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    C7-T1 anterior closing wedge bone-disc-bone osteotomy for the treatment of cervical yyperlordosis in muscular dystrophy a new technique for correction of a rare deformity
    (Lippincott Williams & Wilkins, 2014) Köse, Kamil Çağrı; Çalışkan, İslam; Bal, Emre; İnanmaz, Mustafa Erkan; Işık, Cengiz
    Study Design. A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported. Objective. To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters. Summary of Background Data. Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors' knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously. Methods. Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation. Results. The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up. Conclusion. Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine.
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    Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery?
    (Biomed Central Ltd, 2014) İnanmaz, Mustafa Erkan; Köse, Kamil Çağrı; Işık, Cengiz; Atmaca, Halil; Başar, Hakan
    Background: The prevalence of postoperative wound infection in patients with neuromuscular scoliosis surgery is significantly higher than that in patients with other spinal surgery. Hyperbaric oxygen has been used as a supplement to treat postsurgical infections. Our aim was to determine beneficiary effects of hyperbaric oxygen treatment in terms of prevention of postoperative deep infection in this specific group of patients in a retrospective study. Methods: Forty two neuromuscular scoliosis cases, operated between 2006-2011 were retrospectively reviewed. Patients who had presence of scoliosis and/or kyphosis in addition to cerebral palsy or myelomeningocele, postoperative follow-up >1 year and posterior only surgery were the subjects of this study. Eighteen patients formed the Hyperbaric oxygen prophylaxis (P-HBO) group and 24, the control group. The P-HBO group received 30 sessions of HBO and standard antibiotic prophylaxis postoperative, and the control group (received standard antibiotic prophylaxis). Results: In the P-HBO group of 18 patients, the etiology was cerebral palsy in 13 and myelomeningocele in 5 cases with a mean age of 16.7 (11-27 yrs). The average follow-up was 20.4 months (12-36mo). The etiology of patients in the control group was cerebral palsy in 17, and myelomeningocele in 7 cases. The average age was 15.3 years (8-32 yrs). The average follow-up was 38.7 months (18-66mo). The overall incidence of infection in the whole study group was 11.9% (5/42). The infection rate in the P-HBO and the control group were 5.5% (1/18), and 16.6% (4/24) respectively. The use of HBO was found to significantly decrease the incidence of postoperative infections in neuromuscular scoliosis patients. Conclusion: In this study we found that hyperbaric oxygen has a possibility to reduce the rate of post-surgical deep infections in complex spine deformity in high risk neuromuscular patients.
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    Cohesive taping and short-leg casting in acute low-type ankle sprains in physically active patients
    (Amer Podiatric Med Assoc, 2015) Uslu, Mustafa; İnanmaz, Mustafa Erkan; Özşahin, Mustafa; Işık, Cengiz; Arıcan, Mehmet
    Background: Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. Methods: Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. Results: In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. Conclusions: Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option. (J Am Podiatr Med Assoc 105(4): 307-312, 2015)
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    The effects of diabetes on symptoms of carpal tunnel syndrome treated with mini-open surgery
    (Acta Medica Belgica, 2013) Işık, Cengiz; Uslu, Mustafa; İnanmaz, Mustafa Erkan; Karabekmez, Furkan Erol; Köse, Kamil Çağrı
    This study aimed to evaluate the influence of type H diabetes mellitus (DM) on the postoperative outcomes of mini-open carpal tunnel syndrome (CTS) surgery. A total of 99 hands in 74 patients were included in the study. Of these, 36 patients (54 hands) had type H DM (Group A), and 38 patients (45 hands) had idiopathic CTS (Group B). Mini-open carpal tunnel release surgery was performed on all the hands. The night pain, weakness, paraesthesia, numbness complaints were significantly improved in both groups after surgery. However, thenar atrophy was improved significantly only in group A. Night pain, weakness, paraesthesia, numbness, and pillar pain were significantly worse in Group A than in Group B on postoperative examination. Postoperatively, Tinnel and Phalen tests were positive in 32 hands in Group A and 6 hands in Group B. Persistence of symptoms in diabetic patients was found to be more prevalent compared to non-diabetic controls after mini-open carpal tunnel release.
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    Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis : experimental study in a rat model
    (Wiley, 2014) İnanmaz, Mustafa Erkan; Uslu, Mustafa; Işık, Cengiz; Kaya, Ertuğrul; Taş, Tekin; Bayram, Recep
    Implant-related chronic osteomyelitis is a serious complication of orthopedic surgery requiring implant removal and radical debridement. Extracorporeal shockwave (ESW) have demonstrated significant bactericidal effectiveness in vitro and effectiveness and safety were evaluated in an animal model of osteomyelitis. In this experimental study, we aimed to test our hypothesis that the use of ESW together with systemic antibiotic treatment will provide synergy for the treatment of implant-related chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (MSSA). The proximal tibia of 32 rats was contaminated with (10)8CFU/ml methicillin-sensitive S. aureus (MSSA-ATCC 29213) and Kirschner-wires were placed into the medulla of the tibia. After 4 weeks, Kirschner-wires were removed and the rats were randomly divided into four groups: group I, untreated contaminated control group; group II, receiving only ESW therapy; group III, receiving only systemic teicoplanin; group IV, treated with a combination of ESW and systemic teicoplanin. ESW was applied twice to the infected limbs and all rats were sacrificed at the end of 8th week. The degree of tibial osteomyelitis was assessed by quantitative culture analysis. Bacterial counts in groups III and IV were significantly reduced relative to the control (p=0.002 and 0.001, respectively). The decrease in bacterial counts was more pronounced and significant in group IV compared to group III (p=0.024). In group II, bacterial counts also decreased, but the differences were in significant (p=0.068). Our experimental model suggests that ESW provides significant synergy for systemic antibiotic treatment. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of implant-related chronic osteomyelitis in rats. (c) 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:752-756, 2014.
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    High tibial osteotomy using a locking titanium plate with or without autografting
    (Atha Comunicacao & Editora, 2019) Sarman, Hakan; Işık, Cengiz; Uslu, Mustafa; İnanmaz, Mustafa Erkan
    Objective: To postoperatively evaluate knee scores, radiological assessment results, deficit correction, patellar height change, bone healing time, and weight bearing time in patients undergoing high tibial osteotomy (HTO) with/without autologous iliac bone grafting. Methods: This retrospective examination of treated controls from a randomized controlled study included 63 knees of 58 patients aged 46-59 years who underwent HTO with locking open wedge osteotomy plates. The patients were divided into two groups: Group A, HTO with autologous iliac bone grafts (n = 31); and Group B, HTO without autologous iliac bone grafts (n = 32). Clinical and radiological data were evaluated prospectively at the preoperative consultation and again at 6, 9, and 12 weeks, 6 months, and 1 year after the surgery (and annually thereafter). Results: There were no significant intergroup differences in the radiological assessment, deficit correction, patellar height change, bone-healing time, and weight-bearing time at any time after surgery. The knee scores changed positively in both groups (p < 0.001). Conclusions: There was no difference in the results of patients undergoing HTO with open wedge osteotomy titanium locking plates with or without autografting, and comorbidities resulting from autografts were eliminated with the use of locking plates.
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    Kemik yerine geçen biyomateryaller 1. kısım: İnsan kaynaklı greftler
    (2011) Kömürcü, Erkam; İnanmaz, Mustafa Erkan; Işık, Cengiz; Akan, Burak; Köse, Kamil Çağrı
    Kemik greftleri ortopedi, beyin cerrahisi, plastik cerrahi gibi branşlarda kaynamanın arttırılması, doku boşluklarının doldurulması, kemik eksikliklerinde yapısal güç sağlanması amacı ile giderek artan sıklıkta kullanılmaktadır. Günümüzde kullanılan greftler insan kaynaklı, hayvan kaynaklı ve sentetik greftler olarak çeşitlenmektedir. Okuyacağınız bu derlemede insan kaynaklı kemik greftlerini ve bunların başlıca kullanım alanlarını sunmaya çalıştık.
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    Kemik yerine geçen biyomateryaller 2. kısım: Hayvansal ve sentetik greftler
    (2011) Kömürcü, Erkam; İnanmaz, Mustafa Erkan; Işık, Cengiz; Akan, Burak; Köse, Kamil Çağrı
    Kemik greftleri Ortopedi, Beyin cerrahisi, Plastik cerrahi gibi branşlarda kaynamanın arttırılması, doku boşluklarının doldurulması, kemik eksikliklerinde yapısal güç sağlanması amacı ile giderek artan sıklıkta kullanılmaktadır. Günümüzde kullanılan greftler insan kaynaklı, hayvan kaynaklı ve sentetik greftler olarak çeşitlenmektedir. Okuyacağınız bu derlemede hayvansal ve sentetik kaynaklı kemik greftlerini ve bunların başlıca kullanım alanlarını sunmaya çalıştık.
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    The mechanisms of medial pedicle wall violation: Insertion method is as important as correct cannulation of the pedicle
    (Hindawi Limited, 2014) Işık, Cengiz; Köse, Kamil Çağrı; İnanmaz, Mustafa Erkan; Tagil, Suleyman Murat; Sarman, Hakan
    A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct cannulation of the pedicle. The study presents finding out the effect of insertion angle and insertion force on medial wall violation. We used 100 lumbar pedicles of cadavers. Special wooden blocks were produced to simulate a fixed angle fault after a correct pedicle cannulation. Pedicles were divided into 4 groups: 10-degree free drive (group 10), 15-degree free drive (group 15), 10-degree push drive (group 10P), and 15-degree push drive (group 15P). After insertion of pedicle screws, laminectomies were done and the pedicles were evaluated from the inside. Pedicle complications were more in group 10P than group 10 (P = 0.009). Medial wall fracture (P = 0.002) and canal penetration were more in group 15P than group 15 (P = 0.001). Groups 10P and 15P were similar regarding medial wall fractures but canal penetration was significantly higher in group 15P (P = 0.001). Medial wall breaches can happen after correct cannulation of pedicles. Change in insertion angle is one factor but the most important factor is the use of a pushing force while inserting a screw. The pedicle seems to be extremely tolerant to insertion angulation mistakes up to 10 degrees and tends to lead the screw into the correct path spontaneously. Copyright © 2014 Cengiz Isik et al.
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    Serum ghrelin levels during fracture healing and immunohistochemical investigation of ghrelin in bone tissue
    (Carbone Editore, 2014) Emeli, Adem; İnanmaz, Mustafa Erkan; Işık, Cengiz; Bentli, Recep; Karakurt, Lokman; Belhan, Oktay
    Background: Ghrelin is a hormone with efficacy on increasing osteoblastic cell proliferation, differentiation, growth hormone release, and preventing apoptosis. The present study aimed to investigate whether ghrelin has a role in bone fracture healing process and presence in the bone tissue. Patients and methods: Blood samples of 10 patients, who underwent surgery for fracture repair, were obtained for 4 times in the manner that; before fracture stabilization (preoperative) and on the postoperative lst, 10th, and 60th days. Additionally, blood samples were obtained from 10 healthy subjects (control group). Ghrelin levels in serum samples were measured by enzyme-linked immunosorbent assay method and presence of ghrelin was imnzunohistochemically investigated in bone tissue samples. Results: Although no difference was found between the groups in terms of blood levels of ghrelin, it was observed that acylated ghrelin level was increased beginning from the postoperative 1st day as compared to the control group. Des-acylated ghrelin levels were also increased as compared to the controls, except for the postoperative 10th day. Ghrelin was not detected in bone tissues. Osseous union was observed in all patients of the fracture group. Conclusions: we thought that increased acylated and des-acylated ghrelin levels were contributed to fracture healing process by means of enhancing cell proliferation, preventing apoptosis, presenting anti-inflammatory and antimicrobial effect and increasing growth hormone release.
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    Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine
    (British Editorial Soc Bone Joint Surgery, 2014) Köse, Kamil Çağrı; İnanmaz, Mustafa Erkan; Işık, Cengiz; Başar, Hakan; Çalışkan, İslam
    The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6 degrees (12 degrees to 28 degrees) which was corrected to -1.8 degrees (-5 degrees to 3 degrees) post-operatively and 2.4 degrees (0 degrees to 8 degrees) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.
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    Using a combination of intralaminar and pedicular screw constructs for enhancement of spinal stability and maintenance of correction in patients with sagittal imbalance: clinical applications and finite element analysis
    (Lippincott Williams & Wilkins, 2016) İnanmaz, Mustafa Erkan; Köse, Kamil Çağrı; Atmaca, Halil; Özkan, Arif; Işık, Cengiz
    Study Design:Case series and finite element analysis.Objective:To report the clinical results of using intralaminar screw-rod (ILS) constructs as supplements to regular pedicle screw (PS) constructs in high risk for implant failure patients and to report the results of a finite element analysis (FEA) of this new instrumentation technique.Summary of Background Data:Despite advances in surgery and implantation techniques, osteoporosis, obesity, revision surgeries, and neuromuscular conditions (such as the Parkinson disease) are challenges against achieving solid arthrodesis and maintaining correction. Additional fixation strategies must be considered in these patients. There is only one study in the literature suggesting that ILS can be used as alternative anchor points and/or to increase fixation strength in conjunction with the PSs.Materials and Methods:Five patients (3 male and 2 female) with mechanical comorbidities underwent PS+ILS to treat sagittal imbalance. In radiologic analysis, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis were analyzed. FEA of ILS augmentation technique were carried out.Four different models were created: (1) the full-construct model with ILS+PS 2 levels above and below the osteotomy of T10; (2) only PS 2 levels above and below T10; (3) ILS+PS 1 level above and below the osteotomy; and (4) short-segment PS with only PSs 1 level above and below the osteotomy. The stress/load distributions on the implants in vertebrae were analyzed.Results:The mean age of the patients included in this study was 41 years and the mean follow-up was 28.2 months. A total of 87 PSs and 39 ILSs were used. Both sagittal vertical axis and kyphosis angles showed significant improvements maintained at the latest follow-up. No pseudarthrosis or instrumentation failures were observed. FEA indicated that addition of ILS construct to a PS construct enabled decreased load bearing and increased implant life.Conclusions:Addition of an ILS construct to PS construct decreases osteotomy line deformation and reduces stress on pedicle fixation points, and the combination improves fixation stability over the conventional PS-rod technique.