Cinco anos de seguimento das patologias da coluna lombar tratados com espaçador interespinhoso : uma analise retrospectiva

Orientador : Prof. Dr. Xavier SolerMonografia (especialização) - Universidade Federal do Paraná. Setor de Ciências da Saúde. Curso de Especialização em Cirurgia e Patologia da Coluna VertebralInclui referênciasO princípio de estabilização dinâmica da coluna lombar teve seu desenvolvimento em resposta aos problemas oferecidos pelo método tradicional de artrodese. Os espaçadores dinâmicos interespinhosos fazem parte desse arsenal há quase duas décadas, e podem ser indicados em diferentes patologias lombares da coluna. Seus conceitos biomecânicos são: descomprimir a faceta articular, reestabelecer a altura foraminal, diminui a pressão intradiscal, estabilizar a coluna durante a extensão e preserva o movimento do nível instrumentado. Objetivo: avaliação retrospectiva de uma série de casos com 5 anos de seguimento, submetidos ao uso de espaçador interespinhoso. Materiais e métodos: Quarenta (n=40) pacientes foram submetidos à colocação de espaçador interespinhoso. Trinta (n=30) foram incluídos no estudo sendo quinze (n=15) pacientes, Grupo A tratados com espaçador interespinhoso como único implante e quinze (n=15) Grupo B como fixação do nível adjacente à artrodese. A avaliação foi feita através do Oswestry Disability Index (ODI) e radiografias seriadas com 6, 12, 24, 36 e 60 meses. Resultados: Dezessete (n=17) completaram os 60 meses de seguimento com resultado bom e ótimo, nove (n=9) foram submetidos a cirurgia de revisão por piora clínica ou alteração do funcionamento do implante. Conclusão: O espaçador interespinhoso demonstrou-se um método de estabilização dinâmica com resultados satisfatórios em nossa experiência

CONSERVATIVE TREATMENT AND VITAMIN D LEVELS IN PATIENTS WITH SPINAL FRACTURES

ABSTRACT Objectives: Evaluate the evolution of pain, functional capacity, and vitamin D levels in conservatively treated patients with low-energy spinal fractures. Methods: Between January 2017 and March 2021, patients older than 40 years old affected by these fractures were selected and treated conservatively for six months. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores and Cobb angle were evaluated pre- and post-treatment. Serum vitamin D levels were also measured at the first outpatient visit, and it was investigated whether the patient had a previous diagnosis of osteoporosis or previous fractures. Results: A total of 105 patients were analyzed, 70.5% of whom were women, with a mean age of 73.1 years. The average vitamin D level was 25.3 ng/mL, and hypovitaminosis was found in 75% of patients. Eight patients (7.62%) had a previous diagnosis of osteoporosis, and ten (9.52%) reported the occurrence of previous fractures. Regarding the VAS score, there was a mean reduction of 5.5 points of pain; for ODI, there was an average increase of 1 percentage point and an average increase of 4.3º of kyphosis in the fractured segment between pre- and post-treatment. Conclusion: The treatment improved pain, and patients maintained their functional capacity. Low levels of vitamin D were associated with more complex fractures. Level of evidence III; Retrospective Study

PIOMIOSITE TROPICAL INVADINDO CANAL MEDULAR

Tropical Pyomyositis is a rare disease caused by a muscle bacterial infection. Even rarer is the involvement of the spinal canal due to this condition. In most cases, Staphylococcus aureus is the etiologic agent, leading to abscess and necrosis of tissues. We report a case of a patient with pyomyositis of paraspinal muscles extending to the spinal canal evidenced by magnetic resonance imaging (MRI), with complete resolution of the clinical condition after surgical drainage and antibiotic therapy.A Piomiosite Tropical é uma doença rara, decorrente de uma infecção muscular usualmente causada pelo Staphylococcus aureus, cursando com formação de abscesso e necrose de tecidos. No presente artigo é relatado o caso de uma paciente com piomiosite da musculatura paravertebral, com extensão para o canal medular evidenciado em ressonância magnética (RM), com resolução completa do quadro após drenagem cirúrgica e antibioticoterapia

TRAUMA IN THE VERTEBRAL SPINE: DETERMINING FACTORS IN THE TIME FOR THE SURGERY

ABSTRACT Objective: Quantify the time elapsed between the arrival of the patient with surgical trauma in the spine at the emergency room and the completion of the surgical procedure, analyzing the factors that may have influenced this process. Methods: Retrospective study that included individuals of both sexes aged between 18 and 100 years who arrived at a tertiary trauma center with surgical fractures in the spine. Patients treated between March 2018 and March 2022 were included in the sample. All data to compose the study sample were collected from secondary data sources (medical records). Results: Medical records of 259 patients with spinal injuries were evaluated. Approximately one-third of the patients were operated on between 13h and 24h, and the other third over 72h. Only 6.6% were operated within 12 hours. The mean time to perform the surgical process was 84.3 ± 144.6 hours. Surgical intervention for most patients (59.1%) occurred within the first 48 hours. Patients with systemic arterial hypertension and patients with at least one comorbidity had a statistically longer mean waiting time for the surgical procedure than patients who did not have these characteristics. Conclusion: Most surgical interventions occurred in the first 48 hours, which is considered early. In addition, some factors, such as the existence of comorbidities, are directly associated with the time it takes to perform the surgical procedure. Level of Evidence II; Retrospective Prognostic

INTERLAMINAR ENDOSCOPIC LUMBAR DISCECTOMY - CLINICAL OUTCOME

ABSTRACT Objective: Evaluate the clinical outcome of patients with lumbar disc herniation (HDL) operated by endoscopic interlaminar microdiscectomy. We evaluated epidemiology, time to return to work, and technique-related complications as secondary outcomes. Method: Prospective longitudinal study, where patients with HDL with surgical indications were evaluated. They underwent endoscopic discectomy exclusively using the interlaminar technique. Clinical results were evaluated using the Oswestry 2.0 questionnaire (ODI) and the visual analog scale (VAS). In this study, we inserted the Macnab postoperative satisfaction index. In parallel with these indices, we analyzed the results regarding epidemiology variables, time to return to work, and complications. Such questionnaires were applied preoperatively, postoperatively the day after surgery, and one year after. Results: In 132 patients selected for the study, we obtained significant clinical improvement in the ODI and VAS questionnaires, and 81.3% of the patients had excellent and good Macnab index. The hospital stay was 22.7 hours, and the return to work was 30 days. The rate of complications with the method was 12.8%, with recurrence of disc herniation being the most common complication with 9.8% of cases. Conclusion: The endoscopic technique proved effective in treating lumbar spinal disc herniation with significant clinical improvement in the analyzed period, low incidence of complications, early postoperative rehabilitation, and results close to or superior to the gold standard technique. Level of Evidence III; Prospective cohort stud

CERVICAL ANTERIOR ARTHRODESIS: AUTOLOGOUS OR SYNTHETIC GRAFT?

ABSTRACT Objective: To compare patients who underwent anterior cervical arthrodesis with autologous iliac crest graft and those who used synthetic graft. Methods: Analysis of 38 patients aged between 18 and 100 years with anterior cervical spondylosis of 1 or 2 levels in a spine surgery service. Results: degenerative cervical spine changes associated with cervicalgia and cervicobrachialgia. Excluded: previous cervical spine surgeries, fractures, or surgery above two levels. Two groups were formed with 19 patients, one using autologous graft and the other using synthetic tricalcium phosphate - a questionnaire assessed satisfaction (Oswestry and VAS) pre- and postoperatively. Bone consolidation was evaluated by tomography at nine months. Results: Mean ODI (Group 1) was 68.5% ± 4.6% preoperatively and 27.2% ± 3.8% postoperatively, being statistically relevant (p<0.001). VAS performed to evaluate the cervical region, Group 1 pre and post-op was considered statistically relevant (p<0.001). No significant difference was observed when comparing the mean values found in the postoperative period between Group 1 and Group 2 (p=0.463). Only two patients complained of chronic pain, representing 10% of the total. In nine-month tomography, 100% of patients in Group 1 and 100% of Group 2 showed bone consolidation, with no statistically relevant difference (p=0.676) between the groups. Conclusion: Similar functional and osteointegration outcomes were observed in both types of grafts. Synthetic graft minimizes the risks and complications of using allografts. Level of Evidence III; Retrospective comparative study

Cinco anos de seguimento das patologias da coluna lombar tratados com espaçador interespinhoso : uma analise retrospectiva

Orientador : Prof. Dr. Xavier SolerMonografia (especialização) - Universidade Federal do Paraná. Setor de Ciências da Saúde. Curso de Especialização em Cirurgia e Patologia da Coluna VertebralInclui referênciasO princípio de estabilização dinâmica da coluna lombar teve seu desenvolvimento em resposta aos problemas oferecidos pelo método tradicional de artrodese. Os espaçadores dinâmicos interespinhosos fazem parte desse arsenal há quase duas décadas, e podem ser indicados em diferentes patologias lombares da coluna. Seus conceitos biomecânicos são: descomprimir a faceta articular, reestabelecer a altura foraminal, diminui a pressão intradiscal, estabilizar a coluna durante a extensão e preserva o movimento do nível instrumentado. Objetivo: avaliação retrospectiva de uma série de casos com 5 anos de seguimento, submetidos ao uso de espaçador interespinhoso. Materiais e métodos: Quarenta (n=40) pacientes foram submetidos à colocação de espaçador interespinhoso. Trinta (n=30) foram incluídos no estudo sendo quinze (n=15) pacientes, Grupo A tratados com espaçador interespinhoso como único implante e quinze (n=15) Grupo B como fixação do nível adjacente à artrodese. A avaliação foi feita através do Oswestry Disability Index (ODI) e radiografias seriadas com 6, 12, 24, 36 e 60 meses. Resultados: Dezessete (n=17) completaram os 60 meses de seguimento com resultado bom e ótimo, nove (n=9) foram submetidos a cirurgia de revisão por piora clínica ou alteração do funcionamento do implante. Conclusão: O espaçador interespinhoso demonstrou-se um método de estabilização dinâmica com resultados satisfatórios em nossa experiência

Fungal spondylodiscitis due to Candida albicans : an atypical case and review of the literature

ABSTRACT Spondylodiscitis due to Candida is a rare complication from hematogenic dissemination of infection caused by this fungus. We present an atypical case of spondylodiscitis caused by this germ that occurred after chest contusion and progressed with necrotizing fasciitis of the anterior region of the chest and osteomyelitis of the sternum. Through contiguity, it also affected the upper thoracic spine. The patient evolved with neurological alterations and recovered satisfactorily after appropriate treatment with surgical decompression of the spinal cord and specific antibiotic therapy