6. Spine MCQs

A 28-year-old construction worker falls from a scaffolding, sustaining an L1 burst fracture. He is neurologically intact. Upright radiographs show 20 degrees of local kyphosis, and CT shows 40% canal compromise. The posterior ligamentous complex is intact on MRI. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate treatment?

A 45-year-old female presents with persistent lower back pain and bilateral L5 radiculopathy that has failed 6 months of conservative management. Flexion-extension radiographs reveal a Grade II L4-L5 degenerative spondylolisthesis with 5 mm of dynamic instability. MRI shows severe bilateral foraminal stenosis at L4-L5. Which of the following is the most appropriate surgical intervention?

A 34-year-old male presents to the emergency department with acute onset of severe lower back pain, bilateral sciatica, and perianal numbness after lifting a heavy box. He reports a recent episode of urinary incontinence, and his post-void residual volume is 350 mL. An emergent MRI of the lumbar spine demonstrates a massive central L4-L5 disc herniation. What is the most critical time frame for surgical decompression to optimize the recovery of bladder and bowel function?

A 22-year-old collegiate baseball pitcher complains of medial elbow pain during the late cocking phase of throwing. The moving valgus stress test is positive. Which specific ligamentous structure is the primary restraint to valgus stress at the elbow between 30 and 90 degrees of flexion?

A 21-year-old collegiate pitcher reports medial elbow pain and decreased throwing velocity. The "moving valgus stress test" is positive. What structure is the primary restraint to valgus stress at the elbow during the late cocking phase of throwing?

A 19-year-old rugby player is tackled and sustains a posterior sternoclavicular (SC) joint dislocation. He presents to the ER with mild dyspnea and dysphagia. What is the most critical imaging study required before attempting closed reduction in the operating room?

A 4-year-old child presents with bleeding gums, petechiae, and metaphyseal radiolucent bands on radiographs (Frankel's line). The underlying nutritional deficiency impairs collagen synthesis by directly affecting which enzymatic process?

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is frequently used off-label in anterior cervical discectomy and fusion (ACDF). This specific application is strongly associated with which of the following complications?

During an anterior thoracolumbar spine approach, the artery of Adamkiewicz is at risk. From which side and vertebral level does this artery most commonly arise?

When inserting a pedicle screw in the lumbar spine, the traditional starting point is at the intersection of the pars interarticularis, the midpoint of the transverse process, and which other structure?

During an anterior thoracolumbar spine approach, segmental arteries are ligated. Unintended ligation of the great radicular artery of Adamkiewicz typically leads to ischemia of which specific spinal cord region?

During the insertion of a right-sided pedicle screw at T12, the screw breaches the medial cortex of the pedicle. Which structure is most directly at risk from this errant trajectory?

When performing an anterior cervical discectomy and fusion (ACDF), lateral dissection over the uncinate process is limited to avoid injuring the vertebral artery. The vertebral artery typically enters the transverse foramen at which cervical level?

A patient requires posterior instrumentation of the cervical spine. To avoid vertebral artery injury during lateral mass screw placement at C5, the surgeon must be aware of the artery's path. Through which transverse foramen does the vertebral artery typically first enter the cervical spine?

A 45-year-old male presents with severe radicular leg pain, weakness in great toe extension, and numbness along the dorsum of the foot. An MRI reveals a posterolateral disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

During posterior spinal fusion, a surgeon evaluates the accuracy of lumbar pedicle screw tracts using a ball-tipped probe. If the medial cortical wall of the L4 pedicle is breached, which anatomic structure is immediately at risk?

When placing pedicle screws in the lumbar spine, understanding the changing regional anatomy is critical for safe trajectory. Compared to the T12 pedicle, the typical L5 pedicle is:

When performing a standard posterior approach to the lumbar spine, the surgeon exposes the pars interarticularis. Which neural structure lies immediately anterior to the pars interarticularis?

During anterior cervical spine surgery, aggressive dissection lateral to the uncovertebral joints puts the vertebral artery at risk. At which cervical level does the vertebral artery typically first enter the foramen transversarium?

During anterior cervical spine surgery, recognizing the course of the vertebral artery is vital. In the majority of individuals, the vertebral artery enters the transverse foramen at which cervical level?