6. Spine MCQs

A 13-year-old thin female undergoes posterior spinal fusion for adolescent idiopathic scoliosis. On postoperative day 4, she develops severe nausea, bilious vomiting, and epigastric pain that improves when she is positioned prone or in a left lateral decubitus position. What anatomical structure is directly compressed in this condition?

A 68-year-old male is being evaluated for sagittal plane deformity. His pelvic incidence (PI) is 55 degrees, and his sacral slope (SS) is 35 degrees. What is his pelvic tilt (PT)?

A 9-year-old girl with early-onset idiopathic scoliosis undergoes a successful posterior spinal fusion from T4 to L2. Over the next three years, she develops a progressive rotational deformity and lordosis of the fused segments without hardware failure. Which of the following anatomical features present at the time of her index surgery primarily predicted this complication?

When evaluating skeletal maturity in a female patient with adolescent idiopathic scoliosis, the Sanders Simplified Skeletal Maturity Scale (SSMS) utilizing a left hand radiograph is obtained. Which Sanders stage correlates with the peak height velocity, indicating the period of highest risk for rapid curve progression?

A 5-year-old boy presents with progressive thoracic early-onset scoliosis and thoracic insufficiency syndrome. The decision is made to utilize a growth-friendly construct (e.g., MAGEC rods or VEPTR) rather than a definitive spinal fusion. This strategy is specifically aimed at allowing continued growth of the thoracic spine to maximize what physiological developmental process?

In the surgical treatment of adult spinal deformity, proximal junctional kyphosis (PJK) is a well-known complication. Which of the following surgical strategies significantly increases the risk of developing PJK?

A 15-year-old male volleyball player presents with a 4-week history of worsening axial low back pain. Radiographs are normal. MRI of the lumbar spine reveals bilateral T2 hyperintensity in the L5 pars interarticularis without a cortical break.

What is the most appropriate initial management?

Which of the following best describes the fundamental relationship between spinopelvic parameters?

Which anatomic variant is a well-established risk factor for the development of degenerative spondylolisthesis at the L4-L5 level?

A 10-month-old infant is evaluated for a progressive spinal deformity. Radiographs demonstrate a 35-degree thoracic dextroscoliosis. The rib-vertebral angle difference (RVAD, Mehta's angle) is measured at 28 degrees, and there is phase 2 rib-vertebral overlap. What is the most appropriate next step in management?

Which of the following congenital spinal anomalies carries the highest risk of rapid curve progression and often requires early prophylactic surgical intervention?

A 14-year-old boy with Duchenne muscular dystrophy (DMD) has become wheelchair-bound over the last year. His current Cobb angle is 35 degrees and progressing. Forced vital capacity (FVC) is 45% of predicted. What is the recommended management?

In adult spinal deformity surgery, achieving optimal sagittal balance requires matching the Lumbar Lordosis (LL) to the Pelvic Incidence (PI). What is the widely accepted target goal for this relationship?

A 55-year-old female presents with severe thigh pain and an inability to stand upright. She had a Harrington rod fusion from T10 to L4 at age 16 for idiopathic scoliosis. Radiographs demonstrate a pelvic tilt of 35 degrees and a sagittal vertical axis (SVA) of +12 cm.

What is the primary cause of her symptoms?

When planning an osteotomy for a rigid adult spinal deformity, approximately how much sagittal correction can a surgeon expect from a single classic Pedicle Subtraction Osteotomy (PSO)?

Performing a Gill procedure (isolated laminectomy of the pars defect without fusion) in a growing child with high-grade isthmic spondylolisthesis is strictly contraindicated due to the high risk of:

According to the Sorenson criteria, classic Scheuermann's kyphosis is defined radiographically by anterior wedging of at least:

A 45-year-old male sustains a traumatic Type II Hangman's fracture (traumatic spondylolisthesis of the axis) following a motor vehicle accident. According to the Effendi/Levine classification, the mechanism of injury and hallmark features of a Type II fracture are: