61.一位60歲的女性，有嚴重的下背痛且行走困難。脊椎X光檢查顯示第四、五腰椎椎莖（pedicle）完整、椎間盤空隙變窄 （disc space narrowing）、椎體終板破壞（endplate erosion）。依照X光結果判斷，下列何者是最適當的診斷？
(A)惡性腫瘤轉移
(B)椎間盤退化性病變
(C)脊椎感染
(D)脊椎滑脫症

The winking eye or winking owl sign refers to the appearances of the spine, when a pedicle is absent - almost always due to a bony metastasis.

The usual appearance of the pedicles representing two eyes on the AP projection is lost, as one pedicle is destroyed - it then appears like one eye is open and the other is winking or shut.