Murat Pekmezci

Use of C-reactive protein after spinal surgery: comparison with erythrocyte sedimentation rate as predictor of early postoperative infectious complications.

Study Design. This is a prospective observational study of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in a cohort of patients undergoing spinal surgery. Objective. We sought to characterize the normal kinetics of ESR and CRP after spinal surgery and compare their usefulness as predictors of infectious complications in the early postoperative period. Summary of Background Data. ESR and CRP are nonspecific markers of inflammation used to evaluate postoperative infection. CRP is a quantitative test that exhibits predictable kinetics consisting of a postoperative rise and a peak followed by a decrease toward the normal value. Deviation from normal kinetics may be an indicator of infection. Methods. ESR and CRP were collected before surgery and daily after surgery in consecutive patients. All infectious complications were recorded. Results. One hundred forty-nine patients met inclusion criteria. Infectious complications occurred in 20 patients. A postoperative peak, which is necessary to apply the test, was observed in 78% of patients for CRP and 48% for ESR. Multiple linear regression analysis revealed preoperative CRP, number of levels, and lumbar region as significant predictors of greater CRP peak value (r2 = 0.435, P = 0.001). After the peak, CRP showed an exponential decrease with a half-life of 2.6 days (r2 = 0.701, P < 0.001). No trend could be determined for ESR. A second rise or failure to decrease as expected had a sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 48%, 41%, and 86% for infectious complications, respectively. Of 8 cases of deep wound infection, 7 exhibited substantial deviations from expected CRP values. Conclusion. CRP is more applicable, predictable, and responsive in the early postoperative period compared with ESR. The postoperative kinetics of CRP derived in this study seems to be conserved regardless of operation, magnitude, or region. Knowledge of the kinetics allows assessment of the degree of difference between actual and expected values. Using a second rise or failure to decrease as expected for CRP is sensitive for infection. A negative test is reassuring that infection is unlikely.

Discoid Meniscus An Ultrastructural Study With Transmission Electron Microscopy

Background The ultrastructure of the normal menisci has been thoroughly investigated and found to correlate with meniscal tears. Although discoid menisci are accepted to have the same composition as their normal counterparts, to our knowledge, no study in the literature has investigated this issue. Purpose To investigate the ultrastructure of the discoid menisci and compare it with nondiscoid menisci. Study Design Descriptive laboratory study. Methods Meniscal biopsies were taken from 12 patients who were operated for meniscus tear and diagnosed with discoid meniscus and from 6 patients who were operated for meniscal tear and did not have a diagnosis of discoid meniscus. The samples were examined with transmission electron microscopy. Results The study group demonstrated a decrease in the number of collagen fibers compared with the control group. Also, the homogeneous course of the collagen fibers observed in the control group was replaced by a heterogeneous course in the study group. Conclusion The ultrastructure of the discoid meniscus is different from the normal menisci. Clinical Relevance This difference may contribute to the vulnerability of the discoid meniscus to tears.

Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis.

Study Design. Retrospective cohort analysis. Objective. To evaluate the rate of surgical site infections (SSIs) and cost-effectiveness of the use of intraoperative vancomycin powder in thoracolumbar adult deformity procedures. Summary of Background Data. The rates of SSI remain unacceptably high in adult spinal deformity surgery despite routine intravenous antibiotics. Vancomycin powder applied directly to the wound intraoperatively has shown promise for decreasing SSI in spine surgery. Methods. Adults who underwent adult deformity reconstruction by 2 surgeons between 2008 and 2012 with a minimum of 3 months of clinical follow-up were retrospectively reviewed. The patients were subdivided into those who had received only routine perioperative intravenous antibiotics (control) and those who received intravenous antibiotics and 2 g of vancomycin powder applied into the surgical wound. The primary outcome was SSI within 90 days. Secondary outcomes included surgical/clinical parameters and SSI-related medical costs based on hospital billing records. Results. Two hundred fifteen patients were evaluated—controls (n = 64) and vancomycin powder group (n = 151). The average number of levels fused was 10 (5–17, control) and 12 (5–19, vancomycin). The mean follow-up was 34 months (3–68 mo, control) and 18 months (3–35 mo, vancomycin) (P < 0.05). There were significantly fewer hospital readmissions within 90 days for SSI in patients who received vancomycin powder (2.6%; 4/151) compared with controls (10.9%; 7/64) (P = 0.01). There were no reported adverse events related to the intrawound vancomycin use. The average cost per patient of treating a postoperative SSI was higher in the control group (

Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients.

34,388) than in the study group (

MRI issues for ballistic objects: information obtained at 1.5-, 3- and 7-Tesla

28,169). With the use of vancomycin powder, there was a cost saving of

Comparison of extraarticular leakage values of radiopharmaceuticals used for radionuclide synovectomy

244,402 per 100 complex spinal procedures. Conclusion. Local application of vancomycin powder significantly decreased SSI for adults undergoing spinal reconstructive surgery. This resulted in cost savings of

The validity of Lenke criteria for defining structural proximal thoracic curves in patients with adolescent idiopathic scoliosis.

244,402 per 100 thoracolumbar adult deformity procedures. Level of Evidence: 3

The factors that play a role in the decision-making process of adult deformity patients.

Study Design A retrospective review of a case series. Objective To describe a novel surgical technique for a minimally disruptive lateral transthoracic transpleural approach to treat thoracic disc herniations. Summary of Background Data Thoracic disc herniation is a relatively uncommon spinal condition, and surgical treatment is indicated for patients with myelopathy or radiculopathy that failed to respond to conservative therapy. Presently there is no consensus about the best approach to address thoracic disc herniations. Using the novel retractor system (MaXcess), the authors describe a novel minimally disruptive approach that allows the surgeons to perform a standard anterior discectomy and fusion with instrumentation while minimizing approach-related morbidity. Methods A series of 12 patients with single-level thoracic disc herniations who underwent anterior spinal cord decompression followed by instrumented fusion through a novel retractor system is being reported. Demographic and radiographic data, perioperative complications, and clinical outcomes were reviewed. Results Twelve patients were enrolled with an average age of 51 years (range, 23 to 67 y). The average follow-up was 28 months (range, 12 to 33 mo). The average length of hospital stay was 5 days (range, 2 to 12 d). The average preoperative visual analog scale pain score was 9 (range, 7 to 10), which later decreased to 3 (range, 0 to 5) at final follow-up. All patients with myelopathy and/or sphincter dysfunction had significant improvement of their symptoms. One patient had pleural effusion and 1 patient had intercostal neuralgia. Conclusions Anterior decompression using a transthoracic transpleural approach provides excellent exposure and allows consistent decompression of thoracic disc herniations. This study demonstrated that a new minimally invasive, transthoracic transpleural decompression technique can be safely performed for single-level thoracic disc herniations. The early results showed that this technique allows less dissection, along with the advantages of conventional thoracotomy.

The effect of pedicle expansion on pedicle morphology and biomechanical stability in the immature porcine spine.

BACKGROUND CONTEXT Few studies exist for magnetic resonance imaging (MRI) issues and ballistics, and there are no studies addressing movement, heating, and artifacts associated with ballistics at 3-tesla (T). Movement because of magnetic field interactions and radiofrequency (RF)-induced heating of retained bullets may injure nearby critical structures. Artifacts may also interfere with the diagnostic use of MRI. PURPOSE To investigate these potential hazards of MRI on a sample of bullets and shotgun pellets. STUDY DESIGN Laboratory investigation, ex vivo. METHODS Thirty-two different bullets and seven different shotgun pellets, commonly encountered in criminal trauma, were assessed relative to 1.5-, 3-, and 7-T magnetic resonance systems. Magnetic field interactions, including translational attraction and torque, were measured. A representative sample of five bullets were then tested for magnetic field interactions, RF-induced heating, and the generation of artifacts at 3-T. RESULTS At all static magnetic field strengths, non-steel-containing bullets and pellets exhibited no movement, whereas one steel core bullet and two steel pellets exhibited movement in excess of what might be considered safe for patients in MRI at 1.5-, 3- and 7-Tesla. At 3-T, the maximum temperature increase of five bullets tested was 1.7°C versus background heating of 1.5°C. Of five bullets tested for artifacts, those without a steel core exhibited small signal voids, whereas a single steel core bullet exhibited a very large signal void. CONCLUSIONS Ballistics made of lead with copper or alloy jackets appear to be safe with respect to MRI-related movement at 1.5-, 3-, and 7-T static magnetic fields, whereas ballistics containing steel may pose a danger if near critical body structures because of strong magnetic field interactions. Temperature increases of selected ballistics during 3-T MRI was not clinically significant, even for the ferromagnetic projectiles. Finally, ballistics containing steel generated larger artifacts when compared with ballistics made of lead with copper and alloy jackets and may impair the diagnostic use of MRI.

Biomechanical analysis of revision strategies for rod fracture in pedicle subtraction osteotomy.

ObjectivesRadionuclide synovectomy is a reliable therapy in patients with chronic synovitis. However, radiation doses delivered to non-target organ systems due to leakage of radioactive material from the articular cavity are an important disadvantage of this procedure. In this study we compared extraarticular leakage values of the 3 commonly used radiopharmaceuticals;90Y-citrate,90Y-silicate and186Re-sulfide colloid.Materials and MethodsThirty-five patients with persistent synovitis were enrolled in the study. Twenty-two hemophilic, 8 rheumatoid arthritis and 5 patients with pigmented villonodular synovitis were studied.90Y labeled silicate and citrate were used for knee joints and186Re-sulfide for intermediate sized joints. Radiocolloid leakage values were evaluated using a gamma camera with 20% window centered over the bremsstrahlung photopeak of90Y and a respective window over the 137 keV photopeak of186Re. Regions of interest were drawn over the injection site, the regional lymph nodes and the background areas. Leakage of radiocolloid was calculated by dividing the counts/pixel in the regional lymph node area to the counts/pixel in the injection site.ResultsNo visible leakage was observed. The median leakage values calculated for90Y-citrate,90Y-silicate and186Re-sulfide were found as 1.9%, 2.4% and 2.7%, respectively. The difference between the variability of leakage values was not statistically significant (p > 0.05).Conclusion: There was no significant difference in terms of extraarticular leakage between90Y-citrate,90Y-silicate and186Re-sulfide radiocolloids.