H Ghandhari; M Rashidi; S Sabbaghan; S M Mahdavi; E Mirzamohammadi; A Azizi; F Safdari
Abstract
Introduction: Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by ...
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Introduction: Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by different factors such as ethnicity. In the current retrospective study, the prevalence of these variations in Iranian AIS patients was investigated. Methods: Between 2012 to 2017, spinal fusion was performed for the treatment of AIS in 125 patients. The thoracic and lumbar vertebrae were enumerated on posteroanterior radiographs. The first thoracic vertebra was the one attached to the first pair of ribs. Enumeration was continued in a caudal direction. The lumbar level initiated just below the last vertebra with a pair of associated ribs.Results: Abnormal vertebral enumeration was found in 18 patients (14.4%). The prevalence of abnormal lumbar enumeration was higher than thoracic vertebrae (10.4% versus 4%). Eleven thoracic vertebrae were found in 5 patients (4%). Four lumbar vertebrae were found in eleven patients (8.8%). There were two patients with six lumbar vertebrae (1.6%). There was no patient with abnormal enumeration of both thoracic and lumbar vertebrae.Conclusion: The current study showed a relatively high rate of atypical number of thoracic and lumbar vertebrae in Iranian AIS patients. It is necessary to enumerate the vertebrae on the basis of an organized protocol preoperatively to prevent wrong-level surgery in AIS patients.
Ebrahim Ameri Mahabadi, MD; Hasan Ghandehari, MD; Mahyar Chehrazi, MD; Farshad Safdari, MSc
Abstract
Background: There are limited studies regarding the incidence of degenerative changes in asymptomatic adolescents. This study investigated the incidence of these changes in MRI and demographic factors affecting the presence of these changes.Methods: In a cross-sectional study, lumbar intervertebral disks ...
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Background: There are limited studies regarding the incidence of degenerative changes in asymptomatic adolescents. This study investigated the incidence of these changes in MRI and demographic factors affecting the presence of these changes.Methods: In a cross-sectional study, lumbar intervertebral disks of 84 asymptomatic adolescents aged between 12-18 years were evaluated using MRI in a educational training center in Tehran, Iran. The presence of degenerative changes in different levels was evaluated and demographic characteristics were compared between those with and without degenerative changes. The effects of these changes on mental and physical health were investigated using SF-36.Results: In total, 25.7% of disks were degenerated. The incidence of these changes was different in different levels. The incidence of degenerative changes was highest in L4-L5 level (45.2%) followed by L5-S1 (36.9%) and lowest in L1-L2 (5.9%). The mean of age of subjects with degenerative changes was significantly higher (p < /em>=.005). Gender and body mass index (BMI) had no effect on incidence of degenerative changes. The presence of these changes decreased the physical, mental and total score of SF-36 only at L3-L4 level, but not in other levels.Conclusions: The degenerative changes in lumbar disks occur at earlier ages and have no symptoms. These changes do not affect the quality of life. BMI has no role in development of degenerative changes in adolescents but increased age is associated with increased risk of disk degeneration.
Ebrahim Ameri, MD; Hasan Ghandhari, MD; Navid Nabizadeh, MD; Hamid Hesarikia, MD
Abstract
Chylothorax is a rare complication of spinal surgery. Leakage of chyle into the pleural space occasionally occurs during anterior spinal approach as a result of damage to the thoracic duct. We present a case of chylothorax which took place 24 hours after posterior spinal fusion owing to an unusual etiology. ...
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Chylothorax is a rare complication of spinal surgery. Leakage of chyle into the pleural space occasionally occurs during anterior spinal approach as a result of damage to the thoracic duct. We present a case of chylothorax which took place 24 hours after posterior spinal fusion owing to an unusual etiology. Fourteen years-old boy patient with history of congenital cervicothoracic kyphoscoliosis underwent T7-T12 anterior spinal fusion through left fifth rib resection. He got through Postoperative phase with no untoward consequence. After ten days he underwent T2-L3 posterior spinal fusion with hook instrumentation. Over the next day following this surgical step, he developed tachypnea with milky-color effusion. The biochemical analysis verified chylothorax diagnosis.
Ebrahim Ameri; Hossein Vahidtari; Hassan Ghandhari; Hamid Behtash; Bahram Mobini; Mohammad Saleh Ganjavian; Afshin Ahmadzadeh Heshmati; Arash Motaghi
Abstract
Background: Standing and bending radiographies are pre-operative studies performed in patients with scoliosis to determine flexibility and appropriate treatment planning. The purpose of this study is to find correlation between pre-operative supine bending radiography and final scoliosis correction after ...
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Background: Standing and bending radiographies are pre-operative studies performed in patients with scoliosis to determine flexibility and appropriate treatment planning. The purpose of this study is to find correlation between pre-operative supine bending radiography and final scoliosis correction after surgery to find out if pre-operative bending radiographies could predict post operative final scoliosis correction. Methods: In a cross-sectional study, 83 patients with idiopathic scoliosis were studied and grouped based on Lenke classification of idiopathic scoliosis. Scoliosis curve was measured in standing and bending radiographs by 2 spine surgeons separately and the measurements were compared with post-operative curves. Results: The post-operative measurements were always different from pre-operative bending film values. Conclusion: We cannot predict final scoliosis precisely from pre-operative supine bending radiographs in patients with idiopathic scoliosis.
Bahram Mobini, MD; Ebrahim Ameri, MD; Hamid Behtash, MD; Hassan Ghandhari, MD; Mohammad Khakinahad, MD
Abstract
Background: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace.Methods: ...
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Background: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace.Methods: from 1991 through 2005, 165 cases (39 male, 126 female) who had a diagnosis of idiopathic postural kyphosis were treated with a Milwaukee brace. The mean age at the initiation of treatment was 13.06 years (8-16 years), at the completion of treatment was 15.06 years (11-17 years) and at the final follow-up was 17.9 years (12-25 years). The mean initial kyphosis was 59.26° (51°-74°). The patients were evaluated after an average follow-up of 34 months (6-102 months).Results: The mean angle of kyphosis was 42° (28°-68°) at completion of treatment, and 47.9° (28°-75°) at the final follow-up. Angle of kyphosis was 50° or less in 85.9% at the end of treatment and in 74.7% of patients at final follow-up. 5.9 degrees of original correction was lost in final follow-up. Two cases underwent surgery. Brace was effective in correction of kyphosis (p < /em>=.001).Conclusion: Milwaukee brace is effective in treatment of postural kyphosis. Longer period of treatment, even after maturity, is needed in more stiff deformities.
