6. Spine MCQs

An 82-year-old male with severe COPD and congestive heart failure falls from standing height. CT of the cervical spine reveals a Type II odontoid fracture with 2 mm of posterior displacement. He is neurologically intact. What is the recommended management strategy that balances fracture care with the lowest morbidity and mortality for this specific patient?

A 45-year-old male presents with right arm pain and weakness. Physical examination reveals a diminished triceps reflex, weakness with elbow extension, and numbness over the middle finger. Which of the following nerve roots is most likely affected?

A 68-year-old male with long-standing ankylosing spondylitis sustains a minor fall. He complains of severe neck pain but is neurologically intact. Standard radiographs are inconclusive. What is the most appropriate next step in management?

Which of the following physical examination findings is most specific for differentiating neurogenic claudication from vascular claudication in a patient with lower extremity pain during walking?

An 82-year-old female presents with a Type II odontoid fracture displaced by 4 mm posteriorly after a ground-level fall. She has significant medical comorbidities. What is the most appropriate management?

According to the Thoracolumbar Injury Classification and Severity Score (TLICS), which of the following isolated findings automatically assigns a score strongly recommending surgical intervention?

A 55-year-old male presents with clumsy hands and a wide-based gait. Tapping the volar aspect of the distal phalanx of the middle finger produces a reflex flexion of the thumb and index finger. This clinical test is known as:

A 65-year-old female presents with worsening back pain and inability to stand up straight. A standing lateral radiograph is obtained.

For optimal surgical correction of her adult spinal deformity, the surgeon should aim for a mismatch between pelvic incidence (PI) and lumbar lordosis (LL) of:

A 38-year-old male acutely develops severe right leg pain radiating down the posterior thigh and calf to the plantar aspect of the foot. He has a weakened Achilles reflex. A paracentral disc herniation at which level is most likely responsible?

A 50-year-old intravenous drug user presents with back pain, fever, and progressive lower extremity weakness. MRI reveals a ventral spinal epidural abscess from L1 to L3 with severe canal stenosis. What is the most appropriate surgical approach?

A 14-year-old gymnast presents with persistent low back pain. Radiographs reveal a Grade 1 L5-S1 isthmic spondylolisthesis. After 6 months of physical therapy and bracing, her pain remains debilitating. What is the recommended surgical management?

Which of the following clinical findings is considered the most reliable indicator of urinary retention in a patient suspected of having cauda equina syndrome?

A 30-year-old male is involved in a high-speed motor vehicle collision. He has 0/5 strength in his lower extremities and a sensory level at the nipple line. A lateral cervical radiograph is obtained.

Assuming an MRI shows a large extruded disc herniation behind the displaced vertebral body, what is the safest sequence of surgical management?

In a patient with known metastatic prostate cancer to the thoracic spine, which of the following primary factors is evaluated in the modified Tokuhashi scoring system to predict survival and guide surgical decision-making?

During an anterior cervical discectomy and fusion (ACDF) at C5-C6, the surgeon utilizes a right-sided approach. Postoperatively, the patient has a hoarse voice but normal swallowing. Injury to which of the following nerves is the most likely cause?

A 65-year-old man undergoes a C3-C6 laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops isolated profound weakness in bilateral deltoid and biceps muscles. Sensation and lower extremity function remain completely intact. An MRI shows adequate decompression with a significant posterior shift of the spinal cord. What is the most likely etiology of this complication?

A 35-year-old male sustains a severe flexion-distraction injury to the thoracolumbar spine resulting in a bony Chance fracture. An anterior surgical approach is chosen for stabilization. To minimize the risk of an iatrogenic anterior spinal cord syndrome, the surgeon must be cautious during mobilization of the aorta and segmental vessels. The artery of Adamkiewicz typically arises at which of the following anatomic locations?

A 48-year-old male presents with acute, unprovoked, excruciating right shoulder pain that awakened him from sleep. The severe pain lasts for nearly two weeks and requires narcotic analgesia. As the pain begins to subside, he notes profound weakness in his deltoid and periscapular muscles. An MRI of the shoulder and cervical spine is unremarkable. EMG at 4 weeks shows denervation of the suprascapular and axillary nerves. What is the most likely diagnosis?