Introduction

We prospectively examined the effect of pedicle screw placement at a young age (<5 years) for early-onset spinal deformity on the growth and development of pedicles and the spinal canal.

Introduction: After the introduction of MRI in routine diagnostic work-up, Split cord malformations (SCM) in patients with Congenital spinal deformities (CSD) is more easily diagnosed and probably overtreated.

Aim: To evaluate the necessity of neurosurgical management of SCM before corrective spinal surgery.

Study Design: Retrospective case series

Patients and Methods: Thirty-two patients aged 11 years + 8 months (4–18 years) with CSDs with a follow up of 51,7+/−26,6 months were analyzed. SCM were classified as Type I(septum dividing the spinal cord and dura into two separate hemicords) and Type II(two hemicords within single dura) according to Pang. Eighteen patients with type I underwent neurosurgical intervention (spur excision and creating a single dural cuff) before corrective surgery (15 sequential and 3 simultaneous). Fourteen patients with type II were treated with posterior instrumentation without dealing with the intraspinal abnormalities. The basic maneuvers were translation, compression and shortening to realign spinal column, avoiding distraction forces and intrusion of any instrument into the spinal canal around anomalous segments. Neurological monitoring was done by the wake-up test.

Results: At final follow up, scoliosis improved from 65,7+/−22 to 37+/−15 degrees (45%) in type I and from 74,3+/−21,8 to 39,4+/−18,7 degrees (47%) in type II. The correction loss was 2,3 degrees in patients with type I SCM and 2,9 degrees in patients with type II SCM. One patient with type I SCM had paraparesis resulting from a misplaced upper thoracic pedicle screws with total recovery after revision. Another patient with type I SCM who had simultaneous surgeries had deterioration of her preoperative neurological deficit only to recover partially. Two patients with type I SCM and one patient with type II SCM developed deep wound infections and needed multiple debridements. Two patients with type I SCM had dural leakage that needed repair.

Conclusion: Although it is a common practice to operate all SCMs before corrective surgery in CSD, it may not be necessary in type II which can be managed safely without any neurosurgical intervention.

Aim: The outcome of pelvic fractures are dependent on the anatomic reduction and stabilization of these fractures. Treatment of these fractures evolved recently and percutaneous treatment became the choice of treatment in most cases. The aim of this study is to evaluate the outcome of percutaneous treatment of unstable pelvic fractures.

Material and Methods: Twenty patients (11 female, 9 male) who had unstable pelvic fractures treated percutaneously between August 2004 and August 2006 formed the basis of study. Hospital charts, pre and postoperative PA, inlet and outlet pelvis X-rays, computed tomographies evaluated. Fractures are classified according to Young and Burgess and Injury severity scores(ISS) were calculated. SF-36 health related outcome scores, Majeed scores, Iowa Pelvic scores and Pelvic outcome scores (that also evaluates postoperative X-rays for residual anterior and posterior displacement) were calculated for the assesment of outcome.

Results: The mean age of the patients were 32(11–66) The minimum follow-up was 2 years with a mean of 33,3(24–48). Mean ISS was 31(16–50). Five patients have APC type 3, 3 patients have APC type 2, 3 patients have LC type 2, 4 patients have LC type 3, 4 patients have VS ve 2 patients have CM type injuries. Iliosacral screws are applied to all patients and for 11 patients additional anterior colon screw was applied. One anterior colon screw was removed because of an intraarticular placement and another removed for superficial infection. One iliosacral screw was revised for treatment of pseudoarthrosis. At the last follow-up meanSF-36 pain score was 82 +/−14,9 (normal for urban population: 81.0 ± 20.2) and mean functional SF-36 score was 80.5 +/− 11,8 (normal for urban population: 83.8 ± 20.0). Mean functional pelvic score was 93.3+/−8,7(19 excellent and one good clinical grade) and Iowa pelvic score was 86,2+/−2,8. Mean pelvic outcome score was 33,2+/−3,7 (maximum score is 40)

Conclusion: Percutaneous treatment of unstable pelvic fractures is the treatment of choice as if it avoids extensile approach, bleeding,wound problems and long lasting surgeries. Excellent outcomes can be achieved but since it is a technically challenging procedure good equipment and surgical experience is needed.

Two-staged exchange arthroplasty with an antibiotic-impregnated PMMA cement spacer in-between two stages has a success rate of 85% to 95% in eradication of infection. Use of vancomycine in high doses has a high potential for complications due to nephrotoxicity.

The aim of this study was to evaluate the results of two-staged exchange arthroplasty in infected hip arthroplasty using low-dose vancomycine-impregnated PMMA cement as an interim spacer between stages.

Thirty-five (20 females, 15 males, average age: 60) patients with a confirmed infected total hip arthroplasty who were treated between 1999 and 2005 were the subjects of the study. In the first stage after removal of the prosthesis and debridement, a spacer made of 40 grams of PMMA cement impregnated with 1 gr vancomycine was placed in the infected joint space. Postoperatively, patients were treated with 6 weeks of intravenous antibiotics in consultation with an infectious disease consultant. When CRP and ESR returned to normal levels, revision surgery with cementless components was performed.

The average follow-up after the second stage was 4 years. The ESR and CRP decreased significantly before the second stage with this treatment protocol (from 81.28 to 17.54 mm/h p< 0.001 and 10.05 to 0.64 mg/dl respectively, p< 0.001). The mean interval between the two stages was 193.3 days. A second debridement was needed in 4 patients (10.8 %) because they did not respond to treatment. Two patients (5.4 %) had recurrent infections after reimplantation and underwent a resection arthroplasty. None of the patients suffered from antibiotic toxicity.

Two-stage exchange arthroplasty using a low dose vancomycine-impregnated cement spacer was an effective method in treating infected hip replacements. With using a lower dose than previously reported, we were able to avoid antibiotic toxicity while effectively treating our patients with the same success rate.