Background: Vertebral compression fractures associated with osteoporosis reduce daily living activities. The primary risk factor for osteoporotic vertebral fractures (OVCFs) is the severity of osteoporosis, defined as low bone mineral density (BMD) in both peripheral and central regions. In addition to BMD, sarcopenia is also thought to affect OVCFs by reducing paraspinal muscle mass and strength. Objective: We aimed to evaluate the association between vertebral compression fractures and paraspinal/psoas muscle characteristics, including muscle mass and fatty degeneration, using quantitative MRI measurements. Methods: We retrospectively enrolled 77 patients aged ≥60 years who were diagnosed with acute OVCF between January 2019 and August 2023. The control group consisted of age- and sex-matched patients with osteoporosis (BMD > −2.5) who were followed up without fractures for at least six months. Demographic characteristics, relative total cross-sectional area (rTCSA) and relative functional CSA (rFCSA) of the multifidus (MF), erector spinae (ES), and psoas major (PS) were measured at the L4–5 and L5-S levels on MRI. Results: The TCSA and rTCSA of the multifidus (MF) and erector spinae (ES) muscles at both the L4-5 and L5-S1 levels did not show significant differences between the control and OVCF groups. (all p value > 0.05) The mean FCSAL4-5 of the MF 8.97 ± 2.81, ES 16.73 ± 6.49, the mean FCSAL5-1 of the MF 9.43 ± 3.27, ES 10.76 ± 5.79 in the fracture group, while the mean FCSAL4-5 of the MF 11.39 ± 2.6, ES 19.35 ± 4.04, the mean FCSAL5-1 of the MF 13.42 ± 2.56, ES 14.11 ± 4.6 in the non-fracture group. (PMFL4-5 < 0.001, PMFL5-1 < 0.001, PESL4-5 = 0.003, PESL5-1 < 0.001) The mean TCSA of the psoas muscle was significantly higher in the fracture group (17.65 ± 6.21) than in the control group (15.9 ± 4.14) (p = 0.042). Despite the significantly larger total psoas muscle mass in the fracture group, the rFCSA of the psoas muscle was lower in the fracture group (0.81 ± 0.27) compared to the control group (0.89 ± 0.25) (p = 0.046). Conclusions: The study shows that the functional muscle mass of the paraspinal muscles is significantly lower in patients with osteoporotic vertebral compression fractures (OVCF) as compared to those without fractures. Quantitative measurement of the functional capacity of the paraspinal muscles using MRI can effectively predict the risk of OVCF and enable early intervention and adopt preventive measures to reduce the incidence of these fractures.

Aim and Background: Traumatic epidural hematoma (EDH) is a rare but possibly fatal complication of head trauma in infants. In this study, infants who were younger than 1 year and followed up and treated for TEDH in our clinic were evaluated. Our series is the largest series consisting only infantile cases in the literature. Material and Methods: There were 50 patients younger than 1 year followed up and treated in our hospital between January 2011 and December 2019. Their age, gender, hospital admission signs and symptoms, trauma type, localization and thickness of the hematoma, and accompanying skull fracture were noted from their hospital files. Decisions for conservative or surgical treatment were made according to neurological status, Children Coma Scale (CCS) score, and EDH thickness, degree of the midline shift on cranial computerized tomography (CT), and presence of additional intracranial pathology. Results: Patients’ age ranged from 0 day to 12 months (7 months as median), and their male/female ratio was 30/20. Falling from a height (<1 m) was the most frequent trauma mechanism, with a 96% rate. The most common finding was irritability and unusual crying (88%). The CCS score was 5–15 (median 13). The hematoma was located most frequently in the parietal region (48%) and least frequently in the posterior fossa (2%). Linear fracture was observed in 62% of the cases. Thirty-nine (78%) patients were treated conservatively (hematoma thickness ≤17 mm). Eleven (22%) cases were surgically treated (hematoma thickness was between 15 and 40 mm (26.3 ± 6.6 mm, mean ± standard deviation [SD]). The midline shift in the operated cases was between 1.8 and 11.8 mm (6.4 ± 3 mm, mean ± SD). One of them with a hematoma thickness of 15 mm was operated for associated open depression fracture above the hematoma. Other 10 patients were operated for primarily hematoma evacuation. None of the patients treated conservatively worsened neurologically or required operation during or after hospitalization. Two patients died (4%) during hospitalization, and both of them were anisocoric on admission. The hospital stay was between 1 and 10 (median 3) days, and the follow-up period of the living patients was between 1 month and 6 years (median 24 months). All of the living patients were neurologically normal on their last controls. Conclusions: Because the symptoms and signs in infants are nonspecific, it is difficult to diagnose EDH clinically. Cranial CT should be performed in cases with irritability, swelling of the scalp, pallor, deterioration of consciousness, and anisocoria after head trauma. Traumatic EDHs with normal neurological examination, high CCS score, hematoma thickness below 20 mm, no apparent shift, and without associated brain pathology can be treated conservatively. None of those patients treated conservatively required operation after that.

Osteoporotic vertebral compression fractures (OVCF) are a common complication of osteoporosis, particularly in elderly populations. Percutaneous kyphoplasty (PKP) is a minimally invasive procedure that provides pain relief and spinal stability for patients with OVCF. However, new vertebral compression fractures (NVCF) can occur in 2% to 38% of patients following PKP, posing a significant clinical challenge. Identifying risk factors for NVCF is essential to improve patient outcomes and guide preventive strategies. A retrospective study was conducted on 193 patients aged 60 years or older who underwent PKP for OVCF at a tertiary hospital between January 2017 and December 2023. Patients were divided into 2 groups based on the occurrence of NVCF during follow-up. Preoperative imaging (CT, X-ray, and MRI) and hospital records were analyzed to assess risk factors, including age, gender, bone mineral density, Hounsfield unit (HU) values, paraspinal muscle degeneration, cement volume, and leakage. Statistical analyses were performed using SPSS software, with multivariate regression analysis identifying independent predictors of NVCF. Among the 193 patients, 23.3% (n = 45) developed NVCF during follow-up, while 76.7% (n = 148) did not. Lower HU values (mean 58.1 ± 18.68 vs 79.5 ± 25.44, P = .0001) and increased fatty infiltration of paraspinal muscles were identified as significant independent risk factors for NVCF. Multivariate regression analysis confirmed lower HU values (OR = 0.965, P < .001) and fatty infiltration of the erector spinae muscle (OR = 1.034, P = .038) as predictors. Other factors, such as age, gender, bone mineral density, cement volume, and leakage, were not significantly associated with NVCF. Lower HU values and paraspinal muscle degeneration, particularly reduced functional muscle mass and increased fatty infiltration, are significant predictors of NVCF following PKP. Preoperative evaluations should include HU measurements and paraspinal muscle assessments to identify high-risk patients. Postoperative management should focus on improving bone density and muscle health through targeted therapies and lifestyle modifications to reduce fracture risk.

Introduction: Trigonocephaly (TC), the tapering of the metopic suture toward the anterior, lateral inadequacy of supraorbital bar, hypoplasia of the ethmoid bone, and hypotelorism due to orbital medialization leads to a triangular shape in the head together with frontotemporal stenosis and widening of the biparietal diameter. Arachnoid cysts (ACs) are benign cysts, which are formed by cerebrospinal-fluid entrapment into the arachnoid membrane due to duplication or separation of the arachnoid membrane layers. ACs are typically located in the middle cranial fossa and Sylvian fissure region. They are mostly detected incidentally through neuroimaging. The coexistence of TC and AC is considerably rare; hence, its actual incidence is unknown. To our knowledge, the coexistence of nonsyndromic TC and AC has been revealed in only 2 publications in the literature. In this case study, 2 patients, one of whom were with unilateral and the other with bilateral temporally localized ACs, sizes of which increased following the reconstructive surgeries, and who underwent reconstructive surgery for TC, were presented. Case Report: Both of the 2 patients that we have presented in our study are 7 months old and male. Fronto-orbital advancement and calvarial remodeling operations were performed on both. ACs of the patients were not intervened. However, in the post-op follow-ups, the left temporal cyst of the 1st case and the right cyst of the 2nd case grew radiologically, and the left cyst became very small. Discussion/Conclusion: TC must be treated surgically. ACs may show changes in size secondary to the increase in intracranial volume following reconstructive surgery for TC. However, if it does not give rise to any complaints, it can be followed-up clinically and radiologically. Patients should be followed-up for many years, given that neurodevelopmental and behavioral problems may occur later in both pathologies.

The aim of this study was to discuss the results of craniometric measurements and surgical treatments in patients operated for isolated trigonocephaly (TC) in light of the current literature. A total of 18 cases who underwent surgery for isolated TC were included in the study. Age, gender, family history, follow-up time, complications, duration of surgery, surgical blood loss, and amount of blood replacement in these patients were recorded. Craniometric measurements such as metopic angle (MA), cephalic index (CI), interparietal distance (IPD), intercoronal distance (ICD), and their ratio to each other were evaluated according to pre-and postoperative parameters. Photographs of the patients were taken before and after the operation. The Whitaker classification and Kampf "aesthetic outcome staging" were used in the evaluations. The mean MA values after the operation increased to reach above 147 degrees in all cases. The average CI did not change. ICD measurement averages increased significantly. The average IPD/ICD ratio decreased due to the increase in ICD and the enlargement of the anterior fossa after the operation. According to the Whitaker classification and Kampf “aesthetic outcome staging” scale, 17 of our cases were at stage I, rated as perfect, and one was at stage II, rated as good. Surgery performed at the appropriate time for TC yields cosmetically satisfactory results. Since potential neurological and cognitive morbidities occur mostly in school-age patients, long-term follow-up of the cases is required. Performing craniometric measurements enables patients to be evaluated with objective and measurable numerical data.