Spine
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Surgical management of degenerative cervical myelopathy requires careful pathoanatomic consideration to select between various surgical options from both anterior and posterior approach. Hitherto, unexplored is the relevance of cervical deformity to the pathophysiology of such neurological disability, and whether correction of that deformity should be a surgical objective when planning for reconstruction after spinal cord decompression. ⋯ These conclusions are based on narrative reviews and a selection of primary research data, reflecting the nascency of this field. They further recommend for preoperative assessment of spinal alignment when significant deformity is suspected, and that correction of cervical kyphosis should be an objective when surgery is planned.
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This section of the cervical spondylotic myelopathy (CSM) Spine focus issue collates evidence related to diagnosis, outcome assessment, and genetics. Given that a variety of different disease states can present similarly, a guide for diagnosing and differentiating CSM from other neurological conditions is initially presented. Although the value of magnetic resonance imaging in diagnosing CSM is cemented, its value as a tool to predict future outcome is less well established. ⋯ At present, we recommend that clinicians acquire the modified Japanese Orthopaedic Association scale score and the Neck Disability Index on all patients with CSM at presentation and follow-up. Finally, in regard to genetics, the existing evidence seems to support the principle of an inherited predisposition to both CSM and ossification of the posterior longitudinal ligament. Although several genetic polymorphisms have been consistently associated with ossification of the posterior longitudinal ligament, no specific polymorphisms were consistently associated with CSM.
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An in vitro biomechanical study. ⋯ N/A.
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Retrospective cohort study among Medicare beneficiaries with lumbar spinal fusion surgery. ⋯ 4.