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A 50-year-old woman presents for followup two years after having cervical spine surgery through a left-sided approach with severe neck pain. A recent radiograph is seen in Figure A. Her surgeon advises her that she will need revision surgery. Preoperative laryngoscopy shows abnormal left vocal cord function because of paralysis of the left posterior cricoarytenoid muscle. What approach would be CONTRAINDICATED during revision surgery?
Revision ACDF with a right-sided approach due to superior laryngeal nerve palsy
Revision ACDF with a left-sided approach due to superior laryngeal nerve palsy
Revision ACDF with a right-sided approach due to recurrent laryngeal nerve palsy
Revision ACDF with a left-sided approach due to recurrent laryngeal nerve palsy
Posterior cervical fusion due internal laryngeal nerve palsy
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A 33-year-old male presents with neck and left arm pain. He denies symptoms in his right arm. Based on the MRI image shown in Fig A, what findings would be expected on physical exam?
Weakness to shoulder shrug
Weakness to shoulder abduction and elbow flexion
Weakness to elbow flexion and wrist extension
Weakness to elbow extension and wrist flexion
Weakness to finger abduction
Which of the following patients would be considered the best candidate for treatment with a posterior cervical foraminotomy?
A 72-year-old female with progressive numbness and tingling in her bilateral upper extremities, and complaints of frequently dropping objects (MRI shown in Figure A)
A 36-year-old male that presents following a motor vehicle accident and exam and is an ASIA B on presentation (CT shown in Figure B)
A 56-year-old male that presents left arm pain, and weakness to elbow flexion and wrist extension (MRI shown in Figure C)
A 45-year-old male that presents with right arm pain and weakness to elbow extension and wrist flexion (MRI shown in Figure D)
A 45-year-old female that presents with progressive intermittent weakness and paresthesia is all 4 extremities (MRI shown in Figure E)
A 28-year-old man presents with pain in the distribution shown in Figure A, and numbness in the middle finger. After performing a complete neurological exam, his surgeon orders an MRI of his cervical spine. Which of the following motor exam findings and MRI findings are consistent with the symptoms present?
Biceps weakness, posterolateral C5-6 disc herniation
Hand intrinsic weakness, C8-T1 foraminal stenosis from an uncovertebral osteophyte
Shoulder abduction weakness, posterolateral C4-5 disc herniation
Wrist flexion weakness, C6-7 foraminal stenosis from an uncovertebral osteophyte
Wrist extension weakness, posterolateral C6-7 disc herniation
A 38-year-old male presents with a cervical disc herniation at the C7/T1 level with associated foraminal stenosis, but no significant central stenosis. What would be the expected symptoms and physical exam findings.
Numbness of the lateral shoulder and deltoid weakness
Numbness of 2nd and 3rd fingers and triceps weakness
Numbness of the thumb with weakness to wrist extension
Numbness of 5th finger with weakness to long flexor function in all digits and thumb
Numbness of the medial elbow and weakness to long finger flexion of the 4th and 5th digits only
A 59 year-old man complains of acute pain radiating from the neck down the right upper extremity. Physical exam demonstrates right arm triceps weakness, decreased triceps reflex, and diminished sensation of the middle finger. A cervical disk herniation will likely be found at which level?
Which of the following physical exam findings supports the diagnosis of cervical radiculopathy?
Shoulder abduction test
Lateral forearm pain with resisted extension of the long fingers
Inverted brachioradialis reflex
A 49-year-old male presents with left arm pain of four weeks duration. A T2-weighted axial MRI is shown in Figure A. Which of the following statements would most accurately describe his diagnosis and physical exam findings?
A C5 radiculopathy leading to deltoid and biceps weakness.
A C5 radiculopathy leading to brachioradialis and wrist extension weakness.
A C5 radiculopathy leading to triceps and wrist flexion weakness.
A C6 radiculopathy leading to brachioradialis and wrist extension weakness.
A C6 radiculopathy leading to finger flexion weakness.
A 50-year-old diabetic woman describes left arm pain and tingling in the ulnar side of her hand and wrist. She denies weakness or trouble with fine motor tasks. Her symptoms are worse when she is sleeping without a pillow on her left side, and with her left elbow in an extended position. Sleeping with her left hand above her head seems to improve her symptoms. What is the most likely diagnosis?
Guyon’s canal syndrome
Cubital tunnel syndrome
Treatment options for a symptomatic cervical pseudoarthrosis following anterior cervical diskectomy and fusion include revision anterior surgery versus a posterior instrumented cervical fusion. When comparing these treatment options, all of the following are true of posterior cervical fusion EXCEPT:
Increased intraoperative blood loss
Longer postoperative hospitalization
Decreased revision surgery rate
Decreased fusion rate
Increased complication rate
A 57-year old male presents with right arm pain of 4 weeks duration. He reports the pain began following a tennis match and has not improved with time. He describes the pain as an aching sensation that affects his lateral forearm that improves when he abducts the shoulder. He also describe a sensation of numbness in this right thumb. Reflex exam shows he has 1+ right biceps reflexes and 2+ right triceps reflexes which are both symmetric with the left side. Sensory exam shows paresthesias in the distribution of the right thumb. Motor exam shows no evidence of radial deviation with active wrist extension. Motor exam on the right shows 5/5 deltoid, 5/5 elbow flexion with the palms facing upward, 4/5 wrist extension, and 5/5 elbow extension, and 5/5 wrist flexion. What is the most likely etiology of his symptoms.
Tendinosis and inflammation at origin of ECRB
Compression of the posterior interosseous nerve by the proximal edge of supinator
Compression of the ulnar nerve in Guyon's canal
A paracentral cervical disc herniation at C5/6
A foraminal disc herniation at C6/7
In a patient with arm pain and paresthesias, which of the following symptoms or physical exam findings supports a cervical radiculopathy as opposed to a peripheral neuropathy.
Relief of pain when holding the arm above the head
Reproduction of pain with tilting head to affected side and rotating head to contralateral side
Compensatory inter-phalangeal joint flexion of the thumb when attempting to pinch
Patient is unable to make "AOK" sign with index finger and thumb
Forearm pain with resisted wrist extension
A 52-year-old woman underwent a C5/6 ACDF for cervical radiculopathy through a left-sided approach two years ago. Radiographs are shown in Figure A. She has had an altered voice since this operation. Recently, the patient has developed myelopathic symptoms including gait instability and dexterity problems with her hands. An MRI shows a fusion at C5/6, and an adjacent-level midline disc herniation at C4/5 with cord compression and myelomalacia. Laryngoscopy of the vocal cords demonstrates abnormal function of the vocal cords on the left hand side. Which of the following is the most appropriate treatment for this patient?
Physical therapy and NSAIDS
High dose methylprednisone
C5/6 hardware removal and C4/5 ACDF using a left sided anterior approach
C5/6 hardware removal and C4/5 ACDF using a right sided anterior approach
C5 to C7 posterior laminectomy and fusion
During an anterior diskectomy and fusion at C2-3 there is concern for an injury to the left hypoglossal nerve. What physical findings would be expected if this were the case?
tongue deviation to left when extruded
tongue deviation to right when extruded
ptosis on left side of face
ptosis on right side of face
change in voice
This shows a standard ACDF with allograft placement
This video demonstrates an anterior cervical diskectomy and fusion by Dr. Ali By...
This video demonstrates a cervical total disc replacement using a Synthes ProDis...
HPI - History of recent numbness of the 2nd and 3rd finger of the left hand of 14 days duration, associated with mild neck pain.
What is the diagnosis?
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 - 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.