Alpaslan Senkoylu

Reliability and concurrent validity of the adapted chinese version of scoliosis research society-22 (SRS-22) questionnaire

Study Design. Validation study to define validity and reliability of an adapted and translated questionnaire. Objective. Assessment of the concurrent validity and reliability of a Chinese version of SRS-22 outcome instrument. Summary of Background Data. No valid health-related quality of life (HRQL) outcome instrument exists for patients with spinal deformity in Chinese. The modified SRS-22 questionnaire was proven to be an appropriate outcome instrument in English, and has already been translated and validated in several other languages. Methods. The English version of the SRS-22 questionnaire was adapted to Chinese according to the International Quality of Life Assessment Project guidelines. To assess reliability, 48 subjects with adolescent idiopathic scoliosis (mean age, 16.5 years) filled the questionnaire on 2 separate occasions (Group 1). To assess concurrent validity, 50 subjects (mean age, 21 years) filled in the same questionnaire and a previously validated Chinese version of the Short Form-36 (SF36) questionnaire (Group 2). Internal consistency, reproducibility and concurrent validity were determined with Cronbachs &agr; coefficient, interclass correlation coefficient and Pearson correlation coefficient, respectively. Results. Cronbachs &agr; coefficient for the 4 major domains (function/activity, pain, self-image/appearance and mental health) were high. Intraclass correlation was also excellent for all domains. For concurrent validity, excellent correlation was found in 1 domain, good in 12 domains, moderate in 3 domains, and poor in 1 domain of the 17 relevant domains. Discussion. Both cultural adaptation and linguistic translation are essential in any attempt to use a HRQL questionnaire across cultures. The Chinese version of the SRS-22 outcome instrument has satisfactory internal consistency and excellent reproducibility. It is ready for use in clinical studies on idiopathic scoliosis in Chinese-speaking societies.

Magnetically controlled Growing Rods for Early-onset Scoliosis: A Multicenter Study of 23 Cases With Minimum 2 years Follow-up.

Study Design. Retrospective study. Objective. To report 2-year clinical and radiographic results of patients treated with magnetically controlled growing rods (MCGR). Summary of Background Data. MCGR for early-onset scoliosis has been reported to provide adequate spinal growth and curve correction by eliminating surgical lengthening procedures. This study was designed to report the results of MCGR patients with 2-year follow-up. Methods. A retrospective study of MCGR patients with the following inclusion criteria: (i) major curve size ≥30°, (ii) T1-T12 height <22 cm, (iii) <11-years old; all at the time of index surgery was performed. Of 54 patients enrolled, 23 had 2-year follow-up. Both primary and conversion patients were evaluated at baseline 6, 12, and 24 months. Results. Mean preoperative age in the primary group was 6.6 ± 2.6 years versus 8.3 ± 2.2 years for the conversion group. A total of 41 adverse events occurred in 11 patients, of which 14 events were implant related. Major coronal curve magnitude improved from 61.3° to 34.3° from baseline to postoperation in primary cases and from 49.4° to 43.8° in conversion cases. Curve correction was maintained for 2 years in both groups. T1-S1 height improved from 252.7 to 288.9 mm in primary cases and was maintained for 2 years. However, conversion cases had some decline in T1- S1 height (270.3 at baseline to 294.4 mm post-MCGR and 290.2 mm at 2-year follow-up; mean loss of 4.2 mm (1.5%) from postoperation to 2 years, P > 0.05). Conclusion. This study showed satisfactory curve correction and growth is achieved among primary cases. T1-S1 height in conversion cases had a slight decline in 2 years. However, this decline was not statistically significant. Level of Evidence: 3

Treatment of segmental bone defects in rats by the stimulation of bone marrow osteo-progenitor cells with prostaglandin E2

An alternative to bone grafting is engineered osteo-conductive material that carries osteo-progenitor cells with osteo-stimulant factors impregnated on a malleable osteo-conductive material. We used bone marrow stem cells as the source of osteo-progenitor cells and stimulated them with prostaglandin E2 using demineralised bone matrix as a carrier. We treated 35 skeletally mature male Wistar albino rats with segmentary radial bone defects using five different treatment groups. Group I received no treatment; the remaining four groups all received a mixture of bone marrow and demineralised bone matrix. In group III, a copolymer was added. In group IV, prostaglandin E2 and in group V prostaglandin E2 within a copolymer was added to the mixture. Eight weeks after the surgical procedure, the rats were sacrificed. Radiological and histological evaluation of the radial bone showed that while there was no significant healing in groups I, II and III, there was a significant healing response in groups IV and V.RésuméUne alternative à la greffe osseuse est un matériel ostéoconducteur portant des cellules précurseurs avec des facteurs ostéostimulant imprégnés dans un matériel malléable ostéoconducteur. Nous avons utilisé des cellules de la moelle osseuse comme source de cellules précurseurs et les avons stimulés avec une prostaglandine E2 qui utilise la matrice osseuse déminéralisée comme porteur. Nous avons traité 35 rats Wistar albinos viril à maturation osseuse, avec un défaut segmentaire du radius, en utilisant cinq groupes de traitements différents. Le groupe I n’a reçu aucun traitement. Les quatre autres groupes ont reçu un mélange de moelle osseuse et une matrice d’os déminéralisé. Dans le groupe III a été ajouté un copolymère. Dans le groupe IV, une prostaglandine E2 et dans le groupe V, une prostaglandine E2 et un copolymère ont été ajouté au mélange. Huit semaines après la procédure chirurgicale, les rats ont été tués. L’évaluation radiologique et histologique de l’os radial a montré qu’il n’y avait aucune guérison notable dans les groupes I, II et III, mais une réponse curative appréciable dans les groupes IV et V.

Interaction of Cultured Chondrocytes with Chitosan Scaffold

Chitosan scaffolds with sponge-like structures were prepared by a wet spinning technique. Glutaraldehyde was used to control the swellability (water uptake) of the scaffolds. It was possible to reach a swelling ratio about 56.8% in aqueous medium. These wet scaffolds were soft and easily shaped by hand. The cartilage specimen was obtained from the knee joints of a New Zealand white rabbit. Chondrocyte cells were isolated and cultured in vitro for about 10 days to reach a usable population. The cells were then incubated with the chitosan scaffolds and interactions were examined by microscopy. Chondrocyte cells showed junctional complexes consisting of plaques and filaments at the interface. Cell membranes were strongly attached on the chitosan surface.

Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis: A Multicenter Retrospective Review

Background: Traditional growing rods have a reported wound and implant complication rate as high as 58%. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis. Methods: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (<6 mo from index surgery) versus late (>6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites. Results: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8%) of 54 patients had at least 1 complication. Fifteen (27.8%) had at least 1 revision surgery. Six (11.1%) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean=14.5 mo). Six (11.1%) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0%) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7%) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods. Conclusions: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7% vs. 11.1%). MCGR does not appear to prevent common implant-related complications such as rod or foundation failure. The long-term implication remains to be determined. Level of Evidence: Level IV.

Evaluation of DNA damage after tourniquet-induced ischaemia/reperfusion injury during lower extremity surgery

Ischemia/reperfusion (I/R) injury represents a source of substantial morbidity and mortality in various statuses that is, coronary bypass, myocardial infarction, and so on. Oxygen free radicals, formed during I/R, have been proposed as one of the main causes of tissue injury and play important role in I/R injury. Leucocytes have been shown to play an important role in the development of tissue injury after I/R. Accordingly, numerous studies have shown that even short-time I/R-induced DNA damage can be investigated in human peripheral leucocytes using the alkaline single-cell gel-electrophoresis assay (comet assay). After ischaemia, the genotoxic damage detected in human peripheral leucocytes locally in the reperfused tissue results in numerical, morphologic and biochemical alterations of all circulating white blood cells in the human organism. It leads particularly to the release of substantial amounts of oxygen radicals and other reactive agents. Simultaneously, local ischaemia in the reperfused tissue is extended to the whole body systemically through these activated inflammatory cells and, possibly, results in secondary detectable tissue damage in endothelial cells of the systemic circulation inducing prolonged DNA damage even in the early reperfusion period. Thus, we aimed to investigate whether the I/R during the routinely practised operation causes DNA damage, since other published studies were on animal and in vitro models and did not exactly reflect the operation procedure in the clinic. We measured DNA damage (single-strand breaks, oxidised purines and pyrimidines) by modified alkaline comet assay using two bacterial enzymes (formamidopyrimidine glycosylase (Fpg), endonuclease III (EndoIII)), which recognise oxidised purines and pyrimidine bases, in patients who had lower extremity surgery. There was no statistically significant difference in DNA damage between time periods (before surgery, after I/R; T1, T2 and T3). According to our findings, we indicate that at the molecular level DNA is damaged due to the I/R during the routinely practised operation; however, this effect could not be determined phenotypically. Thus, we may suggest that the surgeons and anaesthetist/operation room personnel could be informed about that fact and encouraged to use antioxidants and/or apply prophylaxis. Our findings showed that I/R injury did not induce DNA damage. Further studies of this approach are needed.

Correction manoeuvres in the surgical treatment of spinal deformities

Correction manoeuvres are as important as the other issues such as hardware selection, graft options, fusion and osteotomy techniques in the surgical treatment of spinal deformities. The property of materials demonstrating both viscous and elastic characteristics when undergoing deformation is called visco-elasticity. Purely elastic materials change in shape with a stress, and go back to their initial form when the stress is removed. However, visco-elastic materials, like the spine, may protect their new formation unless a back stress is applied. Time is a very important parameter during manoeuvre application to the spine because of its visco-elastic behavior. The most common correction manoeuvres that can be used for spinal deformities are rod de-rotation, distraction-compression, in situ rod bending, segmental de-rotation, en bloc de-rotation and cantilever. Spontaneous correction of a minor curve is possible after selective fusion of a major curve due to coupling phenomenon. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170002. Originally published online at www.efortopenreviews.org

Biomechanical comparison of effects of the Dynesys and Coflex dynamic stabilization systems on range of motion and loading characteristics in the lumbar spine: a finite element study

The primary purpose of dynamic stabilization is to preserve the normal range of motion (ROM) by restricting abnormal movement in the spine. Our aim was to analyze the effects of two different dynamic stabilization systems using finite element modeling (FEM).

Core curriculum (CC) of spinal surgery: a step forward in defining our profession

OBJECTIVE The aim our study was to establish a core curriculum (CC) for spine surgery incorporating knowledge, skills and attitudes to help define spine surgery as a medical specialty and serve as a guide for specific spine surgery training. METHODS A committee was established to prepare the CC. Five modules were established; Basic Sciences, Spinal Trauma, Degenerative Spine Diseases, Destructive Spine Pathologies and Spinal Deformity. Prepared CC modules were evaluated in a consensus meeting, translated and reevaluated in a second consensus meeting before being accepted as final. RESULTS In the five modules, 54 subject headings (19 for Basic Sciences, 10 for Spinal Trauma, 4 for Degenerative Spine Diseases, 4 for Destructive Spine Pathologies and 17 for Spinal Deformity) and 165 specific subjects (59 for Basic Sciences, 32 for Spinal Trauma, 10 for Degenerative Spine Diseases, 23 for Destructive Spine Pathologies and 41 for Spinal Deformity) were defined. Learning outcomes and entry and exit criteria were defined for all subjects. CONCLUSION This CC may form the basis of spinal surgery training, defining spinal surgery as a medical specialty and help us spine surgeons to develop better defined identities.