Correlation between ahlbäck classification and gonarthrosis risk factors / Correlação entre a classificacão de ahlbäck e fatores de risco da gonartrose

ABSTRACT Objective: To demonstrate whether or not there is a correlation between the risk factors for gonarthrosis and the radiographic classification of Ahlbäck. Methods: We studied patients with primary gonarthrosis attended at the knee outpatient clinic of the General Hospital of Vila Penteado during their routine visit. We collected data on patient age (years), weight (kg), height (meters), body mass index (BMI = patient weight/height2), personal history of hypertension or diabetes mellitus (positive or negative), sedentarism (physical activity less than three times per week, 30 minutes per session), functional demand (how many blocks walked weekly), time of onset of symptoms (in years) and laterality or bilaterality. The data were correlated with the Ahlbäck classification applied to the radiographs performed at the time of the consultation. Results: A sample of 108 patients was studied. We did not find an association between the Ahlbäck classification and the patient's age, smoking, sedentary lifestyle, laterality, number of blocks walked per week, diabetes mellitus, and sex; however, a positive association was observed in hypertensive patients as well as a weak correlation with height and weight of the patient and moderate correlation with BMI. Conclusion: The Ahlbäck classification is unrelated to most of the risk factors for primary gonarthrosis. Level of evidence III, Case-control study.

RESUMO Objetivo: Demonstrar se existe ou não correlação entre os fatores de risco de gonartrose e a classificação radiográfica de Ahlbäck. Métodos: Estudamos pacientes com gonartrose primária, assistidos no ambulatório de joelho do Hospital Geral de Vila Penteado em sua consulta de rotina. Foram coletados dados referentes a idade do paciente (anos), peso do paciente (kg), altura (metros), índice de massa corporal (IMC= peso do paciente/altura2), antecedente pessoal de hipertensão ou diabetes mellitus (positivo ou negativo), sedentarismo (se pratica atividade física menos de três vezes por semana, 30 minutos por sessão), demanda funcional (quantas quadras caminha semanalmente), tempo do início dos sintomas (em anos) e lateralidade ou bilateralidade. Os dados foram correlacionados com a classificação de Ahlbäck aplicada às radiografias realizadas no momento da consulta. Resultados: Uma amostra de 108 pacientes foi estudada. Não encontramos associação entre a classificação de Ahlbäck e a idade do paciente, tabagismo, sedentarismo, lateralidade, quantidade de quadras percorridas por semana, diabetes mellitus e sexo do paciente, porém verificou-se associação positiva em pacientes hipertensos e correlação fraca com altura e peso do paciente e correlação moderada com IMC. Conclusão: A classificação de Ahlbäck não apresenta relação com a maioria dos fatores de risco de gonartrose primária. Nível de evidência III, Estudo caso-controle.

Standardization of a spinal cord lesion model and neurologic evaluation using mice

OBJECTIVE: To standardize a spinal cord lesion mouse model. METHODS: Thirty BALB/c mice were divided into five groups: four experimental groups and one control group (sham). The experimental groups were subjected to spinal cord lesion by a weight drop from different heights after laminectomy whereas the sham group only underwent laminectomy. Mice were observed for six weeks, and functional behavior scales were applied. The mice were then euthanized, and histological investigations were performed to confirm and score spinal cord lesion. The findings were evaluated to prove whether the method of administering spinal cord lesion was effective and different among the groups. Additionally, we correlated the results of the functional scales with the results from the histology evaluations to identify which scale is more reliable. RESULTS: One mouse presented autophagia, and six mice died during the experiment. Because four of the mice that died were in Group 5, Group 5 was excluded from the study. All the functional scales assessed proved to be significantly different from each other, and mice presented functional evolution during the experiment. Spinal cord lesion was confirmed by histology, and the results showed a high correlation between the Basso, Beattie, Bresnahan Locomotor Rating Scale and the Basso Mouse Scale. The mouse function scale showed a moderate to high correlation with the histological findings, and the horizontal ladder test had a high correlation with neurologic degeneration but no correlation with the other histological parameters evaluated. CONCLUSION: This spinal cord lesion mouse model proved to be effective and reliable with exception of lesions caused by a 10-g drop from 50 mm, which resulted in unacceptable mortality. The Basso, Beattie, Bresnahan Locomotor Rating Scale and Basso Mouse Scale are the most reliable functional assessments, and but the horizontal ladder test is not recommended.

A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis

OBJECTIVES: Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. METHODS: Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. RESULTS: Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. CONCLUSIONS: Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

The influence of body image on surgical decisions in adolescent idiopathic scoliosis patients

OBJECTIVES: The objective of this study was to evaluate whether the severity of deformities in patients with adolescent idiopathic scoliosis contributes to patients’ decision regarding whether to undergo an operation. METHODS: We evaluated body image factors in adolescent idiopathic scoliosis patients. We evaluated the magnitude of the main scoliotic curve, gibbosity (magnitude and location), shoulder height asymmetry and patient’s age. We analyzed the correlation of these data with the number of years the patient was willing to trade for surgery, as measured by the time-trade-off method. RESULTS: A total of 52 patients were studied. We did not find a correlation between any of the parameters that were studied and the number of years that the patient would trade for the surgery. CONCLUSIONS: The magnitude of body deformities in patients with adolescent idiopathic scoliosis does not interfere with the decision to undertake surgical treatment.

Changes in the sagittal balance in congenital scoliosis correction surgery / Alterações do equilíbrio sagital na cirurgia de correção de escoliose congênita / Cambios en el equilibrio sagital en la cirugía de corrección de la escoliosis congénita

ABSTRACT Objective: This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis. Methods: We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis were measured, using the Cobb method, and spinopelvic parameters: pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Results A hundred and eleven medical records were analyzed, but the sample resulted in 10 patients, six of whom were females (60%). The average age was 13.4 years. In the comparative analysis between pre and postoperative, only the coronal deformity (12.37; CI 95% [7.88-16.86]; p<0.001), the sagittal deformity (12.71; CI 95% [4.21-21.22]; p=0.011), and the lumbar lordosis (9.9; CI 95% [0.38-19.42]; p=0.043) showed significant change. Conclusion: There was no change in the spinopelvic parameters of patients with congenital scoliosis undergoing surgery at IOF-FMUSP between 2009 and 2013; however, it was observed decrease in lumbar lordosis, and deformity angle in the sagittal and coronal planes.

RESUMO Objetivos: Este estudo tem como objetivo esclarecer se existe alteração do equilíbrio sagital provocada pela intervenção cirúrgica nos pacientes com escoliose congênita. Métodos: Foram analisados retrospectivamente todos os casos de escoliose operados em um hospital terciário entre janeiro de 2009 e janeiro de 2013. Em todos os casos foram mensuradas a deformidade no plano coronal e sagital, a cifose e lordose, utilizando-se o método de Cobb, e também os parâmetros espinopélvicos: incidência pélvica (PI), inclinação sacral (SS), inclinação pélvica (PT). Resultados: Foram analisados 111 prontuários, porém a amostra resultou em 10 pacientes, dos quais seis eram do sexo feminino (60%). A média de idade foi de 13,4 anos. Na análise comparativa entre pré e pós-operatório, apenas a deformidade coronal (12,37; IC 95% [7,88-16,86]; p < 0,001), a deformidade sagital (12,71; IC 95% [4,21-21,22]; p = 0,011) e a lordose lombar (9,9; IC 95% [0,38-19,42]; p = 0,043) apresentaram alteração significativa. Conclusão: Não foi encontrada alteração nos parâmetros espinopélvicos dos pacientes com escoliose congênita submetidos à intervenção cirúrgica no IOT-FMUSP entre 2009 e 2013, contudo, foi observada diminuição da lordose lombar, do ângulo da deformidade no plano sagital e no plano coronal.

RESUMEN Objetivo: Este estudio tiene por objetivo aclarar si hay cambio de equilibrio sagital causado por la cirugía en pacientes con escoliosis congénita. Métodos: Se revisaron retrospectivamente todos los casos de cirugía de escoliosis en un hospital terciario entre enero de 2009 y enero de 2013. En todos los casos se midieron la deformidad en el plan coronal y sagital, la cifosis y lordosis, utilizando el método de Cobb, y también los parámetros espinopélvicos: incidencia pélvica (IP), pendiente sacra (PS), inclinación pélvica (IP). Resultados: Se analizaron 111 registros médicos, pero la muestra resultó en 10 pacientes, de los cuales 6 eran del sexo femenino (60%). La edad promedio fue de 13,4 años. En el análisis comparativo entre el pre y postoperatorio, solamente la deformidad coronal (12,37; IC 95% [7,88-16,86]; p < 0,001), la deformidad sagital (12,71; IC 95% [4,21-21,22]; p = 0,011) y la lordosis lumbar (9,9; IC 95% [0,38-19,42]; p = 0,043) mostraron cambios significativos. Conclusión: No hubo cambios en los parámetros espinopélvicos de los pacientes con escoliosis congénita sometidos a cirugía en IOT-FMUSP entre 2009 y 2013, sin embargo se observó disminución de la lordosis lumbar y del ángulo de deformidad en el plano sagital y plano coronal.

Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

OBJECTIVE: To evaluate the association of clinical and demographic variables in patients requiring blood transfusion during elective surgery to treat scoliosis with the aim of identifying markers predictive of the need for blood transfusion. METHODS: Based on the review of medical charts at a public university hospital, this retrospective study evaluated whether the following variables were associated with the need for red blood cell transfusion (measured by the number of packs used) during scoliosis surgery: scoliotic angle, extent of arthrodesis (number of fused levels), sex of the patient, surgery duration and type of scoliosis (neuromuscular, congenital or idiopathic). RESULTS: Of the 94 patients evaluated in a 55-month period, none required a massive blood transfusion (most patients needed less than two red blood cell packs). The number of packs was not significantly associated with sex or type of scoliosis. The extent of arthrodesis (r = 0.103), surgery duration (r = 0.144) and scoliotic angle (r = 0.004) were weakly correlated with the need for blood transfusion. Linear regression analysis showed an association between the number of spine levels submitted to arthrodesis and the volume of blood used in transfusions (p = 0.001). CONCLUSION: This study did not reveal any evidence of a significant association between the need for red blood cell transfusion and scoliotic angle, sex or surgery duration in scoliosis correction surgery. Submission of more spinal levels to arthrodesis was associated with the use of a greater number of blood packs. .

O equilíbrio sagital em escoliose de etiologia idiopática e neuromuscular / The sagital balance in idiopatic and neuromuscular scoliosis

Descrever e comparar a distribuição dos parâmetrosespino-pélvicos (PEP) em uma população brasileira de doentescom escoliose idiopática (EI) e neuromuscular (ENM), e avaliara associação entre a incidência pélvica (PI) e lordose lombar(LL). Método: Foi realizada análise de prontuários. Mensuramosmedidas do equilíbrio sagital em pacientes com escoliose neuromusculare idiopática. Resultados: Para EI encontramos as mé-dias (em graus): PI 55,55; inclinação sacral (SS) 45,35; inclinaçãopélvica (PT) 10,19; lordose lombar (LL) 43,48; e cifose torácica(TK) 32,10. Na ENM: PI 53,77; SS 42,31; PT 11,46; LL 49,46; e TK45,69. Na distribuição dos PEP não houve diferença estatisticamentesignificativa entre os dois tipos de escoliose (p=0,057). Aassociação entre IP e LL foi baixa entre os doentes com escolioseidiopática (R=0,074) e entre os doentes com escoliose neuromuscular(R=0,274). Conclusão: Os PEP medidos nos doentes comEI e ENM na população brasileira são semelhantes aos descritosna literatura internacional e não diferem significativamente, já aassociação entre LL e PI não pode ser confirmada. Nível deEvidência IV, Série de Casos...

To describe and compare the distribution of spino--pelvic parameters (SPP) in a Brazilian population with idiopathicscoliosis (IS) and neuromuscular scoliosis (NMS), and evaluatethe association between pelvic incidence (PI) and lumbar lordosis(LL). Method: Medical records investigation was performed. Sagitalbalance angles were measured in patients with neuromuscularand idiopathic scoliosis. Results: IS sample means (in degrees):PI 55.55; Sacral Slope (SS) 45.35; Pelvic Tilt (PT) 10.19; LumbarLordosis (LL) 43.48; and Thoracic Kyphosis (TK) 32.10. In NMS: PI53.77; SS 42.31; PT 11.46; LL 49.46; and TK 45.69. No statisticallysignificant differences in PEP distribution were found between thetwo types of scoliosis (p=0,057). The association between pelvicincidence and lumbar lordosis is low among idiopathic scoliosis(R=0,074) and neuromuscular scoliosis (R=0,274). Conclusion:PEP measurements in a Brazilian population of idiopathic scoliosisand neuromuscular scoliosis patients are similar to those in theinternational literature and do not differ statistically between them.The association between LL and PI could not be assessed in thisstudy. Level of Evidence IV, Case Series...

Laminectomy without instrumentation for surgical treatment of metastatic spinal cord compression / Laminectomia sem instrumentação para tratamento cirúrgico da compressão medular metastática / Laminectomía sin instrumentación para tratamiento quirúrgico de la compresin metastásica de la médula espinal

OBJECTIVE: To analyze the development of mechanical complications as a result of spinal decompression or cauda equina in patients with metastatic tumors of the spine via laminectomy or laminoartrectomy without fixation. METHODS: We studied the medical records of all patients submitted to spine decompression with laminectomy without fixation. The decompression was indicated to treat cord compression or cauda equina caused by metastatic tumors. Patients were evaluated for the development of postoperative mechanical instability by comparing the preoperative radiological examinations with the latest one available in the medical record review.. In these images, we evaluated the emergence of new deformity in the sagittal or coronal planes and translational deformity. We consider new deformity, signs of deformity greater or equal to 5° in the coronal or sagittal planes and signs of increased vertebral translation greater than or equal to 3 mm. RESULTS: No patient developed radiological instability in the period evaluated with an average follow-up of 163.24 days (3-663). The complication rate in our sample was not higher than the previously reported in the literature. CONCLUSION: Isolated laminectomy at one or more levels is a safe procedure for the treatment of metastatic spinal cord compression where the spine is judged stable before surgery. .

OBJETIVO: Analisar o desenvolvimento de complicações mecânicas como resultado da descompressão medular ou da cauda equina de pacientes com doença metastática da coluna vertebral através de laminectomia ou laminoartrectomia sem fixação. MÉTODOS: Estudamos todos os prontuários de pacientes que foram submetidos à descompressão da coluna vertebral por laminectomia sem fixação. A descompressão foi indicada por compressão medular ou da cauda equina por tumores sólidos em doença metastática. Os pacientes foram avaliados quanto ao desenvolvimento de instabilidade mecânica pós-operatória através da comparação dos exames radiológicos pré-operatórios com o último exame disponível no prontuário. Nessas imagens, avaliamos o surgimento de deformidade nova no plano sagital ou coronal e deformidade translacional. Consideramos como deformidade nova, sinais de deformidade maior ou igual a 5º no plano coronal ou sagital e sinais de aumento da translação vertebral maior ou igual a 3 mm. RESULTADOS: Nenhum paciente evoluiu com instabilidade radiológica no período avaliado com tempo médio de seguimento de 163,24 dias (3-663). A taxa de complicações encontrada em nossa amostra não foi superior à encontrada na literatura. CONCLUSÃO: A laminectomia isolada em um ou mais níveis é um procedimento seguro para tratamento da compressão medular metastática quando há julgamento de que a coluna é estável no momento da indicação da cirurgia. .

OBJETIVO: Analizar el desarrollo de complicaciones mecánicas como consecuencia de la descompresión espinal o la cauda equina en los pacientes con enfermedad metastásica de la columna vertebral a través de una laminectomía o laminoartrectomia sin fijar. MÉTODOS: Se estudiaron las historias clínicas de todos los pacientes que fueron sometidos a laminectomía sin fijación. La descompresión se indicó por compresión de la médula o la cauda equina por metástasis de tumores sólidos. Los pacientes fueron evaluados para el desarrollo de la inestabilidad mecánica postoperatoria mediante la comparación de los exámenes radiológicos preoperatorios con última imagen disponible en el registro clínico. En estas imágenes, se evalúa la aparición de nueva deformidad en el plano coronal o sagital y deformidad traslacional. Consideramos nueva deformidad, los signos de una deformidad mayor o igual a 5° en el plano coronal o sagital y signos de aumento de la traslación vertebral superior o igual a 3 mm. RESULTADOS: Ningún paciente desarrolló inestabilidad radiológica en el período evaluado con un seguimiento promedio de 163,24 días (3-663). La tasa de complicaciones en nuestra muestra no era mayor que la encontrada en la literatura. CONCLUSIÓN: Laminectomía aislada en uno o más niveles es un procedimiento seguro para el tratamiento de compresión metastásica de la médula cuando se juzga que la columna es estable en el momento de la indicación quirúrgica. .