Mohammad Ali Erfani, MD; Hormoz Nouraei, MD; Seyed Amir Reza Mesbahi, MD; Fatemeh Toubaei, MD
Abstract
Background: The aim of this study was an assessment of patients with adolescent idiopathic scoliosis (AIS) treated by short anterior fusion of the thoracolumbar/lumbar curve.Methods: In a retrospective study, 12 consecutive patients with Lenke 5 type AIS treated by short segment anterior spinal fusion ...
Read More
Background: The aim of this study was an assessment of patients with adolescent idiopathic scoliosis (AIS) treated by short anterior fusion of the thoracolumbar/lumbar curve.Methods: In a retrospective study, 12 consecutive patients with Lenke 5 type AIS treated by short segment anterior spinal fusion during 2002-2005, were evaluated. The Cobb angles of major and minor curves, upper and lower end instrumented vertebrae angulation, disc angulation below the lower end instrumented vertebrae, apical vertebral angulation and translation, sagittal Cobb angles were assessed preoperatively, 4 days post operatively and at the last follow-up. Patients' satisfaction was assessed by SRS-30 questionnaire.Results: The correction of main curve cobb angle was 66.7%. The unfused thoracic curve improved to 50.2% that was comparable with flexibility data. In the major curve, there were an improvement of 92% in the apical vertebral rotation, 74% apical vertebral translation, 75% upper end instrumented vertebra angulation, 79% lower end instrumented vertebra angulation, and 92% correction of disc angulation below the lower instrumented vertebra. There were no significant changes in thoracic kyphosis or lumbar lordosis. The average SRS-30 at the last follow-up was 116 points.Conclusion: We conclude that short segment anterior selective fusion with anterior instrumentation of the thoraco lumbar/ lumbar curve in Lenke 5 scoliosis with a thoracic curve bending to 25º or less, results in a satisfactory correction and a well balanced spine.
Mohammad Ali Erfani, MD; Hormoz Nooraee, MD; Iman Shahriari, MD
Abstract
Background: The more common technique in instrumentation of adolescent idiopathic scoliosis has been multisegmental fixation and use of hooks and rods. This study is aimed at locking at short-term results of hybrid fixation with pedicular screws in lumbar area and hooks in thoracic area of scolotic curves.Methods: ...
Read More
Background: The more common technique in instrumentation of adolescent idiopathic scoliosis has been multisegmental fixation and use of hooks and rods. This study is aimed at locking at short-term results of hybrid fixation with pedicular screws in lumbar area and hooks in thoracic area of scolotic curves.Methods: Thirty four cases (28 girls, 6 boys) of adolescent idiopathic scoliosis that had received spinal fusion with pedicular screw in lumbar and hook in thoracic area for rod fixation and instrumentation were retrospectively evaluated, with mean age of 14.4 (11-27) years and 33.6 (24-72) months follow-ups. The correction of coronal, sagital, rotational deformities and maintenance of correction at follow-up were assessed. Clinical evaluation according to Scoliosis Research Society questionnaire (SRS-24) was also performed.Results: The initial average coronal angle of 63.2 degrees improved to 27.1 degrees after surgery. This corresponded with the observed correction in preoperative bending films. 60 percent de-rotation and 55 percent improvements in deviation from midline axis were also observed. The angulations of first vertebra and first disc below fusion showed, respectively, 51 and 70 percent improvement. According to Lenke's classification, the ''lumbar modifier'' in sagital plane of (+) 1.1 degrees changed to (-) 8.9 degrees.Conclusions: Use of pedicular screws in lumbar region during instrumentation of adolescent idiopathic scoliosis produces better correction and lowers the chance of ''correction loss'' in short time.
Mohammad Ali Erfani, MD; Hormoz Nooraee, MD; Omidreza Momenzadeh, MD
Abstract
Background: Most investigations agree that unstable thoracolumbar fractures require surgical treatment. There is, however, debate on the best approach-anterior, posterior or combined. We are reporting our short and mid-term results on a «posterior only» approach with ligamentotaxis-dependent canal ...
Read More
Background: Most investigations agree that unstable thoracolumbar fractures require surgical treatment. There is, however, debate on the best approach-anterior, posterior or combined. We are reporting our short and mid-term results on a «posterior only» approach with ligamentotaxis-dependent canal decompression with a segmental instrumentation system.Methods: 37 consecutive patients with thoracic and lumbar vertebrae fractures over 4 year period, with a mean follow-up of 30 months, (12-46 months) were studied. The cases underwent subjective and objective evaluation, using the Denis back pain scale, functional independent measure, employment status, neurologic Frankel grading and radiographic indices of vertebral angles and height change.Results: Twenty patients were pain-free, 35 were functionally independent. Frankel neurological grading showed 1.6 points average recovery. The mean preoperative kyphoitc angle of 19.1º improved 1.1º post surgery and to 5.1º at final follow-up. There were 3 minor infections and one hardware failure.Conclusions: Posterior spinal decompression and instrumentation for unstable thoracic and lumbar fractures is safe, effective and is associated with effective, achievement of radiographic correction, and is easier than anterior approach.
