AIm:The study was conducted to compare the clinical effectiveness of FJ injections (FJI) and FJ radiofrequency (FJRF) denervation in patients with chronic low back pain. mAterIAl and methOds:This study included 100 patients; 50 in FJI 50 in FJRF group. VNS, NASS and EQ-5D were used to evaluate the outcomes. All outcome assessments were performed at baseline, 3 months, 6 months and 12 months. results: FJI in early post-op but FJRF in 1st, 6th and 12th month VNS showed better results (p<0.001). There was no significant difference in the 1st (p=1) and 6th month (p=0.13) but in 12th month (p=0.04) in NASS. Increase in level number showed positive effect in NASS in FJRF group (p=0.018) but no effect in FJI group (p=0.823) in the 12th month follow-up. There was no significant difference with respect to 1st month (p=0.17), 6th month (p=0.22) and 12th month (p=0.11) post-procedure follow-ups in EQ-5D. At the short term FJI was more effective than FJRF however in midterm follow-up FJRF had more satisfying results than FJRF.COnClusIOn: To our knowledge, the first choice should be the FJI and if pain reoccurs after a period of time or injection is not effective, RF procedure should be used for the treatment of chronic lumbar pain.KeywOrds: Facet, Joint, Injection, Radiofrequency, Denervation, Low back pain ÖZ AmAÇ: Lomber faset eklem (FE) bozuklukları kronik bel ağrılarının en sık sebebidir. Bu çalışmada, kronik bel ağrılı hastalarda uygulanan FE enjeksiyonu (FEE) ve radyofrekans denervasyonunun (FER) klinik sonuçlarının karşılaştırılması amaçlamaktadır. yÖntem ve GereÇler: Bu çalışmaya 50 FEE ve 50 FER yapılan 100 hasta dahil edildi. VNS, NASS ve EQ-5D sonuçların değerlendirilmesi amacıyla kullanıldı. Sonuçlar başlangıç, 3. ay, 6. ay ve 12. aylarda elde edildi.BulGulAr: FEE işlem sonrası erken dönemde, FER ise 1., 6. ve 12. ayda daha etkiliydi (p<0,001). NASS sonuçlarında 1. (p=1) ve 6. ayda (p=0.13) anlamlı fark yokken 12. ayda (p=0,04) vardı. İşlem yapılan segment sayısı FER grubunun (p=0,018) 12. aydaki NASS sonucunu pozitif yönde etkilerken FEE grubunda (p=0,823) etkisi yoktu. EQ-5D sonuçları açısından 1. (p=0,17), 6. (p=0,22) ve 12. ayda (p=0,11) iki grup arasında anlamlı fark saptanmadı. Kısa dönemde FEE daha etkiliyken orta dönemde FER'in sonuçları daha başarılıydı. sOnuÇ: Faset eklemden kaynaklanan bel ağrılarında, FEE ve FER birer tedavi seçenekleridir. Sonuçlarımıza göre, kronik bel ağrısının tedavisinde FEE ilk seçenek olarak düşünülmeli ve bir süre sonra tekrarlayan veya FEE etkili olmadığı durumlarda FER tedavi amacıyla kullanılmalıdır.

The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting in Horner's syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this study are to clearly delineate the surgical anatomy and the anatomical variations of CST with respect to the structures around it and to develop a safer surgical method that will diminish the potential risk of CST injury. In this study, 30 cadavers from the Department of Forensic Medicine were dissected to observe the surgical anatomy of the CST. The cadavers used in this study were fresh cadavers chosen at 12-24 h postmortem. The levels of superior and intermediate ganglions of cervical sympathetic chain were determined. The distance of the sympathetic trunk from the medial border of LCM at C6, the diameter of the CST at C6 and the length and width of the superior and intermediate (middle) cervical ganglion were measured. Cervical sympathetic chain is located posteromedial to carotid sheath and just anterior to the longus muscles. It extends longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the CST and medial border of the LCM at C6 is 11.6 ± 1.6 mm. The average diameter of the CST at C6 is 3.3 ± 0.6 mm. Superior ganglion of CSC in all dissections was located at the level of C4 vertebra. The length and width of the superior cervical ganglion were 12.5 ± 1.5 and 5.3 ± 0.6 mm, respectively. The location of the intermediate (middle) ganglion of CST showed some variations. The length and width of the middle cervical ganglion were 10.5 ± 1.3 and 6.3 ± 0.6 mm, respectively. The CST's are at high risk when the LC muscle is cut transversely, or when dissection of the prevertebral fascia is performed. Awareness of the CST's regional anatomy may help the surgeon to identify and preserve it during anterior cervical surgeries.

Carpal tunnel syndrome (CTS) is a common focal peripheral neuropathy. Increased pressure in the carpal tunnel results in median nerve compression and impaired nerve perfusion, leading to discomfort and paresthesia in the affected hand. Surgical division of the transverse carpal ligament is preferred in severe cases of CTS and should be considered when conservative measures fail. A through knowledge of the normal and variant anatomy of the median nerve in the wrist is fundamental in avoiding complications during carpal tunnel release. This paper aims to briefly review the anatomic variations of the median nerve in the carpal tunnel and its implications in carpal tunnel surgery. KeywOrds: Median nerve, Anatomic variation, Carpal tunnel, Transverse carpal ligament ÖZKarpal tünel sendromu (KTS) sık görülen bir periferik nöropatidir. Karpal tünel basıncının artması median sinirin sıkışmasına ve kanlanmasının bozulmasına yol açar. Ağır vakalarda ve konservatif tedavinin yeterli olmadığı durumlarda cerrahi olarak transvers karpal ligamanın kesilmesi tercih edilir. Karpal tünelin gevşetilmesi sırasında komplikasyonlardan kaçınmak için median sinirin bu bölgedeki ayrıntılı anatomisinin ve varyasyonlarının iyi bilinmesi gereklidir. Bu derleme median sinirin karpal tüneldeki olası anatomik varyasyonlarını ve bunun karpal tünel cerrahisine etkilerini kısaca gözden geçirmek amacıyla yazılmıştır.

No abstract

Object The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. Methods The study was conducted in 30 fresh cadavers. Results The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5–6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3–4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6–7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p < 0.001). Conclusions Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.