6. Spine MCQs

A 24-year-old male is involved in a motor vehicle collision. Imaging reveals a fracture through the pars interarticularis of C2 with 4 mm of anterior translation and 12 degrees of angulation. What is the Levine-Edwards classification of this traumatic spondylolisthesis of the axis?

A 15-year-old boy presents with progressive mid-back pain and a notably rounded posture. Standing radiographs reveal a rigid thoracic kyphosis of 65 degrees. According to the classic Sorensen criteria, what specific radiographic finding is required to definitively diagnose Scheuermann's kyphosis?

A 42-year-old male presents to the emergency department with acute onset saddle anesthesia, bilateral leg weakness, and urinary retention. MRI reveals a massive L4-L5 central disc herniation. To maximize the probability of full return of bladder and bowel function, surgical decompression should ideally be performed within what maximum timeframe from the onset of symptoms?

A 68-year-old patient presents with bilateral calf and buttock pain when walking. Which of the following historical findings is most indicative of neurogenic claudication (due to lumbar spinal stenosis) rather than vascular claudication?

A 78-year-old woman presents after a ground-level fall. CT imaging demonstrates a displaced Type II odontoid fracture with 6 mm of posterior displacement. She has severe medical comorbidities precluding surgery. If treated nonoperatively with a hard cervical collar, what is the most likely complication?

A 45-year-old male presents with severe right leg pain, weakness in ankle dorsiflexion, and decreased sensation over the medial aspect of the foot. His right patellar reflex is absent. Which nerve root is most likely compressed, and by what classic anatomical disc herniation?

A 50-year-old male presents with progressive clumsiness in his hands and an unsteady gait. Cervical imaging reveals profound ossification of the posterior longitudinal ligament (OPLL) from C3 to C6, causing severe cord compression. Additionally, his cervical spine has 15 degrees of fixed kyphosis. What is the most appropriate surgical approach?

A 68-year-old female presents with severe back pain and inability to stand upright. Radiographs reveal a pelvic incidence (PI) of 62 degrees, pelvic tilt (PT) of 35 degrees, and lumbar lordosis (LL) of 20 degrees. When planning a corrective osteotomy for this adult spinal deformity, achieving a PI-LL mismatch of less than which of the following values is most highly correlated with favorable health-related quality of life (HRQOL) scores?

Review the imaging study provided in the figure.

A 65-year-old female presents with neurogenic claudication. She is found to have grade 1 degenerative spondylolisthesis at L4-L5. Which of the following radiographic parameters on preoperative MRI is most indicative of dynamic instability, warranting a fusion rather than a decompression alone?

A 72-year-old male with pre-existing cervical spondylosis presents after a hyperextension injury. He has 2/5 motor strength in his bilateral upper extremities and 4/5 strength in his lower extremities, while retaining bowel and bladder function. Which of the following anatomic factors best explains his disproportionate upper extremity weakness?

A 60-year-old male presents with deteriorating handwriting and difficulty buttoning his shirts. Physical examination reveals a positive inverted brachioradialis reflex. This clinical finding most accurately localizes the predominant spinal cord pathology to which of the following levels?

A 24-year-old male is involved in a motor vehicle collision. Lateral cervical spine radiographs show anterior subluxation of C5 on C6 by approximately 25%. A "bow-tie" or "bat-wing" appearance of the articular pillars is noted at the C5 level. Which of the following is the most likely mechanism of this injury?

A 55-year-old male with long-standing ankylosing spondylitis presents to the emergency department after a low-energy ground-level fall. He reports severe neck pain but has no focal neurologic deficits. Initial plain radiographs of the cervical spine are difficult to interpret due to extensive ossification. Which of the following is the most appropriate next step in his imaging workup?

An MRI of the lumbar spine is shown in the figure.

A 45-year-old male presents with severe radicular leg pain. Imaging demonstrates a far lateral disc herniation at the L4-L5 level. Which of the following physical examination findings is most likely expected in this patient?

A 68-year-old male undergoes a 10-hour posterior spinal fusion from T2 to the pelvis for adult spinal deformity while positioned prone. Postoperatively, he reports painless, bilateral visual loss with sluggish pupillary reflexes. What is the most likely etiology of his visual loss?

A 62-year-old female is 4 years status post L4-S1 posterior spinal instrumented fusion. She now presents with a new-onset L3 radiculopathy. Imaging demonstrates adjacent segment degeneration with severe foraminal stenosis at L3-L4. Which of the following intraoperative factors from her index surgery most significantly increased her risk for developing adjacent segment disease?

A 40-year-old male sustains a T12 burst fracture from a fall. He is neurologically intact. MRI demonstrates definitive disruption of the posterior ligamentous complex (PLC). Using the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his total score and the corresponding treatment recommendation?

A 3-year-old child is being evaluated for congenital scoliosis. Which of the following specific vertebral anomalies carries the highest risk for rapid, unremitting curve progression and typically mandates early prophylactic surgical intervention?

A 65-year-old man presents with progressive hand clumsiness and gait instability over 1 year. Exam shows a positive Hoffmann sign and hyperreflexia. Preoperative MRI shows T2 hyperintensity and T1 hypointensity in the spinal cord at C4-C5. What is the prognostic significance of these MRI findings?

A 70-year-old woman undergoes C3-C6 laminectomy and instrumented fusion for cervical spondylotic myelopathy. On postoperative day 2, she develops profound right deltoid and biceps weakness (1/5) with no new sensory deficits. Her lower extremity myelopathic symptoms have improved. What is the most widely accepted pathomechanism for this specific postoperative complication?