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  • Küçük Resim
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    Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery?
    (Biomed Central Ltd, 2014) İnanmaz, Mustafa Erkan; Köse, Kamil Çağrı; Işık, Cengiz; Atmaca, Halil; Başar, Hakan
    Background: The prevalence of postoperative wound infection in patients with neuromuscular scoliosis surgery is significantly higher than that in patients with other spinal surgery. Hyperbaric oxygen has been used as a supplement to treat postsurgical infections. Our aim was to determine beneficiary effects of hyperbaric oxygen treatment in terms of prevention of postoperative deep infection in this specific group of patients in a retrospective study. Methods: Forty two neuromuscular scoliosis cases, operated between 2006-2011 were retrospectively reviewed. Patients who had presence of scoliosis and/or kyphosis in addition to cerebral palsy or myelomeningocele, postoperative follow-up >1 year and posterior only surgery were the subjects of this study. Eighteen patients formed the Hyperbaric oxygen prophylaxis (P-HBO) group and 24, the control group. The P-HBO group received 30 sessions of HBO and standard antibiotic prophylaxis postoperative, and the control group (received standard antibiotic prophylaxis). Results: In the P-HBO group of 18 patients, the etiology was cerebral palsy in 13 and myelomeningocele in 5 cases with a mean age of 16.7 (11-27 yrs). The average follow-up was 20.4 months (12-36mo). The etiology of patients in the control group was cerebral palsy in 17, and myelomeningocele in 7 cases. The average age was 15.3 years (8-32 yrs). The average follow-up was 38.7 months (18-66mo). The overall incidence of infection in the whole study group was 11.9% (5/42). The infection rate in the P-HBO and the control group were 5.5% (1/18), and 16.6% (4/24) respectively. The use of HBO was found to significantly decrease the incidence of postoperative infections in neuromuscular scoliosis patients. Conclusion: In this study we found that hyperbaric oxygen has a possibility to reduce the rate of post-surgical deep infections in complex spine deformity in high risk neuromuscular patients.
  • Küçük Resim
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    Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine
    (British Editorial Soc Bone Joint Surgery, 2014) Köse, Kamil Çağrı; İnanmaz, Mustafa Erkan; Işık, Cengiz; Başar, Hakan; Çalışkan, İslam
    The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6 degrees (12 degrees to 28 degrees) which was corrected to -1.8 degrees (-5 degrees to 3 degrees) post-operatively and 2.4 degrees (0 degrees to 8 degrees) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.