6. Spine MCQs

What is the primary radiographic requirement for the diagnosis of classic Scheuermann's kyphosis according to the Sorensen criteria?

A 68-year-old man with baseline cervical spondylosis is involved in a rear-end motor vehicle accident causing a hyperextension injury. He presents with bilateral upper extremity weakness (2/5) but relatively preserved lower extremity strength (4/5). What is the most likely diagnosis?

Following a multi-level posterior cervical laminectomy and instrumented fusion for severe myelopathy, a patient develops profound, isolated weakness in shoulder abduction and elbow flexion postoperatively. Sensation remains largely intact. What is the most likely complication?

A 22-year-old man presents with chronic low back pain and radicular symptoms. Imaging reveals a bilateral L5 pars interarticularis defect (isthmic spondylolisthesis) with a Grade 2 slip. Which nerve root is most commonly compressed in this specific condition?

A 25-year-old woman wearing only a lap belt is involved in a high-speed frontal collision. She sustains a flexion-distraction injury (Chance fracture) to the L2 vertebra. What associated injury must be aggressively ruled out?

A 65-year-old man presents with progressive dysphagia. Cervical spine radiographs reveal flowing ossification along the anterior longitudinal ligament. To confirm Diffuse Idiopathic Skeletal Hyperostosis (DISH) using Resnick's criteria, how many contiguous vertebral bodies must be involved?

A 55-year-old woman is evaluated for clumsiness of her hands and gait instability. Striking the distal brachioradialis tendon with a reflex hammer elicits isolated flexion of her fingers, without the normal elbow flexion. What does this 'inverted brachioradialis reflex' indicate?

When evaluating a lateral cervical spine radiograph for traumatic occipitocervical dissociation, the Powers ratio is calculated. A ratio greater than what value is considered highly sensitive for anterior occipitoatlantal subluxation?

A 30-year-old man arrives in the emergency department following a rugby tackle. He is fully awake, alert, and cooperative. Imaging reveals a unilateral cervical facet dislocation at C5-C6. He has right-sided arm pain and C6 weakness. What is the most appropriate initial management?

A 28-year-old man sustains a gunshot wound to the lumbar spine. He arrives with bilateral lower extremity weakness, saddle anesthesia, and urinary retention. CT scan shows a retained bullet fragment within the spinal canal at L3. What is the optimal surgical management?

During preoperative planning for a long-segment fusion to correct adult spinal deformity, the surgeon calculates the patient's spinopelvic parameters. To achieve an optimal sagittal balanced profile and minimize the risk of adjacent segment disease, the surgical goal should be to restore Lumbar Lordosis (LL) to within how many degrees of the Pelvic Incidence (PI)?

A 35-year-old man presents to the emergency department after a high-speed motor vehicle collision. He complains of severe neck pain and exhibits bilateral upper extremity weakness (deltoids and biceps 3/5, triceps 4/5) with normal lower extremity strength. Radiographs demonstrate a 50% anterior translation of C5 on C6. The patient is awake, alert, and cooperative. What is the most appropriate next step in management?

A 65-year-old woman presents with severe neurogenic claudication and MRI-confirmed L4-L5 degenerative spondylolisthesis. She has failed 6 months of comprehensive conservative management. Based on the Spine Patient Outcomes Research Trial (SPORT) for degenerative spondylolisthesis, what outcome should she expect if she elects to undergo surgical intervention compared to continued nonoperative treatment?

A 68-year-old woman with severe back pain and forward-flexed posture is being evaluated for an adult spinal deformity correction. Her preoperative full-length standing radiographs demonstrate a Pelvic Incidence (PI) of 62 degrees. To achieve optimal postoperative sagittal balance and minimize the risk of adjacent segment disease or hardware failure, what should her target Lumbar Lordosis (LL) be?

A 42-year-old construction worker falls 10 feet and sustains an L1 burst fracture. He is neurologically intact on examination. CT and MRI show 40% anterior body height loss, 30% retropulsed bone causing canal compromise, and a completely intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate treatment recommendation?

A 72-year-old man presents with deteriorating handwriting, frequent dropping of objects, and a wide-based gait. On physical examination, striking the brachioradialis tendon results in diminished reflex finger flexion but elicits brisk finger flexion of the ipsilateral hand. This specific physical exam finding (an inverted brachioradialis reflex) localizes the primary spinal cord compression to which of the following cervical levels?

A 15-year-old boy presents with progressive mid-back pain and an increasing rounded appearance to his upper back. You suspect Scheuermann's kyphosis. Which of the following radiographic findings represents the classic diagnostic criteria (Sorensen's criteria) for this condition?

A 68-year-old man falls and strikes his chin, sustaining a hyperextension injury to his neck. He has severe weakness in his hands but can walk with assistance. Which of the following is the most likely diagnosis?

In evaluating a patient with a suspected L4-L5 far lateral (extraforaminal) disc herniation, which of the following physical examination findings is most likely expected?

Which of the following represents the most common source of neurogenic claudication in patients older than 60 years?