Transforaminal lumbar interbody fusion as revision surgery for patients previously treated by discectomy or instrumentation of the lumbar spine

Purpose:Transforaminal lumbar interbody fusion (TLIF) is a surgical method that allows stable fusion of the anterior spinal column and restoration of disc height and lumbar lordosis. The aim of this study was to evaluate the clinical and radiological data of the patients who underwent lumbar discectomy, posterior instrumentation and laminectomy or TLIF surgery and who applied to our clinic with the complaint of discogenic back or leg pain and investigate the effectiveness of procedure.Material and Methods:Between the years 2012-2016, patients who underwent TLIF procedure were analyzed retrospectively. Inclusion criteria; patients undergone surgery due to any disc pathology from the lumbar region, complaints that did not respond to a minimum of 6 weeks of conservative treatment, patients undergoing revision surgery with two levels or more TLIF procedure with posterior instrumentation and a follow-up period longer than 2 years. Radiological and clinical data of 13 patients who met these criteria were examined for the study.Results:The study group consisted of 11 women and 2 men. The mean follow-up period was 39.3 months (range 26-58). The mean age was 62.2 (range 56-71). 7 patients had previously undergone lumbar discectomy, 4 patients had posterior instrumentation and laminectomy, 2 patients had posterior instrumentation and TLIF procedure. The dominant complaint was back pain in all patients. There were also complaints of varying rates of radicular pain and combinations of neurological deficit. Indications for revision surgery; lumbar degenerative disc disease, recurrent lumbar disc herniation, lumbar spinal canal stenosis, segmental instability and spondylolisthesis with two levels and higher. A total of 77, mean 5.9 (±1.4) pedicle screws were placed. A total of 32, average 2.4 (±0.5) levels of TLIF were applied. In 8 (61.5%) patients, pedicle screws was augmented with cement. The mean operative time was 378.8 min, and the mean amount of blood loss was 684.6 ml. The mean amount of autotransfusion and allogeneic blood transfusion was 569.2 ml. Mean duration of hospital stay was 4.6 days. One patient had dural tear during the operation. In one patient, the wound drainage that started in the postoperative 10. day was healed with wound debridement and antibiotic treatment. None of the patients had proximal or distal adjacent segment fracture, implant failure, nonunion or loss of correction during the follow-up. Complete neurological recovery was observed in all patients except the patient who was admitted with a 6-month history of foot drop.Conclusions:TLIF is a safe and effective procedure for the treatment of spinal pathologies in revision surgery. Elimination of spinal stenosis and instability, decompression of nerve roots, restoration of intervertebral disc heights, restoring lumbar lordosis, neutralization of global spinal balance and pain relief are possible.Publisher's Versio

Patient-centered outcomes of vertebroplasty via questionnaire

Purpose: Our aim was to evaluate patient centred outcomes of patients with compression fractures treated by vertebroplasty. Methods: Patients with compression fractures treated by vertebroplasty procedure between 2013- 2016 was examined with a 3-question through telephone call. Results: Fifty-two patients completed the telephone satisfaction survey. Of these, 92.5 % of answerers said the procedure was acceptable, 86.5% had full or partial pain remission and 78.8 % would have the procedure again. Conclusions: The use of vertebroplasty is supported by randomized trials in osteoporotic and malignant compression fractures. To the results of our study, patients believe vertebroplasty is a tolerable procedure that produces full or partial pain remission and would try the same procedure again if needed.Publisher's Versio

Adult lumbar scoliosis

Scoliosis in the adult is a disorder that involves a convergence of deformity and degenerative disease in the spine. It can be defined as a coronal deformity with Cobb angle of more than 10 degrees in mature patients. The treatment of adult lumbar scoliosis deformity requires a multidisciplinary approach and preoperative planning, and to be extended to the development of new treatment methods in the future along with the expected life expectancy. It often manifests with low back pain. Etiology of the disease is related with primary degeneration or continuation of a deformity from adolescence. The main objective of surgical management is to decide which patient is to be treated with surgical treatment, to evaluate the general condition and to analyze the comorbidities of the patient and to draw a treatment scheme considering the patient’s expectations.Publisher's Versio

Does Home Birth Reduce the Risk of Pelvic Organ Prolapse?

Objectives: To determine the relationship between vaginal birth and the development of POP among women who deliv­ered in non-hospital settings (home birth). Material and methods: Data were collected retrospectively from the files of patients who presented to a hospital outpatient clinic between April 1, 2011 and April 1, 2012 with complaints of urinary incontinence, uterine sagging, vaginal mass, or vaginal pain. The patients’ age, height, weight, body mass index, menopause age, number of deliveries, and presence of hypertension and diabetes mellitus were noted. Patients whose urogynecologic evaluation included POP Quantification (POP-Q) scoring were included in the study. The patients were separated into a group of women who had never given birth and another group of women with one or more deliveries. Results: Of the 179 patients in the study, 28 had never given birth and 151 had given birth at least once. The nulliparous patients had no cystocele, rectocele, or uterine prolapse. The prevalence rates of cystocele, rectocele, and uterine prolapse were significantly higher in the multiparous group. Cystocele, rectocele, and uterine prolapse development were significantly correlated with number of deliveries, but there was no statistical association with age, body mass index, menopausal age, diabetes mellitus, or hypertension. univariate analysis reveals that the only factor effective in the development of cytocele, rectocele and prolapse is the number of births. Conclusions: Our study suggests that only number of deliveries is associated with development of cystocele, rectocele, and uterine prolapse in women who gave birth by vaginal route in residential settings

Evaluation of satisfaction with a questionnaire according to fracture level and fracture type of patients who underwent balloon kyphoplasty

Objective: The aim of this study is to better understand which type of fracture and localization have more painful or worse outcomes for the kyphoplasty procedure. Materials and Methods: Kyphoplasty cases operated between 2013 and 2018 were included in the study. The patients were contacted through the numbers registered in the hospital system. A questionnaire were asked to the patients. Patients were grouped according to gender, fracture level (T12-L1 and others) and fracture type (Osteoporotic, trauma, malignancy, unknown). Results: Fourty-one patients were included in the study. Three-quarters of the patients were women and average age was 62. Ninety-two percent of the patients stated that the pain of the procedure was tolerable. Seventy percent reported that their pain decreased after the procedure and 75% of the patients stated that they could have this procedure done again. Pain reduction and the desire to have same surgery again were significantly higher in female patients than in the male group (p<0.05). In the T12-L1 group and osteoporotic fracture group, the procedure was more easily tolerated, the pain was relieved more and the desire to have the same surgery was higher (p<0.05). Conclusion: Kyphoplasty is accepted as an operation that is well tolerated by patients and has good pain relief. Additionally more detailed information was obtained about the patient’s complaints after the kyphoplasty procedure, according to the fracture level and type.Publisher's Versio

Design and Development of Material and Information Flow for Supply Chaıns Using Genetic Cellular Networks

Son yıllarda, geri yay ılım tekniğine dayanan yapay sinir ağı (Ziarati and Ucan, January 2001) modeli ile gerçek bir firmanın malzeme tedarik zincirinde geleceğe dönük malzeme talep miktarı tahmin edilebilmiştir. Yapay sinir ağlarının hızlı olması, büyük miktardaki verinin ele alınabilmesi, malzeme akış diagramlarında geleceğe yönelik tahminlerde potensiel bir model olmalarını sağlamaktadır. Bu makale, (Ziarati and Ucan, January 2001) makalesinin geliştirilmiş biçimidir. Burada yapay sinir ağ (YSA) yapısı yerine Genetik Hücresel Yapay Sinir Ağ (HYSA) modeli konulmuştur. Söz konusu yaklaşım daha az parametre ile kestirim yapabilmekte ve dolayısıyla hızlı değişimli gerçek tedarik zincir problemlerine daha hızlı uyum sağlamaktadır. Önerilen modelin, tedarik zinciri problemlerinde, gerek eğitim sürecinin kısaltılmasında gerekse malzeme istek kestirimde üstün başarım göstermesi beklenmektedir.In a recent paper by authors (Ziarati and Ucan, January 2001) a Back Propagation-Artificial Neural Network (BP-ANN) was adapted for predicting the required car parts quantities in a real and major auto parts supplier chain. It was argued that due to the learning ability of neural networks, their speed and capacity to handle large amount of data, they have a potential for predicting components requirements and establishing associated scheduling throughout a given supply chain system. This paper should be considered a continuation of the first paper as the neural network approach introduced in this paper replaces the BP-ANN by a new method viz., Genetic Cellular Neural Network (GCNN). The latter approach requires by far less stability parameters and hence better suited to fast changing scenarios as in real supply chain applications. The model has shown promising outcomes in learning and predicting material demand in a supply chain, with high degree of accuracy

Design and Development of Material and Information Flow for Supply Chaıns Using Genetic Cellular Networks

Son yıllarda, geri yay ılım tekniğine dayanan yapay sinir ağı (Ziarati and Ucan, January 2001) modeli ile gerçek bir firmanın malzeme tedarik zincirinde geleceğe dönük malzeme talep miktarı tahmin edilebilmiştir. Yapay sinir ağlarının hızlı olması, büyük miktardaki verinin ele alınabilmesi, malzeme akış diagramlarında geleceğe yönelik tahminlerde potensiel bir model olmalarını sağlamaktadır. Bu makale, (Ziarati and Ucan, January 2001) makalesinin geliştirilmiş biçimidir. Burada yapay sinir ağ (YSA) yapısı yerine Genetik Hücresel Yapay Sinir Ağ (HYSA) modeli konulmuştur. Söz konusu yaklaşım daha az parametre ile kestirim yapabilmekte ve dolayısıyla hızlı değişimli gerçek tedarik zincir problemlerine daha hızlı uyum sağlamaktadır. Önerilen modelin, tedarik zinciri problemlerinde, gerek eğitim sürecinin kısaltılmasında gerekse malzeme istek kestirimde üstün başarım göstermesi beklenmektedir.In a recent paper by authors (Ziarati and Ucan, January 2001) a Back Propagation-Artificial Neural Network (BP-ANN) was adapted for predicting the required car parts quantities in a real and major auto parts supplier chain. It was argued that due to the learning ability of neural networks, their speed and capacity to handle large amount of data, they have a potential for predicting components requirements and establishing associated scheduling throughout a given supply chain system. This paper should be considered a continuation of the first paper as the neural network approach introduced in this paper replaces the BP-ANN by a new method viz., Genetic Cellular Neural Network (GCNN). The latter approach requires by far less stability parameters and hence better suited to fast changing scenarios as in real supply chain applications. The model has shown promising outcomes in learning and predicting material demand in a supply chain, with high degree of accuracy

Potential anomaly separation and archeological site localization using genetically trained multi-level cellular neural networks

In this paper, a supervised algorithm for the evaluation of geophysical sites using a multi-level cellular neural network (ML-CNN) is introduced, developed, and applied to real data. ML-CNN is a stochastic image processing technique based on template optimization using neighborhood relationships of the pixels. The separation/enhancement and border detection performance of the proposed method is evaluated by various interesting real applications. A genetic algorithm is used in the optimization of CNN templates. The first application is concerned with the separation of potential field data of the Dumluca chromite region, which is one of the rich reserves of Turkey; in this context, the classical approach to the gravity anomaly separation method is one of the main problems in geophysics. The other application is the border detection of archeological ruins of the Hittite Empire in Turkey. The Hittite civilization sites located at the Sivas-Altinyayla region of Turkey are among the most important archeological sites in history, one reason among others being that written documentation was first produced by this civilization

A Comparison of high viscosity and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures

Introduction: Our aim in this clinical trial was to compare the safety and efficacy of highviscosity cement (HVC) with low-viscosity cement (LVC) for the treatment of osteoporotic vertebrae fractures in terms of pain, functional capacity and cement leakage in the percutaneous vertebroplasty procedure (PVP). Methods: From March 2013 to February 2015, 76 patients with vertebrae compression fracture who were admitted into hospital and treated with PVP were reviewed. Pre- and postoperative clinical characteristics of each patient were obtained by using The Visual Analog Scale (VAS) score to evaluate back pain, Oswestry Disability Index (ODI) as a functional assessment. Cement leakage,injected cement volume and the complications assessed due to medical records. Results: VAS and ODI scores improved (P0.05).Paravertebral cement leakage was significantly higher in the LVC group (P<0.05). Pulmonary cement embolism was also significantly higher in LVC group (P<0.05). Conclusion: HVC had lower complication rates with similar clinical results in the comparison with LVC.Publisher's Versio