6. Spine MCQs

A patient involved in a high-speed collision sustains a burst fracture of L1. On examination, he has loss of motor function, pain, and temperature sensation below the umbilicus, but retains proprioception and vibratory sense. This presentation is characteristic of which spinal cord syndrome?

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following injury characteristics assigns the highest independent point value toward the decision for surgical intervention?

A 45-year-old man has a large sequestered (free fragment) disc herniation at L5-S1 causing severe S1 radiculopathy without motor deficit. What is the expected natural history of this specific type of disc herniation?

A 25-year-old man is brought to the ED after a lap-belt restrained motor vehicle collision. X-rays reveal a flexion-distraction injury (Chance fracture) at L2. Which of the following associated injuries must be actively ruled out?

An 80-year-old man with long-standing Ankylosing Spondylitis falls backwards, hitting his head. He reports severe neck pain but has a normal neurological examination. Initial cross-table lateral cervical X-rays are read as normal. What is the most appropriate next step in management?

A 55-year-old woman presents with progressive clumsiness in her hands and difficulty walking. Examination reveals a positive Hoffmann sign bilaterally, hyperreflexia in the lower extremities, and an inverted radial reflex. What is the most likely diagnosis?

A patient with a T4 spinal cord injury presents to the ER with a blood pressure of 80/50 mmHg and a heart rate of 50 bpm. His extremities are warm and well-perfused. What is the primary pathophysiologic mechanism for his hemodynamic state?

In a patient with traumatic spinal cord injury, the end of the "spinal shock" phase is clinically indicated by the return of which of the following?

A 45-year-old woman presents with severe, burning right anterior thigh pain and weakness in knee extension. Her symptoms began acutely after lifting a heavy box. Physical examination reveals a diminished right patellar reflex and a positive femoral stretch test. MRI of the lumbar spine demonstrates a far lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely being compressed?

A 65-year-old man with a history of cervical spondylosis falls forward, striking his forehead. He presents to the emergency department with profound bilateral upper extremity weakness and relatively preserved lower extremity function. Sensation is decreased in a cape-like distribution over his shoulders. Following initial ATLS protocol, which of the following is the most critical medical management parameter for his spinal cord injury?

A 25-year-old man is brought to the trauma bay after a diving accident. He is awake, alert, and cooperative. Neurologic examination is entirely normal. Plain radiographs and CT scans demonstrate a unilateral C5-C6 facet dislocation with approximately 25% anterior translation of C5 on C6. What is the most appropriate next step in management?

An 82-year-old man with multiple medical comorbidities including severe COPD and ischemic heart disease falls from a standing height. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the most appropriate definitive management?

An 18-year-old male is involved in a high-speed motor vehicle collision while wearing a lap belt. He complains of severe back pain. Radiographs demonstrate a horizontal fracture line passing through the spinous process, pedicles, and vertebral body of L2. Neurologic exam is normal. Which of the following is the most essential next step in his evaluation?

A 68-year-old woman presents with worsening back and bilateral leg pain that increases with walking and is relieved by leaning over a shopping cart. She has failed 6 months of non-operative management including physical therapy and epidural steroid injections. Imaging reveals an L4-L5 Grade 1 degenerative spondylolisthesis with severe central canal stenosis. Dynamic radiographs show 4 mm of translation. What is the most effective surgical treatment?

A 24-year-old male arrives in the emergency department after a motorcycle crash. He has a palpable step-off at the upper thoracic spine and is completely flaccid and areflexic below the T4 level. His heart rate is 50 beats/minute and his blood pressure is 80/50 mmHg. His extremities are warm and well-perfused. Which of the following best explains his hemodynamic parameters?

A 14-year-old female gymnast complains of insidious onset lower back pain that worsens with back extension. Neurologic examination is entirely normal. Radiographs reveal a pars interarticularis defect at L5 bilaterally with 15% translation of L5 on S1. What is the most appropriate initial management?

A 40-year-old man presents to the emergency department with severe lower back pain, bilateral lower extremity weakness, and new-onset urinary incontinence. Physical examination reveals perianal numbness and decreased bilateral Achilles reflexes. What is the most appropriate next step in management?

When evaluating an MRI of the cervical spine in a patient with severe cervical spondylotic myelopathy, which of the following intrinsic cord signal changes is associated with the poorest prognosis for neurologic recovery following surgical decompression?

A 55-year-old man with a known history of ankylosing spondylitis presents to the emergency department complaining of severe neck pain after a minor fall from a chair. He is neurologically intact. Standard anteroposterior and lateral cervical radiographs demonstrate osteopenia and syndesmophyte formation but no obvious fracture. What is the mandatory next step in his evaluation?

A traumatic spondylolisthesis of the axis, commonly known as a Hangman's fracture, involves bilateral fractures through which specific anatomic structure?