6. Spine MCQs

A 68-year-old woman presents with progressive clumsiness in her hands and frequent tripping. During her physical examination, you note an inability to actively maintain extension and adduction of her small and ring fingers. This clinical sign is known as:

A 70-year-old female undergoes a T10 to Pelvis posterior instrumented fusion for adult spinal deformity. Six months later, she presents with severe back pain and progressive kyphosis centered at T9. Which of the following intraoperative factors is most strongly associated with the development of this specific complication?

A 55-year-old man with a long history of severe ankylosing spondylitis falls from standing height. He presents to the emergency department with new, severe lower cervical neck pain but no neurologic deficits. Plain radiographs of the cervical spine show typical syndesmophytes but no apparent fracture. What is the most appropriate next step in management?

A 60-year-old Asian male presents with severe progressive cervical myelopathy. CT scan demonstrates a continuous mass of ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. Sagittal alignment is evaluated and determined to be "K-line negative" (fixed cervical kyphosis). What is the optimal surgical approach?

When performing a long posterior instrumented fusion extending to the sacrum for adult degenerative scoliosis, which of the following is the strongest indication to extend fixation distally into the pelvis (e.g., iliac or S2AI screws)?

A 75-year-old man trips and falls forward, striking his chin. He develops acute weakness in his upper extremities (hands worse than shoulders) but maintains functional strength in his lower extremities. The pathophysiology of his neurologic deficit involves injury to which specific region of the spinal cord?

A 60-year-old man presents with progressive hand clumsiness, positive Hoffmann reflexes bilaterally, and a spastic gait. Radiographs demonstrate advanced multi-level spondylosis with a fixed cervical kyphosis of 15 degrees. What is the primary biomechanical reason an anterior surgical approach is favored over a posterior laminoplasty in this patient?

An 82-year-old male with severe COPD, chronic kidney disease, and congestive heart failure sustains a Type II odontoid fracture with 2 mm of posterior displacement after a ground-level fall. He is neurologically intact. What is the most appropriate management strategy for this frail patient?

In evaluating a patient with adult spinal deformity and "flatback" syndrome (loss of lumbar lordosis), the body attempts to compensate to maintain an upright posture. Which radiographic finding represents a primary pelvic compensatory mechanism for positive sagittal malalignment?

A 64-year-old man presents with progressive numbness in his hands and hyperreflexia in all four extremities. He reports mild gait unsteadiness but is able to walk independently without assistance and continues to work full-time as an accountant. According to the Nurick classification for cervical myelopathy, what grade is this patient?

A 65-year-old man presents with progressive hand clumsiness, gait instability, and hyperreflexia. MRI shows multi-level cervical stenosis from C3-C6 with preserved cervical lordosis. He undergoes a C3-C6 laminoplasty. Which of the following is the most common postoperative neurological complication specific to this procedure?

An obtunded 35-year-old polytrauma patient is in the ICU following a high-speed collision. A high-quality fine-cut CT of the cervical spine with sagittal and coronal reconstructions is interpreted as completely normal by a senior radiologist. What is the most appropriate next step regarding cervical spine precautions according to current EAST guidelines?

In a 68-year-old female presenting with adult degenerative scoliosis and severe sagittal imbalance, the goal of surgical reconstruction is to achieve a mismatch between Pelvic Incidence (PI) and Lumbar Lordosis (LL) of less than what value to optimize clinical outcomes?

A 55-year-old man of East Asian descent presents with signs of severe cervical myelopathy. Radiographs and CT reveal continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6 with a K-line negative alignment (kyphotic alignment). What is the most appropriate surgical approach?

A 25-year-old man sustains a severe fracture-dislocation at T10 following a motor vehicle collision. On examination in the trauma bay, he has no motor or sensory function below the umbilicus, absent rectal tone, and an absent bulbocavernosus reflex. What is the clinical significance of the absent bulbocavernosus reflex?

A 72-year-old female with a 45-degree adult degenerative lumbar scoliosis complains primarily of severe, neurogenic claudication in both legs after walking one block. She denies significant mechanical back pain. MRI shows severe L3-L4 and L4-L5 central and lateral recess stenosis. What is the most appropriate initial surgical management?

During the evaluation of a 60-year-old patient with suspected cervical myelopathy, you perform the Hoffmann test. A positive response consists of reflex flexion of the interphalangeal joint of the thumb and distal interphalangeal joint of the index finger. This reflex arc is primarily mediated by which spinal cord level?

A 68-year-old man with known cervical spondylosis falls forward and strikes his chin. He develops bilateral upper extremity weakness (hands significantly worse than shoulders) with relatively preserved lower extremity motor function. Which of the following best explains the pathophysiologic mechanism of this specific syndrome?

A 28-year-old male sustains a hyperflexion-rotation injury to his neck. Radiographs show less than 25% anterior subluxation of C5 on C6. He is awake and cooperative, exhibiting a right-sided C6 radiculopathy but no signs of myelopathy. What is the most appropriate initial management step?

A 62-year-old male with severe fixed global sagittal malalignment (SVA = +15 cm) undergoes spinal reconstructive surgery. The surgeon plans a Pedicle Subtraction Osteotomy (PSO) at L3. Approximately how many degrees of lordosis can be expected from a single-level lumbar PSO?