[Correlation between kyphosis and flexibility of kyphoscoliosis curves]

Patients with idiopathic scoliosis often have hypokyphosis in their spines, but some patients may exhibit an increase in kyphosis instead. The aim of this study was to define the effect of the kyphosis on the flexibility of scoliotic curves. A total of 100 cases of idiopathic scoliosis were studied with standing posteroanterior and lateral radiographies of the entire spine. Based on the degree of kyphosis, cases were classified into two groups and compared statistically. Group 1 included 61 cases with less than 50 degrees of kyphosis, and group 2 included 39 cases with equal or more than 50 degrees of kyphosis. The average of scoliosis in group 1 was 57.5 degrees compared with 51.3 degrees in group 2, and the averages of the flexibility index were 57.1 vs. 52.7, respectively. The two groups were also compared according to the standing and supine bending scoliosis, flexibility index, and the correlation between kyphosis and flexibility index. There was neither a significant correlation between the kyphosis and scoliosis curves [P>0.05; r<0.5] nor in the flexibility of scoliosis curves between the two groups [P=0.23]. In our study, the presence of kyphosis seems to have no impact on scoliosis curves in patients with idiopathic scoliosis

[Study the results of less invasive decompressive surgery in lumbar spinal stenosis]

Spinal stenosis of the lumbar area is the most common problem of this area in older patients and surgery is needed in refractory cases. The purpose of this study was to assess the surgical outcome of the less invasive decompressive surgery in the patients with lumbar spinal stenosis. In a retrospective study, we reviewed 50 cases with lumbar spinal stenosis that carried out this type of surgery and followed regularly. For assessing the results, we used anatomical economical functional rating system of Prolo, visual analogue scale and White and Panjabi instability criteria. The patients were followed-up for a mean of 3.5 years [2 to 8] after surgery. Good or excellent results were obtained in 82% of the patients. A significant reduction of the low back pain intensity and disability was seen. Claudication and radicular pain was disappeared in 100% and 94% of them, respectively. Less invasive decompressive surgery by limited laminotomy, undercutting of the facet joints and not doing extensive laminectomy is a safe and reliable surgery for the treatment of the refractory patients with lumbar spinal stenosis

[Scoliosis associated with syringomyelia]

The differential diagnosis of idiopathic and syringomyelia associated scoliosis is important because corrective surgery for scoliosis associated with syringomyelia prior to management of syringomyelia can be dangerous. There are important imaging indicators for diagnosis of syringomyelia associated with scoliosis. A few of these indicators have been assessed in our study. A retrospective descriptive study including 38 patients with both scoliosis and syringomyelia was performed at the Shafa Yahyaeian center. Standard scoliosis series radiographs and MRI of all patients were studied. The type of scoliosis, location and magnitude of deformity, kyphosis or lordosis in the sagittal plane, location and size of syrinx were assessed. Thoracic kyphosis was present in 94.7% of patients. 37% of patients had scoliosis with convexity to left. Arnold -chiari malformation was present in 36% and cord tethering in 21% of patients. The locations of syrinx were as follows: 47.4%cervical, 44.6 thoracic, 2.7% lumbar and 5.3% were holocord. Kyphosis, abscence of lordosis in sagittal plane, progressive scoliosis and scoliosis with convexity to left are atypical findings and could be indicators of the presence of syringomyelia. If these indicators are present, a diagnosis of idiopathic scoliosis should be made with caution

[ case report of L4 traumatic spondyloptosis]

Traumatic spondyloptosis is a rare condition. It is a neurogenic complication due to high energy trauma and unstable spine which almost always needs surgical treatment . A 30 years old man with L4 spondyloptosis and L5 fracture, neurologic deficit in both lower limbs, urinary incontinence and visceral perforation referred to Shafa Yahyaeian Hospital He underwent nonsurgical treatment because he was a poor surgical candidate [Poor medical condition, visceral perforation and buttock bed sore]. At the last follow up three years after trauma, he was in good general condition with full recovery of his neurologic problem and ambulated without assistance. Although traumatic spondyloptosis needs surgical treatment, in special situations for very high risk patients, nonsurgical treatment can be a good alternative

Total spine and posterior fossa MRI screening in adolescent idiopathic scoliosis [177 eases]

MRI screening for idiopathic scoliosis is controversial. Considering our clinical experiences, the results of MRI in all patients with idiopathic scoliosis were evaluated. In a prospective clinical study, all neurologically normal patients with idiopathic scoliosis screened by posterior fossa and total spine MRI. After excluding 9 patients for mild neurological findings, in other 177 patients [132 female, 45 male], the average age and curve angle was 15 +/- 2 years and 59 +/- 17 0.05]. Left convexity was significantly related to positive MRI findings [P=0.013]. In males with left convex curves, the probability of positive MRI findings was 8.8 folds other patients. Considering our results and other reported articles, it seems that routine MRI screening of all patients presenting as idiopathic scoliosis is necessary for detection of underlying pathologies