6. Spine MCQs

A 4-year-old girl is evaluated for a high-riding left scapula and limited shoulder abduction.

If an omovertebral connection is present in this deformity, between which two structures does it typically articulate or attach?

A 6-year-old boy is diagnosed with Sprengel's deformity. Before planning a surgical correction such as a Woodward procedure, which of the following is the most critical screening evaluation to perform?

A 15-year-old male gymnast presents with a 3-month history of low back pain that worsens with extension activities. Neurological examination is normal. Plain radiographs, including oblique views, are negative for a fracture. What is the most appropriate next imaging modality to evaluate for an acute or stress reaction of the pars interarticularis?

A 5-year-old girl is evaluated after a minor fall. Lateral cervical spine radiographs show a 3 mm anterior translation of C2 on C3. Swischuk's line (spinolaminar line) from C1 to C3 passes exactly through the anterior cortex of the posterior arch of C2. What is the most likely diagnosis?

A 10-year-old girl presents with back pain. Oblique lumbar radiographs reveal a "Scotty dog" sign with a "collar" around the neck. This radiographic finding is pathognomonic for a defect in which anatomic structure?

A 15-year-old gymnast has persistent low back pain unresponsive to 6 months of physical therapy and bracing. Radiographs confirm a Grade II isthmic spondylolisthesis at L5-S1. What is the most appropriate surgical intervention?

A 5-year-old boy is evaluated after a minor motor vehicle collision. A lateral cervical spine radiograph shows 3 mm of anterior displacement of C2 on C3. Swischuk's line passes 1 mm anterior to the anterior aspect of the C3 spinous process. What is the appropriate next step in management?

A 6-month-old infant presents with a left thoracic curve of 28 degrees. Radiographs demonstrate a rib-vertebral angle difference (RVAD) of 26 degrees at the apical vertebra. MRI of the neuroaxis is completely normal. What is the most appropriate initial management?

A 55-year-old male with severe Type I CRPS of the right lower extremity has failed to improve after 4 months of intensive physical therapy, oral NSAIDs, and gabapentin. He exhibits pronounced allodynia and hyperhidrosis. What is the most appropriate next step in confirming the diagnosis of sympathetically maintained pain and providing therapeutic relief?

A 48-year-old female with CRPS Type I of the right lower extremity has failed extensive conservative management, including physical therapy, neuropathic pain medications, and multiple sympathetic nerve blocks.

Her pain remains debilitating and prevents her from participating in rehabilitation. What is the next most appropriate evidence-based intervention?

The AP radiograph of the spine shown demonstrates the 'winking owl' sign. This radiographic finding is most characteristically caused by which of the following pathophysiologic processes?

A patient presents with back pain, and an AP radiograph of the spine is obtained, as shown. The radiograph demonstrates the 'winking owl' sign. This radiographic finding is most characteristic of which of the following pathologic processes?

A 65-year-old man presents with progressive clumsiness in his hands and a wide-based gait. Physical examination reveals hyperreflexia and a positive Hoffman sign.

MRI demonstrates multi-level cervical stenosis. Which of the following MRI findings is the most significant negative prognostic factor for neurologic recovery following surgical decompression?

A 68-year-old man complains of dropping objects, a loss of fine motor dexterity, and a "clumsy" gait. Examination shows a positive Hoffman's sign bilaterally and hyperreflexia. MRI of the cervical spine demonstrates severe stenosis at C4-C5 with an intramedullary hyperintense signal on T2-weighted images. What is the most appropriate management?

A 14-year-old gymnast presents with severe back pain. Radiographs demonstrate an L5-S1 isthmic spondylolisthesis. Which of the following radiographic parameters is the strongest predictor of slip progression and indicates the need for surgical fusion?

A 72-year-old male with a long history of polyostotic Paget's disease presents with progressive bilateral lower extremity weakness, numbness, and neurogenic claudication. What is the most likely cause of his neurologic symptoms?

A 55-year-old patient on hemodialysis presents with mechanical back pain. Lateral radiographs of the lumbar spine demonstrate alternating bands of dense sclerosis at the superior and inferior vertebral body endplates with central lucency.

What is this characteristic radiographic sign called?

A 55-year-old man on hemodialysis presents with chronic back pain. Lateral radiographs of the lumbar spine demonstrate dense sclerotic bands at the superior and inferior endplates of the vertebral bodies, with central radiolucency. What is this classic radiographic sign called?