These cases are to get you to start thinking and questioning your knowledge around the topic of spine for everyone. The full cases, case takeaway videos, recoding of the webinar and RCS CPD certificate (2hours) can be found here.
We are joined for this webinar by:
Let's get straight into it
Background:
54-year-old hairdresser.
Previous left L45 microdiscectomy age 31 for unilateral sciatica.
Hx of VTE – post-partum DVT 10 yrs ago and PE 5 years ago - on lifelong warfarin.
Hx of depression and anxiety. Normal BMI
Presenting Complaint:
Calls an ambulance at 02:05am on a Sunday morning suffering with severe back and bilateral buttock pain, inability to open bowels for 1 week, difficulty passing urine for 48 hours and one episode of urinary incontinence at midnight.
Assessment by ED doctor:
Neurological findings:
PR exam
Loading ...Rightly or wrongly, the ED doctor carries out a bladder scan. This shows 440mls of urine. She doesn’t feel she has a full bladder but she’s in a lot of pain, which makes it hard to assess.
Loading ...Morning comes. She got admitted overnight and she’s seen on the post-take wardround.
She is much more comfortable with the analgesia
Loading ...In this case an MRI scan was booked, which demonstrated a large central disc occupying the spinal canal. Repeat PR exam still shows sensation to be intact and she has some voluntary squeeze also.
Loading ...42 yearr old male with a longstanding history of low back pain, on and off. Recently it has been more persistent and he now has buttock pain.
His symptoms are worst in morning and after sitting. Positive tension signs in both legs affecting L5.
His GP kindly arranged a scan
A diagnosis is made from the CT
Loading ... Loading ... Loading ... Loading ... Loading ...17 year-old male cyclist struck by car. Complaining of neck pain and inability to move upper and lower limbs. Imaging obtained is shown below
On examination he is GCS 15, the airway is patent and cervical spine immobilised. He is ventilating well. RR 20, normotensive and haemodynamically stable.
He has a flicker of movement deltoid and biceps, but no lower limb motor function. A sensory level at C5. Priapism
Decreased anal tone with present but altered perianal sensibility
Loading ... Loading ... Loading ... Loading ... Loading ... Loading ... Loading ...45 year old lady with a chronic history of neck and upper back pain
PMHx: Anxiety / depression – stressed at work. Poor body image because of acne
On examination there is loss of cervical lordosis. Tight paravertebral muscles. A few areas of tenderness C5/6
Loading ... Loading ... Loading ...She had osteopathy, physio, Pilates and Chiro – no improvement
Steroid injection - gave some mild, temporary relief
She remains unhappy and struggling at work
Loading ...Please post your thoughts about these cases in the comments section below.
The full cases, case takeaway videos, recoding of the webinar and RCS CPD certificate (2hours) can be found here
Interesting case studies, thank you
Nice cases to discuss with expertsw expects !
very nice cocktail of cases which reflect real life practice - Thank you
Thank you for this nice and informative case and webinar
You are welcome. Glad it helped. Mike B
Fantastic cases thanks
Thanks for the positive feedback. The cases are great and really help consolidate the messages from these sessions.
Mike