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Publication Metadata only Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature(ELSEVIER SCIENCE INC, 2018) Bayoumi, Ahmed B.; Efe, Ibrahim E.; Berk, Selim; Kasper, Ekkehard M.; Toktas, Zafer Orkun; Konya, Deniz; Bahcesehir University; Free University of Berlin; Humboldt University of Berlin; Charite Universitatsmedizin Berlin; Harvard University; Harvard University Medical Affiliates; Beth Israel Deaconess Medical Center; Harvard Medical SchoolBACKGROUND: The cervicothoracic junction is a challenging anatomic transition in spine surgery. It is commonly affected by different types of diseases that may significantly impair stability in this region. The seventh cervical vertebra (C7) is an atypical cervical vertebra with unique anatomic features compared to subaxial cervical spine (C3 to C6). C7 has relatively broader laminae, larger pedicles, smaller lateral masses, and a long nonbifid spinous process. These features allow a variety of surgical methods for performing posterior rigid instrumentation in the form of different types of screws, such as lateral mass screws, pedicle screws, transfacet screws, and intralaminar screws. Many biomechanical studies on cadavers have evaluated and compared different types of implants at C7. METHODS: We reviewed PubMed/ Medlineby using specific combinations of keywords to summarize previously published articles that examined C7 posterior rigid instrumentation thoroughly in an experimental fashion on patients or cadavers with additional descriptive radiologic parameters for evaluation of the optimum surgical technique for each type. RESULTS: A total of 44 articles were reported, including 22 articles that discussed anatomic considerations (entry points, sagittal and axial trajectories, and features of screws) and another 22 articles that discussed the relevant biomechanical testing at this transitional region if C7 was directly involved in terms of receiving posterior rigid implants. CONCLUSIONS: C7 can accommodate different types of screws, which can provide additional benefits and risks based on availability of bony purchase, awareness of surgical technique, biomechanics, and anatomic considerations.Publication Metadata only Cervical intradural extramedullary epidermoid cyst at the background of congenital scoliosis with a semi-segmented C6 hemivertebra(SPRINGER, 2019) Turgut, Veli Umut; Eksi, Murat Sakir; Ozak, Ahmet; Ozcan-Eksi, Emel Ece; Antalya Ataturk State Hospital; Acibadem University; Bahcesehir UniversityIn the present case study, we present a female adolescent patient harboring a rare clinical presentation of spinal intradural extramedullary epidermoid cyst concomitant with congenital scoliosis. A 17-year-old female patient was admitted to the clinic with long-lasting neck pain. She was neurologically intact yet had cervicothoracic scoliosis. Cervical MRI and CT depicted a right C6 hemivertebra, fused to the lower endplate of the C5 vertebra. At the same vertebra level, she had an intradural extramedullary mass lesion anterior to the spinal cord. We planned to excise the mass lesion first. We used neuromonitoring during the surgery and made the surgery via posterior approach. We observed a pearl-like mass lesion anterolateral to the spinal cord. We excised the mass lesion with its capsule microsurgically via peace-meal route. She was neurologically stable following the surgery. Histopathological diagnosis was epidermoid cyst. Most of spinal inclusion cysts occur secondary to spinal dysraphism or iatrogenic inoculation. Isolated spinal inclusion cyst located anterior to the spinal cord concomitant with vertebral anomalies should be kept in mind before making proper surgical planning. Surgery is the modality of choice for spinal inclusion cyst and should be performed under the guidance of neuromonitoring, especially in cases with lesions located at higher spinal levels.Publication Metadata only Heterotopic Ossification in Cervical Disk Surgery Is Still a Problem. What Are the Key Factors for a Solution?(ELSEVIER SCIENCE INC, 2016) Cesar Noriega, David; Hernandez Ramajo, Ruben; Sanchez-Lite, Israel; Toribio, Borja; Delen, Emle; Sahin, Soner; Bahcesehir University; Trakya UniversityBACKGROUND: The aim of our study was to determine the presence of heterotopic ossifications (HO) in a series of patients with cervical disk arthroplasty treated with different type of prosthesis, as well as to analyze the most suitable systems for diagnosis. METHODS: A retrospective study of patients with cervical disk disease treated with cervical arthroplasty between May 2005 and December 2009, was performed. Patients were divided into 3 groups, depending on the prosthesis implanted: (Group A: Baguera prosthesis, Group B: ProDisc prosthesis, and Group C: PCM prosthesis). The presence of heterotopic ossifications was evaluated with both, simple radiology and computed tomography. RESULTS: As a summary of the results on motion preservation, computed tomography scans showed that 63% of the cervical arthroplasties in Group A presented good mobility at the first check point (December 2010), whereas cervical arthroplasties in Group B and Group C had 74% and 65% severe motion restrictions, respectively (Grade III or Grade IV, according to McAfee classification). The differences between groups were statistically significant when comparing Groups A and B, and Groups A and C (P < 0.05), but there were no differences between Groups B and C (P < 0.05). At the second check point (December 2014), the good mobility was just preserved in the 26% of the disk replacements (all in Group A). CONCLUSIONS: Our results showed that, although cervical disks provide optimal mid-term results, the incidence of HO seems to increase with time. Long term studies, with a larger sample size should be conducted to evaluate the appearance of HO and cervical motion after total disk replacement.Publication Metadata only Anterior transpedicular screw fixation of cervical spine: Is it safe? Morphological feasibility, technical properties, and accuracy of manual insertion(American Association of Neurological Surgeons, 2015) Köktekir, Ender; Toktaş, Zafer Orkun; Şeker, Aśkin N.; Akakin, Akin In; Konya, Deniz; Kilic, Turker D.; Köktekir, Ender, Department of Neurosurgery, Selçuk Üniversitesi, Selçuklu, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Şeker, Aśkin N., Department of Neurosurgery, Marmara Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kilic, Turker D., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyOBJECT: Due to lack of construct stability of the current anterior cervical approaches, supplemental posterior cervical approaches are frequently employed. The use of an anterior-only approach with anterior transpedicular screws (ATPSs) has been proposed as a means of providing 3-column fixation. This study was designed to investigate the feasibility of anterior transpedicular screw (ATPS) fixation of cervical spine, to obtain the morphological measurements for technical prerequisites, and to evaluate the accuracy of the ATPS using fluoroscopy. METHODS: The study included both radiological and anatomical investigations. The radiological investigations were based on data from cervical spine CT scans performed in 65 patients. Technical prerequisites of ATPS were calculated using OsiriX for Mac OS. In the anatomical part of the study, 30 pedicles (C3-7) from 6 formalin-preserved cadavers were manually instrumented. Measurements obtained included pedicle width (PW), pedicle height (PH), pedicle transverse angle (PTA), distance of the entry point from the midline (DEPM), and distance of the entry point from the superior endplate (DEPSEP). The authors also analyzed screw position in the manually instrumented vertebrae. RESULTS: The mean PW and PH values showed a tendency to increase from C-3 to C-7 in both males and females. The means were significantly larger for both PW and PH in males than in females at all levels (p = 0.001). The overall mean PTA value was significantly lower at C-7 (p < 0.0001). The mean value for the distance of entry point from the midline (DEPM) represented a point at the contralateral side of the pedicle for every level except C-7. The mean DEPSEP values showed significant differences between all levels (p < 0.0001). Seven of the 30 screws were identified as breaching the pedicle (23.3%), these screw malplacements were seen at C-3 (3 screws), C-4 (2 screws), and C-5 (2 screws). CONCLUSIONS: The morphological measurements of this study demonstrated that ATPS fixation is feasible in selected cases. They indicate that ATPS insertion using a fluoroscopy-assisted pedicle axis view is safe at the C-6 and C-7 levels, but the results at the other levels did not prove the safety of this technique. © 2018 Elsevier B.V., All rights reserved.Publication Metadata only Heterotopic Ossification in Cervical Disk Surgery Is Still a Problem. What Are the Key Factors for a Solution?(Elsevier Inc. [email protected], 2016) Noriega-González, David; Ramajo, Rubén Hernandez; Sánchez-Lite, Israel; Toribio, Borja; Delen, Emle; Şahin, Soner; Noriega-González, David, Spine-Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Ramajo, Rubén Hernandez, Spine-Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Sánchez-Lite, Israel, Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Toribio, Borja, Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Delen, Emle, Department of Neurosurgery, Trakya Üniversitesi, Edirne, Turkey; Şahin, Soner, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyBackground The aim of our study was to determine the presence of heterotopic ossifications (HO) in a series of patients with cervical disk arthroplasty treated with different type of prosthesis, as well as to analyze the most suitable systems for diagnosis. Methods A retrospective study of patients with cervical disk disease treated with cervical arthroplasty between May 2005 and December 2009, was performed. Patients were divided into 3 groups, depending on the prosthesis implanted: (Group A: Baguera prosthesis, Group B: ProDisc prosthesis, and Group C: PCM prosthesis). The presence of heterotopic ossifications was evaluated with both, simple radiology and computed tomography. Results As a summary of the results on motion preservation, computed tomography scans showed that 63% of the cervical arthroplasties in Group A presented good mobility at the first check point (December 2010), whereas cervical arthroplasties in Group B and Group C had 74% and 65% severe motion restrictions, respectively (Grade III or Grade IV, according to McAfee classification). The differences between groups were statistically significant when comparing Groups A and B, and Groups A and C (P < 0.05), but there were no differences between Groups B and C (P < 0.05). At the second check point (December 2014), the good mobility was just preserved in the 26% of the disk replacements (all in Group A). Conclusions Our results showed that, although cervical disks provide optimal mid-term results, the incidence of HO seems to increase with time. Long term studies, with a larger sample size should be conducted to evaluate the appearance of HO and cervical motion after total disk replacement. © 2017 Elsevier B.V., All rights reserved.Publication Metadata only Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature(Elsevier Inc. [email protected], 2018) Bayoumi, Ahmed B.; Efe, Ibrahim Efecan; Berk, Selim; Kasper, Ekkehard Matthias; Toktaş, Zafer Orkun; Konya, Deniz; Bayoumi, Ahmed B., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Efe, Ibrahim Efecan, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey, Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany; Berk, Selim, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kasper, Ekkehard Matthias, Division of Neurosurgery, Harvard Medical School, Boston, United States; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyBackground: The cervicothoracic junction is a challenging anatomic transition in spine surgery. It is commonly affected by different types of diseases that may significantly impair stability in this region. The seventh cervical vertebra (C7) is an atypical cervical vertebra with unique anatomic features compared to subaxial cervical spine (C3 to C6). C7 has relatively broader laminae, larger pedicles, smaller lateral masses, and a long nonbifid spinous process. These features allow a variety of surgical methods for performing posterior rigid instrumentation in the form of different types of screws, such as lateral mass screws, pedicle screws, transfacet screws, and intralaminar screws. Many biomechanical studies on cadavers have evaluated and compared different types of implants at C7. Methods: We reviewed PubMed/Medline by using specific combinations of keywords to summarize previously published articles that examined C7 posterior rigid instrumentation thoroughly in an experimental fashion on patients or cadavers with additional descriptive radiologic parameters for evaluation of the optimum surgical technique for each type. Results: A total of 44 articles were reported, including 22 articles that discussed anatomic considerations (entry points, sagittal and axial trajectories, and features of screws) and another 22 articles that discussed the relevant biomechanical testing at this transitional region if C7 was directly involved in terms of receiving posterior rigid implants. Conclusions: C7 can accommodate different types of screws, which can provide additional benefits and risks based on availability of bony purchase, awareness of surgical technique, biomechanics, and anatomic considerations. © 2018 Elsevier B.V., All rights reserved.Publication Metadata only Cervical intradural extramedullary epidermoid cyst at the background of congenital scoliosis with a semi-segmented C6 hemivertebra(Springer Verlag [email protected], 2019) Turgut, Veli Umut; Ekşi̇, Murat Şakir; Özak, Ahmet C.; Özcan-Ekşi̇, Emel Ece; Turgut, Veli Umut, Neurosurgery Clinic, Antalya Atatürk State Hospital, Antalya, Turkey; Ekşi̇, Murat Şakir, Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar Üniversitesi, Istanbul, Turkey; Özak, Ahmet C., Neurosurgery Clinic, Antalya Atatürk State Hospital, Antalya, Turkey; Özcan-Ekşi̇, Emel Ece, Department of Physical Medicine and Rehabilitation, Bahçeşehir Üniversitesi, Istanbul, TurkeyIn the present case study, we present a female adolescent patient harboring a rare clinical presentation of spinal intradural extramedullary epidermoid cyst concomitant with congenital scoliosis. A 17-year-old female patient was admitted to the clinic with long-lasting neck pain. She was neurologically intact yet had cervicothoracic scoliosis. Cervical MRI and CT depicted a right C6 hemivertebra, fused to the lower endplate of the C5 vertebra. At the same vertebra level, she had an intradural extramedullary mass lesion anterior to the spinal cord. We planned to excise the mass lesion first. We used neuromonitoring during the surgery and made the surgery via posterior approach. We observed a pearl-like mass lesion anterolateral to the spinal cord. We excised the mass lesion with its capsule microsurgically via peace-meal route. She was neurologically stable following the surgery. Histopathological diagnosis was epidermoid cyst. Most of spinal inclusion cysts occur secondary to spinal dysraphism or iatrogenic inoculation. Isolated spinal inclusion cyst located anterior to the spinal cord concomitant with vertebral anomalies should be kept in mind before making proper surgical planning. Surgery is the modality of choice for spinal inclusion cyst and should be performed under the guidance of neuromonitoring, especially in cases with lesions located at higher spinal levels. © 2019 Elsevier B.V., All rights reserved.