6. Spine MCQs

A 65-year-old male with progressive adult spinal deformity presents for surgical planning. His pelvic incidence (PI) is 60 degrees. To achieve optimal sagittal balance and minimize the risk of adjacent segment disease, what should his target postoperative lumbar lordosis (LL) be?

An 18-year-old football player is tackled forcefully on his shoulder while lying on the ground. He presents to the ER with severe pain at the base of his anterior neck, dysphagia, and difficulty breathing. His right arm is supported across his chest. What is the most appropriate initial imaging modality to definitively diagnose the specific displacement of this injury?

A 25-year-old motorcyclist is involved in a high-speed collision. He presents to the trauma bay with massive swelling over the left shoulder, an absent left radial pulse, and complete flaccidity and anesthesia of the left upper extremity. Radiographs demonstrate an intact clavicle but massive lateral displacement of the scapula relative to the thoracic spine. What is the most appropriate next step in the definitive management of this patient?

A patient presents with right-sided neck pain radiating down to the middle finger, along with weakness in triceps extension. Spurling's test is positive. What is the most likely affected nerve root, and what is the classic mechanism of a positive Spurling's maneuver?

During a low back pain evaluation, the examiner notes that pressing lightly on the patient's head causes severe radiating lumbar pain. The examiner also notes widespread hypersensitivity to light touch over the entire back. These findings fall under Waddell's signs. What is the primary clinical utility of identifying these signs?

During the neurological examination of a 62-year-old man presenting with bilateral hand clumsiness and gait instability, the examiner supports the patient's forearm in a neutral position and strikes the brachioradialis tendon with a reflex hammer. This elicits spontaneous flexion of the fingers and thumb. What does this specific finding suggest?

The examiner flicks the distal phalanx of a patient's middle finger downward. A positive Hoffmann's sign is noted. What is the expected motor response, and what does it suggest?

A 60-year-old man complains of progressive clumsiness in his hands. During physical examination, the examiner rapidly flicks the distal phalanx of the middle finger, which produces a reflex flexion of the patient's thumb and index finger. What is the name of this sign and its primary clinical implication?

To differentiate hip intra-articular pathology from lumbar spine pathology, a patient is asked to actively raise their leg against resistance with the knee extended in the supine position. Pain is forcefully elicited in the groin. This provocative maneuver is known as the:

A 45-year-old female presents with right-sided neck pain radiating to her index and middle fingers. The examiner extends and side-bends her neck to the right, applying axial compression, which reproduces the radiating pain. Which nerve root is most likely compressed?

A 65-year-old female presents with progressive clumsiness in her hands, difficulty buttoning her shirts, and an unsteady gait. Physical exam reveals hyperreflexia in the upper and lower extremities. Which of the following clinical tests is most specific for diagnosing an upper motor neuron lesion in this context?

A 70-year-old male complains of bilateral lower extremity pain and cramping that worsens with walking. To differentiate between neurogenic claudication (lumbar spinal stenosis) and vascular claudication, which of the following historical features strongly supports a neurogenic etiology?

A 25-year-old male sustains an axial load injury to his cervical spine. Open-mouth odontoid radiographs reveal a combined lateral overhang of the C1 lateral masses on C2 of 8.1 mm. According to the Rule of Spence, this specific measurement indicates the disruption of which of the following structures?

A 65-year-old male is involved in a high-speed MVC and sustains a burst fracture of the C1 ring (Jefferson fracture). Open-mouth odontoid radiographs demonstrate lateral displacement of the C1 lateral masses. A total combined overhang of the C1 lateral masses on C2 greater than what threshold implies an incompetent transverse ligament (Rule of Spence)?

A 45-year-old male is involved in a motor vehicle collision and sustains a traumatic spondylolisthesis of C2 (Hangman's fracture). What is the classic primary mechanism of injury for this fracture pattern?

A 70-year-old male complains of bilateral lower extremity heaviness and cramping that worsens with walking upright and improves dramatically when he leans forward on a shopping cart. This neurogenic claudication is most commonly driven by the hypertrophic infolding of which spinal structure?

A 45-year-old male is involved in a high-speed motor vehicle collision and presents with severe neck pain. CT scan demonstrates bilateral fractures through the pars interarticularis of the C2 vertebra (Hangman's fracture). What is the classic mechanism of injury for this fracture pattern?

A 55-year-old female presents with severe neurogenic claudication and L5 radiculopathy. Radiographs reveal a Meyerding Grade 2 isthmic spondylolisthesis at L5-S1. She has failed 6 months of conservative management. What is the most appropriate surgical intervention?

A 50-year-old male presents with acute severe right-sided neck pain that radiates down his arm to his middle finger. Neurological examination reveals marked weakness in elbow extension and wrist flexion, as well as an absent triceps reflex. A herniated nucleus pulposus is suspected at which of the following cervical disc levels?