6. Spine MCQs

A 55-year-old woman underwent an L4-S1 posterior spinal fusion 5 years ago. She now presents with new-onset L3 radiculopathy. Radiographs demonstrate a new grade 1 spondylolisthesis at L3-L4. Which of the following is considered the strongest modifiable intraoperative risk factor for the development of adjacent segment disease (ASD)?

A 48-year-old man presents with severe acute right anterior thigh pain and weakness in knee extension. An MRI reveals a far-lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed by this specific herniation?

A 65-year-old man presents with mild back stiffness. Radiographs show flowing ossification along the anterolateral aspect of four contiguous thoracic vertebral bodies with preservation of disc height and absence of sacroiliac joint sclerosis. What is the most likely diagnosis?

A 55-year-old male presents with progressive upper extremity clumsiness and lower extremity spasticity. CT imaging reveals ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. If an anterior cervical corpectomy is planned, what is the most significant intraoperative risk specifically associated with OPLL excision?

A 45-year-old female presents with right-sided neck pain radiating to her thumb and index finger. Physical examination reveals weakness in wrist extension and a diminished brachioradialis reflex. Which cervical nerve root is most likely affected, and between which vertebrae does it exit?

A 28-year-old male is involved in a motor vehicle accident and sustains an L1 burst fracture with 40% loss of anterior vertebral body height and 30% canal compromise. He is neurologically intact, and MRI confirms the posterior ligamentous complex (PLC) is intact. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is the appropriate management?

An 82-year-old man sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact but has multiple medical comorbidities. Which of the following treatments is associated with an unacceptably high rate of mortality in this specific demographic and is generally avoided?

A 45-year-old male presents with severe acute right leg pain radiating to the anterior thigh. Physical examination reveals weakness in right knee extension and a diminished patellar tendon reflex. An MRI of the lumbar spine reveals a far-lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 62-year-old female presents with neurogenic claudication. Radiographs demonstrate a grade 1 degenerative spondylolisthesis at L4-L5. Which of the following anatomical variations is most strongly associated with the development of degenerative spondylolisthesis at this level?

A 50-year-old male presents to the emergency department with severe lower back pain, new-onset urinary retention, and perianal numbness following a heavy lifting injury. Post-void residual is 400 mL. Which of the following is the most appropriate management?

A 48-year-old mechanic complains of right arm pain, numbness in his long (middle) finger, and weakness when extending his elbow and flexing his wrist. Examination reveals an absent triceps reflex on the right. An MRI of the cervical spine is most likely to show nerve root compression at which level?

A 35-year-old intravenous drug user presents with progressive back pain, subjective fevers, and bilateral lower extremity weakness. MRI with gadolinium reveals a ventral epidural fluid collection with rim enhancement spanning L2-L4. Which organism is most likely responsible for this condition?

A 55-year-old male with a 20-year history of ankylosing spondylitis presents to the trauma bay after a low-speed motor vehicle collision. He complains of severe lower cervical pain. CT of the cervical spine reveals a transverse fracture through the C6 vertebral body extending into the posterior elements. What is the most appropriate definitive management?

A 65-year-old male is 3 years status post an L3-L5 posterior lumbar interbody fusion. He now presents with new-onset L2 radiculopathy and imaging shows severe stenosis at the L2-L3 level. Which of the following intraoperative factors during his index surgery places him at the highest risk for developing this adjacent segment disease?

A 55-year-old Asian male presents with progressive clumsiness in his hands and a wide-based gait. CT of the cervical spine reveals a continuous ossified mass posterior to the vertebral bodies from C3 to C6. If an anterior decompression (corpectomy) is planned, what is the most significant intraoperative complication directly associated with the pathology?

A 30-year-old male falls from a ladder and sustains an L1 burst fracture. He is neurologically intact. MRI demonstrates that the posterior ligamentous complex (PLC) is intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate treatment recommendation?

A 16-year-old gymnast presents with chronic lower back pain that radiates into her buttocks and posterior thighs. Radiographs demonstrate an isthmic spondylolisthesis at L5-S1. If this patient were to develop radiculopathy due to foraminal stenosis from the pars defect fibrocartilage, which nerve root is most commonly affected?

In the evaluation of adult spinal deformity, assessing spinopelvic parameters is essential. Which of the following statements best describes pelvic incidence (PI)?

A 65-year-old male presents with severe multilevel cervical spondylotic myelopathy from C3 to C6. Lateral radiographs demonstrate preservation of normal cervical lordosis (20 degrees). Which of the following surgical approaches is most appropriate and minimizes the risk of adjacent segment disease?