Tehran University Medical Journal

---

Background: The currently accepted treatment of scoliosis are bracing and surgery. Two-stage anterior and posterior spinal fusion is used to correct scoliosis. It seems that the application of a longitudinal force to the axis of the spinal column as a means of stabilizing by halo traction, may increase the correction of the curve. The aim of this study was to evaluate the effect of halo traction used between the two stages of corrective surgery, anterior and posterior spinal fusion, on the correction of scoliosis curvature.
Methods: In this randomized clinical trial twelve scoliotic patients, aged from 12-19 years old, were treated by two-stage anterior spinal release and fusion (ASF) and posterior spinal fusion (PSF). The patients were divided in two groups: 6 scoliotic patients without any traction between ASF and PSF surgeries (group A), and 6 scoliotic patients were undergone halo traction for one week between ASF and PSF surgeries (group B). Major curve angle was measured before surgery, one week after ASF and one year after PSF surgeries. Data were collected and analyzed using SPSS v.13.5.
Results: The mean baseline curve angles were 90° (SD=18.70) and 94.17°(SD=28.18) in groups A and B, respectively. Whereas, the mean final curve angles (one year after PSF) were 51.17°(SD=29.59) and 39.17°(23.11) in groups A and B, respectively. Final angle improvement was 46.58% (SD=20.31) in patients without traction and 61.32% (SD=14.02) in patients with halo traction. The major curve angles showed significantly better correction in patients with traction one week after ASF [38.67°(SD=7.86) vs. 25°(SD=6.28), P=0.012]. This difference persisted at the end of the first year after operation. [55°(SD=8.94) vs. 38.83°(SD=11.65), P=0.022].
Conclusion: Application of halo traction between ASF and PSF surgeries may lead to better improvement of the scoliotic curvature and short time application of halo traction decreases possible complications.

---

Background: Congenital scoliosis is a developmental disorder defined as a lateral curvature of the spine. Its progressive trend and complications, such as cosmetic problems, pain and pulmonary symptoms, have put scoliosis as an important skeletal deformity that should be corrected. One of the currently accepted methods of treatment is posterior spinal fusion (PSF) that may be performed with or without instrumentation. However, the use of implants in conjunction with PSF in congenital spine deformity has been debated over the past three decades primarily because of increased risk of neurological deficit and implant displacement. The aim of this study was to compare short-term and long-term outcomes of spinal fusion with and without posterior instrumentation in congenital scoliosis.

Methods: In this historical cohort study, 41 patients with congenital scoliosis were recruited. All patients underwent PSF surgery between 1977 and 1996. They were divided into two groups according to the use of instrumentation: 22 congenital scoliotic patients who were treated by PSF without any instrumentation (group A), and 19 instrumented PSF patients (group B). Instrumentation was mostly performed using the Harrington rod. The major curve angle was measured before surgery, two weeks and one year after PSF surgery and at the end of the follow-up period.

Results: The mean baseline curve angles were 66.3° and 69.1° in groups A and B, respectively. The mean Cobb angles one year after PSF were 43.1° and 38.4° in groups A and B, respectively. The mean follow-up period was 8 years (SD=3) and, at the end of this period, the final Cobb angles were 47.3° and 39.4° in groups A and B, respectively. Therefore, the final angle correction was 28.7% in patients without instrumentation and 43% in patients with instrumentation. The mean loss of correction was 5.5% and 4.3% in groups A and B, respectively. The final curve angles was significantly more corrected for those patients in whom instrumentation was used than those without instrumentation (p<0.05).

Conclusion: The treatment of congenital scoliosis can be very challenging despite the benefits of modern surgeries and instrumentation methods. The results of our study demonstrate that the application of an implant with PSF surgery may lead to increased improvement of the scoliotic curvature in the short-term and long-term periods, as well as a decrease in the loss of correction and the rate of reoperation. In addition, the low incidence of complications in our study indicates the safety of the posterior instrumentation for the treatment of congenital scoliosis.

---

Background: Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction.

Methods: Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion (PSF), the second group included 29 patients who had anterior and posterior spinal fusion (ASF+PSF), and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty (PSF+ thoracoplasty). The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared and their relations with the undertaken surgical approach were evaluated.

Results: There were no significant correlations between the surgical approaches and changes in the pulmonary function tests (P>0.05). FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years.

Conclusion: There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up.

---

Background: Several studies have suggested higher incidence of osteoporosis in patients with idiopathic scoliosis in comparison with the normal population. The aim of this study was to assess the prevalence of low bone mass among adolescent girls with idiopathic scoliosis.
Methods: In this cross-sectional study performed in shafa Hospital in Tehran, Iran during 2011-2012, we recruited fifty-seven 12- to-20-year old girls with idiopathic scoliosis and compared them with 100 age-matched healthy girls. The patients had no other diseases including neuromuscular disorders, congenital vertebral anomalies or a history of spinal surgery. Bone mineral densities (BMD) of the hip and spine were evaluated and compared in all 157 participants using dual X-ray absorptiometry (DXA). Standard BMD (sBMD) was also calculated at the lumbar spine.
Results: Analysis of the data revealed that hip BMD was significantly (P=0.004) lower in patients with idiopathic scoliosis versus the controls. Moreover, BMD and sBMD of the Spine were also significantly lower in the patients (respectively, P=0.030 and P=0.030). Curve location had no effect on the values of hip BMD, spine BMD or spine sBMD (respectively, P=0.061 and P=0.274 and P=0.208).
Finally, with more severe curves a lower bone mass was detected for sBMD and spine BMD (respectively, P=0.017 and P=0.016), but it was not significant for hip BMD (P=0.069).
Conclusion: Adolescent girls with idiopathic scoliosis had lower bone mass compared with their healthy peers. The lower bone mass was correlated with the severity of the curve but not its location. 

---

Background: Degenerative scoliosis most commonly affects the lumbar spine in the elderly, resulting in facet and disc degeneration, leading to increased pain and progressive deformity. Due to the importance of the results of long fusion and the rate of coronary and sagittal correction of imbalance in patients with degenerative scoliosis, the present study was performed to evaluate the results of long fusion surgery in patients with degenerative lumbar scoliosis.
Methods: The present study was performed as a prospective cohort study in patients with degenerative scoliosis who were candidates for surgery at Al-Zahra Hospital in Isfahan. Basic patient information including age, sex, anatomical location of vertebral deviation and slip, degree of severity of deviation based on cobb angle and number of previous surgeries were reviewed and recorded. The surgical characteristics of the patient were extracted from the medical record including the approach used, the anatomical location of the fusion, whether or not to perform decompression, the number of decompression and fusion levels, the amount of bleeding during surgery, and the duration of surgery.
Results: Eleven female patients participated in this study. The mean age of patients was 55.64 years with a standard deviation of 7.67 years. The minimum age was 40 years and the maximum age was 66 years. Patients' symptoms included low back pain-leg pain (3 cases), back pain-lameness (2 cases) and back pain-leg pain-lameness (6 cases). All patients underwent two stages of surgery. Mean amount of bleeding and time of surgery in the second surgery were significantly reduced compared to the first surgery (p <0.05). Complications of surgery included proximal junctional vertebral fracture (PGK) in two patients.

Conclusion: Degenerative scoliosis is a complex clinical condition in which the patient's main problems are pain and disability. Long fusion surgery in patients with degenerative scoliosis significantly reduced the mean deviation, Patient’s pain and severity of disability 6 months after surgery.