Background: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. Objectives: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. Methods: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). Results: The study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r =-0.400, P < 0.001) and BMI (r =-0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r =-0.569, P < 0.001). Conclusions: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.

Introduction: Os odontoideum (OO) is a form of odontoid anomaly presented by a separate ossicle with a smooth, sclerotic border not fused with C2 body. The current paper reports a boy with irreducible displaced os odontoideum with severe neurologic deficit after a minor trauma. Case Presentation: A 16-year-old boy admitted in the center due to neck pain and torticollis with neurologic deficit. He had a history of multiple minor traumas. Advanced imaging assessment demonstrated displaced os odontoideum with minimal space available for cord (SAC) and myelomalacia. After unsuccessful closed reduction a 2-stage operation was planned: first, the anterior transoral release and odontoid resection with subsequent halo-traction and second, the posterior atlanto-axial instrumented fusion with bilateral C1 hook and C2 pedicular screws. Conclusions: Congenital anomalies of the odontoid are associated with C1-C2 instability that can be subluxated or dislocated with minor trauma and cause permanent neurologic deficit or even death. When acute cervical spine trauma is imaged, os odontoideum should be distinguished from an acute dens fracture with a multimodality imaging approach including computed tomography (CT), magnetic resonance imaging (MRI) and radiography. Here is the report of a rare case with irreducible displaced os odontiodeum treated him with anterior release, odontoid resection and posterior C1-C2 instrumented fusion.

Congenital kyphosis is a less common spinal malformation, which can progress and cause neurological deficits. The treatment of severe cases is complicated. There are several techniques of surgical intervention for the correction of kyphosis, but the selection of surgical methods is entirely dependent on the patient’s condition. This article reports a 14-year-old girl with severe congenital kyphosis, who underwent hemiepiphysiodesis at age 2. Last year, her neurological deterioration began and led to paraplegia over a couple of months. To treat her, we performed 2-stage multi-level vertebral column resection (Schwab type 6). First, she underwent anterior T12-L1-L2 complete corpectomy and cord decompression. Then, the resection of posterior elements from T12 to L2 and posterior fusion with instrumentation from T8 to L5 were performed. However, concerning this kind of severe deformity, we suggest using 3D planning, which facilitates the operation.

Background: There are different classifications for adolescent idiopathic scoliosis (AIS), among which Lenke classification is the most recent and comprehensive method. It is 3 dimensional and treatment organized. In most previous studies, thoracic hypokyphosis was more common, but it may be different in many patients. Objectives: The current study aimed at assessing the prevalence of thoracic hyperkyphosis in AIS for the first time in Iranian population. Methods:The study was performed retrospectively on 242 patients with AIS treated surgically in the university hospital from 2009 to 2014. Three parameters were evaluated in each patient including the 6 curve types of Lenke classification, thoracic sagittal balance, and lumbar spine modifier. Results: Adolescent idiopathic scoliosis was more common in female patients (83.5%). Type one curve was the most common type (48%). In lumbar spine modifier, type A was the most common (44%), similar to other studies. Hyperkyphosis was the most common type of thoracic sagittal balance (54%), which was in contrast to the original study by Lenke. The mean thoracic sagittal balance was hyperkyphosis in all Lenke types except type 5, which was normal. No relationship was found between the prevalence of thoracic kyphosis, and lumbar spine modifier, or the 6 types of Lenke classification. Conclusions:The frequency of different types of curves in Iranian population was the same as that of the original article by Lenke except that in the current study more thoracic hyperkyphosis was observed than hypokyphosis in the population.