10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free Spinal Surgery questions are organized by exam domain, so you can see how each part of the Certification in Spine Surgery blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: BASIC SCIENCES
Question 1
After thoracoabdominal aortic repair complicated by hypotension, a patient develops bilateral leg paralysis and loss of pinprick and temperature sensation below T10. Vibration and joint-position sensation remain intact at both great toes. Upper-limb function is normal, and both feet are warm with palpable pulses. Which vascular-anatomic explanation fits this dissociation of sensation?
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Correct answer: A - Anterior spinal artery ischemia affecting corticospinal and spinothalamic pathways
Question 2
Three years after an instrumented fusion, a patient develops recurrent focal back pain without trauma. Radiographs show a broken rod, and CT shows a persistent gap in the fusion mass at the same level; adjoining levels are bridged. The rod has repeatedly carried physiologic loads below its single-cycle failure strength. What explains the break despite the absence of an unusually large single load?
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Correct answer: C - Fatigue from repeated submaximal loading
Domain 2: CLINICAL SCIENCES
Question 3
An MRI accompanying a referral for painless right foot drop shows right L4-5 lateral-recess stenosis. Ankle dorsiflexion and eversion are weak, but inversion and hip abduction are normal. Nerve conduction studies demonstrate focal conduction block across the fibular neck. Needle examination of tibialis posterior and gluteus medius is normal. Which localization best reconciles the examination and electrodiagnostic findings?
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Correct answer: D - Right common fibular neuropathy at the fibular neck
Question 4
Six weeks of focal lumbar pain prompts MRI in a 57-year-old patient. It shows L2-3 disc-space and adjacent endplate changes consistent with vertebral osteomyelitis, without an epidural abscess or instability. Inflammatory markers are elevated, but hemodynamics and the neurological examination are normal. Two sets of blood cultures obtained before any antibiotics remain negative. Image-guided sampling is available today. What is the appropriate diagnostic and treatment sequence?
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Correct answer: B - Obtain image-guided biopsy while withholding empiric antibiotics under close observation
Domain 3: SURGICAL SCIENCES
Question 5
Walking is limited to 100 meters by bilateral leg pain in a 69-year-old man despite four months of supervised exercise, analgesia, and an epidural injection. Sitting or leaning forward relieves the pain; axial back pain is minor. MRI shows marked L3-4 central and lateral-recess stenosis. Standing and flexion-extension radiographs show no deformity, slip, or instability. Adequate decompression can preserve most of each facet joint. Which treatment plan is best supported by these findings?
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Correct answer: B - Facet-preserving L3-4 decompression without fusion
Question 6
Ninety minutes after an anterior cervical discectomy and fusion, a patient develops rapidly increasing neck swelling, inspiratory stridor, and difficulty handling secretions. He is agitated and can speak only in short phrases. Oxygen saturation is 95% on supplemental oxygen, and the surgical drain has collected little blood. Which action takes priority over further diagnostic imaging?
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Correct answer: C - Initiate emergency airway management and immediate evacuation of the neck hematoma
Question 7
Following a motor vehicle collision, CT demonstrates an L1 burst fracture together with translation and rotation at T12-L1. MRI confirms complete disruption of the posterior ligamentous complex at that segment. No distraction morphology is present. Motor, sensory, and sacral examinations are normal. What is the total Thoracolumbar Injury Classification and Severity Score (TLICS) when the coexisting morphologies are handled correctly?
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Correct answer: B - 6
Question 8
Over four months, a 61-year-old woman has begun dropping utensils and has become increasingly unsteady on stairs. Examination shows hand clumsiness, brisk lower-limb reflexes, and bilateral pathological plantar responses. MRI demonstrates C4-6 degenerative cord compression without intramedullary T2 hyperintensity. Her 18-point modified Japanese Orthopaedic Association (mJOA) score is 13, and she is medically fit for surgery. Which severity classification and guideline-based recommendation are appropriate?
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Correct answer: D - Moderate myelopathy; offer decompression to address neurological decline
Domain 4: GENERAL TOPICS
Question 9
Using the same end vertebrae for both measurements, a right thoracic scoliosis curve has increased from 24° to 34° over six months. The patient is a 12-year-old premenarchal girl who has grown 5 cm during that interval and is Risser 0. The curve apex is T9; neurological examination is normal and there is no significant pain. Her parents ask what treatment can reduce progression during her remaining growth. The recommendation should be:
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Correct answer: A - Begin a custom thoracolumbosacral orthosis, with monitored wear and interval standing radiographs
Question 10
Standing full-length radiographs in a patient with loss of lumbar lordosis show pelvic incidence 62°, L1-S1 lumbar lordosis 30°, pelvic tilt 32°, and a positive sagittal vertical axis of 28 mm. The patient reports fatigue when standing upright. How should the apparently near-normal sagittal vertical axis be interpreted?
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Correct answer: D - Pelvic retroversion compensates for a substantial deficit in lumbar lordosis
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