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6. Spine MCQs

Practice Set 186 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 3701

Topic: Thoracolumbar Spine & Deformity

A 19-year-old female sustains a bony Chance fracture of L2 due to a lap-belt injury during a high-speed collision. Which of the following associated injuries is most commonly found in this patient population?

. Aortic transection
. Gastrointestinal hollow viscus injury
. Renal artery avulsion
. Diaphragmatic rupture
. Splenic laceration

Correct Answer & Explanation

. Gastrointestinal hollow viscus injury

Explanation

Chance fractures are flexion-distraction injuries highly associated with lap-belt use. Up to 50% of patients with these fractures have concomitant intra-abdominal injuries, most commonly involving hollow viscous organs like the small bowel.

Question 3702

Topic: 6. Spine

In patients with progressively increasing positive sagittal imbalance (e.g., flatback syndrome), the body attempts to compensate to maintain a horizontal gaze. Which of the following accurately describes the primary compensatory mechanisms?

. Pelvic anteversion, hip flexion, and knee extension
. Pelvic retroversion, hip extension, and knee flexion
. Pelvic retroversion, hip flexion, and knee extension
. Pelvic anteversion, hip extension, and knee flexion
. Decreased pelvic tilt and cervical kyphosis

Correct Answer & Explanation

. Pelvic retroversion, hip extension, and knee flexion

Explanation

To compensate for anterior sagittal imbalance and maintain horizontal gaze, patients typically increase pelvic retroversion (which increases pelvic tilt), extend their hips, flex their knees, and hyperlordose their cervical spine.

Question 3703

Topic: 6. Spine

Which of the following historical features is most characteristic of neurogenic claudication associated with lumbar spinal stenosis, as opposed to vascular claudication?

. Pain primarily in the calves triggered by walking a set distance
. Symptoms that are completely relieved by standing still
. Symptom relief when walking uphill or leaning forward over a shopping cart
. Diminished peripheral pulses in the lower extremities
. Pain that worsens when riding a stationary bicycle

Correct Answer & Explanation

. Symptom relief when walking uphill or leaning forward over a shopping cart

Explanation

Neurogenic claudication typically improves with lumbar flexion (e.g., sitting, leaning forward, walking uphill) because flexion increases the cross-sectional area of the spinal canal. Vascular claudication worsens with exertion regardless of posture.

Question 3704

Topic: Cervical Spine

An 82-year-old previously independent male presents with a displaced Type II odontoid fracture after a fall. Considering the morbidity associated with various treatments in the elderly, what is generally the most appropriate definitive management?

. Halo vest immobilization for 12 weeks
. Rigid cervical collar for 4 weeks
. Anterior odontoid screw fixation
. Posterior C1-C2 instrumental fusion
. Minerva cast application

Correct Answer & Explanation

. Posterior C1-C2 instrumental fusion

Explanation

In functionally independent elderly patients with displaced Type II odontoid fractures, posterior C1-C2 fusion is favored. Halo vest immobilization in patients >80 years old carries an unacceptably high risk of respiratory complications and mortality.

Question 3705

Topic: 6. Spine

Which of the following congenital spinal anomalies carries the highest risk for rapid curve progression, often necessitating early prophylactic surgical fusion?

. Fully segmented unilateral hemivertebra
. Incarcerated hemivertebra
. Block vertebra
. Unilateral unsegmented bar with a contralateral hemivertebra
. Butterfly vertebra

Correct Answer & Explanation

. Unilateral unsegmented bar with a contralateral hemivertebra

Explanation

A unilateral unsegmented bar with a contralateral hemivertebra has the highest rate of progression (often 5 to 10 degrees per year) because growth is tethered on one side and accelerated on the opposite convex side.

Question 3706

Topic: Thoracolumbar Spine & Deformity

When planning a long spinal fusion for adult degenerative scoliosis to restore sagittal balance, which fixed anatomical parameter is most critical for calculating the patient's target lumbar lordosis?

. Sacral slope
. Pelvic tilt
. Pelvic incidence
. Thoracic kyphosis
. Sagittal vertical axis

Correct Answer & Explanation

. Pelvic incidence

Explanation

Pelvic incidence (PI) is a fixed morphological parameter unique to each individual. Restoring lumbar lordosis to match the PI (ideally within 9 degrees) is the critical target for achieving optimal sagittal balance in deformity surgery.

Question 3707

Topic: 6. Spine

A 65-year-old man presents with severe cervical spondylotic myelopathy. Lateral radiographs reveal a fixed, rigid kyphotic deformity of 25 degrees from C3-C6.

Which of the following surgical approaches is contraindicated in this clinical scenario?

. Anterior cervical corpectomy and fusion
. Anterior cervical discectomy and fusion (ACDF)
. Combined anterior and posterior spinal fusion
. Posterior cervical laminectomy alone
. Anterior osteotomy with posterior fusion

Correct Answer & Explanation

. Posterior cervical laminectomy alone

Explanation

In the setting of a fixed cervical kyphosis, an isolated posterior laminectomy is contraindicated because the spinal cord remains draped and compressed over the anterior pathological osteophytes. An anterior or combined approach is required to correct the deformity and indirectly decompress the cord.

Question 3708

Topic: 6. Spine

Which of the following components are utilized to calculate the Thoracolumbar Injury Classification and Severity (TLICS) score to guide surgical decision-making?

. Degree of kyphosis, vertebral body height loss, and spinal canal compromise
. Injury morphology, posterior ligamentous complex integrity, and neurologic status
. Patient age, bone mineral density, and mechanism of injury
. Canal stenosis, facet joint widening, and anterior longitudinal ligament integrity
. Spinous process distance, translation, and presence of an epidural hematoma

Correct Answer & Explanation

. Injury morphology, posterior ligamentous complex integrity, and neurologic status

Explanation

The TLICS system determines the need for surgical stabilization based on three main categories: injury morphology (e.g., burst, translation), integrity of the posterior ligamentous complex (PLC), and the patient's neurologic status.

Question 3709

Topic: 6. Spine

A 45-year-old man presents with right leg pain. MRI reveals a standard posterolateral (paracentral) disc herniation at the L4-L5 level. Which nerve root is most likely to be impinged?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. L5

Explanation

In the lumbar spine, a classic posterolateral (paracentral) disc herniation impinges the traversing nerve root. Therefore, a herniation at the L4-L5 level affects the L5 nerve root.

Question 3710

Topic: Thoracolumbar Spine & Deformity

A 16-year-old gymnast presents with chronic low back pain exacerbated by extension. Lateral radiographs demonstrate a grade I spondylolisthesis at L5-S1. What is the most likely underlying anatomic defect?

. Degenerative facet arthropathy
. Pedicle stress fracture
. Pars interarticularis defect
. Congenital dysplasia of the sacrum
. Ligamentum flavum hypertrophy

Correct Answer & Explanation

. Pars interarticularis defect

Explanation

Isthmic spondylolisthesis in adolescent athletes (especially those doing repetitive extension) is caused by a stress fracture or defect of the pars interarticularis (spondylolysis).

Question 3711

Topic: 6. Spine

An 82-year-old man sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact. When comparing treatment with a halo vest to a rigid cervical collar in this age group, halo vest immobilization carries a significantly higher risk of which of the following?

. Neurologic deterioration
. Nonunion
. Cervical kyphosis
. Mortality
. Dysphagia

Correct Answer & Explanation

. Mortality

Explanation

In the elderly population, halo vest immobilization is associated with a markedly increased risk of complications, including respiratory failure, cardiac events, and overall mortality, compared to rigid collar treatment.

Question 3712

Topic: 6. Spine

A 65-year-old man with a long history of severe ankylosing spondylitis presents with new neck pain after a minor fall. Initial standard cervical spine radiographs show no acute abnormalities. What is the most appropriate next step in management?

. Discharge with NSAIDs and physical therapy
. Flexion-extension cervical spine radiographs
. Reassurance and outpatient rheumatology follow-up
. CT or MRI of the cervical spine
. Electromyography (EMG)

Correct Answer & Explanation

. CT or MRI of the cervical spine

Explanation

Patients with ankylosing spondylitis have rigid, highly susceptible spines where even minor trauma can cause highly unstable, occult fractures. Advanced cross-sectional imaging (CT or MRI) is mandatory when they present with new pain, even if plain films are negative.

Question 3713

Topic: 6. Spine

A 70-year-old man presents to the emergency department after a motor vehicle collision. He exhibits upper extremity weakness (motor strength 2/5) but relatively preserved lower extremity function (motor strength 4/5). What is the most likely diagnosis?

. Anterior cord syndrome
. Brown-Sequard syndrome
. Central cord syndrome
. Posterior cord syndrome
. Spinal shock

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome typically follows a hyperextension injury in a patient with pre-existing cervical stenosis. It classically presents with a disproportionately greater motor impairment in the upper extremities compared to the lower extremities.

Question 3714

Topic: Thoracolumbar Spine & Deformity

Which of the following represents the classic Sorensen radiographic criteria for diagnosing Scheuermann's kyphosis?

. Anterior wedging of >5 degrees in at least 3 consecutive vertebrae
. Anterior wedging of >10 degrees in at least 2 consecutive vertebrae
. Schmorl's nodes in at least 4 non-consecutive vertebrae
. Thoracic kyphosis >45 degrees with uniform disc space narrowing
. Apophyseal ring fractures at multiple levels

Correct Answer & Explanation

. Anterior wedging of >5 degrees in at least 3 consecutive vertebrae

Explanation

The classic Sorensen criteria require the presence of anterior vertebral wedging of greater than 5 degrees in at least three consecutive vertebrae to diagnose Scheuermann's kyphosis.

Question 3715

Topic: 6. Spine

A 45-year-old woman presents with acute severe back pain, bilateral leg radiculopathy, and numbness in her perineal region. Which of the following is the most consistent and sensitive early symptom indicating cauda equina syndrome?

. Fecal incontinence
. Urinary retention
. Absent Achilles reflexes
. Bilateral foot drop
. Lower extremity spasticity

Correct Answer & Explanation

. Urinary retention

Explanation

Urinary retention is the most sensitive and consistent early symptom of cauda equina syndrome. It often precedes overflow incontinence and necessitates emergent MRI evaluation and decompression.

Question 3716

Topic: 6. Spine

During an anterior cervical exposure, injury to the vertebral artery is a catastrophic risk. The vertebral artery typically enters the transverse foramen at which cervical level?

. C3
. C4
. C5
. C6
. C7

Correct Answer & Explanation

. C6

Explanation

The vertebral artery typically arises from the subclavian artery and enters the transverse foramen of the cervical spine at the C6 level in approximately 90% of cases.

Question 3717

Topic: 6. Spine

A 22-year-old man wearing a lap belt only sustains a Chance fracture (flexion-distraction injury) of his L2 vertebra during a high-speed collision. Due to the specific mechanism of this injury, he is at highest risk for which concomitant injury?

. Thoracic aortic tear
. Renal artery avulsion
. Intra-abdominal hollow viscus injury
. Diaphragmatic rupture
. Pelvic ring disruption

Correct Answer & Explanation

. Intra-abdominal hollow viscus injury

Explanation

Chance fractures result from a flexion-distraction force typically pivoted around a lap belt. Up to 50% of these patients have associated intra-abdominal injuries, most commonly lacerations or ruptures of a hollow viscus (e.g., bowel).

Question 3718

Topic: 6. Spine

Which of the following is an FDA-recognized severe complication specifically associated with the off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical discectomy and fusion (ACDF)?

. Profound systemic hypocalcemia
. Massive prevertebral soft tissue swelling
. Accelerated cervical myelopathy
. Anaphylactic shock upon implantation
. Spontaneous vertebral body fracture

Correct Answer & Explanation

. Massive prevertebral soft tissue swelling

Explanation

The use of rhBMP-2 in the anterior cervical spine has been linked to severe, life-threatening prevertebral soft tissue swelling, hematoma, and dysphagia, leading to an FDA safety warning against its routine use in this anatomical location.

Question 3719

Topic: 6. Spine

A 50-year-old man is diagnosed with a 'far lateral' (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is compressed by this specific type of herniation?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. L4

Explanation

Unlike paracentral herniations which affect the traversing root, a far lateral (extraforaminal) disc herniation compresses the exiting nerve root at the level of the disc. At L4-L5, this impinges the L4 nerve root.

Question 3720

Topic: 6. Spine

A 68-year-old man presents with bilateral upper extremity weakness and numbness after a hyperextension injury to his neck. His lower extremity motor function is mildly decreased but functionally intact. Perianal sensation is preserved. Which of the following is the most likely pathophysiological mechanism for this specific spinal cord syndrome?

. Damage to the anterior horn cells and central corticospinal tracts
. Ischemia to the anterior spinal artery territory
. Hemisection of the spinal cord
. Complete disruption of the dorsal columns
. Avulsion of the brachial plexus nerve roots

Correct Answer & Explanation

. Damage to the anterior horn cells and central corticospinal tracts

Explanation

This patient has Central Cord Syndrome, most commonly caused by a hyperextension injury in a stenotic cervical spine. The central location of the injury disproportionately affects the medially located cervical motor tracts and anterior horn cells, leading to greater upper extremity weakness.

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