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A 40-year-old woman with history of intravenous drug abuse and ongoing Staphylococcus aureus septicemia is referred for intractable neck pain with radiation down her arm. She also complains of progressive hand weakness. Examination reveals long tract signs in the lower extremities. Her MRI scan is shown in Figure A. Besides intravenous antibiotics, what is the most appropriate next step in treatment?
Percutaneous CT guided aspiration, hard cervical orthosis until bony union.
Percutaneous CT guided aspiration, hard cervical orthosis, repeat aspiration at 6-12 weeks followed by anterior corpectomy and fusion if repeat aspiration is sterile.
Anterior cervical debridement and anterior corpectomy without instrumentation
Posterior cervical debridement and instrumented posterior fusion.
Anterior cervical debridement, corpectomy and fusion followed by a posterior instrumented stabilization procedure
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A 31-year-old female from the United States who is an active IV drug abuser presents with worsening gait instability for the last four days. She has no history of prior international travel. Physical exam shows diffuse weakness in her upper and lower extremities. A sagittal MRI is shown in Figure A. What is the next most appropriate step in management?
Anterior decompression and fusion
Posterior decompression and fusion
Methylprednisone loaded at 30 mg/kg followed by drip at 5.4 mg/kg/hr drip for 23 hrs
Broad spectrum IV antibiotics and bracing
CT guided biopsy
A 64-year-old female accountant from Oregon is diagnosed with endocarditis 6 months ago underwent a course of IV antibiotic treatment. She now reports 3 months of severe low back pain and progressive lower extremity weakness and paresthesias for the past week. Her leukocyte count is normal and she is afebrile. The ESR and CRP are elevated. Radiographs and MRI scans are shown in Figures A and B, respectively. What is the most appropriate next step in management?
Intrathecal catheter placement with antibiotic administration for 6 weeks
Irrigation and debridement, corpectomy, and fusion
Oral prednisone regimen for 4 weeks
Irrigation and debridement via posterior approach
Initiation of multiagent antibiotic regimen for tuberculosis for 6 months