6. Spine MCQs

During anterior cervical spine surgery extending to the lower cervical segments, the vertebral artery is at risk. In the vast majority of the population, the vertebral artery enters the transverse foramen at which cervical level?

To properly place a lumbar pedicle screw, the surgeon must identify the correct starting point to avoid neurological injury. Anatomically, the standard starting point is defined by the intersection of the:

The adult spinal cord typically terminates distally as the conus medullaris. In the majority of adults, this termination occurs at which vertebral body level?

When placing a pedicle screw at the L4 level, the optimal starting point is at the intersection of the pars interarticularis, the superior articular facet, and the transverse process. What nerve root is most at risk if the screw breaches the pedicle inferiorly?

A spine surgeon evaluates a pre-operative CT scan for a T8 burst fracture. Compared to the lumbar spine, which of the following is true regarding the anatomy of mid-thoracic pedicles?

An anterior cervical discectomy and fusion (ACDF) is planned at the C6-C7 level. A right-sided approach is historically considered to have a higher risk of recurrent laryngeal nerve (RLN) injury compared to a left-sided approach due to which anatomical variant?

When performing an anterior approach for a thoracolumbar corpectomy, the surgeon must be aware of the artery of Adamkiewicz to prevent anterior spinal cord syndrome. This vessel most commonly arises from the aorta at which levels?

An 8-month-old boy is evaluated for infantile idiopathic scoliosis. Radiographs demonstrate a 25-degree left thoracic curve. According to Mehta's criteria, a Rib-Vertebra Angle Difference (RVAD) greater than which of the following values is most predictive of curve progression?

A 12-year-old boy with Duchenne muscular dystrophy presents with a progressive, sweeping thoracolumbar neuromuscular scoliosis measuring 45 degrees. He became wheelchair-bound 6 months ago. His forced vital capacity (FVC) is 45% of predicted. What is the most appropriate definitive management for his spinal deformity?

A 2-year-old child is being evaluated for congenital scoliosis. Radiographs reveal multiple vertebral anomalies. Which of the following patterns of vertebral malformation carries the highest risk for rapid, unrelenting curve progression?

A 14-month-old boy presents with a left thoracic curve.

The physician is evaluating the curve to determine the risk of progression. Which of the following is the most reliable radiographic prognostic factor for progression in infantile idiopathic scoliosis?

A 2-year-old child is diagnosed with congenital scoliosis. Which of the following vertebral anomalies carries the highest probability of rapid, unrelenting curve progression?

A 14-year-old non-ambulatory male with spastic quadriplegic cerebral palsy presents with a 75-degree sweeping neuromuscular scoliosis and marked pelvic obliquity, causing difficulty with wheelchair seating. What is the recommended surgical intervention?

A 9-year-old girl with Neurofibromatosis Type 1 (NF-1) has a sharp 45-degree thoracic kyphoscoliosis.

Radiographs demonstrate vertebral scalloping, spindling of the transverse processes, and penciling of the ribs. What is the most appropriate surgical treatment?

A 9-month-old boy is diagnosed with infantile idiopathic scoliosis. Radiographs show a 25-degree left thoracic curve. Which of the following radiographic parameters best predicts whether this curve will progress or spontaneously resolve?

A 12-year-old boy with spastic quadriplegic cerebral palsy has a progressive 80-degree neuromuscular scoliosis with marked pelvic obliquity. He is non-ambulatory and has difficulty sitting in his wheelchair. Surgical planning should most likely involve:

A 15-year-old boy presents with back pain and increased thoracic kyphosis. Standing lateral radiographs reveal a thoracic kyphosis of 65 degrees and anterior wedging of 3 consecutive vertebrae of 6 degrees each. What is the most appropriate initial management?

A 14-year-old boy with spastic quadriplegic cerebral palsy presents with a 75-degree thoracolumbar scoliosis and severe pelvic obliquity. He is non-ambulatory and has lost the ability to sit comfortably in his custom wheelchair. Which of the following surgical strategies is most appropriate?

A 10-month-old infant presents with infantile idiopathic scoliosis measuring 25 degrees. The rib-vertebral angle difference (RVAD) of Mehta is 28 degrees, and phase 2 rib-vertebral overlap is present on the convex side. What is the most likely natural history of this condition without intervention?

A 6-year-old boy presents with a left-sided thoracic curve of 25 degrees. His neurological examination is unremarkable. What is the most appropriate next diagnostic step before considering orthotic management?