Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach.

STUDY DESIGN: Narrative review. OBJECTIVE: To provide an overview of the evaluation and diagnosis of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: DCM describes several etiologies of degenerative, nontraumatic spinal cord impairment. Early diagnosis and intervention can decrease neurological decline. METHODS: An extensive literature review was conducted. RESULTS: The incidence and prevalence of DCM are increasing worldwide. Asymptomatic spinal cord compression can progress to cervical myelopathy. Static and dynamic factors contribute to spinal cord compression. Patients frequently present with decreased manual dexterity, gait instability, and neck pain. On physical exam, patients frequently present with upper motor neuron signs, a Lhermitte sign, a failed Romberg test, global proprioceptive dysfunction, and decreased pain sensation. Anatomic variation may complicate physical exam interpretation. The modified Japanese Orthopaedic Association Scale and Nurick Classification, based on functional impairment, provide diagnostic utility. Magnetic Resonance Imaging imaging is useful in narrowing the differential diagnosis, evaluating the severity of neurological impairment, and predicting disease progression. CONCLUSIONS: Understanding the pathophysiology of DCM and the diagnostic utility of the signs and symptoms of DCM is critical. The decision for anterior cervical discectomy and fusion (ACDF), laminoplasty, or combined ACDF and posterior cervical fusion is individualized for each patient.

Transscaphoid Transcapitate Perilunate Fracture-dislocation with Inferior Arc Injury and Acute Ulnar Nerve Compression: A Case Report.

Introduction: Perilunate dislocations and perilunate fracture-dislocations (PLFD) are relatively uncommon injuries, comprising <10% of wrist injuries. Perilunate injuries are often complicated by median neuropathy reported in 23-45% of cases, whereas there are very few reported cases of associated ulnar neuropathy. Combined greater arc and inferior arc injuries are also rare. We report an unusual PLFD pattern with associated inferior arc injury and acute ulnar nerve compression. Case Report: A 34-year-old male sustained a wrist injury after a motorcycle collision. Computed tomography scan revealed a trans-scaphoid, transcapitate, perilunate fracture-dislocation, and a distal radius lunate facet volar rim fracture with radiocarpal subluxation. Examination revealed acute ulnar neuropathy without median neuropathy. He underwent urgent nerve decompression and closed reduction, followed by open reduction internal fixation the next day. He recovered without complication. Conclusion: This case emphasizes the importance of a thorough neurovascular examination to rule out less commonly seen neuropathies. With up to 25% of perilunate injuries misdiagnosed, surgeons should have a low threshold for advanced imaging in high-energy injuries.

Interfacing With the Electronic Health Record (EHR): A Comparative Review of Modes of Documentation.

Electronic health records (EHRs) have provided physicians with a systematic framework for collecting patient data, organizing notes from the healthcare team, and managing the daily workflow in the modern era of healthcare. Despite these advantages, EHRs have proven to be problematic for clinicians. The burdensome regulations requiring increased documentation with the EHR paradigm have led to inefficiencies from data-entry requirements forcing physicians to spend an inordinate amount of time on it, affecting the time available for direct patient care as well as leading to professional burnout. As a result, new modalities such as speech recognition, medical scribes, pre-made EHR templates, and digital scribes [a form of artificial intelligence (AI) based on ambient speech recognition] are increasingly being used to reduce charting time and increase the time available for patient care. The purpose of our review is to provide an up-to-date review of the literature on these modalities including their benefits and shortcomings, to help physicians and other medical professionals choose the best methods to document their patient-care encounters efficiently and effectively.