Results of treatment of unstable thoracolumbar burst fractures using pedicle instrumentation with and without fracture-level screws.

BACKGROUND: Two different techniques of short-segment instrumentation, with and without a pedicle screw at the fracture level, were compared in thoracolumbar burst fractures in neurologically intact (ASIA-E) patients. The sagittal index, kyphosis angle (Cobb), canal compromise ratio, and compression ratio of the anterior vertebral height were analyzed. METHODS: Seventy patients who underwent short-segment stabilization for thoracolumbar (T11-L2) burst fractures in our clinic between 2008 and 2012 were included in this retrospective study. In 35 patients (group 1), a pedicle screw was placed only one level down and one level up from the fracture level. In another 35 patients (group 2), a screw was placed at the fracture level in addition to the short segment. Only neurologically intact patients with burst fractures according to the Denis classification were included. The patients were evaluated according to their age/gender, trauma etiology, and fracture level. Their preoperative and most recent postoperative follow-up radiographs and CTs were evaluated in terms of the sagittal index, kyphosis angle (Cobb), ratio of canal compromise, and anterior vertebral height. RESULTS: The two groups were similar in their ages, follow-up periods, and severity of the deformity and fracture. When the pedicle screw was placed at the fracture level in addition to short-segment stabilization, statistically significant improvements in the sagittal index (p < 0.001), local kyphosis (Cobb) angle (p = 0.006), and compression ratio of the anterior vertebral height (p = 0.002) were observed. Concerning the ratio of canal compromise according to the CT findings (p = 0.189), moderate differences were found. CONCLUSIONS: Short-segment stabilization in thoracolumbar burst fractures with additional screws at the level of the fracture results in an improved kyphosis correction, sagittal index, and compression ratio of the anterior vertebral height. However, long-term follow-up is needed to determine the clinical significance of these findings.

The Effects of Stereotactic Cerebroventricular Administration of Albumin, Mannitol, Hypertonic Sodium Chloride, Glycerin and Dextran in Rats with Experimental Brain Edema.

AIM: To evaluate the effects of cerebroventricular administration of hyperoncotic/hyperosmotic agents on edematous brain tissue in rats with experimental head trauma. MATERIAL AND METHODS: The study included 54 female Sprague-Dawley rats with weights ranging between 200 and 250 g. Six experimental groups were examined with each group containing 9 rats. All rats were exposed to head trauma, and treatment groups were administered 2 µl of one of the drugs (albumin, mannitol, hypertonic sodium chloride (NaCl), glycerin and dextran) 6, 12 and 24 hours after the trauma via the cerebroventricular route and using a stereotactic device. Rats were sacrificed 48 hours after the trauma, and brain tissues were extracted without damage. Biochemical analyses including reduced glutathione (GSH), nitric oxide (NO), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), and interleukin 1 beta (IL-1ß) were performed on the injured left hemisphere. RESULTS: Compared with the control group, the albumin, mannitol, 3% NaCl and glycerin treatment groups revealed dramatic increases in GSH levels (p < 0.001). Levels of MDA, which is the end-product of brain edema and lipid peroxidation, failed to show a statistically significant decrease, but there was a decreasing trend observed in the inter-group comparisons. NO levels were also decreased in the 3% NaCl treatment group. An analysis of TNF-α and IL-1ß, two proinflammatory cytokines associated with the trauma, revealed that IL-1ß decreased significantly in all treatment groups (p=0.001), whereas no significant difference was detected in TNF-α levels. CONCLUSION: Cerebroventricular administration of hyperoncotic/hyperosmotic agents provides substantial effects on the treatment of brain edema.

The Outcomes of Late Term Surgical Treatment of Penetrating Peripheral Nerve Injuries.

AIM: The aim of this retrospective study was to evaluate the follow-up results of patients who received late-term surgical treatment for peripheral nerve lesions caused by penetrating injuries. MATERIAL AND METHODS: The study included 25 patients who underwent surgery for peripheral nerve injuries in our clinic between 2007 and 2013. The patients were evaluated with respect to age, gender, etiology of the trauma, the affected nerve, clinical examinations, electrophysiological findings, surgical techniques and functional outcomes. RESULTS: The study included 30 nerves of 25 patients (19 male, 6 female; mean age 30.1 years). The mean time between the initial injury and admission to our clinic was 11.5 months (range, 3 to 30 months). Cuts caused by glass were the most common cause of injury (68.5%). The most commonly injured nerves in our patients were the median nerve (43.4%) and ulnar nerve (26.6%). External neurolysis and decompression were performed in eleven patients, epineurotomy and internal neurolysis were performed in eight patients, epineural repair was performed in fourteen patients, fascicular repair was performed in three patients, and interfascicular anastomosis using sural nerve grafting was performed in five patients. Postoperative motor strength and electrophysiological analyses showed significant improvements. Better outcomes were obtained in cases with median nerve injuries rather than other nerve injuries. Additionally, patients undergoing external neurolysis and decompression exhibited better outcomes than those undergoing other surgical approaches. CONCLUSION: Although surgical treatment is recommended as early as possible for peripheral nerve injuries, late-term surgical treatments may provide positive outcomes.

Evaluation of the Time-dependent Contamination of Spinal Implants: Prospective Randomized Trial.

STUDY DESIGN: Prospective study OBJECTIVE.: To evaluate contamination in spinal implants using a liquid culture medium and the effect of covering an implant set on contamination. SUMMARY OF BACKGROUND DATA: Postoperative infection rates increase with the use of spinal implants. Because implant contamination may be an important origin for postoperative infections, investigation, evaluation, and taking required precautions to prevent these contaminations are critical. METHODS: Patients operated on for various spinal pathologies were randomized. The patients were divided into groups of covered and uncovered implant sets. The screw samples were placed in liquid culture medium immediately after opening the implant set. The implant set in the covered group was immediately covered with a sterile surgical towel. A new screw was taken from the implant set and cultured in the liquid culture medium every 30 minutes. At the end of 24 hours, swabs with samples from the liquid culture medium were used to culture blood agar. At the end of 48 hours, the samples with growth were considered contaminated. RESULTS: Growth started after 30 minutes in the uncovered group, whereas only a single growth was noted after 60 minutes in the covered group. Contamination increased with time in both groups, but more so in the open group. A statistically significant difference in contamination was found between the groups at and after 30 minutes. CONCLUSION: Contamination increases with time in all implant materials. Contamination rates can be reduced by using simple precautions, such as covering the implant set. Culturing the entire implant samples in liquid culture medium is accepted as a safe and more effective method in evaluating contamination. LEVEL OF EVIDENCE: 2.

Dyke-davidoff-masson syndrome associated with epidermoid tumour and arachnoid cyst: a case report.

BACKGROUND: Dyke-Davidoff-Masson Syndrome (DDMS) is a rarely seen clinical entity which is characterised by cerebral hemiatrophy, contralateral hemiparesis and epilepsy. Radiological features are typical, such as unilateral atrophy of the cerebral hemisphere and associated compensatory bone changes in the skull, like thickening, enlargement of the paranasal sinuses and mastoid air cells. CASE REPORT: In this article, we report the first case of DDMS associated with epidermoid tumour and arachnoid cyst, who underwent operation for an epidermoid tumour in the inter-hemispheric region. To our knowledge, this is the first report of DDMS associated with multiple intracranial pathologies and this association has not been previously described in the literature. CONCLUSION: Any patient who receives DDMS in the light of clinical and radiological findings should be investigated for concomitant pathologies. Different sequences of MRI may be useful in the diagnosis of other intracranial lesions.