Spine
Core concepts
Spine questions emphasize neurologic assessment and the distinction between stable and unstable injuries. Know the three-column concept and the Denis classification, and the TLICS score for thoracolumbar trauma. Master the evaluation of back pain: red flags (fever, weight loss, night pain, neurologic deficit, bowel/bladder changes) and the role of imaging. Understand lumbar stenosis and disc herniation: dermatomal patterns, the straight-leg raise, and the indications for surgery. Review cervical myelopathy (Hoffmann sign, gait changes) and the timing of decompression. Know scoliosis and kyphosis, and the principles of fusion (bone graft, instrumentation, arthrodesis). Also cover cauda equina syndrome as an emergency requiring urgent decompression.
Traps
The classic trap is attributing back pain to a benign cause while missing infection or malignancy. Another is confusing the dermatomes and myotomes, especially L4/L5/S1. Examiners also test that cauda equina syndrome is a surgical emergency regardless of imaging timing.
Rule of thumb
Any patient with back pain plus a neurologic deficit, fever, or bowel/bladder dysfunction gets urgent imaging and a spine consult; do not treat empirically.
Worked example
A 55-year-old with acute low back pain, saddle anesthesia, and urinary retention: suspect cauda equina syndrome; obtain urgent MRI and decompress emergently to preserve function.