Mert Çiftdemir

Tumors of the spine.

Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine. The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are mostly seen in older patients. Primary musculoskeletal system sarcomas involving the spinal column are rare. Benign tumors and tumor-like lesions of the musculoskeletal system are mostly seen in young patients and often cause instability and canal compromise. Optimal diagnosis and treatment of spine tumors require a multidisciplinary approach and thorough knowledge of both spine surgery and musculoskeletal tumor surgery. Either primary or metastatic tumors involving the spine are demanding problems in terms of diagnosis and treatment. Spinal instability and neurological compromise are the main and critical problems in patients with tumors of the spinal column. In the past, only a few treatment options aiming short-term control were available for treatment of primary and metastatic spine tumors. Spine surgeons adapted their approach for spine tumors according to orthopaedic oncologic principles in the last 20 years. Advances in imaging, surgical techniques and implant technology resulted in better diagnosis and surgical treatment options, especially for primary tumors. Also, modern chemotherapy drugs and regimens with new radiotherapy and radiosurgery options caused moderate to long-term local and systemic control for even primary sarcomas involving the spinal column.

Major Extremity Injuries Associated with Farmyard Accidents

Background. The aim of the study is to analyze the major agricultural injuries related to the extremities. Patients. We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. Results. Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60–360). Mean length of stay was 24 days (4–150), and mean number of operations during hospitalization was 2.4 (1–30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). Conclusions. Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.

Non-Operative Treatment in Children and Adolescents with Atlantoaxial Rotatory Subluxation

OBJECTIVE Atlantoaxial rotatory subluxation (AARS) is an uncommon lesion seen mainly in children and adolescents. A retrospective analysis of 12 patients with AARS treated non-operatively is presented in this study. MATERIAL AND METHODS Twelve patients with AARS who were treated non-operatively were evaluated retrospectively in terms of recent trauma and respiratory tract infection history, accompanying injuries, radiological findings, duration of symptoms, amount and duration of traction and clinical results of the treatment. RESULTS Traumatic AARS was present in 8 patients. No evidence of trauma was found in 4 patients. Type I subluxations in 10 and type II subluxations in 2 patients were found according to the Fielding and Hawkins classification. All patients were treated using bed-side mentooccipital tractions. The mean duration of bed-side mentooccipital traction was 3,75 days and the mean amount of load was 1.8 kg. All patients were kept in Philadelphia collars for additional 3 weeks after the clinical recovery. No limitations and pain in head movements were present in any patient at the sixth month follow-up examinations. CONCLUSION Paediatric patients with neck pain and torticollis should be investigated concerning trauma and recent respiratory tract infection history in order to avoid any delay in diagnosis of a possible AARS.

Postoperative evaluation of quality of life in lumbar spinal stenosis patients following instrumented posterior decompression

OBJECTIVES Spinal stenosis is a clinical condition in which bone and soft tissues compress the spinal canal, neuronal foramina and nerve roots. In this study, we aimed to evaluate the effectiveness of surgical treatment on patient satisfaction. Our sample included 64 patients with degenerative lumbar spinal stenosis on whom posterior decompression and instrumentation was applied. METHODS In this retrospective study, files of 64 patients who underwent posterior decompression surgery with instrumentation for degenerative lumbar spinal stenosis between March 2004 and April 2008 were examined. Patients were evaluated with Japanese Orthopaedic Association (JOA) form, form of degenerative lumbar spinal stenosis and the most recent postoperative orthopedic inspection findings for a minimum of one year after surgery. RESULTS Mean age of patients was 59.9 years and mean follow-up was 27.9 months. When evaluated using the Japanese Orthopaedic Association form, postoperative scores in 63.5% of the patients improved. Based on this postoperative improvement; Japanese Orthopaedic Association scores were found statistically significant (p<0.001). Gender (p=0.651), age (p=0.192), with the length of complaint (p=0.095), time passed after surgery (p=0.933), number of laminectomy level (p=0.997), deformity before operation (p=0.773) and systemic disease were not statistically correlated with improvement based upon Japanese Orthopaedic Association scores (p=0.052). But Japanese Orthopaedic Association scores were found to have improved (83%) in cases with no systemic diseases. CONCLUSION Our findings show that posterior decompression surgery with instrumentation is a useful treatment modality for patients with severe degenerative lumbar spinal stenosis. There is no secondary factor affecting improvement and instability after surgery is not observed in patient groups.

Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression.

Purpose: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. Methods: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records. Results: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. Conclusion: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.

Does an abnormal infrapatellar plica increase the risk of chondral damage in the knee.

PurposeThe aim of this study was to evaluate abnormal infrapatellar plicae that cause chondral lesions on the patellofemoral sulcus and superior aspect of intercondylar notch.MethodsIn this study, 133 abnormal infrapatellar plicae were evaluated. The abnormal infrapatellar plicae may lead to chondral lesions on the superior portion of intercondylar notch and on the inferior portion of the patellofemoral sulcus with striking, friction, and compression forces during knee motion.ResultsThe chondral lesions that were caused by abnormal infrapatellar plicae were more severe than the chondral lesions that were caused by normal infrapatellar plicae. The width of the plica did not affect the severity of chondral lesions.ConclusionAbnormal infrapatellar plicae might be one of the causes of chondral lesions on the superior portion of intercondylar notch and on the patellofemoral sulcus. The width of the plica did not affect the severity of chondral lesions.

A Rare Cause of Torticollis: Grisel Syndrome

Painful torticollis in children requires specific attention. Grisel syndrome is diagnosed on suspicion in patients with recent or history of ongoing upper respiratory tract infections and in patients with restriction of movement or deformity following oto-rhino-laryngologic surgery. Pediatricians should be aware of this condition because early diagnosis and intervention are critical for prognosis in Grisel syndrome.

Traumatic posterior hip dislocation and ipsilateral distal femoral fracture in a 22-month-old child: a case report.

Minor trauma may cause hip dislocation in young children because of physiologic hip joint laxity and the soft cartilaginous structure of the acetabulum. In this work, we report on a 22-month-old boy with right-sided traumatic posterior hip dislocation and ipsilateral distal femoral fracture because of an outdoor motor vehicle accident. The patient was treated with emergency closed reduction and one and a half hip spica under general anaesthesia. The femoral fracture and hip dislocation were healed smoothly without any complication. Traumatic hip dislocation is rare in children, which may occur after trivial trauma. Prognosis is better in younger patients with low-energy trauma and in cases treated early.

Long-term Changes in L5-S1 Disks Under the Fusion Region and the Effect of Sagittal Balance on Degeneration

Background:The aim of this study was to radiologically assess long-term degeneration in the L5-S1 disks under the fusion region and to research its association with clinical signs in patients with degeneration. Methods:This study evaluated 23 patients who underwent spinal fusion between January 1994 and July 2005. Degeneration in the L5-S1 disks was assessed radiologically over a long-term 10-year follow-up period, and those cases that showed degeneration were further assessed using the Japan Orthopedic Association score and visual analog scale (VAS). Results:Seven of the cases had mild osteophyte development according to radiographic findings. A statistically significant decrease was observed in the front and back disk heights between the preoperative and postoperative measurements (P=0.001 and 0.000). A statistically significant decrease was also observed in the anterior and posterior disk height between the preoperative and postoperative measurements (P=0.007 and 0.007). A significant difference was observed in disk degeneration and facet joint degeneration (P=0.000 and 0.000). On evaluation of radiologic assessments, degeneration was observed in 15 cases (65.3%). Clinical assessment of the cases revealed that 6 patients (26.0%) with radiologic degeneration had lumbar pain of varying degrees, 3 of whom also had pain that spread to the legs; 1 of these caused loss of sensation in the leg. Clinical assessment of pain levels using VAS scoring for all cases revealed an average preoperative score of 8.71, an average early postoperative VAS score of 2.14, and an average long-term follow-up score of 3.35. The recovery rate of the patients was found to be 37.5%, according to Japan Orthopedic Association scoring. The pain level of the patients decreased by almost 4-fold in the postoperative early period and 2.5-fold in the long term. Conclusions:Spinal fusion surgery is an effective treatment method in terms of its clinical results, despite the adjacent segment degeneration that may be identified radiologically in the long term.

A 10-year-old boy with limping complaint.

A 10-year old boy who had a history of diarrhea and fever approximately 4 weeks before presentation and whose complaints improved with symptomatic treatment in that period without use of antibiotics presented to our outpatient clinic with pain, swelling, erythema and limping in the left foot. On physical examination, erythema, increased temperature and tenderness on the dorsum of the left foot and a purulent bulla with a size of 3 x 3 cm on the dorsolateral part of the 5th metatarsophalengeal joint were noted (Figure 1). The patient and his family reported that pain and limping in the left foot started two days after diarrhea stopped and increased gradually for the last three weeks. Swelling, erythema and increased temperature started 5 days before presentation and reached the status at the time of presentation. At presentation, the white blood cell (WBC) count in the peripheral blood was found to be 11 200/mm3, C-reactive protein (CRP) was found to be 5,94 mg/dL and erythrocyte sedimentation rate (ESR) was found to be 40 mm/h. Foot radiographs were found to be normal. On magnetic resonance imaging, Brodie abscess starting from the distal metaphysis of the 5th metatarsal bone of the left foot and extending to the subcutaneous tissue and soft tissue edema in the periarticular area were observed (Figure 2). No growth occured in urine, stool and blood culture samples obtained at presentation.