Menu

6. Spine MCQs

Practice Set 24 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 461

Topic: 6. Spine
A 75-year-old woman presents with low back pain that is worse with motion and bilateral lower extremity pain that is worse with ambulation. She notes that the pain extends down the posterior aspects of her lower extremities, from the buttocks to the calves. The pain limits her activity—she can only ambulate approximately one block before having to rest. She reports that lumbar flexion, notably leaning over a walker or a shopping cart, considerably diminishes her lower extremity pain. She has a significant past medical history of coronary artery disease, and she has had previous angioplasty of her coronary vessels. On examination, her lower extremity pulses are easily palpable. This patient is diagnosed with degenerative spondylolisthesis with significant lateral recess stenosis. Treatment of this patient could include:
. Epidural steroids
. Decompression alone
. Decompression with noninstrumented fusion
. Decompression with instrumented fusion
. All of the above

Correct Answer & Explanation

. All of the above

Explanation

Treatment options for this patient are legion. Considering her significant coronary artery disease, a conservative approach using anti-inflammatory drugs, physical therapy, and epidural steroids might be chosen by some physicians. Surgical options include decompression alone or decompression with fusion. This patient's significant mechanical low back pain encourages some surgeons to include a fusion with the decompression.

Question 462

Topic: 6. Spine

Which anatomic region of the spine is the most common site for osteoporotic vertebral compression fractures?

. Cervicothoracic junction (C7-T1)
. Mid-thoracic spine (T4-T8)
. Thoracolumbar junction (T11-L1)
. Mid-lumbar spine (L3-L4)
. Lumbosacral junction (L5-S1)

Correct Answer & Explanation

. Thoracolumbar junction (T11-L1)

Explanation

The thoracolumbar junction (T11-L1) is the most frequent site of osteoporotic compression fractures. This is due to the biomechanical stress concentration at the transition zone between the rigid, kyphotic thoracic spine and the mobile, lordotic lumbar spine.

Question 463

Topic: Thoracolumbar Spine & Deformity

A 75-year-old female presents with multiple severe thoracic osteoporotic compression fractures. Which of the following physiologic consequences is most likely to be found on her clinical evaluation?

. Cervical kyphosis compensation
. Decreased forced vital capacity
. Radicular pain radiating down the posterior thighs
. Upper motor neuron signs in the lower extremities
. Enhanced diaphragmatic excursion

Correct Answer & Explanation

. Decreased forced vital capacity

Explanation

Severe progressive thoracic kyphosis from multiple compression fractures reduces the volume of the thoracic cavity. This characteristically leads to restrictive lung disease, demonstrating decreased forced vital capacity on pulmonary function testing.

Question 464

Topic: 6. Spine

A 72-year-old female presents with severe back pain 2 weeks after a minor fall. Radiographs show a T12 compression fracture with 20% anterior height loss. MRI confirms acute edema without spinal canal compromise. Neurological exam is intact. What is the most appropriate initial management?

. Immediate balloon kyphoplasty
. Posterior spinal fusion from T10 to L2
. Short course of bed rest, orthosis, and analgesics
. Laminectomy of T12
. Anterior T12 corpectomy and strut grafting

Correct Answer & Explanation

. Short course of bed rest, orthosis, and analgesics

Explanation

The gold standard initial management for a stable osteoporotic compression fracture without neurologic deficit is conservative care. This includes pain control, early mobilization, and an orthosis, with surgical options reserved for refractory cases.

Question 465

Topic: 6. Spine

A major biomechanical consequence of an uncorrected wedge compression fracture in the mid-thoracic spine is:

. Posterior shift of the sagittal vertical axis (SVA)
. Decreased bending moment on the anterior spinal column
. Anterior shift of the body's center of gravity
. Increased tension on the anterior longitudinal ligament
. Enlargement of the adjacent intervertebral foramina

Correct Answer & Explanation

. Anterior shift of the body's center of gravity

Explanation

A wedge compression fracture increases the local thoracic kyphosis, which shifts the body's center of gravity anteriorly. This creates a longer lever arm and an increased anterior bending moment, placing greater compressive stress on adjacent vertebral bodies.

Question 466

Topic: 6. Spine
During a percutaneous vertebroplasty, extravasation of PMMA cement into the neural foramen most commonly manifests clinically as:
. Areflexic paraplegia
. Acute radiculopathy
. Cauda equina syndrome
. Brown-Séquard syndrome
. Anterior cord syndrome

Correct Answer & Explanation

. Acute radiculopathy

Explanation

Cement leakage into the neural foramen directly impinges upon the exiting nerve root. This typically presents as an acute radiculopathy, characterized by radiating pain, numbness, or focal weakness in the specific distribution of the affected nerve.

Question 467

Topic: Thoracolumbar Spine & Deformity

A 65-year-old female with osteoporosis is being treated conservatively for a T12 compression fracture. What is the expected role of orthotic bracing (e.g., TLSO or Jewett brace) in this patient?

. It prevents progression of kyphotic deformity
. It provides long-term improvement in forced vital capacity
. It is proven to reduce mortality at 1 year
. It provides early pain relief but does not significantly prevent kyphosis
. It accelerates bone healing on serial radiographs

Correct Answer & Explanation

. It provides early pain relief but does not significantly prevent kyphosis

Explanation

Current literature indicates that orthotic bracing for osteoporotic compression fractures aids in early pain control and allows for earlier mobilization. However, it does not significantly prevent long-term progressive kyphosis or accelerate fracture union.

Question 468

Topic: 6. Spine

What is the most common anatomical location for osteoporotic vertebral compression fractures?

. Cervicothoracic junction (C7-T1)
. Midthoracic spine (T4-T8)
. Thoracolumbar junction (T11-L2)
. Midlumbar spine (L3-L4)
. Lumbosacral junction (L5-S1)

Correct Answer & Explanation

. Thoracolumbar junction (T11-L2)

Explanation

The thoracolumbar junction (T11-L2) is the most common site for osteoporotic compression fractures. This is due to the abrupt biomechanical transition from the rigid, kyphotic thoracic spine to the mobile, lordotic lumbar spine.

Question 469

Topic: 6. Spine
Kümmell disease is an eponym historically used to describe which of the following conditions following a spinal fracture?
. A burst fracture with an associated dural tear
. Delayed post-traumatic vertebral body collapse with osteonecrosis
. Traumatic spondylolisthesis of the axis
. Eosinophilic granuloma causing vertebra plana
. Malignant transformation of an osteoporotic fracture

Correct Answer & Explanation

. Delayed post-traumatic vertebral body collapse with osteonecrosis

Explanation

Kümmell disease refers to delayed, progressive post-traumatic vertebral collapse secondary to avascular necrosis of the vertebral body. It frequently presents with an intravertebral vacuum cleft on imaging.

Question 470

Topic: 6. Spine

A 70-year-old male with long-standing ankylosing spondylitis presents with back pain after a minor ground-level fall. Initial plain radiographs of the spine are reported as "unremarkable." What is the most appropriate next step in management?

. Prescribe NSAIDs and discharge with primary care follow-up
. Perform a CT or MRI of the entire spine
. Discharge with a soft cervical collar and muscle relaxants
. Perform a DXA scan to rule out osteoporosis
. Obtain dynamic flexion-extension radiographs of the spine

Correct Answer & Explanation

. Perform a CT or MRI of the entire spine

Explanation

Patients with ankylosing spondylitis have highly rigid, osteoporotic spines. Any minor trauma can cause highly unstable, often occult fractures. Advanced cross-sectional imaging (CT or MRI) of the entire spine is mandatory even if plain films are normal.

Question 471

Topic: 6. Spine

A 71-year-old female presents with bilateral lower extremity weakness and hyperreflexia following a fall. Imaging shows a T8 osteoporotic compression fracture with retropulsion of bone causing severe spinal cord compression. What is the most appropriate management?

. Percutaneous vertebroplasty
. Balloon kyphoplasty
. Jewett hyperextension brace
. Surgical decompression and stabilization
. Epidural steroid injection

Correct Answer & Explanation

. Surgical decompression and stabilization

Explanation

Neurological deficit secondary to spinal cord compression from a retropulsed bone fragment is an absolute contraindication to vertebroplasty or kyphoplasty alone. Such cases require open surgical decompression and formal stabilization to relieve the myelopathy.

Question 472

Topic: 6. Spine



During the vertebroplasty procedure shown, the surgeon visualizes sudden extravasation of cement tracking into the posterior epidural space on lateral fluoroscopy. What is the immediate next best step?

. Increase the injection pressure to bypass the leak
. Withdraw the cannula and halt the injection
. Inject sterile saline to dilute the extravasated cement
. Switch to a lower viscosity cement mix
. Proceed to emergent laminectomy immediately regardless of symptoms

Correct Answer & Explanation

. Withdraw the cannula and halt the injection

Explanation

If cement extravasation into the spinal canal or the basivertebral vein is visualized fluoroscopically, the injection must be halted immediately. The cannula should be repositioned or withdrawn to prevent impending neurological compromise.

Question 473

Topic: 6. Spine

Which of the following factors most significantly increases the risk of an adjacent level fracture following percutaneous vertebroplasty?

. Use of high-viscosity cement
. Restoration of sagittal alignment
. Leakage of cement into the intervertebral disc
. Performance of the procedure under local anesthesia
. Postoperative initiation of teriparatide

Correct Answer & Explanation

. Leakage of cement into the intervertebral disc

Explanation

Cement leakage into the intervertebral disc alters the normal shock-absorbing biomechanics of the spine segment. This transfers disproportionate stress to the adjacent vertebra, significantly increasing the risk of subsequent fracture.

Question 474

Topic: 6. Spine

A 45-year-old male falls from a height and sustains an L1 burst fracture with 40% canal compromise. He is neurologically intact, and MRI confirms an intact posterior ligamentous complex (PLC). What is the most appropriate management?

. Thoracolumbosacral orthosis (TLSO) bracing and early mobilization
. Percutaneous vertebroplasty
. Anterior corpectomy and fusion
. Posterior pedicle screw fixation without fusion
. Laminectomy alone

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing and early mobilization

Explanation

Neurologically intact patients with a stable burst fracture (intact PLC) can be successfully managed non-operatively with a TLSO and early mobilization. Laminectomy alone is contraindicated as it further destabilizes the spine.

Question 475

Topic: 6. Spine
What is the incidence of significant neurologic deficit directly associated with a simple, benign osteoporotic wedge compression fracture?
. Common, usually presenting as cauda equina syndrome
. Common, usually presenting as conus medullaris syndrome
. Frequent, presenting as radiculopathy at the level of the fracture
. Moderate, presenting as Brown-Séquard syndrome
. Extremely rare; their presence should prompt workup for burst or pathologic etiologies

Correct Answer & Explanation

. Extremely rare; their presence should prompt workup for burst or pathologic etiologies

Explanation

Simple osteoporotic wedge compression fractures rarely cause neurologic compromise because the middle and posterior columns remain intact. Any neurologic deficit should raise high clinical suspicion for a burst fracture, malignancy, or epidural mass.

Question 476

Topic: 6. Spine

In the evaluation of a patient with long-standing ankylosing spondylitis who sustains a minor fall,

what is the classic fracture pattern expected?

. Simple anterior wedge compression fracture
. Flexion-distraction injury strictly through the intervertebral disc
. Highly unstable transvertebral or transdiscal fracture extending through all three columns
. Bilateral pars interarticularis stress fractures
. Isolated spinous process avulsion (Clay shoveler's fracture)

Correct Answer & Explanation

. Highly unstable transvertebral or transdiscal fracture extending through all three columns

Explanation

The ankylosed spine is rigid and osteoporotic, acting like a long bone. Even minor trauma can cause highly unstable, "chalk stick" fractures that extend through all three columns (transvertebral or transdiscal), carrying a high risk of neurologic injury and epidural hematoma.

Question 477

Topic: 6. Spine

What is the primary mechanism of injury responsible for producing a Chance fracture of the thoracolumbar spine?

. Axial loading with hyperextension
. Flexion-distraction
. Lateral bending and compression
. Direct high-velocity shear force
. Rotational twisting injury

Correct Answer & Explanation

. Flexion-distraction

Explanation

A Chance fracture is a classic flexion-distraction injury, often occurring in motor vehicle accidents involving poorly positioned lap belts. The axis of rotation is anterior to the spine, leading to tension failure of the posterior and middle columns.

Question 478

Topic: 6. Spine

During a balloon kyphoplasty for an L2 compression fracture

, the surgeon notes a cortical breach of the medial pedicle wall during trocar advancement. What is the most immediate critical concern?

. Aorta or inferior vena cava injury
. Dural tear or spinal cord/nerve root injury
. Iatrogenic tension pneumothorax
. Retroperitoneal bowel perforation
. Vertebral artery transection

Correct Answer & Explanation

. Dural tear or spinal cord/nerve root injury

Explanation

The medial wall of the pedicle forms the lateral boundary of the spinal canal. A medial breach during transpedicular instrumentation immediately jeopardizes the thecal sac, spinal cord, and traversing nerve roots.

Question 479

Topic: 6. Spine

Which biomechanical change most directly accounts for the exponentially increased risk of adjacent vertebral compression fractures following severe kyphosis in the osteoporotic spine?

. Rapid systemic decrease in bone mineral density at adjacent levels
. Anterior shift of the sagittal vertical axis increasing flexion bending moments
. Reflexive decreased paraspinal muscle tone
. Pathologic lengthening and laxity of the anterior longitudinal ligament
. Compensatory severe hypertrophy of the facet joints

Correct Answer & Explanation

. Anterior shift of the sagittal vertical axis increasing flexion bending moments

Explanation

Progressive kyphosis shifts the patient's center of gravity anteriorly. This increases the mechanical flexion moment arm on the anterior aspects of adjacent vertebral bodies, dramatically increasing the risk of subsequent wedge fractures.

Question 480

Topic: 6. Spine

A patient with a fracture dislocation of the spine has a sensory level at the xiphoid process. Which of the following nerve root levels indicates this finding:

. T2
. T4
. T7
. T10
. T12

Correct Answer & Explanation

. T7

Explanation

The skin over the xiphoid process area is innervated by the T7 nerve root. In addition to knowing the innervation of selected muscles and the deep tendon reflexes, the clinician should also know the sensory levels to localize pathologic processes. T4 Nipple line T7 Xiphoid process T10 Umbilicus T12 Groin

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page