How Does the Level of Physical Activity Influence Eating Behavior? A Self-Determination Theory Approach.

Physical activity and diet are two predominant determinants of population health status that may influence each other. Physical activity has been identified as a behavior that may lead to a healthier diet and regulates eating behaviors. This research aimed to investigate how the level of physical activity is associated with the motivation related to eating behaviors and, consequently, the eating style individuals have on a daily basis. This was a cross-sectional study in which participants completed an online questionnaire that assessed the following variables: the level of physical activity, the motivation toward eating behavior, and the type of eating behavior. In total, 440 individuals (180 men and 260 women) who regularly exercised in gyms and fitness centers aged between 19 and 64 years (M = 33.84; SD = 10.09) took part in the study. The data were collected following the Declaration of Helsinki and with the approval of the Ethics Committee of the Polytechnic of Leiria. For the statistical analysis, mean and standard deviations were first calculated, as well as bivariate correlations between all the variables of interest. Then, structural equation model analyses were performed considering the levels of physical activity as the independent variable, motivations toward eating behavior as the mediators, and eating styles as the dependent variables. It was concluded that a greater level of physical activity leads to a more self-determined type of eating regulation, which in turn results in less constricted eating behaviors that are influenced by external factors and emotional factors.

Understanding the Associations across Fibromyalgia-Related Fatigue, Depression, Anxiety, Self-Esteem Satisfaction with Life and Physical Activity in Portuguese and Brazilian Patients: A Structural Equation Modeling Analysis.

Background and Objectives: Fibromyalgia are heterogeneous and differ from patient to patient; however, the most reported are general myalgia and at specific points associated with fatigue and certain psychological adversities. Physical activity can mitigate the effects of the symptoms. However, the associations between fibromyalgia-related fatigue, self-esteem, anxiety, depression, satisfaction with life and physical activity are unclear. Therefore, the aim of the present study was to understand the associations between these symptoms and whether there are differences between these associations across two distinct cultures. Materials and Methods: A total of 473 women aged between 28 and 75 years (M = 49.27; SD ± 8.28) completed five questionnaires about fibromyalgia-related fatigue, physical activity, anxiety, depression, self-esteem, and satisfaction with life. Results: Fibromyalgia-related fatigue was positively associated with depression and anxiety, depression and anxiety were negatively associated with self-esteem, self-esteem was positively associated with satisfaction with life, satisfaction with life was positively associated with physical activity and there were no differences in terms of the perceptions and associations of these variables between Portuguese and Brazilian patients. Conclusions: Our results showed the significant role of associations between these variables and a similarity in the perception and relationship of the variables between the two cultures.

Exploring the Relationship between Fibromyalgia-Related Fatigue, Physical Activity, and Quality of Life.

The symptoms of fibromyalgia are varied, including general muscle pain and pain at specific points (also called tender points), excessive fatigue, anxiety, depression, and some psychological problems that can have a negative impact on quality of life. Physical activity is a widely used option by health professionals to alleviate the effects of this syndrome. However, there is no clear information on the possible mediating role of physical activity in the relationship between fibromyalgia-related fatigue and quality of life. Therefore, this study aims to evaluate the relationship between fibromyalgia-related fatigue and quality of life, and to investigate the mediating role of physical activity in patients with this syndrome. METHODS: In a cross-sectional study, 237 Portuguese women aged 28 to 75 years (M = 49.12; SD ± 8.87) and 117 Brazilian women aged 20 to 69 years (M = 46.72; SD ± 8.38) were recruited to participate in this study. These patients completed three valid and reliable questionnaires related to the assessment of fibromyalgia-related fatigue (MDF-Fibro-17), physical activity (IPAQ), and quality of life (SF-36). RESULTS: Both samples had scores above the midpoint for all dimensions of fibromyalgia-related fatigue and scores below the midpoint for quality of life. Physical activity had no mediating effect in either sample, as the total indirect effect was not significant. CONCLUSIONS: Physical activity does not mediate the relationship between fatigue and quality of life. However, the results also show that the fatigue dimensions associated with fibromyalgia had a negative and significant association with physical and mental health indicators in both samples. Thus, patients with FM with higher scores on fatigue-related symptoms might suffer more from physical and mental health, both of which are related to quality of life.

Costovertebral Osteoarthrosis: Rare Differential Diagnosis of Back pain in young patients. Case Report / Osteoartrose costovertebral: Diagnóstico diferencial raro de dorsalgia no paciente jovem. Relato de caso

Abstract The differential diagnosis of dorsal thoracic pain can be a challange due to the proximity of the dorsal column to vital organs as well as to its unique anatomy, innervation, and rib joint. The patterns of referred visceral pain require, in most cases, extensive complementary diagnostic tests in order to exclude severe conditions. Referred pain patterns often result in numerous and expensive visceral workups in order to exclude serious conditions, and costovertebral joint osteoarthritis is usually only considered when the origin of the pain remains unexplained. The authors present the case of a 40-year-old man with disabling dorsal pain due to isolated costovertebral osteoarthrosis. The symptomatology was controlled after injection of methylprednisolone guided by computed tomography. This clinical case aims to describe the clinical presentation of a rare entity that should be considered in the differential diagnosis of back pain.

Resumo O diagnóstico diferencial de dorsalgia revela-se um desafio pela proximidade da coluna dorsal a órgãos vitais assim como por sua anatomia única, inervação e articulação com as costelas. Os padrões de dor referida visceral obrigam, na maioria das vezes, a extensivos exames complementares de diagnóstico de forma a excluir condições graves. A osteoartrose da articulação costovertebral é um diagnóstico pouco reconhecido, e habitualmente é somente considerado quando a fonte de dor continua sem explicação após extensa investigação. Os autores apresentam o caso de um homem de 40 anos de idade com dor dorsal incapacitante devido a osteoartrose costovertebral isolada. A sintomatologia foi controlada após a injeção de metilprednisolona guiada por tomografia computadorizada. Este caso clínico tem como objetivo descrever a apresentação clínica de uma entidade rara que deverá ser considerada no diagnóstico diferencial de dorsalgia.

Glomus Tumor: "A-Not-So-Rare" Cause of Chronic Shoulder Pain-A Case Report and Literature Review.

CASE: A 61-year-old male presented with chronic shoulder pain resistant to conservative treatment. Imaging identified a nodular lesion in the deltoid muscle, which histology after resection identified as a glomus tumor. After surgery, the patient became asymptomatic and at 4-year follow-up has not shown signs of recurrence. CONCLUSION: Glomus tumors around the shoulder should be considered when investigating chronic shoulder pain, as they are more common than thought. Despite being elusive, when diagnosed, excellent outcomes may be expected, with surgery resection being curative.

Surgical outcome of a post-traumatic dystonic foot: Case report and literature review.

Post-traumatic dystonia is an underrecognized condition that can present with bizarre symptoms after trauma, usually out of proportion to the trigger event. We describe the case of a 31-year-old man with a severe lower extremity deformity, gradually developed after minor trauma. An interdisciplinary treatment was tried without any improvement and surgery was performed as a rescue approach. Tibialis anterior tendon transfer and hindfoot triple arthrodesis were carried out, successfully achieving a plantigrade foot and a functional gait. Despite the scarce literature available about functional results of surgery in dystonic feet, we present a step-by-step comprehensive approach to this disorder. LEVEL OF CLINICAL EVIDENCE: 4.

Exploring Lifestyle Habits, Physical Activity, Anxiety and Basic Psychological Needs in a Sample of Portuguese Adults during COVID-19.

This cross-sectional study aimed to characterize the lifestyle habits, anxiety levels and basic psychological needs (BPN), in Portuguese adults during the Coronavirus Disease 2019 (COVID-19) pandemic, including a comparison between genders and age groups. In total, 1404 adults (36.4 ± 11.7 years; 69.6% female) answered sociodemographic data and three instruments: the International Physical Activity Questionnaire, the Basic Need General Satisfaction Scale and the State-Trait Anxiety Inventory. Males revealed higher values for the total energy expenditure (z = -2.26; p = 0.024; η 2 = 0.004) and for the level of satisfaction of competence (z = -2.62; p = 0.009; η 2 = 0.005). Females showed higher scores for the anxiety state (z = -7.87; p ≤ 0.001; η 2 = 0.044) and anxiety trait (z = -6.49; p ≤ 0.001; η 2 = 0.030). Regarding age, higher values for the anxiety trait (p ≤ 0.001; η H 2 = 0.030) were found in the 18-34 years-old group compared to all the other age groups, also presenting significantly higher values of total energy expenditure (χ² = 13.93; p = 0.008; η H 2 = 0.007) when compared to the 35-44 years-old group. Significant differences were observed between the 18-34 years-old group and the other age groups for the satisfaction of competence (χ² = 40.97; p ≤ 0.001; η H 2 = 0.026), except for the >65 years-old group. Strategies for promoting well-being during periods of social isolation should consider the role of psychological dimensions and lifestyle habits according to the gender or age group.

Coracohumeral distance and coracoid overlap as predictors of subscapularis and long head of the biceps injuries.

BACKGROUND: Subscapularis (SS) lesions are often underdiagnosed because of an incomplete understanding of contributing factors but also because of a greater difficulty in SS tear diagnosis with magnetic resonance imaging or physical examination. In this setting, predicting factors can be useful tools in these injuries' management. The goal of this study was to determine the influence of the coracohumeral distance (CHD) and coracoid overlap (CO) in anterior rotator cuff lesions, as well as to determine the CHD and CO values that can accurately predict SS and long head of the biceps (LHB) injuries. METHODS: We performed a retrospective, controlled, single-blinded study. We analyzed 301 patients with rotator cuff pathology and magnetic resonance imaging studies; patients with SS lesions represented the study group. The CHD and CO were measured. RESULTS: We found that lower CHD and higher CO values were progressively related to more serious injuries of the SS and LHB. The CHD was a very strong predictor of SS injury and tear and a good predictor of LHB injuries. A CHD of 7.6 mm had a sensitivity of 84.4% and specificity of 88.6% for SS tears. The CO was also a very strong predictor of SS tears and a good predictor of LHB injury, with a CO of 16.6 mm reaching a sensitivity of 77.8% and specificity of 68.3% for SS tears. CONCLUSIONS: The CHD is an excellent predictor of SS tears and a good predictor of LHB lesions, with the CO also being a very strong predictor of SS tears and a good model for LHB injuries.

Minimum of 10-year follow-up of V-rod technique in lumbar spondylolysis.

PURPOSE: To describe and analyze the use of the V-rod technique described by Gillet to repair spondylolysis in both early and late postoperative periods. METHODS: Patients submitted to surgical correction of lumbar spondylolysis with a V-rod system were selected upon exclusion of adjacent disk degenerative changes and high-grade spondylolisthesis. A preoperative clinical (ODI and VAS) and radiological evaluation was performed, along with assessments on the early (clinical evaluation-up to 1 year) and late (clinical and radiological-at least 10 years) postoperative periods. RESULTS: Twenty-two patients were included, 21 with L5 spondylolysis. Fifty percent had grade I spondylolisthesis. A significant decrease in ODI and VAS was observed from pre- to early and late post-op evaluation (all p < 0.05) but not during post-op evaluations. Changes from pre- to postoperative of both ODI and VAS were significantly higher than the minimal clinically important difference. Preoperative ODI and VAS were significantly higher in overweight/obese but similar postoperatively. No additional instability was found in late postoperative X-rays. Three patients needed revision surgery, with a survival rate of 81.8% for Gillet instrumentation at a mean follow-up of 687.7 ± 60.0 weeks. CONCLUSIONS: Surgical treatment with V-rod system is associated with a significant improvement in ODI and VAS and radiologic stability, with an equal benefit in obese/overweight patients. This study reports for the first time an improvement that is maintained even 10 years after the initial intervention, associated with a low rate of failure. These slides can be retrieved under Electronic Supplementary Material.

Aneurysmal bone cyst of the lunate: Case report and literature review.

The aneurysmal bone cyst (ABC) is a benign osteolytic bone neoplasm. Although most ABC is asymptomatic, in some cases they produce a mass effect, impinging against soft tissues or interfering with joint function. The authors present a rare case report of a lunate ABC successfully treated by curettage and bone grafting, and review the literature of this pathology.

Circulating endothelial cells in patients with venous thromboembolism and myeloproliferative neoplasms.

BACKGROUND: Circulating endothelial cells (CEC) may be a biomarker of vascular injury and pro-thrombotic tendency, while circulating endothelial progenitor cells (CEP) may be an indicator for angiogenesis and vascular remodelling. However, there is not a universally accepted standardized protocol to identify and quantify these cells and its clinical relevancy remains to be established. OBJECTIVES: To quantify CEC and CEP in patients with venous thromboembolism (VTE) and with myeloproliferative neoplasms (MPN), to characterize the CEC for the expression of activation (CD54, CD62E) and procoagulant (CD142) markers and to investigate whether they correlate with other clinical and laboratory data. PATIENTS AND METHODS: Sixteen patients with VTE, 17 patients with MPN and 20 healthy individuals were studied. The CEC and CEP were quantified and characterized in the blood using flow cytometry, and the demographic, clinical and laboratory data were obtained from hospital records. RESULTS: We found the CEC counts were higher in both patient groups as compared to controls, whereas increased numbers of CEP were found only in patients with MPN. In addition, all disease groups had higher numbers of CD62E+ CEC as compared to controls, whereas only patients with VTE had increased numbers of CD142+ and CD54+ CEC. Moreover, the numbers of total and CD62+ CEC correlated positively with the white blood cells (WBC) counts in both groups of patients, while the numbers of CEP correlated positively with the WBC counts only in patients with MPN. In addition, in patients with VTE a positive correlation was found between the numbers of CD54+ CEC and the antithrombin levels, as well as between the CD142+ CEC counts and the number of thrombotic events. CONCLUSIONS: Our study suggests that CEC counts may reveal endothelial injury in patients with VTE and MPN and that CEC may express different activation-related phenotypes depending on the disease status.

Valuable compounds in macroalgae extracts.

Bioactive compounds present in ethanolic extracts from 18 macroalgae of the Portuguese coast were analysed by gas chromatography-mass spectrometry (GC-MS), leading to the characterization of 14 compounds: proline, phloroglucinol, mannitol, 8 fatty acids and 3 sterols. A dose-dependent response against enzymes with biological significance (α-glucosidase, acetylcholinesterase and butyrylcholinesterase) and free radicals (DPPH, nitric oxide, superoxide and hydroxyl) was found, Phaeophyta being the most promising group. A PCA analysis was performed and allowed the establishment of a correlation between the algae chemical composition and the biological activity. Cystoseira tamariscifolia (Hudson) Papenfuss, Cystoseira nodicaulis (Withering) M. Roberts, Cystoseira usneoides (Linnaeus) M. Roberts and Fucus spiralis Linnaeus are among the most active species, which is in accordance with their higher contents in phloroglucinol, mannitol, oleic, arachidonic and eicosapentaenoic acids, and fucosterol. The results point to the potential interest of the use of Phaeophyta species as food additives, due to their potent antiradical activities, and especially highlights the importance of F. spiralis in the food chain of Mediterranean countries. Moreover, the incorporation of the extracts of these species in food products, nutraceutical and pharmaceutical preparations for human health should also be instigated, since they can suppress hyperglycemia and inhibit cholinesterases.

Montagens curtas com instrumentação do nível fracturado e moldagem in situ no tratamento das fracturas tipo burst da coluna toracolombar / Short-segment fixation of thoracolumbar burst fractures using pedicle fixation at the level of the fracture and in situ bending / Montajes cortas con instrumentación del nivel fracturado y molde in situ en el tratamiento de las fracturas tipo burst de la columna toracolumbar

OBJECTIVO: Avaliação dos resultados clínicos e radiográficos do tratamento cirúrgico de fracturas tipo burst da coluna toracolombar por fixação posterior curta, com instrumentação do nível fracturado e moldagem in situ. MÉTODOS: Entre Novembro de 2007 e Janeiro de 2009, foram seleccionados pacientes que sofreram fractura da coluna toracolombar tipo burst a um nível, com presença de instabilidade neurológica ou mecânica, submetidos a fixação posterior curta com instrumentação do nível fracturado e moldagem in situ. Foi realizada avaliação radiográfica e clínica no pré-operatório, no pós-operatório imediato e, pelo menos, um ano após a cirurgia. RESULTADOS: Foram incluídos 12 pacientes com uma média de idades de 39,1 anos. O seguimento médio foi de 14,5 meses. Um paciente abandonou a consulta aos dois meses, e dois não compareceram à consulta de avaliação clínica. Dois pacientes apresentavam défices neurológicos à entrada (Frankel B). Obtivemos uma melhoria da angulação vertebral de 14,2º, da deformidade cifótica de 11,2º e 27,2 por cento de recuperação da altura vertebral anterior. Ao tempo de seguimento final, verificaram-se perdas de 2,7º, 3,8º e 6,1 por cento, respectivamente. Registou-se um Oswestry Disability Index (ODI) médio de 6,2 e uma Visual Analogic Scale (VAS) de 1,6. Os dois pacientes com lesões neurológicas melhoraram para um nível D de Frankel. Não se observou qualquer caso de desmontagem ou falência do material. CONCLUSÕES: A instrumentação do nível da fractura aumenta a rigidez da montagem, protegendo a vértebra fracturada de cargas anteriores, garantindo um ponto de fixação adicional que permite uma melhor correcção por moldagem in situ. Os resultados obtidos, radiográficos e clínicos, são bons e mantêm-se ao longo do tempo.

OBJECTIVE: Evaluation of clinical and radiographic results of the surgical treatment of thoracolumbar burst fractures with short posterior fixation, including the fractured vertebra and in situ bending. METHODS: From November 2007 to January 2009, the authors reviewed patients with traumatic thoracolumbar burst fractures of a single vertebral level, with neurological or mechanical instability, and surgically treated with short posterior fixation including the fractured level and in situ bending. Clinical and radiographic evaluations were performed before, immediately after surgery, and at least at one year after surgery. RESULTS: Twelve patients were included with an average age of 39.1 years. The average follow-up was 14.5 months. One patient was lost to followup at two months, and two were lost to clinical evaluation. Two patients presented with neurological deficits (Frankel B).We achieved an improvement of 14.2º of vertebral angulation, 11.2º of kyphotic deformity and a restoration of 27.2 percent of anterior vertebral height. At final follow up 2.7º, 3.8º and 6.1 percent were lost, respectively. We obtained an average Oswestry Disability Index (ODI) of 6.2 and a Visual Analogic Scale (VAS) of 1.6. The two patients with neurological deficits improved to a level D of Frankel. There was no instrumentation failure. CONCLUSION: Segmental fixation with instrumentation of the level of the fracture increases construct stiffness and gives additional vertebral body protection from anterior loads, achieving an additional point of fixation that allows a better kyphosis correction by in situ bending. Our clinical and radiographic results are good and long-lasting.

OBJETIVO: evaluación de los resultados clínicos y radiológicos del tratamiento quirúrgico de fracturas tipo burst de la columna toracolumbar por fijación posterior corta, con instrumentación del nivel fracturado y molde in situ. MÉTODOS: entre Noviembre de 2007 y Enero de 2009, fueron seleccionados pacientes que sufrieron fractura de la columna toracolumbar tipo burst a un nivel, con presencia de inestabilidad neurológica o mecánica, sometidos a la fijación posterior corta con instrumentación del nivel fracturado y molde in situ. Se realizó evaluación radiográfica y clínica en el pre operatorio, en el postoperatorio inmediato y por lo menos un año después de la cirugía. RESULTADOS: fueron incluidos 12 pacientes con un promedio de edad de 39.1 años. El seguimiento promedio fue de 14.5 meses. Un paciente abandonó la consulta a los dos meses, y dos no comparecieron a la consulta de evaluación clínica. Dos pacientes presentaron déficits neurológicos a la entrada (Frankel B). Obtuvimos una mejoría del ángulo vertebral de 14.2º, de la deformidad cifótica de 11.2º y el 27.2 por ciento de recuperación de la altura vertebral anterior. Al tiempo de seguimiento final, se verificaron pérdidas de 2.7º, 3.8º y el 6.1 por ciento, respectivamente. Se registró un Oswestry Disability Index (ODI) promedio de 6.2 y una Escala Analógica Visual (VAS) de 1.6. Los dos pacientes con lesiones neurológicas mejoraron para un nivel D de Frankel. No se observó cualquier caso de desmontaje o falencia del material. CONCLUSIONES: la instrumentación del nivel de la fractura aumenta la rigidez del molde, protegiendo la vértebra fracturada de cargas anteriores, garantizando un punto de fijación adicional que permite una mejor corrección por molde in situ. Los resultados obtenidos, tanto los radiográficos cuanto los clínicos, son buenos y se mantienen a lo largo del tiempo.

Tratamento cirúrgico por via anterior na mielopatia cervical espondilótica com seguimento mínimo de dez anos / Tratamiento quirúrgico por vía anterior en la mieolopatía cervical espondilótica con seguimiento mínimo de diez años / Anterior decompression and fusion for spondilotic cervical mielopathy with a minimal ten-year follow-up

A mielopatia cervical espondilótica (MEC) é uma causa freqüente de disfunção da medula espinhal na população adulta. O tratamento implica em descompressão cirúrgica precoce. O objetivo foi apresentar um estudo retrospectivo da descompressão anterior e artrodese para MEC com um seguimento mínimo de dez anos. Métodos: pacientes operados entre Janeiro de 1990 e Dezembro de 1994 foram avaliados por sexo, idade, número de níveis operados, avaliação funcional pela escala de Nurick pré-operatória um ano após cirurgia e após a revisão final que ocorreu em 2004, evidência de consolidação e complicações. Resultados: foram avaliados 91 pacientes, 69 do sexo masculino, 22 do sexo feminino, com uma média de idade de 56,6 anos (42-86) e um seguimento médio de 11,9 anos. (...)Verificou-se uma forte correlação entre a idade e o número de níveis operados (r=0,391; p=0,01), idade e estado neurológico inicial (r=0,238; p=0,05), estado neurológico inicial e número de níveis operados (r=0,251; p=0,05) e sexo e número de níveis operados, sendo as mulheres operadas a mais níveis (r=0,208; p=0,05). Verificou-se também uma maior deterioração neurológica entre o primeiro ano e a avaliação final em doentes mais jovens em comparação com os idosos (r=0,25; p=0,05). Há uma forte correlação entre a recuperação obtida ao primeiro ano e a recuperação final (r=0,838; p=0,01). A taxa de consolidação foi de 100 por cento. Conclusão: na MEC, a cirurgia proporciona uma melhoria neurológica significativa e, apesar de uma deterioração clínica entre o primeiro ano e a avaliação final, os benefícios da descompressão são evidentes pelo menos dez anos após a intervenção.

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction in the adult population. The treatment implies early surgical decompression. The objective was to present a retrospective study of anterior decompression and arthrodesis for CSM with a minimal ten years follow-up. METHODS: patients operated between January 1990 and December 1994 were evaluated for sex, age, number of levels operated, functional evaluation with Nurick scale preoperatively, one year after surgery and at the final revision that took place in 2004, evidence of consolidation and complications. RESULTS: 91 patients were evaluated, 69 male, 22 female, with a mean age of 56.6 years (42).(...) The degradation between the first year and the final evaluation was statistically significant (p=0.004). There was a strong correlation between age and the number of operated levels (r=0.391; p=0.01), age and initial neurologic status (r=0.238; p=0.05), initial neurological status and number of operated levels (r=0.251; p=0.05) and sex and number of operated levels, with women being operated for more levels (r=0.208; p=0.05). There was also a stronger neurological deterioration between the first year and the final follow-up in young patients when compared to older ones (r=0.25; p=0.05). There is a strong relation between the first year improvement and the final improvement (r=0.838, p=0.01). There was a 100 percent rate of consolidation. CONCLUSION: in CSM, a significant neurological improvement can be expected with surgery, and despite a clinical deterioration between the first year and the final evaluation, the benefits of decompression are evident at least ten years after the intervention.

La mielopatía cervical espondilótica (MEC) es una causa frecuente de disfunción de la médula espinal en la población adulta. El tratamiento implica una descompresión quirúrgica precoz. El objetivo es presentar un estudio retrospectivo de la descompresión anterior y artrodesis para MEC con un seguimiento mínimo de diez años. MÉTODOS: pacientes operados entre Enero de 1990 y Diciembre de 1994 fueron evaluados según el sexo, la edad, el número de niveles operados, la evaluación funcional por la escala de Nurick pre operatoria un año después de la cirugía y después de la revisión final que fue en el 2004, evidencia de consolidación y complicaciones. RESULTADOS: fueron evaluados 91 pacientes, 69 del sexo masculino, 22 del sexo femenino, con un promedio de edades de 56.6 años (42 a 86) y un seguimiento promedio de 11.9 años. El agravamiento entre el primer año y la evaluación final fue estadísticamente significativa (p=0.004). Se verificó una correlación fuerte entre la edad y el número de niveles operados (r=0.391; p=0.01), edad y estado neurológico inicial (r=0.238; p=0.05), estado neurológico inicial y número de niveles operados (r=0.251; p=0.05), y sexo y número de niveles operados, siendo las mujeres operadas con más niveles (r=0.208; p=0.05). Se verificó también un mayor deterioro neurológico entre el primer año y la evaluación final en enfermos más jóvenes al ser comparados con pacientes de edad avanzada (r=0.250; p=0.05). Hay una fuerte correlación entre la recuperación obtenida en el primer año y la recuperación final (r=0.838; p=0.01). La tasa de consolidación fue del 100 por ciento. CONCLUSIÓN: en la MEC, la cirugía proporciona una mejora neurológica significativa y, a pesar de un deterioro clínico entre el primer año y la evaluación final, los beneficios de la descompresión son evidentes por lo menos diez años después de la intervención.

[New perspectives on degenerative disease treatment]. / Novas perspectivas no tratamento da doença degenerativa discal.

The degenerative disc disease (DDD) is a chronic and multifactorial condition of the intervertebral disc that can manifest itself by axial pain, radiculopathy, myelopathy and spinal stenosis. It constitutes an increasing cause of lumbar pain and morbidity in Western Societies, with important socio-economic implications. The available treatment options do not modify the intervertebral disc degeneration process and they are not always capable of relieving symptoms. The loss of proteoglycan content of nucleus pulposus appears to be the main event on DDD pathophysiology. The balance between synthesis and catabolism of the extracellular matrix can be altered by the use of several proteins, including growth factors. The transfer of genes encoding these proteins is an attractive treatment option and has been successfully achieved in animal models. Moreover, the transfer of steam cells in order to repopulate the degenerated disc and to revert the pathologic process might be another promissory strategy. The authors describe the actual knowledge about DDD and the investigation that has been made in gene therapy for DDD. The comprehension of the biological mechanisms of degeneration, as well as genetic manipulation and transfer of steam cells could be decisive and revolutionary in the understanding and treatment of this epidemic condition.