Association of polymorphism in leptin receptor gene with susceptibility of adolescent idiopathic scoliosis

PURPOSE

Abnormal leptin bioavailability has play key roles in the etiology of adolescent idiopathic scoliosis (AIS). Both leptin and its receptor levels may be modulated by the presence of genetic polymorphisms. This study aimed to evaluate the role of polymorphisms in the leptin (LEP) and its main receptor (LEPR) genes in the AIS susceptibility in girls.

METHODS

A retrospective case-control study was conducted with 189 AIS and 240 controls. LEP rs2167270 and LEPR rs2767485 polymorphisms were genotyped using a TaqMan validated assay. Associations were evaluated by odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

The AIS group showed a predominance of girls under 18 years old (n = 140, 74.1%), 148 (78.3%) had low or normal BMI, 111 (58.7%) had Cobb ≥ 45º and 130 (68.7%) were skeletally mature. Minor allele frequencies of rs2167270 and rs2767485 were 35.7% and 18.3%, for AIS and 35.6% and 25.4% for controls, respectively. LEPR rs2767485 T and TC + TT were associated with higher risk of AIS (OR = 1.53; 95% CI = 1.09-2.13 and OR = 1.84; 95% CI = 1.69-2.01, respectively), since CC genotype was only present in the control group. In addition, the LEP rs2167270 GA + AA was more frequent in low weight group (BMI ≤ 24.9) of girls with AIS. There was no significant association between LEP rs2167270 and AIS susceptibility, and LEPR rs2767485 and BMI.

CONCLUSION

The LEPR rs2767485 was associated with the genetic susceptibility of AIS and LEP rs2167270 with low BMI. These data can contribute to the identification of genetic biomarkers to improve the diagnosis and treatment.

Sacroiliac joint dysfunction and lumbar pain. Evaluation in a Brazilian population

The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

EVALUATION OF KYPHOSIS MEASUREMENT IN THORACOLUMBAR SPINE FRACTURES

ABSTRACT Objectives: Evaluate the reliability and reproducibility of the kyphosis measurement in thoracolumbar spine traumatic fractures by different assessment methods in different types of fractures. Methods: Fifteen fractures of the thoracolumbar spine, previously classified into types A, B, and C according to Magerl’s classification, were evaluated. The value of kyphosis was measured using five different methods: (1) Cobb angle; (2) Gardner’s method; (3) back wall method; (4) angle of adjacent endplates; and (5) wedge angle. The measurements were performed by five independent observers and repeated five times with a minimum interval of two weeks between each evaluation. Results: Intraobserver reliability was excellent among the five observers, evidencing good reproducibility of the methods. The five methods used also showed great intraobserver reliability in the global analysis, with methods one and four being more consistent. Conclusion: Although there is no universal agreement on measuring kyphosis in thoracolumbar fractures, our study concluded that method 1 (Cobb angle) and method 4 (adjacent endplate angle) presented the best interobserver reliabilities. Furthermore, the use of digitized radiographs and a simple computer program allowed the performance of highly reliable and reproducible measurements by all methods, given the high intraobserver reliability. Level of Evidence II; Comparative study.

USE OF THE uCentrum SYSTEM IN THE SURGICAL TREATMENT OF DISEASES OF THE VERTEBRAL SPINE

ABSTRACT Objectives: Evaluate the treatment outcome and the performance of the uCentum spinal fixation system in treating traumatic, degenerative, and tumoral diseases of the spine. Methods: This is a therapeutic study to investigate treatment outcomes and level of evidence III, including twenty-three adult patients of both sexes undergoing surgical treatment of degenerative (13 patients), traumatic (04 patients), or tumor diseases (06 patients). Patients were prospectively evaluated using clinical parameters: pain (visual analog scale), clinical and functional assessment questionnaires (SF-36, Oswestry and Roland-Morris), and radiological criteria (arthrodesis consolidation, loosening, breakage or deformation of the implants). Results: Twenty patients were followed for a period of 01 month to 12 month (mean 6,5±7,77). Three patients died due to complications unrelated to the primary disease (traumatic brain injury, septicemia, and lung tumor). Improvements were observed in clinical parameters and scores of the evaluation questionnaires used. No implant-related complications (breakage, loosening, deformation) were observed. Conclusion: the uCentum fixation system showed great versatility for performing the surgical treatment, allowing the performance of open, percutaneous procedures, the introduction of acrylic cement inside the implants, and conversion of polyaxial screws into monoaxial screws intraoperatively. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment.

Uso de guia tridimensional personalizado no preparo do orifício do pedículo piloto em deformidades da coluna vertebral

Objective  The present study aimed to develop and evaluate the use of customized guides in patients undergoing surgery to correct vertebral deformity with a pedicular fixation system.

Methods  Four patients with spinal deformity (three with idiopathic scoliosis and one with congenital kyphoscoliosis) underwent surgical treatment to correct the deformity with a pedicular fixation system. Prototypes of 3D cost guides were developed and evaluated using technical feasibility, accuracy, and radiation exposure.

Results  The present study included 85 vertebral pedicles in which pedicle screws were inserted into the thoracic spine (65.8%) and into the lumbar spine (34.2%). Technical viability was positive in 46 vertebral pedicles (54.1%), with 25 thoracic (54%) and 21 lumbar (46%). Technical viability was negative in 39 pedicles (45.9%), 31 of which were thoracic (79.5%), and 8 were lumbar (20.5%). In assessing accuracy, 36 screws were centralized (78.2%), of which 17 were in the thoracic (36.9%) and 19 in the lumbar spine (41.3%). Malposition was observed in 10 screws (21.7%), of which 8 were in the thoracic (17.4%) and 2 in the lumbar spine (4.3%). The average radiation record used in the surgical procedures was of 5.17 ± 0.72 mSv, and the total time of use of fluoroscopy in each surgery ranged from 180.3 to 207.2 seconds.

Conclusion  The customized guide prototypes allowed the safe preparation of the pilot orifice of the vertebral pedicles in patients with deformities with improved accuracy and reduced intraoperative radiation.

Association of FBN1 polymorphism with susceptibility of adolescent idiopathic scoliosis: a case-control study

BACKGROUND

Fibrillin-1 (FBN1) is an extracellular matrix glycoprotein essential to the structural component of microfibrils and FBN1 gene polymorphisms can be associated with adolescent idiopathic scoliosis (AIS) susceptibility. This study aimed to evaluate the potential role of the FBN1 rs12916536 polymorphism in AIS development or severity and the variation in Cobb angle in relation to patient's characteristics.

METHODS

DNA from 563 subjects (185 AIS patients and 378 controls) were genotyped using a validated TaqMan allelic discrimination assay. A multivariate logistic regression model evaluated the association between polymorphism and AIS, using the adjusted odds ratios (OR) with their respective 95% confidence intervals (95% CI). A linear regression analysis evaluated the variation in Cobb angle according to the patient's age and body mass index (BMI).

RESULTS

Among the AIS group there was a predominance of females (12:1), low or normal BMI (90%), 58% had a Cobb angle greater than 45° and 74% were skeletally mature. Age was a risk factor (4-fold) for curve progression higher than BMI (P < 0.001). The allelic frequency of the rs12916536 G > A polymorphism was 40% in controls and 31% in AIS cases; and this difference was statistically significant (P = 0.004). FBN1 rs12916536 GA + AA genotypes were associated with a lower risk of AIS susceptibility (OR = 0.58 and 95% CI = 0.35-0.98), after adjustment for age, sex and BMI. However, no significant differences were detected in polymorphism distribution with the severity of the disease (Cobb < 45° or ≥ 45°).

CONCLUSION

Age was a risk factor for progression of the scoliotic curve and FBN1 rs12916536 polymorphism a protective factor for AIS susceptibility.

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach

BACKGROUND

Readmission followed by surgery to treat spinal fractures has a substantial impact on patient care costs and reflects a hospital's quality standards. This article analyzes the factors associated with hospital readmission followed by surgery to treat spinal fractures.

METHODS

This was a cross-sectional study with time-series analysis. For prediction analysis, we used Cox proportional hazards and machine-learning models, using data from the Healthcare Cost and Utilization Project, Inpatient Database from Florida (USA).

RESULTS

The sample comprised 215,999 patients, 8.8% of whom were readmitted within 30 days. The factors associated with a risk of readmission were male sex (1.1 [95% confidence interval 1.06-1.13]) and >60 years of age (1.74 [95% CI: 1.69-1.8]). Surgeons with a higher annual patient volume presented a lower risk of readmission (0.61 [95% CI: 0.59-0.63]) and hospitals with an annual volume >393 presented a lower risk (0.92 [95% CI: 0.89-0.95]).

CONCLUSION

Surgical procedures and other selected predictors and machine-learning models can be used to reduce 30-day readmissions after spinal surgery. Identification of patients at higher risk for readmission and complications is the first step to reducing unplanned readmissions.

COMPLICATIONS OF SURGICAL TREATMENT OF SPINAL METASTASES

ABSTRACT Objectives: To evaluate the complications of surgical treatment in a group of patients with spinal metastasis with epidural compression, undergoing surgical treatment. Methods: This is a comparative retrospective study (level of evidence III), which evaluated 96 patients with spinal metastases undergoing surgical treatment. Intra- and postoperative complications were obtained from the patients’ medical records and correlated with the following clinical characteristics: tumor type, tumor location, neurological deficit, age, number of affected vertebrae, Tokuhashi scale, Tomita scale, Karnofsky performance scale, and type of approach. Results: Complications of surgical treatment were observed in 29 (30.20%) patients. Surgical wound infection was the most frequent complication, observed in 15% of patients. Conclusions: Surgical treatment of spinal metastases presents complications in about 30% of patients and their occurrence should be considered in the treatment planning, weighing the risks and benefits for achieving the treatment goals. Level III evidence; Retrospective Study.

CERVICAL SPONDYLOTIC MYELOPATHY: IS A COMBINED APPROACH NECESSARY?

ABSTRACT Objective: Cervical spondylotic myelopathy (CSM) is the main cause of spinal dysfunction in adults. The type of surgical approach to treatment is not well defined in the literature. The objective is to report the results obtained through isolated posterior decompression in patients with a previous indication of the combined approach for the treatment of cervical spondylotic myelopathy. Methods: This is a therapeutic study with level of evidence II, according to the Oxford classification table. Ten patients who underwent isolated posterior approach surgery for the treatment of cervical spondylotic myelopathy were evaluated through imaging and questionnaires (visual analog scale, mJOA-Br scale – Brazilian Portuguese version of the Modified Japanese Orthopedic Association Scale, and Neck Disability Index (NDI)), comparing pre- and postoperative results. Results: Late evaluation of the 10 patients was performed in the period ranging from 24 to 36 months (mean of 30.3 months ± 7.25) following surgery. The comparison of the clinical and radiological parameters in all patients showed a statistical difference in relation to the preoperative scales applied and to the degree of cervical lordosis (p <0.05), evidencing improvement after decompression and posterior fixation of the cervical spine. Conclusions: The isolated posterior approach (decompression, fixation and arthrodesis) allowed the clinical and radiological improvement of patients with cervical spondylotic myelopathy and who had an indication of the complementary anterior approach. Level of evidence II; Retrospective study.

UNKNOWN PRIMARY TUMOR SITES IN SPINAL METASTASIS

ABSTRACT Objective: The goal of the study was to report the prevalence of spinal metastasis with unknown primary tumor, clinical features, treatment results and patient survival. Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression, who underwent surgical treatment between March 2009 and August 2015. The prevalence of metastatic spinal tumor with unknown primary tumor was evaluated, as well clinical features, survival and treatment results. Results: Of 103 patients with spinal metastasis and epidural compression, seven patients (6.8%) with unknown primary tumor site were identified; five (71.4%) male and two (28.6%) female, with ages ranging from 37 to 67 years (50.7 years). The metastasis was located in the thoracic spine in six of the patients (85.7%) and in the cervical spine in one (14.3%). The mean survival time was 44.8 days. Conclusion: Spinal metastasis with unknown primary tumor was found in 6.8% of patients. The prognosis and outcomes were poor, and patients had poor survival rates. Level of evidence III; Experimental study.

Rotational dislocation C1-C2 after otoplasty under local anesthesia

Non-traumatic rotational atlantoaxial subluxation (NTARS) is rare and mostly reported after infection of the upper respiratory tract and named Grisel's syndrome. NTARS has also been reported after head-and-neck surgery, but it is extremely rare after otoplasty. A case of NTARS after bilateral otoplasty is reported under local anesthesia, a 15-year-old female being presented with painful torticollis. The diagnosis of atlantoaxial rotatory subluxation was performed using radiographs and computed tomography 2 weeks after the surgery. Closed reduction was performed by traction of the head and transoral direct pressure over an anterior dislocated C1 mass. The reposition of the joint was achieved, but it was very unstable, and it was not possible to keep the reduction. Open posterior reduction and posterior C1–C2 arthrodesis were performed followed by the use of a soft collar during 3 months.

Spinopelvic sagittal balance: what does the radiologist need to know?

Sagittal balance describes the optimal alignment of the spine in the sagittal plane, resulting from the interaction between the spine and lower limbs, via the pelvis. Understanding sagittal balance has gained importance, especially in the last decade, because sagittal imbalance correlates directly with disability and pain. Diseases that alter that balance cause sagittal malalignment and may trigger compensatory mechanisms. Certain radiographic parameters have been shown to be clinically relevant and to correlate with clinical scores in the evaluation of spinopelvic alignment. This article aims to provide a comprehensive review of the literature on the spinopelvic parameters that are most relevant in clinical practice, as well as to describe compensatory mechanisms of the pelvis and lower limbs.

The Role of Pedicle Screw Surface on Insertion Torque and Pullout Strength

Objective  Compare by mechanical tests the pullout resistance and the insertion torque of rough and smooth pedicle screws. Methods  Pedicle screws with rough surface and smooth surface, with diameters of 4.8; 5.5 and 6.5 mm, were inserted in polyurethane blocks with density of 10 PCF (0.16 g/cm3). Insertion torque and pullout strength were assessed. Results  The pullout strength of the rough surface and smooth surface screws did not differ, except in the group of 4.8 mm diameter screws. In this group, the rough surface screws showed greater resistance to pullout. Conclusion  Pedicle screws with a rough surface did not show increased pullout resistance in the acute phase of their insertion in polyurethane blocks compared to smooth surface screws. The rough surface screws had a higher insertion torque than the smooth surface screws, depending on the diameter of the screw and the preparation of the pilot hole.

Cervical Myelopathy Secondary to Gout: Case Report

Gout is a crystalline arthropathy frequent in the population, but gouty spondyloarthropathy, also called axial gout, is uncommon. The current case report presents a rare case of cervical myelopathy secondary to axial gout. A 50-year-old female patient, without previous pathologies, presented with loss of strength, altered sensitivity, and pyramidal release for 2 years. The computed tomography showed a lytic image in the spinous process of C7, and signs of myelopathy with myelomalacia on magnetic resonance imaging of the cervical spine. After the surgical procedure and biopsy of the material, the diagnosis was gout, and treatment for the pathology was started, with complete improvement of the condition. The diagnosis of axial gout should be included in the spectrum of the differential diagnosis of diseases that affect the spine. Although gouty spondyloarthritis (or spondylitis) is uncommon, there is an underestimated occurrence due to the lack of investigation of the cases. The early diagnosis and treatment of the pathology can prevent patients from presenting complications of the disease, as reported in the present study.

INFLUENCE OF DIAMETER AND GEOMETRY IN THE TAPPING OF THE PILOT HOLE IN PEDICLE SCREWS

ABSTRACT Objective: To evaluate the insertion torque and the pulling force of each screw with different diameters and tap. Methods: Polyurethane blocks with a pilot hole of 2.7 mm were used in the study. An experimental group with 5 blocks was formed, the insertion torque was evaluated with a torque meter, and the pullout strength of each Globus screw of 5.5 mm and 6.5 mm was assessed. Results: The comparison of the insertion torque on the 5.5 mm screws with pilot hole without tapping and with a smaller diameter than that of the screw (4.5 mm) and a different thread, and with the tapping with the same diameter as that of the screw (5.5 mm) and equal or different thread presented a statistical difference with a higher value of the insertion torque in the group in which the tapping was not performed. As for the pulling force of the 5.5 mm screw, the non-tapping of the pilot hole resulted in statistical difference with the same diameter of the screw (5.5 mm) and with a different thread of the screw. The pullout force on the 6.5 mm screw was higher in the group where the pilot hole was not tapped according to the non-parametric Kruskal-Wallis test, with significance level of p <0.05 in the comparison of the groups. Conclusions: Pilot hole tapping reduced insertion torque and pullout resistance of the pedicle screw influencing the fixation with tapping with the same screw diameter and different thread design.

Community Care Administration of Spinal Deformities in the Brazilian Public Health System

OBJECTIVE:

Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system.

METHODS:

A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system.

RESULTS:

Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available.

CONCLUSION:

The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.

COMPARISON OF EXPOSURE TO RADIATION DURING PERCUTANEOUS TRANSPEDICULAR PROCEDURES, USING THREE FLUOROSCOPIC TECHNIQUES

ABSTRACT Objective: To compare radiation exposure to the surgeon, patient and radiation technician during percutaneous access of the vertebral pedicle, using three different fluoroscopic imaging set up. Methods: Percutaneous access in pedicle T9-L5 of nine adult male cadavers using three different fluoroscopic set ups: standard C-arm, C-arm with L-arm, and the biplanar technique. The radiation dose exposure of the surgeon, radiation technician, and cadaver were measured using dosimeter in each procedure and in real time. Results: The radiation dose absorbed by the surgeon was higher when using the standard C-arm fluoroscopic technique than when using the C-arm with L-arm or the biplanar technique. Conclusions: The use of the C-arm with L-arm, or the biplanar fluoroscopic technique, for percutaneous access to the vertebral pedicle, reduces the radiation exposure of the surgeon compared to the standard C-arm fluoroscopic technique.

Association Between Lumbar Spine Sagittal Alignment and L4-L5 Disc Degeneration Among Asymptomatic Young Adults

STUDY DESIGN

Cross-sectional observational study on the relationship between the degrees of disc degeneration and sagittal alignment in asymptomatic healthy individuals.

OBJECTIVE

This study sought to determine whether the sagittal spine alignment subtype is related to the prevalence of lumbar disc degeneration.

SUMMARY AND BACKGROUND DATA

Sagittal balance and spinopelvic parameters might be risk factors for disc degeneration.

METHODS

A total of 70 asymptomatic participants (36 women and 34 men) without regular physical activity were categorized according to the four subtypes of sagittal alignment proposed by Roussouly. All participants underwent magnetic resonance imaging of the lumbar spine (1.5T) and panoramic radiography of the spine. The degree of disc degeneration was graded using T2-weighted images according to the Pfirrmann classification. Spinopelvic parameters and vertebral curvatures were measured on digital panoramic radiographs using Surgimap software. Interobserver analyses for the Pfirrmann classification and spinopelvic parameters were assessed using the weighted Kappa and intraclass correlation coefficient (ICC), respectively.

RESULTS

The Kappa associated with disc degeneration classification was 0.79 (95% confidence intervals 0.72-0.87). The ICCs were excellent, with small confidence intervals for all spinopelvic parameters. The type II group (flat lordosis) showed a higher frequency of degenerated discs at L4-L5 (P = 0.03) than the type IV group (long and curved lumbar spine). No significant differences in disc degeneration were observed among the four subtypes at the other disc levels. We found a negative, moderate correlation between the spinopelvic parameters and the occurrence of disc degeneration in the type II group.

CONCLUSION

The Roussouly subtype II sagittal alignment is significantly associated with disc degeneration at L4-L5 in asymptomatic young adults. Our results support the hypothesis that spinal sagittal alignment plays a role in early disc degeneration.

LEVEL OF EVIDENCE

3.

Effect of hypovolemia on traumatic spinal cord injury

Objectives:

Experimentally evaluate the effect of hypovolemia in acute traumatic spinal cord injury.

Methods:

Twenty adult male Wistar rats were submitted to traumatic spinal cord injury through spinal cord contusion by direct impact. Ten animals were subjected to bleeding of 20% of their estimated blood to simulate a hypovolemic condition after spinal cord contusion and 10 animals were used as control. The animals were evaluated before, 1, 3, 7 and 14 days after the production of the spinal cord injury through behavioral tests (inclined plane test and motor assessment).

Results:

The spinal cord contusion associated with hypovolemia had a negative influence on functional outcomes of the spinal cord injury. The animals submitted to hypovolemia after spinal cord contusion had lower scores in behavioral tests (inclined plane test and motor assessment), presenting a slower recovery of the motor function.

Conclusion:

In the experimental model used, the group of animals with hypovolemia after traumatic spinal cord injury had slower recovery and lower intensity in behavioral tests.

HEALTH-RELATED QUALITY OF LIFE AND EXPECTATIONS OF SPINAL STENOSIS PATIENTS TOWARDS THE SURGICAL TREATMENT

ABSTRACT The objective of this cross-sectional analytical study was to compare health-related quality of life, presence of anxiety and depression symptoms, and functional limitation according to the location of the spinal stenosis; and to describe patients' expectations toward the surgical treatment. Thirty-two patients with lumbar stenosis and 22 with cervical stenosis participated in the study. Comparison of health-related quality of life showed statistically significant differences in pain and functional capacity dimensions. There were no statistically significant differences regarding anxiety and depression symptoms. The mean functional limitation was 53.2% (SD=11.9%) for the group with lumbar stenosis and 40.2% (SD=17.5%) for the group with cervical stenosis. Most participants expected great improvement of the symptoms after the surgical treatment. In the preoperative period, expectations of improvement are high and should be discussed with the health staff, since in clinical practice, this improvement is not always achieved with the surgical treatment.

EVALUATION OF HYPERALGESIA AND HISTOLOGICAL CHANGES OF DORSAL ROOT GANGLION INDUCED BY NUCLEUS PULPOSUS

To evaluate the hyperalgesia and histological abnormalities induced by contact between the dorsal root ganglion and the nucleus pulposus. Methods: Twenty Wistar rats were used, divided into two experimental groups. In one of the groups, a fragment of autologous nucleus pulposus was removed from the sacrococcygeal region and deposited on the L5 dorsal root ganglia. In the other group (control), a fragment of adipose tissue was deposited on the L5 dorsal root ganglia. Mechanical and thermal hyperalgesia was evaluated on the third day and the first, third, fifth and seventh weeks after the operation. A L5 dorsal root ganglion was removed in the first, third, fifth and seventh weeks after the operation for histological study using HE staining and histochemical study using specific labeling for iNOS. Results: Higher intensity of mechanical and thermal hyperalgesia was observed in the group of animals in which the nucleus pulposus was placed in contact with the dorsal root ganglion. In this group, the histological study showed abnormalities of the dorsal root ganglion tissue, characterized by an inflammatory process and axonal degeneration. The histopathological abnormalities of the dorsal root ganglion tissue presented increasing intensity with increasing length of observation, and there was a correlation with maintenance of the hyperalgesia observed in the behavioral assessment. Immunohistochemistry using specific labeling for iNOS in the group of animals in which the nucleus pulposus was placed in contact with the dorsal root ganglion showed higher expression of this enzyme in the nuclei of the inflammatory cells (glial cells) surrounding the neurons. Conclusion: Contact between the nucleus pulposus and the dorsal root ganglion induced mechanical and thermal hyperalgesia and caused histological abnormalities in the dorsal root ganglion components. These abnormalities were characterized by an inflammatory and degenerative process in the structures of the dorsal root ganglion, and they presented increasing intensity with longer periods of observation.

OCCULT MANUBRIOSTERNAL JOINT INJURY ASSOCIATED WITH FRACTURE OF THE THORACIC SPINE

The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied by deformation at the sternal level. From imaging examinations, manubriosternal luxation was diagnosed. Because of recurrence of the luxation and the incapacitating pain, open reduction and fixation of the manubriosternal joint had to be performed. At the 12-month follow-up, the patient presented complete recovery of the neurological lesion, consolidation of the arthrodesis on the T7-T11 vertebral segment and maintenance of the reduction of the manubriosternal joint, which was asymptomatic during daily activities.

THE SEVERAL FACES OF SCHMORL'S NODE: PICTORIAL ESSAY

The aim of this review is to present the imaging features of Schmorl's node (SN) occurring in conjunction with several etiologies. The SN is a relatively common finding in diagnostic spinal imaging. This condition is usually asymptomatic and its etiology is not always clear. Any disorder that weakens the subchondral bone of the vertebral body may lead to endplate disruption and consequent intravertebral disc herniation. SN is a common finding among asymptomatic patients, but may possibly be accompanied by symptoms in cases of trauma, hemispherical spondylosclerosis, calcific discitis with intravertebral migration, inflammatory diseases and neoplasms. Even though SN is generally associated with benign diseases, its presence does not exclude the possibility of concomitant malignancy in the vertebral body. Radiologists and spine surgeons must be aware of uncommon conditions that might be associated with SNs, as well as related radiological findings, in order to avoid misdiagnosis.

STANDARDIZED TERMINOLOGY OF ADULT SPINE DEFORMITY FOR BRAZILIAN PORTUGUESE

Objective : To develop a consensus for translation of the most relevant terms used in the study of Adult Spinal Deformity, from their original languages into Brazilian Portuguese. Methods : A panel of 12 experts in spine surgery from the five Brazilian regions was constituted. To obtain the standardization of terminology, the Delphi method with an electronic questionnaire was administered to participants about their opinion on the translation of 13 relevant terms chosen by literature review. Each term was considered standard when there was consensus, that is, concordance higher than 80% among participants as to the suggestion to be adopted, and then on the acceptance of the term and its abbreviation in Portuguese. Results : Initially there was consensus (over 80% concordance) on the translation of seven terms in the electronic questionnaire. The other six terms that have not reached consensus were discussed at a meeting among the participants, relying on the opinion of a specialized professional in simultaneous translation of orthopedic terms in Portuguese and other professional majored in Portuguese language. It was decided how these terms should be translated and there was a consensus among all participants regarding their acceptance. Finally, there was consensus among the participants, who agreed with the translation and abbreviation of the 13 propose terms, defining its standardization for Brazilian Portuguese. Conclusion : We present a standard terminology used in the study of Adult Spinal Deformity through consensus among experts, seeking uniformity in the use of these terms in Brazilian Portuguese.

Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

To evaluate the association of redundant nerve roots of cauda equina (RNRCE) with the degree of lumbar spinal stenosis (LSS) and with spondylolisthesis.

METHOD

After Institutional Board approval, 171 consecutive patients were retrospectively enrolled, 105 LSS patients and 66 patients without stenosis. The dural sac cross-sectional area (CSA) was measured on T2w axial MRI at the level of L2-3, L3-4 and L4-5 intervertebral discs. Two blinded radiologists classified cases as exhibiting or not RNRCE in MRI. Intra- and inter-observer reproducibility was assessed.

RESULTS

RNRCE were associated with LSS. RRNCE was more frequent when maximum stenosis<55 mm2. Substantial intra- observer agreement and moderate inter-observer agreement were obtained in the classification of RNRCE. Spondylolisthesis was identified in 27 patients and represented increased risk for RRNCE.

CONCLUSION

LSS is a risk factor for RNRCE, especially for dural sac CSA<55 mm2. LSS and spondylolisthesis are independent risk factors for RNRCE.

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

Objectives: To study the characteristics of patients who underwent surgical treatment of degenerative spinal stenosis in the last 10 years (2000&#226;&#8364;"2010) at the Hospital das Cl&#237;nicas da Faculdade de Medicina de Ribeir&#227;o Preto (USP-HCFMR) and correlate the postoperative complications and preoperative comorbidities found in the study population. Methods: Retrospective review of medical records and radiographs of patients with degenerative lumbar stenosis treated surgically. Descriptive analysis of data was done with SAS 9.0. Results: 92 patients were included, 47 (51.08%) males and 45 (48.91%) females, with ages ranging from 32 to 86 years (mean age of 64.27 years). The most prevalent comorbidities were hypertension (47.82%) and diabetes mellitus (25%). Twenty-three patients (25%) had two or more comorbidities. Postoperative infection was the most common complication found in 12 cases (13%). Patients with only one preoperative comorbidity showed similar complication rates compared to the population without comorbidities. However, patients with two or more comorbid conditions had a higher incidence of postoperative complications (p&lt;0.001). Conclusions: Comorbidities negatively influenced the outcome of surgical treatment of degenerative lumbar stenosis with higher rates of postoperative complications.

Percutaneous fixation of fractures of the spine: 1-year clinical and radiological follow-up

Objective: To evaluate the preliminary results of the surgical treatment through minimally invasive fixation technique in patients with thoracolumbar spinal fractures. Methods: Retrospective study of 17 patients with fractures of thoracolumbar vertebrae who underwent surgery with percutaneous fixation in the period of 2009 to 2011. The clinical evaluation of the results was performed using the SF-36 and Oswestry questionnaires. The radiographic parameters evaluated were: fracture classification according to Magerl's criteria, wedge angle of the fractured vertebrae and bisegmental Cobb angle. These measurements were made in the preoperative, immediate postoperative and 1 year after surgery. Other data such as associated injuries, neurological deficit, post-surgical infection, loosening and breakage of implants were also considered. Results: The data revealed average scores above 80% in all domains of the SF-36 questionnaire while in Oswestry Questionnaire, 79% of patients had minimal or absent physical limitations with a mean score of 12.4&#177;11.89%. The average Cobb angle for preoperative kyphosis was 5.53&#186;&#177;13.80o, 2.18&#186;&#177;13.38o in the early postoperative period and 5.26&#186;&#177;13.95o one year after surgery. The average correction obtained after surgery was 3.35&#186; and the average correction loss was 3.19&#186;. No complications such as post-surgical infection, permanent neurological deficits and implant loosening and breakage were observed. Conclusion: The surgical treatment of fractures of thoracolumbar vertebrae using a minimally invasive technique provides satisfactory clinical and radiographic results with low complication rates.

Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes?

Objective: To evaluate the clinical and radiological results of treatment of patients with spondylodiscitis. Methods: Imaging exams used in this study were plain radiographs and magnetic resonance imaging of the spine. Results: Data from 33 patients, 10 (30.3%) females and 23 (69.7%) males were evaluated. The average time to diagnosis was four months and 28 days (SD &#177; 1 month and 28 days) and 19 patients (57.5%) presented neurological deficit. Surgical treatment was performed in 22 patients (66.6%) and three patients (9.1%) had complications from the surgery. Conclusions: Despite technological advances in complementary exams, early diagnosis of spondylodiscitis remains a challenge. However, drug treatment associated with surgery shows good results.

Advantages of a combined method of decalcification compared to EDTA

Decalcification of mineralized tissues is an essential step during tissue processing in the routine histopathology. The time required for complete decalcification, and the effect of decalcifier on cellular and tissue morphology are important parameters which influence the selection of decalcifying agents. In this study, we compared a decalcifying solution (ETDA) composed of both acid and chelating agents to a classical and well-known decalcifying agent (EDTA). To this purpose, the optic density of bone radiographs, residual calcium analysis, bone sample weight, and histological and immunohistochemical analysis were performed. Our data suggest that, similarly to EDTA, the ETDA solution completely removes the calcium ions from the samples enabling easy sectioning. However, unlike the EDTA, this agent takes much less time. Furthermore, both agents showed comparable decalcification efficacy, and similarly, they did not produce cellular, tissue or antigenicity impairments. Therefore, ETDA may be a suitable option when it is necessary an association between a rapid and complete removal of calcium minerals, and a suitable preservation of structure and antigenicity of tissues.

Results of kyphoplasty in the minimally invasive treatment of vertebral metastasis

OBJECTIVE: To evaluate the clinical and radiological outcome of minimally invasive surgical treatment of vertebral metastases using the technique of kyphoplasty. METHODS: This was a prospective observational study of patients with the diagnosis of spinal metastasis who underwent minimally invasive surgical treatment by filling the vertebral body with balloon kyphoplasty technique. Clinical evaluation included patient age at surgery, diagnosis of the tumor, biopsy results, data of the surgical procedure performed, visual pain scale (VAS) and complications related to surgery. Radiological evaluation involved the study of radiographic procedures in the anteroposterior and lateral incidences, with the analysis of vertebral body kyphosis and the occurrence of extravasation of cement. RESULTS: 22 patients with spinal metastases who were treated by balloon kyphoplasty, 8 (36%) males and 14 (64%) females were studied. The average age was 56.05 years and the mean follow-up was 8.5 months. The mean preoperative VAS was 8.73, 1.73 in the initial postoperative period, and 1.92 in the late postoperative period. CONCLUSION: Kyphoplasty proved to be a safe and effective technique for symptomatic treatment of vertebral metastases.

Anticipation of vertebral pedicle breach through dynamic surgical guidance

OBJECTIVE: To determine the effectiveness of a pedicle probe to anticipate an impending breach and allow redirection during placement of a pilot pedicle hole. METHODS: Purposely four cortical wall sites were drilled: medial and lateral pedicle wall, and lateral and anterior wall of the vertebral body. The surgeon stopped probing when the sound changed, suggesting abutment against the cortical wall ("anticipation" of impending breach). A fluoroscopy image was then obtained. The surgeon then advanced the PediGuard through the cortex until the sound changed, indicating a breach. In the second part of the study three probes were used: 1) DSG (PediGuard) with curved tip with electronics ON; 2) DSG with electronics OFF; 3) standard Lenke probe. After the images were taken, the operating surgeon (blinded to x-rays) was instructed to redirect and continue drilling into the vertebral body. RESULTS: The surgeon accurately anticipated 60 of 75 (80%) of the breaches, 17 of 19 (89%) in the medial pedicle wall. In the second part of the study the DSG with electronics ON was superior to the DSG with electronics OFF as well as the standard Lenke probe (100% vs. 90% vs. 79%, p = 0.0191). CONCLUSION: Successful redirection by passing the pedicle probes into the vertebral body without a breach after anticipation of an impending pedicle wall breach occurred in 100% of the drillings when done with the DSG with the electronics ON vs only 84% when there was no electronic feedback.

Analysis of stress induced by screws in the vertebral fixation system

OBJECTIVE

To compare, using photoelasticity, internal stress produced by USS II type screw with 5.2 and 6.2 mm external diameters, when submitted to three different pullout strengths.

METHODS

Two photoelastic models were especially made. The simulation was performed using loads of 1.8, 2.4 e 3.3 kgf.The fringe orders were evaluated around the screws. In all the models analyzed the shear stress were calculated.

RESULTS

Independently of the applied load, the smaller screw showed higher values of shear stress.

CONCLUSION

According to the analysis performed, we observed that the place of highest stress was in the first thread of the lead, close to the head of the screws. Experimental study.

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

OBJECTIVE: To evaluate the expectations of patients awaiting surgical treatment of lumbar canal stenosis and the association of Health-Related Quality of Life (HRQoL) with symptoms of anxiety and depression. METHODS: The sample included 49 patients from a university hospital. HRQoL was assessed by the Oswestry Disability Index (ODI) and 36-item Medical Outcomes Survey Short Form (SF-36) and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Expectations were investigated by means of questions used in international studies. Data were analyzed descriptively and by Student's t test. RESULTS: The mean time of disease progression was 34.5 months, the mean age was 58.8 years and 55.1% of the patients were women. Most patients had the expectation of improving with surgical treatment and 46.9% expected to be "much better" with regard to leg pain, walking ability, independence in activities and mental well being. The scores of anxiety and depression were respectively, 34.7% and 12.2%. We observed statistically significant differences between the groups with and without anxiety in the domains: General Health, Mental Health, and Vitality. Between the groups with and without depression there were statistically significant differences in the General Health and Mental Health domains. CONCLUSION: Patients showed great expectation to surgical treatment and the symptoms of anxiety and depression were related to some domains of HRQoL. Thus, the study contributes to broaden our knowledge and we can therefore guide the patients as to their expectations with respect to the real possibilities arising from surgery.

Twelve years of scientific production on Medline by Latin American spine surgeons

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.

Calcific discitis in an adult patient with intravertebral migration and spontaneous remission

Symptomatic disc calcifications have been reported, especially in the pediatric population, and remain of unknown etiology. Such a condition has been very rarely reported in adults. The aim of this paper is to present a case report of calcific discitis in an adult patient with intravertebral migration and spontaneous calcification resorption. The clinical presentation was that of back pain with an abrupt onset, not related to trauma or to physical activity. No fever or neurological deficits were present. Blood count, erythrocyte sedimentation rate, routine urine, and urine culture were negative. The pain regressed in 20 days with analgesic therapy. Findings of thoracic calcific discitis are illustrated with X-rays, CT, MRI, and bone scintigraphy.

Assessing the evolution of publications by Brazilian spine surgeons in the last decade

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.

Effect of melatonin on the functional recovery from experimental traumatic compression of the spinal cord

Spinal cord injury is an extremely severe condition with no available effective therapies. We examined the effect of melatonin on traumatic compression of the spinal cord. Sixty male adult Wistar rats were divided into three groups: sham-operated animals and animals with 35 and 50% spinal cord compression with a polycarbonate rod spacer. Each group was divided into two subgroups, each receiving an injection of vehicle or melatonin (2.5 mg/kg, intraperitoneal) 5 min prior to and 1, 2, 3, and 4 h after injury. Functional recovery was monitored weekly by the open-field test, the Basso, Beattie and Bresnahan locomotor scale and the inclined plane test. Histological changes of the spinal cord were examined 35 days after injury. Motor scores were progressively lower as spacer size increased according to the motor scale and inclined plane test evaluation at all times of assessment. The results of the two tests were correlated. The open-field test presented similar results with a less pronounced difference between the 35 and 50% compression groups. The injured groups presented functional recovery that was more evident in the first and second weeks. Animals receiving melatonin treatment presented more pronounced functional recovery than vehicle-treated animals as measured by the motor scale or inclined plane. NADPH-d histochemistry revealed integrity of the spinal cord thoracic segment in sham-operated animals and confirmed the severity of the lesion after spinal cord narrowing. The results obtained after experimental compression of the spinal cord support the hypothesis that melatonin may be considered for use in clinical practice because of its protective effect on the secondary wave of neuronal death following the primary wave after spinal cord injury.

Experimental model of intervertebral disc degeneration by needle puncture in Wistar rats

Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration.

Fixação percutânea no tratamento de fraturas toracolombares: resultados preliminares

OBJETIVO: Avaliar os resultados preliminares do tratamento cirúrgico de pacientes portadores de fraturas toracolombares da coluna vertebral por meio de fixação percutânea. MÉTODOS: Foram avaliados 10 pacientes com diagnóstico de fratura toracolombar da coluna vertebral. Todos os pacientes foram tratados por meio de técnica minimamente invasiva, com fixação por via posterior sem artrodese. Os parâmetros radiológicos relacionados para a avaliação dos pacientes foram: medida da cifose segmentar, encunhamento da vértebra fraturada e complicações relacionadas à soltura ou quebra dos implantes. RESULTADOS: A análise clínica preliminar foi realizada por meio da avaliação subjetiva dos resultados da cirurgia e todos os pacientes mostraram-se satisfeitos com o procedimento cirúrgico. A avaliação radiográfica não mostrou sinais de mau posicionamento dos implantes, soltura ou quebra dos parafusos, assim como não houve falha mecânica no instrumental. CONCLUSÃO: A utilização da fixação percutânea minimamente invasiva para o tratamento das fraturas toracolombares da coluna vertebral representa uma boa opção de tratamento, apresentando recuperação mais rápida, com resultados clínicos e radiográficos comparáveis às técnicas convencionais.

Influência do macheamento do orifício piloto nos parafusos cervicais anteriores

OBJETIVO: Analisar experimentalmente a influência do macheamento do orifício piloto nas propriedades mecânicas e na interface osso-implante do parafuso cervical anterior. MÉTODOS: Oito carneiros da raça Santa Inês deslanados foram utilizados no estudo. Nos segmentos vertebrais cervicais de C2-C7 foram realizados orifícios piloto de 2,5mm, de ambos os lados da vértebra. No lado direto da vértebra foi realizado o macheamento previamente a inserção do parafuso cortical de 3,5mm, e no lado esquerdo o implante foi colocado sem o macheamento do orifício piloto. Foram realizados ensaios mecânicos para avaliar a força de arrancamento dos implantes e estudo histomorfométrico da interface osso-implante na fase aguda e oito semanas após a colocação dos implantes. O torque de inserção foi mensurado durante a colocação dos implantes. RESULTADOS: O torque de inserção e a resistência ao arrancamento dos implantes foram maiores nos implantes colocados sem o macheamento do orifício piloto. A interface osso-implante apresentou maior área de contato ósseo e maior área óssea no interior da rosca do implante nos parafusos implantados sem o macheamento prévio. Não foi observado diferença na área óssea fora do passo de rosca do implante. CONCLUSÕES: O macheamento do orifício piloto reduz o torque de inserção e a resistência ao arrancamento do implante na fase aguda e crônica, e reduz a área de contato osso-implante e área de osso no interior do passo de rosca.

Parafusos pediculares: estruturas anatômicas em risco no tratamento da escoliose idiopática

OBJETIVO: Avaliar a posição das estruturas anatômicas em risco durante a inserção de parafusos pediculares na coluna torácica e sua relação com a variação do ângulo de Cobb. MÉTODOS: Os parâmetros estudados foram: a medida do ângulo de Cobb nas radiografias e a posição da medula espinhal, da cavidade pleural e aorta na ressonância nuclear magnética em relação a uma linha de 40mm criada para simular o parafuso pedicular nas cinco vértebras apicais. RESULTADOS: A distância da aorta ao corpo vertebral e o ângulo de segurança do lado convexo apresentaram diferença estatística quando relacionados com a variação do ângulo de Cobb medido. CONCLUSÃO: Os resultados apresentados sugerem maior risco de lesão da artéria aorta com o aumento do ângulo de Cobb e aumento do risco na inserção de parafusos pediculares no lado convexo da curvatura, quando se considera o ângulo de segurança.

Avaliação das publicações de cirurgiões de coluna brasileiros na última década

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.

Fat infiltration in the lumbar multifidus and erector spinae muscles in subjects with sway-back posture

AIM

Decreased activity of the lumbar stabilizer muscles has been identified in individuals with sway-back posture. Disuse can predispose these muscles to atrophy, which is characterized by a reduced cross-sectional area (CSA) and by fat infiltration. The aim of this study was to evaluate the amount of fat infiltration in the lumbar multifidus and lumbar erector spinae muscles as a sign of the muscle atrophy in individuals with sway-back posture, with and without low back pain.

MATERIALS AND METHODS

Forty-five sedentary individuals between 16 and 40 years old participated in this study. The sample was divided into three groups: symptomatic sway-back (SSBG) (n = 15), asymptomatic sway-back (ASBG) (n = 15), and control (CG) (n = 15). The individuals were first subjected to photographic analysis to classify their postures and were then referred for a magnetic resonance imaging (MRI) examination of the lumbar spine. The total (TCSA) and functional (FCSA) cross-sectional areas of the lumbar erector spinae together with lumbar multifidus and isolated lumbar multifidus muscles were measured from L1 to S1. The amount of fat infiltration was estimated as the difference between the TCSA and the FCSA.

RESULTS

Greater fat deposition was observed in the lumbar erector spinae and lumbar multifidus muscles of the individuals in the sway-back posture groups than in the control group. Pain may have contributed to the difference in the amount of fat observed in the groups with the same postural deviation. Similarly, sway-back posture may have contributed to the tissue substitution relative to the control group independently of low back pain.

CONCLUSIONS

The results of this study indicate that individuals with sway-back posture may be susceptible to morphological changes in their lumbar erector spinae and lumbar multifidus muscles, both due to the presence of pain and as a consequence of their habitual posture.

Pamidronate for the treatment of osteoporosis secondary to chronic cholestatic liver disease in Wistar rats

Osteoporosis is a major complication of chronic cholestatic liver disease (CCLD). We evaluated the efficacy of using disodium pamidronate (1.0 mg/kg body weight) for the prevention (Pr) or treatment (Tr) of cholestasis-induced osteoporosis in male Wistar rats: sham-operated (Sham = 12); bile duct-ligated (Bi = 15); bile duct-ligated animals previously treated with pamidronate before and 1 month after surgery (Pr = 9); bile duct-ligated animals treated with pamidronate 1 month after surgery (Tr = 9). Rats were sacrificed 8 weeks after surgery. Immunohistochemical expression of IGF-I and GH receptor was determined in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia and the right femur was used for biomechanical analysis. Bone material volume over tissue volume (BV/TV) was significantly affected by CCLD (Sham = 18.1 ± 3.2 vs Bi = 10.6 ± 2.2%) and pamidronate successfully increased bone volume. However, pamidronate administered in a preventive regimen presented no additional benefit on bone volume compared to secondary treatment (BV/TV: Pr = 39.4 ± 12.0; Tr = 41.2 ± 12.7%). Moreover, the force on the momentum of fracture was significantly reduced in Pr rats (Sham = 116.6 ± 23.0; Bi = 94.6 ± 33.8; Pr = 82.9 ± 22.8; Tr = 92.5 ± 29.5 N; P < 0.05, Sham vs Pr). Thus, CCLD had a significant impact on bone histomorphometric parameters and pamidronate was highly effective in increasing bone mass in CCLD; however, preventive therapy with pamidronate has no advantage regarding bone fragility.

What is the influence of surgical treatment of adolescent idiopathic scoliosis on postural control?

PURPOSE

To evaluate the effect of surgical treatment on the control of upright balance in adolescent idiopathic scoliosis (AIS).

METHODS

Thirty adolescents were divided into two groups: Group C (n=15) consisted of individuals without scoliosis (control), and Group S (n=15) consisted of individuals with scoliosis. The mean amplitude and velocity of the center of pressure (COP) evaluations in the anterior-posterior and medial-lateral directions were obtained before surgery and at 7, 30, 60 and 90-days after surgery, in an upright position, using a force platform.

RESULTS

Group S showed larger oscillation than Group C before surgery. The COP oscillation in Group S after surgery was larger than that in the pre-surgery period. The oscillation diminished over the post-surgery period, but individuals in the 90-day post-surgery period still had larger oscillation compared with the oscillation in the pre-surgery period.

CONCLUSION

Group S had larger AP and ML mean amplitude and mean velocity before and after surgery compared with Group C, which suggests that a sensorimotor impairment or sensory integration problem could explain the balance control alterations more than biomechanical factors in the AIS.

Hedgehog signaling and osteoblast gene expression are regulated by purmorphamine in human mesenchymal stem cells

Several biological events are controlled by Hedgehog (Hh) signaling, including osteoblast phenotype development. This study aimed at evaluating the gene expression profile of human mesenchymal stem cells (hMSCs) treated with the Hh agonist, purmorphamine, focusing on Hh signaling and osteoblast differentiation. hMSCs from bone marrow were cultured in non-osteogenic medium with or without purmorphamine (2 µM) for periods of up to 14 days. Purmorphamine up-regulated gene expression of the mediators of Hh pathway, SMO, PTCH1, GLI1, and GLI2. The activation of Hh pathway by purmorphamine increased the expression of several genes (e.g., RUNX2 and BMPs) related to osteogenesis. Our results indicated that purmorphamine triggers Hh signaling pathway in hMSCs, inducing an increase in the expression of a set of genes involved in the osteoblast differentiation program. Thus, we conclude that Hh is a crucial pathway in the commitment of undifferentiated cells to the osteoblast lineage.

Redundant nerve roots of the cauda equina: review of the literature

In imaging diagnosis, redundant nerve roots of the cauda equina are characterized by the presence of elongated, enlarged and tortuous nerve roots in close relationship with a high-grade lumbar spinal canal stenosis. This is not an independent entity, but it is believed to be a consequence of the chronic compression at the level of the lumbar canal stenosis and thus may be part of the natural history of lumbar spinal stenosis. The present paper is aimed at reviewing the histopathological, electrophysiological and imaging findings, particularly at magnetic resonance imaging, as well as the clinical meaning of this entity. As the current assessment of canal stenosis and root compression is preferably performed by means of magnetic resonance imaging, this is the imaging method by which the condition is identified. The recognition of redundant nerve roots at magnetic resonance imaging is important, particularly to avoid misdiagnosing other conditions such as intradural arteriovenous malformations. The literature approaching the clinical relevance of the presence of redundant nerve roots is controversial. There are articles suggesting that the pathological changes of the nerve roots are irreversible at the moment of diagnosis and therefore neurological symptoms are less likely to improve with surgical decompression, but such concept is not a consensus.