Biomedical subjects

Cagatay Ozturk

Publications and source records attributed to Cagatay Ozturk.

At least 19 recordsLinked to original sources

PubMed2006

Coccygectomy in the surgical treatment of traumatic coccygodynia.

THE PURPOSE OF THE STUDY: Direct or indirect trauma to the coccygeal bone can induce chronic coccygodynia. The aim of this study is a retrospective analysis of our patients surgically managed for traumatic coccygodynia and a critical review of the results obtained in comparison to the literature. BASIC PROCEDURES: We have retrospectively investigated patients with traumatic coccygodynia referred to our centre after a failure of conservative treatment. Surgery (coccygectomy) was performed in 74 patients (64 women, 10 men) suffering from coccygodynia resistant to conservative treatment, all without serious complications, between the years 1998 and 2004. The mean follow up was 4.1 years (range, 2-8 years). The mean age of patients on the date of surgery was 43.4 years (range, 16-65 years). The average duration of pain prior to surgery was 7 months (range, 3 months to one year). MAIN FINDINGS: All but three patients had either good or excellent results after surgery. Three patients reported postoperative pain lasting 3-6 months. All three had good results after re-operation of a proximal segment without excision. Five postoperative complications, four superficial and one deep infection were observed. PRINCIPAL CONCLUSIONS: In patients with posttraumatic, conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option. We recommend total or partial coccygectomy using a longitudinal incision in carefully selected and well-informed patients.

Adolescent↗

PubMed2006

Simultaneous versus sequential one-stage combined anterior and posterior spinal surgery for spinal infections (outcomes and complications).

To compare simultaneous with sequential one-stage (same anaesthesia) combined anterior and posterior spinal surgery in the treatment of spinal infections in terms of the operation time, blood loss and complication rate. Fifty-six patients who underwent one-stage (same anaesthesia) simultaneous or sequential anterior decompression and posterior stabilisation of the involved vertebrae for spinal infection from January 1994 to December 2002 were reviewed. In group I (n=29), sequential anterior and posterior surgery was performed. In group II (n=27), simultaneous anterior and posterior spinal surgery was performed. With regard to age and gender, there was no statistical difference between both groups (P=0.05). The analysed and compared data between the two groups included the age, gender, blood loss, operation time and postoperative complications. There was a statistically significant difference between the two groups in terms of the duration of surgery, amount of blood transfusion needed and occurrence of major postoperative complications (P<0.05). The mean correction of the kyphotic deformity was similar in both groups (P>0.05) without a subsequent loss of correction on follow-up radiographic films at a mean follow-up of 6.5 years (range, 3 to 11 years). Simultaneous anterior and posterior surgery is a good alternative procedure. It provides the ability to manipulate both anterior and posterior aspects of the spine at the same time and appears to result in less blood loss, a shorter operative time and fewer complications. However, gaining experience and the availability of two surgical teams are important factors in the success of the procedure.

Adult↗

PubMed2006

Symptomatic polyostotic fibrous dysplasia of the thoracic spine.

We present a case of polyostotic fibrous dysplasia with limited involvement in thoracic spine and adjacent ribs. The patient underwent posterior instrumentation performed between Th3 and Th11 with pedicle screw system, followed by costotransversectomy of 7th and 8th costovertebral junctions and posterior spinal fusion for costal lesions. In the same operation, curettage was done for the lesion in Th6 vertebra and bone grafting and anterior total corpectomy were performed for Th7 and Th8 vertebrae. 360 degrees spinal fusion was done using titanium mesh as strut graft and autogenous rib grafts. Fibrous dysplasia occurs rarely in axial bones than peripheral bones. The cystic lesions in segments of the whole spine should be evaluated for the possibility of fibrous dysplasia with detailed radiographical examination and biopsy.

Adult↗

PubMed2006

Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures.

We report a case of pregnancy-associated osteoporotic vertebral fracture treated by kyphoplasty. This case is important for being the first case of postpregnancy osteoporotic vertebral fracture treated with kyphoplasty. Although kyphoplasty is a very successful procedure in short-term pain relief for osteoporotic vertebral fractures, there is a critical need for randomized controlled trials demonstrating short-term complications of kyphoplasty including new vertebral fractures.

Adult↗

PubMed2006

An uncommon cause of paraplegia: Salmonella spondylodiskitis.

BACKGROUND/OBJECTIVE: Salmonella spondylodiskitis is an uncommon type of vertebral infection. The aim of this study was to present a case of progressive paraplegia caused by Salmonella spondylodiskitis and epidural abscess after endoscopic cholecystectomy. METHODS: The patient underwent posterior instrumentation and posterior fusion between T6 and T12, hemilaminotomies at levels T8-T9-T10, and drainage of the abscess. Through a left thoracotomy, anterior T8-T10 corpectomy, debridement, anterior stabilization, and fusion were conducted. RESULTS: Fifteen months later, final follow-up showed no complications secondary to the vertebral and hip surgeries, and neurological status improved to Frankel grade E. Laboratory investigations showed no evidence of Salmonella infection. CONCLUSION: Immunocompromised patients who undergo endoscopic intervention are vulnerable to Salmonella infections. One must consider Salmonella infection in those who develop acute progressive spondylodiskitis.

Cholecystectomy, Laparoscopic↗

PubMed2006

Bilateral L5 radiculopathy due to osteoporotic L1 vertebral fracture: A case report.

BACKGROUND: The true incidence of osteoporotic vertebral fractures is not well defined because many osteoporotic vertebral fractures are asymptomatic. Although the true incidence of neurological compromise as a result of osteoporotic vertebral fractures is not known, it is thought to be low. In this case report, we present a case of L1 osteoporotic vertebral fracture causing bilateral L5 nerve root compression and manifestation of bilateral foot-drop. METHODS: Pedicle screws were inserted in the vertebrae, 2 above and 2 below the L1 vertebra. A temporary rod was placed on the left. An L1 right hemilaminectomy via a posterior approach and a corpectomy were performed. The spinal cord was decompressed. Anterior fusion was carried out by placing titanium mesh cage into the vertebrectomy site as a strut graft via posterior approach, and posterolateral fusion with spongious allografts were added to the procedure. RESULTS: Two years later the patient was completely symptom free and receiving medical treatment for osteoporosis, which was diagnosed as primary type. CONCLUSION: If a fracture is detected on the posterior wall of the vertebral body in computerized tomography (CT) examination with plain radiographs, a magnetic resonance imaging (MRI) examination should be conducted in the presence of symptoms and physical findings suggestive of neurological compression. Follow-up neurological examinations should be carried out, and it should be kept in mind that most of the neurological symptoms may develop late and manifest as radiculopathy. The majority of the osteoporotic vertebral fractures can be managed conservatively with bed rest and orthosis, but cases with accompanying neurological deficit should be managed surgically using decompression and stabilization by fusion and instrumentation.

Aged↗

PubMed2006

A new material for prevention of epidural fibrosis after laminectomy: oxidized regenerated cellulose (interceed), an absorbable barrier.

Epidural fibrosis, which may cause persistent back and leg pain, may develop after laminectomy. Several materials have been used in attempts to minimize epidural fibrosis, with varying results. We evaluated the efficacy of an absorbable cellulose adhesion barrier in preventing epidural fibrosis. In 25 New Zealand white rabbits, laminectomies were performed at L3 and L5 vertebrae. The dura mater was covered by the adhesion barrier (Interceed, TC7, Johnson & Johnson, USA) at L3 laminectomy site (group 1), with L5 laminectomy site serving as an internal control (group 2) in each animal. There was no neurological deficit in any of the animals during the postoperative period. Animals were sacrificed at postoperative day 28. The lumbar spine was removed en bloc and placed in neutral, buffered formalin for 72 h. The specimens were then decalcified and embedded in paraffin. Permanent sections of 5 to 7 microm were stained with hematoxylin and eosin and Masson trichrome dye. Epidural fibrosis was evaluated in a double-blinded manner. The extent of epidural fibrosis was graded as 0, no reaction seen; 1, mild reaction; 2, moderate reaction; 3, extensive reaction, and 4, severe reaction. The histological findings of each group were compared. For the statistical analysis, Wilcoxon signed rank test was used. In group 1, the fibrotic tissue formation was minimal in 19 and moderate in 6 laminectomy sites. In group 2, the fibrotic tissue formation was determined as being extensive in 17 and moderate in 8 laminectomy sites. Statistical analysis showed significant decrease in epidural fibrosis in group 1 (P<0.05). This study showed that Interceed, which is commercially available in the market, especially for abdominal and gynecological surgeries, could be used to prevent epidural fibrosis.

Absorption↗

PubMed2006

The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases.

Long periods of immobilization, progressive kyphosis and graft failure are the major postoperative problems encountered after anterior radical surgical treatment for tuberculosis of the spine. Posterior fusion and instrumentation can be an effective solution for these problems. Effectiveness of posterior fusion and instrumentation was investigated in this study on the basis of the cases with anterior procedure only, and with combined anterior-posterior procedures. One hundred twenty-seven cases of tuberculosis of the spine were surgically treated between 1987 and 1995. All had either 1 or more of conditions such as spinal cord compression and neurological deficit, vertebral body collapse and kyphosis, or wide paravertebral abscess unresponsive to medical treatment. Of these, 57 had only anterior radical procedure between the years 1987 and 1993. Seventy cases had posterior instrumentation and fusion after the anterior procedure between the years 1991 and 1995. In about two third of the patients (81) autogenous iliac strut graft and in one third of them (40) autogenous fibular strut graft (cases with more than 2 level involvement) was used along with rib grafts after debridement. Twenty-one of the 57 patients who had only anterior procedure demonstrated a postoperative increase of kyphosis of more than 10 degrees. Increased kyphosis was due to graft slippage in 3, resorption in 2 and subsidence in 16 patients. No such increase or graft failure was noted in cases of combined anterior-posterior procedure. The difference in terms of kyphosis was found to be statistically significant (P=0.047). Anterior radical debridement and strut graft is the golden standard in the surgical treatment of spinal tuberculosis, but it should always be accompanied by posterior instrumentation and fusion to shorten the immobilization period and hospital stay, obtain good and long lasting correction of kyphosis, and prevent further collapse and graft failure.

Adolescent↗

PubMed2006

Evaluation of lung cancer metastases to the spine.

Most metastatic spinal lesions (70%) are found at the thoracic level, 20% in the lumbar region, and 10% in the cervical region. A variety of benign and malignant tumours may arise in the lung, but the vast majority is bronchogenic carcinomas (90 to 95%). The aim of this study was to evaluate the lung cancer metastases to the vertebral column in terms of type, localisation and metastasis pattern. Between the years 1995 and 2003, 168 lung cancer patients with metastatic spinal tumour who had received radiotherapy and chemotherapy were retrospectively evaluated. The total number of vertebrae in which metastases were detected was 328. The most common site for metastasis was the thoracic spine. In 49 (29%) patients, there was only one vertebral involvement. Additional extravertebral bony metastases were present in 37 (22%) patients; the femur (20 patients) was the most common site. Only 25 of 168 patients were operated due to spinal cord compression leading to neurological deficit. The rest of the patients were treated by appropriate chemotherapy and radiotherapy protocols. The mean survival after diagnosis of vertebral metastasis was 7.1 months. Squamous cell carcinoma and adenocarcinoma are the lung cancers that mostly metastasise to vertebrae. Most of the metastases involve multiple spinal levels. After the diagnosis of vertebral metastasis, the mean survival is seven months. Pain relief and maintaining quality of life must be balanced with the patient's life expectancy, comorbidities and immunological, nutritional and functional status in treatment decision.

Adenocarcinoma↗

PubMed2005

A new autogenous graft choice in pelvic reconstructions: free vascularized rib (a case report).

Primary or secondary bone tumours are not uncommon in pelvic girdle. In some cases, after radical resection, there is a big bony defect where the prosthesis is not applicable; arthrodesis is the only choice for good functional results. In this instance, the major problem is to achieve the fusion. In this case report, we focused on easy harvesting and minimal time consumption with free vascularized rib graft to achieve the fusion between the resected segments. Two year follow up showed fusion with good functional result.

Arthrodesis↗

PubMed2005

Symptomatic infrapatellar plica.

To assess the clinical outcomes of a group of patients who underwent arthroscopic infrapatellar plica (IPP) excision and to determine, whether the IPP was symptomatic or not, to identify the symptoms or signs in the patient's clinical presentation and to study the correlations between arthroscopic findings and patient's clinical presentation. A retrospective clinical study. We studied all the patients undergoing arthroscopic resection of symptomatic infrapatellar plica without other intraarticular abnormality at our department from February 1996 to April 2001. Fourteen patients with isolated IPP and with regular follow-up intervals were included in the study. Arthroscopy findings, preoperative magnetic resonance imaging (MRI) findings, and clinical presentation were correlated. The mean duration of follow-up was 36 months with a range of 24-60 months. The IPP was found to be in fenestra pattern in seven patients, separate (cordlike) pattern in five patients and vertical septum pattern in two patients. IPP in all patients was excised with a powered instrument. Two patients were rated as excellent, ten patients as good and two patients as poor results. All the patients were documented with pain, popping or snapping with flexion and extension, giving way and swelling. There was no correlation between IPP type and MRI findings with being symptomatic (P>0.05). It was found that IPP type was not a prognostic factor. Infrapatellar plica should be considered as a potential cause of knee pain with probable MRI imaging and no other evidence of internal derangement. We recommend close correlation with the clinical symptoms and exclusion of other internal derangement before suggesting infrapatellar plica as a sole cause for knee symptoms.

Adolescent↗

PubMed2005

Intraspinal metalloma resulting in late paraparesis.

The metal-related complications caused by orthopedic implants have long been a concern, but these problems have been considered mostly in the field of arthroplasty or internal fixation of fractures. The recent prevalence of spinal instrumentation has evoked a similar concern among spine surgeons. Here, we present a case of intraspinal metallosis adjacent to the pedicular hook occurring after treatment of vertebral fracture by posterior spinal instrumentation and fusion, and causing paraparesis at the 3rd postoperative year. Metallic granulomas can appear around the pedicular hooks as in the reported case. Crevice and fretting corrosion are results at the junctions of rod-screw, rod-hook, transverse connector rod and other connector rods in modular spinal implants. Adequate usage of transpedicular screws may inhibit the occurrence of such a complication. For this reason, further studies are necessary to increase metallic corrosive resistance to inhibit crevice and fretting corrosion.

Biocompatible Materials↗

PubMed2005

Conservative treatment of fractures of the thoracolumbar spine.

We reviewed 48 patients with thoracolumbar fractures treated conservatively between 1988 and 1999. The average follow-up was 77.5 (31-137) months and average patient age (23 women, 25 men) was 46 (18-76) years. Twenty-nine patients suffered a fall from a height and 13 patients were injured in traffic accidents. Thirty-two patients had compression-type fractures and 16 burst-type fractures. There were no neurological deficits. Twenty-nine patients were treated by orthosis, 13 by body cast and six by bed rest. In addition to pain and functional scoring, we measured a number of radiographic parameters at the time of admission and at latest follow-up and compared the values. In patients with compression fractures there were significant changes in scoliosis angle and wedging index (p<0.05). The mean pain score was 1.66 and mean functional score 1.03. In patients with burst fractures, vertebral index, wedging index and height loss increased after treatment (p<0.05). The mean pain score was 1.26 and functional score 0.93. Compression fractures with kyphosis angle <30 degrees are supposed to be stable and can be treated conservatively. If the kyphosis angle is more than 30 degrees, magnetic resonance imaging (MRI) should be performed, and if the posterior ligamentous complex is damaged, surgery should be considered. In burst fractures, MRI should always be performed and conservative treatment should only be considered if there is no neurological deficit and the ligaments are intact.

Adolescent↗

PubMed2005

A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach.

Superior hypogastric plexus block has been advocated for the treatment of cancer related pelvic pain. Neurolysis is usually established using the classical posterolateral approach in the prone position, in which correct placement of the needle is sometimes difficult due to vertebral anatomy and the patient's inability to lie prone. We describe an alternative posteromedian transdiscal approach under fluoroscopic guidance for the treatment of intractable pelvic pain in three patients, in whom the classical approach was not possible. The L5-S1 interdiscal space was identified with fluoroscopy. The needle was then introduced through the disc and advanced under lateral fluoroscopic control. After verifying correct needle placement, neurolysis was performed with 8 ml of 10% phenol solution. All patients had significant pain relief immediately after the block, lasting from 6 to 12 months, and their pain severity scores and opioid consumption were reduced by more than 50%. There were no complications such as discitis, disc rupture or nerve injury. Since this new posteromedian transdiscal approach provides easy access to the superior hypogastric plexus with a single puncture and with any patient position, it may be an alternative to the classical approach.

Aged↗

PubMed2005

Enhancement of tendon-bone healing of anterior cruciate ligament grafts by blockage of matrix metalloproteinases.

BACKGROUND: The use of soft-tissue grafts for anterior cruciate ligament reconstruction delays the healing process. This delay may be due to biochemical and/or biomechanical insults. We hypothesized that the blocking effect of alpha2-macroglobulin on synovial matrix metalloproteinase activity may enhance the healing of tendon graft in a bone tunnel. METHODS: The study was performed on twenty-eight healthy, skeletally mature New Zealand White rabbits. Each rabbit underwent bilateral anterior cruciate ligament reconstruction with use of the ipsilateral semitendinosus tendon. Alpha-2-macroglobulin (alpha2-macroglobulin) was injected into the knee joint in one limb, and the contralateral limb served as a control. The rabbits were killed two weeks (fourteen rabbits) or five weeks (fourteen rabbits) after the operative procedures. The presence of matrix metalloproteinases in synovial fluid, and the blocking effect of alpha2-macroglobulin on them, were determined with enzymatic assays. Healing between the tendon and the bone tunnel was assessed morphologically by determining the presence of fibrovascular tissue and collagen fibers. Healing also was assessed quantitatively by measuring the ultimate load to failure of the reconstructed complex. RESULTS: There was an increase in matrix metalloproteinases in the control group; in contrast, there was a decrease in the study group (p < 0.05). In the control specimens, the fibrovascular tissue at the bone-tendon interface had developed into dense connective tissue with poor vascularization. In the treated specimens, the bone tunnel had more areas of denser connective-tissue ingrowth. The interface tissue was more mature and contained numerous perpendicular collagen bundles (Sharpey fibers). The ultimate load to failure was significantly greater in the alpha2-macroglobulin-treated specimens than in the untreated controls at both two and five weeks. CONCLUSIONS: The present study demonstrated that alpha2-macroglobulin blockade of matrix metalloproteinases can enhance bone-tendon healing. This effect of alpha2-macroglobulin could occur through its effect solely on collagenase or on a subset of matrix metalloproteinases that are present at the healing interface.

Animals↗

PubMed2005

Surgical treatment of sprengel's deformity: a modified Green procedure.

Twelve cases of Sprengel's deformity were treated surgically by a modification of Green's procedure. After clavicular osteotomy, all muscular attachments to the scapula were freed; an omovertebral band if present was cut and the scapula was rotated and moved caudal to a more normal position, to be sutured into a pocket of the latissimus dorsi. The patients included 10 female and 2 male patients (age range at the time of operation: 3 to 9 years; mean: 5.2 years). The deformity involved the left shoulder in 8 patients, the right shoulder in 4. All patients were followed for an average of 2 years (range: 6 months to 4.5 years). The range of flexion improved from an average of 95 degrees to 105 degrees and the range of abduction from an average of 81 degrees to 97 degrees. Cosmesis was improved in all 12 patients but three patients had an unsightly surgical scar. Surgical treatment by a modified Green procedure for patients with Sprengel's deformity is indicated when the patient and family want cosmetic or functional improvement.

Child↗

PubMed2005

Radiological analysis of titanium mesh cages used after corpectomy in the thoracic and lumbar spine: minimum 3 years' follow-up.

This study analyses radiological outcome of titanium mesh cages used for anterior column support following corpectomy in the thoracic and lumbar spine in 34 patients with a minimum three-year follow-up. The aim of the study was to assess the complications and radiological outcomes of patients with structural cages implanted into the anterior column. Titanium mesh cages for the anterior column became popular for anterior column reconstruction following discectomy and corpectomy. Few clinical studies are published assessing their efficacy as a structural graft after corpectomy and factors for the development of settling and correction loss are not investigated enough. Thirty-four patients with minimum 3-year follow-up were analysed radiologically for correction achievement, cage settling and fusion inside the mesh cage. The effect of fixation technique, anatomical localisation and diagnosis for the development of settling were analysed. Measurements of preoperative and early postoperative local kyphotic angle revealed that a mean correction of 27 degrees (range: 8 to 60) was obtained. While no dislodgement or fracture of titanium mesh cages was observed, there was a mean correction loss of 4 degrees and settling (> 2 mm) was noted in 6 patients. Short posterior and only anterior instrumentation systems were associated with settling. The anatomical location and diagnosis did not affect the development of cage settling. Following corpectomy and mesh cage implantation, isolated anterior fixation or short posterior fixation do not provide enough stability, and correction loss and settling can occur.

Female↗

PubMed2004

Neglected major vessel injury after anterior spinal surgery: a case report.

STUDY DESIGN: This is a case report. OBJECTIVES: To present a case of neglected major vessel injury after anterior spinal surgery. SUMMARY OF BACKGROUND DATA: Vascular complications during spinal surgery are fortunately few in number. The incidence and management of vascular complications during anterior approaches to the thoracolumbar spine are not well known, and it is likely that most acute or delayed vascular injuries and complications are not reported. METHODS: A case that underwent anterior spinal surgery for T12 burst fracture with an iatrogenic injury to the aorta was presented. RESULTS: Paraparesis (Frankel B) was present before last operation and disappeared completely at 30 months of follow-up. CONCLUSIONS: As with any complication, the best treatment is prevention. Careful and meticulous exposure of the involved anatomic area is very important for prevention. Early recognition with rapid treatment of vascular complications can reduce potential morbidity and mortality.

Adult↗