Publications by authors named "Mehmet Zileli"

67 Publications

Commentary: Transarticular Fixation Following Mobilization of "High-Riding" Vertebral Artery.

Oper Neurosurg (Hagerstown) 2021 Apr 2. Epub 2021 Apr 2.

Ege University Neurosurgery Department, Izmir, Turkey.

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http://dx.doi.org/10.1093/ons/opab082DOI Listing
April 2021

History of WFNS Spine Committee.

Neurospine 2021 Mar 31;18(1):1-6. Epub 2021 Mar 31.

Department of Neurosurgery, Ege University, Izmir, Turkey.

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http://dx.doi.org/10.14245/ns.2040624.312DOI Listing
March 2021

Rehabilitation of Spinal Cord Injury: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):820-832. Epub 2020 Dec 31.

Department of Neurosurgery, Ege University, Izmir, Turkey.

Spinal cord injury (SCI) is accompanied by a significant number of complications associated with damage to the spinal cord, gross functional impairments leading to limited self-care and movement, leading to a high level of disability, social and psychological maladaptation of the patients. Besides, pain and spasticity negatively affect rehabilitation programs. This search was conducted in PubMed/MEDLINE database. All studies published in English language (n = 16,297) were considered for inclusion. Of all studies evaluating rehabilitation in SCI patients (n = 80) were included. Based on the literature review the faculty of the WFNS Spine Committee created statements covering different aspects of the contemporary rehabilitation process of the SCI patients. The prepared statements were subjected to discussions, followed by anonymous voting process by the members of the WFNS Spine Committee. As result of the diccussions and the voting process the statements were modified and published as recommendations of the WFNS Spine Committee. The care for the SCI has gone a long way from the times after the World War II when these patients were considered hopeless in terms of any functional recovery, to the contemporary comprehensive rehabilitation programs. The rehabilitation is important part of the modern comprehencive treatment of SCI patients nowadays. The current manuscript reflects different aspects of the contemporary rehabilitaton process and decision makings, which were discussed by the faculty of the WFNS Spine Committee resulting in issuing of the following recommendations.
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http://dx.doi.org/10.14245/ns.2040270.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788409PMC
December 2020

Outcomes of Spinal Cord Injury: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):809-819. Epub 2020 Dec 31.

Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan.

This comprehensive review article aims to provide some definitive statements on the factors like clinical syndromes, radiological findings, and decompressive surgery, that may influence the outcomes in cervical spinal cord injury management. Literature search on these factors published in the last decade were analyzed and definite statements prepared and voted for consensus opinion by the WFNS Spine Committee members and experts in this field at a meeting in Moscow in June 2019 using Delphi method. This was re-evaluated in a meeting in Pakistan in November 2019. Finally, the consensus statements were brought out as recommendations by the committee to the world literature. Traumatic Spinal Cord Syndromes have good prognosis except in elderly and when the presenting neurological deficit was very poor. Though conservative management provides satisfactory results, results can be improved with surgery when instability and progressive compression was present. Locked facet with spinal cord injury denotes poor prognosis. Magnetic resonance imaging T2 imaging is the essential prognostic indicator that apart from sagittal grade, length of injury, maximum canal compromise, maximum spinal cord compression, axial grading (BASIC) score. Diffusion tensor imaging is the next promising predictor in the pipeline. Decompressive surgery when done earlier especially within 24 hours of injury provides better result and there is no clear evidence to show medical management is better or equivalent to delayed surgical management. Clinical syndromes, radiological syndromes, and surgical decompression have strong impact on the out comes in the management of cervical spinal cord injury. Our comprehensive review and final recommendations on this subject will be of great importance in understanding the complex treatment methods in use.
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http://dx.doi.org/10.14245/ns.2040490.245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788418PMC
December 2020

Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):797-808. Epub 2020 Dec 31.

Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.

Cervical trauma in children have variations from the adults mainly due to anatomic differences. An optimal diagnostic and treatment strategy is critical, particularly when there is a lack of standardized protocols for the management of such cases. This review paper examines the diagnostic and treatment options of pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). A literature search for the last 10 years were conducted using key words. Case reports, experimental studies, papers other than English language were excluded. Up-to-date information on pediatric cervical trauma and SCIWORA were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. This review reflects different aspects of contemporary pediatric cervical trauma decision-making and treatment, and SCIWORA. The mainstay of SCIWORA treatment is nonsurgical with immobilization, avoidance of risky activities. Prognosis generally depends on the initial neurological status and magnetic resonance imaging. Due to a significant discrepancy in the literature on diagnostic and management, future randomized controlled trials are needed to aid in generating standardized protocols.
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http://dx.doi.org/10.14245/ns.2040404.202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788416PMC
December 2020

Pharmacologic and Regenerative Cell Therapy for Spinal Cord Injury: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):785-796. Epub 2020 Dec 31.

Department of Neurosurgery, Kovai Medical Center and Hospital Coimbatore, Tamilnadu, India.

This is a review article examining the pharmacologic and regenerative cell therapy for spinal cord injury. A literature search during last 10 years were conducted using key words. Case reports, experimental (nonhuman) studies, papers other than English language were excluded. Up-to-date information on the pharmacologic and regenerative cell therapy for spinal cord injury was reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. Pharmacologic and regenerative cell therapy for spinal cord injury have long been an interest of many experimental and clinical researches. Clinical studies with methylpredinisolone have not shown clear cut benefit. Other drugs such as Rho inhibitor, minocycline, riluzole, granulocyte colony-stimulating factor have also been tried without significant benefits. Regenerative cell therapy using different types of stem cells, different inoculation techniques, and scaffolds have undergone many trials highlighting the efficacies of cells and their limitations. This review article summarizes the current knowledge on pharmacologic and regenerative cell therapy for spinal cord injury. Unfortunately, there is a need for further experimental and human trials to recommend effective pharmacologic and regenerative cell therapy.
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http://dx.doi.org/10.14245/ns.2040408.204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788403PMC
December 2020

Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):759-784. Epub 2020 Dec 31.

Department of Neurosurgery, Ege University, Izmir, Turkey.

Scientific knowledge today is being generated more rapidly than we can assimilate thus requiring continuous review of gold-standards for diagnosis and treatment of specific pathologies. The aim of this paper is to provide an update on the best early management of spinal cord injury (SCI), in order to produce acceptable worldwide recommendations to standardize clinical practice as much as possible.The WFNS Spine Committee voted recommendations regarding management of SCI based on literature review of the last 10 years. The committee stated 9 recommendations on 3 main topics: (1) clinical assessment and classification of SCI; (2) emergency care and early management; (3) cardiopulmonary management. American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set are considered the most useful and feasible in emergency evaluation and follow-up in case of SCI. Magnetic resonance imaging is the most indicated examination to evaluate patients with symptomatic SCI. In early phase, correction of hypotension (systolic blood pressure < 90 mmHg), and bradycardia are strongly recommended. Surgical decompression should be performed as soon as possible with the ideal surgical time being within 8 hours for both complete and incomplete lesions.
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http://dx.doi.org/10.14245/ns.2040366.183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788427PMC
December 2020

Upper Cervical Spine Trauma: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):723-736. Epub 2020 Dec 31.

Department of Neurosurgery, Ege University, Izmir, Turkey.

Craniovertebral junction (CVJ) trauma is a challenging clinical condition. Being a highly mobile functional unit at the junction of the skull and the vertebral column, traumatic events in this area may produce devastating neurological complications and death. Additionally, many of the CVJ traumatic injuries can be left undiagnosed or even raise difficult treatment dilemmas. We present a literature review in the format of recommendations on the diagnosis and management of different scenarios for upper cervical trauma and produce recommendations, which can be applicable to various areas of the globe.
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http://dx.doi.org/10.14245/ns.2040226.113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788417PMC
December 2020

Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations.

Neurospine 2020 Dec 31;17(4):710-722. Epub 2020 Dec 31.

N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.

Epidemiology, prevention, early management of cervical spine trauma and it's reduction are the objectives of this review paper. A PubMed and MEDLINE search between 2009 and 2019 were conducted using keywords. Case reports, experimental studies, papers other than English language and and unrelated studies were excluded. Up-to-date information on epidemiology of spine trauma, prevention, early emergency management, transportation, and closed reduction were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Global incidence of traumatic spinal injury is higher in low- and middle-income countries. The most frequent reasons are road traffic accidents and falls. The incidence from low falls in the elderly are increasing in high-income countries due to ageing populations. Prevention needs legislative, engineering, educational, and social efforts that need common efforts of all society. Emergency care of the trauma patient, transportation, and in-hospital acute management should be planned by implementing detailed protocols to prevent further damage to the spinal cord. This review summarizes the WFNS Spine Committee recommendations on epidemiology, prevention, and early management of cervical spine injuries.
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http://dx.doi.org/10.14245/ns.2040282.141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788428PMC
December 2020

Cervical Spine Trauma and Spinal Cord Injury Recommendations of WFNS Spine Committee.

Neurospine 2020 Dec 31;17(4):704-707. Epub 2020 Dec 31.

Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan.

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http://dx.doi.org/10.14245/ns.2040658.329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788405PMC
December 2020

Commentary: Microsurgical Anterior Controllable Antedisplacement Fusion to Treat Cervical Ossified Posterior Longitudinal Ligament: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Feb;20(3):E222-E224

Neurosurgery Department, Ege University, Izmir, Turkey.

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http://dx.doi.org/10.1093/ons/opaa439DOI Listing
February 2021

How to Improve Outcomes of Spine Surgery in Geriatric Patients.

World Neurosurg 2020 08;140:519-526

Department of Neurosurgery, Ege University, Izmir, Turkey.

Background: The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery.

Methods: A literature search of the last 10 years was done.

Results: Outcomes of spine surgery using decompressive techniques only are similar to outcomes in younger patients. However, in patients with comorbidities, the outcomes are less favorable with more complications. Complication rates decrease when minimally invasive techniques are used. If a fusion surgery is necessary, especially in cases with deformity correction, complication rates significantly increase up to 60%. Osteoporosis comanagement is necessary to prevent nonunion and implant failure if a fusion surgery is planned. Enhanced recovery after surgery protocols can be an aid to preparation and rehabilitation of elderly patients. A frailty index can help to predict patients with the worst outcomes. Additional psychological support and some other measures will help to reduce the incidence of postoperative delirium.

Conclusions: Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
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http://dx.doi.org/10.1016/j.wneu.2020.04.060DOI Listing
August 2020

Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations.

World Neurosurg X 2020 Jul 23;7:100079. Epub 2020 Jun 23.

Neurosurgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy.

Background: Degenerative lumbar spinal stenosis (LSS) is a progressive disease with potentially dangerous consequences that affect quality of life. Despite the detailed literature, natural history is unpredictable. This uncertainty presents a challenge making the correct management decisions, especially in patients with mild to moderate symptoms, regarding conservative or surgical treatment. This article focused on conservative treatment for degenerative LSS.

Methods: To standardize clinical practice worldwide as much as possible, the World Federation of Neurosurgical Societies Spine Committee held a consensus conference on conservative treatment for degenerative LSS. A team of experts in spinal disorders reviewed the literature on conservative treatment for degenerative LSS from 2008 to 2018 and drafted and voted on a number of statements.

Results: During 2 consensus meetings, 14 statements were voted on. The Committee agreed on the use of physical therapy for up to 3 months in cases with no neurologic symptoms. Initial conservative treatment could be applied without major complications in these cases. In patients with moderate to severe symptoms or with acute radicular deficits, surgical treatment is indicated. The efficacy of epidural injections is still debated, as it shows only limited benefit in patients with degenerative LSS.

Conclusions: A conservative approach based on therapeutic exercise may be the first choice in patients with LSS except in the presence of significant neurologic deficits. Treatment with instrumental modalities or epidural injections is still debated. Further studies with standardization of outcome measures are needed to reach high-level evidence conclusions.
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http://dx.doi.org/10.1016/j.wnsx.2020.100079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322792PMC
July 2020

Mobility-Preserving Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations.

World Neurosurg X 2020 Jul 19;7:100078. Epub 2020 Mar 19.

Neurosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.

Background: Although decompression is the basis of surgical treatment for lumbar spinal stenosis (LSS), under various circumstances instrumented fusion is performed as well. The rationale for mobility-preserving operations for LSS is preventing adjacent segment disease (ASD). We review the rationale for mobility preservation in ASD and discuss related topics such as indications for fusion and the evolving role of minimally invasive approaches to lumbar spine decompression. Our focus is on systematic review and consensus discussion of mobility-preserving surgical methods as related to surgery for LSS.

Methods: Groups of spinal surgeons (members of the World Federation of Neurosurgical Societies Spine Committee) performed systematic reviews of dynamic fixation systems, including hybrid constructs, and of interspinous process devices; consensus statements were generated based on the reviews at 2 voting sessions by the committee several months apart. Additional review of background data was performed, and the results summarized in this review.

Results: Decompression is the basis of surgical treatment of LSS. Fusion is an option, especially when spondylolisthesis or instability are present, but indications remain controversial. ASD incidence reports show high variability. ASD may represent the natural progression of degenerative disease in many cases. Older age, poor sagittal balance, and multilevel fusion may be associated with more ASD. Dynamic fixation constructs are treatment options that may help prevent ASD.
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http://dx.doi.org/10.1016/j.wnsx.2020.100078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322805PMC
July 2020

Fusion Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations.

World Neurosurg X 2020 Jul 18;7:100077. Epub 2020 Mar 18.

Department of Neurosurgery, Ege University Bornova, Izmir, Turkey.

Lumbar spine stenosis represents a complex degenerative pathology that has been a subject of significant dispute when it comes to fusion. A review of the literature from 2008 to 2019 was performed on the role of fusion in the treatment of lumbar spinal stenosis using PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Using the key words "lumbar spinal stenosis," "lumbar fusion," "lumbar decompression," and "lumbar pedicle screw fixation," the search revealed 490 papers. Of these, only Level 1 or Level 2 evidence papers were selected, leading to only 3 randomized controlled trials (RCTs) that were analyzed. None of the good-quality studies (RCTs) performed so far have proven any clinical benefit of adding fusion to degenerative lumbar spine decompression. The effect of spinal instability on the outcome following decompression remains controversial. At present, no unanimous criteria exist among the RCTs to identify what constitutes true instability. Fusion for instability or stenosis alone remains controversial, and the results are unconvincing. At this point, the issue expands to not only lumbar degenerative diseases but spinal fractures and lumbar isthmic spondylolisthesis. We thereby present the consensus of the World Federation of Neurosurgical Societies Spine Committee, which formulated the indications for lumbar spine fusion in degenerative lumbar stenosis.
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http://dx.doi.org/10.1016/j.wnsx.2020.100077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322802PMC
July 2020

Decompressive Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations.

World Neurosurg X 2020 Jul 10;7:100076. Epub 2020 Mar 10.

Neurosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.

Objective: Lumbar spine stenosis is a common disease with a prevalence progressively increasing due to the aging of the population. Despite many papers having been published over the last decades, there still remain many doubts regarding its natural history and appropriate treatment. To overcome these problems and reach some globally accepted recommendations, the World Federation of Neurosurgical Society Spine Committee organized a consensus conference on this topic. This paper describes recommendations about the efficacy of surgical decompression, the difference between surgical techniques, and complications of surgery.

Methods: World Federation of Neurosurgical Society Spine Committee aimed to standardize clinical practice worldwide as much as possible and held a 2-round consensus conference on lumbar spinal stenosis. A team of expert spine surgeons reviewed literature regarding surgical treatment from over the last 10 years, and then drafted and voted on some statements based on the presented literature.

Results: Ten statements were voted. The committee agreed on the effectiveness of surgical decompression in patients with moderate-to-severe symptoms or with neurologic deficits. There was no consensus on the best surgical technique and, in particular, about the equivalence of microscopic techniques and an open approach. Regarding complications, we agreed that the most frequent complications are incidental durotomy and general complications in the elderly.

Conclusions: Surgical decompression represents the treatment of choice for symptomatic lumbar spinal stenosis with a low complication rate. However, which surgical technique is the best is still under debate. Further studies with standardized outcome measures are needed to understand the real complication rate and frequency of different unwanted events.
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http://dx.doi.org/10.1016/j.wnsx.2020.100076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322794PMC
July 2020

Lumbar Spinal Stenosis: Introduction to the World Federation of Neurosurgical Societies (WFNS) Spine Committee Recommendations.

World Neurosurg X 2020 Jul 10;7:100075. Epub 2020 Mar 10.

Neurosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy.

Introduction: Lumbar spinal stenosis (LSS) is a common degenerative disease that every spine surgeon will come across in daily practice. Despite this, the natural history and treatment have not been well established and standardized as yet, and there have been few guidelines published on this topic to date. The aim of the World Federation of Neurosurgical Society Spine Committee Consensus Conference is to define evidence-based and expert-based recommendations for the diagnosis and treatment of LSS, considering the different possibilities and facilities in countries worldwide.

Methods: An international committee of spinal surgeons reunited to perform the Consensus Conference on the topic of LSS. The Delphi method was applied to administer a questionnaire and obtain a consensus on various topics. A multidisciplinary committee defined 6 panels: 1) natural course and diagnosis of LSS; 2) conservative treatment and follow-up; 3) percutaneous techniques; 4) decompressive surgery; 5) fusion surgery; 6) mobility preserving surgery. The statements and the literature review were presented and voted.

Results: A total of 44 statements were stated and then voted by 16 experienced spine surgeons to obtain the final results. A total of 36 statements reached a consensus, of which 34 reached a positive consensus and 2 a negative consensus, whereas no consensus was reached in 8 cases.

Conclusions: In the absence of evidence-based medicine, these recommendations offer support for all practitioners, independent from economic resources and personal experience. Obviously, further studies are needed and will be well accepted to support or modify these recommendations.
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http://dx.doi.org/10.1016/j.wnsx.2020.100075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322795PMC
July 2020

Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations.

World Neurosurg X 2020 Jul 28;7:100073. Epub 2020 Feb 28.

Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy.

Lumbar spinal stenosis (LSS) is defined as a degenerative disorder showing a narrowing of the spinal canal. The diagnosis is straightforward in cases with typical neurogenic claudication symptoms and unequivocal imaging findings. However, not all patients present with typical symptoms, and there is obviously no correlation between the severity of stenosis and clinical complaint. The radiologic diagnosis of LSS is widely discussed in the literature. The best diagnostic test for the diagnosis of LSS is magnetic resonance imaging (MRI). However, canal diameter measurements have not gained much consensus from radiologists, whereas qualitative measures, such as cerebrospinal fluid space obliteration, have achieved greater consensus. Instability can best be defined by standing lateral radiograms and flexion-extension radiograms. For cases showing typical neurogenic claudication symptoms and unequivocal imaging findings, the diagnosis is straightforward. However, not all patients present with typical symptoms, and there is obviously no correlation between the severity of stenosis (computed tomography and MRI) and clinical complaint. In fact, recent MRI studies have shown that mild-to-moderate stenosis can also be found in asymptomatic individuals. Routine electrophysiological tests such as lower extremity electromyography, nerve conduction studies, F-wave, and H-reflex are not helpful in the diagnosis and outcome prediction of LSS. The electrophysiological recordings are complementary to the neurologic examination and can provide confirmatory information in less obvious clinical complaints. However, in the absence of reliable evidence, imaging studies should be considered as a first-line diagnostic test in the diagnosis of degenerative LSS.
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http://dx.doi.org/10.1016/j.wnsx.2020.100073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322797PMC
July 2020

Traumatic Spine Injury: Which Discrepancy Between the Research Output and the Actual Burden of the Disease?

World Neurosurg 2020 10 24;142:e117-e125. Epub 2020 Jun 24.

Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.

Objective: Traumatic spinal injury (TSI) is a global health issue contributing to morbidity and mortality, especially in low- and middle-income countries. The aim of this study is to compare the epidemiological estimates of TSI with the corresponding amount of published papers for different regions.

Methods: A bibliometric analysis was performed by collecting the number of publications concerning TSI from the PubMed database. Results were sorted according to the different geographical World Health Organization regions. A "publication-to-volume ratio" was obtained by comparing the average number of documents per year with the number of TSI cases across each region.

Results: A total of 2304 articles were detected from 2008 to 2018. The major publishing regions were North America (AMR-US/Can: 843 articles, 36.6%) and Europe (EUR: 833, 36.2%), then Western Pacific (WPR: 410, 17.8%), Eastern Mediterranean (EMR: 73, 3.2%), South-East Asia (SEAR: 71, 3.1%), Latin America (AMR-L: 55, 2.4%), Africa (AFR: 19, 0.8%). The United States is the most publishing country in AMR-US/Can (86.0%), and Germany in EUR (22.4%). In 2018, EUR published 36.6% of papers versus AMR-US/Can 26.5% and WPR 25.7%, thanks to an increase in Chinese publications. The highest publication ratios of 4.63 and 2.68 were found for AMR-US/Can and EUR, respectively. The other were EMR (0.22), WPR (0.18), AMR-L (0.07), SEAR (0.03), and AFR (0.01).

Conclusions: A marked divide is currently found between countries with a high burden of TSI and those where there is most research interest, estimated as amount of publications. Data demonstrate the need for increased inclusiveness in guidelines generation from high-income countries including collection and analysis from low- and middle-income countries.
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http://dx.doi.org/10.1016/j.wneu.2020.06.131DOI Listing
October 2020

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.

Neurospine 2019 Sep 30;16(3):435-447. Epub 2019 Sep 30.

Department Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Tamilnadu, India.

This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.
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http://dx.doi.org/10.14245/ns.1938196.098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790741PMC
September 2019

Posterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.

Neurospine 2019 09 30;16(3):421-434. Epub 2019 Sep 30.

Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, India.

Objective: This study was conducted to determine and recommend the most up-to-date information on the indications, complications, and outcomes of posterior surgical treatments for cervical spondylotic myelopathy (CSM) on the basis of a literature review.

Methods: A comprehensive literature search was performed, using the MEDLINE (PubMed), the Cochrane Register of Controlled Trials, and Web of Science databases, for peer-reviewed articles published in English during the last 10 years.

Results: Posterior techniques, which include laminectomy alone, laminectomy with fusion, and laminoplasty, are often used in patients with involvement of 3 or more levels. Posterior decompression for CSM is effective for improving patients' neurological function. Complications resulting from posterior cervical spine surgery include injury to the spinal cord and nerve roots, complications related to posterior screw fixation or instrumentation, C5 palsy, spring-back closure of lamina, and postlaminectomy kyphosis.

Conclusion: It is necessary to consider multiple factors when deciding on the appropriate operation for a particular patient. Surgeons need to tailor preoperative discussions to ensure that patients are aware of these facts. Further research is needed on the cost-to-benefit analysis of various surgical approaches, the comparative efficacy of surgical approaches using various techniques, and long-term outcomes, as current knowledge is deficient in this regard.
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http://dx.doi.org/10.14245/ns.1938274.137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790723PMC
September 2019

Anterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.

Neurospine 2019 09 30;16(3):408-420. Epub 2019 Sep 30.

Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India.

Objective: This study was performed to review the literature and to present the most up-to-date information and recommendations on the indications, complications, and success rate of anterior surgical techniques for cervical spondylotic myelopathy (CSM). The commonly performed anterior surgical procedures are multiple-level anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion and its variants (skip corpectomy and hybrid surgery), and oblique corpectomy without fusion.

Methods: A comprehensive literature search and analysis were performed using MEDLINE (PubMed), the Cochrane Register of Controlled Trials, and the Web of Science for peer-reviewed articles published in English during the last 10 years.

Results: Corpectomy is mandated for ventral compression of fewer than 3 vertebral segments where single-level disc and osteophyte excision is inadequate to decompress the cord. Endoscopic or oblique partial corpectomy improves the sagittal canal diameter by 67% and obviates the need for an additional bone graft procedure.

Conclusion: The indications of anterior surgery in patients with CSM include a straightened or kyphotic spine with a compression level lower than 3. With an appropriate choice of implants and meticulous surgical technique, surgical complications can be seen only rarely. Improvements after anterior surgery for CSM have been reported in 70% to 80% of patients.
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http://dx.doi.org/10.14245/ns.1938250.125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790738PMC
September 2019

Value of Surgery and Nonsurgical Approaches for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.

Neurospine 2019 Sep 30;16(3):403-407. Epub 2019 Sep 30.

Department of Neurosurgery, Ege University, Izmir, Turkey.

Cervical spondylotic myelopathy (CSM) is a common cause of adult spinal cord dysfunction. Although the therapeutic options for moderate to severe CSM patients have been established well, the existing guidelines for therapeutic decisions in mild cases of CSM are unclear. We present a review of literature on conservative treatment and surgery for CSM and suggest general recommendations applicable in various clinical presentations and in different geographic locations across the globe, with due considerations to available resources and locally prevalent practices.
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http://dx.doi.org/10.14245/ns.1938238.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790727PMC
September 2019

Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques -WFNS Spine Committee Recommendations.

Neurospine 2019 Sep 30;16(3):386-402. Epub 2019 Sep 30.

Department Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Tamilnadu, India.

Objective: This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques.

Methods: A literature search was performed for articles published during the last 10 years.

Results: The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease.

Conclusion: The natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.
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http://dx.doi.org/10.14245/ns.1938240.120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790728PMC
September 2019

Recommendations of WFNS Spine Committee.

Authors:
Mehmet Zileli

Neurospine 2019 Sep 30;16(3):383-385. Epub 2019 Sep 30.

Department of Neurosurgery, Ege University, Izmir, Turkey.

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http://dx.doi.org/10.14245/ns.19int003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790736PMC
September 2019

Chiari I Malformation: Is It the Result of an instability, and Should We Perform a Fusion Surgery?

Authors:
Mehmet Zileli

Neurospine 2019 Jun 30;16(2):221-222. Epub 2019 Jun 30.

Department of Neurosurgery, Ege University, Izmir, Turkey.

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http://dx.doi.org/10.14245/ns.19edi.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603838PMC
June 2019

Transverse Process Fractures: A Clinical Series and Coronal Injury of the Spine.

World Neurosurg 2018 Nov 28. Epub 2018 Nov 28.

Neurosurgery Department, Gazi Hospital, Izmir, Turkey.

Background: Transverse process fractures in trauma patients frequently are diagnosed using computed tomography and result in severe pain and limitation of motion. However, there is no accepted standard of care. Thus, these fractures can be treated with excessive measures or inadequately treated. In this study, diagnosis and treatment of transverse process fractures are examined.

Methods: The mechanisms of trauma, findings, and associated organ injuries of 50 patients with transverse process fractures and no other spinal injuries treated between 2013 and 2015 were recorded. The same treatment protocol was applied to each patient. The results of the treatments were examined retrospectively and recorded.

Results: Deformation and edema of the fascia and muscles around the transverse process fractures were detected by computed tomography and magnetic resonance imaging. The average pain intensity of the patients before treatment was 8.8 of 10 on a visual analog scale and 5.2 of 10 after treatment with nonsteroidal anti-inflammatory drugs, muscle relaxants, flexible support corsets, and mobilization. Patients hospitalized for additional pathologies were primarily treated in thoracic surgery wards (11 of 15 patients). Transverse process fractures were caused by backward falls or blows to the back in 49 patients.

Conclusions: Transverse process fractures can be treated quickly and effectively with the recommended protocol after excluding any accompanying organ injuries or other spinal injuries. Transverse process fractures most often occur during backward falls or blows to the back, commonly low-energy injuries. This trauma mechanism can be described as a "coronal injury of the spine."
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http://dx.doi.org/10.1016/j.wneu.2018.11.147DOI Listing
November 2018