6. Spine MCQs

A 65-year-old man presents with progressive gait instability and loss of fine motor skills. Examination demonstrates a positive Hoffman sign, hyperreflexia, and intrinsic hand muscle atrophy. Lateral radiographs reveal a flexible kyphotic deformity of the cervical spine. MRI demonstrates multi-level cervical stenosis (C3-C6) with spinal cord compression anteriorly. What is the most appropriate surgical intervention?

A 68-year-old woman presents with severe neurogenic claudication and low back pain. Radiographs reveal a grade 1 degenerative spondylolisthesis at L4-L5 that increases to grade 2 on dynamic flexion views. MRI confirms severe central canal stenosis at L4-L5. She has failed 6 months of comprehensive nonoperative management. What is the most appropriate surgical treatment?

A 55-year-old man is newly diagnosed with cervical spondylotic myelopathy. Which of the following MRI findings is the most reliable independent predictor of poor neurologic recovery following surgical decompression?

A 72-year-old man complains of bilateral leg pain that worsens significantly with walking. Which of the following historical factors or examination findings is most specific for neurogenic claudication secondary to lumbar spinal stenosis, as opposed to vascular claudication?

Three days following a C3-C6 posterior cervical laminectomy and fusion for cervical myelopathy, a 60-year-old patient develops isolated, profound weakness in unilateral shoulder abduction and elbow flexion. Sensation is completely intact, and his preoperative myelopathic symptoms have improved. What is the most likely etiology?

A 50-year-old man of East Asian descent presents with progressive hand clumsiness and broad-based gait. CT demonstrates a continuous, dense bony mass along the posterior aspect of the C3 to C6 vertebral bodies. MRI shows significant anterior spinal cord compression, but sagittal alignment is lordotic. What is the most appropriate surgical option?

Look at the provided image:

A 67-year-old male presents with progressive lower extremity weakness and neurogenic claudication exacerbated by prolonged standing. Based on standard surgical principles for degenerative lumbar spinal stenosis, if this patient fails non-operative management, what is the primary surgical objective?

In the pathophysiology of central degenerative lumbar spinal stenosis, which anatomical structure primarily contributes to the narrowing of the central spinal canal from a posterior direction?

A 70-year-old woman with suspected cervical spondylotic myelopathy is asked to open and close her hands rapidly. She demonstrates spontaneous abduction of her small finger during the exam. What does the abduction of the small finger represent?

During an L4-L5 laminectomy for severe lumbar spinal stenosis, a 4-mm incidental dural tear occurs dorsally. Cerebrospinal fluid leakage is noted, and the tear is primarily repaired watertight with 4-0 Nurolon sutures. What is the most appropriate next step in management?

When comparing minimally invasive (MIS) tubular decompression (e.g., unilateral laminotomy for bilateral decompression) to traditional open laminectomy for lumbar spinal stenosis, the MIS approach has been most consistently shown in the literature to result in which of the following?

A 32-year-old man presents with severe neck pain and right arm weakness (deltoid and biceps) after a mountain biking accident. He is awake, alert, and cooperative. Plain radiographs demonstrate a right-sided C4-C5 unilateral facet dislocation. What is the most appropriate next step in his management?

A 68-year-old man with a known history of severe cervical spondylosis falls forward and strikes his chin, sustaining a hyperextension injury. He presents with profound bilateral upper extremity weakness (hands greater than shoulders) and relatively preserved lower extremity strength. What is the most likely neurologic diagnosis?

An 82-year-old woman falls from a standing height. CT imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. She has no neurologic deficits but has a history of congestive heart failure and severe COPD. What is the most appropriate management?

A 60-year-old man undergoes an uncomplicated C3-C6 laminectomy and posterior fusion for cervical myelopathy. Two days postoperatively, he develops new-onset isolated right deltoid weakness (2/5) with intact sensation and no lower extremity changes. An urgent MRI shows a well-decompressed cord with no hematoma. What is the most likely diagnosis?

A 65-year-old woman presents with severe neurogenic claudication and an L4-L5 degenerative spondylolisthesis. She has failed 6 months of conservative management. According to classical literature, which surgical treatment provides the lowest rate of reoperation and best clinical outcome?

A 30-year-old man dives into a shallow pool and sustains a burst fracture of C1 (Jefferson fracture). On the open-mouth odontoid radiograph, the sum of the lateral mass displacement of C1 over C2 is measured at 8 mm. What does this finding indicate?

A 72-year-old man presents with deteriorating handwriting, difficulty buttoning his shirt, and a wide-based, unsteady gait. Which of the following physical exam findings is most specific for the likely diagnosis?

A 25-year-old man is involved in a motor vehicle accident. CT reveals a traumatic spondylolisthesis of the axis with C2 pars fractures. There is 4 mm of translation and 15 degrees of angulation of C2 on C3. What is the Levine-Edwards classification and the most appropriate initial management?

A 55-year-old man complains of severe right leg radicular pain. MRI demonstrates a synovial cyst arising from the L4-L5 facet joint, compressing the right L5 nerve root. If non-operative management fails, what is the most appropriate definitive surgical intervention?