Scoliosis refers to curves exceeding 10 degrees observed through posterioanterior direct radiography. In fact, the diagnosis for idiopathic scoliosis is accepted to exclude already available causes. The aim of this paper was to review the etiopathogenesis, classification systems and the treatment management of idiopathic scoliosis. A search in the National Library of Medicine (Pubmed) database using the key words 'idiopathic' and 'scoliosis' was performed. For the literature review, papers concerning the etiopathogenesis, classification and treatment were selected among these articles. A search in the National Library of Medicine (Pubmed) database using the key words 'idiopathic' and 'scoliosis' yielded 4518 articles published between 1947 and 2013. The main hypothesis put forward included genetic factors, hormonal factors, bone and connective tissue anomalies. King, Lenke, Coonrad and Peking Union Medical College (PUMC) classifications were the main classification systems for idiopathic scoliosis. Exercise, bracing and anterior, posterior or combined surgery when indicated are the choices for the treatment. Every idiopathic scoliosis case has to be managed to its own characteristics. It is the post-operative appearance that the surgeons are perhaps the least interested but the adolescent patients the most interested in. The aim of scoliosis surgery is to restore the spine without neurological deficit.

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Object Sexuality is an important aspect of human life. Sexual activity may be affected in lumbar disc herniation through different mechanisms. The aim of this study is to evaluate patients' sexual problems and sexual behavior patterns before and after surgical treatment of lumbar disc herniation. Methods Forty-three patients were included in the study (mean age 41.4 years). A visual analog scale, the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and a sexuality assessment questionnaire developed for this study were administered to the patients to evaluate pain and sexual dysfunction. Results Fifty-five percent of the men and 84% of the women reported experiencing sexual problems after the onset of low-back pain. The most common sexual problems were decreased sexual desire (18%) and premature ejaculation together with erectile dysfunction (18%) for the male patients, and decreased sexual desire (47%) for the female patients. The frequency of sexual intercourse before the operation was reduced in 78% of cases compared with the pain-free period. Postoperatively, the patients first attempted sexual intercourse a mean of 26.5 days after surgery. The frequency of intercourse was found to have increased (p = 0.01), while description of any type of sexual problem had decreased (p = 0.005) significantly. Conclusions Lumbar disc herniation has negative effects on sexual life, and not enough attention is given to the patients' sexual problems by the physicians. Decreased sexual desire and decreased sexual intercourse are the most commonly reported problems. Taking time during examination and giving simple recommendations may improve sexuality and life quality of the patients.

AIM:The term kyphosis is used to describe the spinal curve that results in an abnormally rounded back. Kyphosis may develop due to trauma, developmental anomalies, degenerative disc disease, inflammatory diseases, and infectious diseases and also iatrogenic. The aim of this paper is to review the etiopathognesis and the treatment management of kyphosis. METHODS:A search in the National Library of Medicine (Pubmed) database using key word 'kyphosis' and was made. For the literature review, papers concerning etiopathogenesis, classification and treatment were selected among these papers. RESULTS:A search in the National Library of Medicine (Pubmed) database using key word 'kyphosis' yielded 7506 papers published between 1916 and 2013. The main papers about kyphosis were congenital, Scheuermann, tumour related, neuromuscular, posttraumatic, infectionrelated, iatrogenic kyphosis. CONCLUSIONS:Every patient with kyphosis should be treated based on her/his current state and needs. It should always be remembered that the patients with negative sagittal balance can compensate it with the hip flexion but it is far more difficult to compensate the positive sagittal balance. The main goal of surgery to treat the kyphotic patients is to correct the sagittal curve and also restore a spinal balance within an acceptable range above the hips and knees.

AIm: Cervical spine is the most kinetic segment of the whole vertebrae. The radiologic imaging methods concern with the morphologic changes but give no functional data. At flexion, spinal cord strains, anterior osteophytic compression increases. At extension, spinal canal gets narrower, cord shortens and gets thicker, compression of posterior ligament gets abberant and cord compression increases. mATErIAl and mEThOds: 258 cervical spondylotic myelopathy (CSM) cases were scanned by conventional magnetic resonance imaging (MRI) and additionally dynamic MRI. Contributions of dynamic cervical MRI to the surgical plans and results were evaluated. rEsulTs:We had sagittal and axial T2W MR scans at flexion and extension, in addition to the neutral cervical MR imaging. We found that the AP diameter of spinal canal is increased 14.9 % in flexion and decreased 13.4 % in extension relative to the neutral MR imaging. CONClusION:The changes of the cord compression and the transvers area of cord which is the most important prognostic indicator in spinal diseases and also the area of spinal cord and subarachnoid space can be detected via dynamic axial sections of MRI. Dynamic MR images may be helpfull in the decision making for the surgical treatment of CSM.KEywOrds: Cervical, Cervical spondylotic myelopthy, Dynamic, MRI ÖZ AmAÇ: Servikal vertebra omurganın en hareketli bölümüdür. Radyolojik incelemeler omurga yapısı hakkında bilgi verse de fonksiyonel olarak herhangi bir veri sağlamamaktadır. Fleksiyon duruşunda omurilik gerilir ve ön tarafta yer alan osteofitik değişikliklerin basısı artmaktadır. Ekstansiyon duruşunda ise spinal kanal daralmakta, omurilik kısalmakta ve genişlemekte ve arka tarafta yer alan posterior ligamentlerin basısı artmaktadır. yÖNTEm ve GErEÇlEr: 258 servikal spondilopatik miyelopati hastası klasik MR görüntülerine ek olarak dinamik MR görüntüleri ile incelendi. Dinamik servikal MR görüntülemeleri ile cerrahi planlama ve sonuçları incelendi. BulGulAr:Hastaların fleksiyon ve ekstansiyon duruşunda T2 ağırlıklı sagital ve aksiyel kesitlerine ek olarak nötr duruşta servikal MR görüntüleri elde edildi. Hastaların ön-arka spinal kanal çapı nötral duruşla karşılaştırıldığında fleksiyon duruşunda %14,9 artarken, ekstansiyon duruşunda %13.4 azalmaktadır. sONuÇ: Spinal hastalıklarda spinal kord basısındaki değişiklikler ve spinal kanalın transvers alanındaki değişiklikler prognostik önem taşımaktadır. Spinal kord ve subaraknoid alan ölçümleri dinamik MRG ile elde edilen aksiyel kesitlerden elde edilebilir. Dinamik manyetik rezonans görüntülemeleri servikal spondilopatik miyelopatinin cerrahi kararını vermede yardımcı olmaktadır.

Pott's disease of the craniovertebral junction is extremely rare. The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical stabilization with fusion and antitubercular therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis. This is a retrospective study of the management and outcome in 10 consecutive patients in whom features of spinal cord (with or without) compression were observed, and CVJ tuberculosis was diagnosed in two different neurological departments between 1990 and 2002. They ranged in age from 15 to 72 years. The onset of symptoms was either acute or subacute. Patients presented with neck and occipital pain (90%), progressive tetraparesia (40%), sensory symptoms (40%), neck stiffness (30%) and urinary dysfunction (20%). The disease caused spinal cord compression in six patients, atlantoaxial dislocation in five patients, basilar impression in one and upper vertebral column destruction without dislocation in three. Two patients presented with multiple spinal tuberculosis. Antitubercular therapy was used in all cases for 15 months. Surgical treatment performed in all patients. Four patients underwent transoral drainage of retropharyngeal abscess with granulation tissue and one odontoidectomy. Six patients then underwent occipitocervical (occiput -C3 or -C4) fusion with insertion of titanium plate and screw. Postoperatively, ATT was prescribed for 15 months. At long-term follow-up (median 50.2 months), functional status considerably improved. Two patients died 2 months later due to myocardial infarction. Patients with CVJ with features of cervical myelopathy are ideally treated with transoral decompressive procedures followed by occipitocervical fusion, because this therapy provides immediate neurological improvement, stability and allows early mobilization. The long-term prognosis in patients with this disease is excellent, provided it is treated with appropriate surgical intervention and with adequate duration of ATT. This approach provides excellent access to this region, with a low operative morbidity and no mortality.

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° to 14.36 ± 7.85° 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.

This article describes the clinical and radiological outcomes of a comparison of posterior dynamic transpedicular stabilization and posterior rigid transpedicular stabilization with fusion after decompression in the treatment of degenerative spondylolisthesis. This prospective clinical and radiologic study was conducted between 2004 and 2007 and included 46 patients, of whom 33 were women (71.7%) and 13 were men (28.3%). Mean patient age was 61.67+/-10.80 years (range, 45-89 years). Twenty-six patients who underwent lumbar decompression and posterior dynamic transpedicular stabilization were followed for a mean of 38 months (range, 24-55 months). In the fusion group, 20 patients who underwent lumbar decompression and rigid stabilization with fusion were followed for a mean of 44 months (range, 26-64 months). The intervertebral space measurements of the dynamic group at the preoperative examination and at 12 and 24 months postoperatively were statistically significantly higher than the intervertebral space measurements of the fusion group (P<.05). In the dynamic group, complications occurred in 2 patients; the first was a screw malposition, which was improved with revision surgery within 1 month of the initial surgery, and the second was a fusion performed in the second year in 1 patient because the patient reported continued pain. In the fusion group, adjacent segment disease was observed in 1 patient, with subsequent reoperation. Lumbar decompression and posterior dynamic transpedicular stabilization yield satisfactory results in the treatment of degenerative lumbar spondylolisthesis and can be considered a valid alternative to fusion.