A Retrospective Study of Far Lateral Midline Microlumbar Discectomy in 20 Patients at a Single Center in Turkey.

BACKGROUND Microdiscectomy is a minimally-invasive surgical technique for treating far lateral lumbar disc herniation (FLLDH). This retrospective study from a single center in Turkey aimed to evaluate midlinelumbar discectomy in 20 patients with far lateral lumbar disc herniation. MATERIAL AND METHODS We collected clinical data of 20 patients (11 men, 9 women) operated for FLDDH between January 2006 and January 2022. Patients' age, sex, surgical level, examination findings, motor deficit, duration of operation, complications during the operation and preoperative/postoperative 6 month visual analogue Scala (VAS), preoperative/postoperative 6th month Oswestry Disability Index (ODI) scores were evaluated. RESULTS The patients were 11 men (55%) and 9 women (45%), with a mean age of 52.08±11.21 years. The mean duration of symptoms before the operation was 3.4 weeks. Laseque sign positivity was found in 86.4% of the patients. Motor deficit was present in 30% of the patients. After 6-month follow-up, preoperative VAS value decreased from 9.35±0.75 to 0.84±0.75. Preoperative and postoperative VAS score averages were significantly different (P=0.0001). Operation ODI values were 73.63±3.76 before and after surgery, and decreased to 14.81±3.63 at 6 months. CONCLUSIONS The term distal lateral disc herniation was first defined in the literature in 1974 when the disc was seen in a different location than the normal location compared to the facet. Far lateral disc herniation can be operated on successfully with midline skin incision.

Factors Influencing Recurrence Rates and Surgical Outcomes in Lumbar Microdiscectomy: A Retrospective Study of 130 Patients in Turkey.

BACKGROUND Lumbar disc herniation surgery, specifically lumbar microdiscectomy, shows recurrence in 3-24% of patients, necessitating potential re-operations. This study focuses on the outcomes and recurrence causes in 130 cases of lumbar disc herniations. These cases were managed by a single surgeon at a single center, offering a unique perspective on a common issue in neurosurgery. MATERIAL AND METHODS The study involved 130 patients treated for lumbar disc herniations. Analysis considered various factors: age, sex, symptoms, surgical level, complications, pre- and postoperative pain levels, and quality of life indices. RESULTS Of the 130 cases analyzed, all underwent initial surgery by the same surgeon or sought treatment from this surgeon after recurrence. Inclusion criteria were based on radiologic and clinical indications for re-operation. The demographic split was 76 males (56.4%) and 54 females (43.6%). A notable finding was a higher recurrence rate in males and patients under 45 years, although the sex difference was not statistically significant. The average age was 47.5 years. Significant changes were noted in the Oswestry Disability Index (ODI) levels during follow-ups (P<0.001). CONCLUSIONS This study underscores the effectiveness of lumbar microsurgery in treating recurrent lumbar disc herniations. Techniques such as medial facet utilization and laminectomy border expansion show promise. However, determining instability rates requires long-term patient follow-up. Our findings contribute valuable insights into surgical approaches and patient outcomes in recurrent lumbar disc herniation cases.

Brain, liver, and serum salusin-alpha and -beta alterations in Sprague-Dawley rats with or without metabolic syndrome.

BACKGROUND: This metabolic syndrome (MetS) study was designed to investigate changes in expression of the neuropeptides salusin-α (Sal-α) and salusin-ß (Sal-ß) in brain and liver tissue in response to obesity and related changes induced by high-fructose diet and explored how these changes were reflected in the circulating levels of Sal-α and Sal-b, as well as revealing how the lipid profile and concentrations of glucose and uric acid were altered. MATERIAL/METHODS: The study included 14 Sprague-Dawley rats. The control group was fed ad libitum on standard rat pellets, while the intervention group was given water with 10% fructose in addition to the standard rat pellet for 3 months. Sal-α and Sal-ß concentrations in the serum and tissue supernatants were measured by ELISA, and immunohistochemical staining was used to demonstrate expression of the hormones in brain and liver. RESULTS: Sal-α and Sal-ß levels in both the serum and the brain and liver tissue supernatants were lower in the MetS group than the control group. Sal-α and Sal-ß were shown by immunohistochemistry to be produced in the brain epithelium, the supraoptic nucleus of the hypothalamus, and the liver hepatocytes. CONCLUSIONS: The decrease in Sal-α and Sal-ß might be involved in the etiopathology of the metabolic syndrome induced by fructose.

Effects of irisin and exercise on adropin and betatrophin in a new metabolic syndrome model.

Metabolic syndrome (MetS) is a prevalent public health problem. Uric acid (UA) is increased by MetS. We investigated whether administration of UA and 10% fructose (F) would accelerate MetS formation and we also determined the effects of irisin and exercise. We used seven groups of rats. Group 1 (control); group 2 (sham); group 3 (10% F); group 4 (1% UA); group 5 (2% UA); group 6 (10% F + 1% UA); and Group 7, (10% F + 2% UA). After induction of MetS (groups 3 -7), Group 3 was divided into three subgroups: 3A, no further treatment; 3B, irisin treatment; 3C, irisin treatment + exercise. Group 4, 1% UA, which was divided into three subgroups: 4A, no further treatment; 4B, irisin treatment; 4C, Irisin treatment + exercise. Group 5, 2% UA, which was divided into three subgroups: 5A, no further treatment; 5B, irisin treatment; 5C, irisin treatment + exercise. Group 6, 10% F + 1% UA, which was divided into three subgroups: 6A, no further treatment; 6B, irisin treatment; 6C, irisin treatment + exercise. Group 7, 10% F + 2% UA, which was divided into three subgroups: 7A, no further treatment; 7B, irisin treatment; 7C, irisin treatment + exercise., Irisin was administered 10 ng/kg irisin intraperitoneally on Monday, Wednesday, Friday, Sunday each week for 1 month. The exercise animals (in addition to irisin treatment) also were run on a treadmill for 45 min on Monday, Wednesday, Friday, Sunday each week for 1 month. The rats were sacrificed and samples of liver, heart, kidney, pancreas, skeletal muscles and blood were obtained. The amounts of adropin (ADR) and betatrophin in the tissue supernatant and blood were measured using an ELISA method. Immunohistochemistry was used to detect ADR and betatrophin expression in situ in tissue samples. The duration of these experiments varied from 3 and 10 weeks. The order of development of MetS was: group 7, 3 weeks; group 6, 4 weeks; group 5, 6 weeks; group 4, 7 weeks; group 3, 10 weeks. Kidney, liver, heart, pancreas and skeletal muscle tissues are sources of adropin and betatrophin. In these tissues and in the circulation, adropin was decreased significantly, while betatrophin was increased significantly due to MetS; irisin + exercise reversed this situation. We found that the best method for creating a MetS model was F + UA2 supplementation. Our method is rapid and simple. Irisin + exercise was best for preventing MetS.

Cranially migrated lumbar intervertebral disc herniations: A multicenter analysis with long-term outcome.

OBJECTIVE: Risk factors of cranial migration were investigated in patients with lumbar disc herniation (LDH) that migrated in the cranial direction and the long-term outcomes are discussed in this study. MATERIALS AND METHODS: Patients who underwent surgery for LDH at four different centers between 2012 and 2017 were studied. Extraligamentous discs were located in the lateral part of the posterior longitudinal ligament (PLL) within the spinal canal of the axial plane, and subligamentous discs were located under the PLL. The extent of cranial migration was calculated as a percentage of the height of the migrated corpus. Based on the extent of cranial migration, partial hemilaminectomy or hemilaminectomy was performed at different rates in each patient and the amount of laminectomy performed was recorded. During surgery, all free fragments were attempted to be removed. The appropriate technique was decided intraoperatively, and the surgery was performed on an individual patient basis. RESULTS: Of 1289 patients who underwent surgery for LDH, 654 (50.73%) had caudal migration, 576 (44.68%) had migration at the level of the disc, and 59 (4.57%) had cranial migration. Analysis of 59 patients with cranial migration according to the localization of the disc fragment revealed that 31 had extraligamentous and 28 had subligamentous fragments (P = 0.024). CONCLUSIONS: Extraligamentous intervertebral disc fragments migrate more cranially than subligamentous intervertebral fragments. The anatomy of the PLL that varies along the corpus is the main reason for the weakness of the resistance of the disc material to the dorsolateral region, direction of discrete force vectors, and orientation of the disc fragment due to torsional vertebral movements.

MRI findings of intramedullary spinal cryptococcoma.

Cryptococcus neoformans is a yeast that most commonly infects the central nervous system. Meningitis and meningoencephalitis are the most common presentations of cryptococcosis. Cryptococcoma, however, is a rare entity characterized by localized, solid, tumor-like masses that are usually found in the cerebral hemispheres or cerebellum, but are extremely rare in the spinal cord. We report a case of an immunocompetent patient with intramedullary cryptococcoma in the spinal cord, which presented as a spinal tumor. Diagnosis was made by histological examination of the surgical specimen.

Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases.

BACKGROUND: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs) and to share our experiences. MATERIALS AND METHODS: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1(st), 3(rd), 6(th)-month and 1(st), 3(rd), 5(th) and 7(th)-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. RESULTS: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05). None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. CONCLUSION: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results.

Dural Tear: A Feared Complication of Lumbar Discectomy.

AIM: To show causes of dural tear in isolated lumbar disc surgery, and to investigate the risk factors. MATERIAL AND METHODS: We retrospectively reviewed 1159 cases (532 females and 627 males) involving patients who underwent a surgery for the treatment of lumbar disc herniation between 2006 and 2013. We have analysed the side of the surgery, level of the operation, first or revision surgery, type of anesthesia and type of surgical procedure for the risk of dural tear. To examine differences between disc levels, we used Chi-square testing for categorical variables and the student's t test for continuous variables. To analyze our data, we used STATA version 12. A "p value" less than 0.05 was considered as statistically significant. RESULTS: A total of 1047 (90.3%) cases were treated with microdiscectomy, and 112 (9.7%) required open discectomy. Overall, 820 (70.7%) and 339 (29.3%) surgeries were performed under epidural and general anesthesia, respectively. Dural tear ratio was 1.20%. In dural tear ratio, there was a significant difference in gender (Female: 1.6%, Male: 0.79%) (p < 0.05). Dural tear ratios at primary disc surgery and at recurrent disc surgery were respectively 0.82% and 7.14% (p < 0.05). Most of the tears were on the right side (11/14) (p < 0.05). 13 dural tear cases (1.58%) were noted in patients who operated under epidural anesthesia (820 cases) compared to 1 (0.29%) under general anesthesia (339 cases) (p < 0.05). CONCLUSION: Recurrent disc surgery, female sex, epidural anesthesia, open discectomy, non-dominant hand usage of surgeon, and upper-level affected lumbar discs were risk factors for intraoperative dural tear during lumbar disc surgery.

Lumbar Disc Surgery with Epidural Anesthesia: Review of 700 Cases.

AIM: Lumbar disc surgery can be performed under general anesthesia or regional anesthesia methods. There are long-standing discussions between neurosurgeons, orthopedic surgeons and anesthesiologists concerning the use of epidural anesthesia in lumbar surgery. The results of this study's 700 lumbar disc surgery cases operated with epidural anesthesia in our clinic between September 2006 and December 2011 will contribute to these discussions. MATERIAL AND METHODS: This study included 700 patients underwent lumbar disc surgery with epidural anesthesia, which consisted of 388 males (55%) and 312 females (45%). Forty-two of these cases had recurrence disc herniation and only 11 of 42 cases were operated in our department. RESULTS: Eleven of 700 cases had dural injury and were repaired intraoperatively by primary sutures and tissue sealants. Infection of the incision site developed in six patients, who healed with appropriate antibiotic treatment with no problems. In addition to those 700 cases, 22 patients received general anesthesia in which we started with epidural anesthesia. Microdiscectomies were performed in 578 of 700 cases, and open surgery in 122 cases. CONCLUSION: This study showed that epidural anesthesia seems more advantageous for some patients since it does not have some of the risks that general anesthesia bears.

Why do the patients reject spinal operations? A preliminary study.

AIM: Cases of failed back and spine surgery have increased significantly recently, which leads to patient hesitation in deciding about whether to be operated on. In this article, we present a survey investigating refusal reasons for spinal surgery, and we emphasize the effect of failed back surgery. MATERIAL AND METHODS: A survey was conducted among 100 patients who were admitted to the outpatient clinic of neurosurgery at the Elazig Training and Research Hospital. All of the patients were recommended spinal surgery for various reasons, but did not want to be operated on. Demographic data for the patients, indication of the recommended surgery, the reason for the patient's refusal of the operation, information about previous neurosurgical operations and the history of dissatisfaction with the surgery of an acquaintance were recorded. The data obtained were evaluated statistically and analyzed by percentage. RESULTS: 46 patients stated they had distrust of surgery, and 54 patients did not want to be operated on for personal reasons. When the two groups were compared, neurosurgical operations and the history of dissatisfaction of the patient or an acquaintance was significantly higher in the first group (p < 0.001). It was found that 40% of all the patients (n = 40) had a past unpleasant neurosurgical experience that was either personal or relevant. CONCLUSION: Spinal surgery is a preferred subspecialty of neurosurgery. However, patients' discontent with spinal surgery has been rising gradually in recent years. An accurate indication and proper surgical technique is essential for increasing satisfaction with spinal surgery. Minimally invasive interventions must be considered if necessary. The postoperative expectations of the physician and the patient must also be carefully defined.

Effect of carnosine, methylprednisolone and their combined application on irisin levels in the plasma and brain of rats with acute spinal cord injury.

Spinal cord injury (SCI) might occur to anybody at any time and any age. In its treatment, methylprednisolone (MP) is a first choice worldwide, but there is still no significant breakthrough in truly beneficial treatment due to SCI's complex pathophysiology. We investigated the effect of carnosine, methylprednisolone (MP) and its combination on irisin levels in the plasma, brain and medulla spinalis tissues in SCI using a rat model. The rats were divided into 6 groups: I (Control, saline); II (sham animals with laminectomy without cross-clamping); III (SCI); IV (SCI treated with 150mg/kg carnosine); V (SCI treated with 30mg/kg methylprednisolone); and VI (SCI treated with a combination of carnosine and MP). The animals were given traumatic SCI after laminectomy, using 70-g closing force aneurysm clips (Yasargil FE 721). Irisin concentration was measured by ELISA. The distribution of irisin in brain and spinal cord tissues was examined by immunochemistry. Irisin was mainly expressed in the astrocytes and microglia of brain tissues, and multipolar neurones of the anterior horn of spinal cord tissue in rats of all groups, indicating that irisin is physiologically indispensable. MP and carnosine and the combination of the two, significantly increased irisin in plasma and were accompanied by a significant rise in irisin immunoreactivity of brain and spinal cord tissues of the injured rats compared with control and sham. This finding raises the possibility that methylprednisolone and carnosine regulate the brain and spinal cord tissues in SCI by inducing irisin expression, and may therefore offer a better neurological prognosis.

Fragmentation to epidural space: first documented complication of Gelstix(TM.).

The knowledge of minimal invasive spinal surgery has increased greatly in recent years. A current issue is the hydrogel implant inserted through nucleus pulposus. In this paper we present a case in which the hydrogel implant was found to be fragmented into the spinal canal at follow up. The patient was a 40-year-old female. She was examined at another clinic because of low back pain about four months ago, and a hydrogel implant was inserted at the L5-S1 level. She was admitted to our clinic due to severe radicular pain. Magnetic resonance imaging (MRI) showed a posterolateral annular tear only and she was explored microneurosurgically as she did not benefit from a foraminal injection. A fragmented hydrogel implant that compressed the spinal root was seen peroperatively and it was excised. Postoperatively the radicular complaints of the patient disappeared and she was discharged with total recovery. Although rare, complications causing compression of neural structures can be seen after placing implants into the disc. In this case, the assessment of the patient according to the clinical presentation and microsurgical exploration if necessary are important.

A comprehensive immunohistochemical examination of the distribution of the fat-burning protein irisin in biological tissues.

Irisin was first identified in skeletal muscle cells, but its precise location has not yet been demonstrated, and there is limited information about irisin protein in other human and rat tissues. The present immunohistochemical study was undertaken to screen skeletal muscle and other tissues for irisin immunoreactivity. Irisin staining was found in the brain (neurons and neuroglia), cardiac and skeletal muscle (fibers) and skin (sebaceous glands) tissues in male rats. In both human adult and fetal skeletal muscle, the most intense immunohistochemical staining was in the perimysium and endomysium, in the peripheral nerve (epineurium) and axon and nerve sheaths spreading among the cells, in the sarcoplasma and subendomysium. Irisin was also demonstrated in the testis (seminiferous tubules, some spermatogenic cells in fetal and Leydig cells in fetal and adult testis, ductus epididymis in fetal human epididymis); pancreas (islets of Langerhans, serous acini cells, intralobular and intralobular ducts cells); liver (hepatocytes; Kupffer cells and sinusoidal endothelial cells); spleen (subcapsular region and periarterial lymphatic sheets); the stomach (gastric parietal cells, tunica muscularis cells). We conclude that the fat-burning protein irisin locally produced in peripheral and central tissues could act as a gatekeeper of metabolic energy regulation in those tissues, since this myokine converts white into brown adipose tissue, enhancing energy expenditure.

Cavernous hemangioma of the parietal bone.

PATIENT: Male, 38 FINAL DIAGNOSIS: Cavernous hemangioma Symptoms: Headache • parietal mass MEDICATION: - Clinical Procedure: - Specialty: Neurosurgery. OBJECTIVE: A rare disease. BACKGROUND: Bone hemangioma is a vascular hemartoma of bone structures. In general, this pathology is detected on incidentally investigated patients' films. Bone hemangioma is most commonly seen in 4(th) decade of life and the male/female ratio is 1/1.5. The locations of these lesions are commonly long bones of the vertebral column and the skull. Primary bone hemangiomas constitute less than 1% of all bone tumors, and they are seen at 0.2% in the calvarial region. CASE REPORT: Cases with this pathology are seen on incidental radiological evaluations. We report the case of a 38-year-old man with localized headache and a palpable mass in the left parietal region, admitted and operated on after cranial CT and MRI. Pathology investigation revealed a cavernous hemangioma. CONCLUSIONS: We suspected that in our case head trauma may have been the cause of cavernous hemangioma in the calvarial region, because cavernous hemangiomas are rarely located there. Localized headache and minor discomfort can be seen with this pathology. The best treatment for cavernous hemangiomas is the removal of the mass within the limits of safe surgery.

Spontaneous regression of traumatic lumbar epidural hematomas.

BACKGROUND: The aim of this report is to present a case of spontaneous regression of traumatic lumbar epidural hematomas. CASE REPORT: A 45-year-old man presented at our clinic after falling from a height. After admission, anterior compression was detected by X-ray, so lumbar spinal CT was performed. For ligament damage, emergency MR was performed. There was acute hematoma at 1 cm diameter, which began at the L3 vertebra superior surface and spread to L4 vertebra corpus; therefore the patient was informed and surgery recommended. The patient rejected the surgery, and medical management was designed. At day 45, lumbar MRI was performed. There was no evidence of traumatic epidural hematoma. CONCLUSIONS: The purpose of this study is to report a case with post-traumatic spinal epidural hematomas with normal neurologic findings and spontaneous regression.