Bibliographic record
Abstract
STUDY DESIGN: Case report. OBJECTIVES: To report and discuss the natural evolution of fortuitously found solitary radiodense or "ivory" vertebrae in two asymptomatic patients; to review the existing literature concerning ivory vertebrae; and to provide a practical guide for the diagnostic and management approach to the fortuitous finding of ivory vertebrae in asymptomatic patients. SUMMARY OF BACKGROUND DATA: The asymptomatic and apparently idiopathic ivory vertebra is often a very problematic clinical situation. Previous studies have hypothesized that although several etiologies have been known to be responsible for producing ivory vertebrae, the most likely etiology, particularly for so-called "idiopathic" ivory vertebrae, is early and asymptomatic Paget's disease of bone. METHODS: Two patients, each with an incidentally discovered ivory vertebra, were followed clinically over a period of 13 and 10 years, respectively. During this time the patients underwent a multitude of investigations in an attempt to identify the etiology of the ivory vertebra. After having eliminated ominous etiologies, the authors opted for a conservative approach to management (observation) so as to have a long-term follow-up of the patients and also attempt to determine the natural history of idiopathic solitary ivory vertebrae. RESULTS: Despite the extensive workups, no etiology was ever found for either patient because the tests showed normal results for extended periods of time. Whereas in one patient Paget's disease of bone was suspected, no definitive confirmation for the presence of Paget's disease could be obtained, even on bone biopsy. Both patients remained entirely asymptomatic with respect to the ivory vertebra over the entire follow-up period. CONCLUSION: Based on the observations from the present study as well as a review of the literature on the subject, a decision-making algorithm is put forth for the investigative approach as well as for the subsequent follow-up and management of patients with idiopathic and asymptomatic ivory vertebrae whereby, after baseline screening tests eliminate ominous pathology, observation and periodic clinical reassessment are advised until symptoms develop or until there are radiographic changes in the appearance of the ivory vertebra.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".