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A 73-year-old female with a history of rheumatoid arthritis presents to clinic with worsening bilateral upper extremity paresthesias, clumsiness, and weakness. On exam, she has a positive Babinski, intact sensation to light touch, and 4/5 motor in the bilateral upper extremities. Her cervical MRI is shown in Figure A. What is the most appropriate next step in treatment for the upper cervical spine?
Observation and soft collar
Spinal dose steroids
Posterior fusion with or without decompression
Transoral pannus resection alone
Transoral pannus resection followed by posterior occipitocervical fusion
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A 60-year-old woman with rheumatoid arthritis has long term neck pain and new onset of difficulty holding cards in her weekly poker tournament. She does not complain of weakness, but states she has become "clumsy" in her old age, fumbling with buttons and dropping her change. On exam she has hyperreflexia, but no weakness. Radiographs show atlantoaxial subluxation. She is considering decompressive surgery, but wants to know if she will recover function. Which radiographic marker may predict neural recovery after decompression?
Posterior atlanto-dens interval of >13mm
Atlanto-dens interval of <5mm
Subaxial subluxation of <3.5mm
Basilar invagination <0.5cm
Rotary subluxation of <10 degrees
A 63-year-old woman with rheumatoid arthritis has long standing neck pain and new onset of difficulty with manual dexterity, such as buttoning her shirt and holding small objects. She reports difficulty walking up the stairs, and reports she feels increasingly unsteady on her feet. On exam she has 4+ patellar reflexes. Flexion and extension radiographs are shown in Figure A and B. What is the most appropriate treatment at this time?
Immobilization in a soft cervical collar for 6 weeks
Halo immobilization for six weeks
Transoral odontoid resection
Occipitocervical fusion with instrumentation
Posterior C1-C2 fusion with instrumentation