Tülay Özer

A Rare Cause of Postpartum Low Back Pain: Pregnancy- and Lactation-Associated Osteoporosis

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis. It results in severe low back pain in the last trimester of pregnancy and in the postpartum period, decreases in height, and fragility fractures, particularly in the vertebra. The current case report presents a 32-year-old patient who presented with back and low back pain that began in the last trimester of the pregnancy and worsened at two months postpartum and who was diagnosed with pregnancy- and lactation-associated osteoporosis after exclusion of other causes; the findings are discussed in view of the current literature. PLO is a rare clinical condition causing significant disability. PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. The patients must be evaluated for the risk factors of PLO, and an appropriate therapy must be initiated.

Computed Tomographic Evaluation of Degenerative Spine Changes in Patientswith Obstructive Sleep Apnea Syndrome: A Case Control Study

Objective: Recently few studies have described presence of cervical spine anomalies in obstructive sleep apnoea syndrome (OSAS) patients. It is also reported that some cases of cervical spine pathologies and osteophytes producing obstructive sleep apnea. We aim to investigate the prevalence of facet joint arthrosis and degenerative disc disease (DDD) in cervical spine using computed tomography (CT) in OSAS patients. Materials and Methods: We studied on thirty patients with OSAS who had cervical spine CT. Facet joints were evaluated in four grades and scored in 1-4 points by using multiplanar CT images. Disc levels was evaluated by using two-point subjective scale for loss of height, posterior osteophytes, endplate sclerosis, and spinal canal stenosis to determinate DDD. Degeneration of anterior atlanto-odontoid joint (AAOJ) were classified into four grades. Tomographic findings were compared with those for thirty control subjects. Results: The mean degeneration scores of C2-T1 facet joints and C2-C5, C7-T1 disc spaces were significantly higher in the cases of OSAS group than the cases of the control group. There were no significant differences in the mean degeneration scores for C5-6 and C6-7 cervical intervertebral disc levels between the groups. Degeneration scores of the facet and disc for whole cervical spine in the cases of the OSAS group was significantly higher than in cases of the control group (P<0.001 and P=0.002). AAOJ degeneration degrees showed differences between the groups. Statistically significant correlations were found between the OSAS degrees and the intervertebral disc degeneration (R=0.338, P=0.007) and facet joint degeneration (R=0.543, P=0.000) for all cervical vertebrae. Conclusions: The cervical spine of the OSAS patients has more severe disc degeneration and facet joint and AAOJ arthrosis, compared to subjects without OSAS. This findings may contribute to clinic evaluation of OSAS patients with servical pain and limited movement.