Evaluation of the clinical efficiency of transforaminal epidural steroid injection in the treatment of sciatica

Objective: Evaluation of clinical efficiancy of fluoroscopy-accompanied transforaminal epidural steroid injection in patients with symptomatic lumbar foraminal intervertebral disc herniation and foraminal stenosis. Methods: Fifty patients, who underwent fluoroscopic-guided epidural steroid injection between 19.12.2013 - 28.02.2014, were evaluated retrospectively. Pain levels of patients before the procedure, after 3 weeks and after 6 months were compared using visuel analog scale (VAS). Fifty percent or more decrease, less than 50% decrease and no change in VAS were evaluated as sufficient response, insufficient response and unresponsiveness, respectively. The patients were asked whether they would undergo this process again and “Yes”, “Maybe” and “No” answers were evaluated for patient satisfaction score. Results: In 50 patients (32 female, 18 male), average pain levels were found to be 8.4 (VAS 7-9), 4.3 (VAS 1-9) and 4.4 (VAS 0-9) before the procedure, 3 weeks after the procedure and 6 months after the procedure, respectively. While thirty-seven (74%) of the patients were found to have sufficient response to treatment 3 weeks after the procedure, 10 (20%) patients were found to have insufficient response. There was no response to treatment in 3 (6%) patients. While thirty-five (70%) of the patients were found to have sufficient response to treatment 6 months after the procedure, 10 (20%) patients were found to have insufficient response. Six months after the procedure, there was no response to treatment in 5 patients (%10). Statistically significant improvement was observed when the pre and post-procedure VAS scores were compared. Forty (80%) patients gave the answer “Yes” to the question whether they would undergo this procedure again. Conclusion: We found that fluoroscopic guided transforaminal epidural steroid injection is effective in pain relief in patients with lumbar foraminal intervertebral disc herniation and foraminal stenosis that are resistant to pharmacological and physical therapy and have no absolute indication for surgery

A Real-Life Turkish Experience of Ruxolitinib in Polycythemia Vera

Introduction:Ruxolitinib is a small -molecule inhibitor of the JAK1/2 pathway. This study aimed to reveal the results and side-effect profile of the use of ruxolitinib as a treatment option in polycythemia vera (PV).Methods:A total of 34 patients with PV from 18 different centers were included in the study. The evaluation of the response under treatment with ruxolitinib was determined as a reduction in spleen volume (splenomegaly size: ≥35%) by imaging and control of hematocrit levels (≤45%) compared to baseline.Results:While the number of patients in which a reduction in spleen volume and hematocrit control was achieved was 19 (55.9%) at 3 months of treatment, it was 21 (61.8%) at 6 months. Additionally, while the number of side effects was negatively correlated with the reduction in spleen volume (Spearman’s rho: -0.365, p=0.034), a decrease in the hematocrit level was positively correlated (Spearman’s rho: 0.75, p=0.029). Those without a reduction in spleen volume experienced more constipation (chi-square: 5.988, Fisher’s exact test: p=0.033).Conclusion:This study shed light on the use of ruxolitinib in PV and the importance of splenomegaly on studies planned with larger patient groups

Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases

Background: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs) and to share our experiences. Materials and Methods: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1st, 3rd, 6th-month and 1st, 3rd, 5th and 7th-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. Results: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05). None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. Conclusion: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results

Migration of sequestrated part to posterior epidural region in lumbar disc herniation

Lumbar disc herniation occurs with the emergence of the nucleus pulposus from weakened annulus fibrosus fibers. Lumbar disc herniation can be seen as protruding, extruded and sequestered type. Sequestered parts often replace to superior, inferior and laterally. Migration of disc fragment to the posterior epidural space is extremely rare. Here, two cases with posterior epidural migration were reported. One patient had radicular symptom and other one had cauda equina syndrome. In the lumbar magnetic resonance imaging of the patients, there was a mass at the posterior epidural space, compressing the dural sac. The patients underwent emergency operation and the lesions at the epidural space were proved to be sequestered disc fragments which migrated to posterior epidural space. Clinical symptoms of the patients were improved after surgery and the patients were discharged with full recovery

Primer İzole Total Serebellar Agenezi: Yetişkin bir Hastanın Olgu Sunumu ve Literatür Taraması

Serebellar agenezi oldukça nadir görülür. Yenidoğan dönemde ölüme ve ciddi paraliziye sebep olabileceği gibi, yetişkin hayatta asemptomatik olarak da görülebilir. Radyolojik görüntüleme yöntemlerinin gelişmesiyle birlikte tanı olasılığı artmıştır. Serebellar agenezili hastalarda motor bozukluklar, mental durum bozukluğu serebellar koordinasyon bozukluğu bulunabildiği gibi, bunlardan hiçbiri de bulunmayabilir. Ek konjenital patolojilerin eşlik etmediği serebellar agenezide normal yaşam mümkündür. Serebellumdaki konjenital bozukluklar sıklıkla Dandy-Walker malformasyonu ve Chiari Malformasyonu şeklinde görülür. İleri tanı ve tedavilere gerek kalıp kalmayacağı açısından bu hastaların ayırıcı tanısının önemli olduğunu düşünmekteyiz. Radyolojik görüntüleme ile baş ağrısı yakınmasıyla başvuran 32 yaşındaki erkek hastamızda tespit ettiğimiz primer izole serebellar agenezi’yi literatür eşliğinde değerlendirdik