Reproducibility Analysis Of The Stability And Treatment Of Vertebral Metastatic Lesions

Objectives: To investigate the reproducibility among spine surgeons in defining the treatment of vertebral metastatic lesions, taking into account the mechanical stability of injuries. Methods: Twenty cases of isolated vertebral metastatic lesions were presented to ten experts. Their opinion was then asked about the stability of the lesion, as well as their treatment option. Results: The interobserver Kappa coefficient obtained both for stability analysis as to the decision of the treatment was poor (0.334 and 0.248, respectively). Conclusions: Poor interobserver reproducibility was observed in deciding the treatment of vertebral metastatic lesions when considering the stability of the lesions.133232234American Cancer Society, (2007) Cancer Facts and Figures, , Atlanta: American Cancer SocietyNewman, C.B., Keshavarzi, S., Aryan, H.E., En bloc sacrectomy and reconstruction technique modification for pelvic fixation (2009) Surg Neurol, 72 (6), pp. 752-756Harrington, K.D., Current concepts review: Metastatic disease of the spine (1986) J Bone Joint Surg Am, 68 (7), pp. 1110-1115Gasbarrini, A., Cappuccio, M., Mirabile, L., Bandiera, S., Terzi, S., Barbanti Bròdano, G., Spinal metastases: Treatment evaluation algorithm (2004) Eur Rev Med Pharmacol Sci, 8 (6), pp. 265-274Bilsky, M., Smith, M., Surgical approach to epidural spinal cord compression (2006) Hematol Oncol Clin North Am, 20 (6), pp. 1307-1317Weber, M.H., Burch, S., Buckley, J., Schmidt, M.H., Fehlings, M.G., Vrionis, F.D., Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: A systematic review (2011) Int J Oncol, 38 (1), pp. 5-12Tokuhashi, Y., Kawano, H., Ohsaka, S., Matsuzaki, H., Toriyama, S., A scoring system for preoperative evaluation of the prognosis of metastatic spine tumor (a preliminary report) (1989) Nihon Seikeigeka Gakkai Zasshi, 63 (5), pp. 482-489Tokuhashi, Y., Matsuzaki, H., Toriyama, S., Kawano, H., Ohsaka, S., Scoring system for the preoperative evaluation of metastatic spine tumor prognosis (1990) Spine (Phila Pa 1976), 15 (11), pp. 1110-1113Tomita, K., Kawahara, N., Baba, H., Tsuchiya, H., Fujita, T., Toribatake, Y., Total em bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors (1997) Spine (Phila Pa 1976), 22 (3), pp. 324-333Tomita, K., Kawahara, N., Kobayashi, T., Yoshida, A., Murakami, H., Akamaru, T., Surgical strategy for spinal metastases (2001) Spine (Phila Pa 1976), 26 (3), pp. 298-306Fisher, C.G., DiPaola, C.P., Ryken, T.C., Bilsky, M.H., Shaffrey, C.I., Berven, S.H., A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the Spine Oncology Study Group (2010) Spine (Phila Pa 1976), 35 (22), pp. E1221-E1229Fourney, D.R., Frangou, E.M., Ryken, T.C., Dipaola, C.P., Shaffrey, C.I., Berven, S.H., Spinal instability neoplastic score: An analysis of reliability and validity from the spine oncology study group (2011) J Clin Oncol, 29 (22), pp. 3072-307

Degenerative Lumbar Spinal Stenosis: Corelation Between Oswestry Index And Magnetic Resonance Imaging [estenose Degenerativa Do Canal Lombar: Correlação Entre O índice De Oswestry E Imagem De Ressonância Magnética]

Objectives: To verify the relationship between the degree of lumbar spinal canal stenosis (LCS), in magnetic resonance imaging (MRI) and the severity of disability according to the Oswestry Index in patients with LCS compared to controls without LCS. Methods: Twenty-three patients with a diagnosis of LCS were compared with a control group of 17 volunteers. All participants underwent MRI and completed the Oswestry questionnaire. Statistical analysis used the Fisher exact test, the Mann-Whitney and the Spearman's tests. Results: Low back pain was the most frequent complaint in both groups. The Oswestry index showed average disability in 45.69% patients and 11.60% controls. MRI revealed that the dural sac cross-sectional area, the diameter of the canal and the lateral recesses and foramina were equally changed in both groups. Conclusions: There was no correlation between the degree of lumbar canal stenosis and the disability index in both groups.114278282Goh, K.J., Khalifa, W., Anslow, P., Cadoux-Hudson, T., Donaghy, M., The clinical syndrome associeted with lumbar spinal stenosis (2004) Eur Neurol., 52 (4), pp. 242-249Arbit, E., Pannullo, S., Lumbar stenosis: A clinical review (2001) Clin Orthop Relat Res., (384), pp. 137-143Zouboulis, P., Karageorgos, A., Dimakopoulos, P., Tyllianakis, M., Matzaroglou, C., Lambiris, E., Functional outcome of surgical treatment for multilevel lumbar spinal stenosis (2006) Acta Orthop., 77 (4), pp. 670-676Szpalski, M., Gunzburg, R., Lumbar spinal stenosis: Clinical features and new trends in surgical treatment (2004) Geriatr Times., 5 (4), p. 11. , http://www.cmellc.com/geriatrictimes/g040811.html, Accessed in 2012 (Mar 1)Thomé, C., Börm, W., Meyer, F., Degenerative lumbar spinal stenosis: Current strategies in diagnosis and treatment (2008) Dtsch Arztebl Int., 105 (20), pp. 373-379Postacchini, F., Lumbar spinal stenosis and pseudostenosis. Definition and classification of pathology (1983) Ital J Orthop Traumatol., 9 (3), pp. 339-350Fritz, J.M., Delitto, A., Welch, W.C., Erhard, R.E., Lumbar spinal stenosis: A review of current concepts in evaluation, management, and outcome measurements (1998) Arch Phys Med Rehabil., 79 (6), pp. 700-708Moon, E.S., Kim, H.S., Park, J.O., Shin, D.E., Ha, J.W., Kwak, Y.H., Comparison of the predictive value of myelography, computed tomography and MRI on the treadmill test in lumbar spinal stenosis (2005) Yonsei Med J., 46 (6), pp. 806-811Schonstrom, N.S., Boleander, N.F., Spengler, D.M., The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine (1985) Spine (Phila Pa 1976)., 10 (9), pp. 806-811Sigmundsson, F.G., Kang, X.P., Jönsson, B., Strömqvist, B., Correlation between disability and MRI findings in lumbar spinal stenosis: A prospective study of 109 patients operated on by decompression (2011) Acta Orthop., 82 (2), pp. 204-210Lohman, C.M., Tallroth, K., Kettunen, J.A., Lindgren, K.A., Comparasion of radiologic signs and clinical symptoms of spinal stenosis (2006) Spine (Phila Pa 1976)., 31 (16), pp. 1834-1840Barz, T., Melloh, M., Staub, L.P., Lord, S.J., Lange, J., Röder, C.P., Nerve root sedimentation sign: Evaluation of a new radiological sign in lumbar spinal stenosis (2010) Spine (Phila Pa 1976)., 35 (8), pp. 892-897Schizas, C., Theumann, N., Burn, A., Tansey, R., Wardlaw, D., Smith, F.W., Qualitative grading of severety of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images (2010) Spine (Phila Pa 1976)., 35 (21), pp. 1919-1924Fairbank, J.C., Couper, J., Davies, J.B., Óbrien, J.P., The Oswestry low back pain disability questionnaire (1980) Physiotherapy., 66 (8), pp. 271-273Fairbank, J.C., Pynsent, P.B., The Oswestry disability index (2000) Spine (Phila Pa 1976)., 25 (22), pp. 2940-2952Weishaupt, D., Schmid, M.R., Zanetti, M., Boos, N., Romanowski, B., Kissling, R.O., Positional MR imaging of the lumbar spine: Does it demonstrate nerve root compromise not visible at conventional MR imaging? (2000) Radiology., 215 (1), pp. 247-253Vigatto, R., (2006) Adaptação Cultural Do Instrumento "the Low Back Pain Disability Oswestry Questionnaire" [Cross-cultural Adaptation of Oswerstry Disability Index], , [dissertation]. Campinas: Universidade Estadual de Campinas. Faculdade de Ciências MédicasKirkwood, B., Sterne, J., (2006) Essential Medical Statistics., , Blackwell Science, Philadelphia;Sirvanci, M., Bhatia, M., Ganiyusufoglu, K.A., Duran, C., Tezer, M., Ozturk, C., Degenerative lumbar spinal stenosis: Correlation with Oswestry Disability Index and MR imaging (2008) Eur Spine J., 17 (5), pp. 679-685Genevay, S., Atlas, S.J., Lumbar spinal stenosis (2010) Best Pract Res Clin Rheumatol., 24 (2), pp. 253-265Karppinen, J., Shen, F.H., Luk, K.D., Andersson, G.B., Cheung, K.M., Samartzis, D., Management of degenerative disk disease and chronic low back pain (2011) Orthop Clin North Am., 42 (4), pp. 513-528Katz, J.N., Dalgas, M., Stucki, G., Lipson, S.J., Diagnosis of lumbar spinal stenosis (1994) Rheum Dis Clin North Am., 20 (2), pp. 471-483Falavigna, A., Teles, A.R., Avaliação clínica e funcional no pré- operatório de doenças degenerativas da coluna vertebral. (2009) Coluna/Columna., 8 (3), pp. 245-253Campbell, P., Jordan, K.P., Dunn, K.M., The role of relationship quality and perceived partner responses with pain and disability in those with back pain (2012) Pain Med., 13 (2), pp. 204-214Hart, D.L., Werneke, M.W., Deutscher, D., George, S.Z., Stratford, P.W., Mioduski, J.E., Using intake and change in multiple psychosocial measures to predict functional status outcomes in people with lumbar spine syndromes: A preliminary analysis (2011) Phys Ther., 91 (12), pp. 1812-1825Carragee, E.J., Alamin, T.F., Miller, J.L., Carragee, J.M., Discographic, M.R.I., And psychosocial determinants of low back pain disability and remission: A prospective study in subjects with benign persistent back pain (2005) Spine J., 5 (1), pp. 24-35Apazidis, A., Ricart, P.A., Diefenbach, C.M., Spivak, J.M., The prevalence of transitional vertebrae in the lumbar spine (2011) Spine J., 11 (9), pp. 858-862Boden, S.D., The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine (1996) J Bone Joint Surg Am., 78 (1), pp. 114-124Aalto, T.J., Malmivaara, A., Kovacs, F., Herno, A., Alen, M., Salmi, L., Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: Systematic review (2006) Spine (Phila Pa 1976)., 31 (18), pp. E648-E663Zeifang, F., Schiltenwolf, M., Abel, R., Moradi, B., Gait analysis does not correlate with clinical and MR imaging parameters in patients with symptomatic lumbar spinal stenosis (2008) BMC Musculoskelet Disord, 9, p. 8

Correlation Between Symptoms And Sagittal Alignment Parameters In Patients With Lumbar Canal Stenosis: A Case-control Study

Objective: To examine the relationship between sagittal balance parameters and different symptoms of spinal disease in patients with lumbar canal stenosis (LCS) and controls. Methods: In this prospective, diagnostic, case-control study, we included all patients consecutively admitted to a public teaching hospital for surgical treatment of LCS between July 2010 and October 2011, aged more than 40 years, with back pain plus radiculopathy or neurogenic claudication, and controls without LCS. Magnetic resonance and x-rays allowed the measurement of sagittal axis parameters. Clinical data, the Oswestry Disability Index and the visual analogue scale of pain were assessed. Results: 23 patients were in the Stenosis group, and 17 were controls. The Stenosis group presented lower values of total lumbopelvic lordosis and regional lordosis L1, L2 and L3. In LCS patients and back pain, total lumbopelvic and regional lordosis at L1, L2 and L3 were smaller. Those with stenosis and radiculopathy had higher values of pelvic tilt and lower total lumbopelvic lordosis and regional lordosis in L1 and L2. In patients with claudication, regional lumbopelvic lordosis in L1 and L2 and the T9 sagittal offset were smaller. All patients with pain had higher values of thoracic kyphosis, regional lumbopelvic lordosis in L1, lower values for pelvic tilt, sagittal T1 offset, sacro-femoral distance and overhang compared to patients without pain. Conclusions: This study shows significant correlations between symptoms and sagittal axis parameters between patients with and without spinal canal stenosis and also in subgroups of the patients with stenosis with different complaints.114302309Berthonnaud, E., Dimnet, J., Roussouly, P., Labelle, H., Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters (2005) J Spinal Disord Tech., 18 (1), pp. 40-47During, J., Goudfrooij, H., Keessen, W., Beeker, T.W., Crowe, A., Toward standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions (1985) Spine (Phila Pa 1976), 10 (1), pp. 83-87Glassman, S.D., Berven, S., Bridwell, K., Horton, W., Dimar, J.R., Correlation of radiographic parameters and clinical symptoms in adult scoliosis (2005) Spine (Phila Pa 1976)., 30 (6), pp. 682-688Izumi, Y., Kumano, K., Analysis of sagittal lumbar alignment before and after posterior instrumentation: Risk factor for adjacent unfused segment (2001) Eur J Orthop Surg Traumatol., 11 (1), pp. 9-13. , http://www.springerlink.com/content/q16h14h28xl06pv5/, Acessed in 2012 (may 21)Korovessis, P., Dimas, A., Iliopoulos, P., Lambiris, E., Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: A comparative study in asymptomatic volunteers versus patients with low back pain (2002) J Spinal Disord Tech., 15 (5), pp. 384-390Lazennec, J.Y., Ramaré, S., Arafati, N., Laudet, C.G., Gorin, M., Roger, B., Sagittal alignment in lumbosacral fusion: Relations between radiological parameters and pain (2000) Eur Spine J., 9 (1), pp. 47-55Vaz, G., Roussouly, P., Berthonnaud, E., Dimnet, J., Sagittal morphology and equilibrium of pelvis and spine (2002) Eur Spine J., 11 (1), pp. 80-87Duval-Beaupère, G., Legaye, J., Composante saggitale de la statique rachidienne. (2004) Rev Rhum., 71, pp. 105-105. , http://www.em-consulte.com/article/24130/article/composante-sagittale-de- la-statique-rachidienne, Acessed in 2012 (may 21)Gautier, J., Morillon, P., Marcelli, C., Does spinal morphology influence the occurrence of low back pain? A retrospective clinical, anthropometric, and radiological study (1999) Rev Rhum Engl Ed., 66 (1), pp. 29-34Gelb, D.E., Lenke, L.G., Bridwell, K.H., Blanke, K., McEnery, K.W., An analysis of sagittal alignment in 100 asymptomatic middle and older aged volunteers (1995) Spine (Phila Pa 1976)., 20 (12), pp. 1351-1358Ohtori, S., Ito, T., Yamashita, M., Murata, Y., Morinaga, T., Hirayama, J., Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study: Differences in scores based on age, sex, and type of disease (2010) J Orthop Sci., 15 (1), pp. 86-91Mangione, P., Sénégas, J., L'équilibre rachidien dans le plan sagittal. (1997) Rev Chir Orthop Traumatol., 83 (1), pp. 22-32. , http://www.em-consulte.com/en/article/139714#N10022, Accessed in 2012 (may 21)Aebi, M., Sagittal balance of spine: Consequences for the treatment of the degenerative spine (2011) Eur Spine J, 20 (SUPPL. 5), p. 555Saal, J.S., General principles of diagnostic testing as related to painful lumbar spine disorders: A critical appraisal of current diagnostic techniques (2002) Spine (Phila Pa 1976)., 27 (22), pp. 2538-2545Lund, T., Reviewer's comment on "sagittal balance of 85 patients with a lumbar degenerative disease: A comparative study" (by Cédric Y. Barrey et al.), (ESJ-05-0488.R2) (2007) Eur Spine J., 16 (9), pp. 1469-1470Chaléat-Valayer, E., Mac-Thiong, J.M., Paquet, J., Berthonnaud, E., Siani, F., Roussouly, P., Sagittal spino-pelvic alignment in chronic low back pain (2011) Eur Spine J., 20 (SUPPL. 5), pp. 634-640George, S.Z., Hicks, G.E., Nevitt, M.A., Cauley, J.A., Vogt, M.T., The relationship between lumbar lordosis and radiologic variables and lumbar lordosis and clinical variables in elderly, African-American women (2003) J Spinal Disord Tech., 16 (2), pp. 200-206Barrey, C., Jund, J., Noseda, O., Roussouly, P., Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases (2007) Eur Spine J., 16 (9), pp. 1459-1467Vital, J.M., Gille, O., Gangnet, N., Équilibre sagittal et applications cliniques. (2004) Rev Rhum., 71 (2), pp. 120-128. , http://www.em-consulte.com/article/24131/article/equilibre-sagittal-et- applications-cliniques, Accessed in 2012 (may 21)Roussouly, P., Gollogly, S., Berthonnaud, E., Dimnet, J., Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position (2005) Spine (Phila Pa 1976)., 30 (3), pp. 346-353Rajnics, P., Temphier, A., Skalli, W., Lavaste, F., Illes, T., The importance of spinopelvic parameters in patients with lumbar disc lesions (2002) Int Orthop., 26 (2), pp. 104-108Janssen, M.M., Drevelle, X., Humbert, L., Skalli, W., Castelein, R.M., Differences in male and female spino-pelvic alignment in asymptomatic young adults: A three-dimensional analysis using upright low-dose digital biplanar X-rays (2009) Spine (Phila Pa 1976), 34 (23), pp. E826-E832Geiger, E.V., Müller, O., Niemeyer, T., Kluba, T., Adjustment of pelvispinal parameters preserves the constant gravity line position (2007) Int Orthop., 31 (2), pp. 253-258Kobayashi, T., Atsuta, Y., Matsuno, T., Takeda, N., A longitudinal study of congruent sagittal spinal alignment in an adult cohort (2004) Spine (Phila Pa 1976)., 29 (6), pp. 671-676Kirkwood, B.R., Sterne, J.A.C., (2003) Essential Medical Statistics., , 2nd ed. Massachusetts: Blackwell Science;Boulay, C., Tardieu, C., Hecquet, J., Benaim, C., Mouilleseaux, B., Marty, C., Sagittal alignment of spine and pelvis regulated by pelvic incidence: Standard values and prediction of lordosis (2006) Eur Spine J., 15 (4), pp. 415-422Suzuki, H., Endo, K., Mizuochi, J., Kobayashi, H., Tanaka, H., Yamamoto, K., Clasped position for measurement of sagittal spinal alignment (2010) Eur Spine J., 19 (5), pp. 782-78

Evolution Of Oswestry 2.0 Questionnaire And The Physical Component (pcs) Of Sf-36 During The First Postoperative Year Of Lumbar Spine Fusion In Degenerative Diseases [evolução Dos Questionários Oswestry 2.0 E Do Componente Físico (pcs) Do Sf-36 Durante O Primeiro Ano De Pós- Operatório De Artrodese Da Coluna Lombar Em Doenças Degenerativas]

Objective: Assess the clinical improvement of patients undergoing decompression and posterolateral lumbar arthrodesis for degenerative diseases, evaluating the evolution of the scores of Oswestry 2.0 questionnaire and the physical component (PCS) of the SF-36 scale. Methods: Prospective study of 19 patients with degenerative disc disease (disc herniation, lumbar stenosis or degenerative spondylolisthesis) that underwent decompression and posterolateral arthrodesis. All patients included in our study answered the questionnaire Oswestry 2.0 and the PCS of SF-36 at five different occasions: in the preoperative period and 45, 90, 180 and 360 days after surgery. Results: The scores of Oswestry 2.0 questionnaire and the physical component (PCS) of the SF-36 of the patients showed significant improvement (p<0.001 and p=0.004 respectively) over a year of postoperative follow-up. There was no significant difference in improvement in these scores when comparing the diagnoses made (disc herniation, lumbar stenosis or degenerative spondylolisthesis), sex of patients, and individuals aged up to fifty years and those over fifty years. Conclusion: There was an improvement in Oswestry scores and physical component (PCS) of the SF-36 in patients with degenerative lumbar spine unresponsive to conservative treatment that underwent surgical decompression and arthrodesis after one year of postoperative follow-up.122128132Webb, R., Brammah, T., Lunt, M., Urwin, M., Allison, T., Symmons, D., Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population (2003) Spine (Phila Pa 1976), 28 (11), pp. 1195-202Andersson, G.B., Epidemiology of low back pain (1998) Acta Orthop Scand Suppl, 281, pp. 28-31Cassidy, J.D., Carroll, L.J., Côté, P., The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults (1998) Spine (Phila Pa 1976), 23 (17), pp. 1860-6Kent, P., Keating, J., Do primary-care clinicians think that nonspecific low back pain is one condition? (2004) Spine (Phila Pa 1976), 29 (9), pp. 1022-31Yong-Hing, K., Kirkaldy-Willis, W.H., The pathophysiology of degenerative disease of the lumbar spine (1983) Orthop Clin North Am, 14 (3), pp. 491-504Liao, J.C., Chen, W.J., Chen, L.H., Niu, C.C., Keorochana, G., Surgical outcomes of degenerative spondylolisthesis with L5-S1 disc degeneration: Comparison between lumbar floating fusion and lumbosacral fusion at a minimum 5-year follow-up (2011) Spine (Phila Pa 1976), 36 (19), pp. 1600-7Suratwala, S.J., Pinto, M.R., Gilbert, T.J., Winter, R.B., Wroblewski, J.M., Functional and radiological outcomes of 360 degrees fusion of three or more motion levels in the lumbar spine for degenerative disc disease (2009) Spine (Phila Pa 1976), 34 (10), pp. E351-8Fairbank, J.C., Pynsent, P.B., The Oswestry Disability Index (2000) Spine (Phila Pa 1976), 25 (22), pp. 2940-52Ware, J., Snow, K., Kosinski, M., Gandek, B., (1993) SF-36 Health Survey: Manual and Interpretation Guide, , Boston, MA: The Health Institute;Ware, J.E., Kosinski, M., Keller, S.K., (1994) SF-36 Physical and Mental Health Summaries Scales: A User's Manual, , Boston, MA: The Health Institute;Kirkwood, B.R., Sterne, J.A., (2006) Essential Medical Statistics, , 2nd ed. Massachusetts, USA: Blackwell Science;Neter, J., Kutne, M.H., Nschtsheim, C.J., Wasserman, W., (1996) Applied Linear Statistical Models, , 4th ed. Chicago (IL): Richard D. Irwing;Bridwell, K.H., Sedgewick, T.A., O'brien, M.F., Lenke, L.G., Baldus, C., The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis (1993) J Spinal Disord, 6 (6), pp. 461-72Deyo, R.A., Nachemson, A., Mirza, S.K., Spinal-fusion surgery - The case for restraint (2004) N Engl J Med, 350 (7), pp. 722-6Maghout Juratli, S., Franklin, G.M., Mirza, S.K., Wickizer, T.M., Fulton-Kehoe, D., Lumbar fusion outcomes in Washington State workers' compensation (2006) Spine (Phila Pa 1976), 31 (23), pp. 2715-23Glassman, S.D., Carreon, L., Dimar, J.R., Outcome of lumbar arthrodesis in patients sixty-five years of age or older (2010) Surgical Technique. J Bone Joint Surg Am, 92 (SUPPL. 1 PART 1), pp. 77-84Herkowitz, H.N., Abraham, D.J., Degenerative lumbar spondylolisthesis (1999) Semin Spine Surg, 11, pp. 28-33Rönnberg, K., Lind, B., Zoëga, B., Halldin, K., Gellerstedt, M., Brisby, H., Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery (2007) Spine (Phila Pa 1976), 32 (2), pp. 256-61Turner, J.A., Ersek, M., Herron, L., Haselkorn, J., Kent, D., Ciol, M.A., Patient outcomes after lumbar spinal fusions (1992) JAMA, 268 (7), pp. 907-11Bernard Jr., T.N., Repeat lumbar spine surgery. Factors influencing outcome (1993) Spine (Phila Pa 1976), 18 (15), pp. 2196-200Toyone, T., Tanaka, T., Kato, D., Kaneyama, R., Otsuka, M., Patients' expectations and satisfaction in lumbar spine surgery (2005) Spine (Phila Pa 1976), 30 (23), pp. 2689-94Kornblum, M.B., Fischgrund, J.S., Herkowitz, H.N., Abraham, D.A., Berkower, D.L., Ditkoff, J.S., Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective long-term study comparing fusion and pseudarthrosis (2004) Spine (Phila Pa 1976), 29 (7), pp. 726-33Tsutsumimoto, T., Shimogata, M., Yoshimura, Y., Misawa, H., Union versus nonunion after posterolateral lumbar fusion: A comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis (2008) Eur Spine J, 17 (8), pp. 1107-12Mardjetko, S.M., Connolly, P.J., Shott, S., Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970-1993 (1994) Spine (Phila Pa 1976), 19 (SUPPL. 20), pp. 2256S-2265SFischgrund, J.S., Mackay, M., Herkowitz, H.N., Brower, R., Montgomery, D.M., Kurz, L.T., 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation (1997) Spine (Phila Pa 1976), 22 (24), pp. 2807-12Park, P., Garton, H.J., Gala, V.C., Hoff, J.T., McGillicuddy, J.E., Adjacent segment disease after lumbar or lumbosacral fusion: Review of the literature (2004) Spine (Phila Pa 1976), 29 (17), pp. 1938-1944Glassman, S.D., Carreon, L.Y., Dimar, J.R., Campbell, M.J., Puno, R.M., Johnson, J.R., Clinical outcomes in older patients after posterolateral lumbar fusion (2007) Spine J, 7 (5), pp. 547-51Glassman, S.D., Polly, D.W., Bono, C.M., Burkus, K., Dimar, J.R., Outcome of lumbar arthrodesis in patients sixty-five years of age or older (2009) J Bone Joint Surg Am, 91 (4), pp. 783-9

Translation And Cross -cultural Adaptation To Portuguese Of "swiss Spinal Stenosis Questionaire" [tradución Transcultural Y Adaptación Al Portugués De "swiss Spinal Stenosis Questionaire"]

Objective: Translate and culturally adapt to Brazilian-Portuguese the "Swiss Spinal Stenosis Questionnaire". Method: 1) initial translation; 2) back-translation; 3) pre-test; 4) final test. Results: The Brazilian- Portuguese version was administered to 27 patients with spinal stenosis. Changes were made to terms and expressions that were not understood by patients during the pre-test, and the final version was drawn up in consensus. This final version was applied again, resulting in 100% of patients understanding. Conclusion: Therefore, the final version is available from the Swiss Spinal Stenosis Questionnaire in Brazilian-Portuguese. The validation of this version is already in progress.1213641Sirvanci, M., Bhatia, M., Ganiyusufoglu, K.A., Duran, C., Tezer, M., Ozturk, C., Degenerative lumbar spinal stenosis: Correlation with Oswestry Disability Index and MR imaging (2008) Eur Spine J., 17 (5), pp. 679-685Rodrigues, L.M., Ueno, F.H., Fujiki, E.N., Milani, C., Estudo prospectivo comparativo entre pseu-doartrose e fusão óssea na estenose de canal lombar (2011) Acta Ortop Bras., 19 (3), pp. 159-162De Villiers, P.D., Booysen, E.L., Fibrous spinal stenosis. A report on 850 myelograms with a water-soluble contrast medium (1976) Clin Orthop Relat Res., (115), pp. 140-144Arnoldi, C.C., Brodsky, A.E., Cauchoix, J., Crock, H.V., Dommisse, G.F., Edgar, M.A., Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification (1976) Clin Orthop Relat Res., (115), pp. 4-5Bolender, N.F., Schonstrom, N.S.R., Spengler, D.M., Role of computed tomography and myelography in the diagnosis of central spinal stenosis (1985) Journal of Bone and Joint Surgery - Series A, 67 (2), pp. 240-246Arbit, E., Pannullo, S., Lumbar stenosis: A clinical review (2001) Clinical Orthopaedics and Related Research, (384), pp. 137-143Stucki, G., Daltroy, L., Liang, M.H., Lipson, S.J., Fossel, A.H., Katz, J.N., Measurement properties of a self-administered outcome measure in lumbar spinal stenosis (1996) Spine, 21 (7), pp. 796-803. , DOI 10.1097/00007632-199604010-00004Pratt, R.K., Fairbank, J.C.T., Virr, A., The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford spinal stenosis score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis (2002) Spine, 27 (1), pp. 84-91. , DOI 10.1097/00007632-200201010-00020(2007) Evidence Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Degenerativelumbar Spinal Stenosis, , North American Spine Society Burr Ridge, IL: North American Spine SocietyGonçalves, C.C.K., Peccin, M.S., Almeida, G.J.M., Cohen, M., Tradução validação e adaptação cultural da escala de atividade esportiva (2007) Acta Ortop Bras., 15, pp. 246-250Vilete, L., Figueira, I., Coutinho, E., Portuguese-language cross-cultural adaptation of the Social Phobia Inventory (SPIN) to be used with adolescent students (2006) Revista de Psiquiatria do Rio Grande do Sul, 28 (1), pp. 40-48. , http://www.scielo.br/pdf/rprs/v28n1/v28n1a06.pdfGuillemin, F., Bombardier, C., Beaton, D., Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines (1993) Journal of Clinical Epidemiology, 46 (12), pp. 1417-1432. , DOI 10.1016/0895-4356(93)90142-NTomkins, C.C., Battie, M.C., Hu, R., Construct validity of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire for the measurement of walking capacity (2007) Spine, 32 (17), pp. 1896-1901. , DOI 10.1097/BRS.0b013e31811328eb, PII 000076322007080100001

Use Of Vertical Expandable Prosthetic Of Titanium For The Rib For Treating Congenital Kyphosis In Thoracic Meningomyelocele Patients [uso Da Prótese Vertical Expansível De Titânio Para Costela No Tratamento Da Cifose Congênita Em Portadores De Mielomeningocele Torácica]

Objective: to evaluate clinical and radiographic postoperative results of congenital kyphosis correction in thoracic meningomyelocele patients using vertical expandable prosthetic of titanium for the rib (VEPTR). Methods: a retrospective study of 19 thoracic meningomyelocele and congenital kyphosis patients that were subjected to the VEPTR treatment between October 2005 and October 2008, with radiographic evaluation and immediate post and pre-operative clinical practice. Also, the duration of surgical procedure, the need for blood transfusion and postoperative complications were assessed. Results: the patients' average age was 70 months (from 32 to 130 months). The average follow-up from patients was 13.5 months (from 2 to 26 months). The average duration of the procedure was 117 minutes (variation between 70 and 195 minutes). All children reached trunk balance, 13 of whom had not showed it in the postoperative period. The average of pre-operation kyphosis was 115° (from 80° to 150°) and 77° (from 50° to 104°) for postoperative, with an average correction percentage of 31.2% (from 1.1 to 61.5%). The previous preoperative imbalance of trunk was an average 7.9 cm (from 1.0 to 15.5 cm) and 3.4 cm (from 0 to 8 cm) for postoperative. The average correction of this imbalance was of 50.4% (from 0 to 100%). Regarding weight, in pre-operative the average was 15.4 kg (from 8 to 30 kg) and 20.6 kg (from 8.5 to 35 kg) for postoperative. The average gain of weight was of 36.6% (from 9.8 to 100%). Five of the 19 patients (26.3%) presented postoperative complications. No patient needed blood transfusion. Conclusion: the use of VEPTR in thoracic meningomyelocele and congenital kyphosis patients has proven to be an effective and promising alternative for the control of physical deformity in patients with a potential for growth.83286296Hoppenfeld, 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) J Pediatr Orthop, 5 (6), pp. 691-696Banta, J.V., The evolution of surgical treatment of spinal deformity in myelomeningocele (1987) Z Kinderchir, 42 (SUPPL. 1), pp. 10-12Akbar M, Bremer R, Thomsen M, Carstens C, Abel R. Kyphectomy in children with myelodysplasia: results 1994-2004. Spine (Phila Pa 1976). 2006;31(9):1007-13Raycroft, J.F., Curtis, B.H., Spinal curvature in myelomeningocele: Natural historyand etiology (1972) American Academy of Orthopedic Surgeons Symposium on myelomeningocele, , St. Louis: C.V. Mosby;Burney 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) Clin Radiol, 29 (4), pp. 427-430Carstens, C., Koch, H., Brocai, D.R., Niethard, F.U., Development of pathological lumbar kyphosis in myelomeningocele (1996) J Bone Joint Surg Br, 78 (6), pp. 945-950Banta JV. Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine (Phila Pa 1976). 1990;15(9):946-52Cotta, H., Parsch, K., Schulitz, K.P., The treatment of lumbar kyphosis in spina bifida cystica] (1971) Z Orthop Ihre Grenzgeb, 108 (4), pp. 567-574. , GermanBanta, J.V., Hamada, J.S., Natural history of the kyphotic deformity in myelomeningocele (1976) J Bone Joint Surg Am, 58 A, p. 279Sharrard, W.J., Spinal osteotomy for congenital kyphosis in myelomeningocele (1968) J Bone Joint Surg Br, 50 (3), pp. 466-471Drennan, J.C., The role of muscles in the development of human lumbar kyphosis (1970) Dev Med Child Neurol Suppl, 22 (SUPPL. 22), pp. 33-38Crawford AH, Strub WM, Lewis R, Gabriel KR, Bilmire DA, Berger T, et al. Neonatal kyphectomy in the patient with myelomeningocele. Spine (Phila Pa 1976). 2003;28(3):260-6Niall DM, Dowling FE, Fogarty EE, Moore DP, Goldberg C. Kyphectomy in children with myelomeningocele: a long-term outcome study. J Pediatr Orthop. 2004;24(1):37-44Heydemann JS, Gillespie R. Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation. Spine (Phila Pa 1976). 1987;12(1):37-41Mazur, J., Menelaus, M.B., Dickens, D.R., Doig, W.G., Efficacy of surgical management for scoliosis in myelomeningocele: Correction of deformity and alteration of functional status (1986) J Pediatr Orthop, 6 (5), pp. 568-575Martin Jr, J., Kumar, S.J., Guille, J.T., Ger, D., Gibbs, M., Congenital kyphosis in myelomeningocele: Results following operative and nonoperative treatment (1994) J Pediatr Orthop, 14 (3), pp. 323-328Torre-Healy, A., Samdani, A.F., Newer technologies for the treatment of scoliosis in the growing spine (2007) Neurosurg Clin N Am, 18 (4), pp. 697-705Thompson, G.H., Akbamia, B.A., Campbell Jr, R.M., Growing rod techniques in early-onset scoliosis (2007) J Pediatr Orthop, 27 (3), pp. 354-361Sarwark, J.F., Kyphosis deformity in myelomeningocele (1999) Orthop Clin North Am, 30 (3), pp. 451-455. , viii-ixMintz, L.J., Sarwark, J.F., Dias, L.S., Schafer, M.F., The natural history of congenital kyphosis in myelomeningocele. A review of 51 children. Spine (Phila Pa 1976) (1991), p. 16. , 8 Suppl:S348-50Sharrard, W.J., Drennan, J.C., Osteotomy-excision of the spine for lumbar kyphosis in older children with myelomeningocele (1972) J Bone Joint Surg Br, 54 (1), pp. 50-60Lindseth, R.E., Stelzer Jr., L., Vertebral excision for kyphosis in children with myelomeningocele (1979) J Bone Joint Surg Am, 61 (5), pp. 699-704McCarthy RE, Dunn H, McCullough FL. Luque fixation to the sacral ala using the Dunn-McCarthy modification. Spine (Phila Pa 1976). 1989;14(3):281-3McMaster MJ. The long-term results of kyphectomy and spinal stabilization in children with myelomeningocele. Spine (Phila Pa 1976). 1988;13(4):417-24Lowe, G.P., Menelaus, M.B., The surgical management of kyphosis in older children with myelomeningocele (1978) J Bone Joint Surg Br, 60 (1), pp. 40-45Warner Jr, W.C., Fackler, C.D., Comparison of two instrumentation techniques in treatment of lumbar kyphosis in myelodysplasia (1993) J Pediatr Orthop, 13 (6), pp. 704-708Nolden MT, Sarwark JF, Vora A, Grayhack JJ. A kyphectomy technique with reduced perioperative morbidity for myelomeningocele kyphosis. Spine (Phila Pa 1976). 2002;27(16):1807-13Sriram, K., Bobechko, W.P., Hall, J.E., Surgical management of spinal deformities in spina bifida (1972) J Bone Joint Surg Br, 54 (4), pp. 666-676Duncan, J.W., Lovell, W.W., Bailey, S.C., Ransom, D., Surgical treatment of kyphosis in myelomeningocele (1976) J Bone Joint Surg Am, 58, p. 155Leatherman KD, Dickson RA. Congenital kyphosis in myelomeningocele. Vertebral body resection and posterior spine fusion. Spine (Phila Pa 1976). 1978;3(3): 222-6Ferraretto, I., Mota, D.P., Fernandes, A.C., Machado, P.O., Silva Jr, J.A., Cifoses na mielomeningocele: Conceitos, técnicas de tratamento e apresentação de casos. (1998) Rev Bras Ortop, 33 (12), pp. 963-972Hall, J.E., Poitras, B., The management of kyphosis in patients with myelomeningocele (1977) Clin Orthop Relat Res, 128, pp. 33-40Lintner, S.A., Lindseth, R.E., Kyphotic deformity in patients who have myelomeningocele. Operative treatment and long-term follow-up (1994) J Bone Joint Surg Am, 76 (9), pp. 1301-1307Doers, T., Walker, J.L., van den Brink, K., Stevens, D.B., Heavilon, J., The progression of untreated lumbar kyphosis and the compensatory thoracic lordosis in myelomeningocele (1997) Dev Med Child Neurol, 39 (5), pp. 326-330Dias, R.C.C., Veiga, I.G., Pasqualini, W., Santos, M.A.M., Landim, E., Cavali, P.T.M., Avaliação do tratamento cirúrgico da cifose congênita na mielomeningocele com o uso da via posterior pela técnica de Dunn-McCarthy modificada. (2008) Coluna/Columna, 7 (2), pp. 146-152Campbell Jr, R.M., Hell-Vocke, A.K., Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty (2003) J Bone Joint Surg Am, 85-A (3), pp. 409-420Campbell Jr, R.M., Smith, M.D., Mangos, J.A., The treatment of thoracic insufficiency syndrome associated with progressive early onset scoliosis by opening wedge thoracostomy (2005) the Annual Meeting of the Scoliosis Research Society, , Presented at: Oct. 27-30Miami, FLEmans JB, Caubet JF, Ordonez CL, Lee EY, 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 Spine (Phila Pa 1976). 2005;30(17 Suppl):S58-68Campbell Jr, R.M., Smith, M.D., Mayes, T.C., Mangos, J.A., Willey-Courand, D.B., Kose, N., The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis (2004) J Bone Joint Surg Am, 86-A (8), pp. 1659-1674Hell, 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) J Pediatr Orthop B, 14 (4), pp. 287-293Landim, E., Cavali, P.T.M., Santos, M.A.M., Pasqualini, W., Boechat, R.C.B.M., 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. 160-166Vitale, M.G., Matsumoto, H., Roye Jr, D.P., Gomez, J.A., Betz, R.R., Emans, J.B., Health-related quality of life in children with thoracic insufficiency syndrome (2008) J Pediatr Orthop, 28 (2), pp. 239-24

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

Evaluation Of Spino-pelvic Parameters Acording To Intraoperative Position In Spine Lumbosacral Arthrodesis [avaliação Dos Parâmetros Espinopélvicos Pelo Posicionamento Intra-operat ório Na Artrodese De Coluna Lom Bo-sacra]

Objective: To evaluate the relationship between spino-pelvic preoperative, intraoperative, and postoperative parameters and the influence of surgical positioning with these values. Methods: This retrospective study evaluates radiographs pre-, intra-and postoperative patients who underwent arthrodesis of the lumbosacral spine. Results: Of the 16 patients evaluated a decreased sacral slope between the pre-and postoperative was observed, with a direct influence on the values of lumbar lordosis, with a consequent angular reduction. Conclusion: There is a variation in sacral inclination as a function of position on the operating table, mainly between the pre-and intraoperative position, during fusion surgery of the lumbosacral spine, and the sacral slope is directly responsible for the change in lumbar lordosis.123228231Roussouly, P., Pinheiro-Franco, J.L., Biomechanical analysis of the spino-pelvic organization and adaptation in pathology (2011) Eur Spine J, 20 (SUPPL. 5), pp. 609-618Dubousset, J., Charpak, G., Dorion, I., Skalli, W., Lavaste, F., Deguise, J., Le système eos nouvelle imagerie osteo- articulaire basse dose en position debout (2005) Memoires de Academie Nationale de Chirurgie, 4 (4), pp. 22-27Davis, H., Increasing rates of cervical and lumbar spine surgery in the united states, 1979-1990 (1994) Spine (Phila Pa 1976), 19 (10), pp. 1117-1123Hennemann, A.S., Antoneli, P.H., Oliveira, G.C., Incidência pélvica: um parâmetro fundamental para definição do equilíbrio sagital da coluna vertebral (2012) Coluna/Columna, 11 (3), pp. 237-239Stagnara, P., De Mauroy, J.C., Dran, G., Gonon, G.P., Costanzo, G., Dimnet, J., Reciprocal angulation of vertebral bodies in a sagittal plane: Approach to references for the evaluation of kyphosis and lordosis (1982) Spine (Phila Pa 1976), 7 (4), pp. 335-342Legaye, J., Duval-Beaupère, G., Hecquet, J., Marty, C., Pelvic incidence: A fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves (1998) Eur Spine J, 7 (2), pp. 99-103During, J., Goudfrooij, H., Keessen, W., Beeker, T.W., Crowe, A., Toward standards for posture postural characteristics of the lower back system in normal and pathologic conditions (1985) Spine (Phila Pa 1976), 10 (1), pp. 83-87Le Huec, J.C., Aunoble, S., Philippe, L., Nicolas, P., Pelvic parameters: Origin and significance (2011) Eur Spine J, 20 (SUPPL. 5), pp. 564-571Vialle, R., Levassor, N., Rillardon, L., Templier, A., Skalli, W., Guigui, P., Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects (2005) J Bone Joint Surg Am, 87 (2), pp. 260-267Boulay, C., Tardieu, C., Hecquet, J., Benaim, C., Mitulescu, A., Marty, C., Anatomical reliability of two fundamental radiological and clinical pelvic parameters: Incidence and thickness (2005) Eur J Orthop Surg Traumatol, 15, pp. 197-204Bourghli, A., Aunoble, S., Reebye, O., Le Huec, J.C., Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis (2011) Eur Spine J, 20 (SUPPL. 5), pp. 663-668Neter, J., Kutner, M.H., Nachtsheim, C.J., Wasserman, W., (1996) Applied Linear Statistical Models, , 4th ed. Ilinois: Richard D. Irwing;Roussouly, P., Berthonnaud, E., Dimnet, J., Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: Proposed classification (2003) Rev Chir Orthop Reparatrice Appar Mot, 89 (7), pp. 632-639Izumi, Y., Kumano, K., Analysis of sagittal lumbar alignment before and after posterior instrumentation: Risk factor for adjacent unfused segment (2001) Eur J Orthop Surg Traumatol, 11 (1), pp. 9-13Cavali, P.T., Pasqualini, W., Risso, M.I., Zuiani, G.R., Miranda, J.B., Correlation between symptoms and sagittal alignment parameters in patients with lumbar canal stenosis: A case-control study (2012) Columna/Coluna, 11 (4), pp. 302-310Lazennec, J.Y., Ramaré, S., Arafati, N., Laudet, C.G., Gorin, M., Roger, B., Sagittal alignment in lumbosacral fusion: Relations between radiological parameters and pain (2000) Eur Spine J, 9 (1), pp. 47-55Jackson, R.P., Kanemura, T., Kawakami, N., Hales, C., Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain (2000) Spine (Phila Pa 1976), 25 (5), pp. 575-586Jackson, R.P., Peterson, M.D., McManus, A.C., Hales, C., Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients (1998) Spine (Phila Pa 1976), 23 (16), pp. 1750-1767Roussouly, P., Gollogly, S., Berthonnaud, E., Dimnet, J., Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position (2005) Spine (Phila Pa 1976), 30 (3), pp. 346-35

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

Assessment Of Interobserver Reproducibility Of A New Scale For Management Guidance In Spinal Metastasis - Sins Score [avaliação Da Reprodutibilidade Interobservadores De Uma Nova Escala Para Orientação Da Conduta Terapêutica Nas Metástases Vertebrais - Escore Sins (spine Instability Neoplastic 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.114287289Harrington, K.D., Metastatic disease of the spine (1986) J Bone Joint Surg Am., 68 (7), pp. 1110-1115Tokuhashi, Y., Kawano, H., Ohsaka, S., Matsuzaki, H., Toriyama, S., A scoring system for preoperative evaluation of the prognosis of metastatic spine tumor (a preliminary report) (1989) Nihon Seikeigeka Gakkai Zasshi., 63 (5), pp. 482-489Tokuhashi, Y., Matsuzaki, H., Toriyama, S., Kawano, H., Ohsaka, S., Scoring system for the preoperative evaluation of metastatic spine tumor prognosis (1990) Spine (Phila Pa 1976)., 15 (11), pp. 1110-1113Tomita, K., Kawahara, N., Baba, H., Tsuchiya, H., Fujita, T., Toribatake, Y., Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors (1997) Spine (Phila Pa 1976), 22 (3), pp. 324-333Tomita, K., Kawahara, N., Kobayashi, T., Yoshida, A., Murakami, H., Akamaru, T., Surgical strategy for spinal metastases (2001) Spine (Phila Pa 1976)., 26 (3), pp. 298-306Gasbarrini, A., Li, H., Cappuccio, M., Mirabile, L., Paderni, S., Terzi, S., Efficacy evaluation of a new treatment algorithm for spinal metastases (2010) Spine (Phila Pa 1976)., 35 (15), pp. 1466-1470Fisher, C.G., Dipaola, C.P., Ryken, T.C., Bilsky, M.H., Shaffrey, C.I., Berven, S.H., A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the Spine Oncology Study Group (2010) Spine (Phila Pa 1976), 35 (22), pp. E1221-E1229Chan, P., Boriani, S., Fourney, D.R., Biagini, R., Dekutoski, M.B., Fehlings, M.G., An assessment of the reliability of the Enneking and Weinstein-Boriani- Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group (2009) Spine (Phila Pa 1976)., 34 (4), pp. 384-391Fleiss, J.L., (1986) The Design and Analysis of Clinical Experiments., , New York: Wiley;Toumey, J.W., Metastatic malignancy to the spine (1943) J Bone Joint Surg., 25 (2), pp. 292-395Young, J.M., Funk Jr., F.J., Incidence of tumor metastasis to the lumbar spineA comparative study of roentgenographic changes and gross lesions (1953) J Bone Joint Surg Am., 35 (1), pp. 55-64Harrington, K.D., Current concepts review. Metastaic disease to the spine (1986) J Bone Joint Surg Am, 68 (7), pp. 1110-1115Denis, F., Spinal instability as defined by the three-column spine concept in acute spinal trauma (1984) Clin Orthop Relat Res., (189), pp. 65-76White Iii, A.A., Panjabi, M.M., (1978) Clinical Biomecanic of the Spine., , Philadelphia: JB Lippincott;Galasko, C.S., Norris, H.E., Crank, S., Spinal instability secondary to metastatic câncer: Current concepts review (2000) J Bone Joint Surg Am., 82 (4), pp. 570-576. , Apr