The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review.

PURPOSE: To investigate, through a systematic review, the impact of the waiting time for Adolescent Idiopathic Scoliosis (AIS) surgical correction from the point of view of deformity evolution, treatment cost, and quality of life. METHODS: PubMed, Embase, LILACS, SciELO, Scopus, Web of Science, LIVIVO, and Cochrane Library databases were searched by two researchers to select the articles. The eligibility criteria were: Patients diagnosed with AIS with indication for surgical correction and submitted to waiting lists until treatment. The risks of bias were evaluated using the Risk Of Bias In Non-randomized Studies-Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to classify the level of the evidence for each outcome. The summary of the available evidence is presented in a narrative synthesis. RESULTS: Six observational studies were included. In a Canadian study, the primary outcome was the need for additional spine surgery in patients who had to wait more than three months due to spine deformity progression. American researchers presented a sample of premenarcheal and skeletally immature patients with AIS showing increased Cobb angle and attributed this to a six-month waiting for the surgical treatment. Another study included 177 patients with AIS with a mean waiting time of 225.7 days. There was a worsening average of 7.7° ± 8.6° in Cobb angle, and there was a change in surgical plan in 28 patients, which increased surgical time. Studies that evaluated the treatment cost showed significantly higher mean costs in those who waited longer than six months. Regarding the quality of life, while waiting for surgery, a retrospective study found that patients who underwent surgery earlier showed better results in a questionnaire that assessed their quality of life compared to those who were still waiting. CONCLUSION: Observational studies show that, in individuals who are on waiting lists for AIS surgery, there is a worsening of the spinal deformity (substantial evidence), an increasing cost of treatment (moderate evidence) and it may negatively impact patients' quality of life (insufficient evidence). Performing better methodological quality studies to investigate these outcomes can violate good research practices since randomized clinical trials on this subject have ethical limitations to be carried out. TRIAL REGISTRATION: The authors declare that the systematic review protocol was registered at the international prospective register of systematic reviews (PROSPERO), CRD42020212134, and it was accepted for publication.

Reliability Validity and Responsiveness of the Spinal Cord Independence Measure 4th Version in a Multicultural Setup.

OBJECTIVE: To examine the fourth version of the Spinal Cord Independence Measure for reliability and validity. DESIGN: Partly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations. SETTING: A multicultural cohort from 19 spinal cord injury units in 11 countries. PARTICIPANTS: A total of 648 patients with spinal cord injury. INTERVENTION: Assessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge. MAIN OUTCOME MEASURES: SCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness. RESULTS: Total agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (P<.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (P<.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons. CONCLUSIONS: The validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.

Efficacy of Dynamic Magnetic Resonance Imaging in the Diagnosis of Degenerative Cervical Myelopathy: Systematic Review Protocol.

Cervical degenerative myelopathy (CDM) is a cervical spine condition resulting in clinical manifestations of spinal cord compression related to the chronic, non-traumatic, and progressive narrowing of the cervical spinal canal. Conventional magnetic resonance imaging (MRI) is the gold standard test to diagnose and assess the severity of CDM. However, the patient is in a neutral and static position during the MRI scan, which may devalue the dynamic factors of CDM, underestimating the risk of spinal cord injury related to cervical spine flexion and extension movements. Dynamic MRI is a promising technique to change this scenario. Therefore, the present review aims to answer the following question: "Is dynamic MRI of the cervical spine more accurate in diagnosing CDM than conventional MRI?". We will search for studies in the MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS, and SciELO databases. The search strategy will contain a combination of terms related to cervical myelopathy and magnetic resonance imaging . Two independent reviewers will select studies, extract data, and assess the risk of bias. The synthesis of results will be descriptive, considering the main findings of the studies about the outcomes of interest.

Translation and Cross-cultural Adaptation of the SOSG-OQ 2.0 Questionnaire into Brazilian Portuguese.

Objective: To perform the cross-cultural adaptation and translation into Brazilian Portuguese of the Spine Oncology Study Group - Outcomes Questionnaire 2.0 (SOSG-OQ 2.0) to enable its application to Brazilian patients and to allow Brazilian researchers to use a questionnaire that is on trend in the scientific literature. Materials and Methods: The present is a basic, non-randomized, non-comparative study. The translation followed the proposal by Reichenheime and Moraes, mainly for the semantic equivalence and measurement equivalence sessions, as well as the recommendations by Coster and Mancini mainly in the translation stage. The stages were as follows: first - translation into Brazilian Portuguese; second - back-translation; third - semantic comparison; fourth - validation of the final construct. Results: The translations of the SOSG-OQ 2.0 made by three translators presented a high degree of similarity for most questions. The translators kept all question titles and subtitles, as well as their internal and external orders. Two sworn translators, with native proficiency in English, performed the back-translation of the amalgamated text. Both back-translations were quite similar, and any differences were solved through consensus between the main author and the sworn translators, and the translated text was considered the final version. Conclusion: The present study shows a translated version of the SOSG-OQ 2.0 with semantic validity with the original version published in English. As such, researchers can apply the questionnaire to the Brazilian population, adding another tool for spine surgeons to improve the monitoring of this complex group of patients.

Assessment of ability realization using the 4th version of the Spinal Cord Independence Measure.

CONTEXT: Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities after spinal cord lesions (SCL). OBJECTIVE: To adapt a Spinal Cord Ability Realization Measurement Index (SCI-ARMI) formula to the new Spinal Cord Independence Measure version 4 (SCIM4). METHODS: Using data from 156 individuals for whom American Spinal Injury Association Motor Score (AMS) and SCIM4 scores were collected, we obtained an estimate for the highest possible SCIM4 given the patient's AMS value, using the 95th percentile of SCIM4 values at discharge from rehabilitation (SCIM95) for patients with any given AMS at discharge. We used the statistical software environment R to implement the quantile regression method for linear and quadratic formulas. We also compared the computed model with the SCIM95 model obtained using data from the present study group, positioned in the SCIM95 formula developed for SCIM3. RESULTS: The coefficients of the computed SCIM95 formula based on SCIM4 scores were statistically non-significant, which hypothetically reflects the small sample relative to the goal of estimating SCIM4 95th percentile. Predicting the ability using SCIM4 scores positioned in the SCIM95 formula used for SCIM3, however, yielded SCIM95 values, which are very close to those of the new SCIM95 formula (Mean difference 2.16, 95% CI = 1.45, 4.90). CONCLUSION: The SCI-ARMI formula, which is based on the SCIM95 formula developed for SCIM3, is appropriate for estimating SCI-ARMI at present, when SCIM4 scores are available. When sufficient additional data accumulates, it will be appropriate to introduce a modified SCI-ARMI formula.

The net contribution of rehabilitation to improvement in performance in patients with spinal cord lesions in five countries.

CONTEXT: Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities in patients with spinal cord lesions (SCL). OBJECTIVE: To assess the net effect of rehabilitation of patients with SCL and compare it between countries. METHODS: We calculated the Spinal Cord Ability Realization Measurement Index (SCI-ARMI) and its change from admission to rehabilitation to discharge, for inpatients admitted to SCL units in five countries, between 2016 and 2019. We used chi-square tests, analysis of variance (ANOVA), McNemar's test, Pearson's correlations, and analysis of covariance (ANCOVA) to compare countries and patient groups and assess the relationships of various factors with SCI-ARMI gain during rehabilitation. RESULTS: The study included 218 inpatients (67% males, age 52 ± 17). In Brazil, Israel, Italy, Portugal, and Turkiye, respectively, SCI-ARMI gain was 2 (SD = 15), 19 (SD = 17), 31 (SD = 23), 13 (SD = 15), and 16 (SD = 12). Yet, after controlling for admission SCI-ARMI and the time from SCL onset to the examination, the effect of the country on ability realization gain was found non-significant (P = 0.086). CONCLUSION: The study confirmed that rehabilitation makes a net contribution to improvement in performance in patients with SCL, beyond the contribution of neurological recovery. After controlling for affecting factors, this contribution was quite similar in the participating units from different countries.

Impacts of the Delayed Surgical Correction of Adolescent Idiopathic Scoliosis and its Repercussions for the Brazilian Unified Health System: Systematic Review Protocol.

Surgical correction is an effective treatment for adolescent idiopathic scoliosis (AIS) with deformities over 45°. In the Brazilian Unified Health System (SUS, Sistema Único de Saúde), if the surgical procedure is indicated, the patients are placed on a waiting list and wait until the treatment can be performed. An extended waiting period can be harmful due to worsening symptoms and increased treatment costs. Additionally, it has negative effects on the mental health and quality of life of these patients. This paper is a systematic review protocol to answer the following question: "What is the impact of the delayed surgical correction of AIS considering costs and quality of life?" Collecting health status information is the first step to improve high complex public health actions. Future publications from this protocol may serve as a subsidy to point out potential priority criteria to enhance the global health of AIS patients and the management of Brazilian public health financial resources.

EARLY COMPLICATIONS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY.

Objective: To evaluate the early postoperative complications associated with the surgical approach of the cervical spine of patients with cervical spondylotic myelopathy (CSM), comparing the anterior surgical, the posterior surgical, and the combined approaches. Methods: This is a retrospective study based on a database with 169 patients. Demographic data, such as gender and age, and surgical data, such as surgical approach, number of segments with arthrodesis, surgical time, and complications, were evaluated. Complications were divided into major (deep surgical wound infection, intercurrence with the implant, early new compression, and heart failure) and minor (dysphagia, superficial infection, pain, urinary intercurrence, neuropraxia of the C5 root, acute confusional state, and surgical wound hematoma). Results: This included 169 patients, 57 women (33.7%) and 112 men (66.2%). Age ranged from 21 to 87 years, with a mean of 56.48 (± 11) years. Of these, 52 (30.8%) underwent the anterior approach; 111 (65.7%), the posterior approach; and 6 (3.5%), the combined approach. Conclusion: As in the literature, we evinced dysphagia, pain, and superficial infection of the surgical wound as the most frequent postoperative complications. However, it was impossible to establish a statistical relationship between the incidence of complications and surgical time, access route, and number of fixed segments. Level of Evidence III, Retrospective Comparative Study.

Objetivo: Avaliar as complicações pós-operatórias precoces associadas à abordagem cirúrgica da coluna cervical de pacientes portadores de mielopatia cervical espondilótica (MCE), comparando a abordagem cirúrgica anterior, a abordagem cirúrgica posterior e a abordagem combinada. Métodos: Estudo retrospectivo baseado em um banco de dados com 169 pacientes. Foram avaliados dados demográficos, como gênero e idade, e dados cirúrgicos, como abordagem cirúrgica realizada, número de segmentos artrodesados, tempo cirúrgico e complicações. As complicações foram divididas em maiores (infecção profunda da ferida operatória, intercorrência com o implante, nova compressão precoce, insuficiência cardíaca) e menores (disfagia, infecção superficial, dor, intercorrência urinária, neuropraxia da raiz de C5, estado confusional agudo, hematoma de ferida operatória). Resultados: Foram incluídos 169 pacientes, sendo 57 do sexo feminino (33,7%) e 112 do masculino (66,2%). A idade variou de 21 a 87 anos, com média de 56,48 anos (± 11). Destes, 52 (30,8%) foram submetidos à abordagem anterior, 111 (65,7%) à abordagem posterior e 6 (3,5%) à abordagem combinada. Conclusão: Assim como na literatura, evidenciamos a disfagia, a dor e a infecção superficial da ferida operatória como as complicações pós-operatórias mais frequentes. No entanto, não foi possível estabelecer uma relação estatística da incidência de complicações com o tempo cirúrgico, a via de acesso e o número de segmentos fixados. Nível de Evidência III, Estudo Retrospectivo Comparativo.

PHENOL VERSUS LIDOCAINE IN OBTURATOR NERVE NEUROLYSIS FOR HIP JOINT PAIN.

Introduction: For patients with severe hip osteoarthritis without clinical or socioeconomic conditions for total hip replacement, the obturator nerve block may serve for pain control and functional improvement. Either lidocaine or phenol are used, although the latter is expected to last longer. Objectives: Compare hip pain and functional performance after obturator nerve block with phenol versus lidocaine in patients with severe hip osteoarthritis who failed conservative treatment. Methodology: Forty-four patients scheduled for total arthroplasty due to severe osteoarthritis were randomized to the anterior branch of the obturator nerve with phenol (PG) or 1% lidocaine (LG), guided by electrical stimulation. Patients were evaluated with VAS, WOMAC, and pressure pain dolorimetry before the procedure and in the first and fourth months afterward. Results: Both groups improved significantly in pain control, pressure dolorimetry and functioning in the first month with reduced effect after 4 months, although the scores were still better than baseline. No statistical difference could be noticed between the groups. Severe adverse effects were not reported. Conclusion: Both lidocaine and phenol are equally effective and safe in the obturator nerve block for the control of pain and improvement in functioning in patients with severe hip OA. Evidence Level I; Randomized control trial, double-blind .

Introdução: Em pacientes com osteoartrite grave do quadril, sem condições clínicas ou socioeconômicas para a substituição total do quadril, o bloqueio do nervo obturador pode servir para o controle da dor e ganho funcional. Pode-se usar lidocaína ou fenol, embora seja esperado que o último apresente maior duração. Objetivo: Comparar a dor no quadril e o desempenho funcional após o bloqueio do nervo obturador com fenol versus lidocaína em pacientes com osteoartrite grave do quadril que não obtiveram sucesso no tratamento conservador. Metodologia: Quarenta e quatro pacientes programados para artroplastia total devido à osteoartrite grave foram randomizados para o ramo anterior do nervo obturador com fenol (PG) ou lidocaína a 1% (LG), guiados por estimulação elétrica. Os pacientes foram avaliados com EVA, WOMAC e dolorimetria de dor por pressão antes do procedimento e no primeiro e quarto meses seguintes. Resultados: Ambos os grupos apresentaram melhora significativa no controle da dor, na dolorimetria por pressão e na funcionalidade no primeiro mês, com efeito reduzido após quatro meses, embora as pontuações ainda fossem melhores do que a linha de base. Não foi possível observar nenhuma diferença estatística entre os grupos. Não foram relatados efeitos adversos graves. Conclusão: Tanto a lidocaína quanto o fenol são igualmente eficazes e seguros no bloqueio do nervo obturador para o controle da dor e melhora da funcionalidade em pacientes com OA grave de quadril. Nível de evidência I; Estudo clínico randomizado,duplo cego .

A multi-center international study on the spinal cord independence measure, version IV: Rasch psychometric validation.

CONTEXT: The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL). OBJECTIVE: To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods. STUDY DESIGN: Multi-center cohort study. SETTING: Nineteen SCL units in 11 countries. METHODS: SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis. RESULTS: The study included inpatients aged 16-87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6-6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable. CONCLUSIONS: Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.

SURGICAL TREATMENT FOR RHIZARTHROSIS: A SYSTEMATIC REVIEW OF THE LAST 10 YEARS.

Introduction: Comparison of different surgical techniques to treat patients with rhizarthrosis or carpometacarpal osteoarthritis of the thumb. Materials and Methods: A systematic review was conducted using three electronic databases. Randomized, controlled trials in patients who underwent surgery for the treatment of rhizarthrosis were included. The literature review followed the PRISMA protocol. Results: A total of 15 articles involving a total population of 958 patients were selected. Seven different surgical techniques were compared. Conclusions: We conclude that no procedure is superior to another in terms of pain, physical function, overall patient assessment, range of motion, or strength. Outcome measurements should be standardized to enable better comparison between surgical techniques. Level of evidence II, Systematic Review.

Introdução: Comparação de diferentes técnicas cirúrgicas em pacientes com rizartrose ou osteoartrite carpometacárpica do polegar. Materiais e Métodos: A revisão sistemática foi conduzida em três bancos de dados eletrônicos. Foram incluídos estudos clínicos randomizados e controlados com pacientes submetidos ao tratamento cirúrgico para tratamento de rizartrose. A revisão da literatura seguiu o protocolo PRISMA. Resultados: Foram selecionados 15 artigos, envolvendo uma população total de 958 pacientes. Foram comparadas sete técnicas cirúrgicas distintas. Conclusões: Concluímos que nenhum procedimento é superior a outro em termos de dor, função física, avaliação geral do paciente, amplitude de movimento ou força. A mensuração dos desfechos obtidos devem ser padronizadas a fim de possibilitar melhor comparação entre as técnicas cirúrgicas assim como, permitir uma análise estatística fidedigna. Nível de Evidência II; Revisão Sistemática.

Identification of Ankle Injury Risk Factors in Professional Soccer Players Through a Preseason Functional Assessment.

BACKGROUND: Etiologically, the risk of an ankle injury depends on extrinsic and intrinsic factors, such as muscle strength asymmetry, decreased flexibility, and decreased proprioception, as well as patient age and history of injuries. PURPOSE/HYPOTHESIS: The purpose of this study was to identify risk factors present in the preseason assessment that may predispose professional soccer players to ankle injuries. We hypothesized that analysis of these parameters could relate the incidence of injuries to the deficits found during the preseason period, enabling the identification of risk factors to predict the occurrence of injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 89 professional soccer athletes were evaluated in the preseason period; the evaluation included athlete history and anthropometric data collection, an isokinetic ankle evaluation, and functional tests: the Dorsiflexion Lunge Test and Y-Balance Test (YBT). The athletes were monitored during the competitive period, and the incidence of injuries was surveyed. The association of quantitative variables and injury outcomes was analyzed using the Student t test for independent samples, with P < .05. For the association of categorical variables and injury outcomes, the chi-square test was performed, with P < .05. RESULTS: A higher incidence of ankle injuries was associated with lower YBT scores in the dominant (P = .04) and nondominant (P = .01) limbs. A higher body mass index was also associated with a higher injury occurrence (P = .01). CONCLUSION: Functional tests, such as the YBT, are indicated tools for assessing the physical capacities and possible risks of ankle sprains, as they can evaluate the ankle functional capacity in a complex way, identifying athletes more prone to ankle injuries. Athletes' body mass index should also be taken into account to prevent such injuries.

Translation and Cross-cultural Adaptation of the SOSG-OQ 2.0 Questionnaire into Brazilian Portuguese / Tradução e adaptação transcultural do questionário SOSG-OQ 2.0 para o português brasileiro

Abstract Objective: To perform the cross-cultural adaptation and translation into Brazilian Portuguese of the Spine Oncology Study Group - Outcomes Questionnaire 2.0 (SOSG-OQ 2.0) to enable its application to Brazilian patients and to allow Brazilian researchers to use a questionnaire that is on trend in the scientific literature. Materials and Methods: The present is a basic, non-randomized, non-comparative study. The translation followed the proposal by Reichenheime and Moraes, mainly for the semantic equivalence and measurement equivalence sessions, as well as the recommendations by Coster and Mancini mainly in the translation stage. The stages were as follows: first - translation into Brazilian Portuguese; second - back-translation; third - semantic comparison; fourth - validation of the final construct. Results: The translations of the SOSG-OQ 2.0 made by three translators presented a high degree of similarity for most questions. The translators kept all question titles and subtitles, as well as their internal and external orders. Two sworn translators, with native proficiency in English, performed the back-translation of the amalgamated text. Both back-translations were quite similar, and any differences were solved through consensus between the main author and the sworn translators, and the translated text was considered the final version. Conclusion: The present study shows a translated version of the SOSG-OQ 2.0 with semantic validity with the original version published in English. As such, researchers can apply the questionnaire to the Brazilian population, adding another tool for spine surgeons to improve the monitoring of this complex group of patients.

Resumo Objetivo: Realizar a adaptação transcultural e a tradução para o português brasileiro da versão 2.0 do Questionário de Desfechos do Spine Oncology Study Group (Spine Oncology Study Group - Outcomes Questionnaire 2.0, SOSG-OQ 2.0, em inglês) para viabilizar sua aplicação em pacientes brasileiros e permitir a utilização deste questionário que está em voga na literatura científica por pesquisadores brasileiros. Materiais e Métodos: Trata-se de uma pesquisa básica, não randomizada, não comparativa. As etapas de tradução foram realizadas conforme propostas por Reichenheime e Moraes, principalmente as sessões de equivalência semântica e equivalência de mensuração, e também foram seguidas as recomendações de Coster e Mancini, principalmente na etapa de tradução. As etapas foram as seguintes: primeira - tradução do questionário para o português brasileiro; segunda - retroversão; terceira - comparação semântica; e quarta - validação final do constructo. Resultados: As traduções do SOSG-OQ 2.0 feitas por três tradutores apresentaram grande similaridade na maioria das questões. Todos os títulos e subtítulos de perguntas foram mantidos pelos tradutores, assim como as ordens interna e externa das perguntas. A retroversão da tradução conciliada foi realizada por dois tradutores juramentados, com fluência nativa na língua inglesa. Ambas as retroversões foram bastante similares, as divergências foram sanadas por consenso entre o autor principal e os tradutores juramentados, e a versão traduzida foi considerada a versão final. Conclusão: Neste estudo, apresenta-se uma versão traduzida do SOSG-OQ 2.0 que tem validade semântica com a versão original publicada em inglês, o que permite a sua aplicação na população brasileira, e acrescenta mais uma ferramenta para que os cirurgiões de coluna possam acompanhar de forma melhor este complexo grupo de pacientes.

Efficacy of Dynamic Magnetic Resonance Imaging in the Diagnosis of Degenerative Cervical Myelopathy: Systematic Review Protocol / Eficácia da ressonância magnética dinâmica no diagnóstico da mielopatia cervical degenerativa: Protocolo de revisão sistemática

Abstract Cervical degenerative myelopathy (CDM) is a cervical spine condition resulting in clinical manifestations of spinal cord compression related to the chronic, non-traumatic, and progressive narrowing of the cervical spinal canal. Conventional magnetic resonance imaging (MRI) is the gold standard test to diagnose and assess the severity of CDM. However, the patient is in a neutral and static position during the MRI scan, which may devalue the dynamic factors of CDM, underestimating the risk of spinal cord injury related to cervical spine flexion and extension movements. Dynamic MRI is a promising technique to change this scenario. Therefore, the present review aims to answer the following question: "Is dynamic MRI of the cervical spine more accurate in diagnosing CDM than conventional MRI?". We will search for studies in the MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS, and SciELO databases. The search strategy will contain a combination of terms related to cervical myelopathy and magnetic resonance imaging. Two independent reviewers will select studies, extract data, and assess the risk of bias. The synthesis of results will be descriptive, considering the main findings of the studies about the outcomes of interest.

Resumo A mielopatia cervical degenerativa (MCD) é uma doença da coluna cervical com manifestações clínicas de compressão da medula espinal relacionadas ao estreitamento crônico, não traumático e progressivo do canal vertebral cervical. A ressonância magnética (RM) convencional é o exame padrão-ouro para o diagnóstico e a avaliação da gravidade da MCD. Contudo, o paciente encontra-se em posição neutra e estática durante a realização deste exame, o que pode desvalorizar os fatores dinâmicos da MCD, subestimando o risco de lesão medular relacionados aos movimentos de flexão e extensão da coluna cervical. A RM dinâmica é uma técnica promissora para modificar esse panorama. Portanto, a presente revisão tem o objetivo de responder a seguinte pergunta: "A RM dinâmica da coluna cervical é mais precisa no diagnóstico de MCD em comparação à RM convencional?" As buscas por estudos serão realizadas nas bases de dados MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS e SciELO. A estratégia de busca conterá combinação de termos relacionados à mielopatia cervical e à ressonância magnética. Dois avaliadores independentes irão realizar a seleção dos estudos, a extração dos dados e a avaliação dos riscos de viés. A síntese dos resultados será realizada de maneira descritiva, considerando os principais achados dos estudos relacionados aos desfechos de interesse.

Phenol versus lidocaine in obturator nerve neurolysis for hip joint pain / Fenol contra lidocaina em neurólise do nervo obturador para dor articular do quadril

ABSTRACT Introduction: For patients with severe hip osteoarthritis without clinical or socioeconomic conditions for total hip replacement, the obturator nerve block may serve for pain control and functional improvement. Either lidocaine or phenol are used, although the latter is expected to last longer. Objectives: Compare hip pain and functional performance after obturator nerve block with phenol versus lidocaine in patients with severe hip osteoarthritis who failed conservative treatment. Methodology: Forty-four patients scheduled for total arthroplasty due to severe osteoarthritis were randomized to the anterior branch of the obturator nerve with phenol (PG) or 1% lidocaine (LG), guided by electrical stimulation. Patients were evaluated with VAS, WOMAC, and pressure pain dolorimetry before the procedure and in the first and fourth months afterward. Results: Both groups improved significantly in pain control, pressure dolorimetry and functioning in the first month with reduced effect after 4 months, although the scores were still better than baseline. No statistical difference could be noticed between the groups. Severe adverse effects were not reported. Conclusion: Both lidocaine and phenol are equally effective and safe in the obturator nerve block for the control of pain and improvement in functioning in patients with severe hip OA. Evidence Level I; Randomized control trial, double-blind .

RESUMO Introdução: Em pacientes com osteoartrite grave do quadril, sem condições clínicas ou socioeconômicas para a substituição total do quadril, o bloqueio do nervo obturador pode servir para o controle da dor e ganho funcional. Pode-se usar lidocaína ou fenol, embora seja esperado que o último apresente maior duração. Objetivo: Comparar a dor no quadril e o desempenho funcional após o bloqueio do nervo obturador com fenol versus lidocaína em pacientes com osteoartrite grave do quadril que não obtiveram sucesso no tratamento conservador. Metodologia: Quarenta e quatro pacientes programados para artroplastia total devido à osteoartrite grave foram randomizados para o ramo anterior do nervo obturador com fenol (PG) ou lidocaína a 1% (LG), guiados por estimulação elétrica. Os pacientes foram avaliados com EVA, WOMAC e dolorimetria de dor por pressão antes do procedimento e no primeiro e quarto meses seguintes. Resultados: Ambos os grupos apresentaram melhora significativa no controle da dor, na dolorimetria por pressão e na funcionalidade no primeiro mês, com efeito reduzido após quatro meses, embora as pontuações ainda fossem melhores do que a linha de base. Não foi possível observar nenhuma diferença estatística entre os grupos. Não foram relatados efeitos adversos graves. Conclusão: Tanto a lidocaína quanto o fenol são igualmente eficazes e seguros no bloqueio do nervo obturador para o controle da dor e melhora da funcionalidade em pacientes com OA grave de quadril. Nível de evidência I; Estudo clínico randomizado,duplo cego .

Impact of surgical treatment on the gait of patients with cervical myelopathy / Impacto do tratamento cirurgico na marcha de pacientes portadores de mielopatia cervical / Impacto del tratamiento quirúrgico en la marcha de pacientes con mielopatía cervical

ABSTRACT: Objective: To analyze the impact of surgery on gait characteristics of individuals with Cervical Spondylotic Myelopathy (CSM) after one month of the procedure. Methods: Observational, cohort type study, with a quantitative analysis approach. Two assessments were performed, the first one week before surgery and the second 30 days after the decompression procedure. The following space-time variables were analyzed: steps per minute, step length, cycle time, speed, steps per minute, support time, swing time, step time. The kinematic variables obtained were analyzed by Gait Profile Score (GPS) and Movement Analysis Profile (MAP). Results: comparing pre and postoperative values, there was a decrease in the number of steps per minute (p=0.006), an increase in support time (p=0.011) and an increase in cycle time (p=0.004). Other variables did not present statistically significant differences. The patients' total GPS average in the pre-surgery assessment was 10.41 and 1 month after the procedure, an average of 10.56 was obtained, which does not characterize a statistical difference between the assessments. When establishing a comparison between the two assessments specifically on each joint movement of the lower limbs using the MAP, it was observed that the obliquity and rotation of the pelvis showed some improvement immediately after the surgical procedure. Knee flexion and extension were significantly (p=0.018) more compromised after the procedure when compared to the value of the same population before surgery. Conclusion: the preliminary analysis of the gait of these patients after one month of intervention did not show immediate benefits of the procedure. Level of Evidence II; Therapeutic studies - Investigation of treatment outcomes.

RESUMO: Objetivo: Analisar o impacto da cirurgia na marcha de indivíduos portadores de Mielopatia Cervical Espondilótica (MCE) após um mês do procedimento. Métodos: Estudo observacional, longitudinal, com abordagem de análise quantitativa. Foram realizadas duas avaliações, a primeira uma semana antes da cirurgia e a segunda 30 dias após o procedimento. Foram analisadas as variáveis de espaço-tempo: avanços por minuto, comprimento do passo, tempo de ciclo, velocidade, passos por minuto, tempo de apoio, tempo de balanço, tempo do passo. As variáveis cinemáticas obtidas foram analisadas pelo Gait Profile Score (GPS) e Movement Analysis Profile (MAP). Resultados: comparando os valores pré e pós-operatórios, houve diminuição do número de passos por minuto (p=0,006), aumento no tempo de apoio (p=0,011) e aumento no tempo de ciclo (p=0,004), outras variáveis não apresentaram diferenças estatisticamente significativas. A média do GPS total dos pacientes na avaliação pré-cirurgia foi de 10,41 e após 1 mês do procedimento obteve-se a pontuação média de 10,56 o que não caracteriza diferença estatística entre as avaliações. Ao estabelecer uma comparação entre as duas avaliações em cada movimento articular dos membros inferiores utilizando o MAP, observa-se que a obliquidade e a rotação da pelve apresentaram alguma melhoria imediatamente após o procedimento cirúrgico. Já a flexão e extensão do joelho mostrou-se significativamente (p=0,018) mais comprometida após o procedimento quando comparada com o valor da mesma população pré cirurgia. Conclusão: a análise preliminar da marcha dos pacientes com MCE após um mês de intervenção não evidenciou benefícios imediatos do procedimento. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN: Objetivo: Analizar el impacto del tratamiento quirúrgico en las características de la marcha de personas con Mielopatía Cervical Espondilótica (MCE) después de un mes del procedimiento. Métodos: Estudio observacional, longitudinal, con enfoque de análisis cuantitativo. Se realizaron dos evaluaciones, la primera una semana antes de la cirugía y la segunda 30 días después del procedimiento de descompresión. Se analizaron las siguientes variables espacio-temporales: pasos por minuto, longitud de paso, tiempo de ciclo, velocidad, pasos por minuto, tiempo de apoyo, tiempo de balanceo, tiempo de paso. Las variables cinemáticas obtenidas fueron analizadas mediante Gait Profile Score (GPS) y Movement Analysis Profile (MAP). Resultados: Al comparar los valores pre y postoperatorios, hubo una disminución en el número de pasos por minuto (p=0,006), un aumento en el tiempo de soporte (p=0,011) y un aumento en el tiempo de ciclo (p=0,004), otras variables no presentaron diferencias estadísticamente significativas. La media del GPS total de los pacientes en la evaluación prequirúrgica fue de 10,41 y 1 mes después del procedimiento se obtuvo una puntuación promedio de 10,56, lo que no caracteriza diferencia estadística entre las evaluaciones. Al establecer una comparación entre las dos evaluaciones específicamente sobre cada movimiento articular de los miembros inferiores mediante el MAP, se observó que la oblicuidad y rotación de la pelvis mostraron cierta mejoría inmediatamente después del procedimiento quirúrgico. La flexión y extensión de la rodilla estuvieron significativamente (p=0,018) más comprometidas después del procedimiento en comparación con el valor de la misma población antes de la cirugía. Conclusión: Los pacientes con MCE presentan deterioro de la marcha en comparación con la población típica, el análisis preliminar de la marcha de estos pacientes después de un mes de intervención no mostró beneficios inmediatos del procedimiento. Nivel de Evidencia II; Estudios terapéuticos - Investigación de resultados del tratamiento.

Impacts of the Delayed Surgical Correction of Adolescent Idiopathic Scoliosis and its Repercussions for the Brazilian Unified Health System: Systematic Review Protocol / Impactos da espera para correção cirúrgica da escoliose idiopática do adolescente e suas repercussões para o Sistema Único de Saúde: Protocolo de revisão sistemática

Abstract Surgical correction is an effective treatment for adolescent idiopathic scoliosis (AIS) with deformities over 45°. In the Brazilian Unified Health System (SUS, Sistema Único de Saúde), if the surgical procedure is indicated, the patients are placed on a waiting list and wait until the treatment can be performed. An extended waiting period can be harmful due to worsening symptoms and increased treatment costs. Additionally, it has negative effects on the mental health and quality of life of these patients. This paper is a systematic review protocol to answer the following question: "What is the impact of the delayed surgical correction of AIS considering costs and quality of life?" Collecting health status information is the first step to improve high complex public health actions. Future publications from this protocol may serve as a subsidy to point out potential priority criteria to enhance the global health of AIS patients and the management of Brazilian public health financial resources.

Resumo A correção cirúrgica é uma opção efetiva de tratamento para casos de Escoliose Idiopática do Adolescente (EIA) com curvas acima de 45°. No âmbito do Sistema Único de Saúde (SUS), os pacientes avaliados nos centros de referência e com indicação cirúrgica são cadastrados em fila de espera até que o tratamento definitivo possa ser realizado. Um período de espera extenso pode ser prejudicial, do ponto de vista de piora dos sintomas e de aumento do custo de tratamento, além de gerar efeitos negativos na saúde mental e na qualidade de vida do paciente. O presente artigo trata-se do protocolo de uma revisão sistemática que buscará responder o questionamento: "Qual o impacto do tempo de espera para correção cirúrgica da EIA do ponto de vista de custo e qualidade de vida?." O aperfeiçoamento das ações de saúde pública, na esfera da alta complexidade, inicia-se com o levantamento de informações sobre a situação de saúde de determinada condição. Diante disso, as futuras publicações provenientes deste protocolo poderão servir como subsídio para apontar possíveis critérios de prioridade, com o intuito de promover melhoria tanto no âmbito da saúde global de portadores de EIA, quanto na gestão financeira da saúde pública brasileira.

Early complications of surgical treatment of cervical spondylotic myelopathy / Complicações precoces do tratamento cirúrgico de mielopatia cervical espondilótica

ABSTRACT Objective: To evaluate the early postoperative complications associated with the surgical approach of the cervical spine of patients with cervical spondylotic myelopathy (CSM), comparing the anterior surgical, the posterior surgical, and the combined approaches. Methods: This is a retrospective study based on a database with 169 patients. Demographic data, such as gender and age, and surgical data, such as surgical approach, number of segments with arthrodesis, surgical time, and complications, were evaluated. Complications were divided into major (deep surgical wound infection, intercurrence with the implant, early new compression, and heart failure) and minor (dysphagia, superficial infection, pain, urinary intercurrence, neuropraxia of the C5 root, acute confusional state, and surgical wound hematoma). Results: This included 169 patients, 57 women (33.7%) and 112 men (66.2%). Age ranged from 21 to 87 years, with a mean of 56.48 (± 11) years. Of these, 52 (30.8%) underwent the anterior approach; 111 (65.7%), the posterior approach; and 6 (3.5%), the combined approach. Conclusion: As in the literature, we evinced dysphagia, pain, and superficial infection of the surgical wound as the most frequent postoperative complications. However, it was impossible to establish a statistical relationship between the incidence of complications and surgical time, access route, and number of fixed segments. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar as complicações pós-operatórias precoces associadas à abordagem cirúrgica da coluna cervical de pacientes portadores de mielopatia cervical espondilótica (MCE), comparando a abordagem cirúrgica anterior, a abordagem cirúrgica posterior e a abordagem combinada. Métodos: Estudo retrospectivo baseado em um banco de dados com 169 pacientes. Foram avaliados dados demográficos, como gênero e idade, e dados cirúrgicos, como abordagem cirúrgica realizada, número de segmentos artrodesados, tempo cirúrgico e complicações. As complicações foram divididas em maiores (infecção profunda da ferida operatória, intercorrência com o implante, nova compressão precoce, insuficiência cardíaca) e menores (disfagia, infecção superficial, dor, intercorrência urinária, neuropraxia da raiz de C5, estado confusional agudo, hematoma de ferida operatória). Resultados: Foram incluídos 169 pacientes, sendo 57 do sexo feminino (33,7%) e 112 do masculino (66,2%). A idade variou de 21 a 87 anos, com média de 56,48 anos (± 11). Destes, 52 (30,8%) foram submetidos à abordagem anterior, 111 (65,7%) à abordagem posterior e 6 (3,5%) à abordagem combinada. Conclusão: Assim como na literatura, evidenciamos a disfagia, a dor e a infecção superficial da ferida operatória como as complicações pós-operatórias mais frequentes. No entanto, não foi possível estabelecer uma relação estatística da incidência de complicações com o tempo cirúrgico, a via de acesso e o número de segmentos fixados. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Surgical treatment for rhizarthrosis: a systematic review of the last 10 years / Tratamento cirúrgico de rizartrose: uma revisão sistemática dos últimos dez anos

ABSTRACT Introduction Comparison of different surgical techniques to treat patients with rhizarthrosis or carpometacarpal osteoarthritis of the thumb. Materials and Methods A systematic review was conducted using three electronic databases. Randomized, controlled trials in patients who underwent surgery for the treatment of rhizarthrosis were included. The literature review followed the PRISMA protocol. Results A total of 15 articles involving a total population of 958 patients were selected. Seven different surgical techniques were compared. Conclusions We conclude that no procedure is superior to another in terms of pain, physical function, overall patient assessment, range of motion, or strength. Outcome measurements should be standardized to enable better comparison between surgical techniques. Level of evidence II, Systematic Review.

RESUMO Introdução Comparação de diferentes técnicas cirúrgicas em pacientes com rizartrose ou osteoartrite carpometacárpica do polegar. Materiais e Métodos A revisão sistemática foi conduzida em três bancos de dados eletrônicos. Foram incluídos estudos clínicos randomizados e controlados com pacientes submetidos ao tratamento cirúrgico para tratamento de rizartrose. A revisão da literatura seguiu o protocolo PRISMA. Resultados Foram selecionados 15 artigos, envolvendo uma população total de 958 pacientes. Foram comparadas sete técnicas cirúrgicas distintas. Conclusões Concluímos que nenhum procedimento é superior a outro em termos de dor, função física, avaliação geral do paciente, amplitude de movimento ou força. A mensuração dos desfechos obtidos devem ser padronizadas a fim de possibilitar melhor comparação entre as técnicas cirúrgicas assim como, permitir uma análise estatística fidedigna. Nível de Evidência II; Revisão Sistemática.