Clinical and radiological results of oxford phase-3 medial unicompartmental knee arthroplasty

PubMed ID: 31832288Purpose The aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients. Materials and methods Seventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up. Results The average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination. Conclusion This study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis

Rijit ve kompleks kifotik deformitelerde cerrahi tedavi

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Erişkin spinal deformiteler, torakal ve7veya lomber omurganın hem koronal hem sagital planda gelişen kompleks ve dinamik bozukluklarıdır. Erişkindeki bu deformiteler adölesan dönemdekilerden farklılık gösterir.1. Sagittal Plan Deformiteleri Tarihçesi 1- 20 A. Şükrü Solak, İ. Teoman BENLİ 2. Normal Fizyolojik Sagittal Plan 21- 36 Mutlu AKDOĞAN, M. Mert TÜZÜNER 3.1. Kranioservikal Disosiasyon 37- 46 Selçuk ÖZDOĞAN, Hakan SABUNCUOĞLU 3.2. Atlantoaksiyel İnstabilite 47- 56 Selçuk ÖZDOĞAN, Hakan SABUNCUOĞLU 4.1. Servikal Hipolordoz (Boyun Düzleşmesi) 57- 66 Selahattin ÖZYÜREK, Serkan BİLGİÇ 4.2. Servikal Spondilolistezis 67 -80 Selahattin ÖZYÜREK, Serkan BİLGİÇ 5. Konjenital Kifoz 81- 96 Turgut AKGÜL 6. Adölesan Kifoz 97- 116 Onat ÜZÜMCÜGİL, Ethem Ayhan ÜNKAR 7. Posttravmatik Kifoz 117- 162 Nikola AZAR, Onat ÜZÜMCÜGİL 8. Postenfeksiyöz Kifoz 163- 172 Gökhan DEMİRKIRAN, Altuğ YÜCEKUL 9. Postlaminektomi Kifoz 173- 184 Ali Ender OFLUOĞLU, Uzay ERDOĞAN 10. Bileşke Kifozu 185- 194 Mehmet TAŞKOPARAN, Celal Özbek ÇAKIR, İ. Teoman BENLİ 11. Postradyasyon Kifozu 195- 202 Barış GÖRGÜM, Okan TOK, Gökhan KAYNAK, Hüseyin BOTANLIOĞLU 12. Ankilozan Spondilit 203- 218 Cem ÇOPUROĞLU, Mert ÇİFTDEMİR 13. Rijit ve kompleks kifotik deformitelerde cerrahi tedavi 219- 252 Sinan KAHRAMAN, Azmi HAMZAOĞLU İNDEKS 253-256

Apical and intermediate anchors without fusion improve cobb angle and thoracic kyphosis in early-onset scoliosis.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.BACKGROUND: The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach. DESCRIPTION OF TECHNIQUE: In the initial procedure, polyaxial pedicle screws were placed with a muscle-sparing technique. Rods were placed in situ after achieving correction with intraoperative skull-femoral traction. The most proximal and most distal screws were fixed and the rest of the screws were left with nonlocked set screws to allow vertical growth. The lengthening reoperations were performed every 6 months. METHODS: Between 2007 and 2011, we treated 19 patients surgically for early-onset scoliosis. Of those, 16 (29%) were treated with the modified growing rod technique by the senior author (AH); an additional three patients were treated using another technique that was being studied at the time by one of the coauthors (CO); those three were not included in this study. The 16 children included nine girls and seven boys (median, 5.5 years of age; range, 4-9 years), and all had progressive scoliosis (median, 64°; range, 38°-92°). All were available for followup at a minimum of 2 years (median, 4.5 years; range, 2-6 years). RESULTS: The initial curve Cobb angle of 64° (range, 38°-92°) improved to 21° (range, 4°-36°) and was maintained at 22° (range, 4°-36°) throughout followup. Preoperative thoracic kyphosis of 22° (range, 18°-46°) was maintained at 23° (range, 20°-39°) throughout followup without showing any substantial change. There was a 47 mm (range, 38-72 mm) increase in T1-S1 height throughout followup. The mean number of lengthening operations was 5.5 (range, 4-10). The mean T1-S1 length gain from the first lengthening was 1.18 cm (range, 1.03-2.24 cm) and decreased to 0.46 cm (range, 0,33-1.1 cm) after the fifth lengthening procedure (p = 0.009). The overall complication rate was 25% (four of 16 patients) and the procedural complication rate was 7% (seven of 102 procedures). We did not experience any rod breakages or other complications apart from two superficial wound infections managed without surgery during the treatment period. The only implant-related complications were loosening of two pedicle screws at the uppermost foundation in one patient. CONCLUSIONS: In this preliminary study, the modified growing rod technique with apical and intermediate anchors provided satisfactory curve control, prevented progression, maintained rotational stability, and allowed continuation of trunk growth with a low implant-related complication rate

Osteotomies/spinal column resections in adult deformity

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Osteotomies may be life saving procedures for patients with rigid severe spinal deformity. Several different types of osteotomies have been defined by several authors. To correct and provide a balanced spine with reasonable amount of correction is the ultimate goal in deformity correction by osteotomies. Selection of osteotomy is decided by careful preoperative assessment of the patient and deformity and the amount of correction needed to have a balanced spine. Patient's general medical status and surgeon's experience levels are the other factors for determining the ideal osteotomy type. There are different osteotomy options for correcting deformities, including the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR) providing correction of the sagittal and multiplanar deformity. SPO refers to a posterior column osteotomy in which the posterior ligaments and facet joints are removed and a mobile anterior disc is required for correction. PSO is performed by removing the posterior elements and both pedicles, decancellating vertebral body, and closure of the osteotomy by hinging on the anterior cortex. BDBO is an osteotomy that aims to resect the disc with its adjacent endplate(s) in deformities with the disc space as the apex or center of rotational axis (CORA). VCR provides the greatest amount of correction among other osteotomy types with complete resection of one or more vertebral segments with posterior elements and entire vertebral body including adjacent discs. It is also important to understand sagittal imbalance and the surgeon must consider global spino-pelvic alignment for satisfactory long-term results. Vertebral osteotomies are technically challenging but effective procedures for the correction of severe adult deformity and should be performed by experienced surgeons to prevent catastrophic complications

Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period

The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI inidiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. Aroutine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations.Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum

Dejeneratif lomber spinal stenozun tedavisinde karar verirken aksiyel yüklenmeyle birlikte yapılan manyetik rezonans görüntüleme ve bilgisayarlı tomografi-miyelografinin değeri

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Aim: The degenerative lumbar spinal stenosis (LSS) is a dynamic phenomenon. Changes in posture and physical activities as standing and walking can aggravate symptoms. The aim of the study was to evaluate the results of post axial loading Computed Tomography Myelography (CTM) versus Magnetic Resonance Imaging (MRI) in patients undergoing surgery for multilevel degenerative lumbar spinal stenosis. Methods: Thirty patients with multilevel degenerative LSS scheduled for elective surgery were enrolled in the study. Preoperatively, all patients underwent both MRI and CTM, in supine psoas relaxed position and post loading by axial compression in slight extension. Quantitative evaluation for LSS was conducted by two experienced radiologists. The parameters included dural sac cross sectional area, lateral recess and foraminal evaluations for stenosis, on CTM and MRI. Statistical analysis of the data was performed to evaluate relative advantages and additional information depicted by axial loaded CTM versus MRIAmaç: Dejeneratif lomber spinal stenoz (LSS) dinamik bir olgudur. Postüral değişiklikler ile ayakta durma ve yürüme gibi fiziksel aktiviteler semptomları ortaya çıkarabilir. Çalışmanın amacı, çok seviyeli dejeneratif LSS nedeniyle ameliyat edilen olgularda aksiyel yüklenme sonrası manyetik rezonans görüntüleme (MRG) ile bilgisayarlı tomografi-miyelografi (BTM) nin sonuçlarının karşılaştırılmasıdır. Yöntem: Elektif cerrahi için randevu verilen çok seviyeli dejeneratif LSS olan 30 hasta bu çalışmaya dahil edildi. Preoperatif olarak tüm hastalara supin pozisyonunda psoas kası gevşekken ve hafif ekstansiyonda uygulanan aksiyel kompresyon sonrasında MRG ve BTM çekilmiştir. Deneyimli iki radyolog tarafından LSS açısından kantitatif olarak değerlendirilmiştir. Parametreler, dural kese kesit alanı, lateral reses ve foraminal stenozun değerlendirmesini içermiştir. Verilerin istatistiksel değerlendirmesiyle aksiyel yüklenme ile yapılan BTM ve MRG tetkiklerinin göreceli avantajları ortaya konmuştur

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed