6. Spine MCQs

Which of the following is the strongest indication for adding a concomitant instrumented fusion to a lumbar laminectomy for spinal stenosis?

A 35-year-old man presents with a T11 fracture after a motor vehicle accident. Examination reveals isolated complete loss of motor function and sensation below the umbilicus, with absent rectal tone. The posterior ligamentous complex is disrupted. What is the most appropriate surgical approach?

A 72-year-old woman with known severe lumbar spinal stenosis presents to the emergency department. Which of the following clinical findings most strongly suggests the development of cauda equina syndrome requiring emergent surgical decompression?

A 40-year-old man with ankylosing spondylitis sustains a low-energy fall and complains of severe back pain. Plain radiographs are inconclusive. What is the most appropriate next step in management?

In the evaluation of a patient with suspected lumbar spinal stenosis, which diagnostic imaging modality is considered the gold standard for assessing the degree of central canal, lateral recess, and foraminal narrowing?

When comparing neurogenic claudication to vascular claudication, which of the following characteristics is most specific to neurogenic claudication?

A 50-year-old man presents with an L2 burst fracture after a fall. He is neurologically intact. Radiographs show 20 degrees of focal kyphosis and 30% loss of anterior body height. According to current evidence, what is the expected long-term clinical outcome of conservative management with an orthosis compared to surgical stabilization?

A 60-year-old patient undergoes an L3-L5 laminectomy for severe central stenosis. During the decompression, an incidental durotomy occurs. What is the most appropriate initial intraoperative management of this complication?

Which of the following anatomic structures forms the anterior border of the lumbar intervertebral foramen, and may contribute directly to foraminal stenosis when pathological?

A 45-year-old man presents with severe back pain and right leg radiculopathy. MRI reveals a massive L4-L5 right-sided far lateral (extraforaminal) disc herniation. Which nerve root is most likely compressed by this specific lesion?

A 40-year-old woman has local back pain and intense burning pain in her perianal region after being shot twice in the back. Motor and sensory examination of her lower extremities reveals no apparent deficit. She has present but decreased sensation in her perianal region, an intact anal wink, good rectal tone, and an intact bulbocavernosus reflex. Radiographs and CT scans are shown in Figures 3a through 3d. What is the next most appropriate step in management?

Figure 4 shows the MRI scan of a patient who has had bilateral leg pain, weakness, diffuse numbness, and urinary retention for the past week. Examination reveals that motor strength is diffusely decreased, although it may be secondary to pain. The patient is numb throughout both legs, and reflexes in the lower extremities are absent. Rectal examination shows decreased tone, but voluntary tightening is present. Management should consist of

A 35-year-old male falls from a ladder, sustaining an L1 burst fracture. He is neurologically intact. MRI demonstrates disruption of the posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is the most appropriate management?

A 19-year-old male presents with unilateral distal upper extremity weakness and atrophy that distinctly spares the brachioradialis muscle. An MRI of the cervical spine taken in full flexion reveals forward displacement of the posterior dural sac. What is the most likely diagnosis?

A 55-year-old man with advanced ankylosing spondylitis sustains a minor ground-level fall. He complains of back pain but is neurologically intact on presentation. Twelve hours later, he develops progressive lower extremity weakness. CT shows a non-displaced "chalk-stick" fracture at T8. What is the most likely cause of his neurologic deterioration?

In a patient presenting with L4-L5 degenerative spondylolisthesis, which of the following MRI findings is most highly predictive of segmental instability and the likelihood of future slip progression?

To establish a definitive radiographic diagnosis of Scheuermann's kyphosis based on the classic Sorensen criteria, a patient must demonstrate anterior wedging of at least 5 degrees in a minimum of how many consecutive vertebrae?

In a 3-year-old child diagnosed with congenital scoliosis, which of the following anomalous vertebral patterns carries the highest natural risk of rapid curve progression?

A 60-year-old diabetic male presents with severe back pain, fever, and progressive lower extremity weakness. MRI reveals a large ventral lumbar epidural abscess. What is the most common causative organism for this condition?

In preoperative planning for adult spinal deformity correction, achieving optimal global sagittal balance heavily relies on the relationship between pelvic incidence (PI) and lumbar lordosis (LL). What is the generally accepted target formula for a successful correction?