6. Spine MCQs

A 55-year-old female with severe rheumatoid arthritis is evaluated prior to elective surgery. Flexion-extension cervical spine radiographs are obtained. Which of the following parameters represents an absolute indication for operative stabilization of the cervical spine?

A 15-year-old gymnast presents with chronic low back pain that is heavily exacerbated by lumbar extension. Radiographs show a Grade 1 isthmic spondylolisthesis at L5-S1. What is the defining anatomic defect associated with this specific type of spondylolisthesis?

A 10-year-old child with a highly restricted diet presents with lower extremity pain, gingival bleeding, and perifollicular hemorrhages. Radiographs show a dense zone of provisional calcification (white line of Frankel). The pathogenesis involves a deficiency in an essential cofactor required for which of the following enzymatic processes?

A 60-year-old patient with progressive cervical myelopathy is diagnosed with Ossification of the Posterior Longitudinal Ligament (OPLL). Lateral radiographs demonstrate a negative K-line. Which surgical approach is most appropriate to adequately decompress the spinal cord in this specific scenario?

A 72-year-old man complains of bilateral buttock and posterior thigh pain that worsens with walking. You suspect neurogenic claudication secondary to lumbar spinal stenosis. Which of the following historical features is most specific in differentiating neurogenic claudication from vascular claudication?

A 65-year-old man with lumbar spinal stenosis experiences relief of neurogenic claudication symptoms when leaning forward on a shopping cart. What is the primary biomechanical reason for this improvement in symptoms?

A 35-year-old male is brought to the trauma bay after a high-speed collision. He has flaccid paralysis and absent reflexes below C6. He is currently hypotensive (BP 80/40) and bradycardic (HR 45). Which of the following findings confirms neurogenic shock rather than isolated spinal shock?

A 70-year-old male presents with bilateral leg pain and weakness that worsens after walking 2 blocks. He states the pain is relieved when he leans forward on a shopping cart. Which of the following pathophysiological mechanisms primarily contributes to this classic physical sign?

A 25-year-old male falls from a height and sustains an L1 burst fracture. Neurological examination is completely normal. Radiographs and CT show 40% loss of anterior vertebral body height, 15 degrees of local kyphosis, and 30% canal compromise by a retropulsed bone fragment. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is the most appropriate initial management?

A 55-year-old male with severe spinal stenosis complains of progressive leg pain, heaviness, and weakness that worsens with walking. To differentiate neurogenic claudication from vascular claudication, a bicycle test (van Gelderen test) is performed. Which of the following responses is characteristic of neurogenic claudication?

A traumatic spondylolisthesis of the axis (Hangman's fracture) most commonly occurs via which of the following injury mechanisms?

A 28-year-old male is admitted after a severe cervical spine fracture. He is hypotensive, bradycardic, and warm to the touch. This physiologic state is best described as:

A 65-year-old male presents with bilateral leg pain that worsens with walking. Which finding on history or examination most reliably differentiates neurogenic claudication from vascular claudication?

A 55-year-old male presents with acute onset of severe lower back pain, bilateral sciatica, saddle anesthesia, and urinary retention with overflow incontinence. MRI reveals a massive L4-L5 central disc herniation. What is the maximum recommended timeframe for surgical decompression to optimize neurological recovery?

A trauma patient presents with acute spinal cord injury following a fall. Which of the following clinical findings most accurately differentiates neurogenic shock from spinal shock?

A traumatic spondylolisthesis of the axis (Hangman's fracture) typically involves bilateral fractures through the pars interarticularis of C2. In modern clinical practice (e.g., motor vehicle accidents), what is the most common mechanism of injury?

A 45-year-old man with a known L4-L5 disc herniation presents to the emergency department with acute worsening of back pain, bilateral sciatica, and perineal numbness. Which of the following is the most sensitive early clinical indicator to suspect cauda equina syndrome?

A 62-year-old female presents with deteriorating fine motor skills in her hands and recent gait instability. Physical examination reveals a positive Hoffmann sign bilaterally, hyperreflexia in the lower extremities, and an inverted brachioradialis reflex. Which of the following is the best imaging modality to confirm the suspected diagnosis?

A 55-year-old diabetic male presents with severe, progressive back pain, low-grade fevers, and new-onset bilateral leg weakness. Inflammatory markers are significantly elevated. You suspect a spinal epidural abscess. What is the most common causative organism?

During the physical examination of a 60-year-old male with suspected cervical myelopathy, the examiner supports the patient's forearm and strikes the brachioradialis tendon with a reflex hammer. Instead of elbow flexion, the patient exhibits brisk finger flexion. What is this clinical sign called?