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6. Spine MCQs

Practice Set 29 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 561

Topic: Cervical Spine

A 30-year-old male is involved in a severe motor vehicle crash. Lateral cervical radiograph shows a 50% anterior subluxation of C5 on C6. What is the most likely structural injury?

. Unilateral facet dislocation
. Bilateral facet dislocation
. Clay shoveler's fracture
. Teardrop fracture
. Odontoid fracture

Correct Answer & Explanation

. Unilateral facet dislocation

Explanation

Anterior translation of a cervical vertebral body by 50% or more over the adjacent inferior segment is highly indicative of bilateral facet dislocation. Unilateral facet dislocation typically presents with approximately 25% anterior translation.

Question 562

Topic: 6. Spine

A patient with multiple sclerosis and a known cervical demyelinating plaque complains of a sudden, electric shock-like sensation running down his spine and into his limbs when he flexes his neck. What is this clinical phenomenon?

. Uhthoff's phenomenon
. Spurling's sign
. Hoffmann's sign
. Lhermitte's sign
. Tinel's sign

Correct Answer & Explanation

. Uhthoff's phenomenon

Explanation

Lhermitte's sign is an electric shock-like sensation radiating down the spine or limbs upon neck flexion. It indicates dorsal column dysfunction and is commonly seen in multiple sclerosis or cervical spondylotic myelopathy.

Question 563

Topic: Cervical Spine

A 65-year-old woman with severe, long-standing rheumatoid arthritis is scheduled for a total knee arthroplasty. Which preoperative radiographic view of the cervical spine is most critical for the anesthesiologist to review prior to intubation?

. AP lower cervical spine
. Flexion-extension lateral cervical spine
. Oblique cervical spine
. Swimmer's view
. AP open-mouth odontoid view

Correct Answer & Explanation

. AP lower cervical spine

Explanation

Patients with rheumatoid arthritis frequently develop atlantoaxial instability due to pannus destruction of the transverse ligament. Flexion-extension lateral radiographs are critical to evaluate for abnormal atlantodental interval (ADI) prior to intubation.

Question 564

Topic: 6. Spine

If the C8 cervical spine nerve root is injured during an anterior decompression and fusion, sensation is most likely lost over which of the following areas?

. Lateral aspect of the arm
. Lateral aspect of the forearm
. Dorsum of the middle finger
. Ulnar border of the hand and little finger
. Medial aspect of the forearm

Correct Answer & Explanation

. Lateral aspect of the arm

Explanation

The C8 dermatome provides sensation to the ulnar side of the hand and the little finger. In contrast, C6 supplies the lateral forearm and thumb, C7 the middle finger, and T1 the medial forearm.

Question 565

Topic: Cervical Spine

During an anterior cervical discectomy and fusion (ACDF) at C5-C6, the patient develops postoperative hoarseness. Which nerve was most likely injured and where does it reside?

. Superior laryngeal nerve in the tracheoesophageal groove
. Recurrent laryngeal nerve in the tracheoesophageal groove
. Cervical sympathetic trunk over the longus colli
. Hypoglossal nerve above the hyoid bone
. Vagus nerve within the carotid sheath

Correct Answer & Explanation

. Superior laryngeal nerve in the tracheoesophageal groove

Explanation

The recurrent laryngeal nerve courses in the tracheoesophageal groove and is vulnerable during lower cervical anterior exposures. Injury results in unilateral vocal cord paralysis, which presents clinically as hoarseness.

Question 566

Topic: 6. Spine

An ACDF is performed at the C3-C4 level. Postoperatively, the patient has a normal speaking voice but complains of easy vocal fatigue and an inability to reach high-pitched notes. Which nerve was likely injured?

. Recurrent laryngeal nerve
. Superior laryngeal nerve
. Glossopharyngeal nerve
. Spinal accessory nerve
. Phrenic nerve

Correct Answer & Explanation

. Recurrent laryngeal nerve

Explanation

The external branch of the superior laryngeal nerve innervates the cricothyroid muscle. Injury impairs vocal cord tension, leading to easy vocal fatigue and loss of high-pitched phonation, typically seen in upper cervical exposures.

Question 567

Topic: 6. Spine

Which of the following is the most common neurologic complication following a posterior cervical laminectomy and fusion for multilevel cervical spondylotic myelopathy?

. C4 radiculopathy
. C5 palsy
. C7 palsy
. Recurrent laryngeal nerve injury
. Horner syndrome

Correct Answer & Explanation

. C4 radiculopathy

Explanation

C5 palsy is a well-documented complication following posterior cervical decompression, occurring in up to 10% of cases. It presents as delayed unilateral deltoid and biceps weakness due to posterior shift of the spinal cord and tethering of the C5 root.

Question 568

Topic: 6. Spine

During an anterior exposure of the lower cervical spine, dissection extends laterally over the longus colli muscle. Postoperatively, the patient presents with ipsilateral ptosis, miosis, and anhidrosis. What structure was injured?

. Recurrent laryngeal nerve
. Superior cervical ganglion
. Cervical sympathetic trunk
. Stellate ganglion
. Vagus nerve

Correct Answer & Explanation

. Recurrent laryngeal nerve

Explanation

Injury to the cervical sympathetic trunk, which runs anterior to the longus colli muscles, causes Horner syndrome. Dissection should remain medial to the lateral border of the longus colli to avoid this complication.

Question 569

Topic: 6. Spine

A patient presents with a far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is primarily affected by this specific herniation?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. L3

Explanation

A far lateral disc herniation compresses the exiting nerve root at the same level. Therefore, an L4-L5 far lateral disc herniation compresses the L4 nerve root, whereas a paracentral herniation would compress the traversing L5 root.

Question 570

Topic: 6. Spine

Compression of the L5 nerve root in the lumbar spine typically results in sensory loss in which of the following specific areas?

. Medial lower leg and medial malleolus
. Anterior thigh and knee
. First dorsal web space of the foot
. Lateral aspect of the foot and little toe
. Posterior thigh and calf

Correct Answer & Explanation

. Medial lower leg and medial malleolus

Explanation

The L5 dermatome classically supplies the dorsum of the foot, specifically isolated at the first dorsal web space. It also provides motor innervation to the extensor hallucis longus and gluteus medius.

Question 571

Topic: 6. Spine

Which of the following clinical findings serves as the primary indicator that the phase of spinal shock has ended following a traumatic spinal cord injury?

. Return of voluntary lower extremity movement
. Return of deep tendon reflexes in the lower extremities
. Return of the bulbocavernosus reflex
. Stabilization of systolic blood pressure
. Resolution of neurogenic bladder

Correct Answer & Explanation

. Return of the bulbocavernosus reflex

Explanation

Spinal shock is characterized by areflexia and flaccidity below the level of a spinal cord injury. The return of the bulbocavernosus reflex is the earliest reliable clinical indicator that spinal shock has resolved.

Question 572

Topic: 6. Spine

A patient with a previous T4 spinal cord injury suddenly develops a pounding headache, profuse sweating above the level of injury, and a blood pressure of 210/110 mmHg. What is the most common triggering event for this condition?

. Acute myocardial infarction
. Deep vein thrombosis
. Urinary retention or distended bladder
. Acute respiratory distress syndrome
. Orthostatic hypotension

Correct Answer & Explanation

. Urinary retention or distended bladder

Explanation

Autonomic dysreflexia occurs in patients with spinal cord injuries above T6 and is characterized by massive sympathetic discharge. A distended bladder or bowel impaction is the most common noxious trigger, requiring immediate intervention.

Question 573

Topic: 6. Spine

A 70-year-old man with underlying cervical spondylosis sustains a hyperextension injury to his neck. He presents with bilateral upper extremity weakness, profound in the hands, but has relatively preserved lower extremity strength. What is the most likely diagnosis?

. Anterior cord syndrome
. Central cord syndrome
. Brown-Sequard syndrome
. Posterior cord syndrome
. Conus medullaris syndrome

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome typically occurs after hyperextension injuries in elderly patients with pre-existing cervical stenosis. Due to the medial location of the upper extremity cervical tracts, hand and arm motor function is much more severely affected than the legs.

Question 574

Topic: 6. Spine

During the posterior placement of C1-C2 transarticular screws, an unrecognized injury to the vertebral artery occurs. To minimize the risk of this complication, preoperative imaging must specifically evaluate for which of the following?

. Ossification of the posterior longitudinal ligament
. High-riding vertebral artery
. Aplasia of the odontoid
. Ponticulus posticus
. Cervical rib

Correct Answer & Explanation

. High-riding vertebral artery

Explanation

A high-riding vertebral artery or a narrow C2 pars interarticularis significantly increases the risk of vertebral artery injury during C1-C2 transarticular or C2 pedicle screw placement. Preoperative CT angiography is critical to identify this anomaly.

Question 575

Topic: 6. Spine

Which of the following is typically the earliest clinical symptom reported by patients developing cervical spondylotic myelopathy?

. Neck pain radiating to the shoulder
. Bowel and bladder incontinence
. Difficulty with fine motor tasks such as buttoning a shirt
. Severe burning pain in the lower extremities
. Unilateral foot drop

Correct Answer & Explanation

. Difficulty with fine motor tasks such as buttoning a shirt

Explanation

Hand clumsiness and difficulty with fine motor skills (e.g., buttoning shirts, picking up coins) are often the earliest symptoms of cervical spondylotic myelopathy. Gait imbalance and a feeling of heavy legs also frequently follow.

Question 576

Topic: 6. Spine

A 55-year-old diabetic patient presents with severe back pain, low-grade fever, and progressive bilateral lower extremity weakness over the last 48 hours. An MRI reveals an anterior epidural fluid collection with peripheral enhancement at T8-T9. What is the most appropriate next step in management?

. Intravenous corticosteroids and observation
. CT-guided biopsy and delayed antibiotics
. Immediate surgical decompression and debridement
. Broad-spectrum intravenous antibiotics alone
. Lumbar puncture to analyze cerebrospinal fluid

Correct Answer & Explanation

. Immediate surgical decompression and debridement

Explanation

The patient has a spinal epidural abscess presenting with progressive neurologic deficits, which constitutes an absolute surgical emergency. Immediate surgical decompression and debridement are required to prevent irreversible paralysis.

Question 577

Topic: Cervical Spine

During an anterior cervical discectomy and fusion (ACDF) at the C5-C6 level, a right-sided approach is utilized. Postoperatively, the patient complains of persistent hoarseness. Which of the following structures was most likely injured?

. Superior laryngeal nerve
. Recurrent laryngeal nerve
. Hypoglossal nerve
. Glossopharyngeal nerve
. Cervical sympathetic chain

Correct Answer & Explanation

. Recurrent laryngeal nerve

Explanation

The recurrent laryngeal nerve is at risk during anterior cervical approaches. A right-sided approach has historically been associated with a slightly higher risk due to the nerve's more variable and oblique course compared to the left.

Question 578

Topic: 6. Spine

A 65-year-old male with pre-existing cervical stenosis experiences a hyperextension injury. He presents with bilateral upper extremity weakness, notably worse in the hands than the shoulders, and relatively preserved lower extremity strength. What is the most likely diagnosis?

. Anterior cord syndrome
. Brown-Sequard syndrome
. Central cord syndrome
. Posterior cord syndrome
. Complete spinal cord injury

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome typically occurs after a hyperextension injury in a stenotic cervical spine. It presents with upper extremity weakness greater than lower extremity weakness, particularly affecting distal hand motor function.

Question 579

Topic: Cervical Spine

In a patient with long-standing rheumatoid arthritis, which of the following radiographic findings represents the most critical indication for occipitocervical fusion rather than an isolated C1-C2 fusion?

. Anterior atlantodental interval (ADI) of 4 mm
. Posterior atlantodental interval (PADI) of 15 mm
. Superior migration of the odontoid (cranial settling)
. Subaxial subluxation of 2 mm at C4-C5
. Erosion of the dens

Correct Answer & Explanation

. Superior migration of the odontoid (cranial settling)

Explanation

Cranial settling (basilar invagination or superior migration of the odontoid) indicates vertical instability and typically requires occipitocervical fusion to prevent brainstem compression. An isolated increased ADI without cranial settling may only require a C1-C2 fusion.

Question 580

Topic: 6. Spine

A 60-year-old male undergoes a C3-C7 posterior cervical laminectomy and fusion for multilevel spondylotic myelopathy. On postoperative day 2, he develops isolated deltoid and biceps weakness. What is the most likely etiology?

. Intraoperative spinal cord contusion
. C5 nerve root tethering due to spinal cord drift
. Postoperative epidural hematoma
. Screw malposition at C3
. Recurrent disc herniation

Correct Answer & Explanation

. C5 nerve root tethering due to spinal cord drift

Explanation

C5 palsy is a known complication of posterior cervical decompression, occurring in up to 5-10% of cases. It is thought to be caused by tethering of the short C5 nerve root as the spinal cord drifts posteriorly following decompression.

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