Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study

Background Thoracolumbar burst fractures are common clinical entity encountered in neurosurgical practice, accounting for 10–20% of all spinal fractures. Clinical picture could be devastating due to severe neurological deficits which lead the patients dependent both socially and emotionally. Materials and methods This study compared two groups of patients who were operated because of thoracolumbar burst fracture secondary to spinal trauma in terms of neurologic deficits, degree of improvement, and radiologic measurements at one-year follow-up. The first group (group I) included the patients who underwent posterior total laminectomy, peroperative reduction of intracanal bone fragments, and posterior spinal instrumentation and the second group (group II) included the patients who underwent total laminectomy, and spinal instrumentation without reduction of free bone fragments. Results Neither group showed significant correlation with any measurement parameter. Radiological assessments and clinical improvements did not disclosed significant difference between the two groups at one-year follow-up. Conclusion Retropulsion of free bone fragments extend the time of surgery and causes complications. This study found that there is no need to retropulse the bone fragments in the spinal canal in patients with unstable burst fractures who underwent total laminectomy and posterior long segment stabilization

Karpal Tünel Sendromunda Elektromiyografi ve Manyetik Rezonans Görüntüleme Bulgularının Preoperatif ve Postoperatif Değerlendirilmesi

Giriş: Karpal tünel sendromu (KTS) el bileğinde median sinirin karpal tünel içerisinde sıkışması sonucu gelişen en yaygın tuzak nöropatisidir. KTS tanısında öncelikle nörolojik muayene ve elektrofizyolojik inceleme (EMG) bulguları esas alınır. Bu araştırma karpal tünel sendromu tanısı konmuş hastaların magnetik rezonans görüntüleme tetkikinin hastalığın tanısında ve takibinde ne kadar etkili olduğunun tespit edilmesi amacıyla yapılmıştır. Material method: Araştırmamızda klinik ve elektrofizyolojik testlerle KTS tanısı konan 21 hasta 23 bilek üzerinde gerçekleştirilmiştir. Preoperatif ve post operatif olarak 14.2 haftada 21 hastanın eli anatomik pron pozisyonunda iken el bileği koili kullanılarak magnetik rezonans görüntüleme(MRG) yapılmıştır. Üç düzeyde median sinirin kesitinin boy ve en ölçüleri oranlanarak (boy/en) ve median sinirin yassılaşma oranı, median sinir alanı, median sinir intensitesi, değerlendirilmiştir. Tüm hastalar aynı cerrah tarafından cerrahi uygulanmış, hiçbir hastaya nöroliz uygulanmamıştır. Bulgular: Operasyon öncesi ve sonrası olgu grubunun EMG sonuçlarının incelendiğinde motor ileti hızı ve duysal ileti zamanının operasyon öncesine göre anlamlı oranda düzeldiği saptanmıştır. Olgu grubunun el/bilek MRG'si kontrol grubu ile karşılaştırılınca karpal tünel alanı/el bilek alanı oranı dışında kalan tüm ölçümlerde aritmetik ortalamanın kontrol grubundan büyük olduğu görüldü. Orta ve distalde median sinir yassılaşma oranı, distalde median sinir alanı, fleksör retinakulum kalınlığı, fleksör retinakulum yaylanması, fleksör retinakulum yaylanma oranın da ise farkın anlamlı olmadığı belirlenmiştir. Sonuç: Elektrofizyolojik çalışmalar KTS tanısını koymakta altın standarttır. MRG hastaların ameliyat sonrası değerlendirilmesinde etkin bir yöntemdir. Başarısız cerrahı nedenini ortaya çıkarmada kullanılabilir. MR tetkiki hastaların tanısı koymada ve post operatif takiplerinde etkili bir yöntemdir.Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by the compression of the median nerve in the carpal tunnel in the wrist. In the diagnosis of CTS, neurological examination and electrophysiological studies (EMG) findings are based primarily. This study was conducted in order to determine how effective magnetic resonance imaging examining in the diagnosis and follow-up of patients diagnosed with carpal tunnel syndrome is. Material and methods: Our research was performed on 21 patients with 23 wrists diagnosed with CTS with clinical and electrophysiological tests. Magnetic resonance imaging (MRI) was performed preoperatively and postoperatively in 14.2 weeks for the hands of 21 patients in the anatomical prone position by using a wrist coil. The length and width measurements of the sections of the median nerve were proportionalized at three levels (length / width), and flattening ratio of the median nerve, median nerve area, the intensity of the median nerve were evaluated. All patients was operated by the same surgeon, neurolysis was not applied to any patient. Results: When the results of the EMG before and after surgery of the study group were analyzed, it has been detected that, there was a significant improvement in motor conduction velocity and sensory conduction time compared to preoperative results. Hand / wrist MRI of the study group was compared with the control group, it has been observed that, the arithmetic mean of all measurements, except the ratio of carpal tunnel area / wrist area were greater than the control group. The differences in terms of median nerve flattening ratio in the middle and distal, the distal median nerve area, flexor retinaculum thickness, flexor retinaculum spring, the flexor retinaculum spring ratio were not significant. Conclusion: Electrophysiological studies are the gold standard in the diagnosis of CTS. MRI is an effective method in the evaluation of patients after surgery. It may be used to reveal the cause of failed surgery. MR imaging is an effective method in the diagnosis of patients and in post-operative follow-up

Combined Therapy for Distant Metastasis of Sacral Chordoma

Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach

Transient Gyral Enhancement After Epileptic Seizure in a Patient with CREST Syndrome

Sınırlı skleroderma; otoimmün bağ dokusu hastalığı olan sklerodermanın bir formudur ve CREST sendromu (kalsinozis kutis, Raynaud fenomeni, özefageal dismotilite, sklerodaktili ve telenjiektazi) olarak da adlandırılır. Sklerodermada nörolojik tutulum diğer sistem tutulumlarına göre daha az görülür. Epileptik nöbet ise nadir görülen nörolojik komplikasyonlardandır. Hastalıkta giral kontrastlanma beklenen bir bulgu değildir. Giral kontrastlanma, beyin parankiminin yüzeyel kontrast tutulumudur ve genellikle vasküler, enflamatuvar, enfeksiyöz ve neoplastik süreçler sonucu ortaya çıkar. Üç yıldır CREST sendromu tanısı olan 67 yaşında kadın hasta hastanemize başvurdu. Üç gün önce epileptik nöbet geçirmişti ve nöbet sonrasında davranış değişiklikleri mevcuttu. Özgeçmişinde epileptik nöbet hikayesi yoktu. Nörolojik muayenesinde; apatikti ve kooperasyonu kısıtlı idi. Derin tendon refleksleri yaygın olarak artmıştı, sağda Hoffman ve Babinski refleksleri pozitifti. Laboratuvar incelemelerinde anti-nükleer antikor pozitifti (1/1000) ve anti-sentromer antikor pozitifti. Kontrastlı kraniyal manyetik rezonans görüntülemede (MRG) sol paryeto-oksipital bölgede giral kontrast tutulumu izlendi. Beyin omurilik sıvısı tetkikleri normal sınırlarda idi. Çekilen elektroensefalografide; diffüz serebral disfonksiyon gözlendi. Yatışında hastaya antiepileptik tedavi başlandı. Takipte hastanın apatisi ve kooperasyon kısıtlılığı düzeldi. Nöbeti tekrarlamadı. On gün sonra çekilen kontrol kontrastlı kraniyal MRG'de giral kontrastlanmanın büyük ölçüde azaldığı gözlendi. CREST sendromunda nörolojik tutulum nadirdir ve hastalık seyrinde epileptik nöbet gözlenmesi literatürde sınırlı sayıda yer almıştır. Giral kontrastlanma vasküler ve enflamatuvar süreçlere ikincil olarak ortaya çıkabilmektedir fakat epileptik nöbet sonrası geçici olarak gözlenebildiği de akılda tutulmalıdırLimited scleroderma, also termed CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia), is a form of scleroderma which is an autoimmune connective tissue disease. Neurological involvement is less common than other system involvements in scleroderma. Epileptic seizure is a rare neurological complication. Gyral enhancement is not an expected finding during disease. Gyral enhancement is contrast enhancement of superficial brain parenchyma and it usually occurs as a result of vascular, inflammatory, infectious and neoplastic processes. A-sixty-seven-year old female patient, who was diagnosed as CREST syndrome for three years was admitted to our hospital. She had an epileptic seizure three days ago and behavioral changes after the seizure. There was not epilepsy diagnosis in her medical history. In neurological examination; she was apathic and deep tendon reflexes were hyperactive, Hoffman’s and Babinski reflexes were positive on the right side of her body. In laboratory studies; anti-nuclear antibody was positive at 1/1000 and anti-centromere antibody was positive. On contrast-enhanced cranial magnetic resonance imaging (MRI); gyral enhancement was observed in the left parieto-occipital region. Cerebrospinal fluid tests were within normal limits. Electroencephalography demonstrated diffuse cerebral dysfunction. We administrated antiepileptic drug to the patient during hospitalization. On the follow up, apathy and restriction of the cooperation were improved. Epileptic seizure did not recur. After ten days, in the control cranial MRI, gyral enhancement was reduced significantly. Neurological involvement in CREST syndrome is rare and epileptic seizures have been appeared in a limited number in the literature. Inflammatory and vascular processes can cause gyral enhancement, but also it must be kept in mind that gyral enhancement can be observed transiently after epileptic seizur