Correlation between the Severity of the Lumbar Degenerative Disease and Sagittal Spinopelvic Alignment / Correlação entre a gravidade da doença degenerativa lombar e o alinhamento espinopélvico

Abstract Objective To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal spinopelvic alignment. Methods In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back pain were prospectively included. The severity of the LDD was defined by the following findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss of of height of the intervertebral disc; terminal vertebral plate sclerosis; number of affected segments; deformities; and objective instability. The disease was classified as follows: grade 0-absence of signs of LDD in the lumbar spine; grade I - signs of LDD in up to two segments; grade II - three or more segments involved; grade III - association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed according to the LDD grades. Results The radiographic parameters differed according to the LDD grades; grade-III patients presented higher SVA (p= 0.001) and PT (p= 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects (p= 0.04). Conclusion Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment compared to patients with a milder disease.

Resumo Objetivo Avaliar o impacto da graduação da doença degenerativa lombar (DDL) sobre o alinhamento sagital espinopélvico. Métodos Ao todo, 130 pacientes (dade média: 57 anos; 75% do sexo feminino) com dor lombar associada a DDL foram prospectivamente incluídos. A gravidade da DDL foi definida pelos seguintes achados nas radiografias anteroposterior e de perfil da coluna lombar: osteofitose; perda de altura do disco intervertebral; esclerose na placa vertebral terminal; número de segmentos afetados; deformidades; e instabilidade objetiva. Os pacientes foram graduados segundo a DDL da seguinte maneira: grau 0-ausência de sinais de DDL na coluna lombar; grau I - sinais de DDL em até dois segmentos; grau II - envolvimento em três ou mais segmentos; grau III - quando associada a escoliose, espondilolistese ou laterolistese. Parâmetros radiográficos espinopélvicos, como incidência pélvica (IP), lordose lombar (LL), discrepância entre a IP e a LL (IP-LL), versão pélvica (VP), e eixo vertical sagital (EVS) foram analisados de acordo com os graus de DDL. Resultados Houve diferença nos parâmetros radiográficos comparando-se os graus de DDL, com os pacientes de grau III apresentando maiores valores de EVS (p= 0,001) e VP (p= 0,0005), o que denota maior inclinação anterior do tronco e maior retroversão pélvica do que os pacientes de graus 0 e I. Pacientes de grau III também apresentaram maiores valores de IP-LL, o que denota perda da lordose relativa ao valor da IP, do que pacientes grau I (p= 0,04). Conclusão Pacientes com DDL mais grave demonstraram uma tendência a maior desalinhamento sagital espinopélvico comparados com pacientes com graus mais leves.

Effectiveness of Fluoroscopy-Guided Percutaneous Vertebral Biopsy / Eficácia da biópsia vertebral percutânea guiada por fluoroscopia

Abstract Objective To define the effectiveness of fluoroscopy-guided percutaneous vertebral biopsy. Methods Prospective study of patients with vertebral destruction syndrome at one institution. Percutaneous transpedicular vertebral biopsies guided by fluoroscopy were performed, and bony tissue and intervertebral disc tissue were extracted; histopathology and microbiology studies were also performed. Age, sex, vertebral segment, neurologic status, and biopsy and culture results were analyzed. Results The average age of the patients was 53.8 years (range: 2 to 83 years), and the main spine segment was the lumbar segment in 62% of the cases. According to the impairment scale of the American Spinal Injury Association (ASIA), preoperatively, 49% of the patients were classified as Asia E, and 100% had pain. Definitive etiology was identified in 83% of the sample. The etiology was grouped into three categories: infectious, neoplasia, and degenerative (osteoporotic). The infectious group was composed of 36% of the patients, in whom Staphylococcus aureus was the most common agent identified; in 34.9% the sample, the etiology was neoplastic, most commonly multiple myeloma and metastatic disease due to prostate cancer; 21.7% of the patients had osteoporosis. The average surgical time was of 47.5 minutes, the average blood loss was of 10 mL. No complications were reported. Conclusion Transpedicular percutaneous biopsy guided by fluoroscopy had an effectiveness of 83% for the etiological diagnosis of vertebral destruction syndrome in the present series. It should be considered a useful minimally-invasive procedure, which is easy, economical, and reproducible, with low risk of short- and long-term complications.

Resumo Objetivo Definir a eficácia da biópsia vertebral percutânea guiada por fluoroscopia. Métodos Este é um estudo prospectivo de pacientes com síndrome de destruição vertebral em uma instituição. Os pacientes foram submetidos a biópsias vertebrais transpediculares percutâneas guiadas por fluoroscopia, com obtenção de tecido ósseo e tecido do disco intervertebral, para estudo histopatológico e microbiológico. Idade, sexo, segmento vertebral, estado neurológico, e resultados de biópsia e de cultura foram analisados. Resultados A idade média dos pacientes foi de 53,8 anos (gama: 2 a 83 anos), e o principal local acometido da coluna foi a segmento lombar, em 62% dos casos. Segundo a escala de disfunção da American Spinal Injury Association (ASIA), no pré-operatório, 49% dos pacientes foram classificados como ASIA E, e 100% apresentavam dor. A etiologia definitiva foi identificada em 83% dos pacientes. A etiologia foi agrupada em três categorias: infecciosa, neoplásica, e degenerativa (osteoporótica). O grupo infeccioso era composto por 36% dos pacientes da amostra, e Staphylococcus aureus foi o agente mais comumente identificado; em 34,9% dos casos, a etiologia era neoplásica, principalmente mieloma múltiplo e doença metastática por câncer de próstata; 21,7% dos pacientes apresentavam osteoporose. O tempo cirúrgico médio foi de 47,5 minutos, e a perda média de sangue foi de 10 mL. Nenhuma complicação foi relatada. Conclusão Nesta série, a biópsia percutânea transpedicular guiada por fluoroscopia teve 83% de eficácia no diagnóstico etiológico da síndrome de destruição vertebral. Este procedimento minimamente invasivo deve ser considerado bom, fácil, barato e reprodutível, com baixo risco de complicações em curto e longo prazos.

Efectos del ranelato de estroncio sobre la densidad mineral ósea en hombres / Effect of strontium ranelate on bone mineral density in men

La osteoporosis afecta al 6-7% de la poblaciónmasculina. Es alta la proporción de pacientes confractura osteoporótica sin diagnóstico previo de estaenfermedad. La mortalidad luego de una fracturaes mayor en hombres que en población femenina;a pesar de esto, la mayoría de los pacientes no reciben tratamiento. Los fármacos aprobados, en nuestro medio, para tratar la osteoporosis masculina son:bifosfonatos, teriparatida y ranelato de estroncio. Elobjetivo de este estudio fue evaluar el efecto del ranelato de estroncio sobre la densidad mineral ósea enhombres después de 1 año de tratamiento. Se incluyeron los registros de 20 hombres de 67.8±3.0 años,tratados con ranelato de estroncio (2 g/día) durante 1año. Todos los pacientes presentaban un T-score inferior a -2.5 en cadera o columna vertebral o un T-scoreinferior a -2.0 y factores de riesgo de fractura. Nohubo modificación de parámetros de laboratorio luego del tratamiento (calcemia, calciuria, fósforo sérico,parathormona, 25(OH)vitamina D, fosfatasa alcalinay desoxipiridinolina). Luego de 1 año de tratamiento con ranelato de estroncio se observó incrementode la densidad mineral ósea en columna lumbar:0.953±0.029 versus 0.997±0.030 g/cm2 (p=0.0068),cuello femoral: 0.734±0.013 versus 0.764±0.016 g/cm2 (p=0.0084) y cadera total: 0.821±0.02 versus0.834±0.02 g/cm2 (p=0.0419). Conclusión: luego de1 año de tratamiento el ranelato de estroncio produjoun incremento significativo de la densidad mineralósea en columna lumbar y fémur proximal en hombres con osteoporosis (AU)

Osteoporosis affects 6-7% of the male population. The proportion of patients with fragility fractures but without diagnosis of the disease is high. Mortality after hip fracture is higherin men than in women; in spite of this, mostpatients are left without treatment for osteoporosis. Drugs approved, for the treatment ofosteoporosis in our country are bisphosphonates, teriparatide, and strontium ranelate (SrR).The objective of this study was to evaluate theeffect of SrR on axial BMD in men after one yearof treatment. We obtained pertinent data frommedical registries of 20 men aged 67,8±3,0 years,treated with oral SrR (2 g/day) for 12 months. All patients had a T-score below -2,5 at the hipor the lumbar spine, or a T-score below -2,0and one or more risk factors for fracture. Thelevels of serum calcium, phosphate, alkalinephosphatase, 25-hydroxyvitamin D, or PTH,or urinary calcium and desoxipyridinoline remained unchanged following SrR administration. After treatment with SrR there weresignificant increases in BMD at the lumbarspine: 0,953±0,029 versus 0,997±0,030 g/cm2(p=0,0068), femoral neck: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0.0084), and total hip: 0,821±0,02 versus 0,834±0,02 g/cm2(p=0,0419). Conclusion: in osteoporotic men,treatment with SrR significantly increases BMDin the lumbar spine and the proximal femur (AU)

Los sistemas de descompresión vertebral tienen origen en los estudios realizados por los científicos de la NASA, quienes observaron que los astronautas que tenían dolor de espalda en tierra al subir al espacio, con la ingravidez, les desaparecía el dolor. [Editorial] / The vertebral decompression systems have their origin in the studies carried out by the NASA scientists, who observed that astronauts who had back pain on earth when going up into space, with weightlessness, the pain disappeared. [Editorial]

Los sistemas de descompresión vertebral tienen origen en los estudios realizados por los científicos de la NASA, quienes observaron que los astronautas que tenían dolor de espalda en tierra al subir al espacio, con la ingravidez, les desaparecía el dolor. Con estos antecedentes, el científico canadiense Dr. Alan E. Dyer (médico que inventó y patentó el desfibrilador cardiaco) consiguió recrear este escenario espacial en tierra, patentando una fórmula logarítmica que conseguía tratar aisladamente cada vértebra aplicando una secuencia de tracción controlada, progresiva e indolora sobre la columna vertebral. Estos sistemas de descompresión vertebral están basados en el método clásico de tracción, adaptado a la tecnología moderna. No tracciona, sino que descomprime los discos y las pequeñas articulaciones facetarias de forma progresiva e indolora, utilizando un software que aplica una fuerza de intensidad variable para cada tipo de paciente. Los ordenadores constituyen el "cerebro" que se encarga de controlar y ejecutar el software de la unidad de descompresión; siendo el "corazón" un dispositivo electromecánico que con el propio procesador acciona el servomotor que pone en marcha el sistema.

Proximal type of epithelioid sarcoma: a rare aggressive tumor presenting simultaneously in spine and pelvis

A 40-year-old female presented with bilateral lower limb weakness with bladder and bowel incontinence. MRI study revealed a destructive lesion involving the D7 vertebral body and a large tumor in the gluteal muscles invading the right iliac blade. A histological examination demonstrated a tumor comprising of rounded to ovoid pleomorphic epithelioid cells with marked cytological atypia. Tumor cells expressed CD 34, vimentin and focally pancytokeratin but were negative for CD31, EMA, SMA, WT1 and LCA. A D6-7 laminectomy with posterior decompression was done. Postoperatively, external beam radiotherapy was given. However, the patient deteriorated rapidly with no neurological improvement. Epitheiliod sarcomas and their recently described proximal variant, by virtue of being an exceedingly unusual tumor are often misdiagnosed or diagnosed late beyond the stage of salvage. This report highlights the histopathology and that need to be analyzed to correctly diagnose this entity

Practical Use of Bone Scan in Patients with an Osteoporotic Vertebral Compression Fracture

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Practical Use of Bone Scan in Patients with an Osteoporotic Vertebral Compression Fracture

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia / Avaliação do equilíbrio espinopélvico em pacientes submetidos a tratamento cirúrgico de hérnia de disco lombar

OBJECTIVE: to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment. METHODS: thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that needed to encompass the lumbar spine, sacrum and proximal third of the femur. RESULTS: the spinopelvic balance measurements obtained from the mean angles of the population studied, for pelvic incidence, sacral slope and pelvic tilt, were 45◦ , 36.9◦ and 8.1◦ , respectively. The confidence interval for the mean pelvic incidence was from 41.9 to 48.1 (95% CI), thus including a reference value that characterized it as low, for an asymptomatic population, thus confirming that the sample was extracted from a population with this characteristic. CONCLUSION: among these patients with lumbar disk hernias who underwent surgical treatment, the average spinopelvic balance was found to have pelvic incidence lower than what has been reported in the literature for an asymptomatic population...

OBJETIVO: avaliar o equilíbrio espinopélvico, por meio da incidência pélvica, do declive sacral e da versão pélvica, em pacientes portadores de hérnias discais lombares submetidos a tratamento cirúrgico. MÉTODOS: foram avaliados 30 pacientes do Serviço de Coluna Vertebral do Hospital Santa Casa de Misericórdia de Vitória e do Vila Velha Hospital, por meio da aferição do equilíbrio espinopélvico, obtido pela mensuração dos ângulos da versão pélvica, do declive sacral e da incidência pélvica, com suas respectivas médias, nas radiografias simples lombopélvicas, tipo perfil, que englobaram, obrigatoriamente, coluna lombar, sacro e terço proximal do fêmur. RESULTADOS: a medida do equilíbrio espinopélvico, obtida pela média dos ângulos na população estudada da incidência pélvica, do declive sacral e da versão pélvica, foi de 45◦ , 36,9◦ e 8,1◦ , respectivamente. O intervalo de confiança da média da incidência pélvica entre 41,9 - 48,1 (95% IC) contém o valor de referência que a caracteriza como baixa, para uma população assintomática, o que confirma que a amostra foi extraída de uma população com essa característica. CONCLUSÃO: nos pacientes portadores de hérnia discal lombar submetidos a tratamento cirúrgico foi encontrado, em média, um equilíbrio espinopélvico com incidência pélvica abaixo do encontrado na literatura para uma população assintomática...

Focal Anterior Displacement of the Thoracic Spinal Cord without Evidence of Spinal Cord Herniation or an Intradural Mass

OBJECTIVE: We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. MATERIALS AND METHODS: We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. RESULTS: An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. CONCLUSION: Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass.

Association and Classification Data Mining Algorithms Comparison over Medical Datasets / Comparação de Algoritmos de Classificação e de Associação de Mineração de Dados sobre Bases de Dados Médicos / Comparación de Algoritmos de Clasificación y de Asociación de Míneria de Datos sobre Bases de DatosMédicos

Objectives: Compare Data Mining algorithms related to Classification and Association tasks over medical datasets about dermatology, vertebral column and breast cancer patients, analyzing which is the best one over each of these datasets. Methods: The classification algorithms are ran over these datasets and compared using precision, F-measure, ROC curve and Kappa performance metrics. For associaton task, the Apriori algorithm is ran to get a significant number of rules with confidence above 90%. Results: For diagnostics prediction about breast cancer and dermatology issues, the best classification algorithm was BayesNet and for vertebral column was the Logistic Model Tree. For association task, were extracted 100 knowledge rules for breast cancer and dermatology issues with confidence higher than 90% while for vertebral column were found 18 with same confidence. Conclusion: The comparison was useful to prove the possibility of using Data Mining algorithms to help Medicine decision engine with good precision.

Objetivos: Compar os algoritmos de Mineração de Dados de Classificação e Associação de dados sobre bases de dados de dermatologia, câncer de mâma e de problemas da coluna vertebral. Métodos: Os algoritmos de classificação foram executados sobre essas bases de dados e comparadas pelas métricas de precisão, F-measure, curva ROC e Kappa. Para associação, o algoritmo Apriori é executado para gerar um número significante de regras com confiança acima de 90%. Resultados: Para a predição de diagnósticos sobre câncer de mâma e dermatologia o melhor algoritmo foi o BayesNet e para coluna vertebral foi o de Árvore de Modelo Logístico. Para a tarefa de associação, foram extraídas 100 regras de conhecimento para a base de câncer de mâma e de dermatologia com confiança acima de 90% enquanto para a da coluna vertebral foram encontradas 18 com a mesma confiança. Conclusão: A comparação foi útil para provar a possibilidade do uso de algoritmos de Mineração de Dados no auxílio ao processo decisório na Medicina com boa precisão.

Objetivos: Comparar los algoritmos de minería de datos relacionados con las tareas de clasificación y asociación de conjuntos de datos médicos sobre dermatología, coluna vertebral y patientes con cáncer de mama, analizando cual es el mejor en cada uno de estos conjuntos de datos. Métodos: Los algoritmos de clasificación se pasó por encima de estos conjuntos de datos y se compararon con las métricas de rendimiento precisión, F-medida, la curva ROC y Kappa. Para la tarea Associaton, el algoritmo Apriori obtiene normas de confianza superior al 90%. Resultados: Para la predicción de diagnóstico sobre el cáncer de mama y problemas dermatológicos el mejor algoritmo de clasificación fue BayesNet y de la columna vertebral era el árbol del modelo logístico. Para tarea de asociación, se extrajeron 100 reglas de conocimiento para el cáncer de mama y problemas dermatológicos con confianza mayor que 90%, mientras que para la columna vertebral se encontraron 18 con la misma confianza. Conclusión: La comparación es útil para demostrar la posibilidad de utilizar algoritmos de minería de datos para ayudar a motor de decisóin de Medicina con buena precisión.

Results of fluoroscopic guided percutaneous needle biopsy of vertebral pathologies in our teaching hospital

To determine the frequency of positive findings on Percutaneous Transpedicular biopsy via fluoroscopic guidance in clinically identifiable cases of vertebral pathologies. Descriptive case series study. This study was conducted at department of Orthopedics, Nawaz Sharif Social Security Hospital, Lahore for a period of 06 months from 20[th] February 2012 to 20[th] August 2012. 55 patients fulfilling the selection criteria were identified. Radiographs and MRI of spine were carried out on the basis of clinical examination, to document the site and type of pathology. Transpedicular biopsy was taken. Results were evaluated on the basis of biopsy report. A total of 55 patients were included in the study. 37 [67.3%] were male and 18 [32.7%] were female. The age ranged from 18-80 years. Mean age of patients was 53.54 +/- 16.99 years. Positive diagnosis was obtained in 38 [69.1%] patients. Percutaneous Transpedicular biopsy is a safe procedure without significant operative morbidity, with good diagnostic accuracy

Usefulness of Prone Cross-Table Lateral Radiographs in Vertebral Compression Fractures

BACKGROUND: Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. METHODS: We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. RESULTS: The average NRS scores were 6.23 +/- 1.67 in StLRs and 5.18 +/- 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24degrees +/- 6.16degrees with PrLRs and 3.46degrees +/- 3.47degrees with StLRs. The average changes of VHR were 0.248 +/- 0.178 with PrLRs and 0.148 +/- 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. CONCLUSIONS: In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.

Análise radiográfica comparativa da cifose juncional entre instrumentação híbrida, ganchos e parafusos na escoliose idiopática do adolescente / Comparative radiographic analysis of junctional kyphosis between hybrid instrumentation, hooks and screws in adolescent idiopathic scoliosis / Análisis radiográfico comparativo de la cifosis de unión entre los instrumentos híbridos, los ganchos y los tornillos en escoliosis idiopática del adolescente

OBJETIVO: Avaliação radiográfica das cifoses juncionais proximal e distal em pacientes submetidos a artrodese e diferentes tipos de instrumentação posterior no tratamento cirúrgico da escoliose idiopática do adolescente (EIA). MÉTODO: Foi realizado estudo retrospectivo com avaliação radiográfica de 34 pacientes submetidos à artrodese da coluna vertebral com instrumentação posterior, sendo 10 com ganchos (Grupo I), 13 com ganchos e parafusos (Grupo II) e 11 com parafusos (Grupo III), entre junho de 1997 e dezembro de 2009. Foi avaliada a ocorrência de cifose juncional proximal (CJP) e cifose juncional distal (CJD) à artrodese, no pré-operatório, no pós-operatório imediato e no final do seguimento, pós-operatório tardio, que foi de, no mínimo, 12 meses. RESULTADOS: Os pacientes do grupo I apresentaram cifose torácica de menor valor no pré-operatório, porém a lordose lombar permaneceu inalterada ao longo da evolução. Os pacientes do grupo II e grupo III apresentaram aumento do valor aferido da lordose lombar no pós-operatório. Não houve diferença significativa para a ocorrência de cifose juncional proximal entre os três grupos estudados. Com relação à cifose juncional distal, houve aumento estatisticamente significativo do valor entre pré é pós-operatório, para os grupos II e III. CONCLUSÃO: A avaliação radiográfica das cifoses juncionais proximal e distal em pacientes submetidos à artrodese e diferentes tipos de instrumentação no tratamento cirúrgico da EIA revelou a presença de cifoses juncionais proximais pré-operatórias, que não evoluíram para a deformidade juncional pós-operatória, além de ausência completa da anormalidade juncional distal.

OBJECTIVE: Radiographic evaluation of proximal and distal junctional kyphosis in patients undergoing spinal fusion and different types of posterior instrumentation, in the surgical treatment for adolescent idiopathic scoliosis (AIS). METHOD: A retrospective review was done with radiographic evaluation of 34 patients who were submitted to spinal fusion with posterior instrumentation, divided as follows: 10 using only hooks (Group I), 13 hybrid fixation (screws and hooks) (Group II) and 11 using only pedicle screws (Group III) from June 1997 to December 2009. The study assessed the occurrence of junctional kyphosis both proximal and distal to the arthrodesis, in the preoperative, immediate postoperative periods, in the final follow up, and also in the late postoperative period, which was at least 12 months. RESULTS: Patients in group I showed lower value of thoracic kyphosis preoperatively, but the lumbar lordosis remained unchanged throughout evolution. Patients in group II and group III showed an increase in the assessed value of lumbar lordosis postoperatively. There was no significant difference in the occurrence of proximal junctional kyphosis among the three groups. Regarding the distal junctional kyphosis, there was a statistically significant increase in value between the preoperative and postoperative for groups II and III. CONCLUSION: Radiographic evaluation of the proximal and distal junctional kyphosis in patients who underwent arthrodesis and different types of instrumentation in the surgical treatment of adolescent idiopathic scoliosis, revealed the presence of preoperative proximal junctional kyphosis, which have not progressed to postoperative junctional deformity, and also complete absence of distal junctional abnormality.

OBJETIVO: Evaluación radiográfica de cifosis por unión proximal y distal en pacientes sometidos a artrodesis y diferentes tipos de instrumentación como tratamiento quirúrgico de escoliosis idiopática del adolescente (EIA). MÉTODO: Se realizó un estudio retrospectivo de evaluación radiográfica de 34 pacientes sometidos a artrodesis de la columna con instrumentación posterior, 10 con ganchos (Grupo I), 13 con ganchos y tornillos (Grupo II) y 11 con tornillos (Grupo III), entre junio de 1997 y diciembre de 2009. Se evaluó la aparición de cifosis proximal y distal a la artrodesis en los períodos preoperatorio, postoperatorio inmediato y al final del seguimiento, período postoperatorio tardío, de por lo menos 12 meses. RESULTADOS: Los pacientes del Grupo I presentaron menor valor de cifosis torácica preoperatoria, pero la lordosis lumbar se mantuvo sin cambios durante la evolución. Los pacientes en el grupo II y grupo III mostraron incremento del valor verificado de lordosis lumbar en el postoperatorio. No hubo diferencia significativa en la aparición de cifosis proximal a la unión entre los tres grupos. En cuanto a la cifosis por unión distal, se produjo un aumento estadísticamente significativo del valor entre preoperatorio y postoperatorio en los grupos II y III. CONCLUSIÓN: La evaluación radiográfica de la cifosis por unión proximal y distal en pacientes sometidos a artrodesis y diferentes tipos de instrumentación como tratamiento quirúrgico de escoliosis idiopática del adolescente reveló la presencia preoperatoria de cifosis proximales a la unión , que no evolucionaron para deformidad postoperatoria por unión y además, ausencia completa de anormalidad de la unión distal.

Non-communicating extradural arachnoid cyst of dorsal spine

Extradural arachnoid cyst in the spine is an uncommon cause of spinal cord compression in the paediatric population. Most reported cysts have communication with the intrathecal subarachnoid space through a small defect in the dura. The reported child had spinal cord compression caused by a large spinal extradural arachnoid cyst in dorsal spine that did not communicate with the intradural subarachnoid space. Surgical excision of cyst was done with recovery of neurological deficit postoperatively

Influência do sobrepeso e da obesidade na postura, na praxia global e no equilíbrio de escolares / Influence of overweight and obesity on posture, overall praxis and balance in schoolchildren

O presente estudo teve como objetivo avaliar escolares com sobrepeso ou obesidade, na faixa etária de seis a doze anos de idade, quanto ao equilíbrio, à praxia global e às alterações posturais na coluna e nos membros inferiores decorrente da sobrecarga. Participaram do estudo 34 escolares (27 meninas e sete meninos) matriculados em uma escola estadual de Uberaba/MG, com diagnóstico de sobrepeso ou obesidade infantil segundo Índice de Massa Corporal (IMC). Para avaliação da praxia global e do equilíbrio foi utilizada a Bateria Psicomotora de Fonseca; e da postura uma ficha de avaliação baseada em Kendall. A análise dos dados baseou-se na estatística descritiva simples através do método de porcentagem, e nos testes paramétricos de Kolmogorov-Smirnov para verificar normalidade da amostra e t Student para verificar a diferença entre os grupos, considerando o nível de significância de 5 por cento ( p< 0,05). Os resultados demonstraram alterações posturais em ambos os grupos, equilíbrio estático se apresentou sem diferença significativa. No equilíbrio dinâmico houve diferença significativa, caracterizando o grupo sobrepeso com perfil psicomotor hiperpráxico, enquanto os obesos mostraram-se eupráxicos. Na avaliação da praxia global, houve diferença significativa entre os grupos em três subfatores: coordenação óculo-pedal (p = 0,022); dissociação de membros superiores (p = 0,042) e de membros inferiores (p = 0,045). Quanto à dissociação de membros inferiores e superiores, verificou-se perfil psicomotor eupráxico no grupo com sobrepeso e dispráxico nos obesos. Quanto à coordenação óculo-pedal, ambos mostraram-se dispráxicos. Os resultados obtidos indicam que o sobrepeso e a obesidade infantil podem alterar a postura, o equilíbrio e a praxia global.

Spinal intradural arteriovenous fistula mimicking intramedullary tumor and associated with a giant intracranial aneurysm / Fístula arteriovenosa intradural espinhal mimetizando tumor intramedular e associado com aneurisma intracraniano gigante

Spinal intradural arteriovenous fistulas (AVFs) are a rare type of neurovascular malformation. Many a time hemodynamic disturbs associated to these entities can cause edema with subsequent myelopathy. On MRI study, this edema can mimic an intramedullary tumor. We report a rare case of spinal intradural AVFs mimicking an intramedullary tumor, which also were surprisingly associated with a giant intracranial aneurysm. We highlight in detail the MRI findings in intramedullary lesions, and also emphasize that these entities requires as careful differential diagnosis as supplementary investigation of the neuroaxis looking for other simultaneous neurovascular pathologies.

Fístulas arteriovenosas espinhais intradurais são um tipo raro de malformação neurovascular. Muitas vezes, distúrbios hemodinâmicos associados a essa entidade podem causar edema com subsequente mielopatia. Em estudos de ressonância magnética, esse edema pode mimetizar um tumor intramedular. Relata-se um caso raro de fistula arteriovenosa espinhal intradural mimetizando um tumor intramedular, que também estava associado a um aneurisma cerebral gigante. Destacam-se em detalhes os achados de RM nas lesões intramedulares, assim como se enfatiza que essas entidades requerem tanto um diagnóstico diferencial criterioso quanto uma investigação complementar do neuroeixo procurando por outras patologias neurovasculares associadas.

Vertebral column deformity and hypoxia in Salmo salar / Hipoxia relacionada a deformidad de columna vertebral en Salmo salar

Vertebral Column Deformity (VCD) is a common pathology in Chilean salmon farms, lowering the quality and commercialization of the product. Hypoxia has been related to other musculoskeletal deformities, but not to VCD. This work analyzes the morphology of the vertebral column of Salmo salar alevins, cultured under hypoxic conditions (60 percent O2 saturation in the water tanks) for different time periods after hatching (2, 4, 6 and 8 days). They are compared with their normoxic controls (100 percent O2 saturation). Using histological (H/E), and morphometric techniques, it was found that the time of exposure to hypoxia is inversely proportional to the body length, notochordal diameter and thickness of its sheath. The organic response to hypoxia was quantified by immunohistochemistry for HIF-1a as the sensor of hypoxia. Its expression increased significantly (p<0.05) in the experimental groups that exhibit VCD. Although etiology for VCD is probably multifactorial, this study allows for the conclusion that hypoxia by itself, produces VCD.

La deformidad de columna vertebral (DCV) es una patología que se presenta frecuentemente en la salmonicultura chilena, disminuyendo la calidad y comercialización del producto. La hipoxia ha sido relacionada a otras deformidades musculoesqueléticas pero no a DCV. Este trabajo analiza la morfología de la columna vertebral en alevines Salmo salar cultivados en condiciones de hipoxia (60 por ciento de saturación de O2) en diferentes momentos después de la eclosión (2, 4, 6 y 8 días) y son comparados con sus respectivos controles en normóxia (100 por ciento de saturación de O2). Utilizando técnica histológica (H/E) y morfométrica, se determinó que el tiempo de exposición a hipoxia es inversamente proporcional a la longitud corporal, diámetro notocordal y grosor de su vaina. La respuesta orgánica a hipoxia fue cuantificada mediante inmunohistoquímica contra HIF-1a como censor de hipoxia. Su expresión incrementó significativamente (p<0,05) en los grupos experimentales que presentaron DCV. Aunque la etiología de DCV es probablemente multifactorial, este estudio permite concluir que la exposición a hipoxia puede provocar DCV por sí sola.

Valoración del morfotipo raquídeo en el plano sagital en ciclistas de categoría máster 40 / Spinal posture of thoracic and lumbar spine in master 40 cyclists

El objetivo principal del estudio fue valorar la disposición sagital del raquis torácico y lumbar en bipedestación y sobre la bicicleta, en ciclistas de la categoría máster 40. Un total de 50 ciclistas máster 40 (media de edad: 44,02 +/- 2,51 años) fueron evaluados mediante el sistema Spinal Mouse en bipedestación y sobre la bicicleta en tres agarres del manillar: transversal, de manetas y bajo. En bipedestación, los valores angulares medios para el raquis torácico y lumbar fueron de 49,42 +/- 9,00 y -22,74 +/- 9,38, respectivamente. Un elevado porcentaje de los ciclistas (68 por ciento) presentaron una hipercifosis torácica, mientras que la mayoría tenían valores normales en la lordosis lumbar. Sobre la bicicleta, los ciclistas mostraron una reducción significativa de la cifosis torácica con respecto a la bipedestación, mientras que el raquis lumbar se disponía en una postura de inversión. En conclusión, la frecuente hipercifosis torácica en bipedestación de los ciclistas de la categoría máster 40 no está relacionada directamente con la postura adoptada sobre la bicicleta.

The aim of this study was to determine the sagittal spinal morphology of thoracic and lumbar spine in relaxed standing and sitting on the bycicle in master 40 cyclists. A total of 50 master 40 male cyclists (mean age: 44.02 +/- 2.51 years) were evaluated. The Spinal Mouse system was used to measure the sagittal thoracic and lumbar curve in standing and sitting on the bicycle at three different handlebar-hand positions (high, medium, and low). The values for thoracic and lumbar curvatures in standing were 49.42 +/- 9.00 and -22.74 +/- 9.38, respectively. A high frecuency of thoracic hyperkyphosis in standing was observed (68 percent). When sitting on the bicycle the thoracic curve showed lower angles in the three handlebar.hand positions that in standing. The lumbar curve adopted a kyphotic posture. The standing thoracic hyperkyphosis in master 40 cyclists may be related to other factors than the posture adopted on the bicycle.