass crosses posteriorly to this line (K-line negative).

Based on these imaging parameters, which of the following surgical approaches is most appropriate to adequately decompress the spinal cord?

A 19-year-old female presents to the trauma bay after a motor vehicle collision. She was a back-seat passenger wearing only a lap belt. Radiographs and CT demonstrate a flexion-distraction injury (Chance fracture) through the L2 vertebral body, pedicles, and spinous process. Neurological examination is intact. Due to the mechanism of injury, which of the following associated injuries must be most highly suspected and investigated?