6. Spine MCQs

A 15-year-old boy presents with progressive thoracic kyphosis. Radiographs reveal anterior wedging of multiple vertebral bodies. What are the classic Sorenson radiographic criteria required to diagnose Scheuermann's kyphosis?

A 22-year-old female unrestrained backseat passenger is involved in a high-speed motor vehicle collision. Radiographs show a flexion-distraction injury (Chance fracture) at L2. Which of the following injuries is most commonly associated with this spinal fracture pattern?

A 35-year-old male arrives at the trauma bay with a unilateral C5-C6 facet dislocation following a rugby tackle. He is awake, alert, and complains of C6 radicular pain, but has no myelopathy. What is the most appropriate initial management?

A 65-year-old man undergoes a C3-C6 posterior laminectomy and instrumented fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops isolated, profound weakness in right shoulder abduction and elbow flexion. His sensation remains intact, and lower extremity function is unchanged. What is the most likely etiology of this complication?

A 48-year-old man presents with acute onset, severe left-sided anterior thigh pain and knee weakness. Examination reveals weakness in knee extension and a diminished patellar reflex. Sensation is decreased over the medial aspect of the left calf. MRI reveals a far-lateral disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 72-year-old man with a history of cervical stenosis falls forward and strikes his chin. He presents to the emergency department with profound bilateral weakness in his hands and upper extremities (1/5 strength) but retains 4/5 strength in his lower extremities. Sensation is decreased in a cape-like distribution. What is the most likely diagnosis?

In the surgical planning for adult degenerative scoliosis, sagittal balance is a critical determinant of postoperative outcomes. If a patient has a pelvic incidence (PI) of 55 degrees, what should the target lumbar lordosis (LL) ideally be to minimize the risk of adjacent segment disease?

A 28-year-old man arrives at the trauma bay after a motor vehicle collision. He is awake, alert, and cooperative (GCS 15). Neurological examination is entirely intact. CT of the cervical spine reveals a unilateral facet dislocation at C5-C6. What is the most appropriate next step in management?

An 84-year-old woman presents with severe neck pain after a low-energy fall from a standing height. CT imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. She is neurologically intact. What is the most appropriate management?

A 16-year-old boy presents with back pain and a prominent thoracic curvature. On physical examination, the kyphosis is rigid and does not correct with hyperextension. Standing lateral radiographs reveal irregular vertebral endplates and Schmorl's nodes. By classic Sørensen criteria, Scheuermann's kyphosis requires anterior wedging of at least 5 degrees in how many consecutive vertebrae?

During an anterior approach to the lower cervical spine for corpectomy, the surgeon must mobilize the longus colli muscles. Care must be taken laterally to avoid injury to the vertebral artery. In the majority of the population, the vertebral artery enters the transverse foramen at which cervical level?

A 60-year-old man undergoes a complex T10 to pelvis posterior spinal fusion for severe adult spinal deformity. The surgery lasts 10 hours with an estimated blood loss of 2.5 liters, accompanied by mild intraoperative hypotension. On postoperative day 1, he complains of painless, profound bilateral vision loss. What is the most likely etiology?

A 35-year-old construction worker falls 10 feet, 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 the patient's total score and recommended management?

A 45-year-old male falls from a height and sustains an L1 burst fracture. Neurological examination is normal. Upright radiographs demonstrate 15 degrees of kyphosis and 30% loss of vertebral body height. CT scan shows 40% canal compromise. What is the most appropriate initial management?

A 68-year-old female presents with severe neurogenic claudication. Standing radiographs reveal a grade 1 degenerative spondylolisthesis at L4-L5. Dynamic radiographs show 4 mm of translation. She has failed conservative management. What is the most appropriate surgical intervention?

A 25-year-old male with ankylosing spondylitis sustains a low-energy fall. He complains of severe neck pain but has no neurologic deficits. Plain radiographs of the cervical spine are difficult to interpret due to marked osteopenia and deformity. What is the most appropriate next step in management?

In evaluating a patient with adult spinal deformity, which of the following spinopelvic parameters is a morphologic constant that does not change with patient positioning?

A 75-year-old male with a history of rheumatoid arthritis presents with progressive upper extremity weakness and hyperreflexia. Radiographs reveal an atlantodental interval (ADI) of 8 mm and a posterior atlantodental interval (PADI) of 12 mm. Which of the following is the most critical threshold indicating the need for surgical intervention to prevent irreversible neurologic damage?

A 30-year-old male sustains a C5-C6 bilateral facet dislocation. He is intubated and sedated upon arrival. What is the most appropriate next step in management prior to reduction?

Which of the following findings is considered the most reliable early indicator of urinary retention in a patient with suspected cauda equina syndrome?