Case history
Case history #1
A 44-year-old man presents with a 3-month history of thoracic pain that has increased in severity in the past 3 weeks. The pain eases by lying flat, but keeps him awake at night. He has noticed a weight loss of 20 kg in the past 3 months associated with a loss of appetite and frequent night sweats. He has been through a rehabilitation program for alcohol abuse. In the past 3 weeks he has noticed that he has a progressively unsteady gait and has had frequent falls. He has noticed sharp burning paresthesias in both lower extremities and the lower abdomen, which coincide with the onset of the severe back pain. On examination of his lower limbs, he has spasticity, brisk deep tendon reflexes, extensor plantars, and sensory level of T6 affecting proprioception, light touch, and pin prick. He has a sharp tenderness over T6 with an angular kyphosis of T5 and T6. In due course, he was transferred to a spinal cord rehabilitation facility. Over the past 6 months, he has undergone extensive rehabilitation, including bladder care and prevention of joint contractures due to increasing spasticity. He is dependent on his wheelchair.
Case history #2
A 22-year-old man was involved in a motor vehicle accident 12 months earlier. He was driving under the influence of drugs and alcohol when the car crashed into a tree, and he was not wearing a seatbelt. He was taken to the emergency room, where he was found to have sustained a tear-drop fracture of C6. A neurological assessment determined that he had tetraplegia without sacral sparing. He underwent an emergency C6 vertebrectomy, cord decompression, and anterior stabilization but the neurologic deficit did not improve. He was transferred to a spinal cord rehabilitation facility 2 weeks later. Over the past 12 months, he has undergone extensive rehabilitation, including bladder care and prevention of joint contractures due to increasing spasticity. He is dependent on his wheelchair.
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