ASSIGNMENT 3:

THE SPINE

1. A 65 year old female patient presents to your orthopaedic clinic. She has an unsteady gait, complains
of neckpain and loss of power & dexterity in her hands. On examination she has increased tone in her
muscles, increased tendon reflexes and positive Hofmans reflex. (Chapter 114)

a. What is her diagnosis?

-C-SPINAL STENOSIS: Cervical myelopathy

b. Which imaging modality would best visualise soft tissue structures in the spine and confirm the
diagnosis in this case?
-MRI

c. What is the primary aim of surgery in this case?

-Decompress, fuse and correct deformity(halt progression of disease)

2. A 29 year old HIV positive male patient presents to the outpatient department. He is cachectic and
complains of a gradual, complete loss of power in his lower limbs. On further questioning he has
constitutional symptoms. He has a gibbus in his spine at the T9/10 level. (Appley’s page 472)

a. What is his most likely diagnosis?

TB spine

b. What is the mainstay of treatment for eradication of the disease?

- RHZE – TB regimen

c. How would you confirm the diagnosis?

-Cross needle Biopsy and ESR

3. A 48 year old male presents to your casualty complaining of excruciating back and right legpain. The
pain radiates to the dorsum of the foot, into the first webspace. The pain had an acute onset after
twisting and bending to lift a moderate weight from the floor.

a. Which nerve root is most likely involved?

L5
b. Which disc is most likely involved?
L4 – L5 IV disk

c. What is the mainstay of treatment?

CONSERVATIVE MANAGEMENT: analgesia, physiotherapy, lifestyle modification

d. Which symptoms and syndrome would require the patient to be referred for urgent
decompressive surgery?
Equina syndrome: loss of bladder or bowel control, sexual dysfunction, saddle anaesthesia,
severe progressive weakness