Browsing by Author "Can, Halil"

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The Effect of Using a Dose of Prophylactic Antibiotics on Spondylodiscitis in Lumbar Disc Surgery
(2020) Diren, Furkan; Onal, Mehmet Bulent; Can, Halil; Kircelli, Atilla
Objective: Although spondylodiscitis seen after lumbar discectomy is very rare, its incidence has been reported to be around 0.1-18.8% by many different authors. The most common pathogen is Staphylococcus aureus. Methods: Medical records of 1,154 patients who were operated in our hospital between 2007 and 2015 due to a single or two-level lumbar disc hernia were retrospectively extracted. Of these patients, 554 were female and 600 were male. Discectomy operation was performed in 1,062 of these patients with single-level and 91 with two-level lumbar microdiscectomy. All of these patients were given a prophylactic single dose of cefazolin sodium in accordance with the recommendations of the surgical antimicrobial prophylaxis guidelines during anesthesia. Spondylodiscitis developed in 12 patients (1.03%). Comorbidities in patients who developed spondylodiscitis, isolated pathogens, antibiotic susceptibility, antibiotics used, and hospital stay were noted. Results: Of the 12 patients, 7 were female and 5 were male. Mean age was 45.75 +/- 14.16 years. Eleven of these patients underwent single level, one had 2 levels of lumbar microdiscectomy. Five patients underwent discectomy at L4-5 and 8 patients at L5-S1 levels. Three of these patients had S. aureus (25%), 4 had Staphylococcus epidermidis (33%) and 3 had Escherichia coli (25%) and 2 patients had no reproduction. The mean hospital stay was 29.45 +/- 3.98, and in patients without spondylodiscitois it was 1.99 +/- 0.81, the two groups were significantly different from each other (p=0.0001). Conclusion: Although most surgeons nave a tendency to maintain antibiotic prophylaxis postoperatively or during hospitalization period, our study found that a single dose prophylactic antibiotic administered during anesthesia induction did not increase rate of spondylodiscitis by medical literature.
Is the presence of linear fracture a predictor of delayed posterior fossa epidural hematoma?
(2016) Kircelli, Atilla; Ozel, Omer; Can, Halil; Sari, Ramazan; Cansever, Tufan; Elmaci, Ilhan; 27598608
BACKGROUND: Though traumatic posterior fossa epidural hematoma (PFEDH) is rare, the associated rates of morbidity and mortality are higher than those of supratentorial epidural hematoma (SEDH). Signs and symptoms may be silent and slow, but rapid deterioration may set in, resulting in death. With the more frequent use of computed tomography (CT), early diagnosis can be achieved in patients with cranial fractures who have suffered traumatic injury to the posterior fossa. However, some hematomas appear insignificant or are absent on initial tomography scans, and can only be detected by serial CT scans. These are called delayed epidural hematomas (EDHs). The association of EDHs in the supratentorial-infratentorial compartments with linear fracture and delayed EDH (DEDH) was presently investigated. METHODS: A total of 212 patients with SEDH and 22 with PFEDH diagnosed and treated in Goztepe Training and Research Hospital Neurosurgery Clinic between 1995 and 2005 were included. Of the PFEDH patients, 21 underwent surgery, and 1 was followed with conservative treatment. In this group, 4 patients underwent surgery for delayed posterior fossa epidural hematoma (DPFEDH). RESULTS: Mean age of patients with PFEDH was 12 years, and that of the patients with SEDH was 18 years. Classification made according to localization on cranial CT, in order of increasing frequency, revealed of EDHs that were parietal (27%), temporal (16%), and located in the posterior fossa regions (approximately 8%). Fracture line was detected on direct radiographs in 48% of SEDHs and 68% of PFEDHs. Incidence of DPFEDH in the infratentorial compartment was statistically significantly higher than incidence in the supratentorial compartment (p=0.007). Review of the entire EDH series revealed that the likelihood of DEDH development in the infratentorial compartment was 10.27 times higher in patients with linear fractures than in patients with supratentorial fractures (p<0.05). CONCLUSION: DPFEDH, combined with clinical deterioration, can be fatal. Accurate diagnosis and selection of surgery modality can be lifesaving. The high risk of EDH development in patients with a fracture line in the posterior fossa on direct radiographs should be kept in mind. These patients should be kept under close observation, and serial CT scans should be conducted when necessary.
Lumbosacral Conjoined Root Anomaly: Anatomical Considerations of Exiting Angles and Root Thickness
(2017) Kircelli, Atilla; Can, Halil; Kavadar, Gulis; Civelek, Erdinc; Cansever, Tufan; Aydoseli, Aydin; Onal, Mehmet Bulent; Yilmaz, Cem; 0000-0003-2109-1274; 27593795
AIM: Conjoined nerve roots (CNR) can be damaged during lumbar disc surgery and lead to neuropathic pain due to excessive retraction. The purpose of this study was to investigate the factors that facilitate the identification of CNRs that can lead to the loss of fragments in the secondary axilla, nerve root injury or unpleasant surprises during lumbar disc surgery. Accordingly, we aimed to measure the thicknesses and exit angles of the nerve roots close to the pedicle to obtain scientific data regarding rare double roots. MATERIAL and METHODS: The data of 612 patients who were operated for lumbar disc disease in our hospital between 2012 and 2014 were reviewed retrospectively. Twenty one cases of CNR were detected in this series. RESULTS: The mean nerve root thickness was 1.92 0.45 mm for medially located roots and 3.33 +/- 0.95 mm for laterally located roots. The comparison of medially located roots versus laterally located roots revealed a significant difference in mean values (p<0.0001). The mean exit angle was 12.29 degrees +/- 4.89 degrees for medially located roots, and 22.11 degrees +/- 5.42 degrees for laterally located roots (p<0.0001). In addition, the exit angles of the medially and laterally located roots increased as going down to caudal levels, (p=0.005, p=0.042). CONCLUSION: CNRs are congenital anomalies that are usually diagnosed during the surgical procedure and affect the success of discectomy. The presence of a more medially located or thinner root during surgical exploration and the absence of the fragment in the axilla in extruded or sequestered discs usually indicate a conjoined nerve root closer to the pedicle.