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Publication Metadata only Biological Approaches to Treating Intervertebral Disk Degeneration: Devising Stem Cell Therapies(SAGE PUBLICATIONS INC, 2015) Han, Inbo; Ropper, Alexander E.; Konya, Deniz; Kabatas, Serdar; Toktas, Zafer; Aljuboori, Zaid; Zeng, Xiang; Chi, John H.; Zafonte, Ross; Teng, Yang D.; Harvard University; Harvard Medical School; Harvard University; Harvard University Medical Affiliates; Brigham & Women's Hospital; Pochon Cha University; Barrow Neurological Institute; Bahcesehir University; Reyap Hospital; University of Louisville; Harvard University; Harvard Medical School; Harvard University Medical Affiliates; Spaulding Rehabilitation Hospital; Harvard University; Harvard University Medical Affiliates; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Boston Healthcare SystemIntervertebral disk (IVD) degeneration is a common, chronic, and complex degeneration process that frequently leads to back pain and disability, resulting in a major public health issue. In this review we describe biological therapies under preclinical or clinical development with an emphasis on stem cell-based multimodal approaches that target prevention and treatment of IVD degeneration. Systematical review of the basic science and clinical literature was performed to summarize the current status of devising biological approaches to treating IVD degeneration. Since the exact mechanisms underlying IVD degeneration have not yet been fully elucidated and conservative managements appear to be mostly ineffective, current surgical treatment focuses on removal of the pathological disk tissues combined with spinal fusion. The treatment options, however, often produce insufficient efficacy and even serious complications. Therefore, there have been growing demands and endeavors for developing novel regenerative biology-guided strategies for repairing the IVD via delivery of exogenous growth factors, introduction of therapeutic genes, and transplantation of stem cells, or combinatorial therapies. Overall, the data suggest that when applied under a recovery neurobiology principle, multimodal regimens comprising ex vivo engineered stem cell-based disks hold a high potential promise for efficacious clinical translations.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 Locally Aggressive De Novo Spinal Fibromatosis: Case Report and Review of the Literature(TURKISH NEUROSURGICAL SOC, 2015) Eksi, Murat Sakir; Turkoz, Huseyin Kemal; Ozcan Eksi, Emel Ece; Akakin, Akin; Toktas, Zafer Orkun; Konya, Deniz; University of California System; University of California San Francisco; Marmara University; Bahcesehir UniversityFibromatosis is a benign lesion, which originates from proliferating fibroblasts. Although fibromatosis is a benign tumor, it is locally aggressive and invasive. Spinal presentation of fibromatosis is very rare, and case reports are the only source of the clinical knowledge. Herein, we describe the oldest patient having spinal fibromatosis with de novo occurrence and aggressive nature. A 68-year-old female patient admitted to our outpatient clinic with low back pain and neurological claudication. On lumbar spine magnetic resonance imaging, she had spinal canal stenosis with a concomitant lesion in the left longissimus muscle. We did our best to resect the tumor, entirely. The pathology result was consistent with spindle cell lesion. The lesion recurred 6 months after the primary surgery. In the second surgery, we did en bloc resection. Pathology and immunohistochemical analysis results were consistent with fibromatosis. After the second surgery, she had adjuvant radiotherapy. There was nothing other than radionecrosis in the operation site, still after 2 years. In conclusion, radiological work-up is usually insufficient to make fibromatosis diagnosis and whole pathological specimen should be carefully evaluated to achieve the accurate diagnosis. Spinal fibromatosis is very rare and its treatment methods have not universally been conceptualized. However, adjuvant therapies are necessary after en bloc resection.Publication Metadata only Spinal epidural cavernous angioma: two case reports and review of the literature(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2015) Bayri, Yasar; Eksi, Murat Sakir; Koc, Demet Yalcinkaya; Konya, Deniz; Marmara University; University of California System; University of California San Francisco; Marmara University; Bahcesehir UniversityCavernous angiomas are vascular malformations that occur most frequently in the supratentorial area of the central nervous system (CNS). Spinal epidural occurrence is rare. This article describes 2 cases of spinal epidural cavernous angioma. The lesions were hypo-to isointense on T1-weighted magnetic resonance images (MRIs) and hyperintense on T2-weighted images. Both were enhanced homogenously with intravenous contrast. Total resection was achieved in both cases, and the lesions were histopathologically diagnosed as cavernous angiomas. The patients' symptoms regressed postsurgery. Although the MRI features of cavernous angiomas are well known, spinal epidural occurrence is rare and many differential diagnoses have similar clinical and imaging findings. It is important to definitively diagnose these lesions prior to surgery in order to prevent possible intraoperative complications such as massive bleeding and to maximize chances for complete resection. In addition to case descriptions, this article includes a thorough literature review to raise clinical awareness about this well-known but rare spinal entity.Publication Metadata only Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks(KOREAN SOC SPINE SURGERY, 2019) Bayoumi, Ahmed B.; Ikizgul, Oyku; Karaali, Ceren Nur; Bozkurt, Selma; Konya, Deniz; Toktas, Zafer Orkun; Bahcesehir University; McMaster University; McMaster University Hospital; Bahcesehir University; Bahcesehir UniversityAntidepressant drugs can be advantageous in treating psychiatric and non-psychiatric illnesses, including spinal disorders. However, spine surgeons remain unfamiliar with the advantages and disadvantages of the use of antidepressant drugs as a part of the medical management of diseases of the spine. Our review article describes a systematic method using the PubMed/Medline database with a specific set of keywords to identify such benefits and drawbacks based on 17 original relevant articles published between January 2000 and February 2018, this provides the community of spine surgeons with available cumulative evidence contained within two tables illustrating both observational (10 studies, three cross-sectional, three case-control, and four cohort studies) and interventional (seven randomized clinical trials) studies. While tricyclic antidepressants (e.g., amitriptyline) and duloxetine can be effective in the treatment of neuropathic pain caused by root compression, venlafaxine may be more appropriate for patients with spinal cord injury presenting with depression and/or nociceptive pain. Despite the potential associated consequences of a prolonged hospital stay, higher cost, and controversial reports regarding the lowering of bone mineral density in the elderly, antidepressants may improve patient satisfaction and quality of life following surgery, and reduce postoperative pain and risk of delirium. The preoperative treatment of preexisting psychiatric diseases, such as anxiety and depression, can improve outcomes for patients with spinal cord injury-related disabilities, however, a preoperative platelet function assay is advocated prior to major spine surgical procedures to protect against significant intraoperative blood loss, as serotonergic antidepressants (e.g., selective serotonin reuptake inhibitors) and bupropion can increase the likelihood of bleeding intraoperatively due to drug-induced platelet dysfunction. This comprehensive review of this evolving topic can assist spine surgeons in better understanding the benefits and risks of antidepressant drugs to optimize outcomes and avoid potential hazards in a spine surgical setting.Publication Metadata only Rare Solitary Primary Osseous Lesions of the Spine in Adults, Challenges in CT and MR Imaging Diagnosis With Pathological Correlation(JOURNAL NEUROLOGICAL SCIENCES, 2015) Toktas, Zafer Orkun; Yilmaz, Baran; Akakin, Akin; Demir, Mustafa Kemal; Yapicier, Ozlem; Onat, Elif; Urgun, Kamran; Konya, Deniz; Bahcesehir University; Bahcesehir University; Bahcesehir UniversityThis pictorial essay is a review of the computerized tomography and magnetic resonance imaging of a few solitary primary osseous lesions encountered in the adults. The lesions discussed include giant cell tumor, Langerhans cell histiocytosis, Paget'sdisease, plasmacytoma, fibrous dysplasia and osteoblastoma. Challenges in computerized tomography and magnetic resonance imaging diagnosis of these lesions are mentioned with clinicoradiological differential diagnosis, and include pathological correlation. Although active diagnosis and radiological familiarity of these lesions is crucial for preventing unnecessary examinations or procedures, pathological evaluation is mandatory to establish final diagnosis.Publication Open Access Biological approaches to treating intervertebral disk degeneration: Devising stem cell therapies(Cognizant Communication Corporation inquiries@cognizantcommunication.com 3 Hartsdale Road Elmsford NY 10523-3701, 2015) Han, Inbo; Ropper, Alexander Eli; Konya, Deniz; Kabataş, Serdar; Toktaş, Zafer Orkun; Aljuboori, Zaid S.; Zeng, Xiang; Chi, John H.; Zafonte, Ross D.; Teng, Yang D.; Han, Inbo, Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Neurosurgery, College of Medicine, Pochon CHA University, Pocheon, South Korea; Ropper, Alexander Eli, Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, United States; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kabatas, Serdar, Department of Neurosurgery, Reyap Hospital, Tekirdag, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Aljuboori, Zaid S., Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, University of Louisville School of Medicine, Louisville, United States; Zeng, Xiang, Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Neurosurgery, College of Medicine, Pochon CHA University, Pocheon, South Korea; Chi, John H., Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States; Zafonte, Ross D., Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Boston, United States; Teng, Yang D., Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Boston, United States, Division of SCI Research, VA Medical Center, United StatesIntervertebral disk (IVD) degeneration is a common, chronic, and complex degeneration process that frequently leads to back pain and disability, resulting in a major public health issue. In this review we describe biological therapies under preclinical or clinical development with an emphasis on stem cell-based multimodal approaches that target prevention and treatment of IVD degeneration. Systematical review of the basic science and clinical literature was performed to summarize the current status of devising biological approaches to treating IVD degeneration. Since the exact mechanisms underlying IVD degeneration have not yet been fully elucidated and conservative managements appear to be mostly ineffective, current surgical treatment focuses on removal of the pathological disk tissues combined with spinal fusion. The treatment options, however, often produce insufficient efficacy and even serious complications. Therefore, there have been growing demands and endeavors for developing novel regenerative biology-guided strategies for repairing the IVD via delivery of exogenous growth factors, introduction of therapeutic genes, and transplantation of stem cells, or combinatorial therapies. Overall, the data suggest that when applied under a recovery neurobiology principle, multimodal regimens comprising ex vivo engineered stem cell-based disks hold a high potential promise for efficacious clinical translations. © 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. usjcs@elsevier.com, 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 Open Access Rare Solitary Primary Osseous Lesions of the Spine in Adults, Challenges in CT and MR Imaging Diagnosis With Pathological Correlation(2015) Şahan Yapıcıer, Özlem; Toktaş, Zafer Orkun; Akakın, Akın; Yılmaz, Baran; Urgun, Kamran; Onat, Elif; Demir, Mustafa Kemal; Konya, Deniz; Bahçeşehir Üniversitesi; Bahçeşehir Üniversitesi; Bahçeşehir Üniversitesi; Bahçeşehir Üniversitesi; Bahçeşehir Üniversitesi; Bahçeşehir Üniversitesi; Bahçeşehir Üniversitesi; Bahçeşehir ÜniversitesiBu inceleme yazısında, yetişkinlerde gözlemlenen birkaç çeşit primer soliter kemiklezyonunun bilgisayarlı tomografi ve manyetik rezonans görüntüleme iledeğerlendirilmelerini gözden geçirmeyi hedefledik. Büyük hücreli tümör, Langerhans hücrelihistiositoz, Paget hastalığı, plazmasitom, fibrozdisplazi ve osteoblastom lezyonlarındanbahsedildi. Bu lezyonların bilgisayarlı tomografi ve manyetik rezonans görüntülemelerleyapılan radyolojik tetkiklerinde tanı koyma esnasındaki zorluklar, bu lezyonların klinik- radyolojik ayırıcı tanılarından ve patoloji ile korelasyonlarından bahsederek, anlatılmıştır. Herne kadar gereksiz tetkik ve müdahaleleri engellemek adına bahsedilen lezyonların radyolojiközelliklerini iyi bilmek gerekse de, kesin tanı patolojik inceleme ile mümkündür.