6. Spine MCQs

In the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following morphologic patterns is assigned the highest point value for injury morphology?

A 65-year-old man presents with deteriorating handwriting, difficulty manipulating small objects, and frequent tripping. Examination reveals a positive Hoffmann's sign and sustained ankle clonus. An MRI confirms severe cervical spondylotic myelopathy. Which of the following physical examination findings is also most likely to be present?

A 70-year-old male with severe lumbar spinal stenosis complains of bilateral neurogenic claudication. He notes significant symptom relief when leaning forward over a shopping cart. What is the primary anatomic explanation for this positional relief?

A 6-year-old boy with normal intelligence presents with short trunk dwarfism, knock knees, and a barrel chest. Urine analysis shows elevated levels of keratan sulfate. Radiographs of the cervical spine are most likely to demonstrate which of the following abnormalities?

A 25-year-old male is involved in a severe motor vehicle accident and sustains a burst fracture of T10 with paraplegia. He has flaccid lower extremities, areflexia, and a heart rate of 55 bpm with a blood pressure of 85/50 mmHg. The bulbocavernosus reflex is absent. The resolution of spinal shock in this patient is best indicated clinically by the return of which of the following?

A 65-year-old female with long-standing rheumatoid arthritis presents with progressive hand clumsiness and hyperreflexia. Cervical radiographs reveal atlantoaxial subluxation. Which of the following radiographic parameters is the most critical indicator of impending neurologic deterioration and the need for surgical stabilization?

In evaluating a patient with suspected cervical spondylotic myelopathy, the examiner flicks the distal phalanx of the middle finger, resulting in reflex flexion of the thumb and index finger. What is the name of this clinical sign?

A 68-year-old male presents with bilateral leg pain that worsens with walking and improves when leaning forward on a shopping cart. He is diagnosed with lumbar spinal stenosis. What pathomechanism primarily explains the relief of symptoms when flexing the spine?

A 68-year-old male with pre-existing cervical spondylosis presents after a hyperextension injury to his neck from a fall. He has 2/5 motor strength in his upper extremities and 4/5 motor strength in his lower extremities. He has patchy sensory loss and urinary retention. Which of the following is the most likely diagnosis?

A 35-year-old male is involved in a high-speed motor vehicle collision and sustains a traumatic spondylolisthesis of the axis (Hangman's fracture). What is the classic mechanism of injury for this specific fracture pattern?

In a patient with an L4-L5 degenerative spondylolisthesis and associated lumbar spinal stenosis, which nerve root is most commonly compressed, and where does the compression typically occur?

A 72-year-old man presents with bilateral leg pain and heaviness that worsens with walking and is relieved by leaning over a shopping cart. MRI shows severe L4-L5 central canal stenosis. Which ligament hypertrophies and primarily contributes to this stenosis?

A 45-year-old male sustains a traumatic spondylolisthesis of the axis (Hangman's fracture) following an MVC. Radiographs show a 4mm displacement and 12 degrees of angulation. According to the Levine and Edwards classification, which of the following is the mechanism of this Type II injury?

A 45-year-old male presents with acute urinary retention, saddle anesthesia, and bilateral leg weakness secondary to a massive L4-L5 disc herniation. Current literature indicates that to maximize the chance of urologic recovery, surgical decompression should ideally be performed within what time frame from symptom onset?

A 65-year-old male undergoes magnetic resonance imaging (MRI) of the cervical spine to evaluate progressive hand clumsiness and gait imbalance. Which of the following MRI findings in the spinal cord is most predictive of a poor clinical neurological outcome following surgical decompression?

Which of the following clinical and anatomical features correctly differentiates degenerative spondylolisthesis from isthmic spondylolisthesis in the adult lumbar spine?

Ossification of the posterior longitudinal ligament (OPLL) most commonly occurs in the cervical spine and can cause severe progressive myelopathy. Which of the following patient demographics and genetic markers is most strongly associated with this condition?

During the physical exam of a 65-year-old man with broad-based gait instability and hand clumsiness, you rapidly flex the distal phalanx of his middle finger, which promptly elicits involuntary flexion of the thumb and index finger. What is the eponymous name of this clinical sign?

A 68-year-old male complains of bilateral leg and buttock pain that progressively worsens with walking. You instruct him to perform a clinical stationary bicycle test. The pain does not occur while pedaling in a forward-flexed posture but occurs rapidly when standing upright. This specific finding most strongly points to: