Hossein Mehdian

The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions.

Study Design. Cross-cultural translation and psychometric testing were performed. Objectives. To cross-culturally translate the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and Quebec Back Pain Disability Scale (QDS) into Persian, and then investigate the psychometric properties of the Persian versions produced. Summary of Background Data. To the authors’ knowledge, there is no validated instrument to measure functional status in Persian-speaking patients with low back pain (LBP) in Iran. To our knowledge, the widely used back-specific measures, the ODI, RDQ, and QDS, have not been translated and validated for Persian-speaking patients with LBP. Methods. The translation and cross-cultural adaptation of the original questionnaires were performed in accordance with published guidelines. A total of 100 patients with chronic LBP were asked to complete a questionnaire booklet (the Persian versions of the ODI, RDQ, QDS, Short Form Health Survey (SF-36), and visual analog scale measure of pain). There were 31 randomly select patients with chronic LBP asked to complete the second questionnaire booklet 24 hours later. Results. The Cronbach-α for the ODI, RDQ, and QDS was 0.75, 0.83, and 0.92, respectively. The ODI, RDQ, and QDS showed excellent test-retest reliability (intraclass correlation coefficient = 0.91, 0.86, and 0.86, respectively) (P < 0.01). The correlation among the ODI, RDQ, QDS and physical functioning scales of the SF-36 was −0.66, −0.62, and −0.69, respectively (P < 0.001). The correlation among the ODI, RDQ, and QDS and visual analog scale was 0.54, 0.36, and 0.46, respectively (P < 0.001). Conclusions. The Persian versions of the ODI, RDQ, and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP.They are simple and fast scales, and the use of them can be recommended in a clinical setting and future outcome studies in Iran.

Translation and validation study of Chinese versions of the neck disability index and the neck pain and disability scale.

Study Design. Cultural translation and psychometric testing. Objective. To translate and validate the Iranian versions of the Neck Disability Index (NDI-IR) and the Neck Pain and Disability Scale (NPDS-IR). Summary of Background Data. The widely used the NDI and the NPDS scales have not been translated and validated for Persian-speaking patients with neck pain. This was to provide a validated instrument to measure functional status in patients with neck pain in Iran. Methods. The translation and cultural adaptation of the original questionnaires were carried out in accordance with the published guidelines. One hundred and eighty-five patients with neck pain were participated in the study. Patients were asked to complete a questionnaire booklet including the NDI-IR, the NPDS-IR, the Iranian SF-36, and a visual analog scale (VAS) of pain. To carry out the test-retest reliability, 30 randomly selected patients with neck pain were asked to complete the questionnaire booklet 48 hours later for the second time. Results. Cronbach &agr; coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory (ranging from 0.74 to 0.94). The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability (intraclass correlation coefficient ranged from 0.90 to 0.97; P < 0.01). The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results, indicating a good convergent validity (Pearson correlation coefficients ranged from −0.31 to −0.70). The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 (P < 0.01). Conclusion. The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran. They are simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian speaking communities.

Survivorship Analysis and Radiographic Outcome Following Tantalum Rod Insertion for Osteonecrosis of the Femoral Head

BACKGROUND For early stages of osteonecrosis, preservation of the femoral head is the primary objective; however, there has not been a consensus on how best to achieve this goal. Core decompression alone is associated with a lack of structural support with inconsistent outcomes, whereas vascularized fibular grafting requires an extensive surgical procedure with high donor-site morbidity and prolonged rehabilitation. The adjunctive use of a porous tantalum implant offers the advantages of core decompression, structural support, minimally invasive surgery, and no donor-site morbidity. The purpose of this study was to assess the survivorship and to evaluate the clinical results and radiographic outcomes of hips in which osteonecrosis of the femoral head was treated with core decompression and a porous tantalum implant. METHODS We evaluated fifty-four patients (sixty consecutive hips) in whom osteonecrosis of the femoral head was treated with core decompression and insertion of a porous tantalum implant. Fifty-two patients (fifty-eight hips) were available for follow-up at a mean of twenty-four months. All patients were sixty-five years of age or younger (mean age, thirty-five years). According to the classification system of Steinberg et al., one hip (2%) had stage-I disease, forty-nine hips (84%) had stage-II disease, and eight hips (14%) had stage-III disease. Outcome measures that were used included a limb-specific score (Harris hip score), radiographic outcome measures, and survivorship analysis with revision to total hip arthroplasty as the end point. RESULTS Overall, nine hips (15.5%) were converted to total hip arthroplasty, including six with stage-II disease and three with stage-III disease. The overall survival rates were 91.8% (95% confidence interval, 87.8% to 95.8%) at twelve months, 81.7% (95% confidence interval, 75.8% to 87.6%) at twenty-four months, and 68.1% (95% confidence interval, 54.7% to 81.5%) at forty-eight months. The absence of chronic systemic diseases resulted in a survival rate of 92% at forty-eight months (95% confidence interval, 87.4% to 96.4%). CONCLUSIONS Treatment of early stage osteonecrosis of the femoral head with core decompression and a porous tantalum implant can be accomplished with a minimally invasive technique and no donor-site morbidity. The early clinical results show encouraging survival rates in patients who do not have chronic systemic disease, especially in association with early stage disease. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure

Objective: To translate and validate the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure (Persian DASH). Design: Cultural translation and psychometric testing. Setting: Outpatient departments of orthopaedics surgery, primary care settings, rehabilitation medicine and physical therapy. Subjects: Two hundred and seventy-one consecutive Persian-speaking patients with upper extremity disorders including subacromial impingement syndrome, rotator cuff disease, epicondylitis, ulnar nerve entrapment, bursitis, instability, carpal tunnel syndrome, tenosynovitis and adhesive capsulitis. Methods: The translation and cultural adaptation of the original questionnaire was carried out in accordance with published guidelines. The participants were asked to complete a questionnaire booklet including the Persian DASH, the Short Form General Health Survey (SF-36) and a visual analogue scale (VAS) of pain. In addition, 31 randomly selected patients were asked to complete the questionnaire 48 hours later for the second time. Results: Cronbachs alpha coefficient for the Persian DASH was 0.96. The Persian DASH showed excellent test—retest reliability with intraclass correlation coefficient equal to 0.82 (P<0.01). The correlation between the Persian DASH and the functional scales of the Iranian SF-36 showed desirable results indicating a good convergent validity (Pearsons coefficients ranged from -0.25 to -0.72; P<0.001). The correlation between the Persian DASH and the visual analogue scale was 0.52 (P<0.01). Conclusions: The Persian DASH is a reliable and valid instrument to measure functional status in Persian-speaking patients with upper extremity disorders in Iran. It is simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian-speaking communities.

Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries.

Study Design. A descriptive overview of the literature. Objective. To present a comprehensive descriptive overview of the published papers about epidemiologic features, burden, and current management of low back pain (LBP) in Iran. Summary of Background Data. Little is known about the epidemiology, burden, and management of LBP in developing and low- to middle-income countries, such as Iran. Methods. A literature search was carried out using MEDLINE database to assess existing literature about prevalence, disease burden, impact, and current management of nonspecific LBP in Iran. Results. Twenty-six articles matched inclusion criteria and included in the study. The findings related to point, period, and lifetime prevalence of LBP in general population, working population, school children, and pregnant women ranged from 14.4% to 84.1%. The 1-year incidence of disabling LBP was found to be 2.1%. LBP is the third leading cause of disease burden (measured by Disability Adjusted Life Years) in Iranian population aged 15 to 69 years, without considering causes of intentional and unintentional injuries. High levels of anxiety and depression among patients with LBP and the etiological role of job strain in causing LBP in workers have been reported in Iran. Our search failed to find anyarticles about referral system, direct and indirect costs, social determinants, and current management of LBP in Iran. Conclusion. This overview of the literature illustrates that LBP is a common symptom and an important cause of disease burden in Iran, in particular, in the most productive age for both males and females. The 1-year incidence of disabling LBP in Iran was found to be low. Future research will be necessary to investigate economic cost, social determinants, health technology assessment, and management of LBP in Iran.

Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study.

Study Design. Prospective, multicenter, international observational study. Objective. To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD). Summary of Background Data. The neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study. Methods. The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively. Results. A total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge. Conclusion. Although complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted. Level of Evidence: 3

Reliability and validity of the persian version of the scoliosis research society-22r questionnaire.

Study Design. Cross-sectional validation study to investigate psychometric properties of adapted Persian version of the Scoliosis Research Society-22r (SRS-22r) questionnaire. Objectives. To translate the SRS-22r into Persian and to evaluate the internal consistency, reliability, and validity of the Persian SRS-22r. Summary of Background Data. The SRS-22r has not been translated and validated for Persian-speaking patients with idiopathic scoliosis. This was to provide a validated instrument to measure health-related quality of life in patients with idiopathic scoliosis in Iran. Methods. The translation and cultural adaptation of the original questionnaire were carried out in accordance with the published guidelines. About 84 patients with adolescent idiopathic scoliosis were participated in the study. The Short Form Health Survey (SF-36) was used to test convergent validity of the Persian SRS-22r. Results. Moderate to high correlations were found between the SRS-22r domains and SF-36 subscales. The correlations ranged from 0.54 to 0.67 (function/activity domain), 0.48 to 0.74 (pain domain), 0.45 to 0.55 (self image domain), 0.66 to 0.85 (mental health domain), and 0.35 to 0.55 (satisfaction domain) (P < 0.01). One-way analysis of variance showed that the Persian questionnaire successfully discriminated between patients undergoing observation, brace, and surgical treatments (P < 0.05). Cronbach alpha coefficient for the Persian SRS-22r domains ranged from 0.68 to 0.78. The Persian SRS-22rdomains showed satisfactory test-retest reliability with Intraclass Correlation Coefficient ranged from 0.79 to 0.87 (P < 0.01). Conclusion. The Persian version of the SRS-22r has satisfactory reliability, convergent validity, and discriminant validity to measure health-related quality of life in adolescent patients with scoliosis in Iran. It is simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran.

Surgical decompression: a life-saving procedure for an extensive spinal epidural abscess

Extensive spinal epidural abscesses (SEAs) carry a high mortality rate. Traditionally they are treated non-operatively with longterm antibiotics and/or surgical decompression, but there is a continuing debate as to whether they should be managed by emergency surgical decompression. However, such decisions are made in the light of the clinical setting. We report the successful management of a female patient who presented with features of upper cervical cord compression and later developed septic shock and multisystem failure. Surgical decompression of the cervical spine and irrigation of the epidural space with a paediatric catheter was performed followed by tricortical strut grafting and plating. At review, 36 weeks after surgery, the patient remained asymptomatic, having made full neurological recovery. The purpose of this report is to highlight the importance of emergency surgical intervention for extensive SEA in the presence of progressive neurological loss associated with multisystem failure.

Painful scoliosis secondary to osteoblastoma of the vertebral body

Abstract A 19-year-old boy with a painful thoracolumbar scoliosis was found to have an osteoblastoma of the body of T12. Excision of the tumour was carried out through a left thoracotomy approach and strut bone grafting was performed. Complete excision of the tumour was facilitated by intraoperative radiographs of the removed vertebra. Following surgery the patient’s pain resolved completely and the deformity was partially corrected. Osteoblastoma of the vertebral body in the thoracolumbar region has not previously been reported. Diagnosis may be difficult unless the significance of the association between pain and the scoliosis is appreciated. The tumour is often not readily apparent on plain radiographs. Therefore, further radiological investigation in the form of a bone and CT scan is necessary to establish the diagnosis. Early excision of the tumour is essential to prevent a permanent structural scoliosis from developing.

Atlanto-axial dislocation without fracture: case report of an ejection injury.

We describe an unusual injury to the upper cervical spine sustained during ejection from an aircraft. MRI provided an accurate and direct diagnosis of the severe ligamentous injuries.