Caracterización de un grupo de pacientes sometidos a herniorrafia lateral con malla retromuscular en un centro de tercer nivel de 2015 a 2019 / Characterization of a group of patients who underwent lateral herniorrhaphy with retromuscular mesh in a third level center from 2015 to 2019

Introducción. El objetivo de este estudio fue describir las características de la población y determinar las principales complicaciones de los pacientes que son llevados a cirugía por hernia lateral en el abdomen. Métodos. Estudio observacional retrospectivo, que incluyó a los pacientes sometidos a herniorrafia lateral, entre 2015 y 2019 en un centro de tercer nivel. La información se obtuvo del registro de historias clínicas. Las variables analizadas se clasificaron según las características sociodemográficas de los pacientes, clínicas y quirúrgicas. Se hizo una caracterización de acuerdo con los resultados encontrados. Resultados. Se incluyeron 51 pacientes con hernia lateral, 29 de ellos mujeres, con un promedio de edad de 59 años y de índice de masa corporal de 28 kg/m2. El 60 % tenía comorbilidades de base, siendo la hipertensión arterial la más frecuente. La mayoría se clasificaron como ASA II. En cuanto a la localización, la L3 fue la más común (37,2 %). Se presentaron complicaciones postquirúrgicas en el 27,4 % de los pacientes, siendo las más frecuentes seromas, hematomas e infecciones de sitio operatorio. Ningún paciente requirió reintervención para el manejo de las complicaciones. Conclusión. Conocer la población y determinar cuáles son las principales complicaciones postquirúrgicas de un procedimiento permite tomar medidas para disminuir su frecuencia, pero en este caso, se necesitan estudios adicionales para determinar cuáles son los mayores factores asociados a las complicaciones

Introduction. To describe the characteristics of the population and to determine the main complications of patients who undergo surgery for lateral hernia. Methods. We performed a retrospective observational study, including patients who underwent lateral herniorrhaphy between 2015 and 2019 in a third-level medical center, obtaining information through the registration of medical records. The analyzed variables were classified according to the patients' clinical, surgical and sociodemographic characteristics, performing a characterization according to the results found. Results. Fifty-one patients due to lateral hernia were included, 29 of them were women, with a mean age of 59 years and a body mass index of 28 Kg/m2. Of those, 60% presented basic comorbidities, being arterial hypertension the most frequent. Most were classified as ASA II. Regarding the location, the L3 was the most commonly presented hernia, referring to 37.2%. Postoperative complications occurred in 27.4% of the patients, with seromas being the most frequent, followed by hematomas and surgical site infections. No patient required reintervention for the management of complications. Conclusion. By knowing the population and determining which are the main complications, measures can be taken to reduce their incidence. Additional studies are needed to determine which are the main factors associated with complications

The Brazilian Portuguese version of the Pregnancy Mobility Index: Cross-cultural adaptation and psychometric evaluation - a validation study

ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

Correlation Between Cage Positioning and Lumbar Lordosis in Transforaminal Lumbar Interbody Fusion (TLIF) / Correlação entre posicionamento do cage e lordose lombar em fusão transforaminal minimamente invasiva (TLIF)

Abstract Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° (p< 0.01), SL 30.7° (p< 0.05), and SLC 18.8° (p> 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

Resumo Objetivo Avaliar os resultados radiográficos e comparar a lordose pós-operatória em técnica de artrodese intersomática lombar transforaminal (TLIF, na sigla em inglês), considerando como variável o posicionamento do dispositivo intersomático (cage) em relação ao espaço discal. Métodos Análise retrospectiva radiográfica de pacientes cirúrgicos, em nível único, por doença lombar degenerativa, aplicando-se TLIF e instrumentação pedicular posterior. Os pacientes foram divididos, conforme a posição do cage, em 2 grupos: 1. TLIF-A - cages na posição anterior do espaço discal; e 2. TLIF-P, cages na posição posterior do espaço discal (considerando-se o platô vertebral superior da vértebra inferior incluída na instrumentação, cages que ocuparam a superfície correspondente a 50% anterior da linha média, compuseram o grupo TLIF-A; opostamente, cages em posicionamento posterior compuseram o grupo TLIF-P). Procedeu-se à avaliação dos exames radiográficos ortostáticos em perfil no pré- e pós-operatórios, com a tomada das seguintes medidas: lordose lombar (LL) (ângulo L1-S1); lordose segmentar (LS) (L4-S1) e lordose segmentar do cage (LSC). Resultados Cem pacientes foram incluídos de 2011 a 2018, sendo 44 homens e 46 mulheres, com idade média de 50.5 anos (27-76 anos). Um total de 43 cages foram classificados como "anteriores" (TLIF-A) e 57, "posteriores" (TLIF-P); considerando o grupo TLIF- A, os resultados pós-operatórios médios foram: LL 50.7°, LS 34.9° e LSC 21.6°; para o grupo TLIF-P, comparativamente: LL 42.3° (p< 0,01), LS 30.7° (p< 0,05) e LSC 18.8° (p> 0,05). Conclusão O posicionamento anterior do cage em relação ao espaço discal correlaciona-se a melhora da lordose lombar e segmentar na radiografia em comparação com o posicionamento posterior do implante.

Improvement in Radicular Pain after Endoscopic Transforaminal Lumbar Discectomy at Discs with Advanced Degenerative Changes / Melhora da dor radicular após discectomia lombar transforaminal endoscópica em discos com alterações degenerativas avançadas

Abstract Objectives To evaluate the correlation between radiologic changes (Pfirrmann and Modic) and radicular pain intensity in patients who underwent transforaminal endoscopic surgery for lumbar disc herniation. Methods Series of cases with 39 patients, 50 intervertebral discs in preoperative evaluation from January 29, 2018 to August 28, 2019 in an endoscopic spine surgery service. Demographic data, surgical indication, operative details and complications were obtained from medical records. The patients were divided into three groups based on the Modic classification (Modic absence, Modic 1 and Modic 2) and into two groups considering the Pfirrmann classification (Pfirrmann IV and Pfirrmann V). Data were processed in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with a significance level of p< 0,05. Results There was no difference between genders; age: 50,36 ± 15,05 years old; disease level: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), and L4-L5 + L5-S1 26 (52%); location: right foraminal 7 (14%), left foraminal 15 (30%), central 9 (18%) and diffuse 19 (38%); radicular pain: left 25 (50%), right 11 (22%), and bilateral 14 (28%); preoperative visual analogue scale (VAS): 9,5 ± 0,91, postoperative: 2,5 ± 1,79; surgery duration: 100 ± 31,36 minutes; and follow-up: 8,4 ± 6,7 months. Less postoperative sciatica was registered in the Modic 2 versus Modic 1 group (p< 0,05). There was no difference in the postoperative radicular pain between the Pfirrmann groups (IV versus V). Conclusion Although there is no clinical difference between the groups, in advanced stages of disc degeneration, endoscopic transforaminal discectomy proved to be effective in diminishing radicular pain in patients with lumbar disc herniation.

Resumo Objetivos Avaliar a correlação entre as alterações radiológicas (Pfirrmann e Modic) e a intensidade da dor radicular em pacientes submetidos a cirurgia endoscópica transforaminal para hérnia de disco lombar. Métodos Uma sequência de casos com 39 pacientes, 50 discos intervertebrais em avaliação pré-operatória, no período de 29 de janeiro de 2018 a 28 de agosto de 2019, no serviço de cirurgia endoscópica da coluna vertebral. Os dados demográficos, indicação cirúrgica, detalhes operatórios e complicações foram todos obtidos junto aos prontuários clínicos. Os pacientes foram divididos em três grupos, com base na classificação Modic (ausência de Modic, Modic 1 e Modic 2) e em dois grupos, considerando a classificação de Pfirrmann (Pfirrmann IV e Pfirrmann V). Os dados foram processados no software IBM SPSS Statistics for Windows, versão 22.0 (IBM Corp., Armonk, NY, EUA), com nível de significância de p <0,05. Resultados Não houve diferença entre os gêneros; idade: 50,36 ± 15,05 anos; nível da doença: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), e L4-L5 + L5-S1 26 (52%); localização: foraminal direito em 7 pacientes (14%), foraminal esquerdo em 15 pacientes (30%), central em 9 pacientes (18%), e difuso em 19 pacientes (38%); dor radicular: esquerda em 25 pacientes (50%), direita em 11 pacientes (22%), e bilateral em 14 pacientes (28%); escala visual analógica (EVA) pré-operatório: 9,5 ± 0,91, pós-operatório: 2,5 ± 1,79; tempo cirúrgico: 100 ± 31,36 minutos; e acompanhamento de 8,4 ± 6,7 meses. Foi registrada menos dor ciática pós-operatória nos grupos Modic 2 versus Modic 1 (p< 0,05). Não houve diferença na dor radicular pós-operatória entre os grupos Pfirrmann (IV versus V). Conclusão Embora não exista diferença clínica entre os grupos, em estágios avançados da degeneração discal, a discectomia transforaminal endoscópica mostrou-se eficaz na redução da dor radicular em pacientes com hérnia de disco lombar.

Pelvic fixation for posterior lumbosacral hemivertebra resection and long fusion in adult spinal deformity / 中华骨科杂志

Objective:To evaluate whether pelvic fixation is needed in patients undergoing posterior lumbosacral hemivertebra (LSHV) resection and long fusion.Methods:All 32 adult spinal deformity patients with posterior hemivertebra (HV) resection and long segment fixation treated from April 2005 to August 2019 were analyzed retrospectively, including 12 males and 20 females with a mean age of 32.9±8.8 years. According to the state of coronal balance distance (CBD), there were 15 cases of type A (preoperative CBD≤ 30 mm), 1 case of type B (preoperative CBD>30 mm and C 7 plumb line offset to the concave side), and 16 cases of type C (preoperative CBD>30 mm and C 7 plumb line offset to the convex side). The clinical and imaging data before operation, immediately after operation and at the last follow-up were collected, and the short-term and long-term complications related to operation were recorded. The improvement of Cobb angle and coronal balance of primary curve and compensatory curve were evaluated on the whole spine frontal and lateral X-ray films, and the change of coronal balance type after operation was evaluated. According to the mode of distal internal fixation, the patients were divided into two groups: PF group (pelvic fixation): distal fixation to iliac or sacroiliac; NPF group (non-pelvic fixation): distal fixation to L 5 or S 1. Results:All 32 patients were followed up with an average time of 3.9±2.6 years (range 2-11 years). The Cobb angle of primary curve in PF and NPF groups were 42.6°±13.5° and 41.3°±10.9° respectively before operation, and corrected to 13.1°±5.4° and 17.7°±5.8° respectively after operation. It maintained at 13.4°±5.1°and 18.5°±6.7° in the two groups at the last follow-up, respectively ( FPF=32.58, FNPF=28.64, P<0.001). The correction rates were 69.3%±11.8% and 57.6%±10.3%, respectively ( t=2.14, P=0.012). The compensatory curves of in the two groups were corrected from 54.9°±14.8° and 46.8°±13.6° before operation to 17.3°±9.6° and 15.4°±8.4° after operation. It also maintained at 18.5°±8.8°and 17.6°±9.5° in the two groups at the last follow-up, respectively ( FPF=42.97, FNPF=38.56, P<0.001). The correction rates were 68.4%±16.7% and 67.2%±14.9%, respectively ( t=0.17, P=0.849) in the two groups. In PF group, the primary and compensatory curve were similar (69.3%±11.8% vs. 68.4%±16.7%, t=0.15, P=0.837), while the correction rate of compensatory curve in NPF group was significantly higher than that of the primary curve (67.2%±14.9% vs. 57.6%±10.3%, t=2.13, P=0.013). Coronal decompensation occurred in 12 patients (12/32, 37.5%). The CBD in PF and NPF groups was corrected from 33.3±11.2 mm and 28.8±8.1 mm preoperatively to 18.5±3.5 mm and 27.1±6.8 mm postoperatively, respectively, and it showed no significant change at the last follow-up ( FPF=41.61, P<0.001; FNPF=0.38, P=0.896). While the CBD in PF group was significantly better than that in NPF group ( t=3.23, P=0.002; t=2.94, P=0.008). The incidence of coronal decompensation in PF group was 0%, which was significantly lower than 50% (12/24) in NPF group (χ 2=6.40, P=0.014). In addition, 6 cases in PF group were type C coronal decompensation before operation, and the coronal balance was corrected to type A after surgery (100%). Among 10 patients with type C coronal decompensation in NFP, 4 (40%) patients returned to type A after operation, and the difference was statistically significant (6/6 vs. 4/10, χ 2=5.76, P=0.034). Conclusion:Coronal decompensation (12/32, 37.5%) is not rare in patients after posterior LSHV resection and long fusion. Attention should be paid to the match of the corrections between lumbosacral deformity and compensatory curve, which is of great significance in coronal balance reconstruction. Pelvic fixation is helpful to reduce the incidence of postoperative coronal decompensation, especially for the type C patients.

Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation / 中西医结合学报

OBJECTIVE@#This study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients.@*METHODS@#This retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group (n = 32), patient-controlled analgesia (PCA) group (n = 27), and oral analgesia group (n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale (VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) was used in the acupuncture group.@*RESULTS@#Each of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain (P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the "dull pain" in the acupuncture sensation.@*CONCLUSION@#The results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient's acupuncture sensation and the improvement of pain VAS score.

Current results of conventional lumbar arthrodesis / Resultados atuais da artrodese lombar convencional / Resultados actuales de la artrodesis lumbar convencional

ABSTRACT Objective: To evaluate the peri- and postoperative results and clinical repercussions in patients undergoing decompression surgery and single-level lumbar arthrodesis using the traditional technique (OTLIF) and to compare with the results of minimally invasive techniques (MITLIF) described in the literature. Methods: Our sample consisted of 22 patients who underwent TLIF surgery using the open technique (OTLIF) in the period October 2019 to January 2021, in our hospital. We compared the patients' functional clinical results using the Oswestry scale in the preoperative period and 15 days after surgery, analyzed variables related to the perioperative period: surgery time, length of hospital stay, blood loss, use of a suction drain, and admission to the ICU, and compared these with the results reported in the literature for patients treated by the MITLIF technique. Results: The average age was 48.95 years and the most operated level was L4-L5 (55%). The average surgery time was 112.63 min. We did not use a suction drain in the postoperative period, there was no need for a blood transfusion in any patient, and no patient was admitted to the ICU. The average hospital stay was 1 day. Regarding the Oswestry Disability Index, the mean preoperative score was 44.73 and after 15 days, it was 24.05. Conclusions: surgical treatment using the OTLIF technique for single-level lumbar degenerative disease showed largely positive results, with improvement in disability scores, short hospital stay and low incidence of complications. When properly indicated, OTLIF is an excellent and safe option for the treatment of degenerative lumbar disease. Level of evidence IV; Case series study.

RESUMO Objetivo: Avaliar resultados e repercussões clínicas precoces no peri e pós-operatório de pacientes submetidos à cirurgia de descompressão e artrodese lombar de um nível pela técnica tradicional (OTLIF) e comparar com resultados das técnicas minimamente invasivas (MITLIF) descritos na literatura. Métodos: Nossa amostra foi composta por 22 pacientes submetidos à cirurgia de TLIF pela técnica aberta (OTLIF) no período de outubro/2019 a janeiro/2021 em nosso hospital. Comparamos os resultados clínicos funcionais dos pacientes pela escala de Oswestry no pré-operatório e 15 dias de depois da cirurgia e analisamos variáveis relacionadas com o período perioperatório, a saber, tempo de cirurgia, tempo de internação hospitalar, perda de sangue, uso de dreno e internação em UTI, e comparamos com os resultados da literatura em pacientes tratados pela técnica MITLIF. Resultados: A média de idade foi de 48,95 anos e o nível mais abordado foi L4-L5 (55%). O tempo operatório médio foi de 112,63 minutos. Não utilizamos dreno no pós-operatório, não houve necessidade de transfusão de sangue em nenhum paciente e nenhum deles foi internado em UTI. O tempo médio de internação hospitalar foi de um (1) dia. Com relação ao Índice de Incapacidade de Oswestry, a pontuação pré-operatória média foi de 44,73 e depois de 15 dias foi de 24,05. Conclusões: O tratamento cirúrgico pela técnica OTLIF na doença degenerativa lombar de um nível apresentou resultados amplamente positivos, com melhora nos escores de incapacidade, baixo tempo de internação e baixa incidência de complicações. Quando bem indicada, a OTLIF é uma opção excelente e segura para o tratamento da doença degenerativa lombar. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: Evaluar resultados y repercusiones clínicas precoces perioperatorias y postoperatorias de pacientes sometidos a cirugía de descompresión y artrodesis de un nivel por técnica tradicional (OTLIF); y compararlos con resultados de las técnicas mínimamente invasivas (MITLIF) descritos en la literatura. Métodos: Nuestra muestra fue formada por 22 pacientes sometidos a cirugía TLIF por técnica abierta (OTLIF), en el período comprendido entre octubre/2019 y enero/2021 en nuestro hospital. Se compararon los resultados clínicos funcionales de los pacientes mediante escala de Oswestry en preoperatorio y después de 15 días de cirugía y, analizaron las variables relacionadas al perioperatorio como tiempo de cirugía, tiempo de internación, pérdida de sangre, uso de drenaje e internación en UCI y se compararon con resultados de la literatura de pacientes tratados por la técnica MITLIF. Resultados: La media de edad fue de 48,95 años y nivel más abordado fue L4-L5 (55%). El tiempo promedio de operación fue 112,63 minutos. No se utilizó drenaje en el postoperatorio, no hubo necesidad de transfusión de sangre en ningún paciente y ninguno de ellos fue ingresado en la UCI. El tiempo promedio de internación fue 1 día. Con respecto al Índice de Discapacidad de Oswestry, la puntuación preoperatoria media fue 44,73 y después de 15 días, 24,05. Conclusiones: El tratamiento quirúrgico por técnica OTLIF en la enfermedad degenerativa lumbar de un nivel presentó resultados ampliamente positivos, con mejora en los escores de discapacidad, bajo tiempo de internación y baja incidencia de complicaciones. Bien indicada, OTLIF es una excelente y segura opción para el tratamiento de la enfermedad degenerativa lumbar. Nivel de evidencia IV; Serie de casos.

Terapia manual e exercícios de ampliação de canais versus fisioterapia convencional em estenose lombar - um protocolo de estudo / Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis ­ a study protocol

INTRODUÇÃO: A estenose do canal lombar (ECL) é conhecida como a razão bem estabelecida de dor e capacidade de marcha reduzida em pacientes com manifestações de parestesia e dor na parte inferior das costas, região glútea, coxa posterior e pernas, denominadas 'Claudicação Neurogênica' (NC). A terapia manual combinada com exercícios de alargamento do canal e fisioterapia convencional pode ser considerada na erradicação dos sintomas de dor e NC, melhorando assim a qualidade de vida. MÉTODOS E MATERIAIS: Pacientes com LCS com canal de diâmetro de 8-12 mm no nível de L 4 e abaixo serão recrutados para este estudo por meio do método de randomização em Bloco. Eles serão randomizados em dois grupos de intervenção: grupos Terapia Manual e Alargamento dos Canais (MTCE) (n = 16) e Fisioterapia Convencional (Cp) (n = 16). O grupo MTCE receberá terapia manual e exercícios de alargamento do canal, enquanto o grupo Cp receberá apenas fisioterapia convencional. Ambos os grupos de intervenção receberão 3 dias de tratamento por semana durante 4 semanas. O questionário de deficiência de Oswestry modificado (MODI), diâmetro do canal ântero-posterior (AP), escala numérica de dor (NPRS) e distância de claudicação (CD) serão usados para a avaliação. O índice de deficiência de Oswestry modificado, diâmetro do canal AP, NPRS, distância de claudicação e SLR serão medidos no início e após a intervenção. DISCUSSÃO: Os resultados desta pesquisa ditarão a aplicabilidade da terapia manual com um protocolo de exercícios de alargamento do canal na dor e incapacidade funcional em pacientes com SCL.

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as 'Neurogenic Claudication' (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy & Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), AnteroPosterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.

Lumbar and para-iliac hernias: an alternative technique / Hérnias lombares e para-ilíacas: uma alternativa técnica

ABSTRACT Lumbar and para-iliac hernias are rare and occur after removal of an iliac bone graft, nephrectomies, retroperitoneal aortic surgery, or after blunt trauma to the abdomen. The incidence of hernia after the removal of these grafts ranges from 0.5 to 10%. These hernias are a problem that surgeons will face, since bone grafts from the iliac crest are being used more routinely. The goal of this article was to report the technique to correct these complex hernias, using the technique of fixing the propylene mesh to the iliac bone and the result of this approach. In the period of 5 years, 165 patients were treated at the complex hernia service, 10 (6%) with hernia in the supra-iliac and lumbar region, managed with the technique of fixing the mesh to the iliac bone with correction of the failure. During the mean follow-up of 33 months (minimum of 2 and maximum of 48 months), there was no recurrence of the hernias.

RESUMO Hérnias lombares e para-ilíacas são raras e ocorrem após a retirada de enxerto ósseo ilíaco, nefrectomias, cirurgia aórtica retroperitoneal, ou ainda, após traumas contusos sobre o abdômen. A incidência de hérnia após a retirada destes enxertos varia de 0,5 a 10%. Essas hérnias constituem um problema com o qual os cirurgiões irão se defrontar, uma vez que os enxertos ósseos da crista ilíaca estão sendo usados mais rotineiramente. O objetivo desse artigo foi relatar a técnica para correção dessas hérnias, consideradas complexas, utilizando-se a técnica de fixação de tela de propileno ao osso ilíaco e o resultado dessa abordagem. No período de 5 anos, 165 pacientes foram atendidos no serviço de hérnias complexas, 10 (6%) com hérnia da região suprailíaca e lombar, manejados com a técnica de fixação de tela ao osso ilíaco corrigindo a falha. Durante o seguimento médio de 33 meses (mínimo de 2 e máximo de 48 meses), não houve recidiva das hérnias.

Analysis of the reliability of the lee classification for lumbar disc herniations / Análise da confiabilidade da classificação de lee para hérnias de discos lombares / Análisis de la confiabilidad de la clasificación de lee para hernias de discos lumbares

ABSTRACT Objective To evaluate the intra- and interobserver reliability of the Lee et al. classification for migrated lumbar disc herniations. Methods In 2018, Ahn Y. et al. demonstrated the accuracy of this classification for radiologists. However, magnetic resonance images are often interpreted by orthopedists. Thus, a cross-sectional study was conducted by evaluating the magnetic resonance images of 82 patients diagnosed with lumbar disc herniation. The images were evaluated by 4 physicians, 3 of whom were spinal orthopedic specialists and 1 of whom was a radiologist. The intra- and interobserver analysis was conducted using the percentage of concordance and the Kappa method. Results The report of the classifications used by the four observers had a higher proportion of "zone 3" and "zone 4" type classifications in both evaluation moments. The most affected anatomical levels were L5-S1 (48.2%) and L4-L5 (41.4%). The intra- and interobserver concordance, when comparing both moments evaluation of the complementary examinations of the participants involved, was classified as moderate and very good. Conclusions Lee's classification presented moderate to very good intra- and interobserver reliability for the evaluation of migrated lumbar disc herniation. Level of evidence II; Retrospective Study.

RESUMO Objetivo Avaliar a confiabilidade intra e interobservador da classificação de Lee et al. para hérnias migradas de disco lombar. Métodos Ahn Y et al., em 2018, demonstraram a acurácia dessa classificação para radiologistas. Entretanto, as imagens de ressonância magnética são muitas vezes interpretadas por ortopedistas. Sendo assim, foi realizado um estudo transversal por meio da avaliação de exames de ressonância magnética de 82 casos diagnosticados com hérnia de disco lombar. As imagens foram avaliadas por quatro médicos, sendo três ortopedistas especialistas em cirurgia da coluna e um radiologista. Foi realizada a análise de confiabilidade intra e interobservador com o uso de porcentagem de concordância e do método Kappa. Resultados A relação das classificações utilizadas pelos quatro avaliadores tiveram, em sua maior proporção, as classificações tipo "zona 3" e "zona 4" em ambos os momentos de avaliação. Os níveis anatômicos mais acometidos foram L5-S1 (48,8%) e L4-L5 (41,4%). A concordância intra e interobservador, que comparou os dois momentos de avaliação dos exames complementares dos participantes envolvidos, obteve classificações de moderada a muito boa. Conclusões A classificação de Lee apresentou confiabilidade intra e interobservador moderada a muito boa para a avaliação de hérnia migrada de disco lombar. Nível de evidência II; Estudo Retrospectivo.

RESUMEN Objetivo Evaluar la confiabilidad intra e interobservador de la clasificación de Lee et al. para hernias migradas de disco lumbar. Métodos Ahn Y et al. en 2018, demostraron la exactitud de esa clasificación para los radiólogos. Entretanto, las imágenes de resonancia magnética son a menudo interpretadas por ortopedistas. Siendo así, fue realizado un estudio transversal a través de la evaluación de exámenes de resonancia magnética de 82 casos diagnosticados con hernia de disco lumbar. Las imágenes fueron evaluadas por cuatro médicos, siendo tres ortopedistas especialistas en cirugía de la columna y un radiólogo. Se realizó el análisis de confiabilidad intra e interobservador con el uso de porcentaje de concordancia y Método Kappa. Resultados La relación de las clasificaciones utilizadas por los cuatro evaluadores tuvieron, en su mayor proporción, las clasificaciones tipo "zona 3" y "zona 4" en ambos momentos de evaluación. Los niveles anatómicos más acometidos fueron L5-S1 (48,8%) y L4-L5 (41,4%). La concordancia intra e interobservador, que comparó los dos momentos de evaluación de los exámenes complementarios de los participantes involucrados, obtuvo clasificaciones de moderada a muy buena. Conclusiones La clasificación de Lee presentó confiabilidad intra e interobservador moderada a muy buena para la evaluación de hernia migrada discal lumbar. Nivel de evidencia II; Estudio Retrospectivo.

Facet joint degeneration in patients with lumbar disc herniation and probable determining factors / Degeneração facetária em pacientes com hérnia de disco lombar e prováveis fatores determinantes / Degeneración facetaria en pacientes con hernia de disco lumbar y probables factores determinantes

ABSTRACT Objective To evaluate facet joint degeneration following surgical treatment in patients with lumbar disc herniation, seeking to correlate it with possible determining factors. Methods Cross-sectional observational study, which analyzed medical records, radiographs and magnetic resonance images of 287 patients with lumbar disc herniation treated surgically at the Spine Surgery Service of the Hospital Ortopédico de Passo Fundo. Information about age and sex was collected. In the imaging exams, the following variables were evaluated: facet joint angulation and its tropism, measured by the Karacan method, sacral slope and lumbar lordosis, measured by the Cobb method, arthrosis of the interfacetary joints, measured by the Weishaupt classification, and intervertebral disc degeneration, measured by the Pfirrmann classification. Results A statistically significant relationship was observed between facet joint degeneration and age (p = 0.002), and also between facet joint degeneration and sacral slope (p = 0.038). No correlation was found between facet joint degeneration and lumbar lordosis (p = 0.934). It was found that the most degenerated facet joints were those that had the greatest facet joint asymmetry (tropism). However, the mean degree of facet tropism did not increase homogeneously with the progression of the joint degeneration score (p = 0.380). Conclusion It was verified that there are, in fact, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine. Additional studies, correlated with the asymmetry of the facet joints, would be important to elucidate better preventive management of this degeneration, aiming to avert secondary low back pain and sciatica with advancing age. Level of evidence II; Retrospective study.

RESUMO Objetivo Avaliar a degeneração facetária em pacientes com hérnia de disco lombar tratados cirurgicamente, procurando correlacioná-la com possíveis fatores determinantes. Métodos Estudo observacional do tipo transversal, que analisou prontuários, radiografias e ressonâncias magnéticas de 287 pacientes com hérnia de disco lombar, tratados cirurgicamente no Serviço de Cirurgia da Coluna do Hospital Ortopédico de Passo Fundo. Foram coletadas informações sobre idade e sexo. Nos exames de imagem, foram avaliadas as seguintes variáveis: angulação facetária e seu tropismo, mensurada pelo método de Karacan, inclinação sacral e lordose lombar, medidas pelo método de Cobb, artrose das articulações interfacetárias, pela classificação de Weishaupt e degeneração do disco intervertebral, pela classificação de Pfirrmann. Resultados Foi verificada relação estatisticamente significativa entre degeneração facetária e idade (p = 0,002), assim como entre degeneração facetária e inclinação sacral (p = 0,038). Não foi encontrada correlação entre degeneração facetária e lordose lombar (p = 0,934). Constatou-se que as articulações facetárias mais degeneradas eram as que tinham maior assimetria facetária (tropismo). Porém, a média do grau de tropismo facetário não aumentou de forma homogênea com a progressão do escore de degeneração da articulação (p = 0,380). Conclusões Verificou-se que há, de fato, uma multiplicidade de fatores relacionados com o grau de degeneração facetária da coluna lombar baixa. Estudos adicionais correlacionados com a assimetria das referidas articulações seriam importantes para elucidarmos uma conduta preventiva melhor para a referida degeneração, objetivando evitar lombalgia e ciatalgia secundárias à medida que a idade avança. Nível de evidência II; Estudo retrospectivo .

RESUMEN Objetivo Evaluar la degeneración facetaria en pacientes con hernia de disco lumbar tratados quirúrgicamente, buscando correlacionarla con posibles factores determinantes. Métodos Estudio observacional del tipo transversal, que analizó historiales, radiografías y resonancias magnéticas de 287 pacientes con hernia de disco lumbar, tratados quirúrgicamente en el Servicio de Cirugía de la Columna del Hospital Ortopédico de Passo Fundo. Fueron colectadas informaciones sobre edad y sexo. En los exámenes de imagen, se evaluaron las siguientes variables: angulación facetaria y su tropismo, medida por el método de Karacan, inclinación sacral y lordosis lumbar, medidas por el método de Cobb, artrosis de las articulaciones interfacetarias, por la clasificación de Weishaupt, y degeneración del disco intervertebral, por medio de la clasificación de Pfirrmann. Resultados Se verificó relación estadísticamente significativa entre degeneración facetaria y edad (p = 0,002), así como entre degeneración facetaria e inclinación sacral (p = 0,038). No se encontró correlación entre degeneración facetaria y lordosis lumbar (p = 0,934). Se constató que las articulaciones facetarias más degeneradas eran las que tenían mayor asimetría facetaria (tropismo). Sin embargo, el promedio del grado de tropismo facetario no aumentó de forma homogénea con la progresión del score de degeneración de la articulación (p = 0,380). Conclusiones Se verificó que hay, de hecho, una multiplicidad de factores relacionados con el grado de degeneración facetaria de la columna lumbar baja. Estudios adicionales correlacionados con la asimetría de las referidas articulaciones serían importantes para que elucidemos una mejor conducta preventiva para la referida degeneración, con el objetivo de evitar lumbalgia e ciatalgia secundarias, a medida que la edad avanza. Nivel de evidencia II; Estudio retrospectivo.

The natural history of patients with acute disc herniation: a series of 150 cases / A história natural de pacientes com herniação discal aguda: uma série de 150 casos / La historia natural de pacientes con herniación discal aguda: una serie de 150 casos

ABSTRACT Objective This study aims to analyze the characteristics of patients with acute lumbar/sciatic disc herniation who underwent conservative, pain block procedures and surgical treatment, in order to better understand the natural history of herniations and their surgical indications, as well as the impact of hernia volume. Methods We analyzed 150 patients with a diagnosis of acute lumbar disc herniation. The treatments considered were: conservative, infiltration/pain block procedures and microdiscectomy. For seven patients who were surgically treated, the lumbar sequestrectomy volume was submitted to pathological analysis. Results Of the 150 patients, 80% were treated conservatively; 15.31% were treated with pain block procedures and 4.66% underwent microdiscectomy. The mean age of the surgical group was 42.5 years, and 57.1% of the patients were men. Most of the hernias were at L5-S1 (55.5%), and 77.7% were on the left side. All patients had presented significant lumbar pain or sciatica for a long period prior to the surgery. The Lasègue sign was present in all patients. Of the total number of patients, 85.7% presented hypoesthesia and 42.8% presented focal motor deficits, among other findings. The mean hernia volume was 9.6 cm3. Conclusions Unresponsiveness to conservative treatment is an important indication for surgery. The clinical manifestations in patients with a lumbar/sciatic hernia can be very diverse, as can the disc herniation volume, so these are not good indicators for surgery. Level of evidence IV; Case series

RESUMO Objetivo O presente estudo tem como objetivo analisar as características dos pacientes com hérnia de disco lombar/ciática aguda que passaram por procedimentos conservadores, procedimentos de bloqueio de dor e tratamento cirúrgico, a fim de melhor entender a história natural das hérnias e suas indicações cirúrgicas, assim como o impacto do volume da hérnia. Métodos Analisamos 150 pacientes diagnosticados com hérnia de disco lombar aguda. Os tratamentos considerados foram: tratamento conservador, procedimentos para bloqueio da dor/infiltração e microdiscectomia. Para sete pacientes tratados cirurgicamente, o volume de sequestrectomia lombar foi enviado para análise patológica. Resultados Dos 150 pacientes analisados, 80% foram tratados de modo conservador, 15,31% com procedimentos de bloqueio da dor e 4,66% com microdiscectomia. A idade média do grupo submetido à cirurgia foi 42,5 anos, sendo que 57,1% dos pacientes eram homens. A maior parte das hérnias estavam localizadas em L5-S1 (55,5%) e 77,7% das hérnias estavam no lado esquerdo. Todos os pacientes apresentaram significativa dor lombar ou ciática por um longo período antes da cirurgia. O sinal de Lasègue estava presente em todos pacientes. Do número total de pacientes, 85,7% apresentaram hipoestesia e 42,8% apresentaram déficits motores focais, entre outros achados. O volume médio das hérnias foi 9,6 cm3. Conclusões A falta de resposta ao tratamento conservador é uma importante indicação para cirurgia. As manifestações clínicas dos pacientes com hérnia lombar/ciática podem ser muito diversas, assim como o volume da hérnia de disco, portanto, esses não são bons indicadores para cirurgia. Nível de evidência IV; Série de casos.

RESUMEN Objetivo El presente estudio tiene como objetivo analizar las características de los pacientes con hernia de disco lumbar/ciática aguda que pasaron por procedimientos conservadores, procedimientos de bloqueo de dolor y tratamiento quirúrgico, a fin de entender mejor la historia natural de las hernias y sus indicaciones quirúrgicas, así como el impacto del volumen de la hernia. Métodos Analizamos a 150 pacientes diagnosticados con hernia de disco lumbar aguda. Los tratamientos considerados fueron: conservador, procedimientos para bloqueo de dolor/infiltraci ón y microdiscectom ía . Para siete pacientes tratados quirúrgicamente, el volumen de secuestrectomía lumbar fue enviado para análisis patológico. Resultados De los 150 pacientes analizados, 80% fue tratado de modo conservador, 15,31% con procedimientos de bloqueo de dolor y 4,66% con microdiscectomía. La edad promedio del grupo sometido a cirugía fue de 42,5 años, siendo que 57,1% de los pacientes eran hombres. La mayor parte de las hernias estaban localizadas en L5-S1 (55,5%) y 77,7% de las hernias estaban en el lado izquierdo. Todos los pacientes presentaron dolor lumbar o ciático significativo por un largo período antes de la cirugía. La señal de Lasègue estaba presente en todos los pacientes. Del número total de pacientes, 85,7% de los pacientes present ó hipostesia y 42,8% present ó déficit s motores focales, entre otros hallazgos. El volumen promedio de las hernias fue de 9,6 cm3. Conclusiones La falta de respuesta al tratamiento conservador es una importante indicación para la cirugía. Las manifestaciones clínicas de los pacientes con hernia lumbar/ciática pueden ser muy diversas, así como el volumen de la hernia de disco, por lo tanto, é stos no son buenos indicadores para cirugía. Nivel de evidencia IV; Serie de casos.

Atypical evolution after dengue: extradural hematoma of vertebral canal level l4-l5 / Evolução atípica após dengue: formação de hematoma extradural do canal vertebral nível l4-l5 / Evolución atípica después del dengue: formación de hematoma extradural del canal vertebral nivel l4-l5

ABSTRACT The objective of this paper is to report a case of atypical evolution after a classic case of dengue confirmed by serology, in which the formation of an epidural hematoma with low back pain and radiculopathy was observed. The article is a qualitative and descriptive case report. Data were collected from the medical records of the hospital where the patient was treated. In conclusion, the diagnostic correlation of dengue with this rare condition was possible due to radiological comparisons before and after the formation of the extradural hematoma. Level of evidence V; Expert Opinion.

RESUMO O presente trabalho tem como objetivo relatar um caso de evolução atípica após quadro clássico de dengue, confirmada por sorologia, em que foi observada a formação de um hematoma extradural, com dor lombar baixa e radiculopatia. O artigo é tipo relato de caso, qualitativo e descritivo. Os dados foram coletados no prontuário do hospital onde o doente foi atendido. Como conclusão, a correlação diagnóstica da dengue com essa afecção rara foi possível devido a comparações radiológicas pré- e pós-formação do hematoma extradural. Nível de evidência V; Opinião de Especialista.

RESUMEN El presente trabajo tiene como objetivo relatar un caso de evolución atípica después de un cuadro clásico de dengue, confirmado por serología, en el que se observó la formación de un hematoma extradural, con dolor lumbar bajo y radiculopatía. El artículo es tipo relato de caso, cualitativo y descriptivo. Los datos fueron recolectados en el prontuario del hospital en donde el enfermo fue atendido. Como conclusión, la correlación diagnóstica del dengue con esta afección fue posible debido a las comparaciones radiológicas pre y post formación del hematoma extradural. Nivel de evidencia V; Opinión de Especialista.

Prevalence and management of refractory meralgia paresthetica in lumbar spine surgery: 5 years of experience / Prevalência e manejo da meralgia parestésica refratária em cirurgia de coluna lombar: experiência de cinco anos / Prevalencia y manejo de la meralgia parestésica refractaria en cirugía de columna lumbar: experiencia de 5 años

ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.

RESUMO Objetivo O objetivo do presente estudo consiste em relatar a experiência de cinco anos no reconhecimento e manejo da meralgia parestésica (MP) refratária em pacientes submetidos a cirurgias lombares por via posterior. Métodos Pacientes submetidos a procedimentos na coluna lombar, no período de janeiro de 2010 a janeiro de 2015, em três diferentes centros hospitalares de Belo Horizonte/MG, foram selecionados para avaliação do desenvolvimento da MP pós-operatória. Estudo prospectivo observacional com série de casos comparativos. Nível III de evidência. Avaliação dos seguintes parâmetros: tipo de suporte para o paciente, tempo de cirurgia, índice de massa corporal. Resultados Foram feitas 367 cirurgias por via posterior da coluna lombar para patologias degenerativas da coluna lombar. A MP foi observada em 81 pacientes (22%). Em 65 pacientes (80%), houve resolução completa dos sintomas com manejo conservador (medidas locais e medicamentos para dor neuropática) em menos de dois meses. Doze pacientes melhoraram através de infiltração com corticoide de depósito e anestésico no local no ligamento inguinal e, em quatro pacientes houve necessidade de procedimento cirúrgico no terceiro mês. O suporte pneumático foi o menos envolvido no desenvolvimento da MP, assim como o tempo cirúrgico <1h e índice de massa corporal <25. Conclusão A MP refratária pode ocorrer em pacientes submetidos a cirurgias na coluna lombar por via posterior. O manejo inclui medidas locais, medicamentos para dor neuropática e infiltração com corticoide no ligamento inguinal. A cirurgia descompressiva está reservada para os raros casos refratários. Nível de evidência III; Estudo prospectivo observacional com série de casos comparativos.

RESUMEN Objetivo El objetivo del presente estudio consiste en relatar la experiencia de 5 años en el reconocimiento y manejo de la meralgia parestésica (MP) refractaria en pacientes sometidos a cirugías lumbares por vía posterior. Métodos Pacientes sometidos a procedimientos en la columna lumbar, en el período de enero de 2010 a enero de 2015, en tres diferentes centros hospitalarios de Belo Horizonte/MG, fueron seleccionados para evaluación del desarrollo de la MP postoperatoria. Estudio prospectivo observacional con serie de casos comparativos. Nivel III de evidencia. Evaluación de los siguientes parámetros: tipo de soporte para el paciente, tiempo de cirugía, índice de masa corporal. Resultados Se realizaron 367 cirugías por vía posterior de la columna lumbar para patologías degenerativas de la columna lumbar. La MP fue observada en 81 pacientes (22%). En 65 pacientes (80%) hubo resolución completa de los síntomas con manejo conservador (medidas locales y medicamentos para el dolor neuropático) en menos de 2 meses. Doce pacientes mejoraron a través de infiltración de corticoide de depósito y anestésico en el local en el ligamento inguinal y, en cuatro pacientes, hubo necesidad de procedimiento quirúrgico en el tercer mes. El soporte neumático fue el menos involucrado en el desarrollo de la MP, así como el tiempo quirúrgico <1h e índice de masa corporal <25. Conclusión La MP refractaria puede ocurrir en pacientes sometidos a cirugías en la columna lumbar por vía posterior. El manejo incluye medidas locales, medicamentos para el dolor neuropático e infiltración con corticoide en el ligamento inguinal. La cirugía descompresiva está reservada para los raros casos refractarios. Nivel de evidencia III; Estudio prospectivo observacional con serie de casos comparativos.

A Study Of Prevalence Of Sacralization Of L5 Vertebra

Sacrum is centrally located unpaired bone of pelvis which is composed of 5 sacral vertebrae. Superiorly itarticulates with 5th lumbar vertebra to form lumbosacral joint and laterally it articulates with hip bone to formsacroiliac joint. When 5th lumbar vertebra fuses with 1st sacral vertebra then it is called as sacralization andwhen 1st sacral vertebra gets separated from sacrum then it is called as lumbarization. 79sacra from thedepartment of Anatomy of MGM medical college and D. Y. Patil medical college, Navi Mumbai were studied to seesacralization. Out of 79 sacra in 14sacra(17.7 %) sacralization was observed.Out of 14 sacra, 4 sacra showedbilateral and complete sacralization, 5 sacra showed unilateral and partial sacralization and 5 sacrashowedincomplete fusion between L5 and S1 vertebra. Change in normal structure of lumbar vertebra andsacrum may lead to alteration in kinematics of lumbosacral region which may lead to compression of nerve andlow back pain. Knowledge regarding incidence of sacralization will be useful for radiologist and orthopaedicsurgeon while dealing with low back pain

3D anatomical model for teaching canine lumbosacral epidural anesthesia

Abstract Purpose To develop a 3D anatomical model for teaching canine epidural anesthesia (3DMEA) and to assess its efficacy for teaching and learning prior to the use of live animals. Methods The creation of 3DMEA was based on 3D optical scanning and 3D printing of canine bone pieces of the fifth to the seventh lumbar vertebrae, sacrum and pelvis. A total of 20 male dogs were scheduled for castration. 20 veterinary students watched a video showing epidural anesthesia in dogs before the clinical attempt and were assigned to control or 3DMEA groups. Students in the 3DMEA group trained in the model after the video. For the clinical trial, the epidural procedure was performed by students under the veterinary supervision. When observed the absence of response to nociceptive stimuli, the epidural was considered successful. Then, all students answered a questionnaire evaluating the main difficulty founded in the technique and its degree of difficulty. Results The 3DMEA group reported a lower degree of difficulty to perform the epidural anesthesia technique when compared with the control group (p=0.0037). The 3DMEA reproduced the anatomical structures, allowing the perception of the distance of needle in relation to the iliac prominences during epidural anesthesia. Its mobility allowed simulation of the animal in standing position and sternal recumbency. Conclusion The use of 3DMEA demonstrated greater efficacy in the execution of the technique, being effective in the teaching and learning process before the epidural anesthesia in live animals.

One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis.@*METHODS@#The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L to S. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed.@*RESULTS@#All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively.@*CONCLUSION@#One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.

Tomographic study of the s2-alar-iliac screw technique in brazilian men / Estudo tomográfico da técnica do parafuso de s2-alar-ilíaco em homens brasileiros / Estudio tomográfico de la técnica del tornillo s2-alar-ilíaco en hombres brasileños

ABSTRACT Objective The use of pedicle screws was a milestone for modern spinal surgery. This type of fixation, due to its superior biomechanics, gave greater fixation power, greater capacity to withstand the pulling forces and, therefore, greater stability and lower rates of pseudoarthrosis. Fixation of the lumbosacral junction, even with the development of these new implants, remains a challenge mainly because the considerable rates of pseudoarthrosis. The use of iliac screws solves the biomechanical difficulties. However, its use shows high rates of surgical wound problems. The S2-Alar-Iliac screw (S2AI) came as a solution to these complications. The lack of studies about anatomical and anthropometric parameters in the Brazilian population justifies the study. Methods Eleven hip tomographies of Brazilian adult males were analyzed by four evaluators. The right and left sides were considered. In each patient, measurements were made of greater and shorter bone length, greater and smaller bone diameter, distance from the entry point to the skin, sagittal and axial angles related to the hypothetical insertion of an S2AI screw and compared to the same measurements obtained with the iliac screw. Results The mean bone length was 136.7 mm, the greatest bone diameter was 24.8 mm, the smallest bone diameter was 19.7 mm and the distance from the screw to the skin was 42.1 mm for the S2AI screw. Conclusions The obtained data present an average of the sample that can be useful in the decision of the surgical technique in the studied group. Level of evidence I; Diagnostic Studies (Anatomical Investigation).

RESUMO Objetivo O uso de parafusos pediculares foi um marco para a cirurgia moderna de coluna vertebral. Esse tipo de fixação, devido a sua biomecânica superior, deu maior poder de fixação, maior capacidade de resistir às forças de arrancamento e, portanto, maior estabilidade e menores taxas de pseudoartrose. A fixação da junção lombossacra, mesmo com o desenvolvimento destes novos implantes, permanece um desafio devido, principalmente, às consideráveis taxas de pseudoartrose. O uso de parafusos de ilíaco resolve o problema biomecânico. Entretanto, seu uso mostra elevadas taxas de problemas na ferida operatória. O parafuso de S2-Alar-Ilíaco (S2AI) veio como solução para essas complicações. A falta de estudos acerca dos parâmetros anatômicos e antropométricos na população brasileira justifica o estudo realizado. Métodos Foram analisadas 11 tomografias de bacia de homens brasileiros adultos por 4 avaliadores. Foram considerados os lados direito e esquerdo. Em cada paciente foram feitas medidas de maior e menor comprimento ósseo, maior e menor diâmetro ósseo, distância do ponto de entrada na pele, ângulos sagital e axial relacionadas à hipotética inserção de um parafuso S2AI e comparadas às mesmas medidas obtidas em relação ao parafuso de ilíaco. Resultados O comprimento ósseo médio foi de 136,7 mm, maior diâmetro ósseo foi de 24,8 mm, o menor diâmetro ósseo de 19,7 mm e a distância do parafuso para a pele foi de 42,1 mm para o parafuso S2AI. Conclusão Os dados obtidos apresentam uma média da amostra que podem ser úteis na decisão da técnica cirúrgica no grupo estudado. Nível de evidência I; Estudo Diagnóstico (Investigação Anatômica).

RESUMEN Objetivo El uso de tornillos pediculares fue un marco para la cirugía moderna de la columna vertebral. Este tipo de fijación, debido a su biomecánica superior, dio mayor poder de fijación, mayor capacidad de resistir a las fuerzas de tracción y, por lo tanto, mayor estabilidad y menores tasas de pseudoartrosis. La fijación de la unión lumbosacra, incluso con el desarrollo de estos nuevos implantes, sigue siendo un desafío debido principalmente a las considerables tasas de pseudoartrosis. El uso de tornillos ilíacos soluciona el problema biomecánico. Sin embargo, su uso muestra altas tasas de problemas en la herida quirúrgica. El tornillo S2-Alar-Ilíaco (S2AI) vino como solución para estas complicaciones. La falta de estudios sobre los parámetros anatómicos y antropométricos en la población brasileña justifica el estudio realizado. Métodos Se analizaron 11 tomografías de cadera de hombres brasileños adultos por 4 evaluadores, considerando los lados derecho e izquierdo. En cada paciente se realizaron medidas de mayor y menor longitud ósea, mayor y menor diámetro óseo, distancia del punto de entrada en la piel, ángulos sagital y axial relacionados con la inserción hipotética de un tornillo S2AI y comparados a las mismas medidas obtenidas en relación al tornillo ilíaco. Resultados La longitud ósea promedio fue de 136,7 mm, el mayor diámetro óseo fue de 24,8 mm, el diámetro óseo menor de ١٩,٧ mm y la distancia del tornillo a la piel fue de 42,1 mm para el tornillo S2AI. Conclusiones Los datos obtenidos presentan un promedio de la muestra que puede ser útil en la decisión de la técnica quirúrgica en el grupo estudiado. Nivel de evidencia I; Estudios de Diagnósticos (Investigación Anatómica).

Hidrocefalia asociada a un condroma vertebral lumbar: presentación de un caso / Hydrocephalus associated with a lumbar vertebral chondroma: presentation of a case

RESUMEN Fundamento: los osteocondromas son tumores benignos del hueso que se localizan por lo general, en esqueleto axial y su vínculo con hidrocefalia es inusitado dadas las características fisiopatológicas de ambas enfermedades. Objetivo: presentar un caso operado de condroma vertebral lumbar que desarrolló una hidrocefalia. Presentación del caso: paciente de 43 años de edad, masculino, que acudió con manifestaciones neurológicas de compresión radicular lumbar que no aliviaban con tratamiento sintomático. Se operó por vía lumbar posterior y se realizó laminectomía estándar con resección quirúrgica de la lesión, se confirmó el diagnóstico de un condroma y un mes posterior a la excéresis apareció una hidrocefalia. Conclusiones: los condromas espinales de localización lumbar son infrecuentes y la aparición de hidrocefalia en el postoperatorio de esta lesión es más inusual.

ABSTRACT Background: osteochondromas are benign tumors of the bone that are located, generally, in axial skeleton and their association with hydrocephalus is infrequent due to physiopathologic characteristics of both diseases. Objective: to present an operated case of lumbar vertebral chondroma that developed a hydrocephalus. Case report: a 43-years-old male patient who came with neurological manifestations of lumbar radicular compression that was not relieved with symptomatic treatment. The surgical resection of the lesion is performed and the diagnosis of a chondroma is confirmed and hydrocephalus appears one month after the surgery. Conclusions: the spinal chondromas of lumbar location are infrequent and the appearance of hydrocephalus in the postoperative period of this lesion is more unusual.

La medicina tradicional en afecciones lumbosacras en el adulto mayor / Traditional medicine for lumbosacral conditions in the elderly

RESUMEN Introducción: los métodos empleados por la Medicina Natural y Tradicional son terapéuticos, económicos e inocuos. La lumbalgia es una afección que padecen los adultos mayores en algún momento de la vida. Objetivo: determinar la efectividad de la medicina tradicional en afecciones lumbosacras en el adulto mayor, del Policlínico Universitario Pedro Borrás Astorga, en el período de septiembre de 2016 a junio de 2017. Métodos: se realizó una investigación observacional, analítica, de casos y controles, con un universo de 562 adultos mayores que asistieron a consulta de medicina tradicional con dolor lumbosacro, se seleccionó una muestra aleatoria simple de 200 pacientes, separados en dos grupos, de 100 cada uno, el de casos que recibió tratamiento con medicina tradicional y el grupo de controles tratado con medicina convencional; se utilizaron métodos teóricos, empíricos la revisión de la historia clínica, la escala de Oswestry e índice Womac, se aplicaron técnicas estadísticas (porciento y Chi cuadrado). Resultados: predominaron en ambos grupos las edades entre 60-64 años, el sexo femenino, la ocupación de ama de casa en las féminas y trabajador agrícola en los hombres, la evolución de los síntomas utilizando la medicina tradicional resultó satisfactoria en un 95 %, el 36 % utilizó de 3 a 6 sesiones con ventosas, el 52 % de 7 a 10 sesiones con ventosas, el 88 % recibió tratamiento con digitopuntura y un 48 % presentó gastritis como reacción adversa ante el tratamiento convencional. Conclusiones: la medicina tradicional resultó ser un tratamiento efectivo para los adultos mayores aquejados de afecciones lumbosacras.

ABSTRACT Introduction: the methods used by Natural and Traditional Medicine are therapeutic, economical and harmless. Low back pain is a condition the elderly suffer from at certain moments throughout their lives. Objective: to determine the effectiveness of traditional medicine in lumbosacral conditions in the elderly, at Pedro Borrás Astorga University Polyclinic, from September 2016 to June 2017. Methods: an observational, analytical, case and control research was carried out with a target group of 562 old people who attended a traditional medicine consultation with low back pain, a simple random sample of 200 patients was chosen, who were separated into two groups, of 100 each of cases treated with traditional medicine and the control group treated with conventional medicine; theoretical methods were used, empirical review of clinical history, Oswestry scale and Womac index, along with statistical techniques were applied (percentage and Chi-square). Results: in both groups the ages between 60-64 years predominated, female sex prevailed, the occupation of housewives in women and agricultural workers in men, the development of symptoms using traditional medicine was satisfactory in 95 %, 36 % needed from 3 to 6 sessions with cups, 52 % from 7 to 10 sessions with cups, 88 % underwent treatment with acupressure and 48 % suffered from gastritis as an adverse reactions regarding the conventional treatment. Conclusions: traditional medicine proved to be an effective treatment for the elderly suffering from lumbosacral conditions.