Implant-Related Complications Do Not Interfere with Corrections with the Shilla Technique in Early Onset Scoliosis: Preliminary Results.

Growth-preservation techniques are utilized in early onset scoliosis (EOS) cases requiring surgical intervention. The Shilla technique corrects the deformity by reducing additional surgeries with its growth-guidance effect. As with other techniques, various problems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with the Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least one year after receiving Shilla growth guidance for EOS were included in this retrospective study. No complications occurred, and no unplanned surgery was required in 50% of the cases. Of the remaining eight patients with postoperative implant-related complications (50%), six (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in five cases (31.25%) and deep tissue infection around the implant in one case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. In terms of spinal growth and deformity correction, there were no significant differences between patients with implant-related problems and individuals without occurrences. Although implant-related problems were detected in our dataset and corresponding unexpected surgeries were necessary, these complications had no significant unfavorable influence on correction and spine growth.

Investigation of the effects of subacromial bursal tissue preservation and microfracture procedure on healing after rotator cuff repair in a rat model.

INTRODUCTION: The aim of this study is to compare the preservation of bursal tissue and microfracture techniques and to examine the effectiveness of the combination of the two methods in rotator cuff tear healing in the rat shoulder. HYPOTHESIS: Bursal tissue preservation combined with microfracture is more effective in the rotator cuff repair. MATERIALS AND METHODS: Twenty-three male Sprague-Dawley rats were randomly divided into two groups. The bursal tissue was preserved in group 1 (n=11) and excised in group 2 (n=12). Groups were categorized into subgroups as L (left) and R (right) based on the shoulder side receiving microfracture (L received microfracture, R did not). Histopathological examination was performed using modified Bonar Score System. RESULTS: Cell morphology grades of group 1 were lower than group 2 (p<0.05). In terms of collagen measurements, the grade of group 1L (bursa preservation+microfracture) was lower than groups 1R, 2L, and 2R, and the grade of group 1R was lower than groups 2L and 2R. Cellularity grades of group 2 were higher than group 1 (p<0.05). Extracellular matrix grades of group 1 were lower than group 2 (p<0.05). The overall grades were lower in group 1 than in group 2 (p<0.05). DISCUSSION: Combined treatment of bursal tissue preservation and microfracture was the most efficient method as determined by healing findings in histopathological specimens. Preservation of bursal tissue was a more effective option in tendon healing than performing only microfracture. LEVEL OF PROOF: II, animal research.

Is It Necessary to Evaluate the Craniocervical Junction with Computed Tomoghraphy in Adolescent Spinal Deformities?

AIM: To assess the craniocervical junction (CCJ) by using radiological measurements in patients with adolescent idiopathic scoliosis (AIS) and Scheuermann?s kyphosis (SK), and to compare those reults with healthy adolescent population. MATERIAL AND METHODS: Patients were assigned to three groups. Group 1 consisted of AIS patients, Group 2 consisted of patients with SK, and Group 3 was the control group who did not have any spinal disorder. The groups were matched based on age and gender. Major Cobb angle and kyphosis angle were measured on X-Ray. asion-axial interval (BAI), basion-dens interval (BDI), posterior atlantodental interval (PADI), anterior atlantodental interval (ADI), atlanto-occipital interval (AOI), and Power?s ratio were measured by computerized tomography. The results were compared in each group statistically. RESULTS: A total of 120 participants, comprised of 78 (65%) female and 42 (35%) male were included in the study. There was no statistically difference between 3 groups based on age and gender (p > 0.05). According to the measurements, Group 3 had significantly higher PADI measurements than Group 1 (p=0.01). The ADI measurements of Group 2 were significantly higher than those of Group 1 and Group 3 (p=0.01). Group 3 had significantly higher BDI measurements than Group 1 and Group 2. (p=0.01). The Power ratios of Group 1 and Group 3 were statistically higher than that of Group 2 (p=0.01). There were no statistically significant differences between the groups in terms of AOI and BAI measurements (p=0.84, p=0.18, respectively). CONCLUSION: The presence of AIS and SK may affect the measurement of CCJ, and it may be considered to evaluate instability of the region.

A Novel Mathematical Model to Calculate the Osteotomy in Ankylosing Spondylitis.

MINI: The authors developed a mathematical model to the sagittal vertical axis (SVA) change in ankylosing spondylitis whom PSO is planned. The mathematical model was developed using trigonometric equations. No significant difference exists between postop SVA change amount and SVA calculated. The mathematical model is reliable in restoring the global sagittal balance.

Retrospective study. This study aims to develop a mathematical model to help precalculate the sagittal vertical axis (SVA) change in patients with ankylosing spondylitis (AS) with rigid kyphotic deformity for whom pedicle subtraction osteotomy (PSO) is planned. SVA is an important metric parameter used to evaluate the global sagittal balance. Previous studies have investigated angular changes in pelvic parameters using PSO; however, no mathematical model is available to calculate SVA change as a metric in these studies. Twenty-one patients who met the inclusion criteria were included in the study. The mathematical model was developed using basic trigonometric equations. Measurements for SVA, lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and the mathematical model were performed in the preop and early postop period. The amount of SVA change in the poststop period was calculated in the mathematical model. The mean age was 33.81 ±â€Š6.01 years. No statistical difference was observed between MATLAB and the angles used in the mathematical modeling ( P  > 0.05). No significant difference exists between postop SVA change amount and SVA calculated via mathematical modeling ( P  > 0.05). A statistically significant difference was observed between preop and postop measurements of LL, SVA, PT, and SS variables ( P  < 0.001). No statistically significant difference existed between PI ( P  > 0.05). This novel mathematical model is reliable in restoring the global sagittal balance of the patients with AS scheduled for PSO and prevent the osteotomy complications. Level of Evidence: 3.

Is the Measurement of Pedicle Axial Axes on Computed Tomography in Adolescent Idiopathic Scoliosis Also a Guide for Safer Screwing?

OBJECTIVE: To evaluate the effect of pedicle angle measurement in preoperative axial computed tomography in patients with adolescent idiopathic scoliosis (AIS) on correct thoracic screw placement in free-hand technique on 3-dimensional printing AIS models. METHODS: In this study, 14 3-dimensional spine models with a scale of 1:1, including the entire spine of a patient with Lenke type 1 curve, were used. Group 1 included screwing applications with unknown pedicle axial angles, and group 2 included screwing applications with known pedicle axial angles. The number and direction of screws in malposition were recorded. In addition, medial encroachment distances of the screws were classified as 0-4 mm and greater than 4 mm, and lateral encroachment distances were classified as 0-6 mm and greater than 6 mm. Evaluation parameters were compared statistically between the groups. RESULTS: The number of screws in the correct position in group 1 was lower than that in group 2 (P < 0.05). The medial and lateral malposition rate in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 4 mm and greater and lateral encroachment rate of 6 mm and greater in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 0-4 mm and lateral encroachment rate of 0-6 mm were similar between groups 1 and 2 (P > 0.05). CONCLUSIONS: Measurement of pedicle axial axes of preoperative thoracic vertebrae on computed tomography in patients with AIS offers more reliable screwing in free-hand technique.

Treatment strategy for elderly patients with the isolated greater trochanteric fracture.

BACKGROUND: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. METHODS: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. RESULTS: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). CONCLUSION: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery.

Is quality of YouTube content on Bankart lesion and its surgical treatment adequate?

BACKGROUND: The Internet has developed into a fast and easy to access source of information. The second most popular social media network is YouTube. We aimed to evaluate the accuracy and quality of videos uploaded to YouTube about Bankart lesion without diagnostic or treatment-related criteria. METHODS: Various keywords were searched for on YouTube. Videos were evaluated with the DISCERN and JAMA Benchmark scoring systems by two independent reviewers. RESULTS: A total of 48 videos were taken into evaluation as a result of the search. The mean view count was 28909.68 ± 30264.3. Mean length of the videos was 313,06 ± 344.65. The average DISCERN score of both reviewers was 2.35 ± 0.91. The average JAMA Benchmark score of both reviewers was 2.11 ± 0.77. CONCLUSION: We concluded that the accuracy and reliability of the videos obtained from YouTube by searching for the words Bankart and labrum lesion/injury/treatment are low.

Effects of Mobilization Time on Occurrence of New Fractures after Vertebroplasty.

Introduction: Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods: A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results: The mean follow-up period was 9 months (7-13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p < 0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p > 0.05). Conclusion: We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.

Autologous osteochondral transplantation method of treatment for patellar osteochondral lesions.

PURPOSE: This study evaluated the functional and clinical outcomes of the subjects with symptomatic osteochondral lesions on articular surface of patella, who were treated with autologous osteochondral transplantation (AOT) method. STUDY PLAN: AOT method was applied for the treatment of 14 subjects (eight men and six women; mean age 29.7 years; range 19-49 years) with symptomatic patellar osteochondral lesions between March 2008 and April 2013. After a mean follow-up period of 3.7 years (range 32-80 months), pre- and postoperative clinical and functional evaluations of the patients were performed using Visual Pain Scale (VPS), Lysholm Knee Scoring Scale, and Kujala Anterior Knee Pain Scale. Wilcoxon test was used for statistical evaluation of pre- and postoperative outcomes. Improvement of the lesions was assessed by magnetic resonance imaging (MRI) at year 1 postoperatively at the earliest. RESULTS: The mean lesion size was 1.32 cm2 (range 0.8-1.8 cm2). The mean pre- and postoperative VPS values were calculated to be 75.5 ± 12.32 (range 46-92) and 17.57 ± 10.21 (range 0-40), respectively ( p < 0.01). The mean pre- and postoperative Lysholm knee scores were 44.57 ± 9.35 (range 26-65) and 80 ± 6.9 (range 70-94), respectively ( p < 0.01), and the mean pre- and postoperative Kujala anterior knee pain scores were 48.21 ± 7.78 (range 38-68) and 78.42 ± 7.06 (range 70-96), respectively ( p < 0.01). MRI taken at year 1 postoperatively showed that the autograft bone tissue was sufficiently incorporated into the recipient site in all patients; an even articular surface was formed, but the thickness of the cartilage tissue was mostly uneven between the adjacency of the recipient site and the autograft, which caused no negative effect on clinical and functional outcomes. CONCLUSIONS: Despite the difference in thickness of the cartilage tissue between the recipient and the donor site, the AOT technique for the treatment of patellar osteochondral lesions resolves the symptoms of the patient and ensures an apparent functional and clinical improvement even if an articular surface could be created.

Discrepancy between cervical disc prostheses and anatomical cervical dimensions.

OBJECTIVE: The aim of this study was to assess appropriateness of the sizes of available cervical disc prostheses based on tomographic measurement of human cervical vertebrae. METHODS: The anatomic dimensions of the C3-C7 segments were measured on 50 patients (age range 26-47 years) with computerized tomography scan and compared with the sizes of the popular cervical total disc prostheses (CTDP) at the market [Bryan (Medtronic), Prodisc-C (Synthes), Prestige LP (Medtronic), Discover (DePuy)]. The mediolateral and anteriorposterior diameters of the upper and lower endplates were measured with a digital measuring system. RESULTS: Overall, 43.7% of the largest implant footprints were smaller in the anterior-posterior diameter and 42.6% in the mediolateral diameter were smaller than cervical endplate measurements. Discrepancy of the level C5/C6 and C6/C7 was calculated as 56.2% at the anteroposterior diameter and 43.8% at the center of mediolateral diameter. CONCLUSION: Large disparity has been found between the sizes of devices and cervical anatomic data. Companies that produce CTDP should take care of the anatomical dimensions and generate different sizes of CTDP. Spine surgeon should be familiar with the size mismatch in CTDP that may affect the clinical and radiological outcome of the surgery.