6. Spine MCQs

During the evaluation of a 65-year-old male with cervical spondylotic myelopathy, the examiner flicks the distal phalanx of the middle finger, resulting in reflex flexion of the thumb and index finger. This physical examination finding indicates compression of which tract?

During a neurological examination of a 68-year-old male with suspected cervical spondylotic myelopathy, the examiner strikes the brachioradialis tendon. The patient responds with diminished elbow flexion, but exhibits spontaneous finger flexion and wrist extension. This finding is known as the inverted brachioradialis reflex. What level of spinal cord pathology does this most accurately suggest?

A 14-year-old gymnast presents with persistent lower back pain exacerbated by extension. Radiographs reveal an L5-S1 isthmic spondylolisthesis. If this patient were to develop radicular symptoms due to the pseudarthrosis tissue in the pars defect, which nerve root is most likely to be compressed?

A 55-year-old male with a long-standing history of Ankylosing Spondylitis presents to the emergency department with severe neck pain after a minor ground-level fall. Initial plain radiographs of the cervical spine appear normal without obvious fracture. What is the most appropriate next step in management?

A 40-year-old male presents with acute onset of bilateral sciatica, saddle anesthesia, and urinary retention. A post-void residual is measured at 350 mL. MRI confirms a massive L4-L5 central disc herniation. To maximize the likelihood of recovery of bladder sphincter function, surgical decompression should ideally be performed within what time frame?

A 25-year-old female presents after a motor vehicle accident with an isolated T12 burst fracture. She is neurologically intact. MRI demonstrates definitive disruption of the posterior ligamentous complex (PLC). According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the recommended treatment?

A 45-year-old male complains of neck pain radiating into his left arm. Physical examination reveals weakness in elbow extension, diminished triceps reflex, and paresthesias affecting the dorsal aspect of the middle finger. These clinical findings are most consistent with a disc herniation at which of the following cervical levels?

A 35-year-old male sustains a transverse Type II odontoid fracture with 15% anterior displacement following a diving accident. He is neurologically intact. Which of the following treatments provides the highest rate of fusion while preserving maximal C1-C2 rotatory motion?

A 50-year-old male presents with severe severe right anterior thigh pain and quadriceps weakness. The patellar reflex is absent on the right. MRI demonstrates a large, far-lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed?

A 16-year-old male presents with thoracic back pain and cosmetic concerns about his posture. Lateral radiographs reveal anterior wedging of greater than 5 degrees in three consecutive vertebrae, confirming Scheuermann's kyphosis. Operative intervention via spinal fusion is most commonly indicated when the kyphotic deformity exceeds which of the following angles?

A 45-year-old male complains of severe left-sided radiating leg pain. Magnetic resonance imaging demonstrates an extraforaminal (far-lateral) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 68-year-old male with a long-standing history of ankylosing spondylitis sustains a low-energy fall. He complains of new-onset lower cervical pain but is neurologically intact. Plain radiographs of the cervical spine show no obvious fracture. What is the most appropriate next step in management?

A 22-year-old restrained passenger in a motor vehicle collision sustains a flexion-distraction injury (Chance fracture) at L2. Which of the following associated injuries must be aggressively ruled out?

A 70-year-old female with degenerative lumbar spinal stenosis complains of bilateral lower extremity pain and cramping with ambulation. Which of the following historical findings best differentiates her neurogenic claudication from vascular claudication?

A 65-year-old female with a long history of rheumatoid arthritis presents with progressive hand clumsiness and hyperreflexia. Radiographs reveal atlantoaxial instability. Which of the following radiographic measurements is the most reliable predictor of neurologic recovery following cervical fusion?

A 35-year-old female is involved in a high-speed motor vehicle collision while wearing only a lap belt. She sustains a T12 flexion-distraction injury (Chance fracture). During her trauma evaluation, she is at highest risk for which of the following concomitant injuries?

A 65-year-old female presents with severe neurogenic claudication and low back pain. MRI demonstrates severe L4-L5 central canal stenosis. Weight-bearing radiographs show a Grade I degenerative spondylolisthesis at L4-L5 that increases on flexion views. Which of the following is the most appropriate surgical treatment?

A 60-year-old male presents with bilateral hand clumsiness, frequent dropping of objects, and a broad-based, unsteady gait. Physical exam reveals a positive Hoffman's sign bilaterally and hyperreflexia in the lower extremities. MRI reveals continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6, causing severe ventral cord compression. The cervical spine maintains normal lordosis. What is the most appropriate surgical approach?

A 45-year-old construction worker falls from scaffolding, sustaining an L1 burst fracture. He is neurologically intact. CT imaging shows 15 degrees of local kyphosis, 30% canal compromise, and an intact posterior tension band. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the recommended management?