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

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

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

Clinical and Radiological Morphometry of Posterior Parts of Thoracic and Lumbal Vertebras

The aim of this work is to measure clinically important dimensions of thoracic and lumbal vertebras. Charts of one-hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine between 01.01. 2008. and 31.3.2010. at the Department for Orthopedics and Traumatology, of the Sarajevo Clinical center were retrieved, and only 14 patients, with 46 vetrtebras and 89 pedicles have had complete documentation (clearly visible measured structures on X-ray and CT scans). Digitalized antero-posterior and latero-lateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height and width of the pedicle – PH, PW, axial and vertical cortico-cortical transpedicular distances – AL, VL, and interpedicular distance – IP. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and length scale on CT scans. Enlargement of those parameters, from T1 to L5 level was from 50 to 150%. This increasing was not always linear, sometimes there was even decreasing. For instance, the IP on second and third thoracic vertebra was shorter compared to the first thoracic vertebra. Pedicles from the third to the eighth thoracic vertebra were narrower compared to the second thoracic vertebra. The importance of this work is in to analyze the mentioned dimensions by methods available to the clinician. Every other in vivo measurement is impossible because of the excessive surgical approach, while preoperative CT scanning with a great number of slices per one millimeter for this purpose is not ethical

Omurga kist hidatiği ve albendezol, anteror ve posterior radikal eksizyon ve füzyon ile tedavisi: Olgu sunumu ve 11 yıllık takip sonuçları

Hydatid cyst is a zoonosis caused by the larval form of parasitic tapeworm Echinococcus granulosus. We present a case of vertebral hydatid cyst with paravertebral abscesses operated 11 years ago. A 32 year old woman presented multiple giant paravertebral abscesses at the level of T11-12 and L1 vertebrae and pathological fracture of L1 vertebra because of vertebral hydatid cyst. Posterior instrumentation and fusion followed by anterior L1 corpectomy and fusion were done. Patient was pain-free at eleven-year follow-up. There was no radiological evidence of relapse. Hydatid disease of the spine is rare, misdiagnosis and therefore inadequate treatment and recurrence is frequent. Maintaining the stability of the spine and achieving a fusion mass is important in the decision of surgical technique in vertebral type of hydatidosis.Hidatit kist Echinococcus granülozus’un larva formu ile oluşan bir zoonozdur. Bu çalışmada 11 yıl önce paravertebral apse ile birlikte vertebral hidatit kist nedeni ile ameliyat edilen olgu sunulmuştur. 32 yaşındaki kadın hastada T11-T12 ve L1 seviyelerinde yaygın paravertebral apse, L1 seviyesinde vertebral hidatit kiste bağlı patolojik kırık saptandı. Posterior enstrümantasyon ve füzyon, anterior L1 korpektomi ve füzyon uygulandı. Bir yıl sonraki kontrolde hastanın semptomları tamamen düzelmişti. Radyolojik tetkiklerde apse nüksü görülmedi. Oldukça nadir rastlanan vertebra kist hidatiği tanısı ve tedavisi zor bir enfestasyondur. Nüks ihtimali oldukça yüksektir. Omurganın stabilitesinin temin edilmesi ve füzyon kitlesinin elde edilmesi vertebral hidaditozun cerrahi tedavi kararında oldukça önemlidir

Life cycle assessment of olive pomace gasification for an up-draft fixed bed gasifier system

Biomass gasification has been considered as an important renewable energy alternative to deal with the environmental problems originating from fossil fuels and climate change effects. Olive pomace as a by-product of the olive oil production process is a significant biomass source. Although gasification technology is accepted as an environmentally friendly power system, the studies to determine its environmental impact via Life Cycle Assessment (LCA) are very limited. LCA is a key tool to evaluate all environmental impacts from the beginning to the end of the process. The aim of this study is to assess the overall environmental impacts of the olive pomace gasification for electricity generation and evaluation of its solid by-products namely biochar and tar. Four scenarios were compared to estimate the environmental impacts of gasification by-products with a LCA approach, following to the cradle-to-grave approach. The production of olive, olive pomace generation during its processing for olive oil production, gasification of olive pomace, construction of the gasifier, gas cleaning system and syngas composition have been included in the evaluations. It is clear from the analysis results that the scenarios have very low impact values in the case of beneficial usage of biochar in different industries. In terms of ozone layer depletion potential (2.74 × 10 −6 kg CFC11 eq) and global warming potential (36.99 GWP100a), the paramount scenario from an environmental viewpoint is the scenario having the biochar and tar usage as a resource in another industry