European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the long-term effects in terms of health care use are largely unknown. The aim of the present study was to describe the long-term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective. ⋯ Spinal fusion surgery in older patients does not generate excess hospital-based health care use in the longer term as compared with the background population, but primary care use increases.
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To compare volume-occupying rate of cervical spinal canal between patients with cervical spondylotic myelopathy (CSM) and normal subjects, and to investigate its significance in cervical spine disease. ⋯ Volume-occupying rate of cervical spinal canal is an objective reflection of compression on cervical spine and spinal cord, and it is associated with cervical spinal cord function. These suggest that it may play a significant role in predicting the development of CSM.
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Spinal stenosis at the C2-3 segment is a rare occurrence, and when it occurs myelopathy infrequently results. Furthermore, only a handful of cases involving congenital abnormalities of the posterior arch of the axis have been described resulting in cervical myelopathy many of which described simultaneous congenital abnormalities at adjacent levels and none of which identified ossification of the posterior longitudinal ligament (OPLL) at the same level. We report a case of a previously undescribed combination of abnormalities at the C2-3 segment resulting in clinical myelopathy. ⋯ Deficiencies in the posterior arch of the axis are rare and have not previously been reported in conjunction with OPLL. Advanced imaging is helpful to define the abnormality and site of compression. In the setting of a progressive neurological dysfunction, surgical decompression and stabilization is a reasonable intervention and can be associated with neurological and symptomatic improvement.
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In the realm of spinal surgery, infections have multiple etiologies and sites of origin. In this case series, we describe a juxtafacet cyst spinal infection that can often be missed or attributed to common symptomology of benign processes despite florid infection. ⋯ In our two patient presentations, both were diabetics and had remote histories of cancer that necessitated chemotherapy or radiation therapy. They also seemingly had de novo onset of infected juxtafacet cyst. The variety of causes and presentations of spinal infections should heighten the astute surgeon to be suspicious of these entities and thus intervene early with appropriate management.
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Unilateral hypertrophy of the lateral mass of the atlas is an extremely rare condition. The authors present a rare type of unilateral atlantal mass hypertrophy with atlanto-occipital fusion which is associated with an invaginated lateral mass of the atlas and the odontoid process into the foramen magnum. ⋯ To our knowledge, such a case of unilateral atlantal mass hypertrophy associated with atlanto-occipital fusion has not been described previously. The authors discuss the pathology of this case and review the literature on unilateral atlantal mass hypertrophy and associated anomalies of the upper cervical spine.