6. Spine MCQs

A 25-year-old male falls from a significant height and sustains a U-shaped sacral fracture with transverse extension through the S1-S2 bodies (spinopelvic dissociation). Neurological examination reveals bilateral loss of ankle plantar flexion and absent perianal sensation. What is the most appropriate definitive surgical management for this unstable injury pattern?

A patient with signs of myelopathy exhibits a hyperactive jaw jerk reflex on physical examination. Which of the following best describes the most likely anatomic location of the primary pathology?

A 60-year-old woman with long-standing rheumatoid arthritis presents with progressive neck pain and subjective hand clumsiness. Flexion-extension radiographs reveal an atlantodental interval (ADI) of 11 mm. What is the most appropriate management?

A 24-year-old man is involved in a motor vehicle accident and sustains a traumatic spondylolisthesis of the axis (Hangman's fracture). Imaging shows severe angulation with minimal translation, and flexion-extension views demonstrate an opening of the posterior C2-C3 disc space (Type IIA). Which of the following treatments is strictly contraindicated?

A 55-year-old man with a long-standing history of ankylosing spondylitis sustains a minor ground-level fall. He complains of severe lower cervical neck pain, but initial plain radiographs in the emergency department are read as normal. What is the next best step in management?

A 60-year-old man undergoes a C3-C6 posterior cervical laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops profound new weakness in right shoulder abduction and elbow flexion, but has no new sensory deficits or leg symptoms. What is the most likely etiology?

A 15-year-old female gymnast presents with chronic, insidious-onset low back pain that significantly worsens with spinal extension. Her neurologic examination is normal. Plain radiographs show a bilateral radiolucent line across the pars interarticularis of L5. What is the most appropriate initial management?

A 35-year-old woman is involved in a high-speed collision. CT of the thoracolumbar spine demonstrates an L1 burst fracture with a fracture of the posterior elements.

Her neurologic examination is normal. The TLICS score is calculated as 5 (Morphology=2; PLC=3; Neuro=0). What is the recommended management?

In the surgical evaluation and reconstruction of adult degenerative scoliosis, achieving proper sagittal balance is highly correlated with improved clinical outcomes. Which of the following spinopelvic parameters is the primary target?

A 22-year-old man is a restrained backseat passenger (lap belt only) in a motor vehicle collision. He sustains a flexion-distraction injury to his lumbar spine (Chance fracture). Which associated injury must be most actively excluded during his trauma workup?

A 62-year-old man with poorly controlled diabetes presents with severe, unrelenting back pain and low-grade fevers. MRI with contrast reveals increased T2 signal in the L3-L4 intervertebral disc and adjacent vertebral endplates with enhancement. What is the most common causative organism?

A 16-year-old boy presents with progressive rounding of his upper back and mild pain after prolonged sitting. Lateral radiographs show a rigid thoracic kyphosis of 55 degrees. Which of the following radiographic findings definitively meets the Sorensen criteria for Scheuermann's disease?

A 40-year-old man presents to the emergency department with severe low back pain, bilateral leg weakness, and numbness in his perineal region. He reports he has not urinated in 14 hours. A bedside bladder ultrasound shows a post-void residual (PVR) volume of 600 mL. What is the most appropriate next step?

A 68-year-old man complains of bilateral calf and thigh pain that occurs after walking two blocks. The pain is rapidly relieved when he leans forward on a shopping cart or sits down. Standing perfectly upright exacerbates the pain. His pedal pulses are strongly palpable. What is the most likely diagnosis?

A 30-year-old woman is brought to the trauma bay after a rollover motor vehicle collision. She is fully awake, alert, and neurologically intact. Cervical spine CT demonstrates a left-sided unilateral facet dislocation at C5-C6. What is the most appropriate next step in management?

A 45-year-old man presents with right arm pain radiating to the lateral forearm and thumb. He has weakness in wrist extension and a diminished brachioradialis reflex. Which of the following nerve roots is most likely affected?

A 25-year-old man is involved in a motor vehicle collision. Imaging reveals a fracture through the pars interarticularis of C2 bilaterally with 2 mm of displacement and no angulation. According to the Levine and Edwards classification, what is the most appropriate management?

A 15-year-old male gymnast complains of worsening lower back pain exacerbated by extension. Oblique radiographs demonstrate a 'collar on the Scotty dog' appearance. Which of the following is the most appropriate initial management?

A 55-year-old man with long-standing ankylosing spondylitis presents to the emergency department after a minor ground-level fall. He complains of severe lower neck pain. Neurological examination is intact. Initial plain radiographs of the cervical spine are difficult to interpret due to patient positioning and underlying deformity. What is the most appropriate next step in management?