Changes in spinal alignment. / Alteraciones de la alineación vertebral.

Spinal misalignments are a common reason for consultation at primary care centers and specialized departments. Misalignment has diverse causes and is influenced by multiple factors: in adolescence, the most frequent misalignment is scoliosis, which is idiopathic in 80% of cases and normally asymptomatic. In adults, the most common cause is degenerative. It is important to know the natural history and to detect factors that might predict progression. The correct diagnosis of spinal deformities requires specific imaging studies. The degree of deformity determines the type of treatment. The aim is to prevent progression of the deformity and to recover the flexibility and balance of the body.

[Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous]. / Situación actual de la cirugía toracoscópica del raquis torácico y lumbar. Parte 2: Tratamiento de la hernia de disco torácica, de las deformidades, de la patología tumoral e infecciosa, y miscelánea.

INTRODUCTION: Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. DEVELOPMENT: After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. CONCLUSIONS: Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery.

Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. / [Artículo traducido] Eficacia y seguridad de la tracción de halo-gravedad en el tratamiento de las deformidades de columna: una revisión sistemática de la literatura.

OBJECTIVE: To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity. METHODS: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.

Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature.

OBJECTIVE: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. METHODS: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialised paediatric and adolescent spine unit of a referral centre, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low-cost, accessible, reproducible and with an educational character.

Comparative Analysis Between Isolated Posterior and Anteroposterior Approaches for Severe Scoliosis Treatment.

Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications.

Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature.

The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: "scoliosis", "vision", "eye", "vestibule", "labyrinth" "posture", "balance", "eye movements", "cerebellum", "proprioception", and "physiological adaptation". In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.

The post-surgical transition in adolescents who have idiopathic scoliosis. A qualitative study.

OBJECTIVE: To know the process experienced by adolescents suffering from idiopathic scoliosis when undergoing surgery to correct the physical deformity. METHOD: Qualitative study with a symbolic interactionism approach. 22 semi-structured interviews were conducted with adolescents who underwent posterior spinal fusion in a third-level hospital in Madrid between May 2019 and January 2021. Taylor and Bogdan's analysis in progress was carried out. RESULTS: Patients with adolescent idiopathic scoliosis present with a complex simultaneous health/illness and developmental transition. The main inhibitory conditions of the transition are the meanings about: their identity, social, beliefs about surgery, ignorance about the pathology, the surgical process, and their recovery. As facilitating conditions, we find: a positive attitude towards physical, aesthetic, and social change, socioeconomic level, and family support. CONCLUSIONS: The informants of this study refer that aesthetic affectation and physical limitations are the main elements that cause them discomfort. Surgical intervention is presented as the solution to this situation. Recovery is a critical point in the transition process mainly due to pain. They accept the discomfort suffered during the recovery because they hope to obtain an improvement in the image and physical limitations. The changes and differences they experience during the transition make them think that they will be able to lead a «normal life¼ to which they constantly refer in their speeches.

Juvenile scoliosis as the first manifestation of syringomyelia associated with Chiari malformation type I.

BACKGROUND: Scoliosis is a spinal deformity that usually manifests as a structural curve determining a variable deformity of the trunk. According to some published series, 4 to 26% of scoliosis initially classified as idiopathic show neurological alterations when studied with nuclear magnetic resonance, such as syringomyelia and Chiari malformation, among the most frequent. Chiari malformations are characterized by descending herniation of the cerebellar tonsils, brainstem, and IV ventricle into the spinal canal. CASE REPORT: We present the case of a patient whose first symptomatic manifestation was early-onset scoliosis. The overlapping of some physical examination signs, such as postural lateralization and scoliosis, reinforced the active suspicion of neuroaxis alterations. CONCLUSIONS: Early childhood-onset scoliosis should raise a high degree of suspicion for association with neuro-spinal diseases. Although the frequency of Chiari malformation is low, its early approach could reduce the progression of associated comorbidities. An early detection could change the prognosis of the disease.

INTRODUCCIÓN: La escoliosis es una deformidad de la columna que usualmente se manifiesta como una curva estructural que determina una deformidad variable del tronco. Las malformaciones de Chiari se caracterizan por la herniación descendente de las amígdalas cerebelosas, tronco encefálico y IV ventrículo hacia el canal espinal. Según algunas series publicadas, del 4 al 26% de las escoliosis inicialmente catalogadas como idiopáticas muestran alteraciones neurológicas al ser estudiadas con resonancia magnética nuclear, como la siringomielia y malformación de Chiari, dentro de las más frecuentes. CASO CLÍNICO: Se presenta el caso de un paciente cuya primera manifestación sintomática fue escoliosis de comienzo temprano. El solapamiento de algunos signos del examen físico, como la lateralización de la postura y la escoliosis, reforzaron la sospecha activa de alteraciones del neuroeje. CONCLUSIONES: La escoliosis de inicio temprano en la infancia debe despertar un alto grado de sospecha de asociación con enfermedades neuro-espinales. Dentro de este contexto, aunque malformación Chiari es de baja frecuencia, su abordaje precoz permitiría disminuir la progresión de comorbilidades asociadas. La detección temprana podría cambiar el pronóstico de la enfermedad.

How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method. / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.

Change in triggered EMG thresholds for thoracic pedicle screws caused by pneumothorax during surgery for adolescent idiopathic scoliosis. Report of two cases. / Alteración en los umbrales de estimulación de tornillos pediculares torácicos secundaria a neumotórax en cirugía por escoliosis idiopática del adolescente. A propósito de dos casos.

Posterior spinal instrumentation and fusion with pedicle screws inserted by free-hand technique and controlled by multimodal intraoperative monitoring is the most common technique in adolescent idiopathic scoliosis surgery. Pneumothorax is a described complication of this kind of procedure. Triggered electromyography is used to identify pedicle wall breakthrough and prevent neurological injuries. We report 2 clinical cases in which unilateral decrease in triggered electromyography values associate with ipsilateral pneumothorax. Postoperative chest radiographs need to be done in order to diagnose a pneumothorax. However, routinely performing a chest radiograph has been questioned because of the low incidence of this surgical complication. As a result of the association described in this article, we consider that when a unilateral decrease in triggered electromyography values is detected, a hidden pneumothorax should be suspected and ruled out.

Spinal osteoid osteoma recurring as an aggressive osteoblastoma. / Osteoma osteoide raquídeo recidivante en forma de osteoblastoma agresivo.

We report an uncommon case of osteoid osteoma recurring as an aggressive osteoblastoma of the spine. A 15-years-old male consulted in our department with long-term painful scoliosis. The CT-scans and MRI revealed a sclerotic bone forming tumor of 7mm diameter consistent with a osteoid osteoma. A percutaneous radiofrequency ablation was performed with complete resolution of the symptoms. After 6 months, the symptoms recurred. A new CT and a MRI showed a growth of the nidus on the right L4 lamina, with a size of 15mm. Therefore, a marginal resection by laminectomy of L4 was performed. Pathology confirmed an epithelioid osteoblastoma. A year later, subsequent imaging studies showed a new recurrence with aggressive features and invasion of the spinal canal. The patient then underwent an "in block surgery" needing concurrent stabilization of the spine. Histopathology confirmed the diagnosis of epithelioid osteblastoma.

Bilateral erector spinae plane block for scoliosis surgery: Case series. / Bloqueo bilateral en el plano del músculo erector de la columna para cirugía de escoliosis: serie de casos.

Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. The technical challenges are also highlighted. An ultrasound guided scout scan is necessarry to identify the bony prominences and determine the possible multiple injection points. Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity.

Painful experience in adolescents undergoing surgical correction of scoliosis. / Experiencia dolorosa en adolescentes tratados mediante corrección quirúrgica de escoliosis.

OBJECTIVE: The aim of our study is to learn about the post-surgical pain experience in adolescents undergoing surgical correction of Adolescent Idiopathic Scoliosis (AIS). METHODS: Qualitative study with an interpretative phenomenological approach. Through semi-structured interviews, 7 informants, women aged between 12 and 21, were interviewed between the third and fifth day after being surgically treated for AIS correction. The speeches were recorded and transcribed verbatim. Content Analysis method was used to analyse the discourse. RESULTS: The categories established were: influential factors, values and ideas, coping mechanisms and improvement areas. Painful experience is a determining factor during recovery, influenced by the individuals themselves, as well as by the support received, and the environment. Their main values and ideas about the process are based on pre-surgical information, which they consider insufficient. In order to cope, they use of distraction, relaxation and drug consumption. According to the informants, increasing the information they are given about the process, facilitating visits and incorporating complementary techniques would improve pain control. CONCLUSIONS: Pain is the main focus of the process and is influenced by several factors. The patients' coping mechanisms help in its management. They also put forward different improvement areas.

Escoliosis idiopática del adolescente / Adolescent idiopathic scoliosis

La escoliosis idiopática del Adolescente (EIA) es una deformidad tridimensional de la columna vertebral que aqueja de diversas formas la condición de vida de quien la padece, afectando el desarrollo físico y psicológico del paciente. Proponemos evaluar el resultado clínico, radiológico y el componente de calidad de vida de pacientes tratados quirúrgicamente con EIA, en el servicio de Neurocirugía, Hospital Jesús Yerena del Lídice. Se evaluó patrón de la curva, clasificación según Lenke, ángulo de Cobb pre y postquirúrgico, edad de tratamiento quirúrgico, gradode corrección, calidad de vida según cuestionario SRS-22 pre y postquirúrgica, valoración funcional mediante la escala de discapacidad de Oswestry (ODI) y complicaciones postoperatorias. Se estudiaron 22 casos (95 % femenino), el principal grupo etario fue de 11-14 años (55 %), la escoliosis tipo 1 fue la predominante (60 %), el ángulo de Cobb inicial fue mayor a 50° (50 %) y la madurez esquelética principal fue Risser 3 (55 %). La edad de resolución quirúrgica predominante fue entre 15-18 años (60 %), el grado de corrección postoperatorio fue de 75-100 % (73 %) y la densidad de los tornillos pediculares fue de 1.4-1.7 (64 %). En el cuestionario SRS-22, hubo mayor afectación en las dimensiones de autoimagen con una media de 1.8 y la valoración por ODI mostró un índice de incapacidad mínima, que fue mejorando en los controles sucesivos. Nuestra principal complicación fueron las infecciones (36 %). Concluimos que la cirugía correctiva temprana en la EIA ofrece a una mejoría clínica, radiológica y de la calidadde vida de estos paciente(AU)

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that affects the living condition of those who suffer from it in various ways, affecting the physical and psychological development of the patient. We propose to evaluate the clinical and radiological outcome and the quality-of-life component of patients treated surgically with EIA, in the Neurosurgery Service, Hospital Jesús Yerena del Lídice. Curve pattern, Lenke classification, pre-and post-surgical Cobb angle, age at surgical treatment, degree of correction, quality of life according to pre-and post-surgical SRS-22 questionnaire, functional assessment using the Oswestry Disability Scale (ODI) and postoperative complications were evaluated. 22 cases were studied (95% female), the main age group was 11-14 years (55%), type 1 scoliosis was predominant (60%), the initial Cobb angle was greater than 50° (50%) and the main skeletal maturity was Risser 3 (55%). The predominant age of surgical resolution was between 15-18 years (60%), the degree of postoperative correction was 75-100% (73%) and the density of pedicle screws was 1.4-1.7 (64%). In the SRS-22 questionnaire, there was greater impairment in the self-image dimensions with a mean of 1.8 and the ODI assessment showed aminimal disability index, which improved in successive controls. Our main complication was infections (36%). We conclude that early corrective surgery in AIS offers clinical, radiological and quality of life improvement for these patient(AU)

Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature / Eficacia y seguridad de la tracción de halo-gravedad en el tratamiento de las deformidades de columna: una revisión sistemática de la literatura

Objective: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. Methods: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. Results: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). Conclusions: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.(AU)

Objetivo: Determinar, mediante una revisión sistemática, los efectos de la tracción de halo-gravedad (HGT) en las deformidades de columna. Métodos: Se incluyeron estudios prospectivos o series de casos de pacientes con escoliosis o cifosis tratados con HGT. Los resultados radiológicos se midieron en los planos sagital y/o coronal. También se evaluó la función pulmonar. Finalmente, se recogieron las complicaciones perioperatorias. Resultados: Se incluyeron 13 estudios. La etiología congénita fue la más frecuente. La mayoría de los estudios proporcionaron valores de corrección de la curva clínicamente relevantes en los planos sagital y coronal. Los valores pulmonares mejoraron significativamente tras el uso de HGT. Por último, existieron 83 complicaciones en 356 pacientes, siendo la infección la más frecuente (38 casos). Conclusiones: La HGT mostró ser una intervención segura y eficaz para la deformidad, que permite la corrección antes de la cirugía. Sin embargo, existe una falta de homogeneidad en los estudios publicados.(AU)

[Artículo traducido] Eficacia y seguridad de la tracción de halo-gravedad en el tratamiento de las deformidades de columna: una revisión sistemática de la literatura / Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature

Objective: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. Methods: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. Results: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). Conclusions: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.(AU)

Objetivo: Determinar, mediante una revisión sistemática, los efectos de la tracción de halo-gravedad (HGT) en las deformidades de columna. Métodos: Se incluyeron estudios prospectivos o series de casos de pacientes con escoliosis o cifosis tratados con HGT. Los resultados radiológicos se midieron en los planos sagital y/o coronal. También se evaluó la función pulmonar. Finalmente, se recogieron las complicaciones perioperatorias. Resultados: Se incluyeron 13 estudios. La etiología congénita fue la más frecuente. La mayoría de los estudios proporcionaron valores de corrección de la curva clínicamente relevantes en los planos sagital y coronal. Los valores pulmonares mejoraron significativamente tras el uso de HGT. Por último, existieron 83 complicaciones en 356 pacientes, siendo la infección la más frecuente (38 casos). Conclusiones: La HGT mostró ser una intervención segura y eficaz para la deformidad, que permite la corrección antes de la cirugía. Sin embargo, existe una falta de homogeneidad en los estudios publicados.(AU)

¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria / How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

Epidemiology of pediatriac scoliosis in a tertiary hospital in recife-pe / Epidemiologia da escoliose pediátrica em hospital terciário em recife-pe / Epidemiología de la escoliosis pediátrica en hospital terciario en recife-pe

ABSTRACT: Objective: The present study aims to outline the epidemiological parameters of patients with scoliosis between the ages of 0 and 18 years old, who were evaluated at the Getúlio Vargas Hospital in Recife-PE. Methods: The participants completed a demographic questionnaire, followed by clinical evaluation, including Cobb angle measurement, clinical photographic registration and quality of life questionnaires. Results: The sample consisted of 103 patients, mostly females, with a mean age of 13.86 years, from the interior of the state, diagnosed with adolescent idiopathic scoliosis classified as Lenke 1. Neuromuscular and congenital scoliosis were less common. The quality-of-life questionnaire showed a significant difference in self-image perception among patients with idiopathic scoliosis, those who had a curve measuring under 50 degrees had better scores than those who had greater angles. Patients with larger curves scored lower on all questionnaire items, but there was no significant difference when compared to the other group. Conclusion: It was shown that the main epidemiological parameters in the pediatric population with scoliosis are girls, mean age 13 years, coming from the interior of the state being idiopathic scoliosis, the most common, classified as Lenke 1. Neuromuscular scoliosis was the main type of deformity following the idiopathic; cerebral palsy being the most common etiology. Level of evidence IV; Prognostic Studies Investigating the effect of a Patient characteristic on the outcome of Disease.

RESUMO: Objetivo: Traçar o perfil epidemiológico dos pacientes portadores de escoliose entre as idades de 0 até 18 anos no Hospital Getúlio Vargas em Recife-PE. Métodos: Estudo transversal em que os participantes foram submetidos a um questionário demográfico, em seguida tiveram seu perfil clínico avaliado com a medição do ângulo de Cobb, realização de fotografias clínicas e aplicação de questionários de qualidade de vida. Resultados: A amostra foi construída com 103 pacientes, em sua maioria do gênero feminino, com idade média de 13,68 anos, provenientes do interior do estado, com diagnóstico de escoliose idiopática do adolescente classificadas como Lenke 1. Escoliose neuromuscular e congênita estiveram presentes em menor número. O questionário de qualidade de vida aplicado mostrou que houve diferença significativa na percepção da autoimagem de pacientes com escoliose idiopática que tinham curvas menores que 50 graus em relação aos que tinham maior deformidade. Aqueles com curvas de maior valor angular apresentavam menor pontuação em todos os quesitos do questionário, sugerindo pior qualidade de vida, mas não houve diferença significativa. Conclusão: Conclui-se que, o perfil epidemiológico dos pacientes portadores de escoliose pediátrica é formado por meninas com escoliose idiopática, com média de idade de 13 anos, provenientes do interior do estado, tendo diagnóstico de escoliose idiopática classificada como Lenke 1. Dos demais tipos de escoliose, o mais prevalente foi a escoliose neuromuscular secundária à paralisia cerebral. Nível de Evidência IV; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

RESUMEN: Objetivos: Describir el perfil epidemiológico de los pacientes diagnosticados con escoliosis de 0 a 18 años que son evaluados en el Hospital Getúlio Vargas en Recife-PE. Métodos: Los participantes fueron sometidos a una encuesta demográfica y luego a una evaluación clínica que incluyó la toma de fotos, la medición de ángulo de Cobb y un cuestionario de calidad de vida. Resultados: La muestra fue constituida por 103 individuos, la mayoría de género femenino, con edad media de 13,68 años, que provenían del interior del estado y que fueron diagnosticadas con escoliosis idiopática del adolescente, clasificada en Lenke 1. La escoliosis neuromuscular y congénita estuvieron presentes en un número más pequeño. El cuestionario de calidad de vida mostró que hubo una diferencia significativa en la percepción de autoimagen de los pacientes con escoliosis idiopática con curvas menores a 50 grados cuando se compararon con los que tenían curvas más grandes. Los pacientes con curvas mayores tenían menos puntos en todas las preguntas del cuestionario, pero sin diferencia significativa. Conclusión: Se concluyó que el perfil epidemiológico de los pacientes con escoliosis pediátrica era formado por niñas con escoliosis idiopática, con edad media de 13 años, que provenían del interior del estado, clasificadas como Lenke 1. De los demás tipos de escoliosis, la neuromuscular secundaria a parálisis cerebral fue la más común. Nivel de evidencia IV; Estudios pronósticos - Investigación del efecto de características de un paciente sobre el desenlace de la enfermedad.