Effects of vertebral fusion on levels of pro-inflammatory and catabolic mediators in a rabbit model of intervertebral disc degeneration.

OBJECTIVE: The aim of this study was to explore the alterations in levels of pro-inflammatory and catabolic mediators following vertebral fusion in a rabbit model of intervertebral disc degeneration. METHODS: In this study, 24 female New Zealand albino rabbits (aged 4 to 5 months and weighing 3 to 3.5 kg) were used. All the animals were randomly categorized into four groups, and dorsal spinal exposure of all lumbar vertebrae was routinely performed in each group. While disc degeneration was created in groups B, C, and D, spinal fusion was added to disc degeneration in groups C and D. Disc degeneration was typically created by puncturing the discs with an 18-gauge needle under the guidance of C-arm imaging. Fusion was achieved with posterior/posterolateral decortication and iliac bone grafts. The rabbits in groups A, B, and C were euthanized, and the discs were removed in the first week after the surgery. The rabbits in Group D were sacrificed, and the discs were harvested at 5 weeks after the surgery. The levels of Interleukin (IL)-1ß, IL-6, Nitric Oxide (NO), Matrix Metalloproteinase (MMP)-3, MMP-13, and Tissue Inhibitor of Metalloproteinases-1 (TIMP-1) in the discs were analyzed using enzyme-linked immunosorbent assay kits. RESULTS: Significant increase was observed in the protein levels of both pro-inflammatory and catabolic mediators in disc degeneration groups (Group B, C, and D) compared to Group A. In the fusion groups (Group C and D), these increased mediators decreased, compared to non-fusion group (Group B), (IL1-ß P = 0.017, TIMP-1 P = 0.03, NO P = 0.03). However, there was no statistically significant difference in mediator levels between the short- and long-term fusion (Group C versus D). CONCLUSION: The results of this study have shown that a significant decrease in pro-inflammatory and catabolic mediators may be expected after vertebral fusion whereas there may be no significant difference between the first and fourth week of fusion surgery. These findings may contribute to clarifying the mechanism of action of vertebral fusion in the treatment of low back pain.

Anatomical variations of iliolumbar artery and its relation with surgical landmarks.

OBJECTIVES: The aim of this study was to reveal the variations of origin of iliolumbar artery, and its relations with the surrounding surgically important anatomical structures. METHODS: The origin, diameter, and tract of iliolumbar artery were determined bilaterally in 21 formalin-fixed adult male cadavers (21 right and 21 left arteries) in the Laboratory of Department of Anatomy. RESULTS: Iliolumbar artery was originating from common iliac artery in 4.8% (2 arteries), internal iliac artery in 71.4% (30 arteries), posterior trunk of internal iliac artery in 19% (8 arteries), and as two different arteries from internal iliac artery in 4.8% (2 arteries) of the cases. The mean diameter of the iliolumbar artery was 3.7 mm. CONCLUSION: The anatomical properties of iliolumbar artery and its relation with anatomical landmarks, which were presented here, would be helpful in decreasing iatrogenic trauma to iliolumbar artery during surgery.

Neurovascular risks of sacral screws with bicortical purchase: an anatomical study.

The aim of this cadaver study is to define the anatomic structures on anterior sacrum, which are under the risk of injury during bicortical screw application to the S1 and S2 pedicles. Thirty formaldehyde-preserved human male cadavers were studied. Posterior midline incision was performed, and soft tissues and muscles were dissected from the posterior part of the lumbosacral region. A 6 mm pedicle screw was inserted between the superior facet of S1 and the S1 foramen. The entry point of the S2 pedicle screw was located between S1 and S2 foramina. S1 and S2 screws were placed on both right and the left sides of all cadavers. Then, all cadavers were turned into supine position. All abdominal and pelvic organs were moved away and carefully observed for any injury. The tips of the sacral screws were marked and the relations with the anatomic structures were defined. The position of the sacral screws relative to the middle and lateral sacral arteries and veins, and the sacral sympathetic trunk were measured. There was no injury to the visceral organs. In four cases, S1 screw tip was in direct contact with middle sacral artery. In two cases, S1 screw tip was in direct contact with middle sacral vein. It was observed that the S1 screw tips were in close proximity to sacral sympathetic trunk on both right and the left sides. The tip of the S2 screw was in contact with middle sacral artery on the left side only in one case. It is found that the tip of the S2 screw was closely located with the middle sacral vein in two cases. The tip of the S2 pedicle screw was in contact with the sacral sympathetic trunk in eight cases on the right side and seven cases on the left side. Lateral sacral vein was also observed to be disturbed by the S1 and S2 screws. As a conclusion, anterior cortical penetration during sacral screw insertion carries a risk of neurovascular injury. The risk of sacral sympathetic trunk and minor vascular structures together with the major neurovascular structures and viscera should be kept in mind.

Flexible flatfoot and related factors in primary school children: a report of a screening study.

The aim of this study was to analyze the longitudinal arch morphology and related factors in primary school children. Five hundred and seventy-nine primary school children were enrolled in the study. Generalized joint laxity, foot progression angle, frontal hindfoot alignment, and longitudinal arch height in dynamic position were evaluated. The footprints were recorded by Harris and Beath footprint mat and arch index of Staheli was calculated. The mean age was 9.23 +/- 1.66 years. Four hundred and fifty-six children (82.8%) were evaluated as normal and mild flexible flatfoot, and 95 children (17.2%) were evaluated as moderate and severe flexible flatfoot. The mean arch indices of the feet was 0.74 +/- 0.25. The percentage of flexible flatfoot in hypermobile and non-hypermobile children was found 27.6 and 13.4%, respectively. There was a statistically significant difference in dynamic arch evaluation between hypermobile and non-hypermobile children. There was a significant negative correlation between arch index and age, and a significant negative correlation between hypermobility score and age. Our study confirms that the flexible flatfoot and the hypermobility are developmental profiles.