Concluded Case

Adjacent segment disease

42/m, progressive weakness in lt. ul, ll, with grip weakness, gait unsteadiness, paraesthesia..lmn signs in ul, umn signs in ll.. withholding some information now.. presenting MRI.. let's see if anybody can find that information

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Concluded answer
This is a case of what we call adjacent segment disease... This patient had undergone discectomy in 2005. Was on regular follow up and normal until a few months ago. The fresh scan revealed new findings of proposed disc above the previous level. This is due to relative immobility of operated area transferring excess mobility a level above and below called Adjacent segment disease. it is much more common after operative fixation and hence I never prefer to do fixation.. this patient still developed it, although after a long time and the reason was trauma. However in patient with fixation, this occurs without any trauma.
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Many of the neurological diseases can be diagnosed clinically This patient had lower motor neuron type of muscle weakness in upper limb This indicates that probably there is never root compression in cervical spine which is causing lower motor neuron type of lesion Now one more additional finding is that there is progressive weakness in lower limb which is of upper motor neuron type This indicates that there is pathological compression in cervical spinal cord which is causing upper motor neuron type of weakness in lower limb This clinical picture is confirmed by MRI finding There is significant disc prolapse at C4 - C5 level which is causing compression of spinal cord and producing typical clinical picture as described In addition there is mild disc prolapse at C2- C3 and C3 - C4 level Disc at C5-C6 LEVEL appears to be removed by surgery in past, perhaps it was also causing compression of spinal cord This again explains cervical disc prolapse can cause severe myelopathy
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Narrowing of cord with compression as there are indentation at c3c4 c4c5
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Spinal cord compression C345 decompressive surgery advised
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Spinal cord compression , I agree with Dr.Pushkar Bhomia
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Canal stenosis at C4-5 ,c2-3. Post op case
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Dx: Spinal cord compression c3 c4 c4 c5
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Spinal cord compression C3C4 C4C5
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Spinal Cord Compression
This is a case of what we call adjacent segment disease... This patient had undergone discectomy in 2005. Was on regular follow up and normal until a few months ago. The fresh scan revealed new findings of proposed disc above the previous level. This is due to relative immobility of operated area transferring excess mobility a level above and below called Adjacent segment disease. it is much more common after operative fixation and hence I never prefer to do fixation.. this patient still developed it, although after a long time and the reason was trauma. However in patient with fixation, this occurs without any trauma.
C5 c6 vertebral body destruction with loss of disc space..... To rule out metastasis and tuberculosis .. c4 to c7 disc involved which explains the c5 nerve root to c7 nerve root involvement (1level above)... Lmn type of weakness Cord changes seen in D3 Below probably suggestive of tuberculosis Ask for lumbar and thoracic Mri cuts Look for thoracic and lumbar spine for similar lesions causing myelopathy.... Have to know plantar response, supinator reflex, and in history bowel and bladder involvement
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