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A 48-year-old woman presents to your clinic with 3 weeks of worsening leg heaviness and difficulty with balance. She denies any bladder or bowel issues. On examination, she has 3/5 strength in the bilateral iliopsoas and quadriceps. Sagittal and axial T2 MRI sequences are shown in Figures A and B, respectively. Cervical MRI is unremarkable. What is the next most appropriate step in management?
NSAIDs and physical therapy
Epidural steroid injection
Thoracic laminectomy and instrumented fusion
Thoracic laminectomy with transpedicular discectomy and instrumented fusion
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A 29-year-old male presents with numbness and tingling in his lower extremities and gait instability for two weeks duration. Physical exam shows 3+ brisk patellar reflexes. Magnetic-resonance-imaging is shown in Figure A. What is the most appropriate first line of treatment?
A 47-year-old male presents with back pain of 2 weeks duration. He denies night sweats, fevers, or weight loss. He localizes his symptoms to a dermatomal distribution along the rib cage on the right. On physical exam he has mild paraspinal tenderness, normal patellar reflexes, normal muscle strength in his lower extremities, and a normal gait exam. An MRI is shown in Figure A and B. What is the most appropriate first step in management?
A repeat MRI with gadolinium
CT of chest, abdomen, and pelvis followed by a CT guided biopsy of the spinal lesion
Physical therapy and NSAIDs
Surgical decompression using a midline posterior approach
Surgical decompression using a transthoracic approach
A 55-year-old woman undergoes endoscopic transthoracic anterior surgery for a herniated disk in the thorax. What is the most likely complication following surgery?