6. Spine MCQs

A 45-year-old male with severe ankylosing spondylitis presents with a fixed thoracolumbar kyphosis. A pedicle subtraction osteotomy (PSO) is planned. Which anatomical level is typically the safest and most appropriate for a PSO to correct global sagittal imbalance?

A 14-year-old non-ambulatory male with Duchenne Muscular Dystrophy (DMD) has a progressive 45-degree scoliosis. His FVC is currently 40% of predicted. What is the most appropriate management?

A 24-year-old male presents with chronic insidious-onset lower back pain that improves with exercise but not with rest. Which initial radiographic finding is most characteristic of early Ankylosing Spondylitis?

A 3-year-old child presents with a progressive 60-degree idiopathic scoliosis. What is the primary rationale for utilizing a growth-friendly construct rather than an immediate definitive spinal fusion?

A 55-year-old male with long-standing ankylosing spondylitis sustains a low-energy fall. CT imaging reveals an acute extension-distraction fracture through the T10-T11 ossified disc space. Due to the altered biomechanics of the ankylosed spine, this patient is at the highest risk for which of the following acute complications?

Achondroplasia is the most common form of short-limb dwarfism and frequently presents with spinal manifestations. Which of the following radiographic findings is a hallmark of the lumbar spine in patients with this condition?

In the evaluation of a 6-month-old infant with infantile idiopathic scoliosis, which of the following radiographic parameters is most highly predictive of curve progression?

A 45-year-old male with severe ankylosing spondylitis presents with a fixed "chin-on-chest" deformity, rendering him unable to gaze horizontally. Surgical correction is planned. Which anatomic level is generally preferred for an extension osteotomy to correct this specific deformity?

A 13-year-old boy with Duchenne Muscular Dystrophy (DMD) has recently become wheelchair-bound. His forced vital capacity (FVC) is 50% of predicted, and standing radiographs reveal a progressive 35-degree thoracolumbar scoliosis with significant pelvic obliquity. What is the most appropriate management?

In predicting the natural history of congenital scoliosis, the morphological type of the vertebral anomaly is the most critical factor. Which of the following anomalies carries the highest risk for rapid and severe curve progression?

Scoliosis is the most common musculoskeletal manifestation of Neurofibromatosis Type 1 (NF1). When evaluating an NF1 patient with a progressive spinal deformity, which combination of radiographic features is pathognomonic for "dystrophic" scoliosis?

A 55-year-old male with long-standing ankylosing spondylitis sustains an extension-distraction fracture through the C6-C7 disc space. Following posterior instrumentation and fusion, he experiences an unexpected postoperative neurological decline in the recovery room. What is the most likely cause of this complication?

A 14-year-old male with non-ambulatory spastic cerebral palsy presents with a progressive 85-degree thoracolumbar scoliosis and severe pelvic obliquity. Posterior spinal fusion to the pelvis is planned. What is the primary biomechanical advantage of utilizing S2-alar-iliac (S2AI) or iliac screws over traditional Galveston rod techniques?

A 28-year-old male with HLA-B27 positive ankylosing spondylitis presents with progressive sacroiliitis and morning stiffness. He has failed a 3-month trial of continuous treatment with two different nonsteroidal anti-inflammatory drugs (NSAIDs). According to current clinical guidelines, what is the most appropriate next pharmacological intervention?

A 35-year-old male with a history of intravenous drug use presents with acute onset of severe low back pain, fever, and progressive bilateral lower extremity weakness. MRI shows discitis and osteomyelitis involving L4-L5 with an epidural abscess. White blood cell count is elevated, and ESR/CRP are significantly raised. What is the most critical initial management step after diagnosis?

Which of the following is an accepted indication for surgical treatment of scoliosis in an adolescent with idiopathic scoliosis?

Which of the following describes the 'safe zone' for anterior screw placement into the vertebral body during pedicle screw fixation of the lumbar spine?

A 65-year-old man complains of progressive clumsiness in his hands and difficulty with fine motor tasks, such as buttoning his shirt. Physical examination reveals a positive finger escape sign and a positive Hoffmann reflex. These findings are most indicative of dysfunction in which of the following anatomical structures?

A 72-year-old male presents with deteriorating handwriting, frequent tripping, and bilateral hand numbness. Examination reveals a positive Hoffmann sign and hyperreflexia in the lower extremities. MRI confirms severe cervical cord compression. Which of the following MRI findings is the strongest predictor of permanent neurological deficits and poor post-surgical recovery?

A 68-year-old male presents with bilateral hand clumsiness, difficulty buttoning his shirts, and frequent tripping. Neurological exam reveals a positive Hoffmann's sign and an inverted supinator reflex. The inverted supinator reflex best localizes the compressive spinal cord pathology to which cervical level?