Reproducibility Analysis Of The Stability And Treatment Of Vertebral Metastatic Lesions

Objectives: To investigate the reproducibility among spine surgeons in defining the treatment of vertebral metastatic lesions, taking into account the mechanical stability of injuries. Methods: Twenty cases of isolated vertebral metastatic lesions were presented to ten experts. Their opinion was then asked about the stability of the lesion, as well as their treatment option. Results: The interobserver Kappa coefficient obtained both for stability analysis as to the decision of the treatment was poor (0.334 and 0.248, respectively). Conclusions: Poor interobserver reproducibility was observed in deciding the treatment of vertebral metastatic lesions when considering the stability of the lesions.133232234American Cancer Society, (2007) Cancer Facts and Figures, , Atlanta: American Cancer SocietyNewman, C.B., Keshavarzi, S., Aryan, H.E., En bloc sacrectomy and reconstruction technique modification for pelvic fixation (2009) Surg Neurol, 72 (6), pp. 752-756Harrington, K.D., Current concepts review: Metastatic disease of the spine (1986) J Bone Joint Surg Am, 68 (7), pp. 1110-1115Gasbarrini, A., Cappuccio, M., Mirabile, L., Bandiera, S., Terzi, S., Barbanti Bròdano, G., Spinal metastases: Treatment evaluation algorithm (2004) Eur Rev Med Pharmacol Sci, 8 (6), pp. 265-274Bilsky, M., Smith, M., Surgical approach to epidural spinal cord compression (2006) Hematol Oncol Clin North Am, 20 (6), pp. 1307-1317Weber, M.H., Burch, S., Buckley, J., Schmidt, M.H., Fehlings, M.G., Vrionis, F.D., Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: A systematic review (2011) Int J Oncol, 38 (1), pp. 5-12Tokuhashi, Y., Kawano, H., Ohsaka, S., Matsuzaki, H., Toriyama, S., A scoring system for preoperative evaluation of the prognosis of metastatic spine tumor (a preliminary report) (1989) Nihon Seikeigeka Gakkai Zasshi, 63 (5), pp. 482-489Tokuhashi, Y., Matsuzaki, H., Toriyama, S., Kawano, H., Ohsaka, S., Scoring system for the preoperative evaluation of metastatic spine tumor prognosis (1990) Spine (Phila Pa 1976), 15 (11), pp. 1110-1113Tomita, K., Kawahara, N., Baba, H., Tsuchiya, H., Fujita, T., Toribatake, Y., Total em bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors (1997) Spine (Phila Pa 1976), 22 (3), pp. 324-333Tomita, K., Kawahara, N., Kobayashi, T., Yoshida, A., Murakami, H., Akamaru, T., Surgical strategy for spinal metastases (2001) Spine (Phila Pa 1976), 26 (3), pp. 298-306Fisher, C.G., DiPaola, C.P., Ryken, T.C., Bilsky, M.H., Shaffrey, C.I., Berven, S.H., A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the Spine Oncology Study Group (2010) Spine (Phila Pa 1976), 35 (22), pp. E1221-E1229Fourney, D.R., Frangou, E.M., Ryken, T.C., Dipaola, C.P., Shaffrey, C.I., Berven, S.H., Spinal instability neoplastic score: An analysis of reliability and validity from the spine oncology study group (2011) J Clin Oncol, 29 (22), pp. 3072-307

Surgical Treatment Of Scoliosis In Spinal Muscular Atrophy With Pedicle Screws (third Generation Instrumentation) And Early Complications [tratamento Cirúrgico Da Escoliose Em Pacientes Com Amiotrofia Espinhal Com Parafusos Pediculares (instrumental De 3a- Geração) E Complicações Precoces]

Objectives: to report the results on the treatment of scoliosis in spinal muscular atrophy, using posterior arthrodesis with pedicle screws. Methods: a retrospective study was carried out with 16 patients who underwent posterior spinal fusion with pedicle screws. The general status of the patients, correction of the Cobb angle, correction of pelvic obliquity and early complications were analyzed. Results: the initial Cobb angle mean was 94.6° (65 to 132°) turning into 40, 4° (2 to 20°) after the surgery, correction of 57.2%. The initial pelvic obliquity mean was 34.7° (25 to 56°) turning into 11.3° (0 to 20°), correction of 67.4%. Conclusions: the treatment of scoliosis in spinal muscular atrophy using posterior arthrodesis with pedicle screws presents a great potential of correction for the coronal deformity and pelvic obliquity, without serious early complications.9298103Melki, J., Abdelhak, S., Sheth, P., Bachelot, M.F., Burlet, P., Marcadet, A., Aicardi, J., Babron, M.C., Gene for chronic proximal spinal muscular atrophies maps to chromosome 5q (1990) Nature, 344 (6268), pp. 767-768. , DOI 10.1038/344767a0Werdnig, G., (1990) The Founders of Child Neurology, pp. 383-388. , Ashwal S, editor. San Francisco: Jeremy Norman: Child Neurology SocietySucato, D.J., Spine deformity in spinal muscular atrophy (2007) J Bone Joint Surg Am., 89 (SUPPL. 1), pp. 148-154Bradford, D.S., Lonstein, J.E., Winter, R.B., Ogilve, J.W., (1995) Moe's the Text Book of Scoliosis and Other Deformities, , 3rd ed. Philadelphia: WB SaundersByers, R.K., Banker, B.Q., Infantile muscular atrophy (1961) Arch Neurol., 5, pp. 140-164Weinstein, S.L., (2001) The Pediatric Spine: Principles and Practice, , 2nd ed. New York: Lippincott Williams & Wilkins;Ioos, C., Leclair-Richard, D., Mrad, S., Barois, A., Estournet-Mathiaud, B., Respiratory capacity course in patients with infantile spinal muscular atrophy (2004) Chest, 126 (3), pp. 831-837. , DOI 10.1378/chest.126.3.831Gupta, M.C., Wijesekera, S., Sossan, A., Martin, L., Vogel, L.C., Boakes, J.L., Lerman, J.A., Betz, R.R., Reliability of radiographic parameters in neuromuscular scoliosis (2007) Spine, 32 (6), pp. 691-695. , DOI 10.1097/01.brs.0000257524.23074.ed, PII 0000763220070315000015Blanke, K.M., Kuklo, T.R., Lenke, L.G., O'Brien, M.F., Polly Jr., D.W., Richards, B.S., (2005) Radiographic Measurement Manual., pp. 68-69. , Spinal Deformity Study Group. USAMohamad, F., Parent, S., Pawelek, J., Marks, M., Bastrom, T., Faro, F., Newton, P., Perioperative complications after surgical correction in neuromuscular scoliosis (2007) Journal of Pediatric Orthopaedics, 27 (4), pp. 392-397. , DOI 10.1097/01.bpb.0000271321.10869.98, PII 0124139820070600000006Kim, Y.J., Lenke, L.G., Bridwell, K.H., Riew, K.D., O'Brien, M., CT scan accuracy of free hand thoracic pedicle screw placement in pediatric spinal deformity (2001) Scoliosis Research Society Annual Meeting, , September 2001Cleveland, OhioAprin, H., Bowen, J.R., MacEwen, G.D., Hall, J.E., Spine fusion in patients with spinal muscular atrophy (1982) Journal of Bone and Joint Surgery - Series A, 64 (8), pp. 1179-1187Bridwell, K.H., Baldus, C., Iffrig, T.M., Lenke, L.G., Blanke, K., Process measures and patient/parent evaluation of surgical management of spinal deformities in patients with progressive flaccid neuromuscular scoliosis (Duchenne's muscular dystrophy and spinal muscular atrophy) (1999) Spine, 24 (13), pp. 1300-1309. , DOI 10.1097/00007632-199907010-00006Bentley, G., Haddad, F., Bull, T.M., Seingry, D., The treatment of scoliosis in muscular dystrophy using modified Luque and Harrington-Luque instrumentation (2001) Journal of Bone and Joint Surgery - Series B, 83 (1), pp. 22-28Harrington, P.R., Treatment of scoliosis: Correction and internal fixation by spine instrumentation (1962) J Bone Joint Surg Am., 44 A, pp. 591-610Hamill, C.L., Lenke, L.G., Briedell, K.H., 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. 1241-1249Gaines Jr., R.W., The use of pedicle screw internal fixation for operative treatment of spinal disorders (2000) J Bone Joint Surg Am., 82 A (10), pp. 1458-1476Suk, E.I., Chung, E.R., Kim, J.H., Prevention of crankshaft phenomenon with posterior pedicle screw fixation in scoliosis of immature spine: Is it possible? (2002) Scoliosis Research Society 37th Annual Meeting, pp. 19-21. , Seattle, WALenke, L.G., Kuklo, T.R., Ondra, S., Polly Jr., D.W., Rationale behind the current state-of-the-art treatment of scoliosis (in the pedicle screw era) (2008) Spine, 33 (10), pp. 1051-1054. , DOI 10.1097/BRS.0b013e31816f2865, PII 0000763220080501000002Mercado, E., Alman, B., Wright, J., Does spine fusion influence quality of life in neuromuscular scoliosis? (2007) Spine., 32 (19 SUPPL.), pp. 120-12

Placement Analysis Of Thoracic And Lumbar Pedicle Screws Inserted Under Anatomic And Radioscopic Parameters [avaliação Posicionamento De Parafusos Pediculares Na Coluna Torácica E Lombar Introduzidos Com Base Em Referenciais Anatômicos E Radioscópicos]

Objective: pedicular screw technique has becoming the standard choice for spinal fixation. The goal of the study is to evaluate thoracic and lumbar pedicle screws placement to treat a variety of spinal disorders. These screws were inserted using intrapperative anatomical and fluoroscopic parameters. Methods: the retrospective analysis included 24 patients (7 men and 17 women with a mean age of 34.6 years), the radiograms and the computed tomograms. They were operated due some spinal disease using pedicle screws from T2 to S1 totalizing 183 pedicular screws. The screw insertion technique is based on the intraoperative anatomic and fluoroscopic parameters. The exams were analyzed by three orthopaedic spinal surgeons and one radiologist looking for any cortical violation. When they found any cortical violation until 2mm the screw position was considered acceptable. Results: pedicle screws perforations were seen in 36.06% but only 3.82 % were classified as not acceptable. It was observed 96.18% of screws without or with minimal violation which does not cause any risk of visceral, nervous or vascular lesion. In the violated pedicles. It was seen 63.64% of lateral, 19.69% of medial and 16,66% of anterior perforation. There were no superior or inferior violations. Conclusion: thoracic and lumbar pedicle screw fixation placed based on anatomic and fluoroscopic parameters is a safer and an eftective method for different spine levels in the treatment of a variety of spinal disorders.7117Kim, 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 tomograpy (2005) Spine, 30 (18), pp. 2084-2088Odgers 4th, C.J., Vaccaro, A.R., Pollak, M.E., Cotler, J.M., Accuracy of pedicle screw placement with the assistance of lateral plain radiography (1996) J Spinal Disord, 9 (4), pp. 334-338Carbone, J.J., Tortolani, P.J., Quartararo, L.G., Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: Technique and short-term complications (2003) Spine, 28 (1), pp. 91-97Castro, W.H., Halm, H., Jerosch, J., Malms, J., Steinbeck, J., Blasius, S., Accuracy of pedicle screw placement in lumbar vertebrae (1996) Spine, 21 (11), pp. 1320-1324Sapkas, G.S., Papadakis, S.A., Satathakopoulos, D.P., Papagelopoulos, P.J., Badekas, A.C., Kaiser, J.H., Evaluation of pedicle screw position in thoracic and lumbar spine fixation using plain radiographs and computed tomography. A prospective study of 35 patients (1999) Spine, 24 (18), pp. 1926-1929Youkilis, 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. 771-778. , discussion 778-9Liljenqvist, U.R., Halm, H.F., Link, T.M., Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis (1997) Spine, 22 (19), pp. 2239-2245Kim, Y.J., Lenke, L.G., Bridwell, K.H., Cho, Y.F., Riew, K.D., Free hand pedicle screw placement in thoracic spine: Is it safe? (2004) Spine, 29 (3), pp. 333-342. , discussion 342Belmont Jr, P.J., Klemme, W.R., Dhawan, A., Polly Jr., D.W., In vivo accuracy of thoracic pedicle screws (2001) Spine, 26 (21), pp. 2340-2346Gertzbein, S.D., Robbins, S.E., Accuracy of pedicular screw placement in vivo (1990) Spine, 15 (1), pp. 11-14Suk, S.I., Kim, W.J., Lee, S.M., Kim, J.H., Chung, E.R., Thoracic pedicle screw fixation in spinal deformities: Are they really safe? (2001) Spine, 26 (18), pp. 2049-2057Grauer, 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. 492-497Defino, H.L.A., Mauad Filho, J., Estudo morfométrico do pedículo das vértebras torácicas e lombares. (1999) Rev Bras Ortop, 34 (2), pp. 97-108Cinotti, G., Gumina, S., Ripani, M., Postacchini, F., Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws (1999) Spine, 24 (2), pp. 114-119Ebraheim, N.A., Jabaly, G., Xu, R., Yeasting, R.A., Anatomic relations of the thoracic pedicle to the adjacent neural structures (1997) Spine, 22 (14), pp. 1553-1556. , discussion 1557Boachie-Adjei, O., Girardi, F.P., Bansal, M., Rawlins, B.A., Safety and efficacy of pedicle screw placement for adult spinal deformity with a pedicle- probing conventional anatomic technique (2000) J Spinal Disord, 13 (6), pp. 496-500Rao, G., Brodke, D.S., Rondina, M., Dailey, A.T., Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement (2002) J Neurosurg, 97 (2 SUPPL.), pp. 223-226Ul 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. 2516-2520Roy-Camille, R., Saillant, G., Mazel, C., Internal fixation of the lumbar spine with pedicle screw plating (1986) Clin Orthop Relat Res, 203, pp. 7-17Vaccaro, A.R., Rizzolo, S.J., Balderston, R.A., Allardyce, T.J., Garfin, S.R., Dolinskas, C., An, H.S., Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment (1995) J Bone Joint Surg Am, 77 (8), pp. 1200-120

Preoperative Evaluation For The Use Of Cranial Halo Traction In The Spine Treatment Of Rigid Deformities [avaliação Pré-operatória Visando Ao Uso Do Halo Craniano No Tratamento De Deformidades Rígidas Da Coluna Vertebral]

Objective: to assess the efficacy and safety of using the gravitational cranial halo as a technique for treating rigid deformities in the spinal column and to revisit complications associated to the treatment. Methods: a total often patients with rigid spinal deformities were studied, with the following deformities: kyphosis, scoliosis, kyphoscoliosis and cervical hyperlordosis. The criterion for including a patient was the use of the gravitational cranial halo in a postoperative period and interoperative period for rigid spinal deformities. The patient medical records and their radiographic measurements were studied and compared in a preoperative period, after the installation of the gravitational cranial halo and in the postoperative period. The aspects analyzed were: age, sex, angular value of the main curvature and angular value of the secondary curvature, angular value of the major sagittal curvature, traction protocol and type of procedure. Results: in the frontal plane, an average angle of 89.9° was found in the preoperative period, decreasing to 65° after the installation of the halo and 56.9° in the postoperative period. In the sagittal plane, an angular value of 77.7° was observed, decreasing to 55.4° with the use of the halo and 46.5° in the postoperative period. Conclusion: the conclusion was that the use of cranial halo traction is an efficient method for correcting rigid spinal deformities, taking into account that there was significant correction of the deformities from the preoperative period to the post installation of the halo and the postoperative period, without any neurological lesions or serious complications resulting from the treatment.94417423Seller, K., Haas, S., Raab, P., Krauspe, R., Wild, A., Preoperative Halo-traction in severe paralytic scoliosis (2005) Zeitschrift fur Orthopadie und Ihre Grenzgebiete, 143 (5), pp. 539-543. , DOI 10.1055/s-2005-836750Rinella, A., Lenke, L., Whitaker, C., Kim, Y., Park, S.S., Peelle, M., (2005) Perioperative Halo-gravity Traction in the Treatment of Severe Scoliosis An Kyphosis, 30 (4), pp. 475-482. , Spine (Phila Pa 1976)Stagnara, P., Cranial traction using the Halo of Rancho Los Amigos (1971) Rev Chir Orthop Reparatrice Appar Mot., 57 (4), pp. 287-300Edgar, M.A., Chapman, R.H., Glasgow, M.M.S., Pre-operative correction in adolescent idiopathic scoliosis (1982) Journal of Bone and Joint Surgery - Series B, 64 (5), pp. 530-535Kane, W.J., Moe, J.H., Lai, C.C., Halofemoral pin distraction in the treatment of scoliosis (1967) J Bone Joint Surg Am., 49, pp. 1018-1019Schmidt, A.C., Halo-tibial traction combined with the Milwaukee Brace (1971) Clin Orthop Relat Res., (77), pp. 73-83Campbell, W.C., (1996) Cirurgia Ortopédica de Campbell., , São Paulo: Manole;Perry, J., Nickel, V.L., Total cervicalspine fusion for neck paralysis (1959) J Bone Joint Surg Am., 41 A (1), pp. 37-60Garfin, S.R., Botte, M.J., Waters, R.L., Nickel, V.L., Complications in the use of the halo fixation device (1986) Journal of Bone and Joint Surgery - Series A, 68 (3), pp. 320-325Caird, M.S., Hensinger, R.N., Weiss, N., Farley, F.A., Complications and problems in halo treatment of toddlers: Limited ambulation is recommended (2006) Journal of Pediatric Orthopaedics, 26 (6), pp. 750-752. , DOI 10.1097/01.bpo.0000235395.19042.3f, PII 0124139820061100000011Humbyrd, D.E., Latimer, F.R., Lonstein, J.E., Samberg, L.C., (1981) Brain Abscess As A Complication of Halo Traction, 6 (4), pp. 365-368. , Spine (Phila Pa 1976)Letts, R.M., Palakar, G., Bobecko, W.P., Preoperative skeletal traction in scoliosis (1975) J Bone Joint Surg Am., 57 (5), pp. 616-619Tredwell, S.J., O'Brien, J.P., Apophyseal joint degeneration in the cervical spine following halo-pelvic distraction (1980) Spine (Phila Pa 1976), 5 (6), pp. 497-501O'Brien, J.P., Yau, A.C., Hodgson, A.R., Halo pelvic traction: A technic for severe spinal deformities (1973) Clin Orthop Relat Res., (93), pp. 179-190MacEwen, G.D., Bunnell, W.P., Sriram, K., Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society (1975) J Bone Joint Surg Am., 57 (3), pp. 404-408Ginsburg, G.M., Basse, G.S., Hypoglossal nerve injury caused by halo-suspension traction (1998) A Case Report., 23 (13), pp. 1490-1493. , Spine (Phila Pa 1976)Nickel, V.L., Perry, J., Garrett, A., Heppenstall, M., The halo. A spinal skeletal traction fixation device (1968) J Bone Joint Surg Am., 50 (7), p. 14009Bonnett, C., Perry, J., Brown, J.C., Greenberg, B.J., Halo-femoral distraction and posterior spine fusion for paralytic scoliosis (1972) J Bone Joint Surg Am., 54, p. 202Salim, F.A., Zielke, K., Osteoporosis and halo traction in scoliosis patients (1982) Zeitschrift fur Orthopadie und Ihre Grenzgebiete, 120 (3), pp. 330-33

Use Of Vertical Expandable Prosthetic Of Titanium For The Rib For Treating Congenital Kyphosis In Thoracic Meningomyelocele Patients [uso Da Prótese Vertical Expansível De Titânio Para Costela No Tratamento Da Cifose Congênita Em Portadores De Mielomeningocele Torácica]

Objective: to evaluate clinical and radiographic postoperative results of congenital kyphosis correction in thoracic meningomyelocele patients using vertical expandable prosthetic of titanium for the rib (VEPTR). Methods: a retrospective study of 19 thoracic meningomyelocele and congenital kyphosis patients that were subjected to the VEPTR treatment between October 2005 and October 2008, with radiographic evaluation and immediate post and pre-operative clinical practice. Also, the duration of surgical procedure, the need for blood transfusion and postoperative complications were assessed. Results: the patients' average age was 70 months (from 32 to 130 months). The average follow-up from patients was 13.5 months (from 2 to 26 months). The average duration of the procedure was 117 minutes (variation between 70 and 195 minutes). All children reached trunk balance, 13 of whom had not showed it in the postoperative period. The average of pre-operation kyphosis was 115° (from 80° to 150°) and 77° (from 50° to 104°) for postoperative, with an average correction percentage of 31.2% (from 1.1 to 61.5%). The previous preoperative imbalance of trunk was an average 7.9 cm (from 1.0 to 15.5 cm) and 3.4 cm (from 0 to 8 cm) for postoperative. The average correction of this imbalance was of 50.4% (from 0 to 100%). Regarding weight, in pre-operative the average was 15.4 kg (from 8 to 30 kg) and 20.6 kg (from 8.5 to 35 kg) for postoperative. The average gain of weight was of 36.6% (from 9.8 to 100%). Five of the 19 patients (26.3%) presented postoperative complications. No patient needed blood transfusion. Conclusion: the use of VEPTR in thoracic meningomyelocele and congenital kyphosis patients has proven to be an effective and promising alternative for the control of physical deformity in patients with a potential for growth.83286296Hoppenfeld, S., Congenital kyphosis in myelomeningocele (1967) J Bone Joint Surg Br, 49 (2), pp. 276-280Christofersen, M.R., Brooks, A.L., Excision and wire fixation of rigid myelomeningocele kyphosis (1985) J Pediatr Orthop, 5 (6), pp. 691-696Banta, J.V., The evolution of surgical treatment of spinal deformity in myelomeningocele (1987) Z Kinderchir, 42 (SUPPL. 1), pp. 10-12Akbar M, Bremer R, Thomsen M, Carstens C, Abel R. Kyphectomy in children with myelodysplasia: results 1994-2004. Spine (Phila Pa 1976). 2006;31(9):1007-13Raycroft, J.F., Curtis, B.H., Spinal curvature in myelomeningocele: Natural historyand etiology (1972) American Academy of Orthopedic Surgeons Symposium on myelomeningocele, , St. Louis: C.V. Mosby;Burney Jr, D.W., Hamsa, W.R., Spina Bifida with myelomeningocele (1963) Clin Orthop Relat Res, 30, pp. 167-174Naik, D.R., Lendon, R.G., Barson, A.J., A radiological study of vertebral and rib malformations in children with myelomeningocele (1978) Clin Radiol, 29 (4), pp. 427-430Carstens, C., Koch, H., Brocai, D.R., Niethard, F.U., Development of pathological lumbar kyphosis in myelomeningocele (1996) J Bone Joint Surg Br, 78 (6), pp. 945-950Banta JV. Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine (Phila Pa 1976). 1990;15(9):946-52Cotta, H., Parsch, K., Schulitz, K.P., The treatment of lumbar kyphosis in spina bifida cystica] (1971) Z Orthop Ihre Grenzgeb, 108 (4), pp. 567-574. , GermanBanta, J.V., Hamada, J.S., Natural history of the kyphotic deformity in myelomeningocele (1976) J Bone Joint Surg Am, 58 A, p. 279Sharrard, W.J., Spinal osteotomy for congenital kyphosis in myelomeningocele (1968) J Bone Joint Surg Br, 50 (3), pp. 466-471Drennan, J.C., The role of muscles in the development of human lumbar kyphosis (1970) Dev Med Child Neurol Suppl, 22 (SUPPL. 22), pp. 33-38Crawford AH, Strub WM, Lewis R, Gabriel KR, Bilmire DA, Berger T, et al. Neonatal kyphectomy in the patient with myelomeningocele. Spine (Phila Pa 1976). 2003;28(3):260-6Niall DM, Dowling FE, Fogarty EE, Moore DP, Goldberg C. Kyphectomy in children with myelomeningocele: a long-term outcome study. J Pediatr Orthop. 2004;24(1):37-44Heydemann JS, Gillespie R. Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation. Spine (Phila Pa 1976). 1987;12(1):37-41Mazur, J., Menelaus, M.B., Dickens, D.R., Doig, W.G., Efficacy of surgical management for scoliosis in myelomeningocele: Correction of deformity and alteration of functional status (1986) J Pediatr Orthop, 6 (5), pp. 568-575Martin Jr, J., Kumar, S.J., Guille, J.T., Ger, D., Gibbs, M., Congenital kyphosis in myelomeningocele: Results following operative and nonoperative treatment (1994) J Pediatr Orthop, 14 (3), pp. 323-328Torre-Healy, A., Samdani, A.F., Newer technologies for the treatment of scoliosis in the growing spine (2007) Neurosurg Clin N Am, 18 (4), pp. 697-705Thompson, G.H., Akbamia, B.A., Campbell Jr, R.M., Growing rod techniques in early-onset scoliosis (2007) J Pediatr Orthop, 27 (3), pp. 354-361Sarwark, J.F., Kyphosis deformity in myelomeningocele (1999) Orthop Clin North Am, 30 (3), pp. 451-455. , viii-ixMintz, L.J., Sarwark, J.F., Dias, L.S., Schafer, M.F., The natural history of congenital kyphosis in myelomeningocele. A review of 51 children. Spine (Phila Pa 1976) (1991), p. 16. , 8 Suppl:S348-50Sharrard, W.J., Drennan, J.C., Osteotomy-excision of the spine for lumbar kyphosis in older children with myelomeningocele (1972) J Bone Joint Surg Br, 54 (1), pp. 50-60Lindseth, R.E., Stelzer Jr., L., Vertebral excision for kyphosis in children with myelomeningocele (1979) J Bone Joint Surg Am, 61 (5), pp. 699-704McCarthy RE, Dunn H, McCullough FL. Luque fixation to the sacral ala using the Dunn-McCarthy modification. Spine (Phila Pa 1976). 1989;14(3):281-3McMaster MJ. The long-term results of kyphectomy and spinal stabilization in children with myelomeningocele. Spine (Phila Pa 1976). 1988;13(4):417-24Lowe, G.P., Menelaus, M.B., The surgical management of kyphosis in older children with myelomeningocele (1978) J Bone Joint Surg Br, 60 (1), pp. 40-45Warner Jr, W.C., Fackler, C.D., Comparison of two instrumentation techniques in treatment of lumbar kyphosis in myelodysplasia (1993) J Pediatr Orthop, 13 (6), pp. 704-708Nolden MT, Sarwark JF, Vora A, Grayhack JJ. A kyphectomy technique with reduced perioperative morbidity for myelomeningocele kyphosis. Spine (Phila Pa 1976). 2002;27(16):1807-13Sriram, K., Bobechko, W.P., Hall, J.E., Surgical management of spinal deformities in spina bifida (1972) J Bone Joint Surg Br, 54 (4), pp. 666-676Duncan, J.W., Lovell, W.W., Bailey, S.C., Ransom, D., Surgical treatment of kyphosis in myelomeningocele (1976) J Bone Joint Surg Am, 58, p. 155Leatherman KD, Dickson RA. Congenital kyphosis in myelomeningocele. Vertebral body resection and posterior spine fusion. Spine (Phila Pa 1976). 1978;3(3): 222-6Ferraretto, I., Mota, D.P., Fernandes, A.C., Machado, P.O., Silva Jr, J.A., Cifoses na mielomeningocele: Conceitos, técnicas de tratamento e apresentação de casos. (1998) Rev Bras Ortop, 33 (12), pp. 963-972Hall, J.E., Poitras, B., The management of kyphosis in patients with myelomeningocele (1977) Clin Orthop Relat Res, 128, pp. 33-40Lintner, S.A., Lindseth, R.E., Kyphotic deformity in patients who have myelomeningocele. Operative treatment and long-term follow-up (1994) J Bone Joint Surg Am, 76 (9), pp. 1301-1307Doers, T., Walker, J.L., van den Brink, K., Stevens, D.B., Heavilon, J., The progression of untreated lumbar kyphosis and the compensatory thoracic lordosis in myelomeningocele (1997) Dev Med Child Neurol, 39 (5), pp. 326-330Dias, 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. 146-152Campbell Jr, R.M., Hell-Vocke, A.K., Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty (2003) J Bone Joint Surg Am, 85-A (3), pp. 409-420Campbell Jr, R.M., Smith, M.D., Mangos, J.A., The treatment of thoracic insufficiency syndrome associated with progressive early onset scoliosis by opening wedge thoracostomy (2005) the Annual Meeting of the Scoliosis Research Society, , Presented at: Oct. 27-30Miami, FLEmans JB, Caubet JF, Ordonez CL, Lee EY, 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 Spine (Phila Pa 1976). 2005;30(17 Suppl):S58-68Campbell Jr, R.M., Smith, M.D., Mayes, T.C., Mangos, J.A., Willey-Courand, D.B., Kose, N., The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis (2004) J Bone Joint Surg Am, 86-A (8), pp. 1659-1674Hell, 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) J Pediatr Orthop B, 14 (4), pp. 287-293Landim, E., Cavali, P.T.M., Santos, M.A.M., Pasqualini, W., Boechat, R.C.B.M., Andrade, S.M.S., Uso da prótese vertical expansível de titânio para costela (VEPTR) com opção na instrumentação sem fusão para tratamento da escoliose neuromuscular. (2008) Coluna/Columna, 7 (2), pp. 160-166Vitale, M.G., Matsumoto, H., Roye Jr, D.P., Gomez, J.A., Betz, R.R., Emans, J.B., Health-related quality of life in children with thoracic insufficiency syndrome (2008) J Pediatr Orthop, 28 (2), pp. 239-24

Evaluation Of The Pain And Local Morbidity Of The Insertion Taken Out From The Iliac Crest To The Anterior Cervical Arthrodesis [avaliação Da Dor E Morbidade Local Da Retirada Do Enxerto ósseo Da Crista Ilíaca Para Artrodese Cervical Anterior]

Objective: to evaluate the possible complications associated to the removal of the insertion of the anterior iliac crest in surgery to the anterior cervical arthrodesis, especially to the residual pain. Methods: the retrospective study with the medical records analysis and the application of a form by telephone with 20 patients in a period from August 2008 to November 2009 were performed. All patients were submitted to the same surgical technique for the crest extraction, and were operated by the same team at Hospital das Clinidas da Unicamp (HC Unicamp). The variants analyzed were: residual, pain infection rate, neurologic or vascular lesion and occurrence of the fracture of the iliac wing. The data was placed in a table and the average and percentage were calculated. Results: of the 20 patients, 12 men and 8 women, with average age of 51.75 years (2974) and mean follow-up of 11,83 months (2-29), we did not find any serious lesion like fracture, arterial or neurologic lesion. There was a case of superficial infection (5%), and 25% of the patients complained about light discomfort and not incapacitating difficulty to prowl. Conclusion: the removal of the anterior iliac crest is associated to many complications. It is important to know of other insertion options and make the patient aware of the possible complications. Through this research, we did not find any serious complications, and the patients' percentage with residual pain are the same as in the literature, and can be diminished through a careful dissection of the iliac crest.94424429Silber, J.S., Anderson, D.G., Daffner, S.D., Brislin, B.T., Leland, J.M., Hilibrand, A.S., (2003) Donor Site Morbidity after Anterior Iliac Crest Bone Harvest for Single-level Anterior Cervical Discectomy and Fusion., 28 (2), pp. 134-139. , Spine (Phila Pa 1976)Acharya, N.K., Mahajan, C.V., Kumar, R.J., Varma, H.K., Menon, V.K., Can iliac crest reconstruction reduce donor site morbidity?: A study using degradable hydroxyapatite-bioactive glass ceramic composite (2010) J Spinal Disord Tech., 23 (4), pp. 266-271Sasso, R.C., LeHuec, J.C., Shaffrey, C., Iliac crest bone graft donor site pain after anterior lumbar interbody fusion: A prospective patient satisfaction outcome assessment (2005) J Spinal Disord Tech., 18 (SUPPL.), pp. 77-81. , Spine Interbody Research GroupSkaggs, D.L., Samuelson, M.A., Hale, J.M., Kay, R.M., Tolo, V.T., (2000) Complications of Posterior Iliac Crest Bone Grafting in Spine Surgery in Children, 25 (18), pp. 2400-2402. , Spine (Phila Pa 1976)Banwart, J.C., Asher, M.A., Hassanein, R.S., (1995) Iliac Crest Bone Graft Harvest Donor Site Morbidity. A Statistical Evaluation, 20 (9), pp. 1055-1060. , Spine (Phila Pa 1976)Delawi, D., Dhert, W.J., Castelein, R.M., Verbout, A.J., Oner, F.C., (2007) The Incidence of Donor Site Pain after Bone Graft Harvesting from the Posterior Iliac Crest May Be Overestimated: A Study on Spine Fracture Patients., 32 (17), pp. 1865-1868. , Spine (Phila Pa 1976)David, R., Folman, Y., Pikarsky, I., Leitner, Y., Catz, A., Gepstein, R., Harvesting bone graft from the posterior iliac crest by less traumatic, midline approach (2003) J Spinal Disord Tech., 16 (1), pp. 27-30Robertson, P.A., Wray, A.C., (2001) Natural History of Posterior Iliac Crest Bone Graft Donation for Spinal Surgery: A Prospective Analysis of Morbidity., 26 (13), pp. 1473-1476. , Spine (Phila Pa 1976)Kim, D.H., Rhim, R., Li, L., Martha, J., Swaim, B.H., Banco, R.J., Prospective study of iliac crest bone graft harvest site pain and morbidity (2009) Spine J., 9 (11), pp. 886-892Pollock, R., Alcelik, I., Bhatia, C., Chuter, G., Lingutla, K., Budithi, C., Donor site morbidity following iliac crest bone harvesting for cervical fusion: A comparison between minimally invasive and open techniques (2008) Eur Spine J., 17 (6), pp. 845-852Defino, H.L., Rodriguez-Fuentes, A.E., Reconstruction of anterior iliac crest bone graft donor sites: Presentation of a surgical technique (1999) Eur Spine J., 8 (6), pp. 491-494Smucker, J.D., Akhavan, S., Furey, C., Understanding bony safety zones in the posterior iliac crest: An anatomic study from the Hamann-Todd collection (2010) Spine (Phila Pa 1976), 35 (7), pp. 725-729. , (Phila Pa 1976)Mischkowski, R.A., Selbach, I., Neugebauer, J., Koebke, J., Zöller, J.E., Lateral femoral cutaneous nerve and iliac crest bone grafts-anatomical and clinical considerations (2006) Int J Oral Maxillofac Surg., 35 (4), pp. 366-372Ebraheim, N.A., Yang, H., Lu, J., Biyani, A., Yeasting, R.A., Anterior iliac crest bone graft. Anatomic considerations (1997) Spine (Phila Pa 1976), 22 (8), pp. 847-849. , (Phila Pa 1976)Spallone, A., A less-invasive technique for harvesting autologous iliac crest grafts for cervical interbody fusion: Technical note (2007) Surg Neurol., 67 (2), pp. 160-16

Weight Gain In Patients With Myelomeningocele After Treatment With Vertical Expandable Prosthetic Titanium Rib [ganho De Peso Nos Pacientes Portadores De Mielomeningocele Após Tratamento Com Prótese Vertical Expansível De Titânio Para Costela]

Objective: To evaluate weight gain and change in nutritional status of patients with thoracic myelomeningocele after using the vertical expandable prosthetic titanium rib (VEPTR) as an option for treatment of the spine without fusion. Methods: We conducted a retrospective study including eight patients (mean age of 5.3 years, ranging from 3.6 to 7.6 years at the time of initial surgery), with thoracic myelomeningocele presenting with scoliosis higher than 40° and kyphosis greater than 80°, measured by the Cobb method. All patients were surgically treated with VEPtR by the Scoliosis group of the AACD in São Paulo. We analyzed patient weights and nutritional status by comparing the standard deviations in weight for age groups based on the WhO reference chart. We also analyzed the angular kyphosis at preoperative, and immediate and late post-operative periods. Results: There was an absolute weight gain in all patients with a mean gain of 8.7 kg (range 3 to 20 kg). Six patients (75%) gained weight and had increased value of the standard deviation, resulting in approximation of their weight in relation to the median considered normal weight versus age reference curve after starting treatment with VEPTR. Conclusion: The observed absolute weight gain was not accompanied by an improvement of nutritional status and there was no relationship between kyphosis correction and weight gain.113223225Copp, A.J., Neural tube defects (1993) Trends in Neurosciences, 16 (10), pp. 381-383. , DOI 10.1016/0166-2236(93)90001-3Raycroft, J.F., Curtis, B.H., Spinal curvature in myelomeningocele: Natural historyand etiology (1972) American Academy of Orthopedic Surgeons Symposium on Myelomeningocele, , St. Louis: MosbyBurney Jr., D.W., Hamsa, W.R., Spina Bifida with myelomeningocele (1963) Clin Orthop Relat Res., 30, pp. 167-174Naik, D.R., Lendon, R.G., Barson, A.J., A radiological study of vertebral and rib malformations in children with myelomeningocele (1978) Clinical Radiology, 29 (4), pp. 427-430Carstens, C., Koch, H., Brocai, D.R.C., Niethard, F.U., Development of pathological lumbar kyphosis in myelomeningocele (1996) Journal of Bone and Joint Surgery - Series B, 78 (6), pp. 945-950Banta, J.V., Hamada, J.S., Natural history of the kyphotic deformity in myelomeningocele (1976) J Bone Joint Surg Am., 58, p. 279Hoppenfeld, S., Congenital kyphosis in myelomeningocele (1967) J Bone Joint Surg Br., 49 (2), pp. 276-280Christofersen, M.R., Brooks, A.L., Excision and wire fixation of rigid myelomeningocele kyphosis (1985) Journal of Pediatric Orthopaedics, 5 (6), pp. 691-696Hall, J.E., Poitras, B., The management of kyphosis in patients with myelomeningocele (1977) Clinical Orthopaedics and Related Research, (128), pp. 33-40Heydemann, J.S., Gillespie, R., Management of Myelomeningocele Kyphosis in the Older Child by Kyphectomy and Segmental Spinal InstrumLindseth, R.E., Spine deformity in myelomeningocele (1991) Instr Course Lect., 40, pp. 273-279McMaster, M.J., The long-term results of kyphectomy and spinal stabilization in children with myelomeningocele (1988) Spine (Phila Pa 1976), 13 (4), pp. 417-424Zuiani, G.R., Cavali, P.T.M., Santos, M.A.M., Rossato, A.J., Lehoczki, M.A., Risso Neto, M.I., Et Al., Uso da prótese vertical expansível de titânio para costela no tratamento da cifose congênita em portadores de mielomeningocele torácica Coluna/Columna, 8 (3), pp. 286-296Campbell 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. 409-420Motoyama, 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.d0Skaggs, D.L., Sankar, W.N., Albrektson, J., Wren, T.A., Campbell, R.M., Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome (2009) Spine (Phila Pa 1976), 34 (23), pp. 2530-2533(2006) Length/Height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass Index-for-age: Methods and Development, , WHO Child Growth Standards Geneva: World Health Organization(2007) WHO Growth Reference Data for 15-19 Years, , http://who.int/growthref/en/Vitale, M.G., Matsumoto, H., Roye Jr., D.P., Gomez, J.A., Betz, R.R., Emans, J.B., Skaggs, D.L., Campbell Jr., R.M., Health-related quality of life in children with thoracic insufficiency syndrome (2008) Journal of Pediatric Orthopaedics, 28 (2), pp. 239-243. , DOI 10.1097/BPO.0b013e31816521bb, PII 0124139820080300000020Landim, E., Cavali, P.T.M., Santos, M.A.M., Pasqualini, W., Boechat, R.C.B., Andrade, S.M.S., Uso da prótese vertical expansível de titânio para costela (VEPTR) com opÇão na instrumentaÇão sem fusão para tratamento da escoliose neuromuscular (2008) Coluna/Columna., 7 (2), pp. 160-16