A importancia da ultrassonografia com o eco color doppler no diagnostico da trombose venosa profunda nas artroplastias totais de quadril

Orientador: Iseu A. da CostaDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da Saude, Programa de Pós-Graduação em Clínica CirúrgicaResumo: Em pacientes submetidos a Artroplastia Total da Articulação Coxo- Femoral, foi avaliada a ocorrência de Trombose Venosa Profunda nos Membros Inferiores, através da Ultrassonografia. Foi utilizado o Eco- Color-Doppler como método de exame em todos os casos. Os objetivos foram: avaliar a eficiência do método utilizado e comparar com os resultados publicados na literatura; estabelecer um critério para tratamento dos pacientes com risco de desenvolver Embolia Pulmonar. Os resultados e a Revisão Bibliográfica demonstraram que o Eco- Color -Doppler apresenta um alto grau de confiabilidade no rastreamento da Trombose Venosa Profunda. Desta forma, poderia ser reservada a terapia com anticoagulantes apenas para estes pacientes.Abstract: In patients submitted to total arthroplasty of the hip joint, the occurrence of deep venous thrombosis in the lower limb was evaluated, with the use of ultrasonography. The Eco-Color-Doppler was used as the diagnostic method in all cases. The main objectives were: evaluate the method's efficiency and compare it to other results published in the literature; establish a criteria on treating patients that could develop a pulmonar emboly. The results and the bibliography review showed that the Eco-Color- Doppler is highly reliable in detecting deep venous thrombosis. From these results the anticoagulant therapy could be proposed for these patients only

Influência da terapia celular mononuclear sobre a degeneração discal em coelhos

ResumoObjetivoAvaliar a influência da injeção de células‐tronco mononucleares autólogas sobre as alterações histológicas do colágeno no ânulo fibroso do disco intervertebral após lesão experimental.MétodosForam submetidos 32 coelhos New Zealand a punção do discos intervertebrais lombares seguida de injeção intradiscal de células mononucleares provenientes da crista ilíaca versus injeção de solução salina nos seguintes períodos tempo: dois meses após a lesão (CT2M e SS2M), duas semanas (CT2S e SS2S), imediatamente após a lesão (CTCP e SSCP) e sem induzir a degeneração (CTSP e SSSP). Após dois meses da terapia celular, os animais foram submetidos a eutanásia e as alterações do colágeno nos discos intervertebrais foram avaliadas histologicamente.ResultadosHouve diferença estatisticamente significativa na CEAF entre os grupos CT2S e SS2S (p=0,018). Essa diferença decorreu de um aumento do colágeno do tipo I no grupo SS2S (56,7%) comparado com o CT2S (13,28%).ConclusãoO tratamento com células mononucleares precursoras mesenquimais é capaz de reduzir as alterações na distribuição do colágeno do tipo I e III no AF de discos degenerados de coelhos até duas semanas após a indução da degeneração.AbstractObjectiveThe objective of this research was to evaluate the influence of autologous mononuclear stem cells injections on histological changes of collagen in the fibrous annulus of the intervertebral disc after experimental injury.Methods32 New Zealand rabbits were submitted to intervertebral disc puncture, followed by intradiscal injection of mononuclear cells from the iliac crest versus saline injection in the following time periods: two months after the injury (SC2M and SS2M), two weeks (SC2W and SS2W) immediately after injury (SCCP and SSCP), and without inducing degeneration (SCSP and SSSP). Two months after cell therapy, the animals were euthanized and collagen changes in the intervertebral discs were histologically evaluated.ResultsThere were significant differences in ELAF between SS2W and SS2S groups (p=0.018). This difference was due to an increase in type I collagen in SS2W group (56.7%) compared to SC2S (13.28%).ConclusionTreatment with mononuclear mesenchymal stem cells reduced changes in the type I and III collagen distribution in rabbits AF degenerated discs up to two weeks after the induction of degeneration

Toward Shared Decision-Making in Degenerative Cervical Myelopathy: Protocol for a Mixed Methods Study

BACKGROUND Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this. OBJECTIVE The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes. METHODS Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders. RESULTS Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway. CONCLUSIONS This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46809

Instalação de um sistema de estudo de lesões medulares experimentais em animal

Orientador: Osvaldo MalafaiaTese (doutorado) - Universidade Federal do Paraná, Setor de Ciencias da Saúd

FREE-HAND PLACEMENT OF C7 PEDICLE SCREWS: A CADAVERIC STUDY

Objective : To evaluate the accuracy of free-hand pedicle screws placement at the seventh cervical vertebra. Methods : The authors have exposed the cervicothoracic junction of 9 adult cadavers (7 male and 2 female) preserved in formalin from the Faculty of Medicine of the Universidad Andina Néstor Cáceres Velásquez, city of Juliaca, Puno - Peru, locating the C7 vertebra based on anatomical parameters. According to previous publications, the entry point for the C7 pedicle was determined as 3-4mm lateral and 5-6mm superior to the center of the lateral mass, and the pedicle was drilled manually and instrumented with 3.5mm screws. After the screws placement, the C7 vertebrae were removed for radiographic analysis. Results : The authors were able to adequately locate the C7 entry point in 12 pedicles (66.6% accuracy), finding a great variability both laterally (2-5mm) and cranially (3-10mm). The angulation in the coronal plane was correct in 13 pedicles (72.3%), despite the incorrect location of the entry point. Angle values in the coronal plane ranged from 38 to 62 degrees. In the sagittal plane angulation, 2 screws were placed in the C6-C7 disc. The midtransversal diameter of the 18 pedicles ranged from 4 to 7mm. Conclusions : The location of the entry point for placement of C7 pedicle screws with pure free-hand technique is very variable due to anatomical differences and the authors recommend some type of guidance for increased safety and accuracy

Estudo anatômico da relação do gânglio da raiz dorsal com o disco intervertebral na coluna lombar

ResumoObjetivoDescrever a localização do gânglio da raiz dorsal em relação ao disco intervertebral, incluindo a zona “triangular”de segurança para cirurgia minimamente invasiva na coluna lombar.MétodosOito cadáveres adultos foram dissecados bilateralmente, na região lombar, com a abordagem posterolateral, até exposição dos espaços L3L4 e L4L5 e se obtiveram medidas referentes ao espaço entre o disco intervertebral, os pedículos cranial e caudal ao disco, o trajeto da raiz nervosa, o gânglio dorsal e o triângulo de segurança.ResultadosAs medidas obtidas foram constantes, sem diferenças significativas entre níveis ou lateralidade. O gânglio dorsal ocupou a borda lateral da zona triangular de segurança em todos os espécimes analisados.ConclusãoA localização precisa do gânglio mostra que a margem de segurança para procedimentos minimamente invasivos é menor do que a apresentada nos estudos que envolvem apenas medidas da raiz nervosa, o que explica talvez a presença de dor neuropática após alguns desses procedimentos.AbstractObjectiveTo describe the location of the dorsal root ganglion in relation to the intervertebral disc, including the “triangular” safety zone for minimally invasive surgery in the lumbar spine.MethodsEight adult cadavers were dissected bilaterally in the lumbar region, using a posterolateral approach, so as to expose the L3L4 and L4L5 spaces, thereby obtaining measurements relating to the space between the intervertebral disc, pedicles cranial and caudal to the disc, path of the nerve root, dorsal ganglion and safety triangle.ResultsThe measurements obtained were constant, without significant differences between levels or any laterality. The dorsal ganglion occupied the lateral border of the triangular safety zone in all the specimens analyzed.ConclusionPrecise localization of the ganglion shows that the safety margin for minimally invasive procedures is less than what is presented in studies that only involve measurements of the nerve root, thus perhaps explaining the presence of neuropathic pain after some of these procedures

Anatomical study on the relationship between the dorsal root ganglion and the intervertebral disc in the lumbar spine

ABSTRACTOBJECTIVE: To describe the location of the dorsal root ganglion in relation to the intervertebral disc, including the "triangular" safety zone for minimally invasive surgery in the lumbar spine. METHODS: Eight adult cadavers were dissected bilaterally in the lumbar region, using a posterolateral approach, so as to expose the L3L4 and L4L5 spaces, thereby obtaining measurements relating to the space between the intervertebral disc, pedicles cranial and caudal to the disc, path of the nerve root, dorsal ganglion and safety triangle. RESULTS: The measurements obtained were constant, without significant differences between levels or any laterality. The dorsal ganglion occupied the lateral border of the triangular safety zone in all the specimens analyzed. CONCLUSION: Precise localization of the ganglion shows that the safety margin for minimally invasive procedures is less than what is presented in studies that only involve measurements of the nerve root, thus perhaps explaining the presence of neuropathic pain after some of these procedures

CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular) would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative) radiographs were used for measuring lumbar lordosis (LL), segmental lordosis (SL) at the level of interbody fusion, and sacral slope (SS). Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001) as well as the SS (33.8o:31.2o, p=0.05). SL did not change significantly (11.4:11.06, p=0.85). There were no significant differences when comparing patients who received crescent shaped cage (n=27) and rectangular cage (n=43). Hypolordotic patients (Roussouly types 1 and 2) had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4). Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results

RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks), and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation