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    Comparison of Short-Segment Pedicle Instrumentation with Supplemental Hook Fixation under Axial Compression in Relation to Graft Positioning and Posterior Ligamentous Integrity: A Biomechanical Study on the Calf Spine
    (Korean Society of Spine Surgery, 2021) Muratlı, Sedit Kıvanç; Berk, Haluk
    Study Design: Biomechanical study. Purpose: This study investigates the benefits of supplemental hook fixation (SHF) on short-segment pedicle instrumentation (SSPI) in relation to anterior strut graft positioning. In addition, it seeks to determine whether the integrity of the posterior ligamentous complex (PLC) affects the stability of the spinal construct. Overview of Literature: Implant and/or bone failure with progressive kyphotic deformity after SSPI is common. To prevent this, several approaches are available, including SHF, anterior strut grafting, use of longer spinal constructs, and extension of the fusion to additional adjacent segments. Methods: A total of eight calf spines were instrumented with SSPI (n=4) and SHF (n=4) with strain gauges on the implants. Strain measurements were performed under axial compression in the following order: intact spine, corpectomy, ventral positioned strut grafting, posterior positioned strut grafting, ventral positioned grafting with resected PLC, and corpectomy with resected PLC. Results: The SHF group showed slightly lower strain values than SSPI in instrumented corpectomy-only specimens, but there were no statistically significant differences between them (p >0.05). The SHF group was significantly more stable than SSPI when strut grafting is employed, regardless of the location of the grafts (p =0.000). In the SSPI group, ventral positioning of the graft contributed significantly to the stability (p =0.000). There was no statistically significant difference between the ventral or posterior positioning of the graft in the SHF group (p =0.187). In addition, the integrity of the PLC did not affect stability in either group (p >0.005). Conclusions: Although not statistically significant, our investigation demonstrated that the most stable method was the SHF along with ventral positioned strut graft. However, if the SSPI is the treatment of choice, ventral positioned strut graft support will be useful in minimizing the risk of implant failure and progressive kyphotic deformity.
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    Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study
    (Elsevier Science Inc, 2020) Yilmaz, Hurriyet; Zateri, Coskun; Ozkan, Aslihan Kusvuran; Kayalar, Gulseren; Berk, Haluk
    BACKGROUND CONTEXT: Studies have shown that adolescent idiopathic scoliosis (AIS) prevalence varies between 0.35% and 5.2% and it is generally accepted as an average of 2%-3% in children under age 16. There are a few narrow-scope studies based on school screening performed on the epidemiology of AIS in Turkey. Prevalence rates reported by these studies are lower than reported in neighboring countries. Of note, they were conducted in single cities, generally based on small sample size, and are different from each other in terms of methodology and age groups. The present study was conducted based on a large population in 85 schools of 40 provinces in Turkey. PURPOSE: The aim of this study was to determine the prevalence of AIS in Turkey. Secondary outcomes were to determine age, gender, curve distribution, using standard tests, and radiological verification. STUDY DESIGN: A cross-sectional epidemiological study. PATIENT SAMPLE: The sample size was calculated to estimate the prevalence of AIS in children aged 10-15 years in Turkey. OUTCOME MEASURES: Adams' forward bending test, angle of trunk rotation measurement, and posture analysis were used to screen. Students who had an angle of trunk rotation greater than or equal to five (>= 5 degrees) with scoliometer measurement or who had a positive forward bending test were referred to the mobile X-ray unit located in the school-yard on screening day. Their diagnosis was confirmed using Cobb angles of greater than or equal to 10 (>= 10 degrees). METHODS: Medical personnel, mobile radiological tools, and logistical support needed during fieldwork were provided by the Directorate General for Health Research, Ministry of Health Republic of Turkey. Spine and posture were examined in upright standing position. Examiners looked for shoulder asymmetries, scapular prominence, unequal waist, and lower limb length discrepancy. Potential scoliosis diagnosis was verified with onsite radiographic examination. Cases with a Cobb angle of >= 10 degrees detected in any region were accepted as scoliosis. The direction and location of scoliosis were determined according to the Scoliosis Research Society terminology criteria. RESULTS: A total of 16,045 students were reached whose informed consent forms were signed by their parents. The prevalence of AIS was found to be 2.3% (female, 3.1%; male, 1.5%). Radiological confirmation rate was 98.8%; 256 (69.3%) of 369 adolescents with scoliosis had a single curvature and 108 (29.3%) had a double curvature. The most common single curve type was a lumbar curve. In all, 90.5% of cases with AIS had a mild (range of 10 degrees-19 degrees) Cobb angle. CONCLUSIONS: The prevalence of AIS was 2.3% in Turkey. This prevalence rate was considerably higher than the values in previous regional studies conducted in Turkey; however, it was close to generally accepted averages in the literature. One of the strongest aspects of the study was that radiologic confirmation of each suspected case was made during the screening. (C) 2020 Elsevier Inc. All rights reserved.