The spine journal : official journal of the North American Spine Society
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In recent literature, a soft-tissue communication between the rectus capitis posterior major (RCPma) muscle and the cervical dura mater has been identified. To the best of our knowledge, this communication has yet to be validated from a histological perspective nor has it been examined for neural tissue. ⋯ The existence of a true connection between the RCPma and the cervical dura mater provides new insight in understanding the complex anatomy of the atlantoaxial interspace. The presence of a neural component within this connection suggests that it may serve another function aside from simply anchoring this muscle to the dura mater. Such a connection may be involved in monitoring dural tension and may also play a role in certain cervicogenic pathologies. This study also supports previous reports that no true membrane joins the posterior arch of the atlas to the laminae of the axis and contradicts the conventional belief that the ligamentum flavum joins these two structures.
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Patient satisfaction ratings are increasingly being used in health care as a proxy for quality and are becoming the focal point for several quality improvement initiatives. Affective disorders, such as depression, have been shown to influence patient-reported outcomes and self-interpretation of health status. We hypothesize that patient psychiatric profiles influence reported satisfaction with care, independent of surgical effectiveness. ⋯ Our study suggests that independent of the surgical effectiveness, the extent of preoperative depression influences the reported patient satisfaction after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality should account for the patients' baseline depression as potential confounders.
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Segmental fixation improves fusion rates and promotes patient mobility by controlling instability after lumbar surgery. Efforts to obtain stability using less invasive techniques have lead to the advent of new implants and constructs. A new interspinous fixation device (ISD) has been introduced as a minimally invasive method of stabilizing two adjacent interspinous processes by augmenting an interbody cage in transforaminal interbody fusion. The ISD is intended to replace the standard pedicle screw instrumentation used for posterior fixation. ⋯ In FE, the ISD can provide lumbar stability comparable with Bilat instrumentation. It provides minimal rigidity in LB and AR when used alone to stabilize the segment after an IBS placement. The unilat and the more typical bilat screw constructs were shown to provide similar levels of stability in all directions after an IBS placement, though the bilat construct showed a trend toward improved stiffness overall.
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A bipartite atlas is a rare coincidental finding, and it is reported in only 0.1% of the general population. It is a congenital disorder characterized by incomplete fusion of the anterior and the posterior arches of C1, and it is important to differentiate it from a Jefferson fracture. ⋯ A bipartite atlas is a rare congenital abnormality, caused by a failure of anterior and lateral ossification centers to fuse. It needs to be differentiated from a Jefferson fracture in a trauma setting. It usually requires no specific treatment.