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Today we have a rare emergency • Progressive neurological deficits • Inability to hold her head upright • Losing control of bowel & bladder What's going on? We have a rare emergency. You know, typically most of my cases are elective, but today we got notification that one of our patients we have been working up for a neck problem, came to the hospital early, describing new symptoms that had progressed from where we initially in the clinic. Apologies for the background noise (it's busy today in the OR)... it only lasts a few seconds. Initially, when we saw her in the clinic, she had a difficult time walking straight and was losing her balance. In addition to that, she had what we call upper motor neuron findings. And so we knew she had spinal cord compression in her neck. But like some patients, she complained lower back. So one of the things really important when I see a patient is that we don't just focus on their own their complaint, of times is low back pain, low back pain. So when I do a neurologic exam in my clinic, or my PA's always includes the upper extremities. I always watch the way people walk, I make them walk a tandem gait, where they walk one foot in front of the other like this to see if they can maintain their balance. And then I check their upper extremity strength, their upper extremity reflexes. I do specialized upper and lower extremities. Even if their complaint is back pain, because it's not uncommon to find somebody whose back pain is worse, but spinal cord compression is more concerning. The spinal cord trumps everything. If you have spinal cord compression, a lot of times you don't have a lot of severe pain, but you have neurologic deficits. That's when we do a detailed neurologic exam. And in her case, I was concerned about her neck, and so I sent her for an MRI. And low and behold she had two discs that were pinching the spinal cord, along with a bone spur at C5 and C7. And so our plan was to, like most patients, electively put her on the schedule, take care of her in an elective manner. But over the last week, she started developing loss of control over her bladder, loss of the ability to use her hands. She started having shooting pain in both arms. She was unable to lift her head up, did she had electric shock sensations into her arms and her left leg. And so she I warned all my patients that if you get worse neurologically, don't wait, go to the ER. Go to the hospital. Because sometimes if you lose bowel and bladder control, it's an emergency, and we need to make sure that we take spinal cord pressure, or if it's the cauda equina, like you may have seen me talk about before, where the the nerves in the lower back are so severely compressed that the sphincter and the detrusor muscle of the bowel stopped working. And so we have to take them back emergently as well. So this is one of those cases where she's had progressive neurological deficits. She has an inability to hold her head upright, and she's losing bowel and bladder. An emergency, and we're going to take her to the OR. She's a faithful woman. She found me, through what she describes as prayer, and she was praying about her condition, and then one of my videos popped up. So any of those people that and tell me obviously I'm honored, I'm honored to take care of everyone. But that, that story really resonates with me because of my faith. And so I'm praying that that I can be an answer to her. Obviously, God's in control of my OR. We said a prayer already together, and so we're praying we can get her better and get rid of her issues from top to bottom, whether it's her pain or her bladder control. So let's. Let's she's a sweet, sweet lady, we can get her problem right away. Today we're gonna do a three level fusion of her neck. One level is unstable, two levels are compressing the spinal cord. So it's a C4 to C7 anterior cervical fusion with cage and a plate to decompress the spinal cord and stabilize this patient’s neck. When neurological function starts declining this quickly, waiting is no longer an option. If