The spine journal : official journal of the North American Spine Society
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Over the past decade, the number of adult spinal deformity (ASD) surgeries has more than doubled in the United States. The complex surgeries needed to manage ASD are associated with significant resource utilization and high cost, making them a primary target for increased scrutiny. Accordingly, it is important to not only demonstrate value in ASD surgery as clinical effectiveness but also to translate outcome assessment to cost-effectiveness. ⋯ There is a significant difference in direct hospital costs versus Medicare allowable rates in ASD surgery and in turn, there is a similar difference in the cost per QALY calculation. Utilizing Medicare allowable rates not only underestimates (17%) the cost of ASD surgery, but it also creates inaccurate and unrealistic expectations for researchers and policymakers.
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Spinal degeneration can occur not only in the bone and disc but also in muscles. Fatty infiltration (FI) and decreased volume have been described as characteristic changes that occur in muscle degeneration. Many studies about the lumbar paraspinal muscles have been conducted on patients with spine problems. However, the natural changes of age-dependent degeneration in the paraspinal muscles have not been studied properly. ⋯ As a result, the degree of intramuscular fat infiltration seems to be affected by age, disc level, and muscle type. It seems to be more prominent in the extensor muscles, extending from lower to upper levels.