ACE I/D polymorphism is a risk factor for the clinical severity of COVID-19 in Brazilian male patients.

BACKGROUND: The renin-angiotensin system is potentially involved in the pathogen-host interaction in the disease caused by SARS-CoV-2, since the angiotensin-converting enzyme (ACE) 2 serves as a receptor for the virus. The impact of the pandemic in specific regions and ethnic groups highlights the importance of investigating genetic factors that disrupt the balance of the system in response to SARS-CoV-2 infection, especially in genes with ethnic frequency variations. Therefore, this study aimed to evaluate the influence of the ACE I/D polymorphism on the incidence and severity of COVID-19 in a sample of the Brazilian population. METHODS AND RESULTS: 70 severe cases and 355 mild cases patients were evaluated. DNA extraction was performed using a QIAamp DNA Blood Mini kit. Genotyping of ACE I/D polymorphism was performed. Clinical outcomes were obtained from the patients' records. We found an association between the ACE I/D polymorphism and the incidence or severity of COVID-19 in male participants. Moreover, we observed a relationship between severity and increasing age and body weight and a higher frequency of II genotype individuals among those who had a cough as their symptoms in mild patients. No differences were observed in leukocyte count or other parameters related to the inflammatory response in severe patients. CONCLUSIONS: Our data showed the influence of the ACE I/D polymorphism on severity of COVID-19 in males, as well as on the occurrence of cough in patients with mild symptoms, with a higher incidence in those carrying the I allele.

Sagittal Balance in Professional Brazilian Football Players.

Introduction: Football soccer practice involves considerable risks of lesions, making it difficult to strike a balance between adequate preparation and the demand imposed on athletes. A high incidence of postural disorders among adolescents leads to questions about the influence of sports activity on the athletes' posture and sagittal balance. Methods: A cross-sectional study was conducted from panoramic spine radiographs of 110 professional Brazilian football (soccer) players. They were male and aged between 20 and 30 years. Measurements of pelvic incidence, pelvic tilt (PT), sacral slope, sagittal vertical axis (SVA), and lumbar lordosis were obtained by using the SurgimapⓇ software. Measurement values were compared with the Brazilian literature data. Lordosis type was categorized according to the classification of Roussouly et al., and the presence of spondylolysis and spondylolisthesis was analyzed. Results: Findings indicated that (1) among 110 radiographs analyzed, 104 had appropriate measurement quality; (2) values compared with the Brazilian mean demonstrated that PT and SVA were statistically lower in professional players (P=0.013 and P=0.037, respectively); (3) according to Roussouly et al. most participants presented Type 3 lordosis (54.8%), followed by Type 4 (26.9%); (4) eight athletes (7.7%) had spondylolysis, and among them, seven (6.7%) had spondylolisthesis. Conclusions: Significant differences in PT and SVA were found in professional athletes. The most common type of lordosis was the same as that found in the general population (Type 3), and the incidence of spondylolysis and spondylolisthesis was higher than that found in the general population, but lower than that found in football (soccer) players.

Low Back Pain in Medical Students and Professors During the Pandemic: Retrospective Cohort Study.

Objective This study aimed to determine the prevalence of low back pain before and during the pandemic, comparing both periods. Methods A questionnaire was administered, containing questions about the presence of low back pain, sociodemographic characteristics and environmental factors that could be related to such pain. Results Among the 978 responses obtained, the prevalence of low back pain during the pandemic was 69.94%, which represented a significant increase over values from the pre-pandemic period (57.37%). A high prevalence of low back pain was found between all groups, especially among women. Some factors were associated with the incidence of low back pain, such as having previously diagnosed spinal problems and sedentary lifestyle. Conclusions The prevalence of low back pain increased significantly during the pandemic in the studied groups.

Low Back Pain in Medical Students and Professors During the Pandemic: Retrospective Cohort Study / Lombalgia em estudantes e professores de medicina durante a pandemia: Estudo de coorte retrospectivo

Abstract Objective This study aimed to determine the prevalence of low back pain before and during the pandemic, comparing both periods. Methods A questionnaire was administered, containing questions about the presence of low back pain, sociodemographic characteristics and environmental factors that could be related to such pain. Results Among the 978 responses obtained, the prevalence of low back pain during the pandemic was 69.94%, which represented a significant increase over values from the pre-pandemic period (57.37%). A high prevalence of low back pain was found between all groups, especially among women. Some factors were associated with the incidence of low back pain, such as having previously diagnosed spinal problems and sedentary lifestyle. Conclusions The prevalence of low back pain increased significantly during the pandemic in the studied groups.

Resumo Objetivo Este estudo teve como objetivo determinar a prevalência de lombalgia antes e durante a pandemia, comparando os dois períodos. Métodos Foi aplicado um questionário contendo questões sobre a presença de lombalgia, características sociodemográficas e hábitos que poderiam estar relacionados à essa dor. Resultados Entre as 978 respostas obtidas, a prevalência de lombalgia durante a pandemia foi de 69,94%, o que representou um aumento significativo em relação aos valores do período pré-pandêmico (57,37%). Foi encontrada alta prevalência de lombalgia entre todos os grupos, principalmente entre as mulheres. Alguns fatores foram associados à incidência de lombalgia, como ter problemas de coluna previamente diagnosticados e sedentarismo. Conclusões A prevalência de lombalgia aumentou significativamente durante a pandemia nos grupos estudados.

Sports practice after lumbar discectomy in non-professional athletes: a cross-sectional study / Prática esportiva após discectomia lombar em atletas não profissionais: estudo transversal / Práctica deportiva tras discectomía lumbar en atletas no profesionales: un estudio transversal

ABSTRACT: Introduction: Most athletes treated for lumbar disc herniation return to play between 3 and 9 months after conservative or surgical treatment. In the last two decades, the general population increased the practice and participation in amateur competitions, being more prone to overload injuries. Objectives: To evaluate sports practice after lumbar discectomy in non-professional athletes. Methods: In the last five years, a digital questionnaire was sent to patients submitted to up to two levels of open discectomy. After signing the informed consent form, the patients were instructed to answer the questionnaire with personal and clinical data related to disc treatment and sports practice after the procedure. Results: Of 182 contacted patients, a hundred answered the questionnaire; 65% practiced regular sports activities before surgery. From patients who practiced sports before surgery, 75.38% returned to sports activities after the procedure. 39.29% returned between 3 and 6 months. Only 12.31% referred to impaired sports performance, while 56.92% performed unaffected, and 21.54% reported improved performance after surgery. Prior sports practice, participation in amateur competitions, and regular core strengthening were significantly associated with sports practice after surgery (P<0,05). Conclusions: From the participants who had already practiced sports before surgery, 75.38% returned after the surgical procedure. Sports practice before surgery, participation in amateur competitions, and regular core strengthening were positively associated with a return to sports practice after lumbar discectomy. The study shows that core strengthening should be encouraged and recommended to all non-professional athletes who intend to return to sports after microdiscectomy surgeries. Level of Evidence: III; Cross-Sectional Retrospective Study.

RESUMO: Introdução: A maioria dos atletas tratados de hérnia de disco lombar volta a jogar em um período entre 3 e 9 meses, após tratamento conservador ou cirúrgico. Nas últimas duas décadas, a população em geral aumentou a prática e participação em competições amadoras; sendo mais propenso a lesões por uso excessivo. Objetivos: Avaliar a prática esportiva após discectomia lombar em atletas não profissionais. Métodos: Um questionário digital foi enviado aos pacientes submetidos à discectomia aberta de até 2 níveis, nos últimos cinco anos. Após a assinatura do termo de consentimento livre e esclarecido, os pacientes foram orientados a responder o questionário com dados pessoais e clínicos relacionados ao tratamento e à prática esportiva após o procedimento. Resultados: Dos 182 pacientes contatados, cem responderam ao questionário; destes, 65% praticavam atividades esportivas regulares antes da cirurgia. Dos pacientes que praticavam esportes antes da cirurgia, 75,38% retornaram à atividade esportiva após o procedimento. 39,29% retornaram entre 3 e 6 meses. Apenas 12,31% relataram piora no desempenho esportivo, enquanto para 56,92% o desempenho não foi afetado e 21,54% relataram melhora no desempenho após a cirurgia. A prática esportiva prévia, a participação em competições amadoras e o fortalecimento regular do core foram significativamente associados à prática esportiva após a cirurgia (P<0,05). Conclusões: Dos participantes que já praticavam esportes antes da cirurgia, 75,38% retornaram após o procedimento cirúrgico. A prática esportiva prévia à cirurgia, a participação em competições amadoras e o fortalecimento regular do core foram positivamente associados ao retorno à prática esportiva após a discectomia lombar. O estudo mostra que o fortalecimento do core deve ser incentivado e recomendado para todos os atletas não profissionais que pretendem retornar ao esporte após cirurgias de microdiscectomia. Nível de Evidência III; Estudio Transversal Retrospectivo.

RESUMEN: Introducción: La mayoría de los atletas tratados por hernia de disco lumbar regresan a jugar en un período de entre 3 y 9 meses, luego de un tratamiento conservador o quirúrgico. En las últimas dos décadas, la población en general incrementó la práctica y participación en competencias aficionadas; siendo más propensos a sufrir lesiones por sobrecarga.Objetivos: Evaluar la práctica deportiva posterior a discectomía lumbar en deportistas no profesionales. Métodos: Se envió un cuestionario digital a los pacientes sometidos a discectomía abierta de hasta 2 niveles, en los últimos cinco años. Tras firmar el consentimiento informado, se instruyó a los pacientes para que respondieran el cuestionario con datos personales y clínicos, relacionados con el tratamiento discal y la práctica deportiva posterior al procedimiento. Resultados: De 182 pacientes contactados, cien respondieron el cuestionario; de estos, el 65% practicaba actividades deportivas regulares antes de la cirugía. De los pacientes que practicaban deporte antes de la cirugía, el 75,38% retornó a la actividad deportiva después del procedimiento. El 39,29% volvió entre los 3 y 6 meses. Solo el 12,31 % refirió deterioro del rendimiento deportivo, mientras que para el 56,92 % el rendimiento no se vio afectado y el 21,54 % refirió mejora del rendimiento después de la cirugía. La práctica deportiva previa, la participación en competiciones aficionadas y la realización regular de fortalecimiento del core, se asociaron significativamente con la práctica deportiva tras la cirugía (P<0,05). Conclusiones: De los participantes que ya practicaban deporte antes de la cirugía, el 75,38% regresaron después del procedimiento quirúrgico. La práctica deportiva previa a la cirugía, la participación en competiciones de aficionados y la realización de un fortalecimiento core periódico se asociaron positivamente con la vuelta a la práctica deportiva tras la discectomía lumbar. El estudio muestra que se debe alentar y recomendar el fortalecimiento del core a todos los atletas no profesionales que tengan la intención de volver al deporte después de las cirugías de microdiscectomía. Nivel de Evidencia III; Estudio Retrospectivo Transversal.

Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview.

OBJECTIVE: To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. METHODS: A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. RESULTS: A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. CONCLUSION: Systematic reviews of surgical treatment of cervical degenerative diseases present "fair" to "good" quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.

Next-generation sequencing (NGS) to determine microbiome of herniated intervertebral disc.

BACKGROUND CONTEXT: There is apparent causality between chronic infection of the intervertebral disc and its degenerative process. Although disc is considered a sterile tissue, collected samples of uninfected patients sent to culture testing resulted positive. PURPOSE: The purpose of this study was to analyze the microbiome of the intervertebral disc by using and validating the next-generation sequencing (NGS) molecular test, controlled with tissue culture and clinical presentation of patients. STUDY DESIGN/SETTING: Prospective study of consecutive patients in a hospital. PATIENT SAMPLE: Patients with lumbar disc herniation undergoing open microdiscectomy aging 18 to 65 years. OUTCOME MEASURES: NGS, tissue culture METHODS: Subjects undergoing open decompression surgery for lumbar disc herniation were consecutively included and clinically followed for one year. Three samples of the excised herniated disc fragment were sent to tissue culture and another sample of the disc was sent to NGS test for microbiome analysis. Control samples of the ligamentum flavum and deep muscle were collected and sent to culture. RESULTS: A total of 17 patients were included. All patients presented negative cultures of the removed disc samples, as well as negative cultures of muscle and yellow ligament. None of the patients evolved to clinical infection one year after surgery, nor presented significant alteration of laboratory markers. NGS mapped a mean of 14,645 (range 6,540 to 27,176) DNA sequences for each disc sample of each patient. There were a total of 45 different bacteria genera remnants with different amount of DNA sequences detected. There was a mean of 8 (range 3-17) different bacterial elements in each sample of intervertebral disc. Three bacteria were present in all disc samples (Herbaspirillum, Ralstonia, and Burkolderia). Although there were a considerable mean number of bacterial sequences mapped in each disc sample, the amount of sequences related to bacteria was low. Cutibacterium acnes elements was not found in any disc microbiome analysis. CONCLUSIONS: NGS has been proven to adequately determine bacterial DNA presence within the intervertebral disc. C. acnes was not isolated in culture neither in microbiome analysis of patients with lumbar disc herniation. We cannot confirm disc sterility since, even if it does not cause infection, there is bacterial or remnant DNA in herniated discs.

Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview

ABSTRACT Objective To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. Methods A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. Results A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. Conclusion Systematic reviews of surgical treatment of cervical degenerative diseases present "fair" to "good" quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.

Treatment of non-specific chronic low back pain: resistance training with or without using weights? / Tratamiento de la lumbalgia crónica inespecífica: ¿entrenamiento de fuerza con o sin pesas? / Tratamento da lombalgia crônica inespecífica: treinamento resistido com ou sem pesos?

ABSTRACT Introduction: Dysfunction of the core muscles contributes to the persistence of pain in patients with chronic low back pain. Evidence shows that the active approach is beneficial in the rehabilitation of these patients. However, there is uncertainty as to the most effective methods or form of exercise, as the literature offers little guidance in this regard. Objective: To analyze and compare the impact on quality of life, function, flexibility, abdominal strength and abdominal fat rate in patients with non-specific chronic low back pain after a program of resistance training using two different forms of exercise. Methods: Thirty individuals, aged between 18 and 65 years, participated in the study. Twenty performed physical training program twice a week for eight weeks, and ten did not perform any physical exercises, but received guidance and pain relief. The physically active individuals were randomly divided in two groups and received similar resistance training, focusing on the same muscle groups. Ten performed training with dumbbells and bodybuilding machines (TRCP) and ten did not use this equipment (TRSP). All were assessed before and after the intervention, through questionnaires on quality of life and function, and tests for flexibility, abdominal strength and measurement of the abdominal fat rate. Results: In the intra-group comparison (initial vs eight weeks), there were no significant differences in quality of life in any of the groups. However, regarding function, the three groups showed significant improvement, with TRSP showing the best evolution. For flexibility and abdominal strength gain, TRCP showed the best evolution in both instruments. For decrease in abdominal fat rate, only TRCP showed significant differences. In the intergroup comparison, there were no significant differences for any of the evaluated outcomes. Conclusion: The two exercise programs were effective in improving function, flexibility and abdominal strength in patients with chronic, non-specific low back pain. However, there were no statistically significant differences in any of the outcomes in the comparison between groups. Level evidence II, Comparative prospective study.

RESUMEN Introducción: La disfunción de la musculatura del tronco contribuye para la persistencia del dolor en pacientes con lumbalgia crónica. La evidencia muestra que un enfoque activo para la rehabilitación de estos pacientes es beneficioso. Sin embargo, existe incertidumbre sobre qué método o modalidad es más eficaz, ya que la literatura existente ofrece poca orientación al respecto. Objetivo: Analizar y comparar el impacto en la calidad de vida, función, flexibilidad, fuerza abdominal y porcentaje de grasa abdominal en pacientes con lumbalgia crónica inespecífica, luego de realizar un programa de entrenamiento de resistencia utilizando dos modalidades diferentes. Métodos: Participaron del estudio 30 personas, entre 18 y 65 años; veinte de los cuales se sometieron a un programa de entrenamiento físico dos veces por semana durante ocho semanas, y diez no realizaron ejercicios físicos, pero recibieron orientación y medicación analgésica. Los individuos físicamente activos se dividieron en dos grupos, al azar, y recibieron un entrenamiento de resistencia similar, centrándose en los mismos grupos musculares. Diez se sometieron a entrenamiento con mancuernas y aparatos de musculación (TRCP) y diez no utilizaron esos equipos, realizando ejercicios funcionales (TRSP). Todos fueron evaluados antes y después de la intervención, mediante cuestionarios de calidad de vida y función, además de pruebas de flexibilidad, fuerza abdominal y medición del porcentaje de grasa abdominal. Resultados: En la comparación intragrupo (inicial x 8 semanas), no hubo cambios significativos en la calidad de vida en ninguno de los grupos. Para la función, los tres grupos mostraron una mejora significativa, con TRSP mostrando una mejor evolución. En cuanto a flexibilidad y aumento de la fuerza abdominal, TRCP se desempeñó mejor en ambos instrumentos. Para disminuir el porcentaje de grasa abdominal, solo TRCP mostró diferencias significativas. En la comparación intergrupal, no hubo diferencias estadísticamente significativas para ninguno de los resultados evaluados. Conclusión: Los dos programas de ejercicio fueron efectivos para mejorar la función abdominal, la flexibilidad y la fuerza en pacientes con dolor lumbar crónico inespecífico. Sin embargo, no hubo diferencias estadísticamente significativas en ninguno de los resultados en la comparación entre grupos. Nivel de evidencia II, Estudio prospectivo comparativo.

RESUMO Introdução: A disfunção da musculatura do tronco contribui para a persistência da dor em pacientes com lombalgia crônica. As evidências demonstram ser benéfica a abordagem ativa para reabilitação desses pacientes, porém, existem incertezas sobre qual método ou modalidade mais eficaz, uma vez que a literatura existente oferece poucas orientações nesse aspecto. Objetivo: Analisar e comparar o impacto na qualidade de vida, função, flexibilidade, força abdominal e percentual de gordura abdominal em pacientes com lombalgia crônica inespecífica, após a realização de programa de treinamento resistido utilizando duas modalidades diferentes. Métodos: Trinta indivíduos, entre 18 e 65 anos, participaram do estudo; sendo que 20 realizaram um programa de treinamento físico duas vezes por semana, durante oito semanas, e dez não realizaram exercícios físicos, porém receberam orientações e medicação analgésica. Os indivíduos ativos fisicamente foram divididos em dois grupos, aleatoriamente, e receberam treinamento resistido similar focado nos mesmos grupos musculares. Dez realizaram treinamento com halteres e aparelhos de musculação (TRCP) e dez não utilizaram esses equipamentos, realizando apenas exercícios funcionais (TRSP). Todos foram avaliados antes e após a intervenção, por meio de questionários de qualidade de vida e função, além de testes de flexibilidade, força abdominal e mensuração do percentual de gordura abdominal. Resultados: Na comparação intragrupo (inicial x oito semanas), não houve mudança significativa na qualidade de vida de nenhum dos grupos. No entanto, quanto à função, os três grupos apresentaram melhora significativa, com o TRSP demonstrando melhor evolução. Para flexibilidade e ganho de força abdominal, o TRCP demonstrou melhor evolução em ambos os instrumentos. Para diminuição do percentual de gordura abdominal, somente o TRCP apresentou diferenças significativas. Na comparação intergrupos, não houve diferença estatisticamente significativa para nenhum dos desfechos avaliados. Conclusão: Os dois programas de exercícios foram eficazes para melhora da função, flexibilidade e força abdominal em pacientes com lombalgia crônica inespecífica. No entanto, não houve diferença estatisticamente significativa em nenhum dos desfechos na comparação entre os grupos. Nível de evidência II, Estudo prospectivo comparativo.

Reliability of the goutallier classification system in the evaluation of the multifidus muscle / Concordância da classificação de goutallier na avaliação do músculo multífido / Fiabilidad del sistema de clasificación de goutallier en la evaluación del músculo multífido

ABSTRACT Introduction: The paravertebral musculature is essential for the biomechanics and stability of the spine, and its involvement in the pathophysiology of spinal diseases has been demonstrated. Qualitative evaluation of muscle degeneration is usually performed by analyzing the fat infiltration rate proposed by the Goutallier classification system. Objective: The objective of this study is to analyze the intra- and interobserver agreement of the Goutallier Classification for the evaluation of fatty degeneration of the multifidus muscle, using magnetic resonance imaging exams. Methods: The study included 68 patients, all diagnosed with symptomatic disc hernia and indicated for surgery. Preoperative magnetic resonance images were used for the analyses. The images were initially evaluated by two orthopedists and two medical students, and then re-evaluated after two weeks. Intra- and inter-observer reliability analysis was performed using the Fleiss Kappa test and the Landis and Koch criteria. All the analyses were performed using the R statistical environment (R Development Core Team, version 3.3.1, 2016) and the significance level was set at 5%. Results: The percentages of intra- and inter-observer agreement were 86.76% and 61.03%, respectively. The intraobserver agreement was near perfect and the interobserver agreement was moderate. Conclusion: The Goutallier Classification System showed moderate interobserver and intraobserver agreement, being a relevant tool for the evaluation of paravertebral musculature fat replacement. Level of evidence II; Prospective study for diagnostic purposes.

RESUMO Introdução: A musculatura paravertebral é essencial para a biomecânica e estabilidade da coluna e tem sido demonstrado seu envolvimento na fisiopatologia das doenças da coluna vertebral. A avaliação qualitativa da degeneração muscular é usualmente feita pela análise da taxa de infiltração de gordura proposta pelo Sistema de Classificação de Goutallier. Objetivo: O objetivo deste trabalho é analisar a concordância intra e interobservador da Classificação de Goutallier para avaliação da degeneração gordurosa do músculo multífido por meio de exames de ressonância magnética. Métodos: Fizeram parte do estudo 68 pacientes, todos com diagnóstico de hérnia discal sintomática e com indicação cirúrgica. As imagens de ressonância magnética colhidas no pré-operatório foram analisadas por dois ortopedistas e dois estudantes de medicina e foram reavaliadas duas semanas depois. Foi realizada análise de confiabilidade intra e interobservador por meio do teste Kappa de Fleiss e pelos critérios de Landis e Koch. Todas as análises foram realizadas com o auxílio do ambiente estatístico R (R Development Core Team, versão 3.3.1, 2016), e o nível de significância foi fixado em 5%. Resultados: As porcentagens de concordância intra e interobservadores foram, respectivamente, 86,76% e 61,03%. A concordância intraobservador foi quase perfeita e moderada interobservadores. Conclusões: O Sistema de Classificação de Goutallier demonstrou concordância moderada interobservador e intraobservador, sendo uma ferramenta relevante na avaliação da substituição gordurosa da musculatura paravertebral. Nível de evidência II; Estudo prospectivo para fins diagnósticos.

RESUMEN Introducción: La musculatura paravertebral es fundamental para la biomecánica y la estabilidad de la columna y se ha demostrado su intervención en la fisiopatología de las enfermedades de la columna. La evaluación cualitativa de la degeneración muscular se suele realizar analizando la tasa de infiltración de grasa propuesta por el sistema de clasificación de Goutallier. Objetivo: El objetivo de este estudio es analizar la concordancia intra e interobservador de la Clasificación de Goutallier para evaluar la degeneración grasa del músculo multífido mediante resonancia magnética. Métodos: Formaron parte del estudio 68 pacientes, todos con diagnóstico de hernia discal sintomática y con indicación quirúrgica. Se utilizaron imágenes de resonancia magnética preoperatorias para el análisis. Las imágenes fueron evaluadas inicialmente por 02 ortopedistas y 02 estudiantes de medicina y, después de dos semanas, reevaluadas. El análisis de fiabilidad intra e interobservador se realizó mediante la prueba Kappa de Fleiss y los criterios de Landis y Koch. Todos los análisis se realizaron utilizando el entorno estadístico R (R Development Core Team, 2016), versión 3.3.1, y el nivel de significancia se estableció en 5%. Resultados: Los porcentajes de concordancia intra e interobservador fueron, respectivamente, 86,76% y 61,03%. La concordancia intraobservador fue casi perfecta y la concordancia interobservador fue moderada. Conclusión: el Sistema de Clasificación de Goutallier demostró una moderada concordancia interobservador e intraobservador, siendo una herramienta relevante en la evaluación del reemplazo graso de la musculatura paravertebral. Nivel de evidencia II; Estudio prospectivo con fines diagnósticos.

Candida parapsilosis Infection after Lumbosacral Arthrodesis with a PEEK TLIF Interbody Fusion Device: Case Report.

Spondylodiscitis is an uncommon but serious complication after spine surgeries, and its main etiologic agent is Staphylococcus aureus . Fungal infections are rare and mostly caused by Candida albicans . We report the clinical case of a 69-year-old male patient who underwent a L2-S1 arthrodesis for degenerative scoliosis correction. He presented an infection 2.5 months after the procedure, a spondylodiscitis at L5-S1 levels, caused by Candida parapsilosis . The treatment consisted of surgical material removal, tricortical iliac graft placement in an anterior approach (L5-S1), lumbopelvic fixation (from T10 to the pelvis) in a posterior approach, and drug treatment with anidulafungin and fluconazole. This last medication was administered for 12 months, with good clinical outcomes.

Correlation between previous sedentary lifestyle and CrossFit-related injuries.

OBJECTIVE: To correlate CrossFit-related injuries with previous sedentary lifestyle, and to investigate other factors potentially associated with higher rates of injury among practitioners. METHODS: A nationwide cross-sectional study involving CrossFit practitioners who received a digital questionnaire inquiring into CrossFit-related injuries, previous sedentary life, training intensity and experience, site of injury and general demographics. RESULTS: This sample included 121 CrossFit practitioners, 34.7% of participants were sedentary prior to starting CrossFit practice, from these, 45.2% reported CrossFit-related injuries, compared to 30.4% from previously active practitioners (p=0.104). The shoulder/elbow (60.5%), lumbar spine (30.3%) and wrist/hand (16.3%) were the most common sites of injury among participants reporting CrossFit-related injuries (35.5%). Participants performing intense weight training were more prone to injuries than those practicing light or moderate weight training (p=0.043). On average, participants with a history of injury spent significantly more time training than those with no history of injury (68.4 and 61.7 minutes, respectively; p=0.044). CONCLUSION: The incidence of CrossFit-related injuries did not differ significantly between previously sedentary and physically active participants. Intense weight training was associated with a higher incidence of injuries. The overall injury rate was 35.5%, similar to that found in previous studies, and the most common site of injury was shoulder/elbow.

Candida parapsilosis Infection after Lumbosacral Arthrodesis with a PEEK TLIF Interbody Fusion Device: Case Report / Infecção por Candida parapsilosis em pós-operatório de artrodese lombossacra com dispositivo de fusão intersomático TLIF em PEEK: Relato de caso

Abstract Spondylodiscitis is an uncommon but serious complication after spine surgeries, and its main etiologic agent is Staphylococcus aureus. Fungal infections are rare and mostly caused by Candida albicans. We report the clinical case of a 69-year-old male patient who underwent a L2-S1 arthrodesis for degenerative scoliosis correction. He presented an infection 2.5 months after the procedure, a spondylodiscitis at L5-S1 levels, caused by Candida parapsilosis. The treatment consisted of surgical material removal, tricortical iliac graft placement in an anterior approach (L5-S1), lumbopelvic fixation (from T10 to the pelvis) in a posterior approach, and drug treatment with anidulafungin and fluconazole. This last medication was administered for 12 months, with good clinical outcomes.

Resumo As espondilodiscites são complicações infrequentes, porém graves em pós-operatórios de cirurgias da coluna vertebral, tendo como principal agente etiológico o Staphylococcus aureus. As infecções fúngicas são raras, sendo a Candida albicans a principal representante desse grupo. Relatamos o caso clínico de um paciente do sexo masculino, 69 anos, operado com artrodese de L2 a S1 para correção de escoliose degenerativa. O paciente apresentou quadro clínico infeccioso 2 meses e meio após o procedimento, relacionado à espondilodiscite L5-S1, causada por Candida parapsilosis. O tratamento consistiu na remoção do material cirúrgico, colocação de enxerto tricortical de ilíaco pela via anterior (L5-S1) e fixação lombopélvica (de T10 à pelve) pela via posterior, além de iniciar o tratamento medicamentoso com anidulafungina e fluconazol, mantendo essa última medicação por 12 meses, com boa evolução clínica.

Correlation between degenerative diseases of the lumbar spine and types of lumbar lordosis / Correlação entre doenças degenerativas da coluna lombar e os tipos de lordose lombar / Correlación entre las enfermedades degenerativas de la columna lumbar y los tipos de lordosis lumbar

ABSTRACT Objective: Evaluate the relationship between the incidence of different types of degenerative diseases of the spine and lumbopelvic biomechanics, according to the types of lordosis of Roussouly's classification. Methods: Retrospective study of medical records and results of imaging exams of patients seen at a private hospital in São Paulo. The sagittal alignment of these patients was evaluated by classifying them according to Roussouly into 4 types, based on panoramic radiographs of the spine. These results were correlated with the patient's degenerative diagnosis (Herniated disc, Canal stenosis, Spondylolisthesis, degenerative discopathy and Facet arthrosis). Statistical tests were performed comparing the types of curvature and diagnoses identified. Results: 418 patients were evaluated, 51.4% male and 49.6% female. The vast majority of patients, about 54%, had a diagnosis of herniated lumbar disc. There was a statistically significant difference that showed a predilection for surgical treatment in cases classified as Type I and Type II in the Roussouly classification. There was no statistically significant difference that correlated the types of lumbar lordosis with the diagnosis presented by the patients. Conclusion: There is no statistically significant difference that correlates the type of lumbar lordosis according to Roussouly with lumbar degenerative diseases. In contrast, patients classified as Type 1 and Type 2 by Roussouly underwent a greater number of surgical treatments compared to patients type 3 and 4, with statistical relevance. Level of evidence 2; Retrospective prognostic study.

RESUMO Objetivos: Avaliar a relação da incidência dos diferentes tipos de doenças degenerativas da coluna com a biomecânica lombopélvica, de acordo com os tipos de lordose segundo Roussouly. Métodos: Estudo retrospectivo de prontuários médicos e de resultados de exames de imagens de pacientes atendidos em um hospital privado de São Paulo. Foi avaliado o alinhamento sagital desses pacientes classificando-os de acordo com Roussouly em 4 tipos, com base nas radiografias panorâmicas da coluna vertebral. Esses resultados foram correlacionados com o diagnóstico degenerativo do paciente (Hérnia de disco, Estenose do canal, Espondilolistese, Discopatia degenerativa e Artrose facetaria). Testes estatísticos foram realizados comparando os tipos de curvatura e diagnósticos identificados. Resultados: Foram avaliados 418 pacientes, sendo que 51,4% do sexo masculino e 49,6% do sexo feminino. A grande maioria dos pacientes, cerca de 54%, apresentavam como diagnóstico hérnia de disco lombar. Houve uma diferença estatisticamente significativa que evidenciou uma predileção do tratamento cirúrgico nos casos classificados como Tipo I e Tipo II na classificação de Roussouly. Não houve diferença estatisticamente significativa que correlacionasse os tipos de lordose lombar com o diagnóstico apresentado pelos pacientes. Conclusões: Não houve diferença estatisticamente significativa que correlacione o tipo de lordose lombar de acordo com Roussouly com as doenças degenerativas lombares. Em contrapartida, os pacientes classificados como Tipo 1 e Tipo 2 de Roussouly foram submetidos em maior número ao tratamento cirúrgico em comparação com os pacientes tipo 3 e 4, com relevância estatística. Nível de evidência 2; Estudo prognóstico retrospectivo.

RESUMEN Objetivos: Evaluar la relación entre la incidencia de diferentes tipos de enfermedades degenerativas de la columna y la biomecánica lumbopélvica, según los tipos de lordosis de Roussouly. Métodos: Estudio retrospectivo de registros médicos y resultados de exámenes de imágenes de pacientes atendidos en un hospital privado en São Paulo. La alineación sagital de estos pacientes se evaluó clasificándolos según Roussouly en 4 tipos, en base a radiografías panorámicas de la columna vertebral. Estos resultados se correlacionaron con el diagnóstico degenerativo del paciente (disco herniado, estenosis del canal, espondilolistesis, discopatía degenerativa y artrosis facetaria). Se realizaron pruebas estadísticas comparando los tipos de curvatura y los diagnósticos identificados. Resultados: Se evaluaron 418 pacientes, 51.4% hombres y 49.6% mujeres. La gran mayoría de los pacientes, alrededor del 54%, tenían un diagnóstico de hernia de disco lumbar. Hubo una diferencia estadísticamente significativa que mostró una predilección por el tratamiento quirúrgico en los casos clasificados como Tipo I y Tipo II en la clasificación de Roussouly. No hubo diferencias estadísticamente significativas que correlacionaran los tipos de lordosis lumbar con el diagnóstico presentado por los pacientes. Conclusión: No hubo diferencias estadísticamente significativas que correlacionen el tipo de lordosis lumbar según Roussouly con las enfermedades degenerativas lumbares. En contraste, los pacientes clasificados como Tipo 1 y Tipo 2 por Roussouly se sometieron a un mayor número de tratamientos quirúrgicos en comparación con los pacientes tipo 3 y 4, con relevancia estadística. Nivel de evidencia 2; Estudo de pronostico retrospectivo.

Posttraumatic Arachnoid Cyst in the Thoracic Spine with Medullary Compression: Case Report.

Arachnoid cysts are rare; they can occur at all levels of the dural sac, and can have a congenital, traumatic, iatrogenic or inflammatory origin. In the present article, we report a patient presenting a compressive thoracic myelopathy due to an unusual intradural arachnoid cyst with posttraumatic manifestation and its resolution, in addition to a literature review on the subject. These cysts mainly occur at the thoracic spine, followed by the lumbar, lumbosacral and thoracolumbar spines. Traumatic cysts are caused by an injury to the inner dural layer. These lesions produce neurological deficits through a mass effect on the spinal cord. Concomitant compressive myelopathy is even rarer. In case of myelopathy, cyst resection or drainage is the treatment of choice, and it must be performed immediately. Although rare, arachnoid cysts can be a complication of spine fractures; as such, orthopedists and neurosurgeons, who commonly see these injuries, must be prepared for this unusual situation.

Posttraumatic Arachnoid Cyst in the Thoracic Spine with Medullary Compression: Case Report / Cisto aracnóide após trauma na coluna torácica com compressão medular: Relato de caso

Abstract Arachnoid cysts are rare; they can occur at all levels of the dural sac, and can have a congenital, traumatic, iatrogenic or inflammatory origin. In the present article, we report a patient presenting a compressive thoracic myelopathy due to an unusual intradural arachnoid cyst with posttraumatic manifestation and its resolution, in addition to a literature review on the subject. These cysts mainly occur at the thoracic spine, followed by the lumbar, lumbosacral and thoracolumbar spines. Traumatic cysts are caused by an injury to the inner dural layer. These lesions produce neurological deficits through a mass effect on the spinal cord. Concomitant compressive myelopathy is even rarer. In case of myelopathy, cyst resection or drainage is the treatment of choice, and it must be performed immediately. Although rare, arachnoid cysts can be a complication of spine fractures; as such, orthopedists and neurosurgeons, who commonly see these injuries, must be prepared for this unusual situation.

Resumo Cistos aracnóides são raros, podem ocorrer em todos os níveis do saco dural, e sua origem pode ser congênita, traumática, iatrogênica ou inflamatória. Neste artigo, relatamos o caso de uma paciente com mielopatia torácica compressiva decorrente de um cisto aracnóide intradural incomum, de manifestação pós-traumática, assim como sua resolução, além de realizar revisão da literatura sobre o tema. A principal localização é na coluna torácica, seguida das colunas lombar, lombossacra e toracolombar. O cisto com origem traumática é causado por lesão da camada interna da dura-máter. Essas lesões produzem déficit neurológico por meio de efeito de massa sobre a medula espinhal. A existência de mielopatia compressiva associada é mais rara ainda. A ressecção ou drenagem dos cistos na vigência de mielopatia deve ser imediata, sendo o tratamento de escolha. Apesar de raros, podem ser uma complicação de fraturas da coluna vertebral que são muito comuns na prática de ortopedistas e neurocirurgiões, que devem estar preparados para essa situação incomum.

Degenerative Cervical Disorder-Stand-alone Cage Versus Cage and Cervical Plate: A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVES: The objective of this study was to compare clinical and radiological outcomes following discectomy and anterior cervical fusion for the treatment of cervical degenerative disorder performed with stand-alone cages and anterior cervical plates. METHODS: Electronic searches were performed in the MEDLINE, LILACS, and Cochrane Systematic Reviews databases, according to PRISMA guidelines, with no language or date restriction. The review was registered in PROSPERO under number CRD42018109180. RESULTS: Six randomized clinical trials were selected, which evaluated at least one of the objectives of this work, such as pain control, bone consolidation, neurological symptoms, and cervical lordosis, thus satisfying the inclusion criteria. Articles that did not directly compare the 2 surgical techniques were excluded. A total of 309 patients were included and the results showed no significant difference in clinical (visual analogue scale and neck disability index) or radiological (cervical lordosis and fusion) outcome between the 2 groups. The operative time was shorter in the group with stand-alone cages (mean difference = -18.40; 95% CI = [-24.89, -11.92]; P < .66). CONCLUSION: The stand-alone cages and anterior cervical plate techniques have similar clinical and radiological outcomes. Despite the significantly shorter operative time for one group, other randomized clinical trials are needed to establish conclusive evidence in favor of one of the comparative treatments.

Correlation between previous sedentary lifestyle and CrossFit-related injuries / Correlação entre sedentarismo prévio e lesões relacionadas ao CrossFit

ABSTRACT: Objective: To correlate CrossFit-related injuries with previous sedentary lifestyle, and to investigate other factors potentially associated with higher rates of injury among practitioners. Methods: A nationwide cross-sectional study involving CrossFit practitioners who received a digital questionnaire inquiring into CrossFit-related injuries, previous sedentary life, training intensity and experience, site of injury and general demographics. Results: This sample included 121 CrossFit practitioners, 34.7% of participants were sedentary prior to starting CrossFit practice, from these, 45.2% reported CrossFit-related injuries, compared to 30.4% from previously active practitioners (p=0.104). The shoulder/elbow (60.5%), lumbar spine (30.3%) and wrist/hand (16.3%) were the most common sites of injury among participants reporting CrossFit-related injuries (35.5%). Participants performing intense weight training were more prone to injuries than those practicing light or moderate weight training (p=0.043). On average, participants with a history of injury spent significantly more time training than those with no history of injury (68.4 and 61.7 minutes, respectively; p=0.044). Conclusion: The incidence of CrossFit-related injuries did not differ significantly between previously sedentary and physically active participants. Intense weight training was associated with a higher incidence of injuries. The overall injury rate was 35.5%, similar to that found in previous studies, and the most common site of injury was shoulder/elbow.

RESUMO Objetivo: Correlacionar as lesões durante a prática do CrossFit com sedentarismo prévio e pesquisar outros fatores possivelmente relacionados ao aumento da taxa de lesão entre os praticantes. Métodos: Estudo transversal nacional, envolvendo praticantes de CrossFit, que receberam questionário digital para avaliar lesões relacionadas à prática da modalidade, à vida sedentária anterior, a intensidade e tempo de treinamento, à localização da lesão e à demografia geral. Resultados: Esta amostra incluiu 121 praticantes de CrossFit, 34,7% dos participantes eram sedentários antes de iniciar o CrossFit, desses, 45,2% sofreram alguma lesão relacionada a essa atividade, versus 30,4% dos que eram anteriormente ativos (p=0,104). Dos praticantes avaliados, 35,5% declararam história de alguma lesão relacionada ao CrossFit. Os locais mais frequentes foram ombro e cotovelo (60,5%), coluna lombar (30,3%), e punho e mão (16,3%). Os participantes que realizam levantamento de peso de forma intensa estiveram mais propensos a lesões do que aqueles que realizavam treinamento leve ou moderado (p=0,043). Os participantes com história de lesão apresentaram tempo médio de treinamento significativamente maior quando comparados àqueles sem antecedente de lesão (68,4 minutos versus 61,7 minutos; p=0,044). Conclusão: Não houve diferença significativa na incidência de lesões relacionadas ao CrossFit entre participantes previamente sedentários e fisicamente ativos. O levantamento intenso de pesos esteve relacionado à maior incidência de lesões. A taxa média de lesões encontradas neste estudo foi de 35,5%, semelhante a encontrada em estudos prévios. O local mais frequente foi ombro/cotovelo.

TRANSFORAMINAL INTERSOMATIC LUMBAR ARTHRODESIS: COMPARISON BETWEEN AUTOGRAFT AND CAGE IN PEEK.

OBJECTIVE: To compare the postoperative outcomes of transforaminal intersomatic lumbar arthrodesis with structured iliac bone autograft and PEEK device. METHODS: The total of 93 medical records of patients undergoing transforaminal intersomatic fusion between January 2012 and July 2017 with at least 1 year of postoperative follow-up, with complete medical record, containing clinical file and radiological exams, were reviewed. RESULTS: From the medical records evaluated, 48 patients underwent the procedure with structured iliac autograft (group 1) and 45 with PEEK device (group 2). There was an improvement in functional capacity in both groups (p < 0.001), however there was no difference when comparing them (p = 0.591). CONCLUSION: The postoperative clinical and radiological results of lumbar arthrodesis with TLIF technique, using a structured iliac bone autograft compared to a PEEK device, were similar. Level of Evidence II, Retrospective study.

OBJETIVO: Comparar os desfechos pós-operatórios da artrodese lombar intersomática transforaminal com autoenxerto ósseo ilíaco estruturado e dispositivo em poliéter-éter-cetonico-polímero (PEEK). MÉTODOS: Foram revistos 93 prontuários de pacientes submetidos à fusão intersomática transforaminal entre janeiro de 2012 e julho de 2017 com pelo menos um ano de acompanhamento pós-operatório, com prontuário completo, contendo ficha clínica e exames radiológicos. RESULTADOS: Dos prontuários avaliados, 48 pacientes foram submetidos ao procedimento com autoenxerto ilíaco estruturado (Grupo 1) e 45 com dispositivo em PEEK (Grupo 2). Houve melhora da capacidade funcional em ambos os grupos (p < 0,001), no entanto não houve diferença ao compará-los (p = 0,591). CONCLUSÃO: Os resultados clínicos e radiológicos pós-operatórios da artrodese lombar na técnica Fusão Intersomática Lombar Transforaminal (TLIF) utilizando autoenxerto ósseo ilíaco estruturado, em comparação com o uso de dispositivo em PEEK, foram semelhantes. Nível de Evidência II, Estudo retrospectivo.