6. Spine MCQs

A 75-year-old woman suffers a Type II odontoid fracture after a ground-level fall. The fracture is displaced 3 mm posteriorly. She has severe medical comorbidities, including advanced COPD and heart failure. What is the most appropriate management?

A 65-year-old man presents with neurogenic claudication. What is the most common anatomical cause of central canal stenosis in this patient?

A 72-year-old woman presents with dropping objects, a broad-based gait, and hyperreflexia. A positive Hoffmann sign is noted. MRI shows severe C5-C6 stenosis with cord signal changes. What is the best next step in management?

A 45-year-old man fell from 10 feet. CT reveals an L1 burst fracture with 40% canal compromise. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the recommended treatment?

A 45-year-old man complains of severe anterior thigh pain and weakness in knee extension. MRI shows a far lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed?

A 15-year-old gymnast presents with persistent lower back pain unresponsive to 6 months of conservative management. Radiographs show a grade II isthmic spondylolisthesis at L5-S1. What is the most appropriate surgical treatment?

A 55-year-old man with long-standing Ankylosing Spondylitis suffers a minor mechanical fall. He complains of new-onset, severe lower cervical pain. Initial plain radiographs of the cervical spine are obscured by the shoulders and appear inconclusive. What is the mandatory next step?

In planning reconstructive surgery for adult spinal deformity, achieving appropriate sagittal balance requires restoring lumbar lordosis (LL) to match the patient's pelvic incidence (PI). What is the widely accepted target formula to minimize the risk of adjacent segment disease and mechanical failure?

A 62-year-old man presents with progressive gait instability and hand clumsiness over the past 14 months. Examination reveals hyperreflexia, a positive Hoffmann sign, and a positive Romberg test. MRI shows severe stenosis at C5-C6 with T2 hyperintensity and T1 hypointensity within the spinal cord. What is the most significant predictor of poor postoperative neurological recovery in this patient?

A 30-year-old neurologically intact male sustains an L1 burst fracture. CT shows 30% canal compromise and 15 degrees of local kyphosis. MRI confirms an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and the recommended management?

Based on the Spine Patient Outcomes Research Trial (SPORT) data regarding the treatment of degenerative spondylolisthesis, which of the following statements is true?

A 65-year-old man with long-standing ankylosing spondylitis sustains a low-energy fall. He complains of severe neck pain but remains neurologically intact. Standard anterior-posterior and lateral radiographs of the cervical spine appear normal. What is the most appropriate next step in management?

Which of the following represents the classic Sorensen radiographic criteria required for the diagnosis of typical Scheuermann's kyphosis?

A 45-year-old man presents with severe left anterior thigh pain, decreased sensation over the medial leg, and weakness in knee extension. MRI reveals a far lateral (extraforaminal) disc herniation at the L4-L5 level on the left. Which nerve root is most likely compressed?

A 70-year-old man with preexisting cervical spondylosis presents with upper extremity weakness greater than lower extremity weakness after a hyperextension injury. Which spinal tract's medial fiber topography explains the disproportionate upper extremity involvement in this central cord syndrome?

In the preoperative surgical planning for an adult spinal deformity, restoring sagittal balance is critical to improving clinical outcomes. The optimal postoperative lumbar lordosis (LL) should be matched to which of the following spinopelvic parameters?

A 12-year-old boy with Down syndrome is being evaluated for participation in the Special Olympics. Flexion-extension cervical radiographs show an atlantodens interval (ADI) of 6 mm. He is completely asymptomatic and his neurologic examination is normal. What is the most appropriate recommendation?

A 65-year-old man presents with progressive clumsiness in his hands, difficulty buttoning his shirts, and an unsteady gait. Examination reveals hyperreflexia in the lower extremities, a positive Hoffmann sign bilaterally, and an inverted brachioradialis reflex. What is the most likely diagnosis?

A 72-year-old woman complains of bilateral buttock and posterior thigh pain that worsens after walking for 10 minutes. The pain is rapidly relieved when she sits down or leans forward over a shopping cart. The primary anatomic contributor to her condition is typically hypertrophy of which of the following structures?