Study Design Global cross-sectional survey Objective To develop and refine the techniques for web... more Study Design Global cross-sectional survey Objective To develop and refine the techniques for web-based international validation of fracture classification systems. Methods A live webinar was organized in 2018 for validation of the AO Spine Subaxial Injury Classification System, consisting of 35 unique computed tomography (CT) scans and key images with subaxial spine injuries. Interobserver reliability and intraobserver reproducibility was calculated for injury morphology, subtype, and facet injury according to the classification system. Based on the experiences from this webinar and incorporating rater feedback, adjustments were made in the organization and techniques used and in 2020 a repeat validation webinar was performed, evaluating images of 41 unique subaxial spine injuries. Results In the 2018 session, the AO Spine Subaxial Injury Classification System demonstrated fair interobserver reliability for fracture subtype (κ = 0.35) and moderate reliability for fracture morpholog...
OBJECTIVE Although previous studies have reported the expression of JAK1, STAT3 and phosphorylate... more OBJECTIVE Although previous studies have reported the expression of JAK1, STAT3 and phosphorylated p-STAT3 in hypertrophied ligamentum flavum (LF), the role of the JAK/STAT signalling pathway in hypertrophied LF has not been fully elucidated. The aim of this study was to identify the important JAK/STAT gene expression patterns of the three main receptors involved in this pathway, namely, IFNAR, IFN-γ and IL-6. METHODS The human LF specimens were obtained from 28 patients who underwent lumbar spine surgery for either degenerative lumbar canal stenosis (DLCS) (n=28) or lumbar disc herniation (LDH) (n=20). In this design, LDH patients served as the control group. Fibrosis degrees were showed Masson's trichrome staining. The location and the expression profiling of JAK/STAT pathway were analysed using real-time polymerase chain reaction and western blotting. The thickness of the LF was measured with axial T1-weighted magnetic resonance imaging. RESULTS The most severe fibrotic changes were on the dorsal side of the LF. IL-6 and IFN-I expression significantly increased on the dorsal side of the LF. While expression levels of IL-6R and IFNAR on the dural and dorsal side were significantly higher in the DLCS samples, IFN-γR and endothelial EGFR in LF samples showed a significant increase on only the dorsal side. JAK/STAT genes were significantly expressed particularly on the dorsal side. CONCLUSIONS We think both IFNAR and IL-6 receptor-dependent JAK/STAT signalling pathways may be significant targets for drug development strategies for the treatment of ligamentum flavum hypertrophy.
The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity a... more The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. Avulsion fracture of the iliac crest following bone grafting is an extremely rare occurrence. We present a case report of avulsion fracture of the anterior iliac crest following bone graft harvesting for anterior cervical fusion in a 63-year-old man. Non-operative treatment was the method of our treatment in the patient. By means of the presented case, iliac crest bone grafting techniques, risk factors of avulsion fracture, and treatment options were reviewed.
Turkish journal of trauma & emergency surgery, 2008
With the advent of improved neuroradiological methods, it has been determined that frequency of t... more With the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.
Object Although the gross anatomy of the pedicle in the human spine has been investigated in grea... more Object Although the gross anatomy of the pedicle in the human spine has been investigated in great detail, knowledge of the microanatomy of trabecular and cortical structures of the pedicle is limited. An understanding of the mechanical properties and structure of the pedicle bone is essential for improving the quality of pedicle screw placement. To enhance this understanding, the authors examined human cadaveric lumbar vertebrae. Methods In this study, the authors obtained seven human cadaveric lumbar vertebrae. The lateral and medial cortices of these pedicle specimens were sectioned and embedded in polymethylmethacrylate. Cross-sectional slices of cortex were obtained from each specimen and imaged with the aid of a high-resolution light microscope. Assessments of osteonal orientation, determinations of relative dimensions, and histomorphometric studies were performed. Results The cortex of the pedicle in each human lumbar vertebra had an osteonal structure with haversian canals laid down mainly in the anteroposterior (longitudinal) direction. The organization of osteons across the transverse cross-section was not homogeneous. The layer of lamellar bone that typically envelops cortical bone structures (such as in long bones) was not observed, and the lateral cortex was significantly thinner than the medial cortex (p< 0.05). Conclusions The cortical bone surrounding the pedicle differed from bone in other anatomical regions such as the anterior vertebral body and femur. The osteonal orientation and lack of a lamellar sheath may account for the unique deformation characteristics of the pedicle cortex seen during pedicle screw placement.
Study Design Global cross-sectional survey Objective To develop and refine the techniques for web... more Study Design Global cross-sectional survey Objective To develop and refine the techniques for web-based international validation of fracture classification systems. Methods A live webinar was organized in 2018 for validation of the AO Spine Subaxial Injury Classification System, consisting of 35 unique computed tomography (CT) scans and key images with subaxial spine injuries. Interobserver reliability and intraobserver reproducibility was calculated for injury morphology, subtype, and facet injury according to the classification system. Based on the experiences from this webinar and incorporating rater feedback, adjustments were made in the organization and techniques used and in 2020 a repeat validation webinar was performed, evaluating images of 41 unique subaxial spine injuries. Results In the 2018 session, the AO Spine Subaxial Injury Classification System demonstrated fair interobserver reliability for fracture subtype (κ = 0.35) and moderate reliability for fracture morpholog...
OBJECTIVE Although previous studies have reported the expression of JAK1, STAT3 and phosphorylate... more OBJECTIVE Although previous studies have reported the expression of JAK1, STAT3 and phosphorylated p-STAT3 in hypertrophied ligamentum flavum (LF), the role of the JAK/STAT signalling pathway in hypertrophied LF has not been fully elucidated. The aim of this study was to identify the important JAK/STAT gene expression patterns of the three main receptors involved in this pathway, namely, IFNAR, IFN-γ and IL-6. METHODS The human LF specimens were obtained from 28 patients who underwent lumbar spine surgery for either degenerative lumbar canal stenosis (DLCS) (n=28) or lumbar disc herniation (LDH) (n=20). In this design, LDH patients served as the control group. Fibrosis degrees were showed Masson's trichrome staining. The location and the expression profiling of JAK/STAT pathway were analysed using real-time polymerase chain reaction and western blotting. The thickness of the LF was measured with axial T1-weighted magnetic resonance imaging. RESULTS The most severe fibrotic changes were on the dorsal side of the LF. IL-6 and IFN-I expression significantly increased on the dorsal side of the LF. While expression levels of IL-6R and IFNAR on the dural and dorsal side were significantly higher in the DLCS samples, IFN-γR and endothelial EGFR in LF samples showed a significant increase on only the dorsal side. JAK/STAT genes were significantly expressed particularly on the dorsal side. CONCLUSIONS We think both IFNAR and IL-6 receptor-dependent JAK/STAT signalling pathways may be significant targets for drug development strategies for the treatment of ligamentum flavum hypertrophy.
The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity a... more The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. Avulsion fracture of the iliac crest following bone grafting is an extremely rare occurrence. We present a case report of avulsion fracture of the anterior iliac crest following bone graft harvesting for anterior cervical fusion in a 63-year-old man. Non-operative treatment was the method of our treatment in the patient. By means of the presented case, iliac crest bone grafting techniques, risk factors of avulsion fracture, and treatment options were reviewed.
Turkish journal of trauma & emergency surgery, 2008
With the advent of improved neuroradiological methods, it has been determined that frequency of t... more With the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.
Object Although the gross anatomy of the pedicle in the human spine has been investigated in grea... more Object Although the gross anatomy of the pedicle in the human spine has been investigated in great detail, knowledge of the microanatomy of trabecular and cortical structures of the pedicle is limited. An understanding of the mechanical properties and structure of the pedicle bone is essential for improving the quality of pedicle screw placement. To enhance this understanding, the authors examined human cadaveric lumbar vertebrae. Methods In this study, the authors obtained seven human cadaveric lumbar vertebrae. The lateral and medial cortices of these pedicle specimens were sectioned and embedded in polymethylmethacrylate. Cross-sectional slices of cortex were obtained from each specimen and imaged with the aid of a high-resolution light microscope. Assessments of osteonal orientation, determinations of relative dimensions, and histomorphometric studies were performed. Results The cortex of the pedicle in each human lumbar vertebra had an osteonal structure with haversian canals laid down mainly in the anteroposterior (longitudinal) direction. The organization of osteons across the transverse cross-section was not homogeneous. The layer of lamellar bone that typically envelops cortical bone structures (such as in long bones) was not observed, and the lateral cortex was significantly thinner than the medial cortex (p< 0.05). Conclusions The cortical bone surrounding the pedicle differed from bone in other anatomical regions such as the anterior vertebral body and femur. The osteonal orientation and lack of a lamellar sheath may account for the unique deformation characteristics of the pedicle cortex seen during pedicle screw placement.
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Papers by Cumhur KILINCER