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Changes in Sagittal Alignment After Cervical Disc Arthroplasty: Results of 24 Month Pilot Study

Kemal Yücesoy, Kasım Zafer Yüksel, Mürvet Yüksel, Orhan Kalemci, İdiris Altun
2016 Sinir Sistemi Cerrahisi Dergisi  
Context: For cervical disc replacements to be comparable to the gold standard of cervical discectomy and fusion (ACDF), disc replacements they must be able to provide normal range of motion as well as predictable and reliable correction of cervical alignment. The Synergy Disc was designed to provide correction of alignment in the sagittal plane while restoring physiologic range of motion. Purpose: This study evaluated whether the Synergy Disc provided preservation and/or restoration of sagittal
more » ... alignment while normalizing kinematics and providing acceptable clinical outcomes. The alignment provided by the Synergy Disc was compared with a retrospective cohort of 30 single-level ACDF patients. Study Design/Setting: The pilot trial was a multi-center, prospective, consecutive patient enrollment study using the Synergy Disc for the treatment of single and two-level degenerative disc disease of the cervical spine. Patient Sample: The procedure was performed on 43 patients (45 implants) with follow-up on 40 patients (42 implants). For the historical cohort ACDF arm, 30 patients with similar follow-up with single level anterior discectomy, fusion and plating were used for segmental lordosis measurements. Outcome Measures: For the Synergy Disc group, the kinematic outcome parameters included: range of motion (ROM), shell angle (SA), disc height (DH), sagittal plane translation and center of rotation (COR) in the X and Y direction. Standard assessments of clinical outcomes were also measured (Neck Disability Index, Visual Analog Scale). For the fusion arm, only functional spinal unit (FSU) angle was recorded using a single preoperative and postoperative standing lateral cervical radiograph. Methods: In the Synergy Disc group, static and dynamic radiological assessments were performed in 43 consecutive patients prior to the placement of the Synergy Disc. Forty patients were studied for the course of the study protocol (3 patients lost to follow-up). For the Synergy Disc group, lateral cervical radiographs were evaluated for range of motion, translation, center of rotation, disc height and shell angle before and at the longest postoperativr follow-up. Neck Disability Index and Visual Analog Scale for arm and neck pain were collected and analyzed. For the fusion group, standing lateral radiographs were reviewed. Results: In all the patients (40 patients, 42 implants), followed up for at least 24 months at an average of 28 months the average SA of the Synergy Disc was maintained at 6±2.7° of lordosis. Preoperative ROM, translation and center of rotation on X axis did not change significantly following surgery. There was a significant upward shift in the center of rotation on Y axis. There was significant improvement in all clinical outcome measures. In the fusion group, with a similar follow-up period, there was a 4° increase in lordosis at the FSU. Conclusions: The Synergy Disc provided lordosis at the surgical level, while maintaining preoperative range of motion, translation and COR X. The lordosis of 6±2.7° provided by the Synergy Disc at 2 years following surgery was comparable to the lordotic correction provided by an anterior cervical discectomy with interbody fusion and plating. Arka Plan İçeriği: Servikal disk replasmanlarının altın standart olan servikal diskektomi ve füzyonla (ACDF) karşılaştırılabilir düzeyde olması için disk replasmanları hem normal hareket erimi (ROM) hem de servikal dizilimde öngörülebilir ve güvenilir bir düzelme sağlayabilmesi gerekir. Fizyolojik hareket açıklığını sağlarken sagital düzlemde dizilimi düzeltmek üzere Synergy Disc tasarlanmıştır. Amaç: Bu çalışma, Synergy Disc'in kinematiği normalleştirip kabul edilebilir klinik sonuçlar sağlarken, sagital düzlemde dizilimi düzelttiği ve/veya koruyup koruyamadığını değerlendirmiştir. Synergy Disc ile sağlanan dizilim 30 adet tek seviyeli ACDF uygulanmış bir retrospektif kohortunkiyle karşılaştırılmıştır. Çalışma Tasarımı/Ortamı: Bu çalışma servikal omurganın tek ve iki seviyeli dejeneratif disk hastalığının tedavisinde Sinergy Disc'in kullanıldığı çok merkezli, prospektif ardışık hasta katılımlı bir pilot çalışma idi. Hasta Evreni: Kırk üç hastanın (45 implantla) katıldığı, 40 hasta (42 implantın) takip edildiği bir uygulama yapılmıştır. Retrospektif kohort olan ACDF kolunda, segmental lordoz ölçümleri için tek seviyeli anterior diskektomi, füzyon ve plakla tespit yapılmış benzer takip süreli 30 hasta mevcuttu. Sonuç Ölçümleri: Synergy Disc grubu için kinematik sonuç ölçümleri, hareket açıklığı (ROM), kabuk açısı (SA), disk yüksekliği (DH), sagital planda kayma (translasyon), X ve Y eksenlerinde dönme merkezini (COR) içermiştir. Klinik sonuçların standart ölçümleri de yapılmıştır (Örn. Boyun Disabilite İndeksi, Görsel Analog Ölçeği). Füzyon yapılan çalışma kolunda ameliyat öncesi ve sonrası ayakta çekilen tek bir servikal radyogramda yalnızca fonksiyonel spinal birim açısı (FSU) kaydedilmiştir. Yöntemler: Synergy Disc grubunda, Synergy Disc yerleştirilmeden önce 43 ardışık hastada statik ve dinamik radyolojik değerlendirmeler yapılmıştır. Çalışma protokolü sürecinde 40 hasta çalışılmıştır (3 hasta takibe gelmemiştir). Synergy Disc grubunda hareket açıklığı, dönme merkezi, disk yüksekliği ve kabuk açısı için hem ameliyat öncesinde hem de postoperatif en uzun takipte lateral servikal radyogramlar değerlendirilmiştir. Kol ve boyun ağrısı için Boyun Disabilite İndeksi ve Görsel Analog Ölçeği puanları toplanmış ve incelenmiştir. Füzyon grubunda ayakta çekilen lateral radyogramlar gözden geçirilmiştir. Bulgular: En azından 24 ay izlenen hastaların tümünde (40 hasta, 42 implant) ortalama 28 ayda Synergy Disc'in ortalama kabuk açısı (SA) 6±2.7° lordozda sabitlenmiştir. Cerrahi sonrasında ameliyat öncesi hareket açıklığı, translasyon ve X ekseninde dönme merkezi anlamlı derecede değişmemiştir. Dönme merkezinde Y-ekseninde anlamlı derecede yukarıya doğru yer değişimi olmuştur. Tüm klinik sonuç ölçümlerinde önemli bir iyileşme meydana gelmiştir. Benzer takip dönemli füzyon grubunda spinal birim açısında lordozda 4o artış olmuştur. Sonuçlar: Synergy Disc, preoperatif hareket açıklığını, translasyon ve X-ekseninde dönme merkezini koruyarak cerrahi düzeyde lordoz sağlamıştır. Cerrahiden 2 yıl sonra Synergy Disc ile sağlanan 6±2.7° lordoz, intervertebral füzyon ve plakla fiksasyonla birlikte uygulanan anterior servikal diskektomiye karşılaştırılabilir düzeydeydi. Anahtar kelimeler: Sagital denge, kifoz, servikal artroplasti, servikal sagital dizilim, synergy disc, kinematik, dönme merkezi, yapay disk J Nervous Sys Surgery 2016;6(1-2):1-9 alındığı tarih: 01.01.2018
doi:10.5222/sscd.2016.001 fatcat:emmextht2fhipktxvn2fxusfku

Lumbar herniated disc: spontaneous regression

Idiris Altun, Kasım Zafer Yüksel
2017 The Korean Journal of Pain  
Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. Methods: This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3−L4, L4−L5 or
more » ... 1 were enrolled. Results: The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Lasègue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3−L4, L4−L5, and L5−S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5−22). Conclusions: It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery. (Korean J Pain 2017; 30: 44-50)
doi:10.3344/kjp.2017.30.1.44 pmid:28119770 pmcid:PMC5256262 fatcat:cav7whkxqfdqzm7f67n7rwbznq

Synovial Cyst as an Uncommon Cause of Radiculopathy

İdiris Altun, Kasım Zafer Yüksel
2016 Pamukkale Medical Journal  
Synovial cysts develop as a result of herniation in the synovial membrane of the facet capsule. Synovial cysts, which are seen mostly in the 6th and 7th decades of life, are rarely seen in intraspinal, extradural lesions which lead to lower back pain and radiculopathy. Although they can be seen throughout the spinal region, the most common location is the lumbar L4-L5 disc space. It is very rare that location is in the cervical or thoracic regions and may be due to myelopathy in these regions.
more » ... s those showing location in the lumbar area are close to the nerve root, radiculopathy may occur as a result of pressure on the nerve root. Diagnosis is made from a thick cystic structure seen adjacent to the facet joint on computed tomography and the determination of the capsule with contrast on magnetic resonance imaging. While conservative or surgical methods can be applied in treatment, the most commonly preferred method is surgery. In this paper, the case is presented of a 68-year old male patient with severe left leg pain, who was diagnosed with synovial cyst at the L4-L5 level. In elderly patients with complaints of radiculopathy, synovial cysts must be considered in the differential diagnosis. Pam Med J 2016;9(3):244-247 Özet Sinoviyal kistler, faset kapsülünün sinoviyal zarında fıtıklaşma sonucu gelişirler. Yaşamın en çok 6. ve 7. dekadında görülen sinoviyal kistler, bel ağrısı ve radikülopatiye yol açan intraspinal ekstradural lezyonların nadir nedenleridir. Tüm spinal bölgede görülmelerine rağmen, en sık görüldükleri bölge L4-L5 disk aralığıdır. Servikal ve torasik bölgelerde görülmeleri nadirdir; görülürlerse bu bölgedeki miyelopatiye neden olabilirler. Lumbar alandaki görüldükleri bölge sinir köklerine yakın olduğundan, sinir kökü basısı sonucu radikülopati oluşabilir. Tanı, faset eklem komşuluğunda kalın kistik bir yapının bilgisayarlı tomografide görülmesi ve kontrast tutan kapsülün manyetik rezonans görüntülemesinde belirlenmesi ile konur. Konservatif veya cerrahi yöntemler tedavide uygulanabilmesi ile birlikte, en sık tercih edilen yöntem cerrahidir. Bu yazıda, L4-L5 seviyesinde sinoviyal kist tanılı şiddetli sol bacak ağrısı olan 68 yaşında erkek hasta sunulmuştur. Radikülopati şikayetleri olan ileri yaş hastalarda, sinoviyal kist ayırıcı tanıda dikkate alınmalıdır. Pam Tıp Derg 2016;9(3):244-247
doi:10.5505/ptd.2016.70298 fatcat:piyxupkgrrgy3bhattpnnkpmli

Kitap tanıtımı: Zafer Toprak: Türkiye'de Yeni Hayat İnkılap ve Travma 1908-1928, Doğan Kitap, İstanbul, 2017

YILDIRIM Yüksel
2018 Ankara Üniversitesi Türk İnkılap Tarihi Enstitüsü Atatürk Yolu Dergisi  
Zafer Toprak'ın eserinde, bir taraftan Osmanlı Devleti'nin Balkan Savaşları ve I.  ...  Zafer Toprak'ın iktisat tarihi, düşünce tarihi, sosyal tarih ve kurumlar tarihi üzerine Türkçe ve yabancı dillerde yazılmış çok sayıda makale ve kitabı bulunmaktadır.  ... 
doi:10.1501/tite_0000000505 fatcat:tng7lr7lkvakboff6u3stlviaa

Ankylosing Spondylitis: Patterns of Spinal Injury and Treatment Outcomes

Idiris Altun, Kasım Zafer Yuksel
2016 Asian Spine Journal  
Study Design: Retrospective review. Purpose: We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. Overview of Literature: Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability. Methods: Between
more » ... uary 1, 1998 and March 2011, 30 patients (23 males, 7 females; mean age, 70.43 years; range, 45 to 95 years) with the radiographic diagnosis of AS of the spinal column had 42 fractures. Eight patients presented with significant trauma, 17 after falls, and 5 after minor falls or no recorded trauma. Eleven patients presented with a neurological injury, ranging from mild sensory loss to quadriplegia. Results: There were 16 compression and 10 transverse fractures, two Jefferson's fractures, one type II and two type III odontoid process fractures, and five fractures of the posterior spinal elements (including lamina and/or facet, three spinous process fractures, three transverse process fractures). Twenty-four fractures affected the craniocervical junction and/or cervical vertebrae, 17 were thoracic, and one involved the lumbar spine. The most affected vertebrae were C6 and T10. The mean follow-up was 29.9 months. One patient was lost to follow-up. Eighteen patients were treated conservatively with bed rest and bracing. Twelve patients underwent surgery for spinal stabilization either with an anterior, posterior or combined approach. Conclusions: Nonsurgical treatment can be considered especially in the elderly patients with AS and spinal trauma but without instability or major neurological deficits. The nonfusion rate in conservatively treated patients is low. When treatment is selected for patients with spinal fractures and AS, the pattern of injury must be considered and the need for individualized treatment is paramount. Asian Spine J 2016;10(4):655-662 • http://dx.
doi:10.4184/asj.2016.10.4.655 pmid:27559444 pmcid:PMC4995247 fatcat:wkizcjioinhs7ogojxikugtbd4

Diagnostic Importance of 3D CT Images in Klippel-Feil Syndrome with Multiple Skeletal Anomalies: A Case Report

Murvet Yuksel, Hamza Karabiber, K. Zafer Yuksel, Gonul Parmaksiz
2005 Korean Journal of Radiology  
Zafer Yuksel, MD 3 Gonul Parmaksiz, MD 2 partial body fusion of T1 T2 on the 3D sagittal image (Fig. 1E) , and this finding was not revealed by plain radiography, CT or the MR images.  ...  We also observed Murvet Yuksel, MD 1 Hamza Karabiber, MD 2 K.  ... 
doi:10.3348/kjr.2005.6.4.278 pmid:16374086 pmcid:PMC2684975 fatcat:mxrnfd2v5ngx5lm6zqaqmtzjiq

An uncommon case mimicking cervical trauma: Os odontoideum

Idiris Altun, Kasim Zafer Yuksel
2017 Turkish Journal of Emergency Medicine  
Please cite this article in press as: Altun I, Yuksel KZ, An uncommon case mimicking cervical trauma: Os odontoideum, Turkish Journal of Emergency Medicine (2016), http://dx.doi.org/10.1016/j.tjem.2016.08.001  ... 
doi:10.1016/j.tjem.2016.08.001 pmid:28345069 pmcid:PMC5357087 fatcat:3qoy44eymffqvk53fxpt6lb7k4

Gynecologic manifestations in Emberger syndrome

Hasan Yüksel, Emre Zafer
2021 Journal of Turkish Society of Obstetric and Gynecology  
Turk J Obstet Gynecol 2021;18:65-67 Yüksel and Zafer. Emberger syndrome and vulvar cancer  ... 
doi:10.4274/tjod.galenos.2021.53050 pmid:33715335 pmcid:PMC7962163 fatcat:7tmottokyvdermoryshfv3jtuy

Türkiye'deki Mevduat Bankalarının Fiyat-Kazanç Oranını Etkileyen Değişkenlerin Mars Yöntemi İle Belirlenmesi

Zafer Adalı, İsmail Canöz, Serhat Yüksel
2017 Fiscaoeconomia  
In this study, it is aimed to identify the factors influencing the price-earnings ratio of deposit banks in Turkey. In this context, quarterly cumulative data of 10 deposit banks traded in Istanbul Stock Exchange for the periods between 2002:4 and 2017:1 is analyzed by using MARS method. According to the analysis results, it is concluded that if the ROE of the banks is higher than 5.92%, it affects price-earning ratio positively. However, this effect will be negative when ROE exceeds 21.12%.
more » ... s indicates that investors are willing to pay more for the stocks of the banks when their profitability is increasing. Besides, it is also identified that there is an adverse relationship between the market interest rate and NPL of the banks with the price-earnings ratio. In case of any raise in the interest rate and NPL of the banks, investors' expectation of the future profitability of the banks will be negative. As a result, it is understood that the investors are reluctant to pay more amounts to their bank shares. JEL Classification: G12 G17 G21
doi:10.25295/fsecon.322659 fatcat:h7v5zcr24bf63ftf5mrrmkcmyq

A Turkish family with Clouston syndrome caused by G11R mutation in GJB6

Zafer Yüksel, Özden Kutlay, Kadri Karaer
2015 Turkderm  
Konsept: Zafer Yüksel Dizayn: Zafer Yüksel Veri Toplama veya İşleme: Zafer Yüksel, Özden Kutlay, Kadri Karaer Analiz veya Yorumlama: Zafer Yüksel, Özden Kutlay, Kadri Karaer Literatür Arama: Zafer Yüksel  ...  Yazan: Zafer Yüksel Hakem Değerlendirmesi: Editörler kurulu dışında olan kişiler tarafından değerlendirilmiştir.  ... 
doi:10.4274/turkderm.46343 fatcat:6swubre5ybaz3l62ix5zxe7qxy

Does Investment Horizon Matter? Disentagling the Effect of Institutional Herding on Stock Prices

hasan zafer yuksel
2013 Social Science Research Network  
doi:10.2139/ssrn.2337165 fatcat:dnqm4lz3vbakloxexk76ield5u

Rheumatoid Arthritis Presenting with Low Back and Leg Pain: An Uncommon Case

İdiris Altun, Kasım Zafer Yüksel
2017 Sinir Sistemi Cerrahisi Dergisi  
Yüksel Rheumatoid Arthritis Presenting with Low Back and Lig Pain: An Uncommon Case  ... 
doi:10.5222/sscd.2015.026 fatcat:6hakexqkwbgbvggitzevyv5zfa

Amasya-Alaz Höyük Kazısı Jeofizik Araştırmaları ve Coğrafik Bilgi Sistemi (CBS) Uygulamaları

Fethi Ahmet YÜKSEL, Oya TARHAN-BAL, Zafer KEÇELİ
2010 Höyük  
s Yüksel/Tarhan- Bal 2009.  ...  Yüksel / O. Tarhan-Bal / Z.  ... 
doi:10.37879/hoyuk.2010.28 fatcat:36h3obkl7fb6tlazieie4btrx4

Impact of magnetic field on pressures of programmable cerebrospinal fluid shunts: an experimental study

Idiris Altun, Zafer Yuksel, Tufan Mert
2016 Turkish Neurosurgery  
gramming of the shunt pressure setting has become a routine work for neurosurgeons. In addition, electromagnetic waves which are produced by cell phones may also affect medical devices such as CSF shunts and cardiac pacemakers. Therefore, use of cell phone in hospitals or in crowded trains should be restricted. Patients with adjustable shunt valves should be avoided of exposure to strong magnetic fields (9). Contemporarily, there are several types of programmable and adjustable CSF valves
more » ... ble and all of these devices are dependent on a ball-on-spring valve mechanism that regulates CSF flow. These instruments use the principle of altering the tension of the spring with a magnetic rotor. Valves are programmed using a tool involving a strong external magnet and therefore, these adjustable valves can be influenced █ INTRODUCTION Placement of cerebrospinal fluid (CSF) shunt is the standard treatment of hydrocephalus. Shunt systems involve a valve to control pressure and to drain the CSF when the CSF pressure exceeds the previously set value of the valve. Pressureadjustable shunt valves have a magnetic rotator and these shunts have been in use since the 1990s. The optimal CSF diversion rate for an individual can be easily adjusted after shunt surgery by transcutaneous pressure setting using a magnetic device. But, environmental magnetic fields may change the intended pressure setting (8). A typical instance that necessitates caution is magnetic resonance imaging (MRI) examination, after which checking and re-pro-AIm: To investigate whether programmable cerebrospinal fluid (CSF) shunts are influenced by exposure to the magnetic field and to compare the effects of magnetic field in 4 different brands of programmable CSF shunts. mATERIAl and mEThODS: This experimental study was performed in the laboratory using a novel design of magnetic field. Four types of programmable CSF shunts (Miethke®, Medtronic®, Sophysa® and Codman®Hakim®) were exposed to the magnetic field generated by an apparatus consisting of Helmholtz coil for 5 minutes. In every CSF shunt, initial pressures were adjusted to 110 mmH2O and pressures after exposure to magnetic field were noted. These measurements were implemented at frequencies of 5 Hz, 20 Hz, 30 Hz, 40 Hz, 60 Hz and 80 Hz. In each type, three shunts were utilized and evaluations were made twice for every shunt. RESUlTS: At 5, 30, 40 and 60 Hz, Groups 1, 2 and 3 had significantly higher average pressures than Group 4. At 20 and 80 Hz, Groups 1 and 2 had notably different pressure values than Groups 3 and 4. Group 3 displayed the highest pressure, while Group 4 demonstrated the lowest pressure. CONClUSION: Exposure to magnetic fields may affect the pressures of programmable CSF shunts. However, further controlled, clinical trials are warranted to elucidate the in-vivo effects of magnetic field exposure.
doi:10.5137/1019-5149.jtn.16795-15.2 pmid:27476923 fatcat:g5rwyah4iveqrpddrjnyvin5ci

CAUSALITY RELATIONSHIP BETWEEN FOREIGN DIRECT INVESTMENTS AND ECONOMIC IMPROVEMENT FOR DEVELOPING ECONOMIES

Zafer ADALI, Serhat Yüksel
2017 Marmara iktisat dergisi  
The aim of this study is to determine whether there is a causality relationship between foreign direct investments and economic growth for developing countries. Within this context, 30 developing countries, which have the highest GDP growth rate in 2016, are taken into the consideration. Furthermore, annual data of these countries for the periods between 1991 and 2015 is evaluated with the help of Dumitrescu Hurlin panel causality analysis. It is concluded that there is a causality relationship
more » ... from foreign direct investments to economic growth. In other words, it is identified that foreign direct investment is an important cause of economic growth. Hence, it can be said that developing countries should focus on the ways to attract foreign direct investments to their companies in order to have economic growth. In addition to this situation, it is also identified that there is a causality relationship from economic growth to FDI. This situation shows that when the economies of the countries are improved, it attracts foreign investors to make a direct investment in those countries.
doi:10.24954/mjecon.2017.6 fatcat:nhvd2yu3xffl3f7xols6ovf2dq
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