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    Comparison outcomes of repeat mini-open microdiscectomy versus fusion for recurrent lumbar disc herniations regarding preoperative radiological features-single institute experience
    (2020) Polat, Ayse Esin; Yuksel, Odhan; Ozmanevra, Ramadan; Polat, Baris; Secer, Halil Ibrahim
    Aim: The aim of this study was to compare the clinical results of two different surgical approaches for patients with recurrent lumbar disc herniation. Furthermore, we retrospectively analysed both groups and compared preoperative radiological features, which may be useful to select most appropriate surgical technique. Materials and Methods: 36 patients underwent mini-open microdiscectomy and 14 patients underwent microdiscectomy with fusion surgery for recurrent lumbar disc herniation in our institution between 2007-2017. Patient’s demographic characteristics and clinical results, as well as preoperative radiological features (such as disc height, disc degeneration, facet joint angle on sagittal and axial plane, existence of foraminal stenosis or previous facetectomy, facet joint degeneration, adjacent segment degeneration, sagittal instability, coronal instability) were retrospectively analyzed and compared between two groups. Results: There were no statistically significant differences between the groups in terms of postoperative visual analog scale and Oswestry Disability Index scores. The mean age, mean duration of hospital stay and operation time were significantly lower in microdiscectomy group (p=0.003, p<0.001, p<0.001, respectively). There was no recurrence during a mean follow-up of 54.3 months. Disc degeneration grade, degree of foraminal stenosis and facet joint degeneration, sagittal instability grade, facetectomy rate, adjacent segment degeneration and number of microdiscectomies are statistically higher in stabilization group than simple microdiscectomy group (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.047, p=0.010, respectively). Furthermore, sagittal and axial facet joint angles are significantly higher in the microdiscectomy group than the fusion group (p<0.001, p<0.001, respectively). Conclusion: Preoperative radiological evaluation of patients with recurrent disc herniation can help physicians in order to select the most appropriate surgical approach and therefore minimize surgical risks.
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    Prevalence of anterolateral complex injury and associated injuries in knees with acute complete and partial anterior cruciate ligament injury
    (2020) Polat, Ayse Esin; Gurpinar, Tahsin; Aydin, Deniz; Polat, Baris; Ozmanevra, Ramadan; Dirik, Mehmet Alp; Erler, Kaan
    Aim: Kaplan fibers, Anterolateral capsule, Anterolateral ligament (ALL) and Iliotibial band are defined as secondary stabilizers of the internal tibial rotation of the knee. These structures have been summarized as the "Anterolateral complex" (ALC). We aimed to determine the ALC injury prevalence and the association between Anterior cruciate ligament (ACL) and ALC injury patterns. Materials and Methods: MRI scans of ACL injuries were retrospectively evaluated for the presence of the ACL injury pattern (partial or complete), ALL, iliotibial band, Kaplans fiber, meniscus, bone marrow edema (BME) and collateral ligament pathology. The patients were divided into groups according to the ACL injury pattern. The prevalence of injury of the anatomical structures between groups was examined. Results: MRI scans of 152 patients (152 knees) were evaluated. The mean age of the patients was 28.5±8.6 (range, 18-55). 138 patients were male and 14 were female. Complete ACL injury was detected in 127 (83.6%) patients confirmed by MRI and arthroscopic procedure and partial ACL injury was detected in 25 (16.4%) patients confirmed by MRI. 90 (59.2%) patients had an ALL injury, 87 (57.2%) had an iliotibial band injury, 82 (53.9%) patients had a Kaplans fiber injury, 53 (34.9%) patients had a meniscal injury, 99 (65.1%) patients had BME and 70 (46.1%) patients had a collateral ligament injury. In the complete ACL injury group, the ratio of ALL, iliotibial band, Kaplan fiber, meniscal injury, BME, collateral ligament injury was significantly higher than the partial ACL injury group (p 0.05). Conclusion: The prevalence of injury in at least one anatomic structure of ALC was significantly higher in patients with a complete ACL injury (73.2%) than those with partial ACL injury (32%) at our institution. This study demonstrated that ALC injuries were statistically higher as well as meniscal injuries, BME, collateral ligament injuries after complete ACL injury compared to partial ACL injury.