Role of radiofrequency ablation and cement injection for pain control in patients with spinal metastasis.

BACKGROUND: The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up. METHODS: Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure. RESULTS: The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment. CONCLUSION: Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.

Better neuroprotective profile of caffeic acid phenyl ester over resveratrol in non-traumatic ischemia-reperfusion injury of the spinal cord.

BACKGROUND: Spinal cord ischemia has serious sequelae. The aim of this study is to investigate the effects of resveratrol and caffeic acid phenyl ester (CAPE), a propolis derivative, on spinal cord injury induced by ischemia-reperfusion (IR). METHODS: In our research, 30 male Wistar albino rats, 200-250 gr, were used. Before the experiment, during a week of the process, the rats were fed with these two agents, and the experimental group rats were exposed to spinal cord IR injury. At the end of the experiment, spinal cord samples were taken from the sacrificed rats. Bax, p53, nNOS, and Beclin-1 immunoreactivity moreover TUNEL (+) cells were evaluated with immunohistochemically in the IR-induced damaged rats. RESULTS: It has been clearly determined that the TUNEL (+) apoptotic cell number and immunopositive cells of nNOS, Beclin-1, p53, Bax were raised in the IR group. However, these increments partially were restored in the resveratrol and CAPE-fed rats with IR-induced injury. CONCLUSION: In light of our data, resveratrol, and CAPE could be beneficial in spinal cord IR injury. Although both agents provide beneficial effects, it can be said that CAPE is partially more effective in spinal cord injury caused by IR.

Prognostic value of perihematomal edema area at the initial ED presentation in patients with intracranial hematoma.

OBJECTIVE: Intracerebral hemorrhage (ICH) is a potentially life-threatening condition. Interventions and treatments should be managed on time to reduce mortality. It has been put forth that perihematomal edema absolute volume (PHEAV) is related to mortality, however the effect of perihematomal edema absolute area (PHEAA) on mortality is unknown. The objective of this study was to evaluate the effect of PHEAA on 30-day mortality in patients with ICH. METHODS: Patients were screened with ICD-9, retrospectively. 106 patients were included in the study. Clinical data were obtained from the patient files. Computed tomography (CT) was acquired from the hospital imaging database. PHEAV and PHEAA were measured via CT by two clinicians blinded to the study protocol. The predictors of 30- day mortality were examined. RESULTS: Forty-three (40.6%) patients died within 30days. Older age, lack of trauma, low Glasgow coma scale and high blood glucose were associated with high mortality (P≤.001). PHEAV and PHEAA values were higher in nonsurvivors (P<.001). PHEAA was detected as an independent predictor of 30-day mortality. The cutoff value of PHEAA for mortality was 33.41cm(2) (sensitivity: 84.4%, specificity: 59.0%). There was no difference between receiver operating characteristic curves of PHEAA and PHEAV (P=.55). CONCLUSION: In contrast to PHEAV, PHEAA is a simple value which can be measured without the requirement of any additional techniques or extra costs which can be quickly applied and which is an independent indicator of 30-day mortality. PHEAA can accelerate physician interventions for patients with ICH within several hours of ED admission.

Neuroprotective effect of alpha-lipoic acid and methylprednisolone on the spinal cord ischemia/reperfusion injury in rabbits.

OBJECTIVE: The aim of this study is to investigate the putative neuroprotective effect of alpha-lipoic acid (LA) on spinal ischemia/reperfusion (I/R) injury in rabbits. METHODS: Thirty-five adult female New Zeland rabbits, weighing 2,000-3,500 g (mean: 2,800), were divided randomly into five groups of seven rabbits each (n: 7) as Group 1: sham, only laparotomy; Group 2 (I/R): I/R; Group 3 (LA): I/R and 100 mg/kg of LA; Group 4 (MP): I/R and 30 mg/kg of methylprednisolone (MP); and Group 5 (LA + MP): I/R and 100 mg/kg of LA plus 30 mg/kg of MP. RESULTS: A statically significant effect of LA, MP, and LA plus MP on lowering malondialdehyde levels both in the blood and in the cerebrospinal fluid (CSF) has been observed. Nitric oxide is significantly decreased in the blood and spinal cord tissues, and also in the CSF but it is not significant. Superoxide dismutase, catalase, and glutathione levels were increased by LA administration. CONCLUSION: LA exhibits antioxidant efficacy in spinal cord I/R injury, but it cannot decrease the oxidative stress. The histopathological result of the present study also demonstrated that LA has neuroprotective effect in spinal cord injury.

Protective effect of valproic acid on ischemia-reperfusion induced spinal cord injury in a rat model.

PURPOSE: This study aims to determine the anti-inflammatory, antioxidant, and anti-apoptotic effects of valproic acid (VPA) on rat spinal cord tissue in ischemia-reperfusion (IR) injury model created by abdominal aorta occlusion. MATERIALS AND METHODS: Sprague Dawley rat (male sex) weighing 190-260 g divided into four experimental groups: control only underwent laparotomy, sham group, pre-IR injury (200 mg/kg dose), and post-IR injury (300 mg/kg) VPA. We measured serum levels of TNF-α, IL-6, IL-1ß, IL-18, Total Oxidant Status (TOS) and Total Antioxidant Status (TAS), and serum Oxidative Stress Index (OSI) ratio, and tissue expression of Bax and Bcl2, Caspase3, and Bax/Bcl2 ratio. RESULTS: Serum IL-18 was higher in the sham than the control group(P = 0.001), and there were declines in the pre-IR treatment (P = 0.002) and the post-IR treatment when compared to sham (P = 0.001). Despite these reductions, IL-18 expression levels in both the pre- and post-IR treatment groups were higher than in the control group (P = 0.001 & P = 0.003). The favorable effects of pre-IR VPA administration on immunohistochemical biomarkers were superior to post-IR VPA administration. CONCLUSIONS: Comparative analyses between prophylactic VPA administration and post-IR interventions revealed congruence in their anti-inflammatory and anti-apoptotic ramifications. VPA can reduce spinal cord IR injury in an aortic occlusion model of rats.

Does Foramen Magnum Morphometry Influence the Development of Chiari Malformation?

AIM: To examine foramen magnum morphometry and shape of Chiari malformation in comparison with a control group, and to contribute to the literature on whether Chiari malformation affects foramen magnum morphometry. MATERIAL AND METHODS: In this study, cranial magnetic resonance images of 71 people with Chiari malformation and 61 people as controls were examined. The anteroposterior diameter, transverse diameter, and area of the foramen magnum were measured, and the shape of the foramen magnum was determined. RESULTS: In the Chiari malformation group, the anteroposterior diameter of the foramen magnum was 39.11 ± 4.29 mm, the transverse diameter was 34.25 ± 3.27 mm, and its area was 969.21 ± 199.57 mm < sup > 2 < /sup > . These results were statistically higher in female patients in the Chiari malformation group than in the control group. No significant difference was found between male patients in the Chiari malformation group and those in the control group. Round-shaped foramen magnum was predominant in both groups, but this was not statistically significant. CONCLUSION: In Chiari malformation, the foramen magnum is affected. This effect can be a factor that influences development of a malformation. As a result of a malformation, the foramen magnum may have expanded due to the pressure effect. More detailed and extensive research is needed to explain this phenomenon.

Timeliness of postnatal surgery in newborns with open neural tube defects: a single center experience.

BACKGROUND: This study aims to evaluate the experience of a tertiary health center on the timeliness of postnatal management in newborns with open neural tube defects (NTDs). METHODS: This is a retrospective review of 38 neonates with NTDs who were treated surgically at a tertiary health care center between January 2009 and January 2019. Five neonates with genetic syndromes were excluded. RESULTS: Twenty-six neonates with NTD underwent surgery on the first postnatal day while 12 neonates with NTD had surgery after the first postnatal day. The reasons for the latency in operative treatment were the delay in the referral of the affected newborn from other health care centers (n=8) and the transient abnormalities in coagulation tests (n=4). Rural residence was significantly more frequent, gestational age at delivery was significantly lower, preterm delivery was significantly more frequent and prenatal diagnosis was significantly less frequent in neonates that underwent surgery for NTD repair after the first postnatal day (p=0.001, p=0.048, p=0.024 and p=0.003 respectively). Postoperative motor dysfunction was significantly more severe (p=0.002), postoperative complications were significantly more frequent (p=0.008), the reoperation and postoperative mortality rates were significantly higher (p=0.009 and p=0.048 respectively) and the duration of hospital stay was significantly longer (p=0.033) for the neonates who underwent surgery after the first postnatal day. CONCLUSIONS: Our study appears to favor the early repair of NTD`s within the first 24 hours of life. Such an approach may reduce the risk of infectious and neurological complications significantly.

Posterior Fossa Decompression and superficial durotomy rather than complete durotomy and duraplasty in the management of Chiari 1.

Objective: We aimed to evaluate the effectiveness and reliability of posterior fossa decompression (PFD) and superficial durotomy in patients who underwent surgery for Chiari malformation type 1 (CM1).Materials and Methods: Our study included 54 patients with the diagnosis of CM1 who had surgery between January 2012 and June 2019. The patients were divided into two groups according to the surgical technique applied. Group 1 included 10 patients who underwent classic PFD and duraplasty, and Group 2 included 44 patients who underwent PFD and superficial durotomy surgery. Pre- and postoperative clinical signs and symptoms of each patient were recorded. Simultaneously, morphometric measurements were compared from computed tomography (CT) and magnetic resonance (MRI) images taken pre- and postoperatively. The data of the two groups were compared.Results: Of the 54 patients, 18 were male, and the mean age was 37.51 ± 15.14. A statistically significant difference was found between the pre- and postoperative morphometric measurements of the subarachnoid distance, craniocervical angle, syringomyelia, and hydrocephalus at the cerebellum level in Group 2 patients who underwent PFD and superficial durotomy surgery (p < 0.05). When morphometric measurements and clinical signs and symptoms of both groups were compared, no significant difference was found (p > 0.05). There was a 92% improvement in clinical signs and symptoms postoperatively. The complications seen in Group 1 decreased to a minimum in Group 2.Conclusion: We believe that a minimally invasive surgical method is superior to avoid major complications. We also found PFD and superficial durotomy shorten the duration of the patient's hospital stayAbbreviations: C1: cervical vertebra 1C2: cervical vertebra 2CM: Chiari malformationCM1: Chiari malformation type 1CSF: cerebrospinal fluidCT: computed tomographyMRI: magnetic resonance imagingPFD: posterior fossa decompressionUSG: ultrasonography.

Augmented Reality Supported Cervical Transpedicular Fixation on 3D-Printed Vertebrae Model: An Experimental Education Study.

AIM: To investigate the use of Augmented Reality (AR) technology as it contributes to spinal surgery education with the free-hand technique, and might reduce the error ratio. MATERIAL AND METHODS: Ten candidates, with anatomy education but no surgical experience, applied 36 pedicle screws with C2-C3 posterior transpedicular fixation technique to nine vertebrae models produced via a three-dimensional (3D) printer. RESULTS: Using AR to apply pedicle screws to the experimental vertebrae model increased the safety screw ratio significantly. In comparison of Grade 0 screws to other grades: 6/18 screws (33.3%) in the free-hand technique Group (n=18), and 14/18 screws (77.8%) in the AR Group (n=18), were measured for screw insertion safety ratios. The difference was statistically significant (p=0.018). The resemblance between our results and the results of previous studies researching supportive systems indicates our 3D printed vertebra model might be a helpful educational material. CONCLUSION: AR increases the safety ratio of cervical pedicle screw fixation significantly. The parameters investigated and used for the production of vertebrae models in this study can be used for experimental material production for future studies to investigate pedicle screw positioning.

How necessary is the computerized brain tomography in minor head trauma?

BACKGROUND: Head trauma is a health problem that may be observed in all age groups, and it may cause significant losses in terms of health and economy. The purpose of our study is to evaluate the abnormal computerized brain tomography (CBT) prevalence and the rate of admission to brain surgery clinics in patients who applied to the Emergency Service Department for CBT due to minor head trauma. METHODS: In the present study, the patients who were admitted to Afyonkarahisar Health Sciences University, Faculty of Medicine Hospital, Emergency Service Department between January 1st, 2017, and December 31st, 2017, due to head trauma and in who CBT was performed were examined retrospectively. The electronic files, CBTs, and consultation notes of these patients were accessed in the information system of the hospital. RESULTS: A total of 43,389 patients who applied to the Emergency Service Department in 1 years' time (2017) were examined retrospectively. As a result of the examination, it was determined that a total of 2,515 (5.7%) patients received CBT. The reason for a total of 1,152 (45%) of these patients was traumatic injury. It was determined that 618 (53.6%) of the patients in who CBT was performed due to trauma were aged <18 years; 280 (24.3%) patients were aged <2 years; 179 (15.5%) patients had to consult with the Brain Surgery Clinic; and 94 (8.1%) were hospitalized. It was also determined that there were abnormal computed tomography (CT) findings in only 68 (5.9%) of the patients in who CBT was performed. CONCLUSION: The use of CBT indication criteria, which have been previously established and which reliability has been proven, in emergency trauma cases applying to the Emergency Service Department with minor head traumas may reduce the complication risk that may appear as a result of an unnecessary CBT and avoid complications that may occur in the long run due to CBT.

Effects of 2-Aminoethyl Diphenylborinate, a Modulator of Transient Receptor Potential and Orai Channels in Subarachnoid Hemorrhage: An Experimental Study.

BACKGROUND: Cerebral vasospasm remains a serious problem affecting morbidity and mortality in patients with subarachnoid hemorrhage (SAH) during neurosurgery. We aimed to demonstrate the role of the transient receptor potential channel and other channels for Ca2+ in the etiology of cerebral vasospasm using 2-aminoethyl diphenylborinate (2-APB) and the effective dose range of an unstudied pharmacological agent, which can limit vasospasm. METHODS: We performed an experimental study using 32 Sprague-Dawley rats divided into 4 groups: sham group (n = 8), SAH group (n = 8), 2-APB group (SAH rats intraperitoneally administered with 0.5 mg/kg 2-APB; n = 8), and 2-APB-2 group (SAH rats intraperitoneally administered with 2 mg/kg 2-APB; n = 8). The rats were sacrificed after 24 hours, and superoxide dismutase, glutathione peroxidase, malondialdehyde, tumor necrosis factor-α, and interleukin-1ß in the brain tissue and serum were measured. The histopathological investigation of brain tissue included measurement of the luminal diameter and wall thickness of the basilar artery (BA), and apoptotic cells in the hippocampus were counted after caspase staining. RESULTS: Autologous arterial blood injection into the cisterna magna caused vasospasm in rats. 2-APB treatment increased the BA wall thickness and reduced the BA lumen diameter, inducing significant vascular changes. 2-APB also alleviated cell apoptosis at 24 hours after SAH. CONCLUSION: In experimental SAH in rats, 2-APB treatment increased the BA wall thickness and reduced the BA lumen diameter, inducing significant vascular changes. 2-APB also alleviated cell apoptosis at 24 hours after SAH.

Time-dependent effects of dantrolene on motor evoked potentials in experimental spinal cord injuries.

Objectives:Traumatic spinal cord injury (SCI) is a significant clinical problem with numerous secondary complications and perpetual deficits. No potent treatment is currently available to fully repair motor and other neurological functions. We studied the effects of dantrolene (DNT) at different time points, on the motor-evoked potentials (MEPs) and the apoptosis response in spinal cord injury. Methods:The study was conducted on a total of 38 rabbits divided into five main groups.These were group 1 (sham): only laminectomy (n = 6), group 2 (SCI): laminectomy and traumatic SCI (n = 8), group 3 (DNT 0h): just after the SCI, DNT 10 mg/kg I.P. (n = 8), group 4 (DNT 1h): 1 h after the SCI, DNT 10 mg/kg I.P. (n = 8), and group 5 (DNT 4h): 4 h after the SCI, DNT 10 mg/kg I.P. (n = 8). Results: DNT, which was administered as the treatment, had a therapeutic effect on the motor function. This effect was observed by recording neural transmission obtained via the Tarlov test and a transcranial magnetic stimulator by using the values of the MEPs. A significant decrease was histopathologically observed in the apoptotic cell count. Discussion: The electrophysiological efficacy of our model of trauma as SCI has been complemented with the significant differences between the control group and the SCI group. This creates a need for electrophysiological studies to be conducted in the future because effects, even at a minimum level, may play an important role in finding an applicable medicine for SCI.

A Rare Cause of Calcified Subdural Empyema and Ventriculitis in a Pediatric Patient: Achromobacter Denitrificans.

Intracranial infections in the pediatric age group are still important causes of morbidity in developing countries. A 2-year-old male patient presented with acute onset of seizures and loss of consciousness to our emergency department with a past history of being followed for hypogammaglobulinemia. Unenhanced computerized tomography scan of the brain revealed a right frontoparietal peripherally calcified extraaxial collection, brain edema and a left sided shift. Contrast enhanced magnetic resonance imaging revealed a subdural empyema associated with the brain parenchyma and the ventricular system. In spite of a decompression procedure and subsequent medical therapy, the patient succumbed on the 9. postoperative day. This is the first case report of a pediatric patient with subdural empyema and ventriculitis due to Achromobacter denitrificans.

Cabazitaxel causes a dose-dependent central nervous system toxicity in rats.

BACKGROUND: Chemotherapeutic agents may lead to serious neurological side effects, which in turn can deteriorate the quality of life and cause dose limiting. Direct toxic effect or metabolic derangement of chemotherapeutic agents may cause these complications. Cabazitaxel is a next generation semi-synthetic taxane derivative, which is effective in both preclinical models of human tumors sensitive or resistant to chemotherapy and in patients with progressive prostate cancer despite docetaxel treatment. AIM: The primary aim of this study was to investigate the central nervous system toxicity of Cabazitaxel. Secondary aim was to investigate the safety dose of Cabazitaxel for the central nervous system. METHODS: A total of 24 adult male Wistar-Albino rats were equally and randomly divided into four groups as follows: group 1 (Controls), group 2 (Cabazitaxel 0.5mg/kg), group 3 (Cabazitaxel 1.0mg/kg) and group 4 (Cabazitaxel 1.5mg/kg). Cabazitaxel (Jevtana, Sanofi-Aventis USA) was intraperitoneally administered to groups 2, 3 and 4 at 0.5, 1.0 and 1.5mg/kg (body-weight/week) doses, respectively for four consecutive weeks. Beside this, group 1 received only i.p. saline at the same volume and time. At the end of the study, animals were sacrificed and bilateral brain hemispheres were removed for biochemical, histopathological and immunohistochemical examinations. RESULTS: Intraperitoneal administration of Cabazitaxel has exerted neurotoxic effect on rat brain. We have observed that biochemical and immunohistochemical results became worse in a dose dependent manner. CONCLUSION: Our findings have suggested that Cabazitaxel may be a neurotoxic agent and can trigger apoptosis in neuron cells especially at high doses.

Ligamentum flavum thickening at lumbar spine is associated with facet joint degeneration: An MRI study.

OBJECTIVE: Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. In the present study, we aimed to investigate the potential factors including age, intervertebral disc degeneration (IDD), facet joint degeneration (FJD), end plate degeneration (EPD), which may affect LF thickening and to reveal the relationship among those factors at each level of lumbar spine by evaluating the magnetic resonance images (MRI). METHODS: A total of 200 individuals with low back and/or leg pain complaints who had undergone lumbar MRI were included in this study. The thickness of LF, FJD, IDD and EPD were assessed at all lumbar levels. RESULTS: Totally 1000 end plates, 1000 intervertebral discs and 2000 facet joints were evaluated and the thicknesses of 2000 LFs were measured from MRI images of 200 patients (100 males and 100 females). The mean age was 46.87 ± 12.47 years. LF thickness was strongly associated with FJD especially on the ipsilateral side. Age and IDD were correlated at whole vertebral levels. The age related changes (LF thickness, FJD, IDD and EPD) were more prominent at L4-L5 vertebral level. However, gender had no effect on LF thickness. CONCLUSION: The results of this study suggest that LF thickening may occur independently or could be associated with FJD especially on the ipsilateral side and this relationship is due to the vertebral level. The degree of disc degeneration increases with age and age related changes may be predominantly observed at L4-L5 vertebral level.

Spinal neural fibrolipoma: A case report and review of the literature.

Neural fibrolipoma is characterized by infiltration of the epineurium by adipose and fibrous tissue. Intradural spinal cases are extremely rare. We report an unusual case of spinal neural fibrolipoma. A 31-year-old pregnant woman presented due to weakness of right leg (muscle strength 2/5). Magnetic resonance (MR) evaluation of the spine revealed an extramedullary intradural mass at the T1-T4 level. MR findings were suggesting a dermoid cyst or a lipoma. Subtotal surgical excision of the tumor was done. Histopathological examination showed enlarged nerve bundles infiltrated by fibroadipose tissue. Thus, the diagnosis of neural fibrolipoma was established. One month after surgery, lumbar MR showed residual tumor tissue, but successful decompression of the spinal cord. Six months after surgery, the neurological examination, muscle strength 4/5 evaluated. Neural fibrolipoma is characterized by infiltration of the epineurium by adipose and fibrous tissue. The tissue grows between and around nerve bundles thereby causing enlargement of the affected nerve. Neural fibrolipoma is a benign lesion with no effective therapy. Surgical excision usually causes severe damage of the involved nerve. Although spinal cases are extremely rare, it should be included in the differential diagnosis of extramedullary intradural masses.

Selenium protects cerebral cells by cisplatin induced neurotoxicity.

PURPOSE: To evaluate the central nervous system toxicity of cisplatin and neuroprotective effect of selenium. METHODS: Twenty-one male Wistar albino rats were divided into three groups: control (C), cisplatin (CS), cisplatin and selenium (CSE, n=7 in each group). Cisplatin (12 mg/kg/day, i.p.) was administered to CS and CSE groups for three days. Furthermore, CSE group received 3mg/kg/day (twice-a-day as 1.5 mg/kg) selenium via oral gavage five days before cisplatin injection and continued for 11 consecutive days. The same volumes of saline were administered to C group intraperitoneally and orally at same time. RESULTS: Heterochromatic and vacuolated neurons and dilated capillary vessels in the brain were observed in the histochemical examinations of cisplatin treated group. Rats that were given a dose of 3mg/kg/day selenium decreased the cisplatin induced histopathological changes in the brain, indicating a protective effect. In addition, cytoplasmic staining of the cell for bcl-2, both cytoplasmic and nuclear staining for bax were determined to be positive in the all groups. Bax positive cells were increased in the CS group compared to C group, in contrast to decreased bcl-2 positivity. CONCLUSION: Selenium limited apototic activity and histological changes due to the cisplatin related central neurotoxicity.

Spondylodiscitis: evaluation of patients in a tertiary hospital.

INTRODUCTION: Spondylodiscitis (SD) is an uncommon but important infection. The aim of this work was to study the risk factors, bacteriological features, clinical, laboratory and radiological findings of SD, and to shed light on the initial treatment. METHODOLOGY: A total of 107 patients who underwent treatment for SD were evaluated. The diagnosis of SD was defined by clinical findings, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum tube agglutination (STA) test, Ziehl-Neelsen staining, culture, histopathology, and radiological methods such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. RESULTS: Of the 107 cases, ranging between 17 to 83 years of age, 64 (59.8%) were male. Twenty-seven (25.2%) patients had diabetes mellitus. Laboratory investigations revealed elevated CRP in 70 (65%) patients, elevated ESR in 65 (61%) patients, and elevated white blood cell (WBC) counts in 41 (38.3%) patients. Thirty-six (33.6%) patients were identified as having brucellar SD, and 5 (4.7%) patients were identified as having tuberculous SD. A total of 66 (61.6%) patients were determined to have pyogenic SD. The most frequently isolated microorganism was Staphylococcus aureus. Antibiotic therapy was given intravenously to all pyogenic SD patients. CONCLUSIONS: The incidence of SD has increased as a result of the higher life expectancy of older patients with chronic debilitating diseases and the increase of spinal surgical procedures. In patients with low back pain, SD should be considered as a diagnosis. For effective treatment, it is important to determine the etiology of the disease.

Diffuse idiopathic skeletal hyperostosis and central cord syndrome after minor trauma: a case report.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in a patient with DISH after minor trauma. The patient was treated surgically. We also discuss symptomatology and the common mechanism of cord injury in DISH.