6. Spine MCQs

A 68-year-old male presents with bilateral leg and buttock pain that worsens with walking. You are attempting to distinguish between neurogenic claudication due to lumbar spinal stenosis and vascular claudication. Which of the following historical features is the hallmark of neurogenic claudication?

A 65-year-old man presents with progressive clumsiness in his hands and difficulty with balance. Examination demonstrates hyperreflexia, a positive Hoffmann sign, and a positive inverted radial reflex. According to the Nurick classification, a patient whose gait abnormality prevents employment but who walks unassisted is classified as:

A 16-year-old female presents with low back pain and a grade II L5-S1 isthmic spondylolisthesis. Which of the following spinopelvic parameters is highly correlated with the risk of progression in isthmic spondylolisthesis and is a fixed morphological parameter that does not change with patient positioning?

In a patient with cervical spondylotic myelopathy, the presence of an inverted supinator reflex localizes the primary compressive pathology to which cervical cord level?

An 82-year-old male with multiple medical comorbidities sustains a Type II odontoid fracture after a ground-level fall. The fracture is displaced 2 mm anteriorly. His neurologic exam is completely intact. What is the most appropriate initial management considering his age and fracture pattern?

A 62-year-old male is evaluated for cervical spondylotic myelopathy. An MRI of the cervical spine is obtained. Which of the following MRI signal characteristics within the spinal cord is most highly predictive of myelomalacia and correlates with poor neurological recovery following decompressive surgery?

A 35-year-old man falls from a height and sustains a T12 burst fracture. He is neurologically intact. MRI demonstrates complete disruption of the posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and the recommended management?

A 65-year-old man presents with deteriorating handwriting, dropping objects, and gait instability. On physical examination, tapping the brachioradialis tendon at the distal radius elicits paradoxical flexion of the fingers without the normal elbow flexion or forearm supination. This specific localizing sign is known as:

A 55-year-old male presents with progressive clumsiness in his hands and a broad-based gait. Imaging reveals Ossification of the Posterior Longitudinal Ligament (OPLL) in the cervical spine. Which of the following radiographic findings is a relative contraindication to performing a cervical laminoplasty alone in this patient?

A 65-year-old male presents with bilateral leg pain that worsens after walking 2 blocks. Physical examination shows absent Achilles reflexes but intact knee reflexes, with palpable pedal pulses. Which of the following historical findings most reliably differentiates neurogenic claudication from vascular claudication?

A 68-year-old male complains of bilateral leg pain that worsens after walking two blocks. The pain is relieved by sitting or leaning forward over a shopping cart. He states that riding a stationary bicycle does not provoke the pain. Examination reveals intact distal pulses. What is the most likely diagnosis?

A 35-year-old male sustains a C2 traumatic spondylolisthesis (Hangman's fracture). Imaging reveals a fracture through the pars interarticularis with severe angulation, but minimal translation. The C2-C3 disc space is widened posteriorly. Based on the Levine and Edwards classification, what is the mechanism of injury and the appropriate initial treatment?

A 14-year-old gymnast presents with persistent lower back pain exacerbated by extension. Radiographs reveal a Grade II L5-S1 isthmic spondylolisthesis. After 6 months of conservative management including bracing and physical therapy, her pain remains debilitating. What is the most appropriate surgical intervention?

A 35-year-old male is involved in a high-speed motor vehicle collision. Imaging reveals a traumatic spondylolisthesis of C2 (Hangman's fracture). The fracture passes through the pars interarticularis. Lateral radiographs demonstrate severe anterior angulation of C2 on C3, but with minimal anterior translation. The disc space is disrupted posteriorly. Based on the Levine and Edwards classification, what is the most appropriate initial management?

During the physical examination of a 70-year-old male presenting with clumsiness in his hands and broad-based gait, you ask him to fully extend his fingers, and then you observe that the small (ulnar) fingers spontaneously abduct and he is unable to hold them together with the other fingers. This specific finding is known as:

A 45-year-old man presents after a high-speed motor vehicle collision. CT shows a fracture through the pars interarticularis of C2 with 4 mm of anterior translation of C2 on C3 and severe angulation. According to the Levine-Edwards classification, this is a Type IIA Hangman's fracture. What is the mechanism of this specific injury type and the recommended treatment?

A patient sustains a cervical spine injury. On examination, there is zero motor function below the level of injury. Pinprick and light touch sensation are absent throughout the lower extremities, but the patient retains deep anal pressure and perianal sensation. According to the American Spinal Injury Association (ASIA) Impairment Scale, how is this injury graded?

A 45-year-old male presents with severe radicular leg pain. Magnetic resonance imaging reveals a large paracentral disc herniation at the L4-L5 level compressing the traversing nerve root. Physical examination is most likely to demonstrate which of the following focal deficits?

A 45-year-old male presents with right-sided neck pain radiating down his arm. He complains of weakness when trying to extend his elbow and numbness over the dorsal aspect of his middle finger. The triceps reflex is diminished. Which cervical nerve root is most likely compressed?