Neutrophil Extracellular Trap-related Biomarkers Are Increased in the Synovial Fluid of Patients With Periprosthetic Joint Infections.

BACKGROUND: The diagnosis of periprosthetic joint infection (PJI) is a major challenge in clinical practice. The role of neutrophils in fighting infection has been increasingly understood, and one mechanism of action of these cells is neutrophil extracellular traps. However, little is known about this process in PJI. QUESTIONS/PURPOSES: (1) Are the biomarkers of neutrophil extracellular trap formation (citrullinated histone H3 [H3Cit], cell-free DNA [cf-DNA], and myeloperoxidase [MPO]) increased in the synovial fluid of patients with PJI? (2) What is the diagnostic accuracy of biomarkers of neutrophil extracellular trap formation for PJI? METHODS: Between May 2020 and March 2021, 43 patients who underwent revision THA or TKA were enrolled in this study. Eleven patients were excluded and 32 patients were categorized into the PJI group (n = 16) or non-PJI group (n = 16) according to the 2018 Second International Consensus Meeting on Musculoskeletal Infection criteria. There were 15 men and 17 women in this study, with a median (range) age of 70 years (60 to 80 years). Twenty-seven patients had TKA and five had THA. We measured cf-DNA, MPO, and H3Cit in synovial fluid. The sensitivity, specificity, and receiver operating characteristic curve were calculated for each biomarker using the Musculoskeletal Infection Society criteria as the gold standard for diagnosis and considering a clinical surveillance of 2 years for patients in the non-PJI group. RESULTS: Patients with PJI had higher levels of synovial fluid cf-DNA (median [range] 130 ng/µL [18 to 179] versus 2 ng/µL [0 to 6]; p < 0.001), MPO (1436 ng/µL [55 to 3996] versus 0 ng/µL [0 to 393]; p < 0.001), and H3Cit (2115 ng/µL [5 to 2885] versus 3 ng/µL [0 to 87]; p < 0.001) than those in the non-PJI group. In receiver operating characteristic curve analyses, we observed near-perfect performance for all biomarkers evaluated, with an area under the curve of 1 (95% CI 0.9 to 1), 0.98 (95% CI 0.9 to 1), and 0.94 (95% CI 0.8 to 0.99) for cf-DNA, MPO, and H3Cit, respectively. The sensitivity for detecting PJI using synovial fluid was 100% for cf-DNA, 94% for MPO, and 88% for H3Cit. The specificity was 100% for cf-DNA and MPO, and 88% for H3Cit. CONCLUSION: Our results show that neutrophils in the periprosthetic microenvironment release neutrophil extracellular traps as part of the bactericidal arsenal to fight infection. These results allow a better understanding of the cellular and molecular processes that occur in this microenvironment, enabling the design of more assertive strategies for identifying new biomarkers and improving the available ones. Novel studies are needed to define whether and how neutrophil extracellular trap-related biomarkers can be useful for diagnosing PJI. LEVEL OF EVIDENCE: Level II, diagnostic study.

Association of polymorphism in leptin receptor gene with susceptibility of adolescent idiopathic scoliosis.

PURPOSE: Abnormal leptin bioavailability has play key roles in the etiology of adolescent idiopathic scoliosis (AIS). Both leptin and its receptor levels may be modulated by the presence of genetic polymorphisms. This study aimed to evaluate the role of polymorphisms in the leptin (LEP) and its main receptor (LEPR) genes in the AIS susceptibility in girls. METHODS: A retrospective case-control study was conducted with 189 AIS and 240 controls. LEP rs2167270 and LEPR rs2767485 polymorphisms were genotyped using a TaqMan validated assay. Associations were evaluated by odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The AIS group showed a predominance of girls under 18 years old (n = 140, 74.1%), 148 (78.3%) had low or normal BMI, 111 (58.7%) had Cobb ≥ 45º and 130 (68.7%) were skeletally mature. Minor allele frequencies of rs2167270 and rs2767485 were 35.7% and 18.3%, for AIS and 35.6% and 25.4% for controls, respectively. LEPR rs2767485 T and TC + TT were associated with higher risk of AIS (OR = 1.53; 95% CI = 1.09-2.13 and OR = 1.84; 95% CI = 1.69-2.01, respectively), since CC genotype was only present in the control group. In addition, the LEP rs2167270 GA + AA was more frequent in low weight group (BMI ≤ 24.9) of girls with AIS. There was no significant association between LEP rs2167270 and AIS susceptibility, and LEPR rs2767485 and BMI. CONCLUSION: The LEPR rs2767485 was associated with the genetic susceptibility of AIS and LEP rs2167270 with low BMI. These data can contribute to the identification of genetic biomarkers to improve the diagnosis and treatment.

Comparison of Bone Graft Preparations to Treat a Critical Bone Defect on a Rodent Animal Model / Comparação de preparações de enxertos ósseos para tratamento de defeitos ósseos críticos em um modelo animal roedor

Abstract Objective Although autologous bone grafting is the most widely used treatment for bone defects, the most effective preparation remains unclear. This animal study aimed to compare different autologous bone grafting preparation for the treatment of rats calvaria critical bone defect. Methods 122 rats were randomly allocated into three groups: Simulado, Macerated and Chopped. The specimens underwent craniotomies at the top center of their calvarias with a 7mm diameter circumferential cutter drill. The critical bone defect produced was treated or not according to the group the specimen wasallocated. The rats were euthanized at 3, 6 or 12 weeks post-op and its calvarias were analyzed by histomorphometry, bone densitometry, nanocomputed tomography (nCT), and biomechanical tests. Results The histomorphometry analysis showed the highest percentage of fulfillment of the critical bone defect in the chopped and macerated group when compared to simulado. The densitometry assessment evidenced higher bone mass at all endpoints analysis (p < 0.05) in the chopped group. The nCT data exhibited an expressive increase of bone in the chopped group when compared with the simulado and macerated groups. The biomechanical tests exhibited highest values of deformation, maximum force, and relative stiffness in the chopped group at any time of euthanasia (p < 0.05). Conclusions Our experimental work showed that chopped bone grafting preparation exhibited significant better outcomes than macerated in the treatment of a critical bone defect in rats calvaria.

Resumo Objetivo Embora enxertos ósseos autólogos sejam o tratamento mais utilizado para defeitos ósseos, a preparação mais eficaz ainda é obscura. Este estudo animal teve como objetivo comparar diferentes preparações de enxerto ósseo autólogo para o tratamento de defeito ósseo crítico no crânio de ratos. Métodos No total, 122 ratos foram alocados aleatoriamente em três grupos: Simulado, enxerto macerado e enxerto picado. Os espécimes foram submetidos a craniotomias no centro superior do crânio com broca de corte circunferencial de 7 mm de diâmetro. O defeito ósseo crítico produzido foi tratado ou não de acordo com o grupo de alocação do animal. Os ratos foram eutanasiados às 3, 6 ou 12 semanas após a cirurgia e seus crânios foram analisados por histomorfometria, densitometria óssea, nanotomografia computadorizada (nTC) e testes biomecânicos. Resultados A análise histomorfométrica mostrou maior percentual de preenchimento do defeito ósseo crítico no grupo picado e macerado em comparação ao simulado. A avaliação densitométrica evidenciou maior massa óssea em todos os desfechos de análise (p < 0,05) no grupo picado. Os dados de nTC revelaram um aumento ósseo expressivo no grupo picado em comparação aos grupos simulado e macerado. Os testes biomecânicos mostraram maiores valores de deformação, resistência máxima e rigidez relativa no grupo picado em qualquer momento da eutanásia (p < 0,05). Conclusões Nosso estudo mostrou que a preparação de enxerto ósseo picado gerou resultados significativamente melhores do que os enxertos macerados no tratamento de defeitos ósseos críticos no crânio de ratos.

Extraforaminal Full-Endoscopic Approach for the Treatment of Lateral Compressive Diseases of the Lumbar Spine.

BACKGROUND: The authors conducted a 2-year retrospective follow-up to investigate the efficiency of an extraforaminal full-endoscopic approach with foraminoplasty used to treat lateral compressive diseases of the lumbar spine in 247 patients. METHODS: The visual analogue scale (VAS), Oswestry disability index (ODI), and MacNab scale were used to analyze the results collected during the preoperative and postoperative periods. RESULTS: The most common diagnosis was disk herniation with lateral recess stenosis, and the most common surgical level among patients was between L4 and L5 on the left side. Pain decreased over time, as determined during sessions held to evaluate pain in the lumbar, gluteal, led, and foot regions. The ODI demonstrated significant enhancement over the evaluation period and the MacNab scale classified the surgery as good or excellent. The most common complication was dysesthesia. CONCLUSIONS: An extraforaminal full-endoscopic approach with foraminoplasty can be recommended in cases of lateral herniation or stenosis for patients with symptoms of radiculopathy, and for those who have not responded to conventional rehabilitation treatment or chronic pain management. Few complications arose as a result of this approach, and most of them were treated clinically.

Clinical photographic and radiological correlation in patients with scoliosis / Correlação clínica fotográfica e radiológica em pacientes com escoliose / Correlación clínica fotográfica y radiológica em pacientes com escoliosis

ABSTRACT Objective: The study correlates angular radiographic measurements and measurements from photographs of the trunk of patients with adolescent idiopathic scoliosis. Methods: a cross-sectional study of 10 patients with adolescent idiopathic scoliosis and indication for surgical treatment in follow-up in the spine sector of HCRFMRP-USP. They were evaluated through measurements taken from clinical photographs of the patient's torso and angles on panoramic radiographs of the spine. Results: only the correlation between the axilla angle (AHA) and the proximal thoracic curve and main thoracic curve was observed in the sample studied. No correlation was observed between the other compared variables. The study was carried out in a sample with a small number of patients, whose objective was to carry out a pilot study to explore this topic. Conclusion: the analysis of deformities should consider the aesthetic aspect and radiographic evaluation; however, in this study, no statistical correlation was observed between these parameters. Level of Evidence IV; Case Series Study.

RESUMO: Objetivo: O estudo correlaciona as mensurações radiográficas angulares e as mensurações oriundas das fotografias do tronco de pacientes com escoliose idiopática do adolescente. Métodos: estudo transversal de 10 pacientes com escoliose idiopática do adolescente e com indicação de tratamento cirúrgico, em seguimento no setor de coluna vertebral do HCRFMRP-USP. Foram avaliados por meio de mensurações das fotografias clínicas do tronco dos pacientes e mensurações dos ângulos nas radiografias panorâmicas da coluna. Resultados: na amostra estudada foi observada somente a correlação entre o ângulo axila (AHA) e a curva torácica proximal e curva torácica principal. Não foi observado correlação entre as demais variáveis comparadas. O estudo foi realizado em amostra com pequeno número de pacientes, cujo objetivo era a realização de estudo piloto para explorar esse tópico. Conclusão: a análise das deformidades deve considerar o aspecto estético e avaliação radiográfica, porem neste estudo não foi observado correlação estatística entre estes parâmetros. Nível de Evidência IV; Estudo de Série de Casos.

RESUMEN: Objetivo: El estudio correlaciona medidas radiográficas angulares y medidas de fotografías del tronco de pacientes con escoliosis idiopática del adolescente. Métodos: estudio transversal de 10 pacientes con escoliosis idiopática del adolescente y con indicación de tratamiento quirúrgico, en seguimiento en el sector de columna del HCRFMRP-USP. Se evaluaron mediante medidas tomadas de fotografías clínicas del torso de los pacientes y medidas de ángulos en radiografías panorámicas de la columna vertebral. Resultados: en la muestra estudiada solo se observó la correlación entre el ángulo axilar (AHA) y la curva torácica proximal y torácica principal. No se observó correlación entre las otras variables comparadas. El estudio se realizó en una muestra con un número reducido de pacientes, cuyo objetivo fue realizar un estudio piloto para explorar este tema. Conclusión: el análisis de las deformidades debe considerar el aspecto estético y la evaluación radiográfica, sin embargo, en este estudio no se observó correlación estadística entre estos parámetros. Nivel de Evidencia IV; Estudio de Serie de Casos.

USE OF THE uCentrum SYSTEM IN THE SURGICAL TREATMENT OF DISEASES OF THE VERTEBRAL SPINE / UTILIZAÇÃO DO SISTEMA uCentrum NO TRATAMENTO CIRÚRGICO DAS DOENÇAS DA COLUNA VERTEBRAL / USO DEL SISTEMA uCentrum EN EL TRATAMIENTO QUIRÚRGICO DE ENFERMEDADES DE LA COLUMNA VERTEBRAL

ABSTRACT Objectives: Evaluate the treatment outcome and the performance of the uCentum spinal fixation system in treating traumatic, degenerative, and tumoral diseases of the spine. Methods: This is a therapeutic study to investigate treatment outcomes and level of evidence III, including twenty-three adult patients of both sexes undergoing surgical treatment of degenerative (13 patients), traumatic (04 patients), or tumor diseases (06 patients). Patients were prospectively evaluated using clinical parameters: pain (visual analog scale), clinical and functional assessment questionnaires (SF-36, Oswestry and Roland-Morris), and radiological criteria (arthrodesis consolidation, loosening, breakage or deformation of the implants). Results: Twenty patients were followed for a period of 01 month to 12 month (mean 6,5±7,77). Three patients died due to complications unrelated to the primary disease (traumatic brain injury, septicemia, and lung tumor). Improvements were observed in clinical parameters and scores of the evaluation questionnaires used. No implant-related complications (breakage, loosening, deformation) were observed. Conclusion: the uCentum fixation system showed great versatility for performing the surgical treatment, allowing the performance of open, percutaneous procedures, the introduction of acrylic cement inside the implants, and conversion of polyaxial screws into monoaxial screws intraoperatively. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment.

Resumo: Objetivos: Avaliar o resultado do tratamento e o desempenho do sistema uCentum de fixação vertebral no tratamento de doenças traumáticas, degenerativas e tumorais da coluna vertebral. Métodos: Trata-se de um estudo terapêutico de investigação dos resultados do tratamento e nível de evidência III, incluindo vinte e três pacientes adultos de ambos os sexos submetidos ao tratamento cirúrgico de doenças degenerativas (13 pacientes), traumáticas (04 pacientes) ou tumorais (06 pacientes). Os pacientes foram prospectivamente avaliados por meio de parâmetros clínicos: dor (escala visual analógica), questionários de avaliação clínica e funcional (SF-36, Oswestry e Roland-Morris), e critérios radiológicos (consolidação da artrodese, soltura, quebra ou deformação dos implantes). Resultados: vinte pacientes foram seguidos por um período de 01 a 12 meses (média 6,5 ± 7,77). Três pacientes foram a óbito devido a complicações não relacionadas com a doença primária (trauma cranioencefálico, septicemia e tumor pulmonar). Foi observada melhora dos parâmetros clínicos e escores dos questionários de avaliação utilizados. Não foram observadas complicações relacionadas com os implantes (quebra, soltura, deformação). Conclusão: o sistema de fixação uCentum apresentou grande versatilidade para a realização do tratamento cirúrgico, permitindo a realização de procedimentos abertos, percutâneos, introdução de cimento acrílico no interior dos implantes e conversão dos parafusos poliaxiais em monoaxiais no intra-operatório. Nível de Evidencia III; Estudos terapêuticos - Investigação dos resultados do tratamento.

Resumen: Objetivos: Evaluar el resultado del tratamiento y el desempeño del sistema de fijación vertebral uCentum en el tratamiento de enfermedades traumáticas, degenerativas y tumorales de la columna vertebral. Métodos: Este es un estudio terapéutico para investigar los resultados del tratamiento y el nivel de evidencia III, que incluye veintitrés pacientes adultos de ambos sexos sometidos a tratamiento quirúrgico de enfermedades degenerativas (13 pacientes), traumáticas (04 pacientes) o tumorales (06 pacientes). Los pacientes fueron evaluados prospectivamente mediante parámetros clínicos: dolor (escala analógica visual), cuestionarios de evaluación clínica y funcional (SF-36, Oswestry y Roland-Morris) y criterios radiológicos (consolidación de artrodesis, aflojamiento, rotura o deformación de los implantes). Resultados: veinte pacientes fueron seguidos durante un período de 1 a 12 meses (media 6,5 + 7,77). Tres pacientes fallecieron por complicaciones no relacionadas con la enfermedad primaria (lesión cerebral traumática, septicemia y tumor pulmonar). Se observaron mejoras en los parámetros clínicos y puntuaciones de los cuestionarios de evaluación utilizados. No se observaron complicaciones relacionadas con el implante (rotura, aflojamiento, deformación). Conclusión: el sistema de fijación uCentum mostró una gran versatilidad para realizar el tratamiento quirúrgico, permitiendo la realización de procedimientos abiertos, percutáneos, introducción de cemento acrílico en el interior de los implantes y conversión de los tornillos poliaxiales en tornillos monoaxiales en el intraoperatorio. Nivel de Evidencia III; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Evaluation of kyphosis measurement in thoracolumbar spine fractures / Avaliação da mensuração da cifose nas fraturas da coluna toracolombar / Evaluación de la medición de cifosis en fracturas de la columna toracolumbar

ABSTRACT Objectives: Evaluate the reliability and reproducibility of the kyphosis measurement in thoracolumbar spine traumatic fractures by different assessment methods in different types of fractures. Methods: Fifteen fractures of the thoracolumbar spine, previously classified into types A, B, and C according to Magerl's classification, were evaluated. The value of kyphosis was measured using five different methods: (1) Cobb angle; (2) Gardner's method; (3) back wall method; (4) angle of adjacent endplates; and (5) wedge angle. The measurements were performed by five independent observers and repeated five times with a minimum interval of two weeks between each evaluation. Results: Intraobserver reliability was excellent among the five observers, evidencing good reproducibility of the methods. The five methods used also showed great intraobserver reliability in the global analysis, with methods one and four being more consistent. Conclusion: Although there is no universal agreement on measuring kyphosis in thoracolumbar fractures, our study concluded that method 1 (Cobb angle) and method 4 (adjacent endplate angle) presented the best interobserver reliabilities. Furthermore, the use of digitized radiographs and a simple computer program allowed the performance of highly reliable and reproducible measurements by all methods, given the high intraobserver reliability. Level of Evidence II; Comparative study.

Resumo: Objetivos: Avaliar a confiabilidade e reprodutibilidade da mensuração da cifose nas fraturas traumáticas da coluna toracolombar por diferentes métodos de avaliação nos diferentes tipos de fraturas. Métodos: Foram avaliadas 15 fraturas na coluna toracolombar previamente classificadas em tipo A, B e C de acordo com a classificação de Magerl. Em cada caso, foi medido o valor da cifose através de cinco diferentes métodos: (1) ângulo de Cobb; (2) método de Gardner; (3) método das paredes posteriores; (4) ângulo das placas terminais adjacentes; e (5) ângulo de cunha. As mensurações foram realizadas por cinco avaliadores independentes e repetidas cinco vezes com intervalo mínimo de duas semanas entre cada avaliação. Resultados: A confiabilidade intraobservador mostrou-se excelente entre os cinco avaliadores, evidenciando boa reprodutibilidade dos métodos. Os cinco métodos utilizados também apresentaram grande confiabilidade intraobservador na análise global, sendo mais consistentes o método 1 e o método 4. Conclusão: Apesar de não haver concordância universal em como medir a cifose nas fraturas toracolombares, nosso estudo concluiu que o método 1 (ângulo de Cobb) e o método 4 (ângulo das placas terminais adjacentes) apresentaram as melhores confiabilidades interobservadores. Além disso, o uso de radiografias digitalizadas e um programa computadorizado simples permitiram a realização de medidas altamente confiáveis e reprodutíveis por todos os métodos, visto pela elevada confiabilidade intraobservador. Nível de evidência II; Estudo Comparativo.

Resumen: Objetivos: Evaluar la fiabilidad y reproducibilidad de mensuración de cifosis en fracturas traumáticas de la columna toracolumbar por diferentes métodos de valoración en diferentes tipos de fracturas. Métodos: Se evaluaron quince fracturas de columna toracolumbar, previamente clasificadas en los tipos A, B y C según la clasificación de Magerl. En cada caso, el valor de la cifosis se midió utilizando cinco métodos diferentes: (1) ángulo de Cobb; (2) método de Gardner; (3) método de la pared posterior; (4) ángulo de placas de extremo adyacentes; y (5) ángulo de cuña. Las mediciones fueron realizadas por cinco evaluadores independientes y repetidas cinco veces con un intervalo mínimo de dos semanas entre cada evaluación. Resultados: La confiabilidad intraobservador fue excelente entre los cinco evaluadores, evidenciando una buena reproducibilidad de los métodos. Los cinco métodos utilizados también mostraron una gran fiabilidad intraobservador en el análisis global, siendo el método 1 y el método 4 más consistentes. Conclusión: Aunque no existe un acuerdo universal sobre cómo medir la cifosis en las fracturas toracolumbares, nuestro estudio concluyó que el método 1 (ángulo de Cobb) y el método 4 (ángulo de la placa terminal adyacente) presentaron las mejores confiabilidades entre observadores. Además, el uso de radiografías digitalizadas y un programa informático simple permitieron realizar mediciones altamente fiables y reproducibles por todos los métodos, dada la alta fiabilidad intraobservador. Nivel de evidencia II; Estudio Comparativo.

COSTS ANALYSIS OF SPINAL COLUMN METASTASES SURGICAL TREATMENT.

Introduction: End-of-life cancer treatment is associated with substantial healthcare costs. Objective: This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods: A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results: The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion: The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study .

Introdução: O tratamento do câncer em fim de vida está associado a custos substanciais em saúde. Objetivo: O objetivo do estudo foi analisar o custo do tratamento cirúrgico de pacientes com metástase espinhal e compressão peridural submetidos ao tratamento cirúrgico. Métodos: Uma análise retrospectiva de custos de 81 pacientes com metástase espinhal e compressão peridural submetidos a tratamento cirúrgico. A avaliação de custos foi definida nas seguintes categorias: medicamentos, exames laboratoriais e de imagem, enfermaria, sala de recuperação, unidade de terapia intensiva, procedimento cirúrgico e material consignado. O custo relacionado à melhora da dor, atividade funcional e sobrevida também foi avaliado. Resultados: O custo total do tratamento cirúrgico de 81 pacientes foi de R $ 3.604.334,26 e o valor médio de cada paciente foi de R $ 44.497,95. Os maiores gastos foram relacionados com implantes (41,1%), seguidos de internação (27,3%) e procedimento cirúrgico (19,7%). Conclusão: O custo do tratamento cirúrgico para metástases espinhais é um dos mais caros entre as complicações ósseas em pacientes com câncer. O custo do tratamento relacionado aos desfechos apresentou diferença de acordo com o desfecho analisado e a permanência hospitalar, exames, medicamentos e terapia intensiva tem papel importante em alguns dos custos relacionados ao desfecho específico. Nível de Evidência II, Estudo retrospectivo .

Sagittal Plane Geometry of Cervical, Thoracic, and Lumbar Endplates.

BACKGROUND: Many studies have emphasized the importance of interface contact between implants and the vertebral endplate (VE). The goal of this study was to analyze the shape and other specific parameters of the VE to provide reference data for better implant interface contact in intervertebral disc space procedures. METHODS: Cervical, thoracic, and lumbar spine midsagittal plane magnetic resonance images of 100 adults (58 women) were analyzed. The morphology of the VEs was classified as concave, convex, flat, or irregular. Midsagittal endplate length (ML), endplate concavity depth (ECD), and endplate concavity axis (ECA) location were measured in the midsagittal plane. The parameters were compared between the cervical, thoracic, and lumbar spines and between the sexes. RESULTS: The VE morphology, ML, ECD, and ECA showed variations along the spine, mainly in the cervical and lower lumbar spines. The sagittal geometry of the VE was not flat or uniform along the cervical, thoracic, and lumbar spines. Different morphological types were observed along different spinal segments and according to sex. In the cervical spine, the majority of cranial VEs were flat, while caudal VEs were mostly concave. CONCLUSION: Sagittal VE geometry should be taken into consideration during the use of intervertebral cages or disc arthroplasty.

SPINOPELVIC MOBILITY IN PATIENTS WITH HIP OSTEOARTHRITIS AND TOTAL HIP ARTHROPLASTY INDICATION.

Introduction: Reduction of spinopelvic mobility is associated with an increased dislocation of total hip arthroplasty (THA). Objective: To assess 1) spinopelvic mobility in patients with primary hip osteoarthritis and THA indication and 2) the influence of hip flexion contracture on spinopelvic mobility. Methods: Thirty adult patients with primary hip osteoarthritis and THA indication were evaluated using radiographic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar flexibility, and spinopelvic mobility). Results: Spinopelvic mobility ranged from 6.90 a 54.50° (mean 32.79 ± 11.42) and the group of patients with hip flexion contracture had higher mobility. Spinopelvic mobility was correlated with pelvic tilt as well as with lumbar flexibility. Conclusion: Around 13.4% of patients had spinopelvic mobility under 20° , indicating reduced spinopelvic mobility and risk of THA dislocation. Level of Evidence III, Retrospective Comparative Study.

Introdução: A redução da mobilidade espinopélvica tem sido associada com o risco de luxação da prótese total do quadril. Objetivos: Avaliar a mobilidade espinopélvica nos pacientes com artrose primária da articulação do quadril e com indicação de artroplastia total do quadril (ATQ), e a influência da contratura em flexão do quadril sobre a mobilidade espinopélvica. Métodos: Trinta pacientes adultos com artrose primária do quadril e indicação de ATQ foram avaliados por meio de parâmetros radiográficos (incidência pélvica, versão pélvica, inclinação do sacro, mobilidade da coluna lombar e mobilidade espinopélvica). Resultados: A mobilidade espinopélvica variou de 6,90 a 54,50 graus (média 32,79 ± 11,42), e foi estatisticamente maior no grupo de pacientes com contratura em flexão do quadril. Foi observado correlação entre a mobilidade espinopélvica e a versão pélvica e flexibilidade da coluna lombar. Conclusão: A mobilidade espinopélvica abaixo de 20 graus, que caracteriza a redução da mobilidade espinopélvica e risco aumentado de luxação ou impacto dos componentes da prótese total foi observada em 13,4% dos pacientes. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Use of a Customized Three-dimensional Guide in Preparing the Pilot Pedicle Hole in Spinal Deformities.

Objective The present study aimed to develop and evaluate the use of customized guides in patients undergoing surgery to correct vertebral deformity with a pedicular fixation system. Methods Four patients with spinal deformity (three with idiopathic scoliosis and one with congenital kyphoscoliosis) underwent surgical treatment to correct the deformity with a pedicular fixation system. Prototypes of 3D cost guides were developed and evaluated using technical feasibility, accuracy, and radiation exposure. Results The present study included 85 vertebral pedicles in which pedicle screws were inserted into the thoracic spine (65.8%) and into the lumbar spine (34.2%). Technical viability was positive in 46 vertebral pedicles (54.1%), with 25 thoracic (54%) and 21 lumbar (46%). Technical viability was negative in 39 pedicles (45.9%), 31 of which were thoracic (79.5%), and 8 were lumbar (20.5%). In assessing accuracy, 36 screws were centralized (78.2%), of which 17 were in the thoracic (36.9%) and 19 in the lumbar spine (41.3%). Malposition was observed in 10 screws (21.7%), of which 8 were in the thoracic (17.4%) and 2 in the lumbar spine (4.3%). The average radiation record used in the surgical procedures was of 5.17 ± 0.72 mSv, and the total time of use of fluoroscopy in each surgery ranged from 180.3 to 207.2 seconds. Conclusion The customized guide prototypes allowed the safe preparation of the pilot orifice of the vertebral pedicles in patients with deformities with improved accuracy and reduced intraoperative radiation.

The Influence of Thread Tap Mismatch on Pedicle Screw Pullout Strength.

Objective We aimed to study the "in vitro" pullout strength of SpineGuard/Zavation Dynamic Surgical Guidance Z-Direct Screw (DSG Screw, SpineGuard Inc, Boulder, Colorado, USA), a screw designed to be inserted using a direct insertion technique. Methods Dynamic Surgical Guidance Screws of 5.5 and 6.5 mm were introduced into polyurethane blocks with a density of 10 PCF (0,16g/cm 3 ). According to the experimental group, screws were inserted without pilot hole, with pilot without tapping, undertapping and line-to-line tapping. Screw pullout tests were performed using a universal test machine after screw insertion into polyurethane blocks. Results Screws inserted directly into the polyurethane blocks without pilot hole and tapping showed a statistically higher pullout strength. Insertion of the screw without tapping or with undertapping increases the pullout screw strength compared with line-to-line tapping. Conclusion Dynamic Surgical Guidance Screw showed the highest pullout strength after its insertion without pilot hole and tapping.

Use of a Customized Three-dimensional Guide in Preparing the Pilot Pedicle Hole in Spinal Deformities / Uso de guia tridimensional personalizado no preparo do orifício do pedículo piloto em deformidades da coluna vertebral

Abstract Objective The present study aimed to develop and evaluate the use of customized guides in patients undergoing surgery to correct vertebral deformity with a pedicular fixation system. Methods Four patients with spinal deformity (three with idiopathic scoliosis and one with congenital kyphoscoliosis) underwent surgical treatment to correct the deformity with a pedicular fixation system. Prototypes of 3D cost guides were developed and evaluated using technical feasibility, accuracy, and radiation exposure. Results The present study included 85 vertebral pedicles in which pedicle screws were inserted into the thoracic spine (65.8%) and into the lumbar spine (34.2%). Technical viability was positive in 46 vertebral pedicles (54.1%), with 25 thoracic (54%) and 21 lumbar (46%). Technical viability was negative in 39 pedicles (45.9%), 31 of which were thoracic (79.5%), and 8 were lumbar (20.5%). In assessing accuracy, 36 screws were centralized (78.2%), of which 17 were in the thoracic (36.9%) and 19 in the lumbar spine (41.3%). Malposition was observed in 10 screws (21.7%), of which 8 were in the thoracic (17.4%) and 2 in the lumbar spine (4.3%). The average radiation record used in the surgical procedures was of 5.17 ± 0.72 mSv, and the total time of use of fluoroscopy in each surgery ranged from 180.3 to 207.2 seconds. Conclusion The customized guide prototypes allowed the safe preparation of the pilot orifice of the vertebral pedicles in patients with deformities with improved accuracy and reduced intraoperative radiation.

Resumo Objetivo O presente estudo teve como objetivo desenvolver e avaliar a utilização de guias personalizadas em pacientes submetidos a cirurgia para correção de deformidades vertebrais com sistema de fixação pedicular. Métodos Quatro pacientes com deformidade espinhal (três casos de escoliose idiopática e um caso de cifoescoliose congênita) foram submetidos a tratamento cirúrgico corretivo com sistema de fixação pedicular. Protótipos de guias tridimensionais foram desenvolvidos e avaliados quanto à viabilidade técnica, precisão e exposição à radiação. Resultados O presente estudo incluiu 85 pedículos vertebrais submetidos à inserção de parafusos pediculares na coluna torácica (65,8%) e na coluna lombar (34,2%). A viabilidade técnica foi positiva em 46 pedículos vertebrais (54,1%), sendo 25 torácicos (54%) e 21 lombares (46%). A viabilidade técnica foi negativa em 39 pedículos (45,9%), sendo 31 torácicos (79,5%) e 8 lombares (20,5%). Quanto à precisão, 36 parafusos foram centralizados (78,2%), sendo 17 na coluna torácica (36,9%) e 19 na coluna lombar (41,3%). O mau posicionamento foi observado em 10 parafusos (21,7%), sendo 8 na coluna torácica (17,4%) e 2 na coluna lombar (4,3%). A radiação média registrada nos procedimentos cirúrgicos foi de 5,17 ± 0,72 mSv, e o tempo total de uso da fluoroscopia em cada cirurgia variou de 180,3 a 207,2 segundos. Conclusão Os protótipos de guias personalizadas permitiram o preparo seguro do orifício piloto nos pedículos vertebrais em casos de deformidade, com maior precisão e menor exposição intraoperatória à radiação.

Association of FBN1 polymorphism with susceptibility of adolescent idiopathic scoliosis: a case-control study.

BACKGROUND: Fibrillin-1 (FBN1) is an extracellular matrix glycoprotein essential to the structural component of microfibrils and FBN1 gene polymorphisms can be associated with adolescent idiopathic scoliosis (AIS) susceptibility. This study aimed to evaluate the potential role of the FBN1 rs12916536 polymorphism in AIS development or severity and the variation in Cobb angle in relation to patient's characteristics. METHODS: DNA from 563 subjects (185 AIS patients and 378 controls) were genotyped using a validated TaqMan allelic discrimination assay. A multivariate logistic regression model evaluated the association between polymorphism and AIS, using the adjusted odds ratios (OR) with their respective 95% confidence intervals (95% CI). A linear regression analysis evaluated the variation in Cobb angle according to the patient's age and body mass index (BMI). RESULTS: Among the AIS group there was a predominance of females (12:1), low or normal BMI (90%), 58% had a Cobb angle greater than 45° and 74% were skeletally mature. Age was a risk factor (4-fold) for curve progression higher than BMI (P < 0.001). The allelic frequency of the rs12916536 G > A polymorphism was 40% in controls and 31% in AIS cases; and this difference was statistically significant (P = 0.004). FBN1 rs12916536 GA + AA genotypes were associated with a lower risk of AIS susceptibility (OR = 0.58 and 95% CI = 0.35-0.98), after adjustment for age, sex and BMI. However, no significant differences were detected in polymorphism distribution with the severity of the disease (Cobb < 45° or ≥ 45°). CONCLUSION: Age was a risk factor for progression of the scoliotic curve and FBN1 rs12916536 polymorphism a protective factor for AIS susceptibility.

The Influence of Thread Tap Mismatch on Pedicle Screw Pullout Strength / A influência da incompatibilidade do macho de rosca na resistência à extração do parafuso pedicular

Abstract Objective We aimed to study the "in vitro" pullout strength of SpineGuard/Zavation Dynamic Surgical Guidance Z-Direct Screw (DSG Screw, SpineGuard Inc, Boulder, Colorado, USA), a screw designed to be inserted using a direct insertion technique. Methods Dynamic Surgical Guidance Screws of 5.5 and 6.5 mm were introduced into polyurethane blocks with a density of 10 PCF (0,16g/cm3). According to the experimental group, screws were inserted without pilot hole, with pilot without tapping, undertapping and line-to-line tapping. Screw pullout tests were performed using a universal test machine after screw insertion into polyurethane blocks. Results Screws inserted directly into the polyurethane blocks without pilot hole and tapping showed a statistically higher pullout strength. Insertion of the screw without tapping or with undertapping increases the pullout screw strength compared with lineto-line tapping. Conclusion Dynamic Surgical Guidance Screw showed the highest pullout strength after its insertion without pilot hole and tapping.

Resumo Objetivo Nosso objetivo foi estudar a resistência à extração "in vitro" do parafuso SpineGuard/Zavation Dynamic Surgical Guidance Z-Direct (Parafuso DSG Guia Cirúrgico Dinâmico, SpineGuard Inc, Boulder, Colorado, USA), um parafuso projetado para ser inserido utilizando a técnica de inserção direta. Métodos Os parafusos DSG de 5,5 e 6,5 mm foram introduzidos em blocos de poliuretano com densidade de 10 PCF (0,16g/cm3). De acordo com o grupo experimental, os parafusos foram inseridos sem um orifício piloto, com um orifício piloto sem o macheamento, com macheamento e com macheamento linha a linha. Os testes de extração do parafuso foram realizados em uma máquina de teste universal, após a inserção do parafuso em blocos de poliuretano. Resultados Os parafusos inseridos diretamente nos blocos de poliuretano sem o orifício piloto e o macheamento mostraram uma resistência à extração estatisticamente maior. A inserção do parafuso sem o macheamento ou com o macho de menor diâmetro aumenta a resistência à extração do parafuso em comparação com o macheamento linha a linha. Conclusão O parafuso DSG apresentou a maior resistência à extração após a inserção sem o orifício piloto e o macheamento.

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach.

BACKGROUND: Readmission followed by surgery to treat spinal fractures has a substantial impact on patient care costs and reflects a hospital's quality standards. This article analyzes the factors associated with hospital readmission followed by surgery to treat spinal fractures. METHODS: This was a cross-sectional study with time-series analysis. For prediction analysis, we used Cox proportional hazards and machine-learning models, using data from the Healthcare Cost and Utilization Project, Inpatient Database from Florida (USA). RESULTS: The sample comprised 215,999 patients, 8.8% of whom were readmitted within 30 days. The factors associated with a risk of readmission were male sex (1.1 [95% confidence interval 1.06-1.13]) and >60 years of age (1.74 [95% CI: 1.69-1.8]). Surgeons with a higher annual patient volume presented a lower risk of readmission (0.61 [95% CI: 0.59-0.63]) and hospitals with an annual volume >393 presented a lower risk (0.92 [95% CI: 0.89-0.95]). CONCLUSION: Surgical procedures and other selected predictors and machine-learning models can be used to reduce 30-day readmissions after spinal surgery. Identification of patients at higher risk for readmission and complications is the first step to reducing unplanned readmissions.

Costs analysis of spinal column metastases surgical treatment / Análise dos custos do tratamento cirúrgico das metástases da coluna vertebral

ABSTRACT Introduction End-of-life cancer treatment is associated with substantial healthcare costs. Objective This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study.

RESUMO Introdução O tratamento do câncer em fim de vida está associado a custos substanciais em saúde. Objetivo O objetivo do estudo foi analisar o custo do tratamento cirúrgico de pacientes com metástase espinhal e compressão peridural submetidos ao tratamento cirúrgico. Métodos Uma análise retrospectiva de custos de 81 pacientes com metástase espinhal e compressão peridural submetidos a tratamento cirúrgico. A avaliação de custos foi definida nas seguintes categorias: medicamentos, exames laboratoriais e de imagem, enfermaria, sala de recuperação, unidade de terapia intensiva, procedimento cirúrgico e material consignado. O custo relacionado à melhora da dor, atividade funcional e sobrevida também foi avaliado. Resultados O custo total do tratamento cirúrgico de 81 pacientes foi de R $ 3.604.334,26 e o valor médio de cada paciente foi de R $ 44.497,95. Os maiores gastos foram relacionados com implantes (41,1%), seguidos de internação (27,3%) e procedimento cirúrgico (19,7%). Conclusão O custo do tratamento cirúrgico para metástases espinhais é um dos mais caros entre as complicações ósseas em pacientes com câncer. O custo do tratamento relacionado aos desfechos apresentou diferença de acordo com o desfecho analisado e a permanência hospitalar, exames, medicamentos e terapia intensiva tem papel importante em alguns dos custos relacionados ao desfecho específico. Nível de Evidência II, Estudo retrospectivo.

Spinopelvic mobility in patients with hip osteoarthritis and total hip arthroplasty indication / Mobilidade espinopélvica nos pacientes com artrose do quadril e indicação de artroplastia total

ABSTRACT Introduction: Reduction of spinopelvic mobility is associated with an increased dislocation of total hip arthroplasty (THA). Objective: To assess 1) spinopelvic mobility in patients with primary hip osteoarthritis and THA indication and 2) the influence of hip flexion contracture on spinopelvic mobility. Methods: Thirty adult patients with primary hip osteoarthritis and THA indication were evaluated using radiographic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar flexibility, and spinopelvic mobility). Results: Spinopelvic mobility ranged from 6.90 a 54.50° (mean 32.79 ± 11.42) and the group of patients with hip flexion contracture had higher mobility. Spinopelvic mobility was correlated with pelvic tilt as well as with lumbar flexibility. Conclusion: Around 13.4% of patients had spinopelvic mobility under 20° , indicating reduced spinopelvic mobility and risk of THA dislocation. Level of Evidence III, Retrospective Comparative Study.

RESUMO Introdução: A redução da mobilidade espinopélvica tem sido associada com o risco de luxação da prótese total do quadril. Objetivos: Avaliar a mobilidade espinopélvica nos pacientes com artrose primária da articulação do quadril e com indicação de artroplastia total do quadril (ATQ), e a influência da contratura em flexão do quadril sobre a mobilidade espinopélvica. Métodos: Trinta pacientes adultos com artrose primária do quadril e indicação de ATQ foram avaliados por meio de parâmetros radiográficos (incidência pélvica, versão pélvica, inclinação do sacro, mobilidade da coluna lombar e mobilidade espinopélvica). Resultados: A mobilidade espinopélvica variou de 6,90 a 54,50 graus (média 32,79 ± 11,42), e foi estatisticamente maior no grupo de pacientes com contratura em flexão do quadril. Foi observado correlação entre a mobilidade espinopélvica e a versão pélvica e flexibilidade da coluna lombar. Conclusão: A mobilidade espinopélvica abaixo de 20 graus, que caracteriza a redução da mobilidade espinopélvica e risco aumentado de luxação ou impacto dos componentes da prótese total foi observada em 13,4% dos pacientes. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Complications of surgical treatment of spinal metastases / Complicações do tratamento cirúrgico das metástases vertebrais / Complicaciones del tratamiento quirúrgico de las metástasis vertebrales

ABSTRACT Objectives: To evaluate the complications of surgical treatment in a group of patients with spinal metastasis with epidural compression, undergoing surgical treatment. Methods: This is a comparative retrospective study (level of evidence III), which evaluated 96 patients with spinal metastases undergoing surgical treatment. Intra- and postoperative complications were obtained from the patients' medical records and correlated with the following clinical characteristics: tumor type, tumor location, neurological deficit, age, number of affected vertebrae, Tokuhashi scale, Tomita scale, Karnofsky performance scale, and type of approach. Results: Complications of surgical treatment were observed in 29 (30.20%) patients. Surgical wound infection was the most frequent complication, observed in 15% of patients. Conclusions: Surgical treatment of spinal metastases presents complications in about 30% of patients and their occurrence should be considered in the treatment planning, weighing the risks and benefits for achieving the treatment goals. Level III evidence; Retrospective Study.

RESUMO Objetivo: Avaliar as complicações do tratamento cirúrgico em grupo de pacientes com metástase da coluna vertebral, compressão epidural e submetidos ao tratamento cirúrgico. Métodos: Trata-se de estudo retrospectivo comparativo (nível de evidência III), que avaliou 96 pacientes com metástase da coluna vertebral, submetidos ao tratamento cirúrgico. As complicações intra e pós-operatórias foram obtidas dos prontuários dos pacientes e correlacionadas com características clínicas: tipo de tumor, localização do tumor, déficit neurológico, idade, número de vértebras acometidas, escala de Tokuhashi, escala de Tomita, escala de performance de Karnofsky e tipo de acesso. Resultados: As complicações do tratamento cirúrgico foram observadas em 29 (30,20%) pacientes. A infecção da ferida operatória foi a complicação mais frequente e observada em 15% dos pacientes. Conclusões: O tratamento cirúrgico das metástases da coluna vertebral apresenta complicações em cerca de 30% dos pacientes, e a sua ocorrência deve ser considerada na elaboração do tratamento frente aos riscos e benefícios para a obtenção dos objetivos do tratamento. Evidência nível III; Estudo Retrospectivo.

RESUMEN Objetivos: Evaluar las complicaciones del tratamiento quirúrgico en un grupo de pacientes con metástasis vertebrales, compresión epidural y sometidos a tratamiento quirúrgico. Métodos: Se trata de un estudio comparativo retrospectivo (nivel de evidencia III), que evaluó a 96 pacientes con metástasis en la columna vertebral sometidos a tratamiento quirúrgico. Las complicaciones intra y postoperatorias se obtuvieron de la historia clínica de los pacientes y se correlacionaron con las características clínicas: tipo de tumor, localización del tumor, déficit neurológico, edad, número de vértebras afectadas, escala de Tokuhashi, escala de Tomita, escala de rendimiento de Karnofsky y tipo de acceso. Resultados: Se observaron complicaciones del tratamiento quirúrgico en 29 (30,20%) pacientes. La infección de la herida quirúrgica fue la complicación más frecuente y se observó en el 15% de los pacientes. Conclusiones: El tratamiento quirúrgico de las metástasis de columna vertebral presenta complicaciones en aproximadamente el 30% de los pacientes, y su ocurrencia debe ser considerada en la elaboración del tratamiento, considerando los riesgos y beneficios para lograr los objetivos del mismo. Evidencia de nivel III; Estudio retrospectivo.