Surgical anatomy of the presacral area

Abstract Objective L5-S1 instabilities can be Wxated using minimally invasive presacral approach. The close relationship between the sacrum and neurovascular as well as intestinal structures may complicate the procedure during this approach. This requires knowledge regarding the normal anatomy of the presacral area to avoid the iatrogenic injuries. The aim of this study was to measure the distance between the sacrum and the structures anterior to it. Materials and methods The measurements were performed on ten cadavers Wxed with formaldehyde and ten MR imaging studies on individuals without any pathology in the presacral area. The distances between the sacrum and the presacral structures (i.e., middle and lateral sacral arteries, sympathetic trunks, internal iliac arteries and veins, and colon/rectum) were measured. Results Cadaver study showed that the middle sacral artery was located on the right side in 55.0%, on the left side in 31.7%, and on the midline in the 13.3% of cases. The distance between the sacral midline and middle sacral artery was found to be 8.0 § 5.4, 9.0 § 4.9, 8.7 § 6.0, 8.6 § 6.4, and 4.7 § 5.0 mm at the levels of S1-2, S2-3, S3-4, S4-5, and S5-coccyx, respectively. The distance between the sacral midline and the sympathetic trunk ranged between 22.4 § 5.8 and 9.5 § 3.2 mm in diVerent levels between S1 and coccygeal level. The study also showed that the distance between the posterior wall of the intestine (colon/rectum) and the ventral surface of the sacrum can be as close as 11.44 § 7.69 mm on MR images. Conclusion This study showed that there was close distance between the sacral midline and the structures anterior to it. The close relationships, as well as the potential for anatomical variations, require the use of sacral and presacral imaging before presacral approach

Mustafa Sakarya (1901-1988): Turkish fellow of Walter E. Dandy.

Walter E. Dandy is one of the true pioneers of modern neurosurgery. This eminence led many surgeons to visit his department for training. Mustafa Sakarya, a Turkish surgeon, was Dr. Dandy's only fellow from Turkey. He spent 9 months at the Johns Hopkins Hospital and wrote his observations in a notebook during this period. The notebook contains information regarding the patients, operative schedules, and surgical techniques, as well as theoretical reviews. His notes are of potential interest to both American and Turkish neurosurgeons

History of spine deformity in turkey

Spine deformities are among the most important spinal disorders, affecting health-related life quality. Although there are some studies in past centuries, most spine deformity-related studies and research has started in the last century. Many surgical techniques, performed between 1960 and 1990, made scoliosis a touchable pathology. These techniques started with Harrington's system, wiring techniques, pedicle screw techniques, and all other universal techniques. Anterior and 360 degree techniques contributed to this process. The use of spinal osteotomies, and recent technologies such as magnetic rods, intraoperative neuromonitoring added much to the body of knowledge of literature and improved the outcome. Advancement has not been limited to surgery only and diagnostic advancements had also impact to this process. Surgical techniques performed in the west have been performed soon in our countries. Currently almost all surgical techniques for treatment of spine deformities can be performed in our country. This article reviews historical aspects related to the diagnosis and treatment of spine deformities in Turkey

History of of Spine Deformity in Turkey

Spine deformities are among the most important spinal disorders, affecting health-related life quality. Although there are some studies in past centuries, most spine deformity-related studies and research has started in the last century. Many surgical techniques, performed between 1960 and 1990, made scoliosis a touchable pathology. These techniques started with Harrington's system, wiring techniques, pedicle screw techniques, and all other universal techniques. Anterior and 360 degree techniques contributed to this process. The use of spinal osteotomies, and recent technologies such as magnetic rods, intraoperative neuromonitoring added much to the body of knowledge of literature and improved the outcome. Advancement has not been limited to surgery only and diagnostic advancements had also impact to this process. Surgical techniques performed in the west have been performed soon in our countries. Currently almost all surgical techniques for treatment of spine deformities can be performed in our country. This article reviews historical aspects related to the diagnosis and treatment of spine deformities in Turkey

The contribution of Turkish neurosurgeons to Spine surgery literature Türk nöroşirürjiyenlerin Spinal cerrahi literatürüne katkilari

Objective: To determine the number of articles originating in Turkey and published in international spine-related journals, to compare the number of spine-related publications of different disciplines, and to compare Turkey's spine-related publications with those of other countries. Material and Methods: A five-year review of PubMed from 2000 to 2004 was performed. The reviewed journals were Journal of Neurosurgery: Spine, Spinal Cord, European Spine Journal, Spine, Journal of Spinal Disorders and Techniques, and The Spine Journal. Results: 182 papers had been published by Turkish authors in main spine-related journals during the study period. Turkish authors were among the most productive authors in Spine, Journal of Neurosurgery: Spine, and Spinal Cord. With respect to the published papers in Journal of Neurosurgery: Spine, articles originating from Turkey were second, sixth, fourth, third, and fourth in number in 2000, 2001, 2002, 2003, and 2004 respectively. There was a dominance of papers written by neurosurgeons in Journal of Neurosurgery: Spine, and Spinal Cord while papers written by orthopaedic surgeons dominated in Spine. Comment: There are an increasing number of papers from Turkey in western spinerelated and neurosurgical journals. We expect further contributions from our country to the medical literature in the future

Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery?

As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended

Florence Nightingale: Light to Illuminate the World from the Woman with the Lantern

The Ottoman-Russian war of 1853 to 1855 was significant not only as a war, but also in response to a reflex from the West brought with itself novel approaches related to care of patients under severe health conditions. Florence Nightingale and her associates assigned at that time to care for soldiers in Istanbul who were severely ailing as a result of battle conditions were instrumental in the emergence of a hitherto unknown profession. This article examines the progress of events in the London-Istanbul axis that led to this development