6. Spine MCQs

A 7-year-old child presents with torticollis and severe neck stiffness one week after undergoing a routine tonsillectomy. The child holds their head tilted to the right and rotated to the left. Cervical spine radiographs and a subsequent CT scan demonstrate anterior displacement and rotation of the atlas on the axis without evidence of trauma. What is the most likely diagnosis?

A 70-year-old male with pre-existing multi-level cervical spondylosis sustains a hyperextension injury to his neck during a fall. He presents with severe motor weakness in his upper extremities, but retains relatively preserved functional motor strength in his lower extremities. Which spinal cord tract's anatomical somatotopic arrangement explains this specific pattern of neurological deficit?

A 28-year-old male suffers a stab wound to the right side of his back at the T10 level. Upon examination, he exhibits loss of motor function and proprioception on the right side of his lower extremities, and loss of pain and temperature sensation on the left side. Which of the following best describes this classic neurological presentation?

A 65-year-old male with a 30-year history of advanced ankylosing spondylitis presents to the emergency department with severe, localized thoracic back pain after a minor fall from standing. Initial plain radiographs of the thoracic spine are reported as negative for acute fracture. What is the most appropriate next step in management?

A 15-year-old female gymnast complains of chronic low back pain and radiating left leg pain. Radiographs reveal a Grade II isthmic spondylolisthesis at L5-S1. If this patient is experiencing single-root radicular symptoms, which specific nerve root is most likely compressed by the pathoanatomy of this condition?

A 45-year-old male presents with right-sided neck pain radiating down his arm. Physical exam reveals notable weakness in wrist extension, sensory deficit over the thumb and index finger, and a symmetrically diminished brachioradialis reflex. Which cervical disc herniation level is most likely responsible for these objective findings?

A 35-year-old male dives into a shallow pool and sustains an axial loading injury to his neck. AP open-mouth odontoid radiographs reveal a combined lateral mass overhang of C1 on C2 measuring 8.5 mm. According to the Rule of Spence, this specific radiographic finding suggests rupture of which ligamentous structure?

A traumatic spondylolisthesis of the axis (Hangman's fracture) is characterized by bilateral fractures through the pars interarticularis of C2. What is the classic primary mechanism of injury responsible for this fracture pattern?

A 68-year-old male with a history of an L3-S1 instrumented spinal fusion is planning to undergo a total hip arthroplasty (THA). Evaluation of his spinopelvic parameters demonstrates a stiff spinopelvic junction with an inability to increase his pelvic tilt when transitioning from a standing to a seated position. To minimize the risk of dislocation, how should the acetabular component positioning be modified?

A 68-year-old male with a history of an L2-to-pelvis fusion for degenerative scoliosis is undergoing a primary total hip arthroplasty. Due to his fused lumbosacral spine, his pelvis cannot tilt posteriorly when transitioning from standing to sitting. What complication is he at the highest risk for, and what compensatory adjustment should the surgeon make regarding acetabular cup positioning?

A 72-year-old male with a history of a multi-level lumbar spinal fusion (L2-S1) is undergoing a primary THA. Preoperative standing and sitting lateral spinopelvic radiographs show a change in sacral slope of 5 degrees. How should the acetabular cup positioning be altered to minimize the risk of posterior dislocation during sitting?

A 45-year-old male presents with acute neck pain radiating down his right arm following a weightlifting injury. Neurological examination reveals weakness in wrist extension, diminished sensation over the dorsal web space between the thumb and index finger, and a decreased brachioradialis reflex. Which cervical nerve root is most likely compressed?

A 60-year-old male presents with bilateral hand clumsiness, difficulty buttoning his shirt, and a broad-based, unsteady gait. Physical examination reveals a positive Hoffmann's sign and generalized hyperreflexia. An MRI of the cervical spine is most likely to show significant compression of which of the following structures?

A 68-year-old male presents with bilateral lower extremity pain and cramping that worsens with walking upright, but is completely relieved when he sits or leans forward over a shopping cart. What is the primary pathophysiologic reason for the symptom relief experienced during lumbar flexion?

A 14-year-old gymnast presents with chronic mid-back pain. Lateral radiographs show anterior wedging of greater than 5 degrees in three consecutive thoracic vertebrae, along with Schmorl's nodes. Which of the following is the most likely diagnosis?

A 72-year-old male complains of bilateral leg pain and heaviness that worsens with walking and improves when he leans forward over a shopping cart. MRI of the lumbar spine confirms severe central spinal stenosis. Which pathognomonic ligamentous change most contributes to this dorsal compression?

A 55-year-old female with a history of rheumatoid arthritis presents with neck pain and paresthesias in her hands. Flexion-extension radiographs of the cervical spine demonstrate an atlanto-dens interval (ADI) of 8 mm. Which of the following is the most appropriate management?

A 65-year-old male undergoes a multi-level posterior cervical laminectomy and fusion from C3 to C6 for cervical spondylotic myelopathy. On postoperative day 1, he is noted to have a new-onset right deltoid and biceps weakness (grade 2/5). His sensation is intact, and his myelopathic symptoms in the lower extremities have improved. What is the most appropriate next step in management?