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A 14-year-old boy reports a 4-month history of increasing backache with difficulty walking long distances. His parents state that he walks with his knees slightly flexed and is unable to bend forward and get his hands to his knees. He denies numbness, tingling, and weakness in his legs and denies loss of bladder and bowel control. A lateral radiograph of the lumbosacral spine is shown in Figure 18. What is the best surgical management for this condition?
Vertebrectomy of L5
Posterior spinal fusion with or without instrumentation from L4 to S1
Posterior spinal fusion without instrumentation from L5 to S1
Anterior spinal fusion from L4 to L5
Direct repair of the spondylolysis defect
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A 17-year-old high school football lineman was diagnosed with the condition shown in the Figure A radiograph. He continues to have pain despite 6 months of wearing a custom lumbar spine orthotic (LSO) and avoiding all sports activities. His physical exam is notable for pain with single-limb standing lumbar extension and a normal neurologic exam. How would the surgical management differ if this condition occurred at L3 instead of L5?
Pars interarticularis repair is indicated
Lumbosacral fusion is indicated
Gill procedure is indicated
Combined anterior interbody fusion and posterior decompression is indicated
Iliac crest bone grafting is indicated
A 13-year-old girl presents with back pain for 6 months. Figures A and B are SPECT scan and CT images taken at the time of presentation. What is the most likely diagnosis?
Aneurysmal bone cyst
A 14-year-old soccer player has a history of intermittent low back pain. He reports for the last 4 months he has had no symptoms or limitations in his athletic activity. Treatment should include?
a thoracolumbar orthosis
in situ L5-S1 bilateral posterolateral fusion
repair of pars defect wih screw fixation
limitation of athletic activity
observation with no restriction of physical activity
A 12-year-old gymnast has had progressive low back and buttock pain refractory to conservative management for two years. A sagittal MRI is shown in Figure A. Surgical management with reduction of L5 on S1 would most likely lead to which of the following neurologic complications?
Decreased patellar reflexes
Weakness to hip flexion
Weakness to great toe extension
Weakness to knee extension
Weakness to ankle plantar flexion
A 13-year-old gymnast reports the acute onset of low back pain that began four weeks ago. Radiographs are unremarkable. A single-photon-emission-computer-tomography (SPECT) is shown in Figure A. Initial treatment should consist of?
Bracing with a molded lumbosacral orthosis
Aggressive physical therapy
CT guided biopsy
In-situ posterolateral fusion of L5-S1
Epidural steroid injection
What additional diagnostic test is most sensitive to diagnose pediatric spondylolysis when AP and lateral radiographs are normal.
Flexion-extension lateral radiographs
Oblique radiographs of the of the lumbosacral spine
Single photon emission computed tomography (SPECT)
Indium-labeled bone scan