Cem Atabey

Objective: This study sought to evaluate the long-term clinical efficacy and patient-reported outcomes of decompression combined with instrumented posterolateral fusion in elderly patients with lumbar spinal stenosis through a retrospective analysis and comparison with the current literature. Materials and Methods: A retrospective analysis was performed on 103 patients aged >60 years with LSS who underwent posterolateral stabilization and fusion surgery. Clinical outcomes were evaluated at a mean follow-up of 18 months (range, 12–36 months) using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS). Results: The mean patient age was 66.4 years (range, 60–83); 56 were female and 47 were male. The mean duration of preoperative symptoms was 12 years (range, 2–16 years). All patients had received prior medical treatment and physical therapy. The L4–L5 level was the most commonly affected segment (n = 78). Mean preoperative ODI and VAS scores were 80.7 ± 8.4 (range, 34–100) and 8.77 ± 0.85 (range, 2–10), respectively. Postoperatively, mean ODI and VAS scores improved to 20.5 ± 9.8 (range, 0–100) and 2.05 ± 1.57 (range, 0–10), respectively (p < 0.0001). Postoperative satisfaction assessment showed that 96 patients (93.2%) would choose to undergo the operation again. Seven patients (6.8%) reported dissatisfaction, primarily due to comorbid joint disease, weight gain, or heavy physical labor. Conclusion: In patients over 60 years of age with LSS, decompression with adjunctive transpedicular fixation and posterolateral fusion provides effective neural protection, significant pain relief, and functional recovery, with consistently favorable outcomes.

Objective: Vertebroplasty is a method that stabilizes the fracture and relieves pain by injecting cement into the vertebral body that has lost its height for some reason. Cement injection can also be done through kyphoplasty and cannulated screw. During the injection, protrusion of the cementum from the corpus is a complication that must be avoided in this procedure. Cement extending out of the corpus may cause pulmonary cement embolism (PCE) via the azygos vein. Case: A 76-year-old female patient was admitted to our clinic with the complaint of low back pain that had been going on for one year. The patient, who did not have motor or sensory deficits in the examination, described neurogenic claudication at 200 meters as well as sensitivity in the lumbar region. An osteoporotic collapse fracture in the L1 vertebra was detected in the patient's imaging. Transpedicular fixation, decompression, and cement-augmented pedicle screw were applied to the patient. After the operation, vena azygos cement embolism was detected in the thoracolumbar computed tomography (CT) scan conducted for follow-up. Although detailed tests were performed for pulmonary embolism (PCE), no findings were detected in the asymptomatic patient. During the follow-up examination after discharge, the patient did not report any respiratory complaints, pain in the lumbar region, or neurogenic claudication complaints. Conclusion: PCE may develop after cement leakage into the azygos vein during cement injection. Although most PCEs remain asymptomatic, sometimes serious or even fatal sequelae have been reported. Cement overflows not reflected in fluoroscopy during the procedure can be detected by post-procedure imaging, and patients can be protected from serious complications.

PurposeSacral slope (SS), Lumbar lordosis (LL), Pelvic tilt (PT), Pelvic incidence (PI), Sagittal vertical axis (SVA) measurements regarding anatomical structure and orientation of the lumbosacral region are very important for surgical planning and postoperative follow-up of patients. The lumbosacral transitional vertebra, which is determinant in the formation of these measurements, is effective the sacral vertebra shape and can show various anatomical variations, referred to as "sacralized L5" or "lumbarized S1". MethodsThese variations can significantly alter the sacral surface longitudinally concave on the ventral side and convexity on the dorsal side, which are observed under normal conditions. Therefore, during surgical planning in the spine, the sacrum should be determined radiologically and the vertebrae should be counted correctly. The aim of this study is to demonstrate a practical use for determining the orientation of the sacrum for sagittal balance calculation, and to recognize the sacralized L5 or lumbarized S1 segment as LSTV to avoid incorrect level surgery.ResultsMetrologically, a new index was created using the "Anterior Translational Arch (ATA1)" distance and the "Anterior Translational Angle (ATA2)" angle. 527 cases (83.3%) with anatomically normal sacrum, 35 cases (5.5%) with lumbalization and 71 cases (11.2%) with sacralization were evaluated using this index.ConclusionAs a conclusion, the index calculated in terms of “Anterior Translational Arch (ATA1)” distance and “Anterior Translational Angle (ATA2)” provides a simple measurement to determine the transitional vertebra.

This study aims to evaluate facet tropism in younger patients with lumbar spondylolysis and to investigate the role of facet tropism in the development of spondylolysis. Between February 2013 and December 2015, a total of 102 male patients with bilateral L5 pars defect including 53 with spondylolysis and 49 control subjects were included in this case-control study. The facet joint angles were measured bilaterally and axially at the level of L3-4, L4-5, L5-S1 using computed tomography (CT). The classification was made as follows: A difference between two reciprocal facet joint angles of 12° indicated severe tropism. A total of 612 angles including 318 facet joint angles from 53 patients with spondylolysis and 294 facet joint angles from 49 control subjects were measured. L3-4 measurements in the control group showed no tropism in 87.8% (n=43), moderate tropism in 12.2% (n=6), and severe tropism in 0% (n=0). L4-5 measurements in control group showed no tropism in 79.6% (n=39), moderate tropism in 20.4% (n=10), and severe tropism in 0% (n=0). L5-S1 measurements in the control group showed no tropism in 69.4% (n=34), moderate tropism in 28.6% (n=14), and severe tropism in 2.0% (n=1). The mean facet joint angles in the spondylosis group were 32.9±5.1°, 37.5±5.4°, and 41.2±7.8° at the levels of L3-4, L4-5, and L5-S1, respectively. The mean facet joint angles of the control group were 33.2±5.7°, 39.7±4.9°, and 42.2±4.9° at the levels of L3-4, L4-5, and L5-S1, respectively, indicating no significant difference between the right and left mean facet joint angles between the groups (p>0.05). The frequency of facet tropism and the difference between right and left facet joint angles for all three levels were significantly higher in the spondylolysis group (p<0.05). Facet tropism at the level of L5-S1 was significantly more frequent than facet tropism at L3-4 level (p<0.05). Our study results show that the rate of facet joint tropism is higher in the patients with spondylolysis, suggesting that facet tropism seems to play a role in the etiology of spondylolysis as a predisposing factor.

Object: Nerve compressions due to osteochondromas are extremely rare. The aim of this retrospective study was to investigate the mechanisms, diagnostic evaluations, and treatment of nerve lesions due to osteochondromas, and to review the literature. Methods: The authors retrospectively reviewed their clinic data archive from 1998 through 2008, and 20 patients who were operated on due to peripheral nerve injuries caused by osseous growth were enrolled in the study. Patients' age, duration of symptoms, localizations, intraoperative findings, and modified British Medical Research Council (MRC) and electromyography data obtained from hospital records were evaluated. The literature on this topic available in PubMed was also reviewed. All 20 patients underwent surgery, which consisted of tumor excision performed by orthopedic surgeons and nerve decompression performed by neurosurgeons. Results: There were 17 men and 3 women included in the study, with a mean age of 21 years (range 18–25 years). Three patients had multiple hereditary exostoses, and 17 had a solitary exostosis. All of the patients underwent en bloc resection. The most common lesion site was the distal femur (45%). The peroneal and posterior tibial nerves were the structures that were affected the most frequently. The mean follow-up was 3.9 years (range 2–7 years). After the surgery, all patients (100%) experienced good sensory recovery (modified MRC Grade S4 or S5). Conclusions: To the authors' knowledge, no large series have reported peripheral nerve compression due to exostoses. The authors have several recommendations as a result of their findings. First, all patients with peripheral nerve compression due to an osteochondroma should undergo surgery. Second, preoperative electromyographic examinations and radiographic evaluation, consisting of MRI and CT to provide optimal information about the lesion, are crucially important. Third, immediate treatment is mandatory to regain the best possible recovery. And fourth, performing nerve decompression first and en bloc resection of osteochondroma consecutively in a multidisciplinary fashion is strongly recommended to avoid peripheral nerve injury.

Prolymphocytic leukemia (PLL) is a generalized malignancy of the lymphoid tissue characterized by the accumulation of monoclonal lymphocytes, usually of B cell type. Involvement of the central nervous system (CNS) is an extremely rare complication of T-cell prolymphocytic leukemia (T-PLL). We describe a case of T-PLL presenting with symptomatic infiltration of the brain that was histopathologically proven by stereotactic brain biopsy. We emphasize the importance of rapid diagnosis and immediate treatment for patients presenting with CNS involvement and a history of leukemia or lymphoma.

Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques.