Fratura toracolombar tipo explosão: classificação de McCormack e falha de instrumentação posterior

OBJETIVOS: Verificar a associação entre o colapso sagital, falha da instrumentação posterior e a classificação de McCormack nos portadores de fratura toracolombar tipo explosão submetidos à artrodese posterior maior do que um nível acima e um abaixo da fratura. MÉTODOS: Estudo retrospectivo com base em prontuários e radiografias de 22 pacientes operados entre janeiro de 1990 e dezembro de 2006. Os parâmetros avaliados foram: piora da cifose (Cobb), disfunção neurológica (Frankel) e falha do tratamento cirúrgico (quebra ou soltura do implante). RESULTADOS: Não houve correlação entre o colapso sagital e a pontuação da classificação de McCormack (r = 0,221; P = 0,322). Verificamos ainda inexistência de associação entre a falha do implante posterior e a pontuação desta classificação (p = 0,85). CONCLUSÃO: Nossos achados sugerem a falta de aplicabilidade desta classificação em pacientes submetidos a artrodese posterior maior do que um nível acima e um abaixo da fratura.OBJECTIVES: To assess the relationship between sagittal collapse, implant failure and load sharing classification of patients suffering a thoracolumbar burst fracture treated with posterior instrumentation. METHODS: Retrospective review of radiographs and medical records of 26 patients operated on between January 1990 and December 2006. Kyphotic worsening (Cobb), neurologic dysfunction (Frankel) and the failure of surgical treatment (implant breaking or loosening) were studied. RESULTS: No relationship was found between kyphotic deformity and higher scores in the load sharing classification (r = 0,221; P = 0,322). No relationship was found between implant failure and this classification. (p = 0.85). CONCLUSION: Our findings suggest that this classification is not applicable in patients with an arthrodesis larger than one unit above and below the fracture

Tratamento da discite na criança Treatment of discitis in the child

OBJETIVO: Foram avaliados retrospectivamente nove casos de discite na infância, confirmando suas formas variadas de apresentação, que levam ao atraso e dificuldades no diagnóstico. MÉTODOS: Os autores demonstraram que as radiografias iniciais podem se apresentar sem alterações, sendo importantes os exames de cintilografia ou ressonância magnética, nesses casos. RESULTADOS E CONSLUSÕES: Um paciente necessitou de tratamento cirúrgico para descompressão do canal lombar, devido à presença de abscesso discal. Os demais pacientes foram tratados conservadoramente, através de repouso, antibioticoterapia adequada e imobilização. Todos os pacientes evoluíram satisfatoriamente, e não apresentavam queixas nas suas avaliações finais.<br>BACKGROUND: The authors reviewed nine patients presenting with discitis during infancy, demonstrating that its diverse forms of presentation lead to a delayed and difficult diagnosis. METHODS: This study reports that initial radiographs may not show any alterations, enhancing the importance of scintillography or magnetic resonance for these cases. RESULTS AND CONCLUSIONS: One patient was submitted to surgical treatment for lumbar canal decompression due to the presence of a disk abscess. The remaining patients were treated conservatively only with an appropriate antibiotic therapy, immobilization and restriction of physical activity. All of the young patients had a satisfactory evolution and stated no complaints about sequels during their final evaluation

Analysis of musculoskeletal changes in patients with postural roundback

OBJECTIVE: To analyze the clinical and radiographic changes in patients with postural rounded upper back. METHODS: 30 patients diagnosed with postural rounded upper back were studied, being 22 male and eight female, aged between 10 and 20 years, referred by the outpatient clinic of the Grupo de Cirurgia da Coluna of the Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brazil. Patients underwent assessment of posture, special tests to check for muscle retractions and radiographic examination to measure the curvatures of spine using the Cobb method. RESULTS/CONCLUSION: It is concluded that in the postural roundback there is a moderate increase of the thoracic kyphosis; the lumbar and cervical curvatures do not increase as a compensatory mechanism; the head appears anteriorized and the shoulder is also anteriorized and medially rotated; muscle retractions are present in the hamstrings, hip flexors, pectoralis minor and adductors of the shoulder muscles; the mobility of the lumbar spine is preserved and there is no relationship between the magnitude of thoracic curvature and the retraction of the hamstring muscles