Menu

6. Spine MCQs

Practice Set 178 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 3541

Topic: Cervical Spine

A 78-year-old man falls and sustains a Type II odontoid fracture with 1 mm of displacement. He has a history of severe chronic obstructive pulmonary disease (COPD) and heart failure. He is neurologically intact. What is the most appropriate initial management?

. Halo vest immobilization
. Rigid cervical collar
. Anterior odontoid screw fixation
. Posterior C1-C2 fusion
. Cervical traction

Correct Answer & Explanation

. Rigid cervical collar

Explanation

Elderly patients with Type II odontoid fractures have significantly higher mortality rates with halo vest immobilization. Given this patient's severe medical comorbidities and minimal fracture displacement, a rigid cervical collar is the safest and most appropriate initial management.

Question 3542

Topic: 6. Spine

A 45-year-old male arrives intubated and sedated with a unilateral C6-C7 facet dislocation. What is the most appropriate next step prior to attempting reduction?

. Awake closed reduction
. Closed reduction under general anesthesia
. MRI of the cervical spine
. Anterior cervical discectomy and fusion
. Posterior cervical fusion

Correct Answer & Explanation

. MRI of the cervical spine

Explanation

In an unexaminable (intubated/sedated) patient with a cervical facet dislocation, an MRI is mandatory before attempting reduction to rule out a disc herniation that could cause iatrogenic spinal cord injury.

Question 3543

Topic: 6. Spine

What is the most common associated intra-abdominal injury in a pediatric patient with a flexion-distraction (Chance) fracture of the lumbar spine?

. Splenic laceration
. Hepatic laceration
. Hollow viscus injury
. Renal contusion
. Pancreatic transection

Correct Answer & Explanation

. Hollow viscus injury

Explanation

Chance (flexion-distraction) fractures have a highly significant association (30-50%) with intra-abdominal injuries. The most commonly injured structures are hollow visceral organs, such as the bowel.

Question 3544

Topic: Thoracolumbar Spine & Deformity

In planning for adult spinal deformity correction, which of the following radiographic relationships is the primary goal to achieve a well-balanced spine?

. Lumbar Lordosis (LL) equals Pelvic Incidence (PI) ± 9 degrees
. Pelvic Tilt (PT) greater than 20 degrees
. Sagittal Vertical Axis (SVA) greater than 5 cm
. Thoracic Kyphosis (TK) equals Lumbar Lordosis (LL)
. Sacral Slope (SS) less than 20 degrees

Correct Answer & Explanation

. Lumbar Lordosis (LL) equals Pelvic Incidence (PI) ± 9 degrees

Explanation

A fundamental goal of adult spinal deformity surgery is to restore sagittal balance. This is best achieved by correcting the Lumbar Lordosis to within 9-10 degrees of the patient's fixed Pelvic Incidence.

Question 3545

Topic: 6. Spine

During the anterior approach to the lower cervical spine (C5-C7), which of the following structures is at greatest risk of injury when dissecting in the tracheoesophageal groove on the right side?

. Superior laryngeal nerve
. Recurrent laryngeal nerve
. Sympathetic chain
. Hypoglossal nerve
. Vagus nerve

Correct Answer & Explanation

. Recurrent laryngeal nerve

Explanation

The recurrent laryngeal nerve has a variable, aberrant course on the right side as it loops around the subclavian artery, placing it at higher risk during right-sided anterior lower cervical approaches.

Question 3546

Topic: 6. Spine

A 30-year-old male presents with severe right leg pain and weakness in big toe extension. MRI reveals a large paracentral disc herniation at L4-L5. Which nerve root is most likely affected?

. Exiting L4 nerve root
. Traversing L4 nerve root
. Exiting L5 nerve root
. Traversing L5 nerve root
. Traversing S1 nerve root

Correct Answer & Explanation

. Traversing L5 nerve root

Explanation

In the lumbar spine, a typical paracentral disc herniation at L4-L5 impinges the traversing L5 nerve root. This classically presents with weakness of the extensor hallucis longus (EHL).

Question 3547

Topic: Thoracolumbar Spine & Deformity

Which of the following is an absolute indication for surgical intervention in a patient with a traumatic thoracolumbar burst fracture?

. 30% loss of anterior vertebral body height
. 40% canal compromise without neurologic deficit
. Progressive neurologic deficit
. 15 degrees of local kyphosis
. Concomitant transverse process fractures

Correct Answer & Explanation

. Progressive neurologic deficit

Explanation

The development of a progressive neurologic deficit is an absolute indication for urgent surgical decompression and stabilization in the setting of a thoracolumbar burst fracture.

Question 3548

Topic: 6. Spine

A 60-year-old male with long-standing Ankylosing Spondylitis presents with neck pain after a minor fall. Initial plain radiographs of the cervical spine are unremarkable. What is the most appropriate next step in management?

. Discharge with a soft cervical collar
. Prescribe NSAIDs and physical therapy
. CT scan of the cervical spine
. Flexion-extension cervical radiographs
. Reassurance and clinical follow-up in 2 weeks

Correct Answer & Explanation

. CT scan of the cervical spine

Explanation

Patients with Ankylosing Spondylitis are at extremely high risk for highly unstable, occult cervical fractures even after minor trauma. A CT scan of the entire cervical spine is mandatory if plain films are negative.

Question 3549

Topic: Cervical Spine

In evaluating an atlas (C1) ring fracture, lateral mass displacement on the open-mouth odontoid radiograph indicates a tear of the transverse atlantal ligament if the combined displacement exceeds what value?

. 3 mm
. 5 mm
. 7 mm
. 9 mm
. 11 mm

Correct Answer & Explanation

. 7 mm

Explanation

The Rule of Spence states that a combined lateral mass displacement of C1 on C2 greater than 6.9 mm (typically rounded to 7 mm) on an AP open-mouth radiograph indicates a rupture of the transverse atlantal ligament. This implies transverse instability requiring more rigid fixation or prolonged halo immobilization.

Question 3550

Topic: 6. Spine

A 25-year-old man presents with a unilateral C5-C6 facet dislocation and a C6 radiculopathy following a motor vehicle collision. He is awake, alert, and cooperative. What is the most appropriate initial management?

. Immediate MRI of the cervical spine
. Closed reduction with cervical traction under fluoroscopy
. Anterior cervical discectomy and fusion
. Posterior cervical fusion
. Immobilization in a hard collar and observation

Correct Answer & Explanation

. Closed reduction with cervical traction under fluoroscopy

Explanation

In an awake, alert, and cooperative patient with a cervical facet dislocation, rapid closed reduction using awake cervical traction is indicated. An MRI is not required prior to closed reduction in a cooperative patient, as continuous neurologic monitoring during traction ensures safety.

Question 3551

Topic: Thoracolumbar Spine & Deformity

A 35-year-old woman falls from a height and sustains a T12 burst fracture. Imaging reveals splaying of the spinous processes and an MRI shows disruption of the posterior ligamentous complex. She is neurologically intact. What is her Thoracolumbar Injury Classification and Severity (TLICS) score?

. 3
. 4
. 5
. 6
. 7

Correct Answer & Explanation

. 5

Explanation

The TLICS score is based on morphology (burst = 2 points), posterior ligamentous complex integrity (disrupted = 3 points), and neurologic status (intact = 0 points). A total score of 5 points indicates that surgical stabilization is the recommended treatment.

Question 3552

Topic: Thoracolumbar Spine & Deformity

In planning a corrective surgery for adult spinal deformity, which of the following spinopelvic parameter relationships represents the primary goal to achieve optimal sagittal balance?

. Pelvic Incidence (PI) equals Pelvic Tilt (PT)
. Lumbar Lordosis (LL) equals Sacral Slope (SS)
. Pelvic Incidence (PI) minus Lumbar Lordosis (LL) is less than 10 degrees
. Pelvic Tilt (PT) minus Sacral Slope (SS) is greater than 10 degrees
. Thoracic Kyphosis (TK) matches Lumbar Lordosis (LL)

Correct Answer & Explanation

. Pelvic Incidence (PI) minus Lumbar Lordosis (LL) is less than 10 degrees

Explanation

A key goal in adult spinal deformity surgery is to restore the normal relationship between Pelvic Incidence (PI) and Lumbar Lordosis (LL). Matching PI and LL within 10 degrees (PI - LL < 10 degrees) minimizes compensatory mechanisms like increased pelvic tilt and improves clinical outcomes.

Question 3553

Topic: 6. Spine

A 45-year-old man presents with severe right leg pain. An MRI of the lumbar spine reveals a far lateral (extraforaminal) disc herniation on the right side at the L4-L5 level. Which nerve root is most likely compressed, and what clinical finding would be expected?

. L4 nerve root; diminished patellar reflex
. L4 nerve root; weakness in ankle plantar flexion
. L5 nerve root; weakness in great toe extension
. L5 nerve root; diminished Achilles reflex
. S1 nerve root; weakness in ankle plantar flexion

Correct Answer & Explanation

. L4 nerve root; diminished patellar reflex

Explanation

In the lumbar spine, a far lateral (extraforaminal) disc herniation compresses the exiting nerve root at that level, which is L4 at L4-L5. An L4 radiculopathy classically presents with a diminished patellar reflex, weakness in knee extension, and anterior thigh numbness.

Question 3554

Topic: Thoracolumbar Spine & Deformity

Which of the following anatomical factors is most strongly associated with the development of degenerative spondylolisthesis at L4-L5?

. Coronal orientation of the facet joints
. Sagittal orientation of the facet joints
. Increased sacral slope
. Decreased pelvic incidence
. Presence of a pars interarticularis defect

Correct Answer & Explanation

. Sagittal orientation of the facet joints

Explanation

Sagittal orientation of the facet joints at L4-L5 reduces their ability to resist anterior shear forces, strongly predisposing individuals to degenerative spondylolisthesis. Normal facet joints at this level are typically more coronally oriented, which mechanically blocks anterior translation.

Question 3555

Topic: 6. Spine

A 40-year-old man presents to the emergency department with acute onset of severe back pain, saddle anesthesia, and urinary retention. Post-void residual volume is 400 mL. Emergent MRI confirms a massive L4-L5 disc herniation. To maximize the chance of full neurologic recovery, decompression should ideally be performed within what maximum timeframe from the onset of symptoms?

. 6 hours
. 12 hours
. 24 hours
. 48 hours
. 72 hours

Correct Answer & Explanation

. 48 hours

Explanation

Cauda equina syndrome is a surgical emergency. Decompression performed within 48 hours of symptom onset has been shown to significantly improve the likelihood of resolving bladder and motor dysfunction compared to delayed intervention.

Question 3556

Topic: Cervical Spine

Which of the following factors is most predictive of nonunion following nonoperative management (halo immobilization) of a Type II odontoid fracture?

. Age less than 40 years
. Anterior displacement of 3 mm
. Posterior displacement of 2 mm
. Initial displacement greater than 5 mm
. Concomitant fracture of the C1 posterior arch

Correct Answer & Explanation

. Initial displacement greater than 5 mm

Explanation

High risk of nonunion in Type II odontoid fractures managed conservatively is associated with initial displacement greater than 5 mm, age > 50 years, and posterior displacement. These factors often necessitate surgical stabilization, such as an anterior odontoid screw or posterior C1-C2 fusion.

Question 3557

Topic: 6. Spine

A 65-year-old man undergoes a posterior cervical laminectomy and fusion from C3-C7 for severe cervical spondylotic myelopathy. On postoperative day 2, he develops isolated profound weakness of bilateral deltoids and biceps, but has no sensory changes and lower extremity function remains normal. What is the most likely etiology of this complication?

. Epidural hematoma
. Intraoperative spinal cord contusion
. C5 nerve root traction due to spinal cord drift
. Hardware malposition at C3
. Postoperative C4-C5 disc herniation

Correct Answer & Explanation

. C5 nerve root traction due to spinal cord drift

Explanation

C5 palsy is a known complication following posterior cervical decompression, occurring in up to 10% of cases. It is believed to be caused by posterior shifting (drift) of the spinal cord, leading to traction on the short, horizontally oriented C5 nerve roots.

Question 3558

Topic: 6. Spine

A 60-year-old man with a long-standing history of ankylosing spondylitis sustains a minor ground-level fall. He complains of severe neck pain but has no neurologic deficits. Plain radiographs of the cervical spine are difficult to interpret due to artifact and deformity, but appear unchanged from previous. What is the next best step in management?

. Discharge with NSAIDs and a soft collar
. Flexion-extension cervical radiographs
. CT scan of the cervical spine
. Reassurance and physical therapy
. Immediate halo vest placement

Correct Answer & Explanation

. CT scan of the cervical spine

Explanation

Patients with ankylosing spondylitis are at extremely high risk for highly unstable, transcortical fractures of the rigid spine even after minor trauma. Due to obscured anatomy on plain films, a CT scan of the cervical spine is mandatory to rule out an occult fracture.

Question 3559

Topic: Cervical Spine

An 82-year-old male sustains a Type II odontoid fracture after a ground-level fall. He has multiple medical comorbidities. Which of the following management strategies carries the lowest treatment-related morbidity while still providing acceptable clinical outcomes, despite having the highest rate of nonunion?

. Halo vest immobilization
. Rigid cervical collar
. C1-C2 posterior fusion
. Anterior odontoid screw fixation
. Minerva cast

Correct Answer & Explanation

. Rigid cervical collar

Explanation

A rigid cervical collar is the preferred initial treatment for many elderly patients with Type II odontoid fractures who are poor surgical candidates. While it has a high nonunion rate, fibrous nonunions are generally well-tolerated, and it avoids the high morbidity and mortality associated with halo vest immobilization in the elderly.

Question 3560

Topic: Thoracolumbar Spine & Deformity

A 25-year-old male is involved in a high-speed motor vehicle collision while wearing a lap seatbelt. Radiographs demonstrate a flexion-distraction injury (Chance fracture) at L1. Which of the following is the most commonly associated concomitant injury?

. Aortic tear
. Renal contusion
. Pelvic ring fracture
. Hollow viscus injury
. Splenic rupture

Correct Answer & Explanation

. Hollow viscus injury

Explanation

Chance fractures typically occur due to hyperflexion over a fulcrum (like a lap seatbelt), causing distraction of the posterior and middle columns. They are highly associated with intra-abdominal injuries, most notably hollow viscus injuries such as bowel perforations.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page