Transforaminal lumbar interbody fusion as revision surgery for patients previously treated by discectomy or instrumentation of the lumbar spine

Purpose:Transforaminal lumbar interbody fusion (TLIF) is a surgical method that allows stable fusion of the anterior spinal column and restoration of disc height and lumbar lordosis. The aim of this study was to evaluate the clinical and radiological data of the patients who underwent lumbar discectomy, posterior instrumentation and laminectomy or TLIF surgery and who applied to our clinic with the complaint of discogenic back or leg pain and investigate the effectiveness of procedure.Material and Methods:Between the years 2012-2016, patients who underwent TLIF procedure were analyzed retrospectively. Inclusion criteria; patients undergone surgery due to any disc pathology from the lumbar region, complaints that did not respond to a minimum of 6 weeks of conservative treatment, patients undergoing revision surgery with two levels or more TLIF procedure with posterior instrumentation and a follow-up period longer than 2 years. Radiological and clinical data of 13 patients who met these criteria were examined for the study.Results:The study group consisted of 11 women and 2 men. The mean follow-up period was 39.3 months (range 26-58). The mean age was 62.2 (range 56-71). 7 patients had previously undergone lumbar discectomy, 4 patients had posterior instrumentation and laminectomy, 2 patients had posterior instrumentation and TLIF procedure. The dominant complaint was back pain in all patients. There were also complaints of varying rates of radicular pain and combinations of neurological deficit. Indications for revision surgery; lumbar degenerative disc disease, recurrent lumbar disc herniation, lumbar spinal canal stenosis, segmental instability and spondylolisthesis with two levels and higher. A total of 77, mean 5.9 (±1.4) pedicle screws were placed. A total of 32, average 2.4 (±0.5) levels of TLIF were applied. In 8 (61.5%) patients, pedicle screws was augmented with cement. The mean operative time was 378.8 min, and the mean amount of blood loss was 684.6 ml. The mean amount of autotransfusion and allogeneic blood transfusion was 569.2 ml. Mean duration of hospital stay was 4.6 days. One patient had dural tear during the operation. In one patient, the wound drainage that started in the postoperative 10. day was healed with wound debridement and antibiotic treatment. None of the patients had proximal or distal adjacent segment fracture, implant failure, nonunion or loss of correction during the follow-up. Complete neurological recovery was observed in all patients except the patient who was admitted with a 6-month history of foot drop.Conclusions:TLIF is a safe and effective procedure for the treatment of spinal pathologies in revision surgery. Elimination of spinal stenosis and instability, decompression of nerve roots, restoration of intervertebral disc heights, restoring lumbar lordosis, neutralization of global spinal balance and pain relief are possible.Publisher's Versio

Adult lumbar scoliosis

Scoliosis in the adult is a disorder that involves a convergence of deformity and degenerative disease in the spine. It can be defined as a coronal deformity with Cobb angle of more than 10 degrees in mature patients. The treatment of adult lumbar scoliosis deformity requires a multidisciplinary approach and preoperative planning, and to be extended to the development of new treatment methods in the future along with the expected life expectancy. It often manifests with low back pain. Etiology of the disease is related with primary degeneration or continuation of a deformity from adolescence. The main objective of surgical management is to decide which patient is to be treated with surgical treatment, to evaluate the general condition and to analyze the comorbidities of the patient and to draw a treatment scheme considering the patient’s expectations.Publisher's Versio

Patient-centered outcomes of vertebroplasty via questionnaire

Purpose: Our aim was to evaluate patient centred outcomes of patients with compression fractures treated by vertebroplasty. Methods: Patients with compression fractures treated by vertebroplasty procedure between 2013- 2016 was examined with a 3-question through telephone call. Results: Fifty-two patients completed the telephone satisfaction survey. Of these, 92.5 % of answerers said the procedure was acceptable, 86.5% had full or partial pain remission and 78.8 % would have the procedure again. Conclusions: The use of vertebroplasty is supported by randomized trials in osteoporotic and malignant compression fractures. To the results of our study, patients believe vertebroplasty is a tolerable procedure that produces full or partial pain remission and would try the same procedure again if needed.Publisher's Versio

Evaluation of satisfaction with a questionnaire according to fracture level and fracture type of patients who underwent balloon kyphoplasty

Objective: The aim of this study is to better understand which type of fracture and localization have more painful or worse outcomes for the kyphoplasty procedure. Materials and Methods: Kyphoplasty cases operated between 2013 and 2018 were included in the study. The patients were contacted through the numbers registered in the hospital system. A questionnaire were asked to the patients. Patients were grouped according to gender, fracture level (T12-L1 and others) and fracture type (Osteoporotic, trauma, malignancy, unknown). Results: Fourty-one patients were included in the study. Three-quarters of the patients were women and average age was 62. Ninety-two percent of the patients stated that the pain of the procedure was tolerable. Seventy percent reported that their pain decreased after the procedure and 75% of the patients stated that they could have this procedure done again. Pain reduction and the desire to have same surgery again were significantly higher in female patients than in the male group (p<0.05). In the T12-L1 group and osteoporotic fracture group, the procedure was more easily tolerated, the pain was relieved more and the desire to have the same surgery was higher (p<0.05). Conclusion: Kyphoplasty is accepted as an operation that is well tolerated by patients and has good pain relief. Additionally more detailed information was obtained about the patient’s complaints after the kyphoplasty procedure, according to the fracture level and type.Publisher's Versio

A Comparison of high viscosity and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures

Introduction: Our aim in this clinical trial was to compare the safety and efficacy of highviscosity cement (HVC) with low-viscosity cement (LVC) for the treatment of osteoporotic vertebrae fractures in terms of pain, functional capacity and cement leakage in the percutaneous vertebroplasty procedure (PVP). Methods: From March 2013 to February 2015, 76 patients with vertebrae compression fracture who were admitted into hospital and treated with PVP were reviewed. Pre- and postoperative clinical characteristics of each patient were obtained by using The Visual Analog Scale (VAS) score to evaluate back pain, Oswestry Disability Index (ODI) as a functional assessment. Cement leakage,injected cement volume and the complications assessed due to medical records. Results: VAS and ODI scores improved (P0.05).Paravertebral cement leakage was significantly higher in the LVC group (P<0.05). Pulmonary cement embolism was also significantly higher in LVC group (P<0.05). Conclusion: HVC had lower complication rates with similar clinical results in the comparison with LVC.Publisher's Versio

Surgical treatment of preschool childhood spinal thoracic tuberculosis: Two case reports and technical note

Background: The development of paraplegia and kyphosis are two important problems related to spinal tuberculosis (Pott’s disease) in children. The current study aims to present two pediatric Pott’s disease, point out the progression of this disease in children, surgical options and surgical outcomes.Materials and methods: Two cases of childhood Pott’s disease were referred to our department with progressive neurological deficits (both of children were experienced bilateral weakness in lower extremities; grade C according to Frankel scale) during short periods (less than one month per each). Both cases’ MRIs are demonstrated abscesses in thoracic spine. Both patients are treated surgically. We discussed in this study the technical notes in both cases, especially in 2-year-old child.Results: Both cases were treated surgically after decompressing nerve roots and thecal sac posterior instrumentation was applied. Microbiological examination of both samples revealed on M.Tuberculosis. Orthoses are applied three months after operations. Antituberculosis medication protocol was applied. Preoperative paraparesis had recovered completely and muscle strengths all returned to normal in both children. There is no loss of correction during the follow-up periods.Conclusion: Spinal tuberculosis is a dynamic disease that may lead to severe deformities in childhood. Especially in cases where two or more vertebrae are affected, early surgical treatment is essential to prevent severe kyphosis. Surgical intervention accompanied with antituberculosis medications protocol is essential to cure treatment in pediatric population. In children aged ?6 years and more than one vertebrae were affected, f?bula can be used to allow growth of the child vertebral column

Intraoperative Halo-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves between 70° and 90°: Is It Effective?

Study Design A retrospective clinical study. Purpose To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility 70°. However, few studies have evaluated the results of HFT in AIS patients with Cobb angles between 70° and 90° and flexibility <35%. Methods The study comprised 24 AIS patients (18 females, six males; mean age, 17.4 years; mean preoperative Cobb angle, 80.1°; range, 70°–90°) who underwent surgery using intraoperative HFT. Neurological status was constantly assessed during the surgery using intraoperative neurophysiological monitoring. Results The mean follow-up period was 33.5 months. Radiographic outcomes demonstrated 85.7% correction of the major Cobb angle. Coronal and sagittal balance was achieved in all the patients, and shoulder levels were equalized. The traction was discontinued when a decrease in spinal cord potentials was observed during the surgery. Conclusions Intraoperative HFT is an effective and reliable method for the management of scoliosis curves between 70° and 90°. The most significant advantages of the method are avoidance of the morbidities related to anterior surgery, osteotomy, or vertebral column resection; its contribution in helping achieve adequate reduction and optimum balance by the gradually increased corrective force, lack of any need for extreme correction force during instrumentation; and the high correction rates achieved

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

Do Avanafil and Zaprinast Change Some Selected Cytokine Levels In Ovariectomized Rat’s Liver?

Studies reported that phosphodiesterase-5 inhibitors (PDE-5Is) positively contributed to bone-mineral-density and thickness in rats with ovariectomy, which have the same condition with postmenapozal period. To explain the positive contribution mechanism on bone mineral density of PDE-5Is, we investigated the effect of zaprinast and avanafil on levels of some pro -or anti-resorptive cytokines in ovariectomized-rats. Albino female rats (8 months and 250-350 g) were used and four groups of equal-number were randomly assigned (n=6). Groups; was the sahm operated, positive control (OVX), Zaprinast and OVX, Avanafil and OVX groups, respectively. The levels of Estrogen, IL-1β, IL-6, IL-8, IL-10 and TNF-α were measured by ELISA kits, in liver of rats. IL-1β, IL-6, IL-8 and TNF-α levels were high in groups with OVX compared to sham group, while IL-10 levels were low. Also, IL-1β, IL-6, IL-8 and TNF-α levels were low in zaprinast and especially avanafil-treated groups with OVX and were similar to the sahm group values (p=0.001 for IL-1β, p=0.045 for IL-6, p=0.008 for IL-8, p=0.006 for IL-10, p=0.026 for TNF-α). Zaprinast and especially avanafil inhibited IL-1β, 8 and TNF-α and increased the IL-10 levels compared to the OVX group. This may support opinion that PDE-5Is enhance bone mineralization by inhibiting proresorptive cytokines

Can we stop fusion distally at L3 instead of L4 vertebra in the surgical treatment of adolescent idiopathic scoliosis with lenke type 3C, 5C and 6C curves

İstanbul Bilim Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalıİdiopatik skolyoz tanısı konan bir hastada cerrahi tedavi kararı alındıktan sonra önemli olan nokta spinal füzyon yapılacak sahanın belirlenmesidir. İdeal olarak füzyonun distal ucu lomber hareketli segmentlerin korunması için mümkün olduğunca proksimalde ve gövde imbalansına yol açmayacak kadar distalde olmalıdır. Özellikle çift major veya major torakolomber/lomber (TL/L) eğriliklerde olduğu gibi enstrümentasyonun hem torasik hem lomber eğriliği içermesi gereken durumlarda füzyonun distalde genellikle L4 çok nadir olarak da L3 seviyesinde durması gereklidir. L3 ile L4 arasındaki seçim zorluk teşkil etmektedir. Spinal denge füzyon (enstrümentasyon) distalde stabil vertebrayı içerdiği zaman elde edilebilmektedir. Bu çalışmanın amacı Lenke 3C, 5C and 6C eğriliklerde L3 santral sakral vertikal çizgi (CSVL)’ye dokunmasa bile füzyonu L4 yerine L3’te sonlandırmakta kullanılacak preoperatif radyolojik kriterlerin belirlenmesidir. Bu çalışma 2002 ile 2007 yılları arasında tek bir merkezde adolesan idipatik skolyoz tanısı ile opere edilen 140 hastadan en az 2 yıllık takibi olan 118 hasta dahil edilerek yapıldı. Çalışmaya Lenke tip 3C, 5C and 6C eğriliği olan ve posterior spinal füzyon uygulanan adelosdan idiopatik skolyozlu hastalar alındı. 118 hastanın ortalama takip süresi 42 (24-60) ay, ortalama yaş 15.4 (13-18) yıl idi. Tüm hastalarda füzyon distalde L3 seviyesinde durduruldu. Bu çalışmada; hastaların üçte birinde CSVL L3’e temas etmemekte iken bending ve traksiyon grafileri ve özellikle genel anestezi altında çekilen traksiyon (GAAT) grafisinde L3’ün pelvise paralel hale geldiği görüldü. Bu hastalarda füzyonu distalde L3’te durdurmak mümkündür. Hastaların üçte ikisinde ise CSVL L3’e temas etmediği gibi bending grafilerde de L3’ün pelvise parallel olmadığı görüldü. Genel anestezi altında çekilen traksiyon grafileri özellikle bu hastalarda faydalı oldu çünkü L3’ün pelvise paralel hale geldiği, CSVL’nin L3’e temas ettiği veya kestiği ve L3’ün büyük oranda Harrington’un stabil zonu (HSZ) içinde kaldığı tespit edildi. Bu sebeple bu hastalarda distalde füzyon seviyesi bending grafilere bakarak L3 vertebrada sonlandırılamazken, GAAT grafisi ile somlandırılabileceği görülmüştür. Bu bulgular bizi bu hasta grubunda füzyonun L4 yerine L3’te durmaya teşvik etmiştir. Böylece vertebral kolonun dengesini bozmadan daha fazla hareketli segmenti korumak mümkün olabilmiştir.Important decision after determination of a patient requiring surgery for idiopathic scoliosis is the selection of the segments of the spine for fusion. Ideally, the distal extent of the fusion should be as proximal as possible to preserve lumbar motion segments, yet long enough to avoid creating trunk imbalance in the modern thinking about scoliosis surgery. When instrumentation of both the thoracic and the lumbar curves especially in double major or major thoracolumbar/lumbar (TL/L) curves (Lenke Type 3C, 5C and 6C or King Type I and IV) is required, the distal extention of fusion is usually L4 or rarely L3 level. Choosing between L3 and L4 can be difficult. The most predictable spinal balance occurs when the fusion/instrumentation extends distally to the stable vertebra. The purpose of this study is to determine preoperative radiological criteria to stop the fusion distally at L3 level instead of L4 in Lenke 3C, 5C and 6C curves even when CSVL does not touch L3. This study reviewed 140 patients with adolescent idiopathic scoliosis surgically treated between 2002 and 2007 in a single institution and 118 of them were available for minimum 2-year follow-up evaluation. Included in the study were patients who underwent an instrumented posterior spinal fusion for adolescent idiopathic scoliosis with Lenke type 3C, 5C and 6C curves. For the 118 patients, the average follow-up period was 42 months, ranging from 24 to 60 years. The average age at surgery was 15.4 years, ranging from 13 to 18 years. Distal fusion was stopped at L3 in all patients. In the current study; in nearly one third of our cases, CSVL does not touch L3 but L3 becomes level to pelvis at bending radiographs and traction radiographs, especially when taken under general anesthesia. It is possible to stop fusion at L3 in those cases. In two thirds of cases, CSVL does not touch L3 and it does not become level at bending radiographs. Traction radiographs taken under general anesthesia are especially helpful in these cases because L3 becomes level, CSVL touches or bisects L3 and L3 is completely in Harrington’s stable zone. Thus, according to bending radiographs you can not stop at L3 but you can do so according to traction radiographs taken under general anesthesia. These findings encouraged us to stop the fusion distally at L3 level instead of L4. Thus, it is possible to save more motion segments distally without unbalancing the vertebral column