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

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.

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

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

At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods

By September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients. © The Author(s) 2024