6. Spine MCQs

A 14-year-old female gymnast presents with persistent low back pain unresponsive to 6 months of conservative management. Radiographs reveal a Grade II L5-S1 isthmic spondylolisthesis. What is the most appropriate surgical management?

Which of the following radiographic parameters defines an adequate restoration of sagittal balance following adult spinal deformity corrective surgery?

A 35-year-old man sustains a flexion-distraction injury (Chance fracture) of the T12 vertebra during a high-speed motor vehicle collision. Which of the following associated injuries must be most carefully ruled out?

A 45-year-old man presents with severe right leg pain radiating down the anterior thigh to the medial malleolus. Examination reveals a weakened patellar reflex and 3/5 strength in right knee extension. MRI shows a far-lateral extraforaminal disc herniation. Which spinal level is most likely affected?

During the anterior placement of halo pins for cervical spine immobilization, the pins should be placed in the lateral one-third of the eyebrow to avoid injury to which of the following structures?

A 75-year-old patient with ankylosing spondylitis presents to the emergency department with severe neck pain following a ground-level fall. Neurological examination is normal. Standard anteroposterior and lateral cervical radiographs show no clear fracture. What is the most appropriate next step in management?

Which congenital spinal anomaly carries the highest risk for rapid scoliosis progression and typically warrants early prophylactic in situ fusion?

A 55-year-old woman undergoes a multilevel anterior cervical discectomy and fusion (ACDF) using recombinant human bone morphogenetic protein-2 (rhBMP-2). Postoperatively, she develops severe dysphagia and respiratory distress. This complication is most directly related to which of the following?

A 32-year-old construction worker presents with a burst fracture of L1 and bilateral lower extremity paraparesis. He is awake, alert, and hemodynamically stable. MRI demonstrates significant retropulsion of bone into the spinal canal. What is the most common indication for an anterior corpectomy and strut grafting over a purely posterior approach?

A 60-year-old man presents with neurogenic claudication secondary to severe lumbar spinal stenosis at L4-L5. Which of the following findings on history or physical examination best differentiates neurogenic claudication from vascular claudication?

A 65-year-old woman presents with worsening low back pain and a progressive forward-leaning posture while walking. Radiographs demonstrate degenerative lumbar scoliosis. Her measured pelvic incidence (PI) is 60 degrees. To achieve optimal sagittal balance postoperatively, what should her lumbar lordosis (LL) ideally be reconstructed to?

In the Thoracolumbar Injury Classification and Severity (TLICS) system, which of the following morphological patterns is assigned the highest point value?

A 68-year-old woman presents with classic neurogenic claudication. MRI confirms severe L4-L5 central spinal stenosis associated with a grade 1 degenerative spondylolisthesis. She has failed 6 months of conservative treatment. What is the most appropriate surgical intervention?

In the evaluation of adult spinal deformity, Pelvic Incidence (PI) is a fixed morphologic parameter. What is the anatomic formula relating Pelvic Incidence (PI), Pelvic Tilt (PT), and Sacral Slope (SS)?

A 7-year-old boy presents with torticollis following an upper respiratory infection. Open mouth odontoid radiograph shows asymmetry of the lateral masses, consistent with Fielding Type 1 Atlantoaxial Rotatory Subluxation (AARS). What is the most appropriate initial management, given symptom onset was 3 days ago?

A 60-year-old man with cervical spondylotic myelopathy is being considered for a posterior laminoplasty. Which of the following preoperative radiographic findings is a relative contraindication for this procedure?

An 82-year-old woman sustains a Type II odontoid fracture after a ground-level fall. She has multiple medical comorbidities, severe osteoporosis, and is minimally displaced. What is the most appropriate management strategy with the lowest associated mortality?

A 35-year-old man presents with a complete C5 spinal cord injury after a diving accident. He is awake and cooperative. Imaging shows bilateral C5-C6 facet dislocations without massive disc herniation. What is the most urgent next step in management?

Which of the following radiographic criteria is required for the classical Sorenson diagnosis of Scheuermann's kyphosis?

A patient presents with severe right anterior thigh pain and weakness in knee extension. An MRI reveals a far lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed?