6. Spine MCQs

A 35-year-old male falls from a height and sustains an L1 burst fracture. His neurologic examination is normal. An MRI confirms that the posterior ligamentous complex (PLC) is completely intact. What is his Thoracolumbar Injury Classification and Severity (TLICS) score, and what is the generally recommended treatment?

A 22-year-old female is involved in a high-speed motor vehicle collision while wearing a lap belt. She sustains a severe flexion-distraction injury (Chance fracture) at L2. What is the most commonly associated concomitant injury in this specific scenario?

A 70-year-old male with long-standing ankylosing spondylitis presents with back pain after a ground-level fall. CT scan shows a displaced transverse fracture through the T10-T11 disc space extending into the posterior elements. Which of the following is the most appropriate surgical strategy?

A 60-year-old male with central lumbar spinal stenosis is considering an epidural steroid injection (ESI). Which of the following best describes the expected efficacy of ESIs for neurogenic claudication based on recent randomized controlled trials?

A 40-year-old male presents with a T12 burst fracture and profound paraparesis (ASIA B). CT reveals 60% canal compromise by a large retropulsed bone fragment. What is the most appropriate definitive management?

In the evaluation of a patient with an L5-S1 isthmic spondylolisthesis, which of the following spinopelvic parameters is a fixed morphologic feature of the pelvis that does not change with patient positioning?

During a routine L4-L5 lumbar laminectomy for stenosis, a 3-mm incidental durotomy occurs. A primary water-tight repair is achieved intraoperatively. Which of the following postoperative protocols is most supported by recent literature?

A 65-year-old female presents with new-onset neurogenic claudication 5 years after an L4-L5 posterolateral fusion. Imaging shows severe L3-L4 central stenosis. Which of the following is considered the strongest modifiable risk factor for the development of adjacent segment disease requiring surgery?

A 70-year-old male with calf pain after walking two blocks is evaluated. To differentiate neurogenic from vascular claudication, he undergoes a stationary bicycle test. Which finding is most consistent with neurogenic claudication?

A 55-year-old male with a history of lumbar stenosis presents to the emergency department with acute urinary retention, saddle anesthesia, and bilateral lower extremity weakness. MRI confirms a massive disc extrusion at L4-L5. Surgical decompression is classically recommended within what maximum timeframe to maximize the chance of bladder function recovery?

Which of the following biomechanical characteristics most accurately explains why the thoracolumbar junction (T11-L2) is highly susceptible to traumatic fractures?

The McCormack Load Sharing Classification is used to determine the need for anterior column support in thoracolumbar burst fractures. Which of the following is NOT a criterion assessed in this classification?

In an adult patient with degenerative lumbar scoliosis and concurrent spinal stenosis, which of the following radiographic parameters is most highly predictive of curve progression?

Following a successful multi-level lumbar decompression for central spinal stenosis without instability, which symptom typically demonstrates the LEAST amount of improvement postoperatively?

A 68-year-old female presents with severe neurogenic claudication and an L4-L5 grade I degenerative spondylolisthesis. She has failed 6 months of comprehensive physical therapy and epidural steroid injections. Based on the Spine Patient Outcomes Research Trial (SPORT), what is the most appropriate surgical treatment?

A 35-year-old male falls from 10 feet, sustaining an isolated L1 burst fracture. He is neurologically intact. CT imaging shows 30% canal compromise, and MRI confirms an intact posterior ligamentous complex. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

Which of the following historical or physical examination findings best differentiates neurogenic claudication from vascular claudication?

A 22-year-old male is involved in a high-speed motor vehicle collision wearing a lap-belt only. Imaging reveals a flexion-distraction (Chance) fracture at L2. Which associated injury has the highest likelihood of being present and must be urgently ruled out?

During a wide bilateral lumbar laminectomy for central spinal stenosis, preserving spinal stability is critical. To minimize the risk of iatrogenic pars interarticularis fractures and subsequent instability, what minimum width of the pars must be preserved bilaterally?

A 62-year-old male with long-standing, rigid ankylosing spondylitis presents with new-onset mechanical back pain after a ground-level fall. Plain radiographs of the thoracolumbar spine are unrevealing, and neurologic exam is intact. What is the most appropriate next step in management?