Menu

6. Spine MCQs

Practice Set 226 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 4501

Topic: 6. Spine

A 24-year-old man arrives intubated and sedated after a high-speed motor vehicle collision. Radiographs demonstrate a bilateral facet dislocation at C5-C6. What is the most appropriate next step in management?

. Immediate application of cranial tongs and closed reduction
. Emergent anterior cervical discectomy and fusion
. Emergent posterior cervical fusion
. MRI of the cervical spine
. High-dose methylprednisolone protocol

Correct Answer & Explanation

. Immediate application of cranial tongs and closed reduction

Explanation

In an unexaminable (intubated/sedated) patient with a cervical facet dislocation, an MRI must be obtained prior to any reduction maneuvers to rule out a herniated disc. If a herniation is present, an anterior decompression must precede reduction.

Question 4502

Topic: 6. Spine

When evaluating a patient with adolescent idiopathic scoliosis, which of the following defines the "stable vertebra"?

. The lowest vertebra whose lower endplate is parallel to the floor
. The most severely rotated vertebra
. The lowest vertebra bisected by the central sacral vertical line (CSVL)
. The vertebra with the greatest deviation from the CSVL
. The first vertebra above the sacrum

Correct Answer & Explanation

. The lowest vertebra whose lower endplate is parallel to the floor

Explanation

The stable vertebra is defined as the most proximal (lowest) vertebra whose body is completely bisected by the central sacral vertical line (CSVL). It is a key anatomical landmark used to determine the lowest instrumented vertebra (LIV).

Question 4503

Topic: Cervical Spine

An 85-year-old man sustains a Type II odontoid fracture with 3 mm of posterior displacement. He has multiple medical comorbidities, including severe COPD and coronary artery disease. What is the most appropriate initial management?

. Anterior odontoid screw fixation
. Posterior C1-C2 transarticular screws
. Rigid cervical orthosis
. Halo vest immobilization
. Observation without a collar

Correct Answer & Explanation

. Anterior odontoid screw fixation

Explanation

In an elderly patient with significant comorbidities, a rigid cervical orthosis is the preferred initial management for a Type II odontoid fracture due to the unacceptably high morbidity and mortality associated with surgery or halo vest application.

Question 4504

Topic: 6. Spine

Which of the following radiographic criteria is strictly required to formally diagnose classic Scheuermann's kyphosis?

. >5 degrees of anterior wedging in at least three consecutive vertebrae
. >10 degrees of anterior wedging in a single vertebra
. Schmorl's nodes in at least five consecutive vertebrae
. Thoracic kyphosis > 40 degrees with normal vertebral bodies
. Endplate irregularities without anterior wedging

Correct Answer & Explanation

. >5 degrees of anterior wedging in at least three consecutive vertebrae

Explanation

Sorensen's criteria for the diagnosis of Scheuermann's kyphosis require anterior wedging of greater than 5 degrees in at least three consecutive vertebrae, typically accompanied by endplate irregularities and Schmorl's nodes.

Question 4505

Topic: Cervical Spine

A 55-year-old man presents with progressive clumsiness in his hands and a broad-based gait. Imaging reveals continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6, occupying 65% of the canal. His cervical alignment is lordotic. What is the preferred surgical approach?

. Anterior cervical corpectomy and fusion
. Anterior cervical discectomy and fusion
. Posterior cervical laminoplasty or laminectomy and fusion
. Cervical disc arthroplasty
. Isolated C3-C6 laminectomies without fusion

Correct Answer & Explanation

. Anterior cervical corpectomy and fusion

Explanation

In patients with OPLL and preserved cervical lordosis, a posterior approach (laminoplasty or laminectomy and fusion) is preferred, especially when the ossified mass occupies >50-60% of the canal. Anterior approaches carry a severely elevated risk of dural tears.

Question 4506

Topic: 6. Spine

An 78-year-old woman with known severe cervical spondylosis presents after a hyperextension injury to her neck. She exhibits bilateral motor weakness in her upper extremities (grade 2/5) but retains 4/5 strength in her lower extremities. What is the most likely diagnosis?

. Anterior cord syndrome
. Central cord syndrome
. Brown-Sรฉquard syndrome
. Posterior cord syndrome
. Complete spinal cord injury

Correct Answer & Explanation

. Anterior cord syndrome

Explanation

Central cord syndrome classically occurs after a hyperextension injury in a patient with pre-existing cervical stenosis. It presents with disproportionately greater motor impairment in the upper extremities compared to the lower extremities.

Question 4507

Topic: Thoracolumbar Spine & Deformity

A 65-year-old woman presents with severe back pain and a progressive inability to stand up straight following a previous L4-S1 fusion. Radiographs reveal a pelvic incidence (PI) of 65 degrees and a lumbar lordosis (LL) of 20 degrees. If surgical correction is planned, what is the generally accepted target lumbar lordosis to optimize her sagittal alignment?

. 10 degrees
. 25 degrees
. 40 degrees
. 55 degrees
. 75 degrees

Correct Answer & Explanation

. 10 degrees

Explanation

For optimal sagittal balance, the lumbar lordosis (LL) should be matched to within 10 degrees of the pelvic incidence (PI). With a PI of 65 degrees, the target LL should be approximately 55 degrees to prevent flatback syndrome and adjacent segment disease.

Question 4508

Topic: Cervical Spine

A 78-year-old man with severe COPD sustains a Type II odontoid fracture with 3 mm of posterior displacement. He is neurologically intact. Compared to surgical intervention, nonoperative management with a rigid cervical collar in this patient demographic is associated with a higher rate of which of the following?

. Mortality at 1 year
. Dysphagia
. Pseudarthrosis
. Deep surgical site infection
. Immediate neurologic deterioration

Correct Answer & Explanation

. Mortality at 1 year

Explanation

In elderly patients, nonoperative management of Type II odontoid fractures using a rigid cervical collar is associated with high rates of pseudarthrosis (up to 40-50%). However, it is often favored due to the high perioperative morbidity and mortality associated with surgical fixation in patients with severe comorbidities.

Question 4509

Topic: 6. Spine

A 55-year-old man presents with progressive cervical myelopathy. Imaging reveals ossification of the posterior longitudinal ligament (OPLL) from C3 to C6, occupying 60% of the spinal canal, with an overall cervical kyphosis of 15 degrees.

What is the most appropriate surgical management?

. Cervical laminoplasty
. Cervical laminectomy alone
. Anterior cervical corpectomy and fusion
. Stand-alone anterior cervical discectomy and fusion at a single level
. Posterior foraminotomies

Correct Answer & Explanation

. Cervical laminoplasty

Explanation

Anterior cervical corpectomy and fusion (ACCF) is preferred for OPLL when the canal compromise is >50% and the spine is kyphotic (K-line negative). Posterior-only indirect decompression (laminoplasty) is inadequate here because the kyphotic alignment prevents the spinal cord from drifting backward away from the anterior compression.

Question 4510

Topic: Thoracolumbar Spine & Deformity

A 40-year-old man falls from a height of 10 feet and sustains an L1 burst fracture. He is neurologically intact. MRI confirms an intact posterior ligamentous complex (PLC).

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the score and recommended management?

. TLICS score of 2; nonoperative management
. TLICS score of 4; surgical management
. TLICS score of 4; operative or nonoperative management
. TLICS score of 5; surgical management
. TLICS score of 2; surgical management

Correct Answer & Explanation

. TLICS score of 2; nonoperative management

Explanation

The TLICS score assigns 2 points for a burst fracture morphology, 0 points for being neurologically intact, and 0 points for an intact PLC. A total score of 2 indicates nonoperative management with a brace.

Question 4511

Topic: Thoracolumbar Spine & Deformity

Which of the following anatomical variations is most strongly associated with the development of a degenerative spondylolisthesis at L4-L5 rather than an isthmic spondylolisthesis?

. Pars interarticularis defect
. Coronal facet joint orientation
. Sagittally oriented facet joints
. Elongated pedicles
. Spina bifida occulta

Correct Answer & Explanation

. Pars interarticularis defect

Explanation

Degenerative spondylolisthesis most commonly occurs at L4-L5 and is strongly associated with sagittally oriented facet joints, which provide less resistance to anterior shear forces. Isthmic spondylolisthesis involves a pars interarticularis defect and is most common at L5-S1.

Question 4512

Topic: Thoracolumbar Spine & Deformity

A 22-year-old woman is involved in a high-speed motor vehicle collision while wearing a lap belt. Radiographs show a flexion-distraction injury (Chance fracture) at L2. Which of the following concomitant injuries must be ruled out most urgently?

. Aortic dissection
. Hollow viscus injury
. Renal artery avulsion
. Diaphragmatic rupture
. Pelvic ring disruption

Correct Answer & Explanation

. Aortic dissection

Explanation

Chance fractures (flexion-distraction injuries) are frequently caused by lap seatbelts and have a high association (up to 40-50%) with intra-abdominal injuries, particularly hollow viscus (bowel) rupture. Urgent general surgery evaluation is required.

Question 4513

Topic: 6. Spine

A 45-year-old man with ankylosing spondylitis presents with a severe chin-on-chest deformity, impairing his horizontal gaze and causing difficulty swallowing. Where is the most biomechanically appropriate and anatomically safe level to perform a posterior extension osteotomy to correct his cervical deformity?

. C1-C2
. C4-C5
. C7-T1
. T4-T5
. T10-T11

Correct Answer & Explanation

. C1-C2

Explanation

The cervicothoracic junction (C7-T1) is the standard and safest location for an extension osteotomy in ankylosing spondylitis. It provides a large spinal canal to accommodate cord shifting, good bone for fixation, and typically avoids the vertebral artery which usually enters the foramen transversarium at C6.

Question 4514

Topic: 6. Spine

A 68-year-old man with underlying cervical spondylosis sustains a hyperextension injury. He presents with severe motor weakness in his hands and arms (deltoids 3/5, hand grip 1/5), with relatively preserved strength in his legs (hip flexion 4/5). Bladder function is intact. What is the most likely pathophysiological mechanism for this deficit?

. Anterior spinal artery occlusion
. Ischemia and hemorrhage in the central gray matter of the spinal cord
. Hemisection of the spinal cord
. Disruption of the posterior columns
. Avulsion of the brachial plexus nerve roots

Correct Answer & Explanation

. Anterior spinal artery occlusion

Explanation

This is a classic presentation of Central Cord Syndrome, characterized by upper extremity weakness greater than lower extremity weakness. It results from hyperextension in a stenotic canal, causing a pinch on the cord leading to edema, ischemia, and hemorrhage primarily affecting the centrally located cervical motor tracts.

Question 4515

Topic: Thoracolumbar Spine & Deformity

A 15-year-old boy presents with progressive mid-back pain and a noticeable rounding of his upper back. Standing lateral radiographs reveal a thoracic kyphosis of 65 degrees. According to the Sorensen criteria, what specific radiographic finding confirms the diagnosis of Scheuermann's kyphosis?

. Schmorl's nodes in at least 2 consecutive vertebrae
. Anterior wedging of โ‰ฅ 5 degrees in 3 or more consecutive vertebrae
. Thoracic kyphosis > 45 degrees resolving on a hyperextension bolster
. Pedicle narrowing in the apical thoracic vertebrae
. Intervertebral disc space widening at the apex of the deformity

Correct Answer & Explanation

. Schmorl's nodes in at least 2 consecutive vertebrae

Explanation

The classic Sorensen criteria define Scheuermann's disease radiographically as anterior wedging of 5 degrees or more in at least three consecutive vertebrae. Rigid kyphosis, Schmorl's nodes, and endplate irregularities are also supportive findings.

Question 4516

Topic: 6. Spine

A 42-year-old woman presents to the emergency department with acute onset of severe bilateral radicular leg pain, saddle anesthesia, and urinary retention with overflow incontinence that began 12 hours ago. MRI confirms a massive extruded herniated disc at L4-L5. To maximize the likelihood of recovering normal bladder function, surgical decompression must ideally occur within what maximum timeframe from symptom onset?

. Within 4 hours
. Within 48 hours
. Within 7 days
. After a 72-hour trial of high-dose steroids
. Timing of decompression has no impact on eventual bladder recovery

Correct Answer & Explanation

. Within 4 hours

Explanation

Cauda equina syndrome is a surgical emergency. Decompression should ideally be performed within 24 to 48 hours from the onset of symptoms (especially autonomic dysfunction like urinary retention) to maximize the probability of significant neurologic and urologic recovery.

Question 4517

Topic: 6. Spine

A 65-year-old man with a long-standing history of advanced ankylosing spondylitis presents after a low-energy ground-level fall. CT of the cervical spine reveals a hyperextension injury passing entirely through the C6-C7 disc space. What is the most appropriate management?

. Rigid cervical collar immobilization for 12 weeks
. Anterior cervical plating and fusion alone
. Posterior cervical instrumented fusion alone
. Combined anterior and posterior cervical instrumented fusion
. Halo vest immobilization

Correct Answer & Explanation

. Rigid cervical collar immobilization for 12 weeks

Explanation

Fractures in patients with ankylosing spondylitis are highly unstable due to the long, rigid lever arms of the fused spine. A combined anterior and posterior fusion is generally recommended to provide maximum biomechanical stability and prevent construct failure.

Question 4518

Topic: Thoracolumbar Spine & Deformity

A 65-year-old female presents with severe neurogenic claudication and an L4-L5 degenerative spondylolisthesis as demonstrated on her MRI.

She has failed conservative management. Which of the following factors most strongly supports performing a decompression with fusion rather than an isolated decompression?

. Presence of severe mechanical back pain
. Sagittal orientation of the facet joints
. Preoperative dynamic instability >3 mm on flexion/extension radiographs
. A preoperative visual analog scale (VAS) leg pain score > 8
. Presence of a pars interarticularis defect

Correct Answer & Explanation

. Presence of severe mechanical back pain

Explanation

Decompression with fusion is indicated over decompression alone in degenerative spondylolisthesis when there is clear evidence of dynamic instability (e.g., >3 mm of translation on flexion/extension films) to prevent postoperative progression of the slip.

Question 4519

Topic: 6. Spine

A 19-year-old male presents with slowly progressive, asymmetric weakness and atrophy of his right hand and forearm. He reports no sensory deficits or lower extremity symptoms. An MRI of the cervical spine in neutral is unremarkable, but an MRI taken with the neck in flexion demonstrates forward displacement of the posterior dura with spinal cord compression against the vertebral bodies. What is the most likely diagnosis?

. Amyotrophic lateral sclerosis
. Syringomyelia
. Hirayama disease
. Klippel-Feil syndrome
. Ossification of the posterior longitudinal ligament

Correct Answer & Explanation

. Amyotrophic lateral sclerosis

Explanation

Hirayama disease is a juvenile muscular atrophy of the distal upper extremities caused by dynamic cervical myelopathy. It is characterized by forward displacement of the posterior cervical dura during neck flexion, causing repetitive microtrauma to the anterior horn cells.

Question 4520

Topic: Thoracolumbar Spine & Deformity

In the evaluation of adult spinal deformity, which of the following sagittal radiographic parameters correlates most closely with poor health-related quality of life (HRQOL) scores?

. Coronal Cobb angle > 40 degrees
. High pelvic incidence
. Sagittal vertical axis (SVA) > 5 cm
. Lumbar lordosis exceeding pelvic incidence by > 10 degrees
. Thoracic kyphosis < 20 degrees

Correct Answer & Explanation

. Coronal Cobb angle > 40 degrees

Explanation

Positive sagittal imbalance is the most critical driver of disability in adult spinal deformity. A Sagittal Vertical Axis (SVA) greater than 5 cm is the most reliable radiographic predictor of clinical symptoms and poor HRQOL outcomes.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page