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    Complications of 2-Level Dynamic Stabilization: A Correlative Clinical and Radiological Analysis at Two-Year Follow-up on 103 Patients
    (Turkish Neurosurgical Soc, 2018) Ciplak, Necati Mert; Suzer, Tuncer; Senturk, Salim; Yaman, Onur; Sasani, Mehdi; Oktenoglu, Tunc; Yilmaz, Atilla
    AIM: To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. MATERIAL and METHODS: Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year follow-up. Screw breakage and loosening were evaluated during this duration together with clinical findings. RESULTS: Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. CONCLUSION: Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.
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    Disc Rehydration after Dynamic Stabilization: A Report of 59 Cases
    (Korean Soc Spine Surgery, 2017) Yilmaz, Atilla; Senturk, Salim; Sasani, Mehdi; Oktenoglu, Tunc; Yaman, Onur; Yildirim, Hakan; Suzer, Tuncer
    Study Design: A retrospective study investigating decrease in the nucleus pulposus signal intensity or disc height on magnetic resonance imaging (MRI) and disc degeneration. Purpose: Although a degenerated disc cannot self- regenerate, distraction or stabilization may provide suitable conditions for rehydration and possible regeneration. This study aimed to evaluate clinical outcomes and disc regeneration via MRI in a series of patients with degenerative disc disease (DDD) who underwent lumbar stabilization with a dynamic stabilization system (DSS). Overview of Literature: A dynamic system provides rehydration during early DDD. Methods: Fifty- nine patients (mean age, 46.5 years) who undedwent stabilization with DSS for segmental instability (painful black disc) between 2004 and 2014 were retrospectively evaluated. All patients underwent MRI preoperatively and 12 months postoperatively. Intervertebral disc (IVD) degeneration grades at the implanted segment were categorized using the Pfirrmann classification system. Patients were followed for a mean of 6.4 years, and clinical outcomes were based on visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results: Significant improvements in back pain VAS and ODI scores from before surgery (7 and 68%, respectively) were reported at 6 (2.85 and 27.4%, respectively) and 12 months postoperatively (1.8 and 16.3%, respectively). Postoperative IVD changes were observed in 28 patients. Improvement was observed in 20 patients (34%), whereas progressive degeneration was observed in eight patients (13.5%). Thirty- one patients (52.5%) exhibited neither improvement nor progression. Single Pfirrmann grade improvements were observed in 29% of the patients and two- grade improvements were observed in 5%. Conclusions: Our observations support the theory that physiological movement and a balanced load distribution are necessary for disc regeneration. We conclude that DSS may decelerate the degeneration process and appears to facilitate regeneration.
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    High Infection Rates in Patients with Long-Segment Dynesys System
    (Elsevier Science Inc, 2018) Akyoldas, Goktug; Yilmaz, Atilla; Aydin, Ahmet Levent; Oktenoglu, Tunc; Sasani, Mehdi; Suzer, Tuncer; Akiz, Cenk
    BACKGROUND: Infection follow-up in patients stabilized with the Dynesys system. Infection rates were determined in patients who had >= 5 segments stabilized with the Dynesys system. METHODS: Eighty-three patients with various etiologies were stabilized with the Dynesys system. Long-level stabilization patients were separated from the main group as a result of their high rates of infection. RESULTS: Long-level stabilizations were performed in 8 of 83 patients. Five patients were determined to have infections including 4 deep infections and 1 superficial infection. In patients with deep infections, 3 of them exhibited chronic infections that lasted for approximately 2 years and the system was removed. A deep infection in 1 patient and a superficial infection in 1 patient were diagnosed after 1 month. The early-diagnosed deep infection patient was treated with wound irrigation and antibiotics. The system was not removed, and the wound was closed with daily dressing after 45 days. One superficial infection patient was only treated with daily dressing, and the infection healed within 2 weeks. The infectious agent was determined in 2 patients. Three patients in the chronic infection group underwent a surgical procedure to remove the system. Specific antibiotic treatments were administered to patients whose infectious agents were identified. The remaining patients were treated with wide-spectrum antibiotics. CONCLUSIONS: We report that long-level stabilization with the Dynesys system results in a high infection rate.
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    Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients
    (Korean Orthopaedic Assoc, 2017) Ozer, Ali Fahir; Oktenoglu, Tunc; Egemen, Emrah; Sasani, Mehdi; Yilmaz, Atilla; Erbulut, Deniz Ufuk; Yaman, Onur
    Background: This study compares the clinical and radiological results of three most commonly used dynamic stabilization systems in the field of orthopedic surgery. Methods: A total of 71 patients underwent single-level posterior transpedicular dynamic stabilization between 2011 and 2014 due to lumbar degenerative disc disease. Three different dynamic systems used include: (1) the Dynesys system; (2) a dynamic screw with a PEEK rod; and (3) a full dynamic system (a dynamic screw with a dynamic rod; BalanC). The mean patient age was 45.8 years. The mean follow-up was 29.7 months. Clinical and radiological data were obtained for each patient preoperatively and at 6, 12, and 24 months of follow-up. Results: Clinical outcomes were significantly improved in all patients. There were no significant differences in the radiological outcomes among the groups divided according to the system used. Screw loosening was detected in 2 patients, and 1 patient developed screw breakage. All patients with screw loosening or breakage underwent revision surgery. Conclusions: Each procedure offered satisfactory outcome regardless of which system was applied.