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Of the magnetic resonance images provided in Figures A-E, which circumstance would be most indicated for anterior and posterior approaches with spinal stabilization and fusion? The primary symptoms on presentation are described below:Figure A: A 65-year-old diabetic presents with rapidly progressive gait instability. Serum labs show an elevated WBC, CRP, and ESR.Figure B: A 72-year-old male presents with slowly progressive gait instability over the last 5 years.Figure C: A 42-year-old male presents with the acute onset of left arm pain and triceps weakness.Figure D: A 72-year-old active female who plays golf on a regular basis presents with severe neck pain 3 weeks after falling down the stairs. Figure E: A 37-year-old female presents with vertigo and bilateral upper extremity weakness that has presented intermittently over the last 5 years.
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A 45-year-old HIV-positive homeless man presents with increasing low back pain for the last three weeks. He now reports difficulty ambulating, fever, and loss of appetite. He denies bowel and bladder symptoms. He denies any symptoms radiating into his buttock or legs. On physical exam, he has in obvious discomfort with standing which worsens in the forward flexion position. He has a normal motor and sensory exam in his lower extremities. Blood cultures are performed which come back negative. His imaging is shown in Figures A and B. What would be the most next appropriate step in treatment?
Broad spectrum antibiotics
Isoniazid, rifampin, and pyrazinamide therapy
CT guided biopsy with cultures
Technetium bone scan
Anterior corpectomy with a retroperitoneal approach, strut grafting and instrumentation
A 60-year-old female presents with a 2 week history of low back pain. The pain is described as a dull, persistent ache and radiates down to her buttocks but not past the horizontal gluteal crease. She has a history of Type 2 diabetes mellitus and urinary incontinence. Examination reveals loin tenderness, paravertebral muscle spasm and diminished reflexes but full strength and sensation in the lower extremities. T2-, T1-weighted, and T1 contrast enhanced sagittal MRI images are shown in Figures A through C, respectively. What is the most likely diagnosis and most appropriate treatment plan
These are Modic Type I changes and treatment will involve NSAIDS, a short period of bed rest and physical therapy
These are Modic Type I changes and treatment will involve a lumbar corset and physical therapy
This is spondylodiscitis and treatment will involve intravenous antibiotics and a thoracolumbosacral orthosis (TLSO).
This is spondylodiscitis and treatment will involve needle biopsy, intravenous antibiotics and a thoracolumbosacral orthosis (TLSO).
This is spondylodiscitis and treatment will involve anterior decompression and stabilization, and intravenous antibiotics.
Amphotericin B is most appropriate for the treatment of which type of spine infection?
Bacterial osteomyelitis with a gram-positive organism
Bacterial osteomyelitis with a gram-negative organism
A 69-year-old male presents to the emergency room with low back pain for 1 week duration. His past medical history is significant for diabetes and coronary artery disease that was treated with stenting 7 years prior. Recently he was hospitalized for a urinary tract infection which was treated with oral antibiotics. On physical exam he is afebrile and has no neurologic deficits in his lower extremity. Laboratory studies show a white blood cell count of 10,300/mm3, an erythrocyte sedimentation rate of 35 mm/h (reference range, 0-25 mm/h), and C-reactive protein of 13 mg/L (reference range, 0-5.0 mg/L). A radiograph and MRI are performed and shown in Figure A and B respectively. Repeat blood cultures x2 are performed and both show methicillin-sensitive Staphylococcus aureus. What is the most appropriate next step in treatment.
CT guided biopsy
Referral to an orthopaedic pathologist
Organism specific intravenous antibiotics
Posterior lumbar debridement
Anterior lumbar debridement
A 45-year-old female IV drug user presents to the emergency department with a chief complaint of severe focal low back pain that has progressed over the past 10 days. She now reports the pain is severe enough that it is difficult for her to walk. She reports night sweats, fluctuating fever, and a loss of appetite. Physical exam shows exquisite pain with flexion and extension of the lumbar spine. Routine urinalysis by the ER physician shows evidence of a urinary tract infection. Her blood leukocyte count is 12,600 per mm3, and erythrocyte sedimentation rate is 78 mm/h. A lateral radiograph is shown in Figure A. Which of the following would be the most appropriate next step in treatment?
Discharge from the ER with a course of oral antibiotics
Admission to the hospital with empirical IV antibiotics
Admission, blood cultures, and MRI of the lumbar spine with and without gadolinium
Nuclear medicine bone scan
A 33-year-old man with a history of IV drug abuse presents with low back pain of increasing intensity. His neurologic examination is intact. Laboratory studies reveal a WBC count of 11,000/mm3 and erythrocyte sedimentation rate of 82 mm/h. Blood cultures are negative x 3. Plain radiographs are shown in Fig A. An MRI T1-weighted images and a post gadolinium fat-suppressed T1-weighted images are shown in Fig B. Initial management should consist of:
Physical therapy with supportive therapy
Open surgical decompression and biopsy
CT-guided closed biopsy
Repeat MRI in 6 weeks