6. Spine MCQs

A 72-year-old male presents with bilateral lower extremity pain and cramping that worsens with walking and improves with sitting. To differentiate neurogenic claudication from vascular claudication, a bicycle test is performed. Which of the following findings is characteristic of neurogenic claudication?

A 55-year-old male of Asian descent presents with progressive clumsiness in his hands and a broad-based gait. Imaging shows multi-level ossification of the posterior longitudinal ligament (OPLL) from C3 to C6 causing severe cord compression. His cervical alignment demonstrates 15 degrees of kyphosis. What is the most appropriate surgical approach?

A 72-year-old male with degenerative cervical myelopathy is scheduled for a posterior cervical laminectomy and fusion. Preoperatively, he exhibits a modified Japanese Orthopaedic Association (mJOA) score of 12. Which of the following preoperative MRI findings correlates most strongly with a poor neurological recovery following decompression?

A 55-year-old male with severe cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) from C3-C6 presents for surgical evaluation. MRI and lateral radiographs show a fixed kyphotic alignment. The OPLL mass crosses the K-line (K-line negative). What is the most appropriate surgical strategy?

A 60-year-old Asian male presents with progressive bilateral hand dexterity loss and a wide-based gait. Cervical CT demonstrates continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6.

The 'K-line' connects the midpoints of the spinal canal at C2 and C7 on a neutral sagittal image. In this patient, the OPLL mass crosses the K-line (K-line negative). What is the surgical implication of this finding?

A 20-year-old collegiate pitcher undergoes ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft. Which functional bundle of the UCL is the primary restraint to valgus stress and is the primary target of this reconstruction?

A 68-year-old male presents with acute onset of severe low back pain and bilateral leg weakness following a fall from standing. He has a known history of prostate cancer with bone metastases. On examination, he has bilateral lower extremity weakness (3/5) and urinary retention. Which of the following investigations is most crucial for immediate management?

A 45-year-old male sustains a fall from a roof and is found to have a C5 burst fracture with incomplete spinal cord injury (ASIA C). He has significant pain and weakness. Which of the following is the most appropriate immediate management strategy?

A 45-year-old male is involved in a motor vehicle collision, resulting in severe cervical hyperextension. CT of the cervical spine reveals bilateral fractures through the pars interarticularis of C2 with 2 mm of C2-C3 anterior translation. What is the diagnosis?

The spinothalamic tract is a major ascending pathway for pain and temperature sensation. Where do the second-order neurons of the spinothalamic tract decussate (cross to the contralateral side)?

A 60-year-old man presents with upper extremity weakness that is disproportionately greater than his lower extremity weakness following a hyperextension cervical spine injury. Which spinal cord syndrome is most likely?

A 45-year-old woman presents with neck pain radiating to her middle finger, weakness in elbow extension, and an absent triceps reflex. Which cervical nerve root is most likely compressed?

A 45-year-old male is evaluated for acute cauda equina syndrome secondary to a massive L4-L5 disc herniation. Which of the following preoperative clinical findings is the most reliable predictor of postoperative urinary bladder function recovery?

A 65-year-old male with progressive gait deterioration presents for evaluation. On examination, a rapid flicking of the distal phalanx of the middle finger results in spontaneous flexion of the thumb and index finger (positive Hoffmann's sign). This physical finding typically indicates an upper motor neuron lesion above which specific spinal cord level?

A 45-year-old female presents with acute onset of bilateral sciatica, saddle anesthesia, and urinary retention with overflow incontinence following a heavy lifting injury. An MRI confirms a massive L4-L5 disc herniation. What is the most critical prognostic factor for postoperative bladder function recovery?

A candidate is discussing common inflammatory arthropathies. Which specific HLA allele is strongly associated with ankylosing spondylitis and other spondyloarthropathies?

When assessing a patient for a potential cervical spine injury in a trauma setting, which finding necessitates immediate immobilization and further imaging, even if the patient is neurologically intact?

A candidate is asked about the 'three-column concept' of spinal stability. Which column is primarily responsible for resisting axial compression and is often compromised in burst fractures?