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    Efficacy of epidural steroid injections and evaluation of surgical and anesthetic approaches in far-lateral disc herniations
    (Future Medicine Ltd, 2023) Gurbuz, Hande; Secer, Mehmet; Gokbel, Aykut
    Aim: To observe the long-term effect of epidural steroid injections (ESI) and describe surgical outcomes in patients with far-lateral lumbar disc herniations. Materials & methods: The medical records of 30 patients who underwent surgery for far-lateral lumbar disc herniations were reviewed. Results: ESI outcomes: pain scores decreased significantly after ESI (p = 0.004). The surgery was delayed for 13.78 +/- 8.59 months in patients who received ESI. Surgical outcomes: the improvement in the leg pain was considerably more significant than the back pain (p < 0.001). While motor deficit improved substantially (p < 0.001), there was persistent sensory dysesthesia. Conclusion: ESI does not prevent but may delay the surgery up to 28 months. Although postoperative pain scores were significantly decreased, there was persistent back pain and sensory paresthesia. Plain language summaryFar-lateral lumbar disc herniation is a rare condition, and it constitutes a specific group of lumbar disc hernias regarding its anatomic location. It causes far more severe and intractable back and leg pain than the other widely known group of disc hernias. Sometimes, it can lead to sensation disorders and even functional impairment in the legs. Few can benefit from conservative treatments, including painkillers and physical therapy so surgical treatment becomes inevitable in many patients. Lumbar steroid injections to the epidural space may provide significant symptom relief and delay surgery in certain patients.
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    Salvage posterior atlantoaxial fixation techniques: A retrospective study
    (Elsevier Espana Slu, 2022) Secer, Mehmet; Karakoyun, Oguz Durmus; Ulutas, Murat; Gokbel, Aykut; Cinar, Kadir; Yigitkanli, Kazim
    Object: Since the atlantoaxial region have critical neurovascular anatomy and limited bone surface for fusion, the application and choice of salvage fixation techniques are highly important. To discuss alternative posterior atlantoaxial fixation surgery techniques. Methods: We retrospectively surgical records of 22 patients that posterior atlantoaxial fixation techniques were applied. Results: The patients included 11 males and 11 females (mean age: 65.7 years). The fracture type that caused instability is type 2 odontoid fractures (22). In six of these patients alternative stabilization techniques were applied due to anatomical variations, huge venous bleeding and iatrogenic trauma of the screw entry points during surgery. Conclusions: Owing to anatomical variations, intraoperative challenges, and/or instrumentation failures, performing alternative surgical fixation technique is an important factor that affects the success of stabilization of the atlantoaxial region. Knowledge of salvage techniques especially during the learning curve is vitally important. Surgeons should adapt to intraoperative surgical challenges as required. (c) 2021 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.