6. Spine MCQs

A 6-year-old boy with Morquio syndrome (Mucopolysaccharidosis Type IV) presents with progressive weakness and hyperreflexia in all four extremities. Flexion-extension radiographs of the cervical spine will most likely show instability caused by which underlying anomaly?

A 13-year-old boy with Duchenne Muscular Dystrophy is wheelchair-bound and presents with a 45-degree neuromuscular scoliosis. To minimize perioperative mortality and respiratory complications, spinal fusion is typically indicated before which of the following pulmonary parameters falls below 35%?

A 14-year-old non-ambulatory boy with spastic quadriplegic cerebral palsy presents with an 80-degree neuromuscular scoliosis and severe pelvic obliquity causing sitting imbalance and skin breakdown over the ischium. What is the standard surgical approach for this condition?

A 7-year-old boy presents for evaluation of an asymptomatic spinal deformity. Standing radiographs demonstrate a 30-degree left-sided thoracic scoliosis. His neurological exam is entirely normal. Which of the following is the most appropriate next step in management?

A 12-year-old girl presents with severe lower back pain and radiculopathy. Examination reveals a palpable step-off at the lumbosacral junction. Radiographs show a grade 4 L5-S1 dysplastic spondylolisthesis with a dome-shaped sacrum and a high slip angle. What is the safest and most reliable surgical treatment?

A 10-year-old boy presents with neck pain after a minor fall from a trampoline. Lateral cervical spine radiographs show a rounded, corticated bone fragment situated superior to a hypoplastic dens. Flexion-extension views demonstrate 6 mm of anterior translation of C1 on C2. What is the most likely diagnosis?

A 6-year-old girl presents with torticollis 10 days after undergoing a tonsillectomy. Her head is rotated to the right and tilted to the left. She refuses to move her neck due to pain. Neurologic exam is normal. Which of the following is the most likely diagnosis?

A 12-year-old boy with known Marfan syndrome presents with a 45-degree right thoracic scoliosis. Which of the following statements regarding the behavior and management of scoliosis in Marfan syndrome is most accurate?

An 8-year-old boy with Down syndrome presents with decreasing walking endurance and new-onset clumsiness. Neurological examination reveals hyperreflexia and a positive Babinski sign. Flexion-extension cervical radiographs show atlantoaxial instability. Which of the following radiographic measurements is the most critical threshold indicating the need for surgical stabilization?

A 10-year-old boy with known neurofibromatosis type 1 (NF1) presents with a 45-degree right thoracic scoliosis. Which of the following radiographic findings is most specifically associated with a high risk for rapid, unrelenting curve progression (dystrophic curve)?

A 6-year-old boy with Morquio syndrome (Mucopolysaccharidosis Type IV) is evaluated for decreasing ambulatory function and upper extremity weakness. What is the most likely cervical spine pathology responsible for his presentation?

A 12-year-old boy presents with back pain and a left-sided thoracic scoliosis. Physical examination reveals absent abdominal reflexes on the left side but normal lower extremity strength. What is the most appropriate next step in management?

A 14-year-old girl with neurofibromatosis type 1 has a sharply angulated, dystrophic thoracic kyphoscoliosis measuring 65 degrees. There are no signs of myelopathy. What is the most reliable surgical strategy to achieve a solid arthrodesis and halt progression?

An infant presents with multiple large joint dislocations (hips, knees, and elbows) and spatulate thumbs. A diagnosis of Larsen syndrome is suspected. Which of the following evaluations is most critical to perform early to prevent sudden infant death?

A 6-month-old boy is diagnosed with infantile idiopathic scoliosis. Radiographs demonstrate a 35-degree left thoracic curve. Which of the following Rib-Vertebra Angle Difference (RVAD or Mehta's angle) measurements most strongly predicts that the curve will be progressive rather than resolving?

A 15-year-old boy complains of mid-back pain. Lateral spine radiographs demonstrate a rigid thoracic kyphosis of 65 degrees. To formally diagnose classic Scheuermann's disease (type I), the radiographs must show anterior wedging of at least 5 degrees in how many consecutive vertebrae?

A 10-year-old female with congenital scoliosis is found to have diastematomyelia with a bony spur at T10 on MRI. She is scheduled for surgical deformity correction. How should the diastematomyelia be managed in relation to the deformity surgery?

A 7-year-old boy presents with severe neck pain and a persistent torticollis one week after an uncomplicated tonsillectomy. His head is rotated to the right and tilted to the left. He is afebrile with normal inflammatory markers. What is the most likely diagnosis?

A 14-year-old boy is evaluated for neck pain following a minor tackle in football. Cervical radiographs reveal a round, smoothly corticated ossicle with a wide gap separating it from a hypoplastic odontoid peg. The anterior arch of C1 appears hypertrophied. What is the most likely diagnosis?

A 5-year-old girl is evaluated for an elevated left scapula and limited left shoulder abduction. Radiographs reveal a bony connection extending from the cervical spine spinous processes to the superomedial border of the scapula. What is the eponym for this specific anatomical structure?