Ali Fahir Ozer

Background/Objectives: Third-ventricle colloid cysts are benign but can cause obstructive hydrocephalus and sudden deterioration, and the role of microsurgical transcallosal resection in the endoscopic era remains debated. We evaluated clinical, radiological, and functional outcomes of microscope-assisted interhemispheric transcallosal resection and the effect of preoperative hydrocephalus on recovery. Methods: This retrospective, observational, single-center study analyzed 30 patients with symptomatic, histopathologically confirmed colloid cysts operated on between June 2015 and February 2021, divided into hydrocephalus (n = 16) and non-hydrocephalus (n = 14) groups. Functional outcomes were assessed using the Karnofsky Performance Status (KPS) scale. Results: Mean KPS improved from 65.3 ± 21.0 to 92.0 ± 11.0 (p < 0.001). Patients with hydrocephalus had lower preoperative Glasgow Coma Scale (GCS; p = 0.022) and KPS (p = 0.048) scores, comparable postoperative KPS (p = 0.208), and greater KPS improvement (p = 0.012). Four patients (13.3%) needed external ventricular drainage; none required a permanent shunt. Four patients (13.3%) developed new persistent neurological events (seizures, n = 3; memory impairment, n = 1). No recurrence occurred over a median follow-up of 7.0 years. Conclusions: Microscope-assisted interhemispheric transcallosal microsurgical resection was associated with significant KPS improvement, no permanent shunt requirement, and no recurrence. Despite the increasing use of endoscopic techniques, microsurgical approaches remain valuable due to direct visualization, bimanual dissection, and the potential for durable gross-total resection; however, neurocognitive outcomes were not assessed, and prospective studies are needed.

Objectives: Retrospective comparative cohort study. This study aimed to compare the clinical and radiological outcomes of rigid, dynamic, and hybrid stabilization systems in the surgical management of degenerative lumbar spine disease, with a focus on adjacent segment disease (ASD), fusion-related complications, and postoperative recovery. Rigid fusion techniques provide immediate stability but may increase mechanical stress at adjacent segments, leading to ASD. Dynamic and hybrid constructs aim to preserve more physiological motion, potentially reducing fusion-related complications. Methods: A retrospective analysis was conducted on 86 patients who underwent posterior lumbar stabilization between January 2017 and December 2021. Patients were categorized into four groups based on the surgical technique: Rigid (titanium rod), Dynamic (PEEK rod), Rigid + TLIF (Transforaminal Lumbar Interbody Fusion), and Hybrid (Dynamic + TLIF). Clinical evaluation included the Visual Analog Scale (VAS) for back and leg pain. Radiological assessments comprised segmental and total range of motion (ROM), disc and foraminal height, fusion success, pseudoarthrosis, and the presence of ASD. Results: All surgical approaches resulted in significant postoperative improvement in back and leg pain (p < 0.001). The incidence of ASD was highest in the Rigid + TLIF group (45.5%, p < 0.001) and lowest in the Dynamic (4.8%) and Hybrid (4.2%) groups. Pseudoarthrosis was most frequently observed in the Rigid group (26.3%). The Hybrid group demonstrated favorable outcomes, with a high anterior fusion rate (91.7%) and low rates of ASD and pseudoarthrosis. Conclusions: All stabilization techniques were associated with significant postoperative clinical improvement. In this retrospective cohort, dynamic and hybrid constructs showed lower observed rates of early symptomatic ASD than the Rigid + TLIF construct, while TLIF-treated groups showed higher anterior fusion rates. Because treatment allocation was nonrandomized and adjustment for all potential confounders was not possible, these findings demonstrate associations rather than causal treatment effects. Larger prospective studies with longer follow-up are required to determine whether the stabilization strategy independently influences ASD, fusion, or pseudoarthrosis.

CLINICAL OUTCOMES OF FRAGMENTECTOMY FOR CARRAGEE TYPE I AND III LUMBAR DISC HERNIATIONS: A SINGLE-CENTER EXPERIENCE - The Journal of Turkish Spinal Surgery

Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly in multilevel applications—remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p < 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p < 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization—whether rigid or dynamic—offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications.

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings.

Objective: This study aimed to compare the clinical and radiological outcomes of dynamic rod stabilization with and without transforaminal lumbar interbody fusion (TLIF) in patients undergoing surgery for degenerative lumbar instability. Specifically, we evaluated the prognostic value of hybrid systems in reducing adjacent segment disease (ASD), enhancing fusion rates, and improving functional outcomes. Methods: A retrospective analysis was conducted on 62 patients treated between 2019 and 2022. Group 1 (n = 34) underwent dynamic rod stabilization alone, while Group 2 (n = 28) received dynamic stabilization combined with TLIF. Radiological assessments included disk height index (DHI) and fusion rates. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain at baseline, 12, and 24 months. Statistical analysis was performed using Jamovi^® software (version 2.4.1). Results: The hybrid group (dynamic + TLIF) demonstrated significantly higher anterior fusion rates (p < 0.001) and greater improvement in VAS scores for back (p = 0.005) and leg pain (p < 0.001) at 12 months. Although operative time was longer (p = 0.002), there was no significant difference in hospital stay (p = 0.635). No significant differences were observed in ASD development (p = 0.11) or pseudoarthrosis (p = 0.396). The hybrid group maintained better lumbar lordosis and higher adjacent segment DHI. Conclusions: Hybrid dynamic stabilization combined with TLIF provides superior clinical outcomes and fusion rates compared to dynamic stabilization alone, without significantly increasing the risk of ASD. These findings support the use of hybrid constructs as a balanced strategy for treating degenerative lumbar instability.

Purpose In this study, we aimed to evaluate the effectiveness and safety of UBS (Ultrasonic Bone Scalpel) and HSD (High-speed drill) for performing anterior or posterior decompressions in patients with pathologies in cervical and lumbar regions. Methods Between October 2022 and June 2024, 60 patients underwent surgery in which a UBS (Sonopet UST-2001; Stryker Neuro Spine ENT, MI, USA) and High-speed Midas Rex MR8 (Medtronic, Fort Worth, TX, USA) drill was used. Informed consent was obtained from all patients. The study included 27 men and 33 women with a mean age of 59,5 ± 14.6 years (range: 28–85). The following patient data were recorded: preoperative and postoperative JOA scores, intraoperative blood loss, and operative time for decompression in lumbar and cervical region. Results In UBS group, the mean intraoperative blood loss was 166.0 ± 64.3 ml. The mean preoperative and postoperative JOA scores were 4.5 ± 1.0 and 8.6 ± 1.8 and the mean postoperative follow-up duration was 6.1 ± 4.4 months in UBS group. The mean intraoperative blood loss was 221.2 ± 93.4 ml in HSD group. The mean preoperative and postoperative JOA scores were 5.2 ± 1.1 and 8.2 ± 1.2 in HSD group. In the HSD group, the blood loss (BL) value was significantly higher (p < 0.05) compared to the UBS group. The preoperative/postoperative JOA score improvement in the UBS group was significantly higher (p < 0.05) than in the HSD group. Conclusions The UBS can be safely used in spinal surgery. It reduces intraoperative blood loss and provide better clinical improvement. Authors would like to emphasize that the UBS resects the bone with oscillatory movements rather than rolling motions and this mechanism of action is important in reducing the risk of dura mater injury.