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Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal [lower than normal], further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly

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This is not a conservative estimate

It can also cause normal tissue to be displaced into the spinal canal through a herniation of the disc material, fracture of the bones in the canal, or of contents of the facet joints (synovial cysts)

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