Background: Successful spinal stabilization depends not only on early mechanical fixation but also on durable biological integration at the bone-implant interface. This study aimed to compare a two-stage allograft-augmented fixation strategy, intended to promote biological fixation, with conventional posterior segmental stabilization (PSS) in the treatment of screw loosening following multilevel spinal surgery for degenerative spine pathology. Methods: This retrospective comparative study included 40 patients who underwent multilevel spinal stabilization between January 2022 and February 2025, with follow-up completed by November 2025. Patients were divided into a conventional PSS group (n = 28) and a two-stage allograft-augmented fixation group (OI-focused strategy, n = 12). Demographic characteristics, comorbidity burden, length of hospital stay, complications, Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and sagittal radiographic parameters-including lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope (SS), and pelvic incidence (PI)-were evaluated preoperatively and at 1, 6, and 9 months postoperatively. Results: The groups were similar in terms of age, sex, body mass index, smoking status, and number of operated levels. Despite the significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores in the OI-focused group, hospital stay was significantly shorter. VAS and ODI scores were comparable preoperatively and at 1 month; however, significantly better pain and functional outcomes were observed in the OI-focused group at 6 and 9 months. Radiologically, SVA was significantly lower in the OI-focused group at 6 and 9 months. Late differences were also observed in LL and SS, while PI remained similar between groups. Fusion-related findings were interpreted cautiously because fusion was assessed using plain radiographs and osseointegration was not directly measured. Conclusions: The two-stage allograft-augmented fixation strategy was associated with better mid-term pain control, improved functional recovery, and better preservation of selected sagittal alignment parameters compared with conventional PSS. However, these findings should be interpreted cautiously due to the retrospective design, limited sample size, imbalanced groups, absence of direct osseointegration measurement, and lack of CT-based fusion analysis.

BACKGROUND Comparative clinical data evaluating percutaneous facet cage (PFC)-based minimally invasive decompression against traditional laminectomy and lateral mass screw (LMS) fixation in patients with cervical spondylotic myelopathy (CSM) remain limited. We compared the clinical and radiological outcomes of these 2 surgical strategies. MATERIAL AND METHODS We retrospectively reviewed 76 patients with CSM operated on between 2020 and 2024. Patients were categorized into 2 groups: the LMS group (n=46): laminectomy with LMS fusion; and the PFC group (n=30): speculum-assisted laminotomy with PFC fusion. Clinical outcomes were assessed using modified Japanese Orthopaedic Association, Neck Disability Index (NDI), visual analog scale (VAS), and Oswestry Disability Index (ODI) scores. Radiological parameters included cervical lordosis, T1 slope, cervical sagittal vertical axis, foraminal height, and fusion rate. Complications and perioperative data were compared. RESULTS The PFC group had better perioperative outcomes and numerically fewer complications, and achieved superior NDI, VAS, and ODI scores at 1 year, while both groups improved significantly in all clinical outcomes. Radiologically, foraminal height increased significantly in the PFC group. No significant differences were found between the groups in terms of fusion rates, cervical sagittal vertical axis, or cervical lordosis. CONCLUSIONS In this retrospective cohort, minimally invasive decompression combined with PFC was associated with shorter operative time, lower blood loss, and shorter hospital stay than conventional laminectomy with LMS fixation. Neurological recovery and radiological outcomes were comparable between groups, while pain and disability scores favored the PFC group. Minimally invasive decompression with PFC fusion is a viable alternative for elderly patients, those with multiple comorbidities, or those at high risk of perioperative bleeding.

Objective:To evaluate the clinical and radiological outcomes of percutaneous cervical facet cage stabilization and indirect decompression in patients with cervical spondylotic radiculopathy and myelopathy. Materials and Methods:This retrospective study included 25 patients who underwent bilateral percutaneous cervical facet cage placement between 2022 and 2024. Patients with Kang Grade 1-2 cervical stenosis who underwent indirect decompression without additional decompressive surgery and had at least 1 year of follow-up were included. Clinical outcomes were assessed using the Visual Analog Scale scores for neck and arm pain, Modified Japanese Orthopedic Association score, Neck Disability Index, and Oswestry Disability Index. Radiological evaluation included C2-C7 Cobb angle, C2 sagittal vertical axis, foraminal height, facet height, interspinous height, posterior disc space height, and fusion status. Results:The study included 25 patients (14 males and 11 females), with a mean age of 57 years. Significant improvement was observed in all clinical outcome measures at the 1-year follow-up (P < 0.05). Mean facet height increased by 2.4 mm, interspinous height by 2.3 mm, and posterior disc height by 1.9 mm. Foraminal height increased by 2 mm; however, this change was not statistically significant. Cervical sagittal alignment parameters remained unchanged. Fusion was achieved in 23 of 25 patients (92%). Mean operative duration was 34.2 min for single-level procedures and 49.3 min for two-level procedures. One superficial wound infection occurred and resolved with debridement and antibiotic therapy. Two patients required revision surgery because of recurrent symptoms. Conclusion:Percutaneous cervical facet cage stabilization with indirect decompression is a minimally invasive and effective treatment option in selected patients with cervical spondylotic radiculopathy and myelopathy. The technique provides satisfactory clinical and radiological outcomes with low morbidity and short operative duration.

BACKGROUND: Traumatic brain injury is still an important health problem worldwide. Traumatic brain injury not only causes direct mechanical damage to the brain but also induces biochemical changes that lead to secondary nerve cell loss. In this study, we investigated the neuroprotective effect of milrinone after traumatic brain injury (TBI) in a rat model. METHODS: Forty male Wistar albino rats, were used. Rats were divided into 4 groups: 1) sham, 2) TBI, 3) TBI + Ringers, and 4) TBI + Milrinone. In group 1 (sham), only craniotomy was performed. In group 2 (TBI), TBI was performed after craniotomy. In group 3 (TBI + Ringer), TBI was performed after craniotomy and intraperitoneal Ringers solution was given immediately afterward. Group 4 (TBI + Milrinone), TBI was performed after craniotomy, and milrinone was given 1.0 mg/kg milrinone intraperito-neally directly (0.5 mg/kg milrinone intraperitoneally again 24 hours, 48 hours, and 72 hours after trauma). Tests were performed for neurological and neurobehavioral functions. Immunohistochemistry and histopathology studies were performed. RESULTS: In group 4 compared with group 2 and group 3 groups, tests for neurological functions and neuro-behavioral functions were significantly better. In the mil-rinone treatment used in group 4, plasma and brain tissue tumor necrosis factor, 8-OH 2-deoxyguanosine , and inter-leukin 6 levels were significantly decreased, and increased plasma and tissue IL-10 levels were detected. Histopathological spinal cord injury and apoptotic index increased in groups 2 and 3, while significantly decreasing in group 4. CONCLUSIONS: This study shows for the first time that the anti-inflammatory, antioxidant and antiapoptotic prop-erties of milrinone may be neuroprotective after TBI.

Objective: Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. The most common problem in the follow-up after GBM treatment is the lack of local control. This study aims to evaluate the efficacy and safety of Temozolomide (TMZ) in cases who received post-surgical radiotherapy and TMZ treatment in GBM compared to cases who received only radiotherapy treatment after surgery. Materials and Methods: The cases diagnosed with GBM were divided into two groups. The first group was divided into cases that received only radiotherapy after surgery, and the second group (combined treatment group) was divided into cases that received post-surgical radiotherapy and TMZ treatment. 28 cases who received radiotherapy and TMZ treatment after surgery and 26 cases who received only radiotherapy after surgery were included in the study. Local fractionated radiotherapy (60 Gy total dose: 2 Gyx5 days/week for 6 weeks) was applied to all cases. Only in the second group, 75 mg/m2/day 7 days/week orally, 200 mg/m2/day 5 days as monotherapy for 6 weeks, and six cycles of TMZ every 28 days were administered concomitantly. In addition to the effect of TMZ on prognosis and survival, the effects of age, gender, and resection size on progression-free survival (PSS) and overall survival (GSS) were evaluated in both groups. Results: There was no statistically significant benefit in terms of both PFS and OS in both groups for age and gender, a statistically significant benefit was found for resection size (total-subtotal). At the end of the study, PFS was 14 months in the combined treatment group and 6 months in the radiotherapy alone group (P<0.0001). OS was 16 months in the combined treatment group and 12.5 months in the radiotherapy alone group (P=0.0354). Conclusion: Combined (RT + TMZ) treatment after total surgical treatment was found to be more effective on prognosis and survival than radiotherapy alone.

AIM: To evaluate the effectiveness and outcomes of unilateral dynamic stabilization in patients with recurrent lumbar disc herniation (RLDH). MATERIAL and METHODS: Patients requiring an operation due to RLDH at the L4-5 level were included in the study.They divided into the following two groups: SD group who had only revision discectomy (n=20) and DD group who had unilateral dynamic rod stabilization with discectomy (n=20). Low back and leg pain were evaluated with the visual analog scale (VAS), and functional results were evaluated with the Oswestry disability index (ODI). The VAS scores were evaluated in two different regions as VAS Low Back (VASLB) and VAS Leg (VASL). The results of each patient were evaluated preoperatively and at 1 and 12 months postoperatively. The anterior disc height (ADH), posterior disc height (PDH), and segmental angle (SA) were measured on the sagittal computed tomography (CT) scans of each patient's lumbar spine. Modified Pfirrmann grades in the operated and adjacent segments on lumbar magnetic resonance imaging (MRI) were assessed preoperatively and at 12 months postoperatively. RESULTS: A total of, 40 patients (17 women and 23 men; mean age, 47.9 years) were enrolled. There was no statistically significant difference in the VASLB scores between the two groups (p=0.42). The decrease in VASL scores was statistically significant between groups (p<0.05). A statistically significant decrease in ODI scores was also observed (p<0.05). When ADH and PDH obtained preoperatively and postoperatively were compared for the SD group, the differences were not statistically significant. Significant differences were found for ADH and PDH obtained preoperatively and postoperatively in the DD group (p<0.05). However, for SA, the difference was not significant between the two groups (p=0.28). CONCLUSION: Unilateral dynamic stabilization for RLDH leads to fewer surgical complications and provides sufficient stability by preserving segmental movements.

Objectives: Posterior atlantoaxial stabilization can be technically challenging. Postoperative C2 nerve dysfunction occurs as a complication of this procedure or when a lateral mass is exposed and sacrificed for screw placement. Patients with cervical pathology sometimes complain of low back pain simultaneously. In this study, we aimed to investigate the results of C1-C2 posterior stabilization and C2 nerve root sacrifice on postoperative lumbar complaints. Methods: Twenty-six patients who underwent multicentric posterior C1-C2 stabilization due to atlantoaxial dislocation were retrospectively included in the study. Those that were not sacrificed the C2 nerve root during stabilization were considered group 1 (n = 12), and those that were sacrificed the C2 nerve root were considered group 2 (n = 14). A visual Analogue Scale (VAS) was used for the neck, arm, low back, and leg pain. The EQ-5D Index was used as the overall quality of life scale. Results: Six months postoperatively, both groups showed significant (p < 0.01) improvement in VAS neck, arm, and low back scores between preoperative and postoperative. In addition, there was no significant improvement in the VAS leg and EQ-5D score in either of the groups. While no significant decrease was found in occipital neuralgia in group 1, it showed significant (p < 0.01) improvement in occipital neuralgia in group 2. Conclusions: Although the exact pathophysiology is unknown, cervical stabilization surgery and sacrification of the C2 nerve root in this surgery can, directly and indirectly, improve low back pain.

Mortality in traumatic brain injury (TBI) is thought to be pathology in the heart-brain axis but its effect on the prognosis of traumatic brain injury remains unclear. Our study aimed to investigate the relationship between cardiac troponin I (cTnI) level and prognosis in TBI patients. Between January 2017 and May 2021, 480 patients diagnosed with TBI, who applied to the emergency department, were retrospectively included in this multicentric study. The databases of the hospitals were examined comprehensively and the demographic, clinical, laboratory, radiological, and therapeutic data and results of the patients were obtained. The severity of trauma and clinical status was evaluated with AIS, Injury Severity Score (ISS), ASA physical status, and Glasgow Coma Scale (GCS). The severity of the trauma was evaluated with the ISS. The modified Rankin Scale (mRS) and the Glasgow Outcome Scale (GOS) at discharge were used to evaluate in-hospital clinical outcomes. cTnI levels were classified into three categories: normal (< 0.05 ng/ml), mildly elevated (0.05–0.99 ng/ml), and severely elevated (≥ 1 ng/ml). The mean age of the patients was 41.7 and 75.4% of them were men. It was observed that mortality among patients over 65 years (13.9%) increased. High cTnI was detected in 284 (59.1%) patients. Although it was not statistically significant regarding the elevation of cTnI in patients under 65 years of age ( P = 0.62), the difference was significant for cTnI in patients over 65 years of age ( P < 0.001). The relationship between cTnI elevation was found to be statistically significant ( P < 0.001) as the severity of the trauma increased and when severe additional traumas (thoracic, abdominal, or pelvic) occurred. A high cTnI level is associated with poor prognosis in TBI patients. cTnI measurement is a useful tool for early risk stratification and accelerated care; however, further prospective studies are needed.

Procalcitonin (PCT) is a glicopeptide of 116 amino acid and precursor of calcitonin hormone. At the present day procalcitonin take attention because of being specific to bacterial infection and also is a new indicator for infection which do not affected from viral infection and Systemic Inflamatuar Response Syndrome. The objective of this study was to show the effect of neurosurgical procedures to procalcitonin levels and to distinguish neurosurgical procedure inflammatory reaction from postsurgical associated infection. We carried out our study in Çukurova University Neurosurgery department between May 2007- December 2007. Total number of 44 intracranial tumor existing patients carried out in the study. One day preoperative and four days postoperative values of procalcitonin, white blood cell, C-reactive protein (CRP) and fever were investigated. Results were analyzed in SPSS 15.0 program. In all infection developing patients of the study procalsitonin levels found over 0.1 ng/ml. According to our results patients with a higher of 0.1 ng/ml procalsitonin values in postoperative second and third need attention to followed carefully for postoperative infection. In our study crp exposed a similar kinetic activity in infection developing and infection free patients. We exposed high levels of crp (CRP>5 ng/ml) in both groups. This predicate that crp can not be used in the following of postoperative infection. We may suggest procalcitonin is superior to other existing infection parameters because of not effecting from surgical associated inflamatuar response and a quicker response to routine used other parameters. We suggest that procalcitonin will be a safe and serious parameter in following neurosurgical associated systemic complications by results of new studies which includes more patients and different surgical procedures.

Purpose: The aim of this study was to identify patients with acute neurological findings associated with COVID-19 and to demonstrate the effectiveness of magnetic resonance imaging (MRI) in its diagnosis. Materials and Methods: Between June 2020 and December 2021, 90 patients who were diagnosed with Covid-19 in our clinic, had pneumonia findings in the lung, acute neurological findings, and brain MRI were included in the study. Results were evaluated retrospectively for 46 patients without central nervous system (CNS) involvement and 44 patients with CNS findings. Results: The most common neurological symptoms in COVID-19 patients; Unexplained loss of consciousness by treatment (28/44, 63.6%), focal neurologic deficits (21/44, 47.7%), and seizures (9/44, 20.4%). Increased mortality, increment in the need for ventilator support, and prolonged stay in the intensive care unit were observed in patients with CNS findings. Brain MRI was performed on 44 patients with neurological symptoms. Mean age of 68.3 years (45–78) in patients undergoing MRI. Acute findings were detected in MRI of 32 patients (72%). The most common diagnoses in brain MRI were acute and subacute infarcts. Conclusion: The mechanism of CNS manifestations is still unclear, and neurological symptoms in COVID-19 patients are an important problem, especially in intensive care units. Therefore, early detection and treatment of CNS involvement are very important.