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Paradoxical effect of APM. Severity of the degeneration correlates with poor outcome (red and blue arrows). At the same time the larger the excision, the poorer the outcome despite the disease being more severe (green arrow). APM as an intervention is paradoxical since the extent of procedure and severity of disease are both inversely associated with outcome, meaning that as little as possible should be excised but then the underlying pathology is not addressed.
