6. Spine MCQs

A 22-year-old man was wearing a lap belt during a head-on collision. Radiographs demonstrate a flexion-distraction injury (Chance fracture) through the L2 vertebral body and posterior elements. Which of the following concomitant injuries must be carefully ruled out?

A 42-year-old man develops acute, severe anterior thigh pain and weakness in knee extension. 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 65-year-old woman with long-standing rheumatoid arthritis presents with neck pain and mild myelopathic signs. Flexion-extension radiographs demonstrate an atlantodens interval (ADI) of 11 mm. What is the most critical radiographic parameter to assess the true space available for the spinal cord?

A 65-year-old man undergoes a C3-C6 posterior laminectomy and instrumented fusion for severe cervical spondylotic myelopathy. On postoperative day 2, he develops profound weakness in his bilateral deltoid and biceps muscles (0/5 strength). His sensation is intact, and his myelopathic symptoms in the lower extremities have improved. What is the most appropriate initial management?

When evaluating a 68-year-old female for adult spinal deformity, which of the following postoperative spinopelvic parameters is most closely correlated with achieving a satisfactory health-related quality of life (HRQOL) score?

An 82-year-old man with long-standing, advanced ankylosing spondylitis presents after a ground-level fall. He complains of severe neck pain but is neurologically intact. Computed tomography demonstrates a displaced extension-distraction fracture traversing the C6-C7 disc space and posterior elements. What is the recommended definitive management?

An 80-year-old man sustains a Type II odontoid fracture after a ground-level fall. He has a history of severe COPD and coronary artery disease, but his neurologic examination is completely normal. Which of the following treatment modalities has the highest associated mortality rate in this specific patient population?

A 24-year-old woman is involved in a high-speed motor vehicle collision while wearing only a lap belt.

Radiographs and CT scans reveal a transverse fracture through the L2 vertebral body, pedicles, and spinous process (Chance fracture). Which of the following associated injuries is most critical to rule out?

A 70-year-old man with pre-existing cervical spondylosis trips and falls forward, striking his forehead. He presents with profound weakness in his upper extremities, particularly affecting his intrinsic hand muscles, but retains the ability to ambulate with only mild lower extremity weakness. What is the pathophysiological mechanism of his neurologic deficit?

A 65-year-old woman with a 20-year history of rheumatoid arthritis undergoes routine cervical spine flexion-extension radiographs. She is completely asymptomatic. Which of the following radiographic measurements represents an absolute indication for prophylactic surgical stabilization?

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is sometimes utilized off-label in anterior cervical diskectomy and fusion (ACDF). Which of the following is the most significant, life-threatening complication associated with its use in the anterior cervical spine?

A 55-year-old diabetic male presents with severe mid-back pain, fevers, and rapidly progressive lower extremity paraparesis. MRI reveals a T8-T10 ventral epidural abscess causing severe anterior spinal cord compression, accompanied by T9-T10 discitis. What is the most appropriate surgical approach?

A 45-year-old male presents with right arm pain radiating down the posterior aspect of his forearm into his middle finger. Examination reveals weakness in triceps extension and an absent triceps reflex. A Spurling maneuver reproduces his symptoms. Compression of which cervical nerve root is most likely responsible?

A 68-year-old man complains of bilateral calf pain and heaviness that worsens with walking. He states the pain is reliably relieved when he leans forward on a shopping cart at the grocery store. Which of the following activities or findings is most specific for differentiating his neurogenic claudication from vascular claudication?

A 14-year-old competitive gymnast presents with persistent lower back pain unresponsive to 6 months of physical therapy and bracing. Radiographs demonstrate a Grade II L5-S1 isthmic spondylolisthesis. She is neurologically intact. Surgical intervention is planned. Which of the following procedures is considered the most appropriate standard of care?

A 30-year-old man involved in a high-speed collision sustains a traumatic spondylolisthesis of the axis (Hangman's fracture). Imaging demonstrates a fracture through the bilateral pars interarticularis with 15 degrees of angulation and 4 mm of translation (Levine-Edwards Type II). What is the classic mechanism of this specific injury pattern?

A 25-year-old male falls from a ladder.

CT imaging shows a T12 burst fracture with 30% canal compromise. MRI confirms that the posterior ligamentous complex (PLC) is fully intact. The patient has normal motor and sensory exams in his lower extremities. What is his Thoracolumbar Injury Classification and Severity (TLICS) score, and what is the recommended treatment?

A 65-year-old man presents with bilateral leg pain when walking. He notes the pain is relieved when pushing a shopping cart but worsens when walking down a hill. Pulse examination is normal. Which of the following is the most likely diagnosis?

In a patient with longstanding rheumatoid arthritis, which of the following radiographic findings is the strongest indication for operative intervention to prevent irreversible neurologic damage?

An 82-year-old frail female sustains a minimally displaced Type II odontoid fracture after a mechanical fall. What is the most appropriate initial management, considering her age and comorbidities?