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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Juvenile idiopathic arthritis (JIA) is a chronic condition affecting patients <16 years of age and can be associated with substantial morbidity. Atlanto-axial subluxation (AAS) is a known complication of JIA and can result in pain, reduced neck motion and neurological compromise. In this paper, we present the case of a 10-year old suffering with JIA and significant AAS; we discuss the management options and present the approach and outcome of treatment for this case.
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To investigate the prevalence of axial symptoms (AS) in patients following posterior cervical decompression. ⋯ Posterior cervical surgery carries a high risk of postoperative AS. Postoperative AS may be reduced through preserving posterior muscles and structures, stabilizing cervical vertebrae, and reducing external cervical immobilization time.
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Review Case Reports
Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm.
To review relevant data for the management of esophageal perforation after anterior cervical surgery. ⋯ Following anterior cervical surgery, patients should be closely followed up in the postoperative period for risk of esophageal perforation. Development of symptoms like dysphagia, pneumonia, fever, odynophagia, hoarseness, weight loss, and breathing difficulty in patients with a history of previous anterior cervical surgery should alert us for a possible esophageal injury. Review of the literature revealed that conservative treatment is advocated for early and small esophageal perforations. Surgical treatment may be considered for large esophageal defects.
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Review Comparative Study
C5 nerve root palsy following decompression of cervical spine with anterior versus posterior types of procedures in patients with cervical myelopathy.
C5 palsy is a well-known complication of cervical spine decompression surgery. The complication develops in both posterior and anterior approaches. We aimed to review reports regarding postoperative C5 palsy in hopes for better prevention and treatment of this morbidity. ⋯ Some studies conclude that anterior procedure is more safe. Of all anterior procedures, the multilevel ACDF had the lowest incidence of C5 palsy. The hybrid technique can be chosen for more than two-vertebra corpectomy. In term of posterior procedures, laminectomy is safer. To prevent C5 palsy, electromyography can be used as a sensitive predictor and selective foraminotomy can be performed.
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Randomized Controlled Trial Comparative Study
Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial.
To evaluate the cost-effectiveness of manual therapy according to the Utrecht School (MTU) in comparison with physiotherapy (PT) in sub-acute and chronic non-specific neck pain patients from a societal perspective. ⋯ From a societal perspective, MTU was not cost-effective in comparison with PT in patients with sub-acute and chronic non-specific neck pain for perceived recovery, functional status, and QALYs. As no clear total societal cost and effect differences were found between MTU and PT, the decision about what intervention to administer, reimburse, and/or implement can be based on the preferences of the patient and the decision-maker at hand.