Degenerative Spine Disease and Spondylosis — WACS Viva & Clinical Scenarios (Spinal Neurosurgery and Spinal Cord Disorders)

Exam-style degenerative spine disease and spondylosis viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 58-year-old civil servant presents with an 8-month history of progressive hand clumsiness, gait instability described as walking on cotton wool, neck stiffness, and bilateral burning sensations down the upper limbs. Neurological examination reveals bilateral Hoffmann signs, an inverted radial reflex on the right, hyperreflexia in both lower extremities, and an upgoing right plantar reflex. Formulate your clinical diagnostic localization, stage the functional severity, critique the diagnostic neuro-imaging, and justify your selection of surgical approach (anterior versus posterior).
• SCENARIO 2: A 42-year-old manual worker presents to the emergency department with acute-on-chronic low back pain radiating into the bilateral lower extremities, sudden saddle anesthesia, and acute urinary retention. Outline your emergency diagnostic workup, articulate the critical surgical window, and detail the technical operative steps and complication-avoidance measures during emergent lumbar decompressive intervention.
• SCENARIO 3: A 65-year-old retired trader presents with severe bilateral calf cramping, heaviness, and buttock numbness provoked by walking 50 meters and relieved by sitting down or stooping forward. Plain radiographs demonstrate Grade II L4/L5 anterolisthesis. Defend your clinical differentiation of this presentation from vascular claudication, appraise the utility of dynamic plain radiography versus MRI, and provide a rational justification for decompression alone versus instrumented transforaminal lumbar interbody fusion (TLIF).
• SCENARIO 4: You are presented with sagittal and axial T2-weighted MRI and CT reconstruction scans of a 50-year-old patient demonstrating severe thoracic myelopathy secondary to a calcified central T8/T9 disc herniation associated with multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Discuss the biomechanical and anatomical considerations governing the selection of surgical corridors, and outline the protocol for intraoperative dural tear identification, direct repair, and management of cerebrospinal fluid (CSF) leaks.
• SCENARIO 5: An elderly female with known postmenopausal osteoporosis presents with recurrent low back pain and progressive stooped posture 3 years following an L4-S1 posterior fusion. Analyze the concepts of sagittal spinopelvic balance (pelvic incidence, lumbar lordosis, sagittal vertical axis), define the pathophysiology and management of adjacent segment disease, and detail technical strategies to achieve secure screw purchase and prevent construct failure in osteoporotic bone.