Ten Important Tips in Treating a Patient with Lumbar Disc Herniation

Farzad Omidi Kashani,Hamid Hejrati,Shahrara Ariamanesh 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.5

Lumbar disc herniation is a common spinal disorder that usually responds favorably to conservative treatment. In a small percentage of the patients, surgical decompression is necessary. Even though lumbar discectomy constitutes the most common and easiest spine surgery globally, adverse or even catastrophic events can occur. Appropriate patient selection and effective neural decompression constitute the most important points for better surgical outcomes and avoidance of unpleasant complications. Other important tips include timely performance of magnetic resonance imaging, correct interpretation of scan data, preoperative detection of underlying instability, exclusion of non-discogenic sciatica, determination of the main cause of clinical pathology, avoidance of the wrong side or level, and being sure that the more detailed procedure does not necessarily mean the more effective procedure.

Radiologic and Clinical Outcomes of Surgery in High Grade Spondylolisthesis Treated with Temporary Distraction Rod

Farzad Omidi-Kashani,Alireza Hootkani,Lida Jarahi,Manizheh Rezvan,Amir Moayedpour 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1

Background: Surgical techniques used in the treatment of patients with high grade lumbar spondylolisthesis (> 50% slippage) areusually associated with a great deal of controversies. We aim to evaluate the surgical outcomes of high grade spondylolisthesistreated with an intraoperative temporary distraction rod. Methods: We retrospectively studied 21 patients (14 females and 7 males), aged 50.4 ± 9.2 years, who had high grade lumbarspondylolisthesis that was treated with intraoperative temporary distraction rods, neural decompression, pedicular screw fixation,and posterolateral fusion involving one more intact upper vertebra. The mean follow-up period was 39.2 months. Radiologic andclinical outcomes were measured by slip angle, slip percentage, correction rate, Oswestry Disability Index (ODI), visual analoguescale (VAS), patient’s satisfaction rate in the pre- and postoperative period. Data were analyzed by SPSS ver. 11.5. Results: Analysis of the preoperative visits and final follow-up visits indicated that surgery could improve ODI, lumbar VAS, andleg VAS from 60.5% to 8.2%, from 6.7 to 2.2, and from 6.9 to 1.3, respectively. Slip angle and slip percentage were also changedfrom –8° to –15° and from 59.2% to 21.4%, respectively. Mean correction rate at the final follow-up visit was 64.1%. Loss of correctionwas insignificant and a neurologic complication occurred in one patient due to misplacement of one screw. Excellent andgood levels of satisfaction were observed in 90.5% of the patients. Conclusions: In the surgical treatment of refractory high grade spondylolisthesis, the use of a temporary distraction rod to reducethe slipped vertebra in combination with neural decompression, posterolateral fusion, and longer instrumentation is associatedwith satisfactory clinical and radiologic outcomes.

Failure Rate of Spine Surgeons in Preoperative Clinical Screening of Severe Psychological Disorders

Farzad Omidi-Kashani,Farhad Faridhoseini,Shahrara Ariamanesh,Mahya Hashemi Kazar,Aslan Baradaran 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.2

Background: The surgeon’s attention to the patient’s underlying psychological state is essential to attaining desired outcomes. We aimed to investigate the prevalence and severity of psychological disorders in patients undergoing elective spine surgery. Methods: In this case-control study, associated psychological disorders were assessed using the Hospital Anxiety and Depression Scale (HADS) questionnaire at a single academic spine surgery center from August 2013 to June 2015. The case group consisted of 68 adult patients (mean age, 38.2 ± 9.6 years; male:female = 41:27) undergoing elective spine surgery and the control group included 69 healthy visitors of the orthopedic patients (mean age, 37.1 ± 6.9 years; male:female = 40:29) who voluntarily participated in the study. The 2 groups were compared for statistical analysis and a p-value < 5% was considered significance. Results: There was no statistically significant intergroup difference with regard to gender and age. The incidences of abnormal anxiety and depression were the same in the case group (14 patients, 20.6%). The values were 3 (4.3%) and 5 (7.2%), respectively, in the control group, showing statistically significant difference. Any association between the severity of depression and age or sex could not be identified. Conclusions: In spite of spine surgeons’ attempts to screen severe psychological disorders preoperatively, up to 21% of which cannot be diagnosed prior to elective spine surgery. Therefore, we believe the use of a questionnaire would be helpful in assessing patients’ underlying psychological state before elective spine surgery.

Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

Farzad Omidi-Kashani,Ebrahim Ghayem Hasankhani,Mohammad Dawood Rahimi,Reza Khanzadeh 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.2

Background: The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. Methods: In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 ± 6.1 years, and group B included 52 patients with a mean age of 47.3 ± 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. Results: The most common sites for degenerative and isthmic spondylolisthesis were at the L4–L5 (88.5%) and L5–S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. Conclusions: Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.

Sciatica in a Five-Year-Old Boy

Farzad Omidi Kashani,Ebrahim Ghayem Hasankhani,Ehsan Rafeemanesh 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.3

The prevalence of back pain during childhood is 50%; in 22% of these cases, a specific diagnosis can be found. Osteoid osteoma is a rare benign tumor that occursonly in 20% of cases and involves the spine. The aim of this report is to explain an atypical case of lumbar osteoid osteoma with significant neurologic deficit at a very young age. A five-year-old boy was presented with refractory pain in the low back and left extremity for approximately one year. Positive clinical findings were antalgic gait, stiff lumbar spine, weak left big toe extension force and a positive straight leg rising test on the left side. Paraclinical studies revealed osteoid osteoma in the left-sided pedicle of the fifth lumbar vertebra. With surgical excision, he recovered immediately. Lumbar osteoid osteoma should be suspected as the cause of low back pain or sciatalgia in any young patient.

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

Farzad Omidi Kashani,Ebrahim Ghayem Hasankhani,Amir Ashjazadeh 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.4

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.

A Survey on Low Back Pain Risk Factors in Steel Industry Workers in 2015

Ehsan Rafeemanesh,Farzad Omidi Kashani,Reza Parvaneh,Fatemeh Ahmadi 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.1

Study Design: This was a cross-sectional study. Purpose: The aim of this study was to determine the prevalence of low back pain (LBP) and its association with individual factors and current job status among steel industry workers in Mashhad, Iran. Overview of Literature: Several studies have been conducted on LBP and its related risk factors, some of which emphasized occupational factors as the main etiology of LBP. Meanwhile, individual risk factors have been emphasized in other studies. Despite several published articles, there are still many unresolved, basic issues about developing LBP. Methods: For this study, 358 male workers were selected by a random sampling method and divided into two groups: production workers (n=201) and administrative personnel (n=157). Data were collected using modified Nordic questionnaire and physical examination. Statistical analysis was performed to identify the correlation between individual factors and current job status with LBP. Results: Despite the young age of participants and their short employment duration, the overall prevalence of LBP was high (32.4%) in this industry. The prevalence of non-specific LBP in production workers and administrative personnel was 26.8% and 21.0%, respectively. Disk herniation was observed in 10.4% of production workers and 6.3% of administrative personnel. Age, employment duration, body mass index and smoking status were similar in the two groups. There was no significant relationship between LBP and current job status; however, a significant relationship was found between prevalence of LBP with age, duration of employment, and leisure time physical activity (p <0.05). Conclusions: We have not found any relationship between LBP and current occupational status suggesting that the effects of general health-related factors such as weight, age, leisure time physical activity, and duration of employment are more important than occupational factors in developing LBP.

Treatment Outcomes of Open Pelvic Fractures Associated with Extensive Perineal Injuries

Ebrahim Ghayem Hasankhani,Farzad Omidi-Kashani 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.4

Background: The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. Methods: We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. Results: The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Conclusions: Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate

A Survey on the Short-term Outcome of Microlumbar Discectomy with General versus Spinal Anesthesia

Mohsen Dashtbani,Mehrdad Mokaram Dori,Mohammad Hassani,Farzad Omidi-Kashani 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.4

Background: Surgery on the lower thoracic and lumbosacral spine is possible with both general and spinal anesthesia, but most spine surgeons are reluctant to perform the surgery with spinal anesthesia. We aimed to conduct a survey on the short-term outcome of microlumbar discectomy in the patients who had been treated under general or spinal anesthesia. Methods: In this prospective study, we performed a survey on 72 patients who underwent microlumbar discectomy under general anesthesia (group A) or spinal anesthesia (group B). Demographic characteristics, American Society of Anesthesiologists physical status, duration of operation, blood loss, and complications were all documented. Preoperative and early postoperative (at the time of discharge) disability and pain were assessed by using Japanese Orthopedic Association (JOA) scoring system and a visual analog scale questionnaire. Results: The two groups were homogenous preoperatively. The mean intraoperative blood loss was less and the mean operating time was shorter in group A than in group B, but there was no statistically significant difference between groups. The rate of postoperative improvement in JOA score and improvement in pain were similar between groups. Anesthetic complications were unremarkable. Conclusions: Simple lumbar disc operations in the otherwise healthy patients can be safely performed under either spinal or general anesthesia. Both anesthetic methods led to comparable outcomes with minimal complications.