6. Spine MCQs

A 45-year-old man presents with severe radicular pain radiating down the anterior aspect of his right thigh to the knee, accompanied by weakness in knee extension. An MRI reveals a far lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed?

A spinal surgeon is placing L4 pedicle screws for a lumbar fusion. If the right L4 pedicle screw breaches the medial pedicle wall, which neural structure is at greatest immediate risk of injury?

During a transforaminal endoscopic lumbar discectomy at L4-L5, the surgeon utilizes Kambin's triangle as a safe working zone. Which of the following forms the anterior border of this anatomical safe zone?

During an ulnar collateral ligament (UCL) reconstruction in a baseball pitcher, understanding elbow biomechanics is crucial. Which anatomical band of the UCL is the primary restraint to valgus stress between 30 and 120 degrees of elbow flexion?

A 14-year-old female gymnast complains of insidious onset, mechanical low back pain exacerbated by extension. Plain radiographs of the lumbar spine are normal. What is the preferred next imaging modality to diagnose an early, pre-radiographic pars interarticularis stress reaction while avoiding ionizing radiation?

A 20-year-old collegiate baseball pitcher reports a sudden snap and sharp medial elbow pain during a curveball pitch. Examination reveals marked pain and subjective instability with a moving valgus stress test. Which anatomical structure is most likely acutely injured?

A 20-year-old collegiate baseball pitcher complains of medial elbow pain and decreased pitching velocity. The pain is most severe during the late cocking and early acceleration phases of throwing. A moving valgus stress test is positive. Which bundle of the involved ligament is the primary restraint to valgus stress at 90 degrees of elbow flexion?

A 14-year-old nonambulatory boy with Duchenne muscular dystrophy presents with a progressive 35-degree scoliosis. His current forced vital capacity (FVC) is 45% of predicted. What is the recommended management of his spinal deformity?

A 14-year-old gymnast presents with persistent low back pain and radiculopathy. Radiographs show a grade II L5-S1 isthmic spondylolisthesis. She has failed 6 months of nonoperative management. What is the best surgical option?

A 10-year-old girl with Spinal Muscular Atrophy (SMA) type 2 presents with progressive neuromuscular scoliosis of 65 degrees. She is currently receiving intrathecal nusinersen treatments. What is a critical technical consideration when planning posterior spinal fusion for this patient?

A 6-month-old boy is diagnosed with infantile idiopathic scoliosis. A radiograph reveals a left-sided thoracic curve of 35 degrees. Which of the following parameters is the most important radiographic predictor of curve progression in this patient?

A 14-year-old non-ambulatory patient with spastic quadriplegic cerebral palsy presents with a progressive neuromuscular scoliosis of 75 degrees and a pelvic obliquity of 25 degrees. Surgical correction is planned. What is the most appropriate distal extent of the spinal fusion construct?

A 15-year-old male gymnast complains of worsening low back pain with radicular symptoms into the L5 distribution. Radiographs reveal a high-grade (Meyerding Grade IV) L5-S1 isthmic spondylolisthesis. What is the most common neurologic complication following surgical reduction and instrumented fusion for this condition?

A 6-month-old infant is diagnosed with idiopathic infantile scoliosis with a 25-degree left thoracic curve. The rib-vertebra angle difference (RVAD) of Mehta is measured at 30 degrees. What is the most appropriate initial management?

A 14-year-old male gymnast reports 6 weeks of localized low back pain that worsens with lumbar extension. Neurologic exam is normal. Oblique radiographs show a radiolucency at the pars interarticularis of L5, and a SPECT scan shows intense focal uptake. Initial management should consist of:

An 18-month-old child with achondroplasia presents with central sleep apnea, hyperreflexia, and delayed motor milestones. Which of the following is the most likely anatomic cause of these symptoms?

An infant with achondroplasia presents with central sleep apnea, hyperreflexia, and hypotonia. These clinical findings are most likely secondary to which of the following complications?

A 3-year-old girl is diagnosed with congenital scoliosis secondary to a fully segmented hemivertebra at T8. The curve is currently 35 degrees. Renal ultrasound and echocardiogram are normal. An MRI of the entire spine is obtained. What is the most common intraspinal anomaly associated with this condition?

A 14-year-old male gymnast presents with persistent lower back pain exacerbated by extension. Radiographs and an MRI confirm a bilateral L5 pars interarticularis defect with a Grade I spondylolisthesis. The pain has not improved after 6 months of rest, bracing, and physical therapy. What is the most appropriate surgical treatment?