EFFECTIVENESS OF UNILATERAL PEDICLE SCREW FIXATION IN TRANSFORAMINAL LUMBAR INTERBODY FUSION (TLIF)

Uvod: Cilj je rada utvrditi uspješnost operacijskog zahvata transforaminalne discektomije i ugradnje CAGE-a (TLIF), te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze, uspoređivanjem kliničke slike prije učinjenog operacijskog zahvata i nakon njega. Uspješnost je definirana smanjenje intenziteta boli u križima i nogama pomoću VAS skale prije i poslije operacijskog zahvata, te postojanjem urastanja na radiološkim snimkama. Istraživanje je ustrojeno kao retrospektivno-prospektivna studija. Uključeno je 32 pacijenta, od toga 20 žena i 12 muškaraca. Metode: Za potrebe istraživanja koristili su se podatci iz povijesti bolesti pacijenata prikupljeni iz medicinske dokumentacije Zavoda za ortopediju KBC-a Osijek. Ti podatci koristili su se za procjenu uspješnosti liječenja diskogene boli kirurškom metodom transforaminalne discektomije i ugradnje CAGE-a (TLIF), te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze. Analizirani su podatci: spol, dob, uzrok diskogene boli, nivo fiksacije, procjena boli VAS skalom u križima i nogama prije i poslije operacije, učinjenost fuzije, prisutnost pareze peronealnog živca. Rezultati: Medijan dobi ispitanika u vrijeme operacijskog zahvata bio je 58 godina. Najčešći uzrok bolesti je diskogena bol kod 17/32 ispitanika. Najčešći nivo fiksacije je L4-L5 kod 16/32 ispitanika. Fuzija je učinjena kod 27/32 ispitanika. Pareza peronealnog živca je prisutna kod 3/32 ispitanika. Razlike u bolovima u križima i nogama prije i poslije operacije statistički su značajne i svjedoče o uspješnosti operativnog zahvata. Zaključak: Liječenjem diskogene boli metodom transforaminalne discektomije i ugradnje CAGE-a (TLIF), te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze postiže se značajno smanjenje boli.Introduction: The aim of this study was to evaluate the success rate of transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation and contralateral posteromedial fusion by comparing clinical features before and after the surgical procedure. Success rate was defined by a reduction in pain intensity in the lumbar region and legs using the VAS scale before and after the procedure. Fusion was evidenced on standard X-ray of lumbar spine. The study was set up as a retrospective-prospective study. It included 32 patients, 20 of whom were women, and 12 men. Methods: Data from medical history obtained from medical records of the Department of Orthopaedic Surgery, University Hospital Center Osijek, was used for research purposes. The collected data was used to evaluate the success of surgical method of TLIF with unilateral pedicle screw fixation and contralateral posteromedial fusion. The analyzed data included gender, age, etiology of the disease, spine level for fixation, pain evaluation in the lumbar region and legs using VAS scale before and after surgery, fusion and paresis of the peroneal nerve. Results: The median age of patients at the time of surgery was 58 years. The most common etiology of the disease is discogenic pain in 17/32 participants. The most common spine level for fixation is L4-L5 in 16/32 participants. Fusion was accomplished in 27/32 participants. 3/32 participants had experienced paresis of the peroneal nerve. The difference in pain intensity in the lumbar region and legs before and after the procedure was statistically singnificant and it supports the efficiency of the procedure. Conclusion: A significant reduction of pain was achieved in the treatment of discogenic pain with TLIF with unilateral pedicle screw fixation and contralateral posteromedial fusion

Effectiveness of unilateral pedicle screw fixation in transforaminal lumbar interbody fusion (TLIF)

Cilj istraživanja: Cilj je rada utvrditi uspješnost operacijskog zahvata transforaminalne discektomije i ugradnje CAGE-a (TLIF) te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze uspoređivanjem kliničke slike prije učinjenog operacijskog zahvata i nakon njega. Uspješnost je definirana smanjenjem intenziteta boli u križima i nogama pomoću VAS skale prije i poslije operacijskog zahvata te postojanjem urastanja na radiološkim snimkama. Nacrt studije: Istraživanje je ustrojeno kao retrospektivno-prospektivna studija. Uključeno je 32 pacijenta, od toga 20 žena i 12 muškaraca. Materijali i metode: Za potrebe istraživanja koristili su se podatci iz povijesti bolesti pacijenata prikupljeni iz medicinske dokumentacije Zavoda za ortopediju KBC-a Osijek. Ti podatci koristili su se za procjenu uspješnosti liječenja diskogene boli kirurškom metodom transforaminalne discektomije i ugradnje CAGE-a (TLIF) te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze. Analizirani su podatci: spol, dob, uzrok diskogene boli, razina fiksacije, procjena boli VAS skalom u križima i nogama prije i poslije operacije, učinjenost fuzije, prisutnost pareze peronealnog živca. Rezultati: Medijan dobi ispitanika u vrijeme operacijskog zahvata bio je 58 godina. Najčešći je uzrok bolesti diskogena bol kod 17/32 ispitanika. Najčešća razina fiksacije je L4 – L5 kod 16/32 ispitanika. Fuzija je učinjena kod 27/32 ispitanika. Pareza peronealnog živca prisutna je kod 3/32 ispitanika. Razlike u bolovima u križima i nogama prije i poslije operacije statistički su značajne i svjedoče o uspješnosti operativnog zahvata. Zaključak: Liječenjem diskogene boli metodom transforaminalne discektomije i ugradnje CAGE-a (TLIF) te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze postiže se značajno smanjenje boli.Objectives: The aim of this study was to evaluate the success rate of transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation and contralateral posteromedial fusion by comparing clinical status before and after the surgical procedure. Success rate was defined by a reduction in pain intensity in the lumbar region and legs using the VAS scale before and after the procedure. Fusion was visible in standard X-ray of lumbar spine. Study outline: The study was set up as+ a retrospective-prospective study. It included 32 patients, 20 of whom were women, and 12 men. Participants and methods: Data from medical history obtained from medical records of the Department of Orthopedic Surgery, University Hospital Center Osijek, was used for research purposes. The collected data was used to evaluate the success of surgical method of TLIF with unilateral pedicle screw fixation and contralateral posteromedial fusion. The analyzed data included gender, age, etiology of the disease, spine level for fixation, pain evaluation in the lumbar region and legs using VAS scale before and after the surgery, fusion and paresis of the peroneal nerve. Results: The median age of patients at the time of surgery was 58. The most common etiology of the disease is discogenic pain in 17/32 participants. The most common spine level for fixation is L4 – L5 in 16/32 participants. Fusion was accomplished in 27/32 participants. 3/32 participants had experienced paresis of the peroneal nerve. The difference in pain intensity in the lumbar region and legs before and after the procedure was statistically significant and it confirms the efficiency of the procedure. Conclusion: Significant reduction of pain was achieved in the treatment of discogenic pain with TLIF with unilateral pedicle screw fixation and contralateral posteromedial fusion

Tortikolis kao primarna prezentacija retrofaringealnog apscesa u djece

Uvod: Retrofaringealni apsces je vrlo rijedak oblik duboke infekcije vrata koji se nerijetko primarno prezentira kao tortikolis. Svrha ovoga prikaza slučaja je da se naglasi važnost uzimanja u obzir retrofaringealnoga apscesa u djece kao diferencijalne dijagnoze prilikom nastanka spontanog tortikolisa, te naglašavanje spoznaje da odgađanje operativnog zahvata u takvim slučajevima može dovesti do fatalnih komplikacija. Prikaz slučaja: Petogodišnje dijete se javlja u hitnu traumatološku ambulantu zbog otežanog gutanja krute hrane, oticanja vrata, tortikolisa i anamneze pada na glavu prije nekoliko dana. Učini se RTG snimka vratne kralježnice, gdje se verificira obilni retrofaringealni apsces. Dijete je upućeno od strane traumatologa u hitnu otorinolaringološku ambulantu, gdje se verificiraju visoki upalni laboratorijski parametri. Prema heteroanamnestičkim podacima dan prije hitnog pregleda nije imalo prisutnu oteklinu vrata i nije naginjalo glavu u stranu. U kliničkom statusu je bila prisutna manja oteklina lateralne desne strane orofarinksa, uz spontanu sekreciju gnojnoga sadržaja, a na desnoj strani vrata se palpiralo difuzno, tvrdo i elastično zadebljanje, bez jasno formirane otekline, uredne nadležeće kože. Učinio se CT vrata i toraksa na kojem se opisalo retrofaringealno od razine C2-C6 s protezanjem u područje paravertebralne muskulature desno, a kaudalno završavajući u razini štitnjače, heterodenzna opsežna zona dijelom cistična (nekrotična) koja odgovara retrofaringealnome apscesu. Ordinira se parenteralna antibiotska terapija (Ceftriakson 2x1 g iv. te Klindamicin 3x300 mg iv.). Indicira se hitan operacijski zahvat, te se učini incizija i drenaža parafaringealnog i retrofaringealnog apscesa vrata desno, te eksploracija vrata. Nakon operativnog zahvata dijete se smjesti u pedijatrijsku intenzivnu jedinicu, gdje se višednevno postoperativno prati poboljšanje kliničkoga statusa, te normaliziranje upalnih laboratorijskih parametara. Dijete se sedmi postoperativni dan, urednoga općega i lokalnoga stanja, otpusti na kućno liječenje. Zaključak: Možemo zaključiti da kod djece nakon traume s prisutnom oteklinom vrata i tortikolisom treba razmotriti mogućnost postojanja duboke infekcije vrata (retrofaringealnoga apscesa)

Contralateral neck lymph node metastasis as a primary presentation of papillary thyroid microcarcinoma

Background: Papillary thyroid cancer usually follows a certain order of metastases to the lymph nodes of the neck. We present a case report of a patient with the primary presentation of the cancer in the form of a metastasis in the lateral neck compartment. Case report: A 22-year-old woman was referred for a painful nodule in region IV on the right side of the neck. Ultrasound showed a hypoechoic nodule measuring 0.5×0.4×0.6 cm in the left thyroid lobe and a hypoanechoic nodule measuring 2.5×2.0×3.1 cm in region IV on the right side of the neck. The FNAC finding of a nodule in region IV indicated the metastasis of papillary thyroid cancer, while the finding of the nodule in the left thyroid lobe did not indicate the presence of tumor cells. The multidisciplinary team decided to perform a total thyroidectomy with a selective neck dissection IIVI on the right side. The pathohistological analysis ultimately confirmed a papillary microcarcinoma (0.3 cm) in the left thyroid lobe, and a metastasis in the lymph node in region IV on the opposite side. Conclusion: Papillary cancer normally follows a certain sequence of metastases, and the central neck compartment is most often affected. In very rare cases, metastases can be seen in the lateral neck department without metastases in the central neck department (the so-called skipped metastases). From the presented case of the patient, a good preoperative evaluation and a discussion of the optimal surgical strategy by a multidisciplinary team is of utmost importance

Tortikolis kao primarna prezentacija retrofaringealnog apscesa u djece

Uvod: Retrofaringealni apsces je vrlo rijedak oblik duboke infekcije vrata koji se nerijetko primarno prezentira kao tortikolis. Svrha ovoga prikaza slučaja je da se naglasi važnost uzimanja u obzir retrofaringealnoga apscesa u djece kao diferencijalne dijagnoze prilikom nastanka spontanog tortikolisa, te naglašavanje spoznaje da odgađanje operativnog zahvata u takvim slučajevima može dovesti do fatalnih komplikacija. Prikaz slučaja: Petogodišnje dijete se javlja u hitnu traumatološku ambulantu zbog otežanog gutanja krute hrane, oticanja vrata, tortikolisa i anamneze pada na glavu prije nekoliko dana. Učini se RTG snimka vratne kralježnice, gdje se verificira obilni retrofaringealni apsces. Dijete je upućeno od strane traumatologa u hitnu otorinolaringološku ambulantu, gdje se verificiraju visoki upalni laboratorijski parametri. Prema heteroanamnestičkim podacima dan prije hitnog pregleda nije imalo prisutnu oteklinu vrata i nije naginjalo glavu u stranu. U kliničkom statusu je bila prisutna manja oteklina lateralne desne strane orofarinksa, uz spontanu sekreciju gnojnoga sadržaja, a na desnoj strani vrata se palpiralo difuzno, tvrdo i elastično zadebljanje, bez jasno formirane otekline, uredne nadležeće kože. Učinio se CT vrata i toraksa na kojem se opisalo retrofaringealno od razine C2-C6 s protezanjem u područje paravertebralne muskulature desno, a kaudalno završavajući u razini štitnjače, heterodenzna opsežna zona dijelom cistična (nekrotična) koja odgovara retrofaringealnome apscesu. Ordinira se parenteralna antibiotska terapija (Ceftriakson 2x1 g iv. te Klindamicin 3x300 mg iv.). Indicira se hitan operacijski zahvat, te se učini incizija i drenaža parafaringealnog i retrofaringealnog apscesa vrata desno, te eksploracija vrata. Nakon operativnog zahvata dijete se smjesti u pedijatrijsku intenzivnu jedinicu, gdje se višednevno postoperativno prati poboljšanje kliničkoga statusa, te normaliziranje upalnih laboratorijskih parametara. Dijete se sedmi postoperativni dan, urednoga općega i lokalnoga stanja, otpusti na kućno liječenje. Zaključak: Možemo zaključiti da kod djece nakon traume s prisutnom oteklinom vrata i tortikolisom treba razmotriti mogućnost postojanja duboke infekcije vrata (retrofaringealnoga apscesa)

Contralateral neck lymph node metastasis as a primary presentation of papillary thyroid microcarcinoma

Background: Papillary thyroid cancer usually follows a certain order of metastases to the lymph nodes of the neck. We present a case report of a patient with the primary presentation of the cancer in the form of a metastasis in the lateral neck compartment. Case report: A 22-year-old woman was referred for a painful nodule in region IV on the right side of the neck. Ultrasound showed a hypoechoic nodule measuring 0.5×0.4×0.6 cm in the left thyroid lobe and a hypoanechoic nodule measuring 2.5×2.0×3.1 cm in region IV on the right side of the neck. The FNAC finding of a nodule in region IV indicated the metastasis of papillary thyroid cancer, while the finding of the nodule in the left thyroid lobe did not indicate the presence of tumor cells. The multidisciplinary team decided to perform a total thyroidectomy with a selective neck dissection IIVI on the right side. The pathohistological analysis ultimately confirmed a papillary microcarcinoma (0.3 cm) in the left thyroid lobe, and a metastasis in the lymph node in region IV on the opposite side. Conclusion: Papillary cancer normally follows a certain sequence of metastases, and the central neck compartment is most often affected. In very rare cases, metastases can be seen in the lateral neck department without metastases in the central neck department (the so-called skipped metastases). From the presented case of the patient, a good preoperative evaluation and a discussion of the optimal surgical strategy by a multidisciplinary team is of utmost importance

Analysis of symptoms and clinical signs of laryngopharyngeal reflux depending on pepsia in saliva

In the last fifty years, an epidemic of reflux disease has occurred as a result of poor eating habits, stress, and activities of the food industry. Part of this disease is laryngopharyngeal reflux, a disease characterized by the return of gastric contents to the throat and surrounding organs, leading to hoarseness, coughing, difficulty in swallowing and breathing, and ultimately the development of benign and malignant changes in the larynx. This study is aimed to examine the symptoms and signs of laryngopharyngeal reflux in the study group before and after therapy and to compare the concentration of pepsin in saliva with the above. The prospective longitudinal cohort study included 50 subjects, divided into two groups. The first group consisted of 25 subjects with laryngopharyngeal reflux. The second group consisted of 25 healthy subjects without symptoms and signs of laryngopharyngeal reflux. Symptoms and signs before and after therapy were collected using RSI and RFS questionnaires. Pepsin in saliva was measured with Peptest before and after therapy. The most pronounced symptoms are hoarseness, postnasal drip, and a feeling of "a lump in the throat". The median RSI score after three months of therapy was reduced from 20 to 8. From the first group, 7 subjects had measurable levels of pepsin in saliva, and none after therapy. In the control group, no subjects were found to have pepsin in their saliva. Significant improvement was observed in clinical findings (subglottic edema, posterior commissure hypertrophy, vocal cord edema, dense endolaryngeal secretion) after three months of therapy in subjects with LPR. No association of pepsin with LPR symptoms was observed but there is a significant positive association between pepsin and the clinical finding of erythema/hyperemia. In most cases, we start therapy with medication. It is, therefore, important to emphasize that laryngopharyngeal reflux treatment must always begin with a change in diet, lifestyle, and stress regulation. Treatment must be individual and should include a multidisciplinary team with a nutritionist, psychologist, and psychiatrist