Adult Spinal Deformity and Degenerative Scoliosis

Question 1

A patient presents with backache radiating to lower limbs which increases during walking. This patient has obvious spinal deformity with scoliosis, forward flexion at the wrist, and walking with knees bent. This patient is more than 60 years of age. Standing coronal view X-ray was done which showed Cobb
angle of more than 10 degrees. What is the most probable diagnosis in this case?
● A. Adult degenerative spine disease
● B. Adolescent idiopathic scoliosis
● C. Adult idiopathic scoliosis
● D. Adult spinal deformity
● E. None of the above

Answer 1

A. Adult degenerative spine disease

Question 2

SRS-Schwab classification of adult degenerative spinal deformity has which of the following parameters?
● A. Coronal curve types
● B. Sagittal modifiers
● C. Global alignment
● D. Pelvic tilt
● E. All of the above

Answer 2

E. All of the above

Question 3

Treatment options for adult degenerative scoliosis are based on clinical symptoms and include the following except?
● A. Observation only
● B. Focal decompression
● C. Surgical correction of deformity and stability using traditional open surgery (decompression by laminectomy, PLIF, TLIF, pedicle screw/rod fixation), minimal invasive spine surgery, and combined (both open and MIS)
● D. Anterior corpectomy and cage fixation
● E. None of the above

Answer 3

D. Anterior corpectomy and cage fixation

Question 4

Summary for spinopelvic alignment objectives include the following except?
● A. LL = PI ± 9 degrees
● B. PT less than 20 degrees
● C. PSVL and SSV should be less than 30 degrees
● D. SVA less than 5 cm

Answer 4

C. PSVL and SSV should be less than 30 degrees

Question 5

Which of the following is Schwab grade 3 of surgical spine osteotomies?
● A. Resection of the inferior facet and joint capsule
● B. Resection of the superior and inferior facets, ligamentum flavum, and possible lamina and spinous process
● C. Partial wedge resection of the vertebral body and the posterior elements with the pedicles
● D. Partial wedge resection of the vertebral body and the posterior elements with the pedicles plus inclusion of at least a portion of the endplate and one adjacent disk
● E. Complete removal of the vertebra and both adjacent disks

Answer 5

C. Partial wedge resection of the vertebral body and the posterior elements with the pedicles

Question 6

How much lumbar lordosis can be obtained by Schwab grade 1 osteotomy plus ACR?
● A. 1 degree
● B. 6 degrees
● C. 5 to 10 degrees
● D. 16 degrees
● E. 30 to 40 degrees

Answer 6

D. 16 degrees

Question 7

Morbid obesity (BMI more than 40) doubles the risk of complications of all types including cardiac, renal, pulmonary, and wound complications with spine surgery, and mortality is increased by how much?
● A. Doubled
● B. Tripled
● C. Four times increased
● D. Five times increased
● E. None of the above

Answer 7

B. Tripled

Question 8

Pedicle subtraction can increase LL by 30 to 40 degrees. What is the Schwab grade?
● A. Grade 1
● B. Grade 2
● C. Grade 3
● D. Grade 4
● E. Grade 5

Answer 8

C. Grade 3

Question 9

Coronal balance is measured on AP standing scoliosis X-ray. A plumb line is drawn straight down from the center of the C7 vertebral body. There is coronal imbalance if this falls from midline of the sacrum by more than what?
● A. 2 cm
● B. 3 cm
● C. 4 cm
● D. 5 cm
● E. 6 cm

Answer 9

C. 4 cm

Question 10

CT scan in case of adult degenerative scoliotic patient can provide which of the following information?
● A. Any fusions (spontaneous or surgical)
● B. Vacuum disk (which imply hypermobility)
● C. Calcifications (in herniated disks, ligamentum flavum)
● D. For obtaining measurements for surgical instrumentation
● E. All of the above

Answer 10

E. All of the above

Question 11

Before surgery for adult spinal deformity (ASD), surgeons use teriparatide for how long to rapidly increase the strength of osteoporotic bone?
● A. 2 weeks
● B. 4 weeks
● C. 6 weeks
● D. 3 months
● E. 6 months

Answer 11

D. 3 months

Question 12

Standing scoliosis X-ray must image from C7 down to what level?
● A. T7
● B. Midthoracic level
● C. Thoracolumbar junction
● D. L1
● E. Femoral heads

Answer 12

E. Femoral heads

Question 13

The degree of curve rigidity after scoliosis surgery can be determined with which of the following?
● A. Dynamic standing scoliosis X-ray
● B. Flexion–extension X-rays
● C. CT scan
● D. CT myelogram
● E. MRI with contrast

Answer 13

A. Dynamic standing scoliosis X-ray

Question 14

Pre- and postoperative standing scoliosis X-rays help to confirm that alignment objectives are achieved. Following views are required for adolescent idiopathic scoliosis (AIS) except?
● A. Standing coronal
● B. Lateral
● C. Left bending
● D. Right bending
● E. Sagittal

Answer 14

E. Sagittal

Question 15

According to Schwab’s classification of surgical osteotomies, a complete removal of the vertebra and both adjacent disks and rib resections extended over multiple vertebral levels is what grade?
● A. Zero
● B. II
● C. III
● D. V
● E. VI

Answer 15

E. VI

Question 16

Anterior lumbar interbody fusion (ALIF) is best for lumbar level where the great vessels tend not to interfere with the access, and where every degree of correction produces a more significant amount of improvement in vertical alignment. Which level is this?
● A. L1–L2
● B. L2–L3
● C. L3–L4
● D. L4–L5
● E. L5–S1

Answer 16

E. L5–S1

Question 17

Standing scoliosis X-rays provide information about scoliosis and which of the following?
● A. Sagittal balance
● B. Cobb’s angle
● C. Anterolisthesis
● D. Retrolisthesis
● F. Dynamic stability

Answer 17

A. Sagittal balance