Search

Aim The aim of this study was to document the effectiveness of an alternative surgical technique for concurrent vertebroplasty and decompression without instrumentation for patients with vertebral hemangioma presenting with neural compression symptoms. Material and methods This study is a technical note and a retrospective clinical evaluation. We analyzed the data of 8 patients operated on using our alternative surgical technique for vertebral hemangiomas with epidural extension and neural compression, between 2013 and 2018. The preoperative, postoperative 1st month and postoperative 12th-month Visual Analogue Scale (VAS) scores were assessed and compared. Results Five of the patients had lumbar and 3 had thoracic hemangiomas. The difference between preoperative and 1st and 12th-month Visual Analogue Scale scores were statistically significant. None of the patients received additional intervention, stabilization, or needed a blood transfusion. Conclusion This technique is a safe and minimally invasive approach for vertebral hemangiomas with epidural extension allowing decompression of the spinal cord without massive hemorrhage.

AIM To evaluate the satisfaction of patients operated due to degenerative lumbar spinal diseases with dynamic stabilization placing polyetheretherketone (PEEK) rods and to share their radiological and clinical results (mid-term) with visual analogue scale (VAS) and Oswestry disability index (ODI) scores. MATERIAL AND METHODS The preoperative and postoperative low back pain, leg pain VAS and ODI scores of 172 patients who were operated for degenerative spinal diseases, were evaluated. Preoperative and postoperative lumbar lordosis were compared. The patients included to the study were evaluated postoperatively around the 2nd year with lumbar MRI by means of adjacent segment disease (ASD) and additional problems. RESULTS A statistically but not radiologically-by means of sagittal profile reconstruction-significant increase in lumbar lordosis angle was achieved. Significant improvement was observed in the comparison of preoperative and postoperative period in the analysis of patients’ preoperative low back pain (p < 0.0001), and decompression-related leg pain VAS scores (p < 0.0001). Significant improvement was also observed in the ODI scores of the patients (p < 0.0001). Among 172 patients with dynamic stabilization, there were 10 patients who underwent reoperation (5.8%). CONCLUSION Although it is statistically significant, it can be seen that the lumbar lordosis can not be corrected at significant degrees radiographically in the operations performed with the PEEK rod. Dynamic stabilization with PEEK rod is insufficient for sagittal correction, but the mid-term results reached satisfactory reoperation rates clinically outcomes. Rate of ASD is quite low in stabilization with PEEK rod.

Aim To present a case (3rd report in the literature, 1st case with sequestrated-extruded disc herniation) of thoracic disc herniation that was sequestrated only by ligamentous injury without thoracic osseous pathology. Material and methods We reviewed the diagnosis and treatment of a 25-year-old man presenting with paraplegia after a car accident. Results In this case, no pathology was seen on the X-ray and spinal computed tomography (CT), and the paraplegia of the patient was unexplained in the first examination. Subsequent spinal MRI revealed a T12-L1 cranial-migrated soft disc herniation, which was surgically treated and neurologically recovered within weeks after surgery. Conclusion Traumatic thoracic disc herniations are extremely rare and can be seen without any obvious signs of trauma on X-ray and spinal CT. A spinal MRI scan helps with diagnosis, while rapid surgical treatment (decompression) supports excellent recovery.

AIM To compare clinical outcomes of the patients operated from the contralateral or ipsilateral side for unilateral radiculopathy in spinal stenosis. MATERIAL AND METHODS This was a retrospective study. Twenty patients were listed as Group 1 (Contralateral) with unilateral radiculopathy and spinal stenosis with/without lateral recess syndrome or foraminal stenosis. Decompression from opposite side of radiculopathy was performed to Group 1 patients. Decompression from the radiculopathy side was performed to the patients in Group 2 (Ipsilateral). Twenty eight patients were listed as Group 2. Back pain visual analogue scale (VAS) score and leg pain VAS score were assessed at preoperative, postoperative 1st month and postoperative 12th month. The results were compared statistically. RESULTS Two patients were excluded because of reoperation at the 2nd month from the Group 2 to assessment 12th month VAS score. There was no significant difference between two groups at 1st month back pain VAS and leg pain VAS scores. There was no significant difference between two groups at 12th month back pain VAS and leg pain VAS scores. Dynamic stabilization was performed at 2nd month to two patients after the first operations for instability. So, there was no difference in clinical outcomes between the patients treated by contralateral approach and ipsilateral approach when instability did not occur. However, there is a risk of instability of the same side approach and surgery owing to shaving of the facet joint. CONCLUSION In the contralateral approach, the recess of the contralateral side and foramen can be better seen than in the ipsilateral approach. So, this is a facet-sparing approach to spinal stenosis with/without lateral recess syndrome or foraminal stenosis with unilateral radiculopathy. The contralateral approach to unilateral radicular complaints is quite effective. With this approach, facet joints are protected from possible instability.

The endoscopic foraminal approach in foraminal, lateral and far-lateral disc hernias, is a contemporary minimal invasive approach. This study was performed to show that the approach is possible with using the microscope without an endoscope, and even intervention on the discs within the spinal canal is possible by having access through the foramen.Forty-two cases with disc hernias in the medial of the pedicle were included in this study. Surgeries were performed with the transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin's triangle. The foramen was enlarged and the spinal canal was entered.The procedure took 65 minutes on average, and the mean bleeding amount was about 100 ml. Patients were mobilized within the same day postoperatively. No permenant complications were seen. Follow-up periods ranged between 5 and 84 months and the mean followup period was 30.2 months.Transforaminal microdiscectomy is a method that can be performed in any clinic with standard neurosurgical instruments. It does not require additional equipment or a high amount of investment. Application of transforaminal inter-body fusion is possible when required.

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.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.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.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.

Aim Symptoms of thoracic outlet syndrome (TOS) may be vascular, neurological or combined symptoms involving both. Treatment of TOS is generally conservative. Surgical treatment is required when radiological results indicate anatomical abnormality. This study aims to present the surgical outcomes of TOS patients treated with supraclavicular approach via microsurgery. Material and methods 41 patients with thoracic outlet syndrome were rewieved retrospectively. The pain was determined using both on visual analogue scale (VAS) and Oswestry score both in the preoperative and postoperative period. All patients underwent electromyography including brachial plexus, ulnar and median nerves. Computed Tomography (CT) angiographic examination was applied dynamically with required manoeuvres. Results Post-op VAS scores were recorded as 0.8 for the arm, 0.6 for the shoulder and 0.5 for the neck, while pre-op VAS scores were 6.3 for the arm, 6.0 for the shoulder and 5.2 for the neck. Post-op Oswestry disability index (ODI) average was found as 14,2, while this figure was 67,4 during the pre-operative period. Conclusion Accurate patient selection is imperative for increasing the success of TOS surgery. Microscopic TOS surgery yields satisfactory results with smaller incision, safer surgery and a lower rate of complication.

Surgery for lesions involving the anterior column of the cervicothoracic junction is still challenging. The median transsternal approach provides a direct approach to this junction. The aim of this study was to present the results of cases operated using the median transsternal approach.There were 8 cases (7 males, 1 female) aged between 18-39 (mean 28.2) years. The compression to the spinal cord was secondary to trauma in 3 cases, infection in 3 cases, and tumor in 2 cases.Median sternotomy was performed from the right side in 6 cases, and the left side in 2 cases. 14 level corpectomies were performed in 8 cases. Reconstructions were performed using a fibula allograft in 6 cases, and an iliac autograft in 2 cases. The mean follow-up duration was 104 months. A progressive delayed kyphosis requiring posterior stabilization occurred in one case. Postoperative neurological evaluation revealed improvement in 6 cases, and no change in 2 cases.Median sternotomy is an appropriate and safe approach for selected cases with lesions involving the anterior column of the cervicothoracic junction. The sternal-splitting approach remains the best method for equal exposure of the anterior thoracic and cervical spine from C4 to Th4 vertebrae through a single incision.

Objective: An evaluation of treatment methods and outcomes for coccygodynia cases that do not respond to conservative Treatment. Method: Local anesthetic and steroid injections were applied in 32 coccygodynia cases that did not respond to conservative treatment (average of 15 months). Coccyx excision[for full text, please go to the a.m. URL], 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Aim Surgery for lesions involving the anterior column of the cervicothoracic junction is still challenging. The median transsternal approach provides a direct approach to this junction. The aim of this study was to present the results of cases operated using the median transsternal approach. Material and methods There were 8 cases (7 males, 1 female) aged between 18-39 (mean 28.2) years. The compression to the spinal cord was secondary to trauma in 3 cases, infection in 3 cases, and tumor in 2 cases. Results Median sternotomy was performed from the right side in 6 cases, and the left side in 2 cases. 14 level corpectomies were performed in 8 cases. Reconstructions were performed using a fibula allograft in 6 cases, and an iliac autograft in 2 cases. The mean follow-up duration was 104 months. A progressive delayed kyphosis requiring posterior stabilization occurred in one case. Postoperative neurological evaluation revealed improvement in 6 cases, and no change in 2 cases. Conclusion Median sternotomy is an appropriate and safe approach for selected cases with lesions involving the anterior column of the cervicothoracic junction. The sternal-splitting approach remains the best method for equal exposure of the anterior thoracic and cervical spine from C4 to Th4 vertebrae through a single incision.

AIM To describe a modified technique for the treatment of single level, isthmic spondylolisthesis (IS) MATERIAL and METHODS Forty-two patients who underwent posterior lumbar interbody fusion (PLIF) with spinolaminar autologous bone graft for the treatment of isthmic spondylolisthesis between May 2007 and November 2011, were retrospectively reviewed. All patients underwent total removal of the spinolaminar process, total discectomy and endplate decortication, and proper size spinolaminar autologous bone graft was sequentially inserted into the disc space with posterior instrumentation. Outcomes of the study included visual analogue scale (VAS), Oswestry disability index (ODI), and radiographic fusion. RESULTS The average duration of follow-up was 3.5 years. Neither has implant failure been observed nor has revision been required so far. The mean Oswestry Disability Index improved from 53% to 9.5%, and visual analog scale for back pain from 8.5 to 3.8 at the first month and 1.3 at the sixth month postoperatively. Visual analog scale for leg pain from 8.3 to 1.4 at the first month and 0.8 at the sixth month postoperatively. All patients had clinical and radiographic evidence of solid fusion without any need for revision. CONCLUSION The modified posterior lumbar interbody fusion and posterior instrumentation technique is a safe and effective treatment for isthmic spondylolisthesis.

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.

Aim The endoscopic foraminal approach in foraminal, lateral and far-lateral disc hernias, is a contemporary minimal invasive approach. This study was performed to show that the approach is possible with using the microscope without an endoscope, and even intervention on the discs within the spinal canal is possible by having access through the foramen. Material and methods Forty-two cases with disc hernias in the medial of the pedicle were included in this study. Surgeries were performed with the transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin's triangle. The foramen was enlarged and the spinal canal was entered. Results The procedure took 65 minutes on average, and the mean bleeding amount was about 100 ml. Patients were mobilized within the same day postoperatively. No permenant complications were seen. Follow-up periods ranged between 5 and 84 months and the mean followup period was 30.2 months. Conclusion Transforaminal microdiscectomy is a method that can be performed in any clinic with standard neurosurgical instruments. It does not require additional equipment or a high amount of investment. Application of transforaminal inter-body fusion is possible when required.

Aim Sacral fractures are generally seen together with pelvic ring fractures. They can also develop in isolated form rarely. Instability is observed in these fractures in rates reaching 30%. Material and methods Spinopelvic stabilization was applied to 10 cases with pelvic fractures together with sacral fractures and spinopelvic instability. Two cases were treated with adductive screws extending from the iliac wing to the sacrum, 5 cases with standard lumboiliac instruments and 3 cases were treated with iliac wing plates that are our own design. The cases were evaluated according demographic data, VAS, ASIA and Oswestry scores and the types of the trauma and fracture. Results Six cases had unilateral sacroiliac instability while the instability was bilateral in 4 cases. Follow-up periods range between 6 and 91 months. Preoperative VAS was 8.4, Oswestry mean value was 91.2, postoperative late VAS was 2.2, and Oswestry was 24.4. Conclusion Serious spinopelvic instability can be talked of in sacral fractures accompanied by pelvic fractures, particularly when the anterior and posterior integrity of the pelvic ring is interrupted together. An aggressive stabilization and fixation must be performed without delay.

The optimal treatment modality for traumatic spondylolisthesis of the axis is still a controversial issue. Many conservative, posterior and anterior fixation techniques have been used to treat these injuries. The C2 pars (isthmus) was used as a novel screw anchor point in upper cervical spine injuries. The direct C2 pars screws are also used to fixate the posterior and anterior parts of the C2 vertebra.Four cases with traumatic spondylolisthesis of the axis were presented. The cases were classified as type II according to Levine and Edwards' classification. C2 pars was used to fixate the posterior C2 elements to the C2 body.While a direct C2 pars screw was used for C2 fixation in two cases, a C2 pars-C3 lateral mass screw-plate system was used in the remaining two cases. A clinical and radiological improvement was achieved in all cases.It is concluded that the C2 pars can be used as screw-bone interface in upper cervical spine traumas. The direct C2 pars screw can fixate the C2 in well-selected cases. The additional C2-3 fixation increases the C2-3 stability.