Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study.

Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p > 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p > 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study / Comparação entre tratamento cirúrgico e conservador para fraturas toracolombares AOSpine tipo A3 e A4 sem déficit neurológico: Estudo de coorte prospectivo observacional

Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

Short arthrodesis is as effective as long arthrodesis for the treatment of type b thoracolumbar spine fractures / A artrodese curta é tão eficaz quanto a artrodese longa para o tratamento de fraturas da coluna toracolombar do tipo b / La artrodesis corta es tan eficaz como la artrodesis larga para el tratamiento de fracturas de columna toracolumbar de tipo b

ABSTRACT Objective: Thoracolumbar spine trauma is a world wide health concern that especially affects males of working age, being associated with an elevated morbidity. AO SPINE Type B fractures are unstable and require surgical stabilization. However, the decision between short or long fixation remains controversial. The objective of this study is to analyze the neurological, orthopedic and functional outcomes in patients with Type B spine fractures who have undergone short and long segment posterior arthrodesis. Methods: A prospective cohort study was performed at the Neurosurgery Department of Hospital Cristo Redentor from January 1, 2013 to December 31, 2018. Patients with spine fractures classified as AO SPINE Type B in the thoracic or thoracolumbar segments were eligible for the study. The variables analyzed included demographic data, information about the trauma, neurological status, the treatment performed, and the outcome. Results: A total of 31 patients were included in the study. The majority were Caucasian males with a mean age of 42.6(±15.6), and the main cause of the spine trauma was falling from height (N=18; 56.2%). Fifteen patients (48.3%) had subtype B1 fractures and 16 (51.6%) had subtype B2 fractures. Eleven (35.4%) patients were submitted to short arthrodesis and 20 (64.5%) were submitted to long arthrodesis. There was no statistical difference between groups in terms of neurological, orthopedic and functional outcomes. Conclusions: There is no difference in outcomes between short or long constructs for patients with type B single fracture in the thoracic, thoracolumbar and lumbar spine segments. Level of evidence III; Therapeutic Studies - Investigation of treatment results.

RESUMO: Objetivo: O trauma da coluna toracolombar é um problema de saúde mundial que afeta principalmente o sexo masculino em idade ativa, e é associado a morbidade elevada. As fraturas AO SPINE tipo B são instáveis e requerem estabilização cirúrgica. Todavia, a decisão entre fixação curta ou longa permanece controversa. O objetivo deste estudo é analisar os resultados neurológicos, ortopédicos e funcionais em pacientes com fraturas de coluna de tipo B submetidos à artrodese posterior de segmentos curto e longo. Métodos: Foi realizado um estudo de coorte prospectivo no Departamento de Neurocirurgia do Hospital Cristo Redentor, no período de 1º de janeiro de 2013 a 31 de dezembro de 2018. Foram elegíveis para o estudo pacientes com fraturas de coluna classificadas como AO SPINE Tipo B nos segmentos torácico ou toracolombar. As variáveis analisadas incluíram dados demográficos, informações sobre o trauma, estado neurológico, tratamento realizado e desfecho. Resultados: Um total de 31 pacientes foi incluído no estudo. Amaioria era do sexo masculino, caucasiano, com média de idade de 42,6 (±15,6), e a principal causa do trauma de coluna foi queda de altura (N=18; 56,2%). Quinze pacientes (48,3%) tiveram fratura do subtipo B1 e 16 (51,6%) tiveram fratura do subtipo B2. Onze (35,4%) pacientes foram submetidos à artrodese curta e 20 (64,5%) à artrodese longa. Não houve diferença estatística entre os grupos quanto aos resultados neurológicos, ortopédicos e funcionais. Conclusões: Não há diferença nos resultados entre fixações curtas ou longas para pacientes com fratura única tipo B nos segmentos da coluna torácica, toracolombar e lombar. Nível de evidência III; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN: Objetivo: El traumatismo de la columna toracolumbar es un problema de salud a nivel mundial que afecta especialmente al sexo masculino en edad laboral y está asociado a una elevada morbilidad. Las fracturas AO SPINE Tipo B son inestables y requieren estabilización quirúrgica. Sin embargo, la decisión entre fijaciones cortas o largas sigue siendo controvertida. El objetivo de este estudio es analizar los resultados neurológicos, ortopédicos y funcionales en pacientes con fracturas de columna tipo B sometidos a artrodesis posterior de segmento corto y largo. Métodos: Se realizó un estudio de cohorte prospectivo en el Departamento de Neurocirugía del Hospital Cristo Redentor del 1 de enero de 2013 al 31 de diciembre de 2018. Fueron elegibles para el estudio pacientes con fracturas de columna vertebral clasificadas como AO SPINE Tipo B en los segmentos torácico o toracolumbar. Las variables analizadas incluyen datos demográficos, información sobre traumatismo, estado neurológico, tratamiento realizado y resultado. Resultados: Se incluyeron en el estudio un total de 31 pacientes. La mayoría varones caucásicos con edad promedio de 42,6 (±15,6) y la caída de altura (N=18; 56,2%) fue la principal causa de traumatismo vertebral. Quince pacientes (48,3%) tenían fractura de subtipo B1 y 16 (51,6%) tenían fractura de subtipo B2. Once (35,4%) pacientes fueron sometidos a artrodesis corta y 20 (64,5%) a artrodesis larga. No hubo diferencias estadísticas entre los grupos en términos de resultados neurológicos, ortopédicos y funcionales. Conclusiones: No hay diferencias en los resultados entre fijaciones cortas o largas en pacientes con fractura única de tipo B en los segmentos de columna torácica, toracolumbar y lumbar. Nivel de evidencia III; Estudios terapéuticos-Investigación de los resultados del tratamiento.

Spine trauma epidemiological profile in a tertiary neurosurgery hospital in south Brazil / Perfil epidemiológico de trauma raquimedular em hospital neurocirúrgico terciário no sul do Brasil / Perfil epidemiológico de trauma raquimedular en hospital neuroquirúrgico terciario en el sur de Brasil

ABSTRACT Objective The aim of this paper is to analyze the epidemiological profile of a large series of spine trauma victims in the Southernmost state of Brazil. Methods A retrospective study including spine trauma patients was performed at a tertiary hospital from January 1st, 2013 to December 31st, 2018. The variables analyzed include demographic data, information related to the trauma (etiology, trauma mechanism, type of spine injury, number of vertebrae involved, vertebral segment involved), neurological status at hospital admission (Frankel scale), treatment performed and the outcome (number of days in hospital, neurological outcome, and mortality). Results A total of 808 patients were included. The mean age was 47.9 (±19.0), and the majority were male and Caucasian. The most frequent etiology was falls from height (N=508; 62.9%) followed by traffic accidents (N=185; 22.9%). The thoracolumbar segment was the spinal segment most frequently affected, occurring in 401 (52.1%) patients, followed by the cervical, thoracic and lumbar segments. The incidence of SCI was 16.7%. Non-operative treatment was indicated in 510 (63.1%) patients. Conclusion The authors presented the largest epidemiological profile regarding spine trauma in Latin America, analyzing a total of 808 patients, which represents an incidence of 134.6 cases/year. This paper fills a gap in the medical literature regarding the epidemiological profile of this disease in Latin America. Level of evidence II; Prognostic study.

RESUMO Objetivos O objetivo deste artigo é analisar o perfil epidemiológico, com base em uma grande série de pacientes acometidos por trauma raquimedular no extremo sul do Brasil. Métodos Estudo retrospectivo que incluiu pacientes com trauma raquimedular realizado em um hospital terciário entre 1o de janeiro de 2013 e 31 de dezembro de 2018. As variáveis analisadas incluem dados demográficos, informações referentes ao trauma (etiologia, mecanismo, tipo de lesão, número de vértebras envolvidas e segmento vertebral afetado), estado neurológico à internação (escala de Frankel), tratamento realizado e desfecho (dias de internação, resultado neurológico e mortalidade). Resultados Um total de 808 pacientes foram incluídos. A média de idade do grupo foi de 47,9 (± 19,0), sendo a maioria do sexo masculino e caucasiana. A etiologia mais frequente foi queda de altura (N = 508; 62,9%) seguida de acidentes de trânsito (N = 185; 22,9%). O segmento toracolombar foi o mais acometido, ocorrendo em 401 (52,1%) pacientes, seguido pelo cervical, torácico e lombar. A incidência de lesão raquimedular foi de 16,7%. O tratamento não cirúrgico foi indicado para 510 (63,1%) pacientes. Conclusão Os autores apresentam o maior perfil epidemiológico de trauma de coluna da América Latina, analisando um total de 808 pacientes, o que representa uma incidência de 134,6 casos / ano. Este artigo preenche uma lacuna da literatura médica no que diz respeito ao perfil epidemiológico desta doença na América Latina. Nível de evidência II; Estudo Prognóstico.

RESUMEN Objetivos El objetivo de este artículo es analizar el perfil epidemiológico, con base en una gran serie de pacientes acometidos por trauma raquimedular en el extremo sur de Brasil. Métodos Estudio retrospectivo que incluyó a pacientes con trauma raquimedular realizado en un hospital terciario entre el 1 de enero de 2013 y el 31 de diciembre de 2018. Las variables analizadas incluyen datos demográficos, informaciones referentes al trauma (etiología, mecanismo, tipo de lesión, número de vértebras involucradas y segmento vertebral afectado), estado neurológico para el internamiento (escala de Frankel), tratamiento realizado y resultados (días de internamiento, resultado neurológico y mortalidad). Resultados Fue incluido un total de 808 pacientes. El promedio de edad del grupo fue de 47,9 (± 19,0), siendo la mayoría del sexo masculino y caucásico. La etiología más frecuente fue caída de altura (N = 508; 62,9%) seguida de accidentes de tránsito (N = 185; 22,9%). El segmento toracolumbar fue el más acometido, ocurriendo en 401 (52,1%) pacientes, seguido por el cervical, torácico y lumbar. La incidencia de lesión raquimedular fue de 16,7%. El tratamiento no quirúrgico fue indicado para 510 (63,1%) pacientes. Conclusión Los autores presentan el mayor perfil epidemiológico de trauma de columna de América Latina, analizando un total de 808 pacientes, lo que representa una incidencia de 134,6 casos/año. Este artículo llena un vacío de la literatura médica en lo que se refiere al perfil epidemiológico de esta enfermedad en América Latina. Nivel de evidencia II; Estudio Pronóstico.

Double-blind randomized clinical trial of vancomycin in spinal arthrodesis: no effects on surgical site infection.

OBJECTIVE: Surgical site infection (SSI) results in high morbidity and mortality in patients undergoing spinal fusion. Using intravenous antibiotics in anesthesia induction reduces the rate of postoperative infection, but it is not common practice to use them topically, despite recent reports that this procedure helps reduce infection. The objective of this study was to determine whether the topical use of vancomycin reduces the rate of postoperative SSI in patients undergoing thoracolumbar fusion. METHODS: A randomized, double-blind clinical trial in a single hospital was performed comparing vancomycin and placebo in thoracolumbar fusion patients. RESULTS: A total of 96 patients were randomized to placebo or vancomycin treatment. The mean patient age was 43 ± 14.88 years, 74% were male, and the most common etiology was fall from height (46.9%). The overall rate of postoperative SSI was 8.3%, and no difference was found between the groups: postoperative infection rates in the vancomycin and placebo groups were 8.2% and 8.5% (relative risk [RR] of SSI not using vancomycin 1.04, 95% confidence interval [CI] 0.28-3.93, p = 0.951), respectively. Patients with diabetes mellitus had higher SSI rates (RR 8.98, 95% CI 1.81-44.61, p = 0.007). CONCLUSIONS: This is the first double-blind randomized clinical trial to evaluate the effects of topical vancomycin on postoperative infection rates in thoracolumbar fusion patients, and the results did not differ significantly from placebo.Clinical trial registration no.: RBR-57wppt (ReBEC; http://www.ensaiosclinicos.gov.br/).

Spondylodiscitis investigation and therapeutic protocol: neurosurgery service results / Protocolo investigativo e terapêutico de espondilodiscite: resultados de um serviço de neurocirurgia / Investigación de espondilodiscitis y protocolo terapéutico: resultados del servicio de neurocirugía

ABSTRACT Objective: Spondylodiscitis is still a frequent pathology among neurosurgical services, and its correct treatment involves infectious, neurological and orthopedic goals. The authors describe the protocol and report the diagnostic and therapeutic results after its implementation. Methods: A prospective prognostic study (Level I) including patients with primary spondylodiscitis treated in the Neurosurgical Service of Cristo Redentor Hospital from January 2014 to March 2018. Demographic, spine, infectious and treatment-related variables were analyzed. The numerical variables are presented as mean and standard deviation or median and interquartile range (according to their parametricity), and are compared by the student's t-Test or Mann-Whitney U Test, respectively. Results: Thirty seven patients were included. The sexes were evenly distributed, with predominantly Caucasians, and a mean age of 56.89 ±15.33. Hypertension and type 2 diabetes were the most frequent comorbidities. Vertebral lumbar level was the most involved segment. Pathogens were identified in 34 cases (91%), with Staphylococcus aureus being the most prevalent, followed by Koch Bacilli. Inflammatory markers are higher in pyogenic infections at hospital admission, but lower at hospital discharge when compared to tuberculous discitis (p<0.01). Mean hospital stay was higher in the pyogenic group. Conclusion: The protocol described has a high diagnostic level of the pathogen, with cure of infection and satisfactory neurologic outcome in all cases. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.

RESUMO Objetivo: Espondilodiscite é uma patologia frequente nas enfermarias neurocirúrgicas, cujo tratamento adequado envolve questões infecciosas, neurológicas e ortopédicas. Os autores descrevem um protocolo reportando resultados diagnósticos e terapêuticos após sua implementação. Método: Estudo prognóstico prospectivo (Nível I) incluindo pacientes com espondilodiscite primária tratados de janeiro 2014 a março de 2018. Variáveis relacionadas a dados demográficos, vertebrais, infecciosos e terapêuticos foram analisados. Variáveis numéricas serão apresentadas como média e desvio padrão ou mediana e intervalo interquartil (conforme sua parametricidade) e analisadas com Teste T-Student ou Teste Mann-Whittney, respectivamente. Resultados: 37 pacientes foram incluídos, cuja média de idade foi 56.89 ±15.33. Hipertensão arterial e Diabetes foram as comorbidades mais prevalentes. O segmento lombar foi o mais acometido. Houve identificação do patógeno em 34 casos (91%), sendo o Staphylococcus aureus o mais frequente, seguido pelo Bacilo de Koch. Os marcadores inflamatórios foram maiores no grupo de discite piogênica no momento da admissão hospitalar, mas com valores inferiores aos da discite tuberculosa na alta hospitalar (p<0.01). A média de internação hospitalar foi maior no grupo piogênico. Conclusão: O protocolo descrito tem elevada taxa de identificação do patógeno com critérios de cura infecciosa e desfecho neurológico satisfatório em todos os casos descritos. Nível de Evidência I, Estudos diagnósticos - Investigação de um exame para diagnóstico.

RESUMEN Objetivo: La espondilodiscitis sigue siendo una patología frecuente en los servicios de neurocirugía y su tratamiento correcto incluye objetivos infecciosos, neurológicos y ortopédicos. Los autores describen un protocolo e informan los resultados diagnósticos y terapéuticos después de su implementación. Métodos: Estudio pronóstico prospectivo (Nivel I) que incluyó pacientes con espondilodiscitis primaria tratados en el Servicio de Neurocirugía del Hospital Cristo Redentor desde enero de 2014 hasta marzo de 2018. Se analizaron variables demográficas, vertebrales, infecciosas y relacionadas con el tratamiento. Las variables numéricas se presentan como promedio y la desviación estándar o mediana y rango intercuartil (según su parametricidad) y se comparan mediante la prueba t de Student o la prueba U de Mann-Whitney, respectivamente. Resultados: Se incluyeron 37 pacientes. Los sexos se distribuyeron uniformemente, con predominancia de caucásicos y una edad promedio de 56,89 ± 15,33. La hipertensión y la diabetes tipo 2 fueron las comorbilidades más frecuentes. El nivel lumbar fue el segmento más afectado. Se identificaron patógenos en 34 casos (91%), siendo el Staphylococcus aureus el más frecuente, seguido por el bacilo de Koch. Los marcadores inflamatorios fueron más en las infecciones piógenas en el hospital, pero más bajos en el alta hospitalaria en comparación con la discitis tuberculosa (p < 0,01). La estancia hospitalaria promedio fue mayor en el grupo piógeno. Conclusiones: El protocolo descrito tiene un alto nivel de diagnósticos del patógeno, con curación de la infección y resultados neurológicos satisfactorios en todos los casos. Nivel de Evidencia I, Estudios de diagnósticos - Investigación de un examen para diagnóstico.

Subaxial spine arthrodesis in patients with spine fractures and facet joint dislocations: Is magnetic resonance imaging required to determine the optimal surgical approach?

BACKGROUND: The medical literature suggests that facet dislocations (FDs) must be managed surgically, even in the absence of spinal cord injury. In fact, there is no standard guideline for managing FD cases and whether magnetic resonance imaging (MRI) should be utilized for optimizing treatment planning. METHODS: Fifteen cases of FD were evaluated twice by nine spine surgeons. The first assessment included computed tomography (CT) images only. Secondarily, original CT studies were supplemented with MRI. In each case, the participating surgeon had to acknowledge whether and what surgical treatment they would offer. Data for the two responses from all nine surgeons were then compared. RESULTS: Based on CT images alone, there was no consensus regarding treatment choices in 13 cases, and a trend toward consensus in just two instances (κ = 0.01). When MRI scans were added to CT studies, among the 15 cases evaluated, 10 cases demonstrated a trend toward consensus, and in 1 case consensus was achieved. The Kappa interpersonal agreement based on MRI was 0.13. The analysis of the answers by each contributor in each case demonstrated that in 58.51% of cases the surgical treatment options were changed when analyzed by CT + MRI, in comparison to the options indicated based on CT alone. CONCLUSION: It appears that obtaining an MRI in addition to a CT before spine surgery for FD is essential mandatory, as it changed the treatment option in nearly 60% of cases.

Serum Biomarkers and Clinical Outcomes in Traumatic Spinal Cord Injury: Prospective Cohort Study.

BACKGROUND: A plethora of reactive cellular responses emerge immediately after a traumatic spinal cord injury (SCI) and may influence the patient's outcomes. We investigated whether serum concentrations of neuron-specific enolase, interleukin-6, glial-derived neurotrophic factor, and neurotrophic growth factor reflect the acute-phase responses to different etiologies of SCI and may serve as predictive biomarkers of neurologic and functional outcomes. METHODS: Fifty-two patients were admitted to the intensive care unit after SCI due to traffic accidents, falls, and firearm wounds and had blood samples collected within 48 hours and 7 days after SCI. Thirty-six healthy subjects with no history of SCI were included as controls. Neurologic and functional status was evaluated on the basis of American Spinal Injury Association and Functional Independence Measure scores over a period of 48 hours and 6 months after SCI. RESULTS: Serum NSE increased significantly 48 hours and 7 days after SCI compared with controls, while interleukin-6 increased only at 48 hours. In contrast, the neurotrophic growth factor level significantly decreased 48 hours and 7 days after SCI. Serum glial-derived neurotrophic factor level did not differ from control at any time point. Also, there was no significant difference in biomarker concentrations between the etiologies of SCI or the level of spinal injury. There were no correlations between biomarker levels at 48 hours with neurologic or functional outcomes 7 days and 6 months after SCI. CONCLUSIONS: Our results suggest expansive axonal damage coupled with an acute proinflammatory response after SCI. However, in our study biomarker concentration did not correlate with short- or long-term prognosis, such as survival rate or sensory and motor function.

Prognostic utility of circulating nucleic acids in acute brain injuries.

INTRODUCTION: Acute brain injuries represent major causes of morbidity and mortality worldwide. Nevertheless, therapeutic options are centered mainly on supportive care, and accurate prognosis prediction following traumatic brain injury (TBI) or stroke remains a challenge in clinical settings. Areas covered: Circulating DNA and RNA have shown potential as predictive molecules in acute brain injuries. In particular, plasma cell-free DNA (cfDNA) levels have been correlated to severity, mortality, and outcome after TBI and stroke. The real-time quantitative polymerase chain reaction (qPCR) is the most widely used technique for determination of cfDNA in brain injuries; however, to consider the use of cfDNA in emergency settings, a quicker and easier methodology for detection should be established. A recent study proposed detection of cfDNA applying a rapid fluorescent test that showed compatible results with qPCR. Expert commentary: As a promising perspective, detection of cfDNA levels using simple, rapid, and cheap methodology has potential to translate to clinic as a point-of-care marker, supporting the clinical decision-making in emergency care settings. Conversely, miRNA profiles may be used as signatures to determine the type and severity of injuries. Additionally, in the future, some miRNAs may constitute innovative neurorestorative therapies without the common hurdles associated with cell therapy.

Reliability of Tokuhashi Score to Predict Prognosis: Comparison of 117 Patients.

BACKGROUND: Spinal metastatic disease compromises the quality of life and prognosis of the patients. Prognosis is an important factor for the decision-making process and needs to be precise in order to adjust the intensity of therapy. The Tokuhashi score is a universal instrument to determine the prognosis. The objective was to analyze the effectiveness of the Tokuhashi score in determining the prognosis of the patients with spine metastasis by comparing the expected survival time from the Tokuhashi score with the survival time observed among surgical patients. METHODS: This retrospective study was performed from October 2008 to October 2015. The inclusion criteria were symptomatic patients with spinal metastasis who underwent spinal cord decompression and had a minimum of 1-year follow-up. The exclusion criteria were patients without histologic confirmation and were lost to follow-up. The Tokuhashi score was applied, and once the expected survival was defined, it was compared with the survival time observed in the follow-up. RESULTS: The sample studied was 117 patients. The commonly female (58%) and breast spinal metastasis was often observed (25.6%). The patients were followed for a minimum period of 12 months. The actual survival was beyond that estimated by the Tokuhashi score (P < 0.05). CONCLUSION: The Tokuhashi score was not reliable to predict the prognosis. Patients with lower scores that surgical treatment was not recommended by the Tokuhashi score had better quality of life and longer survival after surgery. Tokuhashi score is not a precise tool to establish the best therapy and survival in patients with spinal metastasis.

Thoracolumbar spinal arthrodesis - epidemiology and costs / Artrodese de coluna toracolombar - epidemiologia e custos / Artrodesis de la columna toracolumbar - epidemiología y costos

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

RESUMO Objetivo: Descrever a epidemiologia dos pacientes com fratura de coluna toracolombar submetidos à cirurgia no Hospital Cristo Redentor e os custos relacionados. Métodos: Estudo epidemiológico prospectivo entre julho de 2014 e agosto de 2015 de pacientes com fratura da coluna toracolombar com indicação de cirurgia. Foram analisadas as variáveis sexo, idade, custo da internação hospitalar, níveis fraturados, níveis de artrodese, infecção de sítio cirúrgico, ITU ou BCP, lesão medular, etiologia, dias de internação, tempo de procedimento e escala visual analógica (EVA) . Resultados: Foram avaliados 32 pacientes no período estudado, com média de idade de 38,68 anos. A relação entre homens e mulheres foi 4:1 e as causas mais frequentes foram queda de altura (46,87%) e acidentes de trânsito (46,87%). A transição toracolombar foi a mais acometida (40,62%) com a vértebra de L1 envolvida em 23,8% das vezes. Apresentaram déficit neurológico 40,62% dos pacientes. O tempo de permanência hospitalar teve mediana de 14 dias e os pacientes com déficit neurológico permaneceram internados por período mais prolongado (p <0,001), com aumento dos custos hospitalares (p= 0,015). O custo médio da internação foi de U$ 2.874,80. A presença de BCP aumentou o custo da internação e os pacientes com lesão medular tiveram mais BCP (p= 0,014). Conclusão: Políticas públicas com ênfase na redução de acidentes de trânsito e quedas podem ajudar a reduzir a incidência dessas lesões e estudos com foco nos gastos hospitalares e em reabilitação precisam ser realizados no Brasil para determinar o fardo socioeconômico do traumatismo vertebral e traumatismo medular.

RESUMEN Objetivo : Describir la epidemiología de los pacientes con fractura de columna toracolumbar sometidos a cirugía en el Hospital Cristo Redentor y los costos relacionados. Métodos : Estudio epidemiológico prospectivo entre julio de 2014 y agosto de 2015 de pacientes con fracturas de la columna toracolumbar con indicación de cirugía. Se analizaron las variables sexo, edad, costo de hospitalización, niveles fracturados, niveles de artrodesis, infección del sitio quirúrgico, ITU o BCP, lesión de la médula espinal, etiología, duración de la estancia hospitalaria, tiempo del procedimiento y la escala visual analógica (EVA). Resultados: Fueron evaluados 32 pacientes durante el período de estudio, con un promedio de edad de 38,68 años. La relación entre hombres y mujeres fue de 4:1 y las causas más frecuentes fueron las caídas de altura (46,87%) y los accidentes de tránsito (46,87%). La transición toracolumbar fue la más afectada (40,62%) con la vértebra de L1 involucrada en 23,8% de los casos. Presentaron déficit neurológico 40,62% de los pacientes. La estancia hospitalaria tuvo mediana de 14 días y los pacientes con déficit neurológico permanecieron hospitalizados por un período más largo (p <0,001), con un aumento de los gastos de hospital (p= 0,015). El costo promedios de hospitalización fue de U$ 2.874,80. La presencia de BCP aumentó el costo de la hospitalización y los pacientes con lesión de la médula espinal tuvieron más BCP (p= 0,014) . Conclusión : Políticas públicas, con énfasis en la reducción de los accidentes de tránsito y las caídas pueden ayudar a reducir la incidencia de estas lesiones y los estudios centrados en los costos hospitalarios y de rehabilitación deben ser llevados a cabo en Brasil para determinar la carga socioeconómica del trauma espinal y la lesión de médula espinal.

Management of Type II Odontoid Fractures: Experience from Latin American Spine Centers.

OBJECTIVE: To analyze characteristics of type II odontoid fracture (TII-OF), including clinical and radiographic factors, that influence surgical planning in 8 Latin American centers. METHODS: Retrospective chart review was performed of 88 patients with TII-OF between 2004 and 2015 from 8 Latin American centers. Parameters studied included 1) demographic data and causes of TII-OF, 2) clinical and neurologic presentation, 3) characteristics of fracture (degree of odontoid displacement, displacement of odontoid relative to C2 body, anatomy of fracture line, distance between fragments, presence of comminution, contact area between odontoid and C2 body), 4) type of treatment, and 5) clinical and radiographic outcome. Bone fusion was assessed using computed tomography. RESULTS: Mean patient age was 45.33 years ± 23.54; 78.4% of patients were male. Surgery was the primary treatment in 65 patients (73.8%), with an anterior approach in 64.6%. Surgery was usually preferred in patients with posterior or horizontal oblique fracture lines, local pain, and a smaller bone contact surface between the odontoid and the body of C2. A posterior approach was chosen when distance between the fractured bone fragments was >2 mm or after failed conservative or anterior odontoid screw treatment in a symptomatic patient. CONCLUSION: The treatment of choice for TII-OF in 8 Latin American trauma centers was surgery through an anterior approach using screw fixation. Posterior segmental C1-C2 fixation was indicated when distance between bone fragments was >2 mm and in symptomatic patients with nonunion.

Estenose de carótida conduta atual / Carotid stenosis: current tendencies

O presente trabalho mostra as tendências atuais de investigaçäo radiológica e de indicaçöes cirúrgicas na doença arteriosclerótica sintomática e assintomótica da artéria carótida. É discutida a importância da monitorizaçäo transoperatória do fluxo sanguíneo cerebral e da magnificaçäo e iluminaçäo coaxial do microscópio cirúrgico durante a etapa de remoçäo dos pequenos fragmentos da placa arteriosclerótica e do fechamento da artéria