The spine journal : official journal of the North American Spine Society
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Over the past two decades, soft-tissue structures communicating with the dura mater within the epidural space have become the focus of many anatomical and histopathologic studies. The relationship between these bridging structures has yet to be evaluated in situ. ⋯ E12 sheet plastination has provided in situ visualization of bridging structures within the cervical epidural space and offers new insight into these structures, as well as the composition and arrangement of the posterior atlantooccipital membrane and cerebrospinal dura at the craniocervical junction. This study aims to expand on the anatomical understanding of the upper cervical region while defining structures that may reduce neurosurgical complications, and aid in the understanding of the pathophysiology of certain neurogenic disorders.
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In adolescent idiopathic scoliosis (AIS), identification of curve patterns and determination of fusion levels are most important for correcting deformity, improving trunk balance, and saving motion segments. Lenke 1A scoliosis is the most common type of AIS, accounting for around 16% of all AIS; however, how to determine the lower instrumented vertebrae in this common curve type is unclear. ⋯ Our analysis suggested that not all Lenke 1A curves yield satisfactory outcome with the same fusion extend although a high percentage of the patients with Lenke 1A curves have shown satisfactory outcome with NV fusion. Thus, it seems that some Lenke 1A curves may require fusion to SV.
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Only Level 3 evidence exists for the diagnosis and treatment of atlantooccipital dislocation (AOD) with few studies examining mortality, neurologic improvement, and patient-reported outcomes (PROs). ⋯ Our work suggests that failure to diagnose AOD is a powerful predictor of mortality. Higher ISS scores and better neurologic presentation were significantly associated with missed diagnosis. Craniocervical arthrodesis preserved neurologic function with low complication rate and unexpectedly high PROs and return-to-work. These results must be carefully interpreted because it is unclear whether missed AOD diagnosis accompanies another death-causing injury (eg, traumatic brain injury) or if failure to treat AOD contributes to mortality in a multifactorial manner.
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Studies have demonstrated sustained improvements in patient-reported outcomes (PROs) after three-column osteotomies (three-COs), but no study has evaluated what factors impact long-term outcomes. ⋯ With a minimum 5-year follow-up, PROs in patients undergoing three-CO were associated with improvements in radiographic alignment but negatively affected by prior surgery and complications necessitating revision surgery.
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Human studies have revealed a link between muscle degeneration and low back pain, although the cause and effect of this relationship is not clear. Dogs provide a naturally developing model of intervertebral disc (IVD)-related low back pain that may provide insight into relationships between IVD and muscle degeneration. ⋯ Dog groups with higher average IVDD grades demonstrated less fatty infiltration within their multifidus and psoas muscles, compared with groups with lower IVDD grades. This finding was consistent across both CD and NCD breeds as well as across dogs presenting with IVDH and those presenting with a non-IVDH spinal pathology. Thus, the presence or severity of IVDD is not uniquely related to fatty infiltration in these muscles, but rather the presence, or possibly severity or chronicity, of general spine pathology is likely a better predictor of fatty infiltration.