Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive cervicalgia, localized to the posterior neck, radiating to the bilateral upper extremities. Symptoms are associated with mechanical instability and nocturnal exacerbation. Denies recent trauma but reports progressive weakness, paresthesia, and gait instability. History of primary malignancy [Insert Primary Site] with known metastatic disease.
Clinical Examination Findings
Cervical spine examination reveals midline tenderness over the spinous processes and paraspinal muscle spasm. Range of motion is severely restricted due to pain. Neurological assessment: Motor strength [X/5] in upper/lower extremities; hyperreflexia noted in bilateral lower extremities with positive Hoffmanโs and Babinski signs. Gait is ataxic. Cranial nerves are intact.
Treatment Protocol
Immediate immobilization with a rigid cervical collar (e.g., Miami J) to prevent neurological deterioration. Initiate high-dose corticosteroids (Dexamethasone) to reduce peritumoral edema. Urgent consultation with Radiation Oncology for palliative radiotherapy and Neurosurgery for stabilization assessment. Pain management via multimodal analgesia.