6. Spine MCQs

A 78-year-old male sustains a Type II odontoid fracture after a ground-level fall. He has no neurologic deficits but has a history of severe COPD and congestive heart failure. Which of the following treatments is associated with the highest morbidity and mortality in this specific patient population?

A 45-year-old male presents with acute severe leg pain. MRI demonstrates a large far-lateral (extraforaminal) disc herniation at the L4-L5 level.

Which of the following physical examination findings is most expected in this patient?

A 62-year-old male undergoes an anterior cervical discectomy and fusion (ACDF). The surgeon chooses a right-sided approach to the lower cervical spine. To avoid postoperative hoarseness, the surgeon must be mindful of the recurrent laryngeal nerve (RLN). Which of the following best describes its anatomic course on the right side compared to the left?

A 65-year-old female with long-standing rheumatoid arthritis presents with progressive clumsiness in her hands and difficulty walking. Flexion-extension radiographs reveal an anterior atlantodental interval (ADI) of 11 mm. What is the most critical parameter to evaluate on imaging to determine her risk of impending severe neurologic deficit?

In the emergency evaluation of a patient with spinal trauma, examination reveals preserved proprioception and light touch sensation in the lower extremities but a complete loss of bilateral motor function and pain/temperature sensation below the umbilicus. Which of the following vascular territories is most likely compromised?

A 70-year-old male presents with bilateral lower extremity pain and cramping that worsens with standing and walking but improves when leaning forward on a shopping cart. He is being evaluated for lumbar spinal stenosis. Which of the following differentiates neurogenic claudication from vascular claudication?

A 35-year-old male falls from a height and sustains a burst fracture of L1. His neurologic examination is completely normal. The Thoracolumbar Injury Classification and Severity (TLICS) score is calculated to be 2. What is the most appropriate management?

A 42-year-old female underwent a posterior spinal fusion for adolescent idiopathic scoliosis extending down to L5 when she was a teenager. She now presents with severe lower back pain and radicular symptoms. Radiographs demonstrate advanced degenerative disc disease, facet arthropathy, and listhesis at the L5-S1 level. What is this specific phenomenon termed?

A 55-year-old male with long-standing ankylosing spondylitis sustains a minor fall at home. He presents with new-onset neck pain and bilateral hand tingling. Initial AP and lateral plain radiographs of the cervical spine are interpreted as "normal" with expected autofusion.

What is the most appropriate next step in management?

A 28-year-old male is diagnosed with an L5-S1 isthmic spondylolisthesis (Meyerding Grade II). He has failed 6 months of conservative therapy and continues to have axial back pain and bilateral L5 radiculopathy. What is the underlying anatomical defect characterizing this specific condition?

During an anterior approach to the cervical spine for a C5-C6 discectomy, the surgeon must elevate the longus colli muscles. Care must be taken to avoid aggressive lateral dissection over the anterior surface of the longus colli to prevent injury to which of the following structures?

A 65-year-old male with long-standing ankylosing spondylitis sustains a minor fall. He complains of new-onset neck pain but is neurologically intact. Radiographs reveal a transverse fracture through the C5-C6 disc space extending through the posterior elements. What is the most appropriate management?

A 55-year-old male undergoes a C3-C6 posterior cervical laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops profound, isolated weakness of his bilateral deltoids and biceps (0/5) with preserved lower extremity function. What is the most likely etiology of this complication?

A surgeon plans to use recombinant human bone morphogenetic protein-2 (rhBMP-2) off-label during an anterior cervical discectomy and fusion (ACDF). The patient should be counseled about a significantly increased risk of which of the following complications compared to autograft?

A 30-year-old neurologically intact male presents after a motor vehicle collision. CT imaging demonstrates a burst fracture of L1 with 40% loss of vertebral body height and 15 degrees of local kyphosis. MRI confirms the posterior ligamentous complex (PLC) is completely intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

In planning corrective surgery for a 62-year-old female with severe adult spinal deformity, achieving optimal sagittal balance is critical. According to the SRS-Schwab classification guidelines, what is the surgical target for the mismatch between pelvic incidence (PI) and lumbar lordosis (LL)?

A 52-year-old diabetic male presents with 3 weeks of progressively worsening back pain, low-grade fevers, and new-onset bilateral iliopsoas weakness (3/5). MRI with contrast reveals an extensive anterior epidural abscess from L2-L4 causing severe compression of the thecal sac. The patient is hemodynamically stable. What is the most appropriate next step in management?

A 72-year-old male with known cervical spondylosis falls forward, striking his chin. He presents with severe upper extremity weakness, particularly in his hands, but can ambulate with a walker. Sensation to pinprick and temperature is diminished in a cape-like distribution over his shoulders. What is the primary pathophysiological mechanism of his spinal cord injury?

A 45-year-old female presents to the emergency department with acute onset of severe right-sided radicular leg pain, saddle anesthesia, and urinary retention. MRI confirms a massive L4-L5 disc herniation compressing the cauda equina. Which timeline for surgical decompression is supported by current literature to maximize the potential for urological and neurological recovery?