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6. Spine MCQs

Practice Set 52 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1021

Topic: 6. Spine

One advantage of posterior laminoforaminotomy in the treatment of cervical radiculopathy is:

. Obviates the need for fusion
. Improves nerve root decompression
. Easier access to midline disk herniations
. Improves wound healing
. Improves postoperative alignment

Correct Answer & Explanation

. Obviates the need for fusion

Explanation

The posterior cervical foraminotomy has a surgical success rate similar to an anterior cervical discectomy and fusion. Proponents argue that the posterior procedure obviates the need for fusion, therefore, postoperative immobilization is unnecessary. The posterior approach cannot address segmental kyphosis or recreate disk space height.

Question 1022

Topic: 6. Spine

The most frequently involved spinal segment in rheumatoid arthritis is:

. C1-C2
. C7-T1
. C5-C6
. T12-L1
. L5-S1

Correct Answer & Explanation

. C1-C2

Explanation

C 1-C2 is the most frequently involved spinal segment in rheumatoid arthritis (RA), and it is also the most clinically significant. These articulations are exclusively synovial and the primary target of RA.

Question 1023

Topic: 6. Spine

The most useful measurement for predicting neurological deficit in rheumatoid arthritis involvement of the cervical spine is:

. Flexion angle
. Posterior atlantodens interval (PADI)
. Anterior atlantodens interval (AADI)
. Lordosis angle
. C2-C3 disk height

Correct Answer & Explanation

. Posterior atlantodens interval (PADI)

Explanation

The posterior atlantodens interval (PADI) is the distance between the posterior surface of the dens and the anterior edge of the posterior ring of C 1, as seen on a lateral radiograph. A PADI < 14 mm was 97% sensitive in predicting the presence of neurological deficit. Patients with a PADI >14 mm had a 94% chance of being neurologically intact.

Question 1024

Topic: 6. Spine

A relative contraindication to cervical laminectomy for the treatment of cervical spondylosis is:

. Positive Babinski sign
. C ervical lordosis
. Positive Hoffman sign
. Wrist extensor weakness
. C ervical kyphosis

Correct Answer & Explanation

. C ervical kyphosis

Explanation

Cervical laminectomy for spondylosis is performed to allow the spinal cord to migrate posteriorly in order to decompress the spine. This can be accomplished only if the spine is lordotic. If kyphosis exists, then the cord may remain draped over anterior osteophytes and continued compression may exist. In cases of cervical kyphosis, anterior decompression is preferred.

Question 1025

Topic: 6. Spine

An infant with achondroplasia presents with hypotonia, sleep apnea, and hyperreflexia. Which of the following is the most likely underlying etiology?

. Hydrocephalus
. Foramen magnum stenosis
. Thoracolumbar kyphosis
. Atlantoaxial instability
. Lumbar spinal stenosis

Correct Answer & Explanation

. Foramen magnum stenosis

Explanation

Infants with achondroplasia have abnormal endochondral ossification at the skull base, placing them at high risk for foramen magnum stenosis. This can cause severe cervicomedullary compression, presenting with sleep apnea, hypotonia, and hyperreflexia.

Question 1026

Topic: Thoracolumbar Spine & Deformity

Which of the following radiographic parameters remains essentially fixed throughout life:

. Pelvic tilt
. Sacral slope
. Pelvic incidence
. T1 tilt
. Lumbar lordosis

Correct Answer & Explanation

. Pelvic incidence

Explanation

Pelvic incidence is a measure of the relationship between the superior sacral endplate and the hips. It does not change significantly during life unless there is a major pelvic fracture. Pelvic incidence is defined as the angle between a line connecting the hip center and the midpoint of the S1 endplate, and a perpendicular to the midpoint of the S1 endplate. This angle is fixed in bone. By contrast, all of the other angles vary with posture and age.

Question 1027

Topic: 6. Spine

A 3-year-old boy presents with refusal to walk and a recent history of irritability. He refuses to pick up toys from the floor and maintains a rigidly straight back. ESR is elevated, but WBC is normal. What is the most accurate diagnostic imaging modality for the suspected condition?

. Technetium-99m bone scan
. Computed tomography (CT) of the spine
. Anteroposterior and lateral radiographs of the hips
. Magnetic resonance imaging (MRI) of the spine
. Ultrasound of the paraspinal muscles

Correct Answer & Explanation

. Magnetic resonance imaging (MRI) of the spine

Explanation

The child's presentation (refusal to walk, loss of lumbar lordosis) is classic for pediatric discitis. MRI of the spine with and without contrast is the most sensitive and specific imaging modality for diagnosing discitis.

Question 1028

Topic: 6. Spine

A 3-year-old boy presents with refusal to walk and crying when placed in a sitting position. He is afebrile. Examination shows loss of lumbar lordosis but no focal neurologic deficits. Radiographs of the spine are normal. What is the most appropriate next step in diagnostic imaging?

. CT scan of the abdomen and pelvis
. MRI of the spine with and without contrast
. Technetium-99m bone scan
. Positron emission tomography (PET)
. Repeat radiographs in 2 weeks

Correct Answer & Explanation

. MRI of the spine with and without contrast

Explanation

The clinical presentation is classic for pediatric discitis. MRI is the most sensitive and specific modality for early detection, demonstrating narrowing of the disc space and signal changes in the adjacent vertebral endplates.

Question 1029

Topic: 6. Spine

A 15-year-old female patient undergoes spine fusion from T2 to the pelvis for scoliosis associated with cerebral palsy. Her past medical history is remarkable for seizure disorder, ventriculoperitoneal shunt, baclofen pump, and gastrostomy tube. Her postoperative course is complicated by disorientation and visual hallucinations on postoperative day 3, whereas she had been communicative preoperatively. The most likely cause of this change is:

. Seizure activity
. Postoperative anemia
. Sepsis
. Baclofen withdrawal syndrome
. Hydrocephalus

Correct Answer & Explanation

. Baclofen withdrawal syndrome

Explanation

This patient most likely has baclofen withdrawal due to interference with the catheter at some point along its path to the thecal sac. Baclofen withdrawal is characterized by increased spasticity, pruritus, hyperthermia, delusions, and hallucination. The pump reservoir should be checked, and a leak may be confirmed by filling the reservoir with a radionuclide and performing a scan. Treatment involves repleting baclofen by oral or intrathecal means and fixing the leak.Correct Answer: Baclofen withdrawal syndrome

Question 1030

Topic: 6. Spine
Three years ago, a 20-year-old female patient underwent posterior spinal fusion for adolescent idiopathic scoliosis. She asks what would happen if the implants were removed. The surgeon's most likely response will be:
. The spine will not change alignment, if the fusion is solid.
. The sagittal alignment will likely change, even if the fusion is solid.
. The scoliosis is likely to increase, even if the fusion is solid.
. Fracture of the fusion mass is likely.
. Increased back pain is likely.

Correct Answer & Explanation

. The sagittal alignment will likely change, even if the fusion is solid.

Explanation

After removal of implants, the sagittal alignment is likely to change, with kyphosis increasing by 10° in nearly half of all patients and by more than 20° in 10% of patients. By contrast, scoliosis increases significantly in only 5% of patients. Most patients who have implants removed experience an improvement in symptoms. Fracture of the fusion mass is rare.

Question 1031

Topic: 6. Spine

A 6-year-old boy undergoes a Woodward procedure for Sprengel deformity. What is the primary surgical objective of this procedure?

. Osteotomy of the clavicle to allow shoulder advancement
. Resection of the coracoid process and transfer of the short head of the biceps
. Distal detachment and inferior advancement of the paraspinal muscular origins of the scapula
. Fusion of the omovertebral bone to the cervical spine
. Excision of the entire body of the scapula

Correct Answer & Explanation

. Osteotomy of the clavicle to allow shoulder advancement

Explanation

The Woodward procedure treats Sprengel deformity (congenital undescended scapula) by releasing the paraspinal origins of the trapezius and rhomboids, excising the omovertebral bone if present, and advancing the muscles inferiorly to lower the scapula.

Question 1032

Topic: 6. Spine

A 12-year-old boy presents for evaluation of a spinal curvature (Slide 1). Which of the following is the most likely cause of the spinal curve:

. Idiopathic scoliosis
. Neurofibromatosis
. Osteoid osteoma
. Limb length inequality
. Cerebral palsy

Correct Answer & Explanation

. Limb length inequality

Explanation

This patient has a 2.5 cm shortening of the left lower extremity, which can be seen from the uneven pelvic height on the radiograph. The shortening produces a compensatory curve. No rotation is present within the curve. Scanogam (Slide 2) documents the inequality. When the patient stands on a 2.5-cm lift, the curve is eliminated (Slide 3).

Question 1033

Topic: 6. Spine

In the embryo, cells from the ectodermal layer give rise to which elements of the spine:

. Spinal cord
. Vertebral body
. Paraspinous muscle
. Nucleus pulposus
. Annulus fibrosis

Correct Answer & Explanation

. Spinal cord

Explanation

The spine is formed from all three elements of the embryonic plate (Slide). The ectoderm develops into a groove, folding into a tube that becomes the spinal cord. The endoderm gives rise to the notochord, which serves as the organizing structure for the spinal column. The notochord persists as thenucleus pulposus. The mesoderm gives rise to muscles and bony elements of the spinal column.

Question 1034

Topic: 6. Spine

How many somites are involved in formation of each vertebral body of the thoracolumbar spine:

. None
. One
. Two
. Three
. Four

Correct Answer & Explanation

. Two

Explanation

The somites are repeating groups of axial mesodermal cells that give rise to the osseous and musculoligamentous elements of the spine during embryonic formation. Each somite divides and contributes to two adjacent vertebral bodies.

Question 1035

Topic: Thoracolumbar Spine & Deformity

Which of the following treatment options is recommended for the patient shown in the image (Slide 1, Slide 2):

. Halo-vest immobilization
. Minerva cast immobilization
. Soft cervical collar
. Open reduction and internal fixation
. Atlantoaxial arthrodesis

Correct Answer & Explanation

. Open reduction and internal fixation

Explanation

Treatment must address the fracture of the C 2 pars interarticularis and the C 2-C 3 facet subluxation. Options include traction to reduce the subluxation followed by external immobilization, or open reduction of the facet subluxation, which includes the opportunity to internally fix the fracture. Traction failed in this patient because the fracture eliminates a means to pullon the arch of C 2. If facet subluxation is not present, then a cervicothoracic orthosis such as a Philadelphia collar is adequate for healing of the C 2 spondylolysis.

Question 1036

Topic: Cervical Spine
A 7-year-old boy is intubated after being involved in a motor vehicle accident. His lateral cervical film (Slide 1) reveals a:
. Normal study
. Jefferson fracture
. Hangman's fracture
. Occiput-C2 subluxation
. Subaxial subluxation

Correct Answer & Explanation

. Occiput-C2 subluxation

Explanation

Extensive prevertebral soft tissue swelling is present. This patient received an injury that disrupted the ligaments of the atlantooccipital and atlantoaxial joint. Additionally, he has a congenital synchondrosis of the C1 ring. The dens-basion distance (dens to the anterior rim of the foramen magnum) is 13 mm; the normal distance is less than 10 mm to 12 mm. The patient is pentaplegic. Three-dimensional computed tomography scans (Slide 2, Slide 3) are presented.

Question 1037

Topic: 6. Spine

The images presented (Slide 1, Slide 2) depict which process:

. Spondylolisthesis
. Spondylolysis (pars defect)
. Aneurysmal bone cyst
. Herniated nucleus pulposus
. Degenerative disk disease

Correct Answer & Explanation

. Spondylolysis (pars defect)

Explanation

The images presented depict a pars interarticularis fracture of the third lumbar vertebra.

Question 1038

Topic: Cervical Spine

A 6-year-old child is involved in a motor vehicle accident. What injury is demonstrated by the computed tomography (C T) (Slide

. Jefferson fracture
. Transverse ligament injury
. Odontoid fracture
. Hangmans fracture
. Pseudosubluxation

Correct Answer & Explanation

. Transverse ligament injury

Explanation

This patient has an avulsion injury of the transverse ligament of the atlas. The bony avulsion is visible from its attachment to the left lateral mass and allows the atlas to move forward in relation to the axis. Hematoma and occiptocervical flexion is visible on the MRI. If it were anodontoid injury, the odontoid would still have a normal relationship to the ring of C 1 on the C T. Treatment involves reduction and fusion of C 1-C 2.

Question 1039

Topic: Thoracolumbar Spine & Deformity

A 15-year-old gymnast presents with chronic lower back pain. Radiographs demonstrate a grade II isthmic spondylolisthesis at L5-S1. She has failed 6 months of conservative management. What is the most appropriate surgical intervention?

. L5-S1 anterior lumbar interbody fusion
. L5-S1 posterolateral in situ fusion
. Laminectomy without fusion
. L4-S1 posterolateral fusion
. Sacroiliac joint fusion

Correct Answer & Explanation

. L5-S1 posterolateral in situ fusion

Explanation

For symptomatic low-grade isthmic spondylolisthesis in adolescents failing conservative care, an in situ posterolateral fusion of L5-S1 is the standard surgical treatment. Decompression alone is contraindicated due to instability.

Question 1040

Topic: 6. Spine

A 14-year-old gymnast presents with chronic low back pain exacerbated by extension. Radiographs and an MRI confirm a bilateral pars interarticularis defect at L5 without spondylolisthesis. What is the most appropriate initial management?

. Posterior spinal fusion
. Pars repair (Buck's technique)
. Activity restriction and physical therapy
. Epidural steroid injection
. Laminectomy

Correct Answer & Explanation

. Activity restriction and physical therapy

Explanation

Spondylolysis in a young athlete is initially managed conservatively with a period of rest, bracing (optional), and core strengthening physical therapy.

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