Spine
Seyyed Mohammad Jalil Abrisham, MD; Mohammad Reza Sobhan; Aboozar Emami
Abstract
Background: Percutaneous vertebroplasty as an effective and relatively new treatment can strengthen broken vertebrae and reduce the pain of osteoporotic fractures. The Present study was conducted to assess the results of such treatment in osteoporotic vertebral fractures.Methods: In the present study, ...
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Background: Percutaneous vertebroplasty as an effective and relatively new treatment can strengthen broken vertebrae and reduce the pain of osteoporotic fractures. The Present study was conducted to assess the results of such treatment in osteoporotic vertebral fractures.Methods: In the present study, all the patients with osteoporotic vertebral fractures, having undergone vertebroplasty were studied by VAS before and after vertebroplasty. Complications after vertebroplasty (infection, nerve lesion, extra vertebrae cement leakage, cement-to-lung leakage and adjacent vertebrae fracture) were documented. Statistical data were entered into SPSS statistical software version 24 and statistical analysis was performed using Chi-square and independent t-tests.Results: Of the 40 evaluated cases, 10 (25%) were male and 30 (75%) females. The mean age of patients was 76.26 years. The mean of Visual Analogue Scale before vertebroplasty was 8.06, and after vertebroplasty was 1.34. The observed side effect was extra vertebrae leakage of cement, which was observed in eight cases (16%). No case of infection, nerve damage, and cement leakage into the lung or adjacent vertebral fracture was observed. Based on the analytical evaluation, there was no statistically significant difference between the mean of Visual Analogue Scale before vertebroplasty considering gender (P = 0.485) and age (P = 0.134). In addition, there was no significant difference between the mean of Visual Analogue Scale after vertebroplasty considering gender (P = 0.325) and age (P = 0.809). However, the mean of Visual Analogue Scale after vertebroplasty had a significant reduction in comparison to before vertebroplasty (P=0.0001). The second lumbar vertebra has been the most commonly involved vertebra.Conclusion: Based on observed results, percutaneous vertebroplasty can reduce the severity of pain in patients with osteoporotic vertebral fractures.
Najmoddin Asadian; Seyed Mani Mahdavi; Marjan Hajahmadi
Abstract
Background: Spinal cord surgery, particularly thoracolumbar surgery, is associated with deep vein thrombosis (DVT). Therefore, this study aimed to evaluate the incidence rate of deep vein thrombosis after thoracolumbar surgery using Doppler sonography.Methods: This prospective cohort study was conducted ...
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Background: Spinal cord surgery, particularly thoracolumbar surgery, is associated with deep vein thrombosis (DVT). Therefore, this study aimed to evaluate the incidence rate of deep vein thrombosis after thoracolumbar surgery using Doppler sonography.Methods: This prospective cohort study was conducted on 51 patients with spinal cord and thoracolumbar surgeries from January 2021 to October 2021. All the patients were evaluated for DVT by Doppler sonography one day before and one month after surgery. The elastic stockings were worn by all the cases, and low molecular weight Heparin (LMWH) was started after surgery and continued for two weeks.Results: According to preoperative results, no evidence of DVT was present. Based on Doppler sonography results, the incidence rate of DVT was 3.92% one month after surgery. Clinical thrombosis was not detected in any of the patients.Conclusion: According to the results, the DVT incidence rate was 3.9% in patients with Thoracolumbar Surgery. Prophylaxis needs to be seriously considered because DVT is a life-threatening issue.
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.
ADEL EBRAHIMPOUR; alireza manafi rasi; bahamin attar; ahmadreza mirblok
Abstract
Background: Spinal fusion is a surgical method to treat degenerative diseases of the spine. We studied the effect of bone graft soaked with zolendronic acid (ZA) on spinal fusion.Method: 60 patients with degenerative disease, scheduled for spinal fusion were randomly divided into 2 equal groups, ...
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Background: Spinal fusion is a surgical method to treat degenerative diseases of the spine. We studied the effect of bone graft soaked with zolendronic acid (ZA) on spinal fusion.Method: 60 patients with degenerative disease, scheduled for spinal fusion were randomly divided into 2 equal groups, receiving either local bone graft or local bone graft plus topical zoledronic acid. The cases were studied with visual analogue scale (VAS), Oswestry low back disability questionnaire, and radiographic bone bridge formation with a 12-months follow-up.Results: 57 patients completed the study: 27 patients in “control group” and 30 patients in “case group”. VAS Score was significantly lower in case group in comparison with control one after 12 months (P value:0.00).In the point of Oswestry low back disability questionnaire score(ODI)score the mean score was decreased significantly in “case group” in comparison with “control group”(P value =0.006). Radiographic grades A or B bone bridging was more frequently observed in Zoledronic acid group at 12 months post-operation compared with the control group (p value=0.00). Conclusion: This study demonstrates that addition of Zolendronic Acid to bone grafting in the spinal fusion of elderly people increases the fusion rate and is associated with better clinical and functional outcome.
Seyed Aref Hosseini Faradonbeh; Nima Jamshidi, Ph.D
Abstract
Background: One of the most important challenges after vertebroplasty (VP) and kyphoplasty (KP) is the stress concentration at the junction of bone and cement which would cause not only pain, but also new microfractures or osteonecrosis. We would like to present a new concept of using hexagonal porous ...
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Background: One of the most important challenges after vertebroplasty (VP) and kyphoplasty (KP) is the stress concentration at the junction of bone and cement which would cause not only pain, but also new microfractures or osteonecrosis. We would like to present a new concept of using hexagonal porous structure. This model is tested biomechanically in comparison with vertebrae treated with VP and KP.
Methods: Ten Ovine vertebrae were divided into 5 groups - 2 in each group: the groups included normal vertebrae, VP, KP and vertebrae treated by hexagonal porous structure as metal pearls (steel or brass). These vertebrae were all put under mechanical static pressure. The displacement and yield points were compared in the 5 groups.
Results: The hexagonal metal treated vertebrae showed a displacement of 5.5-6 mm before reaching the ultimate strength of 3.5-4.5 KN. This displacement for VP and KP was 2.5-3 mm. The improvement of mechanical behavior was observed in vertebrae treated by hexsgonal metal pearls compared to those treated by the VP and KP.
Conclusions: The toughness vertebrae by hexsgonal metal pearl treatment increases and this will reduce the stress in vertebral end plates and interdiscal pressure. This would reduce the chance of fracture in the adjacent vertebrae.
Mohsen Karami; Ali Akbar Esmailiejah; Mohammad Hossein Kazemi; Farshad Safdari, MSc
Abstract
Background: Hemivertebra is one of the common causes of congenital
scoliosis. In cases with curve progression, resection of the hemivertebra
through a combined anterior and posterior approach (CAPA) is one of the usual treatment
modalities which is associated with high morbidity. Recently, hemivertebra
resection ...
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Background: Hemivertebra is one of the common causes of congenital
scoliosis. In cases with curve progression, resection of the hemivertebra
through a combined anterior and posterior approach (CAPA) is one of the usual treatment
modalities which is associated with high morbidity. Recently, hemivertebra
resection through a posterior only approach (POA) is introduced. In the current
study, we are reporting our experience with a single posterior approach. Methods: Ten
patients with lumbar CS who had undergone hemivertebra resection through a POA
with transpedicular instrumentation and short segment fusion, between 2009 and
2012 were retrospectively studied. The main and the compensatory scoliotic
curves and kyphotic curves were measured and compared before surgery and by the
16.1±10 months follow-up. Results: Fusion was
obtained in all of the patients. The mean drop in the main, compensatory and
kyphotic curves were 39.6±6.6 to 11.3±5 degrees, 12.9±5.1 to 7.8±3.4 degrees
and 15.6±8.1 to 2.7±8.2 degrees, respectively (p < /i>
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.
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 ...
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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.
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.
