The New Alternative Technique Outcomes: Atlas Lateral Mass Screw and C2-3 Transfacet Screw Fixation for Complex Atlantoaxial Instability in Patients with Thin C2 Pedicle or High-Riding Vertebral Artery.

OBJECTIVE: The study aimed to evaluate the safety, feasibility, effect on fusion, and clinical efficacy of atlas lateral mass and C2-3 transfacet screw fixation technique, serves as an alternative method to traditional posterior atlantoaxial fixation. METHODS: Patients with atlantoaxial instability who underwent atlas lateral mass and C2-3 transfacet fixation surgery were included. The duration of the surgery and the quantity of blood lost during the operation were recorded. Patients were monitored via X-ray and computed tomography scans to evaluate the degree of fusion at the 1-month and 12-month follow-up. The Neck Visual Analog Scale and Neck Disability Index were evaluated preoperatively, in the postoperative first week, and at the 12-month follow-up for clinical follow-up. RESULTS: A total of 8 patients with atlantoaxial instability due to odontoid fracture or Arnold- Chiari malformation accompanied by bony or vascular abnormalities were included in the study between 2017 and 2024. All 8 patients underwent successful atlas lateral mass and C2-3 transfacet screw fixation, with no neurovascular injury noted during surgery. All patients with fracture exhibited fusion at the 12-month mark, and both the Neck Visual Analog Scale and Neck Disability Index scores demonstrated significant improvement at both the 1-week and 12-month postoperative periods (P < 0.05). CONCLUSIONS: The atlas lateral mass and C2-3 transfacet screw fixation technique, an alternative to conventional posterior fixation, has been demonstrated to be an efficacious method for providing adequate stabilization and fusion in patients with atlantoaxial instability, even in the cases of thin C2 pedicle, high-riding vertebral artery, previous failed surgeries, or reoperation.

Finite Element Analysis of Bilateral Double Rod Constructs in Thoracolumbar Fractures.

AIM: To evaluate bilateral double rod contructs in thoracolumbar fractures in a Finite Element model MATERIAL and METHODS: A computed tomography of a 35-year old male have been chosen to create a vertebra model and 1/3 of the T12 was removed to create the burst fracture model. In model A, transpedicular polyaxial screws were inserted two levels above and two levels below the burst fracture. On each side the screws were connected with a single rod. In model B, the screws were connected with two rods on each side attached to two lateral connectors. A uniform 150 N axial load and 10 N/m torque was applied on the superior T10. RESULTS: ROM and von Mises stress nephrograms revealed that the bilateral double-rod construct is being the most rigid and that the force on the pedicle screws were significantly lower compared to model A. CONCLUSION: We believe that bilateral double-rod constructs for the stabilization of thoracolumbar fractures have a decreased load on pedicle screws and rods compared to the classic bilateral single rod stabilization system and can lower the risk of implant failure and the risk for secondary complications and revision surgery.

Selective Apical Convex Rod Derotation: A Fast and Secure Technique for the Correction of Adolescent Idiopathic Scoliosis-A Case Series of 38 Patients.

BACKGROUND AND OBJECTIVES: We present a novel technique of selective apical convex rod derotation as an effective and safe maneuver for the correction of adolescent idiopathic scoliosis and give the clinical results of our patients. Adolescent idiopathic scoliosis is the three-dimensional deformity of the spine of more than 10° affecting children from 10 to 18 years. The gold standard for the correction of larger curves is posterior fusion. With the help of osteotomies, the spine becomes mobile and the ideal alignment can be achieved with correction maneuvers. Derotations from the concave side harvest numerous complications such as exacerbation of apical rotation, screw pullout, and implant failure. METHODS: After the transpedicular screws are placed, a short titanium rod is put on the convex-side screws just covering the apex and the screw nuts are loosely tightened. The convex apical rod is held with 2 rod holders and derotation is applied to the rod and the convex spine is pulled toward the midline. After the desired correction is reached, a permanent rod is placed to the concave side and screw nuts are tightened. RESULTS: A total of 38 patients have been included in this study. Preoperative median Cobb angle was 47.19°, postoperative Cobb angle was measured as 18.45°, and 1 year follow-up was 17.25°. Thoracic kyphosis values were 19.07°, 30.52°, and 33.05°, respectively. Lumbar lordosis were measured as 42.63°, 43°, and 45.75°, respectively. CONCLUSION: Selective apical convex rod derotation is an effective treatment of adolescent idiopathic scoliosis with minimal risk for screw pullout, pedicular bursting, or hypokyphosis. Correction results are similar to classic correction maneuvers.

Computed Tomography-Based Occipital Condyle Morphometric Analysis in the Turkish Population: A Trajectory Analysis for Optimal Screw Selection.

AIM: To provide a comprehensive analysis for accurate screw size selection and insertion angle during surgical procedures. MATERIAL AND METHODS: In this retrospective study, a total of 120 patients participated, resulting in the analysis of 240 occipital condyles using coronal, sagittal, and axial planes on CT scans. Statistical evaluation was performed using the Wilcoxon rank-sum test, with p < 0.05 considered statistically significant. RESULTS: The mean sagittal length and height were measured at 17.2 ± 1.7 mm and 9.1 ± 1.5 mm, respectively. The average condyle angle, a crucial factor for screw insertion, was assessed at 38.0 ± 5.5 mm in length, 19.6 ± 2.6 mm in width, and 9.5 ± 1.0 mm in height. Condyle height in the anterior and posterior hypoglossal canals was measured at 10.8 ± 1.4 mm and 9.0 ± 1.4 mm, respectively. Screw angle and condyle width were statistically smaller in females compared to the male population. CONCLUSION: The OC is a significant anatomical structure in the craniovertebral junction, playing a crucial role in stability. The obtained morphological values are applicable to the Turkish population and offer statistically significant findings for preoperative planning involving occipital condyle screw instrumentation.

The Safety to Switch from Constant Voltage to Constant Current with a Mixed Internal Pulse Generator in Deep Brain Stimulation.

Background: Deep brain stimulation (DBS) is an efficient modality for the treatment of movement disorders. Differing from the constant voltage (CV)-DBS devices, constant current (CC)-DBS devices may allow more precise stimulation of the target brain regions since they are less influenced by impedance. If internal pulse generators (IPGs) of DBS devices are required to be connected with electrodes of different brands, employing proper adapters is necessary. Such connected DBS devices are called mixed or hybrid devices. Objectives: As there is sparse information about the clinical mixed devices, we studied their safety and efficacy. Materials and Methods: Clinical scores of 13 patients implanted with mixed DBS devices were determined with the Unified Parkinson's Disease Rating Scale (UPDRS) in Parkinson's disease (PD) (n = 10) and with the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) in dystonia (n = 3). Patient satisfaction was assessed with the Timmerman questionnaire. The Clinical Global Impression Improvement (CGI-I) Scale was also evaluated. Results: Patients' overall satisfaction was considerably higher with mixed devices. The UPDRS and BFMDRS clinical scores did not significantly differ after switching to a mixed DBS device. Three patients before the DBS switch suffered from side effects under the CV mode. These patients got rid of the side effects in their follow-up with a reduction in pulse width values. Discussion: Mixed devices working in CC mode are well tolerated with high patient satisfaction. Conclusion: Besides patient satisfaction, mixed IPGs are also considered safe.

Can lumbar paraspinal muscle/fat ratio and spinopelvic parameters predict short-term outcomes after decompressive surgeries in lumbar disc herniation and lumbar spinal stenosis?

Background and Objectives: We aimed to investigate whether the lumbar paraspinal muscle/fat ratio influences the outcomes of patients who had simple decompressive surgeries for lumbar disc herniation (LDH) or lumbar spinal stenosis. We also wanted to see if the spinopelvic parameters change with surgery and whether this change influences the outcomes. Materials and Methods: This was a prospective study on patients with lumbar spinal stenosis (20 patients) and LDH (20 patients) who underwent simple discectomy or decompressive surgery between November 2021 and May 2022. Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index, and Japanese Orthopedic Association (JOA) score were performed before and 3 months after surgery. Spinopelvic parameters were measured on whole spine radiographs before and 3 months after surgery. On axial magnetic resonance images, paraspinal muscle volume and muscle/fat ratios were calculated. All data were statistically analyzed with SPSS program. Results: There was a significant improvement in VAS, Oswestry, and JOA scores after surgery. We observed that more preoperative paraspinal muscle mass was positively correlated with lumbar lordosis (LL) and negatively correlated with sagittal vertical axis (SVA), VAS leg scores, and Oswestry scores. Furthermore, we observed a positive correlation between preoperative SVA and VAS leg scores. Conclusion: Despite limited number of patients, and shorter follow-ups, this prospective study demonstrates a correlation among the lumbar paraspinal muscle/fat ratio, preoperative/postoperative spinopelvic parameters, and surgical outcomes. Increased paraspinal muscle ratio was correlated with lower SVA values and increased LL; lower VAS leg scores; higher Oswestry scores which reflects better surgical outcomes.

Temporary 6TH cranial nerve paralysis after accidental durotomy in endoscopic disc surgery.

We present a unique case of 6th nerve palsy following accidental durotomy in endoscopic lumbar spine surgery, which has not been reported in the literature before. A 72- year-old female patient was admitted to our outpatient clinic complaining of right leg pain for 6 months. A 4/5 motor paresis was observed on her right toe with a positive Lasegue test at 45°. On her magnetic resonance imaging (MRI), a L5-S1 disc herniation was detected. The patient was planned for percutaneous endoscopic interlaminar disc surgery. The extruded disc was adherent to the dura. During removal, a dural tear was observed. She was relieved of her right leg pain immediately after surgery, but after 30 min postoperatively, she complained of double vision with left abducens nerve paralysis. On cranial MRI, no abnormality could be observed. Intravenous fluids were administered and the paralysis resolved on the postoperative 24th hour. The patient was discharged from the hospital and did not show any complaints on her follow-ups. A 6th nerve palsy can be caused due to alterations of intracranial pressure or mechanic injury. We believe that the durotomy following removing of the disc fragment caused a rapid drainage of CSF, leading to intracranial hypotension and injury of the abducens nerve. Intracranial pressure should be monitored perioperatively and brisk deteriorations has to result in immediate finishing of the surgery to avoid further secondary damage.

Modified Kickstand Rod Technique for the Correction of Adult Idiopathic Scoliosis.

Adult idiopathic scoliosis (ADIS) is the delayed form of adolescent idiopathic scoliosis (AIS) which is defined as a three-dimensional deformity with a lateral curvature of more than 10° in adults with prior history of AIS. Surgery is necessary for patients with symptoms of chronic pain, neuromotor deficits and cardiopulmonary problems with a Cobb angle exceeding 45°. In untreated patients, AIS may lead to ADIS which can cause serious problems like osteoarthritis, progressive deformity and spinal stenosis. In recent years, the kickstand rod technique has been introduced in addition to posterior transpedicular stabilization. A kickstand rod is an additional rod which is placed on a supporting iliac screw which is placed on the superior lateral edge of the ilium on the concave side of the deformity (or in other words on the ipsilateral side of the trunk shift) and is connected with a domino connector to the thoracolumbar junction. The rod is then distracted with the screw nuts locked on the contralateral side to achieve coronal correction. The classic kickstand works as a an additional aid to keep the spine in place during maneuvering. We established a modified kickstand rod technique where we put the rod on the concave side and apply compression between the rod on the screw heads and the kickstand to bring the concavity to the midline. The kickstand was used as a temporary tool like a lever to push the spine medially with compression. We believe that our technique can be a useful alternative for correction of coronal imbalance besides the classic one.

Kyphosis After Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations.

Thoracolumbar fractures change the biomechanics of the spine. Load distribution causes kyphosis by the time. Treatment of posttraumatic kyphosis is still controversial. We reviewed the literature between 2010 and 2020 using a search with keywords "thoracolumbar fracture and kyphosis." We removed osteoporotic fractures, ankylosing spondylitis fractures, non-English language papers, case reports, and low-quality case series. Up-to-date information on posttraumatic kyphosis management was reviewed to reach an agreement in a consensus meeting of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The first meeting was conducted in Peshawar in December 2019 with WFNS Spine Committee members' presence and participation. The second meeting was a virtual meeting via the internet on June 12, 2020. We utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized 42 papers on posttraumatic kyphosis. Surgical treatment of thoracolumbar kyphosis due to unstable burst fractures can be done via a posterior only approach. Less blood loss and reduced surgery time are the main advantages of posterior surgery. Kyphosis angle for surgical decision and fusion levels are controversial. However, global sagittal balance should be taken into consideration for the segment that has to be included. Adding an intermediate screw at the fractured level strengthens the construct.

Effects of Resveratrol on Inflammation and Apoptosis After Experimental Spinal Cord Injury.

AIM: To determine the effects of resveratrol on inflammation and apoptosis after experimental spinal cord injury (SCI). MATERIAL AND METHODS: Eighteen Sprague-Dawley rats were randomly divided into three groups. All groups underwent thoracic laminectomy. The first group received no other intervention. The second and third groups suffered SCI via the aneurysm clip compression method, and additionally the third group received resveratrol. After euthanizing the rats, immunohistochemical analysis and biochemical parameters of tumor necrosis factor alpha (TNF-?) and interleukin (IL)-1? were measured. RESULTS: The resveratrol group had statistically significant lower levels of TNF-?, IL -1?, and terminal deoxynucleotidyl transferasemediated dUTP nick-end labeling (TUNEL) positive cells and higher number of glial and motor neuron cells. CONCLUSION: Resveratrol proves to have remarkable neuroprotective effects on SCI in an experimental model in addition to its proven cardioprotective effects.

Restless leg syndrome and sleep quality in lumbar radiculopathy patients.

BACKGROUND: To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative treatment. METHODS: The present study included 66 lumbar radiculopathy patients, who were resistant to conservative treatment and had indication of surgery. Five different questionnaires were performed to assess depression (the Beck Depression Inventory (BDI)), sleep quality (the Pittsburgh Sleep Quality Index (PSQI)), fatigue (the Fatigue Severity Scale (FSS)), and presence of RLS and rapid eye movement sleep behavior disorder (RBD). The same questionnaires were also performed on a control group (n = 61). RESULTS: Of the radiculopathy patients, 68.1% had RLS and 92.4% had fatigue. Of the controls, 16.4% had RLS and 59% had fatigue. RBD was present in 8 (12.1%) patients and 3 (4.9%) controls. The PSQI revealed that sleep quality was impaired in 46 (69.7%) patients and 35 (57.4%) controls (P > 0.05). The number of individuals having substantial depression according to the BDI was significantly higher in the patients than in the controls. CONCLUSIONS: There was a significant increase in the frequency of RLS, which was significantly decreased in the postoperative period in the radiculopathy patients.