6. Spine MCQs

A 60-year-old woman with a 20-year history of rheumatoid arthritis presents with progressive hand clumsiness and a broad-based gait. Cervical spine radiographs demonstrate atlantoaxial instability. What is the most critical radiographic parameter used to assess her risk of impending permanent neurological deterioration?

A 72-year-old man with cervical spondylosis suffers a hyperextension injury. He presents with 2/5 strength in his bilateral upper extremities and 4/5 strength in his lower extremities. He has variable sensory loss. Which specific spinal tract injury is responsible for this classic presentation?

A 45-year-old man develops acute, severe left anterior thigh pain and new-onset weakness in left knee extension. MRI of the lumbar spine reveals a massive far lateral (extraforaminal) disc herniation at the L3-L4 level on the left. Which nerve root is most likely compressed?

A 25-year-old diver impacts the bottom of a pool, sustaining an axial load injury. An open-mouth odontoid radiograph demonstrates a Jefferson fracture. According to Spence's rule, a combined lateral mass overhang of C1 on C2 greater than what measurement implies incompetence of the transverse alar ligament?

A 40-year-old woman presents with saddle anesthesia, bilateral sciatica, and acute urinary retention with a post-void residual volume of 450 mL. MRI confirms a massive L4-L5 central disc extrusion. What is the generally accepted optimal time window to perform decompression to maximize the chance of urologic recovery?

In an adult patient presenting with an L5-S1 isthmic spondylolisthesis and unilateral radicular leg pain, which nerve root is most commonly compressed, and what is the primary anatomical site of this compression?

A 60-year-old patient undergoes a posterior cervical laminectomy and instrumented fusion from C3 to C6 for severe cervical myelopathy. On postoperative day 2, he develops profound new-onset weakness in his bilateral deltoids and biceps, with preserved strength elsewhere. Sensation is intact. What is the most likely etiology?

A 30-year-old female sustains a Levine-Edwards Type IIa Hangman's fracture. Radiographs demonstrate an angulated C2 pars fracture with minimal translation. What treatment modality is strictly contraindicated in this specific injury pattern?

Which of the following congenital spinal anomalies carries the highest risk of rapid curve progression and invariably requires early surgical intervention?

A 70-year-old male with long-standing ankylosing spondylitis presents to the emergency department with neck pain after a ground-level fall. Neurologic exam is intact. CT scan reveals a transverse fracture through the C5-C6 disc space. What is the most dreaded immediate complication that must be monitored for in this patient?

A 35-year-old male falls from a ladder and sustains an L1 burst fracture. He is neurologically intact. MRI confirms the posterior ligamentous complex (PLC) is completely intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the best initial management?

During a complex anterior thoracolumbar reconstruction, the surgeon must be mindful of the Artery of Adamkiewicz. Which of the following best describes the typical origin and function of this critical vessel?

A 22-year-old male requires the placement of a halo vest for a complex upper cervical spine injury.

Where is the correct anatomical "safe zone" for the placement of the anterior halo pins in an adult?

A 45-year-old man presents with severe lower back pain and right leg pain. An MRI reveals a far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed, and what clinical finding would be expected?

A 50-year-old male presents with radiating neck pain into his left arm. Physical examination demonstrates weakness in wrist flexion, finger extension, and triceps extension, along with an absent triceps reflex. Which cervical nerve root is most likely affected?

In the surgical planning for an adult patient with severe sagittal imbalance, achieving proper spinopelvic parameters is critical to postoperative clinical success. What is the universally accepted target for the mismatch between Pelvic Incidence (PI) and Lumbar Lordosis (LL)?

A 70-year-old man with pre-existing cervical spondylosis sustains a hyperextension injury to his neck. He presents with severe motor weakness in his hands and arms, but is able to move his legs with only mild weakness. What is the typical long-term prognosis for this specific spinal cord injury syndrome?

A 55-year-old diabetic male presents with acute, severe, localized back pain and a low-grade fever. He has a history of recent intravenous catheter placement. Neurological examination is currently normal. What is the most common causative organism if an MRI confirms a spinal epidural abscess?

During the evaluation of a 2-year-old child with congenital scoliosis, various vertebral anomalies are noted on plain radiographs. Which of the following structural anomalies carries the highest risk for rapid and severe curve progression?

A 24-year-old male arrives at the trauma bay after a motorcycle accident with flaccid paralysis below the T4 level, absent reflexes, and hypotension. Which of the following clinical signs definitively indicates the resolution of the temporary physiological state known as spinal shock?