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    C7-T1 anterior closing wedge bone-disc-bone osteotomy for the treatment of cervical yyperlordosis in muscular dystrophy a new technique for correction of a rare deformity
    (Lippincott Williams & Wilkins, 2014) Köse, Kamil Çağrı; Çalışkan, İslam; Bal, Emre; İnanmaz, Mustafa Erkan; Işık, Cengiz
    Study Design. A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported. Objective. To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters. Summary of Background Data. Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors' knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously. Methods. Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation. Results. The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up. Conclusion. Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine.
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    Convex Short Segment Instrumentation and Hemi-Chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae A Simple Treatment Option for Patients Under 5 Years Old
    (Lippincott Williams & Wilkins, 2013) Kose, Kamil Cagri; Inanmaz, Mustafa Erkan; Altinel, Levent; Bal, Emre; Caliskan, Islam; Isik, Cengiz; Ergan, Volkan
    Study Design:A case series depicting the results of a novel surgical technique.Objective:To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.Summary of Background Data:Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.Methods:Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively.Results:The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees.Conclusions:Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves.
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    The Use of Intralaminar Screws in Patients With Spinal Deformity
    (Lippincott Williams & Wilkins, 2013) Kose, Kamil C.; Inanmaz, Mustafa E.; Atmaca, Halil; Basar, Hakan; Isik, Cengiz; Bal, Emre
    Study Design:Retrospective study.Objective:To demonstrate that intralaminar screws (ILS) can be used as supplements in spinal deformity surgery in the thoracic and lumbar levels in pediatric and adult patients.Summary of Background Data:Rigid posterior fixation of the spine is generally accomplished using pedicle screws, hooks, or wires. ILSs are useful tools when other spinal fixation techniques have failed or the bony anatomy precludes hook or screw placement.Materials and Methods:All spinal deformity patients (primary/revision) operated between 2007 and 2011 were retrospectively reviewed. The patients with ILS were included in the study. The anteroposterior and lateral standing x-rays were evaluated in terms of preoperative and postoperative coronal and sagittal deformities. The number and level of ILS, intraoperative complications, and postoperative complications were noted.Results:There were 20 patients (12 male and 8 female). The mean age was 21.75 years. The mean follow-up period was 17.4 months. Fifty-seven ILS were inserted. Seventeen screws were used in the uppermost to lowermost levels. Forty screws were used in the middle. There was 1 lamina fracture and screw pull out (1.75%). There were 3 canal violations (corrected intraoperative) and 2 instrument prominences which required implant removal. The mean preoperative/postoperative cobb angles were 78.5 degrees/27.8 degrees and the mean preoperative/postoperative kyphosis angles were 57.2 degrees/32.5 degrees, respectively. The loss of correction was 1.2 degrees. There were no neurological deficits and no instrument failures.Conclusions:ILS are safe and effective when used in deformity correction. However, biomechanical studies and randomized controlled trials are needed to conclude whether ILS will be considered a first-line technique, or will remain a technique for salvage situations.