Analysis of Clinical and Radiological Outcomes of Posterior Dynamic Stabilization for Direct Repair of Bilateral L5 Pars Interarticularis Defect: Dynamic Assessment of Pars Fusion.

AIM: To evaluate the satisfactory clinical and radiological outcomes of posterior dynamic stabilization for the direct repair of bilateral L5 pars interarticularis defects and pars fusion. MATERIAL AND METHODS: This is a retrospective evaluation of postoperative follow-up results of 13 patients with bilateral L5 pars interarticularis defects without spondylolisthesis. The patients underwent dynamic transpedicular stabilization between 2013 and 2018. Our surgical criteria included unilateral or bilateral L5 spondylolysis; excessive low back pain; low back pain accompanied by leg pain without neurological findings; symptoms lasting at least six months despite conservative treatments, age < 50 years; and lack of significant adjacent disc degeneration. RESULTS: There were seven female and six male patients with a mean age of 38.9 years. All patients achieved satisfactory postoperative results during a mean follow-up period of 22 months. Preoperative visual analog scale score and Oswestry Disability Index value were 8.85 ± 0.69 and 54.46 ± 7.62, respectively, which decreased to 1.31 ± 0.48 and 9.85 ± 3.51, respectively, at the postoperative 24th month. In all patients, the bony fusion of the pars interarticularis at the stabilized segment was confirmed on the computed tomography scan at an average of 22 months postoperatively. CONCLUSION: The posterior dynamic system ensures that the spine moves within physiological limits and carries the load by sharing it with the spine. The advantages of direct pars repair using our technique are the restoration of the posterior structures? normal anatomy, protection of the functional mobility segment, and early functional recovery without degeneration in the adjacent segment. Therefore, when there is no significant instability, patients with spondylolysis can be treated with posterior dynamic stabilization techniques with satisfactory clinical and radiological results.

Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft.

OBJECTIVE: This prospective study was performed to evaluate the safety and efficacy of polyetheretherketone (PEEK) cages packed with demineralized bone matrix (DBM) mixed with autologous blood and curettage microchip material for treatment of multilevel cervical disc disease and spondylosis without the use of plates, screws or autogenous iliac crest bone graft. MATERIAL AND METHODS: Sixteen patients underwent multilevel anterior cervical discectomy and fusion (ACDF) for a total of 42 levels. Minimum follow-up was 18 months. Neurological outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system; cervical lordosis and cervical fusion status was assessed on X-ray. Statistical analysis was performed to compare preoperative and postoperative scores using a dependent t-test (P<0.05). RESULTS: Eight patients underwent two-level, six underwent three-level and two underwent four-level operations. The fusion rate was 90.5% and non-fusion rate was 9.5%, but reoperation was not required for these patients in the follow-up period. Cervical lordosis was preserved and neurological status was improved. No cage migration or cage failure occured. CONCLUSION: ACDF using PEEK cages packed with DBM is a safe and efficient method for treatment of multilevel cervical disc disease and spondylosis. It preserves cervical lordosis and obviates the complications related to iliac crest graft harvest and screw-plate fixation.

Use of sonography in carpal tunnel syndrome surgery. A prospective study.

The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.

Two-staged operation on C2 neoplastic lesions: anterior excision and posterior stabilization.

This retrospective study included eight consecutive cases with C2 vertebral body neoplastic lesions. The anterior retropharyngeal approach was used to remove the lesions and decompress the spinal cord. Spinal stabilization with occipitocervical plating in a second-stage operation makes the treatment more tolerable for patients. The object of this study was to determine the effectiveness of a two-stage operation strategy for these lesions. Eight patients were operated on via anterior retropharyngeal approach and then stabilized with occipitocervical plates posteriorly in a second sitting. All neck pain and all dysphagia problems resolved. Partial neurologic improvement was achieved in three out of four patients. No postoperative infection was seen. The retropharyngeal approach to the upper cervical spine and anterior foramen magnum lesions is an effective alternative to transoral surgery because of low complication rates. Neoplastic lesions in the upper cervical spine can safely and effectively be operated with this technique. The general medical status of patients with malignancies does not permit too long, time-consuming operations. Stabilization of the spine in a separate operation increases patient tolerability without any morbidity.

Cramp finding: can it be used as a new diagnostic and prognostic factor in lumbar disc surgery?

In this prospective study, the validity and the importance of a new finding (cramp finding) in the diagnosis and outcome after lumbar disc surgery were tested. The test is performed with the person in prone position. Against a forceful knee flexion, the examiner holds the leg with one hand and applies a force to overcome the knee flexion. The finding is positive if the examined person feels a disturbing cramp in the leg or thigh. The study was performed between October 1997 and December 1999. Besides the cramp finding, the classical disc herniation examination, including mechanical and neurological findings, magnetic resonance (MR) imaging tests, and laboratory findings were checked pre- and postoperatively. The positive cramp finding in the operated group was 72% (n=133) preoperatively and straight leg raising (SLR) test was positive in all of them. Cramp finding was positive in 70%, 52%, 34%, and 8% of patients postoperatively in the first, 3rd, 12th and 24th months, respectively. The presented finding appears to be as valuable as the SLR, and especially contralateral SLR, tests in lumbar disc surgery. Cramp finding is also important in outcome evaluation.