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1.
Eur Spine J ; 25(7): 2050-9, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27095700

RESUMEN

PURPOSE: C5 palsy is a well-known complication of cervical spine decompression surgery. The complication develops in both posterior and anterior approaches. We aimed to review reports regarding postoperative C5 palsy in hopes for better prevention and treatment of this morbidity. METHOD: We systematically reviewed and evaluated the abstracts and full texts of the identified papers in the literature. We reviewed and analyzed papers published between January 1970 and February 2015 regarding C5 palsy as a complication of cervical surgical procedures. We made statistical comparisons as much as possible. RESULTS: We did not find any statistical significance between the pathologies (p = 0.088) and between the surgical routes (p = 0.486). There was statistical significance between the types of procedures (p < 0.05). Posterior laminectomy had low incidence of C5 palsy when compared to laminectomy and fusion (p = 0.029) and laminoplasty (p = 0.37). There was no statistically significant difference between anterior cervical decompression and fusion and other procedures (p > 0.05). CONCLUSION: Some studies conclude that anterior procedure is more safe. Of all anterior procedures, the multilevel ACDF had the lowest incidence of C5 palsy. The hybrid technique can be chosen for more than two-vertebra corpectomy. In term of posterior procedures, laminectomy is safer. To prevent C5 palsy, electromyography can be used as a sensitive predictor and selective foraminotomy can be performed.


Asunto(s)
Vértebras Cervicales/cirugía , Descompresión Quirúrgica/métodos , Enfermedades del Sistema Nervioso Periférico/epidemiología , Complicaciones Posoperatorias/epidemiología , Compresión de la Médula Espinal/cirugía , Electromiografía , Foraminotomía/métodos , Humanos , Incidencia , Laminectomía/métodos , Laminoplastia/métodos , Compresión de la Médula Espinal/etiología , Raíces Nerviosas Espinales , Espondilosis/complicaciones
2.
J Spinal Disord Tech ; 28(1): E35-44, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25089674

RESUMEN

STUDY DESIGN: Prospective in vivo rat tail model of disk degeneration comparing the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) injection over various time points and grades of degeneration. OBJECTIVE: To evaluate the effect of timing and disk grade on rhBMP-2 injection in a rat tail model of disk degeneration. SUMMARY OF BACKGROUND DATA: rhBMP-2 stimulates the proliferation of intervertebral disk cells and the secretion of extracellular matrix. However, few in vivo studies have demonstrated whether rhBMP-2 also improves disk degeneration and the severity of disk degeneration beyond which disks cannot be recovered by rhBMP-2 treatment. METHODS: Two coccygeal disks of each rodent subject were punctured percutaneously using an 18 G needle. At 4 weeks after the puncture, disks demonstrating induced degeneration were divided into 3 groups. Groups 1, 2, and 3 were treated with 7.5 µg rhBMP-2 or phosphate buffered saline by injection into the disk at 4, 6, and 8 weeks postpuncture, respectively. Plain radiographs and magnetic resonance images (MRIs) were obtained on the day of puncture and every 2 weeks thereafter until sacrifice. At 6 weeks after injection, each group was killed and examined with histologic and immunohistochemical analysis. RESULTS: According to MRI disk grade evaluation of the degenerative disk, rhBMP-2 significantly improved degeneration grade in group 1 at 2 weeks after injection. According to radiographic disk height index, groups 1 and 2 showed a trend toward improvement at 2 weeks after rhBMP-2 injection. Chondrogenic differentiation was noted on immunohistochemical staining of many disks treated with rhBMP-2. CONCLUSIONS: rhBMP-2 injection of degenerated disks at 4 weeks postpuncture induced a transient improvement in disk grade on MRI and stimulated chondrogenic differentiation. These data suggest rhBMP-2 as a potential therapy for degenerative disk disease.


Asunto(s)
Proteína Morfogenética Ósea 2/administración & dosificación , Proteína Morfogenética Ósea 2/uso terapéutico , Degeneración del Disco Intervertebral/tratamiento farmacológico , Cola (estructura animal)/efectos de los fármacos , Factor de Crecimiento Transformador beta/administración & dosificación , Factor de Crecimiento Transformador beta/uso terapéutico , Animales , Proteína Morfogenética Ósea 2/farmacología , Modelos Animales de Enfermedad , Humanos , Inmunohistoquímica , Inyecciones , Disco Intervertebral/efectos de los fármacos , Disco Intervertebral/patología , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/patología , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Proteoglicanos/metabolismo , Punciones , Radiografía , Ratas Endogámicas Lew , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/farmacología , Proteínas Recombinantes/uso terapéutico , Coloración y Etiquetado , Factores de Tiempo , Factor de Crecimiento Transformador beta/farmacología
3.
Br J Neurosurg ; 29(2): 285-9, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25365662

RESUMEN

OBJECTIVE: Arachnoiditis is an inflammatory process resulting with the fibrosis of arachnoid mater. It can vary in severity from mild thickenings to catastrophic adhesions that ruins subarachnoid space. As a result, arachnoid cysts can be formed. Arachnoid cyst induced by symptomatic spinal arachnoiditis is a rare complication of subarachnoid haemorrhages. In this article, we aimed to present a case of spinal arachnoid cyst formation following subarachnoid haemorrhage and examine similar cases in the literature. CASE REPORT: Forty-six years old, previously healthy female patient has been treated medically for headaches due to perimesencephalic subarachnoid bleeding. Approximately two and a half months later, she started to have severe headaches and diplopia. We detected hydrocephalus and performed ventriculoperitoneal shunt surgery. Two months later, she started to have complaints of weakness in her lower extremities. On neurological examination, she had paraparesis and on spinal magnetic resonance imaging she had an arachnoid cyst lengthening from C7 to T2 and compressing the spinal cord posteriorly. We performed partial laminectomy, drainage of arachnoid cyst and replacement of cystopleural T tube shunt. On follow-up, her lower extremity strength has ameliorated. She was taken into a physical therapy and rehabilitation programme. Three months later she was able to walk with a crutch. CONCLUSION: Subarachnoiditis and associated arachnoid cyst can cause severe morbidity. This rare situation (which especially occurs following subarachnoid haemorrhage of posterior fossa) should be known and physicians should keep in mind that it requires urgent surgical procedure.


Asunto(s)
Quistes Aracnoideos/cirugía , Aracnoiditis/congénito , Paraparesia/cirugía , Compresión de la Médula Espinal , Hemorragia Subaracnoidea/cirugía , Quistes Aracnoideos/complicaciones , Quistes Aracnoideos/diagnóstico , Aracnoiditis/diagnóstico , Aracnoiditis/cirugía , Femenino , Humanos , Persona de Mediana Edad , Paraparesia/diagnóstico , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/etiología , Vértebras Torácicas/cirugía
4.
Turk Neurosurg ; 20(2): 205-15, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20401848

RESUMEN

Fusion surgeries are still the gold standard in the treatment of the degenerative spine. Spinal fusion has some problems, however. Adjacent segment disease, donor place ailment, and the morbidity of the surgery has emerged as important problems over the years. As a consequence of such complications after fusion, the search for an alternative treatment for the degenerative spine widened. While trying to maintain the motion in the joint, dynamic stabilization aims to remove the pain by distributing the weight between anterior and posterior elements of the spine. Various new devices have now been developed for the dynamic stabilization of the spine. In this report, the dynamic stabilization devices of the spine are classified anew and, the authors explain briefly the historical evolution process, specialties, indications and contraindications of these dynamic stabilization devices.


Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/clasificación , Fusión Vertebral/instrumentación , Tornillos Óseos , Hilos Ortopédicos , Humanos , Prótesis e Implantes
5.
Turk Neurosurg ; 20(3): 373-81, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20669112

RESUMEN

AIM: Minimally invasive surgery is currently a goal for surgical intervention in the spine. The effectiveness of endoscopic thoracic spine surgery and technological improvements are two factors that are always under consideration in the practice of spinal surgery. MATERIAL AND METHODS: We present twenty-five patients whose thoracoscopic spinal surgeries were performed between 2002 and 2008 for the treatment of various spinal diseases. Eleven patients with thoracic disc herniation, five patients with traumatic thoracic spinal compressive fracture, six patients with metastatic thoracic spinal tumors and three patients with tubercular spondylitis underwent thoracoscopic spine surgery. Clinical evaluations were performed at 3, 6,12 and 24 months post-surgery. The Oswestry disability questionnaire and linear visual analog scale (VAS) were used for the evaluation of pain. RESULTS: Postoperatively, two patients had lung contusions, one patient had pneumonia and one patient had instability. There were significant initial improvements in both the Oswestry score and the VAS pain score up to 6 months (p<0.05). The average relative difference in pain scores in all groups was not significant at 12 and 24 months (p>0.05). CONCLUSION: The favorable results of thoracoscopic spinal surgery encourage its application to situations in which a conventional thoracic approach is indicated. Thoracoscopic spine surgery is applicable to all patients with various spinal diseases.


Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fracturas de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Dolor de Espalda/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio , Paraparesia/cirugía , Paraplejía/cirugía , Compresión de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/cirugía , Espondilitis/cirugía , Encuestas y Cuestionarios , Toracoscopía/métodos
6.
Pain Pract ; 9(2): 141-4, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19019045

RESUMEN

Kyphoplasty is an accepted therapeutic modality for the treatment of painful osteoporotic vertebral compression fractures. Complication rates are reported between 1% and 3% for osteoporotic fractures. Most previously reported complications, however, have occurred perioperatively. In this article, we report a case in which balloon kyphoplasty was performed as described by manufacturer guidelines. Four weeks after a successful kyphoplasty, the patient presented with a painful split vertebral fracture with anterior deformity at the same level where the kyphoplasty was initially performed. A recurrent fracture at the same level of a previous successful kyphoplasty may be considered in the differential diagnosis of a patient who presents with new pain at a similar level.


Asunto(s)
Dolor de la Región Lumbar/cirugía , Vértebras Lumbares , Complicaciones Posoperatorias , Fracturas de la Columna Vertebral/etiología , Vertebroplastia/efectos adversos , Anciano de 80 o más Años , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Imagen por Resonancia Magnética/métodos , Fracturas de la Columna Vertebral/patología , Fracturas de la Columna Vertebral/radioterapia , Tomografía Computarizada por Rayos X/métodos
7.
Turk Neurosurg ; 19(2): 177-81, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19431131

RESUMEN

Instability can develop after lumbar spinal surgery. What is also known as secondary segmental instability is one of the important causes of failed back syndrome. In this paper, we described a 45-year-old female patient who was diagnosed with secondary segmental instability caused by left L3 pars interarticularis fracture after a high lumbar disc surgery and was subsequently treated with re-operation. We evaluated the clinical course, diagnosis, and treatment methods for secondary segmental instability caused by postoperative pars interarticularis fracture. Furthermore, we emphasized the importance of preserving the pars interarticularis during upper lumbar disc surgeries in order to avoid a potential stress fracture.


Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/etiología , Inestabilidad de la Articulación/etiología , Vértebras Lumbares/cirugía , Radiculopatía/etiología , Fracturas de la Columna Vertebral/etiología , Fusión Vertebral/efectos adversos , Síndrome de Fracaso de la Cirugía Espinal Lumbar/diagnóstico por imagen , Síndrome de Fracaso de la Cirugía Espinal Lumbar/cirugía , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/cirugía , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Persona de Mediana Edad , Radiculopatía/cirugía , Radiografía , Reoperación , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía
8.
Turk Neurosurg ; 19(2): 121-6, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19431120

RESUMEN

OBJECTIVE: Cervical laminoplasty is an effective procedure. We describe the technique of open-door and french-door cervical laminoplasty and present our clinical results. METHODS: All patients undergoing laminoplasty at our clinic during the 1997- 2008 period were included in the study. All patients had myeloradiculopathy. Neurological functions and recovery in myelopathy in patients were evaluated using the Nurick score. Pre- and postoperative kyphotic evaluation was measured using the sagittal tangent method. Peri- and postoperative complications were recorded. RESULTS: Clinical evaluation showed that all patients had reduced postoperative complaints compared to their complaints before the procedure. Average time of surgery was 180 min. Average blood loss in surgeries was 300 cc. According to the Nurick classification, no improvement was observed in seven patients; nine patients showed improvement of one grade; and three patients showed an improvement of two grades. Temporary C5 nerve root paralysis was observed in two patients as a postoperative complication. Complete recovery was observed in both patients within 2 months. CONCLUSIONS: Laminoplasty is a safe and effective alternative procedure to treat cervical spondylotic myelopathy.


Asunto(s)
Vértebras Cervicales/cirugía , Laminectomía/métodos , Enfermedades de la Médula Espinal/cirugía , Espondilosis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/patología , Femenino , Estudios de Seguimiento , Humanos , Cifosis , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Enfermedades de la Médula Espinal/patología , Espondilosis/patología , Resultado del Tratamiento
9.
Turk Neurosurg ; 19(4): 319-26, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19847749

RESUMEN

AIM: In this study, we examined the results of utilizing the agile posterior dynamic stabilization system with dynamic transpedicular screws in our patients. MATERIAL AND METHODS: Posterior dynamic instrumentation with agile rods and dynamic transpedicular screws was employed in 15 (seven male and eight female) patients (mean age = 42, ranging from 30 to 53). The average follow-up duration was 19 months (ranging from 12 to 25). The primary purpose for the surgery was degenerative disc disease. For subjective evaluation, patients underwent a physical examination utilizing the Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic parameters, including the angle of lumbar lordosis (LL), angle of segmental lordosis (alpha) and intervertebral space (IVS), were also evaluated. Both subjective patient evaluations and radiographic parameters were assessed at the 3rd and 12th postoperative months. RESULTS: Significant postoperative improvements were observed in the ODI and VAS measurements (P < 0.05). There were no significant differences in the LL, alpha and IVS parameters. One patient experienced a broken screw. CONCLUSION: We obtained good clinical results by utilizing dynamic rods with dynamic transpedicular screws.


Asunto(s)
Clavos Ortopédicos , Tornillos Óseos , Desplazamiento del Disco Intervertebral/cirugía , Inestabilidad de la Articulación/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Adulto , Femenino , Humanos , Desplazamiento del Disco Intervertebral/patología , Inestabilidad de la Articulación/patología , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos
10.
J Clin Neurosci ; 41: 46-49, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28343922

RESUMEN

Degeneration of IVD is a progressive and irreversible process and can be evaluated with immunohistochemical examination or radiological grading. MMPs are a family of proteolytic enzymes and involved in the degradation of the matrix components of the IVD. We aimed to compare MMP-1, -2, -3, and -9 expressions with demographic features, visual analogue scale (VAS), Oswestry Disability Index (ODI) and radiological (MRI) grades. The study involved 60 participants. We recorded data about age, complaint, radiological imaging, expression levels of MMP-1, -2, -3, and -9, ODI and VAS for back pain retrospectively. Intervertebral disc degeneration was graded on a 0-5 scale according to the Pfirrmann classification. As a result of the study, the median age was 52.09±12.74years. There were statistical significances between age and MMP-1, and MMP-2. There was a close correlation between grade and MMP-9. We found correlation between the VAS and the MMP-9 expression. In addition, there was relationship between expression of MMP-2 and MMP-1, MMP-3, MMP-9. In conclusion, the expressions of MMP-1 and -2 are increased with aging. There was no relationship between radiological evaluation of IVDD and aging. Increased expression of MMPs affected IVDD positively. The relationship with MMPs is not explained. This study adds to our understanding of the interaction between MMPs and IVDD.


Asunto(s)
Envejecimiento/patología , Degeneración del Disco Intervertebral/enzimología , Metaloproteinasas de la Matriz Secretadas/biosíntesis , Adulto , Anciano , Femenino , Humanos , Degeneración del Disco Intervertebral/diagnóstico , Vértebras Lumbares , Imagen por Resonancia Magnética , Masculino , Metaloproteinasa 1 de la Matriz/biosíntesis , Metaloproteinasa 2 de la Matriz/biosíntesis , Metaloproteinasa 3 de la Matriz/biosíntesis , Metaloproteinasa 9 de la Matriz/biosíntesis , Metaloproteinasas de la Matriz Secretadas/análisis , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos
11.
Turk J Med Sci ; 45(3): 467-73, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26281308

RESUMEN

BACKGROUND/AIM: To investigate the neuroprotective effects of glucagon-like peptide 2 (Glp-2), which increases cerebral blood flow, on the hippocampal complex after cerebral ischemia/reperfusion (I/R) injury in rats. MATERIALS AND METHODS: Animals were randomized into 4 groups: sham, I/R + 0.9% NaCl, I/R + pre-Glp-2, and I/R + post-Glp-2. Cerebral ischemia was performed via the occlusion of the bilateral internal carotid artery for 40 min and continued with a reperfusion process. At the end of 6 h of reperfusion, animals were decapitated in all groups and brain tissues were removed. Malondialdehyde (MDA) and natural intracellular antioxidant glutathione (GSH) levels and myeloperoxidase (MPO) activities were measured in the left hippocampal tissue. The right hippocampal tissues of all group members were taken for histopathologic study. RESULTS: MDA levels and MPO activities increased from Group I to Group II and decreased from Group II to Groups III and IV. On the other hand, GSH levels were not significantly different among the groups. The number of apoptotic hippocampal tissue cells increased from Group I to Group II and decreased from Group II to Groups III and IV. CONCLUSION: Our preliminary study revealed that Glp-2 treatment may decrease oxidative damage from I/R in cerebral tissue.


Asunto(s)
Isquemia Encefálica/metabolismo , Péptido 2 Similar al Glucagón/farmacología , Fármacos Neuroprotectores/farmacología , Daño por Reperfusión/metabolismo , Daño por Reperfusión/prevención & control , Animales , Apoptosis/efectos de los fármacos , Isquemia Encefálica/patología , Muerte Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Glutatión/efectos de los fármacos , Glutatión/metabolismo , Hipocampo/efectos de los fármacos , Hipocampo/metabolismo , Masculino , Malondialdehído/metabolismo , Estrés Oxidativo/efectos de los fármacos , Peroxidasa/efectos de los fármacos , Peroxidasa/metabolismo , Ratas , Ratas Sprague-Dawley , Superóxido Dismutasa/efectos de los fármacos , Superóxido Dismutasa/metabolismo
12.
APMIS ; 123(3): 199-204, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25556322

RESUMEN

Pituitary adenomas are the third most common intracranial tumors. Invasive adenomas account for only 0.1-0.2% of pituitary tumors. SPARC is a matrix glycoprotein that plays a role in progression and invasiveness of neoplasms. In this study, we examined the potential role of SPARC in invasive pituitary adenomas. Forty pituitary adenomas have been examined with histopathological and immunohistochemical techniques. The cohort has been classified into two groups as invasive (n = 25) and non-invasive (n = 15) utilizing the Hardy classification. Formalin fixed tissues have been stained with hematoxylin eosin. Ki-67, p53, and SPARC monoclonal antibodies have been used. We did not detect any significant difference on Ki-67, SPARC, and p53 expression patterns correlating with the pathological subtype or invasiveness. Only 24% of invasive adenomas had Ki-67 levels over 1%. A total of 67.7% non-invasive adenomas had Ki-67 levels below 1%. We did not detect any relation between SPARC levels and invasiveness of pituitary adenomas. Absence of significant SPARC expression in tumor progression, sellar dilatation, erosion and destruction suggest that SPARC scores are not related with invasiveness or progressiveness of pituitary adenomas.


Asunto(s)
Regulación Neoplásica de la Expresión Génica , Osteonectina/metabolismo , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/genética , Neoplasias Hipofisarias/patología , Adulto , Biomarcadores de Tumor/metabolismo , Femenino , Humanos , Inmunofenotipificación , Antígeno Ki-67/metabolismo , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/genética , Osteonectina/genética , Pronóstico , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/metabolismo
13.
Turk Neurosurg ; 25(1): 111-6, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25640554

RESUMEN

AIM: In this study, our aim was to examine if matrix metalloproteinase expressions (MMP-1, MMP-2, MMP-3) in patients operated with a lumbar disc hernia diagnosis are different in terms of clinical and neuroradiological findings. MATERIAL AND METHODS: The study included 80 patients treated with micro discectomy for lumbar disc hernia. Degeneration was scored via magnetic resonance (MR) images. MMP-1, MMP-2, and MMP-3 antibodies were used for immunohistochemical evaluation of degenerated disc materials. MMP expressions were compared between primary and recurrent cases, and correlation analysis was conducted. RESULTS: Discectomy material showed higher expression of MMP-1 and MMP-3 in cases of recurrent lumbar disc herniation than in primary herniation. There was no significant relationship between MMP expression and MR degeneration score. CONCLUSION: MMP-1 and MMP-3 expressions were significantly higher in recurrent cases in terms of magnetic resonance degeneration score. We assume that the higher co-expression of MMP-1 and MMP-3 might be used in targeted treatment regiemens in patients with recurrent LDH.


Asunto(s)
Colagenasas/metabolismo , Desplazamiento del Disco Intervertebral/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Discectomía , Femenino , Humanos , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Metaloproteinasa 1 de la Matriz/metabolismo , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 3 de la Matriz/metabolismo , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos
14.
J Neurosurg Spine ; 20(5): 542-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24579877

RESUMEN

OBJECT: The center (axis) of rotation (COR) in the lumbar spine has been studied well. However, there is limited information on the kinetic and kinematic consequences of imposed shift in the location of the COR, although this type of shift can be seen after surgeries using motion preservation or dynamic stabilization devices. The objective of this study was to assess the kinetic and kinematic changes in the lumbar spinal segment due to various imposed CORs. METHODS: A 3D finite element model of the L4-5 segment was constructed and validated. The segment was loaded under a 7.5-Nm bending moment while constrained to rotate about various imposed CORs in the sagittal and axial motion planes. Range of motion, ligament forces, facet loads, and disc stresses were measured. RESULTS: The present model showed an agreement with previous in vitro and finite element studies under the same load and boundary conditions. Range of motion, facet forces, disc stresses, and ligament loads showed a strong association with the location of the COR. CONCLUSIONS: Acute alterations in the location of the COR can significantly change the load sharing characteristics within the spine segment. The normal location of the COR is a result of the tendency of the vertebra to move in the path of least cumulative resistance.


Asunto(s)
Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiología , Rango del Movimiento Articular/fisiología , Tomografía Computarizada por Rayos X , Fenómenos Biomecánicos , Análisis de Elementos Finitos , Humanos , Rotación
15.
Turk J Med Sci ; 44(2): 237-42, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25536730

RESUMEN

AIM: To carry out comparison and correlation analyses of the intervertebral disc (IVD) and vertebral body (VB) volumes in magnetic resonance (MR) images of patients with degenerated and nondegenerated lumbar discs. MATERIALS AND METHODS: MR images were examined retrospectively in 93 patients. Lumbar VB and IVD volumes in T1-T2 weighted sagittal MR images were calculated via the Cavalieri method, a stereological method. Volumetric changes in degenerated and nondegenerated discs were compared. RESULTS: The percentages of degenerated IVDs were 12.9%, 12.9%, 28%, 50.5%, and 52% in discs from levels L1 to L5, respectively. There were no differences in VB volumes between the degenerated and nondegenerated groups for all lumbar vertebra levels. However, significant volumetric decreases were observed in degenerated IVDs for all lumbar vertebra levels, as compared to nondegenerated IVDs. Comparisons of VB volume and IVD volume ratios also revealed decreases, but they were significant only for levels L1 and L4. CONCLUSION: Disc volumes were found to be decreased, although vertebral bodies were not affected in degenerated IVD groups. However, using VB and IVD volume ratios may not always yield reliable results.


Asunto(s)
Imagenología Tridimensional/métodos , Degeneración del Disco Intervertebral/patología , Disco Intervertebral/patología , Vértebras Lumbares/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos
16.
Asian Spine J ; 8(4): 516-20, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25187872

RESUMEN

Pseudotumor cerebri is a condition of increased intracranial pressure in the absence of clinical, laboratory or radiological pathology. Spinal intradural hematoma formation after lumboperitoneal shunt (LPS) implantation is very rare, but it can cause sudden and serious deterioration. In this report, we present a patient who developed an intradural hematoma following LPS operation. A 27-year-old male patient suffering from headaches and progressive vision loss was diagnosed with pseudotumor cerebri. He underwent LPS operation in January 2009. Four hours after the operation, he developed urinary and fecal incontinence with paraparesis (1/5). Lumbar magnetic resonance imaging identified an intradural hematoma at the level of L2-L3, and he was reoperated. The intradural hematoma was removed. Physical therapy was started because of paraparesis. Two months later, the patient's muscle strength had increased to 3/5. Surgeons must remember that, LPS implantation can cause a spinal intradural hematoma in a small percentage of patients, with catastrophic results.

17.
Case Rep Otolaryngol ; 2014: 756280, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25140266

RESUMEN

Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature.

18.
Turk Neurosurg ; 24(5): 731-6, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25269045

RESUMEN

AIM: The matrix metalloproteinase (MMP) enzyme family has been shown to be active in tumorigenesis and tumor progression. In this study, we analyzed the prevalence of a guanine insertion in the MMP-1 gene promoter region in meningiomas and its effect on invasion and prognosis. MATERIAL AND METHODS: The study was performed with 33 meningioma patients. We also included 33 healthy patients in the study as a control group. The promoter area was amplified by polymerase chain reaction (PCR) following DNA isolation. The polymorphism was detected by restriction fragment length polymorphism (RFLP). RESULTS: According to the WHO classification of meningiomas, 87.9% of the affected patients were grade 1, and 12.1% were grade 2. In total, 72.7% of the meningioma patients (n=24) had at least one copy of the insertion (2G/1G or 2G/2G genotypes) and 27.3% (n=9) did not (1G/1G). There was no significant difference between the meningioma and control groups according to genotype distribution. CONCLUSION: In this study, the polymorphism in the matrix metalloproteinase-1 gene promoter region did not have an effect on the initiation, growth and progression of meningioma.


Asunto(s)
Metaloproteinasa 1 de la Matriz/genética , Neoplasias Meníngeas/genética , Meningioma/genética , Polimorfismo de Nucleótido Simple , Regiones Promotoras Genéticas , Adolescente , Adulto , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , ADN/análisis , Femenino , Genotipo , Humanos , Masculino , Neoplasias Meníngeas/patología , Meningioma/patología , Persona de Mediana Edad , Invasividad Neoplásica , Reacción en Cadena de la Polimerasa , Polimorfismo de Longitud del Fragmento de Restricción , Pronóstico
19.
Acta Cir Bras ; 29(4): 268-73, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24760028

RESUMEN

PURPOSE: To investigate the neuroprotective effects of Sulindac on the hippocampal complex after global cerebral ischemia/reperfusion (I/R) injury in rats. METHODS: Thirty one Sprague-Dawley rats were used, distributed into group I (sham) n:7 were used as control. For group II (n:8), III (n:8) and IV (n:8) rats, cerebral ischemia was performed via the occlusion of bilateral internal carotid artery for 45 minutes and continued with reperfusion process. 0.3 mL/kg/h 0.9 % sodium chloride was infused intraperitoneally to the Group II rats before ischemia, 5µg/kg/h/0.3 ml sulindac was infused intraperitoneally to the Group III rats before ischemia and 5µg/kg/h/0.3 ml sulindac was infused intraperitoneally to the Group IV rats after ischemia and before reperfusion process. The levels of MDA, GSH and MPO activity were measured in the left hippocampus tissue. The hippocampal tissue of all group members were taken for histopathological study. RESULTS: The MDA and MPO levels increased from group I (control) to group II (I/R) (P<0.05) and decreased from group II (I/R) to group III (presulindac + I/R) and IV (postsulindac + I/R) (P<0.05). Beside these, the GSH levels decreased from group I (control) to group II (I/R) (P<0.05) and increased from group II (I/R) to group III (presulindac + I/R) and IV (postsulindac + I/R) (P<0.05).The number of apoptotic neurons increased from group I (control) to group II (I/R) (P<0.05) and decreased from group II (I/R) to group III (presulindac + I/R) and IV (postsulindac + I/R) (P<0.05). CONCLUSION: The Sulindac may have neuroprotective effects on ischemic neural tissue to prevent the reperfusion injury after ischemia.


Asunto(s)
Inhibidores de la Ciclooxigenasa/farmacología , Hipocampo/irrigación sanguínea , Fármacos Neuroprotectores/farmacología , Daño por Reperfusión/prevención & control , Sulindac/farmacología , Animales , Apoptosis , Isquemia Encefálica/prevención & control , Modelos Animales de Enfermedad , Glutatión/análisis , Hipocampo/patología , Infusiones Parenterales , Malondialdehído/análisis , Estrés Oxidativo/efectos de los fármacos , Peroxidasa/análisis , Ratas Sprague-Dawley , Reproducibilidad de los Resultados
20.
Adv Orthop ; 2013: 753470, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23662211

RESUMEN

Fusion and rigid instrumentation have been currently the mainstay for the surgical treatment of degenerative diseases of the spine over the last 4 decades. In all over the world the common experience was formed about fusion surgery. Satisfactory results of lumbar spinal fusion appeared completely incompatible and unfavorable within years. Rigid spinal implants along with fusion cause increased stresses of the adjacent segments and have some important disadvantages such as donor site morbidity including pain, wound problems, infections because of longer operating time, pseudarthrosis, and fatigue failure of implants. Alternative spinal implants were developed with time on unsatisfactory outcomes of rigid internal fixation along with fusion. Motion preservation devices which include both anterior and posterior dynamic stabilization are designed and used especially in the last two decades. This paper evaluates the dynamic stabilization of the lumbar spine and talks about chronologically some novel dynamic stabilization devices and thier efficacies.

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