SURGICAL CASE DISCUSSIONS IN SPINE.pptx

Discussion of surgical cases

1. CASE 1 HIRA MOTI 50 Y / F

2. HISTORY GAIT INSTABILITY SINCE 2 YEARS NUMBNESS AND PARAESTHESIA B/L LOWER AND UPPER LIMB SINCE 2 YEARS INSIDUOUS ONSET ,GRADUAL PROGRESSION

3. EXAMINATION Right Left ELBOW FLEXION 5 5 WRIST EXTENSION 5 5 ELBOW EXTENSION 5 4 FINGER FLEXION 5 4 FINGER ABDUCTION 5 5

4. EXAMINATION Right Left Hip Flexion 5 5 Knee extension 5 5 Ankle Dorsiflexion 5 4 Toe extension 5 4 Ankle Plantar flexion 5 5

5. SENSORY : REDUCED BELOW C3

6. EXAMINATION REFLEXES Right Left BICEPS +++ +++ TRICEPS +++ +++ BRACHIORADIALIS ++ ++ KNEE +++ +++ ANKLE ++ ++ PLANTAR : BILATERAL EXTENSOR

7. TANDEM WALKING : POSITIVE RHOMBERG’S TEST : POSITIVE HOFFMANN’S : B/L POSITIVE

8. X- RAY

9. MRI

10. FLEXION MRI

11. EXTENSION MRI

12. DYNAMIC ATLANTOAXIAL INSTABILITY FLEXION : AADI :10 MM PADI : 12MM EXTENSION : AADI : 4 MM PADI: 20 MM

13. NCCT

14. BASILAR INVAGINATION McRae line : odontoid tip passing above McGregor line : odontoid tip 11 mm above

15. BIMASTOID LINE

16. WACKENHEIM’S CLIVUS CANAL LINE

17. ATLANTO-OCCIPITAL ASSIMILATION

18. HIGH RIDING VERTEBRAL ARTERY

19. DIAGNOSIS ATLANTOAXIAL INSTABILITY WITH BASILAR INVAGINATION WITH ATLANTO-OCCIPITAL ASSIMILATION WITH LEFT HIGH RIDING VERTEBRAL ARTERY WITH HIGH CERVICAL MYELOPATHY

20. PLAN OCCIPUT –C3-C4 FIXATION

21. POST –OP XAY

22. CASE 2 ADITI 19Y /F

23. HISTORY H/O RTA ON 21/12/2023 ( 2 WHEELER HIT BY 4 WHEELER ) PATIENT SUSTAINED INJURY TO LEFT ANKLE AND BACK C/O SUDDEN ONSET ,SEVERE BACK PAIN INABILITY TO SIT AND STAND INABILITY TO PASS URINE AND STOOL

24. EXAMINATION

25. NEUROLOGICAL EXAMINATION Right Left Hip Flexion 5 5 Knee extension 5 5 Ankle Dorsiflexion 5 COULD NOT BE ASSESED Toe extension 5 5 Ankle Plantar flexion 5 COULD NOT BE ASSESED

26. Plantars – FLEXOR PAS – PRESENT VAC – ABSENT

27. XRAY

28. MRI

29. CT SCAN

30. DIAGNOSIS ROY- CAMILLE TYPE 2 SACRAL FRACTURE DENIS ZONE II ISLER TYPE I U TYPE SPINOPELVIC DISSOCIATION

31. PLAN REDUCTION OF SACRAL FRACTURE WITH 1/3 TUBULAR PLATE AND LUMBOPELVIC FIXATION

32. POST OP XRAY