Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data.

OBJECTIVE: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). METHODS: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. RESULTS: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. CONCLUSIONS: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data / Impacto da cirurgia na dor, incapacidade e qualidade de vida de portadores de doença degenerativa lombar: dados brasileiros

ABSTRACT Objective: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). Methods: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. Results: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. Conclusions: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

RESUMO Objetivo: Descrever o impacto da cirurgia na dor, incapacidade, qualidade de vida e a satisfação global do paciente numa amostra unificada de pacientes portadores de DDL. Métodos: Análise retrospectiva de dados colhidos prospectivamente em pacientes operados no período de janeiro de 2014 a março de 2017, que tivessem avaliação pré-operatória e pelo menos uma avaliação pós-operatória entre 6 e 12 meses com os questionários de ODI, SF-36 e o ISP. Resultados: Um total 216 pacientes preenchia os critérios de inclusão. Houve melhora no escore médio de dor (201,2%), incapacidade (39,7%), qualidade de vida física (42%) e mental (37,8%). Da amostra, 57,7% alcançaram o MCID de dor, 59,7% de ODI, 59,7% 50,5% de PCS e 50,5% de MCS; 82,5% dos pacientes se consideraram "Satisfeitos". Conclusões: O efeito da cirurgia foi amplamente favorável na dor, incapacidade e qualidade de vida dos pacientes portadores de DDL. Estes dados podem servir de guia para aconselhamento pré-operatório quanto às perspectivas de sucesso.

Comparative study between cortical bone graft versus bone dust for reconstruction of cranial burr holes.

BACKGROUND: As a consequence of the progressive evolution of neurosurgical techniques, there has been increasing concern with the esthetic aspects of burr holes. Therefore, the objective of this study was to compare the use of cortical bone graft and bone dust for correcting cranial deformities caused by neurosurgical trephines. METHODS: Twenty-three patients were enrolled for cranial burr hole reconstruction with a 1-year follow-up. A total of 108 burr holes were treated; 36 burr holes were reconstructed with autogenous cortical bone discs (33.3%), and the remaining 72 with autogenous wet bone powder (66.6%). A trephine was specifically designed to produce this coin-shaped bone plug of 14 mm in diameter, which fit perfectly over the burr holes. The reconstructions were studied 12 months after the surgical procedure, using three-dimensional quantitative computed tomography. Additionally, general and plastic surgeons blinded for the study evaluated the cosmetic results of those areas, attributing scores from 0 to 10. RESULTS: The mean bone densities were 987.95 ± 186.83 Hounsfield units (HU) for bone fragment and 473.55 ± 220.34 HU for bone dust (P < 0.001); the mean cosmetic scores were 9.5 for bone fragment and 5.7 for bone dust (P < 0.001). CONCLUSIONS: The use of autologous bone discs showed better results than bone dust for the reconstruction of cranial burr holes because of their lower degree of bone resorption and, consequently, better cosmetic results. The lack of donor site morbidity associated with procedural low cost qualifies the cortical autograft as the first choice for correcting cranial defects created by neurosurgical trephines.

Avaliação do erro nas coordenadas de localização estereotática guiada por tomografia computadorizada do encéfalo / CT-guided stereotactic localization for brain lesions. An evaluation of the error in the acquisition and calculation of the coordinates

São analisados 106 procedimentos em pacientes submetidos à estereotomografia. Os procedimentos foram realizados para obtenção de biópsias cerebrais, orientação de craniotomias, colocação de cateter em cavidade tumoral, drenagem de hematoma e de abscesso intracerebrais. As orientações de craniotomia foram realizadas para localizar más-formações arteriovenosas, tumores e processos inflamatórios, em 21 pacientes. As biópsias cerebrais estereotáticas, realizadas em 82 casos para diagnóstico anatomopatológico, apresentaram índice de positividade de 87,5 por cento, com complicações em 1,2 por cento dos casos. São analisadas estatisticamente as variáveis, como: idade, sexo, procedimento realizado, diagnóstico anatomopatológico e volume das lesões. É discutida a imprecisão na aquisição e cálculo das coordenadas estereotáticas com a tomografia computadorizada do encéfalo e verificada a precisão do método estereotomográfico com a utilização de um phanton. O maior erro das coordenadas foi de 6,8 mm com cortes tomográficos axiais de 4 mm a 5 mm.

Lipoma of the cerebellopontine angle: case reports and literature review

Säo estudados dois pacientes com lipoma no ângulo pontocerebelar (APC), submetidos a tratamento cirúrgico. A literatura disponível foi revisada, tendo sido identificados 29 casos submetidos a tratamento cirúrgico, com a mesma lesäo. As manifestaçöes clínicas, possibilidades dos métodos diagnósticos, indicaçöes cirúrgicas e estratégias operatórias säo discutidas. Chama-se a atençäo para as peculiaridades dos lipomas do APC e as discutível validade da tentativa de remoçäo completa em todos os casos