Is Facet Tropism Associated with Increased Risk of Disc Herniation in the Lumbar Spine?

Hassan Ghandhari,Ebrahim Ameri,Habib Hasani,Mir Bahram Safari,Ali Tabrizi 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.3

Study Design: Retrospective case control study. Purpose: In current study, we compared the incidence of facet tropism (FT) in patients with lumbar disc herniation and normal controls. Overview of Literature: It has been suggested that FT can be associated with increased risk of lumbar disc herniation. Methods: A total of 66 and 63 patients with L4/L5 and L5/S1 disc herniation, respectively, were evaluated in the present study. The control group comprised 61 normal subjects. Facet joint angle was measured using axial magnetic resonance images. The FT was defined as a difference of >10° between the right and left facet joints. The incidence of FT was compared between patients and controls. We also investigated the relationship between facet orientation (sagittal or coronal) and side of disc herniation. Results: The incidence of FT at the L4/L5 level was significantly higher in patients with disc herniation (48.5% vs. 26.2%, p =0.01), while it was found to be the same at the L5/S1 level in patients and controls (50.8% vs. 36%, p =0.098). Among the 64 patients with FT, intervertebral disc herniation occurred significantly toward the more sagittally oriented facet joint in 41 patients (p <0.05). Conclusions: FT is associated with increased risk of L4/L5 intervertebral disc herniation, but not at the L5/S1 level. In addition, disc herniation occurred toward the more sagittally oriented facet joint.

Efficacy of Computer-Aided Design and Manufacturing Versus Computer-Aided Design and Finite Element Modeling Technologies in Brace Management of Idiopathic Scoliosis: A Narrative Review

Bidari Shahrbanoo,Kamyab Mojtaba,Ghandhari Hassan,Komeili Amin 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2

The efficiency and design quality of scoliosis braces produced by the conventional casting method depends highly on the orthotist’s experience. Recently, advanced engineering techniques have been used with the aim of improving the quality of brace design and associated clinical outcomes. Numerically controlled machine tools have provided enormous opportunities for reducing the manufacturing time and saving material. However, the effectiveness of computer-aided brace manufacturing for scoliosis curve improvement is controversial. This narrative review is aimed at comparing the efficacy of braces made by the conventional method with those made by two computer-aided methods: computer-aided design and manufacturing (CAD-CAM), and computer-aided design and finite element modeling (CAD-FEM). The comparison was performed on scoliosis parameters in coronal, sagittal, and transverse planes. Scientific databases were searched, and 11 studies were selected for this review. Because of the diversity of study designs, it was not possible to decisively conclude which brace-manufacturing method is most effective. Similar effectiveness in curve correction was found in the coronal plane for braces made by using advanced manufacturing and conventional methods. In the sagittal plane, modern braces seem to be more effective than traditional braces, but there is an ongoing debate among clinicians, about which CAD-CAM and CAD-FEM brace provides a better treatment outcome. The relative effectiveness of modern and conventional methods in correcting deformities in the transverse plane is also a controversial subject. Overall, advanced engineering design and production methods can be proposed as time- and cost-efficient approaches for scoliosis management. However, there is insufficient evidence yet to conclude that CAD-CAM, and CAD-FEM methods provide significantly better clinical outcomes than those of conventional methods in the treatment of scoliosis curve. Moreover, for some factors, such as molding and the patient’s posture during the data acquisition, in brace curve-correction plan, the orthotist’s experience and scoliosis curve flexibility should be explored to confidently compare the outcomes of conventional, CAD-CAM, and CAD-FEM methods.

The Effect of Bracing on Spinopelvic Rotation and Psychosocial Parameters in Adolescents with Idiopathic Scoliosis

Yalda Khoshhal,Maryam Jalali,Taher Babaee,Hassan Ghandhari,Jeffrey L. Gum 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Retrospective study. Purpose: To evaluate the effect of bracing on spinopelvic rotation and psychosocial parameters in adolescents with idiopathic scoliosis (AIS). Overview of Literature: Complex three-dimensional deformity in AIS is proposed to influence the spinopelvic parameters and psychosocial condition in adolescents; however, few studies have quantitatively evaluated these parameters. Methods: Thirty AIS who were prescribed a brace were included in the study. The patients’ standing postero-anterior and total spine radiographs were used to measure the primary curve Cobb angle, vertebral rotation, and pelvic rotation. Apical vertebral rotation (AVR), upper AVR, and lower AVR were measured using the Nash-Moe method. Pelvic rotation was determined using the left-to-right hemi-pelvic width ratio. The curve pattern was classified as per the Lenke classification system. In all, 14 patients had a type I curve, five had type II, six had type III, one had type IV, and four had type V curves. Brace compliance was subjectively evaluated by interviewing the patients and their parents. The health-related quality of life (HRQOL) and stress level of the recruited patients were assessed using the Brace Questionnaire and Bad Sobernheim Stress Questionnaire, respectively. Results: The Cobb angle significantly decreased with at least 6 months of brace use. AVR correction changed significantly; however, no such results were observed for upper and lower AVR. Pelvic rotation and psychosocial parameters were not significantly affected by brace use. No statistically significant correlation was observed between brace compliance and curve correction. Conclusions: The Cobb angle and AVR are crucial measurements that help evaluate the treatment efficacy in AIS with small curves who undergo brace treatment. HRQOL and pelvic axial rotation are not influenced by the brace treatment.

Cross-Cultural Adaptation and Validation of the Persian Version of the 24-Item Early-Onset Scoliosis Questionnaire

Esfandiari Mahmood,Babaee Taher,Kamyab Mojtaba,Kamali Mohammad,Matsumoto Hiroko,Ghandhari Hassan,Vitale Michael G. 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.1

Study Design: Cross-sectional study.Purpose: To translate and culturally adapt the original English version of the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) to the Persian language as well as assess its reliability and validity.Overview of Literature: Early-onset scoliosis (EOS) patients with progressive curves require active treatments, such as serial elongation– derotation–flexion casting, bracing, and surgery, which are stressful and expensive. In order to evaluate the impact of EOS and its treatment strategies, it is important to consider the patients and their parents’ quality of life as the clinical and radiological parameters. The EOSQ-24 is a parent-based measure that evaluates the health-related quality of life of patients with EOS and their caregivers/parents. Similar to other widely used questionnaires, EOSQ-24 needs to be translated into other languages to make it usable in populations from different cultures and societies.Methods: We evaluated the translation and back translation of the EOSQ-24 and made the required revisions as per the analysis performed by the expert committee and an international guideline to adapt it for use in this study. Thereafter, we recruited 100 EOS patients in order to evaluate its reliability and validity. The reliability was assessed with internal consistency. Convergent validity was assessed by comparing the scores of the EOSQ-24 and the 22-item Scoliosis Research Society Questionnaire (SRS-22r). Finally, the known groups validity was assessed as per patient’s sex, curve magnitude, and treatment type.Results: The Persian EOSQ-24 demonstrated very good internal consistency (Cronbach’s α=0.88). All the items had an acceptable corrected item-total correlation (>0.3). Further, the EOSQ-24 and the SRS-22r scores (p <0.001) were significantly correlated. The EOSQ-24 could discriminate patients with different curve magnitudes.Conclusions: The Persian EOSQ-24 can serve as a disease-specific instrument with strong validity and reliability in the evaluation of EOS patients. Its applicability in other Persian-speaking countries and regions of the world needs to be investigated further.