6. Spine MCQs

A 16-year-old boy presents with progressive mid-back pain and a cosmetic deformity. Radiographs reveal a thoracic kyphosis of 65 degrees. According to Sorensen's criteria, which radiographic finding is required for the diagnosis of Scheuermann's disease?

A 42-year-old man presents with acute back pain, bilateral leg pain, perineal numbness, and urinary retention. MRI reveals a massive L4-L5 central disc herniation. Within what timeframe is surgical decompression generally recommended to optimize bladder function recovery?

During a posterior lumbar decompression for L4-L5 spinal stenosis, a dural tear occurs with CSF leak. It is repaired primarily. What is the recommended postoperative management regarding patient mobilization?

A 19-year-old man wearing a lap seatbelt is involved in a high-speed collision. He has a flexion-distraction injury (Chance fracture) at L2. Which of the following concurrent injuries must be highly suspected and investigated?

A 62-year-old man undergoes an anterior cervical discectomy and fusion (ACDF) for myelopathy. Postoperatively, he presents with difficulty swallowing solid foods. Which of the following is the most important intraoperative consideration to minimize postoperative dysphagia?

A 78-year-old man presents with severe neck pain after a low-energy fall. Radiographs and CT scan reveal a Type II odontoid fracture with 6 mm of posterior displacement and comminution at the fracture base. He is neurologically intact. His medical history includes hypertension and mild osteopenia. What is the most appropriate management for this patient?

A 66-year-old woman presents with progressive neurogenic claudication and bilateral leg pain limiting her walking distance to less than one block. MRI demonstrates severe central canal stenosis at L4-L5 with a Grade I degenerative spondylolisthesis. After 6 months of failed nonoperative management including epidural injections, she elects for surgery. What is the most evidence-based surgical intervention?

A 24-year-old man is brought to the emergency department after a shallow water diving accident. He is awake, alert, and cooperative, with no other traumatic injuries. Examination reveals full strength and sensation in all extremities. Radiographs and CT scan show a C5-C6 bilateral facet dislocation with 50% translation. What is the most appropriate immediate management?

A 5-year-old boy is evaluated for early-onset spinal deformity. Radiographs demonstrate multiple congenital vertebral anomalies. Which of the following specific anomalies carries the highest risk for rapid curve progression and often requires early prophylactic surgical fusion?

A 48-year-old man presents with sharp, radiating left lower extremity pain after lifting a heavy box. An MRI of the lumbar spine reveals a large, left-sided far-lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed, and what clinical finding would be expected?

A 62-year-old man with a history of long-standing ankylosing spondylitis presents with new-onset mechanical back pain following a minor slip and fall. Plain radiographs of the thoracolumbar spine show bridging syndesmophytes but no obvious fracture. What is the most appropriate next step in management?

A 55-year-old woman with advanced rheumatoid arthritis presents for preoperative evaluation of severe cervical myelopathy. Which of the following radiographic parameters best predicts the likelihood of postoperative neurologic recovery following cervical decompression and stabilization?

During surgical correction of a complex adult degenerative scoliosis, restoring sagittal balance is a primary goal to optimize postoperative function and pain relief. According to the Schwab criteria, what is the ideal postoperative target relationship between Pelvic Incidence (PI) and Lumbar Lordosis (LL)?

A 16-year-old gymnast presents with persistent, localized low back pain that worsens with extension activities. She has failed 6 months of rest and physical therapy. Radiographs and a CT scan reveal a bilateral pars interarticularis defect at L5 with a Grade II spondylolisthesis. If surgical intervention is pursued, what is the standard treatment of choice?

A 30-year-old male construction worker falls from scaffolding, sustaining a T12 burst fracture. He is neurologically intact. Review of his CT and MRI shows a comminuted burst fracture with 20% canal compromise and an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his score and recommended treatment?

A 52-year-old man of Japanese descent presents with clumsiness of the hands, broad-based gait, and hyperreflexia in both upper and lower extremities. Plain radiographs show dense, confluent ossification along the posterior aspect of the cervical vertebral bodies from C3 to C6. What is the primary pathomechanical cause of his symptoms?

A 45-year-old woman complains of neck and arm pain radiating down to her thumb and index finger. Examination reveals decreased sensation over the radial aspect of the forearm, weakness in wrist extension, and a diminished brachioradialis reflex. An MRI is most likely to show a disc herniation at which cervical level?

A 12-year-old boy with non-ambulatory spastic quadriplegic cerebral palsy presents with a severe, progressive sweeping neuromuscular scoliosis of 85 degrees and a pelvic obliquity of 25 degrees. He is experiencing difficulty sitting in his customized wheelchair. What is the most appropriate definitive surgical intervention?

A 35-year-old woman presents with severe low back pain, bilateral sciatica, and new-onset urinary incontinence. Physical examination reveals saddle anesthesia and decreased anal sphincter tone. To maximize the chance of full bladder function recovery, surgical decompression should ideally be performed within what timeframe from symptom onset?