Alemiddin Özdemir

Objective: This study aimed to predict surgical intervention decision and early prognosis in patients with isolated intracranial epidural hematoma (EDH) using clinical, laboratory, and radiological parameters obtained at admission to the hospital. Materials and Methods: Eighty-three patients with EDH due to "fall from a height" or "traffic accident" were examined. For each patient, age, gender, Glasgow Coma Scale (GCS) scores on admission to the hospital, anisocoria, duration of stay in the intensive care unit and the hospital, and Glasgow Outcome Scale scores were recorded. Brain CT images obtained on admission to the hospital were examined, and the hematoma thickness and midline shift values were measured. Additionally, patients' blood biochemistry results were recorded. Results: ROC curve analysis revealed that hematoma thickness, midline shift, basophil count, and serum potassium level were predictive parameters for surgical intervention in pediatric patients. In addition, preoperative hematoma thickness and midline shift, serum sodium, potassium, ALT, and CRP values could predict the decision to perform surgical intervention in adult patients. Finally, GCS scores and serum sodium values could predict patients' early outcomes. Conclusion: The study results suggested that hematoma thickness, midline shift values, and some blood biochemistry parameters could be used as predictive markers in the decision-making for surgical intervention in patients with isolated EDH. Additionally, the GCS score determined at admission to the hospital could be used as a predictive marker of patients’ early prognosis.

Aim: In literature, anatomical variations of the odontoid process in the sagittal plane have been suggested to influence the magnitude of cervical lordosis. This study investigated the effects of odontoid process morphology on the degree of cervical lordosis. Material and Methods: This retrospective study included individuals who underwent cervical computed tomography (CT) scans and had no cervical vertebral disease. The age and gender of these individuals were recorded. Their CT images were analyzed for the morphologic relationships and morphologic measurements of the C2 vertebra and other cervical vertebrae in relation to their adjacent formations.Results: Thirty-five subjects (male=23, female=12) were included in the study. Correlation analysis revealed a positive correlation between C2-C7 Cobb angle and age, sagittal odontoid height, and sagittal C2 vertebral height values. In addition, positive correlations were found between sagittal C2-C7 height values and sagittal odontoid mid-thickness, sagittal odontoid base thickness, and C2 vertebral height values. Linear Regression analysis revealed that the T1 slope angle, sagittal C2 vertebral height, and sagittal C2-C7 height values could predict the C2-C7 Cobb angle. Conclusion: These findings suggest that cervical lordosis may decrease over time when the T1 slope angle, sagittal odontoid height, sagittal C2 vertebral height, and sagittal C2-C7 height are measured low, and thus, those individuals may be more exposed to cervical vertebral alignment disorders.

Objective: This study aimed to evaluate the functional recovery in patients with upper lumbar vertebral fractures treated with thoracolumbar orthoses and the possible instability that may develop in the spine at the end of this follow-up. Material and Methods: Patients with L1 or L2 vertebral fractures treated conservatively were included in the study. T12- L5 Cobb angle, T12 and S1 slope angles, disc heights, L1-L5 spine height, kyphosis angle of the fractured vertebra, Hounsfield Unit value of the fractured vertebra, and the height of the vertebra above and below the fractured vertebra were measured on the initial and post-treatment computed tomography images. “Karnofsky Performance Scale (KPS)” scores were recorded at the end of the follow-up. Results: Initially measured T12-L5 Cobb angle, fractured vertebra height, and fractured vertebra subsidence rate were different from the values obtained at follow-up. The initial height of the fractured vertebra and the sagittal spinal canal diameter at the fracture level differed from follow-up values in female patients. Additionally, initial Hounsfield Unit and height values in fractured vertebrae measured in male patients differed from follow-up values. Conclusion: Conservative treatment in patients with a collapse rate of less than 20% could not preserve the T12-L5 Cobb angle and the height of the fractured vertebra; however, it could prevent an increase in the kyphosis angle and collapse rate of the fractured vertebra and a decrease in the height of the T12-L5 vertebral column. Moreover, KPS scores of 90 (70-100) in these patients suggested that they could benefit from this treatment.

It has been reported that patients with lumbar disc herniation (LDH), particularly those without severe symptoms, may benefit from conservative treatment, and spontaneous resorption of herniated discs can occur in the natural course of some LDH cases. In this study, two patients with disc herniation were discussed: one with a right lateral recess at L3-4, causing compression of the right L4 nerve root, and the other with a left lateral recess at L2-3, causing compression of the left L3 nerve root. Both patients exhibited no significant neurologic or functional deficits other than radicular pain. MRI images of both patients revealed that the herniated disc material had migrated within the spinal canal, and the T2 signal intensity was increased; therefore, these herniated discs were considered to be soft. Both patients underwent conservative treatment. Follow-up MRI images showed complete disappearance of the herniated disc material at five months for one patient and at nine months for the other. In conclusion, conservative treatment methods should be preferred for LDH patients without severe symptoms. Furthermore, the herniated disc material may undergo resorption and even completely disappear with close follow-up of this patient group.

This study examined the therapeutic effects of tramadol hydrochloride and levetiracetam on preventing peridural fibrosis after laminectomy in rats. Under sedation anesthesia, standard laminectomies at T9, T10, and T11 were performed on 32 male Wistar albino rats weighing 300-350 g. The rats were then divided into groups: Sham (no pharmacological agent administered, n = 6 + 2); MP group (10 mg/kg/day methylprednisolone sodium succinate administered intraperitoneally for 14 days, n = 6 + 2); TRA group (0.6 mg/kg/day tramadol hydrochloride administered intraperitoneally for 14 days, n = 6 + 2); and LEV group (15 mg/kg/day levetiracetam administered intraperitoneally for 14 days, n = 6 + 2). Four weeks after surgery, all animals were euthanized, and their spinal columns were removed en bloc. Peridural fibrosis and collagen density were evaluated using hematoxylin-eosin and Masson-Trichrome staining, respectively. Collagen and alpha-SMA levels were assessed with COL1A1 and ACTA2 staining, respectively. ELISA measurements were taken for TNF-α, IL-6, TGF-ß, CTGF, caspase-3, and GSH/GSSG levels. Western blot analysis was performed to determine pAMPK, mTOR, pmTOR, and mTOR/p-mTOR levels. Histopathological and immunohistochemical analyses showed that methylprednisolone and tramadol reduced peridural fibrosis, collagen density, and collagen formation. Both agents exhibited anti-inflammatory and anti-apoptotic effects by decreasing TNF-α, IL-6, caspase-3, TGF-β, and CTGF levels. They demonstrated antioxidant properties by increasing GSH/GSSG levels, and they supported autophagy by increasing pAMPK and decreasing pmTOR levels. In summary, all three agents possessed anti-inflammatory, antioxidant, anti-apoptotic, and autophagy-associated tissue regenerative properties. Due to these effects, they have the potential to reduce peridural fibrosis in the rat laminectomy model.

Aims: Because the radiological imaging methods may be inadequate in distinguishing extradural intramedullary spinal tumors, histopathological examination methods are still the gold standard. This study was conducted to investigate the relationship between extradural intramedullary spinal tumors and blood count and blood biochemistry parameters, and to present auxiliary parameters that may predict the histopathological diagnosis of these tumors before surgery. Methods: Patients with extradural intramedullary spinal tumors who underwent surgical intervention and healthy individuals were included in the study. Then they were divided into the Control group (healthy individuals; n=14) and the STM group (patients with extradural intramedullary spinal tumors; n=13). In addition, after excluding the control group patients and one patient each with ependymoma and cavernous hemangioma, they were divided into the schwannoma group (patients diagnosed with spinal schwannoma, n=6) and the meningioma group (patients diagnosed with spinal meningioma, n=5). Blood count results and biochemistry findings were analyzed. Results: Leukocyte count results differed between the control and STM groups (t=2.332, p=0.028). ROC-Curve analysis showed that if the hematocrit level was <40.75% (p=0.042) and if the leukocyte count was <8195 uL, these parameters could differentiate patients with IDEM from healthy individuals (p=0.031). Logistic Regression analysis revealed that only leukocyte count was the best predictive marker in distinguishing the IDEM (p=0.041). However, these parameters could not differentiate the patients with extradural intramedullary spinal tumors from healthy subjects because the parameter results were within average laboratory values. In addition, any study parameter could differentiate schwannoma patients from meningioma patients. Conclusion: At the end of the study, it was concluded that the blood count and blood biochemistry analysis results could not distinguish spinal tumors from healthy individuals in clinical practice. It was also seen that these parameters could not distinguish spinal schwannomas from meningiomas. On the other hand, it was argued that intradural extramedullary spinal tumors did not increase or decrease blood count results and serum CRP levels in patients. As a result, they did not cause an increase in a systemic inflammatory response or immunosuppression and did not have a detrimental effect on the functions of systemic organs.

Aims: It was reported in the literature that sagittal balance may be impaired in patients with spinal deformities and lumbar degenerative diseases. In this study, we analyzed the relationship between disc herniation and the results of spinal column morphological measurements related to sagittal balance on lumbar direct radiographs and preoperative blood biochemistry results in patients with single-level lumbar disc herniation and healthy subjects. Methods: Patients who underwent surgery for L4-L5 or L5-S1 intervertebral disc herniation and healthy individuals were included in the study. The participants were then grouped into the control group (n=15) and the LDH group (n=30). Patients were also grouped into the L4-5 HNP group (n=15) and the L5-S1 HNP group (n=15). Age, gender, blood count, and serum C-reactive protein values of all individuals and L1-S1 Cobb angles, T12 and S1 slope angles, L4-S1 Cobb angles, each disc height, and L1-L5 vertebral column height were measured on lumbar direct radiographs. Results: Age (p=0.035), T12 slope angle (p=0.032), L4-S1 Cobb angle (t=3.649, p=0.001), L1-L2 intervertebral disc height (p=0.032), L5-S1 intervertebral disc height (p=0.033), and eosinophil counts (p=0.039) were different between the control group and LDH group. However, there was no statistical difference between patients with L4-L5 disc herniation and patients with L5S1 disc herniation in terms of study parameters. ROC-curve and regression analysis revealed that if age over 39 years if the T12 slope angle was less than 21.50 degrees if the L4-S1 Cobb angle was less than 32.43 degrees if L1-L2 disc height was above 7.45 mm and if L5-S1 disc height was below 8.15 mm (p=0.041) these parameters could be used predictive markers for the diagnosis of the lumbar disc herniation (p

A 26-year-old female patient applied to the outpatient clinic in 2018 due to pain that had been present for a long time (16 years) and had recently spread from the top of the head to the nape of the neck. It was learned from the patient's anamnesis that her pain was relieved with analgesics. Although no pathological findings were found in the neurological examination, brain MRI was requested to reveal possible intracranial pathological conditions. In the MRI images taken, a cystic mass with a lobulated contour and thin septa of 24x31x40 mm and similar intensity to CSF was detected in the right parasagittal area posteriorly at the vertex level. The patient's control brain MRI images 3 months later showed no increase in cyst size. However, the patient's anamnesis, which came for a control in 2022, showed that his current complaints and headaches had increased. The MR images showed that the existing cyst had reached a size of approximately 60x35 mm. Medical treatment was initially planned for the patient (Acetazolamide, 750 mg/day). The MR taken one month later showed that there was no reduction in the cyst size and the optic discs were slightly swollen in the fundus examination. Considering the cyst growth, the patient's failure to benefit from medical treatment and the swelling noted in the optic discs, the patient was fitted with a cystoperitoneal shunt. The patient's early postoperative tomography image showed a significant reduction in the cyst (50.15x25.66) and a slightly swollen optic disc image with blurred borders was detected in the fundus examination. The patient's complaints regressed, and in the radiological images it was determined that the cyst continued to shrink [(45.8x23.19 mm) and (41.1x20.3 mm)], the shunt was in place, and she had no clinical complaints. As a result, it was argued that patients with atypically located arachnoid cysts, as in this case, should be taken under close clinical and radiological follow-up, and surgical treatment methods should definitely be considered in patients who are found to have an increase in cyst size and clinical findings during this follow-up and who do not respond despite medical treatment.

Aims: Vertebral corpus fractures (VCF) can occur after trauma, osteoporosis, benign or malignant tumors, metastases, or infections. In this study, biopsy results of patients undergoing percutaneous vertebroplasty were discussed. Methods: Digital hospital records were retrospectively reviewed and age, gender, hemoglobin, leukocyte, neutrophil, lymphocyte, basophil, eosinophil, platelet, C-reactive protein, biopsy pathology result, and hospitalization day of patients who underwent vertebroplasty for VCF were recorded. In addition, preoperative and postoperative radiologic images were examined. Results: Fifty-one patients (17 males, and 34 females) were included in the study. When the patients were grouped as under and over 65 years of age, infection was found in two patients under 65 years of age, and malignant tumor was found in patients over 65 years of age. When the patients were grouped according to gender, 4 male patients had cancer or infection (one with “Brucella melitensis” in the T7 vertebra, one with “Mycobacterium tuberculosis” in the L1 vertebra, one with “poorly differentiated upper gastrointestinal tumor” in T10 vertebra and one with “multiple myeloma” in T8 vertebra). The diagnoses made in the biopsy materials had already been clinically established in all patients. Although ROC-Curve analysis revealed that gender, leukocyte, and neutrophil counts could be used as predictive markers for diagnosing “pathologic fracture” in VCF, regression analysis showed that none of these parameters could be used as the “best predictive marker”. Conclusion: This study showed that because up to 8% of patients undergoing vertebroplasty might have abnormal biopsy results, it is necessary to obtain a biopsy from these patients, especially male patients, before cementing the fractured vertebra.

A 49-year-old woman who had a headache for ten days was evaluated in the emergency department. Because the physical examination was normal, an intracranial mass was suspected, and brain computed tomography (CT) revealed an edematous intracranial lesion with an 8.3-millimeter shift in the right occipito-parietal region. In venous blood samples, leukocyte count was 17360 uL (normal range:4000-10000 uL), C-reactive protein level was 9.42 mg/L (normal range:0-5 mg/L), procalcitonin 0.027 ng/ml (normal range:0-0.05 ng/ml). Choline/NAA (N-acetyl aspartate) peaks that may be in favor of malignancy were obtained in the mentioned lesion in brain MR-spectroscopy images. Contrast-enhanced CT scan of the thorax, abdomen, and pelvis revealed no tumor focus. She underwent a right occipital craniotomy. After opening the mass capsule, a yellow-green, thick, odorless purulent material discharged. Gram-positive diplococci were detected in the emergency smear preparations of this purulent material and "Streptococcus porcinus" growth was detected in the subsequent culture. After the normalization of blood biochemistry values and marked improvement in brain MR images, the Infectious Diseases Department terminated antibiotic treatment at the end of the fifth month. As seen in this patient, radiologic imaging may sometimes not be sufficient to make the correct diagnosis and may lead to different diagnoses.