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Aim: To measure C2-related morphometric parameters in a Turkish population., Material and Methods: The computed tomography (CT) images of three groups (Group 1: paediatric cases aged 1-6 years, Group 2: age7-16 years, and Group 3: adult cases), who had cervical spine CT were used to measure some morphometric parameters for safe C2 translaminar screw fixation. The measured parameters included thickness, height and length of the C2 lamina on both sides and the C2 lamina-midline angle., Results: C2 lamina thickness at the thinnest point on the right and left sides was found to be 4.4 ± 0.5 mm and 4.6 ± 0.5 mm in Group 1, 5.3 ± 0.8 mm and 5.6 ± 0.8 mm in Group 2, and 6.8 ± 1.4 mm and 7.0±1.5 mm in Group 3, respectively (p > 0.05). The height of the C2 lamina at the thinnest point on the right and left sides was found to be 5.8 ± 0.8 mm, and 5.8 ± 0.7 mm in Group 1,10.4 ± 1.4 mm and 10.6 ± 1.4 mm in Group 2, and 10.6 ± 1.8 mm, and 10.7 ± 1.5 mm in Group 3, respectively (p > 0.05). The mean length of the C2 lamina was found to be 20.6 ± 2.4 mm in Group 1, 31.4 ± 4.1 mm in Group 2, and 36.7 ± 3.3 mm in Group 3 (p < 0.05). There was no significant difference between Group 2 and Group 3 in respect of mean lamina angle (44&ordm; vs 45&ordm;) but it was lower in Group 1 (35&ordm;)., Conclusion: This study revealed the appropriateness of C2 anatomy for safe C2 translaminar screw fixation.

Rigid and semi-rigid fixations are investigated several times in order to compare their biomechanical stability. Interbody fusion techniques are also preferable for maintaining the sagittal balance by protecting the disk height. In this study, the biomechanical comparison of semi-rigid and rigid fixations with posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures is conducted under trauma. There were four different test groups to analyze the effect of acute load on treated ovine vertebrae. First and second groups were fixed with polyetheretherketone rods and transforaminal lumbar interbody fusion and posterior lumbar interbody fusion cages, respectively. Third and fourth groups were fixed with titanium rods and posterior lumbar interbody fusion and transforaminal lumbar interbody fusion cages, respectively. The drop tests were conducted with 7 kg weight. There were six samples in each group so the drop test repeated 24 times in total. The test samples were photographed and X-rayed (laterally and anteroposteriorly) before and after drop test. Two fractures were observed on group 1. Conversely, there were no fractures observed for group 2. There were no anterior element fractures for both groups 1 and 2. However, one fracture seen on group 3 was anterior element fracture, whereas the other three were posterior element fractures. All three fractures were anterior element fractures for group 4. Treated vertebrae with polyetheretherketone rods and posterior lumbar interbody fusion cages showed the best durability to the drop tests among the groups. Semi-rigid fixation gave better results than rigid fixation according to failed segments. Posterior lumbar interbody fusion cages seem to be better option for semi-rigid fixation, however mentioned surgical disadvantages must be considered.

Spine deformities are among the most important spinal disorders, affecting health-related life quality. Although there are some studies in past centuries, most spine deformity-related studies and research has started in the last century. Many surgical techniques, performed between 1960 and 1990, made scoliosis a touchable pathology. These techniques started with Harrington"s system, wiring techniques, pedicle screw techniques, and all other universal techniques. Anterior and 360 degree techniques contributed to this process. The use of spinal osteotomies, and recent technologies such as magnetic rods, intraoperative neuromonitoring added much to the body of knowledge of literature and improved the outcome. Advancement has not been limited to surgery only and diagnostic advancements had also impact to this process. Surgical techniques performed in the west have been performed soon in our countries. Currently almost all surgical techniques for treatment of spine deformities can be performed in our country. This article reviews historical aspects related to the diagnosis and treatment of spine deformities in Turkey.

Aim: Cervical disc herniation (CDH) can be treated using different anterior and posterior methods. Anterior cervical discectomy and fusion (ACDF) is currently gold standard and provides bony fusion and good clinical outcome. Recently many studies reported good clinical and radiological outcomes in cases who underwent anterior cervical discectomy (ACD) and reconstruction with empty cage. This study aimed to review our results after cervical microdiscectomy reconstructed with empty polyether ether ketone (PEEK) cage., Material and Methods: Twenty-five cases with single level CDH who underwent microdiscectomy were included to this study. Reconstruction was performed using empty bladed cervical PEEK cages. Clinical (Visual analogue scale (VAS) and Odom scores) and radiological results (intervertebral disc and foraminal heights, mean cervical spine lordosis angle, and fusion rate) were reviewed one day and one year after surgery., Results: There were 18 males and 7 females, aged between 25 and 54 years (mean: 40.8). Mean neck and arm VAS scores reduced from 2.9 to 1.4, and from 7.2 to 1.8, respectively. Odom scores were found to be 1.6 and 1.4 at 1st day and one year postoperatively, respectively. Subsidence was seen in three cases (12%). There was no significant change in heights of neural foramina and intervertebral discs, and no change in cervical spine lordosis, when compared postoperative 1st day and one year radiographs. Fusion was detected in 92% of cases in one year., Conclusion: Bladed cervical cages are safe with almost no risk of dislocation. Empty cages provide acceptable rates of fusion and subsidence.

Object: The authors reviewed the results of "skip" corpectomy in 29 patients with multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL)., Methods: The skip corpectomy technique, which is characterized by C-4 and C-6 corpectomy, C-5 osteophytectomy, and C-5 vertebral body preservation, was used for decompression in patients with multilevel CSM and OPLL. All patients underwent spinal fixation using C4-5 and C5-6 grafts, and anterior cervical plates were fixated at C-3, C-5, and C-7., Results: The mean preoperative Japanese Orthopaedic Association score increased from 13.44 +/- 2.81 to 16.16 +/- 2.19 after surgery (p < 0.05). The cervical lordosis improved from 1.16 +/- 11.74 degrees to 14.36 +/- 7.85 degrees after surgery (p < 0.05). The complications included temporary hoarseness in 3 cases, dysphagia in 1 case, C-5 nerve palsy in 1 case, and C-7 screw pullout in 1 case. The mean follow-up was 23.2 months. The final plain radiographs showed improved cervical lordosis and fusion in all cases., Conclusions: The authors conclude that the preservation of the C-5 vertebral body provided an additional screw purchase and strengthened the construct. The results of the current study demonstrated effectiveness and safety of the skip corpectomy in patients with multilevel CSM and OPLL.

Objective: The optimal treatment modality for traumatic spondylolisthesis of the axis is still a controversial issue. Many conservative, posterior and anterior fixation techniques have been used to treat these injuries. The C2 pars (isthmus) was used as a novel screw anchor point in upper cervical spine injuries. The direct C2 pars screws are also used to fixate the posterior and anterior parts of the C2 vertebra., Methods: Four cases with traumatic spondylolisthesis of the axis were presented. The cases were classified as type II according to Levine and Edwards' classification. C2 pars was used to fixate the posterior C2 elements to the C2 body., Results: While a direct C2 pars screw was used for C2 fixation in two cases, a C2 pars-C3 lateral mass screw-plate system was used in the remaining two cases. A clinical and radiological improvement was achieved in all cases., Conclusion: It is concluded that the C2 pars can be used as screw-bone interface in upper cervical spine traumas. The direct C2 pars screw can fixate the C2 in well-selected cases. The additional C2-3 fixation increases the C2-3 stability.

Object: Lumbosacral spondylolisthesis (LSS) is a common disorder that often requires a stabilization and fusion procedure. The aim of this study was to determine the early neuroimaging-detected results of instrumentation-assisted (in situ) fusion with no attempt at surgical reduction of the deformity in patients with low-grade LSS. The neuroimaging results were evaluated to determine the extent of reduction and its correlation with different parameters., Methods: Thirty patients with low-grade LSS underwent short-segment transpedicular screw fixation; surgical reduction was not attempted. All patients underwent plain anteroposterior and lateral lumbar radiography, flexion-extension lateral lumbar radiography, and computerized tomography and magnetic resonance imaging of the lumbar spine before and after surgery. Postoperative measurements were determined on the late (9 to 12-month) postoperative radiographs. The findings were recorded and grouped. Correlation analysis was performed among the radiological findings, body mass index, age, and sex. Paired-sample t-tests were performed for each paired group to determine statistically significant differences. There was no significant difference in extent of deformity reduction in patients with different lordotic angles, sagittal-plane rotation angles, and intervertebral disc heights. The extent of reduction was statistically significant at the L4-5 level (p < 0.05), in patients younger than 50 years of age (p < 0.05), and in those in whom the facet joint angle was increased (p < 0.05)., Conclusions: The authors found that in cases of low-grade LSS, short-segment posterior stabilization (in situ fusion and fixation) does not require surgical reduction and in fact is associated with a measurable reduction when used as the sole treatment.

Study Design: Four combinations of cable-graft-screw fixation at C1-C2 were compared biomechanically in vitro using nondestructive flexibility testing. Each specimen was instrumented successively using each fixation combination., Objectives: To determine the relative amounts of movement at C1-C2 after instrumentation with various combinations of one or two transarticular screws and a posterior cable-secured graft. Also to determine the role of each component of the construct in resisting different types of loading., Summary of Background Data: Spinal stiffness increases after instrumentation with two transarticular screws plus a posterior wire-graft compared with a wire-graft alone. Other C1-C2 cable-graft-screw combinations have not been tested., Methods: Eight human cadaveric occiput-C3 specimens were loaded nondestructively with pure moments, and nonconstrained motion at C1-C2 was measured. The instrumented states tested were a C1-C2 interposition graft attached with multistranded cable; a cable-graft plus one transarticular screw; two transarticular screws alone; and a cable-graft plus two transarticular screws., Results: The transarticular screws prevented lateral bending and axial rotation better than the posterior cable-graft. The cable-graft prevented flexion and extension better than the screws. Increasing the number of fixation points often significantly decreased the rotation and translation (paired t test; P < 0.05). Axes of rotation shifted from their normal location toward the hardware., Conclusions: It is mechanically advantageous to include as many fixation points as possible when atlantoaxial instability is treated surgically.