Comparison of clinical and functional outcomes of vertebral body tethering to posterior spinal fusion in patients with adolescent idiopathic scoliosis and evaluation of quality of life: preliminary results.

PURPOSE: This preliminary study was aimed to present the results of the comparison of clinical and functional outcomes of vertebral body tethering (VBT) and posterior spinal fusion (PSF) for the first time in the literature. METHODS: 21 thoracolumbar (T5-L3) VBT patients (VBT group); and 22 age-gender-fusion level and minimum follow-up duration matched thoracolumbar (T3-L3) PSF patients (PSF group) were enrolled. Average FU duration of group 1 and 2 were 37.1/37.8 months (p = 0.33). Patients clinical data together with SRS-22 scores and SF-36 scores were compared. A retrospective, comparative study was undertaken. RESULTS: VBT group was detected to have superior lumbar range of motion; superior anterior-lateral lumbar bending flexibility; superior flexor and extensor endurances of trunk, and superior average motor strength of trunk muscles with high statistical significance. VBT group was also detected to have superior scores regarding life quality, including better average total SRS-22 and better average SF-36 MCS/PCS scores with also high statistical significance. CONCLUSION: This study for the first time in the literature concluded, that in skeletally immature patients with AIS, VBT as a result of the utilization of growth modulation was able to yield significantly superior lumbar range of motion, lumbar anterior and lateral flexibility, trunk flexor-extensor endurance and trunk motor strength as compared to patients who underwent fusion. By yielding significantly superior SRS-22 and SF-36 scores, VBT was detected to provide better life quality and patient satisfaction than fusion. This study concluded hereby, that by applying VBT, spinal motion could be preserved and complications of fusion could be avoided.

Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures' Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients.

OBJECTIVE: This study aimed to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain. METHODS: One hundred nine patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with polymethymetachrylate augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically. RESULTS: Patients had a mean age of 74.1 and a follow-up duration of 92.3 months. Mean duration of operations, hospital stays, and mean loss of blood were 172.3 minutes, 4.3 days, and 205.4 mL. All of the patients were mobilized immediately after surgery. The mean preoperative local kyphosis angle improved from 39.3° to 4.7° at the last follow-up (p = 0.003). Patients preoperative mean visual analogue score, Japanese Orthopaedic Association, and Oswestry Disability Index scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4 (p < 0.001 for all), respectively. The average 36-item Short-Form survey physical component summary/mental component summary scores at the last follow-up were 55.1/56.8. A dural tear was detected intraoperatively in 1 patient and repaired immediately. CONCLUSION: Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures' sequelae in the older population involving spinal cord compression by enabling the decompression of the spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.

Double-sided vertebral body tethering of double adolescent idiopathic scoliosis curves: radiographic outcomes of the first 13 patients with 2 years of follow-up.

PURPOSE: In skeletally immature patients with adolescent idiopathic scoliosis (AIS), vertebral body tethering (VBT) as a fusionless minimally invasive treatment option has been shown to correct the deformity by growth modulation. This prospective cohort study aimed to present the minimum 2 years' results of double-sided VBT applied to double curves of 13 skeletally immature patients with AIS. METHODS: Thirteen skeletally immature patients with AIS and double curves were included. All patients were followed up within a brace for at least 6 weeks. A decision to proceed with surgery was established after the detection of curve progression within the brace (> 40° thoracic, > 35° lumbar) with a minimum curve flexibility of 30%. RESULTS: Patients had an average age of 11.8 years, average follow-up duration of 36.4 months (range 24 to 46), average preoperative main thoracic/thoracolumbar or lumbar curve magnitudes of 48.2°/45.3°. An average of 11.8 levels of tethering was undertaken. Thoracic screws were placed thoracoscopically, while mini-thoracotomy/lumbotomy was added for thoracolumbar levels. Postoperatively, an average first erect thoracic/thoracolumbar major curve magnitudes of 17.3°/14.3° were acquired, while they improved to 9.7°/8.2° at the last follow-up. No neurologic or implant-related complications were acquired. CONCLUSION: Double-sided VBT was detected to provide 80% of thoracic (48.2° to 9.7°) and 82% of thoracolumbar-lumbar curve correction (45.3° to 8.2°) as a result of average two years. As being a growth modulating treatment option, double-sided VBT as applied under strict inclusion criteria was shown to be safe and effective for the correction of double curves in skeletally immature patients with AIS, by yielding a gradual, growth-assisted correction of both curves together with the preservation of coronal-sagittal balance without any major complications.

Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Minimum of 2 Years' Results of 21 Patients.

BACKGROUND: Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS. METHODS: Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%. RESULTS: Patients had an average age of 11.1 and an average follow-up period of 27.4 months. All patients underwent thoracoscopic placement of thoracic screws, from the convex side of curves. An average of 7.1 levels of tethering was undertaken. Average preoperative major thoracic curve magnitudes improved from 48.2 to 16 degrees on the first erect postoperative x-ray, and to 10 degrees at the last follow-up (P<0.001). Immediate postoperatively, 1 case with chylothorax was detected and treated conservatively, and another case with tether breakage was detected at the third postoperative year and replaced thoracoscopically. No other major complication was acquired. CONCLUSIONS: Anterior VBT as a growth modulating treatment option by allowing the correction of the scoliotic deformity and preserving coronal balance was detected to be a safe and effective option for the surgical treatment of AIS in skeletally immature patients, if applied under strict inclusion criteria. VBT by allowing preservation of spinal segmental motion is yielding promising radiographic results without causing any major complications. LEVEL OF EVIDENCE: Level IV.

Total hip arthroplasty without subtrochanteric femoral osteotomy is possible in patients with Crowe III/IV developmental dysplasia: total hip arthroplasty without femoral osteotomy.

BACKGROUND: We aimed to present our THA technique without femoral shortening osteotomy that we perform for the treatment of coxarthrosis on Crowe type III/IV developmental dysplasia of the hip and to present the early clinical outcomes of our patients. METHODS: 77 patients with Crowe type III/IV developmental dysplasia of the hip, who had admitted to our clinic between 2013 and 2017, and had undergone cementless THA without femoral shortening by a single surgeon, were retrospectively evaluated. Patients were called for a final evaluation and assessed by Harris Hip Score. Trendelenburg sign was observed. For radiological evaluation, routine anteroposterior and lateral hip radiography and orthoroentgenogram was used. RESULTS: Mean duration of follow-up was 38.2 (22-52) months. Pre-operative mean Harris Hip Score was 53.9 (49-62) and post-operative mean value was 82.7 (76-95). Mean duration of operation was 44.9 (39-57) min. In post-operative final evaluation only three patients (3.8%) had positive Trendelenburg sign. 3 patients (3.8%) had early dislocation. No sciatic palsy was observed in any of the patients. Revision with acetabular cage was performed for one (1.2%) patient due to protrusion development in the acetabular cup. The mean prosthesis survival rate was 98.8%. CONCLUSIONS: Total hip arthroplasty without femoral osteotomy can be considered as a successful method in selected patients with Crowe III/IV coxarthrosis. It provides good clinical outcomes in the early period, reduces surgery duration, has acceptable complication rates, has high prosthesis survival rates.

A Retrospective Review of Radiographic and Clinical Findings from the M6 Cervical Prosthesis.

STUDY DESIGN: Retrospective clinical study. PURPOSE: To evaluate clinical results of the M6 cervical prosthesis. OVERVIEW OF LITERATURE: Cervical disk prostheses have been developed to preserve motion and reduce degeneration in adjacent segments in degenerative disk diseases. METHODS: A retrospective evaluation was performed on 43 patients who received the M6 cervical disk prosthesis between 2012 and 2016. Standard and dynamic radiographs, computed tomography, and magnetic resonance imaging were used to evaluate all the patients preoperatively and postoperatively. The Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores were examined in evaluating the clinical and functional results of patients with collapsed disk herniation who had received the M6 cervical prosthesis and to evaluate whether the core structure of the prosthesis protects motion. RESULTS: The mean follow-up period was 34.12±6.70 months. Radiologically, the preoperative cervical segment ROM was measured as a mean of 5.77°±2.19° preoperatively and 8.49°±2.37° at the inal postoperative follow-up examination. In the patients with a preoperative disk height of <4 mm, the segmental ROM increased from 4.53°±2.79° preoperatively to 7.2°±3.18° postoperatively. In the patients with a preoperative disk height of >4 mm, the cervical segment ROM increased from 6.4°±1.45° preoperatively to 8.6°±2.02° at the inal postoperative follow-up examination. The NDI scores reduced from 53.86±9.77 preoperatively to 22.69±7.26 postoperatively and the VAS scores reduced from 8.74±0.58 to 1.88±1.14. During follow-up in any patient, no collapse of the levels at which surgery was performed was observed. No heterotopic ossiication or implant failure was recorded in any patient during the follow-up period. CONCLUSIONS: The M6 new-generation cervical disk prosthesis had few complications. No heterotopic ossiication was observed in any patient, and lexion-extension ROM was maintained in all the patients, indicating the M6 prosthesis as a promising alternative.

The Combination of Inlay Patellofemoral Arthroplasty and Medial Unicompartmental Knee Arthroplasty Versus Total Knee Arthroplasty for Mediopatellofemoral Osteoarthritis: A Comparison of Mid-Term Outcomes.

BACKGROUND: To the best of our knowledge, there have been no studies in the literature related to the use of second-generation inlay patellofemoral arthroplasty and unicompartmental knee arthroplasty combination (inlay PFA/UKA) in the treatment of mediopatellofemoral osteoarthritis (MPFOA). The aim of this study is to evaluate the efficacy of inlay PFA/UKA in MPFOA. METHODS: The study included 49 patients applied with inlay PFA/UKA because of MPFOA and 49 patients applied with TKA, matched one-to-one according to age, gender, body mass index, follow-up period, preoperative Knee Society Score, and range of motion. All the patients were evaluated clinically using the Knee Society Score, Knee Injury Osteoarthritis Outcome Score, and range of motion, and were also evaluated radiologically. Complication rates and length of hospital stay were compared. RESULTS: The mean follow-up period was 54 ± 4 and 54.4 ± 3.9 months in inlay PFA/UKA and TKA groups, respectively. (P = .841). No statistically significant difference was determined between the 2 groups in respect of the mean clinical scores at the final follow-up examination (P ≥ .129). Total complications were fewer and length of hospital stay was shorter in the inlay PFA/UKA group than in the TKA group (P = .037 and P = .002). There was no radiographic evidence of progression of lateral compartment osteoarthritis according to Kellgren-Lawrence in any patient in the inlay PFA/UKA group. CONCLUSION: In selected patient groups, inlay PFA/UKA is an alternative to TKA, with lower complication rates, shorter length of hospital stay, and clinical and functional results similar to those of TKA without osteoarthritis progression in the unresurfaced lateral compartment in the mid-term. LEVEL OF EVIDENCE: III.

Surgical Management of Thoracic Disc Herniation: Anterior vs Posterior Approach.

AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. MATERIAL AND METHODS: A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. RESULTS: The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p > 0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p < 0.05). CONCLUSION: The current study showed that higher rates of major complications in central and calcified paracentral TDHs are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.

Clinical outcomes of symptomatic thoracic disk herniations treated surgically through minimally invasive lateral transthoracic approach.

Although symptomatic thoracic disk herniation (TDH) is relatively rare, its treatment is quite difficult. Our aim is to present the outcomes and complications in patients with thoracic disk herniation treated with minimally invasive lateral transthoracic approach (LTTA). Fifty-nine consecutive patients with 69 symptomatic disk herniations that underwent minimally invasive LTTA to treat TDH between 2007 and 2016 were enrolled. Medical records were reviewed retrospectively. The numbers of TDH were as follows: 41 central, 10 paracentral, and 18 both central and paracentral. The number of calcified disk herniations was found to be 32. No patient developed neurological deficit. Postoperative neurological improvement occurred in 39 (90.7%) of 43 patients with myelopathy. Preoperative VAS scores, ODI scores, and SF-36 scores improved at the follow-up, respectively. Mean blood loss, hospitalization period, and follow-up period were found to be 391.2 mL, 4.7 days, and 60 months; respectively. The following complications were observed: dural tear (five patients), intercostal neuralgia (three patients), rib fracture (one patient), pleural effusion requiring chest tube (two patients), hydropneumothorax requiring chest tube (one patient), small pneumothorax (one patient), atelectasis (one patient), pulmonary embolism (one patient), and pneumonia (one patient). Minimally invasive LTTA not only minimizes the manipulation of the thecal sac decreasing the risk for neurological injury compared to traditional posterior methods but also significantly decreases the pulmonary complications associated with traditional open procedures. Based on the authors' experience, anterior approach should be preferred especially in calcified central disk herniations regardless of surgeon's experience.

Intraoperative Halo-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves between 70° and 90°: Is It Effective?

STUDY DESIGN: A retrospective clinical study. PURPOSE: To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility <35%. OVERVIEW OF LITERATURE: Numerous methods have been described to achieve adequate correction and successful results in the surgical treatment of AIS patients with a Cobb angle >70°. However, few studies have evaluated the results of HFT in AIS patients with Cobb angles between 70° and 90° and flexibility <35%. METHODS: The study comprised 24 AIS patients (18 females, six males; mean age, 17.4 years; mean preoperative Cobb angle, 80.1°; range, 70°-90°) who underwent surgery using intraoperative HFT. Neurological status was constantly assessed during the surgery using intraoperative neurophysiological monitoring. RESULTS: The mean follow-up period was 33.5 months. Radiographic outcomes demonstrated 85.7% correction of the major Cobb angle. Coronal and sagittal balance was achieved in all the patients, and shoulder levels were equalized. The traction was discontinued when a decrease in spinal cord potentials was observed during the surgery. CONCLUSIONS: Intraoperative HFT is an effective and reliable method for the management of scoliosis curves between 70° and 90°. The most significant advantages of the method are avoidance of the morbidities related to anterior surgery, osteotomy, or vertebral column resection; its contribution in helping achieve adequate reduction and optimum balance by the gradually increased corrective force, lack of any need for extreme correction force during instrumentation; and the high correction rates achieved.

Comparison of pedicle screw fixation and hybrid instrumentation in adolescent idiopathic scoliosis.

OBJECTIVE: The purpose of this study was to compare pedicle screw fixation (PSF) with hybrid instrumentation (HI) in cases of adolescent idiopathic scoliosis (AIS). METHODS: Thirty-eight patients with AIS who underwent PSF (n=19) or HI (n=19) between 2001 and 2011 were retrospectively reviewed. Patients had similar age at surgery and similar number of fused vertebrae. Operative time, intraoperative blood loss, and postoperative complications were compared between the 2 groups. Spinal radiographs for apical vertebral translation, global coronal balance, major curve Cobb angle, global sagittal balance, thoracic kyphosis, and lumbar lordosis were measured in all patients preoperatively and at 2-year follow-up; the results were then compared between the 2 groups. Postoperative correction was calculated for all patients and compared between the 2 groups. RESULTS: The average time of surgery ofthe PSF group was significantly longer than that of the HI group (p<0.05). The amount of bleeding of the PSF group was significantly higher than the HI group (p<0.01). No statistically significant difference was found between the groups in respect to the development of complications (p>0.05). Both the major curve Cobb angle and the global sagittal balance showed greater improvement in the PSF group compared to the HI group (p<0.01). Postoperative correction was better in the PSF group than the HI group. CONCLUSION: The PSF system provided better improvement than the HI system in major curve Cobb angle and global sagittal balance, and postoperative correction was better in the PSF group than the HI group.

Compartment Syndrome Following Arthroscopic Removal of a Bullet in the Knee Joint after a Low-Velocity Gunshot Injury.

Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome.

Surgical treatment of nail bed subungual exostosis.

INTRODUCTION: A subungual exostosis (SE) is a bony overgrowth that is permanently attached to the tip of the distal phalanx. Its pathology differs from osteocartilaginous exostoses in that it mainly involves the overgrowth of normal bone, which may present beneath the toenail or on the sides of the toe. This retrospective study aimed to report the results of surgical treatment when the diagnosis of SE was delayed; the condition was initially considered to be another pathology affecting a different nail or the terminal toe. METHODS: A total of 17 patients (12 female, five male) were included in the study. All surgical resections were performed by the same surgeon using the same surgical technique, with the patient under digital anaesthesia. The patients were evaluated pre- and postoperatively (on Weeks 1 and 6, the first year, and the last follow-up visit) using the American Orthopaedic Foot and Ankle Society questionnaire and the Visual Analogue Scale score. RESULTS: The patients underwent surgery for SE removal between December 2009 and October 2012. Their mean age was 21.3 ± 4.4 (range 14-29) years and the mean follow-up period was 27.1 ± 7.8 (range 18-45) months. Clinical or radiological recurrence was not observed in any of the patients during the follow-up period. Four patients had superficial infections, which were treated using appropriate antibiotic therapies. CONCLUSION: As SE is an uncommon benign lesion, its diagnosis may be delayed. Radiography may be useful in obtaining a differential diagnosis.

Reconstruction of Traumatic Composite Tissue Defect of Medial Longitudinal Arch With Free Osteocutaneous Fibular Graft.

A 34-year-old male sustained a crush injury resulting in bone and soft tissue loss along the medial longitudinal arch of his left foot. Specifically, the injury resulted in loss of first metatarsal without injury to the medial cuneiform or proximal phalanx, fracture of the third metatarsal, and a 5-cm × 9-cm soft tissue defect overlying the dorsomedial aspect of the right foot. After debridement and daily wound care, the defect was subsequently reconstructed using a free osteocutaneous fibular graft. Approximately 6 months after reconstructive surgery, the patient returned to his job without pain, and his pedogram showed almost equal weightbearing distribution on both feet.

Computerized tomography imaging in adolescent idiopathic scoliosis: prone versus supine.

BACKGROUND: The aim of the present study was to assess the degree of apical vertebral rotation values in Adolescent Idiopathic Scoliosis (AIS) that were obtained on CT scans, and to analyze the influence of patient position (supine versus prone) on the degree of rotation. METHODS: The study included 50 apical vertebra rotation measurements of 34 patients with Type 1A and Type 3C curvature according to the Lenke classification. CT imaging was applied to the patients in supine and prone positions to measure the apical vertebral rotation (AVR). The average AVR angles were measured using the Aaro-Dahlborn method and the results were compared. RESULTS: No significant differences were found between the vertebral rotation measured in the prone and supine positions for the Lenke 1A subgroup and the Lenke 3C thoracic group (p = 0.848; p = 0.659, respectively). In the Lenke 3C lumbar group, however, the vertebral rotation in the supine position was found to be significantly lesser than that in the prone position (difference -1.40° ± 1.79°, p = 0.007). CONCLUSION: The assessment of the apical vertebra rotation is crucial in AIS. Even though the vertebral rotation in the supine position was found to be significantly lesser than that in the prone position, CT imaging in a prone position could not be considered clinically more relevant than the CT images in a supine position as there was less than 3° difference.

Effect of increase in birth weight in a newborn on hip ultrasonography.

Exposure to the pressure experienced by higher birth weight babies during the intrauterine period might cause hip dysplasia. The aim of this study is to determine the effect of birth weight in newborns on hip ultrasonography when the paternal and maternal risk factors are excluded. A total of 701 babies born at 38-42 gestational weeks were included in the study. Hip ultrasonography was performed within 7 days following birth using the Graf technique in the babies without risk factors for developmental dysplasia of the hip. Images obtained were controlled with respect to conformity to the Graf method and angular measurements were performed. According to the α and ß angle values obtained, type 1A and 1B hips were categorized as mature; type 2A hips were categorized as immature; and type 2C, D, 3A, 3B, and 4 hips were categorized as pathological hips. The results obtained were analyzed for the effect of birth weight on the angular values and hip typing. The birth weight of the babies was 338,488 ± 48,241 g (2030-6124 g). It was determined that the birth weight had no effect on the values of α and ß angles in the male babies (P=0.21, 0.76). It was determined that increasing birth weight decreased the α angle value (P=0.001) and caused no difference in the ß angle value (P=0.057) in the female babies. It was found that birth weight had no effect on hip typing in both female and male babies (P=0.060, 0.22). Increases in birth weights caused decreases in ultrasonographic α angles only in female babies.

An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia.

INTRODUCTION: Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. PRESENTATION OF CASE: This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for last one month and after imaging studies posterior longitudinal tibial stress fracture was detected on his left tibia. After six months the patient was admitted to our clinic with the same type of complaints in his right leg. All imaging modalities and blood counts were performed and as a result longitudinal posterior tibial stress fractures were detected on his right tibia. DISCUSSION: Treatment of tibial stress fracture includes rest and modified activity, followed by a graded return to activity commensurate with bony healing. We have applied the same treatment protocol and our results were acceptable but our follow up time short for this reason our study is restricted for separate stress fractures of the posterior tibia. CONCLUSION: Although the main localization of tibial stress fractures were unilateral, anterior and transverse pattern, rarely, like in our case, the unusual bilateral posterior localization and longitudinal pattern can be seen.

Surgical treatment results of carpal tunnel syndrome in patients with and without type 2 diabetes mellitus.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most commonly seen peripheral nerve compression syndrome and CTS surgery is the most common surgery done for peripheral nerve compression syndromes. Type 2 diabetes mellitus (DM) is a systemic disease with a component of peripheral neuropathy. OBJECTIVE: We aimed to investigate the effects of type 2 DM on functional results in type 2 DM patients who underwent carpal tunnel surgery. METHODS: The study included 39 patients with carpal tunnel syndrome which was confirmed by electromyography. Twenty-one patients did not have DM, 18 patients had type 2 DM that were treated for DM and had regulated blood glucose levels. Assessments were done with the Boston scale. All operations were done by the same surgical team using the same surgical technique. Functional and symptomatic scores between the two groups were compared with the Mann-Whitney U test which is the non-parametric version of the Student's t test, and 95% confidence interval p<0.05, which is considered as statistically significant. RESULTS: In patients with type 2 DM, preoperative mean Symptom Severity Score was 3.6±0.35 (2.9 to 4.2) in the last control mean Symptom Severity Score was 1.2±0.16 (1.0-1.7), and preoperative mean functional status score was 3.3±0.56 (2.3 to 4.5) and in the last control mean functional status score was 1.3±0.36 (1.0 to 2.4).The patients without DM, preoperative mean Symptom Severity Score was 3.5±0.45 (2.8 to 4.2) in the last control mean Symptom Severity Score was 1.2±0.19 (1.0 to 1.6), and preoperative functional status score was 3.2±0.47 (2.4 to 4.6) in the last control mean functional status score was 1.3±0.35 (1.0 to 2.5). There was no statistically significant difference between the two groups. CONCLUSION: Type 2 DM patients with regulated blood glucose levels can be operated without additional procedure during and after surgery for carpal tunnel syndrome like in carpal tunnel syndrome patients without DM.

Generalized epileptic seizure in an adolescent idiopathic scoliosis (AIS) patient with syringomyelia after deformity correction surgery.

INTRODUCTION: Adolescent idiopathic scoliosis and epilepsy are pathologies rarely seen together. In this study we report an AIS case we operated in which epilepsy was seen post operatively. We want to emphasize the items one should pay attention in such cases. PRESENTATION OF CASE: In a 14-year-old girl with AIS and concomitant syringomyelia and spondylolisthesis, posterior deformity correction and fusion were performed. After stabilization the patient was discharged on the 10th day of discharge epileptic seizure appeared. DISCUSSION: In scoliosis surgery, the mechanic stress and bleeding caused by the operation itself can cause neurological problems due to primary nervous system injury. The operation and bleeding during and after the operation, pulmonary and cardiac functional instability, metabolic imbalance can be the causes of epileptic seizures. CONCLUSION: Epilepsy seen after a major surgery like scoliosis surgery, can be either as a result of central nervous system origined vascular and hypoxic problems or metabolic. In our case we concluded that massive hemorrhage must have induced epilepsy. In neurologic consultations the case was considered as an incidental epileptic picture.