Background:Deep vein thrombosis (DVT) is a great postoperative challenge in all orthopaedic surgeries. To the authors' knowledge, this study is the first to evaluate the efficacy of aspirin administration in the prevention of DVT in patients undergoing lumbar spinal surgery. Methods:In this double-blind parallel randomized clinical trial, a total of 126 candidates (age 40 yr and older) were admitted between June 2021 to December 2021. Patients were randomly assigned to the intervention chemoprophylaxis group (41 patients receiving 325 mg aspirin) and controls. The DVT occurrence was recorded by clinical features (Well's criteria), Doppler lower limbs ultrasound, and D-dimer levels in all participants at baseline (24 hr before the time of surgery) and 2, 6, and 12 wk after surgery in postoperative visits. Results:The mean age of the participants was 63.72 ± 6.87 yr. Baseline demographic values were similar in both groups (P > 0.05). The mean follow-up duration was 6.11 ± 2.33 mo. No cases of DVT or abnormal findings on Doppler ultrasound were observed in either group. The mean duration of hospitalization or intensive care unit (ICU) admission was similar between the two groups. Mean baseline D-dimer levels were significantly higher in the intervention group compared with the controls (P = 0.047), while it was similar in both groups 3 mo after the operation (P = 0.13). Conclusions:In the current study, no case of DVT was observed in either study group. These data do not support the use of aspirin as an anticoagulant for DVT prophylaxis following regular lumbar spinal surgeries.

Background: Treatment of adolescent idiopathic scoliosis (AIS) is one of the most challenging problems for spine surgeons. Although it has been previously demonstrated that curve pattern in AIS is different between males and females, there are, however, limited studies specially focused on the differences of AIS characteristics between the two genders. Objectives: In current study, we compared the demographics and curve patterns in male and female patients with AIS. Patients and Methods: A total of 68 girls and 17 boys with AIS were included in this cross-sectional study. The magnitude of curvature, thoracic kyphosis, flexibility and pattern of the deformity were measured on x-rays and compared between the two genders. Results: Although girls were significantly younger (15.3 ± 2.5 versus 16.7 ± 2.1 years; P = 0.036), however, the Risser sign was the same. Most of the males were hypokyphotic (70.6%), while most of the girls had normal thoracic kyphosis (69.1%) (P = 0.001). The main scoliotic curve (77.2 ± 18.2 versus 59.6 ± 18.6 degrees) and flexibility (25.5% ± 18.2% versus 41.9% ± 18.6%) were significantly greater and lower in males, respectively (P < 0.05). The typical AIS pattern was present in 64.7% of boys and 95.6% of girls (P < 0.001). Conclusions: The radiographic characteristics of AIS are substantially different between genders. In male patients, AIS is more severe and rigid compared to females. Also, hypokyphosis and atypical pattern of AIS are common findings in males compared to females.

Background: Patients with idiopathic scoliosis are exposed to repetitive x-ray for angle measurement. Therefore, the discovery or development of alternative techniques with less radiation has continuously been a major concern. Objectives: In this study, we compared the Cobb angles on supine Magnetic Resonance Imaging (MRI) with those on standing plain radiographs to figure out how precisely the supine MRI can show the real curve. Consequently, the need for certain exposures throughout the management of idiopathic scoliosis might be eliminated. Methods: A total of 103 patients with idiopathic scoliosis were included in this prospective study. The standing radiographs and supine MRI were obtained with less than a 1-month time lag. One senior author assessed Cobb angles of the major curves were on both standing radiographs and MR images. All the eligible patients had already signed the consent for diagnostic imaging, including MRI. The individuals, who were not requested for x-ray and MRI, were excluded from this study. Results: The Mean±SD Cobb angle was 55.5±11.2°‎‏ on the standing plain radiographs and 44.5±10°‎‏ on MR images (P<0.001). The Mean±SD difference between the Cobb angles on the standing plain radiographs and MR images was 11±1.4°‎‏. A significant positive correlation was found between the Cobb angles calculated on plain radiographs and MRI (r=0.996, P<0.001). Accordingly, Cobb angles on MRI could be converted to Cobb angles on plain radiographs under the formula of MRI=0.9* XRAY-5.31 (absolute error of 5.31°‎‏). Conclusion: Cobb angles on supine MRI correlates with measured ones on standing radiographs with an acceptable range of error and could be used as a valuable alternative for radiographic Cobb angle measurement.

Background Although various pharmacological and nonpharmacological treatments are available for the chronic low back pain (CLBP), there is no consensus on the best optimal treatment for this condition. This study aimed to investigate the efficacy of co-administration of pregabalin and agomelatine versus pregabalin with placebo to treat CLBP. Methods Forty-six CLBP patients without the surgical indication referred to the outpatient orthopedic clinic of Rasoul-e-Akram Hospital, Tehran, Iran, were randomly divided into two study groups: Group A [pregabalin (75 mg twice per day) + placebo] and Group B [pregabalin (75 mg twice per day) + agomelatine (25 mg per night)]. Patients were evaluated at weeks 0, 4, and 8. Outcome measures were the Persian versions of the Brief Pain Inventory (BPI) interference scale, Roland-Morris Disability Questionnaire (RMDQ), The Hospital Anxiety and Depression Scale (HADS), 36-Item Short Form Survey (SF-36), and General Health Questionnaire-28 (GHQ-28) were used. Results At weeks 4 and 8 after the intervention, all evaluated measures showed significant improvement in both study groups (P < 0.01). The mean improvement of GHQ-28 was 3.7 ± 1.22 in group A and 13.1 ± 4.71 in group B. This difference was statistically significant (P = 0.003). Other outcomes did not vary substantially between the two research groups. Agomelatine treatment was well tolerated, with no significant adverse effects seen in patients. Liver tests of all patients were routine during the study period. Major adverse effect was not seen in any patient. The prevalence of Minor side effects was not significantly different between two study groups. Conclusion Compared with the pregabalin and placebo, co-administration of pregabalin and agomelatine had no added effect on improving pain scores in CLBP patients. However, the patients’ general health was significantly improved after the combined administration of pregabalin and agomelatine. Trial registration The study protocol was registered in the Iranian Registry of Clinical Trials before starting the study (NO.IRCT20200620047852N1, Registration date: 23/06/2020).

Purpose: Scoliosis is a three-dimensional deformity of the spine in which the resulting imbalance accompanied by the changes in muscle and nervous components can harm the postural control. Various treatments have been suggested so far to correct scoliosis, in which using corrective exercises along with brace are essential to limit the growing curvature, improve spine stability and postural control, and reduce the degree of curvature. Methods: Our case was a 14-year-old girl who had a 40-degree thoracic curve (T6 to T11) toward the right and a 50-degree lumbar curvature (T12 to L4) toward the left. To evaluate her scoliosis, we took side view radiography for 4 to 6 months. Also, we used balance master posturography to assess the patient's postural control before and after the intervention. The patient's treatment process included a long-term implementation of a corrective exercise protocol in 3 phases plus using the Milwaukee brace. Results: The Cobb angle in the kyphosis curve showed a 15-degree improvement. Also, the Cobb angle showed a 32-degree correction in the thoracic curve and a 30-degree reduction in the lumbar curve. A significant improvement was observed in all of the tests of postural control, indicating improved balance and postural control of the subject during corrective exercises. Conclusion: Simultaneous using the brace and long-term corrective exercises with emphasis on the improvement of postural control could be useful in improving the scoliosis curves in an adolescent girl with idiopathic scoliosis.

Background: Recent studies have revealed the increasing importance of sagittal spinopelvic alignment. Knowing the values of sagittal spinopelvic parameters, which are affected by ethnicity, is essential in the normal asymptomatic population. In the current study, these parameters were measured in a sample of asymptomatic Iranian population. Methods: Seventy asymptomatic participants without complaint of musculoskeletal problems were enrolled. They had no complaint about musculoskeletal problems. Lateral full-length spinal and pelvic x–rays were taken. The following parameters were measured on x-rays and presented as mean ± standard deviation: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), lumbar tilt (LT) and thoracic tilt (TT). Results: The population consisted of 37 males and 33 females aged 26.6 ± 4.27 years. The mean values of PI, SS, PT, LL, TK, LT, and TT were 44.5 ± 10.1, 35.4 ± 6.7, 9.1 ± 7.9, 41.9 ± 14.7, 28.8 ± 8.3, 11.9 ± 7.4 and –7.5 ± 5.7 (median: –10; 5th percentile: –14; 95th percentile: 4.4) degrees, respectively. The variables were similar between males and females except for LL which was significantly higher in females (37.8 ± 16.5 versus 46.5 ± 11; P = 0.013). In addition, the linear regression model revealed age to be independently related with PI (beta = 0.344; P = 0.004) and PT (beta = 0.366; P = 0.002). PI (r = 0.344, P = 0.004) and PT (r = 0.359, P = 0.002) were positively correlated with age. Additionally, PI was positively correlated to SS, PT and LL and negatively to TT. Conclusion: These findings may be used as referential values for sagittal spinopelvic parameters in the Iranian population. The positive correlation of PI with age questions the constancy of PI throughout life. However, larger studies are required.

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This is an extremely rare case of scapular winging following posterior spinal fusion for correction of adolescent idiopathic scoliosis in an 18‐year‐old boy due to iatrogenic injury to a long thoracic nerve. Scapular winging manifested 5 days after the operation and spontaneously improved after 7 months.