6. Spine MCQs

A 60-year-old man presents with myelopathy. CT scan shows continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C5. If an anterior cervical corpectomy is planned, the patient is at highest risk for which of the following intraoperative complications?

A 68-year-old woman returns to the clinic 4 years after undergoing a successful L4-L5 posterior lumbar interbody fusion. She now complains of new-onset neurogenic claudication. MRI demonstrates severe central canal stenosis at a new level. Which level is most commonly affected by symptomatic adjacent segment disease in this scenario?

An 82-year-old man presents with neck pain after a ground-level fall. CT scan reveals a displaced Type II odontoid fracture. He is neurologically intact. Given his age, what is the most appropriate management to minimize mortality and morbidity?

A 45-year-old woman undergoes an anterior cervical discectomy and fusion at C6-C7. Postoperatively, she is noted to have unilateral ptosis, miosis, and anhidrosis on the surgical side. Which structure was most likely injured during the surgical exposure?

A 72-year-old man with a history of cervical stenosis falls forward and strikes his chin, forcefully hyperextending his neck. He presents with severe motor weakness in his hands and arms, but is able to walk with only mild difficulty. What is the most likely diagnosis?

A 30-year-old man sustains an axial loading injury, resulting in a Jefferson burst fracture of C1. Which radiographic measurement on the open-mouth odontoid view best indicates a rupture of the transverse atlantal ligament?

A 50-year-old man presents with right-sided neck pain radiating down his arm. Physical examination reveals weakness in wrist extension, a diminished brachioradialis reflex, and decreased sensation over his thumb and index finger. A herniated disc at which cervical level is most likely responsible?

A 65-year-old woman presents with neurogenic claudication. Imaging reveals a Grade I degenerative spondylolisthesis. What is the most common anatomic level for this specific pathology to occur?

A 35-year-old male sustains a T12 burst fracture after a fall from a height of 10 feet. He is neurologically intact. MRI demonstrates an indeterminate posterior ligamentous complex (PLC) injury. According to the Thoracolumbar Injury Classification and Severity (TLICS) scale, what is the most appropriate management recommendation?

Which of the following physical examination findings is most specific for cervical spondylotic myelopathy localizing to the C5 or C6 level?

A 65-year-old male presents with adult spinal deformity and severe sagittal imbalance. His pelvic incidence (PI) is calculated at 55 degrees. To achieve an optimal sagittal profile and minimize the risk of adjacent segment disease following a long-segment fusion, the patient's postoperative lumbar lordosis (LL) should be targeted to which of the following ranges?

A 25-year-old male is brought to the emergency department after a motor vehicle collision. He is awake, alert, and follows commands. Neurological examination reveals intact motor and sensory function. Radiographs demonstrate a bilateral C5-C6 facet dislocation. What is the most appropriate next step in management?

A 45-year-old female presents with severe right anterior thigh pain and quadriceps weakness. Physical examination reveals an absent right patellar reflex. MRI demonstrates a large, far-lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

In a patient presenting with symptomatic L4-L5 degenerative spondylolisthesis and lumbar stenosis, which of the following MRI findings is most predictive of dynamic instability and the potential failure of decompression alone without fusion?

An 80-year-old male sustains a hyperextension injury to his cervical spine resulting in central cord syndrome. What is the typical sequence of neurological recovery in this condition?

A 60-year-old male with long-standing ankylosing spondylitis presents with severe neck pain following a minor low-speed motor vehicle collision. Standard anteroposterior and lateral cervical radiographs demonstrate no obvious fracture or dislocation. What is the most appropriate next step in management?

Which of the following clinical findings is the most sensitive indicator for diagnosing cauda equina syndrome?

During a posterior spinal fusion for adolescent idiopathic scoliosis, transcranial motor evoked potentials (MEPs) drop by 85% bilaterally in the lower extremities following curve correction. Somatosensory evoked potentials (SSEPs) remain unchanged. Mean arterial pressure is 85 mmHg. What is the most appropriate initial step?

A 15-year-old male presents with hyperkyphosis of the thoracic spine. According to the Sorensen criteria, radiographic diagnosis of Scheuermann's disease requires anterior wedging of at least 5 degrees in how many consecutive vertebrae?

A 52-year-old male presents with radiating arm pain, numbness in the middle finger, and weakness in triceps extension and wrist flexion. Which cervical disc level is most likely herniated?