Analysis of patients submitted to surgical treatment for neuromuscular scoliosis with and without intraoperative traction / Análise de pacientes submetidos a tratamento cirúrgico de escoliose neuromuscular com e sem tração intraoperatória / Análisis de pacientes sometidos a tratamiento quirúrgico de escoliosis neuromuscular con y sin tracción intraoperatoria

ABSTRACT Objectives: To compare the surgical treatment of neuromuscular scoliosis (NMS) with and without intraoperative skull-skeletal traction (ISST) in terms of the degree of curve correction, surgical time, hospitalization time, screw density, use of blood products,and complications. Methods: A comparative retrospective study, in which we analyzed the medical records and radiographs of 17 patients who underwent surgical treatment for neuromuscular scoliosis (NMS). They were divided into two groups, with 9 and 8 patients operated with and without ISST, respectively, at a referral hospital specialized in the treatment of spinal deformitiesfrom 2019 to 2021. The categorical variables were analyzed using the Chi-squared test. Results: Among the 17 patients included in the study, there was a higher prevalence of women in the group without ISST (6 and 2) and of men in group with ISST (5 and 3). The ages of the patients in the two groups ranged from 8-19 years and from 11-29 years, respectively. The screw density used in the traction group averaged 66.33%±8.49 and 82.63%±17.25 in the non-traction group, a statistically significant differencewith a P-value of 0.036. The average percent correction was 76.81%±15.61 in the traction group as compared to an average of 66.39%±12.99 in the non-traction group. In addition, there were complications in 1 patient in each of the groups. Conclusions: Surgical treatment for NMS with ISST allows surgery using fewer blood products to maintain the same hematimetric level in the postoperative period. ISST also allows the use of a lower screw density to correct more severe deformities. Level of evidence III; Comparative retrospective study.

RESUMO: Objetivo: Comparar o tratamento cirúrgico da escoliose neuromuscular (ENM) com e sem uso de tração crânio-esquelética intraoperatória (TCEI), com relação a grau de correção da curvatura, tempo de cirurgia, tempo de internação, densidade de parafusos, uso de hemoderivados e complicações. Métodos: Estudo retrospectivo comparativo, no qual foram analisados prontuários e radiografias de 17 pacientes com ENM submetidos a tratamento cirúrgico, divididos em dois grupos, com nove e oito pacientes operados com e sem TCEI, respectivamente, em hospital de referência de tratamento de deformidades da coluna, entre os anos de 2019 e 2021. As variáveis categóricas foram analisadas através do teste de Qui-quadrado. Resultados: Dos 17 pacientes incluídos no estudo, houve maior prevalência de mulheres no grupo sem TCEI (seis e dois) e de homens no grupo TCEI (cinco e três), sendo a idade dos pacientes entre 8 e 19 anos e 11 e 29 anos, respectivamente. A densidade dos parafusos utilizados no grupo tração foi em média 66,33%±8,49%e82,63%±17,25% no grupo sem tração, diferença estatisticamente significante; o valor de P foi 0,036. A média percentual de correção foi 76,81%±15,61%, em comparação com a média de 66,39%±12,99% em não tracionados. Além disso, houve complicação em um paciente de cada um dos grupos. Conclusões: O tratamento cirúrgico para ENM com TCEI permite a cirurgia com menos usode hemoderivados para manter o mesmo nível hematimétrico no pós-operatório. A TCEI também permite o uso de parafusos com densidade menor para corrigir deformidades maiores. Nível de evidência III; Estudo retrospectivo comparativo.

RESUMEN: Objetivos: Comparar el tratamiento quirúrgico de la escoliosis neuromuscular (ENM) con y sin uso de tracción craneoesquelética intraoperatoria (TCEI), en cuanto al grado de corrección de la curvatura, tiempo quirúrgico, estancia hospitalaria, densidad de los tornillos, uso de hemoderivados y complicaciones. Métodos: Estudio comparativo retrospectivo, en el que se analizaron historias clínicas y radiografías de 17 pacientes con ENM sometidos a tratamiento quirúrgico, divididos en dos grupos, con 09 y 8 pacientes operados con y sin TCEI, respectivamente, en un hospital de referencia para el tratamiento de deformidades de la columna vertebral, entre los años 2019 y 2021. Las variables categóricas se analizaron mediante la prueba de Chi-cuadrado. Resultados: De los 17pacientes incluidos en el estudio, hubo una mayor prevalencia de mujeres en el grupo sin TCEI (6 y 2) y de hombres en el grupo con TCEI (5 y 3), con pacientes entre 8 y 19 años y 11 y 29 años, respectivamente. La densidad media de los tornillos utilizados en el grupo de tracción fue del 66,33% ± 8,49%en el grupo con tracción y del 82,63% ± 17,25% en el grupo sin tracción, una diferencia estadísticamente significativa; el valor P fue de 0,036. El porcentaje de corrección promedio fue de 76,81%±15,61%, en comparación con el promedio de 66,39%±12,99% en no traccionados. Además, hubo complicaciones en 1 paciente en cada uno de los grupos. Conclusiones: El tratamiento quirúrgico de la ENM con TCEI permite una cirugía con menor uso de hemoderivados para mantener el mismo nivel hematimétrico en el postoperatorio. La TCEI también permite el uso de tornillos con menor densidad, para corregir deformidades más grandes. Nivel de evidencia III; Estudio retrospectivo comparativo.

Neurectomy of C2 for the Treatment of Occipital Neuralgia: Case Report

Occipital neuralgia (ON) is an uncommon cause of headache, and it is characterized by a stabbing paroxysmal pain that radiates to the occipital region. The present study includes a review of the literature and a case report. The etiology of this pathology can vary from traumas, infections, compressions of nerves or vertebrae, skull base surgeries, to degenerative changes and congenital anomalies. However, most of the time, the etiology is considered idiopathic. The diagnosis is essentially clinical. However, it is crucial that other types of primary headache are excluded. The treatment for ON may be based on nerve blocks, medications or surgeries. Neurectomy of the second spinal nerve is among the surgical techniques available.

Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but theymay compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, andthe abductormuscle of theVfinger. Regarding the symptoms, the patient feltmoderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomasmay present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exammay aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.