degenerative spine disease
TRANSCRIPT
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CPC 1:
Degenerative Spine Disease
GRAND MENTOR : DATO’ DR HAJI
ZAMYN ZUKI BIN TAN SRI DATO’HAJI MOHD
ZUKI
MENTOR : MR. LIM SZE WEI
PREPARED BY : DR. NEERMALADEVI PARAMASIVAM
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Figure 1: Photo ith !" !entor Mr #i! S$e %ei
CONTENTS
N0 TITLE PAGE
1 ACKNOWLEDGEMENT 1
2 INTRODUCTION
3 CASE STUDYCLINICAL HISTORY E!AMINATION
INVESTIGATIONS
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MANAGEMENT
PROGRESS
" DISCUSSION
# CONCLUSION
$ RE%ERENCES
AC&NO%#EDGEMENT
%&'() *+ ,-- I /*- -& )* ), )4&( *55*')6&)7 )* 85'(( 97 ',)&) ,6
(&6;' )4,6( )* 97 ',6 96)*' D,)*’ D'. H,<& Z,976 Z& +*' =&6 , /*6'+-
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)4 *')4*5,&; 4*(9,6(4&5 )',&6&6.
'NTROD(CT'ON
S5&6,- ()6*(&( &( , ;*6&)&*6 ;4,',;)'&? =7 , 5'*'((&> 6,''*/&6 *+ )4
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6'>( ,' =&6 ;*95'((S5&6,- ()6*(&( &( *+)6 '(-)( +'*9 ,&6 =) &) ;,6 ,-(*
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= , ;*66&),- &(*''. W&)4 ;*66&),- (5&6,- ()6*(&( )4 5,)&6) &( =*'6 /&)4 ,
6,''*/ (5&6,- ;,6,- )* ,=6*'9,--7 +*'9 5,')( *+ )4 (5&6. T4&( ;*6&)&*6 &(
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(795)*9( &6 )4 ;,->(. C*66&),- (5&6,- )6( )* /*'(6 5'*'((&>-7 /&)4 ,.
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*;;5,)&*6 *' ,67 5,')&;-,' =*7 )75.
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&9,&6 &596) (;4 ,( MRI( !',7( *' CT (;,6(. %*' )4*( (++'&6 +'*9
;*66&),- (5&6,- ()6*(&( (''7 ;,6 *++' '-&+. A ;*95'((&> -,9&6;)*97 ,6
*5',)&*6 )4,) /&6( )4 (5&6,- ;,6,- &( 9*() +'6)-7 ( )* )',) ;*66&),-
(5&6,- ()6*(&(.
CASE ST(DY
CHIE% COMPLAINT :
T4 (=<;) *+ 97 ()7 &( , # 7,'( *- I6&,6 /*9,6 /&)4 ;* 9*'=&( *+
7(-&5&9&, 475')6(&*6 (;4&?*54'6&, (&6; 2001 ,6 4&()*'7 *+ 6*9)'&,- /&)4
47()';)*97 *6 +*--*/ =7 ',&*)4',57. S4 5'(6) )* ED HSB *6 @10@1#/&)4 ;*95-,&6)( *+ 6',-&( /,6(( *>' 55' ,6 -*/' -&9=( (&6; 2 /(
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5'&*' )* ,9&((&*6. B(&( (4 6,=- )* 5,(( '&6 +*' 3 ,7( ,6 6,=- )* 5,((
9*)&*6 +*' 1 / 5'&*' )* ,9&((&*6.
HISTORY O% PRESENTING ILLNESS :
S4 (),') )* 4,> 6',-&( /,6(( *>' 55' ,6 -*/' -&9=( (&6; 2
/( ,* /4&;4 55' -&9=( /' 9*' (>' ;*95,' )* -*/' -&9=(.
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5'&*' )* ,9&((&*6.
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)',9, ,7 11F S4 ;-,&9 +-&6 *+ &&6(( ,6 6( ,> /,7 )*
/,6(( (=(6)-7 +-- =,;/,'( 4' *6 =))*;(. A+)' )4 +,-- (4 /,(
6,=- )* ,9=-,) =) ()&-- ,=- )* &; )4 /,-- )&-- 6&4=*' 4,'( 4' ,6 ;,9
*>' /&)4&6 )/* 4*'(. O)4'/&( )4' /,( 6* -*(( *+ ;*6(;&*(6(( 6* ;'>&;,-
5,&6 6* >*9&)&6 *+ ENT =-(. S4 /,( )46 ='*4) )* H*(5&),- T- I6),6 >&,
,9=-,6;. T4 6',-&( =*7 /,6(( (),') (&6; +/ 4*'( ,+)' +,-- 55'
-&9=( ,' 9*' (>' )4,6 -*/' -&9=(. T4 /,6(( /' ,((*;&,) /&)4 =&-,)',-
55' -&9= ,6 -*/' -&9= 69=6(( +'*9 )4 ->- *+ 55' ,=*96. A) )4,) 5*&6)
(4 ()&-- ,=- )* 5,(( '&6 ,6 9*)&*6.
S=(6)-7 (4 /,( ,9&)) +*' 11 ,7( &6 H*(5&),- T- &6),6 ;-,&9( )4,)
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,9&((&*6 )* H*(5&),- T- I6),6. T4' /,( , ';6) ,9&((&*6 &6 H*(5 T-
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C*95) T*9*',547 *+ =',&6 /,( *6 *6 2@@1# )* '- *) ,67 =',&6()9
&6<'7 ,6 '(-) ,( 6*'9,- /&)4 6* &6)',;',6&,- 4,9*''4,. S4 /,( '>&/ =7
5(7;4&,)'7 &6 >&/ *+ ((5;)&6 )4 ,6)&5(7;4*)&; 9&;,)&*6 ;,(&6 4' 67(),9(
5'&*' )* +,-- =) ;-,&9 6-&-7 )4 ;,((. C'>&;,-)4*',;* ! ',7 ,) H*(5&),- )-&6),6 (4*/ '* -+) 5&;- ,) T# ;4,6( /4&- ;'>&;,- ! ',7 4, &6,,)
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&(;4,' 4' /&)4 T,= G,=,56)&6 ,6 5-,66 +*' MRI ,( *)5,)&6).
U6+*')6,)-7 5'&*' )4 TCA *+ MRI (4 5'(6) )* )4&( H*(5&),- S B-*4 *6
@10@1# ,( (4 ;*- 6*) 5,(( '&6 +*' 2,7( ,6 6*) 5,(( 9*)&*6( +*' ,7( ,*. T4
(795)*9( ,((*;&,) /&)4 9&6&9,- ,=*9&6,- &(;*9+*'). ;-,&9( +-- ,,&6 )*
-*/' -&9=( /,6(( &6 +'*6) *+ )4 4*(5&),- /46 ;,9 *) +'*9 ),8&.
A--'&; 4&()*'7 :
N&-
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P,() 9&;,- 4&()*'7 :
1@ D7(-&5&9&, *6 T,= (&9>,(),)&6 209 ON2@ HPT *6 T,= A9-*&5&6 #9 OD ,6 T,= A)6*-*- 1009 OD
3@ S;4&?*54'6&, *6 T '&(5'&*6 (&6; 2001 6' HTI +*--*/ 5
P,() ('&;,- 4&()*'7 :
H&()*'7 *+ 6*9)'&,- ;,6;' /4&;4 &,6*( &6 200 ,) H*(5&),- I5*4.
H7()';)*97 /,( *6 +*--*/ =7 5*() *5 ',&*)4',57. P,)&6) 6(' *+ (),&6
*+ &(,( =) (4 &( 6' 7,'-7 ('>&--,6; ,) *6;*-*7 HKL. L,() CT (;,6 /,(
*6 2 7,'( ,* ,6 5,)&6) /,( )*- &(,( +'.
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N* +,9&-7 4&()*'7 *+ 9,-&6,6;7.
M&;,)&*6 H&()*'7 :
T,= A9-*&5&6 #9 OD
T,= A)6*-*- 1009 OD
T,= C,'&5'&6 1009 OD
T,= (&9>,(),)&6 209 ON
T,= C, L,;),) 3009 OD
T,= %*-,) 1@1 ODT,= R&(5'&*6 29 OD
T,= %-'*8,9&6 #09 OD
S*;&,- H&()*'7 :
S4 &( =-(( /&)4 1 ;4&- =) /,( &>*'; 5'>&*(-7. H' (*6 &( (),7&6 /&)4 4'
84(=,6 ,6 *( 6*) 5 &6 )*;4 /&)4 4' S4 &( (),7&6 &6 T- I6),6 ,-*6.
S4 4,( , (&()' &6 K,-, L95' =) 6,=- )* = 9,&6 ;,' ),'.
PHYSICAL E!AMINATION :P,)&6) GCS +-- /,'9 5'&54'&( CRT 2 (;( ** 5-( >*-9
49*76,9&;,--7 (),=- 6(55*') ,6 (,)',)&6 /-- 6' '**9 ,&'.
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O6 ,(;-),)&*6 -6( /,( ;-,' =&-,)',--7 /&)4 ** ,6 ,- ,&' 6)'7. S1 ,6 S2
4,' *6 4,') ,(;-),)&*6 /&)4 6* 9'9'( );). .A=*96 /,( (*+) 6*) )6' ,6 6*) &()6.
N'*-*&;,- E8,9&6,)&*6.
O6 )4 6; ,6 =,; 6* +*'9&)7 (6.
O6 5,-5,)&*6
N'*-*&;,- 8,9&6,)&*6:
P*/': @10@201#2@10@1#
R&4) L+)
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T4' &( &95,&' (6(,)&*6 69=6((F +'*9 55' ,=*96 */6/,'( T" S1F
M(;- )*6 ,' 475*)*6&, *>' =&-,)',- 55' -&9=( =) ,55,'( 6*'9,- *>' -*/'
-&9=(
B,'=6(& (&6( ,' &>*;,- =&-,)',--7.
O6 5' ';),- 8,9&6,)&*6 ,6,- )*6 &( -,8 /&)4 &95,;) ()**- 5 ,6 (5'+&;&,-
(6(,)&*6 &6),;). B-=*;,'>6*(( '+-8 5'(6).
INVESTIGATIONS
1F H9,)*-*&;,-
P'*5',)&> '(-) *6
%-- B-** C*6) %BCF WCC 11.$2 HB 10 HCT 3. PLT 30
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P*()*5',)&> '(-) *6
%-- B-** C*6) %BCF WCC 10 HB . HCT 33. PLT 2$R6,- P'*+&- RPF U', " N, 13 K ".3 C',)&6&6 ".3
L&>' %6;)&*6 T() L%TF T*),- 5'*)&6 2 A-=9&6 "" T*),- =&-&'=&6
ALT "" AST 12 ALP 10
C*,-,)&*6 P'*+&- PT 12.$@ INR 1.1#@ APTT 31."
E-;)'*-7)( C,-;&9 2.13 M,6(&9 0.$ P4*(54,) 1.#
2F R,&*-*&;,-
!',7 )4*',;*-9=,' ,) H*(5&),- T- I6),6 *6 @10@1#
M,6)&; R(*6,6; I9,&6 MRIF W4*- S5&6 *6 *6 *6 @10@1# )* '- *);,, &6 (76'*9 /&)4 (5&6 9),(),)(&(.
T4 +&6&6( ,' ,( =-*/ :
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L*(( *+ ;'>&;,- -*'*(&(. V')=',- ,-&696) &( 5'('>.
L&6,' T2 475'&6)6(&)7 &( (6 ,) C$ T$ ,6 T ,((*;&,) /&)4 /&6 *+
)4 >')=',- =*&( (()&> *+ ;*95'((&*6 +',;)'(. M*&; )75 II +,))7F ;4,6( ,) )4 *55*(&6 6 5-,)( *+ T10@11 ,6 L"@#.
D(&;;,)&*6 *+ )4 ;'>&;,- &(;( /&)4 9-)&->- ;&';9+'6)&,- &(;( =-
%'*9 C3@" )* C@T1F.
T4 -&,96)9 +-,>9 ,) )4( ->-( ,' ,-(* (>'-7 )4&;6 ,6
*((&+&.
T4 ,=*> ;4,6( '(-) &6 (>' ;'>&;,- ;,6,- 6,''*/&6 ,6 (5&6,- ;*'
;*95'((&*6 /&)4 ;*' *9, +'*9 C3 )* C ->-(.
T4 6,''*/() AP &,9)' 9,('( $.#99 ,) C$ ->-.
L*/ (&6,- &6)6(&)&( ,' *=('> ,) )4 (5&6,- 5'*;(( *+ C$ ,6 )4 ';)*'9(;-( 9,7 '5'(6) ;,-;&+&;,)&*6@*((&+&;,)&*6.
N,''*/&6 *+ )4 C"@# C#@$ C$@ 6',- +*',9&6, 9*' *6 )4 -+) (&
;,(&6 8&)&6 6'> '**) &95&696).
S5&6,- ;*' 6( ,) L1 ->-. N* ;*95'((&*6 *+ )4 ;,, &6,.
N* ,=6*'9,- (5&6,- 64,6;96) *' 5,',>')=',- 9,((.
I95'((&*6: S>' ;'>&;,- ;,6,- ()6*(&( /&)4 ;*' ;*95'((&*6 +'*9 C3 )*
C ->-( ,6 ;'>&;,- 6'> '**)( &95&696) ,( (;'&=.
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MANAGEMENT:
P'*5',)&> 5,)&6) /,( 4,>&6 ,;) '&6,'7 ')6)&*6 46; /,( 5) *6 CBD 6)&-*5',)&*6 &6 /,'
S'&;,- O5',)&*6
P,)&6) 6'/6) -,9&6*5-,()7 *+ C" C#C$ *6 =7 M' L&9 M' T4',& ,((&()
=7 D' H,+&? *6 2@10@1# ,) 1#:2H 1:"#H
P*() *5 &,6*(&(:
C*66&),- S5&6,- S)6*(&( *>' C3C$
I6), *5 +&6&6:
C*66&),- S5&6,- S)6*(&( *>' C3C$
T4&; +&='*( )&(( *>'-7&6 ',- (4,)4
L,9&6*5-,()7 O>' C"C$
I95-,6) (:
M)'*6&; *56 **' 5-,) 109983
S;'/( 2.$998998$
2.$998#998#
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PROGRESS
P*()*5',)&>-7 5,)&6) /,( ,9&)) )* ICU I6)6(&> C,' U6&) F *>'6&4))* 9*6&)*' ;-*(-7. I6&)&,--7 (4 /,( &6)=,) (,) ,6 49*76,9&;,--7 (),=-
6(55*'). S4 /,( 8)=,) /-- ,6 /,( )',6(+'' )* /,' ,) 5*() *5',)&>
,7 1. I6 /,' (4 /,( 49*76,9&;,--7 (),=- 6(55*'). P,&6 (;*' /,( /--
)*-',=- 5*()*5',)&>-7 /&)4 )4 (, *+ 5,)&6) ;*6)'*-- ,6,-(&, 9*'54&6
PCAMF ,6 (=(6)-7 /,6 *++ )* *',- ,6,-(&,. S4 &( 5) *6 C'>&;,- C*--,'
5'*5 5 "# '( ,6 ;*>' /&)4 IV ;+'*8&9 #09 TDS. W*6 &6(5;)&*6
/,( *6 *6 ,7 3 5*()*5',)&> *6 1@11@201#. I) /,( ;-,6 6* ,55&6 6* 5(
&(;4,'. D',&6 /,( *++ *6 )4 (,9 ,7 ,( /--. T*),- ',&6 /,( 9&6&9,- -(( )4,6
#09-. C4; !',7 /4*- (5&6 '>&/ =7 (5&6 ),9 ,6 /,( ,;;5),=-.
P,)&6)( 6'*-*&;,- (),)( /,( &95'*> ,+)' *5',)&*6. S4 (),') )*
9*=&-&? +'*9 -7&6 )* (&))&6 5*(&)&*6 /&)4 ,((&(),6; *6 ,7 3 5*()*5',)&>. O6
,7 $ 5*()*5',)&> 5,)&6) /,( ,=- )* ,9=-,) )* ;4,&' /&)4 )4 4-5 *+
547(&*)4',57 ),9.
N'*-*&;,- 8,9&6,)&*6 5*() *5 ,7 $P*/' : R&4) L+)
C# # #
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S6(,)&*6: B() (6(*'7 ,) C$ ->- 5'*5'&*;5)&*6 &6),;)
P' ';),-: ,6,- )*6 ()&-- -,8 BCR 5'(6) 5 ,6 (5'+&;&,- ,6,- (6(,)&*6 &6),;)S4 ()&-- '&' ,& &6 ,&-7 ,;)&>&)&( ,6 ,9=-,)&6 )* ;4,&'( /&)4 4-5(.
S4 &( ,=- )* (6( +-- ';)9 =) &++&;-) )* &6&)&,) +-- =*/- *56&6 ,6 ()&-- *6
CBD. S4 /,( '+'' )* '4,=&-&),)&*6 ),9 (),') /&)4 )'&,- *+ ;,)4)'
9*=&-&?,)&*6 ()'6)46&6 8';&(( ,6 '(5&',)*'7 8';&( /&)4 )'&+-*/
(5&'*9)'. S4 (),') =*/- *56&6 /&)4 4-5 *+ (7'5 -,;)-*( 1#9- BD ,6
(55*(&)*'7 D-;*-,8 20 9 >'7 *)4' ,7. A) 5*()*5',)&> ,7 5,)&6)’(
/*6 4, 49*('*( &(;4,'(. P( CS ),6 *6 3@11@1# '/ 5(*9*6,(
,'&6*(, /4&;4 &( (6(&)&> )* ,9&,;&6 ,6 ;+5&9. O' ),9 ;*6(-)
&6+;)&*( &(,( *6 #@11@1# &6 >&/ *+ 5,)&6) ;-&6&;,--7 /-- (5)&; 9,''( 6*)',&( 46; /,( 5-,66 )* *++ ,6)&=&*)&;( ,6 *=('> /*6. S4 &( 5) *6 ,;)&;
,;& ,6 =,;)&',(( '((&6 ,&-7 &6 /,'. A) 5*()*5',)&> ,7 13 5,)&6) /,(
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&(;4,' )* H*(5&),- T- I6),6 &6 >&/ -*&()&; 5'*=-9. U5*6 &(;4,' 5,)&6)
,=- )* ,9=-,) (&6 /,-&6 +',9 /&)4 1 5'(*6 9&6&9,- ,((&(). S4 /,( ,-(* ,=-
)* 5'+*'9 +6;)&*6,- ,;)&>&)&( -& + 4'(-+ ='(4 ))4 ,6 (-+ 47&64*/>' ()&-- 6 ,((&(),6; +*' '((&6. W*6 &6(5;)&*6 /,( *66*) ;-,6
,6 '7. P,)&6) /,( *6 =-,' &,'7 ,6 =*/- '+-8( '&9. H' 6'*-*&;,-
5*/' =&-,)',- 55' ,6 -*/' -&9=( ,' # 8;5) CT1 ,' ".
S4 ;*9( +*' TCA *')4*5,&; ;-&6&;( ,( *)5,)&6) 3@12@1# 1 9*6)4 5*()
*5',)&>F (4 &( ,=- )* ,9=-,) /&)4 /,-&6 +',9. P,)&6) ;-,&9( )4' &(
9&6&9,- 5,&6 *>' )4 6; /&)4 5,&6 (;*' 2@10 9&6&9,- ,6 ,=- )* (-5 /--.
O)4'/&( (4 &( ,=- )* ;*6)'*- =*/- ,6 =-,' 4,=&) ,6 ,)&6 /--. S4
;*95-&,6)( )* ;'>&;,- ;*--,'.
N'*-*&;,- 8,9&6,)&*6 '&6 ;-&6&;( TCA
P*/' : R&4) L+)
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L# # #
S1 # #
H6; (4 &( &(;4,' /&)4 TCA ,+)' 2 9*6)4( /&)4 LMS ;',9 5-,66 +*'
;*6)&6*( 547(&*)4',57 ,) )- &6),6 ,6 5 )4 (*+) ;*--,'.
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http://slidepdf.com/reader/full/degenerative-spine-disease 14/21
CPC1 – Degenerative Spine Disease 201
6
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 15/21
CPC1 – Degenerative Spine Disease 201
6
%&' A: !',7 C'>&;,- ,+)' -,9&6*5-,()7 *+ C" C#C$ ,) @10@1#F
P*() *5 8 ',7 ;'>&;,- ,) 30@10@1#F
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 16/21
CPC1 – Degenerative Spine Disease 201
6
Post op ) ra" *ervi*a+ ,at 11-.-1/0
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 17/21
CPC1 – Degenerative Spine Disease 201
6
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 18/21
CPC1 – Degenerative Spine Disease 201
6
MR' one on 1/-12-1/ pre operative
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 19/21
CPC1 – Degenerative Spine Disease 201
6
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 20/21
CPC1 – Degenerative Spine Disease 201
6
Cervi*a+ ) ra" one at ortho *+ni*s 3o++o up 4-1.-1/
7/24/2019 Degenerative spine disease
http://slidepdf.com/reader/full/degenerative-spine-disease 21/21
CPC1 – Degenerative Spine Disease 201
6
DISCUSSION
1@ HISTORY