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.
Mohammad Saleh Ganjavian, MD; Hamid Behtash, MD; Ebrahim Ameri, MD; Bahram Mobini, MD; Seyed Hossein Vahid Tari, MD; Marzieh Nojoomi, MD
Abstract
Background: Reports on associated intraspinal and other organ anomalies in congenital scoliosis are variable. We are reporting such findings in two orthopaedic referral centers in Tehran-Iran.Methods: During a period of 15 years, in a case series study, 381 patients with congenital scoliosis were evaluated ...
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Background: Reports on associated intraspinal and other organ anomalies in congenital scoliosis are variable. We are reporting such findings in two orthopaedic referral centers in Tehran-Iran.Methods: During a period of 15 years, in a case series study, 381 patients with congenital scoliosis were evaluated for intraspinal abnormalities with physical examination, radiographs, MRI and/or myelograms. They were also assessed for cardiac urogenital or anomalies in other areas by physical exam, sonography and echocardiography.Results: Cord anomaly was present in 83 (21%) cases, 26 of whom had neurologic abnormality. Tethered cord syndrome was the most common neurologic problem in 38 patients (45.8%). Anomalies in other parts of body detectable by physical examination were observed in 155 patients, and detected by help of clinical evaluation in 121 and paraclinical tests in 34 patients. 84 cases had trunk anomalies, 4 genitourinary and 10 heart anomaly, 37 head and neck, 7 maxillofacial, 3 upper and 23 lower extremities, 14 Urogenital, 10 heart and 8 cases of gastrointestinal anomalies were also detected.Conclusion: The anomalies of nervous system associated with congenital scoliosis are often without clinical manifestations. Cardiac and urogenital anomalies are not very common in congenital scoliosis.
Mohammad Saleh Ganjavian, MD; Hamid Behtash, MD; Seyed Hossein Vahid Tari, MD; Ebrahim Ameri, MD; Bahram Mobini, MD; Marzieh Nojumi, MD
Abstract
Background: Bracing is the most common non-operative treatment for idiopathic adolescent scoliosis. Milwaukee brace is the best – known orthosis for this purpose. We wish to report our results with the use of this brace in idiopathic scoliosis.Methods: In a retrospective study, among 681 patients who ...
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Background: Bracing is the most common non-operative treatment for idiopathic adolescent scoliosis. Milwaukee brace is the best – known orthosis for this purpose. We wish to report our results with the use of this brace in idiopathic scoliosis.Methods: In a retrospective study, among 681 patients who had been treated for idiopathic scoliosis form 1994 to 2004 in two hospitals in Tehran, 335 cases had received non-operative treatment with Milwaukee brace. The radiographs of these patients were reviewed to evaluate the treatment outcome. These patients, who were 12.1 years old on average and had received no other prior treatment, had started with 23 hours per day bracing and continued in accordance with Scoliosis Research Society (SRS) protocol.Results: Milwaukee brace reduced the cobb ankle from an average of 32.8 to 30.6 degrees. The brace had no appreciable effect on curves of upper thoracic, double or triple curves. Initial thoracic kyphosis had no effect on final bracing outcome. Curve progression, while in brace, was more commonly seen in association with Risser signs "0" to "1". The best prognostic evidence in terms of control of progression was initial reduction of over 30 percent in curve magnitude in the first post-bracing visit. A reduction in curve magnitude of less than 17 percent after the first visit was associated with poor final outcome.Conclusions: Milwaukee brace can effectively reduce and control idiopathic scoliotic curves. However, good patient selection and close follow-up is mandatory.
Hamid Behtash, MD; Mohammad Saleh Ganjavian, MD; Ebrahim Ameri, MD; Bahram Mobini, MD; Seyed Hossein Vahid Tari, MD; Marzieh Nojoumi, MD
Abstract
Background: Congenital vertebral development produces the congenital scoliosis which is often progressive requiring surgical intervention. Convex hemiepiphysiodesis of the involved segments is a useful technique in young children. We are reporting our experience with such a treatment.Methods: Among the ...
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Background: Congenital vertebral development produces the congenital scoliosis which is often progressive requiring surgical intervention. Convex hemiepiphysiodesis of the involved segments is a useful technique in young children. We are reporting our experience with such a treatment.Methods: Among the congenital scoliotic curves treated in Shafa hospital in Tehran in 19-year period, the ones that had undergone convex hemiepiphysiodesis were identified. Twenty three patients (13 females, 10 males) with a mean follow-up of 5.6 years (2-19 years) were clinically and radiographically evaluated, and the pre and post operative findings were analyzed.Results: Improvement in curve magnitude was best observed in hemivertebra cases. Nine cases of hemivertebra obtained 18 degrees correction while in 14 cases of type III (mixed type) anomally 15 degrees correction was observed (p < /em>=.04). Failure (continued progression of scoliotic curve) had a large kyphotic angle at the beginning.Conclusions: Convex vertebral hemiepiphysiodesis in congenital scoliosis, especially hemivertebral cases is a useful procedure when performed in early childhood.
Hamid Behtash, MD; Bahman Ghezelbash, MD; S Mohammad Fereshtehnejad, MD; Mohammad Saleh Ganjavian, MD; Ebrahim Ameri, MD; Bahram Mobini, MD
Abstract
Background: Low back pain is common disease which usually causes considerable individual and community-related functional disability. Lumbar disc herniation is one of the common causes of back pain in the third or forth decade of life. Surgical treatment imposes a heavy functional burden on the patient ...
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Background: Low back pain is common disease which usually causes considerable individual and community-related functional disability. Lumbar disc herniation is one of the common causes of back pain in the third or forth decade of life. Surgical treatment imposes a heavy functional burden on the patient and the society. For this reason we have decided to evaluate the effectiveness of non-surgical treatment in lumber disc herniation in middle age people.Methods: Forthy five patients, who had referred with documented lumber disc herniation with positive clinical and CT scan evidence, were evaluated before and after six months of conservative treatment. The treatment included NSAID steroid 3-cyclic antidepressant, rest, physiotherapy and, at times, bracing or traction. Clinical and repeat CT scan was used for re-evaluation.Results: Among the 45 cases, clinical improvement was seen in 39 (86.7%) and 6 (13.3%) required surgical exploration. The 35 cases who referred for repeat CT scanning, 24 (68.6%) showed regression of disc bulge. Conclusions: In view of high rate of regression of symptoms and improvement on CT scans in this study, it is recommended not to rush to surgery for lumber disc herniation in non-urgent cases, and expect high rate of improvement with conservative approach.
