6. Spine MCQs

A 38-year-old man presents with sudden, severe, unremitting right shoulder pain lasting for 2 weeks, followed by profound weakness of the shoulder and arm as the pain begins to subside. MRI of the shoulder and cervical spine is normal. EMG reveals denervation in the deltoid and supraspinatus. What is the most likely diagnosis?

An 8-year-old boy has a history of easy bruising, swollen gums, and poor wound healing. Radiographs of his lower extremities show a dense zone of provisional calcification at the metaphyses (Frankel line). The underlying pathophysiology involves a defect in the synthesis of which of the following proteins?

A 50-year-old man presents with progressive weakness in his upper extremities. Imaging reveals a chordoma at the cervical spine. Histological examination of this tumor classically demonstrates which of the following cells?

A 10-month-old infant presents with irritability, bleeding gums, and pseudoparalysis. Radiographs show an epiphyseal separation, a white line of Frankel, and a Wimberger ring sign. This condition is caused by a deficiency in which of the following?

A spine surgeon is performing a posterior cervical foraminotomy at C6-C7. Understanding the vascular anatomy of the cervical spine is critical to prevent iatrogenic injury. Which of the following is true regarding the transverse foramen of the C7 vertebra?

When performing an anterior cervical discectomy and fusion (ACDF), knowledge of the vertebral artery's course is crucial. Moving from proximal to distal, the vertebral artery typically first enters the foramen transversarium at which cervical level?

To prevent neurapraxia on a fracture table, the perineal post must be adequately padded to protect the pudendal nerve. The pudendal nerve exits the pelvis through the greater sciatic foramen and re-enters the perineum through the lesser sciatic foramen by wrapping around the:

When preparing for pedicle screw instrumentation in the lumbar spine, understanding the transverse pedicle angulation is critical. How does the medial pedicle angulation in the transverse plane typically change from L1 to L5?

During posterior cervical spine surgery, the suboccipital triangle must be carefully navigated. Which structures are primarily contained within this anatomical boundary?

When placing a pedicle screw in the lumbar spine, violating the medial cortex of the pedicle places which of the following structures at greatest immediate risk?

A 65-year-old man with cervical spondylosis sustains a hyperextension injury to his neck. He subsequently develops profound weakness in his upper extremities with relatively preserved motor function in his lower extremities. The pattern of weakness is due to the somatotopic organization of which of the following spinal cord tracts?

During a far lateral approach to the L4-L5 lumbar spine for a foraminal disc herniation, the exiting nerve root is at risk. Where does the L4 nerve root travel in relation to the L4 pedicle?

The alar ligaments play a critical role in stabilizing the craniocervical junction. What is their primary biomechanical function?

An 18-year-old gymnast complains of chronic lower back pain. Radiographs reveal a pars interarticularis defect (spondylolysis). Anatomically, the pars interarticularis is a bony bridge located between which two structures?

A spine surgeon is planning freehand placement of thoracic pedicle screws for a severe scoliosis deformity. Understanding pedicle morphometry is critical to avoid spinal cord or vascular injury. In the normal thoracic spine, which level typically has the narrowest pedicle diameter in the transverse (mediolateral) plane?

During a posterior cervical foraminotomy at the C5-C6 level for radiculopathy, aggressive lateral dissection with a burr anterior to the neural foramen places a major arterial structure at risk. This artery typically enters the transverse foramen at which cervical level?

During an anterior approach to the thoracolumbar spine for a T11 corpectomy, the surgeon must avoid ligating segmental vessels unnecessarily to prevent spinal cord ischemia. The Artery of Adamkiewicz most commonly enters the spinal canal on the left side between which vertebral levels?

A 45-year-old man presents with a right-sided paracentral disc herniation at the C5-C6 level causing severe radiculopathy. Which nerve root is most likely compressed, and where does it exit relative to the corresponding pedicle?

A patient with advanced rheumatoid arthritis presents with myelopathic symptoms. Flexion-extension radiographs show significant atlantoaxial instability. Which ligament, primarily responsible for limiting axial rotation and lateral bending between the occiput and the axis, is most likely compromised?

A spine surgeon is placing percutaneous pedicle screws in the thoracolumbar junction. A breach of the anterior vertebral body cortex places which major vascular structure at greatest risk on the left side at the T11-L1 levels?