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    Anterior Approach to Disc Herniation With Modified Anterior Microforaminotomy at C7-T2 Technical Note
    (Lippincott Williams & Wilkins, 2009) Ozer, Ali Fahir; Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat
    Study Design. An easy surgical method to reach C7-Th and T1-T2 foraminal disc herniation is described. Objective. To describe a surgical technique that involves an anterior approach to disc herniation with inverted cone-shaped partial minicorpectomy. Summary of Background Data. Anterior approaches to the cervicothoracic junction are difficult in spinal surgery because the operative area is narrow. The manubrium, the clavicles, and the slope of the vertebral bodies obstruct the view of the surgeon. The vascular and neural structures of the superior mediastinum limit the surgical approach. The thoracic duct and recurrent laryngeal nerve present risks for injury, especially with approaches from the right side. Disc herniations at the C7-T2 level are very rare. Posterior approaches at these levels are advocated because radicular symptoms occur more often than myelopathic symptoms, but anterior discectomy and fusion are generally preferred by many spinal surgeons, as these are approaches that are more intuitive. Methods. We review the case histories of all of our patients that underwent inverted cone-shaped partial minicorpectomy and fusion at the C7-T2 disc levels between 2000 and 2008. We applied the surgical techniques described in this manuscript. Results. The mean follow-up duration was 50 months postoperation. Physical examinations were performed and radiographs were taken at the end of the first 6 months postoperative and every 12 months thereafter. No meaningful changes were recorded on either the Visual Analog Scale or the Neck Disability Index. Cervical alignment was unchanged before and after surgery. Conclusion. Minicorpectomy technique of C7 or T1 vertebra is an easy and appropriate method for treating foraminal disc herniation between the C7-T1 and T1-T2 levels.
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    The Combined Use of a Posterior Dynamic Transpedicular Stabilization System and a Prosthetic Disc Nucleus Device in Treating Lumbar Degenerative Disc Disease With Disc Herniations
    (2008) Sasani, Mehdi; Aydin, Ahmet Levent; Oktenoglu, Tunc; Cosar, Murat; Ataker, Yaprak; Kaner, Tuncay; Ozer, Ali Fahir
    Background: Prosthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery. Methods: This was a prospective study of 13 patients averaging 40.9 years of age with degenerative disc disease who underwent posterior placement of a PDN with a PDTS. The Oswestry low-back pain disability questionnaire and visual analog scale (VAS) for pain were used to assess patient outcomes at the 3rd, 6th, and 12th postoperative months. Lumbar range of motion was evaluated using a bubble inclinometer preoperatively and at 12 months postoperatively. Radiological parameters including lumbar lordosis angle (LL), segmental lordosis angle (?), disc height at the operated level (DHo), and disc height of the adjacent level (DHu) were evaluated. A typical midline posterior approach for complete discectomy was followed by the simultaneous placement of the PDN with PDTS. Results: Both the Oswestry and VAS scores showed significant improvement postoperatively (P < .05). There were no significant differences in LL, ?, DHo, and DHu parameters. We observed complications in 3 patients including 2 patients who had the PDN device embedded into the adjacent corpus; 1 had massive endplate degeneration, and the other experienced interbody space infection. In 1 patient, the PDN device migrated to one side in the vertebral space. Conclusion: The use of a PDN in combination with posterior dynamic instrumentation can help to restore the physiologic motion of the anterior and posterior column and could help to establish posterior dynamic instrumentation as an important treatment of degenerative disc disease. Theoretically this concept is superior, but practically we need more advanced technology to replace disc material. Because this study examined the combination of the PDN and stabilization instrumention, the results cannot be compared with those reported in the literature for either PDN alone or dynamic screws alone. Level of Evidence: Prospective cohort study with good follow-up (level 1b). © 2008 The Spine Arthroplasy Society.
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    Utilizing Dynamic Rods with Dynamic Screws in the Surgical Treatment of Chronic Instability: A Prospective Clinical Study
    (Turkish Neurosurgical Soc, 2009) Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat; Ozer, Ali Fahir
    AIM: In this study, we examined the results of utilizing the agile posterior dynamic stabilization system with dynamic transpedicular screws in our patients. MATERIAL and METHODS: Posterior dynamic instrumentation with agile rods and dynamic transpedicular screws was employed in 15 (seven male and eight female) patients (mean age = 42, ranging from 30 to 53). The average follow-up duration was 19 months (ranging from 12 to 25). The primary purpose for the surgery was degenerative disc disease. For subjective evaluation, patients underwent a physical examination utilizing the Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic parameters, including the angle of lumbar lordosis (LL), angle of segmental lordosis ( cc) and intervertebral space (IVS), were also evaluated. Both subjective patient evaluations and radiographic parameters were assessed at the 3rd and 12th postoperative months. RESULTS: Significant postoperative improvements were observed in the ODI and VAS measurements (P<0.05). There were no significant differences in the LL, alpha and IVS parameters. One patient experienced a broken screw. CONCLUSION: We obtained good clinical results by utilizing dynamic rods with dynamic transpedicular screws.
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    Utilizing Dynamic rods with Dynamic screws in the surgical treatment of chronic instability: A prospective clinical study
    (Turkish Neurosurgical Society, 2009) Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat; Ozer, Ali Fahir
    Aim: In this study, we examined the results of utilizing the agile posterior dynamic stabilization system with dynamic transpedicular screws in our patients. Material and Methods: Posterior dynamic instrumentation with agile rods and dynamic transpedicular screws was employed in 15 (seven male and eight female) patients (mean age = 42, ranging from 30 to 53). The average follow-up duration was 19 months (ranging from 12 to 25). The primary purpose for the surgery was degenerative disc disease. For subjective evaluation, patients underwent a physical examination utilizing the Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic parameters, including the angle of lumbar lordosis (LL), angle of segmental lordosis (?) and intervertebral space (IVS), were also evaluated. Both subjective patient evaluations and radiographic parameters were assessed at the 3rd and 12th postoperative months. Results: Significant postoperative improvements were observed in the ODI and VAS measurements (P<0.05). There were no significant differences in the LL, ? and IVS parameters. One patient experienced a broken screw. Conclusion: We obtained good clinical results by utilizing dynamic rods with dynamic transpedicular screws.