6. Spine MCQs

A 78-year-old man is involved in a low-speed motor vehicle collision. CT scan of the cervical spine reveals a displaced Type II odontoid fracture. Which of the following factors is most strongly associated with nonunion if treated conservatively with a halo vest?

A 16-year-old gymnast complains of chronic lower back pain. Radiographs reveal an L5-S1 isthmic spondylolisthesis. If surgical fusion and reduction are indicated, what is the most common neurologic complication during the reduction of a high-grade slip?

A 55-year-old man with a long history of ankylosing spondylitis presents with new-onset neck pain after a minor ground-level fall. Initial plain radiographs are read as normal. What is the most appropriate next step in management?

A 45-year-old man is involved in a high-speed accident. CT scan shows a traumatic spondylolisthesis of the axis (Hangman's fracture) with severe angulation and minimal translation. The C2-C3 disc space is significantly widened. What is the Levine-Edwards classification of this injury?

A 40-year-old man presents with right arm pain, numbness in his thumb, and weakness in wrist extension. The brachioradialis reflex is diminished. Which cervical nerve root is most likely affected?

A 48-year-old man presents with acute severe right leg pain following heavy lifting. An MRI demonstrates a far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 62-year-old man undergoes a C3-C6 posterior cervical laminectomy and fusion. On postoperative day 2, he develops profound weakness in bilateral deltoid and biceps muscles without new sensory changes. What is the most widely accepted pathophysiology of this complication?

A 52-year-old diabetic patient presents with severe back pain, fever, and progressive bilateral lower extremity weakness. MRI reveals a continuous ventral epidural fluid collection from L1 to L4. What is the most commonly isolated organism in spontaneous spinal epidural abscesses?

A 60-year-old woman with a 20-year history of rheumatoid arthritis requires elective total hip arthroplasty. Flexion-extension cervical radiographs reveal an anterior atlantodens interval (ADI) of 8 mm. She is neurologically intact. What is the most appropriate management regarding her cervical spine prior to hip surgery?

A 68-year-old man with adult degenerative scoliosis presents with a 45-degree lumbar curve. Surgery is planned. To minimize the risk of proximal junctional kyphosis (PJK), what is an important intraoperative consideration regarding the upper instrumented vertebra (UIV)?

A 45-year-old intravenous drug user presents with mid-back pain and fevers. MRI shows T8-T9 disc space narrowing with endplate destruction and a small epidural phlegmon without cord compression. The patient is neurologically intact. Blood cultures grow MRSA. What is the primary treatment?

A 25-year-old woman presents to the trauma bay after a high-speed motor vehicle collision where she was wearing only a lap belt. She has a large abdominal ecchymosis. Radiographs reveal a transverse fracture through the pedicles, pars, and vertebral body of L2. What associated injury must be heavily suspected?

A 70-year-old man presents with severe neck pain and weakness after a fall where he struck his forehead. Examination reveals significant motor weakness in the bilateral upper extremities, particularly the hands, with relatively preserved strength in the lower extremities. Which of the following is the most likely diagnosis?

A 25-year-old man is involved in a motor vehicle collision and sustains an isolated Jefferson (C1 ring) fracture. The 'Rule of Spence' on an open-mouth odontoid radiograph evaluates the combined overhang of the C1 lateral masses on C2. Overhang greater than what measurement suggests a rupture of the transverse atlantal ligament?

Which of the following spinopelvic parameters is a fixed morphological parameter that is NOT altered by patient positioning or spinal alignment changes?

A 45-year-old man presents with a far lateral (extra-foraminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed, and what clinical finding would be expected?

A 35-year-old woman undergoes a posterior cervical laminectomy and fusion for cervical myelopathy. Postoperatively on day 2, she develops isolated weakness in bilateral shoulder abduction and elbow flexion. There are no sensory changes or leg weakness. What is the most likely cause of her new deficit?

A 60-year-old man with a 10-year history of ankylosing spondylitis presents to the emergency department after a low-energy fall. He reports new-onset back pain but has intact neurology. Initial plain radiographs are inconclusive. What is the most appropriate next step in management?

A 45-year-old man is diagnosed with a paracentral disc herniation at L5-S1. He presents with severe leg pain, numbness along the lateral aspect of his foot, and weakness. Which physical examination finding corresponds to this specific level of compression?

A 65-year-old patient undergoes a T10 to pelvis posterior spinal fusion for adult degenerative scoliosis. One year later, they complain of severe back pain and leaning forward. Radiographs show failure of the proximal construct with kyphosis above the upper instrumented vertebra. What is this complication called?