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Spine for FRCS (Tr & Orth)

Spine for the general orthopaedic surgeon is about recognising what is urgent and localising what is wrong. The degenerative half covers cervical radiculopathy and myelopathy, lumbar disc prolapse, spinal stenosis and spondylolisthesis, together with the emergencies — cauda equina syndrome, spinal infection and metastatic cord compression. The deformity half covers scoliosis and kyphosis in children and adults, and the inflammatory, metabolic and paediatric spine. Spinal trauma sits in the trauma domain of our syllabus map, but the neurological examination and the cord syndromes belong equally here.

100 questions in the bank · 2 topics Updated 11 November 2026

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Topics in this domain

Degenerative spine & spinal emergencies50
Spinal deformity & inflammatory spine50

What the paper tends to test

Root-level questions give a pattern of weakness, numbness and reflex change and ask which root or which disc is responsible.
Cauda equina questions test recognition and urgency: bilateral leg symptoms, saddle sensory change and bladder dysfunction need an emergency MRI.
Myelopathy questions ask for the upper motor neurone signs in the hands and legs and the natural history that justifies surgery.
Claudication questions ask you to separate neurogenic from vascular causes by posture, pulses and the effect of walking uphill or cycling.
Scoliosis questions turn on skeletal maturity and curve size, and on the features that make a curve atypical and require an MRI.
Inflammatory spine questions centre on the ankylosed spine that fractures after minor trauma and the rheumatoid cervical spine.

Classic traps and discriminators

In the lumbar spine a posterolateral disc prolapse compresses the traversing root, so an L4/5 disc affects L5; a far-lateral prolapse at the same level compresses the exiting L4 root. In the cervical spine the root exits above its numbered vertebra, so a C5/6 disc affects C6.
Painless urinary retention with overflow is a late sign of cauda equina syndrome. Waiting for it before requesting imaging misses the window in which decompression protects bladder function.
A fracture in an ankylosed spine — ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis — is a long-lever, three-column injury that is unstable and often missed on plain films; persistent pain after a minor fall warrants CT or MRI.
A left thoracic curve, a painful curve, rapid progression or abnormal neurology is not typical adolescent idiopathic scoliosis and needs an MRI of the whole spine.
Central cord syndrome follows a hyperextension injury in a spondylotic neck and affects the upper limbs more than the lower; anterior cord syndrome carries the worst prognosis for motor recovery, Brown-Séquard syndrome the best.

Free spine practice questions

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17Spine·Degenerative spine & spinal emergencies

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A 50-year-old man has pain over the right shoulder and lateral arm. Passive shoulder movement is full and pain-free. MRI of the cervical spine shows a right foraminal disc-osteophyte complex at C4/5 and no other abnormality.

Which pattern of findings is expected?

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18Spine·Spinal deformity & inflammatory spine

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A 13-year-old boy, Risser 1, has a 32° thoracic scoliosis convex to the left, noticed by his swimming coach. He has no pain. Power and sensation in the limbs are normal, but the superficial abdominal reflex is absent on the left and present on the right.

What is the most appropriate next step?

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Spine questions, answered

Which nerve root is compressed by an L4/5 disc prolapse?

Usually L5. A posterolateral prolapse compresses the traversing root, which is the root of the level below; it produces weakness of great toe and ankle dorsiflexion and altered sensation over the dorsum of the foot. A far-lateral prolapse at L4/5 compresses the exiting L4 root instead.

How do you tell neurogenic from vascular claudication?

Neurogenic claudication is brought on by standing and walking and relieved by sitting or bending forwards, with preserved pulses; patients are often better walking uphill, cycling or leaning on a trolley, because flexion widens the canal. Vascular claudication is brought on by exertion of any kind, relieved by standing still, and accompanied by reduced pulses.

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