6. Spine MCQs

A 60-year-old female presents with severe right upper extremity pain radiating to the middle finger, along with weakness in elbow extension. A cervical MRI reveals a herniated disc. Which intervertebral level is most likely affected?

According to the long-term results of the Spine Patient Outcomes Research Trial (SPORT) for lumbar disc herniation, which of the following statements is true regarding surgical versus nonoperative treatment?

A 16-year-old non-ambulatory male with Duchenne muscular dystrophy presents with a 45-degree thoracolumbar scoliosis. His forced vital capacity (FVC) is currently 40% of predicted. What is the most appropriate surgical strategy?

In infantile idiopathic scoliosis, the rib-vertebra angle difference (RVAD) of Mehta is used to predict the natural history of the curve. An RVAD greater than what threshold indicates a high probability of curve progression?

A 45-year-old male presents with severe right leg pain, weakness in great toe extension, and diminished sensation over the dorsal aspect of the right foot. He has a normal Achilles reflex. Which of the following disc herniations is the most likely cause of his symptoms?

A 50-year-old female presents with neck pain radiating down her arm to her index and middle fingers. On examination, she has weakness in elbow extension and an absent triceps reflex. Which cervical nerve root is most likely affected?

A 65-year-old male presents with bilateral calf pain that worsens with walking and improves when he leans forward on a shopping cart. To reliably differentiate between neurogenic and vascular claudication, which of the following non-invasive tests is most appropriate initially?

An 8-month-old male is evaluated for infantile idiopathic scoliosis with a 25-degree left thoracic curve. The rib-vertebral angle difference (RVAD) of Mehta is measured at 28 degrees. What is the most appropriate next step in management?

A 42-year-old female presents to the emergency department with severe back pain, bilateral leg pain, and saddle anesthesia. Which of the following is considered the most sensitive early clinical finding for cauda equina syndrome?

During a neurological examination for suspected cervical spondylotic myelopathy, the examiner flicks the distal phalanx of the patient's middle finger, eliciting reflex flexion of the thumb and index finger. What is the name of this clinical sign?

A 12-year-old male with spastic quadriplegic cerebral palsy presents with a 75-degree thoracolumbar neuromuscular scoliosis and a 25-degree pelvic obliquity. He is non-ambulatory and has difficulty sitting in his wheelchair. What is the most appropriate surgical strategy?

A 16-year-old gymnast complains of chronic low back pain worsening with extension. Radiographs confirm a Grade 2 isthmic spondylolisthesis at L5-S1. She has failed 6 months of physical therapy and bracing. What is the most appropriate surgical treatment?

A 50-year-old female presents with severe left anterior thigh pain, weakness in left hip flexion and knee extension, and a diminished left patellar reflex. MRI demonstrates a far lateral disc herniation at the L3-L4 level. Which nerve root is most likely compressed?

When planning corrective surgery for adult spinal deformity, achieving appropriate sagittal balance is highly correlated with improved patient-reported outcomes. Which of the following target thresholds for the Sagittal Vertical Axis (SVA) is considered optimal?

A 40-year-old male presents with isolated C5-C6 radiculopathy. The surgeon is considering a cervical disc arthroplasty (CDA) versus an anterior cervical discectomy and fusion (ACDF). Which of the following is an absolute contraindication to CDA?

A 45-year-old male presents with progressive myelopathy. MRI reveals a large, central, heavily calcified T8-T9 disc herniation causing severe cord compression. Which surgical approach carries the highest risk of iatrogenic spinal cord injury and should generally be avoided?

A 15-year-old male presents with an increased thoracic kyphosis measuring 65 degrees. To meet the radiographic Sorensen criteria for classical Scheuermann's disease, there must be anterior wedging of at least 5 degrees in a minimum of how many consecutive vertebrae?

A 65-year-old female is diagnosed with L4-L5 degenerative spondylolisthesis. Which of the following anatomic variations is the most significant predisposing risk factor for developing this specific condition?

A 55-year-old male undergoes a 9-hour posterior spinal fusion for complex adult deformity. Upon waking, he complains of painless, bilateral visual loss. His pupils are sluggish to light, but the anterior eye segments are normal. What is the most likely diagnosis?