Collapsed L4 Vertebral Body Caused by Brucellosis

Brucellosis is caused by gram-negative, aerobic, non-motile, facultative, intracellular coccobacilli belonging to the genus Brucella. A 50-year-old man working as an employee was admitted to neurosurgery clinic with severe low back, radicular right leg pain and hypoesthesia in right L4-5 dermatomes for 2 months. Brucella tube agglutination (Wright) test was positive in serum sample of the patient with a titer of 1/640. Brucella melitensis was isolated from blood culture. X-ray and MRI of the lomber spine showed massive collapse of L4 vertebral body. Neural tissue was decompressed and then posterior L3-5 short segment transpedicular screw fixation and stabilization was performed. Brucella melitensis was isolated from microbiologic culture of pathologic specimen. Antibiotic therapy was given as doxycycline 200 mg/day and rifampicin 600 mg/day for 6 months. Brucellosis is a systemic zoonotic infection and still an important public health problem in many geographical parts of the world. Vertebral body collapse caused by brucellosis occurs very rarely but represents a neurosurgical emergency because of its potential for causing rapidly progressive spinal cord compression and permanent paralysis. Neurosurgeons, emergency department personnel as well as infectious disease specialists should always keep a high index of suspicion and include brucellosis in the differential diagnosis of vertebral body collapse.

Mini transverse versus longitudinal incision in carpal tunnel syndrome

To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release [CTR] with reference to postoperative functional capacity, symptom severity and complication rate. Analytical study. Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. This study included 93 hands of 79 patients with carpal tunnel syndrome [CTS], which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 [undergoing mini-longitudinal incision] and Group-2 [undergoing mini-transverse incision]. Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire [BQ]. Demographic and clinical data were analyzed and compared statistically between two groups. Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period [p < 0.0001]. BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 [p = 0.044 and p = 0.023 respectively]. The scar hypersensitivity [p = 0.258] and tenderness [p = 1.00] associated with the incision sites were not statistically different. Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision

Surgical Management of Cervical Spinal Epidural Abscess Caused by Brucella Melitensis : Report of Two Cases and Review of the Literature

Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months.

Microvascular Decompression for Primary Trigeminal Neuralgia : Short-Term Follow-Up Results and Prognostic Factors

OBJECTIVE: The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia. METHODS: The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings. RESULTS: The sex of the patient, the patient's age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). CONCLUSION: These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.