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    Analysis of biochemical laboratory values to determine etiology and prognosis in patients with subarachnoid hemorrhage: a clinical study
    (Taylor & Francis Ltd, 2019) Ogden, Mustafa; Bakar, Bulent; Karagedik, Mustafa Ilker; Bulut, Ibrahim Umud; Cetin, Cansel; Aydin, Gulcin; Ozveren, Mehmet Faik
    Objectives: The aim of this study was to establish prognostic and predictive markers in patients with subarachnoid hemorrhage (SAH) using simple laboratory methods. Methods: A retrospective examination was made of patients with SAH diagnosed secondary to isolated head trauma, isolated anterior communicating artery aneurysm rupture, and angiography-negative SAH. Age, gender, Glasgow Coma Scale (GCS) scores, and Fisher's grade scores, Glasgow Outcome Scale (GOS) scores, leukocyte count, neutrophil count, lymphocyte count, platelet count, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio results (PLR) were evaluated. Results: NLR and PLR values, which were similar in patients with spontaneous SAH, were significantly high in patients with traumatic SAH. NLR and PLR values could be 80% sensitive and 75% specific for distinguishing traumatic SAH from spontaneous SAH. Eosinophil count was lower in patients with angiography-negative SAH and patients with aneurysmal SAH than in patients with traumatic SAH. Initially measured GCS score, Fisher's grade score, eosinophil, neutrophil and lymphocyte counts could be prognostic in all patients with SAH. Moreover, it was concluded that the initially measured number of eosinophils might be directly related to patient prognosis. The eosinophil count was generally found to be high in traumatic SAM patients and it was observed that this parameter could be predictive for these patients. Lymphocyte count and NLR values could be prognostic markers in patients with angiography-negative SAH. Conclusion: NLR, PLR and eosinophil count values could be predictive for etiological factors (traumatic SAH or spontaneous SAH) of patients who were admitted unconscious to the emergency room with SAH detected on radiological imaging.
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    Evaluation of the effectiveness of oxytocin and enalapril in the prevention of epidural fibrosis developed after laminectomy in rats
    (Elsevier Sci Ltd, 2023) Karagedik, Mustafa Ilker; Yuksel, Ulas; Kartal, Bahar; Ceylan, Asli Fahriye; Ogden, Mustafa; Bakar, Bulent
    Introduction: Except for methylprednisolone, there is no current low-cost and low-side-effect drug/barrier method to prevent epidural fibrosis after spine surgery. However, the use of methylprednisolone has led to substantial controversy because of its serious side effects on wound healing. This study aimed to evaluate the effects of enalapril and oxytocin on preventing the development of epidural fibrosis in a rat laminectomy model.Materials: Under sedation anesthesia, T9, T10, and T11 laminectomy was performed on 24 Wistar Albino male rats. The animals were then separated into four groups; Sham group (only laminectomy was performed; n = 6), MP group (laminectomy was performed and 10 mg/kg/day methylprednisolone was administered intraperitoneally (ip) for 14 days; n = 6), ELP group (laminectomy was performed and 0.75 mg/kg/day enalapril was administered ip for 14 days; n = 6), OXT group (laminectomy was performed and 160 & mu;g/kg/day oxytocin was administered ip for 14 days; n = 6). Four weeks after the laminectomy, all the rats were euthanised, and the spines were removed for histopathological, immunohistochemical, and biochemical examinations.Results: Histopathological examinations revealed that the degree of epidural fibrosis (X2=14.316, p = 0.003), collagen density (X2=16.050, p = 0.001), and fibroblast density (X2=17.500, p = 0.001) was higher in the Sham group and lower in the MP, ELP, and OXT groups. Immunohistochemical examinations showed that collagen type 1 immunoreactivity was higher in the Sham group and lower in the MP, ELP, and OXT groups (F = 54.950, p < 0.001). The highest level of & alpha;-smooth muscle actin immunoreactivity was seen in the Sham and OXT groups, and the lowest was in the MP and ELP groups (F = 33.357, p < 0.001). Biochemical analysis revealed that tissue levels of TNF-& alpha;, TGF-& beta;, IL-6, CTGF, caspase-3, p-AMPK, pmTOR, and mTOR/pmTOR were higher in the Sham group and lower in MP, ELP, and OXT groups (p < 0.05). The GSH/GSSG levels were lower in the Sham group and higher in the other three groups (X2=21.600, p < 0.001).Conclusion: The study results showed that enalapril and oxytocin, which are known to have anti-inflammatory, antioxidant, anti-apoptotic, and autophagy-related regenerative properties, could reduce the development of epidural fibrosis after laminectomy in rats.
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    Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study
    (Elsevier Science Inc, 2023) Ogden, Mustafa; Karagedik, Mustafa Ilker; Ozdemir, Alemiddin; Bulut, Ibrahim Umud; Erdogan, Ahmet Melih; Bakar, Bulent
    OBJECTIVE: Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or lam-inoplasty. This study aimed to investigate the therapeutic efficacy of the bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD) technique in CSM patients.METHODS: The study included 34 adult patients who u nderwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, n umber of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images.RESULTS: Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 +/- 3.42, kyphosis angles were-13.34 +/- 13.69(degrees) and spinal canal areas were 87.11 +/- 28.30 mm(2). In post-operative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 +/- 3.09, kyphosis angles were-15.07 +/- 12.78(degrees) and spinal canal areas were 149.65 +/- 42.57 mm(2). A statistically significant difference was determined between the preoperative and the post-operative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P [ 0.198), and no instability was observed in any patient in long-term follow-u p.CONCLUSIONS: The UHBOLD technique performed in multilevel CSM patients did not cause any change in cer-vical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.
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    Predictive Markers in Decision-Making for Screwing the Fractured Thoracolumbar Vertebra in the Short-Segment Instrumentation
    (Japanese Soc Spine Surgery & Related Research, 2022) Ogden, Mustafa; Yuksel, Ulas; Karagedik, Mustafa Ilker; Bulut, Ibrahim Umud; Bakar, Bulent
    Introduction: In this study, it is aimed to compare the long-term results of patients with short-segment instrumentation where screws were inserted into the fractured vertebra with those of patients with long-segment instrumentation applied by skipping the fractured vertebra and reveal the predictive markers in decision-making for screwing fractured vertebra.Methods: Patients were separated into two groups, namely, Group A (patients in which the fractured vertebra and vertebrae above and below the fractured vertebra were screwed (short-segment instrumentation, n=22) and Group B (patients in whom the fractured vertebra was not screwed, whereas two vertebrae above and below the fractured vertebra were screwedResults: The presence of pedicle fracture, AOSpine Classification Scale score, the height of the fractured vertebra, vertebra height below the fractured vertebra, spinal canal diameter, and duration of stay in hospital were different between the groups, preoperatively (p<0.05). Fractured vertebra height, vertebra height below the fractured vertebra, and Karnofsky Performance Scale score were different between the groups in long-term follow-up (p<0.05). The preoperative measurement values were similar to each group's postoperative long-term follow-up results. Logistic regression analysis revealed that the presence of pedicle fracture, AOSpine Classification Scale score, vertebra height below the fractured vertebra, and spinal canal diameter could be the best parameters in decision-making for screwing fractured vertebra (p<0.05). Conclusions: Both instrumentation procedures were observed to have similar effectiveness in preventing a collapse in fractured vertebra during long-term follow-up. It was thought that the AOSpine Classification Scale score, presence of pedicle fracture, vertebra height below the fractured vertebra, and spinal canal diameter could be used as predictive markers in decision-making for screwing fractured vertebrae. Consequently, it was concluded that patients with pedicle fractures, more height loss in the vertebra below the fractured vertebra, and narrow spinal canal would not be suitable for screwing the fractured vertebra.