Spine: pedicle sign in vertebral metastasis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: pedicle sign in vertebral metastasis

Sample item

A 60-year-old smoker has persisting back pain. An anteroposterior radiograph of the lumbar spine shows loss of the outline of one pedicle, with the disc spaces preserved. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Vertebral metastasis

Metastases usually begin in the vertebral body and erode a pedicle early, producing the winking owl sign while the disc is spared. Infections cross the disc and destroy it. Osteoporotic fractures preserve the pedicles.

Option by option

  • A. Vertebral metastasis (correct)

    Correct. Pedicle destruction with preserved discs is typical of metastasis.

  • B. Osteoporotic compression fracture

    Osteoporotic collapse causes a wedge or biconcave deformity while the pedicles remain intact.

  • C. Pyogenic spondylodiscitis

    Pyogenic infection destroys the disc early and has marked inflammatory features.

  • D. Tuberculous spondylitis

    Tuberculosis usually starts beside the disc and involves adjacent vertebral bodies, not an isolated pedicle.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Vertebral metastasis. Metastases usually begin in the vertebral body and erode a pedicle early, producing the winking owl sign while the disc is spared.

Why is "Osteoporotic compression fracture" not the answer?

Osteoporotic collapse causes a wedge or biconcave deformity while the pedicles remain intact.

Why is "Pyogenic spondylodiscitis" not the answer?

Pyogenic infection destroys the disc early and has marked inflammatory features.

Why is "Tuberculous spondylitis" not the answer?

Tuberculosis usually starts beside the disc and involves adjacent vertebral bodies, not an isolated pedicle.

What concept does this question test?

It tests Spine: pedicle sign in vertebral metastasis in Orthopaedics. Infections cross the disc and destroy it. Osteoporotic fractures preserve the pedicles.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: pedicle sign in vertebral metastasis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.