History

A 37-year-old man from the United States presented with a 1-year history of neck pain and stiffness that had been unsuccessfully treated with manipulative therapy by a chiropractor at another institution. Past medical history was remarkable only for marijuana and air duster abuse. He denied use of any prescription medications. Physical examination was notable for markedly reduced range of motion of the cervical spine. Laboratory work-up revealed an elevated alkaline phosphatase level (302 U/L [5.0 μkat/L]; normal range, 40–100 U/L [0.7–1.67 μkat/L]), but all other laboratory findings, including complete blood count, renal function, liver function, vitamin A level, serum protein electrophoresis, and hepatitis C antibodies were within normal limits. Cervical spine radiography was performed (Fig 1), followed by MRI (Fig 2). Subsequently, a full skeletal survey was ordered. Included are representative radiographs of the pelvis (Fig 3), left forearm (Fig 4), and distal right leg with ankle (Fig 5).

中文翻译：

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案例298

历史

一名来自美国的 37 岁男性因颈部疼痛和僵硬病史 1 年，曾在另一家机构的脊椎按摩师处以手法治疗失败。过去的病史仅因滥用大麻和空气除尘器而引人注目。他否认使用任何处方药。体格检查发现颈椎活动范围明显缩小。实验室检查显示碱性磷酸酶水平升高（302 U/L [5.0 μkat/L]；正常范围，40-100 U/L [0.7-1.67 μkat/L]），但所有其他实验室检查结果，包括全血计数、肾功能、肝功能、维生素A水平、血清蛋白电泳、丙肝抗体均在正常范围内。进行了颈椎射线照相（图 1），然后进行了 MRI（图 2）。随后，已下令进行全面的骨骼检查。包括骨盆（图 3）、左前臂（图 4）和右腿远端与脚踝（图 5）的代表性 X 光片。