|
Year |
2003 |
|---|---|
|
Question Number |
169. |
|
Category |
Spine |
Question
A 37-year-old man has neck pain and stiffness following a motor vehicle accident 1 week ago. Examination reveals decreased active range of motion in all planes of the cervical spine, weakness of grip strength, and a bilateral Hoffmann’s sign. A lateral radiograph os shown in Figure 58. Further evaluation should include
1- electromyography and nerve conduction velocity studies of the upper extremity
2- MRI of the lumbar spine
3- MRI of the cervical spine
4- Flexion-extension radiographs
5- A bone scan
Figures
Answer (click for answer)
Answer 3
For patients with motor deficits after trauma, MRI is the diagnostic imaging study of choice, it is preferred over EMG for acute injury. The patient’s symptoms are localized to the c-spine, and this is where the studies should be centered. Changes in signal intensity within the cord can be demonstrated on MRI. These changes cannot be seen on plain radiographs, so flexion-extension x-rays would not be helpful.
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MacDonald RL, Fehlings MG, Tator CH, et al: Multilevel anterior
cervical corpectomy and fibular allograft fusion for cervical
myelopathy. J Neurosurg 1997;86:990-997.
Truumees E, Herkowitz HN: Cervical spondylotic myelopathy and
radiculopathy. Instr Course Lect 2000;49:339-360.