6. Spine MCQs

A 62-year-old female presents with severe neurogenic claudication. Standing lateral radiographs demonstrate a grade 1 degenerative spondylolisthesis at L4-L5 with 4 mm of dynamic translation on flexion-extension views. MRI confirms severe central canal stenosis. According to standard board guidelines, what surgical intervention provides the most durable long-term outcome for this patient?

During the neurologic examination of a patient with suspected cervical myelopathy, tapping the distal brachioradialis tendon results in reflexive finger flexion but an absent normal elbow flexion response. This clinical sign indicates primary pathology at which spinal level?

A 68-year-old man reports bilateral leg cramping that worsens after walking 2 blocks. The pain is rapidly relieved when he leans forward over a shopping cart but is not relieved simply by standing still upright. He has 2+ palpable pedal pulses. Hypertrophy of which of the following anatomic structures is most likely the primary contributor to his pathology?

A 55-year-old woman presents with progressive cervical myelopathy.

Radiographs reveal severe multi-level cervical spondylosis from C3 to C6 with a rigid, focal kyphotic deformity of 15 degrees. What is the most appropriate surgical approach?

A 72-year-old male presents with worsening gait instability, hand clumsiness, and frequent falls. He reports an "electric shock-like" sensation radiating down his spine when he bends his neck forward. What is the name of this clinical sign?

In a patient with lumbar spinal stenosis, hypertrophy of the superior articular process most commonly compresses which neurologic structure within the lateral recess?

A 60-year-old Asian male presents with progressive cervical myelopathy. Imaging demonstrates continuous multi-level ossification of the posterior longitudinal ligament (OPLL) from C3-C6. Cervical lordosis is preserved, and the K-line is positive. Which procedure provides adequate decompression while minimizing the risk of a dural tear?

A 64-year-old woman is undergoing an L3-L5 laminectomy for severe lumbar stenosis. During decompression, an incidental 1.5 cm dural tear occurs with visible CSF egress. What is the most appropriate management?

Which of the following best describes the natural history of untreated cervical spondylotic myelopathy?

A 58-year-old man presents with bilateral hand numbness, difficulty buttoning his shirt, and severe neurogenic claudication. Examination shows brisk knee reflexes, absent ankle reflexes, and a positive Hoffmann sign. What is the most appropriate treatment strategy for this presentation of "tandem stenosis"?

A 68-year-old man presents with progressive gait instability and hand clumsiness over the past 6 months. Physical examination reveals an absent brachioradialis reflex with a hyperactive reflex response causing spontaneous flexion of the fingers. This specific examination finding is due to a compressive lesion at which of the following spinal levels?

A 72-year-old woman complains of bilateral posterior leg pain that worsens with walking and improves when she rests or leans forward on a shopping cart. Which of the following diagnostic tests best differentiates neurogenic claudication from vascular claudication?

When counseling a 65-year-old man newly diagnosed with mild cervical spondylotic myelopathy (mJOA score of 16), what is the most accurate description of the natural history of this condition if left untreated?

A 64-year-old woman with persistent neurogenic claudication has failed 6 months of nonoperative management. Dynamic radiographs and MRI demonstrate a mobile grade I degenerative spondylolisthesis at L4-L5 with severe central canal stenosis. What is the most appropriate surgical treatment?

A 55-year-old man of East Asian descent presents with progressive cervical myelopathy. Imaging reveals multilevel Ossification of the Posterior Longitudinal Ligament (OPLL). The OPLL mass extends anteriorly, crossing a line connecting the midpoints of the spinal canal at C2 and C7 (K-line negative). What is the most appropriate surgical approach?

A 64-year-old male presents with progressive clumsiness in his hands and a broad-based gait. Examination shows a positive Hoffmann's sign and bilateral hyperreflexia. MRI of the cervical spine demonstrates multi-level spondylosis with ventral cord compression. Which of the following MRI findings is the strongest predictor of poor neurologic recovery following surgical decompression?

A 68-year-old female presents with severe neurogenic claudication and an L4-L5 grade I degenerative spondylolisthesis. She has failed 6 months of conservative management. According to the Spine Patient Outcomes Research Trial (SPORT), what is the expected long-term outcome if she chooses surgical decompression and fusion compared to continued nonoperative treatment?

A 55-year-old male of East Asian descent presents with progressive myelopathy. Imaging reveals continuous Ossification of the Posterior Longitudinal Ligament (OPLL) from C3 to C6. The OPLL mass is noted to cross the K-line on a neutral sagittal radiograph. What is the most appropriate surgical strategy?

A 72-year-old man complains of bilateral leg pain and fatigue that begins after walking two blocks. The pain is relieved by sitting or leaning over a shopping cart. During a stationary bicycle test, he is able to pedal for 30 minutes without leg pain while leaning forward. Which of the following is the most likely diagnosis?

During the physical examination of a 60-year-old patient with suspected cervical myelopathy, you tap the brachioradialis tendon near the styloid process of the radius. This elicits spontaneous flexion of the digits without flexion of the elbow. This reflex is most indicative of pathology at which spinal level?