Spine
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Sixty radiographs were measured on two separate occasions by three physicians using four different techniques to evaluate the reliability and reproducibility of the measurement of lumbar lordosis. ⋯ The measurement of lumbar lordosis is reproducible and reliable if the technique is specified and one accepts 10 degrees as acceptable variation. Factors that affect the reproducibility of measurement include end vertebra selection (especially with transitional segments) and vertebral endplate architecture.
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The cervical spine of an 86-year-old man known to have a fracture of the odontoid process was removed at autopsy and dissected. ⋯ Both the fatal outcome and the pathologic examination showed that established management concepts, particularly screw fixation of a fractured odontoid process, should be reconsidered in light of the potential occurrence of transdental posterior rotary subluxation. Because the incidence of capsular, ligamentous, and vascular injuries associated with fractures of the odontoid process is still poorly understood, more autopsies would be needed. The case also raises the question of whether, in an elderly patient like ours, a fracture of the odontoid process should prompt immediate surgical stabilization.
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Data were obtained in a Danish cross-sectional postal survey and compared with information from four methodologically similar studies conducted in some of the Nordic countries between 1977-1985. ⋯ When data were examined from five methodologically similar studies on the 30- to 50-year-old Nordic population, there was reasonable consistency of prevalence figures. Thus, approximately 66% report having had low back pain at least sometime during their lifetime and approximately 50% sometime during the preceding year, with no significant differences relating to age or sex. The best method to investigate whether low back pain is on the increase might be through replicate studies.
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Comparative Study
Reducing the lifetime risk of cancer from spinal radiographs among people with adolescent idiopathic scoliosis.
Data from a retrospective cohort study of people with adolescent idiopathic scoliosis were combined with information on full-spinal radiographs to estimate contemporary x-ray doses and lifetime risks for development of cancer. ⋯ The cancer risks from full-spinal radiographs for scoliosis are not negligible and can be reduced from one half to three quarters if the anteroposterior view is replaced with the posteroanterior view.
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Twenty-one cases of chordoma arising in the mobile spine were retrospectively reviewed. ⋯ En bloc excision--even if marginal--is the treatment of choice of chordomas of the spine. Early diagnosis and careful surgical staging and planning are necessary. Megavoltage radiation can be administered as an adjuvant.