6. Spine MCQs

A 22-year-old man is involved in a high-speed motor vehicle collision while wearing only a lap seatbelt. He complains of severe back pain. CT of the lumbar spine reveals a fracture line extending horizontally through the spinous process, pedicles, and posterior vertebral body of L2. What associated injury must be actively ruled out?

A 45-year-old intravenous drug user presents with progressive back pain, fever, and new-onset lower extremity weakness and urinary retention. His ESR and CRP are markedly elevated. MRI with gadolinium shows a large, peripherally enhancing fluid collection in the dorsal epidural space at T8-T10 compressing the spinal cord. What is the most appropriate next step in management?

A 16-year-old boy presents with a prominent mid-thoracic hump and back pain. Standing lateral radiographs reveal a thoracic kyphosis of 65 degrees. There is anterior wedging of 8 degrees at three consecutive vertebrae, and Schmorl's nodes are visible. He has 1 year of remaining skeletal growth. What is the most appropriate initial treatment?

A 65-year-old man undergoes a posterior cervical laminectomy and fusion from C3-C6 for cervical spondylotic myelopathy. Postoperatively on day 1, he develops new-onset weakness in the deltoid and biceps (1/5) bilaterally, with intact sensation and no lower extremity changes. What is the most likely etiology?

A 35-year-old man is brought to the ED after a motor vehicle collision. He is obtunded and intubated. Radiographs reveal a C5-C6 unilateral facet dislocation. What is the next best step in management?

A 72-year-old woman with a history of severe rheumatoid arthritis presents with neck pain and mild myelopathy. Radiographs demonstrate atlantoaxial instability. Which of the following radiographic measurements is the most reliable indicator of potential neurological compromise requiring surgical stabilization?

A 45-year-old man presents with severe back pain and bilateral lower extremity weakness after a fall from a height. A CT scan shows an L1 burst fracture with 60% canal compromise. Examination reveals intact perianal sensation, but decreased rectal tone and urinary retention. Which of the following is the most appropriate management?

A 30-year-old construction worker presents with back pain after lifting a heavy beam. He reports pain radiating down the lateral aspect of his left leg to the dorsum of his foot, along with weakness in great toe extension. Which nerve root is most likely affected?

A 22-year-old male is involved in a high-speed motor vehicle collision. A CT scan of the cervical spine reveals a fracture through the pars interarticularis of C2 bilaterally, with severe angulation and anterior translation of C2 on C3. The C2-C3 disc space is widened anteriorly. Which of the following treatments is absolutely contraindicated?

A 60-year-old diabetic patient presents with 2 weeks of worsening back pain, fevers, and a recent onset of bilateral lower extremity weakness. Laboratory studies show elevated ESR and CRP. An MRI with contrast demonstrates an epidural fluid collection at L3-L4 with peripheral enhancement. What is the next best step in management?

A 12-year-old girl is diagnosed with adolescent idiopathic scoliosis. Her primary curve is a right thoracic curve of 55 degrees. When discussing surgical intervention with pedicle screw instrumentation, what is the most critical potential complication associated with a medial pedicle wall breach in the thoracic spine?

A 45-year-old man with ankylosing spondylitis presents with severe back pain after a low-energy fall. CT imaging demonstrates a displaced transvertebral fracture through T10. What is the most appropriate management for this patient?

An 82-year-old woman with severe COPD and heart failure falls and sustains a Type II odontoid fracture with 2 mm of displacement. What is the most appropriate initial management considering her comorbidities?

A 55-year-old diabetic man presents with progressive bilateral leg weakness, urinary retention, and fever over the last 24 hours. MRI reveals a dorsal epidural abscess from T8 to T10 with severe spinal cord compression. What is the most urgent and appropriate intervention?

A 30-year-old man falls from a roof and sustains a T12 burst fracture. He is neurologically intact, and MRI confirms an intact posterior ligamentous complex. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his score and recommended management?

Which of the following findings is considered the most sensitive early clinical indicator for diagnosing Cauda Equina Syndrome?

A 65-year-old man presents with progressive hand clumsiness, frequent falls, and a positive Hoffman's sign. MRI reveals multilevel cervical stenosis from C3-C6 with cord signal changes. Lateral radiographs show a neutral cervical sagittal alignment without instability. Which surgical approach is most appropriate?

A 55-year-old man undergoes a 10-hour posterior spinal fusion for severe adult scoliosis. Upon awakening, he complains of bilateral painless vision loss, and his pupils are sluggish to react. What is the most likely etiology of his vision loss?

A 20-year-old man is brought to the trauma bay after sustaining a C5 burst fracture resulting in complete quadriplegia. He is noted to have a blood pressure of 80/50 mmHg, a heart rate of 50 bpm, and warm, flushed extremities. What is the primary pathophysiological mechanism for his hemodynamic state?