Intraoperative neuromonitoring for spinal surgery. A case of hemiparesis following posterior laminectomy and fusion with loss of intraoperative SSEP signals
This document discusses coronary artery disease and two conditions that can result from it - angina pectoris and myocardial infarction. It defines angina pectoris as chest pain or discomfort due to reduced blood flow to the heart muscle, and describes the different types of angina including stable, unstable, and variant angina. Myocardial infarction is defined as the death of heart muscle tissue from a lack of oxygen supply. The document outlines the causes, symptoms, diagnostic tests, treatment options including medications, angioplasty and bypass surgery, nursing care, complications, prevention, and cardiac rehabilitation for these two coronary artery disease conditions.
1. This document appears to be notes from a spine conference discussing several patient cases.
2. Details are provided on multiple patients' histories, exams, imaging findings, and surgical procedures and outcomes.
3. Complications, variability in procedures, and long-term outcomes are discussed from a retrospective review of over 400 patients who underwent three-column osteotomies for spinal deformity.
A 45-year-old female presented with gradually progressive proximal muscle weakness over 6 months. On examination, she had facial puffiness, macroglossia, hyporeflexia, and delayed ankle jerk relaxation. Investigations revealed hypothyroidism with a high TSH and low T3 and T4. An EMG showed a myopathic pattern. She was diagnosed with hypothyroid myopathy and started on levothyroxine treatment.
A 56-year-old man presented with worsening lower back pain over the past few days. He had a history of L3-L5 laminectomy in 2003 and was recently hospitalized for MRSA bacteremia and pneumonia. Imaging showed progressive spondylodiscitis at L4-L5 that had worsened since his previous admission. He underwent an incision and drainage of an abscess in his left psoas muscle.
Case Review #33: 49 year old Dancer presented with Idiopathic ScoliosisRobert Pashman
A 49 year old male with Adult Scoliosis presented with low back pain and leg pain. The patient is a professional dancer. He failed conservative therapy and was seeking a surgical opinion.
Chronic Neck & Low Back Pain: A Case of Motor Control Lauren Jarmusz
This patient presents with chronic neck and low back pain. For his neck pain, he experienced weekly exacerbations and headaches following a motor vehicle accident over a year ago. Physical therapy initially focused on his neck, utilizing trigger point release, postural exercises, scapular strengthening, and thoracic mobility work. His neck disability index initially measured 15% and headaches decreased to once per week. The plan was to focus on his neck for the initial 5 visits before shifting focus to his low back pain.
What to do if the spine x-ray shows a ---? – Part 2SpinePlus
This document provides an overview of classifications and types of scoliosis including idiopathic, congenital, neuromuscular, and those caused by tumors or underlying bone conditions. It also describes imaging findings and classifications for common spinal conditions like Scheuermann's disease, disc herniations, spinal stenosis, and degenerative changes. Example imaging reports are presented to demonstrate pathological findings and the importance of correlating clinical details with imaging interpretation.
1. The 62-year-old woman presented with right sciatica and inability to walk independently due to tandem spinal stenosis involving her cervical and lumbar spine.
2. Imaging showed chronic fractures at T4, T5-T6, L3 and L5 with 50% height loss at L5, as well as central stenosis at C3-C4 and L3-L4 with severe lumbar stenosis.
3. She underwent an anterior cervical decompression at C3-C4 for her cervical stenosis. Post-operatively, she was able to walk with a walker with assistance and had no pain two months later.
This document discusses coronary artery disease and two conditions that can result from it - angina pectoris and myocardial infarction. It defines angina pectoris as chest pain or discomfort due to reduced blood flow to the heart muscle, and describes the different types of angina including stable, unstable, and variant angina. Myocardial infarction is defined as the death of heart muscle tissue from a lack of oxygen supply. The document outlines the causes, symptoms, diagnostic tests, treatment options including medications, angioplasty and bypass surgery, nursing care, complications, prevention, and cardiac rehabilitation for these two coronary artery disease conditions.
1. This document appears to be notes from a spine conference discussing several patient cases.
2. Details are provided on multiple patients' histories, exams, imaging findings, and surgical procedures and outcomes.
3. Complications, variability in procedures, and long-term outcomes are discussed from a retrospective review of over 400 patients who underwent three-column osteotomies for spinal deformity.
A 45-year-old female presented with gradually progressive proximal muscle weakness over 6 months. On examination, she had facial puffiness, macroglossia, hyporeflexia, and delayed ankle jerk relaxation. Investigations revealed hypothyroidism with a high TSH and low T3 and T4. An EMG showed a myopathic pattern. She was diagnosed with hypothyroid myopathy and started on levothyroxine treatment.
A 56-year-old man presented with worsening lower back pain over the past few days. He had a history of L3-L5 laminectomy in 2003 and was recently hospitalized for MRSA bacteremia and pneumonia. Imaging showed progressive spondylodiscitis at L4-L5 that had worsened since his previous admission. He underwent an incision and drainage of an abscess in his left psoas muscle.
Case Review #33: 49 year old Dancer presented with Idiopathic ScoliosisRobert Pashman
A 49 year old male with Adult Scoliosis presented with low back pain and leg pain. The patient is a professional dancer. He failed conservative therapy and was seeking a surgical opinion.
Chronic Neck & Low Back Pain: A Case of Motor Control Lauren Jarmusz
This patient presents with chronic neck and low back pain. For his neck pain, he experienced weekly exacerbations and headaches following a motor vehicle accident over a year ago. Physical therapy initially focused on his neck, utilizing trigger point release, postural exercises, scapular strengthening, and thoracic mobility work. His neck disability index initially measured 15% and headaches decreased to once per week. The plan was to focus on his neck for the initial 5 visits before shifting focus to his low back pain.
What to do if the spine x-ray shows a ---? – Part 2SpinePlus
This document provides an overview of classifications and types of scoliosis including idiopathic, congenital, neuromuscular, and those caused by tumors or underlying bone conditions. It also describes imaging findings and classifications for common spinal conditions like Scheuermann's disease, disc herniations, spinal stenosis, and degenerative changes. Example imaging reports are presented to demonstrate pathological findings and the importance of correlating clinical details with imaging interpretation.
1. The 62-year-old woman presented with right sciatica and inability to walk independently due to tandem spinal stenosis involving her cervical and lumbar spine.
2. Imaging showed chronic fractures at T4, T5-T6, L3 and L5 with 50% height loss at L5, as well as central stenosis at C3-C4 and L3-L4 with severe lumbar stenosis.
3. She underwent an anterior cervical decompression at C3-C4 for her cervical stenosis. Post-operatively, she was able to walk with a walker with assistance and had no pain two months later.
Three key points about the document:
1. It describes the medical history and treatment of an 84-year-old man who presented with weakness, tingling, and difficulty walking due to lumbar stenosis.
2. The man underwent decompression surgery to relieve stenosis at four levels from L1 to L5, including a spondylolisthesis at L4-L5.
3. Two years after surgery, the man called the office again complaining of low back pain with ambulation and said he could no longer walk more than one mile without pain.
A 22-year-old male presented with a 1-year history of back pain and 8 months of lower limb weakness and difficulty walking. MRI revealed a tumor in the lower dorsal spine. The patient underwent a posterior midline approach and excision of the tumor. Possible diagnoses included ependymoma, astrocytoma, or tuberculosis of the spine. The surgery aimed to prevent further neurological dysfunction and cure the condition through complete tumor resection.
Case Review #24: 67 year old female with Degenerative ScoliosisRobert Pashman
67 year old female presented with DeNovo Scoliosis, with significant rotation due to Adolescent Idiopathic Scoliosis. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. KIM/SRP Classification 2.
1. A 43-year-old female patient fell down stairs 3.5 hours prior to arriving at the hospital. On examination, she had significant swelling and tenderness of the left ankle with limited range of motion due to pain.
2. X-rays showed a closed bimalleolar fracture of the left ankle. She was placed in a short leg cast and admitted to the ward for pain control and waiting for surgery to undergo an open reduction and internal fixation.
3. Bimalleolar ankle fractures are unstable injuries involving fractures of two malleoli. Surgical treatment with open reduction and internal fixation is usually required for anatomical reduction and stabilization to allow early mobilization.
This document summarizes a case of Paget's disease of the spine in a 42-year-old man who presented with back pain after a slip and fall. Imaging revealed a compression fracture at L2. Paget's disease is characterized by disorganized bone remodeling leading to enlarged and deformed bones. Treatment involves bisphosphonates which suppress bone turnover. Potential risks of long-term bisphosphonate use include atypical femur fractures and malignant transformation of pagetic bone.
The document describes the case of a 47-year-old man presenting with progressive leg weakness over 2.5-3 years. His father had a similar progressive gait difficulty from age 40 until death at 70. Examination found spastic paraparesis, increased tone and reflexes in the legs. Imaging and tests ruled out common causes. The likely diagnosis is hereditary spastic paraparesis, supported by the positive family history. Genetic testing found a novel mutation in the SPG4 gene associated with this condition.
This document describes the arthroscopic Bankart repair procedure for a 26-year-old male patient with recurrent right shoulder instability. An MRI showed a Bankart lesion and Hill-Sachs lesion. During the arthroscopic procedure, the Bankart lesion extending from the 2 to 5 o'clock position on the glenoid was repaired. Post-operatively, the patient's arm was immobilized for 3 weeks followed by a rehabilitation program. Arthroscopic stabilization allows for a complete inspection of the joint and treatment of all intra-articular lesions while preserving range of motion.
This document summarizes an interdisciplinary case discussion night involving physical medicine and rehabilitation (PM&R), physical therapy (PT), and musculoskeletal radiology (MSK Radiology). The case involves a 55-year-old female presenting with lower extremity pain. Students were split into small groups with preceptors from each discipline to discuss the patient's history, physical exam findings, differentials, assessments, and treatment plans. Imaging options and how different specialties could help guide treatment were also reviewed. The goal was to foster interdisciplinary education for an integrated approach to patient care.
The document provides medical details about a 75-year-old male patient who experienced a right hemiparesis due to an ischemic stroke. Key details include:
- The patient presented with inability to lift his right arm and leg and difficulty walking independently.
- Investigations revealed multiple acute infarcts in the left frontal and parietal regions as well as old lacunar infarcts and atherosclerotic changes.
- The patient is undergoing physiotherapy to improve strength, balance and gait. Functional assessments show improvement in motor control but ongoing difficulty with activities like dressing and walking without assistance.
Lecture posterior fusion for ossification of the posterior longitudinal liga...Spiro Antoniades
An 86-year-old woman presented with progressive right arm weakness over 10 days. Imaging showed ossification of the posterior longitudinal ligament (OPLL) at multiple cervical levels from C2 to C5. OPLL most commonly occurs in the 5th to 6th decade of life and is more prevalent in males and Caucasians. Risk factors for progression include more than 60% canal stenosis, a spinal canal diameter of 6mm or less, increased range of motion of the cervical spine, and laterally positioned OPLL. Surgical treatment risks include a high rate of dural tears with an anterior approach if the "double layer sign" is present.
Presented an in-service on the pathophysiology and differential diagnosis of cauda equina syndrome to Arcadia University's 2nd year Doctor of Physical Therapy students.
This document contains 18 multiple choice questions related to orthopaedic surgery. Each question is followed by the preferred response and recommended reading materials. The questions cover topics such as compression of the median nerve at the elbow, congenital muscular torticollis exercises, preventing failure after fixation of an intertrochanteric fracture, osteoblast function, treatment for hip arthroplasty instability, and contraindications for hyperbaric oxygen therapy.
Elderly male with Flaccid paraparesis diagnosed as Cauda Equina Syndrome due ...Dr. Md. Rashedul Islam
A 66-year-old diabetic man presented with progressive difficulty walking and low back pain radiating to his left leg over 1 month. Examination found wasting and weakness in his lower limbs, absent reflexes, and reduced sensation. Imaging showed a fractured L5 vertebra and lytic lesions. Biopsies indicated multiple myeloma, causing cauda equina syndrome through vertebral collapse. He was diagnosed with multiple myeloma and diabetes, treated with steroids, physiotherapy and hematology referral.
Case Review: 42 year old woman with Grade 3 Isthmic SpondylolisthesisRobert Pashman
A 42 year old very athletic woman presented with Grade 3 Isthmic Spondylolisthesis. She had a long history of back pain. Dr. Pashman performed an anterior and posterior spinal fusion.
This case report describes the conservative treatment of a 40-year-old female patient presenting with a left ipsilateral sciatic scoliosis using McKenzie method physical therapy techniques over 17 sessions in 3 months. The patient's lateral shift deformity and lower extremity pain resolved, muscle weakness improved, and disability levels decreased substantially. Corrective side glide mobilizations and self-techniques were effective at reducing the disc protrusion and decompressing the nerve root, resolving the patient's symptoms and abnormal posture.
This document discusses claw hand deformity. It begins by defining claw hand as flattening of the transverse metacarpal arch and hyperextension of the MCP joints with flexion of the PIP and DIP joints. It then discusses normal hand anatomy and the pathoanatomy that leads to clawing. Paralysis of the intrinsic hand muscles results in unopposed extension of the MCP joints and flexion of the IP joints, causing the claw deformity. The document covers evaluation, classification, indications for surgery, principles of tendon transfers to correct clawing, and use of splints. The goal of surgery is to restore independence of movement to the MP and IP joints and correct the longitudinal axial deformity.
Case Review #27: 59 Year Old Female with Progressive Adult ScoliosisRobert Pashman
59 year old female presented with Progressive Adult Idiopathic Scoliosis, Spondylolisthesis, Flatback Deformity, and Stenosis. The patient was treated with a spinal fusion,
- The document discusses the initial management of spinal cord injuries, including stabilization of the spine, maintaining adequate blood pressure and circulation, and preventing complications like hypotension, aspiration, and shock.
- Early management also involves immobilizing the spine, assessing neurological function, and evaluating spinal stability before more definitive treatment.
- Maintaining mean arterial blood pressure at or above 85-90 mm Hg for the first week after injury is recommended to improve spinal cord perfusion.
This document summarizes a case of a 70-year-old man presenting with left sciatica for 10 weeks. Physical therapy did not provide relief for his pain, which was located in his left hip, buttock, posterior lateral leg, and lateral ankle. He has a significant past medical history including diabetes, heart conditions, and end-stage renal disease requiring dialysis. Imaging showed an L5-S1 disc herniation. Treatment options including further non-operative management with medications and therapies or surgical discectomy were discussed.
A 61-year-old man presented with left lower back pain and left leg weakness and numbness, unable to walk. He has a history of lumbar and cervical spine surgeries. MRI showed stenosis at C3-C4 and L2-L3 as well as a disc herniation at T10-T11. The discussion focused on the rare occurrence of thoracic disc herniations and surgical approaches for addressing the T10-T11 herniation.
More Related Content
Similar to Lecture cervical stenosis neuromonitoring 2017
Three key points about the document:
1. It describes the medical history and treatment of an 84-year-old man who presented with weakness, tingling, and difficulty walking due to lumbar stenosis.
2. The man underwent decompression surgery to relieve stenosis at four levels from L1 to L5, including a spondylolisthesis at L4-L5.
3. Two years after surgery, the man called the office again complaining of low back pain with ambulation and said he could no longer walk more than one mile without pain.
A 22-year-old male presented with a 1-year history of back pain and 8 months of lower limb weakness and difficulty walking. MRI revealed a tumor in the lower dorsal spine. The patient underwent a posterior midline approach and excision of the tumor. Possible diagnoses included ependymoma, astrocytoma, or tuberculosis of the spine. The surgery aimed to prevent further neurological dysfunction and cure the condition through complete tumor resection.
Case Review #24: 67 year old female with Degenerative ScoliosisRobert Pashman
67 year old female presented with DeNovo Scoliosis, with significant rotation due to Adolescent Idiopathic Scoliosis. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. KIM/SRP Classification 2.
1. A 43-year-old female patient fell down stairs 3.5 hours prior to arriving at the hospital. On examination, she had significant swelling and tenderness of the left ankle with limited range of motion due to pain.
2. X-rays showed a closed bimalleolar fracture of the left ankle. She was placed in a short leg cast and admitted to the ward for pain control and waiting for surgery to undergo an open reduction and internal fixation.
3. Bimalleolar ankle fractures are unstable injuries involving fractures of two malleoli. Surgical treatment with open reduction and internal fixation is usually required for anatomical reduction and stabilization to allow early mobilization.
This document summarizes a case of Paget's disease of the spine in a 42-year-old man who presented with back pain after a slip and fall. Imaging revealed a compression fracture at L2. Paget's disease is characterized by disorganized bone remodeling leading to enlarged and deformed bones. Treatment involves bisphosphonates which suppress bone turnover. Potential risks of long-term bisphosphonate use include atypical femur fractures and malignant transformation of pagetic bone.
The document describes the case of a 47-year-old man presenting with progressive leg weakness over 2.5-3 years. His father had a similar progressive gait difficulty from age 40 until death at 70. Examination found spastic paraparesis, increased tone and reflexes in the legs. Imaging and tests ruled out common causes. The likely diagnosis is hereditary spastic paraparesis, supported by the positive family history. Genetic testing found a novel mutation in the SPG4 gene associated with this condition.
This document describes the arthroscopic Bankart repair procedure for a 26-year-old male patient with recurrent right shoulder instability. An MRI showed a Bankart lesion and Hill-Sachs lesion. During the arthroscopic procedure, the Bankart lesion extending from the 2 to 5 o'clock position on the glenoid was repaired. Post-operatively, the patient's arm was immobilized for 3 weeks followed by a rehabilitation program. Arthroscopic stabilization allows for a complete inspection of the joint and treatment of all intra-articular lesions while preserving range of motion.
This document summarizes an interdisciplinary case discussion night involving physical medicine and rehabilitation (PM&R), physical therapy (PT), and musculoskeletal radiology (MSK Radiology). The case involves a 55-year-old female presenting with lower extremity pain. Students were split into small groups with preceptors from each discipline to discuss the patient's history, physical exam findings, differentials, assessments, and treatment plans. Imaging options and how different specialties could help guide treatment were also reviewed. The goal was to foster interdisciplinary education for an integrated approach to patient care.
The document provides medical details about a 75-year-old male patient who experienced a right hemiparesis due to an ischemic stroke. Key details include:
- The patient presented with inability to lift his right arm and leg and difficulty walking independently.
- Investigations revealed multiple acute infarcts in the left frontal and parietal regions as well as old lacunar infarcts and atherosclerotic changes.
- The patient is undergoing physiotherapy to improve strength, balance and gait. Functional assessments show improvement in motor control but ongoing difficulty with activities like dressing and walking without assistance.
Lecture posterior fusion for ossification of the posterior longitudinal liga...Spiro Antoniades
An 86-year-old woman presented with progressive right arm weakness over 10 days. Imaging showed ossification of the posterior longitudinal ligament (OPLL) at multiple cervical levels from C2 to C5. OPLL most commonly occurs in the 5th to 6th decade of life and is more prevalent in males and Caucasians. Risk factors for progression include more than 60% canal stenosis, a spinal canal diameter of 6mm or less, increased range of motion of the cervical spine, and laterally positioned OPLL. Surgical treatment risks include a high rate of dural tears with an anterior approach if the "double layer sign" is present.
Presented an in-service on the pathophysiology and differential diagnosis of cauda equina syndrome to Arcadia University's 2nd year Doctor of Physical Therapy students.
This document contains 18 multiple choice questions related to orthopaedic surgery. Each question is followed by the preferred response and recommended reading materials. The questions cover topics such as compression of the median nerve at the elbow, congenital muscular torticollis exercises, preventing failure after fixation of an intertrochanteric fracture, osteoblast function, treatment for hip arthroplasty instability, and contraindications for hyperbaric oxygen therapy.
Elderly male with Flaccid paraparesis diagnosed as Cauda Equina Syndrome due ...Dr. Md. Rashedul Islam
A 66-year-old diabetic man presented with progressive difficulty walking and low back pain radiating to his left leg over 1 month. Examination found wasting and weakness in his lower limbs, absent reflexes, and reduced sensation. Imaging showed a fractured L5 vertebra and lytic lesions. Biopsies indicated multiple myeloma, causing cauda equina syndrome through vertebral collapse. He was diagnosed with multiple myeloma and diabetes, treated with steroids, physiotherapy and hematology referral.
Case Review: 42 year old woman with Grade 3 Isthmic SpondylolisthesisRobert Pashman
A 42 year old very athletic woman presented with Grade 3 Isthmic Spondylolisthesis. She had a long history of back pain. Dr. Pashman performed an anterior and posterior spinal fusion.
This case report describes the conservative treatment of a 40-year-old female patient presenting with a left ipsilateral sciatic scoliosis using McKenzie method physical therapy techniques over 17 sessions in 3 months. The patient's lateral shift deformity and lower extremity pain resolved, muscle weakness improved, and disability levels decreased substantially. Corrective side glide mobilizations and self-techniques were effective at reducing the disc protrusion and decompressing the nerve root, resolving the patient's symptoms and abnormal posture.
This document discusses claw hand deformity. It begins by defining claw hand as flattening of the transverse metacarpal arch and hyperextension of the MCP joints with flexion of the PIP and DIP joints. It then discusses normal hand anatomy and the pathoanatomy that leads to clawing. Paralysis of the intrinsic hand muscles results in unopposed extension of the MCP joints and flexion of the IP joints, causing the claw deformity. The document covers evaluation, classification, indications for surgery, principles of tendon transfers to correct clawing, and use of splints. The goal of surgery is to restore independence of movement to the MP and IP joints and correct the longitudinal axial deformity.
Case Review #27: 59 Year Old Female with Progressive Adult ScoliosisRobert Pashman
59 year old female presented with Progressive Adult Idiopathic Scoliosis, Spondylolisthesis, Flatback Deformity, and Stenosis. The patient was treated with a spinal fusion,
- The document discusses the initial management of spinal cord injuries, including stabilization of the spine, maintaining adequate blood pressure and circulation, and preventing complications like hypotension, aspiration, and shock.
- Early management also involves immobilizing the spine, assessing neurological function, and evaluating spinal stability before more definitive treatment.
- Maintaining mean arterial blood pressure at or above 85-90 mm Hg for the first week after injury is recommended to improve spinal cord perfusion.
Similar to Lecture cervical stenosis neuromonitoring 2017 (20)
This document summarizes a case of a 70-year-old man presenting with left sciatica for 10 weeks. Physical therapy did not provide relief for his pain, which was located in his left hip, buttock, posterior lateral leg, and lateral ankle. He has a significant past medical history including diabetes, heart conditions, and end-stage renal disease requiring dialysis. Imaging showed an L5-S1 disc herniation. Treatment options including further non-operative management with medications and therapies or surgical discectomy were discussed.
A 61-year-old man presented with left lower back pain and left leg weakness and numbness, unable to walk. He has a history of lumbar and cervical spine surgeries. MRI showed stenosis at C3-C4 and L2-L3 as well as a disc herniation at T10-T11. The discussion focused on the rare occurrence of thoracic disc herniations and surgical approaches for addressing the T10-T11 herniation.
This document discusses cement augmentation techniques for osteoporotic fractures, specifically vertebroplasty and kyphoplasty. It provides background on the development of these procedures, including early studies in the 1980s and 1990s introducing percutaneous vertebroplasty. It also discusses a 2009 randomized controlled trial that found no difference in pain relief between vertebroplasty and sham surgery for osteoporotic fractures. However, a 2021 meta-analysis found vertebroplasty provided improved pain relief over nonsurgical treatments in the short, medium, and long term with no greater risk of adjacent fractures. Complications are mentioned but not described in detail.
Lecture metastatic breast carcinoma to the spine (final version)Spiro Antoniades
This document discusses a case of metastatic breast cancer to the thoracic spine in a 74-year-old woman. She presented with mid-thoracic back pain and was later found to have a 5.5 cm breast mass, confirmed to be stage 4 breast cancer with metastases to the spine, ribs, and femur. The document provides historical background on cancer terminology and discusses treatment options and outcomes for spinal metastases, including surgery versus radiation. Prognostic scoring systems like Tokuhashi are mentioned. Overall, the summary discusses evaluation and management of a patient presenting with spinal metastases from breast cancer.
This document summarizes a spine conference presentation on acute low back pain with a normal x-ray. It discusses the evaluation and differential diagnosis of back pain, including red flags indicating more serious underlying causes. Non-spine related causes like pregnancy, UTI, and abdominal issues are reviewed. Imaging findings, treatments including medications and injections, and psychosocial factors are also summarized. Case examples of different back pain presentations are provided.
A 61-year-old man presented with neck pain following an injury. He had a 6-month history of leg weakness. Imaging showed ossification along the thoracic spine consistent with diffuse idiopathic skeletal hyperostosis (DISH). DISH is characterized by flowing ossification along the vertebral borders and preservation of disc height. Risk factors include metabolic syndrome, diabetes, and advanced age. Symptoms may include pain, stiffness, and dysphagia from cervical spine involvement. Treatment is typically conservative with NSAIDs and physical therapy.
Spine Conference: Cervicothoracic stenosis in a patient with DISHSpiro Antoniades
A 61-year-old man presented with neck pain following an injury at work. He has a history of intermittent leg weakness. Imaging showed changes consistent with diffuse idiopathic skeletal hyperostosis (DISH), including flowing ossification along the anterior vertebral bodies from T7-T11. DISH is a metabolic bone disease characterized by ectopic ossification of the anterior longitudinal ligament and vertebral bodies. It can cause neck and back pain as well as dysphagia or breathing difficulties from bone formation. Treatment focuses on pain management and physical therapy.
1. A 41-year-old woman presented with neck and left arm pain after a motor vehicle accident where her car struck a wall head-on.
2. CT scan revealed a nondisplaced C6-C7 facet fracture with a small disc herniation.
3. Due to her pain levels and inability to sit up, surgery was recommended to reduce the facet fracture and address the disc herniation. Intraoperative confirmation of the injury level would be required.
This document discusses a 42-year-old man presenting with back pain who was diagnosed with a fracture of the L2 vertebra after a slip and fall accident. Imaging revealed features consistent with Paget's disease involving the L2-L3 vertebrae. The document then provides background information on Paget's disease, including its epidemiology, typical radiographic and histologic findings, differential diagnosis, evaluation and treatment with bisphosphonates. Risks of long-term bisphosphonate therapy discussed include atypical femur fractures and potential malignant transformation of Paget's lesions.
A 59-year old woman experienced recurrent left sciatica 6 years after initially experiencing left sciatica in 2012, and again 9 years later. She attended a spine conference to discuss her ongoing left sciatica issues over the past years.
This document discusses the medical history and treatment of a 61-year-old man for cervical spondylosis over several years. It details his initial presentation in 2015 with neck pain and neurological symptoms. Imaging showed cervical spine issues including spondylosis and alignment problems. He underwent an anterior cervical discectomy and fusion in 2015. Four years later he experienced new right upper extremity symptoms after an injury. Further imaging and treatment options are discussed, including additional surgery in 2019. At follow-ups he was noted to have good results initially but later developed left neck pain, raising concerns about possible nonunion or infection. The document examines approaches to diagnosing nonunion and reviews risk factors and treatment options.
This document contains medical notes from multiple appointments for a patient with a history of cervical spondylosis and neck pain. It notes dates and results of imaging studies from 2011-2020 showing degenerative changes at multiple cervical levels. The patient is a 66 year old male with additional medical problems including cardiac issues and diabetes. He experienced worsening right upper extremity symptoms after injuries in 2019 and 2020. His most recent notes from 2021 indicate continued neck pain but no further treatment recommendations.
This document discusses spondylolysis and spondylolisthesis. It describes a 16 year old soccer player presenting with low back pain who was treated nonsurgically. Radiographic measurements of spinal alignment in asymptomatic subjects are also presented, showing average sagittal alignment values from S1 to T9. Various imaging options and treatment approaches for spondylolysis are mentioned, including screw fixation techniques. Two case examples are briefly described, a 61 year old man who did well with decompression surgery, and a 30 year old presenting with low back and leg pain.
This document summarizes a patient's medical history involving multiple spine surgeries over several years to address low back and sciatica pain. It notes the patient's initial L5-S1 disc surgery in 1992 and recurrent issues in 2008, 2009, 2013, 2018, and 2020 when additional imaging and surgeries were performed. The most recent surgery in late 2020 addressed severe low back and bilateral sciatica pain and involved fusion from T12 to S1. At follow ups in November 2020 and December 2020, the patient was reported to be doing well. However, in February 2021, the patient reported a new complaint of a painless noise coming from their lower back with motion.
Spine Conference: cauda equina tandem stenosis jan 2021Spiro Antoniades
This document summarizes a spine conference case involving a 61-year-old woman with a neurogenic bladder, lower extremity weakness, and a history of spinal issues. She presented with worsening symptoms over the past month including falls, leg weakness, back and sciatic pain, incomplete bladder emptying, and leakage. Imaging showed severe stenosis from L2-L5 with spondylolisthesis and stenosis from C2-C3 with nonunions from previous surgeries. The conference discussed evaluating for cauda equina syndrome, quantifying nerve root strength, bladder scan findings, and surgery timing which impacts outcomes. Early surgery within 48 hours leads to better bladder function recovery versus later surgery.
This document discusses the use of bone morphogenetic protein (BMP) in spinal fusions. It provides background on BMP and details several complications that have been reported with its use, including soft tissue swelling, ectopic bone formation, osteolysis, and inadvertent fusions. It also references studies that found higher than reported complication rates associated with BMP and suggests the minimally effective dose has not been determined. Case studies are presented of patients who experienced issues like psoas calcification, seromas, and retrograde ejaculation following procedures using BMP.
A 54-year-old woman presented with neck pain radiating to her right shoulder, arm, and hand. Imaging showed cervical deformity from C2 to T1 with multiple levels of disc degeneration, stenosis, and prior fusions from C6 to C7 on the right and C7 facet fracture on the left. Her problems included right C8 radiculopathy, C4-C5 disc degeneration, previous C6-C7 fusion, right C7 pedicle fracture, left C7 facet fracture, small lateral mass size, history of smoking, and C7-T1 anterolisthesis with mild C3-C6 stenosis. She was being evaluated for surgical treatment of her cervical deform
This document discusses odontoid fractures and their treatment. It provides details on the anatomy of the odontoid process (C2 vertebra) and describes a case of a 69-year-old man who fell and suffered a C2 fracture. It then reviews literature on outcomes of operative versus non-operative treatment of odontoid fractures in older patients, finding that operative patients had longer hospital stays but lower mortality rates. Risk factors for non-union of odontoid fractures are discussed. The document also provides further anatomical details on ligaments surrounding the C1-C2 vertebrae.
This 64-year-old woman with a history of multiple lumbar fusions presented with low back pain and right hip pain. Imaging showed flat back deformity, sacral inclination of 21 degrees (normal 40), pelvic incidence of 28 degrees, and lumbar lordosis of 17 degrees (normal 35-50). She underwent a T12-L2 three-column osteotomy to restore sagittal balance, with estimated blood loss of 1.7 liters over a 9-hour procedure. Follow up imaging 6 years later showed progression of proximal junctional kyphosis above the fusion, with the kyphotic angle increasing from 2 to 7 degrees over that period. Proximal junctional failure is a known risk of multi
A 55-year-old woman presented with 6 weeks of right upper extremity pain radiating to her right shoulder and arm. She has cervical radiculopathy likely due to foraminal stenosis. Options for treatment include anterior cervical discectomy and fusion (ACDF) or artificial disc replacement (ADR) to relieve pressure on the nerve root and prevent adjacent segment degeneration. Long-term studies show that both procedures provide relief of symptoms, but ADR is associated with less dysphagia and slightly better preservation of motion compared to ACDF.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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For more information about PECB:
Website: https://pecb.com/
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Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
1. Intraoperative Neuromonitoring in a case of Cervical stenosis with posterior decompression
Upper Chesapeake Medical Center Spine conference
8/18/17
2. 63 year old man
cc: LBP
HPI: Sx for 14 years. Rx with PT, chiropractor, massage, epidural
steroid injections, .
In the last 2-3 months c/o difficulty walking, loss of balance,
numb/pain thumb, IF, MF and radial hands. “Legs do not work
right”. Feet burning.
PMH: L knee scope, HTN, chol
Meds: amlodipine besylate, losartan , K
SH: civil servant, married, grown children
Exam: ataxia, waddling gait, B foot slap, L ankle 3-4 beats of
unsustained clonus, R no clonus, negative Hoffmans, full painless
ROM neck, 5/5 motor U and LE, no sens.
MRI lumbar spine : mild DDD, stenosis L3L5
24. : poor signals RLE
ost flip no change, prone position
nutes after laminectomy B 90% loss of signals
eturned while closing
.6L, EBL: 200cc, U/O: 250cc, op time: 3h20min
25.
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35. RR: 0/5 R motor, normal face, L
• RR: 0/5 R motor upper and
lower, normal face, L 4/5
motor upper and lower
RR: 0/5 R motor, normal face, L 4/5 motor