Duygu Baykal

Aim: Posterior spinal instrumentation using segmental pedicle screw systems is a widely accepted surgical technique for the treatment of non-degenerative structural scoliosis because of its ability to achieve effective three-dimensional deformity correction and provide biomechanical stability. This study aimed to evaluate the early radiological and functional outcomes of posterior spinal instrumentation in patients with non-degenerative structural scoliosis.Material and Methods: This retrospective single-center study included patients who underwent posterior spinal instrumentation for non-degenerative structural scoliosis between January 2025 and May 2026. Demographic, radiological, and clinical data were reviewed retrospectively. Preoperative and postoperative Cobb angles were compared, and deformity correction rates were calculated. Early postoperative functional outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at the 3-month follow-up. Results: Twenty-five patients with a mean age of 15.28 ± 3.29 years were included. In patients with available preoperative and postoperative radiographic measurements, the mean Cobb angle decreased significantly from 58.42 ± 18.54° preoperatively to 13.29 ± 11.06° postoperatively (p < 0.001). The mean deformity correction rate was 78.78 ± 13.31%. At the 3-month follow-up, the mean VAS and ODI scores were 3.96 ± 1.99 and 25.28 ± 10.00, respectively. Adult patients demonstrated significantly higher ODI scores than pediatric patients (p = 0.042). Perioperative complications occurred in three patients (12.0%).Conclusion: Posterior-only segmental pedicle screw instrumentation achieved a mean deformity correction rate of nearly 80%, providing satisfactory early radiological correction and favorable short-term functional outcomes.

Purpose This study investigated the reliability and validity of the five-repetition sit-to-stand (5xSTS) and 30-second chair sit-to-stand (30s-CST) tests in individuals after lumbar spinal surgery. Methods This prospective psychometric study included individuals who had undergone lumbar spinal surgery and were at least 6 weeks post-operatively. Participants performed the 30s-CST, 5xSTS, 10-meter walk test (10MWT), and timed up and go test (TUG), with 2-minute rest intervals between tests. One hour later, the 30s-CST and 5xSTS were repeated for retest analysis. Test–retest reliability and agreement were assessed using the intraclass correlation coefficient (ICC) and Bland–Altman analysis, respectively. ICC values were interpreted as follows: >0.90 excellent, 0.75–0.90 good, 0.50–0.75 moderate, and < 0.50 poor. Concurrent validity was evaluated using Pearson correlation coefficients, and standard error of measurement (SEM) and minimal detectable change (MDC95) were also calculated. Results A total of 128 individuals were assessed for eligibility; 18 were excluded, and 110 participants were included in the final analysis. The test–retest reliability was excellent for both the 30s-CST [ICC (2,1) = 0.958, 95% CI: 0.939–0.971] and the 5xSTS [ICC (2,1) = 0.946, 95% CI: 0.922–0.962]. The SEM and MDC95 values were 0.56 and 1.55 for the 30s-CST, and 0.52 and 1.44 for the 5xSTS, respectively. Bland–Altman analysis revealed good agreement between test and retest measurements for both tests, with narrow limits of agreement and minimal systematic bias. Furthermore, both the 30s-CST and 5xSTS exhibited strong concurrent validity, demonstrating significant correlations with functional mobility measures, including the 10MWT and TUG. Conclusion The 30s-CST and 5xSTS are suggested to be reliable and valid performance tests for individuals after lumbar spinal surgery.

Objectives: This study aimed to evaluate the utility of MRI-based morphometric and qualitative parameters in identifying patients with suspected normal pressure hydrocephalus (NPH) associated with shunt surgery selection following clinical and lumbar puncture evaluation. Methods: We retrospectively analyzed 134 participants: 84 symptomatic patients evaluated for suspected NPH and 50 age-matched controls with normal brain MRI findings. Symptomatic patients were categorized according to subsequent clinical management following lumbar puncture evaluation into those who underwent shunt surgery (Shunt group) and those who received conservative management (Conservative group). The Evans index, fronto-occipital horn ratio (FOHR), bicaudate index, callosal angle, ventricular measurements, and disproportionately enlarged subarachnoid space hydrocephalus (DESH) components were analyzed. The discriminatory performance of MRI parameters for shunt surgery selection was assessed using ROC analysis; independent predictors of shunt surgery selection were determined using logistic regression. Results: Although conventional ventricular indices and ventricular dimensions were significantly greater in symptomatic patients than in the control group (p < 0.001), baseline continuous MRI measurements did not significantly differ between the Shunt and Conservative groups (p > 0.05). Callosal angle demonstrated no discriminatory value for shunt surgery selection. In univariate analyses, an Evans Index > 0.36, a bicaudate index > 0.23, and a DESH score > 2 were associated with shunt surgery selection. High-convexity tightness and an Evans Index > 0.36 differed significantly between groups and remained independently associated with shunt surgery selection in multivariable analysis. Conclusions: Ventricular width-based indices alone appear insufficient for identifying patients selected for shunt surgery among individuals evaluated for suspected NPH. Both qualitative and quantitative MRI features, particularly high-convexity tightness and an Evans Index > 0.36, were independently associated with shunt surgery selection following routine clinical assessment. Integrating multimodal imaging parameters with clinical evaluation may provide a more reliable approach for identifying patients who are ultimately selected for shunt surgery following lumbar puncture assessment.

Intraoperative ultrasonography (IoUSG) is an essential real-time imaging tool in neurosurgical practice. However, a physical mismatch between standard probe dimensions and narrow craniotomy windows often hinders its effectiveness. We present a practical and cost-effective "balloon technique" using a saline-filled sterile surgical glove to establish an acoustic bridge. A 61-year-old male with a metastatic brain lesion in the right frontal region underwent a 3x3.5 cm crani-otomy, where a standard 4 cm wide probe exceeded the bone margins. By utilizing a saline-filled interface, we successful-ly achieved high-resolution visualization and total resection without enlarging the craniotomy. This technique provides real-time feedback and brain-shift compensation while maintaining the principles of minimally invasive surgery, offering a superior alternative to costly and time-consuming intraoperative imaging modalities.

Recurrent lumbar disc herniation remains a prominent clinical challenge following microdiscectomy, particularly at the L5–S1 level, which has distinct biomechanical characteristics. While various radiological and clinical predictors have been proposed, the influence of surgical laterality has not been adequately explored. This study aimed to identify independent predictors of recurrence following L5–S1 microdiscectomy, with a specific focus on surgical laterality. This retrospective cohort study included patients who underwent primary L5–S1 microdiscectomy at a single center with a minimum follow-up of 12 months. Recurrence was defined as same-level, same-side herniation confirmed by imaging and clinical findings. Demographic, clinical, and radiological parameters—including facet tropism, disc height index, Modic changes, and multifidus morphology—were analyzed. Recurrence-free survival was assessed using Kaplan–Meier analysis, and independent predictors were identified through Cox proportional hazards regression. Patients with recurrence were significantly older and had higher rates of preoperative neurological deficits and systemic comorbidities. Radiological parameters showed no significant association with recurrence. In multivariable Cox regression analysis, left-sided surgery emerged as the strongest independent predictor, associated with a 3.5-fold increased hazard of recurrence (aHR: 3.506; 95% CI: 1.537–7.999; p = 0.003). Systemic comorbidities also independently increased recurrence risk (aHR: 2.051; 95% CI: 1.000–4.208; p = 0.050). Kaplan–Meier analysis demonstrated significantly shorter recurrence-free survival in patients undergoing left-sided procedures. Recurrence after L5–S1 microdiscectomy appears to be driven more by surgical and systemic factors than by conventional radiological parameters. Surgical laterality, particularly left-sided procedures, represents a novel and significant predictor of recurrence. These findings highlight the potential role of technical and patient-related factors in surgical outcomes.

Patients presenting with various symptoms to the pediatric emergency department may be diagnosed with a spinal mass. Spinal ependymoma is a central nervous system tumor that is quite rare in childhood. Early diagnosis is important in terms of reducing morbidity and mortality. The presenting symptoms should be well understood, and necessary tests for differential diagnosis should be conducted. In this case, a 9-year-old male patient who presented to our emergency department with complaints of urinary incontinence and walking difficulties and was diagnosed with spinal ependymoma will be discussed.

Background: Chronic subdural hematoma can cause compression of brain tissue followed by neurological deficits. There are several methods for the treatment of chronic subdural hematoma, but the most appropriate treatment is still controversial. we compared 5 different surgical methods applied by five different surgeons in a single center and we suggest the most appropriate treatment method in the literature. Methods: In this study, the files of patients diagnosed with chronic subdural hematoma who underwent surgery at the Neurosurgery Clinic of S.B.U. Bursa City Hospital were retrospectively examined. The patients were evaluated in terms of their complaints, neurological examinations, type of operation, use of subdural drain and postoperative complications. Five different surgical techniques were applied to the patients. Results: We collected data from 185 patients who underwent surgery due to chronic subdural hematoma. Different surgical techniques were used in the treatment of patients. Only one burr hole was opened in 22 of the patients, one burr hole was opened in 40 of them and 1 drain was placed in the subdural space, only two burr holes were opened in 41 of them, two burr holes were opened in 58 of them and 1 drain was placed in the subdural space, and mini craniotomy was performed in 24 patients. Conclusion: Five different surgical methods used in the treatment of chronic subdural hematoma have advantages and disadvantages. We believe that a study conducted by increasing the number of patients, ensuring homogenization of groups, and increasing surgical techniques will shed light on the literature.