The effects of patient related factors on hidden and total blood loss in single-level open transforaminal lumbar interbody fusion surgery.

OBJECTIVE: The aim of this retrospective study was to identify the amount of TBL and HBL and analyse the risk factors using multivariate linear regression analysis during single-level OTLIF surgery. METHODS: In this study 62 patients (32 male, 30 female, mean age 49.22 ± 13.26) who underwent single-level interbody fusion proce dures by a single surgeon between 2015 and 2021 were included. Retrospectively, relevant statistics regarding body mass index (BMI), American Society of Anesthesiologist Score (ASA), preoperative mean arterial pressure (MAP), and age were gathered. Preoperative MR images were used to assess and measure radiological parameters such as skin-disc distance (SDA), canal area (CA), paravertebral muscle area (PVMA),lumbosacral maximum subcutaneous fat thickness (LSMSF), operation level subcutaneous fat thickness (OPSF) and spi nous process length (SPL).Total blood loss (TBL) was calculated according to Nadler's formula. Hidden blood loss (HBL) was measured by deducting the measured (visible) blood loss from TBL. TBL, HBL and their relationship with preoperative parameters were assessed. RESULTS: HBL was determined to be significantly higher in older patients (P = 0.012). MAP was seen to have a statistically significant cor relation with operating time (P = 0.002), operative bleeding (P = 0.002), TBL (P = 0.006), and HBL (P = 0.001), and an inverse correlation with postoperative drainage (P = 0.007). The ASA scores were observed to be statistically significantly correlated with TBL (P = 0.001), and HBL (P = 0.001). LSMSF showed a significant correlation with TBL (P = 0.005) and HBL (P = 0.002). OPSF was determined to be correlated with TBL (P = 0.011), HBL (P = 0.009) and length of stay in hospital (P =0.034). SDD was correlated with TBL (P =0.043), and SPL with HBL (P = 0.013). It was shown that age (P =0.012), MAP (P =0.001), ASA (P =0.001), LSMFS (P = 0.002), OPSF (P = 0.009), SPL (P = 0.013) were risk factors for HBL. According to multivariate logistic regression analysis; two anatomical factors LSMSF and SPL were independent risk factors for HBL (P < 0.05). CONCLUSION: This results of this study have revealed that most patient-related parameters have a significant effect on HBL and TBL.The study has also demonstrated that LSMSF and SPL are independent risk factors for HBL. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years.

AIM: To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. MATERIAL AND METHOD: Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. RESULTS: Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. CONCLUSION: The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

Does It Make a Difference to Stop Fusion at L3 Versus L4 in Terms of Disc and Facet Joint Degeneration: An MRI Study With Minimum 5 Years Follow-up.

OBJECTIVES: To compare the functional outcomes of patients with idiopathic scoliosis who had surgical correction and fusion with all pedicle screw construct down to L3 or L4 and to evaluate whether saving a mobile lumbar motion segment distally would demonstrate any difference in terms of disc degeneration (DD) and facet joint degeneration (FJD) after minimum 5 years follow-up. SUMMARY OF BACKGROUND DATA: Selection of lowest instrumented vertebra (LIV) is often difficult when lumbar curve was included into the fusion (L3 vs L4). Saving L4 is believed to be beneficial for preserving motion and preventing degeneration of unfused lumbar spine. METHODS: The L3 group included 21 patients (mean age of 21.4) and L4 group included 16 patients (mean age 22.9). Control group included 30 healthy individuals with no spinal deformities (mean age of 23.8). Follow-up lumbar magnetic resonance images (MRIs) were evaluated for each patient in terms of DD and FJD. Clinical evaluation was done by using the Scoliosis Research Society-22r, Oswestry Disability Index, and Numeric Rating Scale. RESULTS: Mean follow-up period was 7.4 (5-10) years in the L3 group and 9 (5-17) years in L4 group. Average correction rates for lumbar curve magnitudes were 78% in the L3 group and 79% in the L4 group, with no significant correction loss at the final follow-up. There was no statistical difference for DD in all groups (p > .05). FJD was significantly greater in both L3 and L4 groups compared to the control group (p < .001). Clinical outcome scores were similar among all three groups (p > .05). CONCLUSION: Spinal balance and corrections remained stable, without showing any decompensation over time. This midterm MRI study demonstrated similar disc and facet degeneration rates for L3 and L4 groups. FJD at the upper two levels adjacent to the LIV was significant for both surgically treated groups. Clinical outcome scores were similar for all groups at minimum 5 years follow-up.

Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery.

OBJECTIVES: To evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group. SUMMARY OF BACKGROUND DATA: Selective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments. METHODS: Group A included 25 AIS patients with mean a age of 23.8 years and a mean 11.4 years of follow-up. Group B included 30 age- and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society-22R, Oswestry Disability Index, and numerical rating scale. RESULTS: Sagittal and coronal balance and lowest instrumented vertebra disc angulation were stable over time. Mean grading of lumbar DD was 2.16 (2-4) in Group A and 1.86 (1-3) in Group B. Lumbar FJDs were 2.05 (1-4) in Group A and 1.60 (1-3) in Group B. There was significant difference between the two groups for DD except for the L4-L5 level (p = .26). FJD was significantly higher in the L1-L2 and L2-L3 levels (L1-L2, p = .002, L2-L3, p = .002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p > .05). CONCLUSION: Selective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.

Effect of N-butyl cyanoacrylate on fracture healing in segmental rat tibia fracture model.

BACKGROUND: Comminuted fractures can occur due to severe traumas. The treatment of these fractures that may cause serious morbidity and sometimes mortality is N-butyl cyanoacrylate. It has been reported that this adhesive provides sufficient rigid fixation for bone healing. This study aims to examine cyanoacrylate radiologically and histologically to determine whether it provides adequate recovery in segmental fractures. The secondary objective is to evaluate N-butyl cyanoacrylate, an adhesive material that can hold the fragments on the fracture line together following reduction. METHODS: Sixteen Sprague-Dawley rats were divided in two groups as control (n = 8) and experimental (n = 8) groups. In the control group, segmental fractures were made and fixated with K-wire. In the experimental group, the same surgical procedure was applied and also fragments were stabilized with N-butyl cyanoacrylate. RESULTS: On the sixth week, we did not see any statistically significant difference in the radiological scoring between groups. However, the pathological scores of the control group were statistically higher than the cyanoacrylate group. CONCLUSIONS: We found that cyanoacrylate was rapidly and easily applied in the segmental fractures but did not cause any superior radiological and clinical results compared to the control group. The cyanoacrylate had low viscosity, and it was not capable enough to fill the defects formed between osteotomy surfaces. However, it did not adversely affect fracture healing as seen in biopsies taken as a result of follow-ups.

Osteotomies/spinal column resection in paediatric deformity.

The spinal deformities in paediatric population differ from those in the adult population. Vertebral osteotomies are indicated when the deformity is too rigid to be corrected either with instrumentation alone or with the addition of soft tissue releases. When surgical intervention is to be carried out, correcting the deformity and ceasing progression should be aimed at as well as allowing further growth and improving pulmonary function. Osteotomies in the spine surgery should aim to achieve an appropriate balance in both sagittal and coronal planes. Varied clinical and radiological scenarios necessitate different osteotomy types. The purpose of this article is to introduce each osteotomy type and discuss their indications, prerequisites and complications. Osteotomy options for correcting spinal deformities are Ponte osteotomy, Smith-Petersen osteotomy, pedicle subtraction osteotomy, bone-disc-bone osteotomy and vertebral column resection. All the osteotomy types are technically demanding. Appropriate selection of the type of the osteotomy depends on the surgeons' experience, type of the deformity, magnitude of the curve, remaining growth potential and operative goals. Neuromonitoring should be an indispensible part of the procedure. Spine osteotomies are effective procedures for the treatment of paediatric spine deformities if experienced surgical team performs them.

The relationship between intra-articular meniscal, chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender.

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.

Successful Closed Manipulation of Simple Lateral Dislocation of the Elbow Joint: A Case Report.

The elbow is the second most commonly dislocated joint in adults. Simple lateral dislocation of the elbow joint is a rare traumatic injury, and successful closed reduction is difficult and even rarer. Our proposition is to report this rare case of traumatic simple lateral dislocation treated with closed reduction under sedation emphasizing the use of this simple technique initially in order to avoid possible complications with general anesthesia and surgery.

Examination tests predictive of bone injury in patients with clinically suspected occult scaphoid fracture.

BACKGROUND: This study aims to identify the physical examination tests most indicative of bone injury in patients with clinically suspected occult scaphoid fractures. METHODS: Ten physical examination manoeuvres were performed on 41 patients with a history of a fall on an outstretched hand and tenderness at the anatomical snuffbox and scaphoid tubercle without a radiographically visible fracture line. The results of wrist examination and subsequent magnetic resonance imaging (MRI) were recorded. The sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio of the physical examinations were calculated for the patients who had bone injury confirmed by MRI. RESULTS: The distribution of MRI-confirmed conditions was as follows: 13 cases-no bone involvement; 12 cases-scaphoid fractures; 9 cases-fissures at the distal end of the radius; 6 cases-bone-bruise and 1 case-triquetral fracture. The symptoms most indicative of bone injuries were 'pain during pinching by the thumb and index fingers' and 'pain during pronation of the forearm'. CONCLUSION: The two above-mentioned manoeuvres were most indicative of bone injury in patients with clinically suspected occult scaphoid fracture. These examinations may reduce the number of unnecessary MRI examinations.