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I wish. It was there before I started. MRI pendingDon’t worry Steve, it’s just Contrast that leaked out of the tubing and pooled up on the skin
I wish. It was there before I started. MRI pendingDon’t worry Steve, it’s just Contrast that leaked out of the tubing and pooled up on the skin
it does? little too inferior for that.looks like an avulsed greater trochanter fracture...
I agree that the GT doesn't looked quite right to me. I'm wondering if it's an osteochondroma originating from the GT that broke off.looks like an avulsed greater trochanter fracture...
How are your outcomes with these? What type of patient is your ideal candidate?Had to put in a triangle for insurance reasons. Ran out of room for the third screw so had to free hand it between the alar line and the initial screw.
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What about your SI fusions as a whole?I have only been using SI bone this year. So everyone has done fine post op, but generally too early to tell.
Does it seem to be a particular kit/approach? Posterior Painteq style kits seem like they would be more likely to pseudoarthroseOverall, they have done well. But have around 5 where the pain is coming back around 3 years and they aren’t fused on ct.
I know some insurances only approve SI Bone in particular, but given the choice, posterolateral seems much less invasive and less vascular than lateral. But I have no actual experience.Why do lateral when you can just do posterolateral?
This patient insurance required a triangular implant be used.Why do lateral when you can just do posterolateral?
she is fakin it. freeloaders
Hope aortic calcification prevents worsening kyphosis.
I was so impressed by that spine that I didnt even see the aorta. Didnt know the aorta could kink like that.....Hope aortic calcification prevents worsening kyphosis.
Hope aortic calcification prevents worsening kyphosis.
Doing a lot of procedures with no diagnosis.What yall think about this?
70ish tiny Caucasian woman with rip roaring shoulder, scapular and arm/hand neuropathic pain which began 2-3 days after ACDF done for severe contralateral arm radic. The right arm symptoms resolved completely with the surgery.
PMH/PSH: C6-7 ACDF 02/28/2024, L5-S1 TLIF + decompression 1/20/2021. Chronic tobacco abuse, anxiety, chronic low back and neck pain, endometriosis s/p repeated laparoscopies with LoA, hyperlipidemia, migraines, CVA, septoplasty, thyroid biopsy, oral surgery, C-section, extensive list of surgical interventions and procedures.
C6-7 ACDF 02/28/2024 - Awoke and within 2-3 days has severe left scapular pain, shoulder and left arm pain with poor ROM. Neuropathic pain in the hand behaving similarly to CRPS but without Budapest.
First visit: Left SSNB under US guidance. See her back in 2W. No benefit.
Stellate ganglion 04/23/2024 (procedure 0645 today, phone calls 1600 today). Talked her down from the ledge basically.
What’s the idea behind this pain? Positioning on the table? Brachial plex doesn’t make sense. CRPS weird timeline.
CESI if when I see her in 2W the stellate is deemed a failure.
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Any ideas?Doing a lot of procedures with no diagnosis.
Weakness? C5 palsy?Any ideas?
Take a bowI think her aorta has more calcium than her bones do
MRI? CT? EMG? Flexion/extension X-ray? What workup has been done so far? Dermatomal distribution in the arm? Abnormal reflexes? Has anybody checked the hardware to make sure it’s not displaced? Bit hard to tell much from the X-rays you posted.What yall think about this?
70ish tiny Caucasian woman with rip roaring shoulder, scapular and arm/hand neuropathic pain which began 2-3 days after ACDF done for severe contralateral arm radic. The right arm symptoms resolved completely with the surgery.
PMH/PSH: C6-7 ACDF 02/28/2024, L5-S1 TLIF + decompression 1/20/2021. Chronic tobacco abuse, anxiety, chronic low back and neck pain, endometriosis s/p repeated laparoscopies with LoA, hyperlipidemia, migraines, CVA, septoplasty, thyroid biopsy, oral surgery, C-section, extensive list of surgical interventions and procedures.
C6-7 ACDF 02/28/2024 - Awoke and within 2-3 days has severe left scapular pain, shoulder and left arm pain with poor ROM. Neuropathic pain in the hand behaving similarly to CRPS but without Budapest.
First visit: Left SSNB under US guidance. See her back in 2W. No benefit.
Stellate ganglion 04/23/2024 (procedure 0645 today, phone calls 1600 today). Talked her down from the ledge basically.
What’s the idea behind this pain? Positioning on the table? Brachial plex doesn’t make sense. CRPS weird timeline.
CESI if when I see her in 2W the stellate is deemed a failure.
View attachment 385831View attachment 385832View attachment 385833
C5 palsy should be first on the differential. need a post-op MRI to make sure there is no structural lesion. C5 palsy more common in big decompressions for myelopathy, but it can be seen in just a simple ACDF. they typically get better on their own.Weakness? C5 palsy?
He's involved, but just doesn't really know what to do given the weird timeline and her clinical presentation.I would definitely do MRI cervical. Surgeon seems surprisingly hands off for this early postop
I got a 80ish yo 30mm isthmic spondy who works in a warehouse moving boxes for his son in law.
Sounds like the surgeon dinged C7 during the surgery. CRPS wouldn’t show up this early but may later. I’d do a diagnostic and hopefully therapeutic C7 TFESI or lateral paramedian CESINormal CT 03/2024 - No hardware malpositioning or extruded bone graft.
Traction neuritis or C5 palsy seems reasonable, but she is miserably painful in the inferomedial and lateral border of the scapula, as well as the supralateral and supramedial border of the scapula, left neck and deltoid and upper thoracic paraspinals. She has no motor deficits though the exam is unreliable due to effort. No atrophy or changes in tone. We are 8 weeks out from surgery.
EMG seems like a great idea.
We could MRI the neck and plexus, but she doesn't look like a plexopathy to me. Just super sensitive to touch and constant pain.
My main Q is how fast do yall see CRPS after spine surgery? This began around 2-3 days post op.
inferomedial and lateral border of the scapula, as well as the supralateral and supramedial border of the scapula, left neck and deltoid and upper thoracic paraspinalsgiven location of symptoms and location of surgery, it seems like dorsal scapular nerve injury (C5) would be my guess.
not sure theres anything that can be done...
Never had one go down to the hand?inferomedial and lateral border of the scapula, as well as the supralateral and supramedial border of the scapula, left neck and deltoid and upper thoracic paraspinals
This sounds like every C7 I’ve ever seen. Only thing that corresponds to C5 is deltoid but everything else around the scapula and thoracic parasponals points to C7
Yeah that’s a classic textbook C7 but C7 often goes around the scapula and thoracic paraspinals as well, far more often than C5 for sureNever had one go down to the hand?
Dorsal scapular nerve (DSN) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back and costovertebral pain
Dorsal scapular nerve neuropathy: a narrative review of the literature
The purpose of this paper is to elucidate this little known cause of upper back pain through a narrative review of the literature and to discuss the possible role of the dorsal scapular nerve (DSN) in the etiopathology of other similar diagnoses in this ...www.ncbi.nlm.nih.gov
Traction is my best guess. The velocity of this is insane, which makes me question everything.I agree that’s a good one to keep in the differential but far less common than a C7 radic. But maybe some traction neuropathy occurred during surgery. Who knows
Yeah need to work on your transdiscal approach Spinejack preceded by BVNA cryoablationView attachment 385987View attachment 385988View attachment 385989
T12 looked like I was filling into the T11-12 disc and waited 3 minutes before putting in more cement. I am adequate. Not ready for linkedin.
I bet you don’t even have pointy shoesView attachment 385987View attachment 385988View attachment 385989
T12 looked like I was filling into the T11-12 disc and waited 3 minutes before putting in more cement. I am adequate. Not ready for linkedin.
I bet you don’t even have pointy shoes
I bet you don’t even have pointy shoes
Impressive! Always surprised by what some are able to compensate for compared to our patients with nothing on imaging.