6. Spine MCQs

In evaluating a patient with Cauda Equina Syndrome (CES), the examiner asks for the distinction between CES-I (Incomplete) and CES-R (With Retention). What is the defining clinical feature of CES-R?

A 42-year-old male presents with bilateral sciatica, saddle anesthesia, and urinary retention. MRI reveals a massive L4/L5 central disc herniation. What is the primary pathophysiological mechanism underlying cauda equina syndrome in this setting?

A 65-year-old male undergoes a multi-level posterior cervical laminectomy and fusion (C3-C7) for severe cervical spondylotic myelopathy. On post-operative day 2, he develops isolated, profound weakness in right shoulder abduction and elbow flexion. Sensation and lower extremity function remain unchanged. What is the most widely accepted primary etiology for this complication?

A 35-year-old male is involved in a high-speed motor vehicle collision and sustains a 'Hangman's fracture' (traumatic spondylolisthesis of the axis). What is the classic mechanism of injury for this specific fracture pattern?

A 24-year-old male is involved in a motor vehicle collision and sustains a traumatic spondylolisthesis of C2 (Hangman's fracture). Radiographs show a C2-C3 angulation of 15 degrees and translation of 4 mm, with severe disruption of the C2-C3 disc space. According to the Levine-Edwards classification, this is a Type IIA fracture. What is the most appropriate initial management?

A 65-year-old female presents with bilateral leg pain and cramping that worsens with walking and prolonged standing. She states that the pain is relieved when she sits down or leans forward over a shopping cart. The stationary bicycle test is performed to differentiate neurogenic claudication from vascular claudication. Which of the following responses on the stationary bicycle test strongly supports a diagnosis of neurogenic claudication?

Imaging reveals a traumatic spondylolisthesis of the axis (Hangman's fracture) in a 24-year-old male following a motor vehicle accident. The lateral radiograph demonstrates severe angulation but minimal translation at the C2-C3 junction, indicative of a Levine-Edwards Type IIa fracture. What is the classic contraindication in the acute management of this specific fracture pattern?

Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) is utilized in spine surgery to enhance arthrodesis. When used off-label in anterior cervical discectomy and fusion (ACDF), what is the most significant and potentially life-threatening complication associated with its use?

A 45-year-old male presents with a 4-week history of radiating neck pain into his right arm. Physical examination reveals a diminished reflex, specific motor weakness, and sensory alterations. Which of the following constellations of physical examination findings is most consistent with a C6 radiculopathy?

A 68-year-old female presents with bilateral leg pain and cramping that worsens with prolonged standing and walking, but improves when she leans forward over a shopping cart. MRI demonstrates severe central lumbar spinal stenosis at L4-L5. Hypertrophy of which of the following ligaments is the primary contributor to dorsal compression of the thecal sac in this condition?

A 65-year-old male presents with deteriorating handwriting, difficulty buttoning his shirt, and a broad-based, unsteady gait. Examination reveals a positive Hoffman's sign and hyperreflexia in the lower extremities. Which of the following physical examination tests specifically assesses upper extremity fine motor function in the setting of cervical myelopathy by counting repetitions?

In the Thoracolumbar Injury Classification and Severity Score (TLICS), neurological status is a primary determinant of the final score and treatment recommendation. Which of the following neurological statuses is assigned the highest point value (3 points)?

A 60-year-old male presents with bilateral neurogenic claudication that improves when leaning forward on a shopping cart. MRI of the lumbar spine confirms severe central canal stenosis at L4-L5. Hypertrophy of which of the following ligaments directly contributes to the reduction in the cross-sectional area of the central canal?

A 45-year-old male sustains a T12 burst fracture after a fall. He is neurologically intact. In calculating the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following radiographic findings is most specifically indicative of an unstable Posterior Ligamentous Complex (PLC) injury that would push the score toward surgical management?

A 65-year-old male presents with deteriorating hand dexterity and a broad-based gait. Examination reveals hyperreflexia in the lower extremities and a positive Hoffmann sign. Which of the following MRI findings is most indicative of a poor prognosis for neurological recovery following surgical decompression for cervical spondylotic myelopathy?

In an isthmic spondylolisthesis (Wiltse Type II) at L5-S1, the primary pathology is a defect in the pars interarticularis. Which exiting nerve root is most commonly compressed, and where does the compression typically occur?

A 55-year-old male presents with deteriorating manual dexterity and gait instability. On examination, 'flicking' the nail of his middle finger downward elicits a reflexive flexion of his thumb and index finger. This positive Hoffmann sign indicates an upper motor neuron lesion within which of the following spinal tracts?

A spinal surgeon is evaluating a 45-year-old patient for an isthmic spondylolisthesis at L5-S1. Radiographic measurements reveal a Pelvic Incidence (PI) of 60 degrees and a Pelvic Tilt (PT) of 25 degrees. Based on the established geometric relationship of spinopelvic parameters, what is the patient's Sacral Slope (SS)?

Which of the following clinical or radiographic findings is a strict contraindication to performing a cervical laminoplasty for a patient with cervical spondylotic myelopathy?

A 35-year-old male sustains an L1 burst fracture. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and recommended treatment?