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Aim: To compare the preoperative and postoperative increased signal intensity (ISI) outcomes of cervical spondylotic myelopathy (CSM) patients who underwent posterior decompression and fusion, and to assess the correlation between ISI changes and postsurgical clinical prognosis., Material and Methods: The results from 123 patients were evaluated. In addition to demographic data, such as age and gender, factors, including body mass index (BMI); smoking history; duration of symptoms; follow-up periods; levels of decompression and fusion; comorbidities, such as diabetes, coronary artery disease, and hypertension; ISI grading; cervical sagittal vertical axis; C2-7 cervical lordosis parameters; and Modified Japanese Orthopedic Association (mJOA) scores, were statistically analyzed preoperatively and postoperatively., Results: ISI improved in 39 patients (31.7%), remained unchanged in 53 patients (latent, 43.1%), and deteriorated in 31 patients (25.2%). There were no statistically significant differences in terms of age, gender, BMI, or levels of decompression and fusion between patients with ISI improvement, latent ISI, and worsened ISI. Patients with ISI improvement had the highest postoperative C2-7 lordosis values and shortest duration of symptoms. There was no statistically significant difference in the mJOA scores between patients with and without ISI improvement., Conclusion: ISI improvement in CSM patients undergoing posterior cervical decompression and fusion is influenced by symptom duration and preoperative-postoperative cervical lordosis values. However, this study did not find a correlation between ISI improvement and clinical recovery based on the mJOA scores.

Aim: To evaluate the clinical processes of patients with cervical postlaminectomy kyphosis (PLK) who underwent standalone posterior pedicle screw fixation surgery., Material and Methods: The results of 21 patients with cervical PLK treated using the pedicle screw method between 2015 and 2018 were retrospectively examined. Patient data included demographic information and indications for surgery. Furthermore, the following criteria were calculated for each patient: cervical sagittal vertical axis (cSVA), C2-7 cervical lordosis (CL) parameters, modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI) score and visual analogue scale score, and these were evaluated preoperatively and postoperatively statistically., Results: A total of 21 patients with PLK were evaluated. In terms of radiographic parameters, postoperative cSVA was significantly lower than the preoperative cSVA, and postoperative CL was significantly higher than the preoperative CL (p < 0.001, p < 0.001, respectively). Postoperative mJOA scores were significantly higher than the preoperative scores (p < 0.001). Both postoperative NDI and VAS scores were significantly lower than the preoperative scores (p < 0.001, p < 0.001 respectively)., Conclusion: Pedicle screw fixation was found to be an effective treatment for cervical PLK. Although this technique is not preferred by many spine surgeons because of its high complication rate, it has a positive effect on the quality of life scores and provides optimal correction.

Aim: To evaluate the outcomes of percutaneous spinal cord stimulation (PSCS) in patients with failed back surgery syndrome (FBSS) in an academic tertiary care center., Material and Methods: The hospital records of patients with FBSS who had undergone PSCS were retrospectively reviewed. A total of 19 patients with FBSS matched the search criteria, and among them, 16 were included in the study, in whom permanent implantable pulse generators (IPGs) were implanted. Demographic, clinical and surgical outcomes were evaluated., Results: Twelve (75%) women and 4 (25%) men with a median age of 50 years (range, 35-80 years) were analysed. The average number of surgeries before PSCS was 1.6 ± 1.2 (range, 1-4). Pain was localised in the back and leg in 81.25% of the patients. The mean duration of symptoms was 6.3 ± 3.1 years (range, 2-10 years). The mean length of trial period was 16.3 ± 6.8 days (range, 7?29 days). In this study, the permanent implantation rate was 84.2% (16/19). The mean follow-up time was 18.3 ± 3.9 months (range, 14-26 months). Postoperative back/leg numerical pain rating scale (NPRS) score was significantly lower than preoperative back/ leg NPRS score (p < 0.001). The postoperative Oswestry Disability Index (ODI) score was significantly lower than the preoperative ODI score (p < 0.001)., Conclusion: PSCS is a safe and effective treatment method for patients with FBSS. In this study, the high rate of improvement in the outcome scores may be attributed to the small sample size and early PSCS implantation.

Aim: Some restriction and complications, such as progression of kyphosis, incidence of axial neck pain and decrease of postoperative cervical range of motion are concern. We designed this retrospective clinical study to evaluate the effect of laminoplasty by preserving the muscle attachments of C2 and C7 spinous processes on range of motion (ROM), axial neck pain and cervical lordosis., Material and Methods: Twenty-seven cases with cervical spondylotic myelopathy underwent open-door laminoplasty with the protection of muscle attachments to the C2 and C7 spinous process and laminae between 2007 and 2013. At the end of the followup, cases were evaluated with preoperative and postoperative modified Japanese Orthopedic Association (mJOA) scores, recovery rate, ROM, lordosis angle and visual analogue scale (VAS). Also, patients were divided into two groups and evaluated according to the magnetic resonance imaging (MRI) findings, with or without T2 signal change., Results: The mean age of the patients was 66 years. The mean follow-up duration was 25 months. The postoperative mJOA scores were significantly higher than the preoperative mJOA scores (p < 0.001). The recovery rate was 57.4%. Although the postoperative VAS score was higher than the preoperative VAS score and the mean postoperative ROM was lower than the preoperative ROM there was no significant difference between preoperative and postoperative VAS score and ROM (p > 0.05). The postoperative lordosis angle was significantly lower than the preoperative lordosis angle (p < 0.05). There were no significant differences regarding the postoperative lordosis angle, ROM and mJOA scores with or without T2 signal change on MRI., Conclusion: Protection of the anatomic structures around the cervical spine such as the muscles and ligaments provides us better results regarding ROM and cervical axial pain.

Aim: Misplacement of pedicle screw is the serious complication of spinal surgeries. Intraoperative imaging techniques and navigation systems are currently in use for the prevention of this complication. The aim of this study was to document the results of our experience with the navigation and intraoperative imaging technique and to share our experience with our colleagues., Material and Methods: Between 2011 and 2014, one hundred and two patients underwent instrumented spinal surgery while using intraoperative computed tomography (iCT) and a navigation system. All patients had a CT scan performed no more than three days postoperatively to confirm adequate placement of the screws. The accuracy of pedicle screw placement was assessed by postoperative CT scan. Pedicle violations were graded according to an established classification system., Results: In the 36-month period, a total of 610 screws in 102 patients were evaluated. Stabilization surgery was performed in the lumbosacral region in 51 (50%) patients, lumbar region in 35 (34.31%) patients, cervical region in 5 (4.9%) patients, thoracolumbar region in 7 (6.86%) patients and thoracic region in 4 (3.92%) patients. Of the 610 screws, 396 (64.91%) were placed in lumbar, 66 (10.81%) in thoracic, 106 (17.37%) in sacral and 42 (6.8%) in cervical vertebrae. Of the 610 screws, 599 screws (98.18%) were placed without a breach. Grade 1 breaches occurred in 8 screws (1.31%), Grade 2 breaches occurred in 2 screws (0.32%), and Grade 3 breaches in 1 screw (0.16%). No dural defect or neurological deficit occurred after the surgeries., Conclusion: The use of an iCT scan associated with a navigation system increases the accuracy of pedicle screw placement. This system protects the surgical team from fluoroscopic radiation exposure and the patient from the complications of screw misplacement and repeated surgeries.

Aim: The aim of this study was to investigate the neuroprotective effect of magnesium sulfate and dexamethasone on oxidative damage in intrauterine ischemia., Material and Methods: In this study, 19-day pregnant rats were divided into five groups. Fetal brain ischemia was achieved in the ischemia/ reperfusion (I/R) group by bilaterally closing the utero-ovarian artery with aneurysm clips for 30 min and subsequently removing the aneurysm clips for 60 min for reperfusion. Mg (600 mg/kg) and dexamethasone (0.25 mg/kg) were administered 20 min before the I/R insult. The lipid peroxidation in the brain tissue was determined by the concentration of thiobarbituric acid reactive substances (TBARS). The mitochondrial score was calculated after an evaluation with electron microscopy., Results: Both the electron microscope and TBARS data showed a significant difference between the control and I/R groups. The Mg and dexamethasone treatment groups exhibited significantly lower TBARS values compared to the IR group. Similarly, the mitochondrial scores in the Mg and dexamethasone treatment groups were significantly lower than those in the I/R group., Conclusion: Result showed that magnesium sulfate and dexamethasone prevent lipid peroxidation and reduce mitochondrial injury thus suggests neuroprotective effects in fetal rat brain in intrauterine ischemia-reperfusion (I/R) injury.