Ilksen Gurkan

Anterior Instrumentation for the Treatment of Spinal Tuberculosis

BACKGROUND Kyphosis and neurological impairment are the major residual problems of spinal tuberculosis after the microorganism has been eradicated with use of appropriate medications. Spinal instrumentation is needed to support anterior strut grafts in patients who have kyphosis that affects more than two levels. Most surgeons use posterior instrumentation. Anterior instrumentation, despite its advantages, has not been widely accepted, partly because of concerns about introducing foreign material into infected tissue. The purpose of the current study was to address those concerns. METHODS Twenty-two patients who had tuberculosis of the spine with moderate-to-severe localized kyphosis and sixteen patients who had more than two involved levels had stabilization with anterior instrumentation. Antituberculous medication was used postoperatively according to a standardized regimen. The patients were followed to determine if there was any recurrence of the disease and if the correction had been maintained. RESULTS The twenty-two patients who had involvement of one or two levels had an average correction of the deformity of 64 percent (range, 58 to 90 percent), and the sixteen patients who had more than two levels of involvement had an average correction of 81 percent (range, 75 to 97 percent). The correction was maintained in twenty-one patients, the maximum loss was 3 degrees in sixteen, and one patient died on the second postoperative day. There was no recurrence of the disease. CONCLUSIONS We believe that anterior instrumentation is more effective than posterior instrumentation for reducing the deformity and stabilizing the vertebral column in patients who have kyphosis related to tuberculosis of the spine.

A new approach to scoliosis

Abstract Despite the advantages that new derotation-based systems have brought to the treatment of scoliosis, the debate continues, especially regarding adolescent idiopathic scoliosis. Problems like decompensation, junctional kyphosis, and insufficient sagittal plane alignment are met with new proposals. We now are using a technique and system, the Ibn-I Sina Spinal System (IBS), that we think is able to overcome these problems. It makes use of sublaminar wires, hooks, screws, and rods for correction. The main innovation is that the major corrective force is a controlled translation force acting simultaneously on all segments of the curve. A retrospective assessment of 25 patients treated with this system showed that besides dealing well with decompensation and junctional kyphosis problems, the technique was superior in sagittal plane adjustments, mainly in that it carried the normal kyphosis to its physiologic location. IBS has proved easy and successful in scoliosis treatment, especially with lordotic rigid curves. We encountered no neurologic injury or instrument failure. In addition to these advantages, ease of preoperative planning and application, decreased operation time, easy removal or revision, and versatility and safety of the system has made the Ibn-I Sina Spinal System (IBS) a treatment of choice, especially for adolescent idiopathic scoliosis cases, in some centers in Turkey.

Unilateral radioscaphoid synostosis with bilateral hypoplastic thumbs

A fusion of the right radius and the scaphoid with ipsilateral hypoplasia of the thumb and hypoplasia of the left scaphoid and thumb is described in a 24-year-old man.

What's new in hip arthroplasty.

To The Editor: In their specialty update, “Whats New in Hip Arthroplasty” (2003;85:1852-64), Drs. Huo and Brown included the development of a minimally invasive surgical technique for total hip arthroplasty. We believe the technique of performing total hip arthroplasty through smaller incisions should more properly be called mini-incision arthroplasty. Minimally invasive surgical techniques for total hip arthroplasty involve different intermuscular surgical planes1 than do techniques involving smaller incisions, which are modifications of conventional approaches. We agree with the authors that marketing has stimulated enthusiasm for the use of such mini-incision approaches for total hip arthroplasty, but we do not agree that the literature lacks scientific data supporting the efficacy, safety, and superiority of this approach compared with previously described conventional approaches. The mini-incision arthroplasty that we described2 has been extensively analyzed with regard to the accuracy and reproducibility of implantation, regardless of patient habitus. To our knowledge, our report is the first … Corresponding author: Michael H. Huo, MD Department of Orthopaedic Surgery University of Texas Southwestern Medical School 5323 Harry Hines Boulevard Dallas, TX 75390-8883 michael.huo{at}utsouthwestern.edu