Spine
Ebrahim Ameri; Farshad Nikouei; Hassan Ghandhari; Saeed Sabbaghan; Behrooz Givehchian
Volume 7, Issue 6 , November 2019, , Pages 566-570
Abstract
Osteoid osteoma (OO) is a small tumor of bone that affects the spine in 10% of the cases. The tumor has a tendency toneural arc, and the lumbar spine is the most common site of presentation. Lesions of the odontoid process are very rare.We presented the case of a 20-year-old man who had cervical pain ...
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Osteoid osteoma (OO) is a small tumor of bone that affects the spine in 10% of the cases. The tumor has a tendency toneural arc, and the lumbar spine is the most common site of presentation. Lesions of the odontoid process are very rare.We presented the case of a 20-year-old man who had cervical pain for 8 months. The pain responded to medical therapy.After investigation, there was a lytic lesion at the odontoid process with the characteristic features of OO in computedtomography scan and magnetic resonance imaging. Firstly, medical treatment was initiated with the administration ofnonsteroidal anti-inflammatory drugs; however, due to adverse effects and worsening of his pain, the patient underwentsurgical treatment with intralesional curettage from the transoral approach. In addition, the posterior fusion of the firstand second cervical vertebrae was performed. The pain disappeared, and the patient was symptom-free after one yearof follow-up.Level of evidence: V
Spine
Babak Ganjeifar; Ehsan Keykhosravi; Gholamreza Bahadorkhan; Hossein Mashhadinezhad; Mohammad R. Ehsaei; Fariborz Samini; Masoud Pishjoo; Abdolreza Mahmoodi; Hamid Rezaei
Volume 7, Issue 4 , July 2019, , Pages 321-324
Abstract
Background: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophysealfractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment ofthoracolumbar fractures is challenging, especially due to the difficulty of ...
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Background: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophysealfractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment ofthoracolumbar fractures is challenging, especially due to the difficulty of evaluating the posterior ligamentous complex(PLC). The purpose of this study was to evaluate the diagnostic value of computed tomography (CT) scan in predictingPLC injuries in the patients with thoracolumbar spinal fractures referring to the referral center of spinal trauma in theeast north of Iran in 2016.Methods: This retrospective study was conducted on patients with thoracolumbar injuries referring to Shahid KamyabHospital in Mashhad, east north of Iran, in 2016. The data were collected by entering the data of medical records intospecial forms. The classification of spinal fractures was accomplished using the AO Spine Classification System.Results: According to the results, 71 (71.7%) patients were male, and the subjects had a mean age of 44.6±17.7 years.The PLC injury was observed in 28 (28.3%) patients. The PLC injury showed a significant relationship with facet jointwidening, increased interspinous process distance, and spinous process avulsion fracture (P<0.05).Conclusion: As the findings of this study indicated, the diagnostic results of PLC injury by means of CT scan wassimilar to those obtained by magnetic resonance imaging in patients with thoracolumbar spinal fractures.Level of evidence: III
Spine
Majid Shahbazi Moheb Seraj; javad Sarrafzadeh; Nader Maroufi; Ismail Ebrahimi Takamjani; Amir Ahmadi; Hossein Negahban
Volume 7, Issue 1 , January and February 2019, , Pages 52-60
Abstract
Background: Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there isinsufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present studywas to compare postural control between subgroups of chronic nonspecific ...
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Background: Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there isinsufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present studywas to compare postural control between subgroups of chronic nonspecific LBP and healthy subjects during lifting.Methods: A total of 35 men with chronic LBP (19 active extension pattern [AEP] and 16 flexion pattern [FP]) and 15healthy controls were enrolled in this cross-sectional study. Pooled LBP was subdivided based on the O’Sullivan’sclassification system (OCS). The participants were asked to lift a box from the ground to the waist level and hold it for20 seconds. The load was 10% of the subject’s weight. Force plate system was used to record balance parameters,including standard deviations (SDs) of center of pressure (COP) amplitude and COP velocity in anterior-posterior andmedial-lateral directions and mean total velocity. The test was divided into two static and dynamic phases. Data wereanalyzed using one-way analysis of variance and independent t-test.Results: There were no significant differences between pooled LBP and control groups in any of the variables, exceptfor the SD of the anterior-posterior direction velocity in the X-plane in the static phase (P=0.017). After classifying LBP,the results showed that the healthy and AEP groups were significantly different in SD of COP velocity in the frontal plane(P=0.021), mean total velocity (P=0.010), and SD of COP velocity in the sagittal plane (P=0.039).Conclusion: The present study showed that postural control was not different between the pooled LBP and normalgroups. After classifying pooled LBP based on OCS, we found that the AEP showed different postural control ascompared to healthy controls in the dynamic phase. The FP and AEP exhibited different postural control relative to thehealthy controls in the static phase, and COP velocity was lower in those groups compared to the control group. Theresults of this study support the concept of LBP classification.
Spine
Majid Shahbazi Moheb Seraj; javad Sarrafzadeh; Nader Maroufi; Ismail Ebrahimi Takamjani; Amir Ahmadi; Hossein Negahban
Volume 6, Issue 6 , November 2018, , Pages 560-569
Abstract
Background: Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two importantaspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare theposture and compensatory strategy of hip and lumbar region during trunk flexion between ...
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Background: Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two importantaspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare theposture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand healthsubjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O’Sullivan’sclassification system (OCS).Methods: This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low backpain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3Dmotion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to fullbend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion weredivided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using onewayanalysis of variance (ANOVA) and independent t-test.Results: There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positionsbetween the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significantdifference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significantdifference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group,and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there wasstatistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026).In this position, the difference in hip angles between the healthy group and FP group was statistically significant(P<0.05). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBPgroup (P=0.062), however, there was a significant difference between FP group and the healthy group in the fourthQ of the total hip range of motion. There was no statistically significant difference between the healthy group and theheterogeneous LBP group (P=0.054) but there was a difference between FP group and the healthy group. Lumbar/hipmotion ratio (L/H ratio) was different between and within the subgroups in the second Q.Conclusion: This study supported the subgrouping of LBP and showed that the difference between subgroups couldbe determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It ispossible that the neuromuscular system selects different strategies to compensate and prevent further injury of thechain components (muscle, joint, nerve and etc.).Level of evidence: IV
Spine
Hosein Mashhadinejad; Ebrahim Sarabi; Sara Mashhadinezhad; Babak Ganjeifar
Volume 6, Issue 5 , September 2018, , Pages 397-401
Abstract
Background: Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinicaloutcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In thisstudy, the clinical outcomes of patients treated with microsurgical discectomy ...
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Background: Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinicaloutcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In thisstudy, the clinical outcomes of patients treated with microsurgical discectomy for RLDH were analyzed.Methods: We examined 179 patients undergoing lumbar microdiscectomy surgery for RLDH. The visual analoguescale (VAS), Prolo scoring system, and Oswestry Disability Index (ODI) were used for evaluating the improvementof symptoms and functional outcomes.Results: Among 179 patients, 101 (56%) obtained good and excellent Prolo scores (group 1), while 78 (44%)obtained fair or poor results (group 2). There was no significant difference between the groups regarding age(P=0.515), gender (P=0.545), body mass index (P=0.523), diabetes mellitus (P=0.074), smoking (P=0.100),interval between primary and revision surgeries (P=0.749), and surgical outcomes (P=0. 749). However, significantimprovements were achieved in VAS scores for back (P=0.197) and radicular pain (P=0.606), as well as ODI scores(P= 0.000). Based on the findings, only ODI scores showed a significant inter-group difference in the 12-monthfollow-up (P=0.038).Conclusion: Limited microsurgical discectomy could be considered as the main surgical method in patients with RLDHwithout overt instabilities.Level of evidence: IV
Spine
Hasan Ghandhari; Maryam Ameri Mahabadi; Farshad Nikouei; Saeed Sabbaghan; Abouzar Azizi; Alireza Mirzaei; Behrooz Givehchian
Volume 6, Issue 4 , July 2018, , Pages 324-330
Abstract
Background: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD).In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following thecorrective surgery of sagittal imbalance, in order to explore the ...
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Background: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD).In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following thecorrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter.Methods: A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included inthis study. The mean follow-up period of the patients was 15.5±2.1, ranging from 12 to 18 months. Pre- and postoperativeradiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis(PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI).Results: The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODIwas significantly correlated with all preoperative radiological parameters (r=0.608, P=0.002 for PI-LL; r=0.483, P=0.01for PT; and r=0.464, P=0.02 for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536,P=0.008 and r=416, P=0.04, respectively), but not with PT change (r=247, P=0.25). The outcome was better in pediclesubtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO).Conclusion: Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment.According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes ofcorrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should bedevoted to this parameter.
Spine
Farzad Omidi-Kashani
Volume 6, Issue 4 , July 2018, , Pages 340-341
Abstract
If we want to be honest, how many percent of our surgically treated patients are satisfied with our treatment? 50%, 70%, or 90%? How many percent of our spinal surgeries can restore normal anatomy to the patient? Is it enough to have an academic degree for carrying out spinal surgeries? Does having a ...
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If we want to be honest, how many percent of our surgically treated patients are satisfied with our treatment? 50%, 70%, or 90%? How many percent of our spinal surgeries can restore normal anatomy to the patient? Is it enough to have an academic degree for carrying out spinal surgeries? Does having a gun means having the right to shoot at everyone freely? "Conflict of interest" is a term commonly used in scientific articles. This phrase implies the simultaneous existence of two or more benefits from a research activity that one of these benefits may not be oriented in a same direction of the others. This secondary interest may interfere with primary interest of a professional honest activity and should be clearly explained before the manuscript could be published and used throughout the world.
Spine
Afshin Ahmadzadeh Heshmati; Moghaddameh Mirzai
Volume 6, Issue 2 , March 2018, , Pages 119-123
Abstract
Background: The purpose of this study was validation of the Persian translation of the Swiss Spinal StenosisQuestionnaire in order to be used by Iranian researchers.Methods: A total of 104 patients with spinal stenosis diagnosis, who were candidates for operative treatment wereentered into the study. ...
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Background: The purpose of this study was validation of the Persian translation of the Swiss Spinal StenosisQuestionnaire in order to be used by Iranian researchers.Methods: A total of 104 patients with spinal stenosis diagnosis, who were candidates for operative treatment wereentered into the study. The patients completed the translated questionnaire in the 1st and the 7th days of admissionand 6 months after surgery. Visual analogue scale was used to determine the severity of the pain in the1st day andthe 6th month. Discriminant validity, convergent validity, test-retest reliability, internal consistency, ability to detectchanges and sensitivity to clinical changes were assessed for the statistical purposes.Results: Cronbach’s α was more than 0.9 for all the items. ICC was about 0.9 for all the items. For symptoms, physical andtotal items, Cronbach’s α was 0.942, 0.957, 0.926 and Intraclass correlation were 0.891, 0.918, 0.862, respectively. Pairedt-test was significantly different between the 1st day and the 6th month questionnaire. There was a positive correlation eitherbetween the first VAS and the 1st day questionnaire (1st day Q) (r=0.892, P=0.000) or between the 6th month VAS and 6thmonth Q (r=0.940, P=0.000). The Pearson’s correlation between the difference of the total scores of the 1st day and the6th month and satisfaction score after surgery showed negative correlation (r= -0.746, P=0.000). The effect size was 2.55.Conclusion: The Iranian version of the Swiss Spinal Stenosis has excellent internal consistency, excellent reliability,good ability to alter with changes, especially parallel with clinical improvement, excellent ability to detect changes, andwell either convergent or discriminant validity.
Spine
Felix Tome-Bermejo; Angel R. Piñera; Luis Alvarez
Volume 5, Issue 6 , November 2017, , Pages 363-374
Abstract
Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. ...
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Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
Spine
Felix Tome-Bermejo; Angel Piñera; Luis Alvarez
Volume 5, Issue 5 , September 2017, , Pages 272-282
Abstract
Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosispredisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concernbefore performing spine surgery, especially with bone fusions and instrumentation. ...
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Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosispredisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concernbefore performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often beenconsidered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequateprocedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patientsincrease, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseasesbecomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible tooperate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses thebiomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions,as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients withosteoporosis who need spine operations.
Spine
Hooman Shariatzadeh; Bagher Saeed Modaghegh; Alireza Mirzaei
Volume 5, Issue 3 , May 2017, , Pages 181-185
Abstract
Background: Osteoporosis and hyperkyphosis could impose a considerable financial and therapeutic burden on the affected society. Thus, new strategies to prevent or manage such complications are of significant importance. Here we evaluate the effect of ‘Dynamic Hyperextension Brace’ (DHB) ...
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Background: Osteoporosis and hyperkyphosis could impose a considerable financial and therapeutic burden on the affected society. Thus, new strategies to prevent or manage such complications are of significant importance. Here we evaluate the effect of ‘Dynamic Hyperextension Brace’ (DHB) on bone density, and hyperkyphosis correction. Methods:Sixty postmenopausal women were randomly assigned to the case and control groups and followed for one year. DHB was applied in the case group according to the pre-designed protocol and the patients’ clinical and paraclinical parameters, including bone mineral density (BMD), kyphosis angle, osteoporotic fracture, and serum alkaline phosphatase (ALP) were evaluated in two groups. Results:Despite no significant difference in basic BMD and kyphosis between the case and control groups, BMD and kyphosis were significantly improved in the DHB treated group, at the end of the study (P=0.003 and P=0.001, respectively). Serum ALP level was significantly higher in cases compared to the controls (P=0.48). The vertebral fracture rate was also lower in the case group compared to the controls. Conclusion:The efficacy of bracing in osteoporosis and kyphosis management should be more emphasized. However, more detailed and controlled studies with more patients and a longer follow-up period is needed to adequately evaluate the long-term results of braces, including DHB.