RESUMO
ABSTRACT Around 6% of the elderly population over 65 years of age are affected by adult spinal deformity (ASD). The increasing prevalence of ASD with aging has prompted discussion regarding the use of various techniques for its treatment, such as surgery and conservative treatment. The objective of this study is to investigate whether surgical treatment demonstrates significant benefits as compared to conservative treatment. A literature review was conducted, focusing on the most relevant papers on the topic published in the last five years. Surgical treatment, which costs an average of US$ 99,114 per procedure, enables almost instant improvement of the pain and disability of ASD. The rate of perioperative complications in ASD is approximately 7.5%, and the average improvement in back pain is 6.2 times higher in the surgical approach than in conservative treatment. In addition, the use of modern operative techniques, such as minimally invasive surgery (MIS), reduces the complications and greatly improves patients' quality of life, compared to open surgery. Therefore, the expected benefits of surgical treatment meets the patient's expectations by eliminating the pain caused by ASD. Although surgical treatment has a higher cost and a greater risk of complications, the use of minimally invasive techniques give the ASD patient a better quality of life. Level of evidence III; Non-Systematic Review.
RESUMO Adultos com deformidade na coluna (ASD) representam cerca de 6% da população idosa com mais de 65 anos de idade. Assim, a crescente prevalência da doença com o envelhecimento leva à uma discussão sobre o uso de várias técnicas para tratar ASD, como cirurgia e tratamento conservador. O objetivo deste estudo é verificar se os benefícios do tratamento cirúrgico mostram melhora significativa em relação ao tratamento conservador. Foi realizada uma revisão da literatura dos trabalhos mais relevantes dos últimos 5 anos, que eram pertinentes ao tema do presente estudo. Com um custo médio de US$ 99,114 por procedimento, o tratamento cirúrgico permite a melhora instantânea da dor e da incapacidade causada aos ASD e apresenta uma taxa de complicações perioperatórias de aproximadamente 7.5% . A média de melhora na dor nas costas é 6.2 vezes maior na abordagem cirúrgica do que o apresentado pelo tratamento conservador. Além disso, o uso de modernas técnicas operatórias, como a cirurgia minimamente invasiva (MIS), que permite a diminuição das complicações e uma melhora muito superior na qualidade de vida, diferentemente da cirurgia aberta. Assim, o ganho esperado com o tratamento cirúrgico atende as expectativas do paciente ao eliminar o processo doloroso nos ASD. A escolha pelo tratamento cirúrgico, apesar de apresentar um custo mais elevado e um maior risco de complicações, e o uso de técnicas minimamente invasivas, permitem ao paciente ASD uma melhor qualidade de vida. Nível de evidência III; Revisão não Sistemática.
RESUMEN Alrededor del 6% de las personas mayores de 65 años de edad se ven afectadas por la deformidad espinal adulta (DEA). La creciente prevalencia de DEA con el envejecimiento ha impulsado la discusión sobre el uso de diversas técnicas para su tratamiento, como la cirugía y el tratamiento conservador. El objetivo de este estudio es investigar si el tratamiento quirúrgico demuestra beneficios significativos en comparación con el tratamiento conservador. Una revisión de la literatura, centrada en los artículos más relevantes se llevó a cabo en los últimos cinco años. Con un costo promedio de US$ 99.114, el tratamiento quirúrgico permite una mejora casi instantánea del dolor y la discapacidad de de DEA. La tasa de complicaciones perioperatorias la DEA es aproximadamente del 7,5%, y la mejoría promedio en el dolor de espalda es 6,2 veces mayor en el tratamiento quirúrgico que en el tratamiento conservador. Además, el uso de técnicas quirúrgicas modernas, como cirugía mínimamente invasiva (CMI) reduce las complicaciones y mejora en gran medida la calidad de vida de los pacientes en comparación con la cirugía abierta. Por lo tanto, los beneficios esperados del tratamiento quirúrgico cumplen con las expectativas del paciente al eliminar el dolor causado por la DEA. Aunque el tratamiento quirúrgico tiene un costo más elevado y un mayor riesgo de complicaciones, el uso de técnicas mínimamente invasivas permite que el paciente con DEA tenga una mejor calidad de vida. Nivel de evidencia III; Revisión no Sistemática.
Assuntos
Humanos , Qualidade de Vida , Doenças da Coluna Vertebral , Cirurgia Geral , Terapêutica , Custos e Análise de Custo , Tratamento ConservadorRESUMO
BACKGROUND: Spine surgeries performed via the posterior approach have a higher infection rate. Several theories have been proposed, including poor hygienic condition of bed sheets and traumatized muscle associated with supine position promoting circulatory impairment. We investigated the influence of supine position on the rate of deep wound infection after spine surgery by the posterior approach. METHODS: A total of 106 patients were randomly divided into 2 groups: lateral decubitus only versus dorsal and lateral decubitus. Patient follow-up after hospital discharge was performed at 30, 60, 180, and 360 days. Deep wound infection was diagnosed according to U.S. Centers for Disease Control and Prevention criteria. RESULTS: Patient sample was mainly composed of patients with neoplastic disease and patients with trauma. Postoperative wound infection developed in 12 cases (11.3%), and Streptococcus aureus was the most common pathogen. Incidence of postsurgical deep wound infection was significantly greater in the control group (P = 0.004). CONCLUSIONS: Supine position was significantly correlated with higher rates of wound infection among patients who underwent spine surgery by the posterior approach. Avoidance of supine position may represent a modifiable risk factor to diminish postoperative spine infection rates.
Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Posicionamento do Paciente/métodos , Doenças da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Decúbito Dorsal , Infecção da Ferida Cirúrgica/etiologia , Adulto JovemRESUMO
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.
RESUMO
Adipose lesions rarely affect the peripheral nerves. This can occur in two different ways: Direct compression by an extraneural lipoma, or by a lipoma originated from the adipose cells located inside the nerve. Since its first description, many terms have been used in the literature to mention intraneural lipomatous lesions. In this article, the authors report a case of a 62-year-old female who presented with an intraneural median nerve lipoma and review the literature concerning the classification of adipose lesions of the nerve, radiological diagnosis and treatment.
RESUMO
Vertebroplasty and kyphoplasty are widely used for osteoporotic and cancer-related vertebral compression fractures refractory to medical treatment. Many aspects of these procedures have been extensively discussed in the literature during the last few years. In this article, we perform a critical appraisal of current evidence on effectiveness and ongoing controversies regarding surgical technique, indications and contraindications, clinical outcomes and potential complications of these procedures.
A vertebroplastia e a cifoplastia têm sido amplamente utilizadas para fraturas por compressão osteoporóticas e relacionadas a tumor refratárias ao tratamento clinico. Nos últimos anos, vários aspectos relacionados a esses procedimentos têm sido amplamente discutidos na literatura. Neste artigo, realizamos uma análise crítica da evidência atual sobre a efetividade desses procedimentos e sobre as controvérsias referentes a técnica cirúrgica, indicações e contraindicações, resultados clínicos e possíveis complicações.
La vertebroplastia y la cifoplastia han sido ampliamente utilizadas en fracturas por compresión osteoporóticas y relacionadas con tumor refractarias al tratamiento clínico. En los últimos años, diversos aspectos relacionados con estos procedimientos han sido ampliamente discutidos en la literatura. En este artículo, presentamos un análisis crítico de la evidencia actual sobre la eficacia y las controversias relativas a la técnica quirúrgica, indicaciones y contraindicaciones, resultados clínicos y posibles complicaciones.
Assuntos
Humanos , Fraturas por Compressão/cirurgia , Procedimentos Cirúrgicos Operatórios , Vertebroplastia , CifoplastiaRESUMO
To determinate whether a surgical protocol with immediate extensive debridement, closed irrigation system and antibiotic therapy would be effective to achieve healing of deep wound infection without removing the instrumentation. Prospective cohort study with 19 patients presenting degenerative spinal stenosis or degenerative spondylolisthesis, who developed infection after posterior lumbar arthrodesis. The diagnosis was confirmed by a microbial culture from subfascial lumbar fluid and/or blood. Patients were treated with a protocol of wound exploration, extensive flushing and debridement, placement of a closed irrigation system that was maintained for five days and intravenous antibiotics. The instrumentation system was not removed. Mean age was 59.31 (±13.17) years old and most patients were female (94.7%; 18/19). The mean period for the identification of the infection was 2 weeks and 57.9% underwent a single wound exploration. White blood count, erythrocyte sedimentation rate and C-reactive protein showed a significant decrease post-treatment when compared to pre-treatment values. A significant reduction of erythrocyte sedimentation rate and C-reactive protein was also observed at the final evaluation. No laboratory test was useful to predict the need for more than one debridement. Patients with wound infection after instrumentation can be treated without removal of the instrumentation through wound exploration, extensive flushing, debridement of necrotic tissue, closed irrigation system during 5 days and proper antibiotic therapy. The blood tests were not useful to predict surgical re-interventions.
Determinar se um protocolo cirúrgico de desbridamento extenso imediato, sistema de irrigação fechado e antibioticoterapia seria eficaz para alcançar a resolução da infecção profunda da ferida sem remover a instrumentação. Estudo prospectivo de coorte com 19 pacientes com estenose espinhal degenerativa ou espondilolistese degenerativa, que desenvolveram infecção após artrodese lombar posterior. O diagnóstico foi confirmado por uma cultura microbiana de fluido subfascial lombar e/ou sangue. Os pacientes foram tratados com um protocolo de exploração de ferida, irrigação extensa e desbridamento, colocação de um sistema de irrigação fechado que foi mantido durante cinco dias e antibióticos por via intravenosa. O sistema de instrumentação não foi removido. A média de idade foi de 59,31 anos (± 13,17) e a maioria dos pacientes era do sexo feminino (94,7%; 18/19). O tempo médio para a identificação da infecção foi de duas semanas e 57,9% foram submetidos a apenas uma exploração da ferida. A contagem de eritrócitos, a sedimentação de eritrócitos e a proteína C-reativa mostraram diminuição significativa após o tratamento. Na avaliação final, também foi observada redução significativa da sedimentação de eritrócitos e de proteína C-reativa. Nenhum exame laboratorial foi útil para prever a necessidade de mais do que um desbridamento. Os pacientes com infecção da ferida após a instrumentação podem ser tratados sem a remoção da instrumentação por meio da exploração da ferida, irrigação intensa, desbridamento de tecidos necróticos, sistema de irrigação fechado mantido por 5 dias e antibioticoterapia adequada. Os exames de sangue não foram úteis para prever a revisão cirúrgica.
Determinar si un protocolo quirúrgico de desbridamiento extenso inmediato, sistema de irrigación cerrado y antibioticoterapia seria eficaz para alcanzar la resolución de la infección profunda de la herida sin remover la instrumentación. Estudio prospectivo de corte con 19 pacientes con estenosis espinal degenerativa o espondilolistesis degenerativa, que desarrollaron infección después de artrodesis lumbar posterior. El diagnóstico se confirmó por un cultivo microbiano de fluido subfascial lumbar y/o sangre. Los pacientes fueron tratados con un protocolo de exploración de la herida, lavado profuso y desbridamiento, la colocación de un sistema de irrigación cerrado que se mantuvo durante cinco días y antibióticos por vía intravenosa. El sistema de instrumentación no ha sido retirado. La media de edad promedio fue de 59,31 (± 13,17) años y la mayoría de los pacientes eran mujeres (94,7%; 18/19). El tiempo medio para la identificación de la infección fue de 2 semanas y el 57,9% se sometió a una única exploración de la herida. Recuento de glóbulos blancos, velocidad de sedimentación globular y la proteína C-reactiva mostraron una disminución significativa después del tratamiento en comparación con los valores pre-tratamiento. En la evaluación final también se observó una reducción significativa de la tasa de sedimentación de eritrocitos y de proteína C-reactiva. Ningún análisis de laboratorio fue útil para predecir la necesidad de más que un desbridamiento. Pacientes con infección de la herida después de la instrumentación se pueden tratar sin la remoción de la instrumentación a través de la exploración de la herida, lavado extensivo, desbridamiento de tejido necrótico, sistema de irrigación cerrado durante 5 días y antibioticoterapia adecuada. Los análisis de sangre no fueron útiles ...Assuntos
Humanos
, Infecção da Ferida Cirúrgica
, Artrodese/efeitos adversos
, Antibioticoprofilaxia
, Desbridamento
RESUMO
OBJECTIVE: To demonstrate the responsiveness of depression after surgery for lumbar degenerative disease and to verify the impact of this condition on surgical outcomes. PATIENT SAMPLE: A prospective cohort study with 91 patients with lumbar degenerative diseases who were evaluated preoperatively, at 30 days and 1 year postoperatively. OUTCOME MEASURES: Evolution of depression between the follow-ups and its correlation with satisfaction. METHODS: Depression was assessed with Beck Depression Inventory. According to depression responsiveness, patients were classified into four groups: NN = no depression; ND = normal during the preoperative period and depression within 1 year; DN = depression during the preoperative period and normal within 1 year; DD = depression during the preoperative period and within 1 year. RESULTS: Prevalence of preoperative depression was 28.6% and 17.6% within 1 year postoperatively. Most patients (65.4%) with depression in the preoperative period recovered postoperatively. Poor preoperative HRQoL measures were associated with higher rates of responsiveness of depression during the follow-up. Patients with depression at the 1-year postoperative follow-up had a worse functional outcome. Patients who improved from depression had similar outcome to those without depression. Dissatisfaction within 1 year postoperatively was greater in patients who become depressed after surgery and remain depressed at 1-year follow-up (NN = 8.8%; ND = 42.9%; DN = 17.6%; DD = 44.4%; P = 0.012). CONCLUSION: Most patients with depression in the preoperative recover within 1 year postoperatively. Responsiveness of depression is associated with surgical outcomes. The presence of depression after the surgical treatment, independent of when it starts, had a major negative impact on prognosis.
Assuntos
Depressão/epidemiologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Adulto , Depressão/complicações , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Fatores de Risco , Fatores Sexuais , Estenose Espinal/complicações , Espondilolistese/complicações , Resultado do TratamentoRESUMO
Objective: Evaluate the impact of motor deficit (MD) on pain, disability, depression and quality of life measures of patients with LDH prior to a specific treatment. Methods: A total of 254 consecutively enrolled patients with LDH associated to neurological impairment and sciatica who have not responded to conservative treatment were evaluated. After reviewing the exclusion criteria, 168 were included. Validated instruments were used in the preoperative period to evaluate: pain, disability, quality of life, anxiety and depression. Results: Normal motor strength was observed in 57 (33.9%) patients and MD was observed in 111 (66.1%) cases. No statistically significant differences were observed between patients with and without MD regarding gender, age, level of herniation, lateralization and workers' compensation. Regarding quality of life, no difference was detected in the eight domains of SF36 and between the PCS and MCS groups. The only difference observed was a higher disability rate in the MD group, with the mean ODI difference being 7.84 (CI 95%: 1.82â€"13.87; p=0.011). Motor weakness was observed in 35.1% (n=39/111) of patients who had abnormal results at the motor evaluation, being related to severity (X²: 46.058; p<0.0001). Conclusion: In patients with LDH without prior specific treatment, the presence of MD did not modify the pain, disability, depression measures and self-reported quality of life. The MD has no discriminative ...
Objetivo: Avaliar o impacto do déficit motor (DM) sobre dor, incapacidade, depressão e medidas de qualidade de vida em pacientes com HDL antes de tratamento específico. Métodos: Avaliou-se consecutivamente um total de 254 pacientes inscritos com HDL associado à lesão neurológica e ciática que não responderam ao tratamento conservador. Depois de analisar os critérios de exclusão, 168 foram incluídos. Instrumentos validados foram utilizados no período pré-operatório para avaliar: dor, incapacidade, qualidade de vida, ansiedade e depressão. Resultados: Verificou-se força motora normal em 57 (33,9%) pacientes e o DM foi observado em 111 (66,1%) casos. Não foram observadas diferenças estatisticamente significativas entre pacientes com e sem DM com relação a sexo, idade, nível de hérnia, lateralização e compensação trabalhista. Com relação à qualidade de vida, não foi detectada diferença nos oito domínios do SF-36 e entre os grupos PCS e MCS. A única diferença observada foi taxa de deficiência superior no grupo DM, sendo a diferença média do ODI de 7,84 (IC 95%: 1,82-13,87, p = 0,011) A fraqueza motora foi observada em 35,1% (n=39/111) dos pacientes que tiveram resultado anormal na avaliação motora ...
Objetivo: Evaluar el impacto del déficit motor (DM) en el dolor, la discapacidad, la depresión y de la medida de calidad de vida en pacientes con HDL antes de un tratamiento específico. Métodos: Ha sido evaluado consecutivamente un total de 254 pacientes inscritos con HDL asociado a lesión neurológica y ciática que no han respondido al tratamiento conservador. Después de analizar los criterios de exclusión, se incluyeron 168 pacientes. Se utilizaron instrumentos validados en el preoperatorio para evaluar: dolor, discapacidad, calidad de vida, ansiedad y depresión. Resultados: La fuerza motora normal se observó en 57 (33,9%) pacientes y DM se observó en 111 (66,1%) casos. No se observaron diferencias estadísticamente significativas entre los pacientes con y sin DM con respecto a sexo, edad, nivel de la hernia, lateralización y compensación laboral En cuanto a la calidad de vida no se detectaron diferencias en los ocho dominios del SF-36 y entre los grupos PCS y MCS. La única diferencia observada fue una tasa de deficiencia superior en el grupo DM, con la diferencia promedio del ODI de 7,84 (IC 95%: 1,82-13,87, p = 0,011). La debilidad motora observada fue del 35,1% (n=39/111) de los pacientes con resultados anormales en la evaluación motora, que estaba relacionada con la gravedad (X²: 46,058, p<0,0001). Conclusión: ...
Assuntos
Humanos , Deslocamento do Disco Intervertebral/complicações , Qualidade de Vida , Resultado do Tratamento , Período Pré-OperatórioRESUMO
UNLABELLED: OBJECT.: A previous study published by the authors showed that a single intervention could not change the baseline attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents. METHODS: In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and 2 intervention (single/multiple) groups. The study was conducted in the following 8 stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those affirming the use of safety devices "always or sometimes" and negative as "never" using safety devices. RESULTS: The sample consisted of 535 students. Regarding attitudes, students in all groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple-intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt. CONCLUSIONS: Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no: U1111-1121-0192 (National System of Ethics and Research in Brazil).
Assuntos
Prevenção de Acidentes/métodos , Acidentes de Trânsito/prevenção & controle , Comportamentos Relacionados com a Saúde , Traumatismos do Sistema Nervoso/prevenção & controle , Adolescente , Atitude , Brasil , Criança , Feminino , Humanos , Masculino , Prevenção Primária/métodos , Estudos Prospectivos , Segurança , Instituições Acadêmicas , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Traumatismos do Sistema Nervoso/etiologia , Falha de TratamentoRESUMO
Cavernous malformations (CM) are formed by dilated thin-walled vascular channels without intervening parenchyma and intraventricular lesions are rare. We report a case of an intraventricular cavernoma in a 54-year old female patient. She presented with speech arrests daily for 10 months. Neurological examination revealed no deficits. The brain MRI study revealed an intraventricular lesion at the level of the left atrium, heterogeneously hyperintense on both T1 and T2-weighted images. It was performed an interhemispheric transcallosal approach with gross-total resection of the lesion. The histological examination was compatible with the diagnosis of cavernous haemangioma. In the postoperative period the patient presented with transient right hemiparesis with recovery in two weeks. We briefly review the literature concerning intraventricular cavernomas...
Malformações cavenosas são formadas por canais vasculares dilatados e de paredes finas sem parênquima cerebral no interior. Lesões dessa natureza são raras nos ventrículos. Neste trabalho descrevemos um caso de cavernoma intraventricular em uma paciente feminina de 54 anos. Ela se apresentou clinicamente com bloqueios de fala diários nos últimos 10 meses. Nenhum déficit neurológico foi observado no exame. A ressonância magnética de encéfalo demonstrou lesão heterogênea na topografia do átrio ventricular esquerdo, hiperintensa em T1 e T2. Foi realizada abordagem interemisférica transcalosa com ressecção total da lesão. A análise histopatológica foi compatível com hemangioma cavernoso. No período pós-operatório a paciente apresentou hemiparesia direita, que melhorou em duas semanas. Revisa-se brevemente a literatura em relação a cavernomas intraventriculares...
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hemangioma Cavernoso/complicações , Malformações Arteriovenosas Intracranianas , Distúrbios da FalaRESUMO
BACKGROUND: Despite the small contribution of LA in the Science Citation Index (SCI), a growing contribution by LA research to international literature has been observed in recent years. STUDY DESIGN: Systematic review. PURPOSE: To evaluate the scientific contribution of Latin American (LA) Spine Surgeons in the last decade. METHODS: A literature search of publications by LA spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. The quality of the publication was evaluated with the journal impact factor (IF), Oxford classification and number of citations. RESULTS: This study comprised 320 articles published in the Medline database by LA spine surgeons from 2000 to 2011. In recent years, there has been an increase in the number of publications by LA spine surgeons. It was observed that 38.4% of LA papers were published in LA journals. 46.6% of the articles were published in journals with an IF lower than 1, and there was no statistically significant difference in the number of articles published in journals with a higher IF during the period. Linear-by-linear association analysis demonstrated an improvement in the level of evidence provided by LA articles published in recent years. CONCLUSIONS: This study showed a growth in the number of publications in last 12 years by LA spinal surgeons. It is necessary to discuss a way to increase quantity and quality of scientific publications, mainly through a better education in research.
Assuntos
Pesquisa Biomédica/história , Pesquisa Biomédica/tendências , MEDLINE , Neurocirurgia/história , Feminino , História do Século XXI , Humanos , América Latina , Masculino , Publicações Periódicas como Assunto , Estudos RetrospectivosRESUMO
OBJECTIVE: To verify the association between depression and headache in young adults, as well as to identify the features of headache associated with depression and the influence of this mood disorder on headache-related disability. METHODS: A cross-sectional study with self-administered questionnaires about headache and depression was conducted at the Universidade de Caxias do Sul. Beck Depression Inventory (BDI) and Migraine Disability Assessment (MIDAS) were used to evaluate depressive symptoms and headache-related disability, respectively. Depression was considered if BDI > 15. RESULTS: A thousand and thirteen young adults were included in the study. A clear relationship was observed between headache and depression among the participants. Multivariate analyses demonstrated that nausea or vomiting related to headache and higher headacherelated disability scores were independent factors associated with depression. Migraine was more associated with depression than the other types of headache. CONCLUSION: The results demonstrate an association between headache and depression. Depressive symptoms are more likely to be found in young adults with more disabling headaches.
OBJETIVO: Verificar a associação entre depressão e cefaleia em adultos jovens, assim como identificar as características da cefaleia relacionadas com depressão e a influência da depressão na incapacidade decorrente da cefaleia. MÉTODOS: Estudo transversal com questionários autoadministrados sobre cefaleia e depressão foi conduzido na Universidade de Caxias do Sul. O Inventário de Depressão de Beck (BDI) e o questionário de avaliação da incapacidade por enxaqueca (MIDAS) foram utilizados para avaliação dos sintomas depressivos e incapacidade, respectivamente. Depressão foi definida como BDI > 15. RESULTADOS: Foram incluídos no estudo 1.013 adultos jovens. Observou-se uma clara relação entre cefaleia e depressão entre os participantes. Análisesmultivariadas demonstraramque náuseas ou vômitos relacionados à cefaleia e incapacidade decorrente da dor foram fatores independentes associados à depressão. Enxaqueca foi mais associada com depressão que os outros tipos de cefaleia. CONCLUSÃO: Os resultados demonstram associação entre cefaleia e depressão. Sintomas depressivos são mais comuns em adultos jovens com cefaleias mais incapacitantes.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Transtorno Depressivo/complicações , Cefaleia/psicologia , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Transtorno Depressivo/epidemiologia , Cefaleia/epidemiologia , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Prevalência , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To verify the association between depression and headache in young adults, as well as to identify the features of headache associated with depression and the influence of this mood disorder on headache-related disability. METHODS: A cross-sectional study with self-administered questionnaires about headache and depression was conducted at the Universidade de Caxias do Sul. Beck Depression Inventory (BDI) and Migraine Disability Assessment (MIDAS) were used to evaluate depressive symptoms and headache-related disability, respectively. Depression was considered if BDI ≥ 15. RESULTS: A thousand and thirteen young adults were included in the study. A clear relationship was observed between headache and depression among the participants. Multivariate analyses demonstrated that nausea or vomiting related to headache and higher headache-related disability scores were independent factors associated with depression. Migraine was more associated with depression than the other types of headache. CONCLUSION: The results demonstrate an association between headache and depression. Depressive symptoms are more likely to be found in young adults with more disabling headaches.
Assuntos
Transtorno Depressivo/complicações , Cefaleia/psicologia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Transtorno Depressivo/epidemiologia , Feminino , Cefaleia/epidemiologia , Humanos , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Prevalência , Inquéritos e Questionários , Adulto JovemRESUMO
PURPOSE: To evaluate the scientific contribution of Brazilian Spine Surgeons not only in number of publications but also in their quality between January 2000 to December 2011. METHODS: A literature search of publications by Brazilian spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. A total of 1,778 articles were identified after a Medline search. After exclusion criteria, the study comprised 206 articles. The quality of the Journals was assessed with IF and the article quality using the Oxford classification. RESULTS: An increasing number of publications by Brazilian spine surgeons was observed in recent years: 45.1 % of those papers were published during the last 4 years (2008-2011). Clinical studies and case reports were the most frequent types of article published (37.5 vs 31.1 %). An increasing number of Brazilian publications in non-Brazilian journals has been observed in recent years (linear-by-linear association: 5.449, P = 0.020). The Arquivos de Neuro-Psiquiatria was the most frequent journal in which the papers were published (N = 67, 32 %). The IF of the publications varied from 0.021 to 8.017. The analysis of quality of the articles using the Oxford classification demonstrated that most of them provided LOE 4 (N = 113, 54.9 %) or 5 (N = 45, 21.8 %). CONCLUSIONS: There have been an increasing number of publications by Brazilian spine surgeons in recent years and the quality of the articles published has improved. Also the number of publications by Brazilians in non-Brazilian journals has increased in recent years.
Assuntos
Bibliometria , Cirurgia Geral/estatística & dados numéricos , Editoração/tendências , Doenças da Coluna Vertebral/cirurgia , Pesquisa Biomédica/estatística & dados numéricos , Brasil , Humanos , Editoração/estatística & dados numéricosRESUMO
OBJECTIVE: Evaluate the predictive value of the Lasègue sign on self-reported quality of life measures (HRQoL) in patients who undergo microdiscectomy. METHODS: 95 patients with clinical and radiological diagnosis of LDH who underwent microdiscectomy were included. The patients were assessed by a neurological examination and answered validated instruments to assess pain, disability, quality of life, and mood disorder in the preoperative period, and 1, 6 and 12 months after surgery. RESULTS: Preoperative Lasègue sign was identified in 56.8% (n=54/95) of the cases. There was no difference between the groups in the preoperative period regarding HRQoL. At one year follow-up no statistically significant difference in HRQoL was observed in the Lasègue group. The discrimination capacity of the preoperative Lasègue sign to determinate variations in HRQoL outcomes one year postoperatively was low. CONCLUSION: Lasègue sign is not a good predictor of outcome after microdiscectomy for LDH.
OBJETIVO: Avaliar o valor preditivo do Sinal de Lasègue em medidas de qualidade de vida (HRQoL) em pacientes submetidos a microdiscectomia. MÉTODOS: 95 pacientes com diagnóstico clínico e radiológico de HDL submetidos à microdiscectomia foram incluídos. Os pacientes foram avaliados por exame neurológico e responderam instrumentos validados para medir dor, incapacidade, qualidade de vida e transtornos do humor no período pré-operatório e 1, 6 e 12 meses após a cirurgia. RESULTADOS: O sinal de Lasègue no pré-operatório foi identificado em 56,8% (n = 54/95) dos casos. Não houve diferença entre os grupos no pré-operatório em relação à HRQoL. Em um ano de pós-operatório não foi observada diferença estatística com relação à HRQoL no grupo com Lasègue. A capacidade de discriminação do Sinal de Lasègue pré-operatório para determinar variações na HRQoL em um ano de pós-operatório foi baixa. CONCLUSÃO: O Sinal de Lasègue não é um bom preditor de prognóstico após microdiscectomia na HDL.
OBJETIVO: Evaluar el valor predictivo de la señal de Lasègue en medidas de calidad de vida (HRQoL) en pacientes sometidos a microdiscectomía. MÉTODOS: Se incluyeron 95 pacientes con diagnóstico clínico y radiológico de HDL que se sometieron a microdiscectomía. Los pacientes fueron evaluados por examen neurológico y respondieron a instrumentos para medir dolor, incapacidad, calidad de vida y disturbios del humor en el periodo preoperatorio y 1, 6 y 12 meses después de la cirugía. RESULTADOS: La señal de Lasègue en el preoperatorio se identificó en el 56,8% (n = 54/95) de los casos. No hubo diferencia entre los grupos en el preoperatorio en relación a la HRQoL. En un año de post operatorio no se observó diferencia estadística con relación a la HRQoL en el grupo con Lasègue. La capacidad de discriminación de la señal de Lasègue preoperatoria para determinar variaciones en la MCV en un año de postoperatorio fue baja. CONCLUSIÓN: La señal de Lasègue no es un buen predictor de pronóstico post microdiscectomía en la HDL.
Assuntos
Humanos , Microdissecção , Prognóstico , Qualidade de Vida , Coluna Vertebral/cirurgia , Deslocamento do Disco IntervertebralRESUMO
OBJETIVO: Avaliar a contribuição cientifica de cirurgiões da coluna brasileiros não somente em número de publicações, mas também em relação à qualidade entre Janeiro de 2000 e Dezembro de 2011. MÉTODOS: Uma pesquisa das publicações de cirurgiões da coluna brasileiros em relação à coluna ou medula espinhal foi realizada utilizando uma base de dados online; Pubmed.gov. Os resultados foram limitados para artigos publicados entre Janeiro de 2000 e Dezembro de 2011. Um total de 1.778 artigos foram encontrados após a pesquisa no Medline. Após critérios de exclusão, 206 foram selecionados. A qualidade dos periódicos foi medida através do Fator de Impacto (FI), e do Qualis CAPES e a qualidade do artigo pela classificação de Oxford. RESULTADOS: Um aumento no número de publicações de cirurgiões da coluna brasileiros foi observado. 45,1% das publicações foram nos últimos 4 anos (2008 - 2011). Estudos clínicos e relatos de caso foram os tipos de artigos mais frequentemente publicados (37,5% vs 31,1%). Um aumento no número de publicações brasileiras em periódicos não-brasileiros foi observado nos últimos anos (linear-by-linear association: 5.449, P = 0.020). A publicação Arquivos de Neuro-psiquiatria foi o periódico em que os artigos foram mais frequentemente publicados (n=67, 32%). O FI das publicações variou de 0.021 a 8.017. A análise da qualidade das publicações demonstrou que a maioria delas forneceu NE 4 (N = 113, 54.9%) ou 5 (N = 45, 21,8%). CONCLUSÃO: Houve um aumento no número e na qualidade das publicações de cirurgiões da coluna brasileiros nos últimos anos. Além disso, o número de publicações de brasileiros em periódicos não-brasileiros aumentou nos últimos anos.
OBJECTIVE: To evaluate the scientific contribution of Brazilian spine surgeons not only in number of publications, but also their quality between January 2000 to December 2011. METHODS: A research of publications by Brazilian spinal surgeons on topics concerning the spine or spinal cord was performed using an online data-base; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. A total of 1,778 articles were identified after a Medline search. After exclusion criteria, 206 papers were selected. The quality of the Journals was assessed with Impact Factor (IF), and the Qualis CAPES, and the article quality using the Oxford classification. RESULTS: An increasing number of publications by Brazilian spine surgeons was observed. 45.1% of those papers were published during the last 4 years (2008 - 2011). Clinical studies and case reports were the most frequent types of article published (37.5% vs 31.1%). An increasing number of Brazilian publications in non-Brazilian journals has been observed in recent years (linear-by-linear association: 5.449, P = 0.020). The Arquivos de Neuro-Psiquiatria was the most frequent journal in which the papers were published (n=67, 32%). The IF of the publications varied from 0.021 to 8.017. The analysis of quality of the articles using the Oxford classification demonstrated that most of them provided LOE 4 (N = 113, 54.9%) or 5 (N = 45, 21,8%). CONCLUSIONS: There has been an increasing in the number and quality of publications by Brazilian spine surgeons in recent years. Also, the number of publications by Brazilians in non-Brazilian journals has increased in recent years.
OBJETIVO: Evaluar la contribución científica de cirujanos de columna brasileños, no solamente en número de publicaciones, sino en relación a la calidad, entre enero de 2000 y diciembre de 2011. MÉTODOS: Se realizó una investigación de las publicaciones de cirujanos de columna brasileños en relación a la columna o médula espinal, utilizando una base de datos online: Pubmed.gov. Las búsquedas se limitaron a artículos publicados entre enero de 2000 y diciembre de 2011. Se encontraron 1.778 artículos en la investigación en el Medline. Luego de criterios de exclusión, se seleccionaron 206. La calidad de los periódicos se midió a través del Factor de Impacto (FI) y del Qualis CAPES, y la calidad del artículo, por la clasificación de Oxford. RESULTADOS: Se observó un aumento en el número de publicaciones de cirujanos de columna brasileños, siendo que el 45,1% de las publicaciones se hicieron en los últimos 4 años (2008 - 2011). Estudios clínicos y relatos de caso fueron el tipo de artículos publicados con más frecuencia (37,5% vs 31,1%). Hubo aumento en el número de publicaciones brasileñas en periódicos no brasileños en los últimos años (linear-by-linear association: 5,449, P = 0,020). Arquivos de Neuro-Psiquiatria fue o periódico en que los artículos se publicaron con más frecuencia (n = 67, 32%). El factor de impacto de las publicaciones tuvo una variación de 0,021 a 8,017. El análisis de la calidad de las publicaciones demostró que la mayoría de ellas alcanzó nivel de evidencia 4 (N = 113, 54,9%) o 5 (N = 45, 21,8%). CONCLUSIONES: Hubo un aumento en el número y en la calidad de las publicaciones de cirujanos de columna brasileños en los últimos años. Además, el número de publicaciones de brasileños ha aumentado a lo largo de los últimos años.
Assuntos
Publicações Científicas e Técnicas , Doenças da Coluna Vertebral , Coluna Vertebral/cirurgia , BibliometriaRESUMO
OBJECTIVE: To evaluate the accuracy of the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D) in spine surgery, comparing it to Beck Depression Inventory (BDI). METHODS: In a cross-sectional study, the HADS-D and the BDI were applied to patients undergoing spine surgery for lumbar (n=139) or cervical spondylosis (n=17). Spearman correlation tests for HADS-D and BDI were applied. The internal consistency of HADS-D was estimated by Cronbach's alpha coefficient. RESULTS: According to the BDI, the prevalence of depression was of 28.8% (n=45). The Spearman r coefficient between HADS-D and BDI was 0.714 (p<0.001). Cronbach's alpha for HADS-D was 0.795. The area of the ROC curve was 0.845. Using a cutoff for HADS-D >10, there was a sensitivity of 71.1%, specificity of 95.4%, and positive likelihood-ratio of 15.78. CONCLUSIONS: HADS-D showed a strong correlation with BDI and good reliability. HADS-D is a good alternative for screening depression and assessing its severity.
Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Vértebras Lombares/cirurgia , Espondilose/psicologia , Espondilose/cirurgia , Inquéritos e Questionários , Transtornos de Ansiedade/psicologia , Estudos Transversais , Transtorno Depressivo/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Autorrelato , Sensibilidade e EspecificidadeRESUMO
OBJECT: Trauma is the leading cause of mortality and morbidity in children, young people, and working-age adults. Because of the high incidence of intentional and unintentional injuries in young people, it is necessary to implement injury-prevention programs and measure the efficacy of these initiatives. The authors evaluated the effectiveness of an injury-prevention program in high school students in a city in southern Brazil. METHODS: In a randomized controlled study, 1049 high school students were divided into a control group and intervention group. The study was conducted in the following 3 stages: a questionnaire was applied 1 week before the educational intervention (P0), shortly after the intervention (P1), and 5 months later (P3). In the control group, a questionnaire based on the Pense Bem Project was applied at the 3 time stages, without any intervention between the stages. RESULTS: The postintervention analysis evidenced a slight change in knowledge about unintentional spinal cord and brain injuries. Regarding attitudes, the only significant improvement after the intervention lecture was in the use of helmets, which remained high 5 months later. A substantial number of students only partially agreed with using safety behaviors. The only significant postintervention change was the major agreement to check swimming pool depth before entering the water (P0 89% and P1 97.8%, p < 0.001; P2 92.8%, p = 0.005). CONCLUSIONS: An educational intervention based on a single lecture improved students' knowledge of traumatic brain and spinal cord injuries, but this type of intervention did not modify most attitudes toward injury prevention. Clinical trial registration no.: U1111-1121-0192.
