6. Spine MCQs

Which mechanism of injury is classically associated with a traumatic spondylolisthesis of the axis (Hangman's fracture)?

A 38-year-old male is involved in a high-speed collision. Imaging reveals a fracture through the bilateral pars interarticularis of C2 with 4 mm of anterior translation of C2 on C3 and no severe angulation (Levine-Edwards Type II). What is the preferred initial management?

A 65-year-old man presents with progressive hand clumsiness and gait instability. MRI reveals 4-level cervical stenosis with a fixed kyphotic deformity of 15 degrees. What is the most appropriate surgical approach?

When evaluating an adult patient for a long-segment spinal fusion for degenerative scoliosis, which of the following spino-pelvic parameters correlates most strongly with postoperative health-related quality of life (HRQOL)?

A 24-year-old man is brought to the ED after an MVA. He is awake, alert, and complains of severe neck pain with weakness in his right biceps. CT scan shows a right-sided C5-C6 unilateral facet dislocation. What is the most appropriate next step in management?

During the physical examination of a 55-year-old woman with suspected cervical spondylotic myelopathy, tapping the brachioradialis tendon results in spontaneous flexion of the digits without flexion of the elbow. This finding indicates compression at which of the following spinal levels?

Which of the following is considered a significant risk factor for the development of proximal junctional kyphosis (PJK) following long-segment instrumented fusion for adult spinal deformity?

A 30-year-old woman sustains an L1 burst fracture after a fall. She is neurologically intact. MRI demonstrates an intact posterior ligamentous complex. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is her total score and the recommended treatment?

A 72-year-old man falls forward, striking his chin. He presents with profound weakness in his hands and arms, but is able to ambulate with assistance. Perianal sensation is intact. What is the most likely pathophysiological mechanism of his injury?

A 40-year-old driver involved in a high-speed collision sustains a traumatic spondylolisthesis of C2 (Hangman's fracture). Imaging shows greater than 3 mm of displacement and severe angulation of C2 on C3. What is the mechanism of this specific injury pattern (Levine-Edwards Type IIA), and what is a contraindication in its management?

A 65-year-old woman presents with worsening back pain and an inability to stand up straight. Radiographs show adult degenerative scoliosis. Her pelvic incidence (PI) is 55 degrees, pelvic tilt (PT) is 30 degrees, and sacral slope (SS) is 25 degrees. To achieve optimal sagittal balance postoperatively, her lumbar lordosis (LL) should be reconstructed to approximately:

A 65-year-old man undergoes a C3-C6 laminectomy and posterior spinal fusion for severe cervical myelopathy. On postoperative day 2, he develops profound new-onset weakness of right shoulder abduction and elbow flexion, but sensory examination remains normal. What is the most likely etiology of this deficit?

A 55-year-old Asian male presents with progressive hand clumsiness and an unsteady gait. Imaging demonstrates multi-level ossification of the posterior longitudinal ligament (OPLL) causing severe cervical canal stenosis. Which of the following preoperative findings is an absolute contraindication to a posterior laminoplasty?

A 72-year-old man with known cervical spondylosis falls forward, striking his forehead. He presents with severe weakness in his hands and arms (1/5 strength) but is able to move his legs against gravity (3/5 strength). What is the classic pathophysiologic mechanism for this specific pattern of neurologic deficit?

In adult spinal deformity surgery, achieving optimal sagittal balance is critical to improving health-related quality of life outcomes. Which of the following sets of spinopelvic parameters represents the universally accepted SRS-Schwab postoperative target?

A 24-year-old man sustains a traumatic spondylolisthesis of the axis (Hangman's fracture) following a motor vehicle collision. Imaging shows severe angulation and distraction of the C2-C3 intervertebral space with minimal translation, and the facet joints are intact. Which of the following management steps is strictly contraindicated for this fracture pattern?

A neurologically intact 34-year-old male presents after a motor vehicle collision with a bilateral C5-C6 facet dislocation. An urgent MRI reveals a massive, extruded herniated disc behind the C5 vertebral body. What is the most appropriate next step in management?

When planning corrective surgery for adult degenerative scoliosis, restoring optimal sagittal balance is highly correlated with improved clinical outcomes. To achieve this, the lumbar lordosis (LL) should be corrected to closely match which pelvic parameter?

A 62-year-old man undergoes a C3-C6 posterior laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops isolated profound weakness in his bilateral deltoid and biceps muscles, with no worsening of his long-tract signs. What is the most likely etiology of this complication?

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following findings is the strongest determinant indicating the need for operative stabilization of a thoracolumbar burst fracture?