45 y.o. female with 3 month history worsening Left shoulder pain - - PowerPoint PPT Presentation

▶
45 y o female with 3 month
SMART_READER_LITE
LIVE PREVIEW

45 y.o. female with 3 month history worsening Left shoulder pain - - PowerPoint PPT Presentation

Apr 22, 2023 238 likes •417 views

45 y.o. female with 3 month history worsening Left shoulder pain 9 years prior C5-7 ACDF with plating at another facility Had seen several other spine surgeons and hardware noted to be broken 4 years prior to current

slide-1
SLIDE 1
slide-2
SLIDE 2
  • 45 y.o. female with 3 month

history worsening Left “shoulder” pain

  • 9 years prior C5-7 ACDF

with plating at another facility

  • Had seen several other spine

surgeons and hardware noted to be broken 4 years prior to current presentation

  • Shoulder evaluation was

negative

slide-3
SLIDE 3
  • CT & MRI were
  • btained
  • Previous EMG negative
  • Left C7 SNRB with

temporary results

  • Consider surgical repair

for symptomatic non- union

  • BMI 50
  • Non-smoker
slide-4
SLIDE 4
slide-5
SLIDE 5
slide-6
SLIDE 6
  • 75 y.o. male with 3 month

hx of left shoulder pain and weakness in LUE

  • Mylopathic with gait

disturbance, hyper reflexic, Hoffmans reflex

  • Motor deficit left Tricep,

Wrist Flexor and extensors

  • Otherwise healthy with

undiagnosed ankylosing spondylitis

slide-7
SLIDE 7
  • Admitted to Hospital

and placed in rigid Cervical collar

  • Diagnosis of Multiple

Myeloma

  • Consider :
  • Anterior
  • Posterior
  • Anterior & posterior
  • XRT only
slide-8
SLIDE 8
slide-9
SLIDE 9

Case Presentation: Multi-Level Fusions in the Cervicothoracic Junction

Colin B. Harris, MD Assistant Professor Department of Orthopaedics Rutgers – New Jersey Medical School Newark, NJ

slide-10
SLIDE 10

Case

  • CC: Neck pain
  • HPI: 49 y/o F transferred from

community hospital with progressive neck and upper back pain 4 months after a fall at home. Complains of both dull and sharp intermittent non-radiating pain 8/10 intensity, inability to hold head up.

  • PMHx: Morbid Obesity (BMI 49),

no history of malignancy

  • PHSx: None
  • PE: 5/5 strength bilateral UE/LE,

no focal sensory deficit, +Hoffman’s, 3 beats clonus B/L

slide-11
SLIDE 11

Treatment

  • Patient placed in

cervical tong traction for gradual kyphosis correction for 72 hours

  • Weight was added

in 5lb increments

  • Staged procedure

– C3-C7 ACCF – C3-T3 posterior fusion with inst.

slide-12
SLIDE 12

Treatment

  • Pathology:

– Primary breast CA – ER/PR+ – HER2+

  • Received radiation 4

weeks postop

  • Ambulatory with

preserved motor/sensory function

  • Neck pain 2/10
  • No assistive device
slide-13
SLIDE 13

CT Junction

Andrew K. Simpson, MD

slide-14
SLIDE 14

Patient

  • 60 F smoker otherwise healthy

– 6 months progressive myelopathy – Predominance of upper extremity manifestations – Diffuse UE paresthesias – Motor weakness C6-T1 distributions 3/5 - 4/5 – Superimposed C6 radiculopathy – Moderate axial neck pain, secondary complaint

slide-15
SLIDE 15

Pre

slide-16
SLIDE 16

Post

slide-17
SLIDE 17

Final