6. Spine MCQs

A 72-year-old man with advanced ankylosing spondylitis presents with severe back pain after a minor ground-level fall. Initial plain radiographs are inconclusive. What is the next most appropriate imaging modality, and what fracture pattern is highly suspected?

What is the most common anatomic level for an isthmic spondylolisthesis, and which patient population most frequently presents with symptoms?

A 25-year-old man sustains a gunshot wound to the abdomen. The bullet traverses the colon and lodges in the L3 vertebral body. He is completely neurologically intact. In addition to broad-spectrum antibiotics, what is the recommended orthopedic management for the spine?

A 45-year-old man presents with sudden onset saddle anesthesia, bilateral sciatica, and urinary retention. A post-void residual (PVR) bladder volume is measured. What minimum PVR volume is considered highly sensitive for urinary retention associated with cauda equina syndrome?

A patient complains of neck pain radiating down the lateral arm to the thumb and index finger. Physical examination reveals a diminished brachioradialis reflex and weakness in wrist extension. Which cervical nerve root is most likely compressed?

Iatrogenic flatback syndrome is most commonly historically associated with which of the following prior surgical interventions?

A 25-year-old male presents to the trauma bay after a motor vehicle collision. He is awake, alert, and cooperative. Examination reveals a complete lack of motor and sensory function below C6 (ASIA A). Radiographs demonstrate a bilateral facet dislocation at C5-C6. What is the most appropriate initial management?

A 68-year-old female presents with neurogenic claudication. Imaging reveals an L4-L5 degenerative spondylolisthesis. Which of the following anatomic or radiographic findings is most strongly associated with the development of this condition?

A 65-year-old woman is planning to undergo corrective surgery for progressive adult spinal deformity and sagittal imbalance. To achieve optimal postoperative sagittal alignment and minimize the risk of adjacent segment disease or hardware failure, the surgeon must calculate the target lumbar lordosis (LL). Which of the following formulas represents the accepted target for LL based on her pelvic incidence (PI)?

A 58-year-old male of East Asian descent presents with progressive myelopathy. CT scan shows continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. The cervical spine has maintained lordosis, and on a neutral sagittal image, the OPLL mass does not cross the K-line (K-line positive). What is the most appropriate surgical intervention?

A 32-year-old male falls 10 feet, sustaining an L1 burst fracture. He is neurologically intact (ASIA E). A non-contrast MRI confirms that the posterior ligamentous complex (PLC) is completely intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the patient's score and the recommended management?

A 62-year-old man undergoes a complex 10-hour posterior spinal fusion for adult deformity correction, with an estimated blood loss of 2500 mL. On postoperative day 1, he complains of profound, bilateral, painless visual loss. Pupillary reflexes are sluggish, and funduscopic examination reveals pale, swollen optic discs. What is the most likely etiology?

A 28-year-old motorcyclist is involved in a high-speed collision. He presents with massive shoulder swelling, a pulseless left upper extremity, and a completely flail limb. Radiographs show significant lateral displacement of the scapula. This condition (scapulothoracic dissociation) is most highly associated with which of the following injuries?

During the physiological flexion and extension of a normal healthy lower cervical spine segment, the instantaneous axis of rotation (IAR) is typically located in which anatomical structure?

The Wiltse paraspinal approach to the lumbar spine is frequently used for minimally invasive pedicle screw placement or far-lateral disc excisions. This approach relies on a natural avascular cleavage plane between which two muscle groups?

A surgeon is performing a posterior approach to the upper cervical spine to treat an atlantoaxial subluxation. Deep dissection exposes the suboccipital triangle. Which critical structure lies within the borders of this triangle?

During a right anterior cervical discectomy and fusion (ACDF) at C6-C7, the recurrent laryngeal nerve is at greater risk than on the left side. Which anatomical characteristic explains this increased vulnerability?

When placing thoracic pedicle screws at the T6 level, understanding the local morphometry is critical for safe instrumentation. Compared to the lumbar spine, which of the following best describes the typical anatomic characteristics of the mid-thoracic pedicle?

During an anterior cervical discectomy and fusion (ACDF), aggressive lateral dissection over the uncinate process risks iatrogenic injury to the vertebral artery. At which cervical level does the vertebral artery most commonly enter the transverse foramen?

A patient presents with a symptomatic right-sided far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed by this specific herniation?