6. Spine MCQs

A 48-year-old male taking chronic systemic corticosteroids for severe asthma presents with progressive lower extremity weakness. MRI of the lumbar spine reveals marked compression of the thecal sac by excessive, homogenous T1-hyperintense tissue in the posterior epidural space. What is the most appropriate initial management?

In degenerative lumbar spinal stenosis, compression of the traversing nerve root within the lateral recess is most commonly caused by hypertrophy of which of the following osseous structures?

During an L4-L5 laminectomy for severe stenosis, a 1 cm incidental durotomy occurs. It is primarily repaired with a 4-0 nonabsorbable suture, and a Valsalva maneuver confirms a watertight seal. According to current evidence, what is the best postoperative protocol?

A 35-year-old male sustains a T12 burst fracture after a fall. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) scale, his score is calculated as 2 (Burst = 2, Neurologic status = 0, PLC = 0). What is the most appropriate management?

A 65-year-old man presents with bilateral leg pain when walking. He notes that bicycling causes no pain, and walking downhill exacerbates his symptoms more than walking uphill. Which of the following physical exam findings is most likely to be present?

A 22-year-old female is involved in a high-speed motor vehicle collision while wearing a lap belt. She complains of severe mid-back pain. CT scan reveals a transverse fracture extending through the pedicles, transverse processes, and vertebral body of L1. Which of the following associated injuries is most commonly seen in this patient?

A 70-year-old female presents with severe neurogenic claudication. Imaging demonstrates L4-L5 degenerative spondylolisthesis with severe central canal stenosis. Dynamic flexion-extension radiographs reveal 4 mm of translation upon flexion. What is the most appropriate surgical treatment?

A 55-year-old woman presents with L4-5 spinal stenosis and radicular leg pain. Her MRI demonstrates bilateral facet joint effusions greater than 1.5 mm. What does this specific MRI finding suggest regarding her condition?

A 40-year-old man falls from a scaffold, sustaining an L1 burst fracture. He has incomplete paraplegia (Frankel C), and a CT scan shows 80% canal compromise by a large retropulsed bone fragment. Which surgical approach is most favored to directly decompress the neural elements in this scenario?

A 68-year-old man who underwent an L4-S1 posterior instrumented fusion 5 years ago now presents with new-onset neurogenic claudication. Radiographs show intact hardware but a new grade 1 spondylolisthesis at L3-L4. What is the primary biomechanical cause of this new pathology?

According to the principles of thoracolumbar trauma management, which of the following is considered an absolute indication for surgical decompression and stabilization of a thoracolumbar burst fracture?

When comparing degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) in the adult population, which of the following characteristics accurately differentiates DS from IS?

A 30-year-old woman sustains a T12-L1 fracture-dislocation. She presents with flaccid paralysis of the lower extremities, saddle anesthesia, and severe urinary retention. Her bulbocavernosus reflex is absent. This clinical picture is most consistent with an injury to which anatomical structure?

During a routine L4-L5 decompressive laminectomy for severe spinal stenosis, a 1 cm incidental durotomy occurs ventrally. What is the most appropriate initial intraoperative management of this complication?

A 55-year-old man with a long history of Ankylosing Spondylitis falls from a standing height. He complains of severe back pain but has no neurologic deficits. Plain radiographs show a 'bamboo spine' but no obvious fracture. What is the most appropriate next step in management?

The Spine Patient Outcomes Research Trial (SPORT) evaluated outcomes for surgery versus non-operative care for lumbar spinal stenosis. What did the long-term results conclude regarding decompressive laminectomy for stenosis without spondylolisthesis?

A 25-year-old male sustains an L2 burst fracture with 60% canal compromise and a complete cauda equina syndrome. You elect to perform a posterior-only approach for decompression and stabilization. What technique is most commonly used to decompress the anterior canal from a posterior approach?

A 65-year-old man presents with bilateral leg pain and cramping that worsens with walking and standing, but is relieved when he leans forward on a shopping cart. Pedal pulses are 2+ bilaterally. Which of the following is the most likely primary pathoanatomic cause of his symptoms?

A 24-year-old man falls from a height of 15 feet and sustains a T12 fracture. CT scan shows a burst fracture with 40% loss of anterior vertebral body height, 15 degrees of kyphosis, and 20% canal compromise. He is neurologically intact. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is his total score and the recommended treatment?

According to the Spine Patient Outcomes Research Trial (SPORT) for degenerative lumbar spondylolisthesis with spinal stenosis, how do the outcomes of surgical decompression and fusion compare to nonoperative management at 4-year follow-up?