[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

[Three months follow up of two methods of exercise therapy in treatment of patients with lumbar segmental instability]

The effect of different methods of exercise therapy in the treatment of patients suffering from lumbar segmental instability can be challenged in different following treatment periods. Compare of two different methods of exercise therapy in treatment of patients with lumbar segmental instability after three month. In this clinical trial study twenty-four patients' ranging 18-45 years old with signs of lumbar segmental instability were randomly divided into two groups. The first group did only the routine exercise and the second group did the routine exercise plus stabilizing exercises for eight weeks and continued it until three months after treatment. Studied variables included flexor and extensor trunk muscle endurance, pain intensity, functional disability, flexion and extension lumbar range of motion, right and left trunk muscle side were evaluated before, eight weeks and three months after treatment. Data was analyzed using k-s and repeated measurement tests. The findings showed that flexion lumbar range of motion, right and left trunk muscle side increased and pain, functional disability decreased in stabilizing exercise group. There is statically significant difference in the mean of this mentioned variables between two groups after 8 weeks [P=0.001]. The process of pain intensity and functional disability reduction and muscle endurance time increase was more in stabilizing exercise than routine exercise group, following three months exercise. Regarding the prolonged positive effects of stabilizing exercise in reduction of pain intensity and increase of functional ability and muscle endurance until three months after treatment, it is recommended to use this method along with routine exercises

[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

[ effects of stabilization exercise on pain, functional disability and muscle endurance in patients supected to lumbar segmental instability]

Lumbar segmental instability is one of the subgroups of non specific chronic low back pain and it seems that 30-40% of patients with LBP suffer from lumbar segmental instability. Pain intensity, functional disability and reduced muscle endurance are common in such patients. The aim of this study was to evaluate the effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspected to lumbar segmental instability. Following ethical approval, a randomized clinical trial was carried out on 30 patients suspected to lumbar segmental instability ranging from 18-45 years old. They were randomly divided into two groups; the first group underwent routine exercise only while the second group performed routine exercise plus stabilization training for 8 weeks. Outcome measure included pain intensity, functional disability, and flexion and extension range of motion and flexor, extensor and side support muscle endurance which were evaluated before and after treatment. Data were analyzed using paired t test and independent t test. Muscle endurance and flexion range of motion increased in both groups although the increase was higher in stabilization training group [p=0.00]. Pain intensity and functional disability significantly decreased in both groups [p=0.00], but decreasing of pain intensity and functional disability were more in stabilization training group [p=0.00]. Stabilization training is more effective than routine exercise in improvement of pain intensity, functional disability, muscle endurance and range of motion in patients suspected to lumbar segmental instability

[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

Osteoblastoma of the spine

To identify the factors that are associated with the development of scoliosis and its manifestations. Summary of the background data: Painful scoliosis is a well-recognized presentation of osteoblastoma but as a result of small number of previous reports, the outcome and habits of tumor in spine is not well-known. Ten factors were assessed including; age, sex, duration of symptoms, site of the lesion, site of lesion in individual, Cobs angle at presentation, chief complaint at presentation, neurological involvement, type of treatment, recurrence of tumor. Result: Fifty% of patients had scoliosis. All of the lesions typically were present on the concave side of the curve. In the thoracic and lumber spine 80% had scoliosis, but no scoliosis was seen on cervical and sacral regions. All the patients were under 30 years. The mean time to diagnose at our center was 18.4 months. All of the patients with cervical involvement [2 patients] had deformity [Cock Robin] and restriction in range of motion. The lesion was in posterior elements in all of the cases and localized in only one side of the spine. Chief complaint was pain in 67%, deformity in 16% and both [pain and deformity] in 17%. Radiological exam was diagnostic in 58% of the cases. Conclusions: Findings support the concept that scoliosis is secondary to asymmetric muscle spasm. The most common complaint is pain and then deformity. In the cervical spins deformity and restriction of motion are chief complaints. In children, spastic pain was more obvious than deformity. Treatment is curettage as wide as possible. There was no recurrence

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