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    Comparison of sagittal lumbosacral parameters in patients with ankylosing spondylitis and chronic mechanical back pain
    (2019) Kocyigit, Burhan Fatih; Nacitarhan, Vedat; Koca, Tuba Tulay; Berk, Ejder
    Aim: Lumbosacral parameters can be affected in ankylosing spondylitis (AS) and chronic mechanical back pain.We compared lumbosacral parameters between patients with AS and chronic mechanical back pain to identify specific changes in AS. Material and Methods:This study has a retrospective design. A total of 42 patients with AS (16 females, 26 males) and 66 patients with chronic mechanical back pain (31 females, 35 males) were enrolled in the study. Lumbar lordosis angle (LLA), lumbosacral angle (LSA), sacral tilt (ST), and lumbosacral disc angle (LSDA) were measured using digitalized standing lateral lumbar radiographs. CRP and ESR concentrations of AS patients were obtained from the hospital database. Results: LLA, LSA, ST and LSDA were significantly smaller in the patients with AS (p < 0.05).CRP and ESR were significantly and negatively correlated with LLA and LSA (r = -0.516, p < 0.001; r = -0.401, p = 0.009 for CRP and r = -0.623, p < 0.001; r = -0.474, p = 0.002 for ESR). In AS patients, LLA was significantly and positively correlated with LSA and ST (r = 0.490, p = 0.001; r = 0.399, p = 0.009). Additionally, LSA was significantly and positively correlated with LSDA (r = 0.613, p < 0.001). Conclusion: The sagittal lumbosacral parameters of patients with AS were found to be significantly different from those of patients with chronic mechanical back pain. İnflammation negatively affects lumbosacral alignment in AS. The identification of specific changes in sagittal spinal alignment in patients with AS will contribute to the establishment of appropriate rehabilitation strategies and surgical plans
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    The correlation between neuropathic pain incidence and vitamin D levels in patients with chronic low back pain
    (2019) Kolutek Ay, Bilgehan; Berk, Ejder; Demirel, Adnan; Nacitarhan, Vedat
    Aim: The present study aimed to investigate the correlation between neuropathic pain incidence and vitamin D levels in chronic mechanical low back pain.Material and Methods: Sixty patients (36 females, 24 males) with chronic mechanical low back pain (CMLBP) were included in the study. Leeds Assessment Neuropathic Symptoms and Signs Scale (LANSS), Beck Depression Inventory (BDI), and Visual Analogue Scale (VAS) were applied to the patients. Patient vitamin D levels were measured.Results: It was determined that the neuropathic low back pain incidence was 0.20. No statistically significant difference was determined between the neuropathic pain incidence in the group with subnormal vitamin D values and the group with normal vitamin D values (p = 0.292). The incidence of neuropathic pain was higher in the group with subnormal vitamin D levels when compared to the group with normal vitamin D values. Conclusion: It was demonstrated that neuropathic low back pain was more frequent among CMLBP patients with subnormal vitamin D values when compared to patients with normal vitamin D levels, albeit not statistically significantly. Vitamin D deficiency should be reviewed in the evaluation of CMLBP, neuropathic component of which was not well defined, and its treatment and management requires a multidisciplinary approach, and vitamin D treatment should be considered when necessary.
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    The importance of red cell distribution width and neutrophillymphocyte ratio as a new biomarker in rheumatoid arthritis
    (2019) Koca, Tuba Tülay; Arslan, Aydın; Çiledağ Özdemir, Filiz; Berk, Ejder
    Abstract: Objective: Rheumatoid arthritis (RA) is a long-lasting autoimmune disorder that primarily affects the joints.Various biomarkers have been used for the prognosis and clinical follow-up. There are few studies that haveinvestigated whether or not neutrophil-lymphocyte ratio (NLR) and red cell distribution width (RDW) are goodindicators of systemic inflammation. The present study aims to explore the prognostic value of RDW and NLRin rheumatoid arthritis (RA) as a new inflammatory marker.Methods: RA patients (n = 124) who presented to the Rheumatology outpatient clinic in our hospital betweenMarch 2015 and May 2015 were included in this study retrospectively. As a first group, 47 clinically activeRA patients who had high acute phase proteins were included. In the second group, 73 clinically in-remissionRA patients who had normal acute phase proteins were included. Fifty-five healthy volunteers constituted thecontrol group.Results: The mean RDW was found to be 15.2 ± 2.9 in the active group; 14.6 ± 2 in the inactive group and13.4 ± 1.4 in the control group (p < 0.01). The mean NLR was found to be 3.7 ± 2.2 in the active group; 3.7 ±1.6 in the inactive group and 3.2 ± 0.9 in the control group (p = 0.190). There were statistically significantdifferences between the RDW values of the active-period RA patients with the control group (p < 0.01). Therewas statistically significant difference between RDW values of active RA and inactive RA patients (p < 0.01).The NLR results between the RA group and the control group (p = 0.700); the active RA group, and the inactiveRA group (p = 0.169) were similar. There was not statistically difference between the NLR values of activeRA patients with the control group (p = 0.360). There was statistically difference between the NLR values ofinactive RA patients with the control group (p = 0.047).Conclusion: RDW was found higher in all RA group than control, additionally was also higher in active RAgroup than remission group. NLR values of remission group was higher than control.
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    Lumbosacral alignment in lumbar disc herniation
    (2019) Nacitarhan, Vedat; Kocyigit, Burhan Fatih; Berk, Ejder; Koca, Tuba Tulay
    Aim: Lumbosacral alignment has a potential role in providing proper spinal function, balanced and appropriate posture. The aim of our study was to compare lumbosacral angles between lumbar disc herniation and lumbar disc herniation-free patients. It was aimed to identify specific changes in lumbar disc herniation.Material and Methods: A total of 118 (69 female, 49 male) patients with the complaint of chronic low back pain were enrolled. Lumbar magnetic resonance images and standing lateral lumbar radiographs were obtained from the electronic hospital database. The presence or absence of disc herniation was diagnosed with lumbar magnetic resonance images. Measurement of lumbosacral angles were performed on the standing lateral lumbar radiographs.Results: Lumber lordosis angle and lumbosacral disc angle were significantly smaller in the lumbar disc herniation group (p = 0.033 and p = 0.038). No significant difference was detected in sacral tilt and lumbosacral angle (p = 0.705 and p = 0.413).Conclusion: The variations in lumbosacral angles cause changes in the spinal kinematics that may affect the occurrence of disc herniation. Loss of lumbar lordosis increases the compressive forces on the spine and may associate with the presence of disc herniation. Lumbosacral alignment must be taken into account when evaluate the pathophysiology of lumbar disc herniation.
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    The relationship between median nerve axon count and clinical findings and electrophysiological parameters in patients with carpal tunnel syndrome
    (2019) Berk, Ejder; Nacitarhan, Vedat
    Aim: To determine the association of clinical and electrophysiological findings in cases of carpal tunnel syndrome (CTS) using motor unit (axon) number estimation (MUNE) of the median nerve and to evaluate how these findings can contribute to treatment planning. Material and Methods: Evaluation was made of 43 hands of 25 patients (22 females, 3 males, mean age 45.63±9.89 years) with clinical and electrophysiological diagnosis proven CTS and a healthy control group of 50 hands of 25 subjects (21 females, 4 males, mean age 44.72±8.89 years). Electrophysiological nerve transmission measurements and CTS grading were applied. MUNE measurement was made from the abductor pollicis brevis (APB) muscle with the incremental method. Results: According to the electrophysiological grading, the mean MUNE values were at Grade-0: 134.66±41.00, Grade-1: 78.83±33.51, Grade-2: 71.72±32.15 and Grade-3: 50.25±27.45. A positive correlation was determined between electrophysiological grading and APB muscle atrophy, and median nerve latency. A negative correlation was determined with MUNE, muscle strength, median nerve amplitude and conduction velocity. Between MUNE and muscle strength, median nerve amplitude and conduction velocity there was a positive correlation, between MUNE and median nerve latency, a negative correlation was found. According to regresion analysis, median nerve wrist segment sensory velocity and median nerve distal motor action potential amplitude were predictive parameters for MUNE. Conclusion: Together with the clinical evaluation, patients with grade 3 and/or MUNE value below 2 standard deviations of normal according to the electrophysiological evaluation, should be considered for surgery, while in milder cases, it can be recommended that clinical and electrophysiological follow-up is added to conservative treatment.