Ali Sehirlioglu

A new classification and guide for surgical treatment of spinal tuberculosis

So far, there is no widely accepted classification system based on objective findings that can serve as a guide in selecting the treatment method for spinal tuberculosis. This retrospective study evaluates patients with spinal tuberculosis (Pott’s disease) treated with different surgical procedures. Our aim was to outline a new classification of spinal tuberculosis. A retrospective review of 76 cases (55 male and 25 female patients) of spinal tuberculosis was conducted. Five of the patients were treated medically, and the others who were treated surgically were classified into three types (I, II and III) according to the new classification system for spinal tuberculosis. All 76 patients were classifiable by this new system. The most common complication observed was local kyphosis (maximum 8 degrees) in type-II patients, but none of the patients needed correction. No neurological deterioration was observed in any of the cases. This new classification system helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis. We believe that this new classification system can be used as a practical guide in the treatment of Pott’s disease.RésuméIl n’y a pas de système permettant de classer de façon objective les méthodes de traitement de la tuberculose osseuse. Cette étude rétrospective évalue les patients présentant une maladie de Pott, traités avec différentes techniques dans le but avoué de mettre en évidence une nouvelle classification de cette pathologie. Une étude rétrospective de 76 cas (55 hommes et 25 femmes) de tuberculose osseuse a été réalisée. Cinq patients ont été traités médicalement, les autres chirurgicalement en les classant en trois types A, B et C, selon la nouvelle classification. Les 76 patients ont été classés avec ce nouveau système. La complication la plus habituelle observée a été la cyphose locale (max. 8°) dans les types II. Mais il n’a pas été nécessaire chez ces patients de réaliser une correction chirurgicale. Nous n’avons observé aucune détérioration sur le plan neurologique. Cette nouvelle classification permet de différencier les différentes manifestations de la tuberculose osseuse et permet de faire une corrélation avec le traitement chirurgical. Nous espérons qu’elle pourra être utilisée et réaliser ainsi un guide pratique du traitement du mal de Pott.

Evaluation and Comparison of the Effects of Hyperbaric Oxygen and Ozonized Oxygen as Adjuvant Treatments in an Experimental Osteomyelitis Model

BACKGROUND We evaluated and compared the efficacy of ozone (O(3)) and hyperbaric oxygen (HBO) therapies in an experimental rat model of osteomyelitis. MATERIALS AND METHODS Forty-eight male Sprague-Dawley rats were divided into sham, osteomyelitis (control), vancomycin (V), vancomycin + HBO (VHB), vancomycin + O(3) (VO), and vancomycin + HBO + O(3) (VOHB) groups. Osteomyelitis was induced by a bone injection of 10(8) CFU/mL methicillin-resistant Staphylococcus aureus. HBO was administered daily at 2.8-atm pressure for 90 min; O(3) therapy was provided as intraperitoneal injections of 0.7 mg/kg O(3)/O(2) gas mixture once daily. Treatments were continued from d 7 to 21 after induction of osteomyelitis. Bone tissues and blood samples were harvested for biochemical, histopathologic, and microbiologic analyses. RESULTS Rats in the sham, VO, and VOHB groups gained weight but those in the control, V, and VHB groups did not. Levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase were lower in the VHB, VO, and VOHB groups than in V and control groups. Levels of interleukin-10 and -1β and tumor necrosis factor-α were decreased in the VHB, VO, and VOHB groups; transforming growth factor-β was increased in these groups compared with V and control groups (P ≤ 0.001). Bacteria counts in VOHB were significantly lower than those in group of V (P = 0.012). Histopathologic scores in group VO were significantly lower than those in group V (P = 0.046). CONCLUSIONS O(3) was as effective as HBO in decreasing oxidative parameters and inflammatory cytokines. Rats in the VO and VOHB groups gained more weight than did the other groups. Bacteria counts were significantly decreased in group VOHB compared with the other groups. Histopathologic scores in group VO were significantly decreased compared with the other groups.

Primary paraspinal hydatid cyst treated with puncture, aspiration, injection and re-aspiration (PAIR) technique: a case report

Hydatid disease is a parasitic tapeworm infection that usually involves liver and lungs. Primary skeletal muscle hydatid cyst without liver and lung involvement is rare. En bloc resection without inducing rupture and spreading the daughter cyst is recommended treatment strategy and accepted to be curative for intramuscular hydatid cyst. We report a case of primary hydatid cyst of the erector spinae muscle which was treated successfully with ultrasonography guided puncture, aspiration, injection of 95% ethanol and re-aspiration (PAIR) technique.

Benign fibrous histiocytoma of the lumbar vertebrae

Benign fibrous histiocytoma is an extremely rare spinal tumor with ten reported cases in the literature. Benign fibrous histiocytoma constitutes a diagnostic challenge because it shares common clinical symptoms, radiological characteristics, and histological features with other benign lesions involving the spine. We present a case of benign fibrous histiocytoma of the lumbar spine and discuss its differential diagnosis and management.

An unusual cause of foot pain in a child: osteochondrosis of the intermediate cuneiform.

UNLABELLED Osteochondrosis of the intermediate cuneiform is a rare entity that may cause foot pain and limping in children. We report a case of osteochondrosis of the intermediate cuneiform in a child who underwent a spontaneous recovery after conservative treatment. LEVEL OF CLINICAL EVIDENCE 4.

Removal of a bent inflatable femoral nail: a case report

Intramedullary nailing is the gold standard for the treatment of diaphyseal femoral fractures. Bending of the nail secondary to trauma is a rare complication encountered in unhealed and comminuted fractures. A 23-year-old man was admitted with refracture of the right femoral shaft and a 32-degree bending of an inflatable intramedullary nail due to a fall, two months after the initial surgical treatment. The nail was first straightened by exerting an external force, which decreased the angulation to 10 degrees. Then, the fracture site was opened, the lateral wall of the nail was drilled, and one of the four metal bars of the nail was cut. This allowed complete straightening of the nail by the same maneuver and its removal. A new inflatable intramedullary nail was placed and union was achieved after four months. Tools that may be necessary to cut the nail partially or totally should be made available for removal of bent nails.

Burst fracture of the lumbar vertebra due to a landmine injury: a case report

IntroductionThe reason we report this case is that spine injuries may well occur due to landmines similar to other injuries like traumatic limb amputations and more over they may be overlooked.Case presentationThe patient was 29-years-old Turkish male and was a member of the military. He detonated the landmine that caused his injuries while in a conflict zone. He had a right below knee and left above knee traumatic amputations. He had also mild intermittent pain in his lower back. There were no focal neurological findings such as weakness, altered sensibility, or alteration in the function of the bowel or bladder. Radiographs of the lumbar spine revealed an L2 burst fracture. Computed tomography scans and magnetic resonance imaging of the lumbar spine demonstrated a burst fracture of the L2 vertebrae and moderate compression in the anterior portion of the thecal sac due to the fracture fragment. Because of the stabile nature of the L2 burst fracture and lack of neurological disturbance, operative decompression, instrumentation and fusion was not performed. After healing of the stumps, the patient was mobilized with immediate prostheses and a thoracolumbosacral brace.ConclusionSpine injuries should not be overlooked when evaluating patients after landmine explosions. After the patient has been stabilized, the secondary screening and radiographic evaluations should also comprise the thoracic, thoracolumbar and lumbar spine when treating patients after landmine injuries.

Difference between spinecor brace and rigid brace during treatment

Methods A total of 76 consecutive adolescent idiopathic scoliosis patients who were treated with brace were included in this study. 45 patients were treated with SpineCor brace, 31 patients were treated with rigid braces. After detailing braces and their costs, choice was made by patients’ family. Patient’s height, T1-Coccyx distance, gibbosity, and Cobb angles were documented at the beginning of the treatment and last control. At last visit SRS-22 questionnaire applied to the patients to evaluate clinical effect of braces.

Brace Treatment in Adolescent Idiopathic Scoliosis

Introduction Adolescent idiopathic scoliosis (AIS), the most common pediatric spine problem, is a structural lateral and rotatory curvature of the spine arising in otherwise normal children during puberty [1,2]. It occurs before skeletal maturity. Although there is still no cause for AIS, the natural history of AIS has been established in the literature very well [1-16]. Lonstein and Carlson [2] found that in skeletally immature patients with curves of 20 to 29 degrees, there is a 68% risk of curve progression. They also found that these patients with a curve of <20° are three times more likely to show curve progression than others. Nachemson and Peterson [17], in a prospective study of 286 girls with curves of 25° to 35°, found the incidence of progression to be 66%. Bunnell [1] reported progression of at least 5 degrees in 68% of patients, 10 degrees in 34% of patients, and 20 degrees in 18% of patients in his series. Rogala et al, [18] also reported significant curve progression in their patients. Long-term follow-ups indicate that patients with scoliosis may have a higher prevalence of back pain, and of significant deformity if the curve becomes extremely large [9,10,16]. Severe thoracic curvatures slightly increase risk for pulmonary dysfunction and corpulmonale [9,10,15]. Large curvatures and large degrees of rotation can cause significant cosmetic deformity and psychologic distress to the patients. The aim of nonoperative treatment is mainly an attempt to prevent progression of the curve. Bracing and surgery have been used for large and or

Effect of Spinecor brace on pulmonary functions

Methods A total of 76 consecutive adolescent idiopathic scoliosis patients who were treated with brace included in this study. 20 of 45 patients who were treated with SpineCor brace, and 13 of 31 patients who were treated with rigid brace, were able to finish pulmonary function test (PFT). PFT is administered to 33 patients before and immediately after wearing the brace. TLC, RV, RV/TLC, FVC, FEV1, FEV1/FVC, FEF25-75 parameters of PFT are compared between SpineCor and rigid brace patients.