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    Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly
    (Medknow Publications & Media Pvt Ltd, 2014) Yilmaz, Tevfik; Turan, Yahya; Gulsen, Ismail; Dalbayrak, Sedat
    Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.
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    The Contribution of Cervical Dynamic Magnetic Resonance Imaging to the Surgical Treatment of Cervical Spondylotic Myelopathy
    (Turkish Neurosurgical Soc, 2015) Dalbayrak, Sedat; Yaman, Onur; Firidin, Mustafa Nevzat; Yilmaz, Tevfik; Yilmaz, Mesut
    AIM: Cervical spine is the most kinetic segment of the whole vertebrae. The radiologic imaging methods concern with the morphologic changes but give no functional data. At flexion, spinal cord strains, anterior osteophytic compression increases. At extension, spinal canal gets narrower, cord shortens and gets thicker, compression of posterior ligament gets abberant and cord compression increases. MATERIAL and METHODS: 258 cervical spondylotic myelopathy (CSM) cases were scanned by conventional magnetic resonance imaging (MRI) and additionally dynamic MRI. Contributions of dynamic cervical MRI to the surgical plans and results were evaluated. RESULTS: We had sagittal and axial T2W MR scans at flexion and extension, in addition to the neutral cervical MR imaging. We found that the AP diameter of spinal canal is increased 14.9% in flexion and decreased 13.4% in extension relative to the neutral MR imaging. CONCLUSION: The changes of the cord compression and the transvers area of cord which is the most important prognostic indicator in spinal diseases and also the area of spinal cord and subarachnoid space can be detected via dynamic axial sections of MRI. Dynamic MR images may be helpfull in the decision making for the surgical treatment of CSM.
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    Current and future surgery strategies for spinal cord injuries
    (Baishideng Publishing Group Inc, 2015) Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Tevfik
    Spinal cord trauma is a prominent cause of mortality and morbidity. In developed countries a spinal cord injury (SCI) occurs every 16 min. SCI occurs due to tissue destruction, primarily by mechanical and secondarily ischemic. Primary damage occurs at the time of the injury. It cannot be improved. Following the primary injury, secondary harm mechanisms gradually result in neuronal death. One of the prominent causes of secondary harm is energy deficit, emerging from ischemia, whose main cause in the early stage, is impaired perfusion. Due to the advanced techniques in spinal surgery, SCI is still challenging for surgeons. Spinal cord doesn't have a self-repair property. The main damage occurs at the time of the injury primarily by mechanical factors that cannot be improved. Secondarily mechanisms take part in the following sections. Spinal compression and neurological deficit are two major factors used to decide on surgery. According to advanced imaging techniques the classifications systems for spinal injury has been changed in time. Aim of the surgery is to decompress the spinal channel and to restore the spinal alinement and mobilize the patient as soon as possible. Use of neuroprotective agents as well as methods to achieve cell regeneration in addition to surgery would contribute to the solution.
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    A Modified Technique for the Treatment of Isthmic Spondylolisthesis
    (Turkish Neurosurgical Soc, 2015) Yilmaz, Tevfik; Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Mesut; Ayten, Murat; Turan, Yahya; Ozturk, Kadir
    AIM: To describe a modified technique for the treatment of single level, isthnnic spondylolisthesis (IS) MATERIAL and METHODS: Forty-two patients who underwent posterior lumbar interbody fusion (PLIF) with spinolaminar autologous bone graft for the treatment of isthmic spondylolisthesis between May 2007 and November 2011, were retrospectively reviewed. All patients underwent total removal of the spinolaminar process, total discectomy and endplate decortication, and proper size spinolaminar autologous bone graft was sequentially inserted into the disc space with posterior instrumentation. Outcomes of the study included visual analogue scale (VAS), Oswestry disability index (ODI), and radiographic fusion. RESULTS: The average duration of follow-up was 3.5 years. Neither has implant failure been observed nor has revision been required so far.The mean Oswestry Disability Index improved from 53% to 9.5%, and visual analog scale for back pain from 8.5 to 3.8 at the first month and 1.3 at the sixth month postoperatively. Visual analog scale for leg pain from 8.3 to 1.4 at the first month and 0.8 at the sixth month postoperatively. All patients had clinical and radiographic evidence of solid fusion without any need for revision. CONCLUSION: The modified posterior lumbar interbody fusion and posterior instrumentation technique is a safe and effective treatment for isthmic spondylolisthesis.
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    Supraclavicular Surgical Approach for Thoracic Outlet Syndrome: 10 Years of Experience
    (Turkish Neurosurgical Soc, 2014) Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Mesut; Yilmaz, Teyfik
    AIM: Symptoms of thoracic outlet syndrome (TOS) may be vascular, neurological or combined symptoms involving both. Treatment of TOS is generally conservative. Surgical treatment is required when radiological results indicate anatomical abnormality. This study aims to present the surgical outcomes of TOS patients treated with supraclavicular approach via microsurgery. MATERIAL and METHODS: 41 patients with thoracic outlet syndrome were rewieved retrospectively. The pain was determined using both on visual analogue scale (VAS) and Oswestry score both in the preoperative and postoperative period. All patients underwent electromyography including brachial plexus, ulnar and median nerves. Computed Tomography (CT) angiographic examination was applied dynamically with required manoeuvres. RESULTS: Post-op VAS scores were recorded as 0.8 for the arm, 0.6 for the shoulder and 0.5 for the neck, while pre-op VAS scores were 6.3 for the arm, 6.0 for the shoulder and 5.2 for the neck. Post-op Oswestry disability index (OD!) average was found as 14,2, while this figure was 67,4 during the pre-operative period. CONCLUSION: Accurate patient selection is imperative for increasing the success of TOS surgery. Microscopic TOS surgery yields satisfactory results with smaller incision, safer surgery and a lower rate of complication.
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    Treatment Principles for Coccygodynia
    (Turkish Neurosurgical Soc, 2014) Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Tevfik; Yilmaz, Mesut
    AIM: An evaluation of treatment methods and outcomes for coccygodynia cases that do not respond to conservative treatment. MATERIAL and METHODS: Local anesthetic and steroid injections were applied in 32 coccygodynia cases that did not respond to conservative treatment (average of 15 months). Coccyx excision was performed as surgical treatment in 25 cases that had pain relief after the injections but later re-presented with complaints. The patients' pain levels were assessed with VAS. Postacchini classification was used for patient classification based on plain radiography. RESULTS: 20 (62%) of the cases (the total including injection and surgery groups) had a trauma history. Majority of the cases treated with local steroid injection included patients with Type I, while the 25 cases that received surgical treatment predominantly included Type II patients. One case had post-operative skin infection, which was treated with antibiotics. It was observed by comparing pre-operative and post-operative pain scores that both methods provided significant pain relief in all patients. CONCLUSION: While local steroid injection is an effective method of treatment for Type I patients, the coccyx removal I is an effective method for controlling the pain in patients with trauma history and in Type II, III and IV patients.