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    Percutaneous treatment of lumbar synovial cyst: A case report
    (Acta Medica Mediterranea, 2014) Erbas, Mesut; Ozdemir, Ugur; Toman, Huseyin; Sahin, Hasan; Savluk, Omer Faruk; Luleci, Nurettin
    Introduction and aims: Synovial cysts are benign cystic lesions that form when the joint capsule is worn during joint movement and synovial fluid leaks out. Intraspinal synovial cysts in the lumbar region are generally diagnosed when investigating patients who complaints of back pain or other symptoms which could be attributed to radiculopathy. The aim of this paper is to present the use of the percutaneous needle aspiration method with tomography guidance to treat an L4-L5 synovial cyst causing radicular symptoms. Case report: A 40-year old female, with a 5-year complaint of back pain, applied to our clinic with recent increase in existing complaints and the addition of left leg pain. Lumbar computed tomography and magnetic resonance imaging examinations showed at L4 vertebra corpus level in the spinal canal right posterolateral recess, neighboring the right L5 nerve root, a 9x7x4 mm T2 hyperintense, T1 hypointense nodular appearance. A percutaneous cyst aspiration was planned and after aseptic conditions were ensured, a 22 G spinal needle was used to aspire the fluid in the synovial cyst between L4-L5 guided by tomography images and 80 mg methyl prednisone with 6 ml 0.25% bupivacaine were injected into cyst and the procedure was completed. Discussion and conclusion: In symptomatic lumbar synovial cyst cases percutaneous cyst aspiration, steroid injection or surgical resection may be chosen. However as percutaneous cyst aspiration has a lower rate of complications such as infection, bleeding, nerve damage and dural puncture compared to surgical treatment, it should be first choice.
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    PERCUTANEOUS TREATMENT OF LUMBAR SYNOVIAL CYST: A CASE REPORT
    (Carbone Editore, 2014) Erbas, Mesut; Ozdemir, Ugur; Toman, Huseyin; Sahin, Hasan; Savluk, Omer Faruk; Luleci, Nurettin
    Introduction and aims: Synovial cysts are benign cystic lesions that form when the joint capsule is worn during joint movement and synovial fluid leaks out. Intraspinal synovial cysts in the lumbar region are generally diagnosed when investigating patients who complaints of back pain or other symptoms which could be attributed to radiculopathy. The aim of this paper is to present the use of the percutaneous needle aspiration method with tomography guidance to treat an L4-L5 synovial cyst causing radicular symptoms. Case report: A 40-year old female, with a 5-year complaint of back pain, applied to our clinic with recent increase in existing complaints and the addition of left leg pain. Lumbar computed tomography and magnetic resonance imaging examinations showed at L4 vertebra corpus level in the spinal canal right posterolateral recess, neighboring the right L5 nerve root, a 9x7x4 mm T2 hyperintense, T1 hypointense nodular appearance. A percutaneous cyst aspiration was planned and after aseptic conditions were ensured, a 22 G spinal needle was used to aspire the fluid in the synovial cyst between L4-L5 guided by tomography images and 80 mg methyl prednisone with 6 ml 0.25% bupivacaine were injected into cyst and the procedure was completed. Discussion and conclusion: In symptomatic lumbar synovial cyst cases percutaneous cyst aspiration, steroid injection or surgical resection may be chosen. However as percutaneous cyst aspiration has a lower rate of complications such as infection, bleeding, nerve damage and dural puncture compared to surgical treatment, it should be first choice.
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    Severe headache following ozone therapy: Pneumocephalus
    (Kare Publ, 2017) Toman, Huseyin; Ozdemir, Ugur; Kiraz, Hasan Ali; Luleci, Nurettin
    Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.
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    Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia
    (Dove Medical Press Ltd, 2016) Adas, Cemil; Ozdemir, Ugur; Toman, Huseyin; Luleci, Nurettin; Luleci, Emel; Adas, Hilal
    Objective: Coccydynia is defined as pain in the coccygeal region. Among the many causes of coccydynia, the most common cause is trauma as a result of falling on the buttocks, repetitive microtrauma, or childbirth. Several methods are currently used for the treatment of coccydynia, including nonsteroidal anti-inflammatory drugs, intrarectal manipulation, epidural injections, ganglion impar blocks, and radiofrequency treatment (RFT). Wemm and Saberski used the transacrococcygeal methods to reduce tissue trauma. RFT is a percutaneous minimally invasive procedure. In this study, we aimed to assess the effect of the transsacrococcygeal approach on ganglion impar RFT in patients with chronic coccydynia. Methods: We retrospectively examined the data of 41 patients at the Department of Anesthesiology and Reanimation, Faculty of Medicine, Maltepe University (Pain Clinic), between January 1, 2010, and December 31, 2012. Results: The mean age of the patients was 46.68 +/- 11.00 years (range 28-67 [46] years). The average pain duration was 3.10 +/- 1.37 years. The difference between visual analog scale scores of the pre-and postprocedure was statistically significant. In the examinations carried out in the sixth month of the treatment, 90.2% of patients had a successful outcome, whereas treatment failed in 9.8% of patients. According to our patients' data, most of them had pain due to a trauma, were female, and overweight. Visual analog scale difference between preprocedure and early postprocedure, preprocedure and first month, preprocedure and sixth month were statistically significant (P= 0.001). Conclusion: Based on the lower pain scores and low complication rates after the operations, the results suggest that application of RFT on ganglion impar by the transsacrococcygeal approach is an effective and safe method for the treatment of chronic coccydynia. Patient selection, technique, and experience are the most important factors affecting the success of this method.