Serum Vitamin B12 Level of Children and Its Clinical Relationship with Febrile Seizures

Objective: In the present study, our aim was to investigate the correlation between vitamin B12 levels and febrile seizures (FS) in the pediatric population. Method: The study included a total of 104 patients, comprising 50 children who were admitted with FS and 54 healthy children who served as the control group. Demographic characteristics, seizure types, biochemical parameters (glucose, Na, K, Ca, Mg, P), infection markers (C-reactive protein, procalcitonin) and the serum levels of vitamin B12 in the patients were retrospectively examined by reviewing the records in the hospital database. Results: Demographic parameters were similar between groups. The median age of the children in the FS group was 21.6±11.6 months. The mean temperature of the patients measured by tympanic thermometer during the seizure was 38.3±0.29, 76% of the patients presented with simple FS, 22% with complex FS. In the etiology, upper respiratory tract infections was defined as the most common (72%) cause. The serum vitamin B12, sodium, potassium, calcium, magnesium, phosphorus and platelet values of the febrile convulsion group were statistically lower than the control group. Conclusion: In the course of our research, we observed a significant decrease in vitamin B12 levels among the FS group compared to the control group. These findings suggest that low levels of vitamin B12 may contribute to an elevated risk of FS

The posterior surgical treatment and outcomes of cervical spondylotic myelopathy: Why not C5 nerve root palsy occur

Aim: Cervical spondylotic myelopathy is an age-related degenerative spinal pathology. Anterior or posterior approaches are preferred for surgical treatment. C5 palsy is a common complication after the posterior approach. The aim of our study is to describe the modified laminectomy technique, evaluate short-time surgical outcomes and comment on the C5 nerve root palsy formation. Materials and Methods: 83 patients who had been treated by modified laminectomy for cervical spondylotic myelopathy between the years 2012 and 2017 in our clinic were undertaken in our study. We evaluated the preoperative and postoperative neurologic status of the patients with VAS and JOA scales, complications (C5 palsy) of surgical treatment. The posterior approach was not performed at patients with a >13 degree angle of cervical curvature. Results: 61 of 83 patients were male and 22 were female. The mean age at the time of surgery was 57.8±8.3. The average JOA scale score was 9.4±0.9 preoperatively, 10.1±.0.9 early postoperatively and 15.1±1.0 during the late postoperative follow-up. The average angle of the cervical curvature preoperatively-postoperatively was 17.1±2.6 and 15.8±2.4 respectively. There weren’t any symptoms for C5 nerve root palsy which is a common postoperative complication. Conclusions: The cervical posterior laminectomy, which includes en-bloc laminectomy and preserving of the facet joint capsule, allows a sufficient and safe decompression of the neural structures for cervical spondylotic myelopathy

Diagnosis and treatment of transforaminal epidural steroid injection in lumbar spinal stenosis

Objectives: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients. In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically.Methods: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018. We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year.Results: The mean low back and leg pain Visual Analogue Scale was 5.1 +/- 0.3 before the transforaminal epidural steroid injection procedure, and it was 2.7 +/- 0.1 after two weeks. It was 2.8 +/- 0.2, 3.1 +/- 0.1 at three and six months after procedure, respectively. The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively. The mean Oswestry-Disability-Index was 29.6 +/- 0.4 before the transforaminal epidural steroid injection procedure, and it was 14.1 +/- 0.3 after two weeks. It was 15.3 +/- 0.5, 24.4 +/- 0.2 at three and six months after procedure, respectively. The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months.Conclusion: The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis

Transforaminal epidural steroid injection for recurrent lumbar disc herniation

Aim: Transforaminal epidural steroid injection reduces the low back-leg pain which caused by lumbar disc herniation (LDH). The aim of our study is to evaluate the treatment of transforaminal epidural steroid injection for recurrent LDH. Materials and Methods: 19 patients were included in our study who were treated by transforaminal epidural steroid injection for recurrent LDH in our clinic between 2014 and 2018. We evaluated the patients pre-procedure and at 2 weeks, 3 and 6 months after treatment by Visual Analogue Scale / Oswestry Disability Index (ODI) and followed up for surgical treatment after 6 months. Results: The mean low back and leg pain VAS was 4.2±0.6 before TFESI procedure and it was 1.9±0.3 after two weeks. İt was 2.1±0.3, 3.6±0.8 at 3 and 6 months after procedure respectively. The reduction of low back and leg pain mean VAS is statistically significant between before treatment and at 2 weeks and at 3 months after TFESI procedure respectively (p<0.05). The mean ODI was 21.4±0.3 before TFESI procedure and it was 12.4±0.7 after two weeks. İt was 15.3±0.5 and 18.2±0.1 at 3 and 6 months after procedure respectively. The four of all patients were treated by microdiscectomy for recurrent LDH. Conclusion: The transforaminal epidural steroid injection is safely treatment for non-surgical treatment of recurrent LDH. Our study recommends that transforaminal epidural steroid injection should be considered before surgical intervention and this procedure may support to surgical indication of recurrent LDH

Surgical treatment and outcomes of intramedullary tumors by minimally invasive approach

Intramedullary tumors are uncommon neoplasms which, without treatment, can cause neurologic morbidity or mortality. The goal of the treatment is complete surgical resection with a minimally invasive approach while preserving neurological status and also spinal stability. Out of 1972 patients with tumors of the spinal canal treated between 1994 and 2017, 168 intramedullary tumors of 417 intradural tumors have been presented. All patients had undergone one surgical resection. The mean age is 43 ± 12 years (range 11–67 years). Tumors were subdivided into 4 groups: cervically located-tumors (n = 43), cervicothoracic-region-tumors (n = 32), thoracic-region-tumors (n = 57), and lumbosacral-region-tumors (n = 36). The mean follow-up time was 37 ± 29 months. Gross-total resection rate was higher in cervical located intramedullary tumors compared to the thoracic intramedullary tumors. Cervical intramedullary tumors showed better postoperative functional outcome than the thoracic intramedullary lesions. In intramedullary tumors, extending more than 3 spinal segments, postoperative worsening was significantly increased. A minimally invasive approach (the bilateral decompression via unilateral hemilaminectomy) was used to remove the tumor while preserving spinal stability. Perioperative permanent morbidity was very low. Intramedullary tumors should be surgically treated as soon as neurological symptoms appear. Patients with thoracic intramedullary tumors and tumor extension of more than three segments were at a higher risk for permanent morbidity. The minimally invasive approach allowed complete removal of the intramedullary tumors, and adequate preservation of vertebral stability while providing a good postoperative course