Researcher:
Süzer, Süleyman Tuncer

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Süleyman Tuncer

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Süzer

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Süzer, Süleyman Tuncer

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2015 - 2019112020 - 20222

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    Dynamic stabilization of the lumbar spine using the Dynesys® system
    (Turkish Neurosurgical Soc, 2020) Cevik, Orhun Mete; Akyoldaş, Göktuğ; Süzer, Süleyman Tuncer; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Özer, Ali Fahir; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 203677; 221691; 219451; 220898; 1022
    AIM: To present the clinical results in patients with minor instability with "Dynesys (R)"a soft spinal stabilization system. Material and Methods: A total of 83 patients were operated upon and the Dynesys (R) system was applied. Indications for surgery included painful degenerative disc disease, degenerative spondylolisthesis and lumbar canal stenosis. Results: The results for the Dynesys (R) system were satisfactory, and we have calculated the overall complication rate to be 20.4% (n=17), which is in agreement with the literature. Conclusion: The Dynesys (R) dynamic stabilization system effectively protects lumbar motion and achieves lumbar stability in patients with lumbar spinal problems. Our clinical result support literature that Dynesys (R) system is a strong alternative to fusion and instrumentation system in patient with chronic instabilities.
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    Complications of 2-level dynamic stabilization: a correlative clinical and radiological analysis at two-year follow-up on 103 patients
    (2018) Yılmaz, Atilla; Erbulut, Deniz Ufuk; N/A; Çıplak, Necati Mert; Süzer, Süleyman Tuncer; Şentürk, Salim; Yaman, Onur; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Özer, Ali Fahir; Doctor; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; Faculty Member; N/A; N/A; N/A; N/A; School of Medicine; School of Medicine; School of Medicine; Koc University Hospital; N/A; 221691; N/A; 219524; 219451; 220898; 1022
    AIM: To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. MATERIAL and METHODS: Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year follow-up. Screw breakage and loosening were evaluated during this duration together with clinical findings. ESULTS: Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. CONCLUSION: Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.
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    Enlargement of neural foramina and dynamic stabilization in spondylolisthesis without restoring the alignment: technical note
    (Seoul : Taehan Ch'ŏkch'u Sin'gyŏng Oekwa Hakhoe, 2016) Sasani, Mehdi; N/A; Özer, Ali Fahir; Süzer, Süleyman Tuncer; Egemen, Emrah; Öktenoğlu, Bekir Tunç; Faculty Member; Faculty Member; Doctor; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; N/A; N/A; Koç University Hospital; N/A; 1022; 221691; N/A; 220898
    It is well known that the cause of radiculopathy is the compression of the nerve root within the foramina which is narrowed secondary to sliding of the corpus and reduced disc height. In some patients, unroofing the foramen does not resolve this problem. We described a new decompression technique using pedicle removal and transpedicular dynamic instrumentation to stabilization the spine. We performed this operation in 2 patients and achieved very good results.
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    Lumbar foraminal stenosis classification that guides surgical treatment
    (Elsevier, 2022) Hekimoǧlu, Mehdi; Çevik, Orhun Mete; Çerezci, Önder; Özer, Ali Fahir; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Süzer, Süleyman Tuncer; Akyoldaş, Göktuğ; Aydın, Ahmet Levent; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Doctor; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 1022; 219451; 220898; 221691; 203677; N/A
    Background: There are numerous radiological and anatomical studies on lumbar foramina in the literature, but there are no distinctive studies about the relationship between treatment and the type of foraminal stenosis. This study was conducted to better evaluate foraminal stenosis and to plan treatment accordingly. Methods: Foraminal stenosis was divided into 2 groups: Stable and unstable stenosis. Both groups were also divided into 4 subgroups in relation to the cause and type of compression and based on the structure of the intervertebral disc. The visual analog scale for leg pain (VAS-LP) and Oswestry Disability Index (ODI) scores were investigated before and after surgery. Results: A total of 115 patients (59 women and 56 men) underwent surgery for lumbar foraminal stenosis. The mean patient age was 56.1 years (range 17-80 years). The mean follow-up was 29 months (range 24-39 months). There were 36 patients (32%) with stable foraminal stenosis and 79 patients (68%) with unstable foraminal stenosis. The majority of the patients were identified as having unstable type 1 foraminal stenosis (45 of 115). The VAS-LP and ODI scores for each group decreased gradually during the follow-up periods and showed significant decrease during the last follow-up (P < 0.001). Interobserver and intraobserver agreement in the classification of foraminal stenosis was found to be nearly perfect. No patients experienced postoperative radiculopathy complication. Only 2 patients experienced superficial operation site infection and 1 showed deep wound infection. The patient who had a deep wound infection needed to repeat surgery for the infection. Conclusions: We introduced a novel classification system for lumbar foraminal stenosis. We aimed to guide appropriate treatment modality depending on the determined classification. This classification helps to determine the optimal treatment. In the light of our findings, the patients who were operated according to our classification experienced satisfactory clinical outcomes and low complication rates. Level of Evidence: 3.
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    Novel foraminal expansion technique
    (Korean Spine Society, 2016) Ciplak, Mert; Oktenoglu, Tunc; Sasani, Mehdi; N/A; Özer, Ali Fahir; Şentürk, Salim; Egemen, Emrah; Yaman, Onur; Süzer, Süleyman Tuncer; Faculty Member; Doctor; Doctor; Doctor; Faculty Member; School of Medicine; N/A; N/A; N/A; School of Medicine; N/A; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; 1022; N/A; N/A; 219524; 221691
    The technique we describe was developed for cervical foraminal stenosis for cases in which a keyhole foraminotomy would not be effective. Many cervical stenosis cases are so severe that keyhole foraminotomy is not successful. However, the technique outlined in this study provides adequate enlargement of an entire cervical foraminal diameter. This study reports on a novel foraminal expansion technique. Linear drilling was performed in the middle of the facet joint. A small bone graft was placed between the divided lateral masses after distraction. A lateral mass stabilization was performed with screws and rods following the expansion procedure. A cervical foramen was linearly drilled medially to laterally, then expanded with small bone grafts, and a lateral mass instrumentation was added with surgery. The patient was well after the surgery. The novel foraminal expansion is an effective surgical method for severe foraminal stenosis.
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    High infection rates in patients with long-segment dynesys system
    (Elsevier Science Inc, 2018) Yılmaz, Atilla; Aydın, Ahmet Levent; Akyoldaş, Göktuğ; Öktenoğlu, Bekir Tunç; Sasani, Mehdi; Süzer, Süleyman Tuncer; Akiz, Cenk; Özer, Ali Fahir; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Other; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 203677; 220898; 219451; 221691; N/A; 1022
    Background: Infection follow-up in patients stabilized with the Dynesys system. Infection rates were determined in patients who had >= 5 segments stabilized with the Dynesys system. Methods: Eighty-three patients with various etiologies were stabilized with the Dynesys system. Long-level stabilization patients were separated from the main group as a result of their high rates of infection. Results: Long-level stabilizations were performed in 8 of 83 patients. Five patients were determined to have infections including 4 deep infections and 1 superficial infection. In patients with deep infections, 3 of them exhibited chronic infections that lasted for approximately 2 years and the system was removed. A deep infection in 1 patient and a superficial infection in 1 patient were diagnosed after 1 month. The early-diagnosed deep infection patient was treated with wound irrigation and antibiotics. The system was not removed, and the wound was closed with daily dressing after 45 days. One superficial infection patient was only treated with daily dressing, and the infection healed within 2 weeks. The infectious agent was determined in 2 patients. Three patients in the chronic infection group underwent a surgical procedure to remove the system. Specific antibiotic treatments were administered to patients whose infectious agents were identified. The remaining patients were treated with wide-spectrum antibiotics. Conslusions: We report that long-level stabilization with the Dynesys system results in a high infection rate.
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    PublicationOpen Access
    A rare cause of root-compression: subaxial cervical synovial cyst in association with congenital fusion
    (Elsevier, 2015) Breckwoldt, Tabea; Öktenoğlu, Tunç; Sasani, Mehdi; N/A; Süzer, Süleyman Tuncer; Özer, Ali Fahir; Faculty Member; School of Medicine; 221691; 1022
    INTRODUCTION: Synovial cyst in the cervical spine is a very rare pathology that develops from the facet joint. When a synovial cyst emerges into the surrounding space, it can compress the nervous tissue and cause neurological symptoms. In the cervical area there is additionally the risk of spinal cord compression comparing to the more common presentation of synovial cysts in the lumbar spine. PRESENTATION OF CASE: Here, a cervical synovial cysts from the left facet joint grew into the spinal canal and compressed the C8 nerve root which led to root compressing symptoms. Interestingly we found this synovial cyst with congenital fusion. We identified only nine similar cases in the literature. The cyst was removed surgically and the patient discharged without complications. DISCUSSION: Numerous theories have been established to explain the pathogenesis of synovial cyst. Biomechanical alterations of the spine play a significant role in the development of synovial cyst. However, the etiology is still unclear. CONCLUSION: Surgical treatment should be considered in cervical synovial cysts with neurologic deficit or with cord compression or when the conservative treatment is ineffective.
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    PublicationOpen Access
    A rehabilitation protocol for patients with lumbar degenerative disc disease treated with posterior transpedicular dynamic stabilization
    (Turkish Neurosurgical Society, 2017) Ataker, Yaprak; Çerezci, Önder; Canbulat, Nazan; Öktenoğlu, Bekir Tunç; Sasani, Mehdi; Erçelen, Ömür; Süzer, Süleyman Tuncer; Özer, Ali Fahir; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Koç University Hospital; 58534; N/A; N/A; N/A; 221691; 1022
    AIM: To evaluate the efficacy of the rehabilitation protocol on patients with lumbar degenerative disc disease after posterior transpedicular dynamic stabilization (PTDS) surgery. MATERIAL and METHODS: Patients (n=50) with single level lumbar degenerative disc disease were recruited for this study. Patients had PTDS surgery with hinged screws. A rehabilitation program was applied for all patients. Phase 1 was the preoperative evaluation phase. Phase 2 (active rest phase) was the first 6 weeks after surgery. During phase 3 (minimal movement phase, 6-12 weeks) pelvic tilt exercises initiated. In phase 4 (dynamic phase, 3-6 months) dynamic lumbar stabilization exercises were started. Phase 5 (return to sports phase) began after the 6th month. The primary outcome criteria were the Visual Analogue Pain Score (VAS) and the Oswestry Disability Index (ODI). Patients were evaluated preoperatively, postoperative 3rd, 12th and 24th months. RESULTS: The mean preoperative VAS and ODI scores were 7.52±0.97 and 60.96±8.74, respectively. During the 3rd month, VAS and ODI scores decreased to 2.62±1.05 and 26.2±7.93, respectively. VAS and ODI scores continued to decrease during the 12th month after surgery to 1.4±0.81 and 13.72±6.68, respectively. At the last follow-up (mean 34.1 months) the VAS and ODI scores were found to be 0.68±0.62 and 7.88±3.32, respectively. (p=0.0001). CONCLUSION: The protocol was designed for a postoperative rehabilitation program after PTDS surgery for patients with lumbar degenerative disc disease. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and the presented rehabilitation program.
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    PublicationOpen Access
    Anatomical assessment of variations in Kambin’s triangle: a surgical and cadaver study
    (Elsevier, 2017) N/A; Özer, Ali Fahir; Süzer, Süleyman Tuncer; Falsafi, Mani; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Faculty Member; Faculty Member; School of Medicine; 1022; 221691; N/A; N/A; N/A; N/A; N/A
    Background: The relationship of exiting root and Kambin's triangle is discussed in this article. Transforaminal endoscopic surgery as the gold standard of less invasive lumbar disc surgeries is performed through Kambin's triangle. Existing root damage is one of the most important complication for this type of surgery. Anatomic variations in Kambin's triangle may be the main reason for nerve root damage during endoscopic lumbar disc surgery. Methods: Kambin's triangle was investigated with surgical views and cadaver studies. Thirty-four patients with far lateral disc herniation were treated with an extraforaminal approach under the microscope. On the other hand, 48 Kambin's triangles were dissected on 8 cadavers. Three main types of triangle were identified, and patients were grouped according to these 3 types of the triangle. Results: Only 6 of the 34 patients had type 3 triangles, which is the wide classical triangle described by Kambin; however, 17 patients had type 2, with a narrow space in the triangle, and 11 patients had type 1, with no space inside the triangle. Cadaver results were similar; only 10 of the 48 specimens had the type 3 classical triangle, whereas 23 specimens had type 2, and 15 specimens had type 1 triangles. Our results disclosed narrowed or no space in 82.4% of the patients and 79.2% of the cadavers. Conclusion: We observed that a wide and safe room of the triangle may not be exist in some patients. Therefore, more care must be taken during endoscopic lumbar disc surgery to avoid nerve damage.
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    PublicationOpen Access
    Disc rehydration after dynamic stabilization: a report of 59 cases
    (Korean Spine Society, 2017) Yılmaz, Atilla; Yıldırım, Hakan; N/A; Şentürk, Salim; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Yaman, Onur; Süzer, Süleyman Tuncer; Özer, Ali Fahir; Doctor; Faculty Member; Doctor; Faculty Member; School of Medicine; N/A; N/A; N/A; N/A; 221691; 1022
    Study Design: A retrospective study investigating decrease in the nucleus pulposus signal intensity or disc height on magnetic resonance imaging (MRI) and disc degeneration. Purpose: Although a degenerated disc cannot self- regenerate, distraction or stabilization may provide suitable conditions for rehydration and possible regeneration. This study aimed to evaluate clinical outcomes and disc regeneration via MRI in a series of patients with degenerative disc disease (DDD) who underwent lumbar stabilization with a dynamic stabilization system (DSS). Overview of Literature: A dynamic system provides rehydration during early DDD. Methods: Fifty- nine patients (mean age, 46.5 years) who undedwent stabilization with DSS for segmental instability (painful black disc) between 2004 and 2014 were retrospectively evaluated. All patients underwent MRI preoperatively and 12 months postoperatively. Intervertebral disc (IVD) degeneration grades at the implanted segment were categorized using the Pfirrmann classification system. Patients were followed for a mean of 6.4 years, and clinical outcomes were based on visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results: Significant improvements in back pain VAS and ODI scores from before surgery (7 and 68%, respectively) were reported at 6 (2.85 and 27.4%, respectively) and 12 months postoperatively (1.8 and 16.3%, respectively). Postoperative IVD changes were observed in 28 patients. Improvement was observed in 20 patients (34%), whereas progressive degeneration was observed in eight patients (13.5%). Thirty- one patients (52.5%) exhibited neither improvement nor progression. Single Pfirrmann grade improvements were observed in 29% of the patients and two- grade improvements were observed in 5%. Conclusions: Our observations support the theory that physiological movement and a balanced load distribution are necessary for disc regeneration. We conclude that DSS may decelerate the degeneration process and appears to facilitate regeneration.