Translation, cross-cultural adaptation, and validation of the 10-item spine functional index (SFI-10) in the Brazilians with musculoskeletal spine disorders.

PURPOSE: To translate and cross-culturally adapt the Spine Functional Index (SFI) into Brazilian Portuguese (SFI-Br) in individuals with musculoskeletal spine disorders. METHODS: Participants (n=194) answered the Numerical Pain Rating Scale (NPRS), 36-item Short-Form Health Survey (SF-36), Roland-Morris Disability Questionnaire for General Pain (RMDQ-g), and SFI-25 incorporating the SFI-10. Structural validity, from confirmatory factor analysis (CFA), used comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). The best structure was considered from the lower values of the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Construct and criterion validity used Spearman's correlation coefficient (rho). Internal consistency used Cronbach's alpha, reliability used intraclass correlation coefficient (ICC2,1), with ceiling and floor effects determined. Error used the standard error of the measurement (SEM) and minimal detectable change, 90% level (MDC90). RESULTS: Adequate fit indices demonstrated an unequivocal one-factor structure only for the SFI-10 (chi-square/DF <3.00, CFI and TLI >0.90, RMSEA <0.08). The SFI-10-Br correlation was high with the SFI-Br (rho=0.914, p<0.001), moderate for the RMDQ-g (rho=-0.78), SF-36 functional capacity domain (rho=0.718) and NPRS (rho=-0.526); and adequate for the remaining SF-36 domains (rho>0.30). Test-retest reliability (ICC2,1=0.826) and internal consistency (alpha=0.864) were high. No ceiling or floor effects were observed, and error was satisfactory (SEM=9.08%, MDC90=25.15%). CONCLUSION: The SFI Brazilian version was successfully produced with the 10-item version showing an unequivocal one-factor structure, high construct and criterion validity, reliability, internal consistency, and satisfactory error. Further research on responsiveness is required.

Unexpected findings in cervical spine in spondylometaphyseal dysplasia Sutcliff type FN1-related.

The autosomal dominant spondylometaphyseal dysplasia Sutcliff type or corner fracture type FN1-related is characterized by a combination of metaphyseal irregularities simulating fractures ("corner fractures"), developmental coxa vara, and vertebral changes. It is linked to heterozygous mutations in FN1 and COL2A1. Vertebral changes as delayed vertebral ossification, ovoid vertebral bodies, anterior vertebral wedging, and platyspondyly have been observed in this condition, while odontoid abnormalities have not been reported. We report an odontoid anomaly in a girl with SMD-CF FN1-related showing the heterozygous variant c.505T>A; p.(Cys169Ser), presenting at 11.9 years of age with acute quadriparesis. Images showed spinal cord compression and injury associated with os odontoideum and C1-C2 instability. She required decompression and instrumented occipitocervical stabilization, suffering from residual paraparesis. This paper describes the first case of SMD-CF FN1-related accompanied by odontoid anomalies.

Manifestación clínica inicial de la lipomatosis epidural lumbar grado III de Naka: serie de casos / Initial clinical signs of Naka's grade III lumbar epidural lipomatosis: A case series

Introducción: La lipomatosis epidural espinal es una enfermedad infrecuente caracterizada por el sobrecrecimiento del tejido adiposo no encapsulado dentro del espacio epidural. Esto genera una estenosis del conducto espinal que puede provocar sintomatología compresiva. La presentación típica es insidiosa a lo largo de meses o años. El objetivo de este estudio fue realizar un análisis descriptivo de la manifestación clínica inicial en pacientes con lipomatosis epidural espinal grado III de Naka. Materiales y métodos: Estudio observacional retrospectivo en la Unidad de Patología Espinal de 4 instituciones, de 2010 a 2023. Se incluyó a pacientes >18 años, de ambos sexos, que acudieron por dolor lumbar con irradiación o sin irradiación, y presentaban lipomatosis lumbar Naka III en la resonancia magnética. Resultados: Se incorporó a 40 pacientes (edad promedio 62.5 años). El 75% era obeso, ninguno era fumador. El motivo de consulta más frecuente fue lumbalgia, con una mediana de evolución del dolor de 5.5 meses. Conclusiones:La lumbalgia fue la consulta más frecuente, con excepción del compromiso de L3-S1 que fue la lumbocruralgia. Los pacientes que sufrieron dolor más tiempo (>6 meses) eran más jóvenes y tenían un índice de masa corporal menor; sin embargo, no resultó estadísticamente significativo. Nivel de Evidencia: IV

Introduction: Spinal epidural lipomatosis (SEL) is a rare pathology characterized by the overgrowth of nonencapsulated adipose tissue within the epidural space. This generates spinal stenosis, which might result in compression symptoms. The typical presentation is insidious pain that lasts months or years. The objective of this study was to carry out a descriptive analysis of the initial clinical signs of patients with Naka's grade III lumbar SEL. materials and methods: Retrospective observational study in the Spinal Pathology Unit of 4 institutions, from 2010 to 2023. Patients over the age of 18, of both sexes, who consulted for low back pain with or without radiation and presented Naka's grade III lumbar lipomatosis on magnetic resonance imaging (MRI) were included. Results: We included 40 patients, with a mean age of 62.5 years; 75% were obese, there were no smokers. The most frequent reason for consultation was low back pain, with a median duration of 5.5 months. Conclusions: The most common reason for consultation was low back pain, with the exception of L3-S1 level involvement, which caused lumbar pain with radiation to the thigh. Patients with a longer period of pain (>6 months) were younger and had a lower BMI; although this was not statistically significant. Level of Evidence: IV

Modificación del corredor aorto-psoas para el acceso oblicuo lumbar intervertebral según los cambios posturales y la composición corporal. Estudio multicéntrico observacional mediante resonancia magnética / Modification of the safe corridor for oblique lumbar interbody fusion based on postural changes and body composition. An observational, multicenter study using MRI

Introducción: La cirugía mínimamente invasiva de columna se ha vuelto cada vez más popular en los últimos años. Se han desarrollado técnicas nuevas y menos invasivas que se han convertido en procedimientos de elección para determinadas enfermedades. El tamaño del corredor aorto-psoas es un factor determinante al elegir la técnica oblicua de fusión intersomática. Objetivos: Describir las modificaciones en el tamaño del corredor aorto-psoas en decúbito lateral derecho y decúbito supino mediante resonancia magnética y su asociación con el índice de masa corporal. materiales y métodos: Se realizó una resonancia magnética de los espacios discales de L1-L2 a L4-L5 a 13 voluntarios en decúbito supino y decúbito lateral derecho. Se midió el corredor y se comparó el tamaño en cada nivel. Resultados: El tamaño del corredor aorto-psoas y de la distancia arteria-disco tuvo un aumento estadísticamente significativo al posicionar al paciente en decúbito lateral derecho. Conclusiones: La resonancia magnética es de suma importancia en la planificación prequirúrgica, pues deja en evidencia la movilidad de las estructuras abdominales. Se producen cambios significativos en el corredor aorto-psoas y la distancia arteria-disco al ubicar al paciente en decúbito lateral derecho. Sin embargo, estos cambios no tienen una relación significativa con el índice de masa corporal. Nivel de Evidencia: IV

Introduction: Minimally invasive spine surgery (MISS) has gained popularity in recent years. New and less invasive techniques have emerged as the preferred procedures for certain pathologies. The size of the aorta-psoas corridor is decisive when choosing the oblique interbody fusion technique. Objectives: To describe the changes in the size of the aorta-psoas corridor in the right lateral decubitus and supine decubitus positions by magnetic resonance imaging and their association with body mass index. materials and methods: 13 volunteers underwent MRI of the disc spaces from L1-L2 to L4-L5 in the supine and right lateral decubitus positions. The corridor was measured, and the sizes at each level were compared. Results: A statistically significant increase in the size of the aorta-psoas corridor and the artery-disc distance was obtained when positioning the patient in the right lateral decubitus position. However, these have no significant relationship with BMI. Conclusions: The use of MRI in pre-surgical planning is extremely important. This study reveals the mobility of the abdominal structures. We can conclude that, as stated in the objective of the study, significant changes occur in the aorta-psoas corridor and the artery-disc distance when the patient is positioned in the right lateral decubitus position. Level of Evidence: IV

Estenosis espinal de triple región sintomática: reporte de un caso y revisión narrativa de la bibliografía / Symptomatic triple-region spinal stenosis: Case report and narrative literature review

La estenosis espinal de las tres regiones de la columna en simultáneo es un cuadro infrecuente que requiere una adecuada valoración clínica y de las imágenes. En la actualidad, no existen guías establecidas para su abordaje diagnóstico y terapéutico. El objetivo de este artículo es describir la presentación clínica, el tratamiento y la evolución en un paciente con triple estenosis y contrastarlos con la evidencia disponible a través de una revisión narrativa de la bibliografía. Se presenta a una mujer de 69 años de edad que consultó con un cuadro de paraparesia progresiva asociado a ciatalgia derecha y signos de motoneurona superior positivos. En los estudios por imágenes, se constató una triple estenosis: cervical, torácica y lumbar. Se procedió a la descompresión y la resección tumoral torácica asociadas al tratamiento conservador de las estenosis cervical y lumbar. La evolución era favorable al año de la cirugía. La estenosis espinal de triple región sintomática es una condición rara, las valoraciones clínicas y radiológicas adecuadas permitirán un diagnóstico correcto con un abordaje adecuado y oportuno. Nivel de Evidencia: IV

Simultaneous spinal stenosis across all three regions of the spine is an uncommon condition that requires proper clinical and imaging assessment. There are currently no established guidelines for its diagnosis and treatment. The objective of this paper is to describe, based on a case report, the clinical presentation, treatment, and progression of triple stenosis in a patient and compare it with available evidence through a narrative literature review. A 69-year-old woman presented with progressive paraparesis associated with right sciatica and positive signs of upper motor neuron involvement. Imaging confirmed triple stenosis: cervical, thoracic, and lumbar. She underwent thoracic decompression and tumor resection, as well as conservative treatment for cervical and lumbar stenoses, and showed favorable progress one year after surgery. Symptomatic triple-region spinal stenosis is an uncommon condition. Proper clinical and radiological assessments will enable an accurate diagnosis with appropriate and timely intervention. Level of Evidence: IV

Hernia extraforaminal en el espacio L5-S1 tratada por abordaje transfacetario endoscópico. Presentación de un caso y nota técnica / Extraforaminal L5-S1 disc herniation treated by endoscopic transfacet approach. Case report and technical note

Las hernias de disco extraforaminales en el espacio L5-S1 suelen ser difíciles de tratar por su complicado acceso y el riesgo de lesión nerviosa. Se presenta el caso de un paciente con discopatía en L5-S1 izquierda que fue tratado mediante discectomía endoscópica por abordaje símil Wiltse transfacetario. Este tipo de abordaje permite el acceso seguro a las hernias extraforaminales en el espacio L5-S1 evitando la manipulación e irritación de la raíz de L5. Nivel de Evidencia: IV

Extraforaminal L5-S1 disc herniations are usually difficult to treat due to their complicated access and risk of nerve injury. We present the case of a patient with left L5-S1 disc disease who was treated by endoscopic discectomy using a transfacet Wiltse-like approach. This method provides safe access to L5-S1 extraforaminal herniations while avoiding manipulation and irritation of the L5 root. Level of Evidence: IV

Pérdida de stock óseo no osteoporótico en la columna. Denosumab como herramienta de tratamiento e implicancia / Non-osteoporotic loss of spinal bone. Denosumab as a therapeutic tool and its implications

Introducción: El denosumab es un anticuerpo monoclonal humano que actúa contra el RANKL, inhibiendo la destrucción ósea mediada por los osteoclastos, así evitando la pérdida de stock óseo; por este motivo, se lo utiliza en el tratamiento de la osteoporosis como agente antiresortivo y está autorizado para el tratamiento del tumor de células gigantes y el mieloma múltiple. Nuestro objetivo fue conocer las indicaciones y contraindicaciones para la pérdida de stock óseo de causa no osteoporótica. Materiales y métodos: Revisión sistemática de artículos en inglés publicados en el período 2009-2023. Se incluyeron artículos que indicaran o contraindicaran el uso del denosumab. Resultados: De un total inicial de 4306 artículos, se analizaron 18 artículos que mostraban consenso en la dosis y los controles con tomografía e indicaban o contraindicaban el uso del denosumab. Conclusiones: El denosumab está indicado como una buena opción de tratamiento preferente de tumores vertebrales primarios inoperables, para evitar recidivas o demorar las metástasis de tumores primarios o de tumores sólidos, principalmente de mama, próstata y pulmón, y para el compromiso vertebral del mieloma múltiple. El denosumab está contraindicado, por el momento, para las lesiones infecciosas. Nivel de Evidencia: III

Background: Denosumab is a human monoclonal antibody that acts against RANKL, inhibiting bone destruction mediated by osteoclasts, thus avoiding bone loss. For this reason, it is used in the treatment of osteoporosis as an antiresorptive and is authorized for the treatment of giant cell tumor and multiple myeloma. Our objective is to understand its indications and contraindications for the treatment of non-osteoporotic bone loss. materials and methods: A systematic review of English-language articles published between 2009 and 2023, using PRISMA criteria. Articles indicating or contraindicating the use of denosumab were considered for inclusion. Results: From a total of 4306 articles, 18 articles were analyzed, which showed consensus on the dose and controls with tomography and indicated or contraindicated the use of denosumab. Conclusions: Denosumab is recommended as a primary therapeutic option for unresectable spinal tumors, to prevent recurrences or to delay the formation of metastases from primary tumors or solid tumors, primarily breast, prostate, and lung, as well as for multiple myeloma spinal involvement. Denosumab is currently contraindicated in infectious lesions. Level of Evidence: III

Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain? / A melhora da mobilidade e da força isométrica do tronco se correlacionam com a melhora da dor e da incapacidade após a reabilitação multimodal para dor lombar?

Abstract Objective To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results At the end of treatment, the mean NPRS (p< 0.0001) and ODI (p< 0.0001) scores, mean trunk extension (p< 0.0001), and flexion (p< 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension (p< 0.0001) and flexion (p< 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p= 0.006) and flexion strength (r = -0.28, p= 0.001), as well as between the ODI score and TIS extension (r = -0.30, p= 0.0007) and flexion (r = -0.28, p= 0.001). Conclusion Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.

Resumo Objetivo Determinar a correlação entre a amplitude de movimento (ADM) do tronco pós-tratamento e a força isométrica do tronco (FIT) e a dor e a incapacidade em pacientes submetidos à reabilitação multimodal para dor lombar (DL). Métodos Neste estudo de coorte prospectiva, 122 pacientes submetidos à reabilitação multimodal para DL foram analisados. Foram comparados os escores de escala numérica de dor pré- e pós-tratamento (END) e do índice de incapacidade Oswestry (Oswestry disability index - ODI), a ADM do tronco e a FIT. A correlação de Pearson foi utilizada para determinar a correlação entre desfechos clínicos e a ADM e a FIT pós-tratamento. Resultados Ao final do tratamento, as médias de ADM (p< 0,0001) e ODI (p< 0,0001), as ADMs médias de extensão (p< 0,0001) e a flexão (p< 0,0001) do tronco melhoraram significativamente. Da mesma forma, a FIT pós-tratamento, as FITs médias de extensão (p< 0,0001) e flexão (p< 0,0001) melhoraram significativamente. Houve uma correlação fraca entre o escore do END e a ADM de extensão (r = -0,24, p= 0,006) e força de flexão (r = -0,28, p= 0,001) pós-tratamento, assim como entre o escore de ODI e FIT de extensão (r = -0,30, p= 0,0007) e flexão (r = -0,28, p= 0,001) pós-tratamento. Conclusão Apesar da melhora significativa da dor, capacidade, ADM do tronco e FIT com tratamento multimodal, houve uma fraca correlação entre dor pós-tratamento e função e ADM e FIT de tronco. A melhora da dor e da função com o tratamento de reabilitação física para DL é um fenômeno complexo e precisa de uma investigação mais aprofundada.

Nasotracheal intubation awake in a patient with multiple fractures of the maxilla and cervical spine: A case report.

RATIONALE: Nasotracheal intubation is an advanced airway modality used in specific contexts, such as limited mouth opening, macroglossia, cervical spine instability. In addition, it can be performed with the patient awake, especially when predictors a difficult airway are unknown. PATIENT CONCERNS: A 41-year-old male with a lesion in the C1 cervical vertebra, associated with a fracture of the right maxilla, was intubated through the nasopharyngeal route while awake. The forms of induction were discussed. DIAGNOSES: Based on the mechanism of trauma and on the report of pain, associated with imaging examination, fracture of the body of the right maxilla and a complex fracture of the anterior arch of the C1 cervical vertebra were diagnosed. INTERVENTIONS: In this case, we present a patient with trauma to the face and spine who was intubated through the nasopharyngeal route while awake and guided by video laryngoscopy and using a rigid cervical collar. The patient was operated on under total general anesthesia (propofol and remifentanil) and plates and screws were placed for maxillary osteosynthesis. The pain was alleviated with a peripheral block of the trigeminal nerve of the maxillary branch with 0.5% levobupivacaine. OUTCOMES: The patient woke up from surgery, was extubated uneventfully and without pain. Cervical spine injuries were followed up by the neurosurgery team for conservative treatment. LESSONS: Patients with neck injury and facial trauma may need a definitive airway either for emergencies or for elective procedures. Intubating the awake patient may be an option when the anatomy of the cavity is unknown, and inducing the anesthetic act without this knowledge may be a inappropriate option, due to the risk of intubation/ventilation difficulties.

Acquired butterfly vertebra as a sequela of eosinophilic granuloma.

Butterfly vertebras are an abnormal embryological formation of the spinal bodies that occur because of a lack of fusion of the chondrification centers of the vertebral bodies. Langerhans cell histiocytosis is an entity that frequently involves vertebral bodies resulting in flat vertebras, and recovery of the vertebral body height is a very unusual finding. We present a case report of a pediatric patient with a thoracic acquired butterfly vertebra which occurred secondary to a Langerhans cell histiocytosis involvement. It is extremely rare to find vertebra plana that regains its complete height but is even more infrequent to evidence of a butterfly vertebra deformity that is not congenital.

Development of an intervertebral disc prosthesis prototype for the canine cervical spine / Desenvolvimento de um protótipo de prótese de disco intervertebral para a coluna vertebral cervical de cães

Cervical arthroplasty with disc prosthesis has been proposed as a treatment option for dogs with Cervical Spondylomyelopathy. The present study developed a novel vertebral disc prosthesis for dogs. Sixteen Functional Spinal Units (C5-C6) were collected from dog cadavers with body weights ranging between 25 and 35 kg, and their vertebral measurements were used to design a prosthetic disc. The sizing of the prosthesis was performed based on the averages of the measurements of width, height, and length of the vertebral bodies from C5-C6 of all specimens. The prosthesis was developed using the Rhinoceros 3D® and SolidWorks® programs, and 3D prototyping was carried out to define the best design. The developed prosthesis consisted of two independent parts that are fixed to the cranial and caudal vertebral bodies, in the intervertebral space, and fitted together by metal-to-metal surfaces capable of moving in the lateral, ventral, and dorsal directions. Each part of the prosthesis is angled in two portions: vertically, in the intervertebral space, and horizontally, in contact with the ventral surface of the vertebral bodies, both of which are fixed by means of monocortical locking screws. The design of the developed prototype allowed a good fit in the intervertebral space between C4-C5, C5-C6, and C6-C7.

A artroplastia cervical com prótese de disco tem sido proposta como uma opção de tratamento para cães com Espondilomielopatia Cervical. O presente estudo teve como objetivo desenvolver uma nova prótese de disco intervertebral para cães. Dezesseis Unidades Funcionais de Coluna Vertebral (C5-C6) foram coletadas de cadáveres de cães com peso corporal variando entre 25 e 35 kg, e suas medidas vertebrais foram usadas para projetar um disco intervertebral protético. O dimensionamento da prótese foi realizado com base nas médias das mensurações da largura, altura e comprimento dos corpos vertebrais de C5-C6 de todos os espécimes. A prótese foi desenvolvida nos programas Rhinoceros 3D® e SolidWorks® e utilizou-se prototipagem em 3D para a definição do melhor design. A prótese desenvolvida é formada por duas partes independentes que se fixam às espífises dos corpos vertebrais cranial e caudalmente ao espaço intervertebral, e se encaixam entre si por superfícies de metal-metal com capacidade de movimentação nas direções lateral, ventral e dorsal. Cada parte da prótese é angulada em duas porções: a vertical, que fica no espaço intervertebral, e a horizontal, que fica em contato com a superfície ventral dos corpos vertebrais, ambas as quais são fixadas por meio de parafusos bloqueados monocorticais. O design do protótipo desenvolvido permitiu bom encaixe no espaço intervertebral entre C4-C5, C5-C6 e C6-C7.

[Atlantoid assimilation: malformation, compensation or deformity. Is it part of basilar invagination?] / Asimilación atlantoidea: malformación, compensación o deformidad. ¿Es parte de la invaginación basilar?

INTRODUCTION: atlas assimilation can occur alone or in association with other craniocervical junction malformations and deformities. The etiological and pathological mechanisms are not clear. CASE PRESENTATION: patient in her sixth decade of life, who was treated at the "Eugenio Espejo" Hospital, with asymmetric pyramidal symptoms after a low-energy kinetic fall. The condition completely reverted with conservative management. The patient is currently under periodic observation. CONCLUSION: the atlas assimilation, a congenital malformation, often asymptomatic; it is part of an embryological compensation when it is associated with other malformations. The appearance of deformity is necessary to reach atlantoaxial instability that it is not early. The knowledge of the concepts and distinction of the craniocervical junction abnormalities allows to indicate the best treatment in order to obtain the most suitable results with the individualization of each case.

INTRODUCCIÓN: la asimilación atlantoidea puede presentarse sola o asociada a otras malformaciones y deformidades de la unión craneocervical, los mecanismos etiológicos y patológicos no están esclarecidos. PRESENTACIÓN DE CASO: paciente de la sexta década de vida, quien fue atendida en el Hospital de Especialidades "Eugenio Espejo", con datos clínicos piramidales asimétricos, posteriores a mecanismo de lesión de caída con cinética de baja energía. La sintomatología revirtió con manejo conservador. En la actualidad, la paciente está bajo observación periódica. CONCLUSIÓN: la asimilación atlantoidea es una malformación congénita muchas veces asintomática y parte de una compensación embriológica cuando está asociada a otras malformaciones. Es necesaria la aparición de deformidad para llegar a la inestabilidad atlantoaxoidea que no es temprana. El conocimiento y poder diferenciar los conceptos de las anormalidades de la unión craneocervical permiten indicar el mejor tratamiento y así obtener los resultados más adecuados con la individualización de cada caso.

Adolescent idiopathic scoliosis: progression of untreated cases / Escoliose idiopática do adolescente: progressão de casos não tratados / Escoliosis idiopática del adolescente: progresión de casos no tratados

ABSTRACT Objective: This study aims to evaluate angular progression of patients with a diagnosis of Adolescent Idiopathic Scoliosis (AIS), that await surgical treatment. Methods: This is an observational and descriptive study. Data were collected for age at initial surgical indication, initial date and Cobb angle, date and Cobb angle of the follow-up visit, time elapsed between the initial and follow-up visit, and type of curve. All recorded Cobb angles were reviewed by the authors. Results: 86.1% of the individuals were women, the mean age of indication for surgical treatment was 13.34 years. The most common type of curve was Lenke 3 and the one that progressed the most was Lenke 4. The general average of annual progression was 9.89 degrees for the primary curves and 12.32 for the secondary curves, and the follow-up was, on average, 35.77 months. Conclusion: The progression of the magnitude of the curve increases during the wait for the definitive treatment of AIS, no matter which group of the Lenke classification the curve belongs to. The secondary curves present a progression rate of 12.32º/year, higher than the main curve, which presents a rate of 9.89º/year. The waiting time has been increasing over the years, which is evident compared to older publications. Level of Evidence IV; Type of Study: Prognostic Study.

RESUMO: Objetivo: Este estudo tem como objetivo avaliar a progressão do valor angular de indivíduos com diagnóstico de Escoliose Idiopática do Adolescente (EIA) não tratada, aguardando procedimento cirúrgico. Métodos: Este é um estudo observacional e descritivo. Foram coletados os seguintes dados dos pacientes: idade da indicação cirúrgica inicial, data da avaliação inicial e ângulo de Cobb, data e ângulo de Cobb nas consultas de seguimento, tempo decorrido entre as consultas inicial e de seguimento, bem como os tipos de curva. Todos os ângulos de Cobb registrados foram revisados pelos autores. Resultados: 86,1% dos indivíduos eram mulheres, a idade média de indicação de tratamento cirúrgico foi de 13,34 anos. O tipo de curva mais comum foi a Lenke 3 e a que mais progrediu foi a Lenke 4. A média geral de progressão anual foi de 9,89 graus para as curvas primárias e 12,32 para as curvas secundárias e o acompanhamento foi em média de 35,77 meses. Conclusão: A progressão da magnitude da curva aumentou durante a espera pelo tratamento definitivo da EIA, não importando em qual grupo da classificação de Lenke a curva pertence. As curvas secundárias apresentaram taxa de progressão de 12,32º/ano que é maior se comparada com a curva principal que apresenta taxa de 9,89º/ano. O tempo de espera vem aumentando com o passar dos anos, sendo evidente quando comparado com as publicações mais antigas. Nível de Evidência IV; Tipo de Estudo: Estudo Prognostico.

RESUMEN: Objetivo: Este estudio tiene como objetivo evaluar la progresión del valor angular de individuos no tratados diagnosticados con Escoliosis Idiopática del Adolescente (EIA), que están en espera de un procedimiento quirúrgico. Métodos: Se trata de un estudio observacional y descriptivo. Se recogieron datos de edad de indicación quirúrgica inicial, fecha inicial y ángulo de Cobb, fecha y ángulo de Cobb de la visita de seguimiento, tiempo transcurrido entre la visita inicial y de seguimiento y tipo de curva. Todos los ángulos de Cobb registrados fueron revisados por los autores. Resultados: El 86,1% de los individuos eran mujeres, la edad media de indicación del tratamiento quirúrgico fue de 13,34 años. El tipo de curva más común fue Lenke 3 y el que más progresó fue Lenke 4. El promedio general de progresión anual fue de 9,89 grados para las curvas primarias y 12,32 para las curvas secundarias y el seguimiento fue en promedio de 35,77 meses. Conclusión: La progresión de la magnitud de la curva aumenta durante la espera del tratamiento definitivo de la EIA, independientemente del grupo de la clasificación de Lenke al que pertenezca la curva. Las curvas secundarias presentan una tasa de progresión de 12,32º/año, superior a la curva principal que presenta una tasa de 9,89º/año. El tiempo de espera ha ido aumentando a lo largo de los años, lo cual es evidente al compararlo con publicaciones más antiguas. Nivel de Evidencia IV; Tipo de Estudio: Estudio Pronostico.

Clinical acute presentation of lumbar facet joint ganglia with bilateral sciatica / Apresentação clínica aguda de quistos facetários lombares com ciatalgia bilateral / Presentación clinica aguda de quistes facetarios lumbares con dolor ciático bilateral

ABSTRACT Facet joint ganglia are benign cystic lesions located adjacent to a facet joint. The majority is asymptomatic. However, can cause important low-back pain and radiculopathy. Neurogenic deficit, claudication, and cauda equina syndrome have also been reported. The authors report two cases of acute low back pain with bilateral sciatica, dorsal foot dysesthesia, and hallux dorsiflexion/extension deficit, due to the presence of encapsulated cysts adjacent to the facet joints causing a significant reduction of the spinal canal. Urgent surgical decompression was performed in both patients with an uneventful recovery. Symptomatic facet joint ganglia is a highly unusual cause of back pain, although it can present with acute onset of bilateral sciatica and canal stenosis requiring urgent surgical decompression. This paper highlights facet joint synovial as a differential diagnosis of lumbar pain and describes two different surgical approaches with good outcomes. Level of Evidence IV; Case Series.

RESUMO: Os quistos facetários são lesões císticas benignas localizadas adjacentes a uma articulação facetária. A maioria é assintomática. No entanto, podem ser causa de importante dor lombar e radiculopatia. Estão ainda relatados casos de déficit neurogénico, claudicação e síndrome de cauda equina. Os autores apresentam dois casos de dor lombar aguda com ciatalgia bilateral, disestesia do dorso do pé e défice na dorsiflexão/extensão do hálux, causados por uma redução significativa do canal medular devido à presença de quistos encapsulados adjacentes às articulações facetarias. Os doentes foram submetidos a descompressão cirúrgica urgente com uma excelente recuperação. Os quistos facetários sintomáticas são uma causa rara de lombalgia, porém podem apresentar-se inicialmente com um quadro agudo de ciatalgia bilateral e estenose canalar com necessidade de descompressão cirúrgica urgente. Este artigo realça os quistos facetários como diagnóstico diferencial de lombalgia e descreve duas abordagens cirúrgicas diferentes com bons resultados. Nível de Evidência IV; Série de Casos.

RESUMEN: Los quistes facetarios son lesiones quísticas benignas situadas junto a una articulación facetaria. La mayoría es asintomática. Pero pueden causar dolor lumbar y radiculopatía importantes. También se han descrito déficit neurogénico, claudicación y síndrome de cauda equina. Los autores presentan dos casos de lumbalgia aguda con dolor ciático bilateral, disestesia del dorso del pie y déficit en la dorsiflexión/extensión del hallux, causados por una reducción significativa del canal medular debido a la presencia de quistes encapsulados adyacentes a las articulaciones facetarias. Los pacientes fueron sometidos a descompresión quirúrgica urgente con una excelente recuperación. Los quistes facetarios sintomáticos son una causa poco frecuente de lumbalgia, aunque pueden presentarse inicialmente con un cuadro agudo de dolor ciático bilateral y estenosis del canal que requiere descompresión quirúrgica urgente. Este artículo destaca los quistes facetarios como diagnóstico diferencial de la lumbalgia y describe dos abordajes quirúrgicos diferentes con buenos resultados. Nivel de Evidencia IV; Serie de Casos.

Utilidad de la medición de los músculos psoas y paraespinales mediante tomografía computarizada y resonancia magnética / Usefulness of the measurement of the psoas and paraspinal muscles by computed tomography and magnetic resonance

Introducción: La sarcopenia está revistiendo importancia en el estudio de diferentes enfermedades para predecir la morbimortalidad en el perioperatorio. Los objetivos de este estudio fueron evaluar la eficacia de la tomografía y la resonancia en la medición de la musculatura del psoas y los paraespinales, y comparar estos índices con la edad, el sexo y la enfermedad. materiales y métodos: Se utilizaron las tomografías computarizadas y las resonancias magnéticas de pacientes ambulatorios. La medición de los músculos se realizó en los pedículos de L3 y L4. Resultados: El estudio incluyó 18 tomografías y 34 resonancias. El rango de edad de los pacientes era de 15 a 80 años, divididos en grupos etarios. En los promedios globales, en ambos estudios, el sexo masculino estaba por encima del promedio global. Con respecto a los rangos etarios, se observó que el primer grupo (15-29 años) tenía un mayor volumen muscular y de unidades Hounsfield en el psoas comparado con el grupo >60 años. Los pacientes que consultaron por espondilolistesis tenían menos masa muscular que aquellos con discopatías. Conclusiones: No existe diferencia entre la resonancia magnética y la tomografía computarizada en cuanto a la medición de los músculos paraespinales y psoas. Queda en evidencia que la disminución del volumen muscular es común en pacientes de mayor edad y con enfermedades que afectan el balance espinal. Nivel de Evidencia: IV

background: Sarcopenia is becoming increasingly significant in the research of various diseases to predict morbidity and mortal-ity in the perioperative period. Objectives: The objectives of this study were to evaluate the efficacy of computed tomography and magnetic resonance imaging in measuring the psoas and paraspinal muscles and to compare these indexes with age, sex, and pathology. materials and methods: Computed tomography and magnetic resonance imaging of outpatients were used. Muscle measurements were taken at the L3 and L4 pedicles. Results: The study included 18 CT and 34 MRI scans. The patients were divided into groups based on their age range, which was 15 to 80 years. In the overall averages, males were above the global average in both studies. Regarding age ranges, it was observed that the first group (15-29 years) had a higher muscle volume and Hounsfield units in the psoas compared to the >60 age group. Patients consulting for spondylolisthesis had less muscle mass than those with discopathy. Conclusions: There is no difference between magnetic resonance imaging and computed tomography in measuring the paraspinal and psoas muscles. It is evident that the decrease in muscle volume is common in older patients and those with diseases that affect spinal balance. Level of Evidence: IV

Aspectos morfológicos del absceso epidural espinal piógeno / Morphological aspects of pyogenic spinal epidural abscess

Introducción: El absceso epidural espinal piógeno es la localización de una colección infecciosa dentro del canal raquídeo, por fuera del saco dural. El diagnóstico es difícil y las consecuencias son devastadoras a causa de la compresión o el compromiso vascular. La resonancia magnética tiene una alta sensibilidad y especificidad diagnósticas que aumentan si se administra un medio de contraste. Los objetivos de este estudio fueron: determinar la reproducibilidad inter- e intraobservador, y discriminar los distintos parámetros y diferencias entre especialidades. materiales y métodos: Veintisiete observadores independientes evaluaron 5 parámetros: región, ubicación, compromiso, asociación y perivertebral, absceso extravertebral anterior, lateral o posterior. Se analizaron 35 casos en tres oportunidades, se utilizó el coeficiente kappa. Resultados: El nivel de acuerdo global intra- e interobservador global fue kappa 0,76; los valores obtenidos fueron: región 0,94; ubicación 0,88; compromiso 0,55; asociación 0,67 y perivertebral 0,77. Los tres primeros parámetros dan noción de volumen y los dos últimos reflejan la presencia de focos infecciosos vertebrales por fuera del conducto. Conclusiones: La clasificación morfológica propuesta es de uso simple y tiene una muy buena tasa de reproducibilidad intra- e interobservador. Los parámetros con mayor reproducibilidad son: región y ubicación (>0,87). Nivel de Evidencia: III

Introduction: A pyogenic spinal epidural abscess is an infectious collection inside the spinal canal, outside the dural sac. The diagnosis is difficult and the consequences are devastating due to compression or vascular compromise. MRI has a high diagnostic sensitivity and specificity, which improves when a contrast medium is used. Objectives: To determine the inter- and intra-observer reproducibility, and to discriminate the different parameters and differences between specialties. Materials and methods: Twenty-seven independent observers evaluated 5 parameters: region, location, involvement, association, and perivertebral, anterior, lateral, or posterior extravertebral abscess. The kappa coefficient was used to analyze 35 cases on three occasions. Results: The overall intra- and inter-observer global agreement level is kappa 0.76, with the following values obtained: region 0.94; location 0.88; involvement 0.55; association 0.67 and perivertebral abscess 0.77. The first three parameters indicate volume, while the final two indicate the presence of vertebral infectious foci outside the canal. Conclusions: The proposed morphological classification is simple to use and has high intra- and inter-observer reproducibility. The most reproducible parameters are region and location (>0.87). Level of Evidence: III

Tratamiento endoscópico de la espondilodiscitis lumbar. Reporte de un caso y revisión bibliográfica / Endoscopic treatment of lumbar spondylodiscitis. Case report and literature review

Se describe el caso de un hombre de 62 años de edad, con múltiples comorbilidades que concurre a la consulta por dolor lumbar severo compatible con espondilodiscitis de T12-L1-L2. Se realizó una endoscopia con abordaje posterolateral izquierdo con técnica adentro-adentro para fines diagnóstico y terapéutico. Se aisló un germen y se administró un tratamiento antibiótico específico. Dada la buena evolución clínica del paciente, fue dado de alta a los 7 días de la cirugía, con buen manejo del dolor y antibióticos intravenosos en el domicilio. Se presenta una breve revisión bibliográfica. Nivel de Evidencia: IV

We describe the case of a 62-year-old male patient with multiple comorbidities who attended the outpatient clinic due to severe low back pain compatible with T12-L1-L2 spondylodiscitis. Endoscopy was performed with a left posterolateral approach and an all-inside technique for diagnostic and therapeutic purposes. A germ was isolated and treated with specific antibiotics. Due to the good clinical evolution, the patient was discharged 7 days after surgery with good pain management and home intravenous antibiotic therapy. A brief literature review is presented. Level of Evidence: IV

Bloqueos facetarios y radiculares selectivos como alternativa diagnóstica y terapéutica en pacientes con dolor lumbar crónico / Facet and selective nerve root blocks as a diagnostic and therapeutic alternative in patients with chronic low back pain

Introducción: Los bloqueos facetarios intrarticulares y radiculares selectivos son útiles como método diagnóstico y terapéutico para el manejo del dolor lumbar crónico. El objetivo de este estudio fue describir y analizar los resultados de dichos bloqueos. materiales y métodos: Se realizó un estudio de cohorte retrospectivo con datos de pacientes sometidos a bloqueos facetarios intrarticulares y radiculares selectivos guiados por tomografía computarizada, entre enero de 2014 y febrero de 2015. Se analizaron los datos demográficos, el puntaje en la escala analógica visual antes del bloqueo y después, y se analizó la asociación de estos factores con los resultados. Resultados: El estudio incluyó a 68 pacientes con bloqueo facetario intrarticular y 89 con bloqueo radicular selectivo. En ambos grupos, el dolor mejoró significativamente (p <0,05). Hubo una asociación entre la mejoría del dolor con los bloqueos facetarios intrarticulares y el sexo y la edad, y entre la mejoría lograda por los bloqueos radiculares selectivos y el tipo de dolor inicial. Conclusiones: Los bloqueos facetarios intrarticulares y los bloqueos radiculares selectivos son un método diagnóstico útil en el manejo del dolor lumbar crónico y su acción terapéutica es significativa, aunque hacen falta estudios para conocer su efecto analgésico a mediano y largo plazo, y así poder mejorar la calidad de vida de los pacientes. Nivel de Evidencia: IV

Introduction: Intra-articular facet blocks and selective nerve root blocks are useful as a diagnostic and therapeutic method for the management of chronic low back pain. The objective of this study was to describe and analyze the results of these blocks. materials and methods: A retrospective cohort study was conducted with data from patients undergoing CT-guided intra-articular facet block and selective nerve root block between January 2014 and February 2015. The demographic information, the visual analog scale's score before and after the block, and their relationships to the outcomes were analyzed. Results: The study included 68 patients with intra-articular facet block and 89 with selective nerve root block. In both groups, pain improved significantly (p < 0.05). There was an association between the improvement in pain with intra-articular facet blocks and gender and age, and between the improvement achieved by selective nerve root blocks and the type of initial pain. Conclusions: Intra-articular facet blocks and selective nerve root blocks are a useful diagnostic method in the management of chronic low back pain and their therapeutic action is significant, although studies are needed to know their analgesic effect in the medium and long term, in order to improve the quality of life of patients. .Level of Evidence: IV