M. Nuri Arda

Morphometric analysis of human occipital condyle

OBJECTIVE The human occipital condyle is the unique bony structure connecting the cranium and the vertebral column. The progress in neuroimaging techniques has increased interest for aggressive craniovertebral surgery. Such surgery requires the knowledge regarding anatomical aspects of the craniovertebral junction. The aim of the present study is to analyze the occipital condyle morphometrically. MATERIAL AND METHODS 404 occipital condyles of 202 dry skulls were used for this study. Twenty-seven parameters were measured, including length, width and height of occipital condyle, the distances between the occipital condyle and hypoglossal canal, as well as some important condyle-related angles. RESULTS The length, width and the height of the occipital condyle were found to be 23.4, 10.6, and 9.2 mm, respectively. The anterior and posterior intercondylar distances are 21.0 and 41.6 mm, respectively. Sagittal intercondylar angle was 59.3 degrees. The intracranial orifice of the hypoglossal canal was found in the junction of the second and third quarter on the condyle in more than 55% of specimens. The shape of occipital condyles was classified into eight types as follows--type 1: oval-like condyle; type 2: kidney-like condyle; type 3: S-like condyle; type 4: eight-like condyle; type 5: triangle condyle; type 6: ring-like condyle; type 7: two-portioned condyle and type 8: deformed condyle. The most common type was type 1 (50%), whereas the most unusual type was type 7 (0.8%). CONCLUSION It is concluded that the occipital condyle may present various shapes, length, width, and orientation, requiring a careful radiological analysis before craniovertebral junction surgery.

Relationship between circulating IGF-1 levels and traumatic brain injury-induced hippocampal damage and cognitive dysfunction in immature rats.

It is well known that traumatic brain injury (TBI) induces the cognitive dysfunction resulting from hippocampal damage. In the present study, we aimed to assess whether the circulating IGF-I levels are associated with cognition and hippocampal damage in 7-day-old rat pups subjected to contusion injury. Hippocampal damage was examined by cresyl violet staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Spatial memory performance was assessed in the Morris water maze. Serum IGF-1 levels decreased in both early and late period of TBI. Decreased levels of serum IGF-1 were correlated with hippocampal neuron loss and spatial memory deficits. Circulating IGF-1 levels may be predictive of cognitive dysfunction resulted from hippocampal damage following traumatic injury in developing brain. Therapy strategies that increase circulating IGF-1 may be highly promising for preventing the unfavorable outcomes of traumatic damage in young children.

Functional Anatomy of the Spine by Avicenna in His Eleventh Century Treatise Al-Qanun fi al-Tibb (The Canons of Medicine)

The history of spinal surgery is an important part of the spine-related sciences. The development of treatment strategies for spine-related disorders is acquired from the Western literature. In this article, an Eastern physician, Ibn Sina, who is known as Avicenna in the West, and his treatise, Al-Qanun fi al-Tibb (the Canons of Medicine), are presented. Eight chapters of this book regarding the functional neuroanatomy of the spine were reviewed and are presented to give insight into the development of the understanding of spinal anatomy and biomechanics.

Anatomical and computed tomographic analysis of C1 vertebra

Craniovertebral junction surgery requires knowledge regarding the anatomy of this region, particularly the C1 vertebra. Both C1 laminectomy and C1-2 instrumentation necessitate preoperative information about bony landmarks and the vertebral artery. This study compares the results obtained from anatomic and computed tomographic measurements of C1 bony landmarks. 31 C1 cervical vertebrae were measured; the C1 AP diameter, and C1 transverse diameter, the facet diameter, the distance between the anterior tubercle and the anterior aspect of the C1 lateral mass on a lateral view, the distance between the midline and the vertebral artery groove on the outer cortex of the posterior arch of C1 anatomically and computed tomographically. Anatomic measurements were performed by an anatomist using a Vernier caliper accurate to 0.1 mm, whereas the computed tomographic measurements were performed by a radiologist on bone window computed tomography (CT). The mean values and the differences between two measurement modalities were analysed using a paired t-test. There was no statistical difference between the results obtained by anatomical and radiological measurements for six parameters. There was, however, a statistically significant difference between two modalities regarding the distance between the midline and vertebral artery groove on the outer cortex of posterior arch of C1, while slightly different, the difference is within 1 mm and, therefore, not clinically significant. It is concluded that CT reflects most anatomical details of bony landmarks of C1.

The Relationship between Health Locus of Control and Quality of Life in Patients with Chronic Low Back Pain

AIM To investigate the relationship between health locus of control and quality of life in patients with chronic low back pain. MATERIAL AND METHODS Pain intensity by visual analog scale, quality of life related to health by the World Health Organization Quality of Life (WHOQOL) assessment and disability level by Turkish version of Oswestry Disability Index (ODI) were evaluated. Multidimensional Health Locus of Control (MHLC) for the perception to responsibility and control of the individual over his/her own health was used. RESULTS Patients were separated into two groups according to the scores of ODI as group with Low Disability [0-40 minimal/moderate disability; n=53] and group with High Disability [40-100 severe disability /crippled/bedbound/ exaggerating; n=60]. Scores of chance health locus of control (CHLC) in the subscale of MHLC were significantly higher in the patients who had high disability (p < 0.05). Negative correlation between CHLC scores and all domains of WHOQOL, positive correlation between CHLC scores and disability level and pain severity was found (p < 0.05). CONCLUSION Quality of life was negatively influenced in the patients with low back pain who had chance health locus of control. LOC is an important parameter in evaluation and treatment of patients with LBP.

Bilateral carpal tunnel syndrome in a young carpet weaver

Summary The authors present a case of a median nerve entrapment in a girl who was in the training of carpet weaving.

Morphologic and radiologic anatomy of the occipital bone

Several diseases may cause craniovertebral instability warranting occiput-cervical fusion. As occipital screw and rod constructs are becoming more popular, requiring that screws be placed either medially or laterally in the occipital bone, the need for clearer anatomical and computed tomography (CT)-confirmed data regarding the relative thickness of the occiput in its various localities has become more critical. In 18 cadaveric specimens, the occipital bone was divided into 35 measurable segments. Transversely, the occipital bone was divided into five lines starting at the level of the inion; horizontal lines then proceeded inferiorly in 1-cm segments, 1, 2, 3, and 4 cm below the level of inion. In a comparable fashion, the occipital bone was divided vertically, starting at the midline, and proceeding laterally also in 1-, 2-, and 3-cm segments. Anatomical measurements of thickness were directly performed using a Vernier caliper. Results were directly correlated with axial CT measurements of bony thickness. Anatomical and CT measurements closely correlated within the same specimen, but there was significant interspecimen variability. The marked differences in the occipital bone anatomy noted between specimens indicates that patients undergoing occipital screw placement for cranial-cervical instability would benefit from preoperative occipital CT evaluations.

Course and prognosis of spinal epidural abscess. Report of five cases

Five patients suffering from spinal epidural abscess associated with neurologic deficit are reported. Four patients underwent a decompressive procedure for abscess drainage, and one patient was medically treated. One of the patients showed a neurologic deterioration at the early postoperative period. The long-term follow-up showed a good outcome in all patients. It is concluded that epidural abscess associated with progressive neurologic deficit requires immediate decompression and administration of antibiotic. Postoperative neurological deterioration may be seen despite proper and immediate decompression and in such a case neurologic improvement is observed in the late postoperative period.

The Impact of Disability Level on Intention to Perform Home Exercises in Patients with Spinal Pain

Objectives: The aim of our study is to determine whether or not disability level affects the practice and perception of home exercises. Methods: Seventy-five patients diagnosed with cervical and lumbar disc herniation were included in this study. Some had undergone an operation, others had not. The patients were divided into three groups according to the lumbar and cervical Oswestry Disability Index [ODI] scores. Group 1 comprised those with minimal disability, Group 2 with moderate disability, and Group 3 had patients with severe disability. The patients were questioned on their performance of home exercises with a questionnaire developed from the Triandis model consisting of items about perceived consequences, affects, and social factors. Results: When the various sections of the home-based questionnaire were examined according to the groups, no difference was found in the General Intention scores among the three groups [p <.05]. However, the Perceived Consequences scores were found to be significantly lower in Group 2 compared to other groups. In Group 3, the Social Factors scores were in the worst condition when compared to other groups [p <.05]. The affect scores in Group 3 was significantly higher compared to Group 1 [p <.05]. Conclusions: Improving the perception of home exercises assigned to spinal pain patients according to disability status requires implementing more effective methods, such as written exercise sheets and video demonstrations, especially in the patients with lower disability status.

A simple technique to open the posterior wall of the third ventricle.

Third ventriculostomy is an operating technique which is mostly used in benign adult aqueductal stenosis. The most important stage of this operation is the manipulation of the basal membrane of the third ventricle. A technique which facilitates the opening of the posterior wall of the third ventricle is presented.