6. Spine MCQs

A 38-year-old man injured his neck and spinal cord 6 months ago as a result of a motorcycle accident. He is now a C 6 quadriplegic. He wants to know how his sexual function will be affected by his condition. The patient should be informed that:

When testing the range of motion in the lumbar spine, which maneuver involves stretching of the interspinous and supraspinous ligaments, ligamentum flavum, and posterior longitudinal ligament while relaxing the anterior longitudinal ligament:

A 22-year-old woman sustained an injury to her low back 1 year ago while playing rugby. She now complains of excruciating low back pain with numbness and tingling into her left buttock. This pain is affecting her daily living activities. The patient underwent 6 months of conservative management consisting of restriction of activities, physical therapy, and anti- inflammatory medication with little relief. Based on the image below, the next appropriate step in the management of this patient is:

A 72-year-old man comes to the office complaining of low back and thigh pain that has been progressively getting worse over the years. The pain now bothers him during weather changes. The patient tells you that his pain is worse with standing and walking for long periods. However, leaning forward and sitting alleviates his discomfort. The patient denies any bladder or bowel complaints. This patient most likely has:

A positive straight-leg raise sign:

In describing idiopathic scoliosis, there are several terms given to curve patterns on radiographs to describe the specific type of spinal deformity present. Which term best describes an area of the spine with a lateral curve that lacks normal flexibility noted radiographically by its failure to demonstrate segmental mobility or correction on supine side-bending radiographs:

When trying to distinguish hamstring tightness/discomfort from sciatic pain/radiculopathy, surgeons can perform a straight-leg raise test on the affected side until the point at which the patient develops discomfort. This is followed by slightly lowering the affected extremity. While holding the patient's leg in this position, what maneuver could be performed in order to help reproduce true sciatic pain:

Which anatomic structure(s) may be the cause of referred pain to the lumbar spine region:

A 72-year-old man with a known history of severe cervical spondylosis falls forward and strikes his chin. He is brought to the emergency department presenting with severe weakness in his upper extremities, particularly the hands, but retains the ability to move his legs against gravity. Which spinal cord syndrome does this presentation most likely represent?

A 55-year-old diabetic patient presents with a 2-week history of progressively worsening mid-back pain, low-grade fever, and a recent onset of bilateral lower extremity weakness. What is the most common causative organism for the suspected diagnosis?

A 40-year-old man with a 15-year history of ankylosing spondylitis presents to the emergency department after a minor trip and fall at home. He complains of new-onset neck pain but has no neurologic deficits. Plain radiographs of the cervical spine are heavily obscured by his shoulders. What is the next best step in management?

A 25-year-old man dives into a shallow pool and sustains a Jefferson burst fracture of the atlas (C1). According to the rule of Spence, what is the threshold of total combined overhang of the C1 lateral masses on an open-mouth odontoid radiograph that suggests a rupture of the transverse atlantal ligament?

A 65-year-old male presents with bilateral leg pain that worsens with walking and improves when leaning forward on a shopping cart. Based on the likely diagnosis shown in the representative MRI, what is the most appropriate surgical intervention if prolonged conservative management fails?

A 19-year-old female is involved in a high-speed motor vehicle collision while wearing only a lap belt. She sustains a Chance fracture of L2. Which of the following associated injuries must be highly suspected and ruled out?

A 32-year-old male presents after a motor vehicle accident with neck pain. Neurological examination is intact. Based on the lateral cervical spine radiograph below, what is the most appropriate initial management for a Type II traumatic spondylolisthesis of the axis?

A 68-year-old female complains of bilateral leg pain and heaviness that worsens after walking two blocks. The pain is relieved when she sits or leans forward over a shopping cart. What is the most likely anatomic cause of her symptoms?

A 25-year-old male sustains a severe hyperflexion injury to his thoracic spine. On examination, he has no motor function below the umbilicus and no sensation except for intact perianal sensation (S4-S5). There is no voluntary anal sphincter contraction. What ASIA impairment scale grade does this represent?

In a patient with long-standing rheumatoid arthritis undergoing pre-operative evaluation for a total hip arthroplasty, flexion-extension cervical radiographs are obtained. Which finding would most strongly indicate the need for prophylactic cervical spine stabilization?

A 75-year-old male with known cervical spondylosis falls forward, striking his chin. He presents with severe bilateral upper extremity weakness, particularly in the hands, but retains near-normal strength in his lower extremities. Pain and temperature sensation are diminished in a cape-like distribution. What is the most likely diagnosis?

A 22-year-old male suffers a stab wound to the right side of his back at the T8 level. Examination reveals loss of ipsilateral motor function and proprioception below the lesion, along with contralateral loss of pain and temperature sensation. Which spinal cord tract is responsible for the patient's loss of pain and temperature sensation?