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    Adult lumbar scoliosis
    (Galenos, 2019-01) Sever, Cem; Erdem, Mehmet Nuri; Tezer, Mehmet; Erdem, Gamze
    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.
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    Clinical and radiological results of oxford phase-3 medial unicompartmental knee arthroplasty
    (Cureus INC, 2019-11-04) Karaca, Sinan; Erdem, Mehmet Nuri; Öztermeli, Ahmet; Bal, Emre; Göğüş, Abdullah; Hamzaoğlu, Azmi
    Purpose The aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients. Materials and methods Seventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up. Results The average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination. Conclusion This study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis.
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    A Comparison of high viscosity and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures
    (Galenos, 2019-01) Karaca, Sinan; Öztermeli, Ahmet; Akpolat, Ahmet Onur; Erdem, Mehmet Nuri; Aydoğan, Mehmet
    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 (P<0.05) significantly in the two groups postoperatively on the other hand there was no significant change between two groups (P>0.05).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.
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    Evaluation of satisfaction with a questionnaire according to fracture level and fracture type of patients who underwent balloon kyphoplasty
    (Galenos Publishing House, 2022-04) Kültür, Yiğit; Bal, Emre; Erdem, Mehmet Nuri; Tezer, Mehmet
    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.
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    Patient-centered outcomes of vertebroplasty via questionnaire
    (Galenos, 2019) Karaca, Sinan; Erdem, Mehmet Nuri
    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.
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    Transforaminal lumbar interbody fusion as revision surgery for patients previously treated by discectomy or instrumentation of the lumbar spine
    (Galenos, 2019-01) Erdem, Mehmet Nuri; Tezer, Mehmet; Erdem, Gamze
    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.