6. Spine MCQs

In the lumbar spine, the intervertebral foramen (IVF) is bounded by several osseous and ligamentous structures. What forms the anterior border of the lumbar IVF?

The vertebral artery typically arises from the subclavian artery and ascends through the neck. At which cervical spine level does the vertebral artery typically first enter the transverse foramen?

During a standard anterior (Smith-Robinson) approach to the lower cervical spine, dissection is carried out between the visceral and carotid sheaths. Which structure is at greatest risk if the self-retaining retractor is placed too forcefully over the longus colli muscle laterally?

During a posterior approach to the upper cervical spine, the surgeon exposes the suboccipital triangle. Which vital structure courses within this anatomical triangle over the posterior arch of C1?

A 14-year-old female gymnast presents with insidious onset of low back pain exacerbated by extension. Plain radiographs are normal. An MRI shows marrow edema in the pars interarticularis of L5 bilaterally without a definitive fracture line. What is the most appropriate initial management?

An 8-month-old infant with achondroplasia presents with profound hypotonia, feeding difficulties, and episodes of central apnea. What is the most likely orthopedic cause of these symptoms?

A 4-month-old infant with achondroplasia presents with hypotonia, hyperreflexia, and episodes of central apnea. What is the most critical next step in diagnostic evaluation?

A 65-year-old male undergoes a multi-level posterior cervical laminectomy and instrumented fusion for severe cervical spondylotic myelopathy. On post-operative day two, he develops isolated, profound weakness in right shoulder abduction and elbow flexion. He has no new sensory deficits, and his myelopathic leg symptoms remain improved. What is the most likely pathophysiologic mechanism of this complication?

A 60-year-old male requires surgical decompression for severe L4-L5 lateral recess stenosis presenting as neurogenic claudication. During the central and lateral decompression, which of the following anatomical structures must be partially resected (undercut) to adequately unroof the traversing L5 nerve root within the lateral recess?

A 45-year-old man presents with right-arm pain, numbness in his thumb and index finger, and weakness in wrist extension. The brachioradialis reflex is diminished. If a herniated nucleus pulposus is the cause, which disc level is most likely affected?

A 25-year-old male arrives at the trauma bay after a motorcycle crash. He has complete loss of motor and sensory function below T10. The bulbocavernosus reflex is absent. Which of the following statements is true regarding his neurological status?

A 28-year-old male suffers a severe spinal cord injury at the T6 level. Initially, he presents with flaccid paralysis and areflexia below the level of the injury, indicative of spinal shock. Which clinical finding signifies the definitive end of the 'spinal shock' phase?

A 35-year-old male sustains a severe hyperflexion-distraction injury to his cervical spine in an MVC. Radiographs demonstrate a traumatic spondylolisthesis of the axis (Hangman's fracture) with severe angulation but minimal translation. The C2-C3 disc space is visibly widened posteriorly. According to the Levine and Edwards classification, which of the following is the most appropriate initial management?

A 65-year-old male presents with deteriorating fine motor skills in his hands. MRI confirms severe cervical spinal stenosis at C4-C6 with cord signal changes. On examination, he can ambulate without assistance but is noticeably unsteady and reports mild difficulty with his gait. According to the Nurick classification for cervical spondylotic myelopathy, what grade corresponds to this patient's clinical status?

A patient with suspected cauda equina syndrome undergoes an emergent MRI. Which of the following clinical findings is considered the most reliable indicator of complete cauda equina syndrome with the poorest prognosis for recovery?

When evaluating a lateral cervical spine radiograph of a 6-year-old child following minor trauma, apparent subluxation of C2 on C3 is noted. Which radiographic line or principle is most useful to distinguish physiologic pseudosubluxation from a true traumatic injury?

A 14-year-old gymnast is diagnosed with a L5 isthmic spondylolysis. Which of the following factors is the strongest risk factor for the progression of spondylolysis to spondylolisthesis?

A 5-year-old girl is brought to the ED after a motor vehicle collision. Neurological exam is normal. The lateral cervical spine radiograph shows 3 mm of anterior translation of C2 on C3. Which radiographic reference line is best used to differentiate physiologic pseudosubluxation from a true traumatic ligamentous injury?