Hamid Hesarikia; Alireza Rahimnia; Gholamreza Farzanegan; Musa Reza Anbarloui; Amin Hamidzadeh Khiyavi
Abstract
Background: The application of Tranexamic Acid (TA) is one of the methods to control and reduce bleeding in spinal surgery. The aim is to compare systemic (TA) with local (TA) administration for reduction of blood loss during spinal surgery in order to promote health economics.Method: The research schema ...
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Background: The application of Tranexamic Acid (TA) is one of the methods to control and reduce bleeding in spinal surgery. The aim is to compare systemic (TA) with local (TA) administration for reduction of blood loss during spinal surgery in order to promote health economics.Method: The research schema was cross-sectional and retrospective in the community of patients undergoing spinal surgery in the Baqiyatallah Hospital. The inclusion criteria were elective spinal surgeries of three levels or more. The exclusion criteria were bleeding disorder. The required analyses are performed using SPSS software. Moreover, the significance level of the statistical test is 0.05 The intravenous dose is selected to be 10 mg/kg. The maintenance is also 1 mg/kg/h. The topical dosage is one gram in300 ml at the beginning and 500 mg in 50 ml at the end. The amount of calculated bleeding is the volume of blood in the drain.Results: In this research, 22 patients (44.9% of 49 patients) received TA intravenously and 27 patients (55.1% of 49 patients) received local TA. There was no remarkable relationship between the amount of bleeding in different groups with the surgery type (p: 0.48), surgery level number (p: 0.48), and the amount of total bleeding (p: 0.14). The local TA group’s intra-operative and post-operative bleeding amounts were 563.89 ± 367.48ml and 116.30 ± 71.37ml, respectively. These intra-operative and post-operative bleeding amounts were 496.64 ± 296.84ml and 75.84 ± 120ml for the case of the intravenous (TA) group.Conclusion: The results do not confirm the effectiveness of the local administration compared with the intravenous administration. However, the average amount of bleeding in the local application of tranexamic acid is similar to the systemic one.
Hormoz Nouraei; Morad Motalebi
Abstract
Abstract
Background Primary Epithelioid Hemangioendothelioma (EHE) of spine is an extremely rare malignant vascular neoplasm with unpredictable outcome. As a malignant tumor, total resection offers the best possible disease -free survival, while the location poses difficult technical problems .
Method: ...
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Abstract
Background Primary Epithelioid Hemangioendothelioma (EHE) of spine is an extremely rare malignant vascular neoplasm with unpredictable outcome. As a malignant tumor, total resection offers the best possible disease -free survival, while the location poses difficult technical problems .
Method: A 38-year-old man with a large tumor of T10 vertebra was investigated, had biopsy-confirmed diagnosis of EHE, and underwent simultaneous anterior and posterior resection and reconstruction with anterior strut grafting and posteriorly instrumented fusion.
Results: The patient has had good a post-operative course with no neurological damage and no recurrence found in the one-year follow-up .
Conclusion: EHE of thoracic spine is a rare finding and a well-planned total surgical excision can produce a good outcome.
Spine
Seyyed Mohammad Moein Fatemi; Mohammad Nikkhoo; Mostafa Rostami; Chih-Hsiu Cheng
Abstract
In recent years, spinal fusion surgery has become one of the most common treatments for spinal cord injuries, while the interbody cages, which replace the damaged interbody discs in the surgeries, have undergone extensive changes in design and material. These changes are quite visible, ranging from plain ...
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In recent years, spinal fusion surgery has become one of the most common treatments for spinal cord injuries, while the interbody cages, which replace the damaged interbody discs in the surgeries, have undergone extensive changes in design and material. These changes are quite visible, ranging from plain titanium cages made using the conventional manufacturing methods to customized porous titanium cages, which are made using additive manufacturing technology, or titanium-coated polymer cages. Among all the materials used in manufacturing the interbody cages, PolyEther Ether Ketone (PEEK) and titanium are the most common ones. Each of these two has its own advantages and disadvantages. Several studies have compared these two materials, mostly based on the two characteristics of subsidence and fusion rates. The present study performed a comprehensive review of the published clinical studies comparing the titanium and PEEK cages in order to make a comprehensive evaluation of these two. According to the reviewed studies, both materials had relatively similar results in subsidence rate, with no significant difference. However, it was shown that the titanium cages had a better fusion rate and subsequently were more likely to be successful in the clinical settings than the PEEK cages.
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.
zahra khoz; mohammad nikkhoo; Chih-Hsiu Cheng
Abstract
Background: Low back pain is one of the most common problems that force individuals to seek medical care. Since surgery is the last treatment strategy, predicting the process of conducting surgical procedures seems beneficial and somehow crucial. In this regard, the first step is having a validated biomechanical ...
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Background: Low back pain is one of the most common problems that force individuals to seek medical care. Since surgery is the last treatment strategy, predicting the process of conducting surgical procedures seems beneficial and somehow crucial. In this regard, the first step is having a validated biomechanical model based on the anatomical parameters of patients’ lumbar spine. Despite the impressive progress in this field, there is still a need to designing a model that could include important anatomical parameters and be applicable in terms of clinical applications.Methods: This study aimed to develop the personalized spinal finite element model with 23 anatomical parameters. The initial data was extracted from the radiology picture of the average healthy volunteers and was designed in Catia software. Afterwards, the finite element model was analyzed in Abaqus, and results of the range of motion of motionsegments in movements of flexion, extension and left and right lateral bending were verified based on the results of experimental studies present in the literature.Results: In order to observe the application of the patient-specific spinal parametric model, a model of a patient after spinal fusion was presented. Moreover, results of the range of motion of the motion segments and intradiscal pressure were compared to the healthy model.Conclusion: Since acceptable results were obtained at each step, it is possible to predict the result of spinal fusion and compare the biomechanical results in case of decreased or increased fusion level by developing a parametric parient-specific model for each patient, which can be an effective achievement for clinical fields.
Mohsen Karami, MD; Ali Akbar Esmailiejah, MD; Maryam Sedaghatnia, MD; Ali Akbar Esmailiejah, MD; Ramin Etemadi, MD; Ahmad shafaeizadeh, MD
Abstract
Background: The use of pedicle screws in thoracic or lumbar spinal fusion and deformity correction is becoming more privalent, even in children. Improper screw insertion can produce major complications. The accuracy of the screw placement is evaluated post operatively by CT scanning in a small group ...
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Background: The use of pedicle screws in thoracic or lumbar spinal fusion and deformity correction is becoming more privalent, even in children. Improper screw insertion can produce major complications. The accuracy of the screw placement is evaluated post operatively by CT scanning in a small group of children.Methods: In a cross section study, 7 children under 5 years of age who had undergone spinal surgery, using pedicular screws were evaluated in two training hospitals in Tehran, Iran. The position of pedicular screws was determined by an expert radiologist and documented along with probable neurovascular effect.Results: Seven children with total of 42 pedicle screws were assessed. 34 screws (80%) had been placed in the desired positions. The remaining 9 screws had produced minor breakage through the cortices, mainly in narrow thoracic pedicles. There was no case of neurovascular compromise, or stability problem in the 42 screws.Conclusions: Use of peducular screw in spinal fusion of young children is a proper technique.
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.
Gholamhossain Shahcheraghi; Alireza Tavakoli
Abstract
Background: Spinal deformity in neurofibromatosis, when associated with dystrophic change, is a major treatment challenge. Resection of the vertebral body as an additional step in correction and fusion has not been previously investigated. The purpose of this study is to report an experience with corpectomy ...
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Background: Spinal deformity in neurofibromatosis, when associated with dystrophic change, is a major treatment challenge. Resection of the vertebral body as an additional step in correction and fusion has not been previously investigated. The purpose of this study is to report an experience with corpectomy and circumferential fusion in dystrophic spines of neurofibromatosis. Methods: In a retrospective study, among 16 patients with dystrophic spinal curves, nine cases who had undergone anterior and posterior fusion with 6.7 years (range 2-11.9) average follow-up were evaluated. Results: Nine cases with a mean age of 11.8 years (range 7.8-17) at surgery consisted of seven kyphoscoliotic patients, who had received one or two levels of cord decompression and corpectomy. Surgery improved the mean preoperative scoliosis of 87 (range 60-110) and local kyphosis of 69.3° (range 50-100) to 49 (range 15-85) and 49° (range 35-70), respectively. Loss of correction of 5° in the scoliosis and 13° in the kyphosis angles was observed in the final follow-up. Fusion was achieved in all cases. The average SRS-22 score of 4.1 (range 3-4.6) was obtained. Conclusions: Simultaneous anterior and posterior fusion with corpectomy for dystrophic neurofibromatosis spinal deformities is associated with a high fusion rate, good correction, and also good functional outcome.
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 ...
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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: ...
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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.
Hamid Behtash, MD; Ebrahim Ameri, MD; Bahram Mobini, MD; Seyed Alireza Bassampoor, MD
Abstract
Bioactive glass materials are being, commonly, used in spinal fusion as substitute for bone graft. Continuous serous discharge as a reaction to this foreign material has not been previously reported. The following case is a report of a patient who developed non-infected continuous serous discharge following ...
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Bioactive glass materials are being, commonly, used in spinal fusion as substitute for bone graft. Continuous serous discharge as a reaction to this foreign material has not been previously reported. The following case is a report of a patient who developed non-infected continuous serous discharge following the use of bioactive glass material “Nova Bone” for anterior and posterior spinal fusion.
