Lumbar vertebra morphometry and stereological assesment of intervertebral space volumetry: a methodological study.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention.

Evaluation of cerebellar and cerebral volume in migraine with aura: a stereological study.

Migraine is associated with an increased risk of deep white matter lesions and subclinical posterior circulation infarcts. A significant association between deep white matter hyperintensities and cerebral atrophy is true for various neurological diseases; it was not specifically proven in migraine. The aim of this study was to evaluate the cerebellar and cerebral volume and volume ratios for cerebellum using the Cavalieri principle. We also aimed to examine whether migraine with aura causes cerebellar and cerebral atrophy. Twenty three right-handed patients with migraine with aura diagnosed by means of the International Headache Society criteria and 24 age-matched subjects whose only health problem was headache due to rhinosinusitis and tension type headache were included in the study. Measurements of the cerebellar and cerebral volumes as well as cerebellar/cerebral volume ratios were made using Cavalieri's principle by utilizing the point-counting methods. There were no significant differences between the volumes of cerebrum, cerebellum, and the ratio of cerebellum to cerebrum for males (p = 0.05, p = 0.10, and p = 0.64, respectively) and for females (p = 0.18, p = 0.89, and p = 0.24, respectively). Our results suggest that patients with migraine with aura do not have a significant difference in cerebellar and cerebral volumes and cerebellar/cerebral volume ratios compared to the non-migraine group.

DUPLICATE PUBLICATION: Comparison of entropy and bispectral index values during propofol induction.

OBJECTIVE: To identify the entropy levels that would correspond to bispectral index (BIS) levels in general anesthesia (GA) induction in patients who will undergo elective lumbar disc surgery (LDS). METHODS: Thirty cases who underwent LDS under GA were included in our study after obtaining patient consent and approval of the Ethics Committee of Afyon Kocatepe University Medical School, Afyonkarahisar, Turkey, between January 01, 2004 to December 31, 2005. Bispectral index and entropy electrodes were applied at the same time to 30 cases in the study group. In order to assess the level of sedation during anesthesia and recovery, `Observer`s Assessment of Alertness/Sedation` (OAA/S) scale was used. Bispectral index, state-entropy (SE), response-entropy (RE), and OAA/S values were recorded simultaneously. RESULTS: Induction OAA/S scores were in correlation with BIS and entropy values (RE-SE) in 30 cases. A significant difference was found between BIS and entropy induction values (p=0.0398). Induction mean arterial pressure and heart rate values at 30, 60, 90, and 120 seconds were lower than the values of the control, which was statistically significant (p=0.0412). CONCLUSION: During the induction of GA, we found entropy values to be more sensitive and they demonstrated a more rapid increase than BIS. Therefore, it would be safer to monitor entropy while using agents of induction that might cause severe hypotension. Induction agents that might cause severe hypotension could be more safely administered under entropy monitoring.

Notice of Duplicate Publication in: Neurosciences 2009; Vol. 14 (1): 106.

Which is more effective in reducing secondary brain damage resulting from cyclooxygenase expression following traumatic brain injury: calcium channel blockers or cox inhibitors?

OBJECTIVES: To evaluate localizations of cyclooxygenase (COX)-1 and COX-2 following traumatic brain injury (TBI) and the effects of 2 therapeutic agents on COX inhibition. METHODS: Forty rabbits were used in this study for developing a TBI model and divided into 4 groups (n=10) at Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey in June 2004. Differential cellular COX-1 and COX-2 protein expression profiles were analyzed following TBI, and the effects of 2 therapeutic agents, indomethacin and nimodipine, on COX inhibition were evaluated immunohistochemically. RESULTS: This study revealed that COX-1 and COX-2 protein expression were significantly increased in vascular endothelial, smooth muscle cells, and CD68+ microglia/macrophages following TBI. Indomethacin inhibited the COX expression in glial cells more than nimodipine, however, both did not affect endothelial COX-1 and COX-2 expression. CONCLUSION: The restricted accumulation of COX-1 at the perilesional area points to an acute inflammatory response and the role of COX-1 in TBI. This study revealed that COX-1 expression should be a pharmacological target following TBI, and COX-2 should also be evaluated in this aspect, and indomethacin is more effective than nimodipine for blocking COX-1.

Comparison of unilateral posterior lumbar interbody fusion and bilateral posterior interbody fusion with simple discectomy at degenerative disc herniations.

OBJECTIVES: To evaluate the early results of unilateral posterior lumbar interbody fusion technique in lumbar discectomy cases compared with simple discectomy and bilateral posterior interbody fusion cases using visual analog scale (VAS) and Oswestry outcomes instruments and radiological and physical examinations. METHODS: The control group had 40 patients who underwent simple discectomy. In group one, 8 patients had recurrent disc herniations and facet joint hypertrophy, 21 patients had degenerative disc disease and facet joint hypertrophy. In this group polyetheretherketone (PEEK) cage was used for protecting the disc height and recurrence. In group 2, 15 patients had degenerative lumbar disc herniations and bilateral facet joint hypertrophy. All patients were operated upon between October 2002 between February 2004 at the Neurosurgery Department of Kocatepe University Medical School, and were followed by the help of radiological exams, VAS and Oswestry scores, and clinical exams. The groups were compared to each other statistically. RESULTS: In the control group (n=40) there were recurrences and disc height loss. In group one (n=29) there were no recurrences and the height lost was limited. In group 2, (n=15) there was no recurrence, however, the lost disc height was more than group one. CONCLUSION: If the patient has degenerative disc disease, the use of unilateral posterior PEEK cage and interbody grafting is a safer mode of treatment after discectomy.

Is age a prognostic factor of postoperative outcome of lumbar disc herniation operations?

OBJECTIVE: To evaluate the influence of the patients age on preoperative symptoms and outcome. METHODS: The general data, symptoms, signs, and neurological examination findings were recorded from 511 patients between 2000 and 2006 at Vakif Gureba Hospital and Afyon Kocatepe University Neurosurgery Departments, Afyonkarahisar, Turkey. The mean follow-up of the patients was 44.7 months. All patients younger than 64 were defined as younger patients (n=449). The others were defined as elderly patients (n=62). The measuring method of the outcome was visual analogue rating scale (VAS). RESULTS: Preoperative and postoperative VAS values were found similar in both the younger and older group. Only preoperative differences were found in the older group, due to systemic disease. CONCLUSION: The outcome was not statistically different in both groups, indicating that age is not a valuable prognostic factor for lumbar discectomy.