Sella Volume and Posterior Fossa Morphometric Measurements in Chiari Type 1.

AIM: To retrospectively evaluate the relationships between morphometric measurements in craniovertebral junction, and the possible genetic basis of the disease in Chiari 1 malformation patients undergoing surgical treatment. MATERIAL AND METHODS: We included patients who underwent surgical treatment for Chiari 1 malformation with unknown etiology between 2013-2018 in the Neuosurgery Clinic of Eskisehir Osmangazi University. Morphometric and volumetric measurements of the posterior fossa from cranial and cervical radiological imagings of patients with Chiari 1 malformation were performed by a single experienced observer. The results were independently reviewed by two experienced observers who supervised the process and verified the calculations. RESULTS: It was observed that basal angle was greater in the group of patients with Chiari 1 malformation (125.29° ± 9.522° Vs. 112.33° ± 9.09°), and a significant difference was observed (p=0.000). In patient group, it was also found that the basion-dens distance (3.51 mm ± 1.695mm Vs. 5.27 ± 1.695 mm) (p=0.000), and cerebellar hemispher height were shorter (58.47 ± 5.143 mm Vs. 52.05 ± 5,008 mm) (p=0.000). Tentorium angle was greater in the patient group (97.95° ± 11.321° vs. 87.79° ± 9.891°) (p=0.034). In patient group, dens height was found to be longer (13.9 ± 2.46 mm vs. 14.79 ± 1.631mm) (p=0.041). Sella volume was found to be smaller (41.4 mm3 Vs. 53.3 mm3) in the patient group compared to the control group (p=0.034), and foramen magnum plane was larger (64.6° vs. 31.1°) (p=0.000). CONCLUSION: It is concluded that many parameters including BA, FMP, BDD, CHH, TA, DH, and cellar volume are abnormal, suggesting the need for focussing to the hormonal metabolism - related synchondral changes.

Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

OBJECTIVE: To investigate the effect of fusion on short segment including fractured level (SSIFL) and long segment (LS) transpedicular fixation after acute thoracolumbar junction burst fractures. The 2-year clinical and radiologic follow-up results of the 2 groups also were compared. METHODS: Seventy-four patients were randomized into one of 2 groups: SSIFL (n = 39) or LS (n = 35). The SSIFL group included one level above and one level below, including the fracture level, whereas the LS group included 2 levels above and 2 levels below, excluding the fracture level, for the transpedicular fixation. Fusion was assessed by technetium 99m-methylendiphosphonate, bone scintigraphy, and single-photon emission computed tomography. The 2-year follow-up results were compared clinically (Oswestry Disability Index and visual analog scale) and radiologically (kyphosis angle, sagittal index, anterior vertebral body height loss) at regular intervals. The clinical scores and radiologic parameters of patients with and without fusion also were compared. RESULTS: The number of patients with fusion was significantly greater in the SSIFL group compared with the LS group. There was a significant reduction of the clinical scores of patients who had fusion compared with the fusion-free group; however, there was no radiologically significant difference. Furthermore, there was no significant difference between the SSIFL and LS groups in terms of the 2-year radiologic and clinical follow-up results. CONCLUSIONS: Fusion occurred sooner and patients experienced earlier clinical recovery in the SSIFL group compared with the LS group.