C1-C2 Posterior Segmental Fixation For Traumatic Atlantoaxial Instability

WOS: 000343369500011Cervical spinal trauma is one of the most frequent causes of disability. Upper cervical spinal trauma, caused by more than one mechanism, is a complex injury which may show various neurological statements. Atlantoaxial fractures are seen frequently after motor vehicle accidents and falls from height. Various treatment modalities defined in the upper cervical spine trauma and surgical treatment technique, so there is still unclear. Seven patients, six male and one female, were surgically treated for symptomatic atlantoaxial instability. The major cause of instability was; motor vehicle accident in six patients and falling from height in one patient. C1-C2 posterior fixation and posterolateral fusion was performed in 7 cases. The fusion and C1-C2 stability were achieved in all cases after 6 months. C1-C2 posterior fixation and fusion technique is a reliable and safe method to treat atlantoaxial instability when followed the given instruction by spinal surgeons. But, further prospective clinical studies will be needed to determine the effectiveness of this technique

Travmatik Atlantoaksiyel instabilitede C1-C2 posterior segmental fiksasyon

Cervical spinal trauma is one of the most frequent causes of disability. Upper cervical spinal trauma, caused by more than one mechanism, is a complex injury which may show various neurological statements. Atlantoaxial fractures are seen frequently after motor vehicle accidents and falls from height. Various treatment modalities defined in the upper cervical spine trauma and surgical treatment technique, so there is still unclear. Seven patients, six male and one female, were surgically treated for symptomatic atlantoaxial instability. The major cause of instability was; motor vehicle accident in six patients and falling from height in one patient. C1-C2 posterior fixation and posterolateral fusion was performed in 7 cases. The fusion and C1-C2 stability were achieved in all cases after 6 months. C1-C2 posterior fixation and fusion technique is a reliable and safe method to treat atlantoaxial instability when followed the given instruction by spinal surgeons. But, further prospective clinical studies will be needed to determine the effectiveness of this technique

Düşmeye Bağlı Yaralanmaların Adli Tıp Açısından Değerlendirilmesi

Düşmeye bağlı yaralanmalar; acil servise başvurmalarda ve yaralanmalara bağlı ölümlerde önde gelen nedenlerden biridir. Düşmeler değişik şekillerde sınıflandırılmaktadır. Çalışmamızda, yüksek seviyeden (>5metre) ve alçak seviyeden (<5metre) düşme şeklinde olan sınıflandırma kullanıldı. Düz zemindeki düşmeler çalışmamıza dahil edilmedi. Bu çalışmada Fırat Üniversitesi, Fırat Tıp Merkezine Ocak 2000-Aralık 2004 yılları arasında başvuran 779’u erkek, 439’u kadın, yaş ortalaması 22.2+22.9 (en küçük 1, en büyük 95 yaş) olan toplam 1218 düşme olgusu retrospektif olarak incelendi. Olguların, 927’si alçak, 213’ü yüksek, 78’i ise bilinmeyen bir seviyeden düşmüştür. Olgular; cinsiyet, yaş, yaş grupları, düşme seviyesi, basit tıbbi müdahale, yaşamsal tehlike, Glasgow Koma Skoru (GKS), yaralanan vücut bölgesi, mortalité oranı, aylara göre dağılımı açısından değerlendirildi. Yüksek ve alçak seviyeden düşme açısından cinsiyet ve yaş farkı tespit edilmedi (p = 0.1). Yüksek seviyeden düşmelerde yaşamsal tehlikeye maruz kalma %37.6 iken, alçak seviyeden düşmelerde ise bu oranın %20.4 olduğu saptandı (p = 0.0001). Benzer şekilde yüksek seviyeden düşmelerde GKS’nin, alçak seviyeden düşmelere göre daha düşük puanlarda olduğu belirlendi (p=0.0001). Düşmelerin pediatrik yaş grubunda (%59.2) daha yüksek, erişkin (%32.7) ve yaşlılarda (%8.1) daha düşük olduğu tespit edildi. Sonuç olarak; düşmeler mortalité ve morbidité riski taşımaları ve sağlık sistemine önemli bir yük getirmeleri açısından dikkate almmalıdn. Pediatrik yaş grubunda sıklıkla görülmesinden dolayı; anne baba eğitimi, oyun esnasında çocuğun gözetlenmesi, pencere ve balkonlarda güvenliği sağlayacak önlemlerin alınması gerekmektedir. Anahtar kelimeler: Düşme, yükseklik, yaşamsal tehlike, glasgow koma skoru

Anti-edematous, anti-inflammatory and neuroprotective effect of etanercept in acute stage in experimental head injury

WOS: 000403589400001PubMed: 28530785BACKGROUND: To study the anti-edematous, anti-inflammatory, and neuroprotective effect of etanercept in the model of experimental head injury. METHODS: In this study, 40 male-adult Spraque-Dawley rats, with weight ranging from 250g to 300g, were used. The rats are divided into groups as control; non-penetrating trauma; trauma + NS; post-traumatic normal saline; trauma + D; post-traumatic dexamethasone and trauma + E. All medicines were given into peritoneum. After applying trauma and medicine, rats were decapitated in the 24th hour and the samples were studied histopathologically. RESULTS: In the study, a statistically significant difference was observed between the groups of trauma + NS and trauma dexamethasone according to the variables of edema and inflammation, but no difference was observed according to the variables of neuronal damage, astrocytic damage, and glial apoptosis. Moreover, a significant difference was observed between groups of Trauma + NS and trauma+ etanercept and between the groups of trauma + dexamethasone and trauma + etanercept in terms of all variables. CONCLUSION: It was observed that etanercept has anti-edematous, anti-inflammatory, and neuroprotective effect on the rats which experienced traumatic brain injury

Effect of topical rifamycin application on epidural fibrosis in rats

16th World Congress of Neurosurgery of the World-Federation-of-Neurosurgical-Societies (WFNS) -- AUG 20-25, 2017 -- Istanbul, TURKEYEser Ocak, Pinar/0000-0003-0132-9927WOS: 000476701900004PubMed: 31453541Objectives: This study aims to investigate the effects of topical rifamycin SV application on epidural fibrosis formation in a rat model. Materials and methods: Between March 2015 and April 2015, a total of 20 Wistar rats were equally and randomly divided into laminectomy only group (control group) and laminectomy and rifamycin SV group (treatment group). Laminectomy was performed between L3-L5 in all rats. Surgical field was irrigated with 1 mL rifamycin SV (1 mL). After four weeks, vertebral columns of the rats were removed en bloc between the L1 and L5 levels, and epidural fibrosis and arachnoid involvement were histopathologically evaluated and graded. Results: Grade 3 epidural fibrosis formation ratio was lower in the treatment group (40%) compared to the control group (80%). However, there was no statistically significant difference between the treatment and control groups in terms of epidural fibrosis (p=0.164) and arachnoid involvement (p=0.303). Conclusion: Intraoperative rifamycin irrigation tends to reduce epidural fibrosis formation risk, although not statistically significant.World Federat Neurosurg So

Occipital condyle fractures: A case report

Oksipital kondil kırıkları nadir olup, konservatif tedavi genellikle yeterlidir. Nadiren atlantooksipital dislokasyonun eşlik ettiği olgularda cerrahi tedavi gerekebilir. Acil servise travma nedeniyle başvuran olgularda direkt grafilerde sıklıkla tanı konulamayan kondil kırıklarına, son yıllarda bilgisayarlı tomografinin sık olarak kullanılması ile artan oranda tanı konulabilmektedir. Bu çalışmada, acil servisimize travma nedeniyle kabul edilen hastanın, maksillofasiyal travması ön planda olup, boyun ağrısından şikayet etmekteydi. Servikal direkt grafileri normal olan hastanın, servikal bilgisayarlı tomografisinde tek taraflı oksipital kondil kırığı saptandıOccipital condyle fractures are rare, and conservative treatment is sufficient for many cases. Surgical treatment may be required if the condyle fracture is accompanied by atlantooccipital dislocation. Unfortunately, condyle fracture generally cannot be diagnosed with X-ray in the emergency department. Recently, computed tomography scans have been used more frequently, and enable easier diagnosis of these types of fractures. In this report, we describe a patient who admitted to our emergency department after a major trauma. She complained of neck pain, and maxillofacial trauma was more evident. Her cervical X-rays were normal, but cervical computed tomography revealed unilateral occipital condyle fracture

Revisiting ligament-sparing lumbar microdiscectomy: When to preserve ligamentum flavum and how to evaluate radiological results for epidural fibrosis

WOS: 000432959600042PubMed ID: 29530695OBJECTIVE: Preserving the ligamentum flavum (LF) during lumbar spine surgery can help to limit the extent of postoperative epidural fibrosis (EF), which is a potential cause of persistent leg pain. We present a retrospective analysis of microdiscectomy with preservation of the LF to evaluate the effects of the two LF mobilizing techniques (reflecting inferiorly or medially vs. removing completely) on EF and clinical outcomes. METHODS: Microdiscectomy was performed through a unilateral laminotomy in 93 patients (52 male, 41 female; mean age, 46 years; range, 25-65 years) with L3-L4 (n = 3), L4-L5 (n = 40), and L5-S1 (n = 50) lumbar disc herniation. Patients whose LF was removed were assigned to group 1 (n = 42), and patients whose LF was preserved by mobilizing it medially (n = 31) or inferiorly (n = 20) were assigned to groups 2 and 3, respectively. Follow-up visual analog scale (VAS) scores and magnetic resonance images were evaluated. RESULTS: EF scores, particularly for the anterior quadrants, were significantly higher in group 1 than in groups 2 (P = 0.012) and 3 (P = 0.001). Likewise, postoperative VAS scores in group 1 were also significantly higher than in groups 2 (P = 0.009) and 3 (P = 0.044). CONCLUSIONS: Our results demonstrate that 1) preserving the LF during lumbar microdiscectomy reduces the formation of postoperative EF and improves clinical outcomes; 2) EF in the anterior, rather than the posterior epidural space, is correlated with clinical results; and 3) the ligament mobilizing technique used should be individually tailored on the basis of the features of disc herniation