Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

Study DesignRetrospective study (level of evidence: level 3).PurposeThe purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).Overview of LiteratureThe correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.MethodsWe retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.ResultsForty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (p<0.05).ConclusionsThe clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK

Comparison of cannulated lag screws and lateral locking plate in the treatment of Schatzker type II tibial plateau fractures

Objectives: This study aims to compare the clinical and radiological outcomes of the two fixation methods frequently used in the treatment of Schatzker type II fractures: lag screw fixation and lateral anatomic plate fixation. Patients and methods: This retrospective study, which was conducted between January 2005 and December 2014, included 61 patients (41 males, 20 females; mean age 43.4±13.1 years; range, 20 to 76 years) with Schatzker type II (Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) 41-B3) fractures. Patients were divided into two groups according to the type of surgery as cannulated lag screw fixation group (group 1, n=24, 39.4%) and lateral locking plate fixation group (group 2, n=37, 60.6%). Intraoperative mediolateral and anteroposterior instability were measured. Final knee flexionextention range of motion (ROM), single-leg hop test, Knee Society Score (KSS), Hospital for Special Surgery (HSS) and short form 36 (SF36) scores were obtained at the last follow-up. Results: The mean age of patients was 42.1±13.8 years in group 2 and 45.5±12.2 years in group 1. The mean follow-up period was 34±4 months. Minimal or no arthritis was detected in 75% (n=18) of patients in group 1 and 78% (n=29) of patients in group 2 (p=0.27). Single leg-hop test results (p=0.55), final follow-up knee ROM (p=0.40), KSS (p=0.21), HSS (p=0.15), and SF36 scores of group 1 were similar to group 2. In group 1, the duration of surgery was shorter (p<0.001) and the cost of treatment was lower (p<0.001). Conclusion: Treatment of Schatzker type II tibial plateau fractures with lag screws seems to provide less invasive, cheaper, and faster surgical treatment as compared with lateral locking plate fixation. In addition, patients who underwent internal fixation with lag screws had similar clinical and radiological outcomes with those who underwent lateral locking plate fixation

A Retrospective Study of Congenital Cardiac Abnormality Associated with Scoliosis

Study DesignRetrospective study.PurposeTo identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment for scoliosis.Overview of LiteratureCongenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent surgical treatment for scoliosis.MethodsNinety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female [51%]) and IS (35 patients, 21 female [60%]). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed.ResultsWe found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients).ConclusionsWe determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups

Familial Mediterranean Fever (FMF)

Familial Mediterranean Fever (FMF) is an autosomal recessive genetic disease that affects males and females. FMF gene is on the short arm of chromosome 16. It is most often found in Jews, Arabs, Turks, and Armenians. Amyloidosis is charecterized by the deposition of a particular protein between the cells in the tissue. It is a potentially serious complication of FMF. The kidney is a prime target for the amyloid. [Archives Medical Review Journal 2009; 18(4.000): 260-267

Hemochromatosis

Hemochromatosis is the most common form of iron overload disease. Iron builds up in the body&#146;s organs and damages them. Hemochromatosis is presented with arthropathy, cirrhosis of the liver, melanoderma, heart failure, diabetes mellitus and other endocrine deficiencies. There are two type of this disease. Primary hemochromatosis is known as an inherited disease. Herediter hemochromatosis is caused by the mutations of HFE gene. The most common mutations are H63D (Histidine- Aspartat) and C282Y (Cysteine-Tyrosine) on the gene. Secondary hemochromatosis is caused by anemia, alcoholism, and some of the other disorders. [Archives Medical Review Journal 2009; 18(4.000): 268-275

Effects of Liquid Polymers on the Strength and Freezing-Thawing Properties of Bentonite and Kaolin Clays: A Comparative Study for Cold Climates

Clay soils can exhibit swelling and settlement behaviour when interacted with water. The clays located in road infrastructure can damage the road pavement and cause cracks because of swelling and/or settlement of clays. The freezing-thawing processes of clay soils can increase the damages of pavement. Additionally, the strength losses can occur. Weak soils can be improved using various soil improvement techniques with or without additives. In this study, liquid polymers (polyurethane, epoxy resin, and styrene acrylic) were combined with clays in various amounts (5 wt.%, 10 wt.%, 15 wt.%, and 20 wt.%) to improve the strength and investigate the freezing-thawing behaviour of high-plasticity bentonite and low-plasticity kaolin clay. Unconfined compression tests and freezing-thawing cycles were performed on the samples with additives that were cured for 1 and 7 days. As a result, it was observed that polyurethane, epoxy resin, and styrene acrylic additives had positive effects on both the unconfined compressive and the post freezing-thawing unconfined compressive strengths of low and high plasticity clays in cold climates

The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis

The purpose of this project is to design and fabricate a rotating cylinder 3D printer that allows manufacturing of complex cylindrical structures. Standard cartesian, extruded filament 3D printers have limited capability to produce strong parts due to z-axis layering and have trouble printing vertical lattice structures without plastic drooping. To address these limitations, a 3D printing lathe has been developed which prints on a removable rotating cylindrical surface. The project successfully met objectives to develop the mechanical motion system, extrude PLA plastic, and control the printer with GCode instructions

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100°

Objective: The aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°. Methods: The medical records of 17 patients (mean age 17.9 (range, 9–27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24–64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients. The sagittal plane parameters (local kyphosis angle, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence) were measured in the preoperative and the early postoperative periods and during the last follow-up on the lateral radiographs. Results: The mean preoperative localized kyphosis angle was 121.8° (range, 101°–149°). The mean local kyphosis angle (LKA) was 71.5° at postoperatively evaluation (p < 0.05). Complications were detected in 12 patients (70.6%) with spinal shock in 4 patients, hemothorax in 3 patients, postoperative infection in 2 patients, dural laceration in 2 patients, neurological deficit in 2 patients (1 paraplegia and 1 root injury), the shifted cage in 2 patients and rod fracture in 2 patients. Neurological events occurred in six patients (35%) with temporary neurological deficit in 5 patients and permanent neurological deficit in 1 patient. Conclusion: PVCR is an efficient and a successful technique for the correction of SAK. However, it can lead to a large number of major complications in SAK greater than 100°. Level of evidence: Level IV, therapeutic study. Keywords: Posterior vertebral column resection, Severe angular kyphosis, Complication, Neurological deficit, Neuromonitorin

The effect of distraction-based growth friendly spinal instrumentation on growth in early-onset scoliosis

The benefits and drawbacks of growth friendly spinal instrumentation have been reported as a result of developments in the treatment of early-onset scoliosis. Seventeen patients who underwent growth friendly spinal instrumentation surgery with a minimum 2-year follow-up were included in the review. The mean number of lengthenings was 3, initial surgery age took place at 108.1 ± 30.2 months and follow-up at 40.6 ± 16.6 months. Spinal height (T1–S1 and T1–T12), space available for the lungs, major Cobb angle for scoliosis, maximum thoracic kyphosis, lumbar lordosis, shoulder and pelvic balance, and coronal and sagittal balance were assessed preoperatively and during the latest follow-up. Treatment with growth friendly spinal instrumentation provided an evident increase in spine height and space available for the lungs, and a significant decrease in scoliosis and thoracic kyphosis. In growth friendly spinal instrumentation treatment, the most commonly observed complications were proximal anchor problems (76.4%) and proximal junctional kyphosis (58.8%). In treatments using growing rods, excessive thoracic kyphosis correction should not be made to avoid proximal junctional kyphosis

Generalized lichen nitidus

Liken nitidus genital bölge, karın, göğüs ve ekstremitelerde ortaya çıkan, ufak, deri renginde, parlak papüllerle karakterize etiyolojisi bilinmeyen nadir bir deri hastalığıdır. 11 yaşındaki erkek hastamızda gövde, kol ve bacakta yaygın papülleri vardı. Histopatolojik incelemede dermal papillada lenfohistiyositik infiltrasyon gözlendi. Lenfohistiyositik infiltrasyon rete ridge’ler tarafından çevrelenmişti. Biz hastamıza herhangi bir tedavi vermeden takip önerdik.Lichen nitidus, a rare condition of unknown etiology, is characterized by minute, flesh colored, shiny papules commonly occurring on the genitali, abdomen, chest and extremities. The trunk of 11 year old male patient, with arms and legs had widespread papules. The lymphohistiocytic infiltration in dermal papilla was observed on histopathologic examination. The lymphohistiocytic infiltration was encirculed by rete ridges. Without any treatment, we have recommended follow-up our patient