Objective: The aim of this study was to assess whether a sheep cadaver cervical spine model could be useful in modeling all steps and stages
of the posterior cervical foraminotomy and discectomy surgery, which was frequently used in daily practice, and to assess its suitability for
laboratory training.
Materials and Methods: A whole sheep neck which had not undergone muscle stripping was obtained from a butcher and was used to model
the posterior cervical foraminotomy and discectomy surgery by assessing the following steps performed under microscopy: 1- Stripping of the
paravertebral muscles, 2- Determination of the borders of cervical laminae, 3- Recognition of cervical facets, 4- Performing laminectomy, 5-
Determination and removal of the ligamentum flavum, 6- Defining the cervical duramater, 7- Performing cervical foraminotomy and exposure
of the cervical nerve root, and 8- Determination of disc distance.
Results: The posterior cervical foraminotomy and discectomy model in sheep cadaver cervical spine was able to simulate the osseous,
ligamentous, and neural stages of the surgical approach at a similar level to the human spine.
Conclusion: We believe that the proposed posterior cervical foraminotomy and discectomy model can effectively simulate all steps of this
surgery, thus contributing to the anatomical orientation during surgical intervention, and such studies will most likely have a positive effect
on surgical interventions in general due to their contribution to the ability to recognize and use relevant instruments.
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Objective: The aim of this retrospective study is to compare results of single-level cervical disc arthroplasty (CDA) versus anterior cervical
discectomy and fusion (ACDF) in two different centers with short to mid-term follow-up.
Materials and Methods: Both surgical techniques were applied by 2 different surgeons and in 2 different centers. While ACDF was performed
by the surgeon in one clinic, CDA was performed by another surgeon in another clinic, in order to avoid surgical bias, and another surgeon
from a different clinic performed a statistical evaluation. Modified Japanese Orthopedic Association score (mJOA), Modic changes (MC), neck
disability index (NDI) and visual analogue scale (VAS), perioperative dysphagia, and the time to return work scores of the patients were
evaluated in the study.
Results: Seventy-one patients were included in the study. Thirty-two of them underwent ACDF with a median follow-up period of 15 months,
and 39 underwent CDA with a median follow-up period of 16 months. The median preoperative lost workdays were statistically significantly
higher in the ACDF group compared to the CDA group (p=0.009). Patients in the CDA group had statistically significantly more pain intensity
(p<0.001) and lower mJOA score before the surgery (p<0.001). Neck disability was significantly more severe in the ACDF group compared to
the CDA group according to the preoperative NDI score (p=0.014). Improvements in VAS and mJOA scores were significantly better in the CDA
group compared to the ACDF group (p=0.004 and p<0.001, respectively). The type 1 and type 2 MC were more frequent in the ACDF group than
the CDA group, preoperatively. There was a statistically significant difference in preoperative MC among the groups (p=0.010).
Conclusion: In our study, both surgical techniques achieved satisfactory results. However, due to the short-term nature of the study, MC could
not be evaluated and a definite opinion on this matter could not be reached.
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Objective: The aim of this study is to determine the biomechanical changes in cervical spine parameters following the surgical correction of
lumbar deformity with dynamic stabilization, and to evaluate how the preoperative parameters are related to these changes.
Materials and Methods: Anteroposterior and lateral scoliosis radiographs of 20 patients were obtained, who underwent a dynamic stabilization
(DynesysR, Zimmer, USA) and Safinaz screw peek rod placement procedures for lumbar deformity. The cervical spine parameters in the
radiographs were measured in Surgimap program by an independent researcher, and they were classified into 5 categories and compared
by using the Wilcoxon test in preoperative and early postoperative periods. The data were collected and analyzed using IBM SPSS Statistics
25th Edition.
Results: Between all the parameters examined, the changes in the patients’ T1 Slop Angle were found to be statistically significant (p
value<0.05). Depending on this, it was concluded that dynamic stabilization of lomber deformity could change the biomechanical loads in
the postoperative cervical spine alignment.
Conclusion: Dynamic stabilization surgery for spinal deformity, which is conducted to restore sagittal balance, can also lead to biomechanical
improvement in the cervical spine alignment.
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Objective: Lumbar disc herniation (LDH) is a common cause of low back pain and lumbar radiculopathy. In this study, the relationship between
clinical results and pre-procedural magnetic resonance imaging (MRI) findings of patients with LDH-related radiculopathy symptoms who
underwent lumbar transforaminal epidural steroid injection (TFESI) was evaluated.
Materials and Methods: Between 2017 and 2021, 65 patients who were diagnosed as having LDH clinically and radiologically and underwent
new MRI examination at the latest 3 months before the procedure were included in the study. In the operating room, under the scopy imaging,
1 cc opaque substance (iohexol) was diluted with 5 cc isotonic solution and 1.5-2 cc of this was injected into the area for confirmation in
the scopy vision. Then 1 cc betamethasone and 4 cc 2% prilocaine hydrochloride were mixed, and 5 cc of this was injected. Pain scoring
was evaluated with visual analog scale (VAS) and disability was evaluated with oswestry disability index (ODI). Pre-procedural MRIs were
examined and grouped according to Michigan State University classification.
Results: The patients’ median VAS and ODI scores were 8 [interquartile range (IQR): 7-8] and 74 (IQR: 67-77) before treatment; 2 (IQR: 1-3)
and 14 (IQR: 10-29) in the 2nd week; and 2 (IQR: 1-4) and 16 (IQR: 4-40) in the 3rd month, respectively. It was determined that there was
a statistically significant change in the pain and disability levels of the patients over time (ANOVA type test statistics=338,743, degree of
freedom=1,542, p-value<0.001). It was determined that the change observed in VAS and ODI scores over time did not show a statistically
significant difference according to disc type and location.
Conclusion: The TFESI is a treatment method that can be used safely, independent of the disc type and localization in the MRI performed
before the procedure.
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Objective: This study aims at comparing the patients with spinal trauma in the Coronavirus disease-2019 pandemic era and pre-pandemic era.
Materials and Methods: Patient records for a 9-month period of pandemic (April 1, 2020 - December 31, 2020) and the same period of the
previous year (April 1, 2019 - December 31, 2019) were retrospectively collected. These 2 periods were compared in terms of the total number
of patients with spinal trauma, the type of injuries, the level of injuries in the spine, the treatment methods applied, and whether there was
a neurological deficit . The first group was called as pandemic group (PG) and the latter as control group (CG). The differences between them
were statistically examined.
Results: The study sampled 278 patients (CG: 203 patients, PG: 75 patients). It was detected that the number of patients with spinal trauma in
the PG dropped by 60% compared to the CG. The most frequent cause of spinal trauma for both groups was traffic accidents. No statistically
significant difference was detected in terms of the type, level and severity of injuries, neurological examination findings and method of
treatment (p>0.05). However, the rate of indoor or outdoor falls were significantly different between the two groups (p=0.002).
Conclusion: It has been determined that the pandemic-induced social isolation and lockdown process is an important factor in the primordial
prevention of spinal trauma. With the result obtained, we think that if adequate and correct measures are taken, the number of spinal traumas
will continue to remain low in the post-pandemic period as well.
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Objective: This study assessed the outcomes of transforaminal lumbar interbody fusion (TLIF) in patients with degenerative spine conditions
above the age of 65 years and investigate the effects of fusion levels on the sagittal balance parameters.
Materials and Methods: This retrospective study reviewed patients with degenerative spine diseases who underwent lumbar fusion with the
TLIF procedure older than 65 years. Patients with three or less segments involved in the fusion were assigned to the short-level fusion group,
and the patients with more than three segments involved in the fusion were assigned to the long-level fusion group. The anteroposterior
and lateral spine radiographs of the patients were used to measure pelvic incidence (PI), pelvic tilt (PT), sacral slop (SS), lumbar lordosis (LL),
distal lumbar lordosis, thoracolumbar kyphosis, thoracic kyphosis (TK), T1 spinopelvic inclination (T1SPI), T9 spinopelvic inclination (T9SPI)
and T1 pelvic angle (TPA).
Results: The study included 45 patients, 28 females and 17 males, who met the inclusion criteria. The long- and short-level fusion groups
comprised 25 and 20 patients, with the mean ages of 68.87 and 67.72 years and mean follow-up periods of 26.96±15.53 and 27.61±11.83
months, respectively. TK and T9SPI values showed no difference between the groups before and after surgery, but a statistically significant
increase in the values was observed postoperatively in the patients who underwent long-level fusion. The preoperative SVA values were
significantly higher in the long-level fusion group than in the short-level fusion group. No difference in the postoperative SVA values was
found between the groups. The PT, PI, SS, TPA, T1SPI was not statistically differ between the groups before and after surgery.
Conclusion: TLIF contributes to the improvement of the sagittal balance parameters in both short- and long-level fusions in patients above
the age of 65 years with degenerative spine conditions.
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Objective: The aim of this study is to better understand which type of fracture and localization have more painful or worse outcomes for the
kyphoplasty procedure.
Materials and Methods: Kyphoplasty cases operated between 2013 and 2018 were included in the study. The patients were contacted
through the numbers registered in the hospital system. A questionnaire were asked to the patients. Patients were grouped according to
gender, fracture level (T12-L1 and others) and fracture type (Osteoporotic, trauma, malignancy, unknown).
Results: Fourty-one patients were included in the study. Three-quarters of the patients were women and average age was 62. Ninety-two
percent of the patients stated that the pain of the procedure was tolerable. Seventy percent reported that their pain decreased after the
procedure and 75% of the patients stated that they could have this procedure done again. Pain reduction and the desire to have same surgery
again were significantly higher in female patients than in the male group (p<0.05). In the T12-L1 group and osteoporotic fracture group, the
procedure was more easily tolerated, the pain was relieved more and the desire to have the same surgery was higher (p<0.05).
Conclusion: Kyphoplasty is accepted as an operation that is well tolerated by patients and has good pain relief. Additionally more detailed
information was obtained about the patient’s complaints after the kyphoplasty procedure, according to the fracture level and type.
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Objective: Several studies report that spine surgery in elderly patients (>65 years old) is associated with higher reoperation and complication
rates. Although transforaminal lumbar interbody fusion (TLIF) in elderly patients can result in lower clinical improvement and higher
complication rates, minimally invasive surgery (MIS) TLIF has potential advantages. We compared clinical outcomes and complication rates
after MIS TLIF with pedicle screw fixation in younger and older geriatric patients (those aged 65 to 74 years compared to those aged 75 to
85 years).
Materials and Methods: This was a retrospective cohort study of patients with lumbar degenerative spondylolisthesis. Patients were divided
into those between 65 and 74 years old (n=45) and those between 75 and 84 (n=23). Patients had two-year follow-up.
Results: Older geriatric patients (between 75 and 84 years old) had 1.3 times as many comorbidities as the younger patients, but the
difference was not statistically significant. Surgery was significantly longer in the older cohort, but there were no significant differences in
intraoperative complications. There were no differences in complication rates during postoperative hospitalization or within 30 days after
discharge. No significant differences in complication rates were noted at 6 or 24 months after discharge. There were no differences in patient
reported outcomes. Minimum clinically important differences in patient reported outcomes were the same between cohorts at last reported
outcome.
Conclusion: The MIS TLIF with pedicle screw fixation for degenerative spondylolisthesis is as safe and effective in older geriatric patients as
in younger ones.
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Objective: Amifostine is a known radioprotective agent. It has been known for many years that it protects normal tissue from the undesirable
effects of radiation and some chemotherapeutics due to its antioxidant effect and contains thiol. We investigated the effects of amifostine
on the activity of lipid peroxidation in the spinal cord after experimental spinal cord injury in rats.
Materials and Methods: Thirty-five male Wistar albino rats were randomly divided into five groups, each containing seven rats. Group I (the
control group) received laminectomies and spinal cord samples were obtained 24 h after laminectomy without trauma. Those in groups II to V
all received laminectomies followed by traumatic spinal cord injury and tissue samples were taken 24 h later. Group II received no treatment;
group III received 30 mg/kg methylprednisolone; group IV received 200 mg/kg amifostine; and group V received 2 mL 0.9% sodium chloride
(sulfur tetrafluoride) solution. Medications were given intraperitoneally as single doses immediately after trauma. Spinal cord samples were
taken 24 h post-trauma and studied for lipid peroxidation activity.
Results: Lipid peroxidation activity in the tissue samples was increased by injury. Both amifostine and methylprednisolone treatment
decreased this activity, indicating a reduction in neutrophil infiltration of the damaged tissue. The effect of amifostine on lipid peroxidation
activity was similar to that of methylprednisolone.
Conclusion: Amifostine may be effective in protecting the spinal cord from secondary injury.
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