Use of Dynamic Spinal Instruments (Dynesys) in Adult Spinal Deformities According to Silva-Lenke and Berjano-Lamartina Classifications.

BACKGROUND: Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. OBJECTIVE: This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. METHODS: ASDs were classified according to the Berjano-Lamartina (BL) and Silva-Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. RESULTS: Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). CONCLUSION: The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.

Clinical experience: Outcomes of mesenchymal stem cell transplantation in five stroke patients.

Stem cell therapy, which has promising results in acute disorders such as stroke, supports treatment by providing rehabilitation in the chronic stage patients. In acute stroke, thrombolytic medical treatment protocols are clearly defined in neurologic emergencies, but in neurologic patients who miss the "thrombolytic treatment intervention window," or in cases of hypoxic-ischemic encephalopathy, our hands are tied, and we are still unfortunately faced with hopeless clinical implementations. We consider mesenchymal stem cell therapy a viable option in these cases. In recent years, novel research has focused on neuro-stimulants and supportive and combined therapies for stroke. Currently, available treatment options are limited, and only certain patients are eligible for acute treatment. In the scope of our experience, five stroke patients were evaluated in this study, who was treated with a single dose of 1-2 × 106 cells/kg allogenic umbilical cord-mesenchymal stem cells (UC-MSCs) with the official confirmation of the Turkish Ministry of Health Stem Cell Commission. The patients were followed up for 12 months, and clinical outcomes are recorded. NIH Stroke Scale/Scores (NIHSS) decreased significantly (p = 0.0310), and the Rivermead Assessment Scale (RMA) increased significantly (p = 0.0234) for all patients at the end of the follow-up. All the patients were followed up for 1 year within a rehabilitation program. Major clinical outcome improvements were observed in the overall clinical conditions of the UC-MSC treatment patients. We observed improvement in the patients' upper extremity and muscle strength, spasticity, and fine motor functions. Considering recent studies in the literature together with our results, allogenic stem cell therapies are introduced as promising novel therapies in terms of their encouraging effects on physiological motor outcomes.

Importance of Physiotherapy after Lumbar Microdiscectomy.

AIM: To investigate the effects of a lumbar exercise program after single-level lumbar microdiscectomy on the recurrence of lumbar disc diseases. MATERIAL AND METHODS: Between 2018 and 2021, 223 patients (104 women, 119 men, median age: 49 years) who received their first corrective surgery for lumbar disc herniation were included in this retrospective study. Their clinical status was evaluated before surgery, early post-surgery, and 6-months after surgery using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Patients were divided into two groups: group A (n=124) included those who regularly participated in the postoperative physical therapy and rehabilitation program for 6 months; group B (n=99) included those who did not regularly participated or did not participate at all in the physical therapy and rehabilitation program. Their compliance to the 6-month physical therapy program (started at our clinic in the 1st postoperative month) and its relation to recurrent lumbar disc hernia at the same level was evaluated. RESULTS: In group B, 82 patients showed irregular compliance to the physical therapy program and 17 patients did not participate in the physical therapy program. During the 6-month follow-up period, 27 patients developed recurrent disc hernia at the same level (group A, 9 patients; group B, 18 patients) and they accordingly underwent repeat microdiscectomy surgery. CONCLUSION: Compliance with the postoperative physical therapy program after single-level lumbar microdiscectomy is one of the factors that prevented recurrent disc hernia during the early postoperative period.

A Combined Diagnosis and Treatment Algorithm for Spine Infection Management: A Single-Center Experience.

Background and objective Spinal infection (SI) is an infectious disease affecting the vertebral column, spinal cord, and adjacent structures. The infection can occur following interventions or spontaneously. The aim of this study was to highlight the importance of employing a methodological approach for the accurate and rapid diagnosis of SI and to share information on the most effective treatment method, which involves using a diagnostic-treatment algorithm that can help with SI management. Methodology This study included 50 patients diagnosed with SI between 2016 and 2020. The treatment follow-up period was limited to six months, and the study was conducted as a retrospective cohort analysis. The sample consisted of 22 female patients and 28 male patients, and the mean age of the patients was 50.2 years. All patients received diagnosis and treatment according to the algorithm described in this article. Results In the study group, 60% of patients had an infection in the lumbar spine, 4% in the thoracal spine, 12% in the cervical spine, and 8% in the sacral spine. Previously operated patients were diagnosed on the 30.16th day on average. A total of 19 patients (38%) had no history of undergoing surgery. Radiologically, the most common finding was spondylodiscitis/discitis (32%). Osteomyelitis was detected in one (2%) patient. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism in culture results and was detected in 13 patients (26%). The culture results of 12 patients (24%) were negative. The number of patients with active SI who were unstable and stabilized at the time of diagnosis was 11 (22%), and stabilization materials were removed in two patients (4%). In the 6th month of control, the patients did not have any complaints, signs of an infection, or unstable vertebral column. Conclusions We conclude that the combined algorithm we recommend for the diagnosis and treatment of patients with SI can prevent negative deviation and is an effective treatment for this condition.

Lumbar Foraminal Stenosis Classification That Guides Surgical Treatment.

BACKGROUND: There are numerous radiological and anatomical studies on lumbar foramina in the literature, but there are no distinctive studies about the relationship between treatment and the type of foraminal stenosis. This study was conducted to better evaluate foraminal stenosis and to plan treatment accordingly. METHODS: Foraminal stenosis was divided into 2 groups: stable and unstable stenosis. Both groups were also divided into 4 subgroups in relation to the cause and type of compression and based on the structure of the intervertebral disc. The visual analog scale for leg pain (VAS-LP) and Oswestry Disability Index (ODI) scores were investigated before and after surgery. RESULTS: A total of 115 patients (59 women and 56 men) underwent surgery for lumbar foraminal stenosis. The mean patient age was 56.1 years (range 17-80 years). The mean follow-up was 29 months (range 24-39 months). There were 36 patients (32%) with stable foraminal stenosis and 79 patients (68%) with unstable foraminal stenosis. The majority of the patients were identified as having unstable type 1 foraminal stenosis (45 of 115). The VAS-LP and ODI scores for each group decreased gradually during the follow-up periods and showed significant decrease during the last follow-up (P < 0.001). Interobserver and intraobserver agreement in the classification of foraminal stenosis was found to be nearly perfect. No patients experienced postoperative radiculopathy complication. Only 2 patients experienced superficial operation site infection and 1 showed deep wound infection. The patient who had a deep wound infection needed to repeat surgery for the infection. CONCLUSIONS: We introduced a novel classification system for lumbar foraminal stenosis. We aimed to guide appropriate treatment modality depending on the determined classification. This classification helps to determine the optimal treatment. In the light of our findings, the patients who were operated according to our classification experienced satisfactory clinical outcomes and low complication rates.

The Effects of Rehabilitation Following Anterior Cervical Microdiscectomy and Fusion Surgery.

AIM: To determine the effects of physical therapy and exercise programs that was performed after anterior cervical discectomy and fusion (ACDF) surgery on patient?s pain treatment, a retrospective study was designed. MATERIAL AND METHODS: Of the 127 patients without neurological deficit who underwent ACDF surgery in our clinic in 2019 and 2020 for single-level cervical disc herniation, 40 patients (including 23 men and 17 women) were enrolled. The mean age of the patients was 45.5 years. The patients were separated into two groups. Group A comprised 20 patients who did not apply for a post-ACDF physical therapy and exercise program. Group B comprised 20 patients who applied for a 6-month post-ACDF physical therapy and exercise program and complied with it. The Oswestry Deficiency Index (ODI), visual analog pain scale (VAS), and C2-7 cervical lordosis angle were evaluated. The C2-7 cervical lordosis angles were individually calibrated and calculated for each patient using Surgimap. The relationships between the results were compared using Wilcoxon biostatistics test. RESULTS: The ODI, VAS, and C2-7 cervical lordosis angle parameters of Groups A and B were statistically compared. No significant differences in the ODI, VAS, and C2-7 cervical lordosis angle 2 days after surgery and C2-7 cervical lordosis angle 6 months after surgery were observed between the two groups; however, significant differences were observed in VAS and ODI values 6 months after physical therapy in Group B and in VAS and ODI values 6 months after surgery in Group A. No significant difference in C2-7 cervical lordosis angle 6 months after surgery was observed between post-physical therapy Group B and postoperative Group A. CONCLUSION: Physical therapy and exercise program performed early after ACDF enhances and improves pain management and does not cause any changes in the restoration of cervical misalignment.

Kyphoplasty with Posterior Dynamic Stabilization in the Surgical Treatment of Unstable Thoracolumbar Osteoporotic Vertebral Compression Fractures.

AIM: To evaluate the role of posterior dynamic stabilization (PDS) with kyphoplasty (KP) in the surgical treatment of unstable osteoporotic compression fractures, which are common in the elderly population. MATERIAL AND METHODS: This study included 25 patients with osteoporotic compression fractures. KP with PDS was performed on all patients. Radiological evaluation was performed with magnetic resonance imaging, computed tomography, and plain radiographs. The vertebral kyphosis angle (VKA), local kyphosis angle (LKA), and percentage of collapse were calculated. Clinical evaluation was performed with the visual analog scale and the Oswestry Disability Index (ODI). The preoperative and postoperative clinical and radiological data were compared. RESULTS: The clinical and radiological parameters showed significant improvement following surgical treatment. The mean preoperative visual analog scale score of 7.78 decreased to 0.94 after 12 months. The mean preoperative ODI score of 70.33 decreased to 15.65 after 12 months. The mean preoperative VKA of 17.89° decreased to 9.22° after 12 months. The mean preoperative LKA of 9.61° decreased to 5.50° after 12 months. The mean preoperative percentage of collapse of 32.56% decreased to 19.00% after 12 months. There were no major complications. CONCLUSION: KP with the PDS method offered satisfactory outcomes in the surgical treatment of unstable osteoporotic compression fractures.

Changes in cervical sagittal alignment and the effects on cervical parameters in patients with cervical spondylotic myelopathy after laminoplasty.

OBJECTIVE: To monitor changes in cervical parameters before and after laminoplasty surgery. Cervical parameters and health-related quality-of-life (HRQOL) values that may be affected after laminoplasty were examined before and after surgery. The clinical and radiological course of these values was monitored, and their interaction with all spinal radiological parameters was revealed. MATERIALS AND METHODS: Nineteen patients who underwent clinical and radiological evaluation for 2 years were followed in this study. Neck disability index, visual analog scale, and short form 36 scores were determined to evaluate HRQOL. For radiological parameters, the C0-C2 angle, C2-C7 angle, cervical sagittal vertical axis, T1 slope angle, neck tilt (NT) and thoracic inlet angle were used. The results of the 4-month, 1 year and 2-year follow-ups were statistically evaluated. RESULTS: Both the HRQOL and cervical radiological parameters deteriorated in the first 4 months and returned to normal in the 2nd year. Statistically, all parameters were meaningful (P < 0.05), except for NT. CONCLUSION: Cervical parameters and HRQOL values, which deteriorated in the early period, recovered in the late period in the long-term follow-up of patients undergoing laminoplasty. The important point is that preoperative cervical parameters suitable for laminoplasty should be present, and spinopelvic parameters should be normal.

Should Iliac Wing Screws Be Included in Long Segment Dynamic Stabilization?

Background In this article, clinical satisfaction and radiological results are discussed in a series of patients where the iliac wings participate in dynamic stabilization. Dynamic stabilization is an effective alternative surgical treatment method, especially in clinical pictures that go with pain due to minor instabilities. Practically the unique surgical instrument used in multilevel instabilities is the Dynesys system. The most important drawback of the Dynesys system is that the S1 screws become loose in time. In this article, our aim is to find solution to S1 insufficiency by extension of the system to the iliac wings. Methods Nineteen patients (eight females, 11 males) with a mean age of 54.16 were included in the study. Patients had multilevel (level 2 and above) instability, iliac wings were included in the stabilized segments, and Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for patient follow-up. Results First year results showed a significant improvement in VAS and ODI. Regarding the complications, infection developed in one patient, loosening in the proximal iliac wing in one patient, and both S1 and iliac proximals in one patient, but no clinical findings were encountered. Conclusion When more than two levels of dynamic systems are used in chronic instability, especially in the elderly patients, S1 screws are loosened. In these patients, if the iliac bones are also included in stabilization, this problem is solved successfully. However unfortunately, Dynesys system does not have a screw suitable for the iliac bones.

A Clinical Comparison of Home-Based and Hospital-Based Exercise Programs Following Arthroscopic Capsulolabral Repair for Anterior Shoulder Instability.

CONTEXT: Ideal rehabilitation method following arthroscopic capsulolabral repair surgery for anterior shoulder instability has not been proven yet. Although rapid or slow protocols were compared previously, home- or hospital-based protocols were not questioned before. OBJECTIVE: The aim of this prospective unrandomized controlled clinical trial is to compare the clinical outcomes of home-based and hospital-based rehabilitation programs following arthroscopic Bankart repair. DESIGN: Nonrandomized controlled trial. SETTING: Orthopedics and physical therapy units of a single institution. PATIENTS: Fifty-four patients (49 males and 5 females) with an average age of 30.5 (9.1) years, who underwent arthroscopic capsulolabral repair and met the inclusion criteria, with at least 1-year follow-up were allocated into 2 groups: home-based (n = 33) and hospital-based (n = 21) groups. INTERVENTIONS: Both groups received identical rehabilitation programs. Patients in the home-based group were called for follow-up every 3 weeks. Patients in the hospital-based group admitted for therapy every other day for a total of 6 to 8 weeks. Both groups were followed identically after the eighth week and the rehabilitation program continued for 6 months. MAIN OUTCOME MEASURES: Clinical outcomes were assessed using Disabilities of Arm Shoulder Hand, Constant, and Rowe scores. Mann-Whitney U test was used to compare the results in both groups. Wilcoxon test was used for determining the progress in each group. RESULTS: Groups were age and gender matched (P = .61, P = .69). Average number of treatment sessions was 13.8 (7.3) for patients in the hospital-based group. Preoperative Disabilities of Arm Shoulder Hand (27.46 [11.81] vs 32.53 [16.42], P = .22), Constant (58.23 [14.23] vs 54.17 [10.46], P = .13), and Rowe (51.72 [15.36] vs 43.81 [19.16], P = .12) scores were similar between groups. Postoperative scores at sixth month were significantly improved in each group (P = .001, P = .001, and P = .001). No significant difference was observed between 2 groups regarding clinical scores in any time point. CONCLUSIONS: We have, therefore, concluded that a controlled home-based exercise program is as effective as hospital-based rehabilitation following arthroscopic capsulolabral repair for anterior shoulder instability.

A Rehabilitation Protocol for Patients with Lumbar Degenerative Disc Disease Treated with Posterior Transpedicular Dynamic Stabilization.

AIM: To evaluate the efficacy of the rehabilitation protocol on patients with lumbar degenerative disc disease after posterior transpedicular dynamic stabilization (PTDS) surgery. MATERIAL AND METHODS: Patients (n=50) with single level lumbar degenerative disc disease were recruited for this study. Patients had PTDS surgery with hinged screws. A rehabilitation program was applied for all patients. Phase 1 was the preoperative evaluation phase. Phase 2 (active rest phase) was the first 6 weeks after surgery. During phase 3 (minimal movement phase, 6-12 weeks) pelvic tilt exercises initiated. In phase 4 (dynamic phase, 3-6 months) dynamic lumbar stabilization exercises were started. Phase 5 (return to sports phase) began after the 6th month. The primary outcome criteria were the Visual Analogue Pain Score (VAS) and the Oswestry Disability Index (ODI). Patients were evaluated preoperatively, postoperative 3rd, 12th and 24th months. RESULTS: The mean preoperative VAS and ODI scores were 7.52±0.97 and 60.96±8.74, respectively. During the 3rd month, VAS and ODI scores decreased to 2.62±1.05 and 26.2±7.93, respectively. VAS and ODI scores continued to decrease during the 12th month after surgery to 1.4±0.81 and 13.72±6.68, respectively. At the last follow-up (mean 34.1 months) the VAS and ODI scores were found to be 0.68±0.62 and 7.88±3.32, respectively. (p=0.0001). CONCLUSION: The protocol was designed for a postoperative rehabilitation program after PTDS surgery for patients with lumbar degenerative disc disease. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and the presented rehabilitation program.

A rehabilitation protocol for patients with lumbar degenerative disk disease treated with lumbar total disk replacement.

OBJECTIVES: To evaluate the efficacy of the rehabilitation protocol designed by the Physical Medicine and Rehabilitation Department on the patients with lumbar degenerative disk disease after lumbar disk replacement surgery. DESIGN: Open prospective auto-controlled trial. SETTING: Physical medicine and rehabilitation department, neurosurgery department, and anesthesiology and pain management department. PARTICIPANTS: Patients (N=20) with single level lumbar degenerative disk disease were recruited for this study. INTERVENTIONS: Lumbar disk prosthesis surgery with metal on metal lumbar disk prosthesis; preoperative, provocative, diskography; and a postoperative rehabilitation program were used. MAIN OUTCOME MEASURES: Change in the functional status and pain intensity in patients was evaluated by the Oswestry Disability Index (ODI) and visual analog scale (VAS) during rest and movement. The ODI and VAS during rest and movement were primary outcome criteria, while return to work and duration of hospital stay were secondary outcome criteria. The results for the various scoring systems were statistically analyzed using the t test. RESULTS: Preoperative mean VAS scores ± SD at rest and movement were initially in the range of 6.00±2.47 and 8.65±1.08, respectively. The scores decreased to 1.70±1.12 and 2.60±1.72 at 3 months postsurgery, respectively (P<0.01). The scores decreased to 1.20±0.69 and 1.90±1.07 at 12 months postsurgery, respectively (P<0.01). The mean preoperative ODI score was 73.3±15.5; the postoperative scores were 35.0±15.5 and 20.4±12.9 at 3 and 12 months, respectively (P<0.01). The mean duration of hospital stay ± SD was 3.5±1.6 days, and return to work was achieved after a mean ± SD period of 14.1± 4.3 days with no complications related to surgery or the rehabilitation protocol. CONCLUSIONS: The protocol was designed for postoperative rehabilitation program after artificial lumbar disk replacement surgery for degenerative disk disease patients. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and presented rehabilitation program. These parameters provide early pain relief and return to activities of daily living after surgery.