Tomographic Evaluation Of The Placement Of Pedicle Screws Used In Deformities Of The Thoracic And Lumbar Spine Based On The "free Hand" Technique [avaliação Tomográfica Do Posicionamento De Parafusos Pediculares Em Deformidades Na Coluna Torácica E Lombar Introduzidos Com Base Na Técnica "free Hand]

Objective: To evaluate the placement of pedicle screws in the vertebrae of the thoracic and lumbar spine in patients with scoliosis using the"free hand" technique. Methods: Evaluation of CT scans of 284 pedicle screws in 15 patients (seven men and eight women) aged between 12 and 39 years (mean 16.7 years) with scoliosis. The screws were inserted from T2 to S1 for the following conditions: two congenital scoliosis and 13 neuromuscular, to evaluate the placement of screws in relation to the walls of pedicles. Results: Regarding the cortical pedicle screws, 244 (86%) were positioned between the cortical or just touching it. Lateral cortical lesion was seen in 16 screws and medial cortex lesion in 13 screws, being greater the number of violations in the thoracic vertebrae. Conclusion: The use of pedicle screw instrumentation in thoracic and lumbar vertebrae for scoliosis proved safe and effective when applied to different levels with the "free hand" technique. In the thoracic vertebrae, the pedicular cortical violations were more frequent, but did not impair the stability of fixation and did not injure the neural, vascular and visceral structures.104321324Youkilis, A.S., Quint, D.J., Mcgillicuddy, J.E., Papadoupoulos, S.M., Stereotactic navigation for placement of pedicle screws in the thoracic spine (2001) Neurosurgery, 48 (4), pp. 771-778Kim, Y.J., Lenke, L.G., Thoracic pedicle screw placement: Free-hand technique (2005) Neurology India, 53 (4), pp. 512-519Grauer, J.N., Vaccaro, A.R., Brusovanik, G., Girardi, F.P., Silveri, C.P., Cammisa, F.P., Evaluation of a novel pedicle probe for the placement of thoracic and lumbosacral pedicle screws (2004) J Spinal Disord Tech, 17 (6), pp. 492-497Kim, Y.J., Lenke, L.G., Cheh, G., Riew, K.D., Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: A comparison with computerized tomography (2005) Spine, 30 (18), pp. 2084-2088. , DOI 10.1097/01.brs.0000178818.92105.ecKim, Y.J., Lenke, L.G., Bridwell, K.H., Cho, Y.S., Riew, K.D., Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe (2004) Spine, 29 (3), pp. 333-342. , DOI 10.1097/01.BRS.0000109983.12113.9BDefino, H.L.A., Filho, J.M., Morphometric study of the pedicle of thoracic and lumbar vertebrae (1999) Revista Brasileira de Ortopedia, 34 (2), pp. 97-108De Marco, F.A., Risso Neto, M.I., Cavali, P.T.M., Sussi, M.A., Pasqualini, W., Landim, E., Avaliaçãodo posicionamento de parafusos pediculares na coluna torácica e lombar introduzidos com base em referenciais anatômicos e radioscópicos (2008) Coluna/Columna, 7 (1), pp. 1-7Rodrigues, L.M.R., Nicolau, J.R., Puertas, E.B., Wajchenberg, M., Avaliação tomográfica dos parafusos pediculares torácicos nas escolioses idiopáticas (2008) Coluna/Columna, 7 (2), pp. 139-142Ul Haque, M., Shufflebarger, H.L., O'Brien, M., Macagno, A., Radiation exposure during pedicle screw placement in adolescent idiopathic scoliosis: Is fluoroscopy safe? (2006) Spine, 31 (21), pp. 2516-2520. , DOI 10.1097/01.brs.0000238675.91612.2f, PII 0000763220061001000019Schwarzenbach, O., Berlemann, U., Jost, B., Visarius, H., Arm, E., Langlotz, F., Nolte, L.-P., Ozdoba, C., Accuracy of computer-assisted pedicle screw placement: An in vivo computed tomography analysis (1997) Spine, 22 (4), pp. 452-458. , DOI 10.1097/00007632-199702150-00020Roy-Camille, R., Saillant, G., Mazel, C., Internal fixation of the lumbar spine with pedicle screw plating (1986) Clin Orthop Relat Res, (203), pp. 1-7Castro, W.H.M., Halm, H., Jerosch, J., Malms, J., Steinbeck, J., Blasius, S., Accuracy of pedicle screw placement in lumbar vertebrae (1996) Spine, 21 (11), pp. 1320-1324. , DOI 10.1097/00007632-199606010-00008Hamill, C.L., Lenke, L.G., Bridwell, K.H., Chapman, M.P., Blanke, K., Baldus, C., The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis: Is it warranted? (1996) Spine, 21 (10), pp. 1241-1249. , DOI 10.1097/00007632-199605150-00020Amiot, L.-P., Lang, K., Putzier, M., Zippel, H., Labelle, H., Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine (2000) Spine, 25 (5), pp. 606-614. , DOI 10.1097/00007632-200003010-0001

Treatment Of Scoliosis In Children With Cerebral Palsy Using The Vertical Expandable Prosthetic Titanium Rib (veptr) [tratamento Da Escoliose Em Crianças Com Paralisia Cerebral Utilizando A Prótese Vertical Expansível De Titânio Para Costela (veptr)]

Objective: To evaluate the use of vertical expandable prosthetic titanium rib (VEPTR) as an option for initial treatment of scoliosis in younger children with cerebral palsy. Methods: We evaluated 10 patients with cerebral palsy (CP) treated with VEPTR by the group of scoliosis of the AACD in Sao Paulo. The characteristics of the subjects were progressive scoliosis and skeletal immaturity without severe deformity in the sagittal plane. We evaluated the curve by the Cobb method pre-and postoperatively and after two years of follow up. Results: The correction achieved with the use of VEPTR in the immediate postoperative period was on average 41.4% on initial radiographs without traction (p=0.005) and 9.1% (p=0.055) in the traction radiographs. Four months after surgery the gains of 27.2% were maintained compared to the baseline. There was a correction of pelvic obliquity from 10.2° preoperatively to 5.4° on average (p=0.007). Complications occurred in six patients (60%), and only one patient required removal of the VEPTR. Conclusion: The VEPTR is a method that has obtained significant correction in the temporary treatment of Scoliosis in PC, despite frequent complications with low morbidity.104317320Tsirikos, A.I., Spielmann, P., Spinal deformity in paediatric patients with cerebral palsy (2007) Current Orthopaedics, 21 (2), pp. 122-134. , DOI 10.1016/j.cuor.2007.01.001, PII S0268089007000266Banta, J.V., Drummond, D.S., Ferguson, R.L., The treatment of neuromuscular scoliosis (1999) Instr Course Lect, 48, pp. 551-562Herring, J.A., Disorders of the brain (2002) Tachjian's Pediatric Orthopaedics, pp. 1121-1248. , Herring JA, editor. Philadelphia: WB SaundersMajd, M.E., Muldowny, D.S., Holt, R.T., Natural history of scoliosis in the institutionalized adult cerebral palsy population (1997) Spine, 22 (13), pp. 1461-1466. , DOI 10.1097/00007632-199707010-00007Lonstein, J.E., Akbarnia, B.A., Operative treatment of spinal deformities in patients with cerebral palsy or mental retardation. An analysis of one hundred and seven cases (1983) Journal of Bone and Joint Surgery - Series A, 65 (1), pp. 43-55Madigan, R.R., Wallace, S.L., Scoliosis in the institutionalized cerebral palsy population (1981) Spine, 6 (6), pp. 583-590Ferguson, R.L., Allen Jr., B.L., Considerations in the treatment of cerebral palsy patients with spinal deformities (1988) Orthop Clin North Am, 19 (2), pp. 419-425Kalen, V., Conklin, M.M., Sherman, F.C., Untreated scoliosis in severe cerebral palsy (1992) J Pediatr Orthop, 12 (3), pp. 337-340Comstock, C.P., Leach, J., Wenger, D.R., Scoliosis in total-body-involvement cerebral palsy. Analysis of surgical treatment and patient and caregiver satisfaction (1998) Spine (Phila Pa 1976), 23 (12), pp. 1412-1424Cassidy, C., Craig, C.L., Perry, A., Karlin, L.I., Goldberg, M.J., A reassessment of spinal stabilization in severe cerebral palsy (1994) Journal of Pediatric Orthopaedics, 14 (6), pp. 731-739Lipton, G.E., Miller, F., Dabney, K.W., Altiok, H., Bachrach, S.J., Factors predicting postoperative complications following spinal fusions in children with cerebral palsy (1999) Journal of Spinal Disorders, 12 (3), pp. 197-205Benson, E.R., Thomson, J.D., Smith, B.G., Banta, J.V., Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis (1998) Spine (Phila Pa 1976), 23 (21), pp. 2308-2317. , Nov 1Terjesen, T., Lange, J.E., Steen, H., Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy (2000) Developmental Medicine and Child Neurology, 42 (7), pp. 448-454. , DOI 10.1017/S0012162200000840Thomson, J.D., Banta, J.V., Scoliosis in cerebral palsy: An overview and recent results (2001) Journal of Pediatric Orthopaedics Part B, 10 (1), pp. 6-9Campbell Jr., R.M., Smith, M.D., Mayes, T.C., Mangos, J.A., Willey-Courand, D.B., Kose, N., Pinero, R.F., Surber, J.L., The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis (2004) Journal of Bone and Joint Surgery - Series A, 86 (8), pp. 1659-1674Moe, J.H., Kharrat, K., Winter, R.B., Cummine, J.L., Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children (1984) Clinical Orthopaedics and Related Research, NO. 185, pp. 35-45Campbell Jr., R.M., Hell-Vocke, A.K., Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty (2003) Journal of Bone and Joint Surgery - Series A, 85 (3), pp. 409-420Hell, A.K., Campbell, R.M., Hefti, F., The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children (2005) Journal of Pediatric Orthopaedics Part B, 14 (4), pp. 287-293Allen Jr., B.L., Ferguson, R.L., The Galveston technique for L rod instrumentation of the scoliotic spine (1982) Spine, 7 (3), pp. 276-284. , DOI 10.1097/00007632-198205000-00014Oliveira, G.C., Cavali, P.T.M., Landim, E., Santos, M.A.M., Lehoczki, M.A., (2007) Instrumental de 3a Geração No Tratamento de Escoliose Em Pacientes Com Paralisia Cerebral Tetraparéticos - Análise Dos Resultados Clínico e Radiográfico Coluna/Colunma, 6 (4), pp. 201-210Motoyama, E.K., Deeney, V.F., Fine, G.F., Yang, C.I., Mutich, R.L., Walczak, S.A., Moreland, M.S., Effects on lung function of multiple expansion thoracoplasty in children with thoracic insufficiency syndrome: A longitudinal study (2006) Spine, 31 (3), pp. 284-290. , DOI 10.1097/01.brs.0000197203.76653.d0Emans, J.B., Caubet, J.F., Ordonez, C.L., Lee, E.Y., Ciarlo, M., The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: Growth of thoracic spine and improvement of lung volumes (2005) Spine, 30 (17 SUPPL.), pp. S58-S68Harrington, P.R., Treatment of scoliosis. Correction and internal fixation by spine instrumentation (1962) J Bone Joint Surg Am, 44-A, pp. 591-610. , JunMarchetti, P.G., Faldini, A., End fusions in the treatment of some progressing or severe scoliosis in childhood or early adolescence (1978) Orthop Trans, 2, p. 271Liu, J.M., Shen, J.X., Advances in nonfusion techniques for the treatment of scoliosis in children (2010) Orthop Surg, 2 (4), pp. 254-259. , Nov, :, doi: 10.1111/j.1757-7861.2010.00096.

Epidemiology Of Postoperative Infection In Patients With Myelomeningocele, Treated For The Correction Of Spinal Deformities [epidemiologia Da Infecção Pós-operatória Em Pacientes Com Mielomeningocele, Tratados Para Correção De Deformidades Da Coluna Vertebral]

Objective: The spinal surgeries performed in patients with myelomeningocele are at higher risk of postoperative infection. We made an epidemiological survey of these infections and factors possibly associated to establish risk factors. Methods: A retrospective review of data from spinal surgeries performed in patients with myelomeningocele, in the Associação de Assistência à Criança Deficiente -AACD/ Hospital Abreu Sodré. The comparison of possible risk factors evaluated was made by Fisher's exact test. Results were considered significant at p<0.05. Results: We evaluated 27 surgical procedures with a total of 7 cases of postoperative surgical site infection (25.92%). Five of these patients with surgical site infection had concomitant urinary tract infection (UTI) with p=0.004. We found no statistical significance for the other factors evaluated: surgical approaches, type of procedure and total serum lymphocytes. Conclusion: UTI is related to surgical site infection, but we need a prospective study with more cases to clarify this risk factor with a possible confounding factor: the nutritional and immunologic status.104269272Benson, E.R., Thomson, J.D., Smith, B.G., Banta, J.V., Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis (1998) Spine (Phila Pa 1976), 23 (21), pp. 2308-2317Sponseller, P.D., Laporte, D.M., Hungerford, M.W., Eck, K., Bridwell, K.H., Lenke, L.G., Deep wound infections after neuromuscular scoliosis surgery: A multicenter study of risk factors and treatment outcomes (2000) Spine (Phila Pa 1976), 25 (19), pp. 2461-2466Sanchez-Sotelo, J., Sanchez Perez-Grueso, F.J., Cotrel-Dubousset instrumentation in neuromuscular spinal deformity. A five to eleven-year follow-up study (2000) Acta Orthopaedica Belgica, 66 (1), pp. 69-76Noonan, K.J.M., Myelomeningocele (2006) Lovell and Winteŕs Pediatric Orthopaedics, pp. 605-647. , Morrissy RT, Weinstein SL. Philadelphia: Lippincott Williams & Wilkins, 6a. edJevsevar, D.S., Karlin, L.I., The relationship between preoperative nutritional status and complications after an operation for scoliosis in patients who have cerebral palsy (1993) Journal of Bone and Joint Surgery - Series A, 75 (6), pp. 880-884Hatlen, T., Song, K., Shurtleff, D., Duguay, S., Contributory factors to postoperative spinal fusion complications for children with myelomeningocele (2010) Spine (Phila Pa 1976), 35 (13), pp. 1294-1299Klein, J.D., Hey, L.A., Yu, C.S., Klein, B.B., Coufal, F.J., Young, E.P., Marshall, L.F., Garfin, S.R., Perioperative nutrition and postoperative complications in patients undergoing spinal surgery (1996) Spine, 21 (22), pp. 2676-2682. , DOI 10.1097/00007632-199611150-00018Modi, H.N., Suh, S.W., Yang, J.H., Cho, J.W., Hong, J.Y., Singh, S.U., Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation (2009) Scoliosis, 4, p. 11Dias, R.C.C., Veiga, I.G., Pasqualini, W., Santos, M.A.M., Landim, E., Cavali, P.T.M., Avaliação do tratamento cirúrgico da cifose congênita na mielomeningocele com o uso da via posterior pela técnica de Dunn-McCarthy modificada (2008) Coluna/Columna, 7 (2), pp. 146-152Landim, E., Cavali, P.T.M., Santos, M.A.M., Pasqualini, W., Boechat, R.C.B.M., Andrade, S.M.S., Uso da prótese expansível de titânio para costela (VEPTR) como opção na instrumentação sem fusão para tratamento da escoliose neuromuscular (2008) Coluna/Columna, 7 (2), pp. 160-166Garner, J.S., Jarvis, W.R., Emori, T.G., Horan, T.C., Hughes, J.M., CDC definitions for nosocomial infections, 1988 (1988) Am J Infect Control, 16 (3), pp. 128-140Kass, E.H., Asymptomatic infections of the urinary tract (1956) Trans Assoc Am Phys, 69, pp. 56-64Hoberman, A., Wald, E.R., Reynolds, E.A., Penchansky, L., Charron, M., Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever (1994) Journal of Pediatrics, 124 (4), pp. 513-519Lapp, M.A., Bridwell, K.H., Lenke, L.G., Baldus, C., Blanke, K., Iffrig, T.M., Prospective randomization of parenteral hyperalimentation for long fusions with spinal deformity: Its effect on complications and recovery from postoperative malnutrition (2001) Spine, 26 (7), pp. 809-817. , DOI 10.1097/00007632-200104010-0002