Iranian Journal of Orthopedic Surgery

Abstract Abstract Introduction: Spine disorders are one of the common causes of referral to orthopedic clinics and reasons for orthopedic surgeries. Lumbar spinal surgery helps reduce pain and improve function in patients with certain degenerative conditions. In this paper we investigated the causes of revision spine surgery. Materials & Methods: In a retrospective cohort study the patients who had undergone revision spinal surgery within one year in a teaching hospital were evaluated -in accordance with diagnosis and clinical criteria. The patients were randomly selected and screened, and demographic information (including age, gender, underlying disease, and body mass index (BMI)) was collected through a data collection form using patients’ records. The clinical features including diagnosis of spine disease, type of previous surgery, number of fusions, history of spine surgery, Roussouly classification, and T-score, and also radiographic parameters such as sagittal vertical angle (SVA), pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, sacral slope (SS) and pelvic tilt (PT) were collected and included in the checklist. Results & Discussion: The most common cause of original spine surgery was spinal canal stenosis, which was present in 37 patients (92.5%). The most common surgery was discectomy followed by spinal fusion _ performed in 30 (75%) and 27 patients (67.5%) respectively. 25 patients (62.5%) had a history of only one surgery. According to the Roussouly classification, 30 patients (75%) had SS <35 °, and 10 patients (25%) had SS> 35 °. The mean BMI was 28.28. 2.60 kg / m2. The mean T-score in bone densitometry was -1.86 ± 1.06. The mean size of SVA was 7.12 ± 2.19 cm; the mean PI angle was 52.12 ± 10.80 °; the mean LL angle was 23.42 ± 15.56 °; the mean size of the difference between PI and LL angles was 29.25 ± 15.30 °, the mean SS angle was 27.85 ± 10.69 °, and the mean PT angle was 23.62 ± 7.62 °. SVA size was abnormal in 35 patients (87.5%), PI in 14 patients (35%), the difference between PI and LL in 35 patients (87.5%), SS in 34 patients (85%), and PT in 29 patients (72.5%) was abnormal. There was a significant difference in SVA, PI, PI-LL mismatch, SS, and PT between normal and abnormal groups (P-value <0.001). The patient factors such as old age, previous medical conditions, high BMI, osteopenia, and intraoperative factors, including failure to correct lumbar lordosis, sagittal balance, and correction of angles in primary surgery, showed increased risk for revision spine surgery. Conclusion: Osteopenia and osteoporosis, failure in reconstituting lumbar lordosis and proper sagittal balance are common reasons leading to revision spine surgery.

Abstract Introduction: Hip osteoarthritis is a common condition affecting 10–15% of individuals over 60 years old, leading to significant pain and discomfort. Low back pain is also highly prevalent among the elderly. The hip-spine syndrome describes the relationship between spinal pain, hip disorders, and symptomatic changes following hip reconstruction surgeries, particularly total hip arthroplasty (THA). The impact of THA on the biomechanical structure of the spine and pelvis remains unclear. This study investigates changes in clinical and radiological sagittal spinal alignment parameters following THA. Materials & Methods: This study included 15 patients who underwent THA at one hospital. Radiographic  parameters (Sacral Slope, lumbar lordosis, and S1-L1 distance) and clinical parameters, including low back pain (PSFS questionnaire), daily activity level (PSEQ questionnaire), and hip flexion range of motion, were assessed before and three months after surgery. Results & Discussion: Radiological changes after THA were not statistically significant. However, there was a significant reduction in low back pain (5.01±1.1-, P<0.001). An improvement in activity level (23.47±7.1, P<0.001), and an increase in hip flexion range of motion (38.66±19.62, P<0.001). Additionally, higher BMI was associated with a lower improvement in activity level (P=0.047). Conclusion: THA leads to reduced low back pain, improved activity level, and increased hip flexion range of motion. However, these changes are not correlated with radiological sagittal alignment parameters.

Abstract Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity causing physical/psychological burdens. Optimal preoperative planning enhances appearance while preserving spinal function. Corrective surgery restores spinal mobility and balance. In dual-curve cases, selective fusion corrects one curve, inducing spontaneous correction of the other—preserving spinal motion and attracting surgical interest. However, limited adoption persists due to insufficient data. This study evaluates selective thoracolumbar/lumbar fusion, detailing surgical outcomes and complications to guide surgeons in procedure selection. Evidence confirms selective thoracic fusion is effective and safe for AIS, offering significant correction, improved quality of life, and fewer complications versus extensive approaches. Future research should refine patient criteria and assess long-term effects.

Abstract Lower limb malalignment around the knee may be a risk factor of knee osteoarthritis (OA) progression. A surgical treatment method for preventing OA progression is osteotomy and one of the rare side effects of this surgery is injury to the arteries. We present three cases, two men (24 and 42 years old) and one woman (15 years old) who were diagnosed with lower limb malalignment and received high tibial or distal femoral osteotomies and were complicated with arterial injury. Delay in diagnosis of the injury varied from about an hour to about one month after surgery.