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BACKGROUND: This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients. METHODS: Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput–C2, C1–C2, and C2–C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured. RESULTS: The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2–C7 angle, C1–C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups. CONCLUSIONS: We found that changes at C2–C7 angle, C1–C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.

Many studies evaluated the effect of systemic tranexamic acid (TXA) administration on blood loss reduction during spine in the past decade. However, topical use of TXA during cervical spine surgery is rarely investigated. The present study was conducted to assess the role of topical administration of TXA on intraoperative and postoperative blood loss of patients undergoing posterior cervical laminectomy and lateral mass screw fixation (PCLF) compared to a control group.The data of 88 patients that underwent PCLF surgery, including 41 females and 47 males, were included in this retrospective study. Data elements including intraoperative blood loss (IBL), postoperative blood loss (PBL), amount of blood transfusion, surgical time, use of hemostatic agents, length of hospital stay, and time to return to work were extracted from medical records and compared between those who received topical TXA during surgery (irrigation of the surgical field with a solution of 3 g TXA in 100 ml normal saline) and an age- and sex-matched control group.There were 48 patients in the TXA group and 40 patients in the control group. There were no significant differences in the baseline measurements and the level of operation between the two groups. The results showed that IBL and PBL were significantly lower in the TXA group compared to the control group (p= 0.03 and p 0.01, respectively). There were no significant differences in the need for blood transfusion, surgical time, and hospital stay between the two groups (p 0.05). Moreover, the use of hemostatic materials during surgery and the time to return to work were significantly lower in the topical TXA group (P= 0.04 and p 0.01, respectively).Topical TXA efficiently reduces intraoperative and postoperative bleeding in patients undergoing posterior cervical laminectomy and lateral mass screw fixation (PCLF) surgery. These results need further investigation in future studies to draw a definite conclusion.

Background: Percutaneous iliosacral screw fixation in posterior pelvic ring fractures is challenging and commonly performed under fluoroscopy or navigation techniques. This study aimed to assess the safety and efficacy of percutaneous iliosacral screw implantation under fluoroscopy guidance with only inlet and outlet views. Methods: This retrospective study included 58 consecutive unstable posterior pelvic injury patients (36 sacral fractures and 22 sacroiliac joint disruptions) treated with percutaneous iliosacral screws between January 2015 and November 2019. Acceptable inlet radiographs show the anterior cortex of the S1 body superimposed on the S2 body. Acceptable outlet radiographs show the superior pubic symphysis at the level of the S2 foramen and visualize the S1 and S2 sacral foramina. In our technique, the screw was inserted at the inferior half of the outlet view and the posterior half of the inlet view. The time needed for screw insertion and the radiation exposure time was recorded. Intra and postoperative complications were documented. Postoperative computed tomography (CT) scans assessed screw position. Results: In total, 69 iliosacral screws were inserted in 58 patients. In postoperative CT scans, the screw position was assessed, 89.8% were in a secure position, and 10.2% had malposition. The mean operation time per screw was 21.18 min and the mean fluoroscopy time per screw was 112 s. There was no evidence of wound infection or iatrogenic neurovascular injury. No reoperation was performed. Conclusion: Percutaneous iliosacral screws can be placed using the only outlet and inlet fluoroscopic views with comparable radiological and clinical outcomes to the conventional method.

Surgical decompression, deformity correction, and instrumentation of the upper cervical spine are challenging problems in cervical kyphosis, especially in infants and pediatrics. According to patients' age, surgical exposure is difficult and selecting the appropriate instrument for rigid fixation is crucial. In this article, we present a case of 2 years old with cervical angular kyphosis, which was approached posteriorly at first. Through posterior approach, C3–C5 laminectomy with complete excision of spinous process was performed. Then, the patient's position was changed to supine and C3–C5 corpectomies were performed anteriorly with a longitudinal incision, and the thecal sac was decompressed. A titanium cage with appropriate size and graft was placed after possible deformity correction conducted with head traction and neck extension. Anterior fixation was performed with two, 2-mm T-shaped metacarpal plates with two screws in C2 and four screws in C6. The patient's position was changed to prone again, and posterior fixation was done with two metacarpal plates located on lateral masses. We showed that a novel technique in correction and fixation of cervical kyphosis in pediatric is using metacarpal plates while they are fixed to lateral masses.

Background: The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years9 follow-up. Methods: In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records—including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications—were recorded. Results: The mean preoperative Cobb angle of major curve in coronal plan was 97.5° (range, 82°–131°) with the mean flexibility of 21.4° (range, 10°–25°) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.8° (range, 17°–61°), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5–9) vertebral segments were osteotomized. We experienced no major complications. Conclusions: We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.

There are many proposed core stability exercises in a variety of positions; however, it is not clear that in which position, activation of transverse abdominis muscle is utmost. We aimed to compare the activation of transverse abdominis muscle in different core stability exercise positions through ultrasound imaging. in a 20 subjects' study we compared the effectiveness of drawing-in and bracing maneuvers on transverse abdominis in different core stability exercise positions (supine, hook lying, supine with 90° flexed knee and hip, supine with stretched knees and 90° flexed hips, bridge, bridge with one stretched knee and Bird dog). We used activation ratio and preferential activation ratio as measurements of transverse abdominis activation. Abdominal Bracing in the bridge position showed the highest activation of transverse abdominis (P

Diffuse idiopathic skeletal hyperostosis (DISH) also known as Forestier disease is a noninflammatory, systemic skeletal disease of unknown etiology. DISH is usually asymptomatic but may compress the posterior wall of the aero digestive tract and lead to dysphagia, globus, hoarseness, stridor, dyspnea, and neurological problems. Although dysphagia is not uncommon among the presenting symptoms of DISH but dysphonia and stridor are rarely reported. We report a 68-year-old man who presented with a history of progressive dysphagia over 1 year and recent dysphonia and stridor secondary to cervical osteophytes. We discuss the symptoms, radiological features, and management of this uncommon case of DISH in conjunction with review of literature.

Background: One of implants which is used for fixation of hip fracture (HF) is dynamic hip screw (DHS). Because of the destruction of the head of femur, or even acetabulum, during the cut out process or because of severe osteoporosis, refixation of fracture may be impossible. In this time, total hip arthroplasty (THA) is a good option. Objectives: In this study, we try to retrospectively evaluate the results THA after DHS failure. Materials and Methods: This retrospective study was undertaken in Sina hospital, Tehran, Iran, from 2004 to 2014, and included all patients with intertrochanteric HF which was initially fixed with DHS and failed, that was further treated with THA. Results: In the total of 52 patients, nail cut out was responsible for 49 cases (94%) of DHS failure, whereas in three cases (6%) it was the fracture of the side plate. Pre-operative Harris hip score ranged from 30 to 50 (average 36) and post-operative score ranged between 65 and 90 (average 85). There were 12 cemented cups and 40 cementless cups. Fourteen standard stem and 38 long stem were used. Twelve of the 14 standard stems were cemented. Posterior approach was used in 45 cases and direct lateral approach was used in the remaining seven cases. Prophylactic wiring was done in 46 cases. Intraoperative penetration of the floor of acetabulum occurred in two cases. Constrained liner was necessary in five cases, three of which because of sever osteoporosis of trochanter and insecure fixation of it after fracture and two because of recurrent dislocation. Conclusion: For achieving good results, the THA, after failure of DHS, requires the use of posterior approach, extremely careful acetabular reaming, prophylactic wiring of femur and the passing of the holes of screws with long stems.

In younger adults with fractures of the femoral neck, anatomic reduction is compulsory and maintaining the reduction is crucial. Both cannulated screws and dynamic hip screw (DHS) have the capacity of compression in the fracture site but the strength for keeping reduction is not the same. The aim of this study was to compare the results with fixations of the femoral neck fractures with cannulated screws versus dynamic hip screw. This is a randomized clinical trial study on 58 cases with a minimum of one year follow-up. Leg length discrepancy, Harris Hip Score, infection, avascular necrosis of femoral head, and union of the fracture site were evaluated. There were two failures in the first trimester in the cannulated screw group and three more failures in the second and third trimesters in this group. In the DHS group, there was no reduction and fixation failure in the follow-up period. There was no fixation failure (0 %) in Group B (DHS) but there were five fixation failures (18 %) in Group A (screw), and there is significant difference between the groups (p