Discal cysts of the lumbar spine: report of five cases and review of the literature

Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions

Multifractal analysis of atmospheric carbon emissions and OECD industrial production index

Purpose The purpose of this study aims to analyze the dynamic behavior of the relationship between atmospheric carbon emissions and the Organisation for Economic Co-operation and Development (OECD) industrial production index (IPI) in the short and long term by applying multifractal techniques. Design/methodology/approach Multifractal de-trended cross-correlation technique is used for this analysis based on the relevant literature. In addition, it is the most widely used approach to estimate multifractality because it generates robust empirical results against non-stationarities in the time series. Findings It is revealed that industrial production causes long and short term environmental costs. The OECD IPI and atmospheric carbon emissions were found to have a strong correlation between the time domain. However, this relationship does not mostly take into account the frequency-based correlations with the tail effects caused by shocks that are effective on the economy. In this study, the long-term dependence of the relationship between the OECD IPI and atmospheric carbon emissions differs from the correlation obtained by linear methods, as the analysis is based on the frequency. The major finding is that the Hurst coefficient is in the range 0.40-0.75 indicating. Social implications The results provide information for the analysis of the environmental cost of climate change depending on the magnitude of the impact on the total supply. In addition to environmental problems, climate change leads to economic problems, and hence, policy instruments are introduced to fight against the adverse effects of it. Originality/value This study may be of practical and technical importance in regional climate change forecasting, extreme carbon emission regulations and industrial production resource management in the world economy. Hence, the major contribution of this study is to introduce an approach to sustainability for the analysis of the environmental cost of growth in the supply side economy

Which is Better: Stainless Steel or Titanium Alloy?

WOS: 000437251200018AIM: To investigate immunologic reactions after implantation of stainless steel (SS) alloy and titanium (Ti) alloy in a rat model. Macrophage and cytokine responses have been reported after in vivo and in vitro application of different biomaterials. MATERIAL and METHODS: Wistar albino rats were used. After an exploration of the thoracolumbar paravertebral muscle tissue of the subjects, Group I underwent sham surgery, and Groups II and III underwent implantation of Ti alloy and SS alloy rods respectively. The CD4, CD8, CD25 (IL-2R) (lymphocyte and CD4 gate), CD4+CD8+ and CD4+CD25+Foxp3+ (Tregs), IL-4, IL-10, IL-6, IL-17A, TGF-beta,TNF-alpha in the blood were analyzed. RESULTS: CD4, CD25 (IL-2R), CD4+CD8+ and Tregs levels were lower in Group III compared to Group I (sham) and Group II. IL-6, IL-17A, TGF-beta and TNF-alpha levels in Group III showed a significant increase on all days in comparison with Group I and Group II. IL-4 and IL-10 levels were lower in Group III than those in Group II; and a significant decrease was observed in the IL-10 level. There was a reduction in IL-6 and IL-17A levels in Group II as opposed to Group I. CONCLUSION: As opposed to SS alloy, Ti alloy suppresses the development of inflammation by inhibiting the pro-inflammatory response; strengthens the humoral immune system by intensifying the antibody-dependent immune response; triggers the development of immune tolerance by regulating the immune response; and activates the mechanism that prevents immune response-related damage from occurring

Russell - Silver syndrome associated with low conus medullaris

WOS: 000395657900019PubMed ID: 28217167Russell - Silver syndrome is a rare heterogeneous disorder mainly characterized by intrauterine and postnatal growth retardation, craniofacial disproportion, clinodactyly, variation in urogenital development, and skeletal asymmetry. It is rare to come across tethered cord-associated Russell - Silver syndrome. We report a rare case of Russell-Silver syndrome associated with low conus medullaris in a 2-year-old patient with demonstrative phenotype. Magnetic resonance imaging indicated a low conus medullaris at the inferior border of the L3 vertebral body. Urodynamic study revealed detrusor-sphincter dyssynergia and detrusor overactivity. A decision to follow-up the patient was made because of the suspicion of tethered cord syndrome. Even though tethered cord syndrome is not a common finding in Russell-Silver syndrome, it is important to consider tethered cord syndrome to avoid scoliosis and other long-term complications

Unilateral hemilaminectomy for the removal of the spinal space-occupying lesions

In this study we have evaluated 40 patients with spinal lesions with respect to the value of unilateral hemilaminectomy. Our case study group included 29 intradural extramedullary, 6 intramedullary, and 5 extradural tumors. The thoracic spinal cord was involved in 17, the lumbar region in 13, and the cervical spinal cord in 10 cases. The mean age of the 20 males and 20 females was 35 (range 6-71). The rationale for choosing a unilateral approach is to preserve musculoligamentous attachments and bony posterior elements as much as possible. We did not observe any complication relating to unilateral hemilaminectomy. The patients were mobilized the following day after surgery or given rehabilitation therapy beginning on the second postoperative day without the use of any external support. At follow-up evaluation, a mean of 32 months postoperatively, none of the patients showed spinal deformity or spinal instability

Biomechanical Comparison of Anterolateral Plate, Lateral Plate, and Pedicle Screws-Rods for Enhancing Anterolateral Lumbar Interbody Cage Stabilization

Study Design. A repeated measures in vitro flexibility experiment was performed in calf spines. Objectives. To determine the biomechanical differences among three techniques for augmenting stability of an anterolateral lumbar threaded interbody cage. Background. Stand-alone interbody cages are known to inadequately stabilize the spine. Surgeons often add supplementary instrumentation for a more stable construct. Methods. Six L2-L5 calf spines (L3-L4 level instrumented) were tested: 1) intact; 2) with a single anterolateral interbody cage; 3) with cage plus anterolateral plating; 4) with cage plus lateral plating; and 5) with cage plus pedicle screw fixation. Specimens were loaded in each anatomic plane quasistatically (maximum 5.0 Nm). Angular motion was measured stereophotogrammetrically. Results. The stand-alone interbody cage allowed significantly less range of motion than normal during all loading modes except axial rotation. Addition of pedicle screws-rods, anterolateral plate, or lateral plate significantly further reduced range of motion in all planes. Pedicle screws slightly outperformed the anterolateral plate during extension and lateral bending and slightly outperformed the lateral plate during flexion, extension, and left axial rotation (range of motion differences 0.65°, P \u3c 0.05). The anterolateral plate outperformed the lateral plate during flexion and extension, whereas the lateral plate outperformed the anterolateral plate during lateral bending (range of motion difference 0.57°, P \u3c 0.05). Conclusion. Anterolateral or lateral lumbar plating increases stability significantly compared to stand-alone interbody cage fixation. These findings support anterolateral or lateral plate fixation as a potential clinical alternative to pedicle screws-rods in this role and may obviate the need for combined anterior and posterior approaches when spinal instability exists