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Closed lumbar hernia surgery can be performed in 30 minutes at Aspendos Hospital in Serik. Fifty doctors watched the first surgery live from cinevision. What is Closed Lumbar Hernia Surgery? Closed lumbar hernia surgery was performed for the first time at Aspendos Hospital in Serik district of Antalya. The operation, which lasted for 30 minutes, was watched live by 50 doctors. Chairman of the Board of the Hospital Dr. Ferhat Kayan gave the good news that such surgeries will be performed in hospitals. Neurosurgeon Dr. Medet Yıldız said that after the surgery, the patients recovered in a short time. LIVE BROADCAST SURGERY Fifty of the 200 doctors attending the congress of the 5th ISMISS Association (International Minimally Invasive Spine Surgery Association) held at the Pipolon Zeugma Hotel in Belek, 50 of them watched the lumbar hernia surgery performed at the Aspendos Hospital live through cinevision. Hospital Neurosurgery Dr. In the closed surgery performed by Medet Yıldız and ISMISS Board Member Dr. Tolgay Şatana, Bulgarian citizen Grigor Petkov Gurudev (41), a herniated disc patient, was entered through a 0.5 cm hole with endoscopic instruments. After 30 minutes of surgery, the patient regained his health. SAME DAY Discharge Aspendos Hospital Chairman of the Hospital, Dr. Ferhat Kayan said that they discharged the lumbar hernia patient with a closed method on the same day after the surgery. Stating that such surgeries will be performed in hospitals from now on, Dr. Kayhan said, "Today, we watched the closed (non-surgical) surgery of herniated disc in our hospital to live doctor friends." Dr. Kayhan also emphasized that it is very important for him to have such an operation in hospitals from now on. News: Erdoğan ÖZTÜRK / Antalya

Unfortunately, the biggest danger that awaits motorcycle riders is to be invisible after a fall and to be subjected to a new crash. In this case, we must immediately stop at a safe distance and act as a shield in an accident that occurs right in front of us. As one of the three drivers who showed the same sensitivity in an accident right in front of me at the E5 Zincirlikuyu junction, I will describe the next stages of the scenario. Austrian Motorcycle Council first aid adds 3T in crashes ahead of ABCD rule; Danger, Contact, Tracking. • Danger! Is the casualty safe? Use your vehicle and markers to create a safe space. • Contact! Try to communicate with the victim by voice and touch. • Call the ambulance for the transfer! First of all, calm down and call the emergency number 112 immediately ... Even if you are a physician like me, it may be much more important to transfer the patient to the hospital urgently outside the equipment during the intervention. Read More

Date: 12-14 July 2019 Venue: Hyderabad, India - Radisson Blu Plaza Websitesi: http://spineendoscopy.org/ Congress Directors Dr. Sukumar Sura (Hyderabad, INDIA) Dr. Mahesha Kanthila (Mangalore, INDIA) Scientific Advisor Dr. Said G. Osman, MD (Maryland, USA) Program Manager Mr. Naresh Kumar Pagidimarry Congress Topics » Transforaminal Lumbar Discectomy » Transiliac Transforaminal L5-S1 Discectomy » Transforaminal Decompression in Lateral Recess Stenosis » Transforaminal Endoscopic Spine Fusion » Endoscopic Lamino-foraminoplasty » Interlaminar Decompression of Lumbar Canal Stenosis » Interlaminar Lumbar Discectomy » Endoscopic Posterior Cervical Discectomy & Foraminotomy » Endoscopic Thoracic Discectomy » Endoscopic 360 decompression of Spinal Canal Stenosis » Unilateral Biportal Endoscopic Decompression

12. MISS Summit 2019 Date: 23-24 August 2019 Venue: Aichi, Japan - Aichi Spine Hospital Website: http://missummit.com/ Program http://missummit.com/e/program.html President Fujio Ito (Genel Müdür - Aichi Spine Hospital) Permanent Members of Turkey Tarik Yazar University of Ankara,Faculty of Medicine Orthopaedic and Traumatology, Turkey Murat Erguven StateHospital Orthopaedi Department SpineSection, Japan Ayhan Comert Ankara University Faculty of Medicine Tolgay Satana Avrupa Safak Hospital Istanbul and International Hospital, Turkey Sekreterya Aichi Spine Institute

History: 04-07 July 2019 Place: Raipur, Hindistan Website: http://tssula.com/ MISSION SPINE FOUNDATION FACULTY Dr Satishchandra Gore Dr Shirazahmed Munshi Dr Bhupesh Patel Dr S N Madhariya Dr S Palanikumar Dr Sunil Nadkarni Dr Anand Kavi Dr Janmejay Jamdar Dr Sujit Vidiyala Dr S Namboothiri Dr Malcolm Pestonji Dr Lavkush Pandey Dr Sunil Raghav Dr Ravindranath Dr Sai Sudarshan Puduru MGM HOSPITAL ENDOSCOPIC SPINE UNIT Dr (Lt. Gen.) K. R. Salgotra Dr Alfven Vieira Dr Nilesh Vishwakarma Dr Sarabjit Kohli Dr Shaival Chauhan INTERNATIONAL FACULTY Dr Tolgay Satana (Turkey) Dr Tunc Koc (Turkey) Dr Michael Schubert (Germany) Dr Hyeun-Sung Kim (South Korea) Dr Kangtaek Lim (South Korea)

Benefits of Tango to the body; As the importance of movement and walking gradually increased in our lives, gait disturbances began to be noticed and related injuries started to increase rapidly. In people who do not walk regularly or who perform walking in short distances in their lives, body axis control becomes difficult when the correct steps and load transfer are not performed. It causes waist-hip knee and ankle injuries. However, when stepping and load transfer are done correctly, such injuries can be prevented. Gait mechanics disorders are conditions that need to be corrected under the supervision of experts. It is determined in special gait analysis laboratories and appropriate treatments are arranged. Even people who do not have leg inequality, spine curvature, or pelvic problems may have developed their own wrong walking mechanics. It is inevitable that the structures carrying our skeleton with bad walking habits will be exposed to torsions and cause unexpected injuries. There is a fun side to people with normal body alignment to correct their walking in daily life; "Tango" Tango literally makes walking phases repeat into our brains. It is an excellent walking exercise that repeats the correct step and load transfer accompanied by music to ensure body axis control. It is inevitable for tangoers to put the correct walking skates into their daily lives. Stepping during walking, heel strike, sole pushing, thumb push against standing, thumb push-swing occurs automatically. In the meantime, it is possible to attract individuals who use each phase differently, depending on their personality and developmental characteristics, to the timing and load transfer that should be with Tango. During tango, one has to use the correct gait patterns to accompany the music. Benefits of Tango to the Body While the oscillations of the body and legs are synchronized with the musical rhythm, the incorrectly used muscles start to work in the correct axes. Underused muscles come to the strength and size they should actually be. The abdominal muscles and the structures extending from the spine to the thigh (spinopelvic-spinofemral) become stronger. When the pelvic lordosis improves, the center of pain that leads to low back pain begins to approach where it should be. The aesthetic appearance in the postures of the dancers who started to make tango figures over time emerges when they provide the body alignment that should actually be. Those who are tango dancers and who set their hearts on this path comprehend the importance of exercises such as ballet-plates-squat and lounge in order to correct these ace deficiencies in their bodies and begin to do all the movements that we cannot do for our patients. As a result, a strong muscular structure, correct alignment and posture mechanics that support the skeletal structure! In this way, healthy individuals who walk in their daily life without falling down with real stepping ... It is not for nothing that the Chinese government officially sponsored sports such as Tai chi. Dances such as tango should become widespread and people should be encouraged to both socialize and support their physical structure. Then; DANCE_DANCE

Endoscopic Lumbar Spine Surgery - Nucleoplasty / Basic Training Course Date: April 26-28, 2019 Venue: Istanbul International Spine Endoscopy Academy Dr Farhad B. BAMARNI Dr Hayati AYGÜN Dr Hikmet ULUĞ Dr Tolgay SATANA Dr Tunç KOÇ

Unfortunately, the biggest danger that awaits motorcycle riders is to be invisible after a fall and to be subjected to a new crash. In this case, we must immediately stop at a safe distance and act as a shield in an accident that occurs right in front of us. As one of the three drivers who showed the same sensitivity in an accident right in front of me at the E5 Zincirlikuyu junction, I will describe the next stages of the scenario. Austrian Motorcycle Council first aid adds 3T in crashes ahead of ABCD rule; Danger, Contact, Tracking. • Danger! Is the casualty safe? Use your vehicle and markers to create a safe space. • Contact! Try to communicate with the victim by voice and touch. • Call the ambulance for the transfer! First of all, calm down and call the emergency number 112 immediately ... Even if you are a physician like me, it may be much more important to transfer the patient to the hospital urgently outside the equipment during the intervention. Read More

It is possible to collect 5 Types of Shoulder problems under the following headings. 1. Frozen Shoulder 2. Shoulder impingement syndrome (impingement) 3. Rotator cuff injury and tear 4. Shoulder instabilities (recurrent dislocations) Bankart lesion 5. Acromioclavicular joint problems (collarbone dislocations or calcifications) It is possible to eliminate all of these problems with shoulder arthroscopy. After arthroscopic shoulder surgery, action can be started immediately and it is possible to leave the hospital the next day. Returning to daily life is extremely fast.

Can Archery Be the Solution to Spinal Problems? Archery and Spine Problems: In modern life, the use of computers, driving a vehicle, even correspondence on your smartphone has become an important cause of posture disorder, beyond affecting the neck and shoulder posture negatively. In desk jobs, the shoulder on the wheel stays far ahead of its natural position; these can be thought of as movements that push the shoulder blades away from the back. It is well known that back muscles, which become lazy and weakened by using the same muscles for a long time and maintaining the same posture, cause neck pain. Shoulder impingement problems are also common in office workers as a result of involuntary movements that bring their shoulders forward and keep their heads close to the screen. When the malalignment caused by the posture disorder becomes permanent, severe surgical treatments may be required. Strengthening the muscles that allow the shoulder to move backward plays a key role in correcting the alignment. These muscles keep our neck straight and pull the shoulder back through the shoulder blade. The difficulty of strengthening is that if the movements to be made to work these muscles are not done at the right angles, they remain still as a result of the stronger shoulder and chest muscles. For example, spring-loaded devices trying to be pulled in the back region or backward beating of the wings can be painful and difficult to practice because they force the joint boundaries. However, when the “bow” used in ancient archery sports is pulled regularly, the back movement of our shoulder blades and shoulder is easily achieved by balancing the opposite muscles. Archery and Spine Problems: Archery is outlined in three basic movements. Preparation: Holding and stretching. While the archer grabs the bow with his left hand and pulls the arrow backwards with his right hand, the load that starts with the chest muscles is carried to the back muscles by pulling back the shoulder muscles and shoulder. The bow is stretched to the last stage, the rope is pulled until the left arm is parallel to the ground, the right arm is bent at the elbow, and the shoulder is fully back. Balancing = Engagement: Don’t wait on tension. When the spring is fully stretched, only the back and the balancing shoulder and chest muscles work together. This phase is the moment of exercise, which we call the isometric phase (the muscle being contracted without stretching) is the healthiest and the least risk of injury. Shot: While the arrow is pointing towards the target, the load on the bow is released, while the shoulder and scapula move back to the last limit. This movement is a highly harmonious transition-balancing moment that follows the shoulder to go back like a whip and immediately reciprocate the shoulder muscles and pull the shoulder forward. It works the shoulder muscles together with the back muscles. By focusing on the target, archery relaxes the human mind, provides an involuntary contraction habit apart from voluntary movements, and enables the development of muscles that react strongly and reflexively to adverse conditions in daily and business life. In daily life, an archer can prevent the risk of injury with his archer muscles without realizing it, and draw attention with his special stance. It is a very valuable exercise method, especially in those with a tendency to impairment in child development. Archery should be given importance in order to prevent humpback, neck straightening and shoulder squeezing from diseases. You can contact our doctor for more information about your spine pain and spine complaints. You can subscribe to our YouTube channel to follow our videos on the subject.

Degenerative Disc Disease; The word Laser is an abbreviation consisting of the initials of the word (Light Amplification by Stimulated Emission of Radiation). It is in our language with the word LASER. According to this angle, which briefly summarizes the generation of energy, laser; It is the light that emerges when the liquid crystal located between two mirrors with full and semi-reflections is exposed to concentrated energy (amplification). The laser type is named after the substance in the liquid crystal. Degenerative Disc Disease Laser energy application in the musculoskeletal system was first made by Whipple in 1984 with the use of CO2 laser. The classification of the laser according to its optical parameters (wavelength, power and dose) has been questioned in clinical studies after this date. Laser is known to alter cell proliferation, motility and secretion at different doses. Tissue interaction, on the other hand, may be dose-dependent, in the form of breaking up, liquefying, heating and evaporating. Although the type of laser used in the musculoskeletal system is often the ion resonance type, it can be classified as follows: UV Laser (Excimer) Visible Laser (Argon) IR Laser (Ion Resonance) n  CO2 n  YAG: (Yttrium-Aluminum Garnet) l Neodymium (Figure-2) l  KTP Doubled Neodymium (Potassium-titanyl-Phosphate) l  Holmium l  Erbium Argon laser is well absorbed by hemoglobin and acts by releasing heat in the tissue. This effect results in apoptosis by activating oxygen in the cell nucleus. This is the basis of photodynamic therapy. Excimer breaks the bonds of molecules without generating heat, which is why it is called cold laser. High power is obtained at low frequencies with CO2, it is absorbed by water. It achieves its superficial effect without penetration. Nd YAG penetration and coagulation effect is high. Laser energy effect is examined in three stages: Photo-thermal: coagulation, necrosis and evaporation Photo-chemical (Argon, Excimer): It is the change in the bond structures as a result of the absorption of energy at the molecular level. It provides an advantage in the treatment of metabolically active tissues (such as tumors). The photo-mechanical effect is the combination of short wave and low frequencies and the borderline ultraviolet-infrared effect. While the tissue reacts with fast ionization, the "acoustic shock wave" effect occurs. Even cutting-cutting power on bone is provided with this feature.ır. Radiofrequency energy is short wave sound energy. As in light energy, a physical state change occurs in proportion to the tendency of the substance to become unstable, on which the concentrated short wavelength energy is focused. This change, explained by the conversion to heat energy, is the basis of the cooking feature in microwave ovens. The thermal effect of radiofrequency energy is frictional. There are two separate effects: ohmic and dielectric. Ohmic effect develops at frequencies below 500 mHz. If the dielectric effect is above 500 mHz, microwave destructive effect occurs. In the musculoskeletal system, the 1-300 mHz ohmic effect of radiofrequency energy is utilized. With radiofrequency (RF) energy, tissue can be freed from its covalent bonds (relaxation-cutting), completely evaporated or new bonds (wrinkle-pull) can be formed. The ohmic effect achieved by increasing and decreasing the frequency in medical applications allows the clinician to intervene with less complex choices than laser. However, its disintegrating effect is limited in soft tissues. Knowing which energy will be used, how often and how to use it in the musculoskeletal system is possible by knowing the chemical and physical results of these energies in tissues. Penetration is the leading limiting factor in both energies. Preferring Holmium YAG in laser applications in orthopedic surgery is one of the mechanical advantages it provides despite its low penetration effect. Degenerative Disc Disease Although thermal penetration and related necrosis effect decreases with the use of Holmium YAG laser, it can be used with other advantages of energy. In addition to the acoustic shock effect, thermal coagulation, evaporation, wrinkling and bleeding control are achieved by extremely reduced tissue penetration. Its effect is indispensable, especially in minimally invasive endoscopic surgery applications, arthroscopy, tenoscopy and foraminoscopy in areas that cannot be reached with mechanical devices. Thermal therapy, which has been used since Hippocrates, has been revived with laser and radiofrequency applications. The thermal effect is protein denaturation at 40-70 degrees, coagulation at 70-85 degrees, vacuolization at 85-100, evaporation at 100 degrees, carbonization at 400 degrees. Living tissue begins to die at 45 degrees and 45 degrees is the temperature at which the RF effect has just begun. In order for the radiofrequency thermal effect to end with irreversible tissue contraction, energy must be transferred to create 60-75 degrees of heat. This effect occurs 30% in 5 minutes at 60 degrees, 36% at 62 degrees, and more than 50% after 65 degrees. With the thermal effect, the helix structure turns into a gel form with protein denaturation and reduces its volume, the tissue shortens and gives a morphological response. This effect is called "ablation" for short. The functional results of the thermal effect on regenerative tissues are close to perfect. While the capsule contributes to the healing process in ligament and tendinous structures, functional expectations during remodeling occur in the area limited by RF. However, cellular necrosis caused by thermal effect in structures such as cartilage and intervertebral disc is irreversible. For this reason, mechanisms that try to create the energy transfer created at high temperatures with monopolar electrocautery tips that provide coagulation and ablation effect together, with bipolar radiofrequency tips at low temperatures have been developed. For example, the ablative effect occurs with a spark, depending on the probe shape. Spatter-free energy transferred at monopolar tip shape or bipolar tips enables nonablative RF energy application. Bipolar effect providing coagulation and plasma forming ablative effect (nonablative) is coagulation + ablation = coblation. The difference of coblation effect from multipolar radiofrequency is that it provides plasma conversion at low temperature. In this way, it can be called cold ablation. Therefore, there are two different applications of radiofrequency: Monopolar Bipolar: Coblation-plasma effect-cold ablation Coblation is a breakthrough in intradiscal pressure reduction and nucleoplasty treatment, but gives good results in selected cases. Today, the effect created by the intradiscal ring in cervical disc protrusion has taken its place in the first place in the practical applications preferred by clinicians. In cervical coblation, vand provides 2 mm cavity formation and 10% volume reduction with an average application of 10 minutes in four directions (Figure-4C). Coblation-nucleoplasty effect is achieved by opening channels in the lumbar region. Opening an average of 6 channels with coblation may be sufficient to reduce the disc pressure (Figure-4A). The inability to remove the plasma-debris formed in radiofrequency nucleoplasty should be considered as a disadvantage compared to mechanical nucleoplasty, and intradiscal cefazolin should be added to the previous discography. Residual debris can cause discitis. Intradiscal Treatments: Laser treatment in protruse discs, which started with Choy and Asher's reduction of disc pressure by vaporization in the nucleus pulposus in 1986, was called “percutaneous laser disc decompression” (PLDD). Complications of endplate thermal necrosis, root injury, and discitis of the laser probe are statistically insignificant in multicenter studies up to a hundred thousand cases. Complications in applications with proper dosage and frequency parallel to the Endplate are almost non-existent in correctly selected cases. However, cases of tetraplegia after cervical application reported by authors such as Martin Knight still brought thermal penetration and radiation safety to the spinal cord into the agenda. PLDD is the transfer of 400-1000 joule Nd YAG laser energy into the disc in 10-30 minutes. In KTP laser, this time is 1-2 minutes. Using Richley Holmium, he transferred 1200-2000 joules of total energy, reporting 88% success. Neodymium has twice the ablation depth, thermal effect compared to Holmium. Excessive water absorption and removal of water from the environment increases the thermal effect and causes carbonization. The thermal effect, correct frequency selection and intermittent timing (relapse time) can be reduced. These parameters, which vary according to the wavelength, are 10-15 watts in Holmium YAG laser, and the repetition time of 10 hertz is 1200 joules in total. Casper recommends 1200j total energy using 13 Watt, 10 Hertz, 5 minutes of relapse and application time. Table-1 recommends the use of accepted doses after multi-center studies. Another residual debris disadvantage caused by thermal effect in intradiscal treatment has disappeared with the introduction of Laser Asisted Spine Endoscopy (LASE) (Figure-5). Annuloplasty was achieved with percutaneous intervention, which provided visual and irrigation as well as laser, and it was possible to remove the debris. Although the distance of laser energy to the annular region does not cause a problem during subannular decompression and annuloplasty in the lumbar region, the distance of 10 mm to the posterior longutinal ligament origin in cervical applications is the operation limit. Sang-Ho Lee et al. They suggest 10 watts max, 10-15 hertz max energy in the cervical area. The same safe range should be preferred in the lumbar region. The nonablative limit is the energy transfer that does not exceed 500 joules at a time with a frequency of 10 hz and the application with 5 sec intervals. Chiu recommends gradual energy application in thoracic disc laser application. It recommends starting with 10 watts in nonablative degrees, decreasing to 5 watts of energy and reducing the transferred power to 300 joules (12 hz). In the first stage, vaporization, in the second stage, only wrinkling and hardening are aimed. Sinovertebral neurolysis and denervation is evidenced by the patient's expression of pain reduction in the second stage. Chiu also recommends mechanically removing the debris and endoscopic control. Intradiscal applications of radiofrequency energy take its place in the market in a range from monopolar RF IDET energy to coblation probes. While subannular heat up to 85 degrees provides annuloplasty and nucleoplasty in IDET treatment, the thermal effect transferred to the tissue was measured as 55 degrees. At the epidural distance, this temperature reaches 30 degrees. Even if the patient is sclerotomal, the pain should be taken into account during the application and the energy should be cut off (Figure-4D). Coblation provides a safer nonthermal effect. Cervical application tips are particularly advantageous. The radiation effect of coblation, which works with mechanical-coblative principles by opening a canal in the lumbar region, is in the foreground. Both radiofrequency effects reduce disc pressure. Table 1: Different doses of laser energy applications according to spinal treatment options Percutaneous Endoscopic Applications Endoscopic laser applications that started in parallel with the definition of percutaneous endoscopic surgery by Hijikata and Kambin and continued with Yeung and Knight enabled the definition of the concept of foraminoplasty. The brutal surgical results of lateral spinal stenosis are inconspicuous in the face of endoscopic detection and elimination of formaninal stenosis. During foraminoplasty, the problem of removing structures such as bone-osteophytes was solved by the shock wave effect of the laser (Figure-7). The destructive effect obtained by the continuous application of 30-40 W 10 Hz energy directly on the bone is not only sufficient to provide decompression, but also eliminates the situations that prevent the appearance such as bleeding-debris formation. The use of radiofrequency energy in endoscopy provides great convenience in stopping epidural hemorrhages by the excision of the annular fibrils and the release of the nucleus fragment. Therefore, the use of both energies is preferred in endoscopic discectomy (Figure-6). In spine endoscopic surgery, the choice of laser or radiofrequency energy should be approached selectively. In intradiscal applications, the coblation method in cervical protrusions is safe and effective, and the same application can be performed, especially in asymmetric localized foraminal lumbar hernias, provided that protrusion is limited. Monopolar IDET application may be preferred in diffuse central and diffuse protrusions. However, laser nucleoplasty can be combined in painful discography. In this application, successful clinical results have been reported by eliminating the annular relaxation and providing pressure reduction with laser plasma effect in the nucleus. Mechanical nucleoplasty is recommended especially in cases with protrusion and minimal extrusion together with annular tears in the lumbar region. Lee et al. reported that they also removed the pressure secondary to plastic annular deformation by applying subannular LASE annuloplasty after mechanical nucleoplasty. In our country, it will be possible to reduce posterior pressure with LASE and selective annuloplasty in the near future. In endoscopic spine surgery, the bipolar RF probe provides great benefits in the excision of tissues holding the extrudate disc together with bleeding control. Cutting these tissues with mechanical tools is not preferred because it disrupts the field of vision with bleeding. On the other hand, after the disc is removed, the treatment is riveted by subannular RF application. During the subannular application of the laser, contralateral protrusion can be intervened as well as annuloplasty, but LASE should be preferred for its safety. In addition, LASE can be a serious alternative to mechanical nucleoplasty, as it allows debris to be removed. In foraminoplasty, the superiority of laser is indisputable in the decompression stage performed by removing osteophytes and cutting the foraminal ligament. Considering that foraminoscopic shaver tips offer limited options and cause bleeding, it is clear that laser application will continue to be an integral part of foraminoplasty. Resources: Abelow SP. Thermal Controversies. 11. Imlas 1. AAMISS meeting Lecture Kongre Özet Kitabı Seul Kore  12-15 Mayıs 2004 Atik OS,  Erdogan D,  Omeroglu S, Dural Mn, Baydar Metin L. Histological Alterations After Holmium:YAG Laser Irradiation. Joint Diseases & Related Surgery  Vol 10 • No 1 • 1999: 30-32 Atik O S, Kanatli U, Guzel V, Daglar B, Ozalay M. Lateral Release And    Medial Shrinkage On Patellofemoral Joint Capsule Using Arthroscopic Laser Surgery (Preliminary Report) Joint Diseases & Related Surgery Vol:9 No:1 1998 Atik OS. Chondroplaty Using the Holmium:YAG Laser. In B. E Gerber, M Knight WE Siebert (Eds) Lasers in the Musculoskeletal System. Springer Neuchatel 2000. Atik OS. Neodmium:YAG contact arthroscopic lase surgery. In Brillhar (Ed)  Arthroscopic Laser Surgery. Springer New York P 1994 Gerber BE. Basic Laser Principles and Research:Introductory Remarks. In B. E Gerber, M Knight WE Siebert (Eds) Lasers in the Musculoskeletal System. Springer Neuchatel 2000. Gerber BE, Knight MTN, Siebert WE. Preface. In B. E Gerber, M Knight WE Siebert (Eds) Lasers in the Musculoskeletal System. Springer Neuchatel 2000. Gerber BE, Basic Laser Principles and Research.  Laser In the Musculoskletal System Ed. Gerber, Knight, Siebert.Springer New YorImhoff AB, Basics Laser Physics and Safety. Laser In the Musculoskletal System Ed. Gerber, Knight, Siebert.Springer New York 200Gerber BE, Knşght MTN, Siebert WE. Preface. Recommeded Surgical Parameters. Laser In the Musculoskletal System Ed. Gerber, Knight, Siebert.SpriChiu J. Endoscopic Lumbar Foraminoplasty.Endoscopic Lumbar Foraminoplasty Chapter 19 Chiu JC. Posterior Lateral Endoscopic Thorasic Discectomy with Laser Thermodiskoplasty. 11. Imlas 1. AAMISS meeting Lecture Kongre Özet Kitabı Seul Kore  12-15 Mayıs 2004 Chiu JC, Clifford TJ, Reuter MW. Cervical Endoscopic Discectomy with Laser Thermodiskoplasty. In The Practice of Minimally Invasive Spinal Tecnique Ed. Savitz MH, Chiu JC, Yeung AT. CSS first edition Ohio 2000 Choy DSJ. Percutaneous Laser Disc Decompression. In  Percutaneous Laser Disc Decompression.Ed Daniel Choy Springer New York 2003 Choy DSJ.  Percutaneous Laser Disc Decompression (PLDD) 352 Cases with an 8 ½ Follow up Arthroplasty Arthroscopic Surgery Vol. 6, No:10 (1-5), 1995 Lee SH. Percutaneous Lumbar Disc Decompression (PLDD) with Laser Assisted Endoscopy (LASE). 11. Imlas 1. AAMISS meeting Lecture Kongre Özet Kitabı Seul Kore  12-15 Mayıs 2004 Reuter MW.Evaluation of Cervical Disc Surgery. 11. Imlas 1. AAMISS meeting Lecture Kongre Özet Kitabı Seul Kore  12-15 Mayıs 2004 Şatana T, Ergüven M, Pirbudak L. Lomber Dejeneratif Stenoz ve Dejenere Disk Hastalığına Cerrahi Yaklaşım. Aktüel Tıp Artrit ve Osteoporoz Özel Sayısı Nisan 2004 Cilt9 Sayi4 S:39-46 Şatana T, Ergüven M, Pirbudak L, Aldemir Ö. Dejeneratif Disk hastalıklarında Perkutan Endoskopik Dekompresyon ve Minimal İnvaziv Cerrahi Yaklaşımlar. Aktüel Tıp Artrit ve Osteoporoz Özel Sayısı Nisan 2005 S:35-41 Şatana T. Current Concepts in the Laser&Radiofrequency  Technologies for Minimally Invasive Musculoskletal Applications.12 Imlas 2. AAMISS meeting Lecture Kongre Özet Kitabı Istanbul  22-25 Haziran 2005Gerber BE, Basic Laser Principles and Research.  Laser In the Musculoskletal System Ed. Gerber, Knight, Siebert.Springer New YorImhoff AB, Basics Laser Physics and Safety. Laser In the Musculoskletal System Ed. Gerber, Knight, Siebert.Springer New York 200Gerber BE, Knşght MTN, Siebert WE. Preface. Recommeded Surgical Parameters. Laser In the Musculoskletal System Ed. Gerber, Knight, Siebert.SpriChiu J. Endoscopic Lumbar Foraminoplasty.Endoscopic Lumbar Foraminoplasty Chapter 19 Yeung AT, Tsou PM. Posterolateral Endoscopic Excision for Lumbar Disc Herniation Surgical Technique, Outcome, and Complications in 307 Consecutive Case SPINE Volume 27, Number 7, p 722–731 2002 Park J. Pitfalls and Complications of Thermal Capsuloraphy. 11. Imlas 1. AAMISS meeting Lecture Kongre Özet Kitabı Seul Kore  12-15 Mayıs 2004

Back Pain During Pregnancy - Back Pain During Pregnancy: Fertility, beyond being a reproductive function, includes sacred motherhood; It is a very difficult process where temporary but serious hormonal and emotional peaks are experienced. The expressions on the mother's face created by the accompanying back and back pain have been a source of inspiration for many artists. It is a fact that motherhood constitutes the most serious step of transition to womanhood. Some changes, especially in the genitals and characters, give a "mature woman" appearance by slightly regressing. Such a sacred and respected life experience is like an honorable medallion that emerged with this differentiation in female identity. The response of the musculoskeletal system to hormonal fluctuations in pregnancy is not as rapid as the uterus and breast tissue. Skeletal adaptation develops over months and can be described as the defense that responds to destruction in the adaptation process. The bone roof loses strength, its destruction can cause widespread bone pain. The ligament structures that begin to loosen can cause the limits of the joints to be strained during movement and cause injuries. That is why the excessive load on the disc by loosening ligaments of the spine joints causes ruptures in the wall and waist-neck hernias. Spine pain during pregnancy occurs in different stages at different stages. Therefore, different measures will be required at each stage. Pregnancy is examined in the trimester. However, it would be appropriate to approach pre-pregnancy, pregnancy and puerperium. A mother with a spinal problem before pregnancy should know that her spinal pains will increase and hernias, if any, may progress, and should solve these problems if necessary. In the first trimester, the weight and mass effect of the baby is negligible, but the hormonal effects are severe enough to change the cycles of the skeletal system. At this stage when placenta formation begins, maternal hormones and fetal hormones compete in the maternal circulatory system. First of all, we need to know that female hormones have effects that enable skeletal metabolism and bone cycle to work in the direction of construction, increase carrying power and endurance. It is almost usual for estrogen and progesterone to cause complaints characterized by rhythmic cramps and joint pain, even on the moon. These effects are in the direction of construction, but pregnancy hormones suppress this. Back Pain During Pregnancy - Back Pain During Pregnancy Pregnancy hormone HCG works in the opposite direction by imitating them, just like the genitals, in the steroid structure we call a kind of gonadotropin. With a slow rise, it begins to suppress this cycle of female hormones and literally takes its place, while bones in the skeletal system prepare a calcium store for destruction, the muscles are forced into a sequence that will work in the direction of pushing. All ligaments tend to increase the elastic tissue structure and loosen. All these hormonal influences are essential for the baby to feed, to provide room for growth in the abdomen, and to progress through the birth canal. In the second phase, hormonal effects begin to balance. Maternal and infant circulation begin to diverge. As the gestational months increase, the weight of the fetus becomes increasingly vulnerable to daily traumas with asymmetrical loads on the joints due to loose ligaments and the loading of the muscles working in different directions against a moment that will change the body weight center. The second trimester is the transition phase in this respect, the muscles increase their strength against load. In the first two stages, the biggest difficulty in diagnosing the pain of the musculoskeletal system is that the radiological examinations cannot be performed and the drugs that will harm the baby cannot be used. In the third stage, there is a spine placed in the birth canal in the abdomen that resists an extra 10-15 kg of overload. In this period, if there is aches of muscles that are tired of contraction, joints and ligaments that are injured and healed during pregnancy, pain due to progress in waist and neck hernias occur. When the causes of pain become unbearable, radiological examinations that will cause less harm to the baby are often not accepted by mothers. Drug use may be more appropriate if or not to cross the placental barrier. When our mothers do not agree to take these drugs, it is not possible to relieve the pain. Labor at the end of pregnancy is a painful process in which the musculoskeletal system is subjected to extraordinary loads. While this miracle is happening, all muscle structures put serious strains on weak and loose bone structures. With a new burden after birth, miraculous hormones (oxytocin, prolactin) that help the milk secretion grow to the rescue of the mother in the postpartum phase. These hormones release growth hormone-equivalent replacement agents (somatomedins). Mothers literally reach the capacity of renewal in a child's development. This does not occur in normal situations in women who are not mothers, as in men Breastfeeding mothers suffer less pain after childbirth, and these hormones, which have an endorphin-like effect, relieve pain and also have a miraculous healing function, enter a dramatic production / repair phase within 3-6 weeks. However, the repair process is also painful. These are responsible for the mothers of fatigue, sleepiness, and the tendency to consume sugary foods (puerperal sherbet). So what should we do so that we can fight back pain? Spine problems, if any, should be known before pregnancy and their aggravation should be prevented during later pregnancy. From the first stage of pregnancy, weight training can be performed in addition to exercises such as plates that strengthen the carrier properties of the back and abdominal muscles. However, as we approach the second stage, where the risk of miscarriage will continue to increase, exercises should be performed with plates and isometric movements. Painful situations should be eliminated with cold-hot applications and medical massage, especially without triggering fibromyalgia. Pregnancy is the period of life when ergonomic life is most necessary. Strict compliance with the rules is essential, from the preferred stair step while walking, your seat setting in the vehicle, the way you travel in the bus, the seat at home, to the bench level in the kitchen. Nutrition, and especially a diet containing calcium, phosphate and plenty of protein, greatly reduces the destruction of the skeletal and muscle structure for the baby's needs. The mother who is not well nourished is weakened primarily by the body code that nourishes the baby, and it is inevitable that the spine-muscle-originated pains will increase. If you have a weak body before pregnancy, you should definitely do muscle strengthening in the first months. In the advancing 2nd and 3rd stages, birth preparation groups in pregnancy centers will greatly reduce the pain caused by the skeletal system. Considering that the muscle groups that are tired in the last phase will need more breaks, less repetitive exercises with frequent breaks are preferred. The needs of the skeleton that heals and regenerates rapidly in the 3-6 week period after pregnancy should be met with rich contents with low calories during pregnancy. The weight gained should be lost, the loads on the spine should be reduced. Pain reduces the transition to some drug treatments in mothers who are not breastfeeding, but I would like to emphasize the presence of natural painkillers for breastfeeding mothers, in this respect, breastfeeding is a great advantage with reducing spinal pain and increasing regeneration. Pregnancy is the most beautiful period of holy motherhood. Let's not forget that this period will pass with the least pain and a smiling face, with a healthy diet and regular exercise.