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OA block pt.2
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Nope.
C1-4 congenital block vertebrae with marked DDD.
New patient. Axial neck pain, slow onset, possibly fall from horseback as a kid. No radiating arm pain or neuro deficit. Noticing some difficulty swallowing and "if I put on finger just here on my throat, it's hard to breath."View attachment 198871
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70m 3 weeks moderate back and right L4 distribution parasthesias with "foot slap" after shoveling snow. Tib ant 2/5. Knee extension/quad weak at 4/5 manually, but unable to rise from single leg squat. Bowel/bladder fine. Biggest disc I've seen with cephalad/caudal migration. Lami/microdisc following day after expedited surgery consult...
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whats the rush? damage already done. central canal huge, no cauda equina. his foot will keep slapping. outcome (strength)would be the same with or with surgery.
if the foot slapping gets worse, then yes, surgery. but it wont
if this was pain-free, id just do PT
if there was pain, right L4 TFESI.
dont let the size of the disc scare you.
Thank you for input. I admit the size of disc played a role, but really the degree of weakness pushed me to surgery consult ASAP. What patient called foot slap I called frank foot drop with inability to clear/dorsiflex on gait and less than anti-gravity Tib ant. You sit on that if its your back? I have a hard time sitting on anything less then 3/5 motor.
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Overdevest et al found two risk factors for poor motor recovery after radic due to disc herniation were 1) severe weakness (authors deemed 3/5 "severe") and 2) size of herniation that took up 25% or more of canal. I'd send that person to spine surgeon to at least allow patient to have the option of surgery.
If you breach medial pedicle on the kypho you will have a lead revision case in a few weeks. Prolia yet?
can i ask - do you guys get "approval" from patients before posting? i obviously do not see identifying markers, so it appears HIPAA compliant, but all the same....
86 y.o. with axial LBP.
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Some of sort of seronegative spondyloarthropathy, maybe psoriatic in nature?
nope. he's just old. maybe DISH
I have like this technique for piriformis injections and thought I would post pictures:
http://www.painphysicianjournal.com/current/pdf?article=OTk0&journal=43
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From my office to the ER then OR today......
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Looks like a fingerprint smudge obscuring the left hemicanal on axial. Guess it's no artifact.
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Do I go CESI or MBB first?
Def need to aspirate thatNeither. Cervical SCS obviously with an occipital nerve stim. Follow up with stem cells, ketamine infusion and decompression table with your in house chiropractor. After that, they'll be good as new.
Right arm weakness. No leg symptoms. No breathing problems.
Neck flexor weakness?
U
Undescended testes?