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Öğe Comparison of Lumbar Disc Herniation and Degeneration Relationship with the Sagittal Morphology of the Spine(Derman Medical Publ, 2015) Delen, Emre; Birgili, Bans; Akinci, Ahmet Tolgay; Karabulut, Derya; Turan, Fatma Nesrin; Kunduracilar, Nebile Muge; Memis, Muzafferin this study, the relationship between the lower intervertebral disc herniation and the degeneration of the spine with the sagittal morphological values were investigated. The data on this study is obtained retrospectively from patients who were operated in our center with the diagnosis of lower level lumbar disc herniation. A total of 117 patients, 75 female and 42 male are included. Patients are divided into two groups as with degeneration (Pfirmann stage III-IV-V) and without degeneration (Pfirmann stage I-II). Among 117 patients, 13 were in the with degeneration group, while 104 were in the without degeneration group. The mean age of the first group was 43.0 (+/- 11.2) years, while the second group had a mean age of 45.3 (+/- 11.4) years and there were not a statistically significant differences between them (P > 0.05). Mean lumbar lordosis angle was 23.30 (+/- 8.92) degree in the first group and 28.81 (+/- 9.17) degree in the without dejeneration group, thus a lower degree was observed in the group with degeneration (P = 0.050). Segmental lordosis angle was 24.69 (+/- 8.91) and 28.17 (+/- 5.75) degree respectively, in the group with degeneration the angle value was lower (P = 0.088). The sacral surface angle in the group with degeneration was 99.51 (+/- 5.36) degree and in the second group it was 100.56 (+/- 6.03) degree. Nevertheless the difference was not statistically significant (P = 0.509). The sacral kyphosis angle is determined as 170.13 (+/- 5.41) degree and 155.59 (+/- 45.96) degree in the two groups respectively and there was statistically significant difference between them (P = 0.059). For cases with lower level lumbar disc herniation there exists a significant relationship between the disc herniation and degeneration, therefore the lumbar lordosis and the segmental lordosis angles are lower in patients with degeneration.Öğe Demographic Characteristics of 796 Patients Operated for Lumbar Disc Herniation in Thrace Region, Turkey(Derman Medical Publ, 2016) Delen, Emre; Akinci, Ahmet Tolgay; Tutunculer, Banu; Memis, Muzaffer; Kunduracilar, Nebile Muge; Sahin, SonerAim: This study was designed was to determine the demographic characteristics of patients operated for lumbar disc herniation in Thrace Region, Turkey. Material and Method: We retrospectively searched our data to find out patients who had one sided, one level and only one spinal surgical intervention for herniated lumbar disc. Results: Among 796 cases, 336 (4256) were men and 460 (5831:) were women. The level of the pathology is determined as LI - 2 for 4 cases (0.56b), L2 - 3 for 15 cases (1.9%), L3 - 4 for 5 I cases (6.4%), L4 - 5 for 412 cases (51.8%) and as L5 - 51 on 314 cases (39.4%). While a total of 70 cases (8.9%) were identified on upper -levels ( LI - 2. L2 - 3, L3 - 4); 726 cases (91.1%) were found to be on lower -levels ( L4 - 5, L5 - Si). A mild positive correlation between the pathology level and physical activity intensity (P e 0.05, P = 0.103) has been demonstrated: as well as a strong negative correlation between pathology level and mean age (P < 0.05. P = -0.404). Discussion: The demographic characteristics are consistent with the literature. Physical activity intensity influence on lower -level herniations might have significance due to the large sample size. The strong negative correlation between pathology level and mean age suggests that the degeneration raises the frequency of upper -level herniations.Öğe Effects of Footbath on Postoperative Pain and Sleep Quality in Patients With Lumbar Degenerative Disc Disease: A Randomized Controlled Study(Lippincott Williams & Wilkins, 2023) Unver, Seher; Colakoglu, Ulku; Akinci, Ahmet TolgayBACKGROUND: Pain management and good sleep are essential for patients after surgical procedures. This study aimed to evaluate the effects of footbath on postoperative pain severity and sleep quality levels of patients who have undergone degenerative lumbar spine surgery. METHODS: Sixty patients were randomly assigned to the footbath intervention group or the control group. The intervention was a 20-minute footbath in 42 & DEG;C water before patients fell asleep on the evening of the surgery day. On the morning of the surgery day and the morning of postoperative day, the patient's pain severity and sleep quality scores were obtained using the visual analog scale and the Visual Analog Sleep Scale. RESULTS: There was no significant difference between the pain severity scores of the study groups (P > .05). The sleep quality level of the intervention group was statistically significantly higher than that of the control group (P < .05). CONCLUSION: Consequently, a footbath is effective in increasing sleep quality levels of patients who have undergone degenerative lumbar spine surgery. It may be used as a simple and practical nonpharmacological nursing strategy for improving patients' sleep quality.Öğe The effects of the early and ultra-early intervention on the outcome in aneurysmatic subarachnoid hemorrhage(Turkish Assoc Trauma Emergency Surgery, 2021) Akinci, Ahmet Tolgay; Akturk, Yener; Tutunculer, Banu; Orakdogen, Metin; Simsek, OsmanBACKGROUND: The optimal timing of intervention for aneurysmatic subarachnoid hemorrhage is one of the historically controversial issues in neurosurgery. Although numerous studies investigated the subject, they had many limitations due to the nature of the disease. Early and ultra-early interventions have gained more and more supporters in recent decades. Nevertheless, the effects of the early and ultra-early intervention on the outcome of the disease are far from clarity. METHODS: A single-center retrospective cohort study was carried out at Trakya University Medical Faculty Training and Practice Hospital. The study includes data on all patients admitted with an aneurysmal subarachnoid hemorrhage between January 1, 2001, and December 31, 2005. Patients were divided into two groups according to their WFNS grade status: Good (I-III) or poor (IV-V) grades. Patients are also classified according to their Glasgow Outcome Scale score: Unfavorable (1-2) or favorable (3-5) outcomes. Data were analyzed statistically, and the effects of the early and ultra-early intervention on the outcome were assessed. RESULTS: A total of 580 patients were admitted in the study period. Among them, 494 were eligible for the study. The median age (interquartile range) was 55 (18) years. While 244 (49.4%) patients were women, 250 (50.6%) patients were men. Three hundred and fourteen (63.6%) patients were operated, and 25 patients (5.1%) were undergone endovascular treatment. The ultra-early intervention was achieved in 60 (12.1%) patients and 142 patients (28.7%, including the previous ultra-early intervention group) early intervention was achieved. A meaningful outcome difference was present between the poor-grade ultra-early treatment group and the rest (p=0.007). Analogously, a meaningful outcome difference was present between the poor-grade early treatment group and the rest (p<0.001). CONCLUSION: This study supports the growing trend toward early or ultra-early intervention in aneurysmatic subarachnoid hemorrhage. Our findings showed that both early and ultra-early interventions have positive effects on the outcome in poor-grade aneurysmatic subarachnoid hemorrhage patients. Future studies with more homogenized and larger samples should be realized to clarify the optimal timing of intervention for aneurysmatic subarachnoid hemorrhage.Öğe THE EFFECTS OF ULTRA-EARLY CLIPPING ON SURVIVAL AND NEUROLOGICAL OUTCOME IN POOR-GRADE ANEURYSMAL SUBARACHNOID HAEMORRHAGE(Literatura Medica, 2022) Simsek, Osman; Akinci, Ahmet TolgayBackground and purpose - European Stroke Organisation guidelines advise treating aneurysmal subarachnoid haemorrhage (aSAH) as early as possible. However, the optimum timing along with its beneficial effects is controversial. Therefore, we aimed to investigate the effects of ultra-early clipping on neurological outcomes and survival in poor-grade aneurysmal subarachnoid haemorrhages. Methods - This retrospective study included all poorgrade aneurysmal subarachnoid haemorrhage patients treated by ultra-early surgical clipping at Trakya University Hospital between January 1, 2001, and December 31, 2020. We analysed the outcome and mortality data of these patients. Specifically, we evaluated the effects of ultra- early clipping on outcomes, defined as within six hours of the onset of symptoms. Results - From 813 records, 212 met our inclusion criteria. Of these, 117 (55.2%) were female and 95 (44.8%) male. The mean age was 58.3 +/- 13.7 years. Glasgow Outcome Scale scores differed significantly between age groups, subarachnoid haemorrhage grades, those who did and did not rebleed, and those who did or did not suffer from vasospasms. A beneficiary relationship was found between ultra-early clipping and mortality among patients. Furthermore, favourable outcomes were significantly more frequent in the ultra-early clipping group. Conclusion - The aSAH patients treated at our hospital who received ultra-early clipping had significantly lower mortality rates and more favourable outcomes. The difference was significant among those treated during the last decade and among patients younger than 50.Öğe Hemangiopericytoma at the Craniovertebral Junction: A Case Report(Kare Publ, 2019) Delen, Emre; Akinci, Ahmet Tolgay; Turkkan, Gorkem; Yalta, Tulin Deniz; Simsek, OsmanIntradural extra medullary hemangiopericytomas (HPCs) are extremely rare and a hemangiopericytoma located at the craniovertebral junction might present radiologic features similar to those of meningioma or schwannoma.To the best of our knowledge, this report is among a few reported cases of HPC at the craniovertebral junction. Although they are very rare, HPCs should kept in mind in the differential diagnosis of the intradural extramedullary lesion due to differences in treatment such as adjuvant radiotherapy.Öğe Infection in patients with isolated head injury: risk factors and the impact on treatment cost(Turkish Assoc Trauma Emergency Surgery, 2012) Arslan, Alp; Birgili, Baris; Akinci, Ahmet Tolgay; Simsek, Osman; Kilincer, CumhurBACKGROUND We aimed to determine risk factors and the impact on treatment cost of infection in patients with isolated head injury. METHODS Data acquired from 299 patients (239 males, 60 females; mean age 35,1 +/- 23,2 years) with isolated head trauma who were hospitalized for more than 72 hours at Trakya University Training and Research Hospital between 2001-2007 Were evaluated retrospectively. Data including age, gender, initial neurological examination, radiological findings, duration of hospitalization, need for surgery, cost of infection treatment, total cost of care, and outcome scores were determined. Two groups divided according to the development of infection were compared for risk factors and the impact of infection on the cost of treatment. RESULTS In the group of patients with infection, the mean Glasgow Coma Scale score at delivery was lower; anisocoria, light reflex loss, lateralized deficit, skull base fracture, subdural hematoma, and cerebral edema findings were more frequent. A four-times longer hospital stay, 10-times higher total cost and a significantly increased mortality rate were determined in this group. For the patients with light head injury, in the group of patients with infection, the mean age was found to be higher. CONCLUSION For patients with isolated head injury, there are some risk factors for the development of infection that increase the hospitalization duration, total cost of care and mortality rates.Öğe Internal Validation of Two Models Developed for Prognostication of Patients with Isolated Traumatic Brain Injury(Turkish Neurosurgical Soc, 2023) Akinci, Ahmet Tolgay; Simsek, Osman; Kocaturk, MuratAIM: To evaluate the efficiency of two models for prognostication of patients with isolated traumatic brain injury.MATERIAL and METHODS: The models developed with the data of the patients who applied within ten years were subjected to internal validation with the data of the patients who applied within the following five years. The records of 204 patients with traumatic brain injury admitted into Neurosurgery Department and Intensive Care Units were reviewed. Models were applied to procure estimates of prognosis. The estimates were statistically compared with the actual clinical outcome of patients using discriminant analysis.RESULTS: For Model 1, the correct classification rate was calculated as 87.9%, the specificity as 66.7%, the sensitivity as 94.2%, the positive predictive value as 68.8%, and the negative predictive value as 93.6%. For Model 2 the correct classification rate was evaluated as 90.2%, the specificity as 57.6%, the sensitivity as 96.5%, the positive predictive value as 76%, and the negative predictive value as 92.2%.CONCLUSION: Both of the models had decent correct classification rates and may be efficient estimation tools for the prognostication of unfavourable outcome in patients with isolated traumatic brain injury. These models are good candidates to be used widely following the evaluation of their validity with national and international multicentric studies.Öğe Postoperative Spinal Epidural Haematoma Causing Cauda Equina Syndrome: Case Report(Derman Medical Publ, 2013) Delen, Emre; Birgili, Baris; Akinci, Ahmet Tolgay; Yavuz, SelcukCauda equina syndrome is a neurological disorder defined by urinary and/or anal sphincter dysfunction, bilateral sciatica and bilateral motor and sensory deficits. Regarding the etiology, lumbar disc disease, spinal stenosis, tumors, haematomas, fractures, infectious diseases and ankylosing spondylitis are pathologies causing this syndrome. Spinal epidural haematomas are common amongst complications after spinal surgery. However the majority of these cases are asymptomatic, thus having little clinical importance. Symptomatic postoperative spinal epidural haematomas is a serious complication, and in order to prevent permanent neurologic deficit it requires urgent surgical intervention. This article aims to present the case of a patient with a spinal epidural haematoma after spinal stenosis surgery, causing cauda equina syndrome.Öğe Preoperative Magnetic Resonance Imaging Abnormalities Predictive of Lumbar Herniation Recurrence After Surgical Repair(Elsevier Science Inc, 2022) Karadag, Mehmet Kursat; Akinci, Ahmet Tolgay; Basak, Ahmet Tulgar; Hekimoglu, Mehdi; Yildirim, Hakan; Akyoldas, Goktug; Aydin, Ahmet LeventOBJECTIVE: There are currently no standard criteria for evaluating the risk of recurrent disk herniation after surgical repair. This study investigated the predictive values of 5 presurgical imaging parameters: paraspinal muscle quality, annular tear size, Modic changes, modified Phirrmann disk degeneration grade, and presence of sacralization or fusion. METHODS: Between 2015 and 2018, 188 patients (89 female, 99 male, median age 50) receiving first corrective surgery for lumbar disk herniation were enrolled. Micro-diskectomy was performed in 161 of these patients, and endoscopic translaminar diskectomy approach was performed in 27 patients. Clinical status was evaluated before surgery and 4, 12, and 24 months post surgery using a visual analog scale, Oswestry Disability Index, and Short Form 36. RESULTS: Recurrent disk herniation was observed in 21 of 188 patients. Seventeen of the recurrent disk herniations were seen in those who underwent microdiskectomy and 4 in those who underwent endoscopic translaminar diskectomy. There were significant differences in visual analog scale, Oswestry Disability Index, and Short Form 36 scores at 4, 12, and 24 months between patients with recurrence and the 167 no-recurrence patients. The median annular tear length was significantly greater in patients with recurrence than without recurrence. In addition, there were significant differences in recurrence rate according to Modic change type distribution, sacralization or fusion presence, Pfirmann disk; degeneration grade distribution, dichotomized annular tear size, dichotomized Modic change; and type and simplified 3-tier muscle degeneration classification distribution. CONCLUSIONS: Patients with poor clinical scores and recurrence exhibited additional radiologic abnormalities before surgery, such as poor paraspinal muscle quality, longer annular tears, higher Modic change type, higher modified Phirrmann disk degeneration grade, and sacralization or fusion. This risk evaluation protocol may prove valuable for patient selection, surgical planning, and choice of postoperative recovery regimen.Öğe Primary Cystic Echinococcosis of the Spine: A Rare Case Misdiagnosed as Chordoma(Wolters Kluwer Medknow Publications, 2023) Celik, Ahmet Onur; Ajredini, Mirac; Ustabasioglu, Fethi Emre; Akinci, Ahmet Tolgay; Puyan, Fulya Oz[Abstract Not Available]Öğe Spontaneous subarachnoid haemorrhage incidence among hospitalised patients in Edirne, Turkey(Springer Wien, 2019) Simsek, Osman; Akinci, Ahmet Tolgay; Delen, Emre; Sut, NecdetBackground To the best of our knowledge, no data has been published about the spontaneous subarachnoid haemorrhage (sSAH) incidence in Turkey. We aimed to report the estimation of sSAH incidence in Edirne Province, in Turkey for the first time, using the data acquired from a single medical centre which has the biggest and the most comprehensive emergency department in Edirne and to where a great majority of patients are referred. Methods We investigated all the accessible sSAH patients' data obtained from computer-based automation systems and all the written documents in the neurosurgery and the emergency departments. Patients included in the study were diagnosed with sSAH between the dates of January 2007 and December 2011 and were resident in Edirne. We used this data to calculate the crude and age-adjusted incidence rates of sSAH for every decade. Results One hundred fifty-four patients have been diagnosed with sSAH during a 5-year period. Among them, 72 were men (47.8%) and 82 (53.2%) were women. The mean age of the patients was 60.8 years and age range was 23-85 years. The overall annual adjusted incidence rate for sSAH was 10.3 per 100,000 person-years (95% confidence interval = 10.2-10.3). Annual adjusted incidence rate was 10 per 100,000 person-years (95% confidence interval = 10-10.1) for men. For women, it was 10.4 per 100,000 person-years (95% confidence interval = 10.4-10.5). For both sexes, after the 6th decade, the annual incidence rate of sSAH was higher than 10 per 100,000, reaching over 20 per 100,000 person-years after the 7th decade. The overall crude incidence rate for sSAH was 10.3 per 100,000 person-years. For men, the crude incidence rate was 9.4 per 100,000 person-years and for women, it was 11.2 per 100,000 person-years. Conclusions This study showing the first sSAH incidence estimation in Edirne might also be accepted as an estimation of overall epidemiological sSAH aspect in Turkey. Future investigations should be realised in different parts of Turkey to enlighten the epidemiological state of affairs and the course of sSAH in Turkey.Öğe Treatment of a large and symptomatic septum pellicidum cyst with endoscopic fenestration in a child-Case report and review of the literature(Elsevier Science Bv, 2012) Hicdonmez, Tufan; Suslu, Hikmet Turan; Butuc, Radu; Bilal, Serkan; Akinci, Ahmet Tolgay[Abstract Not Available]
