Long-term radiological outcomes of short-segment stabilization in thoracic burst fracture

Introduction: Short-segment (SS) transpedicular instrumentation and distraction have been used as a popular method recently due to the kyphotic angulation and adequate spinal canal decompression provided by the fusion of fewer mobile vertebra segments. This study aims to demonstrate that adequate decompression of spinal canal and kyphosis angulation can be improved by SS instrumentation and distraction in thoracic vertebrae burst fracture. Methods: Patients who were admitted to our clinic for thoracic vertebra burst fractures between 2014 and 2017 and who underwent fusion with transpedicular screws were retrospectively analyzed. Results: Both the sagittal index (SI) and canal occupation rates (COR) showed statistically significant changes between the pre-operative and early post-operative periods (pSI=0.001, pCOR=0.001). Evaluation results of the patients at 2-year follow-up; mean SI was 16.2°±1.25° and the mean COR was 6.25±2.4%. There was no statistically significant difference between both SI and CORs postoperatively and after 2 years of follow-up (pSI=0.916, pCOR=0.565). Discussion and Conclusion: We believe that SS stabilization is sufficient especially in patients with COR <40%, SI <25°, American Spinal Injury Association score E, and preserved posterior elements of the vertebra

A rare case of cervical epidural extramedullary plasmacytoma presenting with monoparesis

Multiple myeloma and other plasma cell disorders are characterized by production of a large number of plasma cells in the bone marrow. On the other hand, plasmacytoma results from proliferation of abnormal plasma cells in the soft tissue or skeletal system. Neurological complications are frequently observed in these diseases. The most commonly known complications among those complications are spine fractures, spinal cord compressions, and peripheral neuropathies. Although neurological involvements are common in plasmacytomas, extramedullary spinal epidural localizations have been reported very rarely. In this case report, we aimed to present a plasmacytoma case that presented with acute onset of upper extremity monoparesis. A 40-year-old woman was admitted to our clinic with complaints of sudden weakness and numbness in her left arm following neck and left arm pain. Emergency cervical magnetic resonance imaging (MRI) revealed an epidural mass and the patient underwent emergency surgery. The patient showed improvement post-operatively and the pathology was reported as plasmacytoma. Following hematology consultation, systemic chemotherapy was initiated and radiotherapy was planned after wound healing

Thymoquinone ameliorates delayed cerebral injury and cerebral vasospasm secondary to experimental subarachnoid haemorrhage

Aim of the study. Among subarachnoid haemorrhage (SAH) patients, delayed cerebral injury (DCI) and infarction are the most important causes of death and major disability. Cerebral vasospasm (cVS) and DCI remain the major cause of death and disability. Thymoquinone (TQ) is the substance most responsible for the biological activity of nigella sativa (NS) and is useful in the treatment of ischaemic and neurodegenerative diseases, oxidative stress, inflammatory events, cardiovascular and neurological diseases. We conducted an experimental study aimed to investigate the preventive and corrective effects of TQ.Materials and methods. 24 Sprague-Dawley rats were randomly divided into three groups. The first was the control group which was a sham surgery group. The second group was the SAH group where the double haemorrage SAH protocol was used to induce vasospasm. The third group was the SAH+TQ group, where cVS was induced by the SAH protocol and the animals received oral 2 cc thymoquinone solution for seven days at a dose of 10 mg/kg, after the induction of SAH. The rats were euthanised seven days after the first procedure. The degree of cerebral vasospasm was evaluated by measuring the basilar artery luminal area and arterial wall thickness. Apoptosis was measured by the western blot method at brainstem neural tissue. Oxidative stress was measured by the Erel Method. Endothelin-1 was measured with ELISA analysis at blood. Statistical analysis was performed.Results. Endothelin-1 values were found to be statistically significantly lower in the control and SAH+TQ groups compared to the SAH group (P &lt; 0.001). Mean lumen area values were significantly higher in the control and SAH+TQ groups than in the SAH group (P &lt; 0.001). In the control and SAH+TQ groups, wall thickness values decreased significantly compared to the SAH group (P &lt; 0.001). OSI values were significantly lower in the control and SAH+TQ groups than in the SAH group (P &lt; 0.001). Apoptosis was significantly lower in the control and SAH+TQ groups than in the SAH group (P &lt; 0.001).Conclusion. Our results show that post-SAH TQ inhibits/improves DCI and cVS with positive effects on oxidative stress, apoptosis, ET-1, lumen area, and vessel wall thickness, probably due to its anti-ischaemic, antispasmodic, antioxidant, anti-inflammatory, anti-apoptotic and neuroprotective effects

Investigation of the improvement rate regarding the herniation of cerebellar tonsils following shunting procedures in patients with chiari malformation and associated hydrocephalus

Introduction and Aim: Chiari malformation is a congenital anomaly formed as the result of the herniation of posterior fossa structures through the foramen magnum toward the spinal canal. In this study, we aimed to present the improvement rate regarding the herniation in cerebellar tonsils following shunting procedures in patients with Chiari malformation and associated hydrocephalus.Method: We measured in mm the improvement rate regarding the herniation in cerebellar tonsils in postoperative cervical MRI images obtained following ventriculoperitoneal shunting procedures for hydrocephalus in adult patients with symptoms of Chiari malformation such as balance disorder, dizziness, numbness and loss of muscular strength at the hands who were diagnosed with Chiari malformation and hydrocephalus following cranial and cervical magnetic resonance imaging (MRI).Results: A total of fifteen adult patients in whom the cerebellar tonsillar herniation was over 5 mm and accompanied by hydrocephalus were included in our study. The measure of herniation in the patients involved in the study was between 1.11 cm and 8 mm. The amount of improvement in herniation following the shunting procedure was between 7.76 mm and 2.2 mm.Conclusion: In patients with Chiari malformation associated with hydrocephalus, cerebellar tonsillar herniation can regress to 5 mm, which is considered as physiological, and the symptoms related to Chiari malformation can disappear. When Chiari malformation is associated with hydrocephalus, the tonsillar herniation may improve, and symptoms may disappear following the ventriculoperitoneal shunting procedure for hydrocephalus without necessitating posterior decompression for Chiari-related herniation

The effectiveness of the amount of polymethylmethacrylate used in the treatment of lumbar osteoporotic compression fractures

Objective: We aimed to investigate the effectiveness of the amount of polymethylmethacrylate used in pain control and maintenance of long-term vertebra corpus height in patients undergoing percutaneous vertebroplasty due to osteoporotic compression fracture of the lumbar vertebra.Method: A total of 60 patients who underwent unilateral percutaneous vertebroplasty between 2014 and 2019 due to osteoporotic compression fracture of the lumbar vertebrae were included in the study. Patients who received 5 ml and 3 ml cement injection were retrospectively analyzed. Of patients, postoperative visual analogue scale (VAS) score and anterior vertebral height of the patients at 1st-year control were evaluated.Results: In the postoperative period, the mean visual analogue scale score was 2.3 +/- 0.46 in the 5 ml injected group and 2.2 +/- 0.4 in the 3 ml injected group (p5 ml=0.001, p3 ml=0.001). There was a statistically significant decline in pain control in both groups. The mean anterior vertebral height loss (AVHL) in the 5 ml injected group was 31.5 +/- 0.40%, and 32.6 +/- 0.47% in the 3 ml injected group (p5 ml=0.820, p3ml=0.870). There was no statistically significant alteration in both groups.Conclusion: Our results indicate that the 3 ml polymethylmethacrylate injection during the percutaneous vertebroplasty procedure provides adequate pain control and stabilization in patients with lumbar vertebral osteoporotic fracture. Therefore we think that small amount of polymethylmethacrylate (3 ml) is sufficient to avoid undesirable complications in this patient group

A Late Infection After Occipitocervical Instrumentation - A Case Report

Several fusion techniques involving instrumentation are implemented for the surgical treatment of certain pathological conditions of the occipitocervical junction. These surgical approaches may be associated with a number of complications including late surgical infections; the treatment of which is still disputed. In a tetraplegic patient with a history of post-traumatic os odontoideum and basilar invagination who had severe pyramidal signs; dens resection accompanied by C0-C5 fixation plus fusion with auto-grafting were performed. The patient was discharged on Day 7 after surgery with neurological improvement. Eight months after the initial procedure; he re-presented to our unit with discharge and signs of local infection at the site of surgery that were considered to be the manifestations of late instrumentation associated infection. The patient was admitted and antibiotics and hyperbaric oxygen were given for 4 weeks; with no improvement of the infection. Subsequently; surgical implants were removed. Postoperative dynamic x-ray images suggested complete fusion of C0-C3. During the follow-up period; no recurrence of infection was observed and the laboratory abnormalities returned to normal values. The treatment of occipitocervical infections after surgical instrumentation and the management of the infection risk in such cases are discussed below along with the case presentation

Lumbosacral Meningocele in Adulthood

Spinal dysraphism is the incomplete fusion of the neural arch, which can be seen as an occult or open neural tube defect. Meningoceles are a form of open neural tube defect and characterized by cystic dilatation of the meninges containing cerebrospinal fluid (CSF), without the involvement of neural tissue. These lesions are often benign and typically diagnosed at birth. Neurosurgical intervention is necessary in the newborn period, since survival in advancing ages is often impossible. Therefore, meningoceles are rarely reported among spinal dysraphic lesions in adulthood. They are tethering lesions of the spinal cord, adhering to the dura and other soft tissues with fibrous elements. In addition, the caudal lesions tend to leak CSF, unlike cervical congenital midline meningoceles. Here, we present a 41 year-old female patient with a meningocele that has developed CSF leakage. The clinical course, surgical management, and follow-up period of this rarely seen adulthood meningocele are also discussed. [Cukurova Med J 2015; 40(Suppl 1): 131-135

Effect of Antithrombotic Therapy on Development of Acute Subdural Hematoma After Burr Hole Drainage of Chronic Subdural Hematoma

AIM: To evaluate the relationship between the time from cessation of anticoagulant/antiplatelet medication to surgery and risk of postoperative acute subdural hematoma (ASDH) after burr hole drainage of chronic subdural hematoma (CSDH). MATERIAL and METHODS: A retrospective study of patients who underwent burr hole drainage of CSDH between December 2014 and December 2019 was performed. Demographic and clinical data regarding age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms, and neurological examination were collected from the medical records. Patients were divided into 3 groups based on time from referral to surgery: 72 hours. RESULTS: One hundred seventeen patients underwent burr hole drainage of CSDH during the 5-year study period. Seventy-two patients were male (61.5%) and 45 were female (38.5%). Mean age was 70.5 +/- 7.2 years. Postoperative ASDH occurred in 2 of the 32 patients (6.3%) who were not taking antithrombotic medication and 6 of the 85 patients (7.1%) who were taking antithrombotic medication. The difference was not significant (p=0.797). CONCLUSION: The risk of ASDH after burr hole drainage of CSDH was not affected by antithrombotic medication. Although the literature suggests that antiplatelet and anticoagulant drugs to be discontinued between 5 and 7 days before surgery, our results showed that acute hemorrhage was not detected in any patient who underwent surgery more than 72 hours after referral