AIM:To evaluate the postoperative magnetic resonance imaging (MRI) findings and clinical outcomes of patients who underwent monoportal endoscopic lumbar discectomy. MATERIAL AND METHODS:Preoperative and postoperative 3rd and 6th month MRI features, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores, as well as other clinical features of patients who underwent monoportal endoscopic lumbar discectomy between August 2009 and January 2012 were retrospectively analyzed. RESULTS:A total of 65 patients (37 female, 28 male) were included in the study. VAS and ODI scores showed significant improvement postoperatively (p < 0.001). Intervertebral disc height loss was observed only in two patients. In 31 (48%) of the 64 levels treated, no significant anterior soft tissue mass developed. However, 33 patients (52%) showed anterior epidural edema and tissue formation postoperatively. Contrast enhancement of the nerve root was found in 20 levels (29.4%), nerve root edema in 3 levels (4.41%), and nerve root displacement in 3 levels (4.41%). None of the patients had all 3 aforementioned findings concomitantly. Of the 57 levels evaluated, 36 levels (63%) showed no or minimal changes in the posterior elements, and at the 3rd month, 9 levels (15.8%) demonstrated grade 1+ changes, 9 levels showed grade 2+ changes, and grade 3+ changes were seen in only 3 levels; however, at 6-month follow-up, all vertebral levels showed improvements. CONCLUSION:Endoscopic discectomy is a safe and effective minimally-invasive method. However, owing to the lack of definitive radiological criteria indicating success or failure, the radiological findings should always be interpreted in conjunction with clinical outcomes.

BACKGROUND Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with multifaceted origins. In recent studies, neuroinflammation and immune dysregulation have come to the forefront in its pathogenesis. There are studies suggesting that stem cell therapy may be effective in the treatment of ASD. AIM To evolve the landscape of ASD treatment, focusing on the potential benefits and safety of stem cell transplantation. METHODS A detailed case report is presented, displaying the positive outcomes observed in a child who underwent intrathecal and intravenous Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) transplantation combined with neurorehabilitation. RESULTS The study demonstrates a significant improvement in the child’s functional outcomes (Childhood Autism Rating Scale, Denver 2 Developmental Screening Test), especially in language and gross motor skills. No serious side effects were encountered during the 2-year follow-up. CONCLUSION The findings support the safety and effectiveness of WJ-MSC transplantation in managing ASD.

Backgroud: Traumatic spinal cord injury (SCI) is a pathological condition characterized by neurological impairments, the severity of which is contingent upon the level and extent of the injury. In addition to these impairments, SCI is frequently associated with autonomic dysfunctions and complications affecting the cardiovascular and gastrointestinal systems, leading to debilitating consequences such as urinary and bowel incontinence and spasticity, significantly diminishing patients’ quality of life. Aim:This study aimed to evaluate the safety and therapeutic efficacy of mesenchymal stem cell-derived exosomes (MSCdE) in patients with SCI. Methods: Sixteen patients (mean age: 26.25 ± 4.89 years) with SCI resulting from combat-related injuries were enrolled. Of these, 2 patients (12.5%) had lumbar injuries, 11 (68.75%) had thoracic injuries, and 3 (18.75%) had cervical injuries. Exosome administration was performed in 6 treatment cycles over a 4.5-month period. Each cycle involved the intrathecal injection of 3 ml (30 billion) and intramuscular injection of 10 ml (30 billion) of exosomes. Patients were monitored for 1 year following the intervention. Adverse events were assessed according to the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Neurological function was evaluated using the American Spinal Injury Association Impairment Scale (ASIA), spasticity using the Modified Ashworth Scale (MAS), motor and cognitive function using the Functional Independence Measure (FIM), and urinary and bowel incontinence using the Wexner Incontinence Score and Qualiveen Short Form (SFQ). All assessments were conducted by a multidisciplinary team comprising a neurosurgeon and a specialist in physical therapy and rehabilitation. Results: No serious adverse events were reported throughout the treatment and follow-up period. Minor side effects, such as low-grade fever and localized pain, were observed, classified as CTCAE v5.0 Grade 1, and resolved spontaneously within 24 hours without medical intervention. Statistically significant improvements were noted in all clinical parameters. FIM motor scores increased from 26.75 ± 9.81 pre-treatment to 43.88 ± 17.01 post-treatment (p < 0.01). ASIA motor scores improved significantly from 47.00 ± 21.15 to 56.00 ± 18.74 (p < 0.001), and ASIA sensory scores (light touch/pin-prick) increased from 66.06/66.25 to 77.56/79.75 (p < 0.001). MAS values (right/left) decreased from 7.00/6.94

BACKGROUND Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses. Currently, there is a lack of effective pharmacological interventions for nerve damage, despite the existence of several small compounds, peptides, hormones, and growth factors that have been suggested as potential enhancers of neuron regeneration. Despite the objective of achieving full functional restoration by surgical intervention, the persistent challenge of inadequate functional recovery remains a significant concern in the context of peripheral nerve injuries. AIM To examine the impact of exosomes on the process of functional recovery following a complete radial nerve damage. METHODS A male individual, aged 24, who is right-hand dominant and an immigrant, arrived with an injury caused by a knife assault. The cut is located on the left arm, specifically below the elbow. The neurological examination and electrodiagnostic testing reveal evidence of left radial nerve damage. The sural autograft was utilized for repair, followed by the application of 1 mL of mesenchymal stem cell-derived exosome, comprising 5 billion microvesicles. This exosome was split into four equal volumes of 0.25 mL each and delivered microsurgically to both the proximal and distal stumps using the subepineural pathway. The patient was subjected to a period of 180 d during which they had neurological examination and electrodiagnostic testing. RESULTS The duration of the patient’s follow-up period was 180 d. An increasing Tinel’s sign and sensory-motor recovery were detected even at the 10th wk following nerve grafting. Upon the conclusion of the 6-mo post-treatment period, an evaluation was conducted to measure the extent of improvement in motor and sensory functions of the nerve. This assessment was based on the British Medical Research Council scale and the Mackinnon-Dellon scale. The results indicated that the level of improvement in motor function was classified as M5, denoting an excellent outcome. Additionally, the level of improvement in sensory function was classified as S3+, indicating a good outcome. It is noteworthy that these assessments were conducted in the absence of physical therapy. At the 10th wk post-injury, despite the persistence of substantial axonal damage, the nerve exhibited indications of nerve re-innervation as evidenced by control electromyography (EMG). In contrast to the preceding. EMG analysis revealed a significant electrophysiological enhancement in the EMG conducted at the 6th-mo follow-up, indicating ongoing regeneration. CONCLUSION Enhanced comprehension of the neurobiological ramifications associated with peripheral nerve damage, as well as the experimental and therapy approaches delineated in this investigation, holds the potential to catalyze future clinical progress.

BACKGROUND Cerebral palsy (CP) describes a group of disorders affecting movement, balance, and posture. Disturbances in motor functions constitute the main body of CP symptoms. These symptoms surface in early childhood and patients are affected for the rest of their lives. Currently, treatment involves various pharmacotherapies for different types of CP, including antiepileptics for epilepsy and Botox A for focal spasticity. However, none of these methods can provide full symptom relief. This has prompted researchers to look for new treatment modalities, one of which is mesenchymal stem cell therapy (MSCT). Despite being a promising tool and offering a wide array of possibilities, mesenchymal stem cells (MSCs) still need to be investigated for their efficacy and safety. AIM To analyze the efficacy and safety of MSCT in CP patients. METHODS Our sample consists of four CP patients who cannot stand or walk without external support. All of these cases received allogeneic MSCT six times as 1 × 106/kg intrathecally, intravenously, and intramuscularly using umbilical cord-derived MSCs (UC-MSC). We monitored and assessed the patients pre- and post-treatment using the Wee Functional Independence Measure (WeeFIM), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification Scale (MACS) instruments. We utilized the Modified Ashworth Scale (MAS) to measure spasticity. RESULTS We found significant improvements in MAS scores after the intervention on both sides. Two months: Right χ 2 = 4000, P = 0.046, left χ 2 = 4000, P = 0.046; four months: Right χ 2 = 4000, P = 0.046, left χ 2 = 4000, P = 0.046; 12 months: Right χ 2 = 4000, P = 0.046, left χ 2 = 4000, P = 0.046. However, there was no significant difference in motor functions based on WeeFIM results (P > 0.05). GMFCS and MACS scores differed significantly at 12 months after the intervention (P = 0.046, P = 0.046). Finally, there was no significant change in cognitive functions (P > 0.05). CONCLUSION In light of our findings, we believe that UC-MSC therapy has a positive effect on spasticity, and it partially improves motor functions.

BACKGROUND Traumatic brain injury (TBI) is characterized by a disruption in the normal function of the brain due to an injury following a trauma, which can potentially cause severe physical, cognitive, and emotional impairment. Stem cell transplantation has evolved as a novel treatment modality in the management of TBI, as it has the potential to arrest the degeneration and promote regeneration of new cells in the brain. Wharton’s Jelly-derived mesenchymal stem cells (WJ-MSCs) have recently shown beneficial effects in the functional recovery of neurological deficits. AIM To evaluate the safety and efficiency of MSC therapy in TBI. METHODS We present 6 patients, 4 male and 2 female aged between 21 and 27 years who suffered a TBI. These 6 patients underwent 6 doses of intrathecal, intramuscular (i.m.) and intravenous transplantation of WJ-MSCs at a target dose of 1 × 106/kg for each application route. Spasticity was assessed using the Modified Ashworth scale (MAS), motor function according to the Medical Research Council Muscle Strength Scale, quality of life was assessed by the Functional Independence Measure (FIM) scale and Karnofsky Performance Status scale. RESULTS Our patients showed only early, transient complications, such as subfebrile fever, mild headache, and muscle pain due to i.m. injection, which resolved within 24 h. During the one year follow-up, no other safety issues or adverse events were reported. These 6 patients showed improvements in their cognitive abilities, muscle spasticity, muscle strength, performance scores and fine motor skills when compared before and after the intervention. MAS values, which we used to assess spasticity, were observed to statistically significantly decrease for both left and right sides (P < 0.001). The FIM scale includes both motor scores (P < 0.05) and cognitive scores (P < 0.001) and showed a significant increase in pretest posttest analyses. The difference observed in the participants’ Karnofsky Performance Scale values pre and post the intervention was statistically significant (P < 0.001). CONCLUSION This study showed that cell transplantation has a safe, effective and promising future in the management of TBI.

Background: It is known that interactions between programmable Ventriculoperitoneal Shunt (VPS) valves and electromagnetic and hearing devices may change the valve settings. We reported a patient using programmable VPS valves and hearing devices and reviewed the literature. Case Description: A 71-year-old man was implanted with a programmable VPS valve with the diagnosis of Normal Pressure Hydrocephalus. A hearing device (behind-the-ear) was proposed because of hearing difficulties, but it was suggested that it be discontinued because it did not help. However, the patient used it twice because of his current dementia, forgetting the doctor’s recommendations. The setting of the valve has changed in these two different times that this behind-the-ear hearing device is used. Long-term follow-ups showed no change in valve settings except those two situations. Conclusion: It is important to note that patients using hearing devices and programmable VPS valves are a unique group of patients. There are not enough studies showing the relationship between the behind-the-ear hearing devices and programmable VPS. It should be kept in mind that hearing devices with magnetic field strength may change the setting of the valves.

Background: The aim of this study was to evaluate the correlation between serum superoxide dismutase (SOD) enzyme levels and lumbar degenerative spinal diseases (LDSD).Materials and Methods: Ninety-four patients with LDSD and 64 patients without LDSD were investigated. Human SOD ELISA kits were used to measure the amount of enzymes in the samples. Serum SOD enzyme levels were determined by Student-t and Mann Whitney-U tests to determine differences between groups.Results: The patient group was classified according to the characteristics of the disease, clinical symptoms, Visual Analog Scale (VAS) values, and Oswestry Disability Index (ODI) scores. Along with these parameters, serum SOD levels were evaluated statistically. There was no statistically significant difference in serum SOD levels in both groups. However, serum SOD levels were relatively lower in the patient group (p>0.05).Conclusions: Our study could supply objective value for future researchers investigating specific lumbar diseases, should they attempt to find a serum biomarker for the disease. More studies with an increasing number of patients are needed to support the results of our study. Doing so may offer more specific insights on the mechanisms of LDSD and its features, which could contribute to the literature.

“Endoskop”; içeri, içeriye anlamına gelen “endo” ve görmek, görüntülemek anlamına gelen “skope” kelimelerinin birleşmesi ile oluşan Yunanca kökenli bir kelimedir. Nöroşirurji alanında endoskop ilk olarak ventrikül içi patolojilerin ve hidrosefalinin tedavisinde kullanılmıştır. Başarısız cerrahi girişimler nedeniyle gündemden düşen nöroendoskop ilerleyen zamanlarda mikrocerrahiye yardımcı olması amacıyla yeniden kullanıma girmiştir.

BACKGROUND:Hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of death and long-term neurological impairment in the pediatric population. Despite a limited number of treatments to cure HIE, stem cell therapies appear to be a potential treatment option for brain injury resulting from HIE.AIM:To investigate the efficacy and safety of stem cell-based therapies in pediatric patients with HIE.METHODS:The study inclusion criteria were determined as the presence of substantial deficit and disability caused by HIE. Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) were intrathecally (IT), intramuscularly (IM), and intravenously administered to participants at a dose of 1 × 106/kg for each administration route twice monthly for 2 mo. In different follow-up durations, the effect of WJ-MSCs administration on HIE, the quality of life, prognosis of patients, and side effects were investigated, and patients were evaluated for neurological, cognitive functions, and spasticity using the Wee Functional Independence Measure (Wee FIM) Scale and Modified Ashworth (MA) Scale.RESULTS:For all participants (n = 6), the mean duration of exposure to hypoxia was 39.17 + 18.82 min, the mean time interval after HIE was 21.83 ± 26.60 mo, the mean baseline Wee FIM scale score was 13.5 ± 0.55, and the mean baseline MA scale score was 35 ± 9.08. Three patients developed only early complications such as low-grade fever, mild headache associated with IT injection, and muscle pain associated with IM injection, all of which were transient and disappeared within 24 h. The treatment was evaluated to be safe and effective as demonstrated by magnetic resonance imaging examinations, electroencephalographies, laboratory tests, and neurological and functional scores of patients. Patients exhibited significant improvements in all neurological functions through a 12-mo follow-up. The mean Wee FIM scale score of participants increased from 13.5 ± 0.55 to 15.17 ± 1.6 points (mean ± SD) at 1 mo (z = - 1.826, P = 0.068) and to 23.5 ± 3.39 points at 12 mo (z = -2.207, P = 0.027) post-treatment. The percentage of patients who achieved an excellent functional improvement (Wee FIM scale total score = 126) increased from 10.71% (at baseline) to 12.03% at 1 mo and to 18.65% at 12 mo post-treatment.CONCLUSION:Both the triple-route and multiple WJ-MSC implantations were safe and effective in pediatric patients with HIE with significant neurological and functional improvements. The results of this study support conducting further randomized, placebo-controlled studies on this treatment in the pediatric population.

Aim: To compare short and long term pain intensity changes and long term loss of correction rates in patients who were treated either by kyphoplasty or posterior segmentation due to their TLICS and LSC scores, therefore evaluate the specificity of these classifications. Material and Methods: Medical records of 106 patients operated due to thoracolumbar compression or burst fracture in our clinics between years 2012 to 2015 have been evaluated retrospectively. The patients were evaluated with postoperative radiography (loss of reduction) and visual analogue scale (VAS) in their follow-ups. Results: The average stay on hospital was 6.53 ± 4.51 days in kyphoplasty group. The mean preoperative cobb angle was 10.76±11.67 degrees, which improved to 10.19±10.66 degrees at postoperative 1th month. Beside this, the mean preoperative VAS score was 7.93±0.68 then improved to 4.25±0.77 and 2.75 ± 1.43 at postoperative 6th, 12th month follow-ups respectively. There were 42 patients in instrumentation group. The mean hospitalization was 13.47±10.43 days. The mean preoperative cobb angle was 15.84±10.52 and it improved to 11.86±8.15 degrees at the postoperative 1th-month follow-up. The preoperative VAS scores of the patients improved from 7.71±0.71 to 4.09±0.79 and 4.26±1.23 at 6th and 12th month follow-ups. Conclusion: In long term follow up the kyphoplasty group showed more loss of correction however lesser VAS scores comparing to the instrumentation group. Although evaluating TLICS scores to kyphoplasty patients is still based on case reports in our series it was performed to 64 patients.

AIM Traumatic brain injury (TBI) is described as brain parenchyma damage that results in neurological impairment after a trauma. It can cause a main insult accompanied by a series of secondary insults. The primary injury may be repaired through surgical operation, however, there are only limited options for managing the secondary insults. Stem cell transplantation (SCT) became an innovative method of treatment in TBI, since it can halt degeneration and support the renovation of the damaged brain cells. MATERIAL AND METHODS This study included a 29 years old male who had TBI resulting from a vehicle accident which took place one and a half years ago. The participant received six doses of intrathecal, intramuscular, and intravenous transplantation of WJ-MSCs at a goal dose of lxl06 / kg respectively for each route of administration for six months Results: No important negative effects were reported. The patients' speech, cognitive, memory and fine motor skills were improved. The efficacy of treatment with SCT was assessed with cranial magnetic resonance imaging (MRI), computed tomography (CT) screening, and electroencephalography (EEG). CONCLUSION SCT can have a promising future as a medical approach in recurrent TBI.

AIM:To elucidate the characteristics of kyphoplasty in correlation with spinal metastasis.MATERIAL AND METHODS:Data of patients treated by kyphoplasty between January 2017 and December 2019 were reviewed retrospectively. Preoperative prophylactic antibiotics and low-molecular-weight heparin injections were performed. Postoperative follow-up was conducted at least 24 hours after the procedure. All patients were treated under sedoanalgesia. Bone biopsies were collected from all patients.RESULTS:One hundred ninety-nine vertebra fractures were treated in 130 patients. The mean age of the patients was 65.27 ± 8.79 years (18?90 years) and 66 patients were male (50.7%). Forty-five patients had osteoporosis, six patients showed malignancy, and osteomyelitis was found in three patients, while the others? presentations were secondary to trauma. Most commonly, the L1 (n=59), Th12 (n=45), and L2 (n=34) levels were found to develop vertebral fractures. Forty patients had multiple levels of vertebral fracture, with a higher rate of osteoporosis (n=24; 60%). Three patients showed undiagnosed oncologic disease with an initial diagnosis of acute fracture following minor trauma, while the primary oncologic diagnosis was established by bone biopsy taken during the routine procedure in each procedure (e.g., plasmacytoma, lymphoma, adenocarcinoma of the lung). None of the patients developed an infection due to kyphoplasty, permanent neuromotor deficit, or mortality. The mean postoperative hospital length of stay was 1.6 days.CONCLUSION:Bone biopsy should be performed to diagnose early spinal metastases. Although an accurate bone biopsy may not be obtained from some patients, particularly from those with osteoporosis, performing bone biopsy during the procedure does not cause time loss or any other complications, and protects the surgeon from possible medicolegal problems.

Percutaneous vertebral augmentation procedures for vertebral fractures are increasingly becoming popular. However, due to difficulties in thoracic vertebra morphology and live fluoroscopic imaging, alternate imaging modalities may be needed. In this case report, T4 kyphoplasty application under serial computed tomography imaging is presented.