6. Spine MCQs

An 80-year-old female presents after a ground-level fall with severe neck pain. CT scan reveals a Type II odontoid fracture with 6 mm of posterior displacement. She has a history of severe COPD and ischemic heart disease. What is the most appropriate definitive management?

A 55-year-old male with a 20-year history of ankylosing spondylitis presents with severe neck pain after a low-speed motor vehicle collision. Neurologic exam is intact. Radiographs and CT show a transverse fracture through the C5-C6 disc space extending through the posterior elements. What is the most appropriate surgical treatment?

A 35-year-old male is evaluated after a fall from a ladder. CT imaging demonstrates an L1 burst fracture with 15 degrees of kyphosis and 30% canal compromise. The posterior ligamentous complex (PLC) is completely intact on MRI. Neurologic examination is entirely normal. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate management?

During a posterior spinal fusion for an L4-L5 degenerative spondylolisthesis, the neuromonitoring technician reports a sudden 80% decrease in transcranial motor evoked potentials (MEPs) in the right lower extremity. Somatosensory evoked potentials (SSEPs) remain at baseline. What is the most appropriate immediate first step?

A 42-year-old intravenous drug user presents with 2 weeks of worsening back pain, low-grade fevers, and new-onset bilateral leg weakness (3/5) starting 12 hours ago. Inflammatory markers are markedly elevated. MRI reveals a massive L2-L4 dorsal epidural abscess. What is the most appropriate next step in management?

A 15-year-old competitive gymnast presents with intractable mechanical low back pain for 9 months. She has failed intensive physical therapy and bracing. Radiographs show a Grade II L5-S1 isthmic spondylolisthesis. She has no radicular symptoms. What is the gold-standard surgical intervention for this patient?

A 62-year-old female with long-standing rheumatoid arthritis presents with worsening neck pain and myelopathy. Lateral flexion-extension radiographs show an Atlantodental Interval (ADI) of 8 mm. The posterior Space Available for the Cord (SAC) is 12 mm. What is the most appropriate management?

In a 12-year-old patient with a Grade IV L5-S1 dysplastic spondylolisthesis, radiographic evaluation demonstrates a significantly elevated "slip angle". What does an increased slip angle primarily indicate in this clinical scenario?

A 45-year-old male presents to the emergency department with sudden onset perineal numbness, bilateral sciatica, and inability to void. Bladder scan reveals 700 mL of retained urine. MRI shows a massive central disc extrusion at L4-L5. What is the critical time window for definitive intervention to maximize functional recovery?

A 22-year-old female sustains a seatbelt-type injury in a motor vehicle accident. CT demonstrates an L2 flexion-distraction (Chance) fracture strictly confined to the bone, with avulsion of the posterior spinous process and widening of the pedicles. Neurologic exam is normal. What is the most appropriate primary treatment?

A 30-year-old male presents after a diving accident. Radiographs reveal a fracture through the pars interarticularis of C2 with 4 mm of anterior translation and 12 degrees of angulation of C2 on C3 (Levine-Edwards Type II Hangman's fracture). What is the recommended initial management?

A 50-year-old male complains of radiating neck pain into his right arm, specifically accompanied by numbness in his middle finger. On exam, he has 3/5 weakness in right elbow extension and an absent right triceps reflex. Which cervical disc herniation level is the most likely cause of these findings?

A 2-year-old boy is diagnosed with congenital scoliosis secondary to a fully unsegmented unilateral bar with a contralateral hemivertebra at T8. Prior to any planned surgical intervention, which diagnostic modality is absolutely mandatory?

A 48-year-old female undergoes a right-sided anterior cervical discectomy and fusion (ACDF) at C6-C7. Post-operatively, she complains of significant hoarseness. Direct laryngoscopy confirms a unilateral paralyzed vocal cord. Injury to which of the following structures is most likely responsible?

A 30-year-old male sustains an axial load injury to the cervical spine. An open-mouth odontoid radiograph reveals a combined lateral overhang of the C1 lateral masses on C2 of 8.5 mm. Which of the following is the most appropriate next step in management?

A 65-year-old male with a long-standing history of ankylosing spondylitis presents to the emergency department after a low-energy fall. He complains of severe neck pain but has no neurologic deficits. CT scan reveals a non-displaced, highly unstable extension-type fracture through the C6-C7 disc space. What is the most devastating and relatively common early complication associated with this specific injury pattern?

A 70-year-old male with pre-existing cervical spondylosis presents with severe bilateral arm weakness, particularly in his hands, and relatively preserved lower extremity strength after a hyperextension injury. Perianal sensation is intact. What is the anatomic rationale for this specific pattern of neurologic deficit?

A 22-year-old male is involved in a high-speed motor vehicle accident while wearing a lap belt. Radiographs show a flexion-distraction injury (Chance fracture) at the T12 level. Which of the following associated injuries must be urgently ruled out?

During an anterior cervical discectomy and fusion (ACDF) at C5-C6 using a right-sided approach, the patient develops postoperative hoarseness. Which anatomical feature explains why the recurrent laryngeal nerve is more susceptible to injury on the right side compared to the left during this approach?

A 68-year-old female presents with severe neurogenic claudication. Imaging reveals a Grade 1 degenerative spondylolisthesis at L4-L5 with significant lateral recess stenosis. If a single nerve root is primarily compressed in the lateral recess at this level, which physical exam finding is most likely?