6. Spine MCQs

A 78-year-old male with long-standing rheumatoid arthritis presents with progressive quadriparesis and severe neck pain. Flexion-extension radiographs of the cervical spine demonstrate an atlanto-dens interval (ADI) of 11 mm. What is the most appropriate treatment?

A 55-year-old female undergoes a posterior L4-L5 laminectomy and fusion for degenerative spondylolisthesis. On postoperative day 2, she develops a sudden severe headache, photophobia, and nausea when standing, which resolves when lying completely flat. The surgical wound is dry and intact. What is the most likely etiology of her symptoms?

A patient with suspected diffuse idiopathic skeletal hyperostosis (DISH) is evaluated in the clinic. Which of the following radiographic criteria is essential for the formal diagnosis of DISH (Resnick and Niwayama criteria)?

Which physical examination test is most specific for evaluating the presence of cervical radiculopathy?

A 45-year-old female undergoes an anterior cervical discectomy and fusion (ACDF) at C5-C6. During the immediate postoperative period in the recovery room, she develops a rapidly expanding anterior neck mass, respiratory distress, and stridor. What is the most critical and immediate step in her management?

A 68-year-old female is scheduled to undergo a primary total hip arthroplasty (THA). She has a history of a solid instrumented lumbar fusion from L2 to the sacrum. How does this patient's prior spinal fusion alter the normal spinopelvic biomechanics during the transition from a standing to a sitting position, and what compensatory intraoperative adjustment in acetabular component positioning should the surgeon consider?

A 60-year-old female presents with lower back pain and neurogenic claudication. Radiographs reveal a grade I degenerative spondylolisthesis. At which spinal level is this condition most commonly found, and what anatomical variation is most heavily implicated in its pathogenesis?

A 52-year-old man presents with acute onset, severe right leg pain radiating down the anterior thigh to the medial aspect of his lower leg. Physical exam reveals weakness in knee extension and a diminished right patellar reflex. MRI demonstrates a far lateral (extra-foraminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 62-year-old male presents with deteriorating fine motor skills in his hands and broad-based gait. Examination reveals hyperreflexia in the lower extremities and a positive Hoffmann's sign. Striking the brachioradialis tendon yields a diminished brachioradialis reflex but brisk, involuntary flexion of the ipsilateral fingers. What is this specific physical finding called, and what level of pathology does it indicate?

A 70-year-old male with long-standing ankylosing spondylitis presents to the emergency department after a low-energy fall from a standing height. He reports severe, new-onset lower neck pain. Plain radiographs of the cervical spine appear heavily ossified but no obvious fracture is visualized. Neurologic examination is completely normal. What is the most appropriate next step in management?

A 74-year-old male presents with bilateral buttock and calf pain that worsens with walking and is relieved by sitting or leaning forward over a shopping cart.

He undergoes a stationary bicycle test, during which he pedals continuously for 20 minutes while leaning forward without experiencing leg pain. What anatomical mechanism explains the relief of his symptoms during lumbar flexion?

A 62-year-old male undergoes a C3-C6 posterior cervical laminectomy and instrumented fusion for severe cervical spondylotic myelopathy. On post-operative day 1, he demonstrates a new, isolated weakness in shoulder abduction and elbow flexion, but sensation is fully intact. Which of the following is the most widely accepted etiology for this complication?

A 70-year-old man undergoes an L4-L5 posterior decompression and fusion for severe spinal stenosis. Postoperatively, he develops a new foot drop and numbness over the dorsal web space between the first and second toes. Which nerve root is most likely injured, and what is the primary muscle affected?

A 62-year-old man undergoes a C3-C6 posterior cervical laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops profound weakness in bilateral shoulder abduction and elbow flexion, but no new sensory changes or long-tract signs. What is the most likely cause of this complication?

When calculating the pelvic incidence (PI) in a patient with adult spinal deformity, which two anatomical landmarks are utilized to form the angle?

A 54-year-old diabetic male presents with severe back pain, fever, and progressive lower extremity weakness. MRI reveals an anterior epidural abscess at L2-L3 with extensive vertebral body destruction and kyphosis. He is unable to move his legs against gravity. What is the most appropriate definitive surgical management?

A 60-year-old female with metastatic breast cancer presents with severe, mechanical back pain. Which of the following parameters is evaluated in the Spinal Instability Neoplastic Score (SINS) to determine her need for surgical stabilization?

A 45-year-old man with a 15-year history of ankylosing spondylitis falls from a standing height. He complains of severe neck pain but his neurological examination is normal. Plain radiographs of the cervical spine appear unremarkable. What is the most appropriate next step in management?

A 65-year-old female presents with neurogenic claudication and an L4-L5 degenerative spondylolisthesis. She has failed 6 months of conservative treatment. According to the Spine Patient Outcomes Research Trial (SPORT), which of the following is true regarding her treatment options?