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Objective: Lumbar disc herniation is an important disease that causes symptoms of back pain, leg pain, and imbalances in muscle strength in patients, causing socio-economic problems due to loss of workforce in the society. In this study, which was conducted from April 2015 to April 2017, we retrospectively evaluated the patients with lumbar disc herniation, who underwent microsurgery. Materials and Methods: Microsurgery with maximum resection principle was performed on 282 patients. Of these patients, 125 were men and 157 were women. The mean age of the patients was 44 (19-80) years. Operations were planned by using lumbar X-ray and lumbar magnetic resonance imaging techniques. Computed tomography of the lumbar spine and electromyography were used to support the diagnoses when necessary. A retrospective evaluation of the patients was performed considering their gender, age, physical examination and radiological findings, disc distances, preoperative and postoperative findings, complications, recurrences, and patient satisfaction. Results: Of the included patients, 125 were men (44.33%) and 157 were women (55.67%). The mean age was 44 (19-80) years. Among the study patients, pathological findings were found at the intervertebral disc between the L1 and L2 levels in three (1.06%) patients, the L2 and L3 levels in eight (2.84%) patients, the L3 and L4 levels in 32 (11.35%) patients, the L4 and L5 levels in 103 (36.52%) patients, and the L5 and S1 levels in 61 (21.63%) patients. Pathological findings were present in two levels in 61 (21.63%) patients, in three levels in 13 (4.61%) patients, and in four levels in one (0.35%) patient. The dural injury was identified in nine (3.19%) patients, subcutaneous cerebrospinal fluid collection was present in one (0.35%) patient, and a mislabeled laminotomy was found in one (0.35%) patient. Spondylodiscitis developed in one (0.35%) patient, superficial skin infections developed in two (0.71%) patients, and postoperative spondylolisthesis occurred in one (0.35%) patient to whom stabilization was applied. Recurrences developed in eight (2.84%) patients and these patients underwent repeat surgery. According to the Prolo follow-up scale, the results of the surgery were excellent in 137 (48.58%) patients, good in 124 (43.97%) patients, moderate in 20 (7.09%) patients, and poor in one (0.35%) patient. Conclusion:Our study results demonstrate that the microsurgical technique and maximal disc resection in selected cases of surgery are effective and reliable methods in the surgical treatment of lumbar disc herniation.

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Objective: Sacral screw loosening is a common complication after lumbosacral fusion surgery. This study aims to determine the locations where screw loosening may be less with the help of computed tomography (CT)-derived bone density measurements in Hounsfield units (HU) in patients undergoing posterior lumbosacral fusion and to examine the effects of determining the trajectory of sacral screw placement on fusion success. Materials and Methods:The files of patients who underwent lumbosacral posterior fusion for different indications in our clinic between September 2017 and November 2020 were retrospectively reviewed. The patients' admission complaints, neurological examination findings, diagnoses, pre-operative HU values, and intraoperative and post-operative complications were evaluated. Results:The data of 50 patients were analyzed in this study. The study group predominantly consisted of patients with spinal stenosis (n=23). There were differences between the HU values of the right and left vertebral facets and the corpus vertebra (p<0.001). The subgroup analyses revealed higher HU values in the corpus vertebra (213.5) than in the right (82.5) and left (80.5) vertebral facets (p<0.001 and p<0.001, respectively), with no difference between the right and left HU measurements (p>0.999). The comparison between genders showed no significant difference (p>0.05). The mean follow-up duration of the patients was 29.3±14.12 (range, 10-48) months. Conclusion:We are of the opinion that pre-operative CT-derived bone density in HU provides the prediction of normal, osteopenic, and osteoporotic sacral segments, thus preventing screw loosening, which paves the way for surgical failure.