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    Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients
    (IOS Press, 2022) Turan, Kayhan; Kara, Gökhan Kürşat; Çamurcu, Yalkın; Kızılay, Yusuf Onur; Uysal, Yunus; Şahin, Ecem; Aydınlı, Ufuk
    Abstract: BACKGROUND: To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment. OBJECTIVE: The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals. METHODS: Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength. RESULTS: Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081). CONCLUSIONS: The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.
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    Does lumbosacral transitional vertebrae cause low back pain?
    (Galenos, 2020) Kara, Gökhan Kürşat; Kavak, Hüseyin
    Abstract:Objective: Lumbosacral transitional vertebra (LSTV) is the most common congenital anomaly of the lumbosacral area. Its prevalence varies between 4% and 35.9%, and its relationship with back pain is controversial. In this study, we aimed to investigate the relationship of LSTV with low back pain by comparing the prevalence of LSTV between nonspecific low back pain and abdominal pain. Materials and Methods: A total of 411 radiographs from patients with nonspecific low back pain (group 1) and 520 radiographs from patients with abdominal pain (group 2) were included in the study. Data were evaluated according to Castellvi’s radiographic classification, and the prevalence of LSTV was reported. Results: According to Castellvi’s classification, the prevalence of LSTV was 27.5% and 36.7% in groups 1 and 2, respectively. LSVT types Ia, Ib and IIIb were the most common types. Conclusion: In abdominal pain group (group 2), which was used as the control group in our study, statistically significantly (p<0.05) more LSTV was found compared to the nonspecific low back pain group (group 1). Therefore, no correlation was found between LSTV and nonspecific low back pain.
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    The effects of patient related factors on hidden and total blood loss in single-level open transforaminal lumbar interbody fusion surgery
    (Acta Orthopaedica et Traumatologica Turcica, 2022) Kara, Gökhan Kürşat; Kavak, Huseyin; Gökçen, Bahadır; Turan, Kaya; Öztürk, Çağatay; Aydınlı, Ufuk
    Objective: The aim of this retrospective study was to identify the amount of TBL and HBL and analyse the risk factors using multivariate linear regression analysis during single-level OTLIF surgery. Methods: In this study 62 patients (32 male, 30 female, mean age 49.22 ± 13.26) who underwent single-level interbody fusion proce dures by a single surgeon between 2015 and 2021 were included. Retrospectively, relevant statistics regarding body mass index (BMI), American Society of Anesthesiologist Score (ASA), preoperative mean arterial pressure (MAP), and age were gathered. Preoperative MR images were used to assess and measure radiological parameters such as skin-disc distance (SDA), canal area (CA), paravertebral muscle area (PVMA),lumbosacral maximum subcutaneous fat thickness (LSMSF), operation level subcutaneous fat thickness (OPSF) and spi nous process length (SPL).Total blood loss (TBL) was calculated according to Nadler's formula. Hidden blood loss (HBL) was measured by deducting the measured (visible) blood loss from TBL. TBL, HBL and their relationship with preoperative parameters were assessed. Results: HBL was determined to be significantly higher in older patients (P = 0.012). MAP was seen to have a statistically significant cor relation with operating time (P = 0.002), operative bleeding (P = 0.002), TBL (P = 0.006), and HBL (P = 0.001), and an inverse correlation with postoperative drainage (P = 0.007). The ASA scores were observed to be statistically significantly correlated with TBL (P = 0.001), and HBL (P = 0.001). LSMSF showed a significant correlation with TBL (P = 0.005) and HBL (P = 0.002). OPSF was determined to be correlated with TBL (P = 0.011), HBL (P = 0.009) and length of stay in hospital (P =0.034). SDD was correlated with TBL (P =0.043), and SPL with HBL (P = 0.013). It was shown that age (P =0.012), MAP (P =0.001), ASA (P =0.001), LSMFS (P = 0.002), OPSF (P = 0.009), SPL (P = 0.013) were risk factors for HBL. According to multivariate logistic regression analysis; two anatomical factors LSMSF and SPL were independent risk factors for HBL (P < 0.05). Conclusion: This results of this study have revealed that most patient-related parameters have a significant effect on HBL and TBL.The study has also demonstrated that LSMSF and SPL are independent risk factors for HBL. Level of evidence: Level IV, Therapeutic Study.
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    Evaluation of the preferences of Turkish spine society members towards adolescent idiopathic scoliosis treatment
    (Galenos, 2020) Turan, Kayhan; Kara, Gökhan Kürşat; Çamurcu, İsmet Yalkın; Kızılay, Yusuf Onur; Uysal, Yunus; Aydınlı, Ufuk
    Objective: Controversies exist in the follow-up and treatment of adolescent idiopathic scoliosis (AIS). Thus, it is important to identify the attitudes of physicians from a national perspective to determine the status and problems associated with AIS treatment. This study aimed to evaluate the preferences of the Turkish Spine Society (TSS) physicians towards AIS treatment by investigating differences in AIS monitoring and treatment through a web questionnaire survey. Materials and Methods: This cross-sectional observational study employed a simple questionnaire focusing on AIS, which was created using Survey Monkey. Twenty questions, which were deemed as the most controversial topics of AIS, were constructed by the authors. A consensus was considered when 70% of the respondents provided the same answer. Results: A consensus was obtained among TSS physicians for using brace as conservative treatment and the brace was used 22 hours daily. Most TSS physicians agreed about the surgical indication of AIS; however, there was a disagreement about the indication of brace treatment. Conclusion: TSS physicians had a consensus on using brace in AIS treatment. However, there was a disagreement towards the indication of the brace treatment. The results demonstrated a consensus about surgical management and surgical experiences. However, a disparity existed about the time by which activities and contact sports are allowed.
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    Monoaxial pedicle screws with sublaminar fixations in the correction of adolescent idiopathic scoliosis
    (Galenos Yayınevi, 2021) Turan, Kayhan; Kara, Gökhan Kürşat; Çamurcu, Yalkın; Kızılay, Yusuf Onur; Uysal, Yunus; Aydınlı, Ufuk
    Objective: To evaluate the radiological outcomes of posterior spinal instrumentation by using monoaxial pedicle screws with sublaminar fixations for the treatment adolescent idiopathic scoliosis (AIS). Materials and Methods: The data of 14 patients who underwent posterior instrumentation by using monoaxial pedicle screws with sublaminar fixations for the treatment of AIS between 2010 and 2019 were retrospectively analyzed. Patients’ age, gender, preoperative Risser classification, preoperative Lenke classification, and operative data were recorded through our medical records. Proximal thoracic (PT), main thoracic (MT), thoracolumbar/lumbar (TL/L) curve Cobb angles as well as thoracic kyphosis (TK) and lumbar lordosis (LL) Cobb angles were measured through preoperative and postoperative standing full spine X-rays. Results: The mean preoperative PT curve Cobb angle was 33.7 degrees, and it was 4 degrees postoperatively (p=0.068). The mean preoperative MT curve Cobb angle was 53.3 degrees and it was 8.7 degrees postoperatively (p=0.008). The mean preoperative TL/L curve Cobb angle was 43 degrees and it was 9.2 degrees postoperatively (p=0.005). The overall mean coronal plane correction ratio was 84%. The mean preoperative TK Cobb angle was 25.2±17.8 degrees and it was 32.9±8.9 postoperatively (p=0.101). Conclusion: According to the results acquired from this study, monoaxial pedicle screws with sublaminar fixations demonstrated an efficient correction in both PT, MT, and TL/L curves and restoration of TK in AIS surgery
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    The results of hemivertebra resection by the posterior approach in children with a mean follow-up of five Years
    (Hindawi Ltd, 2017) Ertürer, Ramazan Erden; Kılınç, Bekir Eray; Gökçen, Hüseyin Bahadır; Erdoğan, Sinan; Kara, Gökhan Kürşat; Öztürk, Çağatay
    Aim. To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. Material and Method. Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. Results. Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization timewas 7 days. The amount of correction on the coronal planeswasmeasured as 31%. Themean segmental kyphosis angle was 45.7 degrees preoperatively and it wasmeasured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. Conclusion. The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.
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    Results of Posterior Vertebral Column Resection: Surgical Modification of Suk Technique
    (Sage Publications Ltd, 2018) Aydınlı, Ufuk; Kara, Gökhan Kürşat; Mutlu, Müren; Yaray, Osman
    Study Design: Consecutive, retrospective review. Objectives: To evaluate and report a modified posterior vertebral column technique. Methods: We present a retrospective analysis of 20 patients. Patients having severe 3-dimensional deformity with flexibility less than 20% and managed by posterior vertebral body resection (PVCR) between 2011 and 2014 were included in this study. There were 12 female and 8 male patients, with a mean age of 18 year (range = 3-63 years). Results: The average follow-up was 3.5 years (2-5 years). The preoperative coronal plane deformity was 84 degrees (70 degrees to 120 degrees) and corrected to 42 degrees (28 degrees to 68 degrees), showing 60% scoliosis correction. Average preoperative local kyphotic angle was 92 degrees (82 degrees to 110 degrees). Correction rate for kyphosis was 62%. All patients after surgery showed their baseline neurological status, and no complications were encountered. The mean estimated blood loss was 1072mL (350-2000 mL). Thirty-nine percent (33% to 50%) of total blood loss occurred after vertebral body resection, and 61% (50% to 67%) blood loss occurred after the removal of posterior elements. The ratio of estimated blood loss to estimated body blood volume was 26% (range = 19% to 52%). Conclusion: We found that 60% of total bleeding occurs during and after posterior bone resection. Spinal cord is open to possible iatrogenic direct spinal cord injury with surgical instruments for a much shorter period of time compared with the original technique.