Browsing by Author "Ayhan, Selim"

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Anterior Spinal Artery Syndrome: Rare Precedented Reason of Postoperative Plegia After Spinal Deformity Surgery: Report of 2 Cases
(2020) Bahadir, Sinan; Nabi, Vugar; Adhikari, Prashant; Ayhan, Selim; Acaroglu, Emre; 0000-0003-0153-3012; 32502625; U-5409-2018
BACKGROUND: Complications in spinal deformity surgery vary from insignificant to severe. Apart from direct mechanical insult, ischemia can also cause spinal cord injury. Ischemic injury may be detected during surgery or may manifest itself postoperatively. We present 2 cases of anterior spinal artery syndrome. CASE DESCRIPTION: In the first case, a 12-year-old girl developed anterior spinal artery syndrome resulting in total quadriplegia 8 hours after spinal deformity surgery. She was treated with a steroid, immunoglobulin, and lowmolecular-weight heparin. She showed complete recovery at 1 year postoperatively both clinically and radiographically. In the second case, a 62-yearold woman experienced sudden loss of motor evoked potentials intraoperatively during dural tear repair after sagittal and coronal alignment was established. The paraplegic patient was diagnosed with anterior spinal artery syndrome at the thoracic level postoperatively. She was treated with a steroid and heparin. At 1 year postoperatively, she has gained much of her strength and has myelomalacia in her spinal cord. CONCLUSIONS: Anterior spinal artery syndrome is a serious condition with a generally poor prognosis. Though treatment should be directed at the underlying cause, the best strategy is to prevent it from occurring. Peroperative blood pressure control, intraoperative neuromonitoring, avoidance from mechanical stress during surgery, and close neurologic and hemodynamic monitorization postoperatively should be performed.
C1 Laminoplasty and Posterior Atlantoaxial Fusion for Large Retro-odontoid Pseudotumor with Instability: A Technical Note
(2021) Ayhan, Selim
Background: Retro-odontoid pseudotumor (ROPT) is a non-neoplastic pathology of the craniovertebral junction that is usually associated with atlantoaxial instability. The mass compresses the spinal cord, causing cervical myelopathy and potentially resulting in severe disability. Posterior atlantoaxial fixation without laminectomy is a suitable surgical option when the symptoms are mild and the static compression is moderate. In the setting of patients with severe symptoms and large ROPTs, posterior decompression becomes necessary. However, achieving solid posterior atlantoaxial fusion is difficult without a bony surface, namely the C1 posterior arch. Here, we describe a novel technique of C1 laminoplasty to achieve C1 decompression, and posterior atlantoaxial fusion with a modified Goel technique. Methods: An 83-year-old man was referred to our orthopedic department with quadriplegia due to atlantoaxial instability. His daily life had been affected by severe neck pain, clumsiness of bilateral hands, and gait disturbance for more than 2 years. Preoperative cervical radiograms revealed atlantoaxial instability, and magnetic resonance imaging showed a large pseudotumor compressing to the spinal cord. Results: The patient underwent C1 laminoplasty to decompress the spinal cord and retain the posterior arch as a bony surface for grafting and posterior atlantoaxial fusion. The procedure was well tolerated. The patient's quadriparesis was improved and his Japanese Orthopedic Association score improved from 9/17 to 15/17 and his visual analog scale score for neck pain improved from 75 mm to 28 mm at the 1-year follow-up. Conclusion: C1 laminoplasty and posterior atlantoaxial fusion appears useful when C1 decompression and atlantoaxial fusion become necessary.
Can we diagnose disk and facet degeneration in lumbar spine by acoustic analysis of spine sounds?
(2020) Nabi, Vugar; Ayhan, Selim; Acaroglu, Emre; Ahi, Mustafa Arda; Toreyin, Hakan; Cetin, A. Enis; 0000-0003-0153-3012; U-5409-2018
This study aims to investigate spine sounds from a perspective that would make their use for diagnostic purposes of any spinal pathology possible. People with spine problems can be determined using joint sounds collected from the involved area of the spinal columns of subjects. In our sound dataset, it is observed that a 'click' sound is detected in individuals who are suffering from low back pain. Recorded joint sounds are classified using automatic speech recognition algorithm. mel-frequency cepstrum coefficients (MFCC) are extracted from the sound signals as feature vectors. MFCC's are classified using an artificial neural networks, which is currently the state-of-the-art speech recognition tool. The algorithm has a high success rate of detecting 'click' sounds in a given sound signal and it can perfectly identify and differentiate healthy individuals from unhealthy subjects in our data set. Spine sounds have the potential of serving as a reliable marker of the spine health.
Can we diagnose disk and facet degeneration in lumbar spine by acoustic analysis of spine sounds? (September, 10.1007/s11760-020-01776-3, 2020)
(2021) Nabi, Vugar; Ayhan, Selim; Acaroglu, Emre; Ahi, Mustafa Arda; Cetin, Engin; Toreyin, Hakan; Cetin, A. Enis; 0000-0003-0153-3012; U-5409-2018
Unfortunately, the authors have missed to include the fifth author name (Engin cetin) in the group.
Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference
(2020) Acaroglu, Emre; Yuksel, Selcen; Ates, Can; Ayhan, Selim; Bahadir, Sinan; Nabi, Vugar; Vila-Casademunt, Alba; Perez-Grueso, Francisco Javier Sanchez; Obeid, Ibrahim; 0000-0003-0153-3012; 32622065; U-5409-2018
BACKGROUND: Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. METHODS: From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 +/- 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. RESULTS: Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. CONCLUSIONS: Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.
The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery
(2021) Nabi, Vugar; Ayhan, Selim; Yuksel, Selcen; Adhikari, Prashant; Vila-Casademunt, Alba; Pellise, Ferran; Perez-Grueso, Francisco Sanchez; Alanay, Ahmet; Obeid, Ibrahim; Kleinstueck, Frank; Acaroglu, Emre; 0000-0003-0153-3012; 34130379; U-5409-2018
Study design: Retrospective cohort. Purpose: This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery. Conclusions: The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery.
The Influence of Different Sugammadex Doses on Neural Tube Development in Early-Stage Chick Embryos
(2023) Ayhan, Asude; Efe, Ekin; Fidan, Pinar A.; Efe, Oguzhan E.; Ates, Eylem Gul; Sahinturk, Fikret; Ayhan, Selim; 0000-0002-6166-2601; 0000-0001-6955-9839; 0000-0002-3243-7843; 0000-0003-3047-0305; 0000-0002-0471-3177; 37565787; HGE-9282-2022; AAJ-2057-2021; AAJ-4728-2021; W-7908-2019; ABG-5365-2020; AAI-7972-2021
Background: Sugammadex is a modified gamma-cyclodextrin that has been developed with the goal of reversing the steroidal neuromuscular blocking agents. The aim of the present study is to investigate the effects of different sugammadex doses on embryologic and neural tube development in an early-stage chick embryo model. Methods: A total of 100 specific pathogen-free, fertilized domestic chicken eggs were randomly divided into five groups (n = 20, each), and placed in an automatic cycle incubator. The eggs in the "control (C)" group were incubated without administration of any drug till the end of the experiment. Subblastodermic administration of 0.9% NaCl as vehicle control (VC) and different doses of sugammadex solutions prepared with the latter [2 mg/mL (LD), 4 mg/mL (MD), 16 mg/mL (HD)] were performed at 30 hr of incubation. All embryos were removed from the eggs at 72 hr when they were expected to reach Hamburger-Hamilton (HH) stages 19-20, then they were fixed, and evaluated histo-morphologically. Results: Embryonic development was not observed in 11 eggs (1 in C, 1 in VC; 3 in LD, 3 in MD, and 3 in HD). All the developed embryos were compatible with the HH stages 19-20. A neural tube closure defect was detected in one embryo in the HD group. No statistically significant difference was found between the groups in terms of embryonic and neural tube developments. Conclusions: No significant association was found between the drug and adverse outcomes; however, a trend with dosing was seen. Further studies are required before conclude on safety and extrapolate these results to human beings.
The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty
(2023) Sahinturk, Fikret; Sonmez, Erkin; Ayhan, Selim; Gulsen, Salih; Yilmaz, Cem; 0000-0002-5693-3542; 0000-0002-2353-8044; 0000-0002-0471-3177; 37257650; AAJ-5746-2021; AAI-8820-2021; AAK-2948-2021; AAI-7972-2021
-OBJECTIVE: The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae.-METHODS: According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n = 40) and PVP (n = 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured.-RESULTS: The mean follow-up time was 2.53 & PLUSMN; 1.78 years in the BK group and 3.07 & PLUSMN; 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding.-CONCLUSIONS: To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid-to long term.
Letter: Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report
(2022) Sahinturk, Fikret; Ayhan, Selim; Sonmez, Erkin; Gulsen, Salih; Yilmaz, Cem; https://orcid.org/0000-0002-0471-3177; https://orcid.org/0000-0003-0153-3012; 34982931; AAI-7972-2021; U-5409-2018; IYT-2145-2023
Variation of Minimum Clinically Important Difference by Age, Gender, Baseline Disability, and Change of Direction in Adult Spinal Deformity Population: Is It a Constant Value?
(2021) Bahadir, Sinan; Yuksel, Selcen; Ayhan, Selim; Nabi, Vugar; Vila-Casademunt, Alba; Obeid, Ibrahim; Sanchez Perez-Grueso, Francisco Javier; Acaroglu, Emre; 0000-0003-0153-3012; 33259972; U-5409-2018
BACKGROUND: The minimum clinically important difference (MCID), an important concept to evaluate the effectiveness of treatments, might not be a single "magical" constant for any given health-related quality of life (HRQoL) scale. Thus, we analyzed the effects of various factors on MCIDs for several HRQoL measures in an adult spinal deformity population. METHODS: Surgical and nonsurgical patients from a multicenter adult spinal deformity database who had completed pretreatment and 1-year follow-up questionnaires (Core Outcome Measures Index [COMI], Oswestry Disability Index [ODI], Medical Outcomes Study 36-item short-form questionnaire, 22-item Scoliosis Research Society Outcomes questionnaire, and an anchor question of "back health"erelated change during the previous year) were evaluated. The MCIDs for each HRQoL measure were calculated using an anchor-based method and latent class analysis for the overall population and subpopulations stratified by age, gender, and baseline scores (ODI and COMI) separately for patients with positive versus negative perceptions of change. RESULTS: Patients with a baseline ODI score of <20, 20- 40, and >40 had an MCID of 2.24, 11.35, and 26.57, respectively. Similarly, patients with a baseline COMI score of <2.75, 2.8-5.4, and >5.4 had an MCID of 0.59, 1.38, and 3.67 respectively. The overall MCID thresholds for deterioration and improvement were 0.27 and 2.62 for COMI, 2.23 and 14.31 for ODI, and 0.01 and 0.71 for 22-item Scoliosis Research Society Outcomes questionnaire, respectively. CONCLUSIONS: The results from the present study have demonstrated that MCIDs change in accordance with the baseline scores and direction of change but not by age or gender. The MCID, in its current state, should be considered a concept rather than a constant.