Spine Injuries and Disorders (IVDP, Spondylolisthesis, Spinal Cord Injuries) MCQs

Orthopedics · 60 free questions with answers & explanations.

1. A 40-year-old man presents with low back pain radiating down the posterolateral aspect of the left leg to the dorsum of the foot and great toe, with numbness and weakness of great toe dorsiflexion. Straight leg raise is positive at 40° on the left. The nerve root most likely affected is:
2. Following a C5–C6 fracture-dislocation of the cervical spine, a patient has complete motor and sensory loss below C6 bilaterally. However, pain and temperature are also preserved in a saddle distribution. Which spinal cord syndrome is this?
3. A 35-year-old presents with acute onset low back pain radiating to the right leg along L5 distribution (great toe dorsiflexion weakness, foot drop) after lifting a heavy object. MRI confirms L4–L5 right posterolateral disc herniation. He fails conservative therapy for 6 weeks. Indications for urgent (emergency) surgical discectomy include:
4. A 45-year-old presents with low back pain and Grade II spondylolisthesis at L4–L5 (Meyerding classification). Meyerding Grade II specifically means the slip is:
5. A 25-year-old sustains a complete cervical cord injury (ASIA Impairment Scale Grade A) at C5 level in a motor vehicle accident. Regarding acute management, the current evidence-based recommendation for high-dose methylprednisolone is:
6. In assessment of spinal cord injury, the term 'spinal shock' refers to:
7. The ASIA Impairment Scale (AIS) classifies spinal cord injuries. A patient who has no motor or sensory function below the level of injury, but has preserved sacral function (voluntary anal contraction or perianal sensation), is classified as:
8. A 40-year-old man with Grade II isthmic spondylolisthesis (Meyerding) at L5-S1 has persistent low back pain and L5 radiculopathy despite 3 months of conservative treatment. The MOST appropriate surgical option is:
9. In the Denis classification of spinal fractures, the middle column consists of:
10. Neurogenic shock following high thoracic or cervical spinal cord injury is distinguished from haemorrhagic shock by:
11. According to the Meyerding classification, a Grade II spondylolisthesis at L5-S1 implies that the L5 vertebral body has slipped anteriorly over the sacrum by:
12. A 35-year-old man sustains a C5 fracture-dislocation in a diving accident and has complete motor and sensory loss below C5 immediately post-injury. 48 hours later, examination shows no recovery. According to the ASIA impairment scale (AIS), he is classified as:
13. In lumbar disc herniation at L4-L5, the disc compresses the traversing (descending) nerve root. Which nerve root is affected, and what is the characteristic clinical finding?
14. The Denis three-column concept of spinal stability defines the middle column as:
15. A 32-year-old man presents with sudden-onset severe neck pain and bilateral upper limb weakness after diving into a shallow pool. MRI shows a central cervical cord contusion at C5-C6 with no bony fracture. Which clinical syndrome best describes his deficits — greater weakness in arms than legs, sacral sensory sparing, and bladder dysfunction?
16. A 45-year-old woman is assessed after a road traffic accident and found to have an ASIA impairment score of B. Which of the following accurately describes this classification?
17. A 35-year-old woman has isthmic spondylolisthesis at L5-S1 with Meyerding grade II slip (26–50% displacement). She has failed 6 months of conservative treatment and has persistent radiculopathy. Which component of the surgical treatment is MOST critical to prevent progression and relieve neural compression?
18. A 45-year-old male has low back pain radiating to the right leg with numbness in the web space between the first and second toes and weakness of foot dorsiflexion (extensor hallucis longus). MRI shows L4-L5 disc prolapse compressing the right nerve root. Which nerve root is compressed?
19. In the Denis three-column theory of thoracolumbar spine stability, which combination of column disruptions always renders a fracture mechanically unstable?
20. A 28-year-old has an acute cervical spinal cord injury at C5 level. 48 hours later, the patient has preserved sacral sensation and voluntary anal sphincter contraction, with lower limb strength MRC Grade 0 and upper limb MRC Grade 3/5. According to the ASIA Impairment Scale (AIS), this is classified as:
21. Meyerding classification is used for spondylolisthesis grading. A Grade III spondylolisthesis means the vertebral body has slipped what percentage of the width of the subjacent vertebra?
22. A 32-year-old fell from height and sustained a burst fracture of L1 vertebra with 45% canal compromise and intact neurology. According to the TLICS (Thoracolumbar Injury Classification and Severity) score, which statement about scoring is CORRECT?
23. A 28-year-old is diagnosed with isthmic spondylolisthesis (Meyerding Grade II) of L5-S1 with persistent radiculopathy after 6 weeks of conservative treatment. The pars defect in isthmic spondylolisthesis occurs at which anatomical structure?
24. The ASIA Impairment Scale (AIS) grade B spinal cord injury is defined as:
25. A 30-year-old software engineer has acute L4-L5 disc herniation with right L5 radiculopathy causing foot drop (MRC grade 3). Pain has not responded to 3 weeks of conservative management. Which finding mandates urgent surgical discectomy rather than continued conservative management?
26. The Denis three-column concept classifies thoracolumbar fractures. An anterior compression fracture of >50% height loss with middle column intact represents which Denis type and what is the clinical implication?
27. A 25-year-old diver sustains cervical cord injury at C5. He has complete motor and sensory loss below C5 bilaterally. ASIA classification is A. He retains elbow flexion but cannot extend the wrist. Which muscle is expected to function and how can it be used for tendon transfer?
28. In Meyerding grading of spondylolisthesis, a Grade IV slip means the vertebral body has slipped forward by:
29. A 45-year-old construction worker presents with L5 radiculopathy (footdrop, numbness in L5 distribution) following a work injury. MRI confirms a large L4-L5 disc extrusion compressing the L5 nerve root. Conservative management for 6 weeks failed. The indication for surgical discectomy in this patient is:
30. A 20-year-old man sustains a C6 complete spinal cord injury (AIS grade A) in a diving accident. Based on the C6 level, which functional ability and the appropriate assistive device or surgical intervention is most relevant?
31. A 30-year-old presents with acute central cord syndrome (CCS) following a hyperextension injury on a background of cervical spondylosis. The characteristic neurological pattern is:
32. In the management of isthmic spondylolisthesis (Meyerding Grade II–III), the preferred surgical procedure in a young adult with significant symptoms and >50% slip is:
33. A 38-year-old construction worker has a grade II isthmic spondylolisthesis at L5–S1 confirmed on lateral X-ray. The Meyerding classification is used. Which measurement defines each grade and what does 'isthmic' type specifically refer to?
34. A 22-year-old sustains a diving injury with C5–C6 dislocation. ASIA (American Spinal Injury Association) impairment scale assessment reveals no motor or sensory function below C6, including in S4–S5 dermatomes. What is the ASIA grade and the clinical significance?
35. A 45-year-old presents with neck pain and bilateral hand tingling with a burning sensation in the palms. MRI shows a large central and right paracentral C6–C7 disc prolapse compressing the cord. The syndrome characterised by greater weakness of the upper limbs than lower limbs with sacral sensory sparing is:
36. The Meyerding classification grades lumbar spondylolisthesis based on the percentage of slip of one vertebra over the next. A Meyerding Grade III slip corresponds to:
37. A 28-year-old motorcyclist sustains a cervical spinal cord injury at C5. On examination, he has elbow flexion but cannot extend the elbow, has wrist extension power grade 3/5, but no hand or finger function. His ASIA Impairment Scale (AIS) grade is C. Based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the neurological level of injury (NLI) is:
38. Central cord syndrome — the most common incomplete spinal cord injury — is characterised by:
39. A 35-year-old male presents with acute-onset severe low back pain radiating to the left L5 dermatome (dorsum of foot, big toe) with foot drop. MRI shows a large left paracentral disc herniation at L4-L5 level. He also has bilateral leg weakness, saddle anesthesia, and acute urinary retention. The MOST urgent management priority is:
40. A 15-year-old boy has low back pain exacerbated by hyperextension. Standing lateral X-ray shows a defect in the pars interarticularis of L5 (Scotty dog with a collar). There is a grade II spondylolisthesis. The first-line management is:
41. A 35-year-old with L4–L5 disc prolapse presents with weakness of ankle dorsiflexion, big toe extension, and decreased sensation over the dorsum of the foot. The nerve root compressed is:
42. Meyerding classification of spondylolisthesis classifies Grade IV as slippage of:
43. The ASIA Impairment Scale (AIS) classifies a patient as Grade B when:
44. A 30-year-old man dives into shallow water and sustains a C5 burst fracture with complete motor and sensory loss below C5. On examination at 48 hours, bulbocavernosus reflex is absent. This finding indicates:
45. A 45-year-old woman presents with bilateral leg weakness, saddle anaesthesia, and acute urinary retention following a large central L4–L5 disc prolapse. Urgent MRI confirms massive sequestered disc herniation compressing the cauda equina. The single most important prognostic factor for recovery of bladder function is:
46. A 35-year-old laborer has isthmic spondylolisthesis at L5–S1 (Grade II by Meyerding — 26–50% slip). He has failed 6 months of conservative management with persistent radiculopathy and low back pain. The preferred surgical treatment is:
47. A 55-year-old presents with spastic paraparesis developing over 6 months and MRI reveals multilevel cervical cord compression (C3–C6) with intramedullary T2 signal changes at C4–C5. The diagnosis is cervical spondylotic myelopathy (CSM). The surgical approach preferred for multilevel (≥ 3 levels) central canal stenosis without significant kyphosis is:
48. In a patient with Isthmic spondylolisthesis (Meyerding Grade III, L5–S1), which radiographic measurement determines the degree of slip and guides surgical decision-making?
49. In thoracic spinal cord injury at T6 level, which of the following is a characteristic feature of the neurological syndrome expected?
50. A 30-year-old man presents with acute sciatica after lifting a heavy object. MRI reveals a large L4–L5 central disc herniation causing cauda equina compression. Clinically, he has bilateral leg weakness, saddle anaesthesia, and urinary retention. The most important management decision is:
51. In isthmic spondylolisthesis, the defect causing forward slip of one vertebral body on the next is located at the:
52. A 45-year-old man has L4–L5 isthmic spondylolisthesis with grade II slip (25–50% according to Meyerding classification). Despite 6 months of conservative management he has persistent radiculopathy and mechanical back pain. The most appropriate surgical procedure is:
53. A 30-year-old diver sustains a C6 spinal cord injury (SCI). During rehabilitation the team notes he has preserved shoulder abduction and elbow flexion (C5/C6 roots intact) but no triceps function, finger extension, or hand intrinsics. According to the ASIA (American Spinal Injury Association) impairment scale assessment, which motor and sensory levels are expected AND what is the minimum ASIA grade for preserved voluntary anal contraction with absent perianal sensation?
54. A 25-year-old man dives into a shallow pool and sustains a hyperflexion cervical injury at C5–C6. He is quadriplegic below C5 but has preserved sacral sensation (perianal sensation intact) and voluntary anal contraction. The ASIA Impairment Scale classification is:
55. A 35-year-old laborer has isthmic spondylolisthesis at L5–S1, Meyerding Grade II (25–50% slip). He has failed 6 months of physiotherapy and analgesics. He has bilateral L5 radiculopathy on EMG. The most appropriate surgical intervention is:
56. A 45-year-old man presents with low back pain radiating to the right leg in an L5 dermatomal pattern (big toe and dorsum of foot numbness), weakness of extensor hallucis longus, and a normal ankle jerk. MRI shows a posterolateral disc herniation at L4-L5. Which nerve root is compressed?
57. A 70-year-old man presents with bilateral leg pain, weakness, and heaviness on walking that is relieved by sitting or bending forward (shopping trolley sign). MRI shows multilevel lumbar stenosis. What is the pathophysiology of the posture-dependent symptom relief?
58. A 25-year-old male complains of early morning stiffness of the back lasting more than 1 hour, improved by exercise. X-ray of the sacroiliac joints shows bilateral blurring and sclerosis. HLA-B27 is positive. What radiological sign on a lateral lumbar X-ray is a late feature of this condition?
59. A 6-year-old child is brought with progressive back deformity. X-ray shows hemivertebra at T8 producing a structural scoliosis. The parent asks about prognosis. Which of the following statements is most accurate?
60. A 35-year-old man sustains a burst fracture of L1 following a fall from height. CT scan shows 40% canal compromise and 30° kyphosis. Neurological examination reveals bilateral lower limb weakness (grade 3/5) and bladder dysfunction. According to the Denis three-column theory, which columns are disrupted in a burst fracture?