6. Spine MCQs

A 42-year-old man presents with acute onset urinary retention, saddle anesthesia, and bilateral sciatica. MRI confirms a massive L4-L5 disc herniation compressing the cauda equina. To maximize the chance of complete recovery of bowel and bladder function, surgical decompression should ideally be performed within what maximum timeframe from symptom onset?

A 28-year-old woman was rear-ended in a motor vehicle collision. She has posterior neck pain without neurologic deficits. CT of the cervical spine is normal, and dynamic flexion-extension views show no instability. Which of the following is the most appropriate management?

A 35-year-old man presents with severe right-sided back and leg pain extending to the lateral aspect of his right foot. Examination reveals profound weakness in right plantar flexion and an absent right Achilles reflex. Which disc herniation pattern is most likely responsible for his symptoms?

Which of the following physical examination findings is highly specific for spinal cord compression localizing to the C5-C6 level rather than a higher cervical level?

A 45-year-old man presents with severe right leg pain. Examination reveals weakness in knee extension and an absent patellar reflex. Sensation is decreased over the medial aspect of the lower leg. An MRI demonstrates a far-lateral disc herniation at L4-L5. Which nerve root is most likely compressed?

A 25-year-old man arrives at the trauma bay after a diving accident. He is awake, alert, and cooperative, but exhibits 0/5 motor strength in his lower extremities, bilateral hand weakness, and absent sensation below the clavicles. Lateral cervical spine radiographs demonstrate an anterolisthesis of C5 on C6 of approximately 50%. What is the most appropriate next step in management?

A 22-year-old woman is involved in a high-speed motor vehicle collision while wearing a lap belt. She complains of severe back pain. Radiographs reveal a flexion-distraction injury (Chance fracture) at L2. Which of the following associated injuries must be carefully evaluated for in this patient?

A 65-year-old man undergoes a C3-C6 cervical laminectomy and instrumented fusion for severe cervical spondylotic myelopathy. Postoperatively, he develops profound weakness of the bilateral deltoid and biceps muscles (1/5 strength) but maintains full strength in his hands and lower extremities. What is the most likely etiology of this complication?

A 75-year-old woman falls from a standing height and sustains a Type II odontoid fracture with 3 mm of posterior displacement. She is neurologically intact. Given her age, which of the following treatment options is associated with the highest risk of mortality and severe morbidity?

During an anterior cervical discectomy and fusion (ACDF) at C6-C7 using a right-sided approach, the patient subsequently develops postoperative hoarseness. Which anatomical characteristic of the recurrent laryngeal nerve (RLN) makes it more susceptible to injury on the right side compared to the left?

A 55-year-old diabetic man presents with severe mid-back pain, low-grade fevers, and progressive bilateral leg weakness over the past 48 hours. He has a history of recent intravenous drug use. MRI reveals a large dorsal epidural mass at T8 with cord compression, hyperintense on T2 and showing peripheral enhancement. What is the most appropriate management?

A 30-year-old man is involved in a motor vehicle collision and sustains a traumatic spondylolisthesis of the axis (Hangman's fracture). Radiographs reveal severe angulation of C2 on C3 with minimal anterior translation. The disc space is widened posteriorly. Which of the following treatments is strictly contraindicated?

A 68-year-old man presents with bilateral leg cramping and pain that worsens with walking. Which of the following historical features most strongly suggests neurogenic claudication rather than vascular claudication?

A 10-year-old boy is struck by a car and presents intubated in the emergency department. Lateral cervical spine radiographs show a Basion-Dental Interval (BDI) of 14 mm. What is the definitive treatment for this injury?

A 40-year-old patient falls from a height and sustains an L1 burst fracture. Which of the following radiographic findings most strongly indicates a complete disruption of the posterior ligamentous complex (PLC), warranting operative stabilization?

A 38-year-old woman presents with severe low back pain radiating down the posterior aspect of her left calf to the plantar surface of her foot. She has weakness in ankle plantarflexion and an absent Achilles reflex. An MRI demonstrates a typical paracentral disc herniation at the L5-S1 level. Which nerve root is being compressed?

A 62-year-old man undergoes a C3-C6 laminectomy and instrumented fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops isolated profound weakness in shoulder abduction and elbow flexion bilaterally. What is the most widely accepted pathophysiologic mechanism for this complication?

A 45-year-old man presents with severe right leg pain, numbness over the medial aspect of his calf, and weakness in knee extension. An MRI of the lumbar spine reveals a far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 58-year-old woman presents with progressive gait instability and hand clumsiness. Examination reveals positive Hoffman's signs bilaterally. MRI demonstrates multi-level cervical spondylotic myelopathy from C3-C6 with a fixed, rigid 15-degree cervical kyphosis. What is the most appropriate surgical management?

A 42-year-old man presents to the emergency department with severe acute low back pain and bilateral sciatica following heavy lifting. Which of the following is typically the earliest clinical sign or symptom of cauda equina syndrome in this setting?