RCAAP Repository

ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

ABSTRACT Objectives: Determine the most prevalent type of curve in our population, to quantify the radiographic parameters such as PT, IP, SS and compare the physical function according to ODI and SRS-22r. Methods: Retrospective, observational, longitudinal, single-center study, carried out from January 2010 to May 2015 at the Centro Médico ISSEMYM Ecatepec, Spine Surgery Service. Results: A total of 60 patients were obtained, 60% female, with curvatures according to SRS-Schwab, type T (28%), TL (46.6%), D (15%), N (10%), with a mean preoperative VAS of 7 for all curves and post-surgical 2 after 6 months. The SRS-22r preoperative test was 2.1 and postoperatively was 3.75, with p<0.001. Conclusions: Deformities of the adult spine are a growing disease in our country. The surgical management of deformities requires proper clinical and radiographic planning. Patients undergoing surgical treatment in our study showed curvature type TL and demonstrated significant improvement in ODI and SRS-22r.

ABSTRACT Objective: To conduct a descriptive study to find measures of central tendency in the vertebral bodies L3, L4, and L5 in the Mexican population. Methods: Fifty patients were considered, 33 male and 17 female, aged between 30 and 55 years. Measurements were performed at the levels L3, L4 and L5 taking the interpedicular distance (A), mid-sagittal diameter (B), anteroposterior distance (AP) and the depth of lateral recess (R) in axial 2-mm sections of CT scans (Somaton Emotion, SIEMENS, 2 sections) in a Mexican population with healthy vertebral bodies, with no history of lumbar pathology. Results: Overall, the measures obtained were mean interpedicular distance of 22.80 in L3, range of 16.34/28.72. In L4, mean of 23.83, range of 17.62/27.92. In L5, mean of 25.28, range of 21.88/31.29. Conclusions: This study managed to make a database that did not exist in Mexico, using measures of central tendency. Therefore, it opens the way for it to be possible, in future studies, to identify predictive factors or even developing implants.

ABSTRACT Objective: To compare the postoperative clinical course of placement of interspinous spacer with open technique (ISO) with percutaneous interspinous spacer (PIS). Methods: Quasi-experimental, longitudinal study of 42 patients with discogenic pain uncontrolled with analgesics, aged 35-55 years old, 21 women, and 21 men. Clinical history, location of pain, VAS scale before and after surgery, Oswestry Disability Index and Macnab modified scale at 6 months were used. Results: When performing quantitative analysis statistical significance (p = 0.0478, 0.0466, 0.0399) was demonstrated with Student's t test between the results according to VAS scale; in the qualitative analysis with the Oswestry index and Macnab modified scale it was demonstrated the hypothesis that the results is dependent of the surgical technique. Conclusions: According to the results, we can conclude that there is a statistically significant difference depending on the surgical technique used with respect to the rate of disability and functionality in daily life as well as in the improvement of pain symptoms.

Abstract Background: The occurrence of minute-ventilation oscillations during exercise, named periodic breathing, exhibits important prognostic information in heart failure. Considering that exercise training could influence the fluctuation of ventilatory components during exercise, we hypothesized that ventilatory variability during exercise would be greater in sedentary men than athletes. Objective: To compare time-domain variability of ventilatory components of sedentary healthy men and athletes during a progressive maximal exercise test, evaluating their relationship to other variables usually obtained during a cardiopulmonary exercise test. Methods: Analysis of time-domain variability (SD/n and RMSSD/n) of minute-ventilation (Ve), respiratory rate (RR) and tidal volume (Vt) during a maximal cardiopulmonary exercise test of 9 athletes and 9 sedentary men was performed. Data was compared by two-tailed Student T test and Pearson´s correlations test. Results: Sedentary men exhibited greater Vt (SD/n: 1.6 ± 0.3 vs. 0.9 ± 0.3 mL/breaths; p < 0.001) and Ve (SD/n: 97.5 ± 23.1 vs. 71.6 ± 4.8 mL/min x breaths; p = 0.038) variabilities than athletes. VE/VCO2 correlated to Vt variability (RMSSD/n) in both groups. Conclusions: Time-domain variability of Vt and Ve during exercise is greater in sedentary than athletes, with a positive relationship between VE/VCO2 pointing to a possible influence of ventilation-perfusion ratio on ventilatory variability during exercise in healthy volunteers.

ABSTRACT Objective: To identify the factors associated with postoperative infections in spinal surgery. Methods: Descriptive, retrospective, cross-sectional study conducted in the spine surgery department of the Medical Unit of High Specialty (UMAE) at the Hospital of Traumatology and Orthopedics Lomas Verdes, Mexican Institute of Social Security (IMSS) between January 01, 2013 and June 30, 2014 through medical records of the service and the records of clinical care. Data were gathered in accordance with the records of patients with infection after spinal surgery. The factors considered were age group, etiologic agent, surgical site, type of treatment, bleeding volume and pharmacotherapy. Frequency and descriptive statistic was conducted. The rank sum test with the Wilcoxon test for a single sample was performed in different measurements; Pearson's correlation was calculated and all p<0.05 values were considered significant. Results: The sample was composed of 14 patients of which 11 were female (78.6%) and 3 male (21.4%) with predominance of surgical area in the lumbar and dorsolumbar region. There was a significant correlation between the surgical time and the amount of bleeding with p<0.001. Conclusions: It was clear that the infections present in patients after spinal surgery are multifactorial. However, in this study the correlation between time of surgery and bleeding amount had the highest importance and relevance.

ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1) treated with manual percutaneous nucleotomy (MPN) and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH) treated with (MPN). The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS), Oswestry Disability Index (ODI) and Macnab criteria. Descriptive and inferential statistics for differences. Results: N=110: 58 (52.72%) men, 52 (47.27%) women; average age 37.95 years (14-56) ± 10.60; most affected level: L4-L5 in 63 (57.14%) patients. NPS preoperative average: 7.75 (5-9) ± 1.12, and at 365 days: 2.14 (0-7) ± 2.37. The mean preoperative ODI was 37% (28%-40%) + 3.06, and at 365 days 9.52% (0%-40%) + 13.92. The prognosis (ODI) was good to 79 (71.81%) patients at 365 days, regular in 26 (23.63%) and poor in 5 (4.57%), corresponding respectively to patients with no, mild, moderate and severe disability. The Macnab criteria showed similar results (p = 0.00, 95% CI 0.00 to 0.13 - Student's t). Conclusions: The results were good at one-year follow-up (p = 0.00), demonstrating that the MPN is still a good option for lumbosciatic pain relief.

ABSTRACT Objective: To describe the epidemiology of 111 patients to determine the age group affected, the level of fracture, fracture classification, and type of treatment. Methods: Descriptive study of 111 cases of cervical spine fracture treated at the Hospital of Traumatology and Orthopedics Lomas Verdes - IMSS from March 2009 to October 2014. Results: The condition appeared in 88% of men. The age range was 16-81 years, with an average of 40 years. The most common fracture according to the AO classification was type A (57%). The segments most affected were C5-C6, C6-C7, C6 and C4-C5 (24.32%, 17.1%, 9.9% and 8.1%). Neurological involvement occurred in 46.8%. The most common mechanism of injury was high energy. Surgical treatment was performed in 78.4% of patients, being one-level corpectomy with placement of mesh and plate, and posterior fixation with facet screws the most appropriate procedures (31.5% and 27.9%, respectively). Conclusions: Males were the most affected, the highest incidence was in C5-C6 and C6-C7 levels and the surgical procedure was the most used.

ABSTRACT Objective: To compare the measurement of the Cobb angle in printed radiographs and digitalized radiographs displayed with the "PixViewer" tool. Methods: Pre-operative radiographs of 23 patients were performed in printed films and using the software "PixViewer". The same evaluator, a spine surgeon, chose the proximal and distal end vertebrae at the limit of the main curve in printed radiographs without identifying patients, and measured the Cobb angle based on these parameters. The same parameters and measurements were performed in digitalized radiographs. The measurements were compared, as well as the choice of end vertebrae. Results: The average change in the Cobb angle between the methods was 1.48±1.73°. The intraclass correlation coefficient (ICC) was 0.99, demonstrating excellent reproducibility. Conclusion: The Cobb method can be used to evaluate scoliosis through the "PixViewer" tool with the same reliability of the classic method on printed radiographs.

ABSTRACT Objective: To demonstrate that the extrapedicular unilateral percutaneous treatment in multiple thoracolumbar fractures is effective, minimally invasive and can treat several vertebrae at the same time in the same surgery. Method: From January 2007 to January 2015 306 patients with multiple vertebral fractures in the thoracolumbar junction of various etiologies were treated, of which 246 were women and 60 men. Results: The extrapedicular unilateral treatment shows good clinical results that are maintained over time, is performed on an outpatient basis with minimal complications, and enables rapid incorporation of patients to their daily activities. Conclusions: Our study shows that unilateral extrapedicular percutaneous kyphoplasty is an effective treatment for multiple thoracolumbar vertebral fractures. This method makes the procedure less invasive, allowing multiple levels are treated in the same surgical intervention, resulting in relief of pain and stability of the spine, minimal complications and immediate return of the patient to daily activities.

ABSTRACT The high-energy trauma mainly involves vertebral lesions and 6% occur in the cervical region. This poses a challenge to spine surgeons in surgical decision-making, both in terms of approach as the instrumentation. International recommendations establish that the procedures performed are reproducible, safe, and effective. The techniques for placement of pedicle screws are complicated and have been based on intraoperative navigation (limited by cost) and fluoroscopy (greater exposure of health care professionals and patients to radiation). Therefore, the freehand technique is an option. The goal was to identify the level of evidence and grade of recommendation in the medical literature regarding the safety and efficacy of pedicle screw instrumentation with freehand technique in subaxial cervical spine. To this end, we carried out a systematic review with the following MeSH terms: safety, efficacy, vertebral artery. Articles were evaluated twice in a standardized and blind way by two observers skilled in systematic analysis, after CLEIS 3401 authorization in November 2014. Due to the nature of the study and the variables, articles with a high level of evidence and grade of recommendation were not found. Level of Evidence obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: 2b. Degree of Recommendation obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: B, favorable recommendation.

ABSTRACT Objective: Make the cultural adaptation of the spinal appearance questionnaire (SAQ). Method: Twenty patients and their accompanying relatives responded to SAC and were asked about possible improvements. Results: Eighteen girls (90%) and two boys (10%), average age 14.8 years; Cronbach's alpha values of 0.79 and 0.75 were found for patients and parents respectively. Conclusion: The Brazilian Portuguese version of the spinal appearance questionnaire presented in this paper proves to be a valid tool for their purposes in its pre-trial phase.

ABSTRACT Objective: To evaluate the prognostic factors in the treatment of patients diagnosed with adolescent idiopathic scoliosis undergoing spinal fusion by the posterior approach. Methods: The study included 48 patients with idiopathic adolescent scoliosis (43 females and 5 males) who underwent spinal fusion by the posterior approach, with an average age at diagnosis of 12 years, and clinical signs of Risser between 3 and 4 at the time of surgery. Clinical and radiographic measurements were performed, the participants answered the SRS-30 questionnaire, and the analysis of the medical record data was performed in two occasions during the preoperative period and at the end of two years of follow-up. Results: All satisfaction measures showed statistically significant change after the procedure (p<0.05) with respect to the radiographic characteristics, except for the lumbar apical vertebral translation (p=0.540) and Cobb L1-L5 (p=0.225). Conclusion: In general, it was found that patients who received surgical treatment were more satisfied with their appearance than those who underwent conservative treatment.

ABSTRACT Objective: Evaluation of the results of the use of VEPTR (Vertical Expandable Prosthetic Titanium Rib - Synthes Spine Co.(r), West Chester, Pennsylvania, USA) as an option in spinal instrumentation without fusion in younger children with scoliosis, considering the complications inherent to spinal fusion in this age group. Methods: Sixteen (16) patients with scoliosis, regardless of etiology, with a mean age of 5.2 (3-8) years, were followed up by Spine Surgery Group at Hospital Getúlio Vargas, Recite-PE, and were submitted to surgical correction of the deformity using VEPTR, from April/2009 to July/2014. The survey was conducted through medical register review, and photographic and radiographic records, with the measurement of pre- and postoperative curves by the Cobb method. Results: The mean values of Cobb angle in the preoperative period, in the immediate postoperative period and after the last distraction were, respectively, 84.1° (112°-60°), 55.4° (92°-16°) and 64.4° (100°-16°), with an average initial correction of 28.7° (34.1%) and final correction of 19.7° (23.4%). The mean follow-up was 23.1 (0-61) months with an average distraction of 3.1 (0-8). The complication rate in this study was 62.5%. Conclusion: The VEPTR presented considerable correction rates of scoliosis curves in patients whose age contraindicate the spinal fusion methods. It is necessary to improve the technique and the implant itself in order to reduce complication rates, which can be considered relatively high, in addition to the conduction of more studies with longer follow-up to determine the actual efficacy of the implant and the maintenance of long-term correction.

ABSTRACT Objective: Selective dorsal rhizotomy (SDR) used for spasticity treatment could worsen or develop spinal deformities. Our goal is to describe spinal deformities seen in patients with cerebral palsy (CP) after being treated by SDR. Methods: Retrospective study of patients operated on (SDR) between January/1999 and June/2012. Inclusion criteria: spinal Rx before SDR surgery, spinography, and assessment at follow-up. We evaluated several factors emphasizing level and type of SDR approach, spinal deformity and its treatment, final Risser, and follow-up duration. Results: We found 7 patients (6 males): mean age at SDR 7.56 years (4.08-11.16). Mean follow-up: 6.64 years (2.16-13), final age: 14.32 years (7.5-19). No patient had previous deformity. GMFCS: 2 patients level IV, 2 level III, 3 level II. Initial walking status: 2 community walkers, 2 household walkers, 2 functional walkers, 1 not ambulant, at the follow-up, 3 patients improved, and 4 kept their status. We found 4 TL/L laminotomies, 2 L/LS laminectomies, and 1 thoracic laminectomy. Six spinal deformities were observed: 2 sagittal, 3 mixed, and 1 scoliosis. There was no association among the type of deformity, final gait status, topographic type, GMFCS, age, or SDR approach. Three patients had surgery indication for spinal deformity at skeletal maturity, while those patients with smaller deformities were still immature (Risser 0 to 2/3) although with progressive curves. Conclusions: After SDR, patients should be periodically evaluated until they reach Risser 5. The development of a deformity does not compromise functional results but adds morbidity because it may require surgical treatment.

No summary/description provided

ABSTRACT Objective: To evaluate the loss of correction after treatment of spine deformities with the technique of isolated posterior vertebrectomy. Methods: Twenty-one patients were followed-up for three years after surgery with panoramic X-rays, CT scans, SF-36 and Oswestry questionnaires. We evaluated the loss of correction, CAGE subsidence and the evolution of the pelvis-T1 angle during follow-up. The correlation among the radiographic changes and functional and quality of life scores was also assessed. Results: All patients had some degree of loss of correction and subsidence of CAGE, especially in the first year of follow-up. Such losses exerted negative impact on the function, pain and self-image of the patients. Factors such as the stiffness of the fusion mass and size of implant used appear to have contributed to the occurrence of subsidence, regardless of age and bone mineral density. Conclusions: The use of spacers with larger cross-sectional diameter and more rigid rods can reduce the overloading on the anterior column of Denis, reducing the subsidence and loss of correction. Additional stabilization strategies such as the use of orthoses postoperatively can also be useful, and should be evaluated in subsequent studies.

ABSTRACT Objective: The study aimed to determine the association between postural changes and practice of classical ballet among ballerinas from Integrated Administrative Region of Development (RIDE) in Polo Petrolina/PE and Juazeiro/BA. Methods: Cross-sectional observational study with 19 classical ballerinas aged over 15 years and at least 5 years of uninterrupted classical ballet practice. The anthropometric assessment included measurements of total body mass, height and body mass index (BMI). Postural evaluation was performed using the photogrammetric method with help of Posturograma(r) and SAPO(c) software. Results: The mean age was 25.3±11.7 years and the mean BMI was 21.4±2.9 kg/m². Approximately 74% of classical ballerinas had normal anthropometric profile. The postural profile of the classical ballerinas showed inclination and protrusion of the head, trunk rotation, rectification of cervical lordosis, increased thoracic kyphosis, increased lumbar lordosis, pelvic inclination and anteversion. Conclusion: The practice of ballet led to changes in body alignment of the classical ballerinas evaluated. The results points out to the need of postural re-education in order to contribute for the kinetic-functional balance of classical ballet practitioners.

No summary/description provided

ABSTRACT Objective: The anatomical study of the vertebrae C7 and T1 of the cervicothoracic junction aimed to evaluate quantitatively, by axial computerized tomography (CT), the linear and angular dimensions of the anatomical laminae of the vertebrae of the cervicothoracic junction C7 and T1 in adults over 18 years. Methods: We retrospectively analyzed 49 CT of the cervical and thoracic spine (C7 and T1) of individuals over 18 years, of both sexes. We also evaluated the length and thickness of the laminae, as well as spinolaminar angle in axial sections of C7 and T1 at the point of least thickness between the inner cortical layers. The variables were correlated with age groups and sex of the individuals. Statistical analysis was performed using the t test and the results were considered significant when p<0.05. Results: After analyzing tomographic measurements of 49 patients, it was found that men had greater laminae thickness than women, both in C7 and T1, with 71% of C7 laminae and 92% of T1 laminae thicker than 5mm, and 97% of C7 laminae and 100% of T1 thicker than 4mm. The mean spinolaminar angle was 56.40 degrees in C7 and 57.31 degrees in T1. Conclusion: This study brings important anatomical information about the cervicothoracic junction C7 and T1 in the Brazilian population, showing that fixation of C7 and T1 with intralaminar screws is anatomically possible.