Azmi Hamzaoglu

Indomethacin for prevention of heterotopic ossification after total hip arthroplasty

Twenty-four patients (29 hips) undergoing total hip arthroplasty were routinely given 75 mg of indomethacin daily for 4 weeks after operation and reviewed radiographically for heterotopic ossification (HO) for a minimum of 6 months. A comparison group of 25 patients (27 hips) without indomethacin treatment was formed and studied in the same manner. This group of patients received the usual postoperative analgesic treatment, which is diclofenac sodium twice daily parenterally for 5-10 days. The indomethacin group also received the same treatment. In the indomethacin group no patient had grade II, III, and grade IV HO and the incidence of grade I HO was 31% (nine patients). In the comparison group one patient (3%) had grade I, three (11%) grade II, and eight (30%) grade III HO. These findings suggested that indomethacin effectively prevented higher grades of HO following total hip arthroplasty. Two patients not included in the study had gastrointestinal bleeding and recovered after withdrawal of the drug.

Surgical correction of kyphosis: posterior total wedge resection osteotomy in 32 patients.

Backgroundu2003Many surgical procedures have been developed for the treatment of kyphoscoliosis. We present our experience of one technique for posterior total wedge resection osteotomy, with clinical and radiographic results. This is a one-stage solution which results in a shortened posterior column and reduced tension on the spinal cord in rigid angular kyphosis. Patients and methodsu2003Between 1990 and 2000, we treated 32 patients with rigid local kyphosis by posterior wedge osteotomy and instrumentation. The etiology was congenital malformation in 17 cases, infection in 11 and previous laminectomy in 4 cases. The osteotomy is performed at the apex of the kyphotic deformity and covers two vertebrae. The upper and lower borders of the osteotomy are right inferior to the transverse processes of the upper and lower vertebrae respectively. The apex of the posteriorly based triangular osteotomy is either at the anterior vertebral body or anterior longitudinal ligament. Resultsu2003The mean preoperative angle of local kyphosis was 72 (25–112) degrees mainly at the thoracolumbar region, and it improved to a mean of 23 (0–48) degrees after an average follow-up of 57 (24–108) months. The mean preoperative sagittal plumbline imbalance of 5.5 (2–12) cm was improved to 1.2 (−2–3.5) cm postoperatively. The mean loss of correction since operation was 3.4 (0–11) degrees. Radiographically, solid anterior and posterior fusion was achieved in all patients by 6 months. 1 patient had irreversible paraplegia and 2 others had transient nerve root injury postoperatively. Interpretationu2003Posterior total wedge resection osteotomy eliminates the need for anterior procedure and does not cause tractional force on the spinal cord, since the posterior column is shortened. This is an effective one-stage procedure, especially for the treatment of sharp and rigid kyphosis.

Magnetic resonance imaging of tuberculous spondylitis.

The clinical and imaging findings of patients with a confirmed diagnosis of tuberculous spondylitis were retrospectively analyzed to assess the diagnostic value of magnetic resonance imaging (MRI) and determine the different patterns of spine involvement. Fifty-three patients with plain radiographs and MRI of the entire spinal column were included in the study. Sagittal T1- and T2-weighted MRIs of the entire spine and axial T1- and T2-weighted MRIs at the levels of interest were retrospectively evaluated. Plain radiographic correlation was obtained in all patients. The lower thoracic and thoracolumbar spine was the most commonly involved region. Magnetic resonance imaging is effective in the early diagnosis of tuberculous spondylitis. It also detects lesions, which may not be apparent on plain radiographs.

Anterior instrumentation for adolescent idiopathic scoliosis

Abstract Thirty-two patients with adolescent idiopathic scoliosis underwent anterior fusion with rigid single rod (third generation instrumentation) and titanium mesh cages. The mean follow-up was 31 (24–45) months and the mean age was 14.9 years. There were 8 patients with King type I, 10 with type II, 6 with type III, 4 with type IV and 4 with lumbar curves. Titanium mesh cages were used in all the lumbar procedures and at the cranial and caudal ends of the instrumented area in thoracic cases. All the patients were immobilized in an orthosis for 3–6 months postoperatively. Mean preoperative primary coronal Cobb angle of 56° was improved to 8.6°. Average correction rate was 84%. Sagittal balance was restored with a mean thoracic kyphosis of 28° and a mean lumbar lordosis of 38°. Spontaneous secondary curve decompensation did not occur and postoperative thoracolumbar junctional kyphosis was not seen. One case had to be revised due to proximal screw pull out and loss of correction.Résumé. 32 patients atteints de scoliose idiopathique de ladolescence ont subi une fusion vertébrale antérieure avec une seule tige seule rigide (instrumentation de la troisième génération) et cages en maille du titane. Le suivi moyen était de 31 (24–45) mois, lâge moyen de 14.9 années. Il y avait 8 patients de type King I, 10 de type II, 6 de type III, 4 de type IV et 4 avec courbure lombaire. Les cages en titane ont été utilisées dans toute les procédures lombaires et aux extrémités crânienne et caudale de la région instrumentée dans les localisations thoraciques. Tous les patients ont été immobilisées dans un corset pour 3 à 6 mois postopératoires. Langle coronal primaire de Cobb étaient de 56° avant lopération et a été amélioré de 8.6°. Le taux moyen de correction était 84%. La balance sagittale a été restaurée avec une cyphose thoracique moyenne de 28° et un lordose lombaire moyenne de 38°. Il ny a pas eu de décompensation de la courbure secondaire ni de cyphose postopératoire à la jonction thoraco-lombaire. Une reprise a été nécessaire à cause de larrachement dune vis proximale avec perte de la correction.

Vertebral osteomyelitis after cardiac surgery

BACKGROUNDnMediastinitis after open-heart surgery is a serious complication that has a decreasing incidence but still a significantly high mortality rate. Back pain may develop during the course of treatment for mediastinitis, and this should suggest vertebral osteomyelitis in the differential diagnosis. Diagnosis of vertebral osteomyelitis may be difficult because of the insidious onset and delayed diagnosis, and treatment may result in serious neurologic compromise and even death of the patient.nnnMETHODSnThis retrospective study involves 5 patients who had open-heart surgery and mediastinitis that was further complicated by vertebral osteomyelitis. Average delay in diagnosis was 18 days after the onset of symptoms. Magnetic resonance imaging was the most helpful tool for diagnosis. Methicilline-resistant Staphylococcus aureus was identified as the responsible microorganism in all patients. Neurologic compromise occured (one paraplegia and one paraparesia) in 2 patients during medical treatment.nnnRESULTSnAlong with the medical treatment, all patients were surgically treated due to either one or more of the following reasons: unresolving symptoms, sudden neurologic compromise, or impaired spinal column stability despite appropriate conservative treatment. One patient died 10 days postoperatively. The mean follow-up period for the remaining 4 patients was 47 (12 to 95) months. Complete recovery was achieved, and they were able to return to their routine daily activities.nnnCONCLUSIONSnVertebral osteomyelitis should be borne in mind when a patient develops back pain during the course of mediastinitis. Suspicion, early diagnosis with appropriate imaging, and proper treatment are crucial to prevent catastrophic complications.