Iranian Journal of Orthopedic Surgery

Abstract Introduction: Scoliosis is one of the most common spinal deformities, which in severe cases requires extensive surgical intervention. These surgeries are often associated with significant blood loss and a need for blood transfusion. This study aimed to evaluate changes in complete blood count (CBC) parameters in patients undergoing scoliosis correction surgery over a five-year period at medical centers affiliated with Tabriz University of Medical Sciences.

Materials and Methods: In this retrospective study, data from 70 patients who underwent scoliosis surgery between 2015 and 2020 were analyzed. Demographic information, body mass index (BMI), hemodynamic status, duration of surgery, volume of blood loss, and details of intraoperative and postoperative blood transfusions were recorded. CBC variables were assessed preoperatively and over a five-day postoperative period.

Results: The mean age of the study population was 24 ± 18.43 years. The results indicated that higher body weight (p = 0.007), lower BMI (p = 0.033), and longer operative duration (p = 0.007) were significantly associated with increased intraoperative blood transfusion. Statistical analysis of CBC trends showed a significant decrease in RBC, PLT, HB, and HCT levels up to the fifth postoperative day. Conversely, WBC levels significantly increased on the first postoperative day, followed by a gradual decline.

Conclusion: These findings underscore the importance of accurate prediction of blood loss and optimal management of blood transfusion in scoliosis surgery. As postoperative hemoglobin decline is often self-limiting, unnecessary transfusions should be avoided. Moreover, in patients with high-risk indicators, preoperative preventive measures can help reduce complications. This study provides a foundation for developing more precise perioperative care protocols in scoliosis surgery.

Abstract Abstract Introduction: The aim of this study is to investigate the radiographic and clinical findings in patients before and after Smith-Peterson osteotomy to correct adult spine deformity. Materials & Methods: This is a case series study. Data be prepared and extracted retrospectively from patients' records. Inclusion criteria were age >18 years, American Society of Anesthesiology (ASA) risk class III or less, and sagittal spine deformity within three years. All the patients had pre-operative full standing digital spine radiography. Radiographic and clinical parameters were extracted from the patients' files before the operation and 1 month after the operation. Demographic and surgical and clinical information: information was obtained for each patient. The information from the questionnaire was coded and entered SPSS software. The level of significance was considered less than 5%. Results & Discussion: A total of 10 patients met the conditions for entering the study and were examined. The amount of change in SAV before and after correction of deformity post-surgery decreased significantly (P<0.0001), the amount of Pelvic Incidence increased from 51.7 to 52.5 after surgery, which is not statistically significant(p=0.269). Pelvic tilt decreased from 28.7 to 23.5 after surgery (P=0.002). Sacral slope increased from 23.5 to 29.4 (p=0.002). Lumbar Lordosis also increased from 8.5 to 42.1 after surgery (p<0.0001). The rate of Thoracic Kyphosis also increased significantly from 24.4 to 25.2 after surgery (P=0.003). There was a significant decrease in VAS from 7.7 to 3.1 after surgery (P<0.00001). Conclusion: The spinal deformity correction by the Smith-Peterson osteotomy method can improve the radiographic as well as clinical parameters in short term.

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 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 Introduction and purpose: loss of lordosis is an important factor in causing degeneration of the spine. There are several treatment methods for the correction of segmental lumbar lordosis. In this study, correction of lumbar lordosis in patients undergoing posterior interbody lumbar fusion was compared using peek cage and allograft impaction.
Methods: In this clinical trial, the correction of segmental lumbar lordosis after Posterior Interbody Lumbar Fusion was investigated in patients referred to Firuzgar Hospital in 2001. A total of 21 patients were randomly evaluated in two groups: treatment with impaction allograft (10 patients) and treatment using Peek cage (11 patients). correction of lumbar lordosis before and day after surgery, as well as pain intensity and side effects after 2 weeks of surgery were investigated in patients. The results were analyzed using SPSS version 25 software.
Results: The median age of the patients was 56 years and 38.1% were male. The results showed that in both impaction allograft (P<0.001) and PEEK cage (P<0.0001), lumbar lordosis increased significantly after surgery compared to before. The percentage of changes in the lordosis angle in impaction allograft method was significantly higher than PEEK cage (P=0.01). There was no significant difference in pain intensity after surgery in the two methods. No serious side effects were reported in any of the patients in the two groups.
Conclusion: Impaction allograft provides more correction of lumbar lordosis compared to PEEK cage in patients undergoing posterior Interbody lumbar fusion.

Abstract Background: Congenital kyphosis is a spinal deformity resulting from disruption in the formation of the anterior part of the vertebrae on the sagittal plane during early fetal development. Understanding demographic trends and associated anomalies in affected individuals within specific regions and countries is pivotal for tailoring more suitable treatment approaches within these patients.
Methods: This retrospective cross-sectional study was conducted on 108 patients referred to Shafa Yahyaian Hospital in Tehran between 2010 and 2019. Demographic and radiological criteria were assessed in all patients who underwent surgery for congenital kyphosis at this hospital. Parameters such as age, gender, BMI, presence of cardiac, urogenital system, and spinal anomalies, kyphosis type, as well as Cobb's angle before and after surgery, were gathered, reviewed, and analyzed from patients' records.
Results: Of the cohort, 74 patients were categorized as congenital kyphosis type 1, 21 as type 2, and 13 as type 3, encompassing 69 female (63.9%) and 39 male patients (36.1%). The mean age at the time of examination and symptom onset was 6.5 years, while the mean age at the time of surgery was 16.5 years. Notably, 38 patients exhibited a cardiac anomaly, 14 had genitourinary system anomalies, and 39 presented with spinal anomalies. A statistically significant correlation existed between the presence of a cardiac anomaly and the type of congenital kyphosis, with type one exhibiting a markedly higher incidence of cardiac anomalies compared to the other two types.
Conclusion: The findings revealed a higher frequency of type 1 congenital kyphosis. Moreover, patients with type 3 congenital kyphosis underwent surgery at a significantly younger age than those with the other two types, potentially attributed to its higher progression rate. Spinal cord, cardiac, and genitourinary tract anomalies were respectively observed as the most prevalent anomalies among the patients.

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, 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.
 
 

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 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.