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Study Design This was a retrospective study. Purpose This study aimed to assess the value of the Spinal Infection Treatment Evaluation (SITE) score, Brighton Spondylodiscitis Score (BSDS), and Pola classification to predict the need for surgical intervention in patients with spondylodiscitis. Overview of Literature Spondylodiscitis is a rare disease, and the prediction of its outcome is crucial in the decision-making process. Methods All case records were assessed to extract information on the American Spinal Injury Association (ASIA), Visual Analog Scale (VAS), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores before and after surgery. The SITE score, Pola classification, and BSDS were recorded. The receiver-operating characteristic (ROC) curve analysis and the area under the curve (AUC) were applied to estimate the predictive ability of the scoring systems. Patients’ satisfaction with surgery outcomes was evaluated using the VAS, ASIA, JOABPEQ, and Likert scale for quality-of-life evaluation. Results In all 148 patients, case records were reviewed. The mean±standard deviation age of the patients was 54.6±14.7 years. Of these, 112 patients underwent surgery. The AUC scores were 0.86, 0.81, and 0.73 for the SITE score, BSDS, and Pola classification, respectively. In the comparison of the AUC of ROC curves, SITE score vs. BSDS showed a significantly greater AUC, 0.13 (Z=2.1, p=0.037); SITE score vs. Pola classification, 0.05 (Z=0.82, p=0.412); and Pola classification vs. BSDS, 0.08 (Z=1.22, p=0.219). The optimal cutoff score was 8.5 (sensitivity, 80.6%; specificity, 81.2%) for the SITE score and 9.5 (sensitivity, 52.8%; specificity, 83.0%) for the BSDS in the decision to surgery. VAS back pain and JOABPEQ subscales showed a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients experienced neurological deterioration. Overall, patients’ satisfaction was observed. Conclusions The findings suggest that the SITE score is a useful measure and helps clinicians make clinically sound decisions in patients with spondylodiscitis.

Abstract Introduction A disorder causes congenital kyphosis in the last stages of ossification and cartilage formation during embryonic development. The main treatment for this disease is surgery with various methods. The present study was performed to evaluate the results of the posterior surgery. Methods This study was a descriptive study comparing the results before and after surgery which was performed in 2022 on 14 patients with the congenital kyphosis referred to Al-Zahra Hospital in Isfahan. Initial assessments were performed, and the patient underwent surgery. The patients were re-evaluated immediately after surgery which were followed up and evaluated two years after surgery. Data were collected by a checklist and described and analyzed in SPSS software version 22. Results The mean age of the patients was 23.15 ± 13.24 years, 7 patients (50%) were male, and the mean duration of surgery was 405.85 ± 123.99 min. Seven patients (50%) were under 18 years old. No disease died and the highest T12 involvement was in 5 patients (35.8%). Sagittal Vertical Axis, Kyphosis Angle and Lumbar Lordosis decreased in two stages immediately after surgery and follow-up, which were statistically significant (P 0.05). The mean Kyphosis Angle were significantly different in adults, and children at follow-up stages (P

A 40-year-old male presented with progressive paresthesia and weakness of the lower limbs and sphincter dysfunction. He had a history of low back pain and disk herniation from five years ago. Magnetic resonance imaging (MRI) revealed a very large mass-like lesion at L5-S1 segments, and computed tomography (CT) showed destruction of L5 lamina. While the main diagnosis was a large extruded disc, the possibility of extradural masses such as chordoma was also considered. The patient was immediately started on corticosteroid therapy and underwent laminectomy and discectomy surgery to remove the large free fragment compressing the neural elements. The patient reported feeling improvement in his feet and perineum one day after surgery, but follow-up examinations one and three months after surgery described incomplete recovery in sphincter function. This case highlights the importance of considering other possible diagnoses based on physical examination and imaging findings, even when the initial diagnosis seems clear, and emphasizes the need for timely intervention in cases of spinal cord compression to prevent permanent damage to the neural elements.

Abstract Background The association of LSTV with low back pain has been debated in the literature for nearly a century, but the relationship between LSTV and spondylolisthesis is still under discussion. There is currently no valid information about LSTV’s prevalence in Iran. This study investigated the relationship between the presence of LSTV and lumbosacral spondylolisthesis regarding frequency, gender and age variation, grade and level of spondylolisthesis, and clinical signs and symptoms. Methods This cross-sectional study included spondylolisthesis patients admitted for surgery between March 2021 to December 2022. All patients underwent CT imaging. After evaluating medical records, the baseline data were collected. Patients were categorized into No LSTV, Sacralization, and Lumbarization groups. Demographic and clinical characteristics of the studied groups were compared using an independent T-test and Chi-Square. Multiple logistic regression was used to assess the age and sex variations between groups. Results 219 patients with a mean age of 57.07 ± 11.04 were included. A significant relationship was observed between the presence of sacralization and gender diversity with female predominance (P = 0.01). The level of spondylolisthesis and the presence of motor deficits (paresis) significantly differed among study groups (P

Aim: To investigate the role of fusion construct properties, vertebral column reconstruction (VCR) techniques, steroid therapy, laminectomy versus ligamentotaxis in treatment of thoracolumbar junction fractures (TLJF). Methods: A non-randomized clinical trial was conducted. All the eligible patients with TLJF (T12-L2) were operated with a standardized long fusion protocol and followed. Fusion rate, hardware failure, sagittal imbalance and functional outcome were identified as the primary outcome. P

Introduction: Transforaminal injections have been associated with rare but major complications. Despite several studies on epidural steroid injection as a minimally invasive non-surgical method to relieve the pain of spinal canal stenosis, there is no consensus about some details. Therefore, the present study aimed to determine the effect of transforaminal steroid injection on patients with grade 1 to 3 spinal canal stenosis. Method: The present randomized controlled trial study examined 110 patients with spinal canal stenosis. The case group (A) included 55 patients injected with bupivacaine solution and dexamethasone. The control group (B) consisted of 55 patients without intervention. The patients were examined before injection, two weeks, three and six months, and one year after the treatment using the disability index (ODI), functional status (FRI), Visual Analog Scale (VAS), and Numeric Rate Scale (NRS). Results: According to the results, transforaminal steroid injection for patients with grades 1 and 2 spinal canal stenosis had a suitable effect on reducing the severity of disability and improving functional status; however, the pain relief process was achieved gradually in them. In patients with grade 3 canal stenosis, pain relief was observed after 6 months of injection; however, improvement of functional status and reduction of disability did not follow proper trends. Conclusion: Transforaminal steroid injection has a better effect on improving the performance and ability of the patient, but its effect on reducing pain requires more time.

Background: Spondylodiscitis is a rare illness and serious complication of the vertebral column. The suitable type of surgery is debatable for these patients. This study describes a series of cases that are treated with modified interbody fusion for the treatment of spondylodiscitis by combining allograft and autograft bone chips with posterior segmental fusion. Methods: This was a retrospective study. The clinical deficit was evaluated with ASIA, VAS, and JOABPEQ scores before and after surgery. Radiological parameters were assessed with local kyphosis angle (degree), segmental height correction, and loss of correction. Post-operative bone union was evaluated as suggested by Tan et al. Results: The mean age of patients (n=34) was 52.3(SD=13.6) years and 67.6% were males. The mean follow-up duration was 25.8 (2.3) months. In the last follow-up, VAS back pain 4.9(0.77), VAS leg pain 4.6(0.78), JOABPEQ low back pain 68.1 (9.3), JOABPEQ lumbar function 81.3 (8.9), and JOABPEQ walking ability 72.8 (8.3) shows a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients deteriorated neurologically (all p

BACKGROUND: Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team. MATERIALS AND METHODS: This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10. RESULT: During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged. CONCLUSION: Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.

Background and importance: Cervical laminectomy and fixation (PCF) is a surgery used in the treatment of symptomatic patients who are resistant to medical therapy, though it can have serious complications affecting patient outcomes. Case Presentation: This case report describes a rare occurrence of a solitary fibrous tumor (SFT) at the site of a previous cervical laminectomy in a 45-year-old female patient. Following non-surgical treatment for paresthesia and weakness in the upper limbs due to cervical stenosis, the patient underwent cervical laminectomy from C3-6 without instrumentation. Conclusion: One year after surgery, the patient presented with severe pain and swelling at the surgical site, and radiological evaluation revealed a large mass in the para-vertebral muscular layer. The mass was removed, and microscopic evaluation revealed a typical SFT. The patient underwent an extension of laminectomy and fusion with lateral mass screw, and follow-up at six months showed no recurrence of the tumor.

Abstract A 67‐year‐old female was hospitalized due to right‐sided hemiparesis and neck pain with rapid deterioration to a deep coma. She had received the Sinopharm vaccine 2 days earlier. MRI showed extensive cervicothoracic hematomyelia. She received intensive medical care for 2 months and was discharged. An 18‐month follow‐up showed significant neurological recovery.

Background and Aim: Perry and Nickel introduced the halo vest in 1959. It is the most common immobilization device for the unstable cervical spine. In the literature review, most articles review the beneficial effects of the halo vest, and a few report its complications. This study aims to evaluate the complications associated with halo orthosis. Methods and Materials/Patients: This is a narrative study about halo vest complications. To provide up-to-date information, we reviewed the articles written about halo complications. All relevant articles were retrieved from Google Scholar, Medline, PubMed, etc., using the keywords of “halo vest orthosis”, “unstable cervical spine fracture”, “halo vest complications”, “halo vest immobilization”, “pin-site-related complications”, and “vest-related complications”. Afterward, we reviewed and critically analyzed the articles. Results: At first, the halo vest was used for postoperative paralyzed poliomyelitis patients, and later, it was also used for traumatic injury of the cervical spine or postoperatively in cervical spine reconstructive surgery. Compared to other orthoses, the halo vest provides a more effective external fixation and maintains normal anatomic alignment of the cervical spine without impacting jaw motion and resulting in eating problems. However, it has many temporary complications. To prevent halo vest complications, experienced people should apply it, and the patients should be regularly followed up for early detection and treatment of complications. Conclusion: Our review is the starting point for the evaluation and investigation of halo vest complications. Because of the high incidence of pin loosening and infection, it is better to evaluate the design and application of halo pin. Since the initial design of the halo vest, only its superstructure has been redesigned without any significant change in other parts of it.

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. Patientschr('39') 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

Abstract A 61‐year‐old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Postoperative clinical evaluation showed improved neurologic status.

Introduction: Midkine (MK), a heparin-binding growth factor, is involved in neurological diseases by mediating the inflammatory responses through enhancing the leukocyte migration. The present study assesses the serum concentration of this growth factor among newly developed Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) patients. Methods: The present research, as a cross-sectional study, was performed at Isfahan University of Medical Sciences, Isfahan City, Iran. All samples were selected from patients who visited Kashani and Alzahra hospitals for two years (2014 to 2016). The MK level was assessed in 80 new MS cases, 80 NMO patients, and 80 healthy subjects. After collecting blood sera samples, MK serum level was measured using the ELISA. The obtained data were analyzed in SPSS. Results: The Mean±SD MK level was 1038.58±44.73 pg/mL in the MS group, which was significantly higher than the Mean±SD MK level in the NMO (872.62±55.42 pg/mL) and control groups (605.02±9.42 pg/mL). Conclusion: Overall, these results demonstrated that MK plays a prominent role in inflammatory reactions and neuroautoimmune diseases, especially in MS. So, the MK level may be used for earlier diagnosis and also prevention of disease progression by using a special inhibitor.

Introduction: One of the most common types of spinal diseases is spondylolisthesis, which in advanced cases requires surgical intervention. This study aimed to compare the results of L4-L5-S1 and L5-S1 vertebral fusion treatment in high-grade L5-S1 spondylolisthesis. Methods: A study design that randomized controlled trial. A total of 70 consecutive patients who underwent surgery for the treatment of spondylolisthesis at Al-Zahra Hospital in Isfahan, Iran, were evaluated from July 2020 to February 2021 (35 patients underwent L4-L5-S1 and 35 received L5-S1 vertebral fusion treatment). The radicular and low back pain (LBP) intensity (Vanguard Australian Shares), blood loss, wound infection, reduction, and quality of life (SF-12 scores) were quantified before the surgery, 1, 3, and 6 months after surgery in two groups. Results: Patients involved in the two groups had similar baseline demographic characteristics. The percent slip in L4-L5-S1 and L5-S1 group, respectively, postoperative 81.11% and 57.89%, P = 0.0001. Intraoperative blood loss and postoperative were higher in the L4-L5-S1 group when compared to the L5-S1 group (P < 0.05). The wound infection rate of the L4-L5-S1 group was similar to that of the L5-S1 group (8.6% vs. 2.9%, P = 0.303). There was no difference in radicular and LBP intensity, SF-12 scores among patients with L4-L5-S1 and L5-S1 groups (P < 0.05). Conclusion: Both L4-L5-S1 and L5-S1 were equally beneficial in improving short-term functional outcomes for patients with high grade L5-S1 spondylolisthesis. However, L4-L5-S1 was associated with statistically significant higher incidences of blood loss, but it was accompanied by a better reduction. Therefore, caution should be exercised when considering L4-L5-S1.

Background: Spinal cord injury (SCI) is the second cause of complications and disability after brain injury. Although primary prevention is the best strategy, obtaining the necessary knowledge about the patient's condition and follow-up treatment can lead to the use of safety measures and appropriate healthcare planning. This is the basis of this study with the aim of a two-year follow-up of patients with traumatic SCI (TSCI) who underwent surgery. Materials and Methods: This study was a descriptive and analytical type that examined 79 patients with TSCI who had undergone surgery two years ago. The data were collected by a standard questionnaire and analyzed in Statistical Package for the Social Sciences (SPSS) version 24 software. Results: Among the patients in our study, 39.2% of them had the initial C American Spinal Injury Association (ASIA) score followed by patients with grade D (31.6%), grade A (15.2%), and grade E (14%), respectively, and also, a most common type of vertebral column injuries is burst fractures with a prevalence of 62%, followed by fracture–dislocation injury (25.3%) and compressed fracture (12.7%). Regarding the improvement of patients according to ASIA grade, the highest percentage of improvement is seen in grad grades D (84% and 77%), and grade A patients have improved to grade B by about 33.3%. In the study conducted, 5% of patients died during 24 months of follow-up, which means 75% of the deceased patients were grade A patients at the time of admission. Conclusion: As mentioned, the most important predictor of the patient's prognosis is the patient's initial condition.

The use of the cervical collar to support the head and neck is inevitable in many patients with head and spinal cord injuries. One of the consequences of using this instrument is the development of pressure injuries. Therefore, in this review study, the incidence of as well as the risk factors for cervical collar-related pressure injury in this group of patients was evaluated. The current study is a scoping review conducted in 2022. Five scientific databases (PubMed, Scopus, Web of Science, ProQuest, and CINAHL), as well as Google Scholar, were searched for relevant studies published from 1990 to 2022 using the following keywords: trauma, spinal cord injury, head injury, head trauma, collar, cervical collar, cervical immobilization, risk factors, incidence, pressure injury, pressure ulcer, and bed sore. The search was performed independently by two researchers. Articles from the initial search were first recorded in special tables, and then, were reviewed and analyzed separately by two researchers. After extraction, information from each article was entered into a special table categorized by year, country, study design, study population, the incidence of cervical collar-related pressure injury, risk factors for cervical collar-related pressure injury, and grades of pressure injury. Of the 10 articles, 6 were retrospective cohort studies, 3 were cross-sectional descriptive studies, and 1 was a case report study. In terms of the study population, one study was conducted on pediatric patients, one was conducted on elderly patients, and eight were conducted on adults with head and neck trauma. In eight articles, the incidence of cervical collar-related pressure injury was reported. The reported incidence varied between 1.1% and 78.4%. In eight articles, risk factors for cervical collar-related pressure injury were reported. The most common risk factors were duration of cervical collar use, hospitalization in intensive care units, low level of consciousness, and longer hospital stay. The current review study showed that a significant percentage of head and neck trauma patients for whom cervical collar is used suffer from different grades of pressure injuries. Hence, healthcare providers should consider this issue when caring for this group of patients and take the necessary preventive measures in this regard. It should be noted that previous studies in this field had significant limitations, and thereby, it is strongly recommended to conduct further studies with a stronger methodology.

Abstract A 73‐year‐old man experienced four limb paresthesia and weakness following severe COVID‐19 pneumonia. EMG‐NCS showed inflammatory demyelinating polyneuropathy pattern while cervicothoracic imaging showed hematomyelia. The patient underwent laminectomy and hematoma evacuation. Neurological status improved to ASIA score C, postoperatively.

Background: This study aimed to compare the preventive effect of local infiltration of magnesium sulfate and bupivacaine on postoperative pain in lumbar fusion surgery under general anesthesia. Methods: In a double-blind clinical trial study, 60 candidates for lumbar fusion surgery during 2018-19 in Alzahra hospital, Isfahan, Iran, were randomly divided into three groups. In the first group, magnesium sulfate, in the second group, bupivacaine, and in the third group, normal saline was infiltrated at surgery site. The severity of the pain, the amount of morphine received, and hemodynamic data were recorded and compared before and after operation, immediately after surgery, every 15 minutes until the end of recovery, and 1, 2, 6, 12, 18, and 24 hours after recovery. Findings: The mean pain severity was not significantly different in the preoperative groups at 12, 18, and 24 hours after the test; but, at 2, 6, and 8 hours after the operation, the pain severity was significantly less in magnesium sulfate group compared to the other two groups. The median morphine obtained in 24 hours after surgery was significantly less, and the first time to receive morphine was in magnesium sulfate group more in magnesium sulfate group compared to the other two groups. Conclusion: It seems that infusion of magnesium sulfate at the site of fusion surgery has been associated with prolongation of the first time to receive morphine by patients, reducing the amount of morphine received, and pain intensity up to 24 hours after surgery.

Background and Aim: Bleeding during surgery is one of the most common surgical complications. In this study, we decided to determine the effect of Tranexamic Acid (TA) in reducing blood loss in patients undergoing spinal surgeries. Methods and Materials/Patients: In this clinical trial, 100 patients undergoing spinal surgeries were randomly divided into two groups. One group received TA and the other was selected as the control group. Patients in the treatment group received 1 gram of intravenous TA and another 250 milligram intravenously, one hour after the beginning of the surgery. Bleeding during the surgery, in the first 24 hours and the first 48 hours were recorded separately. The need for transfusion and its volume, as well as the hospital stay length were compared in the two groups. Results: Bleeding during surgery in TA group was significantly lower than that in the control group (433 ml vs. 522 ml respectively, P=0.009). Also, during the first 24 hours after surgery, bleeding in TA group was significantly less than that in the control group (P=0.011). During the second 24 hours after surgery, bleeding was similar between the two groups (P=0.112). The values of hemoglobin in both groups slowly decreased and the trend of decrease was not significantly different between them (P=0.154). Conclusion: In spinal surgeries, TA administration in the beginning of the process reduces surgical bleeding during surgery and in the first 24 hours after surgery. Considering the possible complications, TA administration is suggested for patients with hemoglobin less than 12 g/dl. Future studies are needed to conclude the advantages and disadvantages of TA administration in spinal surgeries.

Background: This study aimed to compare the effect of Clexane injection with bondage and bondage only in the prevention of deep vein thrombosis in patients undergoing instrumented spinal surgery. Methods: In a clinical trial study, 300 patients under instrumented spinal surgery were selected and randomly divided into two equal groups. In the first group, bondage was used with injection of 1 mg/kg Clexane daily until patient’s ambulatory, and in the second group, bondage was used only. All patients were followed up for 14 days, and the incidence of deep vein thrombosis was determined and compared between the two groups. Findings: 4 patients suffered from deep vein thrombosis, 3 of them (2.0%) were in the control group and 1 (0.7%) in the treatment group (bondage and Clexane); but the incidence of deep vein thrombosis was not significantly different between the two groups (P = 0.620). The mean volume of bleeding was significantly higher in patients receiving Clexane (203.4 ± 8.3 ml) than control groups (163.0 ± 7.7 ml) (P < 0.001). Conclusion: There was no significant difference between the two groups of bondage alone and bondage and Clexane in preventing deep vein thrombosis. On the other hand, there is still no study to prove the definitive effect of this drug in preventing deep vein thrombosis and thromboembolism. Therefore, more studies are recommended to be done with larger sample sizes in order to determine the effect of Clexane in preventing deep vein thrombosis.

Study Design Randomized clinical trial. Purpose In this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding. Overview of Literature Bleeding is the most significant complication in patients undergoing spinal surgery. Methods We randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively. Results T-tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed (p =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group (p =0.056). Diabetic females had the highest bleeding amount between the groups (p =0.03). Bleeding was higher in patients with higher BMI (p =0.02) and was related to operative time (p =0.001) in both the groups. Conclusions Preoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose.

مقدمه: مطالعه‌ی حاضر با هدف ارزیابی سطح مقطع و ارتشاح چربی عضلات مولتی‌فیدوس، ارکتور اسپاین و سواس در مهره‌ی L5 در بیماران مبتلا به کمردرد مزمن در مقایسه با بیماران مبتلا به کمردرد حاد انجام شد. روش‌ها: این مطالعه‌ی آزمایشی بر روی 30 بیمار با کمردرد مزمن و 30 بیمار با کمردرد حاد انجام گردید. شاخص توده‌ی بدنی، نمره‌ی درد (بر اساس شاخص دیداری)، میزان ناتوانی بیمار (بر اساس شاخص تاتوانی Oswestry)، طول مدت درد، اندازه‌ی سطح مقطع عضلات مولتی‌فیدوس، ارکتور اسپاین و سواس و میزان ارتشاح چربی این عضلات در بیماران تحت مطالعه از طریق Magnetic resonance imaging (MRI) اندازه‌گیری و مقایسه گردید. یافته‌ها: شاخص توده‌ی بدنی و نمره‌ی درد بیماران در دو گروه تحت مطالعه تفاوت معنی‌دار آماری نداشت (050/0 < P). نمره‌ی شاخص ناتوانی بیماران در گروه کمردرد حاد، به طور معنی‌داری از گروه کمردرد مزمن بیشتر بود (007/0 = P). میانگین سطح مقطع عضلات مولتی‌فیدوس، ارکتور اسپاین و سواس بین دو گروه تفاوت معنی‌دار آماری نداشت. میانگین میزان ارتشاح چربی عضلات در بیماران با کمردرد مزمن به طور معنی‌داری از بیماران با کمردرد حاد بیشتر بود (050/0 > P). شاخص توده‌ی بدنی با سطح مقطع عضله‌ی مولتی‌فیدوس (030/0 = P، 280/0 = r) و سطح مقطع عضله‌ی سواس (036/0 = P، 271/0 = r) ارتباط مستقیم و معنی‌داری داشت. نتیجه‌گیری: بیشتر بودن میزان ارتشاح چربی عضلات پارا اسپاینال در بیماران با کمردرد مزمن نسبت به مبتلایان به کمردرد حاد، می‌تواند نشان دهنده‌ی اهمیت و نقش آن در مزمن شدن انواع کمردرد باشد.

Background and Aim: Although operation is the most appropriate treatment for Cauda Equina Syndrome, the effectiveness of operation on clinical symptoms is still under discussion. This study aimed to determine the prognosis of Cauda Equina Syndrome in patients with lumbar disk surgery in Al-Zahra Hospital of Isfahan City, Iran, from 2013 to 2015. Methods and Materials/ Patients: In This prospective study, patients diagnosed with Cauda Equina Syndrome who underwent operation in Al-Zahra Hospital of Isfahan from 2013 to 2015 were followed up for two years and the effect of the surgery on the improvement of their clinical symptoms was investigated. Results: In this study, 33 patients with Cauda Equina Syndrome were evaluated. About 24-month follow-up of patients showed muscle weakness improvement in 26(78.8%) of them. Of all 19 patients with urinary dysfunction, 18(94.7%) recovered. Six (33.3%) cases improved the day after surgery, 6(33.3%) cases in one month, 4(22.2%) cases in six months, and 2(11.1%) cases within 24 months after the surgery. All 4(100%) patients with bowl disorder also recovered during the study. One (25%) of them improved the day after operation, 1(25%) one month after the operation and 2(50%) within 24 months following the operation. Conclusion: According to the results of this study, operation of the lumbar disks leads to improvement of Cauda Equina Syndrome, including recovery of sphincter disorders and muscle weakness, but considering the limitations of our investigation (including a small sample size), further studies are recommended in this area.

Introduction: Problem-oriented medical record (POMR) is a method of documentation and medical record organization. Problem list is the main component of POMR and the core of the electronic health record (EHR) definition. The aim of the present study was to explain the requirements and challenges in establishing an electronic problem list in hospitals. Methods: This descriptive-applied study was conducted in 2016 in Alzahra Hospital affiliated with Isfahan University of Medical Sciences, Iran. One of the requirements of patient problem lists was content development that, after designing the software, was implemented at neurosurgery and neurology wards. Results: Establishing an electronic problem list showed that content development was its most challenging requirement. These challenge included terminology, patient problems documentation, and interdisciplinary documentation management. Conclusion: Implementation of the problem list as a key component of POMR, especially in inpatient settings with various treatment groups, has challenging requirements. Thus, it requires knowledge and administrative, financial, and technical support.

Background: We planned a study to investigate the effect of spinal anesthesia in producing low back pain (LBP) in women following Cesarean section. Methods: During a prospective cohort study, 100 women who underwent spinal anesthesia and Cesarean operation were compared with 100 women who underwent general anesthesia and Cesarean operation during a 3-months follow-up as developing later low back pain. Findings: During 3-months follow-up, 25 and 43 patients in general and spinal anesthesia groups developed low back pain, respectively, which was statistically different according to chi-square test (P = 0.007). So, the prevalence of low back pain was 1.99 times more in spinal anesthesia group. It is important to note that the infant's weight had strong effect in producing low back pain; as increasing every 1 kg in weight increased the chance of low back pain for 2.1 times. Conclusion: There incidence low back pain was higher in women who underwent Cesarean operation under spinal anesthesia; this high incidence not only depended on the type of anesthesia, but on other factors such as the infant's birth weight. Thus, when planning Cesarean operation, it is necessary to consider the underlying factors in mother and child which can be effective in producing later low back pain and then accept the type of anesthesia.

Background: This study aimed to determine the effect of bowel preparation on bleeding in spinal fusion surgery. Methods: In this clinical trial study, 110 patients who were candidates for lumbar fusion operation were randomly divided in two groups. The first group underwent bowel preparation with solution of polyethylene glycol in water for 16 hours and 8 hours fasting and the second group underwent routine surgical preparation that was at least 8 to 12 hours of fasting. Hemoglobin level, hemorrhage volume and complications during and after the surgery were compared between the two groups. Findings: The mean (± standard deviation) of hemorrhage volume during the surgery in the two groups of with and without bowel preparation was 780.4 ± 290.5 and 931.9 ± 475.0 ml, respectively (P = 0.046). The mean hemorrhage volume in the two groups of with and without bowel preparation was 97.3 ± 45.7 and 110.7 ± 55.6 ml (P = 0.170) during 24 hours after the surgery and 118.2 ± 74.3 and 138.6 ± 101.5 (P = 0.230) during 48 hours after surgery, respectively. Conclusion: Bowel preparation in patients undergoing spine fusion surgery likely tends to reduce of complications during and after the surgery, particularly bleeding. Therefore, it is suggested in spine surgery and spinal fusion surgeries, to use with bowel preparation for patients.

Background: Matrix metalloproteinase-9 (MMP-9) polymorphisms, C−1562 T and -90 (CA) n repeats, which influence transcriptional activity of this gene, are proposed to play a role in MS susceptibility and its development. In the present study, the possible association of MMP-9 polymorphisms in Iranian MS patients is studied. Methods: Association of MMP-9 mentioned gene polymorphisms with MS susceptibility was evaluated in unrelated Iranian subjects referred to Al-Zahra Hospital, Isfahan, Iran during 2014 to 2017. Results: -1562 T allele of MMP-9 was associated with increased MS risk. However, we found no overall significant effect of −90 (CA)n repeat on MS susceptibility. Conclusion: For as much as MMP-9 molecule is a potential target for MS therapy, to determine whether any of MMP-9 polymorphisms influence MS susceptibility in Iranian MS patients or not, concerning the significant influence of T allele on MS susceptibility and the non-significant association regarding CA repeats, further research is needed before proposing any definite conclusion.

This study aimed to investigate the differences in pelvic incidence (PI) between three standing, maximal anterior and maximal posterior pelvic rotation. This cross-sectional study was done on 150 healthy subjects. Lateral spine radiography was taken in 3 different positions in the same standard radiographic protocol. Sacral slope (SS) pelvic tilt (PT), lumbar lordosis (LL) and lumbosacral junction angle were measured by two independent, experienced spine surgeons. PI was calculated as sum SS and PT. The mean of PI in standing positions was 52.6±5.1, in anterior position was 52.6±5.5 and in posterior position was 52.3±5.2 degree. The mean of PI, PT, and SS in total and between male and female subjects was not statistically significant in three different positions (P>0.05). PI in 136 subjects (90.7%) is changed when the position was changed from standing to the posterior position, by mean of 2.06 degree. When the position was changed from standing to an anterior position, the change in PI degree was observed in 126 subjects (84%) by mean of 2.12 degree. Despite the none, significant value of PI in three different positions, a large number of subjects with a change in their PI when the position was changed to anterior or posterior (90.1%) position, show that PI can be varied by pelvic rotation in healthy adult subjects.

Background: The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The “cytokine storm” is considered as the main cause of pathogenesis for coronavirus disease-19 (COVID-19)-related respiratory failure, hemoperfusion may be a modality for treatment of disease. Materials and Methods: Thirty-seven an patients with positive real-time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case–control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV. Results: Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO2/FIO2, high-sensitivity C-reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups (P < 0.05, CI: 95%). Conclusion: It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay.

مقدمه: شیوع اختلالات روان‌پزشکی در بیماران مبتلا به کمردرد، بیشتر از جمعیت عادی گزارش شده است. هدف از انجام مطالعه‌ی حاضر، تعیین ارتباط شدت افسردگی با میزان بهبود درد پس از عمل جراحی فتق دیسک بود. روش‌ها: در یک مطالعه‌ی مقطعی که در سال 1394 در بیمارستان الزهرای (س) اصفهان انجام شد، 300 بیمار کاندید عمل جراحی فتق دیسک کمر انتخاب شدند. وضعیت روحی- روانی بیماران با استفاده از پرسش‌نامه‌‌ی SCL-90 ‏(‏Symptom Checklist-90‎‏) ‏و شدت درد آنان قبل از عمل، موقع ترخیص و 14 روز بعد از عمل نیز با استفاده از معیار VAS (Visual Analogue Scale) مورد بررسی قرار گرفت. همچنین، ارتباط بین شدت اختلال روانی و میزان درد قبل و بعد از عمل تعیین گردید. یافته‌ها: میانگین نمره‌ی اختلال روانی بیماران 37/0 ± 91/1 به دست آمد. بین میانگین نمره‌ی درد قبل از عمل و نمره‌ی اختلال روانی همبستگی مستقیم و معنی‌داری وجود داشت (67/0 = r، 001/0 > P). همچنین، بین نمره‌ی اختلال روانی با نمره‌ی درد هنگام ترخیص (74/0 = r، 001/0 > P) و نمره‌ی درد 14 روز بعد از عمل (55/0 = r، 001/0 > P) همبستگی مستقیم‌ و معنی‌داری مشاهده شد. نتیجه‌گیری: بین میزان اختلال روانی و شدت کمردرد در بیماران مبتلا به فتق دیسک بین مهره‌ای، ارتباط مستقیمی وجود دارد و با توجه به این که اختلال روانی می‌تواند بر کیفیت زندگی و روند بهبودی تأثیرگذار باشد، لازم است بیماران مبتلا به فتق دیسک بین مهره‌ای، از نظر ابتلا به اختلالات روانی مورد بررسی و درمان قرار گیرند

مقدمه: خونریزی، مهم‌ترین عارضه‌ی ضربه‌ی مغزی می‌باشد و در صورتی که بتوان به نحوی جلوی افزایش حجم خونریزی را گرفت، نه تنها میزان ناخوشی و مرگ و میر کاهش می‌یابد، بلکه نیاز به دخالت جراحی نیز کمتر می‌شود. هدف از انجام این مطالعه، تعیین تأثیر داوری ترانگزامیک اسید بر انواع خونریزی مغزی در تروماهای مغزی بود. روش‌ها: طی یک مطالعه‌ی کارآزمایی بالینی، 190 بیمار مبتلا به ترومای مغزی، به روش تصادفی در دو گروه 95 نفره توزیع شدند؛ گروه مورد، تحت تزریق ترانگزامیک اسید و گروه شاهد، تحت تزریق دارونما (نرمال سالین، قرار گرفتند و بیماران در قبل از تجویز دارو و 24 ساعت بعد، تحت Computed tomography scan (CT scan) قرار گرفتند و یافته‌های قبل و بعد از درمان، از نظر وجود نوع خونریزی داخل جمجمه و حجم آن، ایجاد خونریزی جدید و میزان افزایش حجم آن توسط پزشک رادیولوژیست تعیین و داده‌های به دست آمده با استفاده از نرم‌افزار SPSS بین دو گروه مقایسه شد. یافته‌ها: میانگین حجم خونریزی اولیه در دو گروه مورد و شاهد به ترتیب 9/4 ± 7/4 و 2/4 ± 0/5 سی‌سی بود و بر حسب آزمون t، اختلاف معنی‌داری بین دو گروه وجود نداشت (640/0 = P). حجم خونریزی در 24 ساعت بعد از مداخله، در دو گروه مورد و شاهد به ترتیب 80/5 ± 69/4 و 85/4 ± 12/5 سی‌سی بود و تفاوت معنی‌داری بین دو گروه مشاهده نشد (590/0 = P). میانگین تغییرات حجم خونریزی در دو گروه مورد و شاهد نیز به ترتیب 71/3 ± 01/0- و 48/2 ± 13/0- بود؛ اما اختلاف معنی‌داری بین دو گروه مشاهده نشد (810/0 = P). بررسی حجم خونریزی بر حسب نوع و محل خونریزی، نشان داد که در بیماران کانتوژن، حجم خونریزی به طور معنی‌داری کاهش پیدا کرد. نتیجه‌گیری: تأثیر تزریق ترانگزامیک اسید در بیماران دچار ترومای مغزی، بیشتر به محل و نوع ضایعه بستگی دارد و اثرات آن در بیماران دچار کانتوژن مشهودتر می‌باشد، اما برای مشخص شدن تأثیر کلی دارو، انجام مطالعات بیشتر توصیه می‌گردد.

مقدمه: در سطح جهانی، مطالعات اندکی در مورد روش ارجح زمان‌بندی جراحی گردن و کمر در بیماران مبتلا به درگیری هم‌زمان ستون فقرات گردنی و کمری با فرایندهای دژنراتیو از قبیل تنگی کانال هم‌زمان کمری و گردنی انجام شده است که اغلب این مطالعات، گذشته‌نگر هستند. از این رو، كارآزمایی بالینی حاضر، با هدف مقایسه‌ی پیامدها و عوارض عمل جراحی یک مرحله‌ای با دو مرحله‌ای طراحی گردید. روش‌ها: مطالعه‌ی حاضر یک کار آزمایی بالینی بود. 20 بیمار مبتلا به تنگی هم‌زمان فقرات گردنی و کمری که بر اساس معیارهای بالینی نیازمند مداخله‌ی الزامی جراحی روی هر دو ناحیه‌ی گردنی و کمری بودند، به صورت تصادفی به دو گروه تقسیم شدند. در گروه یک مرحله‌ای، رفع فشار، وسیله‌گذاری و جوش‌دهی ستون فقرات گردنی و کمری به صورت هم‌زمان و طی یک عمل توسط دو تیم جراح انجام شد. در بیماران گروه دو مرحله‌ای، جراحی‌های گردن و کمر به صورت جداگانه و طی دو عمل مجزا انجام شد. خونریزی حین عمل، تعداد واحد گلبول قرمز ترانسفیوژن شده‌ی حین و بعد از عمل، مجموع زمان عمل، زمان ریکاوری، روزهای بستری در بیمارستان، مجموع هزینه‌ها و عوارض بعد از عمل میان دو گروه مقایسه شد. همچنین، نتایج بهبود بالینی اولیه در پایان ماه اول پس از اعمال جراحی با استفاده از پرسش‌نامه‌ی گردنی و کمری Oswestry میان دو گروه ارزیابی شد. از آزمون‌های t، 2χ و همبستگی Pearson جهت آنالیز داده‌ها استفاده شد. یافته‌ها: زمان عمل، زمان ریکاوری، تعداد روزهای بستری در بیمارستان و هزینه‌های کلی در گروه یک مرحله‌ای، به شکل معنی‌داری کاهش یافته بود. اختلاف آماری معنی‌داری میان دو گروه از لحاظ میزان خونریزی حین عمل، تعداد واحد خون تزریق شده و عوارض بعد از عمل وجود نداشت. نتایج بهبود بالینی اولیه، پس از اعمال جراحی در دو گروه یکسان بود (05/0 < P). نتیجه‌گیری: انجام عمل به شیوه‌ی یک مرحله‌ای در صورت اجازه‌ی شرایط عمومی بیمار و وجود امکانات و تیم‌های مجرب جراحی، نتایج بالینی قابل مقایسه‌ای با روش دو مرحله‌ای دارد و عوارض بالقوه و خطرات بیشتری نیز ندارد.

Background: In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient-overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation. Methods: In this cross-sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al-Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems. Results: Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12. Conclusions: ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding.

Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. Materials and Methods: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Conclusion: Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.

Background: Steroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR. Materials and Methods: This randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes. Results: A total of 59 patients (31 female, mean ± SD age = 46.2 ± 9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7 ± 21.4 vs. 12.9 ± 10.2) and VRS (4.4 ± 2.7 vs. 1.6 ± 1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001). Conclusion: A short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.

A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was re-ferred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that. Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the fo-ramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia.

In this paper, we will present a case of a 63-year-old female with bifrontal epidermoid tumor who has gone under bilateral craniotomy. In a case report study, a 63-year-old female with a chief complaint of progressive headache that has been admitted to Department of Neurosurgery was studied. Magnetic resonance imaging was performed for better evaluation. After detection of bifrontal epidermoid cyst, the patient underwent surgery, and following the surgery, a cut of the tumor has been excised, sent for pathology sampling and reviewed for detection of cyst. Microscopic review of the resected part reported normal brain tissue along with sections containing parts of cyst wall covered by squamous epithelium and huge amount of irregularly stratified keratin within its lumen, which clearly emphasizes on diagnosis of a typical epidermoid tumor. Bifrontal epidermoid cyst is rare, and according to our study, the clinical symptoms and patients imaging were consistent with other studies.

Background: As marcaine is administered to a great extent due to minor complications and reasonable expenses and as discectomy is prevalently used in Iran, this study makes a comparison between effect of marcaine alone, lidocaine alone, and marcaine plus lidocaine on pain relief of patients undergoing lumbar disc open surgery. Materials and Methods: In a clinical trial study, 192 patients were selected and randomly divided into four groups. Patients in Groups 1–4 received 0.5 ml marcaine during surgery, 5 ml lidocaine 2% before incision, 5 ml lidocaine 2% before incision plus 5 ml marcaine during surgey and normal saline, respectively. After patients gained knowledge of visual analog scale (VAS) criteria, their severity of pain was measured and was recorded in their profiles, along with demographic details and history of diseases. After surgery and their transfer to their rooms, their severity of pain was measured and recorded again by using VAS criteria. Finally, difference between the four groups was compared by SPSS software. Results: The mean (±standard deviation) of postoperative pain in marcaine + lidocaine, marcaine, lidocaine, and normal saline was 3.5 ± 1.3, 3.5 ± 1.6, 36.1.9, and 4.2 ± 1.8, respectively, and we did not observe any significant difference in severity of pain after surgery in these groups (P = 0.15). The highest and lowest degree of satisfaction occurred in marcaine-lidocaine group and control group, respectively, (40 patients [83.3%] vs. 25 patients [52.1%]). Conclusion: Lidocaine-marcaine treatment reduces the need to opiates in cases of postoperative pain relief of discectomy and provides patients with great satisfaction.

Background: Cerebral vasospasm is a prolonged, occasionally severe, but reversible narrowing of the cerebral arteries that begins 3 to 5 days after the hemorrhage becomes maximal at 14 days. This study is designed to evaluate the effect of dantrolene on the reduction of vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods: This randomized controlled clinical trial was conducted on 32 patients with proven aneurysms in AL-Zahra hospital during 2011-2013. They were randomly divided into two groups. In all patients, daily transcranial Doppler sonography was performed and as soon as the diagnosis of vasospasm onset in the first group, in addition to conventional treatment of vasospasm 2.5 mg/kg Dantrolene infusion within 60 minutes and while the blood pressure and heart rate of patient monitored, and arterial flow velocity changes such as PSV and MFV were measured by transcranial Doppler sonography in 45, 90 and 135 minutes. Data was analyzed by SPSS 22 and Chi-square, Student t, Mann-Whitney and ANOVA tests with repeated observations. Results: There was no significant difference in the site of the aneurysm in the two groups. The mean of PSV index prior to treatment and the 45th minute was not different but at 90th and 135th minutes it was significantly lower in the Dantrolene receiving group (P < 0.05). The mean of MFV index prior to intervention and in the 45th minute was not different between two groups, but at 90th and 135th minutes was significantly lower in the target group Conclusion: Using dantrolene in patients with artery vasospasm significantly reduced artery spasm and increased the patient recovery.

Background: A large number of stroke patients are not the perfect candidate for craniotomy and invasive procedures, so providing an alternative and noninvasive method, which is applicable in terms of costs and facilities, is necessary. Thus, the present study aimed to determine the effects of mannitol 20% on outcome of the patients with nontraumatic intracerebral hemorrhage (ICH) in patients admitted to Isfahan's Al-Zahra Hospital during 2012 and 2013. Materials and Methods: This is a clinical trial study which is conducted during 2012–2013 in Isfahan's Al-Zahra Hospital. In this study, 41 patients suffering from ICH received mannitol 20% for 3 days, and volume of hemorrhage and Glasgow Coma Scale (GCS) of patients were controlled every 12 h. The collected data were analyzed via SPSS software. Results: The mean ICH volume was 22.1 ± 6.3 ml in pre intervention and 38.4 ± 19.3 ml in post intervention, and according to the t-paired test, before and after treatment the difference was significant (P < 0.001). Hemorrhage volume was stable in nine patients (22%), it increased in 25 patients (61%), and decreased in seven patients (17.1%). The mean index of GCS before and after treatment was 11.85 ± 1.6 and 9.37 ± 2.65, respectively. Moreover according to t-paired test, the difference was significant before and after treatment (P < 0.001). During using mannitol, the GCS index was stable in eight patients (19.5%), it increased in eight patients (19.5%) and decreased in 25 patients (61%). Conclusions: Mannitol injection was not effective in reducing hemorrhage size, and its use is not recommended, also, further studies in this field have been proposed.

مقدمه: ستون مهره‌ها محور اصلی بدن است که نقش مهمی در حفظ و نگهداری بدن بر عهده دارد. مطالعه‌ی زوایای بین مهره‌ها و انحنای ستون فقرات، در بررسی‌های آسیب‌شناختی ناحیه‌ی لومبوساکرال مورد استفاده قرار می‌گیرد. در این مطالعه از روش‌های پردازش تصویر عکس‌های رادیولوژی دیجیتال به منظور دستیابی به زوایای بین مهره‌ای و انحنای ستون فقرات با دقت بیشتر و سریع‌تر استفاده ‌شد. روش‌ها: این مطالعه‌ی توصیفی-تحلیلی در سال 1389 در دانشگاه علوم پزشکی اصفهان انجام شد. 100 بیمار با تظاهرات بالینی کمر درد، که دارای کلیشه‌ی پرتونگاری و فایل الکترونیکی نیم‌رخ کمر بودند، جهت مطالعه انتخاب شدند. درجه‌ی زاویه انحنای کمر آن‌ها هم بر روی کلیشه‌ی نیم‌رخ پرتونگاری کمر با استفاده از روش دستی رایج و هم به روش پیشنهادی پردازش تصویر ذیجیتالی اندازه‌گیری شد. داده‌ها با استفاده از آمار توصیفی و آزمون‌ همبستگی تجزیه و تحلیل شدند. یافته‌ها: در این مطالعه تعداد 100 بیمار (50 زن و 50 مرد) با میانگین سنی 8 ± 44 سال بررسی شدند. میانگین کلی زاویه‌ی انحنای کمر در روش دستی 1/8 ± 35 درجه و در روش پیشنهادی در این مطالعه 6/7 ± 37 درجه بود. بدین صورت میانگین زاویه‌ی انحنا در دو روش مورد استفاده در این مطالعه دارای همبستگی معنی‌داری (89/0 = r، 05/0 > P) بود. نتیجه‌گیری: نتایج نشان داد که هر چند روش‌های مرسوم شامل بررسی دستی تصاویر و همچنین استفاده از خط‌کش منعطف از ابزارهای بسیار دقیق و معتبر به خصوص برای اندازه‌گیری انحناهای ستون فقرات در برنامه‌های آزمون غربالگری و جمعیت‌های بسیار بزرگ محسوب می‌شوند، ولی با توجه به زمان صرف شده در خصوص استفاده از این روش و میزان همبستگی نتایج به دست آمده در این مطالعه، استفاده از تکنیک‌های مبتنی بر پردازش تصویر می‌تواند در حداقل زمان ممکن نتایج مشابهی به دست دهد. واژگان کلیدی: زوایای بین مهره‌ای، رادیوگرافی، پردازش تصویر

Background: To evaluate the efficacy and side-effects of cyclosporine-A (CsA) in improvement of consciousness and cognitive dysfunction of patients with diffuse axonal injury (DAI) after traumatic brain injury (TBI). Materials and Methods: This study is designed as a randomized double-blind placebo-controlled with 100 patients suffered from DAI. CsA was administered to the intervention group (n = 50) as 5 mg/kg/24 h via 250 ml dextrose water (DW) 5% solution (DW 5%) during the first 8 h after trauma. The control group (n = 50) received only DW 5% in the same course. The presenting Glasgow coma scale in addition to the Glasgow outcome scale-extended (GOS-E) and mini-mental state examination (MMSE) in the 3 rd and 6 th months after trauma were documented. The serum values for complete blood count (CBC), blood urea nitrogen (BUN), creatinine (Cr), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were checked to assess for complications. Results: Most patients in both groups had type II DAI (46%). There was no significant difference between groups in the GOS-E scores after 3 and 6 months. All participants were in moderate or severe classes of MMSE with no statistically significant difference. Except for the higher BUN level in the cyclosporine treated group, 48 h after admission (P = 0.012), the difference in the level of Cr, AST, ALT, and ALP was not significant and all were in the normal range. The CBC results showed only significant difference for White Blood Cell (WBC) count at 12 h (P = 0.000). Conclusion: The administration of CsA is not effective in the improvement of consciousness and cognitive function. However, it brings about no adverse effects.

Background: Axonal polyneuropathy (APN) is a common kind of neurologic disorders, which is normally diagnosed by electrodiagnostic methods. Different muscles were studied to find a muscle, which can be considered as a reliable site for early diagnosis of mild APN; this muscle should be easily activated by patient, has the highest sensitivity to EMG changes of APN, and has the lowest rate of false positive results in normal subjects. Materials and Methods: Based on the inclusion and exclusion criteria, 32 patients were recruited, and all of them underwent needle EMG of 3 different muscles including Peroneus tertius (PT), tibialis posterior (TP), and dorsal interoseous pedis (DIP). EMG Findings of different muscles [Motor Unite Action Potential (MUAP) duration, MUAP amplitude, polyphasic MUAP, fibrillation potential (FP), and the ability of subjects to contract special muscle] were recorded and compared. Results: Mean of MUAP amplitude was significantly different between all 3 muscles (P-values < 0.001). PT showed a significantly higher frequency of polyphasic MUAP than others (P-value: 0.001). The frequency of FP was significantly lower in TP than PT and DIP (P-values: 0.03 and 0.001, respectively). DIP showed significantly shorter MUAP duration than PT and TP (P-values 0.002 and 0.003, respectively). All cases were able to activate TP and PT voluntarily though only 20 patients could activate DIP (P-value < 0.0001). Conclusion: The higher frequency of polyphasic MUAP, the higher frequency of FP, and finally, the ability of all patients in activation of PT voluntarily, all support the usefulness of PT for EMG studies in APN patients.

Background: Despite different treatments, cerebral vasospasm is still the most important cause of death in patients after subarachnoid hemorrhage. This study was conducted to explore the effect of intracisternal washing with papaverine on cerebral blood flow. Materials and Methods: This study was performed on 40 patients and totally 120 arteries in 2010. Then, variations in cerebral blood flow before and after washing with papaverine were measured and analyzed. Results: Twenty (20) patients with aneurysm of the anterior communicating artery (ACOM) and 20 patients with aneurysm of the middle cerebral artery (MCA) were assessed. Mean blood flow before aneurysm and before washing in ACOM and MCA was 70.68 ± 14.8 cm/s and 65.66 ± 9.3 cm/s, respectively, which reached 23.25 ± 5.17 cm/s and 34.1 ± 4.7 cm/s, respectively after washing (P value = 0.016 and 0.024). Mean blood flow after aneurysm and before washing in ACOM and MCA was 95.12 ± 13.9 cm/s and 67.44 ± 15.16 cm/s, respectively, which reached 35.69 ± 6.2 cm/s and 38.01 ± 8.28 cm/s, respectively after washing (P value = 0.001 and 0.01). Conclusion: Washing with papaverine significantly reduces cerebral blood flow and relieves vasospasm.

Background: Due to the heterogeneity of traumatic brain injury (TBI), many of single treatments have not been successful in prevention and cure of these kinds of injuries. The neuroprotective effect of progesterone drug on severe brain injuries has been identified, and recently, the neuroprotective effect of vitamin D has also been studied as the combination of these two drugs has shown better effects on animal samples in some studies. This study was conducted to examine the effect of vitamin D and progesterone on brain injury treatment after brain trauma. Materials and Methods: This study was performed on patients with severe brain trauma (Glasgow Coma Scale (GCS) ≤ 8) from April to September, 2011. The patients were divided to 3 groups (placebo, progesterone, progesterone-vitamin D), each with 20 people. Upon the patients′ admission, their GCS and demographic information were recorded. After 3 months, they were reassessed, and their GCS and GOS (Glasgow outcome scale) were recorded. The collected data were analyzed using SPSS 18 software (SPSS Inc., Chicago IL, USA). Results: Before intervention, GCS mean of the placebo, progesterone, and progesterone-vitamin D groups were 6.3 ± 0.88, 6.31 ± 0.87, and 6 ± 0.88, respectively. They increased to 9.16 ± 1.11, 10.25 ± 1.34, and 11.27 ± 2.27, respectively 3 months after intervention. There was a significant difference among GCS means of the 3 groups (P-value = 0.001). GOS was classified to 2 main categories of favorable and unfavorable recovery, of which, favorable recovery in placebo, progesterone, and progesterone-vitamin D was 25%, 45%, and 60%, respectively which showed a statistical significant difference among the groups (P-value = 0.03). Conclusion: The results showed that recovery rate in patients with severe brain trauma in the group receiving progesterone and vitamin D together was significantly higher than that of progesterone group, which was in turn higher than that of placebo group.