6. Spine MCQs

A pedestrian is struck by a vehicle and is intubated at the scene. Lateral cervical spine radiographs show a basion-dental interval (BDI) of 14 mm. What is the most appropriate management for this patient?

A 50-year-old man has severe left leg pain radiating down his anterior thigh. Exam reveals 3/5 strength in knee extension and an absent patellar reflex. MRI confirms a disc herniation. Based on the clinical presentation, what is the level and location of the herniation?

A 40-year-old man is brought in comatose (GCS 6) following a high-speed collision. CT imaging demonstrates a unilateral C5-C6 facet dislocation. What is the most appropriate next step in the management of his cervical spine?

A 62-year-old woman presents with new neurogenic claudication 5 years after an L3-L5 posterior spinal fusion. Radiographs show a new Grade 1 spondylolisthesis at L2-L3. What biomechanical consequence of her prior surgery most directly contributed to this adjacent segment disease?

A 42-year-old man presents to the emergency department with acute bilateral leg weakness, perianal numbness, and urinary retention with a post-void residual volume of 400 mL. MRI confirms a massive L4-L5 central disc extrusion. What is the optimal surgical timing to maximize his neurologic recovery?

A 55-year-old woman complains of chronic axial low back pain. MRI of her lumbar spine shows high signal intensity on both T1-weighted and T2-weighted images in the vertebral body endplates at L4-L5. What do these changes represent?

A 28-year-old man presents with complete quadriplegia following a diving accident. Lateral cervical radiographs reveal a C5-C6 bilateral facet dislocation. What is the primary mechanism of this specific injury?

An 82-year-old man presents with neck pain after a ground-level fall. CT scan reveals a Type II odontoid fracture with 2 mm of posterior displacement. He has a history of severe COPD, ischemic heart disease, and osteoporosis. Neurologic examination is completely normal. What is the most appropriate initial management?

A 25-year-old man is brought to the emergency department after a shallow water diving accident. He complains of severe neck pain but is completely neurologically intact, alert, and cooperative. Imaging demonstrates a bilateral C5-C6 facet dislocation. What is the most appropriate next step in management?

A 55-year-old woman presents with severe, acute right anterior thigh pain and new-onset weakness in her right leg. MRI demonstrates a right-sided far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed, and what specific physical exam finding is expected?

A 42-year-old man presents to the emergency department with a 12-hour history of bilateral lower extremity weakness, saddle anesthesia, and urinary retention after lifting a heavy box. A bladder scan reveals a post-void residual volume of 450 mL. MRI confirms a massive L4-L5 central disc herniation. What is the most appropriate definitive management?

A 68-year-old man complains of bilateral calf and buttock pain that worsens with walking. He states the pain is reliably relieved by sitting down or leaning forward on a shopping cart, but does not resolve if he simply stops walking and stands still. Examination reveals diminished ankle reflexes but palpable pedal pulses. Which of the following is the most likely diagnosis?

A 65-year-old woman presents with classic neurogenic claudication. Radiographs reveal a grade 1 degenerative spondylolisthesis at L4-L5 with intact pars interarticularis. Which anatomic factor is the primary stabilizer preventing the progression of this specific slip?

A 50-year-old man with a long-standing history of ankylosing spondylitis is involved in a low-speed motor vehicle collision. He reports new-onset neck pain but no neurologic deficits. Initial standard plain radiographs of the cervical spine are interpreted as normal. What is the most appropriate next step in his workup?

A 35-year-old construction worker presents with sudden lower neck pain after forcefully shoveling heavy debris. Examination reveals focal tenderness over the prominent spinous process at the cervicothoracic junction. Radiographs demonstrate an isolated oblique fracture of the C7 spinous process. What is the most appropriate management?

A 72-year-old man with known preexisting cervical spondylosis falls forward, striking his chin and sustaining a hyperextension injury to his neck. He presents with profound motor weakness in his hands and arms, but is able to move his legs relatively well against resistance. He also has urinary retention. What is the most likely diagnosis?

A 40-year-old man presents after a motor vehicle collision with 3/5 strength in left wrist extension and elbow extension. Radiographs show 25% anterior translation of C5 on C6. MRI reveals a unilateral facet dislocation and a large, extruded disc herniation posterior to the C5-C6 disc space causing cord compression. What is the most appropriate management?

A 65-year-old man with a history of ankylosing spondylitis falls from a standing height. He complains of severe neck pain but has a normal neurologic examination. Initial lateral cervical spine radiographs are difficult to interpret due to lower cervical anatomy overlap and preexisting deformity. What is the most appropriate next step in imaging?

A 45-year-old woman presents with sudden onset of severe low back pain, bilateral lower extremity weakness, and perineal numbness after lifting a heavy box. Her post-void residual bladder volume is 300 mL. MRI reveals a massive L4-L5 central disc herniation. Which of the following statements regarding the timing of surgical intervention is most accurate?

A 32-year-old man is involved in a motor vehicle accident. He complains of right-sided arm pain and exhibits weakness in elbow flexion and wrist extension. Radiographs demonstrate an anterolisthesis of C5 on C6 of approximately 25%. What is the most likely diagnosis?