Utilizing Surgeon-Performed Intraoperative Translaryngeal Ultrasound for Verifying Vocal Fold Function: A Troubleshooting Approach for Intraoperative Neuromonitoring in Neck Surgery.

INTRODUCTION: We investigated transcutaneous laryngeal ultrasonography (TLUS) for assessing vocal fold (VF) mobility during thyroid and parathyroid surgeries, emphasizing its precision and utility in signal loss scenarios. METHODS: Between October 2020 and January 2023, we performed TLUS, Doppler sonography, laryngeal twitch response (LTR) palpation, and electromyography (EMG) to monitor recurrent laryngeal nerve function during neck surgeries. Postoperatively, the VF activity was verified using fiberoptic video laryngoscopy (FL). Concordance with FL was categorized based on VF activity. RESULTS: Of the 443 VF evaluations, no instances of permanent bilateral paralysis were noted. Temporary unilateral palsy was found in 3.38% and permanent in 0.45%. TLUS displayed 97.8% agreement with EMG and was diagnostically superior (99.7% vs 98.2%) and more affordable ($68 vs $300) compared to analogous operative durations. CONCLUSION: TLUS rivals EMG in terms of intraoperative neuromonitoring accuracy and outperforms LTR. Being cost-effective, TLUS can effectively address signal loss situations, thereby averting additional surgeries.

Investigation of the effect of weight loss after laparoscopic sleeve gastrectomy on cobb angle, waist and back pain: a prospective study.

BACKGROUND: In many studies, it has been stated that obesity causes severe increases in the risks of disc degeneration, vertebral fracture, low back, and back pain. One of the most effective treatment options for obesity is bariatric surgery. OBJECTIVES: In this study, the effect of weight loss on these parameters was investigated by evaluating the Cobb angle, low back, and back pain. SETTING: University Hospital METHODS: A total of 89 patients were included in the study. Laparoscopic sleeve gastrectomy (SG) was performed on all patients. In addition, Cobb angle, height, weight, and body mass index (BMI) measurements were recorded at each visit. Investigating the quality and quantity of low back pain and the loss of function caused by the patients; visual analog scale (VAS), Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), Roland-Morris Disability Questionnaire (RMDQ), and SF-36 Quality of Life Questionnaire (SF36) were administered. RESULTS: According to the preoperative Cobb angles, the decrease in the 6th month (P = .029) and 12th month (P = .007) measurements after the operation was found to be statistically significant (P < .05), but it was found to be clinically insignificant. When the changes in RMDQ, OLBPDQ, VAS, and SF-36 scores were examined, the decrease in the 6th month (P = .001) and 12th month (P = .001) scores after the operation was found to be significant compared to the preoperative scores (P < .01). CONCLUSIONS: In this study, weight loss after SG improved for patients with chronic low back and back pain and significantly improved their quality of life.

The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty.

OBJECTIVE: The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae. METHODS: According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n = 40) and PVP (n = 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured. RESULTS: The mean follow-up time was 2.53 ± 1.78 years in the BK group and 3.07 ± 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding. CONCLUSIONS: To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid- to long term.

Effects of iron oxide particles on MRI and mammography in breast cancer patients after a sentinel lymph node biopsy with paramagnetic tracers.

OBJECTIVE: The aim of this study is to evaluate the effect of iron oxide particle deposition on follow-up mammograms and MRI examinations of patients who underwent sentinel lymph node detection with iron oxide particles. MATERIALS AND METHODS: Two hundred and eighteen patients who had sentinel lymph node biopsy (SLNB) with iron oxide particles were evaluated. Follow-up MRI and mammography were available in 36 and 69 cases respectively. MRI examinations were evaluated for ferromagnetic artifacts that were graded as follows: 0 = No artifact, 1 = Focal area, 2 = Segmental and 3 = Regional signal void artifact. Mammography artifacts were evaluated for the presence of dense particles. Pearson's chi-square test was used for statistical analyses and P < 0.05 was accepted as significant. RESULTS: MRI artifact grading was as follows: Grade 0: 11 (30.6%), Grade 1: 14 (38.9%), Grade 2: 3 (8.3%), and Grade 3: 8 (22.2%). The grade of artifacts differed across surgery types (P = 0.019). Grade 3 artifacts were higher in breast conserving cases whereas Grade 0 was more frequent in subcutaneous mastectomy cases. Three out of 69 (4.4%) cases who had follow-up mammography had artifacts due to iron oxide particle accumulation which presented as Grade 3 MRI artifact in all. CONCLUSION: Accumulation of iron oxide particles after SLNB with paramagnetic tracers causes artifacts on follow-up MRI examinations in half of the cases but it is significantly low in mammograms. These artifacts may be confusing in the evaluation of the images. Radiologists must be aware of these tracers and their artifacts whereas patients should be questioned for the type of SLNB before a follow-up examination.

Balloon Kyphoplasty Is a Safe and Effective Option for the Treatment of Vertebral Compression Fractures in Solid-Organ Transplant Recipients.

OBJECTIVES: Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. MATERIALS AND METHODS: We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. RESULTS: There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P < .05). Sagittal alignment improved (> 5 degrees) in 2 of 7 patients (28%). CONCLUSIONS: Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.

Unexpected Finding on Mammography and MRI due to Accumulation of Iron Oxide Particles Used for Sentinel Lymph Node Detection.

We present a case with imaging artefacts on mammography and Magnetic Resonance Imaging (MRI) caused by iron oxide particles. After being diagnosed with the medullary cancer of the breast, the female patient had a breast conserving surgery on right breast. Iron oxide particles were used for the detection of the sentinel lymph node during operation. On follow ups, a de novo density on mammography, which was initially thought to be a new tumour, was found. MR images proved that the lesion is an artefact caused by iron oxide accumulation. Our aim in this case study is to underline and discuss the imaging artefacts caused by these particles and raise awareness.

Turkish Board of Neurological Surgery.

AIM: To provide information on the process and the results of the Turkish Board of Neurological Surgery and increase the relevant awareness. MATERIAL AND METHODS: The number of applications to the written and oral board exams organized by the Turkish Neurosurgical Society Proficiency Board since 2006, the number of successful and unsuccessful participants, and the number of the neurosurgery residents and specialists who applied to the exam were evaluated. RESULTS: A total of 554 candidates took the exam since 2006 when the first TBNS was applied. Two hundred and sixty of the candidates were successful (46.9%), and 294 (53.1%) were unsuccessful. Two hundred and forty six (44.4%) of those who took the test were neurosurgeons, 308 (55.6%) were neurosurgery residents who had completed their 3rd year in their training. The highest score in the written exams was 93/100, and the lowest score was 33/100. In verbal exams, a total of 73 candidates participated, and 66 (90.4 %) of them were successful while 7 of them (9.6%) were unsuccessful. CONCLUSION: Board exams are inevitable to provide a certain level of education and standardization in the training of neurosurgery. Our duty as neurosurgeons is to participate in these exams and work to increase participation for continuing education.

The Effects of Proanthocyanidin on Vasospasm After Experimental Subarachnoidal Hemorrhage in Rats.

AIM: Delayed ischemic neurological deficit (DIND) and cerebral vasospasm (CV) remain the most common and debilitating neurological complications following aneurysmal subarachnoidal hemorrhage (SAH). Many reports demonstrate the importance of proanthocyanidins (PR) on the vascular system, including endothelium-dependent relaxation of blood vessels. These effects of PR on the cerebral vascular system were examined in this study. < p < MATERIAL and METHODS: Fifty-two adult Sprague-Dawley male rats were used for the experimental double hemorrhage model. They were divided to control, sham, pre- and post-interventional treatment groups. 100 mg/kg PR was administered for the treatment for respect to groups. Basilar artery diameter (BAD) and arterial wall thickness were measured and the apoptosis ratio of the endothelial cells was calculated. Arterial walls were examined electron microscopically (EM). RESULTS: There were significant differences between the groups except control and pre-SAH (p=0.37) and post-SAH and pre- SAH groups (p=0.15) with respect to BAD. According to arterial wall thickness, apoptosis ratio, and grading, there were significant differences between the groups except control and pre-SAH (p=0.85, p=0.49 and p=0.18 respectively) and SAH and post-SAH (p=0.08, p=0.21 and p=0.24 respectively) groups. EM findings revealed that pro-apoptotic and pro-necrotic degenerated endothelial cells with seldom vacuolization in post-SAH treatment group which were more serious in SAH group. CONCLUSION: Pre-SAH administration of PR induces better vasodilatation and protection of basilar artery (BA) from vasospasm (VS), which could yield neuroprotective and vasodilatator effects. In addition, PR appears to be involved in relieving oxidative damage, with an antioxidant-antiapoptotic-antinecrotic effect that may contribute to vascular dilation.

Thoracic Intramedullary Lipoma in a 3-year-old Child: Spontaneous Decrease in the Size Following Incomplete Resection.

Nondysraphic intramedullary spinal cord lipomas are even rarer. We present a thoracic intramedullary lipoma which spontaneously decreased in size following surgical debulking. A 3-year-old girl was admitted to our department with complaints of back pain since 1 year and progressive difficulty in walking since 6 months. Her magnetic resonance imaging (MRI) revealed T8-9 intramedullary mass showing increased signal intensity in both T1- and T2-weighted images. The patient was operated with a T8-9 laminoplasty and debulking, and internal decompression of the tumor was made. Histologically, the tumor was uniformly composed of mature adipose tissue revealing a lipoma. First-month control MRI revealed the rest mass almost the half volume of the preoperative mass. The 2nd year MRI revealed the size of the lipoma was spontaneously decreased to almost half of postoperative size and 3rd year was the same as the 2nd year with a mild kyphosis. Decompression and debulking with or without duraplasty is the most appropriate treatment for symptomatic patients. Dietary measures with control of fat intake and long-term follow-up are also suggested.

The influence of adjunctive caudal epidural steroid injection on the therapeutic effect of transforaminal epidural steroid injection.

BACKGROUND: Epidural steroid injection is widely used to treat the short and long-term symptoms of low back and radicular pain. To the best of our knowledge, the influence of transforaminal epidural steroid injection (TFSI) combined with caudal epidural steroid injection (CESI) on pain intensity, patient satisfaction, and quality of life in lumbar radiculopathy has not been examined. AIM: To evaluate the short and long-term efficacy of TFSI, and TFSI combined with CESI (TFSI + CESI) in patients with lumbar radiculopathy. MATERIALS AND METHODS: We retrospectively examined the records of 104 patients with lumbar radicular pain and L4/5 and/or L5/S1 intervertebral disc disease who underwent TFSI or TFSI + CESI. We compared the pain intensity using a Visual Numeric Scale (VNS), North American Spine Society (NASS) pain satisfaction index, and EuroQol five dimensions (EQ-5D) quality of life scores before intervention, and after 1, 6 and 12 months. RESULTS: In the TFSI group, the mean pre-treatment VNS score was 9.2, which improved to 4.9 after 1 month and to 7.2 after 12 months. In the TFSI + CESI group, the mean pre-treatment VNS score was 9.4, which improved to 2.6 and 4.6 after 1 and 12 months, respectively. Improvement in the VNS scores was significantly higher in the TFSI + CESI group (P < 0.0001 for each). Mean EQ-5D quality of life index in the TFSI group improved from 0.59 in the pre-treatment phase to 0.76 after 12 months of intervention, while it improved from 0.62 in the pre-treatment phase to 0.84 at 12 months of intervention in the TFSI + CESI group. The EQ-5D scores were significantly better in the TFSI + CESI group at 1, 6, and 12 months after the procedure (P = 0.004, 0.036, and 0.042, for 1, 6, and 12 months, respectively). The NASS scores were significantly better in the TFSI + CESI group at 6 and 12 months after the intervention (P = 0.025 and 0.001 for 6 months and 12 months, respectively). CONCLUSION: In patients with lower lumbar radiculopathy, a combined TFSI + CESI technique offers superior short and long-term pain relief, quality of life, and long-term patient satisfaction, than when TFSI is performed alone.

Herpes Zoster Brachial Plexopathy: Direct Steroid Injection.

Herpes zoster (shingles) is a viral disease, characterized by painful skin eruptions and neuropathic sensory symptoms. Motor involvement and brachial plexus involvement in herpes zoster are rare conditions. Together with antiviral medication and pain therapy, palliative and supportive modalities take an important role in the treatment of herpes zoster. It is well documented in previous reports that oral or intravenous steroid administrations may be additive in management. In this case report, positive effects of direct steroid injection onto the brachial plexus via ultrasonography guidance in a patient with motor weakness due to herpes zoster involvement of brachial plexus is presented.

Spontaneous Spinal Subarachnoid Hemorrhage with Residual Arachnoid Cyst: A Case Report.

Spinal subarachnoid hemorrhage is a rare condition that usually occurs because of secondary causes and idiopathic spontaneous ones are extremely rare. We report a 56-year-old woman who presented with severe headache, neck pain and urinary retention. Magnetic resonance imaging revealed subarachnoid hemorrhage that extended from T1 to lumbar vertebrae. She was treated conservatively and symptoms were resolved within 1 month. An asymptomatic arachnoid cyst was observed on the follow-up magnetic resonance imaging after 3 months with no neurologic deterioration. She was still stable clinically and radiologically at the end of 19 months. Spinal subarachnoid hemorrhage is a surgical emergency, although in some cases a conservative approach may be useful.

Endovascular Treatment of Wide Necked Ruptured Saccular Aneurysms with Flow-Diverter Stent.

AIM: Flow diverter (FD) stents have been used in the treatment of unruptured intracranial aneurysms. There are a few studies that report the use of these devices in ruptured blister-like aneurysms. We present 5 consecutive patients, who had ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, with no other treatment options, treated with FD stents and coil embolization. MATERIAL AND METHODS: Between September 2012 and April 2015, 139 ruptured aneurysms of 133 consequent patients were treated. Of these, 48 were surgically treated aneurysms. Five of the remaining 85 aneurysms treated with FD stents. Three aneurysms were in the posterior communicating artery, and 2 were in the supraclinoid internal carotid artery (ICA). Partial coil embolization was performed in addition to FD stents in three patients. All patients were treated in the first 3 days after bleeding. RESULTS: Technical success was 100%. Inappropriate deployment of silk stent and partial thrombus formation occurred in one patient due to the jailed micro-catheter. Inappropriate apposition of stent was corrected with a balloon, and the thrombus resolved with tirofiban, tissue plasminogen activator (t-PA) injections. No other complication or death occurred related to the procedure. One patient who had a giant ICA aneurysm and Fisher grade 4 bleeding died due to vasospasm, cerebral edema and sepsis on the postoperative 13 < sup > th < /sup > day. The other patients were followed-up uneventfully with computed tomography angiography (CTA) at 6th month and digital subtraction angiography (DSA) at 12 < sup > th < /sup > month. CONCLUSION: FD stents can be used in the treatment of ruptured large wide necked or side branch close to the neck of saccular aneurysms when other treatment options can not be used.

Lumbosacral Conjoined Root Anomaly: Anatomical Considerations of Exiting Angles and Root Thickness.

AIM: Conjoined nerve roots (CNR) can be damaged during lumbar disc surgery and lead to neuropathic pain due to excessive retraction. The purpose of this study was to investigate the factors that facilitate the identification of CNRs that can lead to the loss of fragments in the secondary axilla, nerve root injury or unpleasant surprises during lumbar disc surgery. Accordingly, we aimed to measure the thicknesses and exit angles of the nerve roots close to the pedicle to obtain scientific data regarding rare double roots. MATERIAL AND METHODS: The data of 612 patients who were operated for lumbar disc disease in our hospital between 2012 and 2014 were reviewed retrospectively. Twenty one cases of CNR were detected in this series. RESULTS: The mean nerve root thickness was 1.92 ± 0.45 mm for medially located roots and 3.33 ± 0.95 mm for laterally located roots. The comparison of medially located roots versus laterally located roots revealed a significant difference in mean values (p < 0.0001). The mean exit angle was 12.290± 4.890 for medially located roots, and 22.110 ± 5.420 for laterally located roots (p < 0.0001). In addition, the exit angles of the medially and laterally located roots increased as going down to caudal levels, (p=0.005, p=0.042). CONCLUSION: CNRs are congenital anomalies that are usually diagnosed during the surgical procedure and affect the success of discectomy. The presence of a more medially located or thinner root during surgical exploration and the absence of the fragment in the axilla in extruded or sequestered discs usually indicate a conjoined nerve root closer to the pedicle.

Patient Selection and Efficacy of Intradiscal Electrothermal Therapy with Respect to the Dallas Discogram Score.

AIM: Intervertebral disc degeneration can cause severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption unresponsive to conservative medical care. We aimed to evaluate 12-month pain and functional outcomes and predictors of clinical success in patients with discogenic back pain treated with IDET with respect to the Dallas Discogram Scale (DDS). MATERIAL AND METHODS: This was a retrospective analysis of patients undergoing IDET for low back pain from 2009 through 2014 at Baskent University, Department of Neurosurgery. A total number of 120 consecutive patients data were collected retrospectively. The degree of disc degeneration was graded using the DDS during discography, and the presence of a high intensity zone (HIZ) on magnetic resonance (MR) imaging was noted. The primary outcome measure was assessment of back pain severity based on the Visual Analogue Scale (VAS); function was assessed by the Oswestry Disability Index (ODI). Follow-up examinations for ODI and VAS scores were assessed at 1, 6, and 12 months post-treatment. Outcomes were discussed with respect to morphological changes in intervertebral discs on discogram. RESULTS: There was an average 57.39% and 47.16% improvement in VAS and ODI scores, respectively, between pretreatment and 12 months follow-up (p < 0.0001 for both comparisons). Predictors of 12-month clinical success was depended on DDS (p < 0.0001), a HIZ on MR imaging (p < 0.0001). CONCLUSION: Durable clinical improvements can be realized after IDET in select surgical candidates with mild disc degeneration and HIZ, discography, and low-grade DDS, with more effective treatment results.

Association Between Brain Venous Drainage, Cerebral Aneurysm Formation and Aneurysm Rupture.

AIM: The brain venous drainage dominance is generally divided into three groups; right or left dominance and co-dominance. There is no study in the literature examining the link between brain venous drainage and aneurysm formation or rupture. Our aim was to evaluate the association between venous dominancy, aneurysm formation and rupture. MATERIAL AND METHODS: Eighty-six patients, who underwent cerebral digital subtraction angiography and who had cerebral aneurysms, were included in the study. The angiographic images, patient charts, and tomography images were scanned retrospectively. We recorded the aneurysm"s location, size, dome to neck ratio (D/N); the patient"s gender, age, whether there was a ruptured aneurysm, smoking history, and/or hypertension; dominance of venous drainage, aneurysm side, Fisher scores and the World Federation of Neurosurgical Societies (WFNS) Grading System for Subarachnoid Hemorrhage scores for patients who had a ruptured aneurysm. We assessed whether or not venous drainage was associated with rupture of the aneurysm and if venous dominance was a predisposing factor for aneurysm formation like location, size, and hypertension. RESULTS: There was a statistically significant association between venous dominance and side of aneurysm; and also a statistically significant association between venous dominance and rupture. There was a positive correlation between hypertension and rupture. The most common aneurysm location was the anterior communicating artery, followed by the middle cerebral artery. CONCLUSION: Brain venous drainage dominance may be a predisposing factor for aneurysm formation and it can be predictive for rupture.

Biphasic Pulmonary Blastoma Associated with Cerebral Metastasis.

Pulmonary blastoma is a very rare malignant tumor of the lungs. A biphasic pulmonary blastoma was histologically diagnosed by a characteristic finding as it was mainly constituted of immature tumor tissue that had both epithelial and mesenchymal components. We present a case of a 68-year-old man with biphasic pulmonary blastoma. The patient underwent cranial metastatectomy and left lung upper lobectomy. Although the tumor was resected, there was rapid metastasis to the cranial, liver, kidney and multiple bones. Although radiotherapy and chemotherapy were administrated, the patient died about 6 months postoperatively. Close follow-up and aggressive chemotherapy should be considered for such tumours. In the light of this case, the authors review the pathologic, clinical, radiological and therapeutic features of this very rare malignant lung tumor.

The retrospective analysis of the effect of balloon kyphoplasty to the adjacent-segment fracture in 171 patients.

STUDY DESIGN: Analysis of the adjacent-segment fractures in 171 balloon kyphoplasty (BK)-performed patients. OBJECTIVE: The purpose of this study was to investigate the risk factors for new symptomatic vertebral compression fractures (VCF) after BK. SUMMARY OF BACKGROUND DATA: Although there are many studies about the incidence and possible risk factors for occurrence of adjacent-level fractures, there is no consensus on the increased risk of adjacent-level fractures after BK. METHODS: We performed a retrospective analysis of 171 patients treated with percutaneous kyphoplasty. The follow-up period was 41.04±21.78 months. The occurrence of new symptomatic VCF was recorded after the procedure. We evaluated the variables of patient age and sex, the amount of injected cement, the initial kyphotic angle (KA) of VCF, the change of the KA after BK, the severity of osteoporosis, and the percentage of height restoration of the vertebral body. Furthermore, possible risk factors were reported for new symptomatic VCFs. RESULTS: The only 2 factors identified as being significantly associated with adjacent-level fractures were the sex (P=0.001) of the patient and the preoperative KA (P=0.013). The patients with new symptomatic compression fracture had higher initial KA than those without fractures. The female group had higher risk than the male group in occurrence of the new vertebra fractures. The severity of the osteoporosis (low bone mineral density) was not a determinant in occurrence of the new VCF after BK. CONCLUSIONS: If the patients experience severe or mild back pain with higher preoperative KA, especially in the first 2 months, then they deserve detailed radiologic examination. To avoid subsequent fracture in the same or adjacent level, vertebral body should be filled adequately and sagittal balance should be obtained with KA correction. BK alone did not influence the incidence of subsequent VCF.

Curved and folded micropatterns in 3D cell culture and tissue engineering.

Cells live in a highly curved and folded micropatterned environment within the human body. Hence, there is a need to develop engineering paradigms to replicate these microenvironments in order to investigate the behavior of cells in vitro, as well as to develop bioartificial organs for tissue engineering and regenerative medicine. In this chapter, we first motivate the need for such micropatterns based on anatomical considerations and then survey methods that can be utilized to generate curved and folded micropatterns of relevance to 3D cell culture and tissue engineering. The methods surveyed can broadly be divided into two classes: top-down approaches inspired by conventional 2D microfabrication and bottom-up approaches most notably in the self-assembly of thin patterned films. These methods provide proof of concept that the high resolution, precise and reproducible patterning of cell and matrix microenvironments in anatomically relevant curved and folded geometries is possible. A specific protocol is presented to create curved and folded hydrogel micropatterns.