Minimally Invasive Spine Surgery — MCQs

10 questions

Which of the following movements is least permitted in the lumbar region of the vertebral column?

The operative procedure known as "microfracture" is done for the

A 50-year-old male presents with chronic low back pain that has failed physical therapy and conservative measures. MRI shows disc herniation at L5-S1 with radiculopathy. What is the next step in management?

Discectomy can be performed using:

In spinal anesthesia, the needle is pierced up to which space?

A 47-year-old man awakens with low back pain after a weekend of gardening. He recalls no specific incident of trauma and has never had back pain before. There is no radiation of the pain and no disturbance of normal bowel or bladder function. The ROM of the low back is painful and restricted in all planes, and there is paraspinal tenderness from L2 to L5 on the right. Scoliosis and kyphosis are absent. Findings on straight-leg-raising test are negative, reflexes are active and equal, and the patient can walk on his heels and toes. Findings on x-rays of the lumbar spine are normal. Which is the best treatment?

What is vertebroplasty?

Most common post-operative complication of spinal anesthesia?

What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

Q10

Best method of treatment for segmental trichiasis

Minimally Invasive Spine Surgery Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following movements is least permitted in the lumbar region of the vertebral column?

A. Flexion
B. Extension
C. Lateral flexion
D. Rotation (Correct Answer)

Explanation: ***Rotation*** - The **lumbar spine permits the LEAST rotation** of all movements (~5° total rotation), making this the correct answer. - The PRIMARY limiting factor is the **sagittal (near-vertical) orientation of the lumbar facet joints**, which are oriented in the coronal plane and face medially/laterally. - This facet orientation creates a **mechanical block to rotational movement**, acting like interlocking barriers. - The thick **intervertebral discs** in the lumbar region also resist torsional forces, further limiting rotation. *Flexion* - The lumbar region permits **excellent flexion** (forward bending), with approximately 50-60° of range. - The **large, wedge-shaped intervertebral discs** allow substantial anterior compression and movement. - This is one of the primary movements of the lumbar spine. *Extension* - **Extension** (backward bending) is moderately permitted in the lumbar spine, with approximately 15-20° of range. - Eventually limited by contact between **spinous processes** and the posterior ligamentous structures. - Still considerably more movement than rotation. *Lateral flexion* - **Lateral flexion** (sideways bending) is well permitted, with approximately 20° of movement to each side. - The structure of the vertebral bodies and **compressible intervertebral discs** allows good range of motion in the coronal plane. - Significantly more mobile than rotation.

Question 2: The operative procedure known as "microfracture" is done for the

A. Delayed union of femur
B. Osteochondral defect of femur (Correct Answer)
C. Non union of tibia
D. Loose bodies of ankle joint

Explanation: ***Osteochondral defect of femur*** - **Microfracture** is a surgical technique used to stimulate the growth of **fibrocartilage** in areas of damaged articular cartilage, such as an **osteochondral defect**. - It involves creating small holes in the **subchondral bone** to allow stem cells and growth factors from the bone marrow to form a new reparative tissue. *Delayed union of femur* - **Delayed union** typically involves an extended time for fracture healing, which is often managed through prolonged immobilization, **bone grafting**, or sometimes revision surgery. - Microfracture specifically targets cartilage repair, not the process of **bony union** after a fracture. *Non union of tibia* - **Non-union** refers to the failure of a fractured bone to heal within a reasonable timeframe, often requiring surgical intervention with **bone grafts** or **internal fixation**. - This condition involves bone healing problems, distinct from cartilage defects that microfracture addresses. *Loose bodies of ankle joint* - **Loose bodies** in a joint are typically removed surgically, often arthroscopically, to relieve pain and prevent joint damage. - This procedure does not involve the repair of cartilage defects, which is the primary goal of microfracture.

Question 3: A 50-year-old male presents with chronic low back pain that has failed physical therapy and conservative measures. MRI shows disc herniation at L5-S1 with radiculopathy. What is the next step in management?

A. Epidural steroid injection (Correct Answer)
B. Surgical decompression
C. Acupuncture
D. NSAIDs

Explanation: ***Epidural steroid injection*** - This is often the appropriate **next step** for radiculopathy from disc herniation that has failed conservative management, as it can reduce **inflammation** and pain at the nerve root. - It helps manage pain and allows patients to engage more effectively in **physical therapy**. *Surgical decompression* - This is typically considered after **less invasive methods** like epidural steroid injections have failed, especially if there are progressive neurological deficits or intractable pain. - While it can relieve nerve compression, it carries higher risks than injections and is not the immediate next step after failure of basic conservative measures. *Acupuncture* - While acupuncture can be used as an **adjunctive therapy** for chronic pain, it is not primary management for symptomatic disc herniation with radiculopathy that has failed physical therapy. - There is limited evidence to support its effectiveness in resolving nerve compression or significant radicular symptoms. *NSAIDs* - **NSAIDs** are part of the initial conservative management for low back pain and disc herniation. - Since the question states that **conservative measures have failed**, continuing or restarting NSAIDs alone would likely be ineffective and is not the next step.

Question 4: Discectomy can be performed using:

A. Open surgery
B. Microdiscectomy
C. Endoscopic approach
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Discectomy** can be performed through various surgical approaches, including open surgery, minimally invasive techniques using a microscope, and endoscopic procedures. - The choice of method depends on factors such as the **location and size of the disc herniation**, patient anatomy, and surgeon’s preference and expertise. *Open surgery* - This involves a larger incision to directly visualize and access the spinal structures and remove the **herniated disc material**. - While effective, it typically involves more muscle dissection, leading to increased **postoperative pain** and a longer recovery time compared to minimally invasive approaches. *Microscope* - **Microdiscectomy** uses a surgical microscope to provide magnified visualization of the surgical field through a smaller incision. - This minimally invasive approach reduces tissue dissection, leading to less pain, smaller scars, and **faster recovery** than traditional open surgery. *Endoscope* - **Endoscopic discectomy** utilizes a small camera (endoscope) inserted through a tiny incision, allowing the surgeon to view the surgical area on a monitor. - This is a highly minimally invasive technique that typically results in even **less tissue damage** and a quicker return to normal activities compared to microdiscectomy.

Question 5: In spinal anesthesia, the needle is pierced up to which space?

A. Subarachnoid space (Correct Answer)
B. Intrathecal space
C. Epidural space
D. Subdural space

Explanation: ***Subarachnoid space*** - In **spinal anesthesia**, the anesthetic agent is injected directly into the **cerebrospinal fluid (CSF)**, which is located in the subarachnoid space. - This space is targeted to achieve rapid and widespread blockade of spinal nerves, leading to anesthesia and paralysis below the level of injection. *Epidural space* - The **epidural space** is located outside the **dura mater** and contains fat and blood vessels; it is targeted in **epidural anesthesia**, not spinal anesthesia. - Anesthetic agents in the epidural space provide a slower onset and a more segmental block compared to spinal anesthesia. *Intrathecal space* - The term **intrathecal space** broadly refers to the space containing CSF, which includes the subarachnoid space, but is a less precise anatomical term for the site of injection in spinal anesthesia. - While technically correct in referring to an injection into the CSF, "subarachnoid space" is the specific anatomical term for where the needle tip rests. *Subdural space* - The **subdural space** is a potential space between the **dura mater** and the **arachnoid mater**; it is not the intended target for either spinal or epidural anesthesia. - Accidental injection into the subdural space during spinal or epidural procedures can lead to an unpredictable block with delayed onset and variable spread.

Question 6: A 47-year-old man awakens with low back pain after a weekend of gardening. He recalls no specific incident of trauma and has never had back pain before. There is no radiation of the pain and no disturbance of normal bowel or bladder function. The ROM of the low back is painful and restricted in all planes, and there is paraspinal tenderness from L2 to L5 on the right. Scoliosis and kyphosis are absent. Findings on straight-leg-raising test are negative, reflexes are active and equal, and the patient can walk on his heels and toes. Findings on x-rays of the lumbar spine are normal. Which is the best treatment?

A. Bed rest for 48 hours, anti-inflammatory agents, heat to the low back, and nonnarcotic analgesics (Correct Answer)
B. Immediate magnetic resonance image (MRI) for the lumbar spine
C. Bed rest for 7-10 days, heat to the lower back, anti-inflammatory agents, muscle relaxants, and analgesics
D. Hospitalization for pelvic traction, physical therapy, anti-inflammatory agents, intramuscularly analgesics, and muscle relaxants

Explanation: ***Bed rest for 48 hours, anti-inflammatory agents, heat to the low back, and nonnarcotic analgesics*** - This approach addresses acute, **self-limiting low back pain** with conservative measures, promoting comfort and recovery without aggressive interventions. - The absence of neurological deficits (normal reflexes, walking on heels/toes, negative straight-leg-raising) and bowel/bladder dysfunction makes **conservative management** the most appropriate initial treatment. *Immediate magnetic resonance image (MRI) for the lumbar spine* - An MRI is generally not indicated for acute low back pain without **red flag symptoms** such as neurological deficits, progressive weakness, or suspicion of serious underlying pathology (e.g., tumor, infection). - The patient's presentation suggests **musculoskeletal strain**, for which imaging is not beneficial in the acute phase and can lead to unnecessary interventions. *Bed rest for 7-10 days, heat to the lower back, anti-inflammatory agents, muscle relaxants, and analgesics* - **Prolonged bed rest** (more than 2-3 days) is generally discouraged for acute low back pain as it can delay recovery and lead to deconditioning. - While other components (heat, NSAIDs, analgesics) are appropriate, the excessive bed rest makes this option less ideal. *Hospitalization for pelvic traction, physical therapy, anti-inflammatory agents, intramuscularly analgesics, and muscle relaxants* - **Hospitalization** and **pelvic traction** are overly aggressive and unnecessary for uncomplicated acute low back pain without severe neurological compromise or intractable pain. - This approach is typically reserved for more severe or complex spinal conditions not present in this patient.

Question 7: What is vertebroplasty?

A. Stabilization of vertebral compression fracture (Correct Answer)
B. Replacement of vertebral body with intervertebral disc
C. Replacement of vertebral body only
D. Fusion of the adjacent vertebrae

Explanation: ***Stabilization of vertebral compression fracture*** - **Vertebroplasty** is a minimally invasive procedure used to stabilize **vertebral compression fractures**, most commonly caused by **osteoporosis**. - It involves injecting **bone cement** (polymethyl methacrylate or PMMA) into the fractured vertebra to reduce pain and prevent further collapse. *Replacement of vertebral body with intervertebral disc* - This describes entirely different surgical procedures, such as **total disc replacement** or **corpectomy** with fusion, which are more extensive than vertebroplasty. - Vertebroplasty aims to fortify the existing fractured bone, not replace the vertebral body or disc. *Replacement of vertebral body only* - The replacement of an entire vertebral body is a procedure known as **corpectomy**, often performed for tumors or severe trauma. - This is a reconstructive surgery that is far more invasive than vertebroplasty, which simply injects cement into the existing fractured body. *Fusion of the adjacent vertebrae* - This describes **spinal fusion**, a surgical technique that permanently connects two or more vertebrae to eliminate motion between them. - While fusion stabilizes the spine, it is distinct from vertebroplasty, which focuses on stabilizing a single fractured vertebra through cement injection.

Question 8: Most common post-operative complication of spinal anesthesia?

A. Post-dural puncture headache
B. Hypotension due to spinal anesthesia (Correct Answer)
C. Urinary retention post-anesthesia
D. Infection leading to meningitis

Explanation: ***Hypotension due to spinal anesthesia*** - **Hypotension** is the **most common** immediate complication of spinal anesthesia due to **sympathetic blockade**, leading to **vasodilation** and decreased venous return. - This effect is often dose-dependent and can be managed with fluids and vasopressors if clinically significant. *Post-dural puncture headache* - While a notable complication, a **post-dural puncture headache (PDPH)** is less common than hypotension, occurring in a smaller percentage of spinal anesthesia cases. - PDPH results from persistent leakage of **cerebrospinal fluid** through the dural puncture site, leading to intracranial hypotension. *Urinary retention post-anesthesia* - **Urinary retention** is a relatively common complication after spinal anesthesia, but it is typically not as immediate or frequent as hypotension. - It occurs due to the **blockade of sacral parasympathetic nerves** that control bladder function, requiring temporary catheterization in some cases. *Infection leading to meningitis* - **Meningitis** is a **rare but severe** complication of spinal anesthesia, usually resulting from inadequate aseptic technique during the procedure. - Its incidence is very low compared to hemodynamic changes or even PDPH.

Question 9: What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

A. Delorme's procedure
B. Wells' procedure
C. Thiersch's operation (Correct Answer)
D. Low anterior resection

Explanation: ***Thiersch's operation*** - **Thiersch's operation** is a perineal procedure involving the placement of a **circum-anal cerclage** (a non-absorbable suture) around the anal canal to prevent external prolapse. - It is preferred in elderly or frail patients due to its **minimal invasiveness**, low operative risk, and suitability for local or regional anesthesia as a palliative measure for symptoms. *Delorme's procedure* - **Delorme's procedure** is a perineal approach that involves the **mucosal stripping** of the prolapsed rectum, plication of the muscularis, and re-anastomosis. - While less invasive than abdominal approaches, it is more complex than Thiersch's and may still carry higher operative risks for very frail patients. *Wells' procedure* - **Wells' procedure** (rectopexy via an abdominal approach) involves **mobilization of the rectum** and its fixation to the sacrum, often with a mesh. - This is a more invasive abdominal procedure with a higher operative risk, making it unsuitable for elderly patients unfit for major surgery. *Low anterior resection* - **Low anterior resection** is a major abdominal procedure primarily used for rectal cancer or severe inflammatory bowel disease, involving the **surgical removal of a segment of the rectum**. - It is a highly invasive procedure with significant morbidity and mortality, making it inappropriate for the palliative management of rectal prolapse in frail elderly patients.

Question 10: Best method of treatment for segmental trichiasis

A. Argon laser destruction
B. Cryoepilation (Correct Answer)
C. Electrolysis
D. Epilation

Explanation: ***Cryoepilation*** - Cryoepilation is effective for **segmental trichiasis** because it destroys the **hair follicle** and the associated melanocytes, preventing regrowth. - It utilizes **freezing temperatures** to create a zone of necrosis, leading to permanent destruction of misdirected eyelashes. *Argon laser destruction* - Argon laser destruction is generally **less effective** for trichiasis because it primarily targets pigmented structures and may not reliably destroy the entire **hair follicle**. - It has a higher risk of **collateral damage** to surrounding tissues compared to cryotherapy, especially in non-pigmented lashes. *Electrolysis* - Electrolysis is useful for **solitary** or a few misplaced lashes but is **time-consuming** and less practical for segmental involvement. - The procedure involves inserting a **fine needle** into each follicle to deliver an electric current, which can be tedious and prone to recurrence if the follicle isn't fully destroyed. *Epilation* - Epilation, or **plucking**, offers only **temporary relief** as the lash will regrow in 3-6 weeks. - Repeated epilation can lead to **follicular distortion** and ultimately worsen trichiasis or cause secondary complications like infection.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free