6. Spine MCQs

In the normal lumbar spine anatomy, the exiting nerve root travels through the intervertebral foramen in what relation to the pedicle of the corresponding numbered vertebral body?

During a lateral transpsoas approach (LLIF) to the lumbar spine at the L4-L5 level, the surgeon uses neuromonitoring to map the lumbar plexus. At this specific level, where is the lumbar plexus typically located relative to the psoas major muscle?

In the normal anatomical course of the cervical spine, the vertebral artery typically enters the transverse foramen at which vertebral level?

When placing a pedicle screw at the L5 level, the starting point is identified at the intersection of the pars interarticularis, superior articular process, and transverse process. What is the typical medial angulation required to safely traverse the L5 pedicle?

During corrective spinal deformity surgery, the anterior spinal cord is vulnerable to ischemic injury. Which vascular territory is responsible for supplying the anterior spinal artery in the lower two-thirds of the spinal cord?

During an anterior cervical discectomy and fusion (ACDF), the longus colli muscles are elevated to define the lateral margins. Overzealous lateral dissection and retraction past the longus colli places which structure at immediate risk?

During the insertion of a thoracic pedicle screw at T7, the surgeon inadvertently directs the screw too far laterally, breaching the lateral wall of the pedicle. What anatomic structure is at greatest risk of direct injury?

During an anterior cervical discectomy and fusion (ACDF), aggressive lateral dissection places the vertebral artery at risk. In standard human anatomy, the vertebral artery typically enters the transverse foramen at which cervical level?

A 60-year-old man undergoes L4-L5 posterior spinal fusion. What is the classic anatomical landmark for the starting point of an L4 pedicle screw?

An orthopaedic spine surgeon is performing an anterior cervical discectomy and fusion (ACDF). The surgeon must be aware of the vertebral artery anatomy. In most individuals, at what cervical vertebral level does the vertebral artery initially enter the transverse foramen?

A surgeon is placing pedicle screws in the lumbar spine for a burst fracture. On an anteroposterior (AP) fluoroscopic view, the medial border of the pedicle corresponds to which structural boundary of the spinal canal?

A 4-year-old boy is brought to the emergency department after a high-speed motor vehicle collision. Lateral cervical spine radiographs reveal a 3.5 mm anterior displacement of C2 on C3. Swischuk's line (posterior cervical line) passes 1 mm anterior to the anterior aspect of the posterior arch of C3. What is the most appropriate management?

A 6-month-old infant is noted to have a left-sided thoracic scoliosis measuring 25 degrees. The Rib-Vertebral Angle Difference (RVAD) of Mehta is measured at 28 degrees. What does this finding indicate regarding the natural history of the curve?

A 14-year-old boy with Duchenne Muscular Dystrophy (DMD) has a progressive neuromuscular scoliosis of 40 degrees. His Forced Vital Capacity (FVC) is 45% of predicted. What is the recommended surgical strategy to optimize his quality of life and sitting balance?

Which of the following fixed spinopelvic radiographic parameters is most strongly associated with the severity and progression risk of an isthmic spondylolisthesis in a pediatric patient?

An 8-month-old infant is evaluated for a left-sided thoracic spinal curve. Radiographs show an infantile idiopathic scoliosis with a Rib-Vertebra Angle Difference (RVAD) of 28 degrees. What is the most appropriate next step in management?

A 7-year-old boy with Down syndrome undergoes routine cervical spine screening radiographs. Flexion-extension views reveal an Atlanto-Dens Interval (ADI) of 9 mm. He is neurologically intact and asymptomatic. What is the recommended management?