Corrective Maneuvers Used in Different Scoliosis Deformities With the Experience of 72 Operated Patients.

PURPOSE: This study aimed to show the correction maneuvers used in scoliosis surgery and give hints and tips on achieving optimal correction with the help of visual content. MATERIALS AND METHODS: Seventy-two scoliosis patients with 96 major curves operated between 2011 and 2018 evaluated retrospectively. Seven different correction maneuvers (Ucar convex rod rotation technique, cantilever technique, convex double-rod rotation technique, convex double-rod translation technique, double-rod rotation with coronal bending, convex rod rotation with coronal bending, direct vertebral rotation) were used in these surgeries alone or together. Each method is explained with figures and videos. Type of scoliosis, follow-up time, age, preoperative and postoperative degree of curvature, amount of correction, surgical time, amount of transfusion, hemoglobin level, and hospital stay were evaluated. RESULTS: The mean follow-up was 42.5 (24-108) months, and the mean age was 15.8 (12-29) years. The mean preoperative scoliosis angle of the patients was 75.9 (50-139) degrees, and the final follow-up was 15.6 (5-40) degrees. The scoliotic deformity correction rate was 79.3%. The mean preoperative thoracic kyphosis of the patients was 58.7 (12-110) degrees, and the final follow-up was 41.2 (25-62) degrees. The mean surgical time was 293 (160-440) minutes. The mean hospitalization length was 5.8 (2-21) days. The blood delivered to patients during surgery and postoperative was 715 (300-1800) mL. There was a statistically significant difference between the preoperative and final follow-up scoliosis angle ( P =0.000). CONCLUSIONS: Providing an ideal correction without damaging the spinal cord depends on correctly applying the correction maneuvers. The use of correction maneuvers alone or in combination in the appropriate order will shorten the duration of the case, decrease the amount of bleeding, shorten the hospital stay, increase the amount of correction, and reduce complications.

Effects of isotretinoin and acitretin on neuroregeneration in experimental spinal cord injury.

OBJECTIVE: This study aimed to determine whether isotretinoin and acitretin have beneficial effects on neural tissue damage following acute spinal cord injury. METHODS: Thirty-six rats were randomly divided into 6 groups: control, sham spinal cord injury, spinal cord injury with isotretinoin 15 mg/kg for 14 days, spinal cord injury with isotretinoin 15 mg/kg for 28 days, spinal cord injury with acitretin 10 mg/kg for 14 days, and spinal cord injury with acitretin 10 mg/kg for 28 days. The damage to the spinal cord was formed by the clip compression technique. A neurological evaluation was conducted on days 1, 14, and 28. All rats were sacrificed following the treatment period, and samples of their spinal cords were collected for histopathological analysis. RESULTS: The inclined plane angle was significantly increased on the 14th and 28th days in the isotretinoin 15 mg and acitretin 10 mg groups, compared to the spinal injury group (P=.049 and P=.009, respectively). The Drummond-Moore criterion was significantly higher in the acitretin 10 mg group than in the injury group (P=.026). Cleaved Caspase-3 expression was similar in the isotretinoin 15 mg day 28 group and the control group (P > .05), but significantly decreased in the acitretin 10 mg 14th-day and acitretin 10 mg 28th-day groups compared to spinal injury isotretinoin 15 mg 14th-day and isotretinoin 15 mg 28th-day groups (P < .05). CONCLUSION: This was the first study elaborating that isotretinoin and acitretin reduced neuronal apoptosis and improved functional recovery after spinal cord injury. These neuroprotective effects might open a window of opportunity for patients.

Comparison of intramedullary nailing and plate fixation in the surgical treatment of isolated fractures of the distal two-thirds of ulna diaphysis.

OBJECTIVES: This study aims to compare the clinical and radiological results of intramedullary nailing and plating, which are both techniques utilized frequently in the surgical treatment of isolated fractures of the distal third of the ulna diaphysis. PATIENTS AND METHODS: Between January 2010 and December 2016, a total of 54 patients (34 males, 20 females; mean age: 37.8±7.4 years; range, 22 to 56 years) with isolated fractures of the distal third of the ulna diaphysis were retrospectively analyzed. The patients were divided into those treated with locking plates (Plating group, n=25) and those treated with intramedullary nailing (IMN group, n=29). The operating time and clinical and radiological results were compared between the groups. RESULTS: The median follow-up time was 93 (range, 84.5 to 99.5) months in the Pg and 86 (range, 80 to 97) months in the IMNg (p=0.179). No significant difference was observed between the groups in respect of age, sex, trauma mechanism, fracture classification, smoking status, and time from trauma to surgery. The median operating time was 46 min in the Pg and 33 min in the IMNg (p<0.001). No significant difference was found in the postoperative length of stay in hospital, reduction quality, infection rates, clinical results, radiological results, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score between the groups. Implant removal was only needed in the locking plate group (p=0.007). CONCLUSION: In the surgical treatment of isolated fractures of the distal third of the ulna diaphysis, locked IMN seems to be a good alternative to the plate method with a shorter operating time and less need for implant removal.

Bone Morphology as a Determinative Risk Factor for Type of Ankle Fracture.

BACKGROUND: We investigated the relationship between ankle radiographic bone morphology and observed fracture type. METHODS: We retrospectively reviewed patients who had visited the emergency department with ankle injuries between June 1, 2012, and July 31, 2018. Patients were treated with open reduction and internal fixation. Patients were grouped by fracture pattern. Group 1 consisted of isolated lateral malleolar fractures, and group 2 comprised bimalleolar fractures. Group 1 was further divided into subgroups A and B based on classification as Weber type B and C fractures, respectively. Four radiographic parameters were measured postoperatively on a standing whole-leg anteroposterior view of the ankle: talocrural angle (TCA), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), and distance between the talar dome and distal fibula. RESULTS: One hundred seventeen patients were included in group 1-A, 89 in group 1-B, and 168 in group 2. The TCA and MMRL were significantly larger in group 2 than in group 1. Lateral to medial malleolar length ratio was also significantly different between the groups. However, there were no significant differences between the groups in terms of LMRL and the distance between the distal fibula tip and talar process. Between subgroups 1-A and 1-B, LMRL (P = .402) and MMRL (P = .592) values were not significantly different. However, there was a significant difference between groups in TCA and the distance between the distal fibula tip and talar process. CONCLUSIONS: The TCA, MMRL, and lateral malleolar length to medial malleolar length ratio were significantly higher in patients with bimalleolar fracture than in patients with isolated lateral malleolar fractures.

Lumbopelvic Fixation with Bridged Distal Iliac Screws for Vertically Unstable Sacral Fractures.

Purpose: The purpose of this study is to evaluate preliminary outcomes of vertically unstable sacral fractures treated by lumbopelvic fixation (LPF) augmented transiliac bridged screws. Methods: From April 2017 to December 2019, fifteen consecutive patients with vertically unstable sacral fractures who had undergone LPF augmented transiliac bridged screws were enrolled. The radiological assessment included standard lumbopelvic x-rays and pelvic computed tomography (CT) to evaluate the lumbosacral angle (LSA), sacral kyphosis angle (SKA), lumbar lordosis angles (LLA) and Matta's reduction criterias (MRC). Clinical and neurologic impairment outcomes were evaluated by the Majeed grading scale (MGS) and Gibbons criterias, respectively. Results: All patients were followed for an average of 18 months (range, 14-25). All sacral fractures eventually healed and implant failure did not occur in any patient, though there were two patients with a loss of reduction (< 5 mm) during the follow-up period. According to the MRC, the results were excellent on 14 sides, good on five sides, and fair on one side. The MGS mean score was 82 points (range, 49-98 points); the results were excellent in nine cases, good in four cases, and fair in two cases. There was no statistically significant difference in SKA and LLA in preoperative and postoperative final controls. The preoperative and postoperative LSA were 72 ± 13.9 and 44.1 ± 11.3, respectively, and a statistically significant improvement was observed (p = 0.01). Conclusion: In vertically unstable sacrum fractures, we believe that LPF augmented with transiliac bridging technique may expedite the reduction of vertical sacrum fracture and offers a reinforced fixation choice.

Risk factors for cut-out in intertrochanteric fractures treated with proximal femoral nail of double proximal screw design.

Background: Intertrochanteric femoral fractures (IFF) are often seen in the elderly after a simple fall because of osteoporosis, and treatment is generally provided with proximal femoral nail (PFN). The complication of cut-out, which can develop as a result of PFN treatment of IFF, is a significant cause of morbidity. The aim of this study was to examine the risk factors for cut-out in cases treated with double proximal screw design nail (DPSDN). Methods: A retrospective examination was made of patients aged> 70 years, who were operated on for IFF using DPSDN between January 2018 and December 2020. A record was made of the potential risk factors of age, gender, osteoporosis level (Singh Osteoporosis Index), fracture classification (AO/OTA classification), reduction quality, tip-apex distance(calTAD), and proximal screw placement values. Using logistic regression analysis, it was attempted to determine predictive factors for cut-out complication in cases operated on with DPSDN. Results: With 219 cases included in the study, two groups were formed as cut-out and non-cut-out. Reduction quality, calTAD, and proximal screw placement were seen to be risk factors for cut-out. According to the univariate logistic regression analysis, the cut-out risk was 57.917-fold greater in those with "poor" reduction quality compared to those with "good" reduction quality, the risk was 17-fold greater in those with "superior"screw placement compared to "central" placement (p < 0.001), and 9.24-fold greater in those with "anterior" placement compared to "central" placement (p < 0.001). The cutoff value for calTAD for the diagnosis of cut-out was found to be > 25.5 mm (p = 0.026). Conclusion: The results of this study demonstrated that the most important risk factors in the use of DPSDN are reduction quality, calTAD and proximal screw placement,. It was also concluded that just as in implants designed with a single screw, there is an increased risk when calTAD is > 25 mm.

Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury?

INTRODUCTION: The present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HYPOTHESIS: Patients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. MATERIAL AND METHODS: The study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). RESULTS: No statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DISCUSSION: Although AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. LEVEL OF EVIDENCE: IV; retrospective, case-control study.

Predictive Factors and Amputation Level for Reamputation in Patients With Diabetic Foot: A Retrospective Case-Control Study.

The aim of this study was to assess the rate and level of reamputation in patients who had a previous amputation from diabetic foot. We retrospectively analyzed patients who underwent amputation and reamputation due to diabetic foot in our clinic between 2011 and 2019. Fifty-nine were evaluated as the healed group after the first amputation and 55 were evaluated as the reamputation group. Given 55 patients who needed reamputation: there were 13 finger or ray, 23 transmetatarsal or syme, 18 transtibial, and 1 transfemoral in the first operation. We found the reamputation rate was 65.4% in distal amputations. When serum parameters were examined before the first amputation in each group, there was no statistically significant difference in white blood cells, neutrophils, lymphocytes, platelets, sedimentation, C-reactive protein, total protein, hematocrit, urea, creatinine, and HgA1c values. There was, however, a significant difference between groups in albumin levels. When comorbidities were assessed for smoking, hypertension, duration of diabetes, and number of debridements after the first surgery, a significant difference between groups was found. When peripheral artery disease and chronic renal failure were examined, no significant difference was observed. In our study, it was observed that the rate of reamputation was higher in distal level amputations for diabetic foot patients. Accordingly, albumin values, smoking, hypertension, duration of diabetes, number of debridements after surgery, were seen as risk factors for reamputation patients.

Angiotensin-Converting Enzyme Inhibitor Reduces Radiation-Induced Periprosthetic Capsular Fibrosis.

BACKGROUND: The capsular contracture is one of the main complications after radiotherapy in patients with implant-based reconstruction. The aim of this study is to evaluate the efficacy of ramipril for the prevention of radiation-induced fibrosis around the silicone implant. MATERIALS AND METHODS: Thirty Wistar rats in 5 groups were used. Group 1: implant; group 2: implant + radiation; group 3: ramipril + implant; group 4: ramipril + implant + radiation; group 5: sham. Ramipril treatment was started 5 d before surgery and continued for 12 wk after surgery. A mini silicone implant was placed in the back of the rats. A single fraction of 21.5 Gy radiation was applied. Tissues were examined histologically and immunohistochemically (TGF-ß1, MMP-2, and TIMP-2 expression). The alteration of plasma TGF-ß1 levels was examined before and after the experiment. RESULTS: After applying implant or implant + radiation, capsular thickness, percentage of fibrotic area, tissue and plasma TGF-ß1 levels significantly increased, and MMP-2/TIMP-2 ratio significantly decreased compared with the sham group. In ramipril-treated groups, the decrease in capsular thickness, fibrosis, TGF-ß1 positivity, and an increase in MMP-2/TIMP-2 ratio were found significant. In the ramipril + implant + radiation group, the alteration values of TGF-ß1 dramatically decreased. CONCLUSIONS: Our results show that ramipril reduces radiation-induced fibrosis and contracture. The results of our study may be important for the design of the clinical trials required to investigate the effective and safe doses of ramipril, which is an inexpensive and easily tolerated drug, on humans.

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.

Could percutaneous fixation with crossed Schanz pins be an alternative to open reduction in the treatment of intra-articular calcaneal fractures?

PURPOSE: Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs). METHODS: Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes. RESULTS: VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively). CONCLUSION: Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term results.

Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint.

BACKGROUND: The purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. METHODS: One hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7-10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. RESULTS: Finally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). CONCLUSION: Patient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. LEVEL OF EVIDENCE: Level I prognostic randomized controlled trial.

Retrospective observational study of intramuscular oxygen-ozone therapy for the treatment of neck pain: cervical paravertebral injection.

Neck pain is one of the major pathologies responsible for loss of labor. Many conservative treatment methods for neck pain have been described. The purpose of this study was to obtain pain scores for patients undergoing paravertebral ozone-oxygen (O3/O2) injections for neck pain caused by cervical disc disease. Over the last 6 months of 2018, 72 patients who undergoing intramuscular O3/O2 injections to treat neck pain were examined retrospectively in this multicenter study. Patients were injected with 30 mL of 20 µg/mL O3/O2 gas (into the paravertebral space). Subjects were treated once a week for 6 weeks. The visual analog scale pain scores and Japanese Orthopedic Association scores were obtained before (pre-injection) and after treatment (i.e., at 2 and 6 months). Significant improvements were observed in visual analog scale and Japanese Orthopedic Association scores at both 2 and 6 months versus the pre-injection scores. There was no significant difference in the visual analog scale or Japanese Orthopedic Association scores between 2 and 6 months. Paravertebral O3/O2 injection is a reliable and effective treatment of neck pain caused by cervical disc disease. The study was approved by Umraniye Education and Research Hospital, University of Health Sciences, Turkey (Reference Number: 00102187854) on September 25, 2019.

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele.

BACKGROUND: The aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy. METHODS: Between 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients' pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated. RESULTS: The mean patient age was 6.9 (4-10) years. Mean preoperative kyphosis was 115° (87-166°), mean early postoperative kyphosis was 3.9° (20-10°), and final follow-up postoperative kyphosis was 5.1° (22-8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115-35°) preoperative, as 12.9° (32-0°) early postoperative, and 15.7° (34-0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1-T12 and T1-S1, respectively. CONCLUSION: Kyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients. LEVEL OF EVIDENCE: Level 4.

Assessment of risk factors in de novo aneurysm development.

Aneurysms that occur anywhere in intracranial except where primary aneurysms develop, are called "de novo aneurysms". The risk factors and formation time of de novo aneurysms are not fully known. Congenital, environmental and hemodynamic factors can play a role in aneurysm development. The 43-year-old female patient was operated with the middle cerebral artery superior trunk aneurysm in our clinic. She came to us again after 17 months with a severe headache. In computed cranial tomography angiography, the middle cerebral artery superior trunk placement aneurysm was found to have a partial clip and "de novo aneurysm" was developed. She was re-operated for "de novo aneurysm". In this study, the risk factors in development of "de novo aneurysms" were discussed in the light of literature through this patient.

A new approach for spinal deformity patients with meningomyelocele: reverse Y incision.

We report a new surgical incision for spinal deformity in patients who had undergone meningomyelocele closure surgery. Six patients underwent kifectomy using an inverse Y incision. They all had multiple prior operations in the lumbar region due to dural meningomyeloceles. Four of the patients were girls. The primary indication for the reverse Y incision was a T12 and above posterior fusion defect and a large lumbar posterior fusion defect. These patients included four with kyphoscoliosis, one with lordoscoliosis, and one with lumbar kyphosis. The median age of the patients was 5.52 at the time of operation. The median follow up time was 17.3 months. Under appropriate indication, the reverse Y approach offers a reliable and successful solution for surgery.

Assessment of the Quality and Reliability of the Information on Rotator Cuff Repair on YouTube.

INTRODUCTION: YouTube® has become a common health information source for patients. Recent studies have determined that videos on YouTube® contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of videos pertaining to rotator cuff (RC) repair surgery. HYPOTHESIS: YouTube® users prefer watching videos with high educational quality which are provided by physicians. MATERIAL AND METHODS: A search was performed using keywords "rotator cuff surgery" and "rotator cuff repair" on YouTube® and the first 100 videos for each keyword were analyzed. Video source, time since upload, duration, and number of views, likes, and dislikes were recorded. Video popularity was reported using the video power index (VPI) and view ratio. Video educational quality was measured using the recognized DISCERN, the Journal of the American Medical Association (JAMA) score and a novel RC-specific score (RCSS). RESULTS: Among the 200 videos identified, 67 were included. The mean duration was 7.7minutes and the mean number of the views was 147,430. Videos uploaded by a physician had significantly higher DISCERN, JAMA, and RCSS (p<0.001). While the main video source was physicians (48%), the most popular videos were uploaded by patients and commercial websites, according to the VPI and view ratios. The number of likes, view ratios, and VPI were negatively correlated with each score. There were negative correlations between duration and VPI scores, and positive correlations with DISCERN, JAMA score, and RCSS. Animated videos showed significantly lower results for all quality scores (p<0.05), while their VPI was significantly higher (p<0.01). DISCUSSION: Online information on RC repair surgery provided by YouTube® was low quality, despite being mostly uploaded by physicians and having relatively higher quality scores. YouTube® users prefer watching low quality videos which were provided by patients and commercial websites. LEVEL OF EVIDENCE: IV, Case series.

A Simple Technique for Removing Broken Pedicle Screws.

Removing a broken pedicle screw is not always easy. Different methods and tools have been developed to remove the broken screw. Preserving the pedicle is an advantage for re-instrumentation. The head of the broken screw can be modified with the aid of a high-speed drill and the screw can be removed using a fractured screw removal tool without any problems. In addition, performing this procedure under the microscope reduces the risk of injury in the surrounding dura mater and the root. We believe that this simple technique can be conveniently used while removing a broken pedicle screw.

Transforaminal Lumbar Interbody Fusion For Lumbar Degenerative Disease: Patient Selection And Perspectives.

Most adults will experience low back pain during their lifetime, with most of these instances resolving or improving without sequelae in a few weeks. For the small number of patients with severe, recalcitrant pain, lumbar fusion may be required, particularly when concomitant leg pain or deformity is present. Lumbar interbody fusion surgery is the usual treatment for degenerative lumbar disease, but it requires a long recovery period. Many surgical techniques have been described in the literature for spondylolisthesis. The main objective is to create interbody fusion, decompression of normal structures and a stable vertebrae. TLIF surgical techniques has a long learning curve. Comorbidities of the patient may make surgery more difficult. Methods such as transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion, anterior lumbar interbody fusion and lateral lumbar interbody fusion are also available for interbody fusion in the literatüre. The aim of this review is to show which patients are more suitable for TLIF surgery and to discuss the advantages and disadvantages of TLIF surgery over other techniques.

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.