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HPI

The patient is a 79F that initially presented for evaluation of lower back pain gait instability. She has utilized a walker to assist with ambulation due to instability. Additionally, she reports having bilateral upper extremity weakness without decreased fine motor movements. She denies any cervicalgia but endorses lumbar spine pain.

PMH

Hyperlipidemia, hypertension, hypothyroidism, C. difficile infection requiring colostomy and bowel resection

PE

No gross deformities, neutral spinal alignment, cervical flexion and extension 50-60°, rotation 80°, lateral bend 45°. No pain through ROM. 4/5 motor strength biceps, triceps, and FDP. Positive Hoffman's bilaterally. Unable to perform tandem walk due to imbalance. Positive finger escape sign bilaterally. 3/4 triceps, biceps, and patellar reflexes.

Poll
1 of 16
1. In addition to AP + LAT Xrays of the cervical spine, what additional imaging studies would you get to determine management?
No - AP and LAT of the Cervical Spine are sufficient
2%
10/346
Yes - additional radiographs(etc. flexion-extension, scoliosis films) (aXR)
3%
13/346
Yes - CT scan of cervical spine (CT)
1%
4/346
Yes - MRI of cervical spine (MRI)
44%
154/346
Yes - aXR + CT
1%
5/346
Yes - aXR + MRI
8%
29/346
Yes - MRI + CT
20%
70/346
Yes - aXR + CT + MRI
15%
52/346
Yes - Other
0%
1/346
Outside my area of expertise - best if I don't vote
2%
8/346
2. If you choose additional radiographs (aXR), would you get standing lateral scoliosis films to measure sagittal imbalance?
I would NOT choose additional radiographs (aXR)
27%
84/304
Yes - I would get standing scoliosis films
30%
94/304
No - I would not get standing scoliosis films
35%
107/304
Outside my area of expertise - best if I don't vote
6%
19/304
3. Would you use a Classification System to guide your treatment?
No - I would not use a Classification system
37%
113/302
Yes - Nurick
6%
20/302
Yes - Ranawat
5%
18/302
Yes - Modified Japanese Orthopedic Association (JOA)
23%
71/302
Yes- Ames ISSG Cervical Spine Deformity Classification (ISSG-CDC)
3%
10/302
Yes - JOA + ISSG-CDC
3%
11/302
Yes - Other or Other Combination of Above
2%
7/302
Outside my area of expertise - best if I don't vote
17%
52/302
4. How would you manage this patient?
Nonoperative
7%
23/307
Operative
87%
270/307
Outside my area of expertise - best if I don't vote
4%
14/307
5. If you choose Operative Management, what would be your approach?
I would not choose Operative Management
0%
3/309
Anterior Alone
35%
109/309
Posterior Alone
36%
113/309
Anterior + Posterior
18%
56/309
Outside my area of expertise - best if I don't vote
9%
28/309
6. If you choose an Anterior Approach Alone, what technique would you perform?
I would not choose an Anterior Approach Alone
22%
64/284
Multilevel ACDF Alone
42%
122/284
Multilevel Arthroplasty Alone
1%
3/284
Multilevel Hybrid ACDF + Arthroplasty
8%
24/284
Corpectomy + Plate Fusion Alone
3%
10/284
Hybrid Corpectomy + ACDF
4%
13/284
Hybrid Corpectomy + Arthroplasty
0%
2/284
Other
1%
3/284
Outside my area of expertise - best if I don't vote
15%
43/284
7. If you choose a Posterior Alone Approach, what treatment would you perform?
I would not choose a Posterior Only Approach
21%
63/291
Laminectomy Alone
6%
18/291
Laminectomy + Fusion
42%
125/291
Laminoplasty Alone
18%
55/291
Skip Laminectomy Alone
0%
1/291
Other
0%
0/291
Outside my area of expertise - best if I don't vote
9%
29/291
8. If you choose a Laminectomy + Fusion, what levels would you fuse?
I would not choose a Laminectomy + Fusion
15%
42/268
C3 - C6
10%
27/268
C3 - C7
18%
49/268
C3 - T1
8%
22/268
C3 - T2
1%
5/268
C4 - C6
6%
18/268
C4 - C7
23%
64/268
C4 - T1
5%
15/268
C4 - T2
0%
1/268
Other
0%
1/268
Outside my area of expertise - best if I don't vote
8%
24/268
9. If you choose a Laminectomy + Fusion to the thoracic spine, would you place fixation at C7, and if so how?
I would not choose a Laminectomy + Fusion to the thoracic spine
28%
56/194
I would SKIP C7 fixation (C6 lateral mass to T1 pedicle screw)
8%
17/194
C7 lateral mass screw
8%
17/194
C7 laminar screw
3%
7/194
C7 pedicle screw - anatomic approach - confirm by xrays after screws placed
10%
20/194
C7 pedicle screw - fluoroscopic approach - fluoro during screw placement
13%
26/194
C7 pedicle screw - navigated with intraop CT
8%
17/194
C7 pedicle screw - navigated with preop CT
1%
2/194
Other
0%
0/194
Outside my area of expertise - best if I don't vote
16%
32/194
10. If you choose a Laminectomy or Laminoplasty, would you perform a prophylactic C4-5 foraminotomy to deter post-op C5 nerve palsy?
I would NOT choose a a Laminectomy or Laminoplasty
14%
35/248
Yes - perform foraminotomy
38%
96/248
No
32%
81/248
Outside of my area of expertise - best if I don't vote
14%
36/248
11. If you choose a Laminoplasty, what levels would you include in your laminoplasty?
I would NOT choose a Laminoplasty
21%
50/233
C4-6 (C4, C5, C6)
30%
70/233
C3-6 (C3, C4, C5, C6)
28%
66/233
C2-6 (C2, C3, C4, C5, C6)
0%
1/233
C2-7 (C2, C3, C4, C5, C6, C7)
8%
19/233
Other
1%
4/233
Outside of my area of expertise - best if I don't vote
9%
23/233
12. If you choose a Laminoplasty, what technique would you utilize?
I would NOT choose a Laminoplasty
20%
46/227
Open-door (Hirabayashi)
48%
109/227
Double-door (Kurokawa)
14%
33/227
Myoarchitectonic
1%
3/227
Other
0%
1/227
Outside of my area of expertise - best if I don't vote
15%
35/227
13. If you choose an Open-door Laminoplasty, what side would you open and hinge?
I would NOT choose an Open-door Laminoplasty
23%
50/213
Left-side open, right-side hinge
47%
102/213
Right-side open, left-side hinge
11%
24/213
Outside my area of expertise - best if I don't vote
17%
37/213
14. If you choose a Laminoplasty, would you immobilize in a C-collar post-operatively?
I would NOT choose a Laminoplasty
17%
36/210
No - no collar required
9%
20/210
Yes - Soft cervical collar
35%
74/210
Yes - Hard cervical collar
27%
57/210
Outside my area of expertise - best if I don't vote
10%
23/210
15. If you choose laminoplasty, when would you permit cervical spine range of motion?
I would NOT choose a Laminoplasty
14%
30/208
1 week (1-7 days)
8%
17/208
2 weeks (8-14 days)
10%
22/208
3 weeks (15-21 days)
10%
21/208
4 weeks (22-28 days)
13%
29/208
5 weeks (29-35 days)
1%
3/208
6 weeks (36-42 days)
28%
60/208
Other
0%
1/208
Outside my area of expertise - best if I don't vote
12%
25/208
16. If you choose Operative Management, would you order a Cervical-thoracic Extension Exercise Program (EEP) working on cervicothoracic alignment preop and/or postop?
I would not choose Operative Management
2%
5/206
No - I would not order a Extension Exercise Program (EEP)
35%
73/206
Yes - EEP Preop Alone
3%
8/206
Yes - EEP Postop Alone
16%
34/206
Yes - EEP Preop + Postop
24%
51/206
Outside my area of expertise - best if I don't vote
16%
35/206
PROCEDURE #1

C3-6 laminoplasty, C7 laminectomy

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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