The effect of intermittent diet and/or physical therapy in patients with chronic low back pain: A single-blinded randomized controlled trial.

BACKGROUND AND PURPOSE: This study aimed to investigate the effect of intermittent diet and/or physical therapy in patients with chronic low back pain. MATERIALS AND METHODS: Sixty sedentary volunteers with chronic low back pain participated in the study. Body weight and body mass index (BMI) were measured. Pain severity was assessed using Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), while assessment of disability was done using Barthel Index (BI). RESULTS: The weight and BMI were reduced after treatment with diet only and diet plus physical therapy (p < 0.001). The pain severity was reduced in all the treated groups (p < 0.001), while BI was increased in the group treated with only physical therapy (p < 0.001). CONCLUSION: The present study indicated that intermittent diet and/or physical therapy are beneficial to patients with chronic low back pain in terms of pain sensation and daily activities.

Comparison of Unilateral versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion for Single Level Lumbar Degenerative Diseases and Review of Literature.

AIM: There are some recognized treatment modalities in the literature for the treatment of lumbar degenerative diseases,which cause pain and avoidance of daily life activities for the patients.The most widely accepted algorithm in the literature is medical treatment,physical therapy and minimally invasive pain-relieving therapies,if necessary,followed by surgical interventions.The common procedure used in neurosurgery practice is the decompression of neural elements followed by fusion.It is reported in the literature that unilateral pedicle fixation and Transforaminal Lumbar Interbody Fusion(TLIF) procedure have many advantages compared to bilateral pedicle screw implementation(PSF).We examined the clinical and radiological follow-up and results of our patients undergoing fusion procedure by unilateral versus bilateral pedicle screw fixation along with TLIF. MATERIAL AND METHODS: 54 patients were included in the study.33 patients were operated with bilateral PSF and TLIF and 21 had unilateral PSF and TLIF.The patients were evaluated preoperatively,on the postoperative 15th day,6th and 12th month, and at the time of last examination (38 months in average for all patients) using Visual Analogue Scale(VAS) and Oswestry Disability Index(ODI).Fusion rates were examined with direct X-ray films with flexion-extension dynamic views and 3D CT scan. RESULTS: Operation times are shorter and blood loss is less in the unilateral PSF group.Fusion rates are similar in both groups with no statistical significance.For both groups significant clinical improvement was observed in the preoperative and postoperative scores. CONCLUSION: Unilateral PSF along with TLIF procedure is an effective option in selected patients.We need prospective randomized studies with higher number of patients and longer follow-up periods for more reliable results.

Thoracic vertebral hemangioma causing paraplegia in Klippel-Trenaunay-Weber syndrome: case report.

Vertebral hemangiomas are the most common tumours of the vertebral column. Generally, these tumours are asymptomatic but some patients complain of back pain and develop neurologic symptoms due to extraosseous extension. Vertebral hemangiomas can extend extradurally causing neurological impairment as a result of compression of the spinal cord and nerve roots. Vertebral hemangiomas may be multiple and detectable as a component of the Klippel-Trenaunay-Weber syndrome. Although this syndrome consists of deep venous thrombosis, lymphatic anomalies, cutaneous capillary malformations, and hypertrophy of soft tissue and bone on extremities, its clinical presentation may be very variable. We present a unique case of vertebral hemangioma causing spinal cord compression due to the extradural extension that also had deep venous thrombosis, hematuria, hypophyseal cyst and ventricle asymmetry, diagnosed as the Klippel-Trenaunay-Weber syndrome.

Tenosynovial giant cell tumor in the cervico-thoracic junction.

Tenosynovial giant cell tumor (TGT) rarely arises from the posterior coloumn of the cervical spine. Most lesions of TGT involve the tendon sheath and joint lining of the small joints of the fingers and hands, and consecutively the knee, ankles and feet, and hips. Rate of extra-articular presentation is about 5-15% in all cases. In this report, a case with paraparesis caused by TGT in the cervico-thoracic junction is presented. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed. In the treatment of TGT of the vertebral column, the main aim should be total surgical excision of the tumor.

CT findings of a thoracic vertebral hemangioma presenting with acute neurological symptoms.

Vertebral body hemangiomas are benign lesions and account for 4% of all spinal tumors. The most common histological type is cavernous hemangioma. These tumors generally locate in the vertebral body as a solitary lesion. Multiple lesions are seen in approximately 25-30% of vertebral hemangiomas. Mostly they are asymptomatic and incidentally found with radiological studies. Symptomatic vertebral hemangiomas are rare and represent < 1% of all hemangiomas; however, if untreated, they may cause local or radicular pain and neurological deficits ranging from myeloradiculopathy to paralysis. In this case we aim to present preoperative and postoperative Computed Tomography findings of a cavernous hemangioma that caused sudden motor deficit and was localised to the thoracic vertebra corpus and posterior elements.

The ATA and its surgical importance: a newly described ligament lying between the dural sac and the ligamentum flavum at the L5 level.

STUDY DESIGN: The anatomy of a new ligament in the human spine the ATA is described. OBJECTIVE: To describe a new ligament; the ATA, which lies between the dural sac and the ligamentum flavum at the L5 level and to discuss it's surgical importance. SUMMARY OF BACKGROUND DATA: Postoperative cerebrospinal fluid (CSF) leakage translates into longer hospital stays with significant implications for the patient, the health care system, and society as a whole. To avoid injury to the dural sac during lumbar surgery, it is crucial to know the surgical anatomy and its variations. METHODS: The length and the number of ATAs were examined in 14 consecutive patients, which underwent an L5 laminoflavectomy in our department. The ATA and its anatomic landmarks are described here for the first time in the literature. We named this ligament the ATA; reminding us to pay attention to the Terminal Attachment. RESULTS: The presence of the ATA is demonstrated in 10 patients (71%). There was a double ATA in four patients (40%). The mean length of the ATA was 7.7 ± 1.8 mm. The ATA originates from the dorsal surface of the dura mater at the level of the superior border of the superior facet of the S1 vertebra and projects toward the ligamentum flavum. Histologic examination of the ATA revealed fibrous connective tissue. CONCLUSION: In this preliminary study, we have described a new ligament, the ATA, between the dural sac and the ligamentum flavum at the L5 level. The ATA is an important structure that creates a potential risk for inadvertent dural lacerations during flavectomy. Dissecting the ATA before the flavectomy may be an important step in reducing postoperative cerebrospinal fluid leaks, which may result in significant benefits for patients and health care organizations.

Immunomodulation of acute experimental spinal cord injury with human immunoglobulin G.

Immunomodulation of acute spinal cord injury may inhibit the activity of specific inflammatory cascades and result in recovery of motor function. In this study, evaluation of the protective effect of a well-known anti-inflammatory immunomodulator, immunoglobulin G (IgG), was conducted in rats after a 50 g/cm contusion spinal cord injury. Following injury, 400 mg/kg of IgG was administered to the treatment group. Twenty-four hours later, animals were assessed functionally via an inclined plane and the Basso-Beattie-Bresnahan motor scale and compared to controls. Tissue was reviewed for myeloperoxidase activiy (MPO) and lipid peroxidation (LPO), and electron microscopy was conducted to assess tissue ultrastructure. Significant functional preservation was observed in the IgG treatment group. In addition, biochemical assays revealed decreased MPO activity, and electron microscopic views of tissue showed preserved ultrastructure. IgG treatment following acute contusion injury to the rat spinal cord confers functional and structural neuroprotection.

Atorvastatin efficiency after traumatic brain injury in rats.

BACKGROUND: The neuroprotective effects of statins possibly depend on their pleiotropic effect such as antioxidative and anti-inflammatory properties. In this study, we have evaluated the efficiency of atorvastatin on brain edema, lipid peroxidation, and ultrastructural changes in TBI animal model. METHODS: Modified Feeney method has been used for the trauma model in rats. Only craniectomy for group A and trauma after craniectomy for group B was the procedure for animals. For the trauma, rods weighing 24 g were dropped on a foot plate just over the dura. Atorvastatin (1 mg/kg, IP) was administered to the animals in group C after craniectomy and trauma; but on the other hand, animals in group D received only 0.5 mL PEG as the vehicle. Brains were harvested 24 hours after the trauma for the assays of wet-dry weight, lipid peroxidation level, and ultrastructural investigations. Lipid peroxidation levels, TEM, and UNGS were the investigated parameters. The statistical comparisons between the groups were investigated by 1-way ANOVA and post hoc analysis by Duncan and Dunnett T3 test within the groups at the significance level P = .05. RESULTS: Trauma increased water contents of the brain tissues and lipid peroxidation levels in groups B and D. When compared with the results of group B (brain edema, 84.694% +/- 1.510%; lipid peroxidation, 74.932 +/- 2.491 nmol/g tissue), atorvastatin (1 mg/kg) significantly decreased brain edema (77.362% +/- 1.448%), lipid peroxidation level (58.335 +/- 3.980 nmol/g tissue), and UNGS scores in group C (P < 0.05). CONCLUSION: In this descriptive study, the remarkable improvements of atorvastatin on brain edema, lipid peroxidation, and ultrastructural investigations encouraged us for a further dose optimization study.

Dysphagia due to diffuse idiopathic skeletal hyperostosis of the cervical spine.

Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is a common disorder of unknown etiology that is characterized by ossification of the anterior longitudinal ligament of the spine and various extra-spinal ligaments. We present the case of a 54-year-old woman with progressive dysphagia due to DISH of the cervical spine, which is a relatively rare pathology in neurosurgical practice. The cervical osteophytes extending from C2 to C4 and external compression of the pharyngoesophageal segment by the large osteophytes were demonstrated by X-ray, magnetic resonance imaging, and computed tomography. Surgical removal of the large osteophytes and a shortterm nonsteroidal anti-inflammatory drug regimen led to the resolution of dysphagia. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed.

Dermoid tumour of the lateral wall of the cavernous sinus.

Congenital intracranial dermoid tumors are very rare. Supratentorial dermoid cysts have been more frequently reported over the past decade and they are known to have a predilection for the cavernous sinus. Dermoid tumors originating from the cavernous sinus are usually interdural and thus, presentation with ophthalmoplegia is uncommon. They are congenital benign tumors and are believed to originate from ectopic inclusion of epithelial cells during closure of the neural tube during embryonic development. The location of these dermoid lesions in the cavernous sinus and the complexity of the operative procedure for these lesions have been noted by several authors. In this report, we describe the case of a dermoid cyst that was embedded in the lateral wall of the cavernous sinus and review the literature relating to related cavernous dermoid lesions.

Neuroprotective effect of erythropoietin after experimental cold injury-induced vasogenic brain edema in rats.

BACKGROUND: The aims of this study were to evaluate the efficiency of EPO in the treatment of cold injury-induced brain edema, apoptosis, and inflammation and to compare its effectiveness with DSP. METHODS: One hundred fifteen adult male Sprague-Dawley rats weighing between 280 and 300 g were used for the study. Rats were divided into 5 groups. Controls received craniotomy only. The injury group underwent cold injury and had no medication. In the EPO group, a single dose of 1000 IU/kg body weight of EPO was administered. The DSP group received 0.2 mg/kg body weight of DSP. The vehicle group received a vehicle solution containing human serum albumin, which is the solvent for EPO. Brain edema was formed by cold injury using metal sterile rods with a diameter of 4 mm that were previously cooled at -80 degrees C. Twenty-four hours after the injury, animals were decapitated and brain tissues were investigated for brain edema, tissue MPO and caspase-3 levels, and ultrastructure. RESULTS: A significant increase in brain water content was revealed in injury group of rats at 24 hours after cold injury. Injury significantly increased tissue MPO and caspase-3 levels and resulted in ultrastructural damage. Both EPO and DSP markedly decreased tissue MPO and caspase-3 levels and preserved ultrastructure of the injured brain cortex. CONCLUSIONS: Erythropoietin and DSP were found to be neuroprotective in cold injury-induced brain edema model in rats via anti-apoptotic and anti-inflammatory actions.

A comparative study of treatment for brain edema: magnesium sulphate versus dexamethasone sodium phosphate.

Treatments for brain edema are important and one of the major options is corticosteroids. Cell membrane stabilization and prevention of formation of free radicals are the main mechanisms of action of steroids in edema treatment. As an alternative therapeutic agent, magnesium sulphate has been used for its neuroprotective effect in various injury models. In our animal model of brain injury, cold has been used in Sprague-Dawley rats. After brain injury, magnesium sulphate (600 mg/kg) or dexamethasone sodium phosphate (0.2 mg/kg) were administered to experimental groups. The degree of brain edema and lipid peroxidation was evaluated using the wet-dry weight method, the determination of malondialdehyde (MDA) levels and an ultrastructural grading system. Magnesium sulphate treatment was found to be the most effective choice due to the absence of side effects and comparable efficacy to corticosteroids.

Multiple isolated spinous process fracture (Clay-shoveler's fracture) of cervical spine: a case report.

Fractures of isolated spinous processes of cervical and thoracic vertebrae are called as Clay shoveler's fracture. In this report, a case of 32-year-old male with multiple isolated spinous process fracture of cervical spine is reported. The patient treated conservatively with a cervical collar. These fractures may be a warning sign of more severe spinal injuries.

Effects of magnesium sulphate following spinal cord injury in rats.

Neutrophil infiltration has been implicated in the secondary destructive pathomechanisms after initial mechanical injury to the spinal cord. Tissue myeloperoxidase (MPO) activity has been shown to be an exclusive indicator of the extent of post-traumatic neutrophil infiltration. We have studied the effect of magnesium sulphate on MPO activity after spinal cord injury in rats. Rats were randomly allocated into 5 groups. Group 1 was control and normal spinal cord samples were obtained after clinical examination. Forty g-cm contusion injury was introduced to Group 2. Group 3 was vehicle, 1 ml of physiological saline was injected post-trauma. Group 4 was given 30 mg/kg methylprednisolone sodium succinate (MPSS) immediately after trauma. Group 5 was given 600 mg/kg magnesium sulphate immediately after trauma. Animals were examined by inclined plane technique of Rivlin and Tator 24 h after trauma. Spinal cord samples obtained following clinical evaluations. Magnesium sulphate treatment improved early functional scores and decreased MPO activity. These findings revealed that magnesium sulphate treatment possesses neuroprotection on early clinical results and on neutrophil infiltration after acute contusion injury to the rat spinal cord.

Effect of immunomodulation with human interferon-beta on early functional recovery from experimental spinal cord injury.

STUDY DESIGN: Electron and light microscopic changes, neutrophil infiltration, and lipid peroxidation in the spinal cord and early neurologic examination were studied in rats. OBJECTIVE: To examine the effects of immunomodulator treatment with recombinant human interferon-beta after spinal cord contusion injury. SUMMARY OF BACKGROUND DATA: Immunomodulator treatment with interferon-beta has been the subject of extensive studies, but mainly in relation to multiple sclerosis. Recently, it was reported that interferon-beta possessed significant neuroprotection after experimental transient ischemic stroke. However, to our knowledge, there have been no previous reports about the neuroprotective effect of interferon-beta after spinal cord injury. METHODS: Rats were randomly allocated into 5 groups. Group 1 was control and after clinical examination, normal spinal cord samples were obtained. Group 2 was introduced 50 g/cm contusion injury. Group 3 was vehicle, immediately after trauma 1 mL of physiologic saline was injected. Group 4 was given 30 mg/kg methylprednisolone sodium succinate intraperitoneally immediately after trauma. Group 5 was given 1 x 10(7) IU interferon-beta immediately and 0.5 x 10(7) IU interferon-beta 4 hours after trauma. Animals were examined by inclined plane and Basso-Beattie-Bresnahan scale 24 hours after trauma. Spinal cord samples obtained following clinical evaluations. Neutrophil infiltration was evaluated by myeloperoxidase activity and lipid peroxidation was estimated by thiobarbituric acid test. Electron and light microscopic results were also performed to determine the effects of interferon-beta on tissue structure. RESULTS: Interferon-beta treatment improved neurologic outcome, which was supported by decreased myeloperoxidase activity and lipid peroxidation. Electron and light microscopic results also showed preservation of tissue structure in the treatment group. CONCLUSIONS: Immunomodulator treatment with interferon-beta possesses obvious neuroprotection after acute contusion injury to the rat spinal cord.

Recombinant human erythropoietin decreases myeloperoxidase and caspase-3 activity and improves early functional results after spinal cord injury in rats.

Inflammatory response and apoptosis have been proposed as mechanisms of secondary injury of the spinal cord after primary insult. Recent studies have shown that erythropoietin (EPO) has neuroprotective properties. In this study, we assessed the efficacy of recombinant human erythropoietin (r-Hu-EPO) in the treatment of acute spinal cord injury (SCI) in rats. Rats were divided into five groups of eight rats each. Controls (Group 1) received laminectomy only. The trauma-only group (Group 2) underwent 40 g/cm contusion injury and had no medication. In group 3, 30 mg/kg of methylprednisolone (MPSS) was administered. Group 4 received 1000 IU/kg body weight of r-Hu-EPO. The vehicle group (Group 5) received a vehicle solution containing human serum albumin, which is the solvent for r-Hu-EPO. Twenty-four hours after trauma, animals were functionally evaluated and a spinal cord samples were obtained for the assessment of caspase-3 and myeloperoxidase (MPO) activities. The results showed that MPO and caspase-3 activities increased to statistically significant higher levels in the spinal cord after contusion injury comparing to the control group. MPO and caspase-3 enzyme activity levels were significantly reduced in animals treated either with r-Hu-EPO or MPSS. In addition, we observed significant early functional recovery in EPO-treated rats. EPO has anti-apoptotic and anti-inflammatory effects, and improves early clinical results after SCI.

Metoprolol treatment decreases tissue myeloperoxidase activity after spinal cord injury in rats.

Neutrophil infiltration has been reported to play an important role in spinal cord injury (SCI). In addition to their cardioprotective effects, beta-blockers have been found to have neuroprotective effects on the central nervous system, but their effect on SCI has not yet been studied. In the current study, we investigated the effect of metoprolol on myeloperoxidase (MPO) activity, a marker of neutrophil activation, in the spinal cord after experimental SCI in rats. Rats were divided into six groups: controls received only laminectomy and spinal cord samples were taken immediately; the sham operated group received laminectomy, and spinal cord samples were taken 4h after laminectomy; the trauma only group underwent a 50g/cm contusion injury but received no medication; and three other groups underwent trauma as for the trauma group, and received 30mg/kg methylprednisolone, 1mg/kg metoprolol, or 1mL saline, respectively. All the medications were given intraperitoneally as single doses, immediately after trauma. Spinal cord samples were taken 4h after trauma and studied for MPO activity. The results showed that tissue MPO activity increased after injury. Both metoprolol and methylprednisolone treatments decreased MPO activity, indicating a reduction in neutrophil infiltration in damaged tissue. The effect of metoprolol on MPO activity was found to be similar to methylprednisolone. In view of these data, we conclude that metoprolol may be effective in protecting rat spinal cord from secondary injury.

Intracranial metastasis of lung adenocarcinoma mimicking colloid cyst of the third ventricle.

A patient with intracranial lung adenocarcinoma metastasis mimicking a colloid cyst of the third ventricle is reported. These tumours may be associated with excessive bleeding and may infiltrate into surrounding structures. Open microsurgery rather than endoscopic surgery should be considered for these cases, particularly a transcortical-transventricular or transcallosal approach, in order to avoid serious complications.

The efficiency of dexamethasone sodium phosphate-encapsulated chitosan microspheres after cold injury.

OBJECTIVE: The aims of this study were to evaluate the efficiency of dexamethasone sodium phosphate (DSP) in the treatment of cold injury-induced brain edema and to compare systemic and topical application of DSP. METHODS: Sprague-Dawley rats weighing nearly 300 g were used in the experiments. Brain edema was formed by cold injury using metal sterile rods with a diameter of 4 mm that were previously cooled at -80 degrees C. Twenty-four hours after the injury, animals were decapitated and brain tissues were investigated by wet-dry weight method, lipid peroxidation ratio, and histological examination. RESULTS: The degree of edema was significantly lowered in groups in which DSP was administered using chitosan microspheres and by intraperitoneal route (P < .05). The statistical evaluation of the experimental results was performed using Mann-Whitney U test. Histological findings transmission electron microscopy (TEM) correlated with the quantitative results. CONCLUSION: Both intraperitoneal- and microsphere-administered DSP were found to be very effective in a cold injury brain edema model. The authors believe that future studies should lead to new applications of the microsphere formulations prepared by chitosan as the matrix material in many other therapies.

Magnesium sulfate treatment decreases caspase-3 activity after experimental spinal cord injury in rats.

BACKGROUND: Apoptosis has increasingly been considered as an important factor in secondary injury after spinal cord injury (SCI). Manifestation of apoptotic cell death process involves activation of the caspase-3 apoptotic cascade. The aim of the study was to demonstrate the effect of magnesium sulfate on caspase-3 activity and to compare its effectiveness with methylprednisolone after acute SCI. METHODS: The rats were randomly and blindly allocated into 5 groups of 8 rats each. Spinal cord contusion injury was produced by the weight drop method. The control group consisted of non-injured rats. In the trauma group, no treatment was given, whereas 1 mL saline, 600 mg/kg magnesium sulfate, and 30 mg/kg methylprednisolone sodium succinate (MPSS) were administered in the vehicle and both treatment groups immediately after injury. Twenty-four hours after trauma, spinal cord samples were obtained, and tissue caspase-3 activity levels were examined. A 1-way analysis of variance and the post hoc test were used for statistical analysis. RESULTS: The results showed that caspase-3 activity increased to statistically significantly higher levels in spinal cord after contusion injury than in the control group. Caspase-3 enzyme activity levels were significantly reduced in animals treated either with magnesium sulfate or MPSS. CONCLUSIONS: We have shown that magnesium sulfate decreases caspase-3 activity in rat spinal cord subjected to contusion injury. Magnesium sulfate may have potential therapeutic benefits by reducing apoptotic tissue damage after SCI.