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ÖZETServikal omurganın yapısal ve işlevsel bütünlüğünü travma, dejenerasyon, tümöral ve infeksiyöz hastalıklarbozabilirler. İnstabilite ayrıca, çeşitli nedenlerle yapılan cerrahi girişimlerden sonra da iyatrojenik olarak dagörülebilir. Servikal instabilite hafif nörolojik kusurlardan, ağır nörolojik defisitlere hatta ölüme neden olabilecekciddi bir durumdur. Tedavisi nöral ve vasküler yapıların dekompresyonunu, normal anatomik dizilimintekrar sağlanmasını ve rijid bir fiksasyonu gerektirir.Uzun süre immobilizasyon, traksiyon ve eksternal fiksatörler gibi ortez kullanımı şeklindeki konservatif tedaviler,bazı olgularda uygulanıyor olsa da gelişen cerrahi ve enstrumantasyon sistemleri günümüzde cerrahiile sağlanan internal fiksasyonu öne çıkarmıştır. Pedikül vidaları ile son derece güçlü stabilizasyon sağlanır.Bu nedenle torakolomber omurgada en sık kullanılan enstruman olan pedikül vidalarının son yıllarda servikalbölgede de kullanımına başlanmıştır. İnce pedikül yapısı ve vertebral arterin yakın komşuluğu servikalbölgede pedikül vidalarının kullanımını zorlaştıran faktörlerdir. Komplikasyonsuz bir cerrahi için bölge anatomisininson derece iyi bilinmesi, vida giriş noktalarının, açılarının, vida genişlik ve derinliklerinin ölçülereuygun şekilde seçilmesi şarttır.Ölçümlerimizde pedikül kalınlıklarının kranio-kaudal yönde arttığını, 3.5 mm vida kalınlığının genel olarakuygun olduğu, pedikül yüksekliklerinin pedikül kalınlıklarından fazla olduğunu gördük. Pedikül transvers açılarını30-45º arasında ölçtük. Ölçümler hem kişiye hem de ölçülen seviyeye göre farklılıklar göstermektedir.Bu durum, cerrahi öncesi radyolojik yöntemlerle yapılacak bir planlamanın pedikül vidalamasındaki öneminigösterir.Anahtar Kelimeler: Vertebra; Pedikül; MorfometrikABSTRACTTrauma, dejeneration, tumoral and infectional diseases may get demaged to integrity of structural and functionalcervical spine. And also, instability may be seen as an iatrogenic after the surgery. Servical instabilityis a situation that may cause minimal neurologic order to high neurologic deficit and even it may causeto death. Treatment requires vascular and neural structures of decompression, providing again of normalanatomic order and a rigid fixation.Even so conservative treatment which is usage of as an orthesis as a long time immobilization, tractionand external fixator, is implemented in some cases, it puts forward internal fixation, which is provided withsurgery today, with the help of devoloping surgery and instrumentation systems. With the pedicle screwsare provided strong stabilization for that reason, in recent years pedicle screws which are used in thoracolumbarspine, are started to be used cervical region. It’s slim pedicle structure and the nearer of vertebralartery are made difficult to usage of pedicle screws in cervical region. Surgery which is not involved incomplication, needs to be well-known the region of anatomy, screw entrance points, angles, wideness anddeepness must be choosen as a suitable form.According to our measurements, the pedicle thickness increase towards craniocaudale, 3.5 mm screw thicknessis suitable for surgery and pedicle highnesses are more than pedicle thicknesses. We measure thatpedicle transverse angles are 30-45º. Measurements may be different for every level and each person. Thissituation shows the importance of planning in computerized tomography imaging before the surgery.Key Words: Vertebra; Pedicule; Morphometric

Servikal omurganın yapısal ve işlevsel bütünlüğünü travma, dejenerasyon, tümöral ve infeksiyöz hastalıklar bozabilirler. İnstabilite ayrıca, çeşitli nedenlerle yapılan cerrahi girişimlerden sonra da iyatrojenik olarak da görülebilir. Servikal instabilite hafif nörolojik kusurlardan, ağır nörolojik defisitlere hatta ölüme neden olabilecek ciddi bir durumdur. Tedavisi nöral ve vasküler yapıların dekompresyonunu, normal anatomik dizilimin tekrar sağlanmasını ve rijid bir fiksasyonu gerektirir. Uzun süre immobilizasyon, traksiyon ve eksternal fiksatörler gibi ortez kullanımı şeklindeki konservatif tedaviler, bazı olgularda uygulanıyor olsa da gelişen cerrahi ve enstrumantasyon sistemleri günümüzde cerrahi ile sağlanan internal fiksasyonu öne çıkarmıştır. Pedikül vidaları ile son derece güçlü stabilizasyon sağlanır. Bu nedenle torakolomber omurgada en sık kullanılan enstruman olan pedikül vidalarının son yıllarda servikal bölgede de kullanımına başlanmıştır. İnce pedikül yapısı ve vertebral arterin yakın komşuluğu servikal bölgede pedikül vidalarının kullanımını zorlaştıran faktörlerdir. Komplikasyonsuz bir cerrahi için bölge anatomisinin son derece iyi bilinmesi, vida giriş noktalarının, açılarının, vida genişlik ve derinliklerinin ölçülere uygun şekilde seçilmesi şarttır. Ölçümlerimizde pedikül kalınlıklarının kranio-kaudal yönde arttığını, 3.5 mm vida kalınlığının genel olarak uygun olduğu, pedikül yüksekliklerinin pedikül kalınlıklarından fazla olduğunu gördük. Pedikül transvers açılarını 30-45º arasında ölçtük. Ölçümler hem kişiye hem de ölçülen seviyeye göre farklılıklar göstermektedir. Bu durum, cerrahi öncesi radyolojik yöntemlerle yapılacak bir planlamanın pedikül vidalamasındaki önemini gösterir. Trauma, dejeneration, tumoral and infectional diseases may get demaged to integrity of structural and functional cervical spine. And also, instability may be seen as an iatrogenic after the surgery. Servical instability is a situation that may cause minimal neurologic order to high neurologic deficit and even it may cause to death. Treatment requires vascular and neural structures of decompression, providing again of normal anatomic order and a rigid fixation. Even so conservative treatment which is usage of as an orthesis as a long time immobilization, traction and external fixator, is implemented in some cases, it puts forward internal fixation, which is provided with surgery today, with the help of devoloping surgery and instrumentation systems. With the pedicle screws are provided strong stabilization for that reason, in recent years pedicle screws which are used in thoracolumbar spine, are started to be used cervical region. It’s slim pedicle structure and the nearer of vertebral artery are made difficult to usage of pedicle screws in cervical region. Surgery which is not involved in complication, needs to be well-known the region of anatomy, screw entrance points, angles, wideness and deepness must be choosen as a suitable form. According to our measurements, the pedicle thickness increase towards craniocaudale, 3.5 mm screw thickness is suitable for surgery and pedicle highnesses are more than pedicle thicknesses. We measure that pedicle transverse angles are 30-45º. Measurements may be different for every level and each person. This situation shows the importance of planning in computerized tomography imaging before the surgery.

In this study, we aimed to investigate the incidence of neurosurgical events in patients with childhood trauma to determine risk factors and to standardize the neurosurgical approach to pediatric trauma for reducing the request of unnecessary tomography imaging. According to the age distribution of children aged 17 and under who applied to the emergency department from Jan 2019 to Jan 2021 was examined in 3 separate groups; the infant-early childhood group (0-3 years old), the preschool group (4-7 years), and the pre-adolescence and adolescence group (8-17). Radiological images, type of trauma, neurosurgical damage of trauma (spinal, cranial) and treatment approaches were examined. The mean age of 1247 pediatric trauma patients admitted to the emergency department within two years was 7.71 ± 5.01. The most common reasons in terms of trauma etiology were found to be falling from height (61.2%), traffic accidents (26.5%), and then running into a hard object (10%). It was determined that 249 (19.3%) of the patients were consulted to the Neurosurgery department and 128 patients were hospitalized to the neurosurgery service due to spinal (n: 29) and cranial (n: 99) events. 11 of these patients were operated due to cranial, 2 to spinal events and a patient with spinal injury was followed up with conservative treatment due to SCIWORA (spinal cord injury without radiographic abnormalities). Although trauma is the most important cause of mortality and morbidity in the pediatric age group, most of them are preventable. Computed tomography (CT) indications for pediatric head/spinal traumas are still controversial. We think that unnecessary CT usage should be avoided as much as possible, although there is a need for imaging in order not to miss the diagnosis of severe traumatic brain injury.

Background The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up. Methods Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure. Results The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p p Conclusion Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.

Background Neural tube defects are among the most frequent congenital abnormalities of the central nervous system. Progression of neural tube deficits is affected by hereditary predilection and environmental determinants. Pethidine (meperidine) is a fast and powerful opioid analgesic in U.S. Food and Drug Administration category C. There are reports about developmental anomalies due to this medication. The aim of this study was to investigate the effects of different doses of pethidine hydrochloride on neural tube development in a chick embryo model resembling the first month of vertebral growth in mammals. Methods Seventy-five specific pathogen–free eggs were incubated for 28 hours and divided into 5 groups (including the control group), each consisting of 15 eggs. Pethidine hydrochloride was administered sub-blastodermically with a Hamilton microinjector in 4 different doses. Incubation was continued until the end of the 48th hour. Subsequently, all eggs were opened, and embryos were cut from the embryonic membranes and evaluated morphologically, genetically, and histopathologically. Results Crown-rump length, somite numbers, and silver-stained nucleolar organizer region (AgNOR) number averages, and total AgNOR/nuclear area ratios decreased in a dose-dependent manner. Examination of neural tube closure revealed statistically significant differences in all experimental groups (P

Postoperative complications are becoming more and more important than the risk given in preoperative pulmonary evaluation due to the increase in patients requiring surgical intervention. Patients undergoing craniotomy are routinely evaluated preoperatively, but the role of these evaluations in predicting outcomes has not been adequately studied. We aimed to investigate the effect of preoperative pulmonary risk assessment and the type of operation performed on postoperative complications and mortality concerning the presence of chronic disease in patients undergoing cranial surgery in the light of the literature. Preoperative pulmonary consultation data and postoperative pulmonary consultations, if any, of cranial surgery patients who were operated on in the neurosurgery clinic of a tertiary hospital were retrospectively analyzed. 85 (43.8%) of the surgical patients were male and 109 (56.2%) were female, and the average age of 194 people was 74 (35-90). 83 (42.7%) of the patients had at least one chronic disease. Considering the preoperative pulmonary risks, 72 (37.1%) patients were given medium risk. Statistically, the mortality rate was higher in those with ICU beds. Atelectasis in 10 (5.15%) patients, pneumonia in 7 (3.608%) patients, embolism in 3 (1.5%) patients, respiratory failure in 3 (1.5%) and bronchospasm in 2 (1%) patients, respectively. Postoperative pulmonary complications developed in 25 (12.9%) patients. Prediction of respiratory complications with effective preoperative pulmonary evaluation is important in terms of decreasing morbidity and mortality and decreasing the length of hospital stay. Since most of the complications are seen in patients given high risk in the preoperative period, close follow-up of high-risk patients in the postoperative period is important.

Traumatic injuries of the subaxial cervical spine (C3-7); considered among the most common and most damaging injuries to the axial skeleton. Decompression of the spine is standard approach after cervical spinal cord injury.In this study, 72 patients who underwent early decompression with the decision of surgery according to the classification system with the Subaxial Injury Classification and Severity Scale (SLICS) among 212 patients who developed spine fractures as a result of acute traumatic subaxial cervical trauma were examined.ASIA scoring system was used for neurological examination evaluation.Patients were included in the rehabilitation program, which lasted at least six months after the operation.Neurological recovery results were evaluated with ASIA scores obtained after the rehabilitation program.It has been shown that early surgery for subaxial cervical spine fractures contributes significantly to the patient's neurological recovery.