Use Of The Vascularized Iliac-crest Flap In Musculoskeletal Lesions.

Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors' experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm), three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity.201323714

Radiographic study of sagittal balance in a asymptomatic populational sample

Este estudo teve o objetivo de apresentar valores normais de alguns parâmetros de equilíbrio sagital da coluna cervical na população brasileira assintomática e analisar a correlação entre eles, distribuindo-se os dados em grupos diferentes entre os sexos e às faixas etárias. Também se buscou comparar os dados obtidos com relatos prévios de literatura. Trata-se de um estudo observacional prospectivo baseando-se em dados obtidos pela análise de 132 radiografias panorâmicas de indivíduos assintomáticos e realizadas aferições em software próprio dos seguintes parâmetros de equilíbrio sagital: lordose cervical (LC), Eixo Vertical Sagital de C2 (EVS-C2), Eixo Vertical Cervical (EVSc), Inclinação Angular de T1 (IT1), Discrepância entre T1 SLOPE e lordose cervical (IT1 - LC). Os valores obtidos foram comparados segundo o sexo e segundo três grupos de faixas etárias (18 à 39 anos, 40 à 59 anos e acima de 60 anos de idade). A lordose cervical apresentou média de -17,1o (SD 13.3o). O EVS-C2 apresentou valor médio de -4,8mm (SD 29,4mm). O EVSc apresentou média de 12,4mm (SD 10,1mm). O IT1 teve como valor médio +27,1o (SD 8,1o), já para a discrepância IT1 - LC obteve-se em média +10,9o (SD 12,4o). Houve uma tendência do EVSc ser maior no sexo masculino (p=0,047), diferente de dados observados em estudos prévios. Houve uma tendência significativa (p<0,05) para lordose cervical e IT1 - LC apresentarem valores mais negativos com o aumento da idade. Já o EVS-C2 foi menor no grupo etário mais novo. O EVSc apresentou correlação com a lordose cervical e com o IT1, sendo que estes parâmetros explicaram 30,6% da variabilidade do EVSc. A expansão do acesso a tecnologias que possam permitir análise global do equilíbrio sagital com parâmetros descritivos de mecanismos compensatórios da coluna vertebral, bacia e membros inferiores, poderá fornecer dados mais amplos das características individuais da população brasileira.The aim of the present study was to show normal values of some parameters of sagittal balance in cervical spine in asymptomatic Brazilian individuals and to analyze correlation between then, distributing the data in different groups by sex and age. In addition, to comparing the data obtained with previous literature reports. A prospective observational study was performed by the analysis of 132 panoramic full spine radiographies obtained from asymptomatic subjects and submitted of specific software analysis of the following cervical sagittal parameters: Cervical Lordosis (CL), C2 Sagittal Vertical Axis (C2-SVA), Cervical Vertical Axis (cSVA), T1 SLOPE and Cervical Mismatch (T1 SLOPE minus Cervical Lordosis). The values obtained were compared according to sex and according to three age groups (18 to 39 years old, 40 to 59 years older than 60 years). The Cervical Lordosis showed an average value of -17,1o (SD 13.3o). The C2-SVA showed an average value of -4,8mm (SD 29,4mm). The cSVA showed an average value of 12,4mm (SD 10,1mm). The T1 SLOPE mean was +27,1o (SD 8,1o) whereas for cervical mismatch it was obtained an average +10,9o (SD 12,4o). There was a tendency of higher cSVA in male subjects (p=0,047), a different data than those observed in previous studies. There was a significant tendency (p<0,05) for more negative values of Cervical Lordosis and Mismatch with increasing age. The C2-SVA, was lower in younger subjects. The cSVA was correlated with Cervical Lordosis and T1 SLOPE, and these parameters explain 30,6% of cSVA variability. We hope that access to new technologies - which can promote full global sagittal balance performances with analysis of compensatory mechanisms of vertebral column, pelvis and lower limbs - will allow to describe broader data of individual characteristics found in Brazilian population

Use of the Vascularized Iliac-Crest Flap in Musculoskeletal Lesions

Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors’ experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm), three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity

Estudo da estabilidade da coluna lombar após facetectomia

OBJETIVO: determinar a presença, ou não, de instabilidade lombar após a realização de facetectomia total unilateral para a descompressão radicular. MÉTODOS: os autores realizaram uma análise retrospectiva por avaliação clínica e radiográfica de 29 pacientes operadores, por discopatia, durante o período de janeiro de 1985 até janeiro de 1995. Os pacientes apresentavam queixa de dor ciática aguda, sem dor lombar prévia, e foram submetidos à facetectomia total unilateral para a descompressão radicular. Os casos operados por esta técnica necessitaram de manipulações excessivas com riscos de lesão da raiz nervosa. RESULTADOS: após um seguimento que variou de 9 a 17 anos, os resultados foram excelentes em 17 pacientes, bom em 9, regular em 3. CONCLUSÃO: nessa série de casos, a facetectomia total unilateral não foi fator determinante de instabilidade lombar

PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index), which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture

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

CORRELATION BETWEEN QUALITY OF LIFE AND OSTEOLYSIS AROUND LUMBAR PEDICLE SCREWS

ABSTRACT Objective: 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