6. Spine MCQs

A 9-month-old boy is evaluated for a left thoracic scoliosis measuring 28 degrees. Radiographic measurement shows a rib-vertebral angle difference (RVAD) of Mehta of 25 degrees with Phase 2 rib head overlap. What is the most appropriate management strategy?

A 14-year-old non-ambulatory boy with Duchenne muscular dystrophy (DMD) presents with a progressive 55-degree thoracolumbar scoliosis. His forced vital capacity (FVC) is currently 40% of predicted. What is the most appropriate intervention for his spinal deformity?

Which of the following congenital spinal anomalies carries the highest risk of rapid curve progression, typically necessitating the earliest surgical intervention?

An 8-month-old boy is diagnosed with infantile idiopathic scoliosis. Radiographs reveal a 25-degree left thoracic curve. Which of the following radiographic parameters best predicts whether this curve will progress rather than spontaneously resolve?

A 14-year-old female presents with back pain and is diagnosed with an L5-S1 isthmic spondylolisthesis. Which of the following radiographic findings is considered the most significant risk factor for further slip progression?

A 15-year-old boy presents with a Lenke Type 1 (main thoracic) adolescent idiopathic scoliosis curve of 55 degrees. When planning posterior spinal fusion, what is the primary goal regarding the selection of the lowest instrumented vertebra (LIV)?

A 15-year-old male gymnast complains of chronic lower back pain exacerbated by extension. Radiographs show a grade II isthmic spondylolisthesis at L5-S1. He has failed 6 months of physical therapy and bracing, and his hamstring tightness is worsening. What is the recommended surgical management?

A 15-year-old male sprinter feels a sudden pop in his pelvis during a race. Radiographs demonstrate an avulsion fracture of the anterior superior iliac spine (ASIS). Which muscle is responsible for this specific avulsion?

A 14-year-old gymnast presents with persistent low back pain exacerbated by extension. Imaging reveals an acute, unilateral pars interarticularis stress fracture at L5 without spondylolisthesis. What is the most appropriate initial treatment?

A 14-year-old elite gymnast complains of 6 weeks of worsening low back pain exacerbated by lumbar extension. Neurologic examination is normal. Standard AP, lateral, and oblique lumbar radiographs are unremarkable. What is the most appropriate next imaging modality to evaluate for an acute pars interarticularis stress reaction?

A 70-year-old woman with a history of an L2-pelvis posterior spinal fusion is scheduled for a total hip arthroplasty. Spino-pelvic evaluation reveals a stiff spine with less than 10 degrees of pelvic tilt change from standing to sitting. How should the surgeon adjust the acetabular component positioning to minimize the risk of posterior dislocation?

A patient with ankylosing spondylitis and a fused lumbar spine is planned for a THA. Spinopelvic mobility assessment demonstrates no change in pelvic tilt from standing to sitting. To prevent instability, how should the acetabular component positioning be adjusted?

A 55-year-old male with a rigid lumbar spine fusion from L2 to the pelvis requires a primary THA. Compared to a patient with normal spinopelvic mobility, how should the acetabular component positioning be adjusted to minimize the risk of dislocation?

A 65-year-old man with a history of an L2-S1 spinal fusion is undergoing a primary total hip arthroplasty. Due to his ankylosed lumbar spine, his pelvis fails to retrovert when transitioning from a standing to a seated position. What is the primary instability risk, and how should the acetabular cup positioning be modified intraoperatively?

A 67-year-old woman has persistent anterior thigh and knee pain after undergoing total knee arthroplasty 1 year ago. Examination and radiographs reveal no problems in the knee, mild hip flexor weakness (grade 4+), and decreased sensation over the anterior thigh including and proximal to the incision. MRI of the lumbar spine will most likely reveal which of the following findings?

Understanding normal cervical spine anatomy is crucial during anterior approaches and lateral mass screw placement to avoid iatrogenic injury. The vertebral artery typically enters the transverse foramen at which cervical level?

When comparing typical lumbar vertebrae to typical thoracic vertebrae, the pedicles of the lumbar spine are anatomically oriented in which manner?

During a posterolateral approach to the spine for a T10-T11 disc herniation, a major radicular artery is injured, resulting in anterior spinal artery syndrome. This artery (of Adamkiewicz) most frequently enters the spinal canal at which level and on which side?

A 30-year-old man reports pain and weakness in his right arm. Examination reveals grade 4 strength in wrist flexion and elbow extension, decreased sensation over the middle finger, and decreased triceps reflex. These symptoms are most compatible with impingement on what spinal nerve root?

A 25-year-old man falls from a height of 20 feet. Imaging reveals a Zone 3 sacral fracture according to the Denis classification. What is the most likely neurologic deficit associated with this specific injury pattern?