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1.  Treatment of Advanced Stage Gonarthrosis With Prolotherapy: Case Report 
This case report aims to discuss the clinical and radiological outcomes of prolotherapy at a patient whom to total knee prosthesis had been planned but surgery couldn’t be performed due to co-morbidities.
Case Presentation
A 72 year old woman presented with severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was applied to measure the osteoarthritis level of the patient: Pain level; 25 points, stiffness level; 10 points, Physical function loss; 80 points, and total WOMAC 115 points. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing. Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly.
Significant improvement was noted at WOMAC scale (Pain level; 5 points, stiffness level; 2 points, Physical function loss; 15 points, and total WOMAC 22 points). Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year. Our case is the report that presents radiological evidence in addition to clinical findings of improvement of osteoarthritis level. As a result of this case report, further studies aiming to offer a different minimally invasive treatment option to the patients before surgery may be performed. We are in the opinion that prolotherapy may be preferred more commonly as an efficient method once the importance of ligamentous structures at pathogenesis of osteoarthritis is established.
PMCID: PMC3961030  PMID: 24660149
Osteoarthritis, Knee; Degeneration; Treatment
2.  Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy 
Asian Spine Journal  2012;6(2):98-104.
Study Design
Clinical study.
The dimensions of the working zone for endoscopic lumbar discectomy should be evaluated by preoperative magnetic resonance images. The aim of this study was to analyze the angle of the roots, root area, and foraminal area.
Overview of Literature
Few studies have reported on the triangular working zone during transforaminal endoscopic lumbar discectomy. Many risk factors and restrictions for this procedure have been proposed.
Images of 39 patients were analyzed bilaterally at the levels of L3-L4 and L4-L5. Bilateral axial and coronal angles of the roots, root area, and foraminal area were calculated.
No significant difference was observed between the axial angle of the left and right L3 root. A significant difference was found between the axial angle of right and left L4 roots. A significant difference was observed when the coronal angle of the right and left L3 roots were compared, but no significant difference was found when the coronal angle of the right and left L4 roots were compared. No significant difference was observed when the foraminal area of the right and left L3 and L4 roots were compared, but a significant difference was observed when the root area of right and left L3 and L4 roots were compared.
We suggest that these radiological measurements should be obtained for safety reasons before endoscopic discectomy surgery.
PMCID: PMC3372555  PMID: 22708013
Triangular working zone; Endoscopy; Lumbar
3.  Intramedullary lumbar lesion mimicking spinal cord tumor: a case of non-neoplastic intramedullary spinal cord lesion 
European Spine Journal  2010;19(Suppl 2):169-173.
Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.
PMCID: PMC2899622  PMID: 20049487
Spinal tumor; Non-neoplastic; Intramedullary
4.  Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults 
The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries.
Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions.
The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis.
Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.
PMCID: PMC2718880  PMID: 19627573

Results 1-4 (4)