Is Shoulder Imbalance a Useful Parameter in the Screening of Idiopathic Scoliosis? A Preliminary Study.

Objective The present study aims to analyze the use of shoulder imbalance as a parameter for scoliosis screening as well as its relationship with other parameters of physical examination. Methods This study assesses a smartphone application that analyzes several parameters of the physical examination in adolescent idiopathic scoliosis. Medical and non-medical examiners applied the screening tool in students in a public school and in a private sports club. After data collection, interobserver correlation was done to verify shoulder imbalance and to compare shoulder imbalance with Adam's bending test and with trunk rotation. Results Eighty-nine participants were examined, 18 of whom were women and 71 of whom were men. Two subjects were excluded from the analysis. The mean age of subjects from the public school was 11.30 years and, for those from the sports club, it was 11.92 years. The examiners had poor-to-slight interobserver concordance on shoulder asymmetry in the anterior and posterior view. No significant statistical correlation was found between shoulder asymmetry and positive Adam's forward bending test. Conclusion Our preliminary study shows that the shoulder asymmetry has a poor correlation with the Adam's forward bending test and measuring trunk rotation using a scoliometer. Therefore, the use of shoulder imbalance might not be useful for idiopathic scoliosis screening. Level of Evidence III; Diagnostic Study.

Is Shoulder Imbalance a Useful Parameter in the Screening of Idiopathic Scoliosis? A Preliminary Study / O desequilíbrio do ombro é um parâmetro útil na triagem da escoliose idiopática? Um estudo preliminar

Abstract Objective The present study aims to analyze the use of shoulder imbalance as a parameter for scoliosis screening as well as its relationship with other parameters of physical examination. Methods This study assesses a smartphone application that analyzes several parameters of the physical examination in adolescent idiopathic scoliosis. Medical and non-medical examiners applied the screening tool in students in a public school and in a private sports club. After data collection, interobserver correlation was done to verify shoulder imbalance and to compare shoulder imbalance with Adam's bending test and with trunk rotation. Results Eighty-nine participants were examined, 18 of whom were women and 71 of whom were men. Two subjects were excluded from the analysis. The mean age of subjects from the public school was 11.30 years and, for those from the sports club, it was 11.92 years. The examiners had poor-to-slight interobserver concordance on shoulder asymmetry in the anterior and posterior view. No significant statistical correlation was found between shoulder asymmetry and positive Adam's forward bending test. Conclusion Our preliminary study shows that the shoulder asymmetry has a poor correlation with the Adam's forward bending test and measuring trunk rotation using a scoliometer. Therefore, the use of shoulder imbalance might not be useful for idiopathic scoliosis screening. Level of Evidence III; Diagnostic Study

Resumo Objetivo O objetivo deste estudo é analisar o uso da assimetria de ombros como parâmetro para a triagem de escoliose e sua relação a outros parâmetros do exame físico. Métodos Este estudo avalia um aplicativo para smartphone que analisa diversos parâmetros do exame físico de adolescentes com escoliose idiopática. Examinadores médicos e não médicos utilizaram o instrumento de triagem em alunos de uma escola pública e de um clube esportivo privado. Após a coleta de dados, a correlação interobservador foi determinada para verificar a assimetria de ombros e compará-la ao teste de inclinação de Adam e à medição da rotação do tronco. Resultados Oitenta e nove participantes foram examinados, sendo 18 do sexo feminino e 71 do sexo masculino. Dois indivíduos foram excluídos da análise. A média de idade dos participantes da escola pública foi de 11,30 anos e do clube esportivo, 11,92 anos. Os examinadores apresentaram concordância interobservador baixa a branda quanto à assimetria de ombros em incidência anterior e posterior. Não houve correlação estatística significativa entre a assimetria de ombros e o resultado positivo no teste de inclinação do tronco de Adam. Conclusão Nosso estudo preliminar mostra que a assimetria de ombros tem baixa correlação com o teste de inclinação de Adam e assim como com a medição de rotação do tronco com escoliômetro. Portanto, o uso da assimetria de ombros pode não ser útil na triagem da escoliose idiopática. Nível de Evidência III; Estudo Diagnóstico

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.

International and Multicenter Prospective Controlled Study of Dysphagia After Anterior Cervical Spine Surgery.

BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group ( P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

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.

Prevention of Surgical Site Infections in Spine Surgery: An International Survey of Clinical Practices Among Expert Spine Surgeons.

STUDY DESIGN: Questionnaire-based survey. OBJECTIVES: Surgical site infection (SSI) is a common complication in spine surgery but universal guidelines for SSI prevention are lacking. The objectives of this study are to depict a global status quo on implemented prevention strategies in spine surgery, common themes of practice and determine key areas for future research. METHODS: An 80-item survey was distributed among spine surgeons worldwide via email. The questionnaire was designed and approved by an International Consensus Group on spine SSI. Consensus was defined as more than 60% of participants agreeing to a specific prevention strategy. RESULTS: Four hundred seventy-two surgeons participated in the survey. Screening for Staphylococcus aureus (SA) is not common, whereas preoperative decolonization is performed in almost half of all hospitals. Body mass index (BMI) was not important for surgery planning. In contrast, elevated HbA1c level and hypoalbuminemia were often considered as reasons to postpone surgery. Cefazoline is the common drug for antimicrobial prophylaxis. Alcohol-based chlorhexidine is mainly used for skin disinfection. Double-gloving, wound irrigation, and tissue-conserving surgical techniques are routine in the operating room (OR). Local antibiotic administration is not common. Wound closure techniques and postoperative wound dressing routines vary greatly between the participating institutions. CONCLUSIONS: With this study we provide an international overview on the heterogeneity of SSI prevention strategies in spine surgery. We demonstrated a large heterogeneity for pre-, peri- and postoperative measures to prevent SSI. Our data illustrated the need for developing universal guidelines and for testing areas of controversy in prospective clinical trials.

Why are frailty indices not used systematically during preoperative spine consultations?

INTRODUCTION: Frailty indices are highly predictive of major medical and mechanical complications, lengths of hospital stay, and mortality rates after spine procedures. However, several barriers limit the extent to which spine surgeons employ these indices. The main purposes of the current study were to assess the use of frailty indices by Latin-American spine surgeons and identify the main barriers perceived to restrict their clinical application. METHODS: For this cross-sectional survey, a questionnaire evaluating the demographic characteristics of participating surgeons and their utilization of frailty indices were created in Google form and sent by e-mail to every registered member of AO Spine Latin America between October and November 2020. RESULTS: Of the 1047 surgeons sent the survey, 293 responded (response rate=28%). Half of the surgeons (51.7%) said they were unfamiliar with the terms ¨frailty´ and ¨frailty index", while 70.3% claimed not to use any frailty scale during their pre-operative assessments. The most frequently utilized index was the modified Frailty Index (mFI) (18%). The most important perceived barrier was the excessive amount of time required to calculate each patient's frailty score. Ninety-two percent of the spine surgeons felt sure that these scores could influence their therapeutic decisions, while 91% desired an easier-to-use risk-prevention scale. CONCLUSION: The main perceived barriers restricting the use of frailty indices were the time required to complete them, lack of index validation, and need for specific instruments to calculate the index score.

Scientometric Analysis of Publications from 2004-2021 in the Spine Surgery Field: A Latin American Perspective.

OBJECTIVE: To determine characteristics of Latin American (LA) productivity in spine surgery published worldwide between 2004 and 2021 compared between periods and global literature. METHODS: A comprehensive search about LA productivity in the field of spine surgery using the Scopus and PubMed databases was performed in February 2022. The results were limited to articles published in indexed journals from 2004 to 2021. RESULTS: A total of 1447 publications were identified in the study period. The number of publications has increased across evaluated decades, with 583 between 2004 and 2013 (58.3/year) and 864 between 2014 and 2021 (108/year), and a yearly increase was demonstrated (P = 0.0001). Comparing the most productive year in the first (2012) and last decade (2020), a 1.79-fold increase was demonstrated. Brazil ranked first in productivity (51.14%), followed by Mexico (26.40%) and Argentina (8.64%). Coluna/Columna published the largest number, with 309 articles (21.35%). The top 10 institutions published at least 475 (32.82%) and the most productive was the University of Campinas (Brazil, 74). CONCLUSIONS: This scientometric study is one of the first regional evaluations worldwide. The number of publications in the spine surgery field in Latin America has continued to increase over evaluated decades from 58.3 per year to 108, and a 1.79-fold increase between the most productive years for each decade. Brazil is still the greatest contributor (51.14%), with Mexico (26.40%) and Argentina (8.64%) as growing contributor countries. Most publications were classified as Level of Evidence 4, and this result reflects the importance of continuous research development in the quality of research for our region.

Knowledge, attitudes, and behaviors regarding the use of clinical practice guidelines among spine surgeons in Latin America.

Background: Clinical Practice Guidelines (CPGs) are invaluable tools to assure evidence-based spine surgery care. In this study, we aimed to identify perceptions, barriers, and potential determinants for the use of CPG among Latin American spine surgeons. Methods: A 28-item questionnaire regarding the use of CPGs was sent to the members of AO Spine Latin America. The questionnaire was subdivided into three sections: (1) demographic data; (2) perceptions and awareness of CPGs; (3) and potential barriers to CPG use. Multivariate logistic regression was performed to assess potential associations with CPG use. Results: A total of 304 spine surgeons answered the questionnaire. Most of the participants were male (91.8%) and orthopedic spine surgeons (52.3%) who averaged 45-65 years of age. Most respondents were aware of some CPGs for spine care (68.8%) and reported using them (70.4%); lack of awareness about CPGs was the most frequent barrier to their use (65.1%). Conclusion: Awareness of CPGs in spine surgery is of paramount importance for their use. Educational programs explaining the importance and benefits of spine care CPG surgical and clinical practice would increase the adherence of physicians to the guidelines.

Representation of Women on Editorial Boards of Medline-Indexed Spine, Neurosurgery, and Orthopedic Journals.

BACKGROUND: Both neurosurgery and orthopedic surgery are male-dominated specialties. However, the prevalence of women appears to be even lower in the spine surgery field. We intend to determine this prevalence on the editorial boards of spine, neurosurgery, and orthopedic journals. METHODS: The gender of editorial board members of Medline-indexed spine, neurosurgery, and orthopedic journals was systematically analyzed in 2019, and female representation was compared among these fields. RESULTS: In the 34 journals included (5 spine, 13 neurosurgery, and 16 orthopedic journals), women represented 8.84% (N = 185/2094) of editorial board members. Their representation was 5.53% (N = 30/542) in spine, 8.58% (N = 47/548) in neurosurgery, and 10.77 % (108/1003) in orthopedic journals. Only 5.4% (N = 2/37) of the editors-in-chief were women. The likelihood of having female members was higher in orthopedic than in spine journals (OR = 2.06; 95% CI = 1.35-3.13; P = 0.001). Neurosurgery journals did not show a significant greater likelihood of having female editorial board members than spine journals (OR = 1.60; 95% CI = 0.99-2.57; P = 0.058). CONCLUSIONS: The representation of women on editorial boards of spine, neurosurgery, and orthopedic journals is very low and appears to be even lower for spine surgery. However, it is still not understood whether or not women are barred from advancing in academics by gender bias within these specialties.

Genotoxic parameters of human degenerated intervertebral discs are linked to the pathogenesis of disc degeneration.

BACKGROUND: Degenerative disc disease (DDD) is a prevalent disorder that brings great incapacity and morbidity to the world's population. Its pathophysiology is not fully understood. DNA damage can influence this process, but so far, there have been few studies to evaluate this topic and its true importance in DDD, as well as whether there is a relation between degeneration grade and DNA damage. The objective of this study is to evaluate the degree of damage to the DNA and the relation to the severity of DDD and measure its response to this insult compared to live/dead cell parameters and reactive oxygen species activity in human discs. METHODS: An experimental study was performed with 15 patients with grade IV or V Pfirrmann classification who underwent spinal surgery. Five patients were operated on two levels, resulting in 20 samples that were submitted to the comet assay to measure DNA damage. Of these, six samples were submitted to flow cytometry, and apoptosis, necrosis, cell membrane integrity, intracellular esterase activity, reactive oxygen species (ROS), caspase 3 and mitochondrial membrane potential were evaluated. RESULTS: All samples had DNA damage, and the average of index damage (ID) was 78.1 (SD ± 65.11) and frequency damage (FD) was 49.3% (SD ± 26,05%). There was no statistical difference between the Pfirrmann grades and genotoxic damage. Likewise, all samples that underwent flow cytometry showed apoptosis and ROS to many different degrees. CONCLUSIONS: DNA damage occurs in high-grade degeneration of human discs and contributes to activation of the apoptosis pathway and ROS production that can accelerate disc degeneration.

Surgical timing in traumatic spinal cord injury: current practice and obstacles to early surgery in Latin America.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To evaluate current practice of Latin American spine surgeons regarding surgical timing in patients with traumatic spinal cord injury (tSCI) and to identify potential barriers for early surgery. SETTING: Web-based. METHODS: A web-based questionnaire was sent to members of AOSpine Latin America. Questions involved demographic features, familiarity with management of tSCI, and timing of surgery in various tSCI scenarios. The participants were also asked if they would like to operate earlier on patients with tSCI, indicating potential obstacles to early surgery. RESULTS: A total of 307 surgeons answered the questionnaire. Early surgery (<24 h) is performed by 66.8% for ASIA A, 76.9% for ASIA B, and 76.9% for ASIA C/D injuries. For traumatic cauda equina syndrome (tCES), 85.2% performed surgery within 24 h. For traumatic central cord syndrome (tCCS) without osteoligamentous instability, only 31.5% performed surgery within 24 h and 41.2% follow-up on these patients, indicating surgery if no symptom improvement. Early surgery was performed always or in most cases by 50.4% and 41.8% of surgeons for incomplete and complete tSCI, respectively. The majority (85.4%) would like to operate earlier on patients with tSCI than they actually do. The most frequently perceived barriers to early surgery were difficulty of access to surgical implants (70.9%) and delay in patient transport to reference hospital for surgery (57.8%). CONCLUSION: Latin American spine surgeons tend to operate earlier on patients with tCES and incomplete tSCI, then on those with complete tSCI and tCCS. The most reported obstacles for early surgery involved healthcare resources.

Evaluation of Blended Online Learning in Three Spinal Surgery Educational Courses.

COVID-19 pandemic created a need to improvise and redefine blended learning to be executed fully online. Background information on the effectiveness of fully online blended learning activities, especially for surgical disciplines is limited. This study describes a fully online blended learning course format on spinal surgery and aims to provide data regarding it effectiveness. Fully online blended courses on three topics of spinal surgery designed as six-week asynchronous and followed by 3-day live parts. Learning gaps (LGs) were identified with a survey at the beginning of asynchronous part, at its end, and at the end of the live part. The effectiveness of the asynchronous and live parts was assessed by LGs and a quiz, login statistics of learners and faculty and a post-course survey. Participants' LGs decreased in all courses, statistically significant in two. Faculty and learner login rates significantly correlated with each other. Faculty and learner satisfaction was very high. A fully online blended learning course can be delivered effectively on spine surgery with a high participant and faculty satisfaction rate. The asynchronous part contributes to learning significantly.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study

ABSTRACT BACKGROUND: Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE: To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING: Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS: Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS: The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS: The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study.

BACKGROUND: Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE: To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING: Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS: Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS: The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS: The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Perception of gender discrimination among spine surgeons across Latin America: a web-based survey.

BACKGROUND CONTEXT: Female physicians rarely choose spine surgery as their specialty. Although the specialty's nature and its associated lifestyle are potential barriers, gender-related issues may play an important part. PURPOSE: To evaluate the gender discrimination among spine surgeons across Latin America. STUDY DESIGN: Cross-sectional survey. PATIENT SAMPLE: The participants in this study were 223 AO Spine Latin America (AOSLA) registered members who answered the web-based survey. OUTCOME MEASURES: Personal and professional demographics; gender-related objective and subjective experiences regarding career and personal life. METHODS: A survey link containing a 24-item questionnaire was sent to the members' e-mails in September 2019. The survey was designed to evaluate the perception of gender discrimination by spine surgeons during their academic and professional lives. RESULTS: Out of 223 members who answered the survey, 196 (87.96%) were male and 27 (12.11%) female. Most were orthopedic surgeons (64.13%), ≥40 years of age (55.16%), and had <20 years of experience (69.95%). Gender discrimination was more frequent among women than among men (66.67% vs. 1.02%), as did discouragement from becoming a spine surgeon, orthopedic surgeon, or neurosurgeon (81.48% vs. 0.51%). Females reported higher rates of sexual harassment (44.44% vs. 7.65%) and more often felt disadvantaged because of gender (55.56% vs. 2.55%). Working harder than men to achieve the same prestige and lack of female mentorship were the most common obstacles reported by women (55.56%). Residency/fellowship influenced the decision to postpone/avoid having children for 66.67% of women but only 37.75% of men. Creation of a Women's Committee in AO Spine was supported by 74.07% of women and 38.78% of men. CONCLUSIONS: Gender-based discrimination affects women more frequently than men in spine surgery. These experiences likely contribute to the low prevalence of female spine surgeons. Efforts to mitigate bias and support the professional development of women in neurosurgery, orthopedics and spine communities are encouraged.

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.

Hyaluronic Acid In Vitro Response: Viability and Proliferation Profile of Human Chondrocytes in 3D-Based Culture.

OBJECTIVES: This study aimed to evaluate the efficacy of hyaluronic acid in the viability and proliferation profile of human femoral-tibial joint cartilage affected by osteoarthritis using in vitro models of chondrocytes in a 2-dimensional (2D)- and 3-dimensional (3D)-based culture model by spheroids. DESIGN: In vitro study of knee cartilage affected by osteoarthritis that required surgical treatment. Samples were cultured and exposed to hyaluronic acid (100 and 500 µM; intervention group) or vehicle solution. In monolayer or 2D culture, proliferation and cell viability were measured, and nuclear morphometry was analyzed by 4',6'-diamino-2-fenil-indol (DAPI) staining. The 3D-based culture established from the culture of articular cartilage of patients submitted to total knee arthroplasty evaluated the diameter, viability, and fusion ability of the chondrospheres created. RESULTS: Samples from 3 patients resulted in viable cultures, with chondrocyte cells exhibiting a potential for cell proliferation and viability to establish a culture. Hyaluronic acid (100 and 500 µM) improved chondrocyte viability and proliferation up to 72 hours in contact when compared with the control group, and no nuclear irregularities in morphology cell characteristics were observed by DAPI. In the 3D evaluation, hyaluronic acid (500 µM) improved the cellular feedback mechanisms, increasing the survival and maintenance of the chondrospheres after 7 days of analysis, showing the intrinsic capacity of chondrospheres grouped in the attempt to rearrange and reestablish new articular tissue. CONCLUSIONS: The 2D- and 3D-based culture models with hyaluronic acid improved chondrocyte viability and proliferation and demonstrated the ability of freshly formed chondrospheres to undergo fusion when placed together in the presence of hyaluronic acid.

Spine Surgeons Burnout and Quality of Life: Results of a Worldwide Survey.

STUDY DESIGN: Cross-sectional survey study. OBJECTIVE: To evaluate the prevalence of burnout, assess the personal and professional characteristics associated with burnout in spine surgeons and determine their quality of life. SUMMARY OF BACKGROUND DATA: Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and decreased sense of accomplishment that leads to decreased effectiveness at work. To date, there has been a lack of information on the prevalence of burnout among spine surgeons worldwide and the risk factors associated with this condition. METHODS: An electronic survey with members of AO Spine was performed in May 2018. The survey evaluated demographic variables, practice characteristics, burnout, and quality of life. Maslach Burnout Inventory (MBI) and EuroQol 5-dimensions (EQ5D) were used to evaluate burnout and quality of life, respectively. RESULTS: A total of 818 surgeons from 86 countries completed the survey. The prevalence of burnout was 30.6%. In the multiple linear model, emotional fatigue was independently associated with younger age (B = -0.17, CI95% = -0.26 to -0.07, P < 0.0001), and longer working hours per week (B = -2.71, CI95% = -4.34 to -1.07, P = 0.001); depersonalization was independently associated with younger age (B = -0.13, CI95% = -0.19 to -0.07, P < 0.0001), practicing outside Latin America (LA) (B = 0.71, CI95% = 0.41-1.01, P < 0.0001) and currently being a fellow (B = 0.54, CI95% = 0.06-1.02, P = 0.02); and higher scores of personal fulfilment was associated with practicing in LA (B = -1.27, CI95% = -1.69 to -0.85, P < 0.0001). CONCLUSION: Burnout is a common condition among spine surgeons worldwide. There is a significant association between burnout scores and decreased general quality of life. These results highlight the need to develop interventional programs to better identify, prevent, and manage this condition among practicing spine surgeons.Level of Evidence: 4.