6. Spine MCQs

A 45-year-old woman presents with progressive weakness and muscle wasting in both hands, accompanied by fasciculations. She also reports difficulty walking. Examination shows hyperreflexia in the lower extremities but absent reflexes in the upper extremities. Sensation is completely intact throughout. What is the most likely diagnosis?

A 65-year-old female presents with severe back pain and an inability to stand up straight. Which of the following radiographic parameters correlates most strongly with poor health-related quality of life (HRQOL) scores in adult spinal deformity?

A 55-year-old male presents with progressive cervical myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). On a lateral neutral cervical radiograph, the OPLL mass crosses the K-line. What is the most appropriate surgical approach?

A 35-year-old male sustains a fall. CT shows a burst fracture of L1 with 40% canal compromise. He is neurologically intact, and MRI confirms the posterior ligamentous complex (PLC) is intact. What is his Thoracolumbar Injury Classification and Severity (TLICS) score and recommended management?

A 68-year-old man with underlying cervical spondylosis sustains a hyperextension injury. He presents with profound upper extremity weakness, relatively preserved lower extremity strength, and intact perianal sensation. This syndrome is most accurately characterized by injury to which portion of the spinal cord?

In preoperative planning for a 60-year-old patient with flatback syndrome and adult degenerative scoliosis, the surgeon aims to restore ideal sagittal balance. To achieve optimal postoperative alignment, the lumbar lordosis (LL) should be within how many degrees of the pelvic incidence (PI)?

A 50-year-old male presents with painless, progressive weakness and muscle atrophy of his bilateral upper extremities. He has hyperreflexia in the lower extremities but intact sensation throughout. EMG reveals widespread fasciculations and denervation in multiple myotomes. What is the most likely diagnosis?

A 25-year-old male is involved in a high-speed MVA. He is awake, cooperative, but has complete paralysis below C6. Radiographs show a C5-C6 bilateral facet dislocation. What is the most appropriate next step in management?

Proximal junctional kyphosis (PJK) is a recognized complication following long segment fusions for adult spinal deformity. Which of the following factors most significantly increases the risk of developing PJK?

During the physical examination of a 62-year-old male with progressive gait difficulty, the examiner quickly flicks the nail of the patient's middle finger downward, resulting in reflexive flexion of the thumb and index finger. This clinical sign is indicative of:

The recurrent laryngeal nerve is at greatest risk during an anterior approach to the lower cervical spine on the right side due to its unique anatomic course. Where does the right recurrent laryngeal nerve loop before ascending into the neck?

A 68-year-old woman with adult degenerative scoliosis presents with severe back pain and a forward stooped posture. Standing full-length radiographs reveal a sagittal vertical axis (SVA) of +12 cm. To achieve optimal sagittal balance postoperatively, surgical correction should aim for a relationship between Pelvic Incidence (PI) and Lumbar Lordosis (LL) of:

A 30-year-old construction worker falls from a scaffolding, sustaining an L1 burst fracture. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) system, what is his total score and the recommended management?

A 72-year-old man with a history of severe cervical spondylosis falls forward, striking his chin. He presents with profound weakness in his bilateral hands and arms, but retains functional motor strength in his legs. Perianal sensation and sphincter tone are intact. Which of the following best describes the anatomical basis for his neurological deficit?

A 35-year-old woman undergoes an L4-5 anterior fusion via a left retroperitoneal approach. Postoperative examination reveals that her right foot is cool and pale. Her neurologic examination is normal, and her pedal pulses are asymmetric. What is the most likely reason for the right foot finding?

A 78-year-old man presents with severe neck pain following a ground-level fall. Imaging reveals a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. What is the most appropriate definitive management?

A 65-year-old woman with adult spinal deformity is undergoing surgical planning. Her pelvic incidence (PI) is 60 degrees. To optimize her postoperative sagittal alignment, what should be the target lumbar lordosis (LL)?

A 35-year-old construction worker falls from a height and presents with paraplegia at the T10 level.

Imaging demonstrates a T10 flexion-distraction injury with posterior ligamentous complex disruption. What associated injury must be urgently ruled out?

In a patient with cervical spondylotic myelopathy (CSM), which of the following physical examination findings is considered the earliest indicator of myelopathy?