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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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    Evaluation of Depression, Temperament and Character Profiles in Female Patients with Fibromyalgia Syndrome
    (Aves, 2011) Altunoren, Ozlem; Orhan, Fatma Ozlem; Nacitarhan, Vedat; Ozer, Ali; Karaaslan, Mehmet Fatih; Altunoren, Orcun
    Objective: Fibromyalgia syndrome (FMS) is a musculoskeletal disorder characterized by diffuse body pain and is also regarded as a psychosomatic disorder. FMS is most commonly associated with depression among the psychological disorders. It is known that personality plays an important role in the etiology of psychosomatic disorders. In this study, we analyzed the temperament characteristics of FMS patients and healthy control group and, using data obtained from both groups, investigated whether these traits were associated with clinical features and depressive states in FMS patients. Methods: Fifty-one FMS patients and 51 healthy women were included in the study. Both groups were evaluated according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision) (DSM-IV-TR). The Temperament and Character Inventory (TCI), the Hamilton Depression Rating Scale (HAM-D), the Fibromyalgia Impact Questionnaire (FIQ), and the Visual Analogue Scale (VAS) were applied to both groups. Results: According to DSM-IV-TR, 76.5% of FMS patients were diagnosed with psychiatric disorder. FMS patients had higher harm avoidance scores and lower self-directedness and persistence scores than healthy controls. Harm avoidance scores were found higher and self-directedness scores were found lower when the total corrected increment (TCI) points were used, but cooperation scores increased. HAM-D scores correlated positively with harm avoidance scores, but negatively with both self-directedness and cooperation scores. Conclusion: Depressive symptoms and personality features are related to the duration and severity of FMS, and therefore, should be further evaluated by physicians when planning the treatment and follow-up in FMS patients. (Archives of Neuropsychiatry 2011; 48: 31-8)
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    Fibromiyalji sendromlu kadınların depresyon ve mizaç karakter özellikleri açısından değerlendirilmesi
    (Nöropsikiyatri Arşivi, 2011) Altunören, Özlem; Orhan, Fatma Özlem; Nacitarhan, Vedat; Özer, Ali; Karaaslan, Mehmet Fatih; Altunören, Orçun
    Öz: Amaç: Fibromiyalji Sendromu (FMS); yaygın vücut ağrılarıyla seyreden, psikosomatik hastalık olarak da değerlendirilen kas-iskelet sistemi hastalığıdır ve en sık depresyon olmak üzere çeşitli ruhsal bozukluklara eşlik ettiği bilinmektedir. Psikosomatik hastalıkların etiyolojisinde kişiliğin de önemli rol oynadığı düşünülmektedir. Bu çalışmada FMS hastaları ile sağlıklı kontrol grubunun, mizaç karakter özelliklerinin incelenmesi ve elde edilen verilerin hastaların klinik özelllikleri ve depresif durumu ile ilişkili olup olmadığı araştırıldı. Yöntemler: Çalışmamıza 51 FMS hastası, 51 sağlıklı kadın alındı. FMS’lu hastalar ve sağlıklı kontroller DSM-IV TR (Mental Bozuklukların Tanısal ve Sayımsal Elkitabı) tanı ve değerlendirme sistemine göre psikiyatrik yönden değerlendirildi. Mizaç ve Karakter Envanteri (Temperament and Character Inventory-TCI), Hamilton Depresyon Derecelendirme Ölçeği (HAM-D), Fibromiyalji Etkilenme Anketi (FEA), Görsel Ağrı Skala (GAS) uygulandı. Bulgular: FMS hastalarının %76.5’i DSM-IV TR’ye göre psikiyatrik tanı aldı. FMS’lu hastalarda, sağlıklı kontroller ile karşılaştırıldığında yüksek zarardan kaçınma (HA), düşük kendini yönetme (S), düşük sebat etme (P) puanları bulundu. Düzeltilmiş TCI puanları kullanıldığında (HAM-D puanlarının etkisi ortadan kaldırıldıktan sonra) hastalarda kontrol grubuna göre benzer şekilde yüksek zarardan kaçınma, düşük kendini yönetme puanları ile işbirliği yapma (C) puanında artış bulundu. HAM-D puanları ile zarardan kaçınma skorları arasında pozitif korelasyon saptanırken, HAM-D puanları ile kendini yönetme ve işbirliği yapma puanları arasında negatif korelasyon saptandı. Sonuç: Fibromiyalji sendromunun süresi ve şiddetinin depresif belirtiler ve kişilik özellikleriyle ilişkisi olduğundan, FMS hastalarının takibi ve tedavisi planlanırken bu hastaların, kişilik özellikleri ve depresif durumlarının da ayrıca değerlendirilmesi gerekmektedir.
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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.