Spinal anatomy in an essential illustrated medical treatise of the late Ottoman era.

OBJECTIVE: The aim of this article is to introduce a great physician of the late Ottoman period and his writings on spinal anatomy. METHODS: The article presents chapters related to the anatomy of vertebra and the vertebral column in the book of Sanizade Ataullah Mehmed, Mir'at al-Abdan fi Tashrih-i A'dai'l-Insan (Mirror of the Bodies in the Dissection of the Members of the Human Body). RESULTS: Works of Sanizade are viewed as important landmarks in Turkish medical history. Anatomy education in Turkey can be divided into four historic periods and the second period is called the Sanizade Period (1816-1827). This period leads up to the opening of the first modern medical school in Turkey on March 14, 1827. CONCLUSIONS: The most important characteristic of Sanizade's work is that it is the first illustrated anatomy book printed in the Ottoman Age, and the value of the work is shown by Sanizade being one of the originators of medical terms in Ottoman Medicine.

Effectiveness of lumbar zygapophysial joint blockage for low back pain.

AIM: Zygapophysial joints have been a well-recognized source of low back pain. This paper compares the efficacy of lumbar zygapophysial joints blockage and medical therapy in terms of pain relief, loss of working days and recurrence of pain in a population with mechanical low back pain. MATERIAL AND METHODS: 80 patients suffering from low back pain were included in the study. Patients were divided into 2 groups. Patients in Group I were given diclofenac sodium, thiocolchicoside and were recommended bed rest. Patients in Group II received zygapophysial joints blockage by prilocaine, bupivacaine and methylprednisolone acetate. Both of the groups were evaluated with a Oswestry low back pain disability questionnaire and visual analog scale for pain. RESULTS: Posttreatment VAS and ODQ scores were significantly lower than pretreatment scores. The decrease in these scores in Group II was greater than those of Group I. CONCLUSION: Blockage of the lumbar facet joints is a rapid and effective way to reduce pain originating from lumbar facet joints.

Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal.

OBJECT: This study was designed to evaluate the efficacy of decompressive surgery for degenerative lumbar spinal stenosis (LSS) on a functional and clinical basis. METHODS: A prospective analysis and follow-up of 125 consecutive patients with degenerative LSS between 2000 and 2006 were performed. All patients underwent surgery for lumbar stenosis. Functional evaluations of the patients were performed using a treadmill, the visual analog scale, and the Oswestry Disability Questionnaire (ODQ). These parameters were recorded before surgery and the 3rd month and 1st and 2nd years after treatment. The first symptom time (FST), maximal walking duration (MWD), and thecal sac cross-sectional area (CSA) before and after surgery were also recorded. Statistical relations between variables were calculated. RESULTS: As patient ages increased, the CSA of the thecal sac decreased. Decompressive surgery reached the target according to the difference between the preoperative and postoperative thecal sac CSA. A correlation between the CSA of the thecal sac and FST, and between the CSA of the thecal sac and MWD could not be established. There was a significant correlation between the FST and MWD, and a negative correlation could be established between the MWD and the ODQ score. Surgery led to significant decreases in the ODQ score. Maximal improvement was observed in the 3rd month after decompressive surgery. CONCLUSIONS: The treatment for LSS should be decided using functional criteria; radiological criteria may not correlate with the severity of the disease. Improvements following lumbar decompression surgery continued within 1 year of treatment according to the ODQ and did not change significantly thereafter.

Augmentation of third generation instrumentation with sublaminar titanium wiring in late onset idiopathic scoliosis: the surgical results and analysis of trunk balance.

In recent years, third generation instrumentation systems which achieve correction by maneuvers like derotation and translation, have been widely used in the treatment of idiopathic scoliosis. To increase correction, additional procedures that increase stability, such as screw application for every segment, have been used. In this study, as a new technique, the effects of combined translation and derotation maneuver with augmentation by using titanium double crimp Songer cable applied on apical region, on trunk balance, sagittal and frontal planes have been examined. 45 idiopathic scoliosis patients operated between 1996 and 2002 have been included in the study. Mean age was 14.5+/-1.7 years and female/male ratio was 30/15. Mean follow up time was 51.9+/-22.7 months. According to King Classification, 15 patients had Type II, 18 patients Type III and 12 patients had Type IV curves. One of the apical cables has been tensioned and translation has been performed. At the second step, derotation has been applied to the vertebra, which is firmly attached to the rod. Sagittal and frontal Cobb angles have been measured in preoperative, postoperative and recent radiographic examinations. Trunk balance has been examined both clinically and radiographically. Also, secondary curves have been measured in every examination for decompensation findings. In overall frontal plane measurements, postoperative correction was 79.9+/-13.5 %, loss of correction 2.9 degrees +/-3.2 degrees and final correction 74.3 % +/-14.3 %. In postoperative measurements, normal physiological contours have been achieved in 97.8 % of the patients for the thoracic region (30 degrees -50 degrees ) and 80.7 % of the patients for the lumbar region (40 degrees -60 degrees ). In secondary curves, 75.2+/-34.4 % postoperative correction has been observed. No decompensation findings have been observed in the last examination. In postoperative and last follow up examinations, balanced and totally balanced vertebral column has been achieved in every patient of the study group. Solid fusion mass has been observed in every patient. No early or late, local or systemic postoperative complications have been observed. Given these findings, we conclude that derotation-translation combined maneuver performed with 3rd generation instrumentation reinforced sublaminar wires is a good choice in the treatment of the late-onset idiopathic scoliosis.