As often happens, my experience with a patient got me to thinking. Not that I had given up thinking before that, but a novel thought is often welcome. The new patient, a 40-ish lady, had brought in X-rays of her neck. In viewing them, I was astonished at the deterioration in her mid-cervical spine. The degeneration was extreme for a woman of her age, and seemed to surround the fourth cervical vertebra, C4, wedged in flexion at an awkward angle. 

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