Neurosurgery
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Adult cervical deformity (ACD) classifications have not been implemented in a prospective ACD population and in conjunction with adult spinal deformity (ASD) classifications. ⋯ Cervical deformities displayed higher TS-CL grades and different cSVA grade distributions. Preoperative associations with global alignment modifiers and Ames-ACD descriptors were observed, though only cervical modifiers showed postoperative differences.
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Jefferson's fracture, first described in 1927, represents a bursting fracture of the C1 ring with lateral displacement of the lateral masses. It has been determined that if the total lateral mass displacement (LMD) exceeds 6.9 mm, there is high likelihood of transverse atlantal ligament (TAL) rupture, and if LMD is less than 5.7 mm TAL injury is unlikely. Several recent radiographic studies have questioned the accuracy and validity of the "rule of Spence" and it lacks biomechanical support. ⋯ Our findings suggest that although the rule of Spence is a conceptually valid measure of TAL integrity, TAL failure occurs at a significantly lower value than previously reported (P < .001). Based on our literature review and findings, LMD is not a reliable independent indicator for TAL failure and should be used as an adjunctive tool to magnetic resonance imaging rather an absolute rule.
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Hospital readmission rate has become a major indicator of quality of care, with penalties given to hospitals with high rates of readmission. At the same time, insurers are increasing pressure for greater efficiency and reduced costs, including decreasing hospital lengths of stay (LOS). ⋯ A decreasing LOS over time has been associated with an increasing readmission rate at the population level. However, at the individual level, a prolonged LOS was associated with a higher risk of readmission. This was attributed to patient comorbidities. However, this increasing readmission rate may represent many factors including patients' overall health status. Thus, the rate of readmission may represent a burden of illness rather than a valid metric for quality of care.