• History & Exam

    History
     
    A 65-year-old male presents with a rapidly progressive history of triceps, hands and lower extremity weakness. His hands have progressively lost strength and he has been non-ambulatory over the past day. He was recently admitted with fevers and a diagnosis of pneumonia and bacteremia. His remote history is notable for an esophageal achalasia, esophageal perforation, esophagectomy and gastric pull-up surgery. 
     
    Exam
     
    Afebrile and normotensive. Tachycardia HR 100.  Malnourished.
    No scars on anterior or posterior neck. Healed scar over abdomen and lower chest.  
    Positive sagittal balance with cervical kyphosis. Neck and back are not tender. Reduced range of motion neck.
    Negative Spurling’s sign. Positive Lhermitte's sign
    Cranial nerves II-XII are intact
    DTRs – 3+ upper extremities, 3+ lower extremities
    Strength- 5/5 Deltoid and biceps; 4/5 Triceps; 3/5 wrist extensors/flexors; 3/5 hand intrinsics
    4+/5 bilateral lower extremities
    + Clonus bilateral lower extremities, Positive Hoffman’s sign bilateral, Positive bilateral Babinski Sign.
    Slightly decreased pinprick sensation from upper chest down
    Spastic gait
     

    Upright Radiographs

    Upright Radiographs

    Magnetic Resonance Imaging

    Magnetic Resonance Imaging

    Magnetic Resonance Imaging

    Magnetic Resonance Imaging

    1. Perioperative steroid use in anterior cervical discectomy and fusion procedures

    2. Which of the following increases the likelihood that nonoperative management of spinal epidural abscesses will fail?

    3. What is the incidence of abnormal vertebral artery location in the cervical spine?

    4. Which of the following describes you?

    5. I practice in one of the following locations.

     

    6. Comments

    7. Which of the following is an indication for a combined circumferential cervical fusion.

     

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site here. Privacy Policy