Influence of Distal Fusion Level on Sagittal Spinopelvic and Spinal Parameters in the Surgical Management of Adolescent Idiopathic Scoliosis

STUDY DESIGN: Retrospective analysis of adolescent idiopathic scoliosis. PURPOSE: This study aimed to investigate the influence of distinct distal fusion levels on spinopelvic parameters in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior instrumentation and fusion surgery. OVERVIEW OF LITERATURE: The distal fusion level selection in treatment of AIS is the one of milestone to effect on surgical outcome. Most of the paper focused on the coronal deformity correction and balance. The literature have lack of knowledge about spinopelvic changing after surgical treatment and the relation with distal fusion level. We evaluate the spinopelvic and pelvic parameter alteration after fusion surgery in treatment of AIS. METHODS: A total of 100 patients with AIS (88 females and 12 males) were retrospectively reviewed. Patients were assigned into the following three groups according to the distal fusion level: lumbar 2 (L2), lumbar 3 (L3), and lumbar 4 (L4). Using a lateral plane radiograph of the whole spine, spinopelvic angular parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were radiologically assessed. RESULTS: The mean age was 15±2.4 years, and the mean follow-up period was 24.27±11.69 months. Regarding the lowest instrumented vertebra, patients were categorized as follows: 30 patients in L2 (group 1), 40 patients in L3 (group 2), and 30 patients in L4 (group 3). TK decreased from 36.60±13.30 degrees preoperatively to 26.00±7.3 degrees postoperatively in each group (p=0.001). LL decreased from 52.8±9.4 degrees preoperatively to 44.30±7.50 degrees postoperatively (p=0.001). Although PI showed no difference preoperatively among the groups, it was statistically higher postoperatively in group 3 than in the other groups (p 0.05). However, mean SS was significantly higher in group 3 (p=0.042, p < 0.05). PT decreased from 15.50±7.90 degrees preoperatively to 15.2±7.10 degrees postoperatively. The positive relationship (28.5%) between LL and PI measurements was statistically significant (r=0.285; p=0.004, p < 0.01). Furthermore, the positive relationship (36.5%) between LL and SS measurements was statistically significant (r=0.365; p=0.001, p < 0.01). CONCLUSIONS: When the distal instrumentation level in AIS surgery is below L3, a significant change in PT and SS (pelvic parameters) is anticipated.

Polymorphisms in the growth differentiation factor 5 [GDF 5] gene in knee osteoarthritis

Objective: to identify the frequency of the rs143383 SNP in the GDF5 gene, which is located in the 5'-untranslated region of Turkish population with knee osteoarthritis [OA]

Study Design: a case-control study

Place and Duration of Study: orthopedics and Traumatology Department, Bozok University Medical Faculty, Yozgat, Turkey, from 2012 to 2014

Methodology: patients diagnosed with OA [n=94] and patients who did not have joint complaints [n=279] were enrolled in this study. Patients diagnosed with osteoarthritis according to the 1986 American College of Rheumatology osteoarthritis criteria and Kellgren and Lawrence scores were investigated, based on age, gender, and X-ray findings. Blood samples were taken for the identification of GDF5 [rs143383] SNPs by PCR/RFLP, according to a standard protocol

Results: this study included 373 patients. The OA group [25.2%; n=94] was characterized by specific genotypes: TT [39.4%; n=37]; heterozygotes [TC; 45.7%; n=43]; and homozygotes [CC; 14.9%; n=14]. The control group [74.8%; n=279] was comprised of TT [26.5%; n=74], TC [54.8%; n=153], and CC [18.6%; n=52] genotypes. An analysis of rs143383 SNP of the GDF5 gene polymorphism revealed that the rs143383 TT genotype had a higher risk for OA [crude OR=1.798, 95% CI=1.010-2.941, p=0.021]

Conclusion: this study demonstrated that there is a correlation of +104T/C polymorphism in the 5'-UTR of GDF5 with knee OA in a Turkish population

Efficacy of treatment with glucosamine sulfate in patients with knee effusion due to osteoarthritis

Evaluation of anti-inflammatory effect of Glucosamine sulfate [GS] versus diclofenac sodium [DS] in effusion of osteoarthritic knees. In this study, patients were included in this study from 2007-2010 based on American College of Rheumatology criteria with OA and physical examination in effusion of osteoarthritic knees. The patients were divided into two groups. First group [27 patients] DS was given in doses 75 mg twice daily for ten day. In the group II [25 patients] GS was used in doses of 1500 mg two times daily over the first 12 weeks of the study. A closed aspiration was performed. The knee circumference was measured in patients before and 12 week after treatment. Before and after 12 weeks of treatments, both groups of patients were assessed according to the WOMAC questionnaire of knee pain and function scores. Comparison of knee mean circumference between the two groups was not statistically significant before treatment [p=0.938], but significant after treatment [p < 0.001]. At the end of the 12 week, there was 66.6% complete resolution of effusion in the DS group [18 patients] and 24.0% [6 patients] in the GS group, this was statistically significant [P < 0.001]. DS groups, results of the beginning and at the end of 12 week measurement showed significant differences in WOMAC pain mean score [P < 0.001] but GS groups not statistically significant [P=0.160]. The WOMAC function mean scores in pre and post-treatment periods of follow-up showed significant variation between the two groups [P < 0.001, P < 0.001]. Our observations suggest that GS is not able to suppress the progression of adjuvant arthritis in OA with effusion of knee osteoarthritis. GS should not be expected as anti-inflammatory influence as DF in the treatment of OA-related effusion

Bursa formation with scapular osteochondroma in hereditary multiple exostosis

Osteochondroma is the most common benign bone tumour present multiple hereditary exostosis [HME]. Scapular osteochondroma associated with pain and bursitis is rarely reported in literature. Here, we describe a 49-year-old male with the diagnosis of HME who was admitted to the Department of Thoracic Surgery with a painful and rapidly enlarging mass behind the left scapula. Computed tomography and magnetic resonance imaging indicated a large bursa formation associated with chest wall mass. Pre-operatively, the mass was diagnosed as osteochondroma and resected. Pathological findings confirmed that mass was a large bursa formation due to scapular osteochondroma without any evidence of malignancy. Osteochondroma should be considered in differential diagnosis of chest wall tumours located at this specific site. We discuss this rare complication of HME and emphasize the importance of early diagnosis and differentiation from malignant transformation of osteochondroma

Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: new technique

There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1 +/- 0.5 years. The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 [63.2%] female and 7 [36.8%] male subject with volar wrist ganglion cyst. The mean age of patients was 27.63 +/- 6.6 years. Fourteen [73.7%] patients of total had cysts close to the artery. We didn't observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three [15.8%] patients. This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention

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