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Although there are many reports regarding the spinal surgical applications before the 19th century, the definition of spinal disorders and application of the most novel surgical techniques have been performed in last 2 centuries. Lumbar spinal stenosis was reported in the first half of the 20th century. The definition of the lumbar spinal stenosis was commonly attributed to Dr. Verbiest. However, there were some reports regarding the symptoms attributable to lumbar spinal stenosis before him. On the other hand, Dr. Sarpyener, a Turkish surgeon, reported for the first time congenital spinal stenosis, a special variety of spinal stenosis. The aim of this study is to review the biography, scientific studies, and spine applications of Dr. Sarpyener, a pioneer in the field of spina bifida and congenital spinal stenosis. [ABSTRACT FROM AUTHOR]

Rationale: Kikuchi-Fujimoto disease (KFD) also known as histiocytic necrotizing lymphadenopathy is an exceedingly rare cause of cervical lymphadenopathy, commonly accompanied by systemic symptoms such as fever, fatigue, night sweats, myalgia, skin rash., Patient Concerns: In this paper, we report the case of a 22-year-old female patient who experienced a flare-up of leukocytoclastic vasculitis that was complicated by the appearance of a cervical lymph node with dysphagia, fever and nausea., Diagnosis: Infectious and autoimmune workup came back negative., Interventions: Excisional lymph node biopsy was done and the pathology results were consistent with histiocytic necrotizing lymphadenitis in keeping with Kikuchi-Fujimoto disease., Outcomes: Patient improved on intravenous corticosteroids and was discharged on per os prednisone. Six month follow-up shows complete resolution of her symptoms., Lessons: KFD should be ruled out in patients with autoimmune or inflammatory diseases who develop lymphadenopathies., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

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Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented., Competing Interests: The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest., (© 2018 American Heart Association, Inc.)

Study Design: Retrospective clinical study., Objective: The aim of this study is to reveal the effectiveness of HBO therapy in iatrogenic spinal infections intractable to antibiotic therapy alone., Summary of Background Data: The efficiency of hyperbaric oxygen (HBO) therapy, which is currently being used in many areas, has been proven in infections in deep and superficial locations and in osteomyelitis. The aim of this study is to reveal effectives of HBO therapy in iatrogenic spinal infections intractable to antibiotic alone therapy., Methods: HBO therapy was given to 19 cases of iatrogenic spinal infection between 2008 and 2013. Adjuvant HBO therapy was applied to cases that had exhibited no improvement in clinical and laboratory findings despite medical treatment for at least 3 weeks. Several parameters including demographic characteristics, surgical area, etiology and the surgical treatment modality, microbiology (culture material and causative organism), clinical and laboratory results, duration of HBO therapy, and outcome were reviewed., Results: The mean age was 54.6 years (range: 32-75 years). Iatrogenic spinal infections were most frequent in the lumbar region. It occurred after spine instrumentation in 12 cases and after micro-discectomy in 7 cases. The average number of HBO therapy sessions applied was 20.1 (range: 10-40). Wound discharge and clinical and laboratory findings recovered in all cases at the end of the therapy course. No revision or removal of the instrumentation was necessary in the instrumented cases., Conclusion: HBO therapy is a treatment modality, which is safe and efficient as an adjuvant therapy in the treatment of infections. It was also seen to be effective in the prevention of revision procedures and instrumentation failures in iatrogenic osteomyelitis cases, which had occurred following spinal instrumentation., Level of Evidence: 4.

Study Design: Analysis of chapters related to spinal fractures and dislocations of an important medical book from medieval age. A historical study., Objective: To present the sections on spinal fractures and dislocations in the treatise of Paulus Aegineta or Paul of Aegina, and to discuss their relationship with preceding and subsequent literature., Summary of Background Data: Paul of Aegina was influenced by precedent great authors and provided a significant link in the transmission of the surgical knowledge to present day via the prominent physicians of Islamic golden age., Methods: The edition on which this study is based was translated from Greek into English by Francis Adams and was published in 1846 by The Sydenham Society in London in 3 volumes. The related sections were examined and compared with the treatises of earlier and subsequent writers., Results: Although Paul of Aegina was influenced by Hippocrates, Celsus, and Galen, he also put forward his own opinions. The most prominent representatives of the Islamic Golden Age, Rhazes, Albucasis, Avicenna, and Haly Abas were influenced by Paul of Aegina., Conclusion: Paul of Aegina, who was the last representative of the Byzantine School, compiled approximately 1000 years of medical knowledge up to his own era. By taking on this task, he provided a significant link in the transmission of ancient knowledge to later generations. He is also considered as a bridge between Western and Eastern medicines as he conveyed medical knowledge of the ancient era to Islamic authors.

Spinal stenosis may rarely involve both cervical and lumbar spines. An alternative surgical strategy used for the treatment of combined cervical and lumbar spinal stenosis is presented. Two cases with symptomatic combined stenosis of the cervical and lumbar spinal canal are described. Simultaneous surgery was performed in both cases. The combined stenosis of the cervical and lumbar spinal canal dictates careful neurologic and neuroradiologic examinations. Simultaneous surgery is an alternative approach for patients with symptomatic multilevel spinal stenoses, whose general conditions necessitate a one-session and short-lasting surgery.

Several diseases may cause craniovertebral instability warranting occiput-cervical fusion. As occipital screw and rod constructs are becoming more popular, requiring that screws be placed either medially or laterally in the occipital bone, the need for clearer anatomical and computed tomography (CT)-confirmed data regarding the relative thickness of the occiput in its various localities has become more critical. In 18 cadaveric specimens, the occipital bone was divided into 35 measurable segments. Transversely, the occipital bone was divided into five lines starting at the level of the inion; horizontal lines then proceeded inferiorly in 1-cm segments, 1, 2, 3, and 4 cm below the level of inion. In a comparable fashion, the occipital bone was divided vertically, starting at the midline, and proceeding laterally also in 1-, 2-, and 3-cm segments. Anatomical measurements of thickness were directly performed using a Vernier caliper. Results were directly correlated with axial CT measurements of bony thickness. Anatomical and CT measurements closely correlated within the same specimen, but there was significant interspecimen variability. The marked differences in the occipital bone anatomy noted between specimens indicates that patients undergoing occipital screw placement for cranial-cervical instability would benefit from preoperative occipital CT evaluations.

The authors describe a patient with severe lower back and left leg pain in the early postoperative period after cardiac surgery. Radiologic examination revealed gas in the spinal epidural space at the level of L4-5. The pain could not be relieved with analgesics and the patient underwent lumber surgery after cardiac surgery. After decompression, the patient improved and was discharged with no symptoms.

One hundred fourteen patients (64 men, 50 women) with prior lumbar disc surgery underwent a reexploration for intractable back and/or leg pain. The finding in revision surgery included disc herniation in 89 cases (78%), epidural fibrosis in 14 cases (12.2%), adhesive arachnoiditis in 4 cases (3.5%), isolated lateral spinal stenosis in 3 cases (2.6%), and iatrogenic instability in 4 cases (3.5%). Review of operative reports of patients who underwent a first operation in our institute revealed that seven cases (12.5%) had a second laminotomy without a discectomy in addition to the previous laminotomy and discectomy performed in the same session. Fifty-six of the patients with disc hemiation in revision surgery had a true recurrence. Disc hemiation was protruded in 38 cases (42.8%), extruded in 44 cases (49.4%), and sequestrated in 7 cases (7.8%). The outcome was assessed using Prolo's functional and economic scale. According to Prolo's scale, a good outcome was detected in 79 cases (69.2%), moderate in 22 (19.2%), and a poor outcome was detected in 13 cases (11.4%). The best outcome was achieved in patients with disc hemiation. It is concluded that recurrent disc disease is the most important cause of reexploration. This fact dictates a careful preoperative workup and discectomy in the first intervention. The likelihood of occurrence of disc herniation in the negative laminotomy level (i.e., laminotomy without discectomy procedure) also requires a careful preoperative radiologic workup before lumbar disc surgery.

The obstetric outcome (abortions, stillbirths, prematurity, mature births, and congenital abnormalities) in a group of 1522 consecutive pregnant patients who had smallpox vaccinations during recent pregnancies was compared to that in a similar control group of 2024 consecutive pregnant patients who did not receive any antenatal vaccination. Results showed that smallpox vaccination during pregnancy did not increase the rate of stillbirths, premature births, or congenital abnormalities in patients who had been vaccinated at least once before. However, it was noted that women vaccinated during the first trimester of pregnancy more often had children with clubfoot. Therefore, unless there is an immediate risk, we recommend delaying smallpox vaccination during pregnancy until the second or third trimester. However, during epidemic, vaccination should be done regardless of gestational age.

The aim of this study was to determine the types, patterns, and frequencies of congenital anomalies among newborns of both consanguineous and nonconsanguineous parents in southern Iran. From 9526 consecutive pregnancies observed, 9623 newborns resulted (9431 singleton and 95 sets of multiple gestation). There were 7261 newborns from nonconsanguineous parents and 2362 (24.5%) babies from consanguineous marriages. Of the total pregnancies, 1.54% resulted in malformed children (1.53% of singleton and 2.1% of multiple gestations). The incidence of congenital abnormalities in newborns of nonconsanguineous parents was 1.66% as compared to 4.02% for newborns of the consanguineous group. Major and multiple malformations were found to be slightly more common in the consanguinous group. Prematurity, prenatal mortality rate, and congenital abnormalities were more common in the consanguineous group. Probably the closer the familial relationship of the parents, the greater the chances of congenital abnormalities.