Neurospine Flashcards by Neurosurgery Udayana

Approximately what percentage of cervical rotation occurs at the C1-2 level?
a. 10%
b. 25%
c. 75%
d. 90%
e. 50%

50%

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For which type of lumbar fusion is the use of recombinant human bone morphogenetic protein (HBMP-2) FDA approved?
a. Instrumented posterolateral lumbar fusion procedures
b. Anterior lumbar interbody fusion procedures
c. Non-instrumented posterolateral lumbar fusion procedures
d. Transforaminal lumbar interbody fusion procedures
e. Posterior lumbar interbody fusion procedures

Anterior lumbar interbody fusion procedures

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Amyotrophic lateral sclerosis (ALS) is diagnosed by which pattern of neurological dysfunction?
a. Isolated lower motor neuron dysfunction with progression
b. Upper or lower motor neuron dysfunction without progression
c. Both upper and lower motor neuron dysfunction without progression
d. Both upper and lower motor neuron dysfunction with progression
e. Isolated upper motor neuron dysfunction with progression

Both upper and lower motor neuron dysfunction with progression

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A patient awakens from left-sided costotransversectomy at T10 for resection of a ventral metastatic tumor with complete paraplegia and loss of pain and temperature sensation. His sensation to light touch in the lower extremities is spared. Post operative MRI reveals no evidence of spinal cord compression or hematoma. What is the most likely diagnosis?
a. Weber’s Syndrome
b. Posterior cord syndrome.
c. Central cord syndrome.
d. Brown-Sequard syndrome.
e. Anterior cord syndrome.

Anterior cord syndrome.

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A 30 year-old woman oresents with progressive difficulty using her hands and gait dysfunction. She has pain the back of her neck that radiates into her head. She notes pain and paraesthesias in both arms that are refractory to neuropathic pain medication. Her imaging is shown in the figures. What is the most appropriate initial surgical management?
a. VP shunt
b. Cyst shunt
c. Suboccipital decompression
d. Cervical laminectomy and duraplasty
e. Cyst fenestration

VP shunt

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A 35-year-old woman presents with an L1 burst fracture after a motor vehicle accident. Which of the following characteristic(s) predicts likelihood instrumentation failure with short segment posterior instrumented fusion?
a. Incomplete neurologic deficit
b. Disrupted posterior ligamentous complex
c. Spinal canal compromise > 50%
d. Involvement of both vertebral endplates
e. Comminuted fracture with fragment displacement and kyphosis

Comminuted fracture with fragment displacement and kyphosis

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A 24 year old male presents within 3 hours of a gunshot wound to the lower neck with progressive quadriparesis. A C-spine CT demonstrates an epidural hematoma from C6 - T1. What is the most appropriate next step in management?
a. Repeat CT in 4 hours to evaluate if the epidural hematoma is expanding.
b. Emergent surgical decompression.
c. Initiation of high-dose methylprednisolone for a full 48 hours.
d. MRI of the C-spine to better evaluate for cervical disk hernation.
e. ICU management with fluid boluses and pressors to increase mean arterial pressure.

Emergent surgical decompression.

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A 58 year old male presents with longstanding progressive neck and back pain and dysphagia. The following CT is obtained. What is the most likely diagnosis?
a. hypercalcemia
b. age-appropriate spine
c. rheumatoid arthritis
d. diffuse idiopathic skeletal hyperostosis
e. ankylosing spondylitis

diffuse idiopathic skeletal hyperostosis

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A 62 year old with known metastatic renal cancer presents unbearable back pain and lower extremity myelopathy a fall. Her imaging is displayed in the accompanying figures. The best management strategy of this lesion would be:
a. Stereotactic Radiosurgery
b. Kyphoplasty/Vertebroplasty followed by radiotherapy
c. Conventional external beam radiotherapy
d. Laminectomy and resection of epidural disease followed by radiotherapy
e. Vertebrectomy with posterior stabilization followed by radiotherapy

Vertebrectomy with posterior stabilization followed by radiotherapy

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A 50 year old male has a cervical myelopathy, Imaging shows cervical disc osteophyte complexes at C4-5. C5-6, and C6-7 with severe canal stenosis at these levels
and cord signal. Standing - show mild kyphosis of the cervical spine centered at C5-6 . Which surgical approach would most likely result in worsening clinical
picture post-operatively?
a. C4-C6 laminectomies and C4-C7 posterior instrumented fusion/fixation
b. C5 and C6 corpectomies and C4-C7 anterior reconstruction and fusion with cage and plating
c. C5 and C8 corpectomies. C4-C7 anter reconstruction and fusion with cage and plating, with supplemental posterior instrumented fusion C4-C7
d. Anterior cervical discectomy and fusion at C4-5, C5-7
e. C4-C6 laminectomies and decompression

C4-C6 laminectomies and decompression

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What is the most common indication for surgical treatment of Scheuermann’s thoracic kyphosis?
a. Painful kyphosis
b. Radiculopathy from disc herniation
c. Severe compression fractures
d. Progressive scoliosis
e. Pulmonary compromise

Painful kyphosis

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A 50 year old male presents with a 2 week history of low back pain radiating down the postero-lateral thigh, lateral shin, dorsum of the foot and great toe on the right side. His neurologic exam is intact except for a (+) straight leg raise at 30 degrees and 4-15 strength on the right. The most likely diagnosis is:
a. L4-L5 far lateral disc herniation
b. L3-4 central disc herniation
c. L3-L4 paracentral disc herniation
d. L5-S1 paracentral disc herniation
e. L5-S1 foraminal disc herniation

L5-S1 foraminal disc herniation

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A twenty-four year old woman presents with right arm and leg weakness and left cranial nerve VI following a high-speed motor vehicle accident. Her lateral cervical spine x-rays shows up upper cervical prevertebbral soft tissue swelling and a basion-dental interval of 16mm. Her head CT is negative for intracranial hemorrhage. What is the recommended treatment of this injury?
a. Traction followed by immobilization in a halo.
b. In situ arthrodesis and immobilzation in a 4-poster brace
c. Internal fixation and arthrodesis.
d. Immobilization in a hard collar.
e. Immobilization in a halo.

Internal fixation and arthrodesis.

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A 19 year-old man presents after a helmeted ATV accident. On the patient neurologically intact. He denies any midline tenderness. Trauma survey
labs are normal. What imaging test should be ordered before clearing his collar.
a. Cervical CTA
b. Cervical MRI
c. Cervical CT Scan
d. No imaging.
e. Cervical X-ray

No imaging

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A 47 year-old diabetic woman presents with pain across her buttocks and bilateral lower extremities with ambulation, improved by leaning forward. She reports transient response epidural injections and no response to NSAIDs and neuropathic pain medication.
She has no neurologic deficit. Imaging is shown (figures). What intervention is most likely to best reduce her disability over 4 years?
a. L4-5 laminectomy
b. L4-5 decompression and fusion
c. Bilateral L4-5 hemilaminotomies with preservation of midline structures
d. Long term corticosteroids
e. L4-5 dynamic interspinous spacer placement

L4-5 decompression and fusion

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After a type I odontoid fracture, the function of which ligament/membrane most strongly influences treatment options:
a. transverse
b. anterior longitudinal
c. apical
d. alar
e. interspinous

transverse

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A 6 year-old girl presents with progressive scoliosis. Physical examination reveals a clob foot and a midline hairy nevus in the lumbarba region. MRI is shown (Figure 1). What is the most likely diagnosis?
a. Dermal sinus tract
b. Diastematomyelia
c. Myelomeningocele
d. Lipomyelomeningocele
e. Neurenteric cyst

Diastematomyelia

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Failure to account for which radiographic measurement is associated with delayed treatment failure after surgical treatment of positive sagittal imbalance?
a. Sacral Slope
b. Thoracic Kyphosis
c. Pelvic Incidence
d. Lumbar coronal Cobb angle
e. Central Sacral Vertical Line

Pelvic Incidence

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A 65 year-old woman presents with progressively worsening gait instabilty over 4 weeks. She has 4/5 strength in in bilateral illiopsoas, 3+ patellar tendon reflexes, and difficulty with tandem gait. of the thoracic spine is depicted (Figure 1), Selective spinal angiography of the right T11 intercostal artery is shown in the early (Figure 2A) and delayed (Figure 2B) phases. What is the goal of surgery?
a. Divide the arteriovenous connection at the nerve root sleeve
b. Coagulate the abnormal dilated pial veins
c. Gross total resection of the nidus
d. Decompression of the spinal cord via expansile duraplasty
e. Sacrifice the feeding vessel to the anterior spinal artery

Divide the arteriovenous connection at the nerve root sleeve

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What proportion of pediatric patients who undergo temporal lobectomy for intractable epilepsy have a favorable outcome (seizure freedom or substantial decrease in
seizure frequency)?
a. 65-80%
b. 50-65%
c. 35-50%
d. 80-95%

65-80%

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A 42 year old woman suffers gunshot injury the abdomen. A scan shows intraperitoneal free air as well a bullet lodged within the L3 vertebral body with minimal retropulsion of the posterior wall. She is neurologically intact. What is the most appropriate next step in management?
a. Exploratory laparotomy to repair intraperitoneal injury with L3 corpectomy and fusion.
b. Administration of prophylactic antifungal coverage.
c. Administration of tetanus prophylaxis.
d. Gunshot wound cultures.
e. L3 laminectomy, removal of all loose bone fragments, and antibiotic washout.

Administration of tetanus prophylaxis.

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A patent presents with bilateral nondisplaced Factures trough he C2 pars (Hangman’s fracture), flexion-extension dynamic cervical radiographs show
2 mm motion and no significant deformity. What is the most appropriate treatment modality?
a. Anterior C2-3 discectomy and fusion
b. C1-2 transarticular screw fixation
c. Posterior C1-C3 fixation
d. Anterior odontoid screw fixation
e. External immobilization

External immobilization

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What is the first priority in the overall assessment of a trauma patient with an acute cervical spine fracture?
a. Airway integrity
b. Ongoing hemorrhage
c. Neurological deficit
d. Spinal stability
e. Blood pressure

Airway integrity

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A 76 year-old man presents with worsening back pain unresponsive to conservative measures. 36-inch radiographs
were performed at nis office vit. What Schwab grade osteotomy will provide the best correction of his saggital plane
deformity over one segment?
a. Grade 1
b. Grade 5
c. Grade 4
d. Grade 3
e. Grade 2

Grade 2

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A 36 year old restrained driver presented after a motor vehicle collision. What is the classification of the spinal illustrated in the figure? a. Teardrop fracture b. Fracture dislocation c. Chance fracture d. Compression fracture e. Burst fracture

Chance fracture

A 71 year-old man with cervical myelopathy underwent C4-6 laminoplasty. On postoperative day 2 he develops deltoid and biceps weakness and sensory loss in a C5 dermatomal pattern. Postoperative CT and MRI are unremarkable. What is the most likely outcome? a. Chronic C5 neuropathic pain b. Permanent motor and sensory deficit c. Complete resolution of motor and sensory deficit d. Recovery of sensory function but permanent motor deficit e. Recovery of motor function but permanent sensory deficit

Complete resolution of motor and sensory deficit

A 30 year old male with history of IV drug use presents to the ER with fever and low back pain. His MRI demonstrates a small sacral epidural abscess. He has blood cultures positive for methicilin resistant staph aureus. His erythrocyte sedimentation rate (ESR) on presentation is elevated at 110 mm/ hr. He is neurologically intact. He is to undergo 8 weeks of vancomvcin IV. What is the most appropriate test for determining that his sacral epidural abscess has resolved at the conclusion of antibiotic therapy? a. Repeat ESR b. Repeat MRI with and without contrast c. Repeat blood culture d. CT guided biopsy e. Bone scan

Repeat ESR

What is the most common spinal cord anormay in a 6 month-old male with an area of focal hirsutism located just above gluteal crease? a. Fatty filum. b. Split cord malformation. c. Lipomyelomeningocele. d. Dermal sinus tract. e. Atretic meningocele.

Split cord malformation.

A 27 year old patient presents following a trauma that involved an axial load to the spine. He has undergone CT imaging. He notes neck pain but otherwise has a normal neurological examination. What does the following conal CT scan of the cervical spine depict (figure)? a. C1-2 Rotatory Subluxation b. Occipital condyle fracture c. Type 1 odontoid fracture d. Unstable C1 (Jefferson) fracture e. C2 Hangman's Fracture

Unstable C1 (Jefferson) fracture

A 60 year old man presents with 3 months of worsening diffuse severe unremitting left upper extremity pain, parasthesias, and hand weakness. Exam shows 4:5 weakness of hand muscles including abductor policis brevis and all intrinsics, scattered sensory loss on the ulnar side of the forearm, normal deep tendon reflexes and no evidence of myelopathy. MRI of the cervical spine shows mild degenerative changes throughout the neck. What imaging study would assist in the diagnosis? a. Cervical spine flexion-extension x-rays b. Bone scan c. Chest CT d. Scoliosis survey e. Thermogram

Chest CT

What is the definitive treatment of atlanto-occipital dislocation (AOD)? a. Cranio-cervical internal fixation and fusion b. Observation with serial radiographs c. Halo vest immobilization d. Cervical traction e. Rigid cranio-cervico-thoracic orthosis

Cranio-cervical internal fixation and fusion

A 19 year old male presents with tussive headaches located at the posterior base of the skull. Neurogic examination reveals weakness of the hands bilaterally with hypesthesia. the brain and cervical spine are shown the figures. What is the best initial management strategy for this presentation? a. Anterior transoral odontoid resection b. Posterior cervical decompression c. Syringo-subarachnoid shunt d. Posterior fossa decompression e. Ventriculoperitoneal shunt

Posterior fossa decompression

According to the Guidelines for the Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine, the literature supports the use of fusion in in lumbar decompression surgery for degenerative stenosis when associated with what imaging finding? a. spina bifida. b. conjoined nerve root. c. focal disc herniation. d. congenital stenosis. e. spondylolisthesis.

spondylolisthesis

A 68 year-sld male with a history prostatic cancer presents fever and severe low pain progressing to indude lower extremity numbness. CT shows extenensive destucton the T11 and T12 vetebra bodies with relive sparing of the T disc space, as well as a large paraspinous abscess with calcification. Thoracic MRI shows a kyphotic deformity with enhancing soft tissue and bone extending into the anterior spinal canal and resulting in moderate stenosis and spinal cord compression. The MOST likely pathologic process is: a. Spinal tuberculosis b. Pathologic fracture c. Osteoporotic compression fracture d. Discitis - Staph epidermidis e. Discitis- Staph aureus

Spinal tuberculosis

A sagital, upright long-cassette radiograph is shown (figure) a year-old woman with a history of T12-L5 instrumented fusion 2 months ago who now presents with back and thigh pain. Which of the following dagnoses is most likey based on her history and imaging? a. Instrumentation failure b. Flatback syndrome c. Pseudarthrosis d. Adjacent segment disease e. Sagittal spinal imbalance

Flatback syndrome

A 51 year-old woman presents to the ED with a subcutaneous fuid collection in the lumbar area two days after undergoing a redo L4-5 laminectomy/discectomy at another institution. She is afebrile and has no neurological deficits but complains of headaches when she sits up or stands. What is the most likely etiology of her fluid collection? a. cerebrospinal fluid leak b. wound infection c. subcutaneous foreign body d. wound seroma e. wound hematoma

cerebrospinal fluid leak

Which of the following is considered a major risk factor osteoporosis by the National Osteoposis Foundation? a. Current smoking b. Prior falls c. Use of NSAIDs d. Alcohol use of 1 drink per day e. High body mass index (BMI)

Current smoking

A 60 year old male with type 2 diabetes presents with fever, back pain and < 24 hours of acude onset 2/5 motor weakness lower extremities. Thoracic MRI (Figure 1) and CT (Figure 2) imaging is performed. What is the most appropriate management for this patient's acute neurologic deficits? a. Thoracic laminectomy b. Kyphoplasty c. Corpectomy and instrumented fusion d. Percutaneous aspiration e. Antibiotic therapy and external orthosis

Corpectomy and instrumented fusion

A 26 year old male presents after motor vehicle crash with absent right and partally preserved left lower extremity motor function (more than half of left leg muscles have less than anity strength). Sensation to pain and temperature is markedy dimished i in the left leg. Proprioception is markedly dimished in the right leg . Neuro-imaging studies are obtained and depicted in Figures 1 and 2. Which spinal cord syndrome BEST describes the injunjuny? a. Brown-Sequard b. Central cord c. Anterior spinal d. Cauda equina e. Posterior cord

Brown-Sequard

A 46-year IV drug abuser presents with 2 week history of lever and progresive low back pain. He is neurologically intact. MRI reveals increased T2 signal in the L3-4 disc space with endplate destruction without an apprecible fluid collection. There is no evidence of instabilty or segmental kyphosis. Blood cultures are negative. What is the most appropriate next step in management? a. Anterior discectomy and interbody fusion b. Laminectomy for surgical debridement c. Posterior instrumentation and fusion without laminectomy d. Empiric antibiotics e. Needle biopsy of disc space

Needle biopsy of disc space

The radiographic and magnetic resonce imaging findings at L2-L3 (shown in Figures 1-3) are most consistent with a diagnosis of: a. metastatic carcinoma. b. chordoma. c. degenerative disc disease. d. discitis/osteomyelitis. e. fracture.

discitis/osteomyelitis

After a ground level fall, a 62 year-old man with a history of ankylosing spondylitis reports persistent mid-back pain. CT reveals a fracture through the entire T7 vertebral body. STIR signal MRI reveals three column injury without evidence of canal compromise. What is the most appropriate management? a. Posterior T4-9 instrumented fusion b. Transthoracic T6-7 discectomy and anterior instrumentation c. Thoraco-lumbo-sacral orthosis d. T7 Vertebroplasty e. Cervico-thoracic orthosis

Posterior T4-9 instrumented fusion

Vertebral artery injury dung C1-2 transaricular screw placement is in the likely result when the screw is misplaced in which direction? a. anteriorly b. laterally c. medially d. caudally e. cranially

caudally

A 42 year old male is undergoing L5-S1 anterior lumbar interbody fusion for spondylolisthesis. What anatomic structure overying the disc is potentially at risk during exposure for discectomy?: a. vena cava b. distal aorta c. iliolumbar vein d. hypogastic plexus e. genitofemoral nerve

hypogastic plexus

The ventral cervical plate pictured below spans three vertebral levels, and reveals a pseudoarthrosis. It consists of two screws at each end that are rigidly affixed the plate. Which of following biomechanical properties best describe the type of fixation pictured in the radiograph that lead to the pseudoarthrosis? a. Constrained dynamic. b. Constrained three-point bending. c. Semi-constrained cantilever beam. d. Constrained cantilever beam. e. Semi-constrained four-point bending.

Constrained cantilever beam

What characteristic imaging finding on MRI would best differentiate neuromyeltis optica from multiple sclerosis? a. Presence of high burden of periventricular, juxtacortical and infratentorial demyelinating lesions. b. Multiple enhancing intramedullary spinal lesions spanning 1-2 segments. c. Multiple non-enhancing intramedullary spinal lesions spanning 1-2 segments. d. Optic nerve enhancement. e. An intramedullary spinal cord lesion spanning 3 or more segments.

An intramedullary spinal cord lesion spanning 3 or more segments.

A 56- year old man presents with a 4-year history of progressive lower extremity numbness, paresthesias, weakness and spastic gait. MRI and CT Myelogram of the thoracic spine is shown (Figure 1 & 2), What is the most appropriate treatment option? a. Thoracic laminectomy and posterior fusion b. Thoracotomy for thoracic discectomy c. Fenestration of dorsal arachnoid cyst d. Observation and physical therapy e. Intradural exploration and detethering of ventral spinal cord

Intradural exploration and detethering of ventral spinal cord

In a patient with traumatic quadriparesis and difficuilty breathing, vertical displacement of the occipital condyles from the lateral masses of C1 is most consistent with rupture of what soft tissue structures? a. Rupture of the transverse ligament. b. Rupture of the tectorial membrane and alar ligaments. c. Rupture of ligamentum flavum. d. Rupture of the posterior longitudinal ligament. e. Rupture of the anterior longitudinal ligament.

Rupture of the tectorial membrane and alar ligaments

For which spinal disorder are children of mothers with diabetes mellitus at risk? a. Meningocele manque b. Sacral agenesis c. Thoracic hemivertebrae d. Spinal dysraphism e. Intraspinal lipomas

Sacral agenesis

What is the most common complication of anterior cervical discectomy and fusion (ACDF)? a. Hoarseness b. Thoracic duct injury c. Dysphagia d. Horner's syndrome e. New radiculopathy

Dysphagia

What is the recommended treatment of an isolated unilateral occipital condylar fracture (OCF) without associated atlanto-occipital ligamentous injury or evidence of instability? a. Cranio-cervical instrumentation and arthrodesis b. Cervical immobilization c. Physical therapy d. Foramen magnum decompression e. Observation with serial radiographs

Cervical immobilization

During atlantoaxial rotatory subluxation with left axial hyper-rotation, several ligaments of the upper cervical spine can be torn. In rotatory subluxation, which ligament is most likely to retain its integrity? a. Alar ligament b. Accessory ligament c. Ipsilateral C1-C2 facet capsular ligament d. Contralateral C1-C2 facet capsular ligament e. Transverse ligament

Transverse ligament

What is the most common adverse event following laminoplasty for cervical spondylotic myelopathy? a. Progressive cervical kyphosis b. C5 root palsy c. Accelerated adjacent level deterioration d. Loss of cervical range of motion e. Inadequate cord decompression

Loss of cervical range of motion

A 22-year-old sustained a spinal cord injury after a fall with an L2 burst fracture and canal compromise. More than half of the muscles below the level of injury have a strength grade less than 3. There is impaired pain and temperature sensation below the middle of the thighs bilaterally, but preserved light touch and proprioception.There is bilateral Babinski sign and loss of anal tone and wink reflex. According to the 2000/2002 ASIA Standards, what (modified) ASIA Impairment Scale classifion is this patient? a. C b. B c. D d. E e. A

An 8 year-old child with a history of myelomeningocele presents with progressive back pain, scoliosis, right calf numbness, right leg weakness, incontinence, and bladder spasticity. Which of her symptoms is most likely to improve following a third untethering procedure? a. Leg weakness b. Scoliosis c. Leg numbness d. Back pain e. Bladder spasticity

Back pain

What mechanism underlies the injury depicted in Figures 1 and 2? a. Compressive extension b. Distractive extension c. Compressive flexion d. Torsional rotation e. Distractive flexion

Compressive flexion

A 37 year-old man presents with worsening low back pain and night L5 radicular pain and a normal examination. Lumbar spine MRI (Figure 1) and (Figure 2) are shown. Work-up revealed this solitary lesion. What is the most appriate next step in management? a. External beam radiotherapy b. Observation with serial imaging c. Surgical excision and stabilization d. Open surgical biopsy e. CT-guided biopsy

CT-guided biopsy

During lateral ostephyfe removal in anterior decompressive discectomy, you encounter brisk bleeding in the region of the nerve root. What is the next best step? a. Abort the procedure b. Order blood for transfusion c. Explore the vertebral artery d. Call interventional radiology e. Apply gelfoam and pressure

Apply gelfoam and pressure

A 75 year-old healty woman suffered a tall 3 months ago and immediately noticed neck pain. She has been treating her with over-the-counter medications, but the pain continues to worsen over time. On exam, she has no focal deficits. X-ray (Figure 1) and CT (Figure 2) are depicted. What is the optimal management for this patient? a. Odontoid screw placement b. Cervical collar c. C1-2 posterior fusion d. Occipital-cervical fusion e. Halo-vest placement

C1-2 posterior fusion

A patient complains of hip and thigh pain 2 month following thoracolumbar fusion surgery (figure). Based on the provided radiograph, what is the best treatment option to correct the primary problem producing pain and disability? a. Re-arthrodesis to address pseudarthrosis b. T12 to L5 decompressive Laminectomy c. Extension of instrumented fusion to the pelvis d. Pedicle subtraction osteotomy e. Extension of instrumented fusion to T10

Pedicle subtraction osteotomy

A 58 year old woman with a history of breast cancer presents with lower thoracic spine pain. The pain is worse at night and does not worsen with movement. She is neurologically intact. An MRI reveals a contrast-enhancing lytic lesion isolated to the T12 body without evidence of fracture. There are multiple smaller lesions noted throughout her entire spinal axis. She is currently undergoing systemic therapy for her bone only disease. What is the most appropriate treatment option for this patient? a. T12 vertebrectomy with pedicle screw instrumentation followed by radiotherapy. b. Fractionated external beam radiotherapy. c. Posterior T12 laminectomy with pedicle screw instrumentation followed by radiotherapy. d. Percutaneous biopsy and vertebroplasty followed by conventional fractionated radiotherapy. e. Percutaneous biopsy and vertebroplasty followed by radiosurgery.

Fractionated external beam radiotherapy.

When placing bicorical sacral pedicle screws, which structure is at most risk with a laterally placed screw that perforates the anterior cortex? a. Internal Iliac artery b. L5 nerve root c. Aorta d. Lumbosacral plexus e. S1 nerve root

L5 nerve root

A 56 year-old man presents with theumatoid arthritis and a several month history of progressively severe neck pain and numbness in all four extremities as well as gait disturbance. Cervical MRI reveals myelomalacia at C1-2. Dynamic radiographs reveal an atlanto-dental interval of 3 mm in extension and 12mm in flexion. Which of the following is the MOST appropriate surgical intervention: a. C2-3 Lateral mass fixation b. Posterior C1 ring resection c. Anterior odontoid screw fixation d. C1-2 fixation e. Transoral odontoid resection

C1-2 fixation

A 55 year-old female presents with back pain, progressive right leg pain, atrophy and weakness. Exam reveals bilateral non-dermatomal lower extremity hypalgesia and a hemangioma with hypertrichosis over the lumbar spine. Imaging reveals a 10 degree thoracic scoliosis, right sided disc bulge at L1/2, conus terminating at L4, and fatty filum terminale (3mm). What is the treatment of choice for this patient? a. L1/L2 microdiscectomy b. Conservative therapy (PT, NSAIDS, etc) c. Release of filum terminale d. Spinal deformity correction e. Monitoring with serial imaging

Release of filum terminale

Which of the following most accurately defines, from a biomechanical perspective, the location of rod fracture depicted in Figure 1? The point of: a. maximum strain application. b. narrowest diameter. c. maximum stress application. d. 3-point bending. e. greatest flexibility.

maximum stress application.

A 78 year-old man with a 10-year history intermittent chronic neck pain has cervical spine X-rays (Figure 1) MRI (Figure 2). The patient denies any current neck pain, radiculopalhy or subjective symptoms of myelopathy. His exam is normal. What is the recommended management for this patient? a. Clinical observation b. Immobilization with cervical collar c. High-dose steroids and cervical traction d. Surgery e. Serial MRI

Clinical observation

A 65 year-old patient awakens from a left subcostal infusion pump surgery done in the latenal position with compints of painless right leg weakness. Examination shows weakness of ankle dorsiflexion and eversion and sensory loss limited to the dorsal foot. Ankle inversion, toe fiexion and deep tendon reflexes are normal. Babinski response is normal. An urgent EMG/NCV is normal. What is the most likely cause of this man's weakness? a. L5 radiculopathy b. Sciatic neuropathy c. Lumbar plexopathy d. Peroneal neuropathy e. Tibialis anterior compression

Peroneal neuropathy

You are seeing a patent with leg pain and foraminal stenosis at four lumbar levels on the left side. You considering decompressive surgery, but want to idenify the symptomatc level(s) prior to operating. Which procedure would best suited to idenify the nerve root(s) responsible for the pain? a. Selective nerve root block b. Interlaminar epidural steroid injection c. Provocative discography d. Facet joint injection e. Sacroiliac joint injection

Selective nerve root block

A 52 y/o restrained driver presented after a motor vehicle accident with an L2 sensory level, 4/5 strength in his proximal and 4-/5 strength in his distal lower extremities and a severe L2 fracture. What is this patient's ASIA Impairment Scale score (modified Frankel score)? a. A b. B c. E d. D e. C

What clinical finding best characterizes cauda equina syndrome? a. foot drop b. sciatica c. ankle plantar flexion weakness d. decreased patellar tendon reflex e. saddle anesthesia

saddle anesthesia

This lumbosacral spine MRI (figure) is from a 23-year old woman who presented with severe low back pain radiating to her leg. Which nerve root is most likely compressed by the herniated disc? a. Traversing L5 nerve root b. Exiting L5 nerve root c. Traversing S1 nerve root d. Traversing L4 nerve root e. Exiting S1 nerve root

Traversing S1 nerve root

A patient presents with a classic type ll odontoid fracture. A magnetic resonance image and flexion-extension dynamic radiographs of the cervical spine are consistent with disruption of the transverse ligament. The MOST appropriate treatment is: a. Occipital-cervical fusion b. Halo immobilization c. Posterior C1-C2 fixation d. Hard cervical collar e. Anterior odontoid screw fixation

Posterior C1-C2 fixation

A 60 year old man presents with 10 weeks of back pain. ESR and CRP are elevated and WBC is normal. Blood cultures show no growth. The patient has normal strength and sensation and no bowel or bladder incontinence. The MRI reveals osteomyelitis and disctis of L3/4 without epidural abscess or canal compromise. What is the best next step in the management of this patient? a. Empiric antibiotics b. Lumbar Puncture c. Disc space biopsy d. Surgical Debridement e. Lumbar Brace

Disc space biopsy

Which of the following pedicle screw characteristics increases pullout strength? a. bilateral screw triangulation with crosslink b. increased minor - major diameter ratio c. smaller inter-thread distance d. unicortical purchase e. tapered screw shape

bilateral screw triangulation with crosslink

What is a contraindication for posterior cervical foraminotomy as a treatment for cervical radiculopathy due to dise hemiation? a. Associated osteophyte formation b. Central disc herniation c. Degenerative changes at other levels d. Kyphotic neck deformity e. Ipsilateral vocal cord palsy

Central disc herniation

A diabetic patient with known peripheral vascular disease undergoes an anterior cenvical discetomy at C4-5. The course is unremarkable; however, in the recovery room the patient is noted to have decreased sensation in the 4th and 5th digits of the left hand and decreased grip. What is the MOST likely diagnosis? a. Positioning nerve injury b. Embolic stroke c. Surgical trauma d. Brachial plexus stretch injury e. Residual muscle relaxation

Positioning nerve injury

A 12 year-old with Down syndrome has abnomal fexion-exdension cervical spine x-ays. The child no signifint neurologic complains or neck pain. On exam, the child has full range of motion and no tenderness to palpation. The fiexion-extension x-rays show a 7-8 mm atlantodental interval in flexion which reduces to 4 mm in extension. What is the most appropriate next step? a. Occipital cervical fusion with sublaminar wires b. Observation with no repeat imaging necessary c. Observation with repeat flexion-extension in the future d. C1-2 transarticular screw placement and autologous fusion e. C1-2 wiring with halo placement and autologous fusion

Observation with repeat flexion-extension in the future

A 50-year-old woman presents with a one-year history of progresive low back pain and constipation. Magnetic resonance imaging demonstrates a large sacral mass (figure), She is neurologically intact. What is the most impont next step to determine further management? a. Proctoscopic examination to assess the consistency of lesion b. CT-guided biopsy of the mass c. MRI with contrast of the pelvis d. Formal urodynamics studies e. MRI of the skull-base

CT-guided biopsy of the mass

A pedicle subtraction osteotomy (PSO) hinges on which anatomic region? a. The posterior column of the spine b. Posterior to the spinal column c. Anterior to the spinal column d. The anterior column of the spine e. The middle column of the spine

The anterior column of the spine

A 68 year-old woman presents with progressive myelopathy with MRI shown. Why is an isolaled posterior approach contraindicated in this patient? a. Compressive pathology across multiple levels b. Ventral compressive pathology c. Posterior ligamentous hypertrophy d. Fixed kyphotic deformity e. Subluxation at C3/4 and C4/5

Fixed kyphotic deformity

What is the most common cause of perioperative visual loss (POVL) in patients undergoing spinal fusion? a. Retinal vascular occlusion b. Cortical blindness c. Corneal abrasion d. Posterior ischemic optic neuropathy e. Anterior ischemic optic neuropathy

Posterior ischemic optic neuropathy

You are treating a patient with chronic, medically-refractory low back pain. You decide to proceed with a trial of spinal cord stimulation. What would be the most appropriate spinal level for electrode placement to achieve the best stimulaion coverage of the patient's painful area? a. T11 b. C1 c. L5 d. L2 e. T9

A 50 year old man prents with prossive gait and micturition difficulty from a spinal dural AV fistula. What the most reliable predictor of postoperative recovery of function? a. Spinal level of dural AV fistula b. Patient age c. Degree of preoperative disability d. Treatment modality e. Number of arterial feeders

Degree of preoperative disability

Two days after performing heavy manual labor, your patient awakens with severe left shoulder pain, severe enough to require narcolics for relief. Ten days later, he notices rapidly gressive weakness of his shoulder girdle muscles and biceps. Examination reveals a normal sensory exam. MRI of the cervical spine is unremarkable. What is the most likely diagnosis? a. Acute left C5-C6 disc herniation b. Brachial plexus stretch injury c. Amyotrophic lateral sclerosis d. Parsonage-Turner syndrome e. Thoracic outlet syndrome

Parsonage-Turner syndrome

A 61 year old previoslu healhy man presents with progressive hand weakness, tingling in his fingers, and gait instability. Examination reveals atrophy and weakness of the hands, impared rapid alternating movements, diminished pinprick sensation in the fingers, diffuse hyper-reflexia, and lower extremity spasticity. What is the MOST likely diagnosis: a. Subacute Combined System Disease b. Amytrophic Lateral Sclerosis c. Normal Pressure Hydrocephalus d. Multiple Sclerosis e. Cervical Spondylotic Myelopathy

Cervical Spondylotic Myelopathy

What is the most likely diagnosis demonstrated by the findings in the MRI images shown (see figures)? a. Multiple sclerosis b. Chordoma c. Basilar invagination d. Chiari 1 malformation with syrinx e. Pilocytic astrocytoma

Chiari 1 malformation with syrinx

A 28-year old male presents to the Emergency Department with complaints of severe low back and right leg pain after injury while working as a carpenter the previous day. He deries weakness, numbness and gait or bowel/bladder disturbance. Examination reveals trace weakness of dorsi-flexion on the right associated with pain. What is the best initial management strategy for this patient? a. Lumbar discectomy b. Epidural steroid injection c. Seven day course of bed rest d. Posterior lumbar interbody fusion e. Nonsteroidal anti-inflammatory medications

Nonsteroidal anti-inflammatory medications

What radiographic finding is a contraindication to cervical laminoplasty? a. Cervical kyphosis. b. Multilevel cervical spondylosis. c. Ossified posterior longitudinal ligament (OPLL). d. Spinal cord signal change. e. Congenital cervical stenosis.

Ossified posterior longitudinal ligament (OPLL).

A 68 year-old man presents to the office with neck and right upper extremity paresthesias. He reports mild difficulty buttoning his shirt and intiating micturition. He has decreased sensation in the right first and second dight and loss the right biceps reflex. He also has mild loss of balance with tandem gait. His cervical spine MRI is depicted (Fig 1). Whatis the most aporopriale mangement? a. Structured physical therapy with gait training b. Surgical decompression of the cervical spinal cord c. Electrodiagnostic studies (EMG/NCV) to assess for carpal tunnel syndrome d. Right C5-C6 transforaminal epidural injection e. Medrol dose pack and soft cervical collar for 6 months

Surgical decompression of the cervical spinal cord

What is the best method to screen for cervical spine injury in the unconscious, intubated multrauma patient? a. C-Spine MRI b. A/P, Lateral, Oblique, and Open Mouth Odontoid radiographs c. C-spine CT d. Fluoroscopic Flexion/Extension Imaging e. Dynamic traction fluoroscopy

C-spine CT

During a rebroperioneal approach to the lumbar spine, what structure runs along the medial aspect the psoas muscle and and lateral aspect of the spine? a. Sympathetic trunk b. Genitofemoral nerve c. Ilioinguinal nerve d. Aorta e. Ureter

Sympathetic trunk

A 66-year old male with a history of ACDF performed 3 months ago presented with a 6 week history of fever, dysphagia, and neck pain. The patient was neurologically intact. MR imaging is consistent with cervical vertebrai osteomyelitis and reveals a retrophangeal abscess. What test is most helpful to diagnose the source of the infection? a. Esophagoscopy b. Tagged white blood-cell scan c. Peripheral blood cultures d. Bone scan e. Echocardiogram

Esophagoscopy

If pelvic alignment is not addressed during spinal deformity surgery, what clinical outcome is most likely to occur? a. Hardware failure b. Piriformis syndrome c. Spinal misalignment d. Hip dislocation e. Acetabular fracture

Spinal misalignment

A 47 year-old woman underwent a C5-6 ACDF via a left sided approach. postoperatively she has a weak, drooping eyelid and a constricted pupil. What technique reduces risk of this complication? a. Place retractors under the medial edge of the longus colli muscles during periosteal dissection b. Deflate and re-inflate the endotracheal balloon after retractor placement c. Perform surgical approach from the patient's right side d. Minimize excessive traction on the shoulders when positioning e. Minimize distraction of the vertebral bodies

Place retractors under the medial edge of the longus colli muscles during periosteal dissection

A 47 year-old woman with a history of multiple prior lumbar spine surgeries with temporary relief of back and leg pain after each, now presents with severe low back pain. Her pain worsens thoughout the day, requing her to use a walker in the evening. She denies new radicular symptoms and is neurologically intact on exam. X-rays are obtained (Figure 1) What the likely etiogy of her pain and disability? a. Residual lumbar stenosis b. Pseudarthrosis c. Positive sagittal imbalance d. Sacroiliac joint dysfunction e. Adjacent level foraminal stenosis

Positive sagittal imbalance

Compared to posterior surgery, what risk is associated with Anterior cervical surgery for OPLL? a. Kyphosis b. shoulder girdle pain c. CSF leak d. C5 root palsy e. OPLL growth

CSF leak

What radiographic finding is most commonly associated with Chiari I malformations? a. Spina Bifida b. Hydrocephalus. c. Syringomyelia. d. Scoliosis. e. "Pigeon Breast" deformity of the brainstem.

Syringomyelia.

Immediately afer closing the osteotomy for corrrection of a thoracolumbar scoliosis, the intraoperative monitoring technician informs you that there has been a sudden >50% decrease in amplitude on the motor evoked potentials. What is the first step in management? a. reverse the osteotomy closure b. check MEP leads and connections c. fluoroscopy to confirm pedicle screw position d. perform a wake up test e. decrease inhalant anesthetic

reverse the osteotomy closure

What lateral plain film measurents of the cervical spine is used to make the diagnosis of atlanto-occipital dislocation (AOD)? a. Combined C1 Lateral mass displacement b. Atlanto-dens interval c. Chamberlain's line d. Basion-posterior axial line and basion-dens interval e. Mcgregor's line

Basion-posterior axial line and basion-dens interval

A 56 year-old man presents with rheumatoid arthritis and a several month history of progressively severe neck pain and numbness in all four extremities as well as gait disturbance. Cervical MRI reveals myelomalacia at C1-2. Dynamic radiographs reveal an atlanto-dental interval of 3 mm in extension and 12 mm in flexion. Which of the following is the MOST appropriate surgical intervention: a. Posterior C1 ring resection b. C1-2 fixation c. Anterior odontoid screw fixationYour Answer d. Transoral odontoid resection e. C2-3 Lateral mass fixation

C1-2 fixation

Neurospine Flashcards

(100 cards)