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Aim: In this study, our aim was to examine if matrix metalloproteinase expressions (MMP-1, MMP-2, MMP-3) in patients operated with a lumbar disc hernia diagnosis are different in terms of clinical and neuroradiological findings., Material and Methods: The study included 80 patients treated with micro discectomy for lumbar disc hernia. Degeneration was scored via magnetic resonance (MR) images. MMP-1, MMP-2, and MMP-3 antibodies were used for immunohistochemical evaluation of degenerated disc materials. MMP expressions were compared between primary and recurrent cases, and correlation analysis was conducted., Results: Discectomy material showed higher expression of MMP-1 and MMP-3 in cases of recurrent lumbar disc herniation than in primary herniation. There was no significant relationship between MMP expression and MR degeneration score., Conclusion: MMP-1 and MMP-3 expressions were significantly higher in recurrent cases in terms of magnetic resonance degeneration score. We assume that the higher co-expression of MMP-1 and MMP-3 might be used in targeted treatment regiemens in patients with recurrent LDH.

Aim: The matrix metalloproteinase (MMP) enzyme family has been shown to be active in tumorigenesis and tumor progression. In this study, we analyzed the prevalence of a guanine insertion in the MMP-1 gene promoter region in meningiomas and its effect on invasion and prognosis., Material and Methods: The study was performed with 33 meningioma patients. We also included 33 healthy patients in the study as a control group. The promoter area was amplified by polymerase chain reaction (PCR) following DNA isolation. The polymorphism was detected by restriction fragment length polymorphism (RFLP)., Results: According to the WHO classification of meningiomas, 87.9% of the affected patients were grade 1, and 12.1% were grade 2. In total, 72.7% of the meningioma patients (n=24) had at least one copy of the insertion (2G/1G or 2G/2G genotypes) and 27.3% (n=9) did not (1G/1G). There was no significant difference between the meningioma and control groups according to genotype distribution., Conclusion: In this study, the polymorphism in the matrix metalloproteinase-1 gene promoter region did not have an effect on the initiation, growth and progression of meningioma.

Aim: Minimally invasive surgery is currently a goal for surgical intervention in the spine. The effectiveness of endoscopic thoracic spine surgery and technological improvements are two factors that are always under consideration in the practice of spinal surgery., Material and Methods: We present twenty-five patients whose thoracoscopic spinal surgeries were performed between 2002 and 2008 for the treatment of various spinal diseases. Eleven patients with thoracic disc herniation, five patients with traumatic thoracic spinal compressive fracture, six patients with metastatic thoracic spinal tumors and three patients with tubercular spondylitis underwent thoracoscopic spine surgery. Clinical evaluations were performed at 3, 6,12 and 24 months post-surgery. The Oswestry disability questionnaire and linear visual analog scale (VAS) were used for the evaluation of pain., Results: Postoperatively, two patients had lung contusions, one patient had pneumonia and one patient had instability. There were significant initial improvements in both the Oswestry score and the VAS pain score up to 6 months (p<0.05). The average relative difference in pain scores in all groups was not significant at 12 and 24 months (p>0.05)., Conclusion: The favorable results of thoracoscopic spinal surgery encourage its application to situations in which a conventional thoracic approach is indicated. Thoracoscopic spine surgery is applicable to all patients with various spinal diseases.

Fusion surgeries are still the gold standard in the treatment of the degenerative spine. Spinal fusion has some problems, however. Adjacent segment disease, donor place ailment, and the morbidity of the surgery has emerged as important problems over the years. As a consequence of such complications after fusion, the search for an alternative treatment for the degenerative spine widened. While trying to maintain the motion in the joint, dynamic stabilization aims to remove the pain by distributing the weight between anterior and posterior elements of the spine. Various new devices have now been developed for the dynamic stabilization of the spine. In this report, the dynamic stabilization devices of the spine are classified anew and, the authors explain briefly the historical evolution process, specialties, indications and contraindications of these dynamic stabilization devices.

Aim: In this study, we examined the results of utilizing the agile posterior dynamic stabilization system with dynamic transpedicular screws in our patients., Material and Methods: Posterior dynamic instrumentation with agile rods and dynamic transpedicular screws was employed in 15 (seven male and eight female) patients (mean age = 42, ranging from 30 to 53). The average follow-up duration was 19 months (ranging from 12 to 25). The primary purpose for the surgery was degenerative disc disease. For subjective evaluation, patients underwent a physical examination utilizing the Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic parameters, including the angle of lumbar lordosis (LL), angle of segmental lordosis (alpha) and intervertebral space (IVS), were also evaluated. Both subjective patient evaluations and radiographic parameters were assessed at the 3rd and 12th postoperative months., Results: Significant postoperative improvements were observed in the ODI and VAS measurements (P < 0.05). There were no significant differences in the LL, alpha and IVS parameters. One patient experienced a broken screw., Conclusion: We obtained good clinical results by utilizing dynamic rods with dynamic transpedicular screws.

Instability can develop after lumbar spinal surgery. What is also known as secondary segmental instability is one of the important causes of failed back syndrome. In this paper, we described a 45-year-old female patient who was diagnosed with secondary segmental instability caused by left L3 pars interarticularis fracture after a high lumbar disc surgery and was subsequently treated with re-operation. We evaluated the clinical course, diagnosis, and treatment methods for secondary segmental instability caused by postoperative pars interarticularis fracture. Furthermore, we emphasized the importance of preserving the pars interarticularis during upper lumbar disc surgeries in order to avoid a potential stress fracture.

Objective: Cervical laminoplasty is an effective procedure. We describe the technique of open-door and french-door cervical laminoplasty and present our clinical results., Methods: All patients undergoing laminoplasty at our clinic during the 1997- 2008 period were included in the study. All patients had myeloradiculopathy. Neurological functions and recovery in myelopathy in patients were evaluated using the Nurick score. Pre- and postoperative kyphotic evaluation was measured using the sagittal tangent method. Peri- and postoperative complications were recorded., Results: Clinical evaluation showed that all patients had reduced postoperative complaints compared to their complaints before the procedure. Average time of surgery was 180 min. Average blood loss in surgeries was 300 cc. According to the Nurick classification, no improvement was observed in seven patients; nine patients showed improvement of one grade; and three patients showed an improvement of two grades. Temporary C5 nerve root paralysis was observed in two patients as a postoperative complication. Complete recovery was observed in both patients within 2 months., Conclusions: Laminoplasty is a safe and effective alternative procedure to treat cervical spondylotic myelopathy.