A 65-Year-Old Man With Rapidly Progressive Quadriparesis
History & Exam
Your answers will be added to those already obtained and tabulated at the end of the month.
The imaging in this case is suggestive of an an epidural abscess with a significant solid phlegmon component spanning from C5/6 to C7/T1. It superimposed on a C5/6 herniated disc leading to mass effect on the cord which displays T2 signal.
Question 1: The correct answer is delays time to fusion. Perioperative steroids do significantly delay time to fusion due to anti-inflammatory mechanisms. Steroids do not reduce the risk of infection. Steroids increases risk of perioperative hyperglycemia but improves dysphagia symptoms.
Question 2: The correct answer is diabetes. Spinal epidural abscesses treated with medical management alone has a high risk for failure if the patient is diabetic. Other risk factors include age > 65, methicillin resistant staphyloncus aureus infection, or neurologic compromise. Sex and serum leukocyte count are not predictive of nonoperative treatment failure.
Question 3: The correct answer is 2.7%. The incidence of abnormal vertebral artery location was found to be 2.7% in cadaveric studies.
Question 7: The correct answer is cervical kyphosis. Relative indications for circumferential approach to decompress and stabilize the cervical spine include cervical kyphosis due to biomechanical loads. Other indications include but are not limited multi-level anterior corpectomy, poor bone quality, metabolic disorders, and poor nutritional state. Predominantly posterior compression supports posterior surgery. Single level corpectomies may not require posterior stabilization. Advanced age is not an indication for circumferential surgery.
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