6. Spine MCQs

An 84-year-old frail female is evaluated after a mechanical fall at her nursing home. She complains of high neck pain but is neurologically intact.

A CT scan of the cervical spine reveals a Type II odontoid fracture with 3 mm of posterior displacement. She has severe COPD, congestive heart failure, and osteoporosis, making her a prohibitive surgical risk. What is the most appropriate management?

A 35-year-old male presents to the emergency department with an acute massive L4-L5 disc herniation. He reports saddle anesthesia and an inability to urinate for the past 12 hours. Which of the following urodynamic findings is most characteristic of early cauda equina syndrome in this patient?

When performing a multi-level posterior lumbar instrumented fusion for degenerative scoliosis, which of the following is the most significant modifiable radiographic risk factor for the subsequent development of adjacent segment disease (ASD)?

A 78-year-old man presents with neck pain after a low-speed motor vehicle collision. CT scan shows a displaced Type II odontoid fracture. He has a history of severe COPD and ischemic heart disease. What is the most appropriate management?

A 65-year-old man presents with severe weakness in his upper extremities and mild weakness in his lower extremities following a hyperextension injury to his neck. MRI of the cervical spine reveals severe spondylosis without fracture, but with increased T2 signal intensity in the central portion of the spinal cord at C4-C5. Which of the following is the most likely prognosis regarding his recovery?

In evaluating a 60-year-old woman for adult spinal deformity, her standing full-length lateral radiograph reveals a pelvic incidence (PI) of 65 degrees, pelvic tilt (PT) of 30 degrees, and lumbar lordosis (LL) of 35 degrees. Which of the following best describes her spinopelvic alignment?

A 45-year-old man presents with right-sided neck pain radiating down his arm into his thumb and index finger. Physical examination reveals weakness in wrist extension and decreased sensation over the dorsal aspect of the thumb. The biceps reflex is diminished. Which cervical nerve root is most likely compressed?

A 55-year-old man of Japanese descent presents with progressive clumsiness in his hands and difficulty walking. A lateral cervical radiograph demonstrates a dense, continuous band of ossification posterior to the vertebral bodies from C3 to C6. During surgical planning for decompression, which of the following represents the most significant specific intraoperative risk associated with the anterior approach for this condition?

A 42-year-old man with a long-standing history of ankylosing spondylitis is brought to the emergency department after a low-energy fall from a standing height. He complains of severe neck pain but has no neurologic deficits. Initial plain radiographs of the cervical spine are difficult to interpret due to marked cervicothoracic kyphosis but show no obvious fracture. What is the most appropriate next step in management?

A 60-year-old man presents with severe, acute right-sided leg pain radiating down the anterior aspect of his thigh to the knee. Physical examination shows weakness in knee extension and an absent right patellar reflex. An MRI of the lumbar spine reveals a far-lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 54-year-old man with a history of intravenous drug use presents with a 2-week history of worsening back pain, low-grade fevers, and new-onset bilateral lower extremity weakness and urinary retention over the past 24 hours. Laboratory studies show an elevated ESR and CRP. MRI with contrast reveals an extensive posterior epidural abscess from T8 to T11 causing severe spinal cord compression. What is the most appropriate management?

A 70-year-old woman presents with bilateral buttock and posterior thigh pain that worsens with walking and standing, but is relieved when she sits or leans forward over a shopping cart. She has a normal neurologic examination at rest. MRI confirms severe lumbar spinal stenosis at L3-L4 and L4-L5. She has failed 6 months of conservative management including physical therapy and epidural steroid injections. Which of the following surgical interventions is most commonly indicated to provide long-term symptomatic relief of her leg pain?

Which of the following MRI findings in a patient with cervical spondylotic myelopathy is the strongest predictor of poor neurological recovery following decompression surgery?

An 84-year-old man sustains a Type II odontoid fracture after a ground-level fall. He has a history of COPD and mild heart failure. Which of the following management strategies is associated with the highest rate of major complications and mortality in this specific patient population?

Based on the Spine Patient Outcomes Research Trial (SPORT) for degenerative spondylolisthesis, which of the following statements regarding surgical versus nonoperative treatment is true at 4-year follow-up?

In the assessment of sagittal balance for adult spinal deformity, Pelvic Incidence (PI) is a constant morphological parameter unaffected by posture. Which of the following equations correctly describes the relationship between Pelvic Incidence (PI), Pelvic Tilt (PT), and Sacral Slope (SS)?

A 68-year-old man with a long-standing history of ankylosing spondylitis presents to the emergency department after a minor ground-level fall. He complains of severe neck pain but has a normal neurological examination. A CT scan reveals a transverse fracture through the C5-C6 intervertebral disc space extending into the posterior elements.

What is the most critical next step in management?

Following a posterior C4-C7 laminectomy and instrumented fusion for severe cervical spondylotic myelopathy, a 55-year-old patient develops new-onset weakness in the right deltoid and biceps (Medical Research Council grade 2/5) on postoperative day 2. Sensation is decreased over the lateral shoulder. His long-tract signs have otherwise improved. What is the most likely etiology of this new deficit?

A 45-year-old immunocompromised patient presents with progressive back pain, night sweats, and a low-grade fever. MRI of the thoracic spine demonstrates relative preservation of the intervertebral disc spaces, large paraspinal fluid collections with calcification, and destruction of the anterior vertebral body elements over three consecutive levels leading to focal kyphosis.

What is the most likely causative organism?

A 65-year-old man presents with bilateral leg pain that worsens with walking and improves with leaning forward on a shopping cart. Physical exam shows normal lower extremity pulses and intact deep tendon reflexes. An MRI is obtained, demonstrating severe central canal stenosis at L4-L5. Which of the following is the most appropriate initial management?