Istanbul Educational and Research Hospital

İstanbul, Turkey

Istanbul Educational and Research Hospital

İstanbul, Turkey
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Kotil K.,Istanbul Educational and Research Hospital | Savas Y.,Haseki Educational and Research Hospital
Journal of Spinal Disorders and Techniques | Year: 2013

STUDY DESIGN:: Prospective cohort data by merging data from comparative studies. OBJECTIVE:: This study aimed to compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease. SUMMARY OF BACKGROUND DATA:: The unilateral lumbar interbody fusion technique has gained popularity in the management of many lumbar degenerative conditions requiring fusion. TLIF is routinely performed with the support of pedicle screws. The use of the TLIF procedure without pedicle screw support has not yet been reported. METHODS:: Between February 2006 and May 2009, surgical decompression and fusion was performed in patients with lumbar degenerative conditions using the TLIF technique either with (n=30, group A) or without pedicle screw support (n=30, group B). The 2 groups had similar age, sex distribution, pain level, and pain history. In this prospective study, patients were followed for a mean period of 31 months (range, 22 to 38 mo). The mean age was 45.5 years (range, 29 to 78 y), and all patients had a disease involving a single intervertebral space. RESULTS:: The female to male ratio was 19:11 and 18:12 in groups A and B, respectively. Pain and function were evaluated by the Oswestry disability index and visual analog scale. Pseudoarthrosis developed in 2 patients from group A and in 3 patients from group B. Although these 5 patients had insufficient fusion, they did show a clinical improvement. The mean duration of the operation was 110 and 73 minutes in groups A and B, respectively. The mean total amount of bleeding was 410 and 220 mL in groups A and B, respectively. Cage loosening did not occur in group A, but 1 patient in group B developed asymptomatic cage loosening limited to the endplates. Four patients in group A suffered sciatic pain because of the malposition of the screw, and 1 patient in group B had contralateral sciatic pain lasting for 2 months. The visual analog scale and Oswestry disability index scores were higher in group A than in group B 1 month after the operation (P<0.005), but the groups did not significantly differ at 3 months (P<0.89). The cost of the procedure was 3-fold higher in group A compared with group B. CONCLUSIONS:: This study showed that the TLIF procedure without pedicle screw support would be sufficient in the management of preoperatively stable patients with lumbar degenerative spinal disease requiring fusion after single-level decompression. This technique is minimally invasive, requires only unilateral intervention, allows magnetic resonance imaging during the postoperative period and is associated with less costs and complications when compared with pedicle screwing. This study represents the first prospective comparative report on this technique showing several of its advantages. © 2012 Lippincott Williams and Wilkins.

Kotil K.,Istanbul Arel University | Koksal N.S.,Istanbul Educational and Research Hospital | Kayaci S.,Recep Tayyip Erdoğan University
Journal of Clinical Neuroscience | Year: 2014

It remains unknown whether aggressive microdiscectomy (AD) provides a better outcome than simple sequestrectomy (S) with little disc disruption for the treatment of lumbar disc herniation with radiculopathy. We compared the long term results for patients with lumbar disc herniation who underwent either AD or S. The patients were split into two groups: 85 patients who underwent AD in Group A and 40 patients who underwent S in Group B. The patients were chosen from a cohort operated on by the same surgeon using either of the two techniques between 2003 and 2008. The demographic characteristics were similar. The difference in complication rates between the two groups was not statistically significant. During the first 10 days post-operatively, the Visual Analog Scale score for back pain was 4.1 in Group A and 2.1 in Group B, and the difference was statistically significant (p < 0.005). The Oswestry Disability Index score was 11% in Group A and 19% in Group B at the last examination. The reherniation rate was 1.5% in Group A and 4.1% in Group B (p < 0.005). We argue that reherniation rates are much lower over the long term when AD is used with microdiscectomy. AD increases back pain for a short time but does not change the long term quality of life. To our knowledge this is the first study with a very long term follow-up showing that reherniation is three times less likely after AD than S. © 2014 Elsevier Ltd. All rights reserved.

Kotil K.,Istanbul Educational and Research Hospital | Akcetin M.A.,Haseki Educational and Research Hospital | Savas Y.,Istanbul Educational and Research Hospital
Journal of Clinical Neuroscience | Year: 2012

We rarely use the cervical transpedicular fixation (CPF) technique in the neurosurgery departments of the authors' institutions because the pedicle is thin and there is a risk of neurovascular damage. In this study we investigated postoperative neurovascular injury caused by the transpedicular screws of 210 pedicles in 45 patients on whom we performed CPF for various cervical pathologies. Fixation was performed between C3 and C7, and the iliac crest and lamina were used as autografts for fusion. In 205 of 210 pedicles (97.6%), the screws were in the correct position, while a non-critical lateral orientation was detected in three pedicles (1.4%). Two screws (one in each of two patients) were positioned inappropriately (0.9%, Grade 3), unilaterally and directly in the vertebral foramen, as shown on postoperative CT scans; blood circulation was normal on angiography. The fusion rate was 100%. The average screw length used for C3 to C7 was 32 mm. The patients were followed up for an average of 35.7 months (range: 17-60 months). There was no morbidity or mortality in our study. We concluded that CPF provides very strong cervical spine fixation but also carries a risk of pedicle perforation without neurovascular injury. However, a free-hand technique performed by an experienced surgeon is acceptable for CPF for various cervical pathologies. © 2011 Elsevier Ltd. All rights reserved.

Kotil K.,Istanbul Educational and Research Hospital | Ozyuvaci E.,Istanbul Educational and Research Hospital
Journal of Craniovertebral Junction and Spine | Year: 2011

Objective: Cervical laminectomies with transpedicular insertion technique is known to be a biomechanically stronger method in cervical pathologies. However, its frequency of use is low in the routine practice, as the pedicle is thin and risk of neurovascular damage is high. In this study, we emphasize the results of cervical laminectomies with transpedicular fixation using fluoroscopy in degenerative cervical spine disorder. Materials and Methods: Postoperative malposition of the transpedicular screws of the 70 pedicles of the 10 patients we operated due to degenerative stenosis in the cervical region, were investigated. Fixation was performed between C3 and C7, and we used resected lamina bone chips for fusion. Clinical indicators included age, gender, neurologic status, surgical indication, and number of levels stabilized. Dominant vertebral artery of all the patients was evaluated with Doppler ultrasonography. Preoperative and postoperative Nurick grade of each patient was documented. Results: No patients experienced neurovascular injury as a result of pedicle screw placement. Two patients had screw malposition, which did not require reoperation due to minor breaking. Most patients had 32-mm screws placed. Postoperative computed tomography scanning showed no compromise of the foramen transversarium. A total of 70 pedicle screws were placed. Good bony fusion was observed in all patients. At follow-up, 9/10 (90%) patients had improved in their Nurick grades. The cases were followed-up for an average of 35.7 months (30-37 months). Conclusions: Use of the cervical pedicular fixation (CPF) provides a very strong three-column stabilization but also carries vascular injury without nerve damage. Laminectomies technique may reduce the risk of malposition due to visualization of the spinal canal. CPF can be performed in a one-stage posterior procedure. This technique yielded good fusion rate without complications and can be considered as a good alternative compared other techniques.

Kotil K.,Istanbul Educational and Research Hospital | Tari R.,Istanbul Educational and Research Hospital | Savas Y.,Istanbul Educational and Research Hospital
Journal of Clinical Neuroscience | Year: 2010

Hydatid disease of the spine is rare and has a poor prognosis, presenting both diagnostic and therapeutic challenges. Paraplegia is the most serious complication of the disease and is caused by compression of the spinal cord by the cysts. We report a 30-year-old woman with an isolated primary hydatid cyst that responded to treatment with albendazole. She presented with back and right leg pain. MRI of the lumbar spine showed a solitary cyst measuring 2.2 × 2.7 cm, with an intraspinal extension at L4-L5. Physical examination did not reveal any focal deficit and the patient was treated with albendazole drug therapy (400 mg daily). After 7 months' treatment, she had improved both clinically and radiologically. Albendazole drug therapy appears to be effective for conservative treatment of patients with primary solitary hydatid disease in the lumbar spine. © 2009 Elsevier Ltd. All rights reserved.

Aysan E.,Istanbul Educational and Research Hospital | Bektas H.,Istanbul Educational and Research Hospital | Ersoz F.,Istanbul Educational and Research Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2010

Objective: Covering peritoneal surfaces with aloe vera gel may prevent peritoneal trauma and hence postoperative peritoneal adhesions. Study design: Forty Wistar albino out-bred female rats (mean weight, 180 ± 25 g; mean age, 6 months) were divided into four groups. In Group 1, 0.1 mL aloe vera gel was injected into the peritoneal cavities. In Group 2, peritoneal adhesions were induced. In Group 3, adhesions were induced and the modeled area was covered by 0.1 mL aloe vera gel. In Group 4, the area was covered with aloe vera gel prior to adhesion induction. The rats were sacrificed on postoperative day 10 and the adhesions were scored both microscopically and macroscopically. Results: The mean macroscopic adhesion score in the four groups was 0, 5.8 ± 0.42, 5.2 ± 0.79, and 1.1 ± 1.2 respectively, with the difference between Group 4 and Groups 2 (p < 0.001) and 3 (p < 0.05) statistically significant. The mean histopathological fibrosis values were significantly higher in Group 3 than in Group 4 (2.6 ± 0.51 vs 1.2 ± 0.91, p = 0.002). Conclusion: Aloe vera gel can effectively decrease adhesion formation if applied before, but not after, after peritoneal trauma. This effect is likely due not to its chemical properties but to its viscosity, providing a covering to prevent peritoneal trauma. Crown Copyright © 2009.

Kotil K.,Istanbul Educational and Research Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2011

PURPOSE; To evaluate the accuracy of fluoroscopyassisted cervical transpedicular fixation in different pathologies. 28 men and 17 women aged 34 to 65 (mean, 41) years underwent 210 one-stage cervical transpedicular fixations. The indications were trauma (n=35), degenerative disease leading to cervical spondylotic myelopathy (n=4), tumours (n=4), and Pott's disease (n=2). Regarding the 35 trauma patients, fractures were at C5-C6 (n=22), C4-C5 (n=8), and C3-C5 (n=5); 16 of them had dislocated vertebrae, of whom 13 had cervical disc herniation. Two of the patients with degenerative disease underwent additional laminectomy. Both anterior and posterior surgeries were performed for the 2 of the patients with tumours; all other patients underwent posterior surgery only. The length, diameters, and frontal, sagittal, and longitudinal angles of all pedicle screws were calculated. The dominant vertebral artery was detected using Doppler ultrasonography. Biplanar fluoroscopy was also used. Postoperatively, patients were allowed to mobilise at day 1; a collar was not used. The position of the pedicle screws was graded. The mean operating time was 105 (range, 90-155) minutes. The mean follow-up period was 26 (range, 17-34) months. Of the 210 pedicles fixed, 192 (91%) were at the correct screw position (grade I), 16 (8%) were at an acceptable position (grade II), and 2 (1%) were completely perforated but without morbidity (grade III). The overall perforation rate was 9%. There were no neurovascular injuries or instrumentation-associated complications (failure of implant components, screw loosening, or lucent zone formation around the pedicle screws). The fusion rate was 100%. Cervical transpedicular fixation provides strong stabilisation. With the aid of biplanar fluoroscopy, the risk of pedicle perforation was about 8%, but no neurovascular injury was ensued.

Kotil K.,Istanbul Educational and Research Hospital | Tari R.,Istanbul Educational and Research Hospital
Turkish Neurosurgery | Year: 2011

Aim: There is no clear knowlegde in the literature about two-level vertebral corpectomy using the iliac bone crest for fusion and rigid plate fixation. We present our experience with two-vertebral level cervical corpectomy and reconstruction. Material and methods: Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rates were calculated. All patients had two-level vertabral corpectomy. Anterior iliac crest bone graft with titanium plate fixation was applied to all patients. Results: Postoperatively the mJOA score raised up to 15.5. Mean recovery rate was 69%. Average 25.2 degrees correction of kyphosis was achieved in 21 patients. Among the postoperative complications, three cases (12%) had temporary C5 nerve palsy that was resolved in three weeks, two cases had (8 %) graft malposition and infection, and three cases (%12) had temporary donor site pain. Conclusion: Excellent fusion rates can be achieved following two-level corpectomy with iliac bone graft repacement. This techique is easy, cost effective and safe. If the bone graft is harvested from the iliac crest by standart approach and between anatomical landmarks, most patients do not experience persistent pain at the donor site.

Kotil K.,Istanbul Educational and Research Hospital | Sengoz A.,Istanbul Educational and Research Hospital
Turkish Neurosurgery | Year: 2011

Aim: Cervical disc herniation at C2-C3 level is an uncommon condition. In this paper, the management C2-C3 disc herniation and long-term follow-up data of 5 cases is reported. Material and Methods: 1100 patients who have been operated in our department for cervical disc herniation between 2000 and 2009 were studied retrospectively. A total of 5 patients were found to have been operated for C2-C3 herniation in that period. The preferred procedure was anterior cervical discectomy with fusion via retropharyngeal approach. Results: The incidence of C2-C3 disc herniations was 0.45%. The mean patient age was 63 years (41-82 years). Upper extremity paresis was the predominant neurological sign. Magnetic resonance images (MRI) revealed central, large and hard disc herniations in 4 cases and accompanying cord signal changes in 4 cases. Successful anterior decompresion was performed in 5 patients. Correct fusion was achieved in 4 patients, and one patient died of an operation unrelated cause early in the follow-up period. Conciusion: C2-C3 disc herniation is rare but may result with severe myelopathy. This kind of herniations tend to be central and large. The present study demonstrates that diagnosis and adequate anterior decompression in C2-C3 disc herniations may provide an excellent outcome.

Transcutaneous, arterial and end-tidal measurements of carbon dioxide were compared in patients (American Society of Anesthesiology physical status classes II and III) with chronic obstructive pulmonary disease (COPD) who underwent laparoscopic cholecystectomy with carbon dioxide insufflation. General anaesthesia was performed in all patients. The Sentec(®) system was used for transcutaneous monitoring of the partial pressure of carbon dioxide (TcPCO(2)). TcPCO(2) and arterial partial pressure of carbon dioxide (PaCO(2)) were recorded preoperatively, after induction of anaesthesia, during insufflation and postoperatively; end-tidal carbon dioxide (ETCO(2)) was recorded after induction and during insufflation. PaCO(2) increased during insufflation and reached a maximum at extubation. It declined within 20 min postoperatively but did not return to preoperative levels during this time. TcPCO(2) levels followed a similar pattern. ETCO(2) was significantly lower than PaCO(2) after induction and during insufflation. TcPCO(2) was a valid and practical measurement compared with ETCO(2). In patients with COPD undergoing laparoscopic cholecystectomy, TcPCO(2) and ETCO(2) could be used instead of arterial blood gas sampling.

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