HPI - This man showed up in outpatient clinic complaining about neck and shoulder(right) pain. We conducted an AP & Lateral x-ray just to check his cervical spine. At the lateral view we noted a small long bone at the rear end of the cervical spine (at c6-c7). Never seen this before. We asked him if he put his hand or anyone else tried to help him, but he denied everything. He was alone in the x-ray room with his hands down.
What's this bone?
HPI - Three days prior, patient was admitted due to a gunshot wound through the thorax. The pulmonary artery was transected while entering the spinal canal without damaging the vertebral body.
On imaging the T8 posterior structures are seen damaged with the bullet doing a traumatic laminectomy through the level. The disc material and vertebral body was spared, however the bullet trajectory can be seen crossing the spinal canal.
How would you treat this SCI given limited resources?
HPI - Patient was riding a motor bike in South East Asia when a car pulled out in front. Patient then swerved to miss the car and ended up going head first into a metal pole on the side of the road. He was wearing a helmet and traveling at 40 km/hr.
At hospital MRI showed no ligament damage but CT showed fracture of the right anterior arch and left posterior arch right behind the left lateral mass. CT also showed a clay shovelers fracture attributed to the patient holding on tightly to the handlebars. The patient was then airlifted to Singapore.
Time frame and Planning:
Week 1: Fitted with halo (discharged from hospital after 10 days)
Week 8: Halo removed Aspen Vista applied, no union
Week 12: New Scans, no improvement, gap widened.
Week 14: Soft Collar used during sleeping and on and off during day.
Week 16: Sleeping without brace, no brace for 50% of day. Return to work part time
Week 18: No brace.
Week 22: Return to work full time.
Currently the patient is a
Many patients have non-union. Is this a cause for concern?
HPI - 75yo F w h/o L4-L5 L5-S1 laminectomy and discectomy several years ago without instrumented fusion presents complaining of severe axial lumbar pain of increasing intensity x 2 years despite physical therapy. She was seen by a Neurosurgeon who recommended no surgical intervention.
Non-operative vs operative?
HPI - tetraplegic pt - Heterotopic ossification of both hip joints...
what is the preferred treatment choice for this patient?
HPI - fell from a height years ago, neglected till pain became worse ,morning stiffness started one year ago ,pain now is uncontrollable with NSAID. also she took lots of muscle relaxants but, improvement was temporary and very little
patient own words"while walking", i feel a click on my lower back, like friction of 2 objects".
-pain has been felt for one year now
-she is a house wife with 3kids, she has a lot of work to do every day with no help.
How would you treat this Grade 1 adult isthmic spondylolithesis with back pain only, and a negative neurologic exam.
HPI - 18 month old girl with scoliosis
The curve measures 63 degrees and has been stable for 6 months. How would you treat this at this time?
HPI - S/P snowmobile accident. C/O severe LBP, R leg pain, parasthesia and weakness.
What would be your choice of treatment?
HPI - Severe Back pain since 12 days, with particular exacerbation at night. No history of trauma. Doesn't complain of any numbness in any of her limbs. No Bladder/ Bowel involvement. Has Loss of appetite. No loss of weight recently. Had a febrile illness for three days 15 days ago.
What treatment would you suggest for her Back pain?
HPI - Fall from a height of 30 feet. Complained of immediate loss of all sensation below waist, severe pain in the back and no movement in both lower limbs.
Transferred from another hospital, 20 hours after injury.
Surgery performed 40 hours after injury
Would you consider stem cell treatment for this patient`s neurological recovery?
HPI - Patient is 32-year old orthopedic surgeon with history of right side S1 radiculopathy for 8 months that progressed to bilateral S1 radiclopathy for last 3 months. Epidural steroid injection after 1st 2 month did not lead to improvement in sign and symptom. No complaints of muscle weakness and no bladder or bowel involvement.
Paraesthesia improved after first 3 month. Pain last 2 month increase , interfere significantly with daily activity
Lumbar discectomy performed in 4 / 12 / 2013.
Fenestration done and sequestrectomy done .
Surgeon how did the surgery tell me he found all disc sequestrated annulus healed no any further compression on root .
Bleeding from epidural vein occur , gel foam
Postop. No any improvement ,still bilateral S1 radiculopathy more sever in right side with intermitten throbbing pain in right paraspinal area at level of sacral ala at rest With Backache
The pain even more intense than preoperative p
what your opnion about the case
HPI - # Pain in the neck and right arm since 8 weeks. Pain significant in the first 2 weeks and gradually getting better and is under control on Pregabalin (75 mg BD). Initially treated with Diclofenac and oral steroid course. Pain still present but intermittent and mild discomfort. Noted especially while repeatedly abducting the shoulder.No interruption in daily routines.
# Weakness: Initial weakness using the right hand in the first 2 weeks. Gradually improving. Currently some subjective weakness.
No history of trauma
What should be the next step of management for pain (still requiring oral medications) and subjective weakness
HPI - Insidious onset of neck pain and painful movement since 2 weeks.
What would be your next step in treatment for this patient?
HPI - The patient, a retired professional tennis player, developed pain in his right arm approximately 12 weeks ago following a tennis match. Initially the pain was severe, but with a trial of physical therapy, and selective corticosteroid injections the pain resolved. However, now we continues to have significant weakness in the right arm that is severe enough that he can no longer play tennis anywhere near the level he use to. He reports some mild numbness and tingling in his right thumb. He denies any weakness or paresthesias in the left arm.
He reports ~ 30 years ago he had a diving accident where he hit his head and had immediate and severe neck pain. He denies having any neurologic symptoms at that time.
An EMG was done which showed a C5 and C6 radiculopathy.
How would you treat this patient with weakness (C5 and C6) and paresthesias (C6) but no significant pain.
HPI - Insidious onset gradually progressive spasticity of lower limbs since 6 years. associated weakness on lt lower limb. decreased sensation below xiphisternum.
How would you treat this patient as a FIRST LINE of treatment?
HPI - low back pain radiating to b/l lower limb (L>R)since 9 months
Associated numbness in b/l lower limb below L2.
Pain aggravated by bending forward, with activities.
normal bowel/bladder habits
HPI - The patient presents with 6 week hx of rt side leg pain and paraesthesia below knee in the S1 dermatome. He has a mild backache, no fever, no weakness. Pain intensity changes with position. It is mild in the morning and increases gradually. It is worse with sitting more than 30 minutes. Current management with NSAISs and physical therapy.
What would be your next step in management for this patient?
HPI - Patient first noticed spine assymetry at age of 9. She was never braced and was referred to our insitution at age of 15.
How would you treat this patient?
HPI - 30 yo Somali man from Nairobi now living in Juba fell off a big truck onto his upper back and neck. Had LOC, and I don't know how he was transferred to Juba Teaching Hospital.
How would you treat this patient? Keep in mind you are in South Sudan, with very few resources.
HPI - The patient is a 32-year-old male mechanic that fell 8 mm from a tree in late December. Since then he has had persistent and severe neck pain, paresthesia in this middle and index finger, and reports his right hand no longer has the strength it use to.
How would you approach this, anterior or posterior. We are in Nicaragua and have very few implants available.
HPI - The patient is 43 year old gentleman, who was assaulted and placed in a head lock 2 months ago. He said he heard something "crack" in his neck. He immediately had severe neck pain, and difficulty swallowing over the first few days, but denied any weakness. Over the following weeks he developed weakness in his upper and lower extremities that evolved to the point that he lost his ability to ambulate, and was admitted to the public hospital in Managua, Nicaragua.
How would you treat this patients? Keep in mind we are in Nicaragua, and there are very few implants available.
HPI - The patient is a 23 yo male, college graduate and athlete, with no unusual recent history, that developed severe neck pain 3 days ago. He resports there has been no improvement, and he has difficulty moving his neck.
What do you think is the most likely diagnosis?
HPI - The patient is an 81-year-old female that was involved in a MVA and sustained a Type 2 odontoid fracture. An initial attempt at nonoperative treatment with a hard cervical orthosis was attempted for three weeks. However, the patient had continued severe pain in the neck, and was having troubles tolerating the cervical orthosis. Therefore, after a conversation with the patient regarding the pros and cons of surgery, we elected to proceed with anterior screw osteosynthesis.
How would you have treated this Type II odointoid fx?
HPI - The patient is a 39-year-old male immigrant that become intoxicated and fell down the stairs. He was found the following morning, unable to move any of his extremities. He was brought to the emergency room via ambulance.
Would you have done anything differently with the odontoid fracture?
HPI - The patient is a 48-year-old gentleman who presents with progressive gait instability and dexterity problems with his hands. He also reports numbness/tingling in his b/l upper extremities. He reports at times he holds his hand out against the wall because he feels unsteady on his feet. He reports he frequently drops object. He also reports a decreased ability to hold his bladder for long periods of time, and says when he needs to urinate he needs to rush to the bathroom.
Would you proceed with a posterior cervical decompression to augment his anterior decompression?
HPI - The patient is 59-year-old male that was moving a tree branch when he developed severe pain in his left leg 10 days ago. He localizes the pain to his knee and his medial calf and ankle. He reports his pain was so severe initially he could not get off the ground, and has remained severe enough that he is unable to perform ADL, and is having difficulty sleeping. He was given a steroid taper and narcotics by his PCP, but his symptoms remained severe so an MRI was performed and he was referred to my office. He does report initially he could not "extend his knee", but reports that is improving.
Would you operate on this patient acutely
HPI - The patient is a 40 yo male that was involved in a motor vehicle accident. He was brought to the emergency room via an ambulance. He complained of severe low back pain, but without pain radiating into the legs. He denied subjective weakness in his lower extremities, but reports he is having difficulty with urination because of the pain he is in.
Would you operate on this patient?
HPI - The patient is a 70-year-old Jehovah witness that has progressively lost his ability to ambulate over the last year. He has been wheelchair bound for the last 4 months. He is slowly loosing the function of his hands, and it is becoming increasingly difficult to feed himself. He reports whenever he stands upright he has numbness/tingling in his bilateral LE.
Would you operate on this patient, and if so what techniques would you use?
HPI - The patient is a 30-yearmale that was a restrained driver in an MVA. There was no LOC. Her was brought to the ER via an ambulance. On presentation he had symptoms of mild neck pain and numbness and tingling in his right hand. He denied subjective wea
HPI - History of fall in 2008 where the patient hit her head and "hurt her neck". Symptoms of progressive loss of balance, dexterity problems, numbness and tingling in bilateral upper extremities. She also reports cramping in bilateral thighs. She reports
HPI - The patient presents with severe bilateral buttock pain that makes it difficult for her to walk. She is comfortable when sitting, but can not stand upright due to the pain radiating into her buttocks and posterior thighs.