6. Spine MCQs

A 55-year-old man with a long history of Ankylosing Spondylitis sustains a minor fall. He complains of severe neck pain without neurologic deficits. Radiographs appear unchanged from his baseline showing a "bamboo spine." What is the most appropriate next step?

A 25-year-old man is brought to the trauma bay after a high-speed motorcycle accident. Lateral cervical spine radiographs show a basion-dens interval of 14 mm. Which of the following is the most appropriate definitive management for this injury?

A 50-year-old woman presents with neck pain radiating down her right arm. Physical examination reveals weakness in wrist extension and decreased sensation over the dorsal aspect of the thumb and index finger. The brachioradialis reflex is diminished. Which cervical disc herniation is most likely responsible?

A patient presents with triceps weakness, absent triceps reflex, and numbness in the middle finger. Which nerve root is affected?

A 65-year-old man presents with stiffness in his mid-back and mild dysphagia. Radiographs of the thoracic spine demonstrate flowing ossification along the anterolateral aspect of five contiguous vertebral bodies. The disc heights are preserved, and the sacroiliac joints are normal. What is the most likely diagnosis?

A 65-year-old man presents with bilateral upper extremity weakness and numbness following a hyperextension injury to his neck. His lower extremity strength is nearly normal. MRI of the cervical spine demonstrates central cord edema with multilevel congenital stenosis but no fracture or ligamentous instability. What is the most appropriate initial management?

A 45-year-old man complains of severe right anterior thigh pain and weakness in knee extension. He has no significant back pain. Examination reveals a diminished right patellar reflex and decreased sensation over the anterior thigh. MRI shows a far lateral disc herniation. At which lumbar level is this herniation most likely located?

An 82-year-old man with a history of falls presents with neck pain. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the most appropriate management?

A 55-year-old man with long-standing ankylosing spondylitis presents to the emergency department with acute back pain after tripping and falling on level ground. Plain radiographs of the thoracic and lumbar spine are inconclusive. What is the most appropriate next step in management?

A 30-year-old man is brought to the trauma bay following a motor vehicle collision. He is awake, alert, and cooperative but has no motor or sensory function below the C5 level (ASIA A). Imaging shows a bilateral facet dislocation at C5-C6. What is the next best step in management?

A 25-year-old woman falls from a height and sustains an L1 burst fracture. CT shows 40% retropulsion into the spinal canal. She is neurologically intact, and MRI confirms the posterior ligamentous complex is intact. What is the most appropriate management?

A 65-year-old man complains of bilateral calf, thigh, and buttock pain that worsens with walking and improves when he leans forward over a shopping cart. Lower extremity pulses are normal. Which of the following physical examination findings is most characteristic of his condition?

A 50-year-old man of East Asian descent presents with progressive clumsiness in his hands and a broad-based gait. CT of the cervical spine shows continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. On sagittal imaging, the OPLL mass crosses the "K-line" (a negative K-line). What is the recommended surgical approach?

A 40-year-old man underwent an L4-L5 microdiscectomy 2 years ago with excellent relief of his right leg pain. He now presents with a 6-week history of recurrent right L5 radicular pain that has failed conservative therapy. MRI shows a recurrent L4-L5 right paracentral disc herniation. He has minimal back pain and no instability on dynamic radiographs. What is the recommended surgical intervention?

A 22-year-old man wearing a lap-only seatbelt is involved in a high-speed motor vehicle collision. Imaging reveals an L2 fracture extending transversely through the vertebral body, pedicles, and spinous process. He is neurologically intact. What is the most appropriate management?

A 68-year-old woman with neurogenic claudication and an L4-L5 Grade 1 degenerative spondylolisthesis has failed non-operative treatment. What is the primary advantage of performing a lumbar decompression with fusion rather than a decompression alone?

A 55-year-old male intravenous drug user presents with severe back pain, subjective fevers, and progressive paraparesis. MRI reveals a large posterior spinal epidural abscess at T8-T10 causing severe cord compression. What is the most appropriate immediate management?

A 30-year-old man sustains a C1 burst fracture. An open-mouth odontoid radiograph demonstrates that the lateral masses of C1 overhang the lateral masses of C2 by a combined total of 8 mm. What does this finding most likely indicate?

A 45-year-old woman presents with pain radiating down her posterior arm into her middle finger. Physical examination reveals weakness in triceps extension and wrist flexion, with a diminished triceps reflex. Which nerve root is most likely compressed?

A patient is evaluated for a traumatic spondylolisthesis of the axis (Hangman's fracture). Imaging shows significant angulation with minimal translation, and widening of the posterior C2-C3 disc space. According to the Levine-Edwards classification, what treatment modality is absolutely contraindicated in the initial management?