6. Spine MCQs

A 65-year-old woman is planning to undergo corrective surgery for a symptomatic adult spinal deformity. Her preoperative radiographs demonstrate a pelvic incidence (PI) of 60 degrees. To achieve optimal spino-pelvic alignment and minimize adjacent segment disease, the target postoperative lumbar lordosis (LL) should be within how many degrees of her PI?

A 45-year-old man with ankylosing spondylitis presents after a minor motor vehicle collision. A non-contrast CT shows a highly displaced fracture through the C5-C6 disc space extending through the posterior elements.

Which of the following is the most significant acute risk associated with patient positioning and transport?

A 58-year-old female with breast cancer presents with back pain. MRI shows a lytic metastasis at T8. According to the Spinal Instability Neoplastic Score (SINS), which of the following clinical or radiographic features contributes most strongly to a higher score (indicating instability)?

A 70-year-old man with severe cervical spondylosis falls and strikes his chin. He develops bilateral upper extremity weakness that is far worse than his lower extremity weakness. Which spinal tract is predominantly responsible for this disproportionate motor deficit?

A 62-year-old male presents with severe myelopathy. Imaging reveals dense ossification along the posterior margin of the C3-C6 vertebral bodies, consistent with OPLL.

If an anterior surgical approach (corpectomy) is selected, what is the most common and feared intraoperative complication specific to this pathology?

A 68-year-old man reports bilateral calf pain after walking two blocks. The pain is rapidly relieved when he leans forward on a shopping cart. Which of the following findings most reliably differentiates this neurogenic claudication from vascular claudication?

A 24-year-old man presents after a high-speed motor vehicle collision. Radiographs demonstrate a Type II traumatic spondylolisthesis of the axis (Hangman's fracture).

What is the classic mechanism of injury for the initial pars interarticularis fracture in this scenario?

A 35-year-old construction worker sustains an L1 fracture with 50% canal compromise and 25 degrees of kyphosis after a fall. Neurologic exam is normal. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, how many points are assigned specifically for the burst morphology of this fracture?

A 42-year-old woman presents with sudden onset severe low back pain, bilateral sciatica, perineal numbness, and difficulty initiating micturition (post-void residual is 350 mL). MRI confirms a massive L4-L5 central disc herniation. What is the most appropriate management?

A 15-year-old boy presents with a progressive thoracic kyphosis of 55 degrees. Imaging is evaluated for Scheuermann's kyphosis.

To meet the classic Sorensen criteria, what is the minimum degree of anterior wedging required in each of three consecutive vertebrae?

A 48-year-old woman undergoes a right-sided C5-C6 anterior cervical discectomy and fusion (ACDF). Postoperatively, she exhibits significant hoarseness and a weak voice. Laryngoscopy confirms unilateral vocal cord paralysis. Injury to which of the following structures is responsible?

A 65-year-old man presents with progressive gait clumsiness and deteriorating hand dexterity. Examination reveals a positive Hoffman's sign bilaterally and hyperreflexia in the lower extremities, but diminished biceps reflexes bilaterally. What is the most likely location of the primary pathology?

An 82-year-old woman falls and presents with neck pain. The radiograph shows a displaced Type II odontoid fracture. She has significant medical comorbidities (Charlson Comorbidity Index of 6) and no neurologic deficit. What is the most appropriate initial management?

A 54-year-old intravenous drug user presents with severe lower back pain, a low-grade fever, and new-onset urinary retention. What is the most sensitive imaging modality and expected elevated laboratory marker to confirm the suspected diagnosis?

A 68-year-old man complains of bilateral calf pain and heaviness that occurs after walking two blocks. Which of the following historical factors is most specific for neurogenic claudication rather than vascular claudication?

A 15-year-old male gymnast presents with mechanical low back pain. Radiographs reveal a Grade 1 slip at L5-S1. What is the anatomic location of the defect causing this specific type of spondylolisthesis?

A 72-year-old man with known cervical spondylosis sustains a hyperextension injury in a motor vehicle accident. He presents with 2/5 motor strength in his upper extremities and 4/5 motor strength in his lower extremities. What spinal cord injury syndrome does this represent?

When evaluating an adult patient for spinal deformity correction, achieving spinopelvic harmony is a primary goal. To minimize the risk of adjacent segment disease and mechanical failure, the lumbar lordosis (LL) should ideally be matched to within 10 degrees of which specific pelvic parameter?

A 45-year-old man presents to the emergency department with acute urinary retention, saddle anesthesia, and bilateral lower extremity weakness following a heavy lifting event. What is the most consistent early clinical finding in cauda equina syndrome?