Question 1

Which of the following is not a typical characteristic of Scheuermannâ s kyphosis:

Explanation

Scheuermannâ s kyphosis may affect any region of the thoracic spine; it also may affect the thoracolumbar junction or the lumbar spine. Endplate irregularity, wedging of three vertebrae, narrowing of disk space, and Schmorls nodes are characteristic of Scheuermanns kyphosis.

Question 2

A 17-year-old boy presents with thoracic kyphosis. He has minimal discomfort in his back. Radiographs show a 62° Scheuermanns kyphosis, with wedging of T8-T10. His Risser sign is 4, and his Tanner stage is 4. He states that he is not cosmetically aware of his kyphosis. Recommended treatment includes:

Explanation

This patient is too skeletally mature to benefit from bracing. Bracing is not likely to change the natural history of the curve at maturity. Surgery is indicated if a patient experiences pain or dissatisfaction with the appearance of the back. Otherwise, the natural history is benign and observation is indicated.

Question 3

Adults with untreated Scheuermannâ s kyphosis do not differ from controls in terms of this parameter:

Explanation

Patients with Scheuermannâ s kyphosis have no decrease in pulmonary function compared to controls; however, they have increased severity of back pain, seek jobs with lower activity levels, and have more thoracic back pain and less trunk extension. They also have a 30% incidence of scoliosis of less than 35°.

Question 4

Correction of Scheuermannâ s kyphosis from a posterior approach involves this mechanical principle:

Explanation

Compression of the posterior column is the principal method of correcting Scheuermannâ s kyphosis. Compresssion is usually achieved by resecting portions of the elongation.

Question 5

A 13-year-old boy has a Scheuermanns kyphosis of 68°, apex at T8. His Risser sign is 1. His mother is concerned about his appearance and possible future progression. Recommended treatment includes:

Explanation

Brace treatment for Scheuermannâ s kyphosis is successful in decreasing the kyphosis, usually permanently, by 10° to 20° if worn properly. A patientâ s Risser sign must be below 3. Because this patient has a Risser sign of 1, bracing is appropriate treatment. The Milwaukee brace is the most effective type of brace for kyphosis. However, the Boston brace is also somewhat effective in treating patients with Scheuermannâ s kyphosis because it corrects the compensatory lordosis and stimulates active correction of the thoracic curve.

Question 6

The mother of a 4-month-old boy brings him to a physician to be evaluated for a swollen leg (Slide). The most likely diagnosis is:

Orthopedic Prometric Exam Chapter 3 Image

Explanation

This radiograph shows two fractures in different stages of healing. Note the old femur fracture at the top of the field. No evidence of decreased cortical thickness, diaphyseal thinning, or bowing suggests OI. The physis of the distal femur and proximal femur show no signs of rickets. The presence of fractures rather than periosteal reaction make C affeyâ s disease unlikely. The fractures in scurvy are more commonly located in the physis. The diagnosis of nonaccidental injury should be made only after performing a thorough patient history and physical.

Question 7

Which of the following is not a contraindication to the repair of a spondylolytic defect:

Explanation

Repair of a spondylolytic defect is usually a successful procedure for relieving symptoms. Repair is not indicated in patients older than 35 years of age. Repair should not be done if there is a significant slip over a grade 1 at most or if the patient has minimal, tolerable symptoms or has symptoms complicated by a degenerative disk at the same level.

Question 8

A 14-year-old boy has grade 1 isthmic L5-S1 spondylolisthesis. He has no back pain and wants to play football. The patient should be advised to:

Explanation

Asymptomatic spondylolisthesis occurs in approximately 5% of the pediatric population. Slips of up to grade 1 develop in at least one third of patients with asymptomatic spondylolisthesis. Most patients with asymptomatic spondylolisthesis are minimally symptomatic or asymptomatic. The patient presented in this scenario may be allowed to play football as long as he understands that he may develop symptoms.

Question 9

Most cases of L5 spondylolysis develop in patients by:

Explanation

A study was conducted to monitor the development of L5 spondylolysis in patients from birth to 6 years of age. The study showed that no cases of L5 spondylolysis were present at birth in any of the patients. The majority of the patients developed L5 spondylolysis by the time they had reached 6 years of age. A 45-year follow-up study showed that none of the 30 patients had more than a 40% slip and that only 1 patient required fusion.

Question 10

Patients with high-grade spondylolisthesis develop a vertical position of the sacrum in response to which condition:

Explanation

As spondylolisthesis progresses to a high grade, the fifth lumbar vertebra shifts forward into a kyphotic position termed a slip angle. The slip angle can reach a value of more than 30° and results in verticalization of a patients sacrum to decrease force on the involved vertebra.

Question 11

Which of the following is not a feature of Klippel-TrÃ©naunay-Weber syndrome:

Explanation

Klippel-Trnaunay-Weber syndrome is a constellation of varicose veins, cutaneous nevus, and an increase in the length or width of the involved limb. Seizure disorder is a feature of von Hippel- Lindau disease.

Question 12

Epiphyseal osteochondroma is also known as:

Explanation

Epiphyseal osteochondroma is also known as Trevorâ s disease. Epiphyseal osteochondroma is localized to a specific region of the body, unlike multiple osteochondroma, which affects the entire body. Epiphyseal osteochondroma and multiple osteochondroma are unrelated disorders.

Question 13

All of the disorders listed below are examples of osteochondrosis except:

Explanation

The term osteochondrosis refers to symptomatic disorders involving cartilage growth. Cartilage affected by osteochondrosis may be epiphyseal, physeal, or apophyseal. Gorhamâ s disease is not an example of osteochondrosis. Gorhams disease is a lymphatic disorder known as disappearing bone disease.

Question 14

Which of the following symptoms is not characteristic of congenital constriction band syndrome:

Explanation

Syndactyly in constriction band syndrome is a fenestrated syndactyly, is incomplete, and has slits between the digits proximally. Syndactyly in constriction band syndrome is also not complex because the bones are not fused.

Question 15

Which of the following conditions requires an ultrasound of the abdomen:

Explanation

An ultrasound of the abdomen is indicated for patients with idiopathic hemihypertrophy to determine the development of Wilms tumor. Children with idiopathic hemihypertrophy have an increased incidence of Wilmsâ tumor. C hildren require periodic monitoring, and they should have an abdominal ultrasound 2 to 3 times per year until 8 years of age.

Question 16

How often should patients with hemihypertrophy have an abdominal ultrasound:

Explanation

Patients with idiopathic hemihypertrophy require periodic monitoring to determine the risk of Wilms tumor. The best method to monitor patients with idiopathic hemihypertrophy is a renal ultrasound two to three times per year until the patient is 8 years of age.

Question 17

Which of the following rays is most commonly used to treat patients with macrodactyly of the foot:

Explanation

The second ray is most commonly used to treat patients with macrodactyly of the foot. The third ray is the next most commonly used ray in treating patients with macrodactyly of the foot.

Question 18

Macrodactyly of the foot commonly displays which of the following patterns of overgrowth:

Explanation

Macrodactyly displays overgrowth that is greatest plantarly and distally. Plantar overgrowth causes the sole to become convex plantarly and the toes to become dorsiflexed.

Question 19

A 1-year-old patient presents with a pseudarthrosis of the left clavicle. Which of the following conditions is most likely to coexist with pseudarthrosis of the left clavicle:

Explanation

Almost all cases of congenital pseudarthrosis involve the right clavicle. C ases of congenital pseudarthrosis involving the left clavicle often coexist with dextrocardia. Patients with pseudarthrosis of the clavicle respond well to standard orthopedic treatment, unlike patients with congenital pseudarthrosis of the tibia.C orrect Answer: Dextrocardia

Question 20

A 14-year-old girl presents with a swollen foot. She had sustained a contusion to the dorsum of her foot for 4 weeks. Her temperature is 99.2° F. Her foot is tender to touch. She is able to dorsiflex and plantarflex her toes. Radiographs are normal. The best treatment is:

Explanation

This patient demonstrates signs of early reflex sympathetic dystrophy. She may later develop osteopenia, a positive bone scan, and contracture. Physical therapy is the best treatment for reflex sympathetic dystrophy in this case because it will increase the patients range of movement and her tolerance to touch. Multimodality therapy is also required to treat reflex sympathetic dystrophy. Analgesics may be appropriate treatment for the patient and can be supplemented by antidepressants, if needed. Repeated regional block treatment is recommended for patients with established cases of reflex sympathetic dystrophy.

Question 21

The Sorensen criteria are commonly used to diagnose typical Scheuermann's disease. Which of the following radiographic findings must be present to satisfy these criteria?

Explanation

The classic Sorensen criteria define Scheuermann's kyphosis by the presence of anterior wedging of greater than 5 degrees in at least three consecutive vertebral bodies.

Question 22

What is the primary indication for initiating Milwaukee brace treatment in a patient with Scheuermann's kyphosis?

Explanation

Bracing is typically indicated for progressive Scheuermann's kyphosis between 50 and 75 degrees in skeletally immature patients with significant remaining growth.

Question 23

A 16-year-old boy presents with progressive back pain and cosmetic deformity. Radiographs show a rigid thoracic Scheuermann's kyphosis of 85 degrees. His Risser sign is 4. What is the most appropriate management?

Explanation

Operative treatment, typically a posterior spinal fusion, is indicated for Scheuermann's kyphosis >75 degrees, especially in skeletally mature patients or those with intractable pain.

Question 24

Which clinical maneuver is most useful in differentiating Scheuermann's kyphosis from a postural roundback deformity?

Explanation

Scheuermann's kyphosis is characterized by a structural, rigid deformity that does not correct upon hyperextension, whereas postural kyphosis is flexible and will fully correct.

Question 25

Type II (atypical) Scheuermann's disease usually affects the thoracolumbar or lumbar spine. It is most commonly associated with which of the following patient profiles?

Explanation

Type II Scheuermann's involves the thoracolumbar or lumbar spine, frequently lacking the classic cosmetic deformity, and is often seen in athletic adolescents subjected to heavy axial loading.

Question 26

A lateral spine radiograph of a 14-year-old boy with thoracic kyphosis reveals herniations of the intervertebral disc material through the vertebral endplates into the spongiosa. What is the proper term for this finding?

Explanation

Schmorl's nodes are intraosseous disc herniations commonly seen in Scheuermann's disease due to weakened vertebral endplates and disordered ossification.

Question 27

A 15-year-old boy presents with mid-back pain. Evaluate the provided radiograph.

Based on the typical radiographic signs associated with this condition, including endplate irregularities and wedging, what is the most likely diagnosis?

Explanation

The image highlights anterior wedging of multiple vertebral bodies and endplate irregularities, which are the hallmark radiographic features of Scheuermann's kyphosis.

Question 28

When performing a posterior spinal fusion for Scheuermann's kyphosis, what is the most critical factor in choosing the lower instrumented vertebra (LIV) to prevent distal junctional kyphosis?

Explanation

To minimize the risk of distal junctional kyphosis, the lower instrumented vertebra (LIV) must include the first lordotic disc space, ensuring it is the sagittal stable vertebra.

Question 29

What is considered the most common major complication following posterior spinal fusion for the correction of Scheuermann's kyphosis?

Explanation

Junctional kyphosis, either proximal or distal to the construct, is the most common complication and is frequently related to improper selection of fusion levels.

Question 30

Histological analysis of the vertebral endplates in classic Scheuermann's disease typically demonstrates which of the following abnormalities?

Explanation

Histologically, Scheuermann's disease is characterized by disorganized endplate cartilage and defective ossification, predisposing the spine to disc herniation and wedging.

Question 31

To minimize the risk of proximal junctional kyphosis (PJK) following corrective surgery for Scheuermann's kyphosis, the upper instrumented vertebra (UIV) should typically be selected as:

Explanation

Extending the fusion construct to include the proximal end vertebra of the kyphotic curve, or one level proximal to it, is a standard strategy to prevent proximal junctional kyphosis.

Question 32

In an adolescent patient with untreated Scheuermann's kyphosis who reports pain, where is the pain most typically located?

Explanation

Pain in Scheuermann's disease is typically described as a non-radiating, dull ache located directly over the apex of the thoracic or thoracolumbar kyphosis.

Question 33

Which of the following spinal deformities is most frequently associated as a concurrent finding with Scheuermann's kyphosis?

Explanation

Mild scoliosis, usually measuring 10 to 20 degrees, is observed in approximately 20% to 30% of patients presenting with Scheuermann's kyphosis.

Question 34

When utilizing a Milwaukee brace for Scheuermann's kyphosis, optimal curve correction relies on a three-point bending principle. Where should these forces be directed?

Explanation

The three-point bending principle uses a posterior pad to apply an anteriorly directed force at or slightly below the curve's apex, countered by posteriorly directed forces anteriorly at the sternum and pelvis.

Question 35

Historically, severe Scheuermann's kyphosis was treated with combined anterior-posterior spinal fusion. Today, an all-posterior approach is preferred. What is the primary advantage of modern all-posterior pedicle screw constructs over combined approaches?

Explanation

Modern all-posterior pedicle screw constructs achieve equivalent or superior deformity correction compared to historic methods, avoiding the significant pulmonary morbidity associated with an anterior thoracotomy.

Question 36

Which ligamentous structure is characteristically thickened and contracted in Scheuermann's disease, acting as a major anterior tether against curve correction?

Explanation

The anterior longitudinal ligament (ALL) becomes significantly thickened and contracted in Scheuermann's disease, contributing to the rigidity of the kyphotic deformity.

Question 37

When evaluating sagittal balance in a patient with severe Scheuermann's kyphosis, increased cervical and lumbar lordosis are frequently observed. What is the primary physiological reason for these findings?

Explanation

Hyperlordosis in the cervical and lumbar regions is typically a flexible, compensatory response to the rigid thoracic kyphosis, allowing the patient to maintain their head centered over the pelvis.

Question 38

Although rare, neurologic deficit can occur in severe Scheuermann's kyphosis. When present, it is most commonly caused by which of the following?

Explanation

Neurologic compromise is very rare in Scheuermann's disease. When it does happen, it is usually due to a compressive thoracic disc herniation or an epidural cyst located at the apex of the severe kyphosis.

Question 39

A 2-year-old child presents with a sharp, angular thoracic kyphosis. Radiographs reveal a failure of formation of the anterior vertebral body. How does the expected management of this condition differ fundamentally from Scheuermann's kyphosis?

Explanation

Congenital kyphosis (Type I, failure of formation) has a high propensity for severe, rapid progression and neurologic compromise, often requiring early surgical intervention, unlike the more benign course of Scheuermann's.

Question 40

Following an all-posterior pedicle screw instrumented fusion for Scheuermann's kyphosis, what is the standard postoperative immobilization protocol in a compliant patient?

Explanation

Modern pedicle screw instrumentation provides highly rigid internal fixation, typically eliminating the need for any postoperative bracing or casting.

Question 41

According to the Sorensen criteria, what is the strict radiographic definition required to diagnose classical Scheuermann's kyphosis?

Explanation

The Sorensen criteria for diagnosing Scheuermann's kyphosis require anterior wedging of greater than 5 degrees in at least three consecutive vertebrae. Additional common findings include Schmorl's nodes and endplate irregularities.

Question 42

A 14-year-old skeletally immature boy (Risser 1) presents with a thoracic kyphosis measuring 68 degrees. He reports moderate mechanical back pain. Radiographs demonstrate 7 degrees of anterior wedging at T7, T8, and T9. What is the most appropriate initial management?

Explanation

Bracing is indicated for skeletally immature patients (Risser 0-2) with a flexible Scheuermann's kyphosis measuring between 55 and 80 degrees. An extension orthosis like the Milwaukee brace should be worn 16-23 hours daily for optimal results.

Question 43

In planning surgical correction for a severe Scheuermann's kyphosis using posterior pedicle screw instrumentation, selecting the correct distal fusion level is critical. To minimize the risk of distal junctional kyphosis, the distal instrumented vertebra should typically be:

Explanation

To prevent distal junctional kyphosis, the distal fusion level must include the first lordotic disc, which corresponds to the sagittal stable vertebra. Stopping short of this level leaves the construct vulnerable to progressive kyphosis below the fusion.

Question 44

Type II (Lumbar) Scheuermann's disease is clinically and radiographically distinct from classical thoracic Scheuermann's. Which of the following is most characteristic of Type II Scheuermann's disease?

Explanation

Type II Scheuermann's disease affects the thoracolumbar or lumbar spine and usually presents in adolescent athletes involved in heavy lifting or repetitive trauma. It causes loss of normal lumbar lordosis and presents with mechanical back pain.

Question 45

Which type of congenital kyphosis carries the highest risk of progression and devastating neurologic compromise (e.g., paraplegia) if left untreated?

Explanation

Type I congenital kyphosis (anterior failure of formation) results in a sharp, angular deformity with the highest propensity for rapid progression and spinal cord compression. Early surgical intervention (posterior fusion in situ) is often required.

Question 46

Long-term natural history studies comparing adults with untreated Scheuermann's kyphosis to the general population demonstrate that patients with Scheuermann's have increased back pain. However, they do NOT significantly differ from the general population in which of the following?

Explanation

While adults with untreated Scheuermann's kyphosis have higher rates of back pain and cosmetic concerns, long-term studies show no significant difference in severe disability, neurologic compromise, or occupational limitations compared to controls.

Question 47

A 2-year-old child is diagnosed with a progressive Type I congenital kyphosis measuring 45 degrees. Neurologic examination is normal. What is the most appropriate management?

Explanation

Type I congenital kyphosis has a high rate of progression and neurologic risk. In young children (under age 3-5) with curves <50 degrees, early in situ posterior spinal fusion is the treatment of choice to halt progression.

Question 48

An adolescent weightlifter presents with severe lower back pain and hamstring tightness. Radiographs and MRI demonstrate a displaced fracture of the posterior ring apophysis at L4. What is the primary underlying pathophysiology of this lesion?

Explanation

A slipped vertebral apophysis (apophyseal ring fracture) typically occurs in adolescents when disc material herniates through the unossified ring apophysis, displacing it posteriorly into the spinal canal. It is often mistaken for a simple disc herniation.

Question 49

Untreated severe thoracic Scheuermann's kyphosis frequently leads to which of the following compensatory sagittal alignment changes to maintain a level horizontal gaze?

Explanation

To compensate for the rigid hyperkyphosis in the thoracic spine and maintain a horizontal gaze, patients will typically develop hyperlordosis in both the cervical and lumbar spine.

Question 50

A 15-year-old boy presents with progressive mid-back pain. Lateral radiographs show the deformity seen in the provided image.

If surgical correction is undertaken, failure to include the proximal end vertebra in the fusion construct most commonly leads to which complication?

Explanation

Failure to extend the proximal fusion level to include the proximal end vertebra (typically T2 or T3) in Scheuermann's kyphosis significantly increases the risk of proximal junctional kyphosis (PJK).

Question 51

When selecting the proximal fusion level for surgical correction of Scheuermann's kyphosis, which anatomic landmark is generally accepted as the optimal stopping point to minimize junctional complications?

Explanation

The proximal fusion level should be the proximal end vertebra of the kyphosis, which is usually T2 or T3. Stopping lower (e.g., T4 or T5) leaves the patient highly susceptible to proximal junctional kyphosis.

Question 52

Schmorl's nodes are a common radiographic finding in Scheuermann's kyphosis. What do these nodes represent pathologically?

Explanation

Schmorl's nodes occur when the intervertebral disc (nucleus pulposus) herniates vertically through a weakened or defective cartilaginous endplate into the cancellous bone of the vertebral body.

Question 53

During posterior spinal fusion for Scheuermann's kyphosis, surgeons must avoid overcorrection of the deformity. Overcorrection (e.g., reducing the curve by >50% of its initial magnitude) is most strongly associated with an increased risk of:

Explanation

Overcorrection of the kyphotic deformity alters spinal biomechanics aggressively and is a major independent risk factor for the development of proximal junctional kyphosis (PJK). Correction to high-normal ranges (40-50 degrees) is preferred.

Question 54

What is the primary biomechanical principle utilized by the Milwaukee brace to correct or halt the progression of Scheuermann's kyphosis?

Explanation

The Milwaukee brace works primarily via three-point bending. It applies anteriorly directed corrective force via a posterior pad situated just below the apex of the kyphosis, countered by posterior forces at the neck and pelvis.

Question 55

A 14-year-old female presents with a rounded back. On the Adams forward bending test, the deformity is smooth. Clinically, she can actively hyperextend to fully correct the curve. Radiographs show a 50-degree thoracic kyphosis with no vertebral wedging. What is the most appropriate management?

Explanation

This presentation describes postural kyphosis, characterized by a flexible deformity with no structural vertebral wedging. Management consists of reassurance and postural exercises; bracing or surgery is not indicated.

Question 56

In the modern era of spine surgery utilizing all-pedicle screw constructs, anterior release is typically reserved for which specific subset of Scheuermann's kyphosis patients?

Explanation

Historically, anterior release was recommended for curves >75 degrees. With powerful modern pedicle screw constructs, posterior-only approaches are standard unless the curve is exceptionally severe (>100 degrees) and highly rigid.

Question 57

Wide posterior release is often necessary to achieve adequate correction in Scheuermann's kyphosis. What anatomic structures are resected during a standard Ponte osteotomy?

Explanation

A Ponte osteotomy is a posterior column shortening osteotomy that involves wide resection of the spinous process, lamina, ligamentum flavum, and the bilateral facet joints to drastically increase posterior flexibility.

Question 58

Histological examination of the vertebral endplates in patients with classical Scheuermann's kyphosis typically demonstrates:

Explanation

The primary histological defect in Scheuermann's disease is an abnormality in the cartilaginous endplate, characterized by disorganized cellularity, defective ossification, and focal defects allowing disc herniation (Schmorl's nodes).

Question 59

During posterior correction of a 90-degree Scheuermann's kyphosis, the surgeon applies heavy compression across the apical pedicle screws to shorten the posterior column. A sudden loss of bilateral lower extremity Motor Evoked Potentials (MEPs) is noted, while SSEPs remain stable. What is the most appropriate immediate action?

Explanation

Loss of MEPs indicates compromise to the anterior spinal cord (motor tracts), which can occur from over-shortening or distraction. The immediate first step is to release the corrective forces. MEPs are more sensitive to this specific ischemia than SSEPs.

Question 60

Dystrophic kyphoscoliosis in Neurofibromatosis Type 1 is characterized by vertebral wedging, scalloping, and penciling of the ribs. Due to the exceptionally high risk of rapid progression and pseudarthrosis, what is the recommended surgical approach for a progressing dystrophic curve?

Explanation

Dystrophic curves in NF1 are highly aggressive and carry a massive risk of pseudarthrosis. They typically require robust stabilization with combined anterior and posterior spinal fusion to achieve successful arthrodesis.

Question 61

Which of the following represents the classic Sorensen criteria for the radiographic diagnosis of Scheuermann's kyphosis?

Explanation

The Sorensen criteria define classic Scheuermann's disease as anterior wedging of greater than 5 degrees in at least three consecutive vertebrae.

Question 62

According to Sorensen's radiographic criteria, which of the following is an absolute requirement for the classic diagnosis of Scheuermann's kyphosis?

Explanation

Sorensen's classic criteria for Scheuermann's disease requires anterior wedging of at least 5 degrees in three or more sequential adjacent vertebrae. This distinguishes it from postural kyphosis and normal variant spinal curves.

Question 63

A 14-year-old boy presents with a progressive thoracic kyphosis of 65 degrees. The apex of the curve is at T8, and his Risser sign is 1. He complains of mild aching back pain after sports. What is the most appropriate management?

Explanation

For a skeletally immature patient (Risser 0-2) with a flexible curve between 50 and 75 degrees, bracing is indicated. Because the apex is at T8 (T7 or below), a TLSO is effective; an apex above T7 would require a Milwaukee brace.

Question 64

When performing posterior spinal fusion for Scheuermann's kyphosis, failing to extend the lower instrumented vertebra (LIV) to include the sagittal stable vertebra (SSV) most commonly results in which of the following postoperative complications?

Explanation

The lower instrumented vertebra (LIV) must include the sagittal stable vertebra (SSV) and the first lordotic disc space. Stopping short of the SSV significantly increases the risk of distal junctional kyphosis (DJK).

Question 65

A 15-year-old male presents with cosmetic concerns regarding his back. A lateral radiograph is shown. Which histologic abnormality at the vertebral endplate is considered the primary etiology for the characteristic findings seen in this condition?

Explanation

The image demonstrates Scheuermann's kyphosis with anterior wedging and Schmorl nodes. The primary histologic defect is abnormal enchondral ossification of the vertebral endplates, leading to weakened cartilage and subsequent herniation of the disc material.

Question 66

A 16-year-old male competitive weightlifter presents with chronic, activity-related low back pain. Radiographs reveal anterior wedging and endplate irregularity localized to L1 and L2, but his global thoracic kyphosis is normal (35 degrees). What is the most likely diagnosis?

Explanation

Type II (Atypical or Lumbar) Scheuermann's disease, also known as Appellgren's, primarily involves the thoracolumbar or lumbar spine and is heavily associated with athletic activity and heavy lifting in adolescents. It tends to be more painful than classic thoracic Scheuermann's.

Question 67

To minimize the risk of proximal junctional kyphosis (PJK) following posterior spinal fusion for Scheuermann's disease, the upper instrumented vertebra (UIV) should typically be selected as:

Explanation

To prevent proximal junctional kyphosis, the proximal fusion level must incorporate the upper end vertebra of the kyphosis. Fusing short of this curve boundary leaves the patient vulnerable to progressive deformity above the construct.

Question 68

Patients with severe Scheuermann's kyphosis have an increased incidence of which of the following concomitant spinal pathologies?

Explanation

Spondylolysis is observed at a higher rate in patients with Scheuermann's kyphosis. This is thought to be due to increased shear forces on the pars interarticularis resulting from the compensatory lumbar hyperlordosis.

Question 69

Which of the following radiographic views is considered the gold standard for assessing the flexibility of a rigid Scheuermann's kyphosis prior to surgical planning?

Explanation

The supine cross-table lateral radiograph with a hyperextension bolster placed under the apex of the curve best demonstrates the flexibility and correctability of the kyphosis.

Question 70

When counseling a 13-year-old patient regarding brace treatment for a 60-degree Scheuermann's kyphosis, which factor is the strongest predictor of ultimate treatment success?

Explanation

Similar to idiopathic scoliosis, the amount of initial in-brace correction is highly predictive of final outcomes in Scheuermann's disease. Correction of at least 15 degrees or >40% in the brace correlates with a successful result.

Question 71

Compared to older combined anterior-posterior spinal fusion techniques, modern posterior-only fusion with all-pedicle screw constructs and Ponte osteotomies for Scheuermann's kyphosis has been shown to result in:

Explanation

Modern posterior-only approaches using rigid all-pedicle screw constructs and multiple posterior column (Ponte) osteotomies achieve equivalent or superior correction to combined AP approaches, while eliminating anterior approach-related morbidity.

Question 72

During posterior spinal fusion for an 85-degree Scheuermann's kyphosis, multiple Ponte osteotomies are performed. If over-correction and excessive distraction of the posterior column occurs, what is the most likely neurologic complication?

Explanation

Excessive correction of kyphosis can cause relative lengthening of the spinal column compared to the spinal cord, leading to cord traction or ischemia. Neurologic monitoring is critical during deformity correction.

Question 73

In preoperative surgical planning for Scheuermann's kyphosis, the Sagittal Stable Vertebra (SSV) is defined as the most proximal vertebra bisected by a vertical line drawn from the:

Explanation

The Sagittal Stable Vertebra (SSV) is determined by drawing a vertical plumb line from the posterior superior corner of the sacrum (S1). The most proximal vertebra bisected by this line is the SSV.

Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 10

Orthopedic Prometric MCQs - Chapter 3 Part 10

Chapter Index