A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I.

PURPOSE: Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia. PATIENTS AND METHODS: A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared. RESULTS: Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach. CONCLUSION: Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences. LEVEL OF EVIDENCE: 3 (Retrospective case-control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table.

Neuroendoscopy-Assisted Minimal Invasive Management of Chiari 1 Malformation.

Objective The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia. Design, Setting, and Participants In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared. Results The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80-150 minutes). The average blood loss was 40 mL (20-110 mL). Conclusion Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients.

Evaluation of Sexual Function in Patients with Lower Lumbar Disc Herniation: A Comparison of Pre- and Postoperative Status.

BACKGROUND: Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions. METHODS: A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment. RESULTS: According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery (p < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively (p < 0.001). CONCLUSION: The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy.

Establishing Safe Surgical Parameters for Placement of C2 Pedicle Screws: A Retrospective Study.

BACKGROUND: The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed. METHODS: This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal computed tomography (CT) scans were examined. Anatomical measurements were taken to determine the horizontal and vertical distances from the C2 pedicle projection to the vertebral foramen using CT images. Based on the anatomical location of the vertebral artery within the C2 vertebral foramen, the patients were divided into four subgroups using the horizontal pedicle width (HPW) and vertical pedicle width (VPW) of the C2 spine. RESULTS: The average age of the patients included in the study was 46.48 years. The patient population comprised 32 (48.5%) males and 34 (51.5%) females. Based on the anatomical measurements, the distribution of C2 vertebra types was as follows: type 1 accounted for 68.9%, type 2 for 3.8%, type 3 for 16.7%, and type 4 for 10.6%. Significantly narrower pedicle widths were observed in types 2 and 4 compared to other vertebra types. Type 2 had the largest medial angle (MA), while type 4 had the narrowest MA. In terms of the sagittal plane, type 4 exhibited the widest MA and type 3 had the narrowest MA, but these differences were not statistically significant. Among the cases, 12 (18.1%) involved the vertebral foramen, with 1 case (8.3%) showing screw-related vertebral artery injury (0.75% of all screws). No vertebral artery injuries were observed with the other transpedicular screws. CONCLUSION: Preoperative anatomical measurements for patients undergoing transpedicular instrumentation on the C2 vertebra should include planning CT images on three planes: axial, sagittal, and coronal.

Maternal Serum and Fetal Cord Blood Concentrations of Thiol/ Disulfide and Ischemia-Modified Albumin as Predictors of Neural Tube Defects.

AIM: To investigate the predictive role of thiol/ disulfide homeostasis and Ischemia-modified albumin (IMA) levels for NTDs. MATERIAL AND METHODS: A total of 71 pregnant women (31 with NTD and 42 healthy controls) were enrolled in this study. This prospective case-control study included pregnant women with NTDs as the study group and randomly selected age-matched pregnant women with healthy fetuses as the control group. The two groups were compared on the basis of thiol/disulfide and IMA levels in the maternal and fetal samples. RESULTS: No statistically significant difference in native thiol, total thiol, disulfide, and calculated ratios was observed between the groups. However, maternal IMA values were significantly higher in the study group. The IMA was proven to be a predictor with a sensitivity of 77.4% and specificity of 100% for NTDs at a cut-off value of 1.32. CONCLUSION: The examination of the maternal levels of IMA may be useful in the detection of NTDs.

Effect of sequential-combined solar energy assisted hot air and hot air assisted radio frequency drying on the physical and chemical properties of dried apricots.

Quality characteristics of sulphured and non-sulphured apricots dried with a sequential combined pilot scale solar assisted hot air and hot air assisted radio frequency dryer and conventional sun system were compared. The combined drying approach showed improved color, hardness, antioxidant activity and retention of vitamin C, ß-carotene and total phenolic content values compared to conventional sun drying both for sulphured and non-sulphured samples. The effects of sulphur concentration and addition of pistachio hull extract as a treatment prior to drying were also investigated. Increase in sulphur concentration and addition of extract resulted in considerable quality (with respect to color, Vitamin C, ß-carotene and total phenolic content) increase in apricots. The apricots pretreated with extract had the highest total phenolic content and antioxidant activity. This study demonstrated that combined drying process is an effective drying method for apricots with the better preservation of product quality attributes.

A case of atlantoaxial dislocation associated with ipsilateral vertebral and carotid artery dissections: highlighting the injury biomechanics and management strategy.

INTRODUCTION: Traumatic cervical artery dissections carry significant morbidity and mortality among blunt trauma victims. The current paper illustrates a case with a young male who presented with atlantoaxial dislocation associated with ipsilateral carotid and vertebral artery dissections complicated by middle cerebral artery (MCA) infarction. CASE REPORT: We report a young male who presented to the emergency department with ipsilateral carotid and vertebral artery dissections complicated by middle cerebral artery (MCA) stroke associated with atlantoaxial dislocation after jumping into the water from a height. A young patient presented to us 1 year after sustaining an injury. We did posterior C1/2 fusion using the technique described by Harms and Goel to treat his atlantoaxial dislocation. The patient tolerated the surgery well and was discharged on postoperative day 4. CONCLUSIONS: We highlighted the complicated course of the simultaneously traumatic dissections of ipsilateral cervical arteries along with atlantoaxial dislocation, the biomechanics of this combination of injuries, and their management strategy.

Hot air-assisted radio frequency drying of apricots: Mathematical modeling study for process design.

Conventional hot air and solar energy processes have been used for apricot. These processes had adverse effects on the quality due to the longer process times, and this indicates the need for an innovative approach. Radio frequency (RF) processing has innovation potential for drying with its volumetric heating feature, but an optimal process should be designed for process efficiency in industrial-scale applications. Therefore, the objective of this study was to confirm the RF process for industrial-scale apricot drying. For this purpose, a mathematical model was developed to predict temperature and moisture content change of apricots during drying, and experimental validation study was carried out. For the RF drying process, pre-dried apricots (0.58-0.75 kg water/kg dry matter, db) by solar energy were used. The purpose was to start the RF process at a suitable moisture content level as this process was not feasible to apply directly due to the high initial moisture content of apricots (up to 4 kg water/kg dry matter, db). RF drying experiments were carried out in a 10 kW hot air-assisted (50-60°C) staggered through electrode system. Optimum electrode gap was 81 mm with 2500 V potential of the charged electrode. Final moisture content of the dried apricots was 0.25-0.33 kg water/kg dry matter (db). Following the model validation for temperature and moisture content change, industrial-scale apricot drying scenarios were demonstrated to confirm the RF process for feasibility and process design. PRACTICAL APPLICATION: A comprehensive mathematical model was developed for radio frequency (RF) drying of apricots. This model was experimentally validated with respect to the temperature and moisture content change. Various process design studies were carried out for an industrial-scale apricot drying process to confirm the process feasibility. With this background, the results of this study can be directly used in an industrial drying for an optimal process design and energy efficiency.

Clinical Results of Unilateral Dynamic Rod Application in the Short-Medium Period.

AIM: To evaluate the clinical results of patients who underwent unilateral dynamic rod stabilization after unilateral facet joint excision during spinal surgery. MATERIAL AND METHODS: Twenty patients who were diagnosed with degenerative spinal disease or spinal tumor, who were operated on using a unilateral approach, who underwent facet joint resection, and who were stabilized with a unilateral dynamic rod were examined. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to clinically evaluate the cases during the preoperative and postoperative periods. Radiological examinations for sagittal alignment, segmental angle, and bone fusion were also conducted. RESULTS: The mean preoperative VAS and ODI scores were 7.6 and 71.7, respectively, and the 12 < sup > th < /sup > postoperative month scores were 1.1 and 12.8, respectively. The mean segmental angle measurements were 22.1° in the preoperative period and 21.6° at the postoperative 12 < sup > th < /sup > month. No deterioration in sagittal alignment and no bone fusion were observed. CONCLUSION: We can protect segmental movements and provide sufficient stability by applying unilateral dynamic rod stabilization after unilateral facetectomy. In addition, applying screws to one side can reduce operation time and cost as well as the possibility of complications.

Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation.

OBJECTIVE: To evaluate the clinicoradiologic conditions of patients with a herniated cervical disk who were treated with percutaneous endoscope-assisted cervical diskectomy. MATERIALS AND METHODS: The medical data of 27 patients (16 men and 11 women; mean age: 40.9 years) who were operated on with the posterior endoscope-assisted cervical diskectomy method were reviewed retrospectively. The mean follow-up was 35.1 months, and the patients were assessed with combined preoperative and postoperative visual analog scale (VAS), Prolo Functional Economic Outcome Rating scale, MacNab scale, and clinical imaging. RESULTS: The mean preoperative VAS level was 8.6 (range: 7-10), and mean Prolo score was 2.5 (range: 2-5). A postoperative assessment performed 1 week postsurgery found a mean VAS level of 2.1 (range: 0-4). At the final examination, the mean VAS level was 0.81 (range: 0-3), and the mean Prolo score was 4.5 (range: 3-5). The final MacNab scale scores were 62.9%, excellent; 25.9%, good; 7.4%, moderate; and 3.7%, poor. CONCLUSION: Percutaneous endoscope-assisted cervical diskectomy is a suitable and effective treatment method for soft cervical disk herniation.

Endoscopic Untethering of Tight Filum Terminale: An Operative Technique.

AIM: To demonstrate the various technical advantages of minimally invasive endoscopic untethering of tight filum terminale for the treatment of tethered cord syndrome (TCS). MATERIAL AND METHODS: In five pediatric cases of TCS, we performed untethering by using the endoscopic technique. The age of the patients were 6, 7, 8, 9, and 12 years old. We used a nasal speculum of the transsphenoidal approach during the endoscopic surgical procedure. RESULTS: All the procedures were performed uneventfully, except for one case with a split cord malformation that showed neurologic deterioration caused by excision of the diastematomyelic fibrous septum at the thoracic level (unrelated to the endoscopic procedure at the L5-S1 level). This patient was referred to a rehabilitation clinic 5 days after surgery and showed significant improvement by the third postoperative month. The other four patients were discharged 1 day after the operation. CONCLUSION: Endoscopic release of filum terminale is a safe technique especially if it is performed with neuromonitoring. This technique may shorten the length of hospital stay and reduce perioperative blood loss. However, futher studies with a larger number of patients and long-term follow-up are needed.

A dual-phase scaffold produced by rotary jet spinning and electrospinning for tendon tissue engineering.

Tendon is a highly hierarchical and oriented tissue that provides high mechanical strength. Tendon injuries lead to loss of function, disability, and a decrease in quality of life. The limited healing capacity of tendon tissue leads to scar tissue formation, which can affect mechanical strength and cause a re-tear. Tissue engineering can be the solution to achieving complete and proper healing of tendon. The developed constructs should be mechanically strong while maintaining a suitable environment for cell proliferation. In this study, a dual-phase fibrous scaffold was produced by combining fibrous mats produced by rotary jet spinning (RJS) and wet electrospinning (WES), with the intent of improving the healing capacity of the construct. Dual-phase scaffolds were formed from aligned poly(ϵ-caprolactone) (PCL) fibers (Shell) produced by RJS and randomly oriented PCL or PCL/gelatin fibers (Core) produced by WES systems. The scaffolds mimicked i) the repair phase of tendon healing, in which randomly-oriented collagen type III is deposited by randomly-oriented WES fibers and ii) the remodeling stage, in which aligned collagen type I fibers are deposited by aligned RJS fibers. In vitro studies showed that the presence of randomly-oriented core fibers inside the aligned PCL fiber shell of the dual-phase scaffold increased the initial attachment and viability of cells. Scanning electron microscopy and confocal microscopy analysis showed that the presence of aligned RJS fibers supported the elongation of cells through aligned fibers which improves tendon tissue healing by guiding oriented cell proliferation and extracellular matrix deposition. Tenogenic differentiation of human adipose-derived mesenchymal stem cells on scaffolds was studied when supplemented with growth differentiation factor 5 (GDF-5). GDF-5 treatment improved the viability, collagen type III deposition and scaffold penetration of human adipose derived stem cells. The developed FSPCL/ESPCL-Gel 3:1 scaffold (FS = centrifugal force spinning/RJS, ES = wet electrospinning, Gel = gelatin) sustained high mechanical strength, and improved cell viability and orientation while supporting tenogenic differentiation.

Urgent operation improves weakness in cauda equina syndrome due to lumbar disc herniation.

OBJECTIVES: This study aims to examine the effect of surgical timing on the sphincter function and improvement of motor function in patients with cauda equine syndrome (CES) due to lumbar disc herniation (LDH). PATIENTS AND METHODS: Between January 2005 and December 2013, a total of 33 patients (18 males, 15 females; mean age 48.6±2.2 years, range, 24 to 73 years) who underwent lumbar spinal surgery and were diagnosed with CES due to LDH were retrospectively analyzed. Data including demographics, muscle weakness, sensory deficit, sphincter control, LDH level, time from the initiation of symptoms to admission, and time to surgery were documented. The latest muscle weakness, sensory deficits, and sphincter control were also recorded. The patients were divided into two groups according to the rate of muscle strength improvement and data including age, sex, and operation time were compared. RESULTS: The weakness remained unchanged in 11 (33.3%), improved in 13 (39.4%), and returned to normal in nine (27.3%) patients. Sphincter control resolved in five patients. Sensory loss resolved in two patients. While admission duration was shorter in the group with improved muscle strength (p=0.02), there was no significant difference in the time to surgery (p=0.63). Logistic regression analyses revealed that only the admission within 0 to 24 hours was significant for the muscle strength improvement (regression coeeficient [B]=2.83, standard error [SE]=0.86, p=0.006). CONCLUSION: A significant improvement in the motor strength can be achieved in patients with CES who are operated within 24 hours. On the other hand, patients with CES should be received surgery immediately when first seen, regardless of the time, since the muscle strength is slightly improved.

Nanocrystalline Zn2+ and SO42- binary doped fluorohydroxyapatite: A novel biomaterial with enhanced osteoconductive and osteoinconductive properties.

In this study, we have successfully doped hydroxyapatite (HA) with zinc (Zn2+), sulphate (SO42-) and fluoride (F-) ions to develop a new composition of bioceramic, Ca10-x Znx(PO4)6-y(SO4)y(OH)2-z-yFz(SO4)y, (x = 0, 0.2, 0.6, 1.0, y = 0, 0.5 and z = 0,1.0 mol), using wet precipitation method. The obtained materials were analysed using XRD, FTIR, FESEM, and XPS techniques to investigate the phase purity, particle morphology and elemental composition, respectively. A model anticancer drug (Doxorubicin, DOX) was loaded onto the surface of the Zn/SO4-FHA materials. About 100% loading of DOX with a controlled release profile was obtained. Degradation of materials in Simulated body fluid (SBF) was greatly improved with the incorporation of Zn2+/SO42- ions in comparison to HA/FHA, which makes it highly bioactive materials. In vitro cell viability and adhesion of Human fetal osteoblast (hFOB) cell were investigated. Cell viability has demonstrated that the hFOB cells proliferated at a high rate on Zn/SO4-FHA materials, confirming the in vitro biocompatibility of the materials. Alkaline phosphatase (ALP) activity and intracellular calcium deposition of hFOB cells seeded on 1ZnSO4-FHA disc surface was statistically higher than observed on pure HA and FHA discs, indicating that hFOB cells differentiated into mature osteoblasts on 1Zn/SO4-FHA disc surfaces. Taken together, our results suggest that HA substituted by (Zn2+, 0.2 mol), (SO42-, 0.5 mol) and (F-, 1 mol) (1Zn/SO4-FHA) material was a promising material for hard tissue scaffolds.

Diatom shell incorporated PHBV/PCL-pullulan co-electrospun scaffold for bone tissue engineering.

Tissue engineering can benefit from wide variety of materials produced by microorganisms. Natural origin materials often possess good biocompatibility, biodegradability with sustainable production by microorganisms. A phytoplankton, diatom, produces an amorphous silica shell that can be obtained by a cost efficient production process. Diatom shells (DS) are promising for bone tissue engineering since silicon enhances bone regeneration. Biocompatible and biodegradable biopolymers with microorganism origin can be combined with DS to produce tissue engineering constructs. In this study, a novel multifunctional 3D fibrous scaffold for bone tissue engineering was produced by co-electrospinning system; antibiotic loaded poly(hydroxybutyrate-co-hydroxyvalerate)/poly(ε-caprolactone) (PHBV/PCL) fibers and DS incorporated pullulan (PUL) fibers. Controlled release of cefuroxime axetil (CA) from DS and scaffolds were investigated upon loading CA into DS or PHBV/PCL fibers. Purified DS were characterized with ESCA, SEM, and EDX analyses while scaffolds were evaluated in terms of morphology, porosity, degradation, calcium deposition, water retention and mechanical properties. In vitro studies showed that scaffolds bearing DS have improved human osteosarcoma (Saos-2) cell viability. Developed co-electrospun scaffold showed higher osteocompatibility with better cell spreading and cell distribution. Results showed that DS loaded, co-electrospun scaffold having both hydrophobic and hydrophilic characteristics can be a promising biomaterial for bone tissue engineering.

A new therapeutic combination for osteosarcoma: Gemcitabine and Clofazimine co-loaded liposomal formulation.

Osteosarcoma is the most common cancer in bone. Drug resistance is a challenge of current treatments that needs to be improved with novel treatment strategies. In this research, a new dual drug delivery system was developed with Gemcitabine (GEM) and Clofazimine (CLF) co-loaded liposome formulations. GEM is a well-known anticancer agent and CLF is a leprostatic and anti-inflammatory drug recently recognized as effective on cancer. GEM and CLF co-loaded liposomal formulation was achieved with compartmentalization as hydrophilic GEM being in core and lipophilic CLF sequestering in lipid-bilayer. Liposomes had high encapsulation efficiency (above 90%, GEM and above 80%, CLF). CLF release was enhanced while GEM release was slowed down in co-loaded liposomes compared to single cases. GEM/CLF co-loaded liposomes significantly enhanced cytotoxicity than GEM or CLF loaded liposomes on osteosarcoma cell line. CLF and GEM had synergistic effect (CI < 1). Results of flow cytometry showed higher apoptotic cell ratio, caspase-3 activity, mitochondrial membrane depolarized cells' ratio for GEM/CLF co-loaded liposome treatments than other liposomes. Cytotoxicity of CLF on bone cancer cells and also its synergistic effect with GEM on osteosarcoma is reported for the first time with this study. CLF's loading with GEM into liposome was also a new approach for enhancement of anticancer effect on Saos-2 cells. Therefore, GEM/CLF co-loaded liposomal delivery system is proposed as a novel approach for treatment of osteosarcoma.

Silicate-doped nano-hydroxyapatite/graphene oxide composite reinforced fibrous scaffolds for bone tissue engineering.

In this study, novel graphene oxide-incorporated silicate-doped nano-hydroxyapatite composites were prepared and their potential use for bone tissue engineering was investigated by developing an electrospun poly(ε-caprolactone) scaffold. Nanocomposite groups were synthesized to have two different ratios of graphene oxide (2 and 4 wt%) to evaluate the effect of graphene oxide incorporation and groups with different silicate-doped nano-hydroxyapatite content was prepared to investigate optimum concentrations of both silicate-doped nano-hydroxyapatite and graphene oxide. Three-dimensional poly(ε-caprolactone) scaffolds were prepared by wet electrospinning and reinforced with silicate-doped nano-hydroxyapatite/graphene oxide nanocomposite groups to improve bone regeneration potency. Microstructural and chemical characteristics of the scaffolds were investigated by X-ray diffraction, Fourier transform infrared spectroscope and scanning electron microscopy techniques. Protein adsorption and desorption on material surfaces were studied using fetal bovine serum. Presence of graphene oxide in the scaffold, dramatically increased the protein adsorption with decreased desorption. In vitro biocompatibility studies were conducted using human osteosarcoma cell line (Saos-2). Electrospun scaffold group that was prepared with effective concentrations of silicate-doped nano-hydroxyapatite and graphene oxide particles (poly(ε-caprolactone) - 10% silicate-doped nano-hydroxyapatite - 4% graphene oxide) showed improved adhesion, spreading, proliferation and alkaline phosphatase activity compared to other scaffold groups.

Relationship of biological factors to survival in spinal gunshot injuries.

BACKGROUND: Gunshot injuries are the third leading cause of spinal injuries, after falls from a significant height and traffic accidents. Severity of spinal damage from gunshot injury depends upon certain mechanical and biological factors. The aim of the present study was to investigate the effect of biological factors on survival in cases of spinal gunshot injury. METHODS: A total of 110 cases of spinal gunshot injury admitted multiple times to emergency services between 2012 and 2014 were included. Age, sex, region of trauma, additional organ or systemic involvement, treatment modalities (conservative, surgical), and mortality rates were analyzed. Effects of biological factors on survival were evaluated. RESULTS: Mean age of the study population was 25.51±11.74 years (min: 4; max: 55) and 95.5% of the population was male. Regions of trauma were thoracic in 50 (45.4%) subjects, cervical in 42 (38.2%), and lumbar in 18 (16.4%). Most common American Spinal Injury Association (ASIA) score was category A, as was found in 77 (70%) cases. No significant correlation was found among age, sex, ASIA score, treatment modality (conservative or surgical), and survival (p>0.05). Additional organ or systemic injury was present in 66 (60%) patients. Additional organ or systemic injury significantly affected survival, independent of the spinal region of trauma (p<0.01). CONCLUSION: Spinal gunshot injuries are complex, with unclear treatment protocol. Irrespective of the indications of spinal surgery, additional organ injuries unfavorably affect survival in cases of spinal gunshot injury. Appropriate management of all biological factors directly affects mortality rate in cases of spinal gunshot injury.

Initial Discectomy Associated with Aging Leading to Adjacent Disc Disease and Recurrence.

AIM: Failure of surgery for lumbar disc herniation (LDH) can be commonly caused by recurrence. There are many debates regarding the risk factors of recurrent LDH (rLDH) and it is very difficult to define them because many clinical and complicated biomechanical parameters are involved. The purpose of study was to evaluate the long term result of re-discectomy for LDH at the same level and adjacent segments. MATERIAL AND METHODS: Between 1999 and 2009, 1898 cases were operated and 142 (6.4%) patients underwent re-discectomy following initial operation. The study included 65 patients who were operated for single level discectomy, and their charts were analyzed retrospectively. RESULTS: There were 33 (50.8%) women and mean age was 45.5 years (24-73 years). rLDH was diagnosed at the initial level in 40 (61.5%) but adjacent and/or opposite level herniation (with or without the first level) was found in the remaining 25 cases (39.1%). Recurrence at the same level (SLG) and adjacent level groups (ALG) were similar according to the clinical outcomes in follow-up (mean 34.1 months). Admission period after initial operation was also parallel in SLG and ALG (54.7 and 53.1 months, respectively). However, the mean age of ALG (49.4 years) was significantly higher (p≤0.05) than SLG (42.8 years). CONCLUSION: After discectomy, collapsed discs are biomechanically more stable than those with preserved disc heights, and responses to axial compression on intervertebral disc pressure produced deformations of adjacent levels despite limitations. Altered biomechanical loading next to a fusion resulted in ongoing degeneration with aging at the affected entire lumbar spine.

Neuroprotective effects of adalimumab on rats with experimental peripheral nerve injury: An electron microscopic and biochemical study.

BACKGROUND: Adalimumab, a new-generation anti-inflammatory agent, exerts its effect through tumor necrosis factor α (TNF-α), secreted from immune response cells such as macrophages and lymphocytes. TNF-α has been shown to play an important role in the processes of apoptosis and demyelination, and blockage of its activity may improve neural healing. Investigated in the present study is the probable neuroprotective influence of adalimumab in rats using a peripheral nerve injury model with biochemical and electron microscopic methods. METHODS: Forty adult Wistar albino rats were randomly divided into control, sciatic nerve trauma, low-dose adalimumab, and high-dose adalimumab groups. Six rats from each group were assigned biochemical microscopy, and 4 were assigned electron microscopy. Neural injury was induced with clip compression following dissection of sciatic nerves. Adalimumab was simultaneously injected. The rats were sacrificed after 2 weeks of adalimumab treatment. RESULTS: Nerve tissue lipid peroxidation values were found to be significantly decreased in both the low- and high-dose adalimumab treatment groups, compared to the group subjected only to sciatic nerve trauma. CONCLUSION: Results demonstrate that adalimumab is an effective neuroprotective agent for neural healing, particularly in the early phase.