Ali Fatih Ramazanoğlu

Objectives: This study aims to investigate the impact of early initiated rehabilitation on outcomes in patients with spinal cord injuries related to tumors. Patients and methods: In this retrospective cohort study conducted between January 2015 and March 2021, a total of 31 patients with tumor-related spinal cord injury were assessed. Two patients were excluded due to incomplete clinical records, and the remaining 29 patients were divided into the early rehabilitation group (n=15; 8 males, 7 females; mean age: 45.53±16.73 years; range: 8 to 68 years) and the late rehabilitation group (n=14; 9 males, 5 females; mean age: 54.86±14.76 years; range: 28 to 78 years). Demographic and clinical characteristics, Functional Ambulation Category (FAC), and Barthel Index scores for outcome measurement were recorded. Results: The neurological level of the patients was predominantly at the thoracic level. The majority of patients were in the American Spinal Injury Association D category. In the evaluation of treatment outcomes, a significant difference was observed within each group of FAC and Barthel Index scores before and after rehabilitation (p=0.034, p=0.002; p=0.007, p=0.005 in early and late rehabilitation groups). In the comparison of FAC and Barthel Index scores before and after rehabilitation between groups, there was a significant difference in favor of the late rehabilitation group in both scores, both before and after rehabilitation (respectively, before rehabilitation p=0.032, p=0.005; after rehabilitation p=0.026, p=0.003). However, there was no significant difference in the FAC difference and Barthel Index scores percentage changes between groups. Conclusion: This study demonstrates that functional outcomes improved with rehabilitation in patients with spinal cord injuries related to tumors. Although the timing of rehabilitation initiation did not result in significant differences in functional outcomes, early rehabilitation did not appear to increase the risk of surgery-related adverse events.

Aim: Vertebral compression fractures are a common cause of pain and disability in the elderly population. Percutaneous vertebroplasty is an established minimally invasive intervention, yet the optimal approach (unilateral or bilateral) remains controversial. This study focused on comparing the clinical and radiological outcomes of unilateral versus bilateral percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures.Material and Methods: A retrospective review was conducted on 203 patients (73 males, 130 females; mean age 65.3 ± 8.9 years) with 309 treated vertebral levels from 2014 to 2024. Patients underwent either unilateral (n = 104) or bilateral (n = 99) PVP. Pain and disability were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological outcomes included anterior vertebral height restoration and segmental Cobb angle correction. Results: Both approaches provided significant pain relief and functional improvement. Bilateral PVP achieved lower postoperative VAS (1.9 vs 2.1, p = 0.040) and ODI scores (23.1% vs 26.3%, p = 0.020) compared to unilateral PVP. Radiologically, bilateral procedures resulted in superior anterior height restoration (25.8% vs 19.2%, p = 0.001) and greater Cobb angle correction (9.1° vs 6.4°, p = 0.001). Cement leakage rates were similar in both groups (≈4%), with no symptomatic complications.Conclusion: Unilateral and bilateral PVP are both safe and effective for osteoporotic VCFs. Bilateral PVP demonstrated superior radiological correction, whereas unilateral PVP remains advantageous due to reduced operative burden. Treatment decisions should be individualized based on patient anatomy and procedural goals.

Aim: Lumbar decompression surgery is a frequently utilized technique in degenerative spine conditions including disc herniation and spinal stenosis. In this study, the perioperative outcomes of patients undergoing lumbar decompression with either general anesthesia (GA) or spinal anesthesia (SA) are compared. Methods: 1152 patients who underwent lumbar decompression surgery without fusion/instrumentation were retrospectively reviewed. Patients were categorized into two groups: GA(n=516) and SA (n=636). Duration of operation, intraoperative blood loss, preoperative and postoperative VAS and ODI scores, time to mobilization, length of hospital stay and complications were analyzed.Results: SA group showed better postoperative early VAS scores, shorter time to mobilization and length of hospital stay. Intraoperative blood loss was also lower in the SA group (p

Aim: Epidural injections have become popular for relieving back and radicular pain that is persistent to conservative therapy and is being widely used as an alternative to surgery. In this retrospective clinical study, we describe a new technique for direct anterior epidural space targeting via an extreme lateral approach for epidural injection and present 1-year outcomes of the intervention. Material and Methods: In this clinical study, patients who had persistent back or radicular pain despite conventional treatment for 4 weeks were included. Anterior epidural injection via extreme lateral approach was performed in patients with degeneration of the lumbar spine, lumbar disc bulging or protrusion, and lumbar spinal stenosis. Visual Analogue Scale and Oswestry Disability Index scores were evaluated preoperatively, on postoperative 1st week, 1st month, and 12th month. Results: 186 patients were included in the study. The mean age was 48.42±11.2. 72 (38.71%) patients were male, and 114 (61.29%) patients were female. The mean duration of symptoms was 16.4±14.13 weeks. The mean VAS score for back pain preoperatively was 7.92±1.77. The postoperative VAS for back were 2.1±1.29, 2.36±2.25, and 3.11±3.25 respectively for the 1st week, 1st month, and 12nd month.The average VAS for radicular pain was 4.49±1.91 preoperatively. Postoperative VAS were 1.89±2.68, 2.32±1.08, and 2.56±1.52 respectively for the 1st week, 1st month, and 12nd month. The ODI scores were 49.76±13.59, 11.69±5.35, 12.27±7.01, 14.3±7.32 respectively preoperatively, on the postoperative 1st week, 1st month, and 12th month. Conclusion: The extreme lateral approach for anterior epidural injection is a safe and feasible technique method for the treatment of back and radicular pain.

Background: Intraoperative cytological consultation (IOC) is a practical, rapid, and reliable method for evaluating central nervous system (CNS) tumors, enhancing the neurosurgical oncological approach. While some studies have used Papanicolaou (Pap) staining for diagnosis, its exact contribution in comparison to the rapid hematoxylin and eosin (HE) staining technique and its cytological staining characteristics remains to be fully clarified. Method: During 12 months, this prospective study examined and contrasted the final histopathological section diagnoses of 161 specimens collected from 146 consecutive patients who received intraoperative touch‐imprint cytology (TIC) and squash smear preparation (SP) techniques, using both HE and Pap staining methods. Results: The diagnostic accuracy of TIC, relative to the final integrated histopathological diagnosis, was 85.1%. Although data for frozen sections were not separately quantified, TIC remains a rapid, reliable, and practical method for intraoperative evaluation. The evaluation of CNS lesions is best achieved by histopathology, which is considered the gold standard. The most common neoplasms were glioblastoma IDH‐wild type, metastatic cancers, pituitary neuroendocrine tumor (adenoma), and meningiomas. Kappa statistics between Pap and HE staining demonstrated very good overall agreement (kappa 0.9–1, p < 0.01) across all assessed cytological features, with the highest concordance observed for nuclear details, artifacts, mitotic background, necrosis, and cytoplasmic details. Although the Wilcoxon rank‐sum test indicated small but statistically significant differences in the median scores for nuclear details and artifacts, these differences reflect minor quantitative variations and do not affect the very good overall agreement between the two staining methods. Conclusion: Intracranial TIC and SP specimens stained with both HE and Pap demonstrated excellent diagnostic performance, characterized by high sensitivity and specificity. The combined use of Pap staining alongside HE provides a reliable and effective alternative to traditional cytological staining methods.

Background The current standard of care for spinal schwannoma, which is the most common nerve sheath tumor, is total microsurgical resection. The localization, size, and relationship with the surrounding structures of these tumors are crucial in terms of preoperative planning. A new classification method for surgical planning of spinal schwannomas is presented in this study. Methods All patients who underwent surgery for spinal schwannoma between 2008 and 2021 were reviewed retrospectively, along with radiologic images, clinical presentation, surgical approach, and postoperative neurologic status. Results A total of 114 patients (57 males and 57 females) were included in the study. Tumor localizations were cervical in 24 patients, cervicothoracic in 1 patient, thoracic in 15 patients, thoracolumbar in 8 patients, lumbar in 56 patients, lumbosacral in 2 patients, and sacral in 8 patients. All tumors were divided into seven types according to our classification method. Type 1 and 2 groups were operated on with a posterior midline approach only, type 3 tumors were operated on with a posterior midline approach and an extraforaminal approach, and type 4 tumors were operated on with only an extraforaminal approach. While the extraforaminal approach was sufficient in patients with type 5 tumors, partial facetectomy was required in 2 patients. A combined surgery including hemilaminectomy and extraforaminal approach was performed in the type 6 group. A posterior midline approach with partial sacrectomy/corpectomy was performed in the type 7 group. Conclusion Effective treatment of spinal schwannoma depends on preoperative planning, which includes correctly classifying tumors. In this study, we present a categorization scheme that covers bone erosion and tumor volume for all spinal localizations.

Objective In our study, we aimed to summarize the etiology of subdural hematoma that was not traumatic and required operation in pediatric patients. The subdural hematoma characteristics, possible etiologies, and treatment, as well as the patient outcomes, were analyzed. Methods A retrospective examination was made of pediatric patients with subdural hematoma who were operated on at Ümraniye Training and Research Hospital. Patients with a history of trauma were excluded. Data on patient sex, age, bleeding location, type of hematoma based on computed tomography imaging, surgical treatment, presenting symptoms, presence of comorbidities, Glasgow Coma Scale, thrombocyte counts, and international normalized ratio values were recorded. Results Of the 19 patients included in the study, 4 were female and 15 were male. Their ages ranged between 0 and 15 (mean = 5.84) years. In 57.8% of the patients, comorbidities, including acute myeloid leukemia, a history of shunt operation, epilepsy, mucopolysaccharidosis, known subdural effusion, autism, coagulopathy, ventricular septal defect/tetralogy of Fallot, cerebrospinal fluid leakage after baclofen pump administration, Marfan's syndrome, and late neonatal sepsis were present, while 21% had arachnoid cysts and 21% had no reported comorbidities. Conclusion This study suggests that, in pediatric patients with subdural hematoma with an amount of bleeding requiring surgical management, any underlying comorbidities should be investigated regardless of the presence of a history of trauma. While investigating systemic diseases, special attention should be paid to the presence of arachnoid cysts or disruption in cerebrospinal fluid dynamics along with a history of hematologic diseases.

Objective: The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors. Methods: This study comprised a retrospective examination of patients who received percutaneous vertebroplasty between 2008 and 2020 for the treatment of tumor-induced symptomatic cervical vertebra involvement. The study summarized the demographics, vertebral levels, pain control rates, clinical results, and complications of percutaneous vertebroplasty using an anterolateral approach. Results: The study sample consisted of 6 female and 2 male patients aged between 20 and 56 (mean=41.37) years. Tumors were located at C2 in 6 cases, at C3 in 1 case, and at C5 in another. The mean volume of poly (methyl methacrylate) injected was 1.5 mL (range: 1-2 mL). Biopsy results showed the presence of metastasis in 5 cases and plasmacytoma in 3. No postoperative complications or mortality were observed after the procedure. Preoperative mean 7.75 visual analog scale score decreased to 2.62. Pain control was reported to be 66.2%. Conclusion: Anterolateral cervical vertebroplasty seems to be a safe, effective, and helpful therapeutic alternative for the treatment of cervical spine tumors. It reduces the risk of infection compared to the transoral method. Level of Evidence: Level IV, Therapeutic Study Cite this article as: Ramazanoğlu AF, Sarıkaya C, Etli MU, Yaltırık CK, Önen MR, Naderi S. Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors. Acta Orthop Traumatol Turc. 2022;56(4):268-271.