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Case Studies

Case 1

50 years old gentleman, without any known medical illness was admitted with complaints of acute onset abnormal movements of left upper limb since 3 days prior to admission. No history of headache, vomiting, confusional state, motor weakness, gait disturbances etc. Clinical examination revealed stable vitals. BP – 120/70 mm Hg, well oriented with normal speech and cranial nerve functions. Motor system examination revealed normal power with prominent Choreoathetotic movements, predominantly involving left upper limb. His cranial imaging including MRI brain was all normal. His random serum blood glucose level examination was quite high (540 mg/dl) but urine ketone came out to be negative.

He was treated with IV fluids, Insulin, oral haloperidol, Clonezepam etc. He had rapid symptomatic improvement with correction of blood glucose and Choreoathetotic movement subsided completely within 2-3 days of hospital stay.

Case 2

A 36 year old male presented with persistent neck pain following a road traffic accident. A month later he started developing stiffness of all 4 limbs. The x-ray of the cervical spine was reported as normal. The MRI scan showed a C7-T1 total dislocation with pressure on the cord from both anterior and posterior.

He was operated in a single stage anesthesia. Under skull traction, a posterior approach was first utilized to release the facets at C7-T1. The posterior elements of T1 were found to be floating and these were removed.

The patient was mobilized on the 8th postoperative day and was discharged without any fresh deficits. The patient is asymptomatic at one year follow up and the radiology is showing good fusion and proper implant position.

The patient was then turned supine and through a classical anterior cervical approach and a trans-clavicular trans-sternal extention, corpectomy of T1 was done along with discectomy of the adjacent levels. The gap was bridged by a tricorticate bone graft, and stabilization was performed using an anterior monocortical locking cervical plating system.

Case 3

The patient was once again turned prone and a posterior fusion and stabilization was done using Hartshill rectangle and wires. Thus the spinal cord was decompressed and a 3600 stabilisation was done.

A 36 year old male presented with persistent neck pain following a road traffic accident. A month later he started developing stiffness of all 4 limbs. The x-ray of the cervical spine was reported as normal. The MRI scan showed a C7-T1 total dislocation with pressure on the cord from both anterior and posterior.