6. Spine MCQs

According to the ASIA Impairment Scale, a patient who has sensory preservation but no motor function preserved below the neurological level of injury is classified as:

A 30-year-old male is brought to the emergency department after a motor vehicle accident. He is comatose with a Glasgow Coma Scale score of 6. A CT scan demonstrates a right-sided C5-C6 unilateral facet dislocation. What is the most appropriate next step in management regarding his cervical spine injury?

A 65-year-old male presents with bilateral leg pain that worsens with walking and is relieved by leaning forward over a shopping cart. Examination reveals normal pedal pulses. Which of the following findings is most likely to be present on electrodiagnostic testing (EMG/NCS)?

A 16-year-old male presents with increasing thoracic kyphosis and mid-back pain. Radiographs reveal anterior wedging of multiple thoracic vertebrae. According to the Sorensen criteria, what specific radiographic finding is required to formally diagnose classic Scheuermann's kyphosis?

A 45-year-old construction worker falls 15 feet, sustaining an L1 burst fracture. He is neurologically intact on presentation. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following radiographic parameters is the strongest indication for operative stabilization over nonoperative brace management?

A 72-year-old woman complains of deteriorating handwriting, clumsiness in her hands, and unsteadiness when walking in the dark. On examination, rapidly flicking the distal phalanx of her middle finger into flexion causes a reflex flexion of her thumb and index finger. What is the name of this clinical sign?

An 80-year-old male trips and falls, striking his chin. CT of the cervical spine shows a fracture through the base of the odontoid process extending down into the cancellous body of C2. According to the Anderson and D'Alonzo classification, what type of fracture is this, and what is the typical initial treatment for a neurologically intact elderly patient?

A 65-year-old man with pre-existing cervical stenosis is involved in a rear-end collision, sustaining a hyperextension injury. He presents with profound weakness in his hands and arms (1/5 strength), but retains functional 4/5 strength in his legs and is able to walk. What is the most likely diagnosis?

A 42-year-old male presents with severe right anterior thigh pain and weakness in knee extension. An MRI of the lumbar spine reveals a far-lateral (extra-foraminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed by this specific herniation?

A 45-year-old male with long-standing Ankylosing Spondylitis presents with a severe, rigid chin-on-chest cervicothoracic kyphotic deformity. He is unable to see straight ahead. Which of the following surgical procedures is the standard, safest choice at the cervicothoracic junction to correct this deformity?

A 14-year-old competitive gymnast presents with chronic low back pain. Radiographs demonstrate a grade II L5-S1 spondylolisthesis. Which of the following pathoanatomical features is characteristic of this condition (isthmic spondylolisthesis) as opposed to degenerative spondylolisthesis?

A 55-year-old male undergoes a complex 9-hour posterior spinal fusion for adult spinal deformity. Upon waking, he complains of severe bilateral vision loss. A diagnosis of postoperative visual loss (POVL) is made. What is the most common etiology of POVL following prolonged posterior spine surgery?

According to the Canadian C-Spine Rules, which of the following is considered a "high-risk" factor that strictly mandates obtaining cervical spine radiography in an alert, stable trauma patient?

The off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical discectomy and fusion (ACDF) has been associated with a significantly increased risk of which of the following life-threatening postoperative complications?

A 12-year-old male with spastic quadriplegic cerebral palsy (Gross Motor Function Classification System level V) presents with a severe 90-degree sweeping thoracolumbar scoliosis and significant pelvic obliquity. When planning surgical correction and posterior fusion, what is the most appropriate distal extent of the instrumented fusion?

A 78-year-old man sustains a Type II odontoid fracture with 5 mm of posterior displacement after a fall. He is neurologically intact. Non-operative management with a halo vest is being considered. Compared to rigid cervical collar immobilization, halo vest placement in this specific patient population is associated with a significantly higher risk of:

A 65-year-old man with neurogenic claudication secondary to L4-L5 spinal stenosis fails conservative management and undergoes a lumbar decompression. During the procedure, which of the following anatomic structures must be partially resected to adequately decompress the traversing nerve root in the lateral recess?

A 35-year-old man falls from a height and sustains an L1 burst fracture. He is neurologically intact. Upright radiographs demonstrate 20 degrees of kyphosis and 40% loss of anterior vertebral body height. CT shows 30% canal compromise. The posterior ligamentous complex is intact on MRI. What is the most appropriate management?

A 55-year-old man presents with progressive bilateral hand clumsiness and a broad-based gait. Physical examination reveals positive Hoffman signs bilaterally. MRI shows multi-level cervical stenosis from C3-C6 with focal cord signal changes. Which of the following is the most reliable clinical indicator of a poor prognosis for neurologic recovery after surgical decompression?

A 25-year-old woman is involved in a motor vehicle accident. She is awake and alert. Neurologic exam reveals 0/5 strength in the bilateral triceps and hand intrinsics, with absent sensation below C7. Radiographs show a bilateral C6-C7 facet dislocation. MRI cannot be obtained within the next 4 hours. What is the most appropriate next step?