Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele.

OBJECTIVE: Neural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8-15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique. PATIENTS AND METHODS: In this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients. RESULTS: Mean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87-175°) and 0.79° (- 20-24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values (p < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1-T12 and T1-S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant (p < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed. CONCLUSION: We believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.

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.

Assessment of the Quality and Reliability of YouTube as an Information Source for Transforaminal Interbody Fusion.

BACKGROUND: This study aims to assess the quality and reliability of the information for patients from YouTube videos on transforaminal interbody fusion (TLIF). MATERIAL AND METHODS: One hundred videos were listed by inputting "TLIF," "TLIF surgery," and "transforaminal interbody fusion" in the YouTube search engine. The top 50 most popular videos based on video power index (VPI), view ratio, and exclusion criteria were selected for review. One orthopedic consultant surgeon and one neurosurgeon consultant analyzed the videos together. The modified DISCERN score, the Global Quality Score (GQS), the Journal of the American Medical Association (JAMA) score, and a novel interbody fusion score were used to evaluate videos. Data of video length, view count, number of likes and dislikes, like ratio (like x 100/(like+dislike)), video source, and comment rate were collected. RESULTS: The quality of the videos could have been better according to all scoring systems, regardless of the video source. The scores of the videos published by patients and commercials were significantly lower than those of physicians and allied professionals (p <0.05). VPI and view ratios were similar in all sources.  Conclusion: The study demonstrates that YouTube videos providing information related to TLIF surgery are available and accessed by the public. The results of this study would suggest that YouTube is not currently an appropriate source of information on TLIF surgery for patients. Most of the YouTube videos about TLIF surgery contain information about the surgical technique and have limited information about the post-operative condition of the patients.

Extruded disc herniations are experienced earlier by inactive young people in the high-tech gaming era.

In this study, we would like to draw attention to the advanced disc diseases seen in young people. The objective is to investigate the reasons for the increasing trend of disc herniations in young people. A total of 33 young patients with extruded lumbar disc herniations managed by conservative or surgical approaches between 2017 and 2018 were included. The average patient age was 25 years. Smoking, familial predisposition, sporting activity, and the occupation of the patients were questioned and noted. A visual analog scale (VAS) was used to assess the efficacy of pain. Body mass index (BMI) was calculated. All patients were subjected to lumbar magnetic resonance imaging. Eighteen patients (8 females, 10 males) had disc extrusion at the L5-S1 level, whereas 12 patients (8 females, 4 males) had disc extrusion at the L4-L5 level. Three other patients had disc extrusion at the level of both L4-L5 and L5-S1 levels. Motor deficits were detected in four patients, and surgical treatment was required and performed. The other 29 patients were treated conservatively. Young non-sport-oriented patients may face severe disc herniations. Understanding how spine degeneration can affect the likelihood of developing a herniated disc can help people make small lifestyle changes to postpone any serious pain and deficits. While aging is unavoidable, simple lifestyle changes can help improve overall spine health and deter the risk of developing a degenerative spine condition.

The effectiveness of preoperative colon cleansing on post-operative surgical site infection after hip hemiarthroplasty.

AIM: This study aimed to evaluate the effectiveness of prophylactic mechanical bowel preparation in elderly patients undergoing hip hemiarthroplasty in a single training institution over a period of 2 years. PATIENTS AND METHODS: The study was conducted in a prospective-randomised manner. All patients, who underwent primary hip hemiarthroplasty for femoral neck fracture in our institution between 20 February 2015 and 29 December 2016, were included. B.T. Enema (sodium dihydrogen phosphate + disodium hydrogen phosphate) 135 ml (Yenisehir Laboratory, Ankara, Turkey) was used for colon cleansing. RESULTS: Ninety-five patients were followed up for at least 1 year after surgery (16.3 ± 4.2 months). Of these, 46 were in the enema group and 49 were in the control group. Demographic and clinical characteristics of patients were similar in both groups (p > 0.05). Infection rates between the two groups were not significantly different (p > 0.05). In addition, ASA, age, sex, presence of diabetes mellitus, duration of surgery, time to surgery, ambulation status and blood count did not have a significant effect on surgical site infections (p > 0.05). However, all infections in the enema group were monobacterial and were successfully treated, whereas two of the four infections in the control group were polymicrobial and could not be successfully treated. CONCLUSION: Although preoperative colon cleansing did not reduce the overall incidence of post-operative infections, our study suggested that it may reduce polymicrobial infections after hip hemiarthroplasty. Polymicrobial infections after hip hemiarthroplasty seem to have worse prognosis. Therefore, the effectiveness of preoperative colon cleansing in remediating such infections must be investigated in a larger number of patients.

Neurocutaneous melanosis with transposition of the great arteries and renal agenesis.

Neurocutaneous melanosis (NCM) is rare and is characterized by the proliferation of melanocytes in the central nervous system. A 6-day-old infant boy was referred to our department with giant congenital melanocytic nevi and convulsions. On physical examination the patient had a giant black-brown pigmented nevus covering his face, neck, scalp, shoulders, back, chest, and abdomen. Numerous satellite lesions were noted on the face, neck, and upper extremities. In the right bulbar conjunctiva, a brown plaque was present. Magnetic resonance imaging (MRI) showed hyperintense areas in the brain on short repetition time/short echo time sequences, compatible with intraparenchymal melanin deposits. No leptomeningeal abnormality was seen. Further investigation also revealed agenesis of the right kidney and transposition of the great arteries. Transposition of the great arteries, which has never been reported in NCM, may be an incidental finding. We present a case of NCM associated with agenesis of the right kidney and transposition of the great arteries.

Risk factors for intraventricular haemorrhage in very low birth weight infants.

OBJECTIVE: In a prospective study at Uludag University Hospital, 120 premature infants with birthweights of 1500 g or less were screened for intraventricular hemorrhage (IVH) using cranial ultrasound. With the purpose of studying the incidence of IVH, the associated risk factors for these neonates were considered. METHODS: We studied all the very low birth weight infants admitted in our neonatal unit. We examined the following variables as risk factors for IVH: sex, birth weight, gestational age, Apgar score, mechanichal ventilation, hypercapnia, use of antenatal steroids, tocolytic drugs, vaginal versus cesarean section delivery, and inborn versus outborn status, vasopressor infusion (any vasoactive drug such as dopamine, dobutamine, or epinephrine) not associated with resuscitation, and surfactant administration. RESULTS: The incidence of IVH was 15% (18/120), 50% grade I (9/18), 17% grade II (3/18), 11% grade III (2/18), and 22% grade IV (4/18). IVH occurred mainly in the first week of life (78%; 14/18). The significant risk factors for IVH were found to be prematurity, outborn status, low 5 minute Apgar score, vaginal delivery, hypercapnia, mechanical ventilation, hypotension, and use of vasopressors on the day of admission. Significant protective factors against IVH included antenatal steroid therapy, cesarean section, magnesium sulfate tocolysis, increasing gestational age, and increasing birth weight. CONCLUSION: Our results concur with the notion that a tertiary center is the optimal location for delivery of the high risk neonate. Transportation of infants in utero to a perinatal center specializing in high risk-deliveries results in a decreased incidence of IVH when compared to infants transported postnatally. Aggressive resuscitation, with avoidance of hypercarbia, and rapid restoration of hypovolemia could potentially reduce the incidence of PVH/IVH.