6. Spine MCQs

A 28-year-old patient suffers a severe hyperflexion injury to the cervical spine resulting in Anterior Cord Syndrome. Which of the following modalities will remain intact below the level of the injury?

MRI of the lumbar spine in a 55-year-old patient with chronic mechanical low back pain reveals Modic Type 2 changes at the L4-L5 endplates. What histologic process do Modic Type 2 changes represent?

A 60-year-old woman presents with severe neurogenic claudication. MRI reveals severe central and lateral recess stenosis at L3-L4. Which nerve root is most likely compressed within the lateral recess at this level?

A patient arrives intubated and comatose (Glasgow Coma Scale score of 6) after a rollover MVC. Lateral radiographs demonstrate a bilateral facet dislocation at C6-C7. Before any attempt at closed reduction is made, what is the most critical next step?

Which of the following fracture patterns in the cervical spine carries the highest risk of concomitant vertebral artery injury, warranting screening with a CTA or MRA?

A 50-year-old male undergoes posterior lumbar decompression and fusion for degenerative spondylolisthesis. When placing pedicle screws, understanding the pedicle anatomy is critical. What anatomical structure forms the medial border of the lumbar pedicle?

A 24-year-old male presents after a motor vehicle accident with right upper extremity weakness. Examination shows 3/5 wrist extension and triceps strength. CT reveals a right-sided C6-C7 unilateral facet dislocation. MRI confirms a large extruded disc herniation behind the C6 body compressing the spinal cord. What is the most appropriate surgical management?

A 55-year-old male complains of severe anterior thigh pain and new-onset weakness in knee extension. MRI shows a far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed by this specific herniation pattern?

An 82-year-old male with severe COPD and ischemic heart disease falls from a standing height. Imaging reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the most appropriate management for this patient?

A 68-year-old female presents with neurogenic claudication. Flexion/extension radiographs demonstrate an L4-L5 grade I degenerative spondylolisthesis that increases from 4 mm to 5 mm of translation. MRI confirms severe central canal stenosis. Which of the following findings most strongly supports performing a concomitant fusion rather than decompression alone?

A 65-year-old male with pre-existing cervical spondylosis presents after a hyperextension injury. Examination demonstrates 2/5 motor strength in the upper extremities and 4/5 strength in the lower extremities. MRI shows increased T2 signal in the central spinal cord at C3-C4 without fracture or acute instability. What is the most appropriate initial management?

A 60-year-old female underwent an L5-S1 posterior instrumented spinal fusion 5 years ago. She now presents with new-onset left-sided foot drop and pain radiating down the lateral aspect of her leg to the dorsum of her foot. MRI demonstrates severe new lateral recess stenosis at the L4-L5 adjacent segment. Which nerve root is most likely affected?

According to the Subaxial Cervical Spine Injury Classification (SLIC) system, which of the following morphologic injury patterns is assigned the highest point value?

During an L4-L5 laminectomy for severe spinal stenosis, a 3 mm incidental durotomy occurs ventrally, making primary suture repair technically impossible. Cerebrospinal fluid is observed pooling in the surgical field. Which of the following is the most appropriate next step in intraoperative management?

A 28-year-old female sustains a burst fracture of the C1 ring (Jefferson fracture) after a shallow water diving accident. An AP open-mouth odontoid radiograph reveals lateral displacement of the C1 lateral masses relative to the C2 articular facets. According to the Rule of Spence, a combined overhang greater than what value strongly suggests a transverse ligament rupture?

A 42-year-old female presents to the emergency department with acute severe lower back pain, bilateral sciatica, and perineal numbness. Her post-void residual bladder volume is 450 mL. MRI demonstrates a massive L4-L5 central disc extrusion compressing the cauda equina. Current literature suggests that surgical decompression should ideally be performed within what timeframe from symptom onset to maximize full neurologic recovery?

A 32-year-old male sustains a severe flexion-distraction injury to the cervical spine resulting in a bilateral facet dislocation at C5-C6 and an incomplete spinal cord injury. Which of the following vascular injuries has the highest incidence in this specific trauma pattern and warrants screening?

A 35-year-old male suffers a traumatic unilateral C5-C6 facet dislocation following a motor vehicle collision. He is neurologically intact. An urgent MRI reveals a large, extruded disc herniation posterior to the C5 body. What is the most appropriate initial management?

An 82-year-old man falls from standing and sustains a Type II odontoid fracture with 3 mm of posterior displacement. His neurologic examination is completely normal. What is the most appropriate management?

A 68-year-old man with known cervical spondylosis presents after a hyperextension injury. He exhibits severe weakness in his bilateral upper extremities but only mild weakness in his lower extremities. What is the most likely pathophysiological mechanism of his spinal cord injury?