Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

ABSTRACTinjury classification and severity score (TLICS), described by Vaccaro et al. (7). In this system, most type A fractures of the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification system, even burst-type fractures in the thoracolumbar junction that had usually been operated on before, are classified within the conservative treatment group █ INTRODUCTION T raumatic spinal fractures are quite common lesions. In recent years, there has been a trend towards conservative treatment instead of surgery for thoracic, thoracolumbar, and lumbar fractures. This is partly due to the widening usage of a new classification system, thoracolumbar AIM: Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. MATERIAL and METHODS:Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. RESULTS:Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients (>60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. CONCLUSION:Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.

Context: Spinal osteoid osteoma (OO) is an infrequent tumor and due to both its smallness and complex anatomy of the spine diagnosis is challenging. In addition, associated undefined soft tissue changes on magnetic resonance imaging (MRI) frequently cause misdiagnosis. Evidence Acquisition: PubMed database was searched for "spinal osteoid osteoma" and larger clinical series related to clinical pictures, diagnosis or treatment modalities, and also case reports with especially soft tissue changes and related to special treatment modalities were introduced to the study. It was aimed at to make conscious practitioners of clinical and diagnostic characteristics of spinal OOs. Results: Spinal OOs constitute about 10% of OOs and the most of the tumors are seen in adolescents or young adults. The most frequent clinical picture is painful scoliosis or torticollis according to the level of the tumor. On MRI that is the most frequently performed imaging modality in the patients with painful scoliosis, undefined extensive bone and soft tissue changes is quite frequent. Clinicians must be aware from these findings and they must suspect and investigate the patients with bone scintigraphy and thin sectioned computerized tomography that both of them together can show presence of the lesion and provide to determine exact location of the lesion. Despite the increasing number of the studies using percutaneous ablation techniques, standard treatment of spinal OOs is still intralesional excision. Surgical excision usually provides immediate pain relief, and recurrence is not frequent. Conclusions: Diffuse paravertebral muscle and soft tissue involvement having resemblance to myositis is not quite rare in the patients with spinal OO. This may be the sole finding on MRI and it must be alert for the clinicians to look for small OO nidus by bone scintigraphy or thin sectioned CT scan.

Laminar screw technique is easy, safe and effective at C2, C7 and upper thoracic levels. Some modifications may be required due to the anatomical variations.It can be used at other subaxial levels also in theselected cases that other techniques could not be performed.

Objective: One of the new treatment methods for lumbar degenerative disc disease is percutaneous application of a hydrogel implant into the intervertebral disc. The aim of this method is to increase the disc height, to widen the neural foramen, and to decrease discogenic pain and leg pain caused by root compression. However, there may be serious complications related to intervertebral hydrogel implants that have been increasingly used during the last few years because of their minimally-invasive nature. A case with lumbar root compression due to hydrogel implant is being reported.Case Report: A 61-year-old male was admitted with severe left leg pain due to compression of the left L5 root by a hydrogel implant that had been percutaneously introduced into the L4-5 disc level 6 months ago.On magnetic resonance imaging, a lesion compressing the left L5 root at the L4-5 disc level and mimicking a disc herniation was seen. It was hypointense on T1-weighted and hyperintense on T2-weighted sections. Sonuç: İntervertebral hidrojel implant komşu dokulardan su çekerek şişer. Aslında disk yüksekliğinin artmasını sağlayan asıl mekanizma da budur. Ancak eğer çok fazla şişerse, spinal kanal içine taşıp kök ya da dural kese basısına ve nörolojik bulgulara neden olabilir.

Follicular type thyroid carcinoma (FTC) rarely presented with spinal metastasis. We aimed to report such a case and to review the literature. Method: A 45 year old male with L2 metastasis of FTC was reported, and other 26 cases were found in literature. Characteristics of the patients and tumors were evaluated. Results: Total 27 patients were 55.2±15 years of age, and male/ female ratio was 12/15. Nineteen patients had paresis of extremities, 9 of them could not mobilize on admission. Total resection of the spinal tumor had been performed in 14 cases and subtotal resection in 5. Radioactive iodine treatment had been added in 20 cases with or without other adjuvant treatment. Twenty-three patients had been followed for 43.7±53.2 months. Only four of them died 214, 66, 36 and 7 months after their presentations. Out of other 19 cases, 13 had been neurologically normal. Type of surgery (total resection versus others) the only factor affecting outcome. In the patients treated with total resection, outcome had been statistically better. Conclusion: Spinal metastasis as initial finding is very rare in the patients with FTC. However, prognosis is quite well with total tumor resection and adjuvant treatment. This cancer type must be kept in mind for differential diagnosis and must be screened in the patients with spinal tumors.

Objective: To evaluate and compare the radiological changes on adjacent mobile segments and clinical findings in patients having undergone single-segment simple anterior cervical discectomy versus discectomy plus intervertebral fusion. Material and Methods: Twenty-five patients were treated with discectomy plus fusion and 20 patients with simple discectomy. Clinical pictures of the patients were evaluated with ODOM criteria before and 1 year after operation, and their improvement rates were calculated. The disc heights of superior and inferior adjacent segments, superior and inferior foramen heights, superior and inferior end plate heights of superior and inferior adjacent segments, new osteophyte development, segmental angulation and loss of cervical lordosis were evaluated on cervical radiographies before and 1 year after operation. Results: Although there were new degenerative findings in adjacent mobile segments in all patients when preoperative and postoperative measurements were compared, these radiological findings did not translate into clinical findings. In the fusion group, radiological degeneration findings were seen more frequently statistically; however, clinical results were not different between the two groups. On the other hand, loss of lordosis was significantly more frequent in the simple discectomy group. Conclusion: Although adding fusion to single-segment anterior cervical discectomy caused more frequent radiological degenerative changes in adjacent segments after 1 year compared to simple discectomy, clinical results were similar. It was thought that longer follow-up was necessary to observe clinical adjacent segment disease that was expected to become more frequent because of excessive mobility due to fusion. Keywords: Discectomy, intervertebral disc displacement, spinal fusions -adverse effects ÖZETTek seviye anterior servikal diskektomi ile diskektomi ve füzyon sonrası radyolojik ve klinik komşu seviye dejenerasyonu oranlarının karşılaştırılması Amaç: Tek seviye basit anterior servikal diskektomi uygulanan olgularda komşu seviyelerde gelişen radyolojik değişiklikleri ve klinik bulguları diskektomiyle birlikte füzyon uygulanan olgularda görülenlerle karşılaştırmak. Gereç ve Yöntemler: Diskektomiyle birlikte füzyon uygulanan 25, basit diskektomi uygulanan 20 olgu vardı. Olguların klinik tabloları girişim öncesinde ve girişimden 1 yıl sonra ODOM kriterlerine göre değerlen-dirildi ve iyileşme oranları hesaplandı. Üst ve alt komşu seviyelerdeki disk yükseklikleri, üst ve alt foramen yükseklikleri, üst ve alt komşu seviyelerin üst ve alt son plaklarının yükseklikleri, yeni osteofit gelişimi, segmenter açılanma ve servikal lordoz derecesi girişim öncesi ve girişimden 1 yıl sonraki grafilerde ölçüldü. Bulgular: Girişim öncesi ve 1 yıl sonraki ölçümler karşılaştırıldığında bütün olgularda bütün komşu seviyelerde yeni dejeneratif değişiklikler ortaya çıkmasına rağmen radyolojik bulgular klinik bulgulara yansıma-mıştı. Füzyon grubunda radyolojik dejenerasyon bulguları anlamlı olarak daha sı...

The aim of this study was to assess the effect of sociodemographic and professional characteristics of nurses working in the surgical services on their burnout and job satisfaction levels. Method: The study was conducted with 95 nurses, who were voluntary to participate in the study, among 104 nurses working in the surgical services (except for outpatient clinics and emergency surgery units). Introductory information form, Maslach Burnout Inventory, and Minnesota Satisfaction Questionnaire were used in order to collect the data. The statistical analysis was performed using frequency and percentage distribution, t-test, one-way analysis of variance, Tukey test, Kruskal-Wallis test, and Mann-Whitney U test. Results: It was found that 78.9% of the nurses were female, 28.4% were in the age group of 30-34 years, 38.9% had a bachelor's degree, 56.8% were single, 46.3% were working in the institution for 0-3 years, 57.9% had no children, 64.2% had an income equal to expenses, and 60% used public transportation. It was observed that the emotional exhaustion and depersonalization subscale scores of the nurses were higher in the age group of 25-29 years than the age group of 20-24 years (p<0.05) and 40 years and over (emotional exhaustion p<0.01; depersonalization, p<0.05). It was determined that the depersonalization subscale scores of those without children were higher than those having two and more children (p<0.05). Personal accomplishment subscale scores of the nurses working for 9-11 years were lower than the other groups. It was observed that those having a working year of 1-3 years had higher scores on extrinsic satisfaction than those having a working year of 4-8 years (p<0.05). All score of nurses who chose the profession due to finding a job quickly was significantly lower than the other groups (p<0.05). It was determined that intrinsic, extrinsic and general satisfaction of those who Amaç: Bu çalışma, cerrahi servislerinde çalışan hemşirelerde sosyodemografik ve mesleki özelliklerin, tükenmişlik ve iş doyumu düzeylerine etkisinin değerlendirilmesi amacıyla yapıldı. Yöntem: Araştırma cerrahi servislerinde çalışan (poliklinikler ve acil cerrahi birimler dışında) 104 hemşireden çalışmaya katılmayı gönüllü olarak kabul eden 95'i ile gerçekleştirildi. Verileri toplamak amacıyla hemşirelere tanıtıcı bilgi formu, Maslach Tükenmişlik Ölçeği ve Minnesota Doyum Ölçeği uygulandı. İstatistiksel analizde; frekans ve yüzde dağılımı, t-test, tek yönlü varyans analizi, Tukey testi, Kruskal-Wallis test, Mann-Whitney U testleri kullanıldı. Bulgular: Hemşirelerin %78,9'unun kadın, %28,4'ünün 30-34 yaş grubunda, %38,9'u lisans mezunu, %56,8'i bekar olduğu, %46,3'ünün 0-3 yıldır kurumda çalıştığı, %57,9'unun çocuk sahibi olmadığı, %64,2'sinin gelirinin gidere eşit olduğu, %60'ının toplu taşımayla ulaşım sağladığı saptandı. Yirmi beş-yirmi dokuz yaş grubu hemşirelerin duygusal tükenme ve duyarsızlaşma alt boyut puanlarının 20-24 yaş grubundan (p<0,05), 40 yaş ve üzeri hemşirelerden (duygusal tükenme p<0,01; duyarsızlaşma, p<0,05) da...