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6. Spine MCQs

Practice Set 7 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 121

Topic: 6. Spine

During the initial assessment of a complete cervical spinal cord injury, the return of the bulbocavernosus reflex clinically signifies:

. The transition from complete to incomplete spinal cord injury
. The end of spinal shock
. The onset of neurogenic shock
. Spontaneous functional recovery of the sacral roots
. Development of autonomic dysreflexia

Correct Answer & Explanation

. The end of spinal shock

Explanation

The bulbocavernosus reflex is typically the first reflex to return after a spinal cord injury. Its return signifies the end of spinal shock, meaning any persistent neurologic deficits are likely permanent.

Question 122

Topic: 6. Spine

Unilateral cervical facet dislocation typically occurs via which distinct mechanism of injury?

. Hyperextension and axial loading
. Flexion and distraction combined with rotation
. Pure axial loading
. Lateral bending and pure compression
. Pure hyperflexion

Correct Answer & Explanation

. Flexion and distraction combined with rotation

Explanation

Unilateral facet dislocations result from a coupling of flexion, distraction, and axial rotation. This causes one inferior articular process to ride up and over the superior articular process of the vertebra below.

Question 123

Topic: 6. Spine

Which of the following defines the 'K-line' in the evaluation of cervical ossification of the posterior longitudinal ligament (OPLL)?

. A straight line connecting the midpoints of the spinal canal at C2 and C7
. A straight line connecting the anterior border of the foramen magnum to the C7 body
. A line tracing the posterior margins of the vertebral bodies from C2 to C7
. A line connecting the spinous processes of C2 and C7
. A line measuring the sagittal vertical axis from the C2 plumb line to S1

Correct Answer & Explanation

. A straight line connecting the midpoints of the spinal canal at C2 and C7

Explanation

The K-line connects the midpoints of the anteroposterior diameter of the spinal canal at C2 and C7. If the OPLL exceeds this line anteriorly (K-line negative), posterior decompression alone is insufficient.

Question 124

Topic: 6. Spine

When evaluating the boundaries of the cervical intervertebral foramen, which anatomical structure forms its anterior border?

. Ligamentum flavum
. Superior articular process
. Inferior articular process
. Uncovertebral joint (joint of Luschka)
. Pedicle of the superior vertebra

Correct Answer & Explanation

. Uncovertebral joint (joint of Luschka)

Explanation

The anterior border of the cervical intervertebral foramen is formed by the uncinate process (uncovertebral joint) and the adjacent intervertebral disc. Hypertrophy here directly compresses the exiting nerve root.

Question 125

Topic: 6. Spine

Using the Subaxial Cervical Spine Injury Classification (SLIC) system, what is the total score for a neurologically intact patient presenting with a simple C5 burst fracture and an intact posterior ligamentous complex on MRI?

. 2
. 3
. 4
. 5
. 6

Correct Answer & Explanation

. 2

Explanation

The SLIC score assigns 2 points for a burst morphology. With an intact discoligamentous complex (0 points) and intact neurologic status (0 points), the total score is 2, indicating nonoperative management.

Question 126

Topic: Cervical Spine

To mitigate the incidence of postoperative dysphagia following a multi-level Anterior Cervical Discectomy and Fusion (ACDF), which intraoperative maneuver is most supported by evidence?

. Deflating and re-inflating the endotracheal tube cuff after deep retractor placement
. Utilizing the highest profile anterior cervical plate available
. Maintaining the cervical spine in maximum hyperextension
. Routinely placing retractor blades deep into the longus colli muscle bellies
. Avoiding the use of any local anesthetics near the esophagus

Correct Answer & Explanation

. Deflating and re-inflating the endotracheal tube cuff after deep retractor placement

Explanation

Deflating and subsequently re-inflating the endotracheal tube cuff after retractor placement reduces the compressive pressure against the pharyngeal wall and recurrent laryngeal nerve, significantly lowering the risk of postoperative dysphagia.

Question 127

Topic: 6. Spine

Horner's syndrome, a known complication of lower cervical spine surgery or trauma, results from injury to the sympathetic chain. At what precise anatomical location does the sympathetic trunk typically form the stellate ganglion?

. Anterior to the C3 vertebral body
. Anterior to the C4-C5 disc space
. Anterior to the C6 vertebral body
. Anterior to the C7-T1 junction and neck of the first rib
. Within the carotid sheath at the C5 level

Correct Answer & Explanation

. Anterior to the C7-T1 junction and neck of the first rib

Explanation

The stellate ganglion is formed by the fusion of the inferior cervical and the first thoracic sympathetic ganglia. It is located anterior to the C7-T1 junction, making it vulnerable during cervicothoracic junction approaches.

Question 128

Topic: Cervical Spine

An 82-year-old male with severe congestive heart failure and COPD sustains a Type II odontoid fracture after a low-energy fall. He is neurologically intact. Which of the following is the most appropriate management for this patient?

. Halo vest immobilization
. Rigid cervical collar immobilization
. Anterior odontoid screw fixation
. Posterior C1-C2 transarticular screws
. Occipitocervical fusion

Correct Answer & Explanation

. Rigid cervical collar immobilization

Explanation

In elderly patients with severe comorbidities, rigid cervical collar immobilization is heavily favored. Surgical intervention and halo vest placement both carry unacceptably high morbidity and mortality rates in frail, elderly populations.

Question 129

Topic: 6. Spine

A 55-year-old male presents with severe radicular leg pain. Magnetic resonance imaging demonstrates a far lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely to be compressed?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. L4

Explanation

A far lateral (extraforaminal) disc herniation compresses the exiting nerve root at that specific level. Therefore, an L4-L5 far lateral disc herniation compresses the L4 nerve root.

Question 130

Topic: 6. Spine

Degenerative spondylolisthesis most commonly occurs at which spinal level, and is associated with which facet joint orientation?

. L3-L4 with coronally oriented facets
. L4-L5 with sagittally oriented facets
. L4-L5 with coronally oriented facets
. L5-S1 with sagittally oriented facets
. L5-S1 with coronally oriented facets

Correct Answer & Explanation

. L4-L5 with coronally oriented facets

Explanation

Degenerative spondylolisthesis most commonly affects the L4-L5 level. It is strongly associated with sagittally oriented facet joints, which provide less biomechanical resistance to anterior shear forces.

Question 131

Topic: 6. Spine

Which of the following clinical presentations is the hallmark of Central Cord Syndrome?

. Complete loss of motor and sensory function below the level of injury
. Ipsilateral motor loss and contralateral pain/temperature loss
. Bilateral loss of pain and temperature with preserved proprioception
. Bilateral upper extremity motor weakness that is greater than lower extremity weakness
. Saddle anesthesia with asymmetrical lower extremity weakness

Correct Answer & Explanation

. Bilateral upper extremity motor weakness that is greater than lower extremity weakness

Explanation

Central cord syndrome typically occurs after a hyperextension injury in a stenotic cervical spine. It selectively damages the centrally located cervical tracts, causing disproportionately greater motor impairment in the upper extremities compared to the lower extremities.

Question 132

Topic: 6. Spine

A 45-year-old man with advanced Ankylosing Spondylitis suffers a hyperextension injury to his neck. Initial CT shows a C6-C7 fracture through the disc space. Two days post-admission, he develops sudden, rapidly progressive quadriplegia. What is the most likely cause of his deterioration?

. Syringomyelia
. Epidural hematoma
. Vertebral artery dissection
. Spinal cord infarction
. Subdural empyema

Correct Answer & Explanation

. Epidural hematoma

Explanation

Patients with Ankylosing Spondylitis have highly vascularized epidural spaces and altered biomechanics, placing them at an exceptionally high risk for developing an epidural hematoma following spinal fractures. Prompt MRI and decompression are required.

Question 133

Topic: 6. Spine

A patient presents with a severe L5 radiculopathy due to an L4-L5 paracentral disc herniation. Which of the following physical examination findings is most specific to the L5 nerve root?

. Decreased patellar reflex
. Weakness in ankle plantar flexion
. Weakness in extensor hallucis longus
. Numbness along the medial aspect of the calf
. Positive femoral nerve stretch test

Correct Answer & Explanation

. Weakness in extensor hallucis longus

Explanation

The L5 nerve root innervates the extensor hallucis longus and supplies sensation to the dorsum of the foot and the first web space. The patellar reflex is mediated by L4, and ankle plantar flexion is primarily S1.

Question 134

Topic: 6. Spine

What is the classic clinical triad for a spinal epidural abscess, and what is the gold-standard imaging modality for diagnosis?

. Back pain, fever, neurologic deficit; MRI with gadolinium
. Back pain, fever, neurologic deficit; CT myelogram
. Radiculopathy, fever, clonus; Non-contrast MRI
. Radiculopathy, claudication, fever; Technetium bone scan
. Kyphosis, fever, weight loss; PET scan

Correct Answer & Explanation

. Back pain, fever, neurologic deficit; MRI with gadolinium

Explanation

The classic triad for a spinal epidural abscess is back pain, fever, and progressive neurologic deficit. The gold standard for diagnosis is a gadolinium-enhanced MRI of the entire spine to evaluate for skip lesions.

Question 135

Topic: Thoracolumbar Spine & Deformity

Which of the following describes the widely accepted radiographic diagnostic criteria for Scheuermann's kyphosis?

. Anterior wedging of >3 degrees in 5 consecutive vertebrae
. Anterior wedging of >5 degrees in 3 consecutive vertebrae
. Anterior wedging of >10 degrees in 2 consecutive vertebrae
. Lateral wedging of >5 degrees in 3 consecutive vertebrae
. The presence of Schmorl's nodes in any 3 vertebrae regardless of wedging

Correct Answer & Explanation

. Anterior wedging of >5 degrees in 3 consecutive vertebrae

Explanation

The classic Sorensen criteria for diagnosing Scheuermann's disease require radiographic evidence of anterior vertebral body wedging of greater than 5 degrees in at least three consecutive vertebrae.

Question 136

Topic: 6. Spine

A Hangman's fracture represents a traumatic spondylolisthesis of the axis (C2). What is the primary mechanism of injury responsible for this fracture pattern?

. Hyperflexion and distraction
. Hyperextension and axial loading
. Axial rotation
. Lateral compression
. Flexion and compression

Correct Answer & Explanation

. Hyperextension and axial loading

Explanation

A Hangman's fracture involves bilateral pars interarticularis fractures of C2. It is typically caused by hyperextension combined with axial loading forces, frequently seen in motor vehicle accidents or falls.

Question 137

Topic: 6. Spine

A 65-year-old male with severe Cervical Spondylotic Myelopathy (CSM) requires surgical decompression. Preoperative radiographs reveal a rigid cervical kyphosis of 15 degrees. Which of the following surgical approaches is most appropriate?

. Posterior cervical laminectomy alone
. Posterior cervical laminoplasty
. Anterior cervical discectomy and fusion (ACDF) or corpectomy
. Posterior microdiscectomy
. Posterior cervical foraminotomy

Correct Answer & Explanation

. Anterior cervical discectomy and fusion (ACDF) or corpectomy

Explanation

Posterior decompression procedures (laminectomy or laminoplasty) rely on the spinal cord drifting backward away from anterior compression, which cannot occur in a kyphotic spine. An anterior or combined approach is necessary when the spine is kyphotic.

Question 138

Topic: Thoracolumbar Spine & Deformity

According to the Denis three-column classification of thoracolumbar fractures, which structures comprise the middle column?

. Anterior longitudinal ligament and anterior half of the vertebral body
. Posterior half of the vertebral body, posterior half of the annulus fibrosus, and PLL
. Facet joints, ligamentum flavum, and posterior neural arch
. Spinous processes and interspinous ligaments
. Pedicles, laminae, and pars interarticularis

Correct Answer & Explanation

. Posterior half of the vertebral body, posterior half of the annulus fibrosus, and PLL

Explanation

The Denis middle column consists of the posterior half of the vertebral body, the posterior half of the annulus fibrosus, and the posterior longitudinal ligament (PLL). Disruption of this column distinguishes a burst fracture from a simple compression fracture.

Question 139

Topic: 6. Spine

A 70-year-old man presents with bilateral leg pain upon walking. Which of the following historical features most strongly differentiates neurogenic claudication from vascular claudication?

. Pain relief when standing completely still
. Decreased bilateral pedal pulses
. Proximal-to-distal symptom progression
. Pain palliation when leaning forward or pushing a shopping cart
. Symptoms strictly elicited by stationary biking

Correct Answer & Explanation

. Pain palliation when leaning forward or pushing a shopping cart

Explanation

Flexion of the lumbar spine (e.g., leaning over a shopping cart) increases the cross-sectional area of the spinal canal and neural foramina, temporarily relieving compression on the cauda equina in neurogenic claudication.

Question 140

Topic: 6. Spine

Grisel's syndrome is best defined as which of the following?

. Atlantoaxial subluxation associated with severe rheumatoid arthritis
. Non-traumatic atlantoaxial rotatory subluxation secondary to head/neck infection or ENT surgery
. A burst fracture of the C1 ring from an axial loading mechanism
. Congenital fusion of the cervical spine with a short neck and low hairline
. Basilar invagination secondary to osteogenesis imperfecta

Correct Answer & Explanation

. Non-traumatic atlantoaxial rotatory subluxation secondary to head/neck infection or ENT surgery

Explanation

Grisel's syndrome is a non-traumatic atlantoaxial rotatory subluxation most often seen in children. It typically follows upper respiratory tract infections or head/neck procedures due to inflammatory laxity of the transverse ligament.

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