6. Spine MCQs

Figure 1 shows the lateral radiograph of a 30-year-old man who sustained a whiplash-type injury in a motor vehicle collision. He presents with neck pain and weakness in wrist extension, but normal triceps strength. The imaging demonstrates a unilateral facet dislocation at C6-C7. Which nerve root is most likely affected, and what is the typical biomechanical mechanism of this injury?

A 65-year-old woman presents with severe mechanical back pain and an inability to stand upright. Standing full-length spine radiographs reveal a pelvic incidence (PI) of 60 degrees and a sacral slope (SS) of 20 degrees. What is her pelvic tilt (PT), and what is the optimal target for her postoperative lumbar lordosis (LL) to restore sagittal balance?

A 55-year-old diabetic male presents with 2 weeks of worsening back pain, fevers, and recent onset of bilateral lower extremity weakness (3/5) and urinary retention. MRI (Figure 2) shows an extensive ventral epidural abscess from L2 to L4 causing severe canal stenosis. What is the most appropriate next step in management?

A 62-year-old man of East Asian descent presents with clumsiness in his hands, fine motor difficulty, and a wide-based gait. Lateral radiograph and CT (Figure 3) demonstrate continuous linear ossification along the posterior aspect of the C3-C6 vertebral bodies, with a local kyphotic angle of 18 degrees. Which of the following is the most likely diagnosis, and what surgical approach is generally favored given his alignment?

An 82-year-old woman sustains a ground-level fall and complains of severe neck pain. CT scan (Figure 4) reveals a Type II odontoid fracture with 2 mm of posterior displacement. She is neurologically intact. Which of the following treatments has the highest risk of morbidity and mortality in this specific patient demographic?

A 58-year-old female presents with severe neurogenic claudication secondary to L4-L5 degenerative spondylolisthesis. Preoperative dynamic radiographs show 4 mm of translation on flexion-extension. Based on the Spine Patient Outcomes Research Trial (SPORT) study on degenerative spondylolisthesis, how do the outcomes of surgical management compare to nonoperative management at the 4-year follow-up?

A 40-year-old male falls from a height of 10 feet. Neurological examination is completely normal (Grade E). CT of the spine (Figure 5) shows an L1 burst fracture with 40% loss of anterior body height, 20 degrees of kyphosis, and 30% canal compromise. MRI demonstrates an intact posterior ligamentous complex (PLC). Using the Thoracolumbar Injury Classification and Severity (TLICS) score, what is this patient's score and the recommended management?

A 68-year-old male complains of bilateral calf, thigh, and buttock pain that worsens with ambulation. Which of the following clinical features is most indicative of neurogenic claudication (secondary to lumbar spinal stenosis) rather than vascular claudication?

A 60-year-old man with a long-standing history of ankylosing spondylitis sustains a cervical spine fracture after a ground-level fall. Upon presentation, he complains of severe neck pain but remains neurologically intact. Radiographs and a CT scan reveal a displaced fracture extending through the C5-C6 disc space and the posterior elements. What is the most appropriate definitive management for this patient?

A 65-year-old man presents with chronic back pain and bilateral leg heaviness that worsens with walking and is relieved by leaning forward. MRI demonstrates severe L4-L5 spinal stenosis without spondylolisthesis. He is scheduled for an L4-L5 decompressive laminectomy. Which of the following intraoperative factors is the most significant risk factor for the development of postoperative iatrogenic spondylolisthesis requiring secondary fusion?

A 35-year-old man falls from a height of 15 feet and sustains a T12 thoracolumbar burst fracture. Imaging reveals a 40% loss of anterior vertebral body height, 20% retropulsion of bone into the spinal canal, and an intact posterior ligamentous complex (PLC). Physical examination confirms he is completely neurologically intact. What is the most appropriate management?

During an anterior cervical discectomy and fusion (ACDF), meticulous dissection is required to avoid injury to the recurrent laryngeal nerve (RLN). Which of the following statements most accurately describes the anatomical characteristics and surgical implications of the RLN?

A 68-year-old woman presents with severe low back pain and a progressive forward-leaning posture. Standing full-length spinal radiographs reveal a pelvic incidence (PI) of 60 degrees, a pelvic tilt (PT) of 35 degrees, and a lumbar lordosis (LL) of 25 degrees. To optimally correct her sagittal imbalance during surgical reconstruction, what is the primary realignment goal regarding these spinopelvic parameters?

Which of the following radiographic parameters is considered the gold standard for quantifying global sagittal alignment on a standing 36-inch lateral radiograph?

A 54-year-old man with a history of intravenous drug use presents with severe midthoracic back pain, subjective fevers, and progressive lower extremity weakness over 48 hours. Physical examination reveals 3/5 motor strength in both legs, diminished sensation below T10, and a palpable distended bladder. MRI demonstrates a large dorsal epidural abscess spanning T8-T11 with severe cord compression. What is the most appropriate next step in management?

A 14-year-old female gymnast presents with a 1-year history of unrelenting low back pain exacerbated by extension maneuvers. Radiographs demonstrate a Grade II isthmic spondylolisthesis at L5-S1. She has failed 6 months of comprehensive conservative management, including Boston bracing, physical therapy, and strict activity modification. Which of the following is the most appropriate surgical intervention?

A 65-year-old man with known preexisting cervical spondylosis presents to the emergency department after sustaining a hyperextension injury to his neck in a rear-end motor vehicle collision. He exhibits significant weakness and a burning sensation in his upper extremities, but retains 4/5 strength in his lower extremities. His bowel and bladder functions are intact. Which of the following best explains the anatomical basis for this specific neurologic deficit?

A 45-year-old man presents with an acute onset of severe right leg pain. Physical examination reveals weakness in the right extensor hallucis longus (EHL) muscle (3/5 strength) and decreased pinprick sensation over the dorsal aspect of the first web space of the right foot. His patellar and Achilles reflexes are symmetric and intact. Which of the following disc herniations is the most likely cause of this patient's clinical presentation?

In the preoperative planning for a 62-year-old woman undergoing corrective surgery for adult degenerative scoliosis and sagittal imbalance, analyzing spino-pelvic parameters is critical. To minimize the risk of mechanical failure, proximal junctional kyphosis, and adjacent segment disease, the postoperative lumbar lordosis (LL) should ideally be matched to the patient's pelvic incidence (PI) within what range?