End-To-End Computerized Diagnosis of Spondylolisthesis Using Only Lumbar X-rays.

Lumbar spondylolisthesis (LS) is the anterior shift of one of the lower vertebrae about the subjacent vertebrae. There are several symptoms to define LS, and these symptoms are not detected in the early stages of LS. This leads to disease progress further without being identified. Thus, advanced treatment mechanisms are required to implement for diagnosing LS, which is crucial in terms of early diagnosis, rehabilitation, and treatment planning. Herein, a transfer learning-based CNN model is developed that uses only lumbar X-rays. The model was trained with 1922 images, and 187 images were used for validation. Later, the model was tested with 598 images. During training, the model extracts the region of interests (ROIs) via Yolov3, and then the ROIs are split into training and validation sets. Later, the ROIs are fed into the fine-tuned MobileNet CNN to accomplish the training. However, during testing, the images enter the model, and then they are classified as spondylolisthesis or normal. The end-to-end transfer learning-based CNN model reached the test accuracy of 99%, whereas the test sensitivity was 98% and the test specificity 99%. The performance results are encouraging and state that the model can be used in outpatient clinics where any experts are not present.

Comparison of the effect of bipolar coagulation and fibrillar structured oxidized cellulose on formation epidural fibrosis in rats

Background/aim: Epidural fibrosis (EF) is a common cause of failed back surgery syndrome seen after spinal surgeries. The most frequent reason for the formation of EF is accumulated blood and its products in the operation zone. On the development of EF, the effect of bipolar coagulation and fibrillar oxidized cellulose, which are used frequently to control bleeding, was investigated. Materials and methods: In the study, 45 male Sprague Dawley rats were divided into three groups (control, fibrillar, and bipolar). Lumbar laminectomy was applied to all rats under sterile conditions. In the control group, the epidural area was washed with saline solution. Bleeding was controlled with fibrillar oxidized cellulose in the fibrillar group, with bipolar coagulation in the bipolar group. The area to which laminectomy had been applied was removed as a block 6 weeks later and evaluated histopathologically and genetically in terms of EF development. Fibrosis degree was determined histopathologically by counting fibroblasts using the modified Lubina and EF He grading systems. Interleukin-6 (IL-6), transforming growth factor beta-1 (TGFß-1), and mRNA levels were measured by the droplet digital polymerase chain reaction method. Results: The number of epidural fibroblasts, percentage of modified Lubina, amount of IL-6, and He grading rates were significantly lower in the fibrillar group than in the bipolar and control groups (p ˂ 0.05). On the other hand, there was no significant difference among the control, fibrillar, and bipolar groups in terms of TGFß-1 values (p= 0.525). Conclusion: The use of fibrillar oxidized cellulose was more effective for hemostasis than bipolar coagulation in reducing the development of EF.

Histopathological and immunohistochemical investigation of the effect of Shilajit in rats with experimental spinal cord injury.

BACKGROUND: This experimental study was designed to investigate the histopathological and immunohistochemical effects of Shilajit in rats with experimentally induced spinal cord injury (SCI). METHODS: The rats were divided into three groups: Control group: The group in which spinal cord damage was created but no drug was administered. Low-dose group: This is the group in which intraperitoneal Shilajit is given at a dose of 150 mg/kg at the 1st h, 1st day, 2nd day, and 3rd day after spinal cord damage was induced. High-dose group: This is the group in which intraperitoneal Shilajit is given at a dose of 250 mg/kg at the 1st h, 1st day, 2nd day, and 3rd day after spinal cord damage was induced. Thin sections taken from the spinal cord after euthanasia were sent for histopathological and immunohistochemical examination. RESULTS: Histopathological examination of the high-dose group showed lower amounts of morphological findings compared to the low-dose group and control group. While a significant CD68 immune reaction was observed in the control group of rats with spinal injury, the positive immune reaction was found to be significantly decreased in the Shilajit-applied groups. CONCLUSION: It is thought that the use of Shilajit in SCI will reduce the effects of secondary damage in SCI and that its administra-tion to such patients will have positive effects on the results.

Comparative Effectiveness of Epidural Steroid Injections in Patients With Disc Bulging and Disc Protrusion.

Purpose Discogenic low back pain is a widespread disorder in the world. Many methods have been developed and continue to be developed in the treatment of discogenic low back pain. We aimed to examine the effect of epidural steroid administration on disc bulging and disc protrusion in patients with discogenic low back pain. Design The clinical effects of interlaminar epidural steroids administered to 71 patients who were admitted to our clinic and whose treatment did not require surgery were radiologically divided into two groups disc bulging and disc protrusion. Patients were followed up for six months and clinical results were recorded. Methods The scores of the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were measured before the procedure, one week after the procedure, one month after the procedure, and six months after the procedure. The normal distribution of continuous variables was evaluated using the Kolmogorov-Smirnov test. Continuous variables were compared with the Mann-Whitney U test and categorical variables were compared using the Chi-square test or Fisher's exact test. Results There was no significant difference in demographic data in patients with disc bulging and disc protrusion. In the disc protrusion group, the VAS scores in the first week after, the first month after and the sixth month after the procedure showed a significant decrease compared to the pre-procedure. There was no significant difference between the disc bulging and protrusion groups in the first week of post-procedure VAS score reduction. In the Disc Bulging group, the ODI score one week after, one month after, and six months after the procedure showed a significant decrease compared to the pre-procedure. In the Disc Protrusion group, the ODI score one week after, one month after, and six months after the procedure showed a significant decrease compared to the pre-procedure. Conclusion There was strong evidence that lumbar interlaminar steroid injection is an effective treatment for disc bulging and discogenic pain due to protrusion. When the ODI and VAS scores of patients with both disc bulging and disc protrusion were evaluated, it was seen that they benefited from epidural steroid injection. In the disc protrusion group, except for the first week of injection, relief due to the use of epidural steroids was observed to be greater compared to disc bulging.

Effect of Local Use of Rifampicin on the Development of Surgical Site Infection after Lumbar Microdiscectomy.

OBJECTIVE: To investigate the effect of local use of rifampicin (RIF) on the development of postoperative surgical site infection (SSI) after lumbar microdiscectomy. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Van YuzuncuYil University Medical School Neurosurgery Clinic, between 2020 and 2022. METHODOLOGY: This retrospective study reviewed the clinical and laboratory records of 178 patients who underwent lumbar microsurgery. After lumbar microsurgery, one ampoule of rifampicin (RIF) (250 mg) was locally injected into the surgical site in 62 patients (RIF group), while the remaining 116 patients (non-RIF group) received no injection into the surgical site after lumbar microsurgery. Normal distribution of data was analysed using Kolmogorov-Smirnov test. Continuous variables were compared using Mann-Whitney U test and categorical variables were compared using chi-square test or Fisher's exact test as needed. RESULTS: In the postoperative period, local infection developed in one patient in the RIF group, while local infection developed in 11 and deep infection developed in three of the patients in the non-RIF group. Moreover, the risk of local infection development was significantly higher in the non-RIF group compared to the RIF group. The rate of superficial SSI was lower in the RIF group compared to the non-RIF group. No significant difference was observed between the two groups with regard to the rate of deep SSI. CONCLUSION: Postoperative infection is an extremely important clinical condition manifesting in the form of superficial or deep SSI. The utmost care and necessary precautions should be taken to avoid postoperative infections. Intraoperative antibiotic prophylaxis is the most effective method in preventing postoperative spinal infections. KEY WORDS: Infection, Lumbar microdiscectomy, Rifampicin, Local infection, Deep infection.

Schwannoma-like thoracic glomangioma: case report.

In this study, we present an extremely rare case of thoracic spinal glomangioma located at the thoracic T7-8 level in the foraminal region, mimicking a schwannoma tumor, in a 65-year-old female patient who was admitted to our clinic with a 6-month history of back pain and weakness in legs.

Risk Factors and Compression and Kyphosis Rates after 1 Year in Patients with AO type A Thoracic, Thoracolumbar, and Lumbar Fractures Treated Conservatively.

AIM: Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. MATERIAL AND METHODS: Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. RESULTS: Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients ( > 60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. CONCLUSION: Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.