6. Spine MCQs

A 45-year-old patient presents with acute, burning right anterior thigh pain, weakness in right knee extension, and an absent right patellar reflex. MRI reveals a far lateral (extraforaminal) disc herniation. At which lumbar level is this herniation most likely located?

A 22-year-old female sustains a severe seatbelt-type flexion-distraction injury (Chance fracture) at the L2 level during a high-speed motor vehicle collision. Which concomitant visceral injury is most classically associated with this specific fracture pattern?

A 65-year-old Japanese male presents with cervical myelopathy. CT scan shows a dense, continuous calcified mass along the posterior aspect of the C3-C5 vertebral bodies, consistent with Ossification of the Posterior Longitudinal Ligament (OPLL). Which surgical approach carries the highest specific risk of iatrogenic dural tear?

A Levine-Edwards Type II traumatic spondylolisthesis of the axis (Hangman's fracture) typically demonstrates significant anterior translation and angulation. What is the classic mechanism of injury required to produce this specific Type II pattern?

A 25-year-old male is evaluated after a motor vehicle collision. He complains of right-sided neck pain and a C6 radiculopathy. Lateral cervical radiographs reveal exactly 25% anterior translation of C5 on C6 and a characteristic "bowtie" sign. What is the primary mechanism of this injury?

A 45-year-old male presents with severe myelopathy secondary to a massive, centrally located, calcified T8-T9 disc herniation. The surgeon is contemplating the operative approach. Which of the following approaches is strictly contraindicated due to an unacceptably high risk of catastrophic spinal cord injury?

A 65-year-old man presents with progressive gait instability and loss of fine motor skills in his hands. Physical exam reveals hyperreflexia in the lower extremities, a positive Hoffman's sign, and a wide-based gait. MRI of the cervical spine shows severe stenosis at C4-C5 and C5-C6 with T2 signal changes in the spinal cord. Which of the following MRI findings is the most significant predictor of poor neurological recovery after decompressive surgery?

A 25-year-old man is brought to the trauma bay after a motorcycle accident. He has a T12 burst fracture with 50% loss of vertebral body height and 20 degrees of kyphosis. Neurological examination is completely normal. MRI confirms that the posterior ligamentous complex (PLC) is intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

A 78-year-old woman falls from a standing height and sustains a Type II odontoid fracture. She has a history of severe osteoporosis and COPD. Her neurologic exam is normal. What is the most appropriate initial management?

A 62-year-old woman presents with severe low back pain and an inability to stand up straight. Her standing full-length spine radiographs reveal a pelvic incidence (PI) of 60 degrees and a lumbar lordosis (LL) of 30 degrees. Which of the following best describes her spinopelvic parameters?

A 42-year-old male with a 15-year history of advanced ankylosing spondylitis presents to the emergency department complaining of severe neck pain after a minor fall at home. Initial cross-table lateral radiographs show extensive syndesmophytes but no obvious fracture line. What is the most appropriate next step in management?

A 35-year-old construction worker presents with severe left-sided buttock pain radiating down the posterolateral thigh and calf to the dorsum of his foot. On examination, he has decreased sensation over the dorsal web space between his first and second toes and 3/5 weakness in the extensor hallucis longus (EHL). A disc herniation at which level is most likely responsible?

A 55-year-old woman undergoes an uncomplicated multi-level anterior cervical discectomy and fusion (ACDF) from C3 to C6 for severe myelopathy. On postoperative day 2, she complains of profound inability to abduct her shoulders and flex her elbows, though her hand function and leg strength remain normal. What is the most likely cause of this complication?

A 16-year-old gymnast presents with chronic, activity-limiting low back pain. Radiographs demonstrate a Grade II isthmic spondylolisthesis at L5-S1 with an intact pars defect. Despite 6 months of comprehensive physical therapy, core strengthening, and bracing, her pain remains severe. What is the most appropriate surgical intervention?

A 55-year-old male undergoes a multi-level posterior cervical laminectomy and fusion for severe cervical spondylotic myelopathy. On postoperative day 2, he develops profound weakness in bilateral shoulder abduction and elbow flexion, with no sensory deficits or lower extremity symptoms. What is the most likely etiology of this complication?

A 45-year-old man presents with severe, acute left leg pain. MRI reveals a far-lateral (extraforaminal) disc herniation at the L4-L5 level on the left. Which of the following physical examination findings is most expected?

A 68-year-old man with known cervical spondylosis presents after a hyperextension injury. He exhibits 2/5 motor strength in his bilateral upper extremities and 4/5 motor strength in his bilateral lower extremities. Perianal sensation and proprioception are preserved. What is the most likely diagnosis?

A 30-year-old male falls from a roof, sustaining an L1 burst fracture. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and recommended treatment?

In the surgical planning for a 65-year-old woman with adult degenerative scoliosis and sagittal imbalance, her pelvic incidence (PI) is measured at 55 degrees. To achieve optimal sagittal alignment and minimize the risk of adjacent segment disease, what should be the target postoperative lumbar lordosis (LL)?

During an anterior cervical discectomy and fusion (ACDF), a right-sided approach is chosen. Which of the following statements regarding the recurrent laryngeal nerve (RLN) is most accurate?