Relação Entre Qualidade De Vida E Osteólise Em Torno De Parafusos Pediculares Lombares

To evaluate whether the presence of osteolysis around the pedicle screws affects the quality of life of patients who underwent posterolateral arthrodesis of the lumbosacral spine. Methods: A retrospective study of patients undergoing lumbar posterolateral or lumbosacral arthrodesis due to spinal degenerative disease. CT scans of the operated segments were performed at intervals of 45, 90, 180, and 360 postoperatively. In these tests, the presence of a peri-implant radiolucent halo was investigated, which was considered present when greater than 1mm in the coronal section. Concurrently with the completion of CT scans, the participants completed the questionnaire Oswestry Disability Index (ODI) to assess the degree of disability of the patients. Results: A total of 38 patients were evaluated, and 14 (36.84%) of them showed some degree of osteolysis around at least one pedicle screw at the end of follow-up. Of the 242 analyzed screws, 27 (11.15%) had osteolysis in the CT coronal section, with the majority of these occurrences located at the most distal level segment of the arthrodesis. There was no correlation between the presence of the osteolysis to the quality of life of patients. The quality of life has significantly improved when comparing the preoperative results with the postoperative results at different times of application of ODI. This improvement in ODI maintains linearity over time. Conclusion: There is no correlation between the presence of peri-implant osteolysis to the quality of life of patients undergoing lumbar or posterolateral lumbosacral arthrodesis in the follow-up period up to 360 days. The quality of life in postoperative has significantly improvement when compared to the preoperative period.15429029

Evaluation of the pain and local morbidity of the insertion taken out from the iliac crest to the anterior cervical arthrodesis

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 Clínidas 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 (29-74) 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.OBJETIVO: avaliar as possíveis complicações associadas à retirada de enxerto da crista ilíaca anterior em cirurgia para artrodese cervical anterior, em especial a dor residual. MÉTODOS: foi realizado estudo retrospectivo com análise de prontuários e aplicação de questionário via telefone com 20 pacientes no período compreendido entre Agosto de 2008 e Novembro de 2009. Todos os pacientes foram submetidos à mesma técnica cirúrgica para extração do enxerto, sendo operados pela mesma equipe no Hospital de Clinicas da Unicamp (HC Unicamp). As variantes analisadas foram dor residual, taxa de infecção, lesão neurológica ou vascular e ocorrência de fratura da asa do ilíaco. Os dados foram colocados em uma tabela e as médias e porcentagens foram calculadas. RESULTADOS: dos 20 pacientes, 12 homens e 8 mulheres, com média de idade de 51,75 anos (29-74) e follow-up médio de 11,83 meses (2-29), não houve nenhuma lesão grave, como fratura, lesão arterial ou neurológica. Houve um caso de infecção superficial (5%) e 25% dos pacientes queixaram-se de desconforto leve e dificuldade para deambular não incapacitante. CONCLUSÃO: a retirada de enxerto da crista ilíaca anterior está associada a muitas complicações, sendo importante o conhecimento de outras opções de enxerto e exposição ao paciente das possíveis complicações. Por meio deste levantamento, não verificamos nenhuma complicação grave, e o percentual de pacientes com dor residual acompanha os achados na literatura, podendo ser diminuído com uma dissecção cuidadosa da crista ilíaca.OBJETIVO: evaluar las posibles compilaciones asociadas a la retirada del injerto de la cresta ilíaca anterior en cirugía para artrodesis cervical anterior, principalmente los dolores residuales. MÉTODOS: fue realizado un estudio retrospectivo con análisis de prontuarios y con aplicación de cuestionario por teléfono para 20 pacientes entre agosto de 2008 y noviembre de 2009. Todos los pacientes fueron sometidos al mismo procedimiento cirúrgico para la retirada del injerto, siendo que fueron operados por el mismo equipo en el Hospital de Clínicas de la Unicamp (HC Unicamp). Las variantes analizadas fueron: dolor residual, tasa de infección, lesión neurológica o vascular y aparición de fractura en el ala ilíaca. Los datos fueron colocados en una tabla, y las mediciones y porcentajes fueron calculados. RESULTADOS: de los 20 pacientes, 12 hombres y 8 mujeres, con edad media de 51,75 años (29-74), acompañamiento medio de 11,83 meses (2-29). No tuvo ninguna lesión grave como fractura, lesión arterial o neurológica. Hubo un caso de infección superficial (5%), y 25% de los pacientes se quejaron de malestar leve y dificultades para andar no incapacidad. CONCLUSIÓN: la retirada del injerto de la cresta ilíaca anterior esta relacionada a muchas complicaciones, siendo importante el conocimiento de otras opciones de injerto y exposición al paciente de las posibles complicaciones. A través del levantamiento, no se verificó ninguna complicación grave y el porcentual de pacientes con dolor residual pude se comparar con los encontrados en literatura, pudiendo ser reducidos a través de una disección cuidadosa de la cresta ilíaca.42442

Assessment of interobserver reproducibility of a new scale for management guidance in spinal metastasis: SINS score

OBJECTIVE: To evaluate the impact on the management and quantify the inter-observer reproducibility of SINS Score. Also, determine its applicability to our milieu. METHODS: A presentation of 20 cases of secondary spine lesions was compiled, which was examined by 10 observers. They defined the stability of each injury and, after the presentation of SINS Score, the same cases were presented to the same observers and again they were asked to determine the stability of the lesion. The collected data were analyzed by the Fleiss' Kappa Calculation and Intra-class Correlation. RESULTS: Inter-observer moderate agreement was obtained by using SINS classification. CONCLUSIONS: The classification is applicable to our milieu. There was a change of opinion about the stability of the lesions after the presentation of the classification to the observers.OBJETIVO: Avaliar o impacto na conduta e quantificar a reprodutibilidade interobservador do escore SINS. Além disso, determinar sua aplicabilidade em nosso meio. MÉTODOS: Compilou-se uma apresentação com 20 casos de lesões secundárias da coluna, que foi analisada por 10 observadores. Estes definiram a estabilidade de cada lesão e, após a apresentação do sistema SINS, os mesmos casos foram apresentados aos mesmos observadores para que novamente determinassem a estabilidade da lesão. Os dados colhidos foram analisados por meio do cálculo do Kappa de Fleiss e da correlação intraclasse. RESULTADOS: Obtivemos concordância moderada interobservador com o uso do escore SINS. CONCLUSÕES: O sistema é aplicável em nosso meio. Houve mudança de opinião quanto à estabilidade da lesão após a apresentação do escore aos observadores.OBJETIVO: Evaluar el impacto en la conducta y cuantificar la reproducibilidad interobservador de la escala SINS. Además de eso, determinar la aplicabilidad de la clasificación en nuestro medio. MÉTODOS: Se compiló una presentación de 20 casos de lesiones secundarias de la columna vertebral que fue examinada por 10 observadores. Estos definieron la estabilidad de cada lesión y después de la presentación de la puntuación SINS, los mismos casos fueron presentados a los mismos observadores para que de nuevo determinasen la estabilidad de la lesión. Los datos obtenidos fueron analizados mediante el cálculo de Kappa de Fleiss y de la correlación intraclasse. RESULTADOS: Obtuvimos concordancia moderada interobservador con el uso de la puntuación SINS. CONCLUSIONES: La puntuación es aplicable en nuestro medio. Hubo un cambio de opinión en cuanto a la estabilidad de la lesión después de la presentación de la puntuación a los observadores.28728

Evaluation of the effect of pulsed electromagnetic field in the consolidation of posterolateral fusion on lumbosacral spine : a prospective, double-blind and randomized study

Orientador: João Batista de MirandaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: O sucesso da consolidação das artrodeses da coluna depende do local da fusão, e sua preparação, o tipo quantidade de enxerto utilizado, fatores locais e fatores sistêmicos. A literatura é escassa sobre o efeito do campo eletromagnético pulsado em artrodeses póstero-laterais lombares: os poucos estudos publicados não foram controlados nem tiveram metodologia reprodutível. Objetivos: Avaliar a influência do campo eletromagnético pulsado (CEMP) na consolidação das artrodeses lombares posterolaterais instrumentadas em pacientes operados por doença degenerativa da coluna. Métodos: Estudo prospectivo randomizado e duplo cego, que recrutou 40 pacientes entre 163 pacientes consecutivos submetidos a artrodese lombar num mesmo serviço. Pacientes foram randomizados em 2 grupos de 20 pacientes: Grupo Ativo, com pacientes expostos ao CEMP durante 4 horas por dia por 90 dias após procedimento cirúrgico; Grupo Inativo, em que os pacientes utilizaram dispositivo idêntico, com a mesma orientação, porém sem capacidade de gerar CEMP. Os pacientes realizaram tomografia computadorizada aos 45, 90, 180 e 360 dias após a cirurgia a fim de se constatar a ocorrência ou não de artrodese em cada nível vertebral operado. Resultados: No curso do estudo, 2 pacientes foram excluídos de cada grupo, e foram considerados para análise 36 pacientes. Não houve diferença estatística quanto a idade, sexo, prática do tabagismo e número de níveis vertebrais incluídos na artrodese entre os grupos. O percentual de consolidação dos níveis vertebrais avaliados aumentou comparando os momentos 90, 180 e 360 (p < 0,001) com o momento 45 dias em ambos os grupos. O Grupo Ativo apresentou 276% maior chance de consolidação nos níveis vertebrais (OR = 3,76; IC95%: 1,39 - 10,20), independentemente do momento de avaliação. Pacientes do Grupo Ativo apresentaram 16% mais consolidação que pacientes do grupo inativo (p = 0,018). Conclusões: A exposição ao CEMP no pós-operatório das artrodeses instrumentadas da coluna lombossacra, em pacientes operados por doença degenerativa da coluna, aumentou os índices de consolidação no primeiro ano de pós-operatórioAbstract: Introduction: The success in the consolidation of spinal arthrodeses depends on the location of the fusion and its preparation, the type of graft used, and on local and systemic factors. The literature is sparse on the effect of the pulsed electromagnetic field on lumbar posterolateral arthrodeses, and the few published studies were neither controlled nor reproducible. Objectives: To assess the effect of pulsed electromagnetic field (PEMF) on the consolidation of instrumented lumbar posterolateral arthrodeses in patients who were surgically treated for degenerative spine disease. Methods: Forty cases were recruited from 163 consecutive patients undergoing lumbar arthrodesis at the same center, in this prospective, randomized, controlled trial. The patients were randomized into 2 groups of 20 patients: the Active Group, in which patients were exposed to PEMF for 4 hours a day for 90 days after surgery; and the Inactive Group, in which patients received an identical device, with the same instructions for use but without the ability to generate PEMF. The patients underwent computed tomography scans at 45, 90, 180 and 360 days after surgery to check for the occurrence of arthrodesis at each spinal level that was operated upon. Results: In the course of the study, 2 patients were excluded from each group; thus 36 patients were considered for the analysis. There were no significant differences between the groups with respect to age, gender, smoking habit, or the number of vertebral levels included in the arthrodesis. The percent consolidation of the vertebral levels increased at 90, 180 and 360 days compared to 45 days (p < 0.001) in both groups. The Active Group had a 276% greater chance of consolidation in the vertebral levels (OR = 3.76; 95% CI: 1.39-10.20), regardless of the time of evaluation. Patients in the Active Group presented 16% more consolidation than patients in the inactive group (p = 0.018). Conclusions: Post-operative exposure to PEMF following instrumented arthrodesis of the lumbar spine for degenerative spine disease increased consolidation in the first year after surgeryDoutoradoFisiopatologia CirúrgicaDoutor em Ciências4411FUNCAM

CORRELATION BETWEEN LUMBAR SPINAL STENOSIS BASED ON MORPHOLOGY OF THE DURAL SAC AND THE QUALITY OF LIFE

ABSTRACT Objective: To evaluate the possible existence of a significant correlation between quality of life and severity classification of lumbar stenosis based on dural sac morphology in outpatients. Methods: Forty patients with a diagnosis of lumbar stenosis followed at a university hospital were submitted to magnetic resonance imaging (MRI) and quality of life questionnaires: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) and EQ-5D. They were classified as type A, B, C or D based on MRI. For the statistical analysis, the Spearman correlation was used. Results: Seventeen female patients and 23 male patients with mean age of 56.5 years constituted the sample. ODI had a mean dysfunction of 44.9%, the PCS score averaged 29.9, the MCS score was 41.3. The general symptoms of SSS presented a mean of 3.2 and the EQ-5D presented an average of 0.491. The patients with the highest severity in the classification were not necessarily those who presented worse scores in the quality of life questionnaires. Conclusion: The classification of severity of the lumbar spinal stenosis based on dural sac morphology does not correlate with the applied quality of life questionnaires. Level of Evidence III; Cross-sectional observational study

Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

OBJECTIVE: To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.METHODS: One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.RESULTS: The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.CONCLUSION: Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.</sec

PARAMETERS FOR THE EVALUATION OF CERVICAL SAGITTAL BALANCE IN IDIOPATHIC SCOLIOSIS

ABSTRACT Objective: There are no values defined as standard in the literature for the parameters of assessment of cervical sagittal balance in patients with idiopathic scoliosis. This study describes the sagittal cervical parameters in patients with idiopathic scoliosis. Methods: Study carried out in a tertiary public hospital in patients with adolescent idiopathic scoliosis, through the evaluation of panoramic radiographs in lateral view. The Cobb method was used to evaluate cervical lordosis from C2 to C7, distance from the center of gravity (COG) of the skull to C7, measurement of T1 slope, thoracic inlet angle (TIA), neck tilt, and plumb line from C7 to S1 (SVA C7-S1). A statistical analysis was performed, to demonstrate the relationship between the alignment of the thoracic spine in the sagittal plane and the cervical sagittal balance of patients with scoliosis. Results: Thirty-four patients were female (69.4%) and 15 male (30.6%). The mean values for COG-C7 were 0.71 mm (median 0.8 mm/standard deviation [SD]= 0.51 mm). For Cobb C2-C7, the mean was -11.7° (median -10°/SD= 20.4°). The mean slope of T1 was 23.5° (median 25°/SD= 9.5°). The mean cervical version was 58.8° (median 60°/DP= 15.4°). The mean TIA was 81.8° (median 85°/SD= 16.7°). The mean plumb line C7-S1 was -0.28 (-0.3/SD= 1.0). Conclusion: The analysis of the results showed that the mean values for the cervical lordosis are lower than the values described as normal in the literature, suggesting a loss of sagittal cervical balance in these patients

Avaliação tomográfica do posicionamento de parafusos pediculares em deformidades na coluna torácica e lombar introduzidos com base na técnica "free hand"

OBJETIVO: Avaliar o posicionamento de parafusos pediculares aplicados em vértebras da coluna torácica e lombar em pacientes portadores de escolioses, introduzidos pela técnica "free hand". MÉTODOS: Avaliação de quinze tomografias computadorizadas de 284 parafusos pediculares em 15 pacientes (sete homens e oito mulheres), com idade entre 12 e 39 anos (média de 16,7 anos) com escoliose. Os parafusos foram inseridos de T2 a S1 para as seguintes afecções: duas escolioses congênitas e 13 escolioses neuromusculares, visando avaliar o posicionamento dos parafusos com relação às paredes dos pedículos. RESULTADOS: Em relação às corticais do pedículo, 244 parafusos (86%) foram posicionados entre as corticais ou apenas as tocaram. Houve lesão da cortical lateral em 16 parafusos e lesão da cortical medial em 13 parafusos, sendo maior o número de violações nas vértebras torácicas. CONCLUSÃO: O uso de parafusos pediculares na instrumentação de vértebras torácicas e lombares nas escolioses mostrou -se segura e efetiva quando aplicado em diferentes níveis com a técnica "free hand''. Nas vértebras torácicas as violações da cortical pedicular foram mais frequentes, mas não prejudicaram a estabilidade da fixação e não lesaram estruturas neurais, vasculares e viscerais