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Cervical radiculopathy and spinal cord indentation caused by vertebral artery loop formation is a rare entity. We report here an 85-year-old woman had a four-year history of neck pain and left arm weakness. Radiologic evaluation showed vertebral artery loop formation compressing the adjacent nerve root and spinal cord. Accurate radiologic diagnosis of this condition is crucial to reduce unexpected surgical complications.

Aim: In neurosurgery, posterior approaches intended at the craniovertebral junction are frequently used. The most popular procedures for treating upper cervical instability are C1 lateral mass, C2 pedicle, and C1-C2 transarticular screw stabilization. Due to their proximity to neural structures and the presence of the high-riding vertebral artery, these techniques are complicated. By mobilizing the vertebral artery, the risk of VA damage can be decreased. Using cadaveric specimens in this study was aimed to demonstrate C2 pedicle and C1-C2 transarticular screw placement with vertebral artery mobilization and a novel C2 screw placement technique Method: In this study, twelve adult cadaveric specimens and two adult dry cadaveric C2 bones were used with the permission and decision of the University Research Ethics Committee. Colored silicone was injected into the arteries and veins of these twelve cadaveric specimens. Then, muscle dissection was performed stepwise, and the C2 vertebrae of the cadavers were revealed with a Surgical Microscope. Each specimen and entire stages of the dissections were recorded photographically. After cadaver dissections were completed and screw placement was performed with three different techniques, radiological imaging was done with fluoroscopy. Results: After dissection, the lateral mass of the C2 vertebra was observed, and lateral to it the transverse process and foramen were detected with the help of a hook. Next, the posterior wall of the vertebral artery groove was removed until the vertebral artery loop could partially be observed to mobilize the vertebral artery using a 1 mm thin plate Kerrison rongeur. This enables us to find the top of the loop of the vertebral artery and mobilize it inferiorly by using a dissector. Following this step, the C1-2 transarticular, C2 pedicle, and the novel C2 inferior corpus screw placement can be performed safely by directly visualizing the artery (Figure 1). Conclusion: Due to the nearby neurologic and vascular structures, placing the C2 pedicle and C1-2 transarticular screw is a challenging procedure, especially in high-riding vertebral artery cases. However, it is possible to place the C2 pedicle, C1-2 transarticular, and novel C2 inferior corpus screw after the mobilization of the vertebral artery. This study aimed to show all of them together on a cadaver for the first time, to understand the anatomy of the C2 vertebra, and to use screw placement techniques to minimize the risk of complications.

Servikal spondilotik miyelopati, 55 yaş üstü hastalarda en sık görülen dejeneratif omurga problemidir. İlerleyici spinal kanalda daralma olması durumunda omurilikte direkt bası etkisi haricinde iskemik hadiseler neticesinde miyelomalazi gelişebilmektedir. Bu olguların erken tanı ve tedavisinde ilerleme kaydedilmesine rağmen cerrahi tedavisinde optimal yaklaşımla ilgili tartışmalar devam etmektedir. Servikal dar kanal cerrahisinde anterior servikal diskektominin, korpus hizasında dekompresyon sınırlarının kısıtlılığı nedeniyle endikasyonları sınırlıdır. İki seviye üzerinde korpektomi yapılması füzyon ve enstrümantasyon başarısızlıklarını artırabilmektedir. Bunu önleyebilmek adına atlayarak korpektomi tekniği önerilmiştir. Atlayarak korpektomi, arada bir korpus korunduğu için daha kısa greftler ve enstrümantasyon kullanımına izin verir. Böylece sıyırma kuvvetlerinin azaltılması hedeflenir. Oblik korpektomi enstrümantasyon kullanılmaması avantajına sahiptir ancak cerrahi oryantasyon kaybı yaşanabilmektedir. Bu yazımızda servikal spondilotik miyelopati hastalarında anterior yaklaşımla uygulanan cerrahi tedaviler ele alınmıştır. Cervical spondylotic myelopathy is the most common degenerative spine problem in patients over 55 years of age. In case of progressive narrowing of the spinal canal, myelomalacia may develop as a result of ischemic events in addition to the direct compressive effect on the spinal cord. Although progress has been made in the early diagnosis and treatment of these cases, discussions about the optimal approach in the surgical treatment continue. Anterior cervical discectomy has a limited number of indications due to the restrictions in the decompression limits at the corpus level. In addition, the possibility of developing complications has been found to be higher with multi-level corpectomy. More than two levels of corpectomy may increase fusion and instrumentation failures. In order to prevent this, the skip corpectomy technique has been suggested. Skip corpectomy allows the use of shorter grafts and instrumentation as some corpi are preserved with skipping, aiming to reduce the stripping forces. Oblique corpectomy has the advantage of not using instrumentation, but loss of surgical orientation can occur. In this article, the surgical treatments applied with the anterior approach in patients with cervical spondylotic myelopathy are discussed.

Stem cell destiny can be controlled with scaffold biomaterials in tissue engineering and regenerative medicine. This study aimed to investigate the neuronal differentiation potential of human adipose tissue-derived mesen- chymal stem cells in graphene nanofiber matrix in vitro. Stem cell isolation was performed from adipose tissue taken from human by mechanical and enzymatic methods. The differentiation potential was examined after incubation of adipose stem cells in normal medium and neural differentiation medium, on graphene oxide (GO) and polycaprolactone (PCL) composite scaffolds produced by electrospinning technique. In vitro studies indi- cated that the presence of GO in PCL scaffold increases an effect on cell attachment, proliferation, infiltration into the scaffold, and neuronal differentiation. Also, unlike subcutaneous tissue, it has been shown immunohis- tochemically that mesenchymal stem cells derived from epidural adipose tissue tend to differentiate into oligodendrocytes.

AIM: To evaluate the clinical processes of patients with cervical postlaminectomy kyphosis (PLK) who underwent standalone posterior pedicle screw fixation surgery. MATERIAL and METHODS: The results of 21 patients with cervical PLK treated using the pedicle screw method between 2015 and 2018 were retrospectively examined. Patient data included demographic information and indications for surgery. Furthermore, the following criteria were calculated for each patient: cervical sagittal vertical axis (cSVA), C2–7 cervical lordosis (CL) parameters, modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI) score and visual analogue scale score, and these were evaluated preoperatively and postoperatively statistically. RESULTS: A total of 21 patients with PLK were evaluated. In terms of radiographic parameters, postoperative cSVA was significantly lower than the preoperative cSVA, and postoperative CL was significantly higher than the preoperative CL (p