6. Spine MCQs

A 70-year-old woman with multilevel lumbar spinal stenosis presents with an increasingly forward-leaning posture. Radiographs show a marked loss of lumbar lordosis. Which of the following spinopelvic compensatory mechanisms is she most likely utilizing to maintain global sagittal balance?

A 65-year-old male undergoes a C3-C6 posterior laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops profound weakness in bilateral deltoid and biceps muscles (1/5 strength) but maintains full strength in his hands. What is the most likely etiology of this complication?

A 65-year-old man presents with mild, non-progressive numbness in his hands and hyperreflexia but normal gait. His mJOA score is 16. What is the most likely natural history of his condition if managed nonoperatively?

A 55-year-old woman is planning to undergo a posterior cervical laminectomy and fusion for multilevel cervical spondylotic myelopathy. Which of the following preoperative factors is the strongest predictor of a poor functional recovery following surgery?

A 72-year-old man reports a 1-year history of bilateral buttock and calf pain that occurs after walking two blocks. He notes the pain is relieved when he leans forward on a shopping cart or sits down. His pedal pulses are palpable. Which of the following physical examination findings is most characteristic of his underlying pathology?

A 68-year-old woman has severe neurogenic claudication and L4-L5 degenerative spondylolisthesis. Flexion-extension radiographs show 4 mm of dynamic translation. She has failed 6 months of nonoperative management. What is the most appropriate surgical treatment?

Three days after undergoing a C3-C6 posterior laminectomy and fusion for cervical myelopathy, a 62-year-old man develops profound weakness in his bilateral deltoid and biceps muscles. He has no sensory changes, and his lower extremity strength is normal. What is the most likely etiology of this complication?

A 70-year-old man presents with neurogenic claudication. Sagittal and axial MRI scans demonstrate severe central canal stenosis at L3-L4 and L4-L5.

Which of the following anatomical structures is the primary contributor to dorsal compression of the thecal sac in this condition?

During an L3-L5 laminectomy for severe spinal stenosis in a 74-year-old woman, an incidental 4-mm dural tear occurs ventrally during removal of hypertrophic ligamentum flavum. Cerebrospinal fluid is noted to be leaking. The tear is inaccessible for direct primary suture repair. What is the most appropriate next step in management?

A 64-year-old man has severe cervical spondylotic myelopathy due to continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. He has a neutral cervical alignment. Which of the following is the most appropriate surgical approach to decompress the spinal cord?

A 72-year-old woman with lumbar spinal stenosis reports mild, intermittent neurogenic claudication that does not limit her daily activities. Which of the following is the most appropriate initial management strategy?

Which of the following characteristics best differentiates degenerative spondylolisthesis from isthmic spondylolisthesis in the lumbar spine?

In a patient with progressive cervical spondylotic myelopathy, an MRI of the cervical spine reveals focal hyperintensity on T2-weighted images and hypointensity on T1-weighted images within the spinal cord at C4-C5. What does this specific pattern of MRI signal change indicate?

A 65-year-old woman underwent an L4-S1 posterior decompression and instrumented fusion 5 years ago. She now presents with new-onset L3 radiculopathy and neurogenic claudication. Radiographs reveal a new spondylolisthesis at L3-L4. What is the most significant biomechanical risk factor for this condition?

A 65-year-old man presents with progressive gait instability, hand clumsiness, and hyperreflexia. Imaging demonstrates multilevel cervical spondylosis from C3-C6 with focal kyphosis of 15 degrees and cord compression. Which of the following surgical approaches is most appropriate?

A 55-year-old woman with cervical spondylotic myelopathy undergoes a posterior cervical laminectomy and fusion from C3-C6. On postoperative day 2, she develops profound weakness in right shoulder abduction and elbow flexion, with a normal sensory exam and unchanged lower extremity function. What is the most likely etiology of this complication?

Which of the following MRI findings in a patient with severe cervical spondylotic myelopathy portends the poorest prognosis for neurologic recovery following surgical decompression?

A 62-year-old man complains of bilaterally radiating leg pain, heaviness, and numbness that worsens after walking two blocks. He notes immediate relief when he leans over his shopping cart at the grocery store. On physical examination, which of the following findings is most reliable for differentiating his condition from peripheral vascular claudication?

A 72-year-old woman presents with severe neurogenic claudication. Radiographs demonstrate an L4-L5 degenerative spondylolisthesis (Grade 1). MRI confirms severe central canal stenosis. Dynamic flexion-extension radiographs show 4 mm of translation. According to the Spine Patient Outcomes Research Trial (SPORT), what is the expected outcome if she chooses surgical intervention compared to nonoperative management?

You are evaluating a 68-year-old man with progressive bilateral hand numbness and clumsiness. He demonstrates a positive finger escape sign. During the exam, you briskly flick the distal phalanx of his middle finger downward, resulting in reflexive flexion of his thumb and index finger. What is the name of this clinical sign?