Congenital spinal deformity and associated anomalies

Background & Objective: Congenital spinal deformities usually present in infancy and make parents  worry about their child future. Because of congenital nature of these deformities, cord anomalies and other organ abnormalities must be evaluated. This study was done to determine Congenital spinal deformity and associated anomalies.   Materials & Methods: This cross sectional study was done on 97 patients who referred to Shafa hospital in Tehran- Iran with congenital back deformities from October 2005 to January 2007. All patients were assessed with physical examination, spinal radiography, MRI, urinary system sonography and echocardiography.   Results: Mean age of patients at presentation was 81 month. 81 patients had congenital scoliosis and 16 patients had congenital kyphosis. Mean cobb angle was 52 degrees for congenital scoliosis and 70 degrees for congenital kyphosis. 22 patients had neurologic or skin signs that 81% of them had cord abnormalities (p<0.05). Cord anomalies were seen in 36 scoliosis (46.5%) and 2 kyphosis (15%) (p<0.05). Most common cord anomalies were syingomyelia,diastematomyelia and tethered cord. Congenital heart anomalies was seen in 3 patients (4%) and valvular heart disease in 10 patients (13.5%) and kidney anomalies in 7 patients (12%). Only one patient with congenital heart disease and one patient with kidney anomaly had kyphosis.   Conclusion: Regarding to prevalence of congenital spinial deformity (CSD) in scoliosis and kyphosis patients, all of patients with CSD should screued for determiation of conganital anomalies by MRI, Eco cardiography and kidny sonography

The prevalence and risk factors of the Syndrome of Inappropriate Anti-Diuretic Hormone secretion (SIADH) following spinal surgery

&lt;ul&gt; &lt;li&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;: The Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH) secretion is the most common etiology of normovolemic hyponatremia, which occurs following non-physiologic release of antidiuretic hormone (ADH) from the posterior pituitary, or an ectopic source. SIADH has been reported as a complication of cardiothoracic, brain, and spinal surgeries. This study was conducted to assess the prevalence of SIADH following spinal surgeries and to identify the underlying risk factors.&lt;/li&gt; &lt;li&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: Samples were patients undergoing any spinal surgery at the Hospitals of Shafa Yahyaian and Rasoul Akram, Tehran, Iran in a 2-year period. Blood and urine sodium concentrations and osmolarity were measured before and after surgery. The amount of hemorrhage, as well as the patients' fluid input and output during surgery were recorded. Fluid input and output was also recorded on the first postoperative day.&lt;/li&gt; &lt;li&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: The prevalence of SIADH following spinal surgeries was 60.3%. Mean duration of surgery in SIADH patients was longer than in others. Mean amount of hemorrhage and total fluid loss during surgery were significantly higher in SIADH patients than in healthy individuals.&lt;/li&gt; &lt;li&gt;&lt;strong&gt;CONCLUSIONS&lt;/strong&gt;: SIADH is the principal cause of hyponatremia following spinal surgeries; the reported prevalence rates vary widely from 5 to 100%. SIADH following surgery has been attributed to stress, and in spinal or neurological surgeries to dural damage or traction of neuronal pathways. Time is of the essence in the treatment of hyponatremia and prevention of complications that may increase the mortality and morbidity of spinal surgeries.&lt;/li&gt; &lt;li&gt;&lt;strong&gt;KEYWORDS&lt;/strong&gt;: Inappropriate ADH Syndrome, spinal surgeries, hyponatremia.&lt;/li&gt; &lt;/ul&gt

The Prevalence of Distal Junctional Kyphosis Following Posterior Instrumentation and Arthrodesis for Adolescent Idiopathic Scoliosis

Distal junctional kyphosis (DJK) is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients (mean age 15.6 years) with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of follow-up was 36 months. The incidence of DJK at latest follow-up was 6.9% (9 patients). In DJK group ,distal junctional angle from pre-operative of -12.5 ̊ lordosis (-30 to 0) reached to -5.5 ̊ (P=0.015) at 6 weeks postoperation and to -1.4 ̊ (-20 to 12 ̊) (P=0.000) at 2 years follow-up,with mean of 12.1 ̊ kyphotic change (10-20 ̊). In non DJK group, distal junctional angle from pre-operative angle of -7.5 ̊ reached -8.1 ̊ at 2 years follow-up (P=0.43). The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years (P=0.022). Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct

The Validity and Reliability of Measurement of Thoracic Kyphosis Using Flexible Ruler in Postural Hyper Kyphotic Patients

Objective: Increased normal thoracic kyphosis due to postural reasons is one of the conditions which needs accurately be measured for better evaluation and treatment .Flexible Ruler is a tool which measures the amount of kyphosis non-invasively but there is not any study about its validity and reliability in postural hyper Kyphotic subjects. The objective of this study was investigating the validity and reliability of measurement taken by flexible ruler in quantifying the amount of thoracic kyphosis in postural hyper kyphotic patients. Materials & Methods: In 25 patients with postural hyper-kyphosis and 15 healthy subjects we measured the amount of kyphosis twice using flexible ruler by a single tester. In kyphotic subjects also the amount of kyphosis was measured as Cobb angle on radiographic films in two times by one tester and repeated in one time by another tester. The Reliability of measurements in two subject groups and validity of measurements compared with radiology in kyphotic group was studied. Results: In both of the groups we found excellent Intratester reliability in measurement of kyphosis using flexible ruler. The measurement of kyphosis on radiological films also had excellent Intratester and intertester reliability. The validity of the measurement of kyphosis angle using flexible ruler was very good but the" Index of Kyphosis" on the curve taken by flexible ruler had poor validity. Conclusion: Based on our results, the flexible ruler can be used as a valid and reliable tool for non-invasive measurement of thoracic curve in healthy and postural kyphotic subjects

Clinical Examinations and Radiographic Variables Reliability for Evaluation of Lumber Segmental Instability

Objective: To determine intrarater reliability of clinical examinations and radiographic variables that proposed to identify patients with lumbar segmental instability. Materials & Methods: In this descriptive and methodological research, 15 patients with chronic non specific low back pain aged 22-43 years with non probability and simple selection (sample of convenience) participated. Clinical examinations included pain intensity, flexion and extension range of motion (ROM) with modified schober method, aberrant movement patterns, ito method of flexion and extension endurance test, sid support test, bilateral straight leg rising (SLR) & sit-up, prone instability test and oswestry index. Radiographic variables included: 1) Quantity of movement (sagital plane transition & rotation) measured with Dupuis and Panjabi method 2) Quality of movement (instability factor, centre of rotation & Centroid). Proposed method from Putto was used for flexion-extension radiography. Five x-rays were taken in neutral, full flexion & extension, mid range of flexion & extension positions from lateral view. We used ICC for reliability of quantitative variables, and Kappa statistic for nominal variables. Results: Reliability of Pain intensity (ICC=0.89), flexion (ICC=0.93) & extension (ICC=0.74) ROM, Sid support test (ICC=0.85-0.86), extension (ICC=0.86) & flexion (ICC=0.82) endurance were high. Kappa value for aberrant movement patterns (k=0.66), bilateral SLR & sit-up (k=0.65), prone instability test (k=0.66) were substantial. Centre of rotation on X axis (ICC=0.99) & Y axis (ICC=0.96), rotation with Dupuis (ICC=0.83) & Panjabi (ICC=0.88) had very high reliability. Centroid length with 3 (ICC=0.60) & 5 (ICC=0.64) x-rays, instability factor with 3 (ICC=0.61) & 5 (ICC=0.72) x-rays, transition with Dupuis (ICC=0.69) & Panjabi (ICC=0.76) method had moderate to high reliability. Conclusion: Clinical examinations includig pain intensity, flexion & extension ROM, sid support test, extension & flexion endurance and oswestery index have high to very high reliability. Aberrant movement patterns, bilateral SLR & sit-up and prone instability test have substantial agreement. Radiographic variables have moderate to very high reliability

Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Segmental Posterior Spinal Instrumentation and Fusion; Minimum 2 Years Follow-Up

Background:To evaluate proximal junctional segment changes in Adolescent Idiopathic Scoliosis(AIS) the posterior spinal fusion and also instrumentation also and finding of probable risk factors, were all considered in this study.Methods: We retrospectively reviewed radiographs of 121 consecutive patients who underwent posterior spinal fusion for AIS from T3 or below, with a mean follow-   up of 32.8 months(range,24-83). All coronal and sagittal measurements including the proximal junctional kyphosis (PJK)angle recorded on standing anteroposterior and lateral radiographs preoperative, early postoperative and on follow-up radiographs.The data were analyzed using the Spss 10.0 software.Dependent(paired) samples student t-test was used for analysis between the groups Results: There was PJK angle above normal for the same junctional segment preoperatively in 13 patients (10.7%) and the incidence of the PJK postoperatively was   7.4% (9 patients, 7 female and 2 male), all detected until 2 years postoperation.The mean increase in the PJK angle from pre-operation until 6 weeks postoperation was 5.9° (range,0-13°)(P=0.02) and until 2 years post operation was 14.3° (range, 2- 16°)(p=0.000).The mean proximal junctional angle increased 1.6° until 2 years postoperation in non-PJK group(n=112).Conclusion: The prevalence of Proximal Junctional Kyphosis was low and a silent radiographic problem. In some cases is preventable with perfect pre-operative planning. There is no specific demographic or radiographic variables or instrumentation types associated with developing PJK