Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats.

OBJECTIVE: The present study aimed to determine the topical and systemic efficacy of tranexamic acid (TXA) on epidural fibrosis in a rat laminectomy model. METHODS: Thirty-two 12-month-old adult Sprague-Dawley rats were used in this study. Each rat underwent bilateral laminectomy at the L1 and L2 vertebral levels. Rats were divided into four groups : in group I (control group, n=8), a laminectomy was performed and saline solution was applied into the surgical space. In group II (topical group, n=8), laminectomy was performed and 30 mg/ kg TXA was applied to the surgical site before skin closure. In group III (systemic group, n=8), 30 mg/kg TXA was administered intravenously via the tail vein in the same session as the surgical procedure. In group IV (topical and systemic group, n=8), TXA was administered 30 mg/kg both topical and intravenous. The rats were sacrificed at 4 weeks postoperatively. Masson's trichrome and hematoxylin and eosin were used to assess acute inflammatory cells, chronic inflammatory cells, vascular proliferation, and epidural fibrosis. RESULTS: Epidural fibrosis, acute inflammation, chronic inflammation, and sum histologic score value were significantly lower in the systemic TXA group, systemic and topical TXA groups than in the control group (p<0.05). In addion, the sum histologic score was significantly lower in the topical TXA group than in the control group (p<0.05). CONCLUSION: In this study, epidural fibrosis formation was prevented more by systemic application, but the topical application was found to be effective when compared to the control group. As a result, we recommend the systemic and topical use of TXA to prevent epidural fibrosis during spinal surgery.

The Effects of the Use of Single-Screw Plates (Univertebral Screw Plates) versus Double-Screw Plates (Bivertebral Screw Plates) on Fusion After One-Level or Two-Level Anterior Cervical Discectomy and Fusion.

OBJECTIVE: In this study, we aimed to retrospectively analyze the effects of the use of univertebral screw plates (USPs) and bivertebral screw plates (BSPs) on fusion in patients who underwent anterior cervical discectomy and fusion (ACDF). METHODS: Forty-two patients who were treated with USPs or BSPs after 1-level or 2-level ACDF and had a minimum follow-up period of 2 years were included in the study. Fusion and the global cervical lordosis angle were evaluated using direct radiographs and computed tomography images of the patients. The clinical outcomes were assessed using the Neck Disability Index and visual analog scale. RESULTS: Seventeen patients were treated using USPs and 25 patients using BSPs. Fusion was achieved in all patients who underwent BSP fixation (1-level ACDF, 15 patients; 2-level ACDF, 10 patients) and 16 of the 17 patients who underwent USP fixation (1-level ACDF, 11 patients; 2-level ACDF, 6 patients). The plate of the patient with fixation failure had to be removed because it was symptomatic. A statistically significant improvement was observed in the immediate postoperative period and at the last follow-up in terms of global cervical lordosis angle, visual analog scale score, and Neck Disability Index of all patients who underwent 1-level or 2-level ACDF surgery (P < 0.05) CONCLUSIONS: Although USPs are less costly and easier to implant, the effect of USPs and BSPs on fusion and clinical outcomes is similar. Thus, surgeons may prefer to use USPs after 1-level or 2-level ACDF.

Improvement of Life After PVCR in Complete Paraplegic Patients with Posttraumatic Severe Kyphosis.

AIM: To determine the effect of posterior vertebral column resection (PVCR) in patients with paraplegia by using the American Spinal Injury Association (ASIA) score and Scoliosis Research Society (SRS)-22 questionnaire. MATERIAL AND METHODS: Twelve patients with posttraumatic paraplegia and severe angular kyphosis ( > 60?) had undergone PVCR between 6-24 months after the trauma for severe pain, persistent vertebral instability and difficulty in adherence to rehabilitation. ASIA scores and SRS-22 questionnaire results obtained in the preoperative and postoperative periods, and the last control were statistically compared to assess the presence of any change. RESULTS: The average age of twelve patients included in this study was 35.6 ± 10.2 (21-51) years. Female/male ratio was 2/10 (20.0%). The mean follow-up duration was 50.3 ± 17.6 (24-86) months. None of the patients had additional changes in neuromonitoring records during surgery. The mean preoperative kyphotic angle of the patients was 66.58° ± 7.1? (60?-82?) which decreased to 7.0? ± 5.4? in the postoperative period (p < 0.05). The mean ASIA score, which was 43.3 ± 5.1 preoperatively, increased to 44.4 ± 4.4 in the postoperative period. The SRS-22 score, which was 2.4 ± 0.3 in the preoperative period, increased to 4.2 ± 0.4 in the early postoperative period. This increase was found to be statistically significant (p < 0.05). The SRS-22 score was 4.1 ± 0.4 at last follow-up and was not statistically different from the early postoperative value (p > 0.05). CONCLUSION: In the light of these data, it can be stated that PVCR is a safe and reliable procedure in paraplegic patients with rigid posttraumatic kyphosis and increases patient satisfaction.

Radiologic Outcomes and Complication Analysis of the Posterior Vertebral Column Resection in the Treatment of Previously Operated Severe Kyphoscoliosis: A Retrospective Case Series.

OBJECTIVE: The aim of this study was to evaluate the radiologic outcomes and complication analysis of posterior vertebral column resection (PVCR) performed on previously operated patients with severe kyphoscoliosis (SK). METHODS: Twelve patients (6 men and 6 women) with SK underwent PVCR. The mean age of the patients preoperatively was 16 years (range, 10-26 years). The mean follow-up period was 5.3 years (range, 2-7 years). Previous surgeries included posterior growth arrest in 3 patients, hemivertebrectomy in 4 patients, and posterior fusion in 5 patients. The sagittal plane parameters and coronal parameters were measured in the preoperative, in the early postoperative, and during the last follow-up stages. Complications were also noted. RESULTS: The mean thoracic scoliosis Cobb angle was 76.8° (range, 35°-142°) preoperatively, 37.8° (range, 5°-80°) early postoperatively, and 41.5° (range, 11°-80°) during the last follow-up (P < 0.0001). The mean thoracic kyphosis angle was 84.7° (range, 23°-132°) preoperatively, 50.3° (range, 25°-78°) early postoperatively, and 48.5° (range, 25°-80°) during the last follow-up (P = 0.0032). Complications occurred in 5 patients (41.7%); a hemothorax in 1 patient, rod fracture in 3 patients, and permanent neurologic deficit in 1 patient. Temporary loss of neuromonitoring motor evoked potentials developed in 2 patients during deformity correction. CONCLUSIONS: PVCR provides effective correction in patients with SK. However, expected surgical correction of a deformity may not always be achieved because of intraoperative neuromonitoring changes. Furthermore, PVCR can lead to a large number of major complications in patients with SK who have undergone previous spinal surgery.

Can Breast Asymmetry Following the Treatment of Juvenile Idiopathic Scoliosis with Growing Rod Be Prevented? : A Preliminary Analysis.

OBJECTIVE: It can be assumed that the progression of scoliosis in the juvenile period will increase the asymmetry in the rib cage, and thus will contribute to an increase in the breast asymmetry (BA) in the future. We are looking for answers to the questions; "How will the breasts look with respect to each other and what is the possibility of developing BA in the early follow-up period following the early surgical treatment and final fusion surgery of juvenile idiopathic scoliosis (JIS)?" For this reason, in this study, we aimed to evaluate the breast asymmetries of patients in the period after the final fusion. METHODS: Following growing rod treatment, final fusion was achieved in 12 females with JIS. We used the anthropomorphic measurement of the modified BREAST-V formula to assess whether there was an asymmetry between the breasts after an average of 4.8 years (2-11) following final fusion. RESULTS: In comparison, the mean volume of the left breast (222.4 mL [range, 104.1-330.2]) was larger than the mean volume of the right breast volume (214.5 mL [range, 95.2-326.7]) (p=0.034). The left breast was larger in 75% of the patients. BA was observed in 50% of the patients. No correlation was detected between the Cobb angle of the patient after final fusion and BA (p=0.688). CONCLUSION: In the late follow-up period, BA was detected in 50% of the patients with JIS who achieved final fusion after treatment with growing rod. In majority of the patients, left breast was larger. The patients with JIS and their families can be informed prior to the operation about the probability of BA seen in the follow-up period after fusion.

Neuroprotective Effects of Lacosamide in Experimental Peripheral Nerve Injury in Rats : A Prospective Randomized and Placebo-Controlled Trial.

OBJECTIVE: To evaluate the neuroprotective effects of lacosamide after experimental peripheral nerve injury in rats. METHODS: A total of 28 male wistar albino rats weighing 300-350 g were divided into four groups. In group I, the sciatic nerve exposed and the surgical wound was closed without injury; in group II, peripheral nerve injuries (PNI) was performed after dissection of the nerve; in group III, PNI was performed after dissection and lacosamide was administered, and in group IV, PNI was performed after dissection and physiological saline solution was administered. At 7 days after the injury all animals were sacrificed after walking track analysis. A 5 mL blood sample was drawn for biochemical analysis, and sciatic nerve tissues were removed for histopathological examination. RESULTS: There is low tissue damage in lacosamide treated group and antioxidant anzymes and malondialdehyde levels were higher than non-treated and placebo treated group. However there was no improvement on clinical assessment. CONCLUSION: The biochemical and histological analyses revealed that lacosamide has neuroprotective effect in PNI in rats. This neuroprotective capacity depends on its scavenger role for free oxygen radicals by increasing antioxidant enzyme activity.

Comparison of the Effects of Magnetically Controlled Growing Rod and Tradiotinal Growing Rod Techniques on the Sagittal Plane in the Treatment of Early-Onset Scoliosis.

OBJECTIVE: Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS). METHODS: Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients' demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1-S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period. RESULTS: Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8-15) and 4.8 (3-7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1-S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group. CONCLUSION: There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

Spinal Instrumentation in Growing Children Retards the Natural Development of Pelvic Incidence.

BACKGROUND: Pelvic incidence increases gradually throughout growth until skeletal maturity. Growing rod instrumentation has been suggested to have a stabilizing effect on the development of the normal sagittal spinal alignment. The purpose of this study is to determine the effect of fixed sagittal plane caused by dual growing rod instrumentation on the natural progression of sagittal spinopelvic parameters in children with idiopathic or idiopathic-like early onset scoliosis. METHODS: Hospital records of children with growing rod instrumentation from 4 separate institutions were reviewed retrospectively. Inclusion criteria were idiopathic or idiopathic-like early onset scoliosis, treatment with dual growing rods with lower instrumented vertebra L4 or upper and more than 2 years of follow-up. Instrumentation levels, magnitudes of major curve, thoracic kyphosis (T2-T12), lumbar lordosis (L1-S1) and pelvic incidence were recorded from preoperative and postoperative standing whole-spine radiographs. Estimated pelvic incidence was also calculated for each patient as if their spines had not been instrumented using the previous normative data. RESULTS: A total of 37 patients satisfied the inclusion criteria. Average age at initial surgery was 7.4±1.8 years (range, 4 to 12 y). Mean follow-up time was 71±26 months (range, 27 to 120 mo). Mean preoperative Cobb angle of 59±13.5 (range, 30 to 86) degrees was reduced to 35.1±17.5 (range, 11 to 78) degrees at the last follow-up. Mean preoperative T2-T12 kyphosis angle was 46.2±14.9 degrees (range, 22 to 84 degrees). At the latest follow-up, it was 44.8±16.2 degrees (range, 11 to 84 degrees) (P=0.93). Mean L1-S1 lordosis angle was 50.5±10.7 degrees (range, 30 to 72 degrees) preoperatively. At the latest follow-up, mean L1-S1 lordosis angle was 48.8±12.7 degrees (range, 26 to 74 degrees) (P=0.29). Mean preoperative pelvic incidence was 45.7±7.9 degrees (range, 30 to 68 degrees). At the latest follow-up, it was 46.7±8.4 degrees (range, 34 to 72 degrees) (P=0.303). The estimated average pelvic incidence was 49.5 degrees (P=0.012). CONCLUSIONS: Previously reported developmental changes of the sagittal spinal parameters were not observed in children who underwent posterior spinal instrumentation. Our findings suggest that spinal instrumentation impedes the natural development of the sagittal spinal profile. LEVEL OF EVIDENCE: Level IV-this is a retrospective case-series.

The proprioception of the knee joint following tibia plateau fractures.

Proprioception is a conscious and/or unconscious perception of position change in an extremity or joint in space. In our study our purpose was to evaluate whether the lower extremity proprioception in long term, is altered following tibia plateau fractures and to assess its relation with age and type of fracture. This retrospective study includes the evaluation of proprioception in 38 tibia plateau fracture patients (29 male, 9 female) of various types who were operated with open reduction and internal fixation (ORIF) technique in our clinic, by comparison of both operated knee and unaffected knee. The mean age of the patients were 38,8 (range, 20-60) and mean follow-up time was 56 months (range, 13-120 months). Proprioception measurements were assessed at 30° and 60° of knee flexion degrees both passively and actively. There were no significant difference between the operated knee and unaffected knee by mean absolute angular deviation values at passive (p = 0,22) or active 60° (p = 0,22). Accordingly passive (p = 0,47) and active 30° (p = 0,62) mean absolute angular deviation values showed no significant difference. Our study has indicated that proprioception at the operated extremity is not significantly different from the unaffected knee in tibia plateau fractures at long term follow-up.

The Treatment of Cleidocranial Dysostosis (Scheuthauer-Marie-Sainton Syndrome), a Rare Form of Skeletal Dysplasia, Accompanied by Spinal Deformities: A Review of the Literature and Two Case Reports.

Cleidocranial dysostosis is a skeletal dysplasia inherited in an autosomal dominant manner and may lead to complications such as scoliosis and kyphosis, concurrent with various orthopedic involvements. Since concurrent spinal deformities are of progressive nature, surgical treatment may be necessary. In addition to other orthopedic problems, possible accompanying complications such as atlanto-axial subluxation, myelopathy, syringomyelia, congenital spine deformities, spondylosis, and spondylolisthesis should be kept in mind while planning for the treatment of scoliosis and kyphosis. Lengthening the use of growth-friendly systems (growing rod) in patients, like ours, with an early onset of symptoms, and performing posterior instrumentation and fusion once the spinal growth is complete will yield successful results with no complications in the middle and the long term. Further multicenter studies with more comprehensive assessments are required to find solutions to spinal problems related to this rare skeletal dysplasia.

DIAGNOSIS AND TREATMENT OF RETAINED WOODEN FOREIGN BODIES IN THE EXTREMITIES USING ULTRASOUND.

OBJECTIVE: This study investigates ultrasonography as an effective tool for localizing and measuring the depth and size of wooden foreign bodies to perform less invasive and easier surgery without the need for any additional radiological techniques. METHODS: Fifteen patients were operated to remove foreign bodies in the extremities in 2016. The side of the affected extremity, the material, size, and location of the foreign body and time of admission after injury were noted, along with CRP, WBC, and erythrocyte sedimentation rate; length of incision, surgery duration, and complications were evaluated. RESULTS: The mean patient age was 39.66 (range: 6 to 68). Of the total, 8 of the foreign bodies were in the plantar surfaces of the feet, 3 were in the cruris, 2 were in the palm of the hand, and 2 were in the fingers. All patients underwent ultrasound evaluation before surgery. The surgeries lasted less than 10 min in 13 (87%) of the cases and from 10 to 20 min in 2 cases. No complications were observed in any of the patients. CONCLUSION: Delayed extraction of foreign bodies can lead to local infections. Ultrasonography can be a reliable option for diagnosing and localizing radiolucent foreign bodies such as wooden objects. Level of Evidence IV; Case series.

OBJETIVO: Neste estudo, procuramos mostrar que a ultra-sonografia é uma ferramenta eficaz para localizar e medir a profundidade e o tamanho dos corpos estranhos em madeira, a fim de realizar uma cirurgia menos invasiva e mais fácil, sem a necessidade de técnicas radiológicas adicionais. MÉTODOS: 15 pacientes foram submetidos à cirurgia para penetração de corpo estranho nas extremidades em 2016. O lado da extremidade afetada, o material, tamanho e localização do corpo estranho e o tempo de admissão após lesão foram observados. CRP, WBC e taxa de sedimentação de eritrócitos também foram observados. O comprimento da incisão, duração da operação e complicações foram avaliados. RESULTADOS: A idade média do paciente foi de 39,66 (intervalo: 6 a 68). No total, oito de todos os corpos estranhos estavam no lado plantar dos pés, três estavam no crúis, dois estavam na palma da mão e dois estavam nos dedos. Todos os pacientes foram submetidos a avaliação ultra-sonográfica antes da cirurgia. A duração da operação foi inferior a 10 minutos em 13 (87%) dos casos e entre 10 a 20 minutos em dois casos. As complicações não foram observadas em todos os pacientes. CONCLUSÃO: A extração retardada de corpos estranhos pode levar a infeções locais. A ultra-sonografia pode ser uma opção confiável para diagnosticar e localizar corpos estranhos radiolúcidos, como objetos de madeira. Nível de evidência IV; Série de casos.

Diagnosis and treatment of retained wooden foreign bodies in the extremities using ultrasound / Diagnóstico e tratamento com ultra-som de corpos estranhos de madeira retidos nas extremidades

ABSTRACT Objective This study investigates ultrasonography as an effective tool for localizing and measuring the depth and size of wooden foreign bodies to perform less invasive and easier surgery without the need for any additional radiological techniques. Methods Fifteen patients were operated to remove foreign bodies in the extremities in 2016. The side of the affected extremity, the material, size, and location of the foreign body and time of admission after injury were noted, along with CRP, WBC, and erythrocyte sedimentation rate; length of incision, surgery duration, and complications were evaluated. Results The mean patient age was 39.66 (range: 6 to 68). Of the total, 8 of the foreign bodies were in the plantar surfaces of the feet, 3 were in the cruris, 2 were in the palm of the hand, and 2 were in the fingers. All patients underwent ultrasound evaluation before surgery. The surgeries lasted less than 10 min in 13 (87%) of the cases and from 10 to 20 min in 2 cases. No complications were observed in any of the patients. Conclusion Delayed extraction of foreign bodies can lead to local infections. Ultrasonography can be a reliable option for diagnosing and localizing radiolucent foreign bodies such as wooden objects. Level of Evidence IV; Case series.

RESUMO Objetivo Neste estudo, procuramos mostrar que a ultra-sonografia é uma ferramenta eficaz para localizar e medir a profundidade e o tamanho dos corpos estranhos em madeira, a fim de realizar uma cirurgia menos invasiva e mais fácil, sem a necessidade de técnicas radiológicas adicionais. Métodos 15 pacientes foram submetidos à cirurgia para penetração de corpo estranho nas extremidades em 2016. O lado da extremidade afetada, o material, tamanho e localização do corpo estranho e o tempo de admissão após lesão foram observados. CRP, WBC e taxa de sedimentação de eritrócitos também foram observados. O comprimento da incisão, duração da operação e complicações foram avaliados. Resultados A idade média do paciente foi de 39,66 (intervalo: 6 a 68). No total, oito de todos os corpos estranhos estavam no lado plantar dos pés, três estavam no crúis, dois estavam na palma da mão e dois estavam nos dedos. Todos os pacientes foram submetidos a avaliação ultra-sonográfica antes da cirurgia. A duração da operação foi inferior a 10 minutos em 13 (87%) dos casos e entre 10 a 20 minutos em dois casos. As complicações não foram observadas em todos os pacientes. Conclusão A extração retardada de corpos estranhos pode levar a infeções locais. A ultra-sonografia pode ser uma opção confiável para diagnosticar e localizar corpos estranhos radiolúcidos, como objetos de madeira. Nível de evidência IV; Série de casos.

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100°.

OBJECTIVE: The aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°. METHODS: The medical records of 17 patients (mean age 17.9 (range, 9-27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24-64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients. The sagittal plane parameters (local kyphosis angle, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence) were measured in the preoperative and the early postoperative periods and during the last follow-up on the lateral radiographs. RESULTS: The mean preoperative localized kyphosis angle was 121.8° (range, 101°-149°). The mean local kyphosis angle (LKA) was 71.5° at postoperatively evaluation (p < 0.05). Complications were detected in 12 patients (70.6%) with spinal shock in 4 patients, hemothorax in 3 patients, postoperative infection in 2 patients, dural laceration in 2 patients, neurological deficit in 2 patients (1 paraplegia and 1 root injury), the shifted cage in 2 patients and rod fracture in 2 patients. Neurological events occurred in six patients (35%) with temporary neurological deficit in 5 patients and permanent neurological deficit in 1 patient. CONCLUSION: PVCR is an efficient and a successful technique for the correction of SAK. However, it can lead to a large number of major complications in SAK greater than 100°. LEVEL OF EVIDENCE: Level IV, therapeutic study.

The effect of Kinesio taping on back pain in patients with Lenke Type 1 adolescent idiopathic scoliosis: A randomized controlled trial.

PURPOSE: This study investigated the short-term effects of KT on back pain (BP) in patients with Lenke Type 1 adolescent idiopathic scoliosis (AIS). METHODS: We chosen Lenke Type 1 scoliosis who have had only back pain (the localization of the pain: the only in the apical convex edge). Forty patients suffering from BP with Lenke Type 1 AIS were randomly separated into two groups, Group 1 (20 patients) and Group 2 (20 patients). Group 1 was given KT with tension and home exercises and Group 2 was given KT without tension and home exercises. KT and home exercises was applied to the thoracic area of the patients in both groups for four weeks. Pain intensity was measured using a visual analog scale (VAS) and SRS-22 (subtotal SRS-20) before and after treatment. RESULTS: Mean age of both groups was 16.1 years. Mean Cobb angle of the thoracic scoliosis was 31.8° (range: 17°-44°) in Group 1 and 32.8° (range: 19°-43°) in Group 2 before the treatment. The decrease in VAS score of Group 1 after taping was higher than that of Group 2. The difference between the pre- and post-treatment VAS scores of both groups was statistically significant (p < 0.05). The increase in mean SRS-20 score of Group 1 following taping application was significantly higher than the increase in the control group (p < 0.05). CONCLUSION: Results demonstrated that KT application with tension effectively leads to back pain relief shortly after application. In addition, KT has a positive impact on quality of life. Thus, KT may be a suitable intervention in treating back pain of patients with AIS. LEVEL OF EVIDENCE: Level 1, Therapeutic study.

Vitamin-D measurement in patients with adolescent idiopathic scoliosis.

Our retrospective study compared vitamin-D levels in 229 patients with adolescent idiopathic scoliosis (AIS) and 389 age-matched controls, and evaluated the correlation between vitamin-D levels and sex, Cobb's angle, and serum levels of calcium (Ca), phosphorus, and alkaline phosphatase in the AIS group. Vitamin-D levels were lower in the AIS group, with no sex-specific effects, indicative of a possible vitamin-D resistance in AIS. Vitamin-D levels correlated positively with Ca levels and negatively with Cobb's angle, indicative of a possible role of vitamin D in the etiopathogenesis of AIS. Patients with AIS should be monitored for vitamin-D deficiency/insufficiency.

A New Radiological Sign for Severe Angular Kyphosis: "The Baltalimani Sign".

STUDY DESIGN: Retrospective diagnostic study. PURPOSE: To define a new radiological sign, "Baltalimani sign," in severe angular kyphosis (SAK) and to report its relationship with the risk of neurological deficits and deformity severity. OVERVIEW OF LITERATURE: Baltalimani sign was previously undefined in the literature. METHODS: We propose Baltalimani sign as the axial orientation of the vertebrae that are located above or below the apex of angular kyphosis on anteroposterior radiographs. Patients with SAK of various etiologies with kyphotic angles ≥90° were selected and evaluated for the presence of Baltalimani sign. Demographic data of the patients including age, gender, etiology, neurological status, local kyphosis angles, and the location of the kyphosis apex were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of Baltalimani sign for the risk of the neurological deficits were evaluated by the IBM SPSS ver. 20.0. A p-values of <0.05 were considered statistically significant. Cohen's kappa was used for analysis of interrater agreement. RESULTS: The mean local kyphosis angle in all patients was 124.2° (range, 90°-169°), and 15 of 40 (37.5%) patients had neurological deficits. Baltalimani sign was seen in 13 of 15 patients with neurological deficits (p=0.001). Baltalimani sign showed a sensitivity and specificity PPV and NPV of 61.9%, 86.7%, 89.5%, and 68.8% for the risk of the neurological deficits in SAK patients, respectively. Cohen's kappa value was moderate (κ=0.506). CONCLUSIONS: The detection of Baltalimani sign in SAK may indicate severity of deformity and the risk of neurological deficits.

The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

PURPOSE: The aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively. METHODS: Datas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months. RESULTS: The mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5mm(range, 1-30mm). The mean early postoperative coronal balance was measured as 3.5mm(range, 0-36 mm). The mean coronal balance was measured as 5.5mm(range, 0-38mm) during the last follow-up (p>0.05). CONCLUSION: We suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively.

The effect of simple local resection on pain and scoliotic curve in patients with scoliosis secondary to osteoid osteoma and osteoblastoma in the spine.

OBJECTIVE: The aim of this study was assess the results of local resection without instrumentation in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma. METHODS: The review of our database revealed 176 cases of osteoid osteomas and 18 of osteoblastomas. Painful scoliosis was seen in 5 out of 6 cases. The lesion was found on the posterior part of the apical vertebra in the concave side of the scoliotic curve. Surgical treatment consisted of simple en bloc excision. Mean period between diagnosis and operation was 2.6 years, mean age at the time of surgery was 12.5 years, and mean preoperative major Cobb angle was 37.2°. RESULTS: Four patients with a mean follow-up of 4.3 years were included in the study. At final follow-up, Cobb angle was 7.6°, and the average percentage of correction was 79.6%. Coronal decompensation was corrected by 87.7%. Pelvic tilt and shoulder imbalance were corrected by 15% and 74.5%, respectively. The preoperative mean Visual Analog Scale score was 9 before the treatment and 0 at the final follow-up. CONCLUSION: Our results suggested that simple en bloc resection may be a safe and effective treatment option in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma, if patient less than 16 years, with major Cobb angle less than 40°, and duration of complaint less than 22 months.

Factors affecting results of fluoroscopy-guided facet joint injection: Probable differences in the outcome of treatment between pure facet joint hypertrophy and concomitant diseases.

STUDY DESIGN: Retrospective cohort study. PURPOSE: Facet joints are considered a common source of chronic low-back pain. To determine whether pathogens related to the facet joint arthritis have any effect on treatment failure. MATERIALS AND METHODS: Facet joint injection was applied to 94 patients treated at our hospital between 2011 and 2012 (mean age 59.5 years; 80 women and 14 men). For the purpose of analysis, the patients were divided into two groups. Patients who only had facet hypertrophy were placed in group A (47 patients, 41 women and 6 men, mean age 55.3 years) and patients who had any additional major pathology to facet hypertrophy were placed in group B (47 patients, 39 women and 8 men, mean age 58.9 years). Injections were applied around the facet joint under surgical conditions utilizing fluoroscopy device guidance. A mixture of methylprednisolone and lidocaine was used as the injection ingredient. RESULTS: In terms of Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, no significant difference was found between preinjection and immediate postinjection values in both groups, and the scores of group A patients were significantly lower (P < 0.005) compared with that of group B patients at the end of the third, sixth, and twelfth month. CONCLUSION: For low-back pain caused by facet hypertrophy, steroid injection around the facet joint is an effective treatment, but if there is an existing major pathology, it is not as effective.

Preoperative and Postoperative Photographs and Surgical Outcomes of Patients With Kyphosis.

STUDY DESIGN: A retrospective clinical study was performed. OBJECTIVE: The aim of the study was to show patients their pre- and postoperative body photographs, and determine the effect on postoperative patient satisfaction for thoracic and thoracolumbar sharp and round angular kyphosis. SUMMARY OF BACKGROUND DATA: Previous studies have reported the normative values of pelvic sagittal parameters and the classification of normal patterns of sagittal curvature, but no study has investigated and compared the clinical photographs of sharp and round kyphosis. METHODS: In patients who underwent surgery for thoracic and thoracolumbar sharp and round angular kyphosis, whole spine anteroposterior and lateral radiographs, and clinical photographs were obtained preoperatively and at the final follow-up. Pelvic and spinal parameters were measured, and the pre- and postoperative photographs were shown to patients. The Scoliosis Research Society 22r (SRS22r) and Short Form 36 surveys were administered to all patients, and the scores were analyzed. RESULTS: Thirty-eight patients diagnosed with kyphosis (mean age 19.6 yr, mean follow-up duration 26.4 mo) were divided into two groups: sharp (18 patients, mean age 20.1 yr) and round (20 patients, mean age 19.6 yr) kyphosis. There was no difference between values in the sharp and round groups in terms of age, follow-up duration, and Risser score (P > 0.05). In both groups, the subscores for pain, self-image, mental health, and satisfaction, except for the function/activity score, and the total score of the SRS22r survey were, however, significantly different between pre- and postoperative photographs. In addition, there was no significant difference between the two groups in any SRS22r domain and Short Form 36 scores. CONCLUSION: The surgical treatment of kyphosis was uniformly associated with improved quality of life, regardless of the kyphosis type. Thus, showing patients their pre- and postoperative photographs may enhance patient satisfaction, as measured by SRS22r scores. LEVEL OF EVIDENCE: 4.