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Ozer AF, Akgun MY, Ucar EA, Hekimoglu M, Basak AT, Gunerbuyuk C, Toklu S, Oktenoglu T, Sasani M, Akgul T, Ates O. Can Dynamic Spinal Stabilization Be an Alternative to Fusion Surgery in Adult Spinal Deformity Cases? Int J Spine Surg 2024:8588. [PMID: 38561203 DOI: 10.14444/8588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Rigid stabilization and fusion surgery are widely used for the correction of spinal sagittal and coronal imbalance (SCI). However, instrument failure, pseudoarthrosis, and adjacent segment disease are frequent complications of rigid stabilization and fusion surgery in elderly patients. In this study, we present the results of dynamic stabilization and 2-stage dynamic stabilization surgery for the treatment of spinal SCI. The advantages and disadvantages are discussed, especially as an alternative to fusion surgery. METHODS In our study, spinal, sagittal, and coronal deformities were corrected with dynamic stabilization performed in a single session in patients with good bone quality (without osteopenia and osteoporosis), while 2-stage surgery was performed in patients with poor bone quality (first stage: percutaneous placement of screws; second stage: placement of dynamic rods and correction of spinal SCI 4-6 months after the first stage). One-stage dynamic spinal instrumentation was applied to 20 of 25 patients with spinal SCI, and 2-stage dynamic spinal instrumentation was applied to the remaining 5 patients. RESULTS Spinal SCI was corrected with these stabilization systems. At 2-year follow-up, no significant loss was observed in the instrumentation system, while no significant loss of correction was observed in sagittal and coronal deformities. CONCLUSION In adult patients with spinal SCI, single or 2-stage dynamic stabilization is a viable alternative to fusion surgery due to the very low rate of instrument failure. CLINICAL RELEVANCE This study questions the use of dynamic stabilization systems for the treatment of adult degenerative deformities. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
- Bioengineering and Orthopaedic Surgery Colleges of Engineering and Medicine, University of Toledo, Toledo, OH, USA
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ege Anil Ucar
- Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Mehdi Hekimoglu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | | | | | - Sureyya Toklu
- Department of Neurosurgery, Erzurum Bolge Research and Education Hospital, Erzurum, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Turgut Akgul
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
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Akgun MY, Ates O, Akyoldas G, Tepebasili MA, Sasani M, Oktenoglu T, Ozer AF. Does long segment subarachnoido-subarachnoid shunt prevent posttraumatic and postinfectious spinal arachnoid cyst recurrence?: technical note and case series. Neurochirurgie 2024; 70:101555. [PMID: 38520969 DOI: 10.1016/j.neuchi.2024.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/15/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
Syringomyelia associated with extensive spinal adhesive arachnoiditis (SAA) can be defined as a rare but progressive disease with potentially devastating clinical consequences. Diagnosis can be challenging due to the absence of specific clinical findings, confusion with other pathologies, and late imaging modalities. The treatment strategy for syringomyelia associated with extensive SAA should include direct drainage of the syringomyelia, and dissection of the adhesive arachnoid with expansive duraplasty. Hence, several approaches have been reported for arachnoid dissection and decompression of the subarachnoid space. The high risk of recurrence after the operation is one of the most challenging situations. First two cases were operated previously, and the cyst walls were removed and anastomosed to the intact subarachnoid space at the upper and lower ends by each other. However, in both cases, the cyst recurred after a short time and they were anastomosed again in our clinic. A subarachnoid-subarachnoid shunt was placed with a multi-hole silicone tube extending to the proximal and distal intact subarachnoid spaces and passing through the cyst removal area. In our third case, the shunt system we described was applied directly, and satisfactory results were obtained in the clinical follow-up of the patient. It has been demonstrated that subarachnoido-subarachnoid shunt is a very satisfactory treatment option for this type of pathology, which is difficult to follow and treat.
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Affiliation(s)
- Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Goktug Akyoldas
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | | | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey; Bioengineering and Orthopaedic Surgery Colleges of Engineering and Medicine, University of Toledo, Toledo, OH, USA.
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Akgun MY, Ucar EA, Gedik CC, Gunerbuyuk C, Hekimoglu M, Cerezci O, Oktenoglu T, Sasani M, Ates O, Ozer AF. Use of Dynamic Spinal Instruments (Dynesys) in Adult Spinal Deformities According to Silva-Lenke and Berjano-Lamartina Classifications. Diagnostics (Basel) 2024; 14:549. [PMID: 38473021 DOI: 10.3390/diagnostics14050549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. OBJECTIVE This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. METHODS ASDs were classified according to the Berjano-Lamartina (BL) and Silva-Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. RESULTS Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). CONCLUSION The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.
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Affiliation(s)
- Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ege Anil Ucar
- Medical Faculty, Koc Univesity School of Medicine, 34010 Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Caner Gunerbuyuk
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Mehdi Hekimoglu
- Department of Neurosurgery, American Hospital, 34010 Istanbul, Turkey
| | - Onder Cerezci
- Department of Physical Medicine and Rehabilitation, American Hospital, 34010 Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
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Sasani M, Sasani H, Akgun MY, Hekimoglu M, Basak AT, Oktenoglu T, Ates O, Ozer AF. Posterior video-assisted trans pedicular surgery for calcified midline thoracic disc herniation. J Orthop Sci 2024:S0949-2658(24)00010-1. [PMID: 38331600 DOI: 10.1016/j.jos.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND In the treatment of patients with calcified midline thoracic disc herniation (CMTDH), the posterior video-assisted transpedicular surgery (VATPS) technique is employed. Both anterior and posterior surgical approaches for treating CMTDH carry a significant risk of surgical complications and potential morbidity. This technical note introduces a surgical procedure that avoids the drawbacks associated with these approaches. METHODS The VATPS technique presents a comprehensive approach for treating thoracic disc herniation, combining both microscopic and endoscopic stages. The microscopic phase entails a small thoracoscopic incision, muscle release, hemilaminotomy, facet joint resection, and vertebra removal, culminating in creating a corpectomy cavity for endoscope access. Careful separation of adhesions between the dura and ligaments marks this stage. Transitioning to the endoscopic phase, an endoscope is inserted into the cavity, allowing for precise visualization and separation of residual adhesions, removal of calcified disc fragments using specialized instruments, and ensuring complete discectomy. RESULTS Fourteen patients underwent VATPS for CMTDH. During the procedure, evoked responses were reduced in one patient. However, no postoperative neurological deficits were observed. We also noted significant improvements in the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) scores when comparing the preoperative and postoperative assessments. CONCLUSION VATPS, a minimally invasive technique, offers excellent anterior visibility comparable to that of the anterolateral approach, all while avoiding the adverse effects associated with thoracotomies and the complications resulting from spinal cord encroachment often seen in the posterolateral approach. Moreover, it is a safer alternative to conventional endoscopic posterior thoracic surgery. The cavity formed within the vertebral corpus provides ample working space for the use of an endoscope.
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Affiliation(s)
- Mehdi Sasani
- Koc University School of Medicine, Neurosurgery Department, Turkey; American Hospital, Neurosurgery Department, Turkey
| | - Hadi Sasani
- Namik Kemal University, Faculty of Medicine, Radiology Department, Turkey
| | | | | | | | - Tunc Oktenoglu
- Koc University School of Medicine, Neurosurgery Department, Turkey; American Hospital, Neurosurgery Department, Turkey
| | - Ozkan Ates
- Koc University School of Medicine, Neurosurgery Department, Turkey
| | - Ali Fahir Ozer
- Koc University School of Medicine, Neurosurgery Department, Turkey; American Hospital, Neurosurgery Department, Turkey
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Karadag MK, Akgun MY, Basak AT, Ates O, Tepebasili MA, Gunerbuyuk C, Oktenoglu T, Sasani M, Ozer AF. Clinical and radiological analysis of the effects of three different lumbar transpedicular dynamic stabilization system on disc degeneration and regeneration. Front Surg 2023; 10:1297790. [PMID: 38162089 PMCID: PMC10757836 DOI: 10.3389/fsurg.2023.1297790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Objective This study aims to assess the clinical outcomes of three transpedicular dynamic systems in treating degenerative disc disease and evaluate their impact on both clinical and radiological aspects of the operated and adjacent segments. Materials and methods A total of 111 patients who underwent posterior transpedicular short-segment dynamic system procedures for treatment of degenerative disc disease were included. The patients were categorized into three groups, namely, Group 1 (Dynesys system, n = 38), Group 2 (Safinaz screw + PEEK rod, n = 37), and Group 3 (Safinaz screw + titanium rod, n = 36). Disc regeneration in the operated segment and disc degeneration in the operated, upper, and lower adjacent segments were assessed using the Pfirrmann Classification. Results Postoperatively, a statistically significant difference was observed in visual analog scale and Oswestry Disability Index scores (p < 0.001). However, no statistically significant difference was seen in disc degeneration/regeneration and degeneration scores of the upper and lower adjacent segments between the preoperative and postoperative groups (p = 0.763, p = 0.518, p = 0.201). Notably, a positive effect on disc regeneration at the operated level (32.4%) was observed. No significant differences were found between the groups in terms of operation rates, screw loosening, and screw breakage after adjacent segment disease (p > 0.05). Conclusion In patients without advanced degeneration, all three dynamic systems demonstrated the ability to prevent degeneration in the adjacent and operated segments while promoting regeneration in the operated segment. Beyond inhibiting abnormal movement in painful segments, maintaining physiological motion and providing axial distraction in the operated segment emerged as key mechanisms supporting regeneration.
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Affiliation(s)
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | | | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
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Akgun MY, Toklu S, Gunerbuyuk C, Ates O, Aydin AL, Baran O, Oktenoglu T, Sasani M, Ozer AF. Foraminoplasty with Partial Pediculectomy in Degenerative Spondylolisthesis Cases with Nerve Compression. World Neurosurg 2023; 172:e532-e539. [PMID: 36702240 DOI: 10.1016/j.wneu.2023.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Degenerative spondylolisthesis refers to a forward displacement of a vertebra relative to the underlying vertebra. Patients with radicular pain and/or neurogenic claudication are considered suitable candidates for surgical intervention. The aim of this study was to present clinical results of dynamic stabilization applied after pediculectomy and neural foramen enlargement in patients with degenerative spondylolisthesis and normal spinal sagittal balance. MATERIALS AND METHODS All patients who underwent pediculectomy and dynamic stabilization for lumbar degenerative spondylolisthesis were retrospectively identified. Diagnosis was made with detailed neurological and radiological imaging examinations for the anatomical location of the pain. Demographic data, visual analog scale scores, and quality-of-life scores were obtained. RESULTS Patients included 3 (33.3%) men and 6 (66.7%) women with a mean age of 61.3 ± 13.0 years (range, 46-80 years) at initial symptom onset. Grade 1 degenerative spondylolisthesis was present in 5 (55.6%) patients, and grade 2 was present in 4 (44.4%) patients. Pathology was detected in L4-5 in 4 patients (44.4%) and L5-S1 in 5 patients (55.6%). In all patients, at the 3-month follow-up, statistically significant decrease in visual analog scale and Oswestry Disability Index scores was observed. At the last follow-up, no implant-related complications requiring revision were observed. CONCLUSIONS In patients without any pathology in the sagittal balance, the optimal physiological treatment modality can be created by applying posterior dynamic stabilization together with pediculectomy to support the posterior tension band.
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Affiliation(s)
- Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey.
| | - Sureyya Toklu
- Department of Neurosurgery, Erzurum Bolge Research and Education Hospital, Erzurum, Turkey
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | | | - Oguz Baran
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
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Karadağ MK, Akıncı AT, Başak AT, Hekimoğlu M, Yıldırım H, Akyoldaş G, Aydın AL, Ateş Ö, Öktenoğlu T, Sasani M, Akgün MY, Günerbüyük C, Özer AF. Preoperative Magnetic Resonance Imaging Abnormalities Predictive of Lumbar Herniation Recurrence After Surgical Repair. World Neurosurg 2022; 165:e750-e756. [PMID: 35803567 DOI: 10.1016/j.wneu.2022.06.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There are currently no standard criteria for evaluating the risk of recurrent disk herniation after surgical repair. This study investigated the predictive values of 5 presurgical imaging parameters: paraspinal muscle quality, annular tear size, Modic changes, modified Phirrmann disk degeneration grade, and presence of sacralization or fusion. METHODS Between 2015 and 2018, 188 patients (89 female, 99 male, median age 50) receiving first corrective surgery for lumbar disk herniation were enrolled. Microdiskectomy was performed in 161 of these patients, and endoscopic translaminar diskectomy approach was performed in 27 patients. Clinical status was evaluated before surgery and 4, 12, and 24 months post surgery using a visual analog scale, Oswestry Disability Index, and Short Form 36. RESULTS Recurrent disk herniation was observed in 21 of 188 patients. Seventeen of the recurrent disk herniations were seen in those who underwent microdiskectomy and 4 in those who underwent endoscopic translaminar diskectomy. There were significant differences in visual analog scale, Oswestry Disability Index, and Short Form 36 scores at 4, 12, and 24 months between patients with recurrence and the 167 no-recurrence patients. The median annular tear length was significantly greater in patients with recurrence than without recurrence. In addition, there were significant differences in recurrence rate according to Modic change type distribution, sacralization or fusion presence, Pfirmann disk; degeneration grade distribution, dichotomized annular tear size, dichotomized Modic change; and type and simplified 3-tier muscle degeneration classification distribution. CONCLUSIONS Patients with poor clinical scores and recurrence exhibited additional radiologic abnormalities before surgery, such as poor paraspinal muscle quality, longer annular tears, higher Modic change type, higher modified Phirrmann disk degeneration grade, and sacralization or fusion. This risk evaluation protocol may prove valuable for patient selection, surgical planning, and choice of postoperative recovery regimen.
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Affiliation(s)
| | - Ahmet Tolgay Akıncı
- Neurosurgery Department, Trakya University School of Medicine, Edirne, Turkey
| | | | - Mehdi Hekimoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Hakan Yıldırım
- Radiology Department, American Hospital, Istanbul, Turkey
| | - Göktuğ Akyoldaş
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Özkan Ateş
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey; Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Department, American Hospital, Istanbul, Turkey; Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Yiğit Akgün
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Caner Günerbüyük
- Orthopedics Department, Koc University School of Medicine, Istanbul, Turkey
| | - Ali Fahir Özer
- Neurosurgery Department, American Hospital, Istanbul, Turkey; Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey.
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Başak AT, Çakıcı N, Özbek MA, Hekimoğlu M, Çerezci Ö, Ates O, Oktenoglu T, Sasani M, Özer AF. A Combined Diagnosis and Treatment Algorithm for Spine Infection Management: A Single-Center Experience. Cureus 2022; 14:e28251. [PMID: 36158394 PMCID: PMC9490500 DOI: 10.7759/cureus.28251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background and objective Spinal infection (SI) is an infectious disease affecting the vertebral column, spinal cord, and adjacent structures. The infection can occur following interventions or spontaneously. The aim of this study was to highlight the importance of employing a methodological approach for the accurate and rapid diagnosis of SI and to share information on the most effective treatment method, which involves using a diagnostic-treatment algorithm that can help with SI management. Methodology This study included 50 patients diagnosed with SI between 2016 and 2020. The treatment follow-up period was limited to six months, and the study was conducted as a retrospective cohort analysis. The sample consisted of 22 female patients and 28 male patients, and the mean age of the patients was 50.2 years. All patients received diagnosis and treatment according to the algorithm described in this article. Results In the study group, 60% of patients had an infection in the lumbar spine, 4% in the thoracal spine, 12% in the cervical spine, and 8% in the sacral spine. Previously operated patients were diagnosed on the 30.16th day on average. A total of 19 patients (38%) had no history of undergoing surgery. Radiologically, the most common finding was spondylodiscitis/discitis (32%). Osteomyelitis was detected in one (2%) patient. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism in culture results and was detected in 13 patients (26%). The culture results of 12 patients (24%) were negative. The number of patients with active SI who were unstable and stabilized at the time of diagnosis was 11 (22%), and stabilization materials were removed in two patients (4%). In the 6th month of control, the patients did not have any complaints, signs of an infection, or unstable vertebral column. Conclusions We conclude that the combined algorithm we recommend for the diagnosis and treatment of patients with SI can prevent negative deviation and is an effective treatment for this condition.
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Özer AF, Başak AT, Özbek MA, Hekimoğlu M, Aydın AL, Ateş Ö, Günerbüyük C, Akgül T, Sasani M, Öktenoğlu T. Lumbar Dynamic Stabilization With 2-Stage Surgery: Early Results. Int J Spine Surg 2022; 16:8306. [PMID: 35728831 PMCID: PMC9421274 DOI: 10.14444/8306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Screw loosening, which is a major problem in dynamic systems, can be easily overcome with 2-stage surgery. In this article, the clinical and radiological results of patients undergoing dynamic stabilization with a Dynesys device in 2 stages are discussed. METHODS A total of 10 male and 13 female adult patients were included in this single-center retrospective study conducted between 2018 and 2021. The mean age of the patients was 65.6 years. All of the patients had pain complaints that affected their daily lives. Bone density T scores were determined with the dual-energy x-ray absorptiometry method before patients were admitted for surgery. In the first surgery, Dynesys system pedicle screws were inserted. After 6 months of osteointegration, Dynesys system spacers and elastic bandages were placed. Preoperative, early postoperative, and late postoperative visual analog pain scale (VAS) scores and Oswestry Disability Index (ODI) scores were determined and statistically compared. RESULTS Patients were followed for an average of 30 months. Complications and recurrence were not observed. Neurological deficits were not observed after patients recovered from anesthesia. Significant improvement was observed in the ODI and VAS parameters in the preoperative (ODI: 66.2%, VAS: 7.8), early postoperative (ODI: 20.3%, VAS: 2.4), and late postoperative (ODI: 6.8% and VAS: 1.1) periods. Symptomatic improvement was seen in all patients. No screw breakage or loosening was detected by radiological evaluation in any of the patients during the 2-year follow-up period. CONCLUSIONS In our experience, the insufficiency of the proximal and distal end screws is eliminated when 2 stages of dynamic system stabilizations are completed after osteointegration of the screws. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ali Fahir Özer
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | | | | | - Mehdi Hekimoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Özkan Ateş
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Caner Günerbüyük
- Orhopeaedics Department, Koc University School of Medicine, Istanbul, Turkey
| | - Turgut Akgül
- Orhopeaedics Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
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Özer AF, Akyoldaş G, Çevik OM, Aydın AL, Hekimoğlu M, Sasani M, Öktenoğlu T, Çerezci Ö, Süzer T. Lumbar Foraminal Stenosis Classification That Guides Surgical Treatment. Int J Spine Surg 2022; 16:8311. [PMID: 35710724 PMCID: PMC9421203 DOI: 10.14444/8311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are numerous radiological and anatomical studies on lumbar foramina in the literature, but there are no distinctive studies about the relationship between treatment and the type of foraminal stenosis. This study was conducted to better evaluate foraminal stenosis and to plan treatment accordingly. METHODS Foraminal stenosis was divided into 2 groups: stable and unstable stenosis. Both groups were also divided into 4 subgroups in relation to the cause and type of compression and based on the structure of the intervertebral disc. The visual analog scale for leg pain (VAS-LP) and Oswestry Disability Index (ODI) scores were investigated before and after surgery. RESULTS A total of 115 patients (59 women and 56 men) underwent surgery for lumbar foraminal stenosis. The mean patient age was 56.1 years (range 17-80 years). The mean follow-up was 29 months (range 24-39 months). There were 36 patients (32%) with stable foraminal stenosis and 79 patients (68%) with unstable foraminal stenosis. The majority of the patients were identified as having unstable type 1 foraminal stenosis (45 of 115). The VAS-LP and ODI scores for each group decreased gradually during the follow-up periods and showed significant decrease during the last follow-up (P < 0.001). Interobserver and intraobserver agreement in the classification of foraminal stenosis was found to be nearly perfect. No patients experienced postoperative radiculopathy complication. Only 2 patients experienced superficial operation site infection and 1 showed deep wound infection. The patient who had a deep wound infection needed to repeat surgery for the infection. CONCLUSIONS We introduced a novel classification system for lumbar foraminal stenosis. We aimed to guide appropriate treatment modality depending on the determined classification. This classification helps to determine the optimal treatment. In the light of our findings, the patients who were operated according to our classification experienced satisfactory clinical outcomes and low complication rates. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Ali Fahir Özer
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Göktuğ Akyoldaş
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
| | - Orhun Mete Çevik
- Neurosurgery Department, Bakırköy Training and Research Hospital for Psychiatric and Nervous Diseases, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
| | - Mehdi Hekimoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Önder Çerezci
- Physical Treatment and Rehabilitation Department, American Hospital, Istanbul, Turkey
| | - Tuncer Süzer
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
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Özer AF, Ateş Ö, Çerezci Ö, Hekimoğlu M, Aydın AL, Öktenoğlu T, Sasani M. Changes in cervical sagittal alignment and the effects on cervical parameters in patients with cervical spondylotic myelopathy after laminoplasty. J Craniovertebr Junction Spine 2021; 12:183-190. [PMID: 34194166 PMCID: PMC8214234 DOI: 10.4103/jcvjs.jcvjs_213_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To monitor changes in cervical parameters before and after laminoplasty surgery. Cervical parameters and health-related quality-of-life (HRQOL) values that may be affected after laminoplasty were examined before and after surgery. The clinical and radiological course of these values was monitored, and their interaction with all spinal radiological parameters was revealed. Materials and Methods: Nineteen patients who underwent clinical and radiological evaluation for 2 years were followed in this study. Neck disability index, visual analog scale, and short form 36 scores were determined to evaluate HRQOL. For radiological parameters, the C0-C2 angle, C2-C7 angle, cervical sagittal vertical axis, T1 slope angle, neck tilt (NT) and thoracic inlet angle were used. The results of the 4-month, 1 year and 2-year follow-ups were statistically evaluated. Results: Both the HRQOL and cervical radiological parameters deteriorated in the first 4 months and returned to normal in the 2nd year. Statistically, all parameters were meaningful (P < 0.05), except for NT. Conclusion: Cervical parameters and HRQOL values, which deteriorated in the early period, recovered in the late period in the long-term follow-up of patients undergoing laminoplasty. The important point is that preoperative cervical parameters suitable for laminoplasty should be present, and spinopelvic parameters should be normal.
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Affiliation(s)
- Ali Fahir Özer
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Özkan Ateş
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Önder Çerezci
- Department of Physical Treatment and Rehabilitation, American Hospital, Istanbul, Turkey
| | - Mehdi Hekimoğlu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
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Özer AF, Aydın AL, Hekimoğlu M, Çerezci Ö, Başak AT, Ates O, Oktenoglu T, Sasani M. Should Iliac Wing Screws Be Included in Long Segment Dynamic Stabilization? Cureus 2021; 13:e13543. [PMID: 33815968 PMCID: PMC8009454 DOI: 10.7759/cureus.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In this article, clinical satisfaction and radiological results are discussed in a series of patients where the iliac wings participate in dynamic stabilization. Dynamic stabilization is an effective alternative surgical treatment method, especially in clinical pictures that go with pain due to minor instabilities. Practically the unique surgical instrument used in multilevel instabilities is the Dynesys system. The most important drawback of the Dynesys system is that the S1 screws become loose in time. In this article, our aim is to find solution to S1 insufficiency by extension of the system to the iliac wings. Methods Nineteen patients (eight females, 11 males) with a mean age of 54.16 were included in the study. Patients had multilevel (level 2 and above) instability, iliac wings were included in the stabilized segments, and Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for patient follow-up. Results First year results showed a significant improvement in VAS and ODI. Regarding the complications, infection developed in one patient, loosening in the proximal iliac wing in one patient, and both S1 and iliac proximals in one patient, but no clinical findings were encountered. Conclusion When more than two levels of dynamic systems are used in chronic instability, especially in the elderly patients, S1 screws are loosened. In these patients, if the iliac bones are also included in stabilization, this problem is solved successfully. However unfortunately, Dynesys system does not have a screw suitable for the iliac bones.
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Affiliation(s)
- Ali Fahir Özer
- Neurosurgery, Koç University School of Medicine, Istanbul, TUR
| | | | | | - Önder Çerezci
- Physical Treatment and Rehabilitation, American Hospital, Istanbul, TUR
| | | | - Ozkan Ates
- Neurosurgery, Koç University School of Medicine, Istanbul, TUR
| | - Tunc Oktenoglu
- Neurosurgery, Koç University School of Medicine, Istanbul, TUR
| | - Mehdi Sasani
- Neurosurgery, Koç University School of Medicine, Istanbul, TUR
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Kulle CB, Azamat IF, Vatansever D, Erus S, Tarim K, Akyoldas G, Gokler O, Deveci MA, Cakar N, Ergonul O, Agcaoglu O, Kiremit MC, Yavuz O, Kiris T, Unsaler S, Giray B, Korkmaz M, Dilege E, Kilic M, Cesur E, Solaroglu I, Altuntas O, Simsek A, Tanju S, Erkan M, Canda E, Sasani M, Hafiz AM, Kordan Y, Balik E, Bilge O, Bugra D, Taskiran C, Dilege S. Is elective cancer surgery feasible during the lock-down period of the COVID-19 pandemic? Analysis of a single institutional experience of 404 consecutive patients. J Surg Oncol 2021; 123:1495-1503. [PMID: 33621377 PMCID: PMC8013582 DOI: 10.1002/jso.26436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/23/2022]
Abstract
Background We aimed to assess the feasibility and short‐term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID‐19)‐free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. Materials and Methods This was a single‐center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS‐CoV‐2 infection and 30‐day pulmonary or non‐pulmonary related morbidity and mortality associated with SARS‐CoV‐2 disease. Results Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS‐CoV2 infection because of acute respiratory distress syndrome. The overall non‐SARS‐CoV2 related 30‐day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS‐CoV2 related 30‐day morbidity and mortality rates were 0.2% and 0.2%, respectively. Conclusions Under strict institutional policies and measures to establish a COVID‐19‐free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.
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Affiliation(s)
- Cemil Burak Kulle
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | | | - Dogan Vatansever
- Department of Obstetrics and Gynecology, School of MedicineKoc UniversityIstanbulTurkey
| | - Suat Erus
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Kayhan Tarim
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Goktug Akyoldas
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Ozan Gokler
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Mehmet Ali Deveci
- Department of Orthopedic Surgery and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, School of MedicineKoc UniversityIstanbulTurkey
| | - Onder Ergonul
- Department of Infectious Diseases, School of MedicineKoc UniversityIstanbulTurkey
| | - Orhan Agcaoglu
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Murat Can Kiremit
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Omer Yavuz
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Talat Kiris
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Selin Unsaler
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Burak Giray
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of MedicineKoc UniversityIstanbulTurkey
- Department of Obstetrics and GynecologyZeynep Kamil Training and Research HospitalIstanbulTurkey
| | - Murat Korkmaz
- Department of Orthopedic Surgery and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
| | - Ece Dilege
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Mert Kilic
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Ezgi Cesur
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Ihsan Solaroglu
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Ozan Altuntas
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Aykin Simsek
- Department of Orthopedic Surgery and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
| | - Serhan Tanju
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Mert Erkan
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Erdem Canda
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Mehdi Sasani
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Aysenur Meric Hafiz
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Yakup Kordan
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Emre Balik
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Orhan Bilge
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Dursun Bugra
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, School of MedicineKoc UniversityIstanbulTurkey
| | - Sukru Dilege
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
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Oktenoglu T, Hekimoglu M, Aydin AL, Sasani M, Cerezci O, Ozer AF. Kyphoplasty with Posterior Dynamic Stabilization in the Surgical Treatment of Unstable Thoracolumbar Osteoporotic Vertebral Compression Fractures. Turk Neurosurg 2021; 31:924-930. [PMID: 34664690 DOI: 10.5137/1019-5149.jtn.33511-20.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Patients with unstable osteoporotic vertebral compression fractures (VCFs) underwent posterior dynamic stabilization (PDS) besides kyphoplasty (KP). The patients were followed up for 12 months. This study aimed to evaluate the role of PDS with KP in the surgical treatment of unstable osteoporotic compression fractures, which are common in the elderly population. KP is a highly preferable surgical method; however, significant decreases in vertebral height may lead to segmental instability. Despite KP treatment, development or progression of kyphosis and persistent chronic back pain are major problems. The PDS technique offers similar stabilization as rigid systems. MATERIALS AND METHODS This study included 25 patients with osteoporotic compression fractures. KP with PDS was performed on all patients. Radiological evaluation was performed with magnetic resonance imaging, computed tomography, and plain radiographs. The vertebral kyphosis angle (VKA), local kyphosis angle (LKA), and percentage of collapse were calculated. Clinical evaluation was performed with the visual analog scale and the Oswestry Disability Index (ODI). The preoperative and postoperative clinical and radiological data were compared. RESULTS The clinical and radiological parameters showed significant improvement following surgical treatment. The mean preoperative visual analog scale score of 7.78 decreased to 0.94 after 12 months. The mean preoperative ODI score of 70.33 decreased to 15.65 after 12 months. The mean preoperative VKA of 17.89° decreased to 9.22° after 12 months. The mean preoperative LKA of 9.61° decreased to 5.50° after 12 months. The mean preoperative percentage of collapse of 32.56% decreased to 19.00% after 12 months. There were no major complications. CONCLUSIONS KP with the PDS method offered satisfactory outcomes in the surgical treatment of unstable osteoporotic compression fractures.
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Aydın AL, Sasani M, Sasani H, Üçer M, Hekimoğlu M, Öktenoğlu T, Özer AF. Comparison of Two Minimally Invasive Techniques with Endoscopy and Microscopy for Extraforaminal Disc Herniations. World Neurosurg 2020; 144:e612-e621. [DOI: 10.1016/j.wneu.2020.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
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Aydin AL, Sasani M, Erbulut DU, Oktenoglu T, Ozer AF. A new concept of motion preservation surgery of the cervical spine: PEEK rods for the posterior cervical region. Biomed Mater Eng 2020; 31:235-251. [PMID: 32894236 DOI: 10.3233/bme-206004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laminectomy may cause kyphotic postoperative deformity in the cervical region leading to segmental instability over time. Laminoplasty may be an alternative procedure to laminectomy, as it protects the spine against post-laminectomy kyphosis; however, similar to laminectomy, laminoplasty may cause sagittal plane deformities by destructing or weakening the dorsal tension band. OBJECTIVE Using finite element analysis (FE), we attempted to determine whether a posterior motion preservation system (PEEK posterior rod system concept) could overcome the postoperative complications of laminectomy and laminoplasty and eliminate the side effects of rigid posterior stabilization in the cervical region. METHODS We compared PEEK rods in four different diameters with a titanium rod for posterior cervical fixation. The present study may lead to motion preservation systems of the cervical vertebra. RESULTS When PEEK rod is compared with titanium rod, considerable increase in range of motion is observed. CONCLUSIONS PEEK rod-lateral mass screw instrumentation systems may be useful in motion preservation surgery of the posterior cervical region.
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Affiliation(s)
- Ahmet Levent Aydin
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Tunc Oktenoglu
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
| | - Ali Fahir Ozer
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
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Abstract
AIM To present the clinical results in patients with minor instability with Dynesys® a soft spinal stabilization system. MATERIAL AND METHODS A total of 83 patients were operated upon and the Dynesys® system was applied. Indications for surgery included painful degenerative disc disease, degenerative spondylolisthesis and lumbar canal stenosis. RESULTS The results for the Dynesys® system were satisfactory, and we have calculated the overall complication rate to be 20.4% (n=17), which is in agreement with the literature. CONCLUSION The Dynesys® dynamic stabilization system effectively protects lumbar motion and achieves lumbar stability in patients with lumbar spinal problems. Our clinical result support literature that Dynesys® system is a strong alternative to fusion and instrumentation system in patient with chronic instabilities.
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Affiliation(s)
- Goktug Akyoldas
- Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey
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Sasani H, Solmaz B, Sasani M, Vural M, Ozer AF. Diagnostic Importance of Axial Loaded Magnetic Resonance Imaging in Patients with Suspected Lumbar Spinal Canal Stenosis. World Neurosurg 2019; 127:e69-e75. [PMID: 30857995 DOI: 10.1016/j.wneu.2019.02.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE AND BACKGROUND To study the efficacy of lumbar (AL) magnetic resonance imaging (MRI) in patients with suspected lumbar spinal stenosis (LSS), with and without AL compression. Supine MRI is used in the assessment of patients with LSS. However, MRI findings may poorly correlate with neurologic findings because of the morphologic changes of the lumbar spinal canal between upright standing and supine positions. In patients without significant stenosis in routine lumbar MRI, by applying AL, MRI can show significant LSS. METHODS This study included 103 consecutive patients (188 disc levels) who presented with neurogenic claudication with and without low back pain. AL was performed using a nonmagnetic compression device for 5 minutes. T1- and T2-weighted axial and sagittal sequences were obtained during AL applied to the spine. The dural sac cross-sectional area (DSCA) appeared to be narrow at each disc level of L4-5 to L5-S1 in all patients and was measured using T2-weighted images in routine supine and AL images. RESULTS The groups included patients with a reduction in the DSCA (>15 mm2) according to patient age and DSCA in routine spine MRI. The mean DSCA of the disc levels without and with AL were 138 mm2 and 123 mm2, with a mean difference of 15 mm2 at L4-5, 134 mm2 and 125 mm2 and a mean difference of 9 mm2 at L5-S1, respectively. CONCLUSIONS The use of AL MRI in patients with clinically suspected LSS could reduce the risk of misdiagnosis of stenosis, leading to inappropriate treatment.
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Affiliation(s)
- Hadi Sasani
- Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
| | - Bilgehan Solmaz
- Department of Neurosurgery, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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Ozer AF, Cevik OM, Erbulut DU, Yaman O, Senturk S, Oktenoglu T, Sasani M, Suzer T, Goel V. A Novel Modular Dynamic Stabilization System for the Treatment of Degenerative Spinal Pathologies. Turk Neurosurg 2019; 29:115-120. [PMID: 30614508 DOI: 10.5137/1019-5149.jtn.23227-18.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM To show the preliminary clinical results of the Orthrus modular dynamic stabilization system that is a new instrumentation system intended for degenerative diseases of the lumbar spine. MATERIAL AND METHODS The system utilizes two different types of screws that can be used in conjunction with different types of rods such as titanium, carbon fiber or PEEK. The first type of screw is a double headed screw to interconnect to the upper and lower level with independent rods. The second type of screw is a sliding screw to be used on a immovable vertebrae that allows movement in two planes on the tip. RESULTS The system has been used on 36 patients with pathology varying from degenerative disc disease to degenerative lumbar scoliosis. Satisfactory results have been obtained in a all 36 patients in the 12-month follow-up period. CONCLUSION The Orthrus dynamic system shows better clinical results than the available dynamic systems on the market. It also proves to provide similar fusion with considerably less postoperative morbidity which makes it a better method to treat adult degenerative spine diseases for carefully chosen patients.
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Affiliation(s)
- Ali Fahir Ozer
- Koc University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
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20
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Ciplak NM, Suzer T, Senturk S, Yaman O, Sasani M, Oktenoglu T, Yilmaz A, Erbulut DU, Özer AF. Complications of 2-Level Dynamic Stabilization: A Correlative Clinical and Radiological Analysis at Two-Year Follow-up on 103 Patients. Turk Neurosurg 2018; 28:756-762. [PMID: 30192368 DOI: 10.5137/1019-5149.jtn.21036-17.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. MATERIAL AND METHODS Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year followup. Screw breakage and loosening were evaluated during this duration together with clinical findings. RESULTS Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. CONCLUSION Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.
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Affiliation(s)
- Necati Mert Ciplak
- Koc University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
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Canbulat N, Oktenoglu T, Ataker Y, Sasani M, Ercelen O, Cerezci O, Suzer T, Ozer AF. A Rehabilitation Protocol for Patients with Lumbar Degenerative Disc Disease Treated with Posterior Transpedicular Dynamic Stabilization. Turk Neurosurg 2017; 27:426-435. [PMID: 27593792 DOI: 10.5137/1019-5149.jtn.16326-15.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the efficacy of the rehabilitation protocol on patients with lumbar degenerative disc disease after posterior transpedicular dynamic stabilization (PTDS) surgery. MATERIAL AND METHODS Patients (n=50) with single level lumbar degenerative disc disease were recruited for this study. Patients had PTDS surgery with hinged screws. A rehabilitation program was applied for all patients. Phase 1 was the preoperative evaluation phase. Phase 2 (active rest phase) was the first 6 weeks after surgery. During phase 3 (minimal movement phase, 6-12 weeks) pelvic tilt exercises initiated. In phase 4 (dynamic phase, 3-6 months) dynamic lumbar stabilization exercises were started. Phase 5 (return to sports phase) began after the 6th month. The primary outcome criteria were the Visual Analogue Pain Score (VAS) and the Oswestry Disability Index (ODI). Patients were evaluated preoperatively, postoperative 3rd, 12th and 24th months. RESULTS The mean preoperative VAS and ODI scores were 7.52±0.97 and 60.96±8.74, respectively. During the 3rd month, VAS and ODI scores decreased to 2.62±1.05 and 26.2±7.93, respectively. VAS and ODI scores continued to decrease during the 12th month after surgery to 1.4±0.81 and 13.72±6.68, respectively. At the last follow-up (mean 34.1 months) the VAS and ODI scores were found to be 0.68±0.62 and 7.88±3.32, respectively. (p=0.0001). CONCLUSION The protocol was designed for a postoperative rehabilitation program after PTDS surgery for patients with lumbar degenerative disc disease. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and the presented rehabilitation program.
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Affiliation(s)
- Nazan Canbulat
- Koc University, School of Medicine, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
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Ozer AF, Oktenoglu T, Egemen E, Sasani M, Yilmaz A, Erbulut DU, Yaman O, Suzer T. Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients. Clin Orthop Surg 2017; 9:310-316. [PMID: 28861198 PMCID: PMC5567026 DOI: 10.4055/cios.2017.9.3.310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/12/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study compares the clinical and radiological results of three most commonly used dynamic stabilization systems in the field of orthopedic surgery. METHODS A total of 71 patients underwent single-level posterior transpedicular dynamic stabilization between 2011 and 2014 due to lumbar degenerative disc disease. Three different dynamic systems used include: (1) the Dynesys system; (2) a dynamic screw with a PEEK rod; and (3) a full dynamic system (a dynamic screw with a dynamic rod; BalanC). The mean patient age was 45.8 years. The mean follow-up was 29.7 months. Clinical and radiological data were obtained for each patient preoperatively and at 6, 12, and 24 months of follow-up. RESULTS Clinical outcomes were significantly improved in all patients. There were no significant differences in the radiological outcomes among the groups divided according to the system used. Screw loosening was detected in 2 patients, and 1 patient developed screw breakage. All patients with screw loosening or breakage underwent revision surgery. CONCLUSIONS Each procedure offered satisfactory outcome regardless of which system was applied.
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Emrah Egemen
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Atilla Yilmaz
- Department of Neurosurgery, Mustafa Kemal University, Hatay, Turkey
| | - Deniz Ufuk Erbulut
- Department of Biomedical Engineering, Medipol University, Istanbul, Turkey
| | - Onur Yaman
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tuncer Suzer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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Egemen E, Tuncer Süzer S, Yaman O, Sasani M, OktenoAAlu BT, YAAlmaz A, Ozer AF. Perspective of Lumbar Segmental Instability for Surgical Evalua tion of Lumbar Disc Herniation. ACTA ACUST UNITED AC 2017. [DOI: 10.4172/2165-7939.1000354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Aydin M, Sasani M, Oktenoglu T, Durmaz MO, Bozkus H, Keskin F, Ozer AF. Clinical evaluation of 34 cases treated with sequestrectomy: Minimum two year follow up. International Journal of Surgery Open 2017. [DOI: 10.1016/j.ijso.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ulusoy OL, Sasani H, Barlas SB, Mutlu A, Sasani M. A Case of Anomalous Origin and Course of Vertebral Artery in a Patient with Klippel Feil Syndrome. Korean J Radiol 2016; 17:554-7. [PMID: 27390547 PMCID: PMC4936178 DOI: 10.3348/kjr.2016.17.4.554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/15/2016] [Indexed: 11/15/2022] Open
Abstract
Patients with Klippel-Feil syndrome (KFS) have an increased incidence of vascular anomalies as well as vertebral artery (VA) anomalies. In this article, we presented imaging findings of a 15-year-old female patient with KFS with a rare association of extraforaminal cranially ascending right VA that originated from the ipsilateral carotid bulb. Trifurcation of the carotid bulb with VA is a very unusual variation and to the best of our knowledge, right-sided one has not been reported in the literature.
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Affiliation(s)
- Onur Levent Ulusoy
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Hadi Sasani
- Department of Radiology, Near East University School of Medicine, Nicosia 99138, Northern Cyprus
| | - Sezgi Burçin Barlas
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Ayhan Mutlu
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Mehdi Sasani
- Department of Anatomy, Trakya University, Faculty of Medicine, Edirne 22030, Turkey
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Sasani M, Aydın AL, Aytan N, Yapicier O, Oktenoglu T, Ozer NK, Ozer AF. Effect of a hypercholesterolemia as a starting factor on spinal degeneration in rabbits and role of Vitamin E (α-tocopherol). Surg Neurol Int 2016; 7:36. [PMID: 27127701 PMCID: PMC4838922 DOI: 10.4103/2152-7806.180092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/25/2016] [Indexed: 11/04/2022] Open
Abstract
Background: To identify the role of the hypercholesterolemia as a starting factor in discovertebral degeneration that ultimately causes lower back pain, and investigate the role of Vitamin E in this process. Methods: The rabbits (n = 32) were divided into two broad experimental groups: A control group, and a hypercholesterolemia group, namely cholesterol, and cholesterol plus Vitamin E groups and they were fed sequentially for 4 or 8 weeks. Serum cholesterol and Vitamin E (α-tocopherol) levels were determined; vascular tissue was prepared for histopathological analyses and vertebra was decalcified for the study. Results: Cholesterol diet group resulted approximately 44-fold of increase plasma cholesterol levels over the 4-week control values. Additional supplementation with Vitamin E group induced a plasma cholesterol level increase of only 37-fold as compared to the control group. In the cholesterol groups, light microscope examination revealed atherosclerotic plaque in major arteries. However, in the cholesterol plus Vitamin E treatment groups, no lipid accumulation or foam cell formation was visible in the abdominal aorta and vertebral segmental artery. In histopathological examination, we found degenerative changes in the discovertebral unit in cholesterol treated groups. Conclusion: Hypercholesterolemia causes fat accumulation in the disc endplate and vertebral body that causes blood supply disturbances which might be a starting factor of discovertebral degeneration. This event was not reversed by the elimination of cholesterol from the diet. Vitamin E supplementation was not effective in reducing fat accumulation in vertebral bone marrow. As a result, we conclude that degeneration of the discovertebral unit is not related to atherosclerotic changes in the major blood vessels.
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Affiliation(s)
- Mehdi Sasani
- Department of Neurosurgery, American Hospital, Istanbul, Turkey, Turkey
| | - Ahmet Levent Aydın
- Department of Neurosurgery, Istanbul Physical Therapy and Rehabilitation Training Hospital, Istanbul, Turkey
| | - Nurgul Aytan
- Department of Neurology, School of Medicine, Boston University, Boston, MA, USA
| | - Ozlem Yapicier
- Department of Pathology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey, Turkey
| | - Nesrin Kartal Ozer
- Department of Biochemistry, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, School of Medicine, Koc University, Istanbul, Turkey
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Ozer AF, Suzer T, Sasani M, Oktenoglu T, Egemen E. Enlargement of Neural Foramina and Dynamic Stabilization in Spondylolisthesis without Restoring the Alignment: Technical Note. Korean J Spine 2016; 13:37-9. [PMID: 27123030 PMCID: PMC4844660 DOI: 10.14245/kjs.2016.13.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 12/05/2022]
Abstract
It is well known that the cause of radiculopathy is the compression of the nerve root within the foramina which is narrowed secondary to sliding of the corpus and reduced disc height. In some patients, unroofing the foramen does not resolve this problem. We described a new decompression technique using pedicle removal and transpedicular dynamic instrumentation to stabilization the spine. We performed this operation in 2 patients and achieved very good results.
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tuncer Suzer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Emrah Egemen
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
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Canbay S, Ataker Y, Canbulat N, Kabaoglu ZU, Oktenoglu T, Sasani M, Ozer AF. Effect of Posterior Dynamic Instrumentation on High-Intensity Zone in Lumbar Degenerative Disc Disease. Turk Neurosurg 2016; 25:578-85. [PMID: 26242335 DOI: 10.5137/1019-5149.jtn.12350-14.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To investigate high-intensity zone (HIZ) changes after lumbar posterior dynamic instrumentation. MATERIAL AND METHODS Our study included 53 patients: 27 patients in group 1, 26 patients in group 2. All patients had one or two levels of degenerative disc disease with an HIZ confirmed by magnetic resonance imaging (MRI). Group 1 underwent one- or two-level dynamic lumbar posterior instrumentation. Group 2 was treated conservatively with an exercise program. Patients were evaluated using MRI, a numerical visual analog pain scale (VAS), and the Oswestry Disability Index (ODI) at baseline, at 1 year after surgery, and at final follow-up evaluation. RESULTS The mean duration of follow-up was 49.3 months in group 1 and 47.19 months in group 2. The baseline VAS and ODI scores were similar for both groups. The mean VAS score of group 1 was significantly improved at 1 year after surgery and at final follow-up. The mean ODI value was lower in group 1 than in group 2 at 1 year and at final follow-up. Pfirrmann grades in group 1 significantly differed at 1 year and at final follow-up but did not change in group 2. The number of HIZs significantly decreased in from baseline to 1 year and from baseline to final follow-up in group 1 but did not differ in group 2. CONCLUSION Dynamic lumbar stabilization systems are promising. Observations such as Pfirrmann grade improvements and disappearance of HIZs are concordant with improvements in VAS and ODI scores demonstrate that dynamic stabilization systems may provide an environment for regeneration.
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Affiliation(s)
- Suat Canbay
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Neurosurgery Department, Ankara, Turkey
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Breckwoldt T, Oktenoglu T, Sasani M, Suzer T, Ozer AF. A rare cause of root-compression: Subaxial cervical synovial cyst in association with congenital fusion. Int J Surg Case Rep 2015; 16:90-2. [PMID: 26433927 PMCID: PMC4643443 DOI: 10.1016/j.ijscr.2015.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Synovial cyst in the cervical spine is a very rare pathology that develops from the facet joint. When a synovial cyst emerges into the surrounding space, it can compress the nervous tissue and cause neurological symptoms. In the cervical area there is additionally the risk of spinal cord compression comparing to the more common presentation of synovial cysts in the lumbar spine. PRESENTATION OF CASE Here, a cervical synovial cysts from the left facet joint grew into the spinal canal and compressed the C8 nerve root which led to root compressing symptoms. Interestingly we found this synovial cyst with congenital fusion. We identified only nine similar cases in the literature. The cyst was removed surgically and the patient discharged without complications. DISCUSSION Numerous theories have been established to explain the pathogenesis of synovial cyst. Biomechanical alterations of the spine play a significant role in the development of synovial cyst. However, the etiology is still unclear. CONCLUSION Surgical treatment should be considered in cervical synovial cysts with neurologic deficit or with cord compression or when the conservative treatment is ineffective.
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Affiliation(s)
- Tabea Breckwoldt
- University of Fribourg, Faculty of Sciences, Fribourg, Switzerland
| | - Tunc Oktenoglu
- American Hospital, Neurosurgery Department, Istanbul, Turkey.
| | - Mehdi Sasani
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Tuncer Suzer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Ali Fahir Ozer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
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Ozer AF, Suzer T, Sasani M, Oktenoglu T, Cezayirli P, Marandi HJ, Erbulut DU. Simple facet joint repair with dynamic pedicular system: Technical note and case series. J Craniovertebr Junction Spine 2015; 6:65-8. [PMID: 25972711 PMCID: PMC4426524 DOI: 10.4103/0974-8237.156049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Facet joints are important anatomical structures for the stability of spine. Surgical or degenerative damage to a facet joint may lead to spinal instability and causes clinical problems. This article explains the importance of facet joints, reviews facet replacement systems, and describes a simple and effective method for facet replacement after surgical removal of facet joints. Materials and Methods: Ten patients were operated with the diagnosis of unilateral nerve root compression secondary to facet degeneration. The hypertrophic facet joints were removed with microsurgical techniques and the roots were decompressed. Then, a unilateral artificial facet joint was created using two hinged screws and a dynamic rod. Results: The clinical outcome of all the patients was determined good or excellent at second and last follow-up (mean 13.3 months) controls using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Radiological evaluations also demonstrated no implant-related complications. Conclusions: The authors suggest that, if removal of a facet joint is necessary to decompress the nerve roots, the joint can be replaced by a construct composed of two hinged screws connected by a dynamic rod. This simple system mimics the function of a normal facet joint and is an effective technique for unilateral facet joint replacement.
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Affiliation(s)
- Ali Fahir Ozer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Tuncer Suzer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Mehdi Sasani
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Tunc Oktenoglu
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Phillip Cezayirli
- Albert Einstein College of Medicine/Montefiore Medical Center, Neurosurgery Residency, New York, USA
| | - Hosein Jafari Marandi
- Iran University of Medical Science, Hazrat Rasoul Medical Complex, Spine Surgery Division, Tehran, Iran
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Abstract
AIM Previous studies have not identified a preferred surgical technique to treat posttraumatic syringomyelia. Both syringopleural shunting and arachnoidolysis are used in neurosurgery practice for the surgical treatment of posttraumatic syringomyelia. In this study, we present a new technique designed to achieve a better outcome following surgery. MATERIAL AND METHODS A 33-year-old man, who exhibited pain and spasticity below the thoracic region after a traffic accident that occurred 16 years ago, was treated with a new technique. He also had paraparesis and urinary incontinency before the surgery. The initial cervicothoracic Magnetic Resonance Imaging (MRI) scans showed the development of a syrinx in the T4-5 region. A syringopleural shunt and bilateral subarachnoid to subarachnoid catheters from proximal to distal zones of the syrinx were performed under surgical microscope. RESULTS The operative time was 90 minutes, and the blood loss was approximately 100 mL. The patient was mobilized on postoperative day 2 and was discharged 4 days after surgery with mild improvement of his preoperative symptoms. Postoperative MRI scans revealed partial regression at 6 months and complete decompression of the syrinx at 3 years follow-up without any clinical symptoms. CONCLUSION This is a report of minimal-access insertion combining syringopleural with subarachnoid-subarachnoid bypass shunt insertion. This minimally invasive technique seems to be an effective and safe method.
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Affiliation(s)
- Ali Fahir Ozer
- Koc University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
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Abstract
PURPOSE Choroid plexus papillomas (CPP) are rare benign neoplasms of the central nervous system that occur most often in children during the first decade of life. They occur most often in the lateral ventricle. It is extremely rare for a CPP to occur in the pineal region. We describe the case of a child with a CPP located in the pineal region, who was initially diagnosed with obstructive hydrocephalus by cranial computed tomography (CT). METHODS A 9-year-old female patient presented with complaints of visual disturbance, nausea, and vomiting. Magnetic resonance imaging (MRI) showed a poor contrast-enhanced pineal-localized lesion. Anatomical variations within the patient caused her surgery to proceed using a supratentorial-occipital interhemispheric approach. RESULTS The tumor was totally removed, and a histological examination revealed the tumor to be a typical CPP. The patient received follow-up neurological and ophthalmologic examinations at 3, 6, 9, 12, 24, and 36 months postoperatively, which demonstrated her progressive improvement. CONCLUSIONS CPPs may have a wide range of locations and resulting symptoms. However, the pineal region is a rarely encountered location, particularly for pediatric patients. It is of great value to correctly differentiate neoplasms such as germ cell tumors, pineocytomas, meningiomas, and astrocytomas, so that patients receive the correct diagnosis and treatment approach.
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Affiliation(s)
- Mehdi Sasani
- Neurosurgery Department, American Hospital, Guzelbahce Sk. No: 20, 34365, Nisantasi, Istanbul, Turkey,
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Stemmler N, Solaroglu I, Aydin AL, Gomleksiz C, Sasani M, Oktenoglu T, Ozer AF. Unusual pain due to unilateral facet degeneration at the C1-2 level. Turk Neurosurg 2014; 24:430-3. [PMID: 24848189 DOI: 10.5137/1019-5149.jtn.8249-13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
AIM Neck pain is a common problem that may result from abnormalities in the soft tissues, bones and joints of the spine. However, upper neck and occipital pain syndrome due to unilateral idiopathic arthrosis of a C1-2 lateral articulation is a very rare condition. MATERIAL AND METHODS We describe two patients with unilateral arthrosis of a C1-2 lateral articulation who were successfully treated with C1-2 fusion. RESULTS The patients presented with severe headache and/or neck pain. The diagnosis was made with a careful history and imaging studies, including X-ray films, CT scans, and MRI studies. Posterior atlanto-axial transfacet screw fixation was performed in both patients. There were no surgical complications. CONCLUSION C1-2 fusion is necessary to relieve intractable pain after failure of conservative treatment and/or invasive pain procedures in unilateral C1-2 arthrosis.
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Affiliation(s)
- Nelly Stemmler
- Rheinische Friedrich Wilhelm University, Medical Faculty, Germany
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Oktenoglu T, Erbulut D, Kiapour A, Ozer A, Lazoglu I, Kaner T, Sasani M, Goel V. Pedicle screw-based posterior dynamic stabilisation of the lumbar spine:in vitrocadaver investigation and a finite element study. Comput Methods Biomech Biomed Engin 2014; 18:1252-1261. [DOI: 10.1080/10255842.2014.890187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Keskin F, Gomleksiz C, Sasani M, Oktenoglu T, Suzer T, Ozer AF. Clinical results of anterior odontoİd screw fixation for type ii odontoid fractures. Turk Neurosurg 2014; 24:750-6. [DOI: 10.5137/1019-5149.jtn.9814-13.0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Çelebi İ, Öz A, Sasani M, Bayındır P, Sözen E, Vural Ç, Başak M. Using Dynamic Maneuvers in the Computed Tomography/Magnetic Resonance Assessment of Lesions of the Head and Neck. Can Assoc Radiol J 2013; 64:351-7. [DOI: 10.1016/j.carj.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 01/09/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022] Open
Abstract
Despite advances in technology, the radiologic assessment of certain head and neck lesions may still pose difficulties because of the complex anatomy of this region, the small and mobile structures that this region harbors, and the apposition of mucosal surfaces in the neutral position. Certain maneuvers have been described in the literature to overcome these difficulties. We review the use of the Valsalva and the modified Valsalva maneuver, the puffed-cheek technique, phonation, and inspiration, with possible applications in head and neck imaging.
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Affiliation(s)
- İrfan Çelebi
- Radiology Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Aysel Öz
- Radiology Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Clinic, VKV American Hospital, İstanbul, Turkey
| | - Petek Bayındır
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Esra Sözen
- Otorhinolaryngologic Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Çetin Vural
- Department of Otolaryngology, Head and Neck Surgery, Maltepe University School of Medicine, İstanbul, Turkey
| | - Muzaffer Başak
- Radiology Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
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Abstract
AIM Chordoma is a rare, slow-growing primary malignant tumor of the axial skeleton, arising from the embryonic cells of primitive notochord. Chordomas may arise at different sites of the vertebral column simultaneously or more probably they may metastasise along the neural axis insidiously. Recurrence despite radical surgery and following adjuvant therapy is possible. MATERIAL AND METHODS A 46-year-old female patient presented weakness and numbness of the lower extremities. She was operated for clivus chordoma five years ago at another institute. RESULTS First the patient underwent surgery for resection of the tumor at the cervical region. a second surgery was performed to resect tumor on the foramen magnum and at the C1 level. Histologic examination of the removed vertebra confirmed the diagnosis of chordoma involving the vertebral body. Radiotherapy was administered after the second surgery. Follow-up neurological and radiological examinations revealed no abnormal neurological symptoms 2,5 years after second surgery. There were no distant organ metastases. CONCLUSION A patient with diagnosed chordoma of the spine must be investigated with MRI of other regions of the neuraxis to exclude second or even third source of chordoma metastases. In metastatic chordoma cases, radical or gross total resection should be performed for each lesion but if complete surgical resections are impossible, preoperative or postoperative radiation therapy should be planned to improve life expectancy.
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Affiliation(s)
- Ahmet Levent Aydin
- Istanbul Physical Therapy and Rehabilitation Hospital, Department of Neurosurgery, Istanbul, Turkey
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Canbay S, Aydin AL, Aktas E, Erten SF, Basmaci M, Sasani M, Ozer AF. Posterior dynamic stabilization for the treatment of patients with lumbar degenerative disc disease: long-term clinical and radiological results. Turk Neurosurg 2013; 23:188-97. [PMID: 23546904 DOI: 10.5137/1019-5149.jtn.6459-12.0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Comparison of long-term preoperative and postoperative clinical and radiological results for patients diagnosed with degenerative disc disease that underwent posterior dynamic stabilization. Lumbar disc degeneration is caused by a variety of factors. Disruptions in the vertebral endplate result in defects in disc nutrition and, thus, disc degeneration. The aims of dynamic stabilization are to unload the disc/facet joints, preserve motion under mechanical load, and restrict abnormal motion in the spinal segment. MATERIAL AND METHODS Twenty-five patients diagnosed with lumbar degenerative disc disease were enrolled. Totally, 25 vertebral segments were subjected to posterior dynamic stabilization. Patients were clinically evaluated in the preoperative and postoperative periods using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS). Segmental movement was evaluated radiologically in the late postoperative period by measuring the segmental angles during flexion and extension. RESULTS Significant postoperative improvements were observed in the ODI and VAS measurements (P < 0.01). During the long postoperative period (averaging 5 years and 2 months), lumbar lordosis angles, intervertebral space ratio and segmental ratio were measured and compared statistically. Adjacent segment disease developed in two patients. Both patients received L5-S1 discectomy. CONCLUSION Good clinical outcomes were observed in the treatment of lumbar degenerative disc disease with a posterior dynamic system.
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Affiliation(s)
- Suat Canbay
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey
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Abstract
AIM Minimally invasive surgical techniques for spine surgery have gained popularity over the last decade. In this study, the authors describe a unilateral dynamic stabilization for unilateral spinal pathologies. MATERIAL AND METHODS A total of 7 patients with an average age of 46.1 years (range 21-80 years) were included in this study. They are represented various spinal pathologies (degenerative disorders, various tumor pathologies) and having undergone a unilateral facetectomy (or facetectomies) with or without a hemilaminectomy procedure were analyzed in this study. The surgical stabilization was achieved with unilateral dynamic stabilization. RESULTS The new surgical concept is described here, and the comparative early results of the Oswestry disability index (ODI) and the visual analog scale (VAS) are presented as well. The preoperative average ODI was 73.14 (range 62-94), and the average VAS was 8.14 (range 7-10). Twelve months after the surgery, ODI was 10.6 (range 0-16), and the average VAS was 1 (range 0-2) (p < 0.01). CONCLUSION Although the limited number of cases analyzed reflects data of only early patient outcome, the procedure is safe, feasible, and cost effective. The unilateral dynamic pedicle screw stabilization without fusion is as a technical option to avoid possible segmental instability after unilateral total facetectomy procedure.
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Affiliation(s)
- Hakan Bozkus
- American Hospital, Department of Neurosurgery, Istanbul, Turkey.
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Ozer AF, Oktenoglu T, Sasani M, Kaner T, Ercelen O, Canbulat N. Unusual cause of acute low-back pain: sudden annulus fibrosus rupture. Orthop Rev (Pavia) 2012; 4:e22. [PMID: 22802990 PMCID: PMC3395991 DOI: 10.4081/or.2012.e22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/24/2012] [Accepted: 05/25/2012] [Indexed: 11/23/2022] Open
Abstract
Low-back pain is a common problem in neu-rosurgery practice, and an algorithm has been developed for assessing these cases. However, one subgroup of these patients shares several clinical features and these individuals are not easy to categorize and diagnose. We present our observations for 8 of these patients, individuals with low-back pain caused by atypical annulus fibrosus rupture (AAR). The aim of this study is to show the consequences of overlooked annular tears on acute onset of low back pain. Eight patients with acute-onset severe low-back pain were admitted. Physical examinations were normal and each individual was examined neurologically and assessed with neuroradiologic studies [plain x-rays, magnetic resonance imaging (MRI), discography and computed tomography (CT) discography]. AAR was ultimately diagnosed with provocative discography. In all cases, MRI showed a healthy disc or mild degeneration, whereas discography and CT discography demonstrated disc disease. Anterior interbody cage implantation was performed in 3 of the 8 cases and posterior dynamic stabilization was carried out in 3 cases. The other 2 individuals refused surgery, and we were informed that one of them developed disc herniation at the affected level 1 year after our diagnosis. Clinical and radiological outcomes were evaluated. In cases where AAR is suspected, MRI, discography, and CT discography should be performed in addition to routine neuroradiologic studies.
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Affiliation(s)
- Ali Fahir Ozer
- Neurosurgery Department, Koc University School of Medicine
| | | | | | - Tuncay Kaner
- Neurosurgery Department, Istanbul Medeniyet University School of Medicine
| | - Omur Ercelen
- Anesthesiology and Pain Department, American Hospital
| | - Nazan Canbulat
- Physical Treatment and Rehabilitation Department, American Hospital, Istanbul, Turkey
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Sasani M, Sasani H, Kaner T, Fahir Ozer A. Resection of a large spinal intradural ependymoma using a limited unilateral laminectomy approach in the lumbosacral region. J Neurosurg Sci 2012; 56:55-59. [PMID: 22415383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ependymomas are the most common gliomas of the lower spinal cord, conus medullaris and filum terminale. Although there are several surgical modalities indicated in the removal of spinal tumors, total laminectomy is the conventional method used. However, surgical complications, such as spinal deformities and instability are more common with this approach compared to limited unilateral hemilaminectomy. To present the clinical and radiologic results of patient with a large spinal intradural ependymoma via a limited posterior unilateral laminectomy approach in the lumbosacral region. The aim of this study was to present a modified duramater incisions and surgical positions setup, and discussed the major controversies in treatment in the literature. This article reports the surgical resection of a lumbosacrally localized ependymoma in a 25-year-old male patient using unilateral laminectomy at the L4 to S3 levels. The tumor was removed with any difficulty in reaching to contralateral side. A follow-up lumbar magnetic resonance imaging scan with and without contrast performed 18 months postoperatively showed no residual or recurrent tumor lesions. This procedure may be more difficult than the conventional total laminectomy as suturing of the duramater. However, modified duramater incisions and setup of microscope-operating table provides best facilitates to surgery manipulation. Besides, unilateral limited laminectomy protected the posterior supporting elements. In order to reduce the postoperative complications and minimize the destruction of tissue, unilateral limited hemilaminectomy is recommended for the removal of intradural tumors. This technique facilitates the return of the patient to ordinary life.
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Affiliation(s)
- M Sasani
- Neurosurgery Department, American Hospital, Istanbul, Turkey
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Kaner T, Oktenoglu T, Sasani M, Ozer AF. L5 vertebrectomy for the surgical treatment of tumoral and traumatic lesions of L5 vertebra. Orthop Rev (Pavia) 2012; 4:e10. [PMID: 22577498 PMCID: PMC3348685 DOI: 10.4081/or.2012.e10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 01/03/2012] [Accepted: 01/06/2012] [Indexed: 11/23/2022] Open
Abstract
We retrospectively reviewed the clinical characteristics and the surgical results of seven patients treated with L5 vertebrectomy. The pathologies, clinical characteristics, preoperative and postoperative radiological findings, surgical techniques, and instrumentation for seven patients operated on between 1998 and 2009 are presented in this article. Biopsies were performed on all patients except those involving trauma. Patients were followed up at three-month intervals in the first year, at 6-month intervals in the second year, and on a regular basis afterward. One patient had a traumatic L5 burst fracture; the other six had tumoral pathologies in the L5 vertebrae. One tumoral lesion was a chordoma, another was a hemangioma, and the remaining four were metastatic lesions. Radiotherapy and chemotherapy were performed for the metastatic tumor patients during the postoperative period. Patients with renal cancer and chordoma survived for 3 years; patients with lung cancer and bladder cancer survived for 1 year; and patients with breast cancer survived for 16 months. The lumbosacral region presents significant stabilization problems because of the presence of sacral slope. In our opinion, if the lesion involves only the L5 vertebra, anterior cage-filled bone cement or bone graft should be performed, as dictated by the pathology and posterior transpedicular instrumentation. If the lesion involves the L4 vertebra or the sacrum and the L5 vertebra, the instrumentation can be extended to cover other segments with sacral attachments. The present cases involved only L5 vertebra and treatment with short-segment stabilization covering the anterior and posterior columns.
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Sasani M, Fahir Ozer A, Oktenoglu T, Kaner T, Solmaz B, Canbulat N, Ercelen O. Thoracoscopic surgery for thoracic disc herniation. J Neurosurg Sci 2011; 55:391-395. [PMID: 22198592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Technical improvements in endoscopy have had a major effect in the practice of minimally invasive surgery, which is preferable to more invasive surgical procedures for central and hard thoracic disc herniation. Eleven patients underwent surgery between 2002 and 2008. Data was collected from self-reporting questionnaires completed by the patient at each visit before surgery and after surgery at 3,6,12 and 24 months. The questionnaires included in the study were the Oswestry Disability Questionnaire and a visual analog scale(VAS) for the evaluation of pain. In all eleven patients, the thoracoscopic approach was technically performed satisfactorily. There was a significant initial improvement in both the Oswestry score and the VAS pain score at up to nine months(P<0.05). The average relative difference in the Oswestry and VAS score was not significant at 12 and 24 months. The complication rate(pleurisy and lung contusion) in our small study was 18%, which compares favorably with the literature. Video assisted thoracic spine surgery (VATS) clearly provides a minimally invasive and effective alternative to open thoracic surgery. A surgeon must be familiar with the surgical anatomy and the endoscopic techniques to ensure an optimal surgical outcome. Hence, that is one limitation in the practice of thoracoscopic discectomy.
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Affiliation(s)
- M Sasani
- Neurosurgery Department, American Hospital, Istanbul, Turkey.
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Aydin AL, Sasani M, Erhan B, Sasani H, Ozcan S, Ozer AF. Idiopathic spinal cord herniation at two separate zones of the thoracic spine: the first reported case and literature review. Spine J 2011; 11:e9-e14. [PMID: 21862417 DOI: 10.1016/j.spinee.2011.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 04/26/2011] [Accepted: 07/01/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy. Preoperative diagnosis can be made with magnetic resonance imaging (MRI). Many surgical techniques have been applied by various authors, and ISCH is usually reversible by surgical treatment. PURPOSE To present a case of ISCH in two separate zones at two thoracic levels. To our knowledge, this is the first such case to be published in English literature. We also discuss the clinical findings, surgical procedures, and surgical outcomes for other previously reported cases of ISCH in the literature. STUDY DESIGN Case report. METHODS A 52-year-old woman with bilateral lower extremity weakness underwent thoracic MRI, which revealed transdural spinal cord herniation at two separate zones, namely, the T4-T5 and T5-T6 intervertebral disc levels. RESULTS During surgery, the spinal cord was reduced, the two separate dural defects were connected, and the new single defect was restored then reinforced with a thin layer of fascial graft. The posterior dural defect was then closed with interrupted stitches. The patient's neurologic status was characterized by no changing of the preoperative motor status. Follow-up MRI scans showed that the cord was replaced in the dural sac and showed cord hyperintensity in the herniation levels. The patient could move with a cane at the sixth month postoperatively. CONCLUSIONS Idiopathic spinal cord herniation is a rare clinical condition that should be considered in the differential diagnosis of paraplegia. Although progression of neurologic deficits can be very slow, reduction of the spinal cord and repair of the defect are crucial to stop or reverse the deterioration. The outcome for patients who initially have Brown-Séquard syndrome is significantly better than for patients who presented with spastic paralysis. To our knowledge, this case study represents the first reported instance in which two separate anterior dural defects caused two levels of anterior spinal cord herniation.
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Affiliation(s)
- Ahmet L Aydin
- Neurosurgery Department, Istanbul Physical Therapy and Rehabilitation Training Hospital, Istanbul, Turkey
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Sasani M, Bayhan M, Sasani H, Kaner T, Oktenoglu T, Cakiroglu G, Ozer AF. Primary central nervous system lymphoma presenting as a pure third ventricular lesion: a case report. J Med Case Rep 2011; 5:213. [PMID: 21619666 PMCID: PMC3121681 DOI: 10.1186/1752-1947-5-213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/28/2011] [Indexed: 11/14/2022] Open
Abstract
Introduction Primary central nervous system lymphomas are infrequently occurring lymphomas that account for only 0.3-1.5% of all intra-cranial neoplasms in patients without acquired immune deficiency syndrome. However, a pure third ventricle lymphoma is extremely rare. Here, we discuss the similar radiological appearances of lesions localized in the third ventricle and the importance of accurately diagnosing primary central nervous system lymphomas for favorable treatment outcomes. Case presentation A 38-year-old Caucasian man from Turkey presented with a severe headache lasting for three months that failed to respond to any medication. Both severity and duration of the symptoms increased gradually, resulting in vomiting, nausea and gait disturbance that accompanied the headache for three weeks. Neuro-imaging studies showed a lesion located solely in the third ventricle, resulting in partial obstruction of the foramen of Monro. The pre-operative diagnosis was a colloid cyst. Following the surgical procedure, the results of pathological and immunochemical assays revealed that the pre-operative diagnosis was incorrect and that the lesion was a primary central system lymphoma. Conclusion Pure third ventricle lymphomas are extremely rare and are exceptionally localized. It is important to be aware of, and to differentiate between, other possible third ventricular lesions that may mimic the same radiological appearance. Accurate diagnosis is necessary for selecting appropriate treatment modalities.
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Affiliation(s)
- Mehdi Sasani
- American Hospital Neurosurgery Department, Nisantasi, Istanbul, Turkey.
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Sasani M, Yazgan B, Celebi I, Aytan N, Catalgol B, Oktenoglu T, Kaner T, Ozer NK, Ozer AF. Hypercholesterolemia increases vasospasm resulting from basilar artery subarachnoid hemorrhage in rabbits which is attenuated by Vitamin E. Surg Neurol Int 2011; 2:29. [PMID: 21451728 PMCID: PMC3062808 DOI: 10.4103/2152-7806.77600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/22/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aneurysm rupture results in subarachnoid hemorrhage (SAH) with subsequent vasospasm in the cerebral and cerebellar major arteries. In recent years, there has been increasing evidence that hypercholesterolemia plays a role in the pathology of SAH. It is known that hypercholesterolemia is one of the major risk factors for the development of atherosclerosis. Among the factors that have been found to retard the development of atherosclerosis is the intake of a sufficient amount of Vitamin E. An inverse association between serum Vitamin E and coronary heart disease mortality has been demonstrated in epidemiologic studies. Therefore, we tested, in an established model of enhanced cholesterol feed in rabbits, the effects of hypercholesterolemia on vasospasm after SAH by using computed tomography (CT) angiograms of the rabbit basilar artery; in addition, we tested the effects of Vitamin E on these conditions, which have not been studied up to now. METHODS In this study rabbits were divided into 3 major groups: control, cholesterol fed, and cholesterol + Vitamin E fed. Hypercholesterolemia was induced by a 2% cholesterol-containing diet. Three rabbit groups were fed rabbit diet; one group was fed a diet that also contained 2% cholesterol and another group was fed a diet containing 2% cholesterol and they received i.m. injections of 50 mg/kg of Vitamin E. After 8 weeks, SAH was induced by the double-hemorrhage method and distilled water was injected into cisterna magna. Blood was taken to measure serum cholesterol and Vitamin E levels. Basilar artery samples were taken for microscopic examination. CT angiography and measurement of basilar artery diameter were performed at days 0 and 3 after SAH. RESULTS Two percent cholesterol diet supplementation for 8 weeks resulted in a significant increase in serum cholesterol levels. Light microscopic analysis of basilar artery of hypercholesterolemic rabbits showed disturbances in the subendothelial and medial layers, degeneration of elastic fibers in the medial layer from endothelial cell desquamation, and a reduction of waves in the endothelial layer. However, the cholesterol + Vitamin E group did not exhibit these changes. The mean diameter of the basilar artery after SAH induction in the cholesterol-treated group was decreased 47% compared with the mean diameter of the control group. This value was less affected in cholesterol + Vitamin E-treated rabbits, which decreased 18% compared with the mean diameter of the control group. CONCLUSIONS Hypercholesterolemia-related changes in the basilar artery aggravate vasospasm after SAH. Adding Vitamin E to cholesterol-treated rabbits decreased the degree of vasospasm following SAH in the rabbit basilar artery SAH model. We suggest that Vitamin E supplements and a low cholesterol diet may potentially diminish SAH complicated by vasospasm in high-risk patients.
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Affiliation(s)
- Mehdi Sasani
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
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Canbulat N, Sasani M, Ataker Y, Oktenoglu T, Berker N, Ercelen O, Cerezci O, Ozer AF, Berker E. A rehabilitation protocol for patients with lumbar degenerative disk disease treated with lumbar total disk replacement. Arch Phys Med Rehabil 2011; 92:670-6. [PMID: 21367399 DOI: 10.1016/j.apmr.2010.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/10/2010] [Accepted: 10/22/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy of the rehabilitation protocol designed by the Physical Medicine and Rehabilitation Department on the patients with lumbar degenerative disk disease after lumbar disk replacement surgery. DESIGN Open prospective auto-controlled trial. SETTING Physical medicine and rehabilitation department, neurosurgery department, and anesthesiology and pain management department. PARTICIPANTS Patients (N=20) with single level lumbar degenerative disk disease were recruited for this study. INTERVENTIONS Lumbar disk prosthesis surgery with metal on metal lumbar disk prosthesis; preoperative, provocative, diskography; and a postoperative rehabilitation program were used. MAIN OUTCOME MEASURES Change in the functional status and pain intensity in patients was evaluated by the Oswestry Disability Index (ODI) and visual analog scale (VAS) during rest and movement. The ODI and VAS during rest and movement were primary outcome criteria, while return to work and duration of hospital stay were secondary outcome criteria. The results for the various scoring systems were statistically analyzed using the t test. RESULTS Preoperative mean VAS scores ± SD at rest and movement were initially in the range of 6.00±2.47 and 8.65±1.08, respectively. The scores decreased to 1.70±1.12 and 2.60±1.72 at 3 months postsurgery, respectively (P<0.01). The scores decreased to 1.20±0.69 and 1.90±1.07 at 12 months postsurgery, respectively (P<0.01). The mean preoperative ODI score was 73.3±15.5; the postoperative scores were 35.0±15.5 and 20.4±12.9 at 3 and 12 months, respectively (P<0.01). The mean duration of hospital stay ± SD was 3.5±1.6 days, and return to work was achieved after a mean ± SD period of 14.1± 4.3 days with no complications related to surgery or the rehabilitation protocol. CONCLUSIONS The protocol was designed for postoperative rehabilitation program after artificial lumbar disk replacement surgery for degenerative disk disease patients. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and presented rehabilitation program. These parameters provide early pain relief and return to activities of daily living after surgery.
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Affiliation(s)
- Nazan Canbulat
- Physical Medicine and Rehabilitation Department, American Hospital, Istanbul, Turkey.
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Oktenoglu T, Sasani M, Cetin B, Bozkus H, Ercelen O, Vural M, Ozer AF, Sarioglu AC. Spontaneous pyogenic spinal epidural abscess. Turk Neurosurg 2011; 21:74-82. [PMID: 21294095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Spontaneous pyogenic spinal epidural abscess (SEA) is a rare condition but might be devastating and fatal. Traditional treatment is surgical decompression and antibiotics. A retrospective study was designed to assess the eff ect of clinical findings and treatment methods on the outcome. MATERIAL AND METHODS 14 patients were reviewed (10 male, 4 female, mean age 59.14). Six dorsal, seven ventral and one dorsal with ventral SEA were observed. SEA found in thoracal (5), lumbar (4), cervical (3) regions. One patient showed both cervical and thoracal and one patient showed cervical, thoracal and lumbar involvement. All patients received minimum 3 weeks of I.V., followed by minimum 3 weeks of oral antibiotics. All patients complained of spinal pain. Ten patients presented with fever. Neurological deficit was observed in 9 cases. RESULTS A total of 22 interventions was performed. Instrumentation was applied in 5 cases. Full recovery was achieved in 7 patients, significant improvement was observed in 5 patients. The neurological findings did not change in one patient. One mortality and one morbidity were observed. CONCLUSION Spontaneous SEA is a rare disease but might result in catastrophic neurological deficits and fatal even with prompt treatment. Therefore, one should always keep SEA in mind if a patient presents with fever, vague and spinal pain.
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Affiliation(s)
- Tunc Oktenoglu
- American Hospital, Department of Neurosurgery, Istanbul, Turkey.
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Kaner T, Sasani M, Oktenoglu T, Aydin AL, Ozer AF. Clinical outcomes of degenerative lumbar spinal stenosis treated with lumbar decompression and the Cosmic "semi-rigid" posterior system. SAS J 2010; 4:99-106. [PMID: 25802657 PMCID: PMC4365643 DOI: 10.1016/j.esas.2010.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background Although some investigators believe that the rate of postoperative instability is low after lumbar spinal stenosis surgery, the majority believe that postoperative instability usually develops. Decompression alone and decompression with fusion have been widely used for years in the surgical treatment of lumbar spinal stenosis. Nevertheless, in recent years several biomechanical studies have shown that posterior dynamic transpedicular stabilization provides stabilization that is like the rigid stabilization systems of the spine. Recently, posterior transpedicular dynamic stabilization has been more commonly used as an alternative treatment option (rather than rigid stabilization with fusion) for the treatment of degenerative spines with chronic instability and for the prevention of possible instability after decompression in lumbar spinal stenosis surgery. Methods A total of 30 patients with degenerative lumbar spinal stenosis (19 women and 11 men) were included in the study group. The mean age was 67.3 years (range, 40–85 years). Along with lumbar decompression, a posterior dynamic transpedicular stabilization (dynamic transpedicular screw–rigid rod system) without fusion was performed in all patients. Clinical and radiologic results for patients were evaluated during follow-up visits at 3, 12, and 24 months postoperatively. Results The mean follow-up period was 42.93 months (range, 24–66 months). A clinical evaluation of patients showed that, compared with preoperative assessments, statistically significant improvements were observed in the Oswestry and visual analog scale scores in the last follow-up control. Compared with preoperative values, there were no statistically significant differences in radiologic evaluations, such as segmental lordosis angle (α) scores (P = .125) and intervertebral distance scores (P = .249). There were statistically significant differences between follow-up lumbar lordosis scores (P = .048). There were minor complications, including a subcutaneous wound infection in 2 cases, a dural tear in 2 cases, cerebrospinal fluid fistulas in 1 case, a urinary tract infection in 1 case, and urinary retention in 1 case. We observed L5 screw loosening in 1 of the 3-level decompression cases. No screw breakage was observed and no revision surgery was performed in any of these cases. Conclusions Posterior dynamic stabilization without fusion applied to lumbar decompression leads to better clinical and radiologic results in degenerative lumbar spinal stenosis. To avoid postoperative instability, especially in elderly patients who undergo degenerative lumbar spinal stenosis surgery with chronic instability, the application of decompression with posterior dynamic transpedicular stabilization is likely an important alternative surgical option to fusion, because it does not have fusion-related side effects, is easier to perform than fusion, requires a shorter operation time, and has low morbidity and complication rates.
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Affiliation(s)
- Tuncay Kaner
- Neurosurgery Department, Pendik State Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Tunc Oktenoglu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Ahmet Levent Aydin
- Neurosurgery Department, Istanbul Physical Therapy and Rehabilitation Training Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Neurosurgery Department, American Hospital, Istanbul, Turkey
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