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    Aerobic culture results of samples taken during lumbar disc herniation operations
    (2020) Ozger, Ozkan; Kaplan, Necati
    Aim: This study aimed to determine the rate of aerobic bacterial infection in disc samples taken from the surgical field in patients with lumbar disc herniation (LDH) undergoing single-level lumbar microdiscectomy (LMD).Material and Methods: Disc tissue samples were collected from the surgical fields in patients with single-level LDH undergoing elective LMD between September 2019 and May 2020. Tissues were then cultivated in cultures to determine the rate of aerobic bacteria and the results obtained were noted. The effects of parameters such as age, gender, affected side, Modic changes (MCs), and accompanying systemic diseases on culture results were statistically investigated. The patients were examined retrospectively with their demographic values. Results: This study included 33 patients with single-level LDH and all of these patients underwent LMD. Two patients additionally underwent posterior lumbar instrumentation. The mean age was 50.87±12.20 years (25-71 years) and 17 (51.51%) of the patients were men and 16 (48.49%) were women. The mean follow-up duration was 3.03±1.64 months (1–8 months). Aerobic infection was observed in four patients (12.12%). Two of them (6.06%) were Enterobacteriaceae and the other two (6.06%) were coagulase-negative staphylococci (CNS). The antibiotic that patients were sensitive to was added to the postoperative medical treatment for two weeks according to the culture and antibiogram results. Age, gender, affected side, MC, and accompanying systemic diseases were found to have no statistically significant effect on culture results.Conclusion: The prevalence of subclinical aerobic bacterial infection has been found to be 12.12% in patients undergoing LMD. Although sterilization rules have been strictly followed, the possibility of contamination of disc cultures could have not been completely rejected. In conclusion, the present study has shown that culture results have no effect on postoperative outcomes.
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    Comparison of simple discectomy and uninstrumented lumbar interbody fusion in patients with lumbar disc herniation
    (2020) Ozger, Ozkan; Kaplan, Necati
    Aim: This study aimed to compare the surgical outcomes of simple discectomy (SD) and uninstrumented posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) in patients with lumbar disc herniation (LDH). Materials and Methods: The files of randomly selected 100 patients with LDH, who underwent SD, were analyzed. The patients were divided into two groups as Group 1 involving 50 patients undergoing SD alone and Group 2 involving 50 patients undergoing SD plus unilateral PLIF and TLIF without posterior lumbar instrumentation. The pain was measured by the visual analog scale (VAS) and the functionality of the patients was measured by the Oswestry disability index (ODI).Results: In both groups, leg and low back pain VAS scores and ODI scores improved significantly one year after surgery (p0.001). There was a significant increase in the VAS scores of Group 2 in the first month compared to Group 1 (p0.05). Conclusion: This study has shown that PLIF and TLIF performed following unilateral SD without posterior lumbar instrumentation support in single-distance LDH treatment will not be sufficient.
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    Epidemiological investigation of 673 patients who resorted to the emergency department for mild head trauma complaints
    (2019) Kaplan, Necati; Ozger, Ozkan; Karaaslan, Numan
    Aim: Mild head trauma (MHT) or mild traumatic brain injury (MTBI) is an injury whose incidence is increasing in emergency services. This retrospective study carried out an epidemiological evaluation of patients with MHT, who underwent head computed tomography (HCT) with a 15-point score on the Glasgow Coma Scale (GCS).Material and Methods: This study retrospectively evaluated 673 patients with MHT, who were examined by the department of neurosurgery in the emergency department of Istinye University, Canakkale Anatolian Hospital between 2015 and 2019. The cases were evaluated because of age, gender, cause of trauma, HCT findings, duration of admission to the emergency department, and other body traumas associated with head trauma.Results: 390 (57.95%) patients were male, while 283 (42.05%) were female. The mean age and standard deviation were calculated as 23.72 ± 24.87 years. Of the 673 cases, 494 (73.40%) were admitted to the emergency department due to non-high falls. After trauma, 642 (95.39%) patients were admitted to the emergency department within the admitted to the emergency department within the first two hours after injury. 656 (97.48%) of the patients were treated in the emergency department. 105 (15.60%) patients had a scalp incision and underwent a small surgical procedure. The most common accompanying body trauma detected was that of the maxillofacial region in 26 (3.86%) patients. HCT pathology was detected in 20 (2.97%) patients. These pathologies included; 14 (2.08%) non-surgical intracerebral hemorrhage, 2 (0.30%) skull base fractures, 1 (0.15%) traumatic subdural hematoma, 1 (0.15%) traumatic epidural hematoma, 1 (0.15%) pneumocephalus and 1 (0.15%) cerebral edema.Conclusion: Head trauma is an important issue in this country. Brain CT may not be necessary in patients with a GCS score of 15. After a short observation, if patients live near the medical center, they can be sent home to return the next day for further evaluation.
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    Evaluation of clinical outcomes of 271 patients undergoing lumbar microdiscectomy in the light of literature
    (2020) Ozger, Ozkan; Kaplan, Necati
    Aim: Lumbar microdiscectomy (LMD) is considered as a gold standard surgical technique for the treatment of patients with lumbar disc hernia (LDH) although various types of treatment are being developed. This study aimed to investigate the safety and efficacy of LMD in our clinic.Material and Methods: The study exclusively included 271 patients undergoing LMD due to LDH. Preoperative and postoperative (10th day, 1st month, and long-term) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared. Clinical outcomes were analyzed retrospectively based on modified Macnab criteria. Complications were noted. SPSS Statistics 22.0 software package was used to analyse the data for pre- and postoperative VAS and ODI scores. A p value of 0.05 was considered statistically significant.Results: The mean length of stay in the operating room and hospital was 165.04±36.99 min and 1642.02±574.90 min, respectively. There was a significant decrease in postoperative VAS and ODI (%) scores compared to preoperative scores. Preoperative VAS and postoperative long-term VAS scores were 8.99±0.62 and 1.38±0.95, respectively whereas preoperative ODI (%) and postoperative long-term ODI (%) scores were 85.33±6.74 and 12.96±9.58, respectively (p0.001). The success rate for excellent or good outcomes according to the modified Macnab criteria was 87.45%. During surgery, cerebrospinal fluid (CSF) leak and dura defect developed in four patients (1.48%) and there was only dura defect in two patients (0.73%). After the surgery, recurrent LDH, spinal infection, and spinal epidural hematoma developed in seven (2.58%), three (1.11%), and one patient (0.37%), respectively.Conclusion: LMD is an effective and safe method in the treatment of LDH as it has low complication rates and high success rates.
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    Incidence of early postoperative ischemic stroke in lumbar discectomy: A retrospective study
    (2020) Ozger, Ozkan; Kaplan, Necati
    Aim: Ischemic stroke (IS) is one of the leading causes of death worldwide. It may cause undesirable neurological sequels. This study aims to determine the incidence of IS in the early postoperative period in patients operated for lumbar disc herniation. Material and Methods: The electronic medical records of patients who underwent elective lumbar disc herniation surgery between January 2017 and August 2019 were reviewed retrospectively. Patients with preoperative infection and neoplastic disease were excluded from the study. Patient demographics, pre and postoperative pain and disability levels, operated disc levels, duration of surgery and hospital stay, and complications were recorded.Results: Of the 179 patients who underwent lumbar microdiscectomy for lumbar disc herniation, a total patient of one (0.55%) patient developed IS in the right cerebellar region in the early postoperative period. The risk factors detected in the patient included hypertension, carotid artery stenosis and therefore irregular use of acetylsalicylic acid. Postoperative infection was detected in two patients (1.12%), peroperative cerebrospinal fluid leak in two patients (1.12%), and recurrent lumbar disc herniation in three patients (1.67%) in the late period. No mortality was observed.Conclusion: In recent years, there has been an increase in minimally invasive spine surgeries, especially in elderly patients at risk of ischemic stroke. It is important to identify and optimize these patients before surgery. While the incidence of ischemic stroke following lumbar microdiscectomy is low, it is necessary to be careful as a high risk of morbidity and mortality is in question.