Situation-Specific Theory from Autonomic Dysreflexia Nursing Diagnosis Based on Roy's Adaptation Model

Introduction: Autonomic dysreflexia (AD) is a condition developed secondary to a spinal cord injury, which manifests with the loss of coordinated autonomic responses and cardiovascular control. For the care of the person, the nurse has the nursing diagnosis of AD, which allows the precise interpretation of the human responses of each individual. However, it is necessary to strengthen and update the diagnosis to the new disciplinary knowledge that evolved with nursing practice. For this, proposing a situation-specific theory is essential to explain the phenomenon of interest and guide practice. Objective: To construct a situation-specific theory for the nursing diagnosis of AD derived from the adaptation model of Sor Callista Roy. Materials and methods: Theoretical study developed in five stages: defining the approach to construct the theory, defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. Results: The situation-specific theory included defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. We described the concepts and their relationships through seven propositions and identified 19 ineffective behaviors and 43 environmental stimuli. Of them, 39 are focal, and four are contextual stimuli. Conclusions: This situation-specific theory offers a substantiated and comprehensive explanation of the human response to AD for supporting nursing care.

Introducción: La direflexia autónoma (DA) es una afección secundaria a una lesión en la médula espinal que se manifiesta en la pérdida de respuestas autónomas coordinadas y de control cardiovascular. Para el cuidado del paciente, las enfermeras cuentan con el diagnóstico de la DA, que permite interpretar adecuadamente las respuestas humanas de cada individuo. Sin embargo, es necesario fortalecer y actualizar el diagnóstico a los nuevos conocimientos disciplinarios que evolucionan con la práctica de la enfermería. Para esto es esencial una teoría de situación específica que explique el fenómeno de interés y guíe la práctica. Objetivo: Construir una teoría de situación específica para el diagnóstico en enfermería de la DA derivada de la adaptación del modelo de Sor Callista Roy. Materiales y métodos: Estudio teórico desarrollado en cinco etapas: definición del enfoque para construir la teoría, definición de los conceptos clave, desarrollo de un diagrama pictórico, construcción de las proposiciones y establecimiento de las relaciones causales y la evidencia para la práctica. Resultados: La teoría de situación específica incluyó la definición del enfoque para construir la teoría, la definición de los conceptos clave, el desarrollo de un diagrama pictórico, la construcción de las proposiciones y el establecimiento de las relaciones causales y la evidencia para la práctica. Se describen los conceptos y sus relaciones por medio de 7 proposiciones y se identificaron 19 comportamientos ineficaces y 43 estímulos ambientales. De ellos, 39 son focales y 4 contextuales. Conclusiones: Esta teoría de situación específica proporciona una explicación informada y completa de la respuesta humana a la DA para apoyar el cuidado en enfermería.

Introdução: a disreflexia autonômica (DA) é uma condição secundária à lesão da medula espinhal que se manifesta na perda de respostas autonômicas coordenadas e no controle cardiovascular. Para o atendimento ao paciente, os profissionais de enfermagem contam com o diagnóstico de DA que permite a interpretação adequada das respostas humanas do indivíduo. No entanto, há necessidade de fortalecer e atualizar o diagnóstico para o novo conhecimento disciplinar que evolui com a prática de enfermagem. Para isso, é essencial uma teoria situacional específica que explique o fenômeno de interesse e oriente a prática. Objetivo: Construir uma teoria situacional específica para o diagnóstico de enfermagem da DA derivada da adaptação do modelo de Sor Callista Roy. Materiais e método: estudo teórico desenvolvido em cinco etapas: definição da abordagem para construir a teoria, definição de conceitos-chave, desenvolvimento de um diagrama pictórico, construção de proposições e estabelecimento de relações causais e evidências para a prática. Resultados: a teoria específica da situação incluiu a definição da abordagem para a construção da teoria, a definição dos principais conceitos, o desenvolvimento de um diagrama pictórico, a construção de proposições e o estabelecimento de relações causais e evidências para a prática. Os conceitos e suas relações são descritos por meio de 7 proposições e foram identificados 19 comportamentos ineficazes e 43 estímulos ambientais. Destes, 39 são focais e 4 são contextuais. Conclusões: essa teoria específica da situação fornece uma explicação informada e abrangente da resposta humana à DA para apoiar a assistência de enfermagem.

Mielopatía por déficit de cobre: serie de casos y revisión de la literatura / Myelopathy due to copper deficiency: A case series and review of the literature

El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial. Se deben incluir siempre la determinación de los niveles de cobre dentro del abordaje diagnóstico de todo paciente con enfermedad gastrointestinal crónica, con diarrea crónica, síndrome de mala absorción o reducción significativa de la ingestión en la dieta, y que desarrolle síntomas neurológicos sugestivos de compromiso de los cordones, ya que se ha reportado que el retraso en el diagnóstico de las mielopatías se asocia con pobres desenlaces neurológicos.

Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.

Lesão medular por traumatismo raquimedular e malformação de Chiari tipo I: uma comparação de características clínicas / Spinal cord injury and Chiari type I malformation: a comparison of clinical features

Foram comparadas características clínicas e epidemiológicas de pacientes com tetraplegia traumática e Malformação de Chiari tipo I, atendidos em centro de neurorreabilitação através de estudo observacional analítico e retrospectivo, realizado por meio de análise de prontuário eletrônico. No grupo de pacientes com Malformação de Chiari tipo I predominaram mulheres, com marcha e que apresentavam transtornos de ansiedade e a presença de siringomielia. No grupo com tetraplegia traumática predominaram os homens, com locomoção em cadeira de rodas e maior presença de espasticidade e disfunções neurogênicas do intestino e do trato urinário inferior. Os pacientes com Malformação de Chiari tipo I representam um grupo com diferentes características clínicas e epidemiológicas em relação aos pacientes com sequelas de traumatismo raquimedular, tradicionalmente o principal grupo atendido dentro dos programas de neurorreabilitação. Desta forma, os pacientes com Malformação de Chiari tipo I necessitam de uma abordagem diferenciada que contemplem suas necessidades nos programas de neurorreabilitação.

Clinical and epidemiological characteristics of patients with traumatic tetraplegia and Chiari malformation type I treated at a neurorehabilitation center were compared through an analytical and retrospective observational study, carried out through electronic medical record analysis. In the group of patients with Chiari malformation type I predominated female gender, with gait, the presence of syringomyelia and anxiety disorders. In the group with traumatic tetraplegia predominated male gender, use of wheelchair and presence of spasticity and neurogenic dysfunctions of the bowel and lower urinary tract. Patients with Chiari malformation type I represent a group with different clinical and epidemiological characteristics in relation to patients with sequelae of spinal cord injury, traditionally the main group treated within neurorehabilitation. Thus, patients with Chiari malformation type I need a differentiated approach that addresses their needs in neurorehabilitation.

Factores de mal pronóstico en pacientes geriátricos con lesión medular traumática

Introducción: El trauma raquimedular es una afección devastadora que cursa con alteraciones sensitivas, motoras y autonómicas, sin embargo, la sobrevida depende de factores pronósticos descritos en la literatura como son: la edad, las comorbilidades propias del individuo, la severidad del trauma inicial, el nivel y tipo de lesión ente otras. Objetivo: Evaluar los factores clínicos-epidemiológicos que afectan la evolución en los enfermos geriátricos portadores de lesión medular cervical traumática. Métodos: La investigación se realizó en un periodo de tres años, en el servicio de Neurocirugía y constó con varias etapas: se dedicaron dos años a la selección de los enfermos: enero 2018 a julio 2020, se completó el tiempo destinado al estudio con el seguimiento por consulta hasta los seis meses. Resultados: Predominó el grupo de 60 a 69 años del sexo masculino con un 56,6 % con dominio de los grupos de severidad A y B de la escala de ASIA. Los factores de mal pronóstico en el daño medular fueron los cambios degenerativos del raquis, el nivel de lesión baja y el alto índice de complicaciones entre otros. Como resultado, el grado de dependencia social en el grupo fue moderado o severo y los fallecidos fueron el 46,6 % de los casos tratados. Conclusiones: El trauma raquimedular cervical representa un evento complejo y multifactorial en el que influyen las comorbilidades, las características del evento traumático y el desarrollo tecnológico del centro. La valoración adecuada de cada uno de ellos puede mejorar los resultados para los lesionados de más de 60 años.

Introduction: Spinal cord trauma is a devastating condition that causes sensory, motor and autonomic alterations, however, survival depends on prognostic factors described in the literature such as: comorbidities of the individual, the severity of the initial trauma, the level of the injury, among others. Objective: To evaluate the clinical and epidemiological factors that overshadow the evolution in geriatric patients with traumatic cervical spinal cord injury. Methods: The research was carried out over a period of three years, in the Neurosurgery service and consisted of several stages: two years were dedicated to the selection of patients: January 2018 to July 2020, the time allocated to the study was completed with follow-up by consultation up to six months. Results: The group of 60 to 69 years of male sex prevailed with 56.6% with domain of severity groups A and B of the ASIA scale. Poor prognostic factors in spinal cord injury were degenerative changes of the spine, low injury level and high rate of complications among others. As a result, the degree of social dependence in the group was moderate or severe and the deceased were 46,6% of the cases treated. Conclusions: Cervical spinal cord trauma represents a complex and multifactorial event that is influenced by comorbidities, the characteristics of the traumatic event and the technological development of the center. Proper assessment of each of them can improve outcomes for those injured over 60 years of age.

Knowledge scale of Nursing students about sexuality of people with spinal cord injury / Escala de conocimiento de estudiantes de Enfermería sobre sexualidad de personas con lesión medular / Escala de conhecimento de estudantes de Enfermagem sobre sexualidade de pessoas com lesão medular

ABSTRACT Objectives: to build, validate and verify the reliability of the Scale of knowledge about sexuality of people with spinal cord injury for nursing students. Methods: a methodological study, following the steps: 1) Construction based on literature review; 2) Validation of the content with calculation of the Content Validity Index and the Modified Kappa Coefficient; 3) Pre-test with Nursing students; and 4) Measurement of reliability by internal consistency (Cronbach's alpha). Results: the first version of the instrument presented 13 items. After validation, the items received values above 0.80 and 0.76 for the Content Validity Index and Modified Kappa Coefficient, and it was suggested to separate three items to contemplate gender-specific aspects. After pre-testing, it was recommended that the writing of two items be revised. The final scale, with 16 items, showed Cronbach's alpha equal to 0.93. Conclusions: the constructed scale presented valid content and proved to be reliable for application with nursing students.

RESUMEN Objetivos: construir, validar y verificar confiabilidad de Escala de conocimiento sobre sexualidad de personas con lesión medular para estudiantes de Enfermería. Métodos: estudio metodológico, siguiendo las etapas: 1) Construcción basada en revisión de la literatura; 2) Validez de contenido con cálculo del Índice de Validez de Contenido y Coeficiente Kappa Modificado; 3) Pretest con estudiantes de Enfermería; y 4) Medida de confiabilidad por consistencia interna (alfa de Cronbach). Resultados: la primera versión del instrumento presentó 13 ítems. Posterior validación, estos recibieron valores arriba de 0,80 y 0,76 para el Índice de Validez de Contenido y Coeficiente Kappa Modificado, y sugerido separar tres ítems para contemplar aspectos específicos del sexo. Posterior pretest, recomendado la revisión de la escrita de dos ítems. La escala final, con 16 ítems, presentó alfa de Cronbach igual a 0,93. Conclusiones: la escala construida presentó contenido válido y se mostró confiable para aplicación con estudiantes de Enfermería.

RESUMO Objetivos: construir, validar e verificar a confiabilidade da Escala de conhecimento sobre sexualidade de pessoas com lesão medular para estudantes de Enfermagem. Métodos: estudo metodológico, seguindo as etapas: 1) Construção baseada em revisão da literatura; 2) Validação do conteúdo com cálculo do Índice de Validade de Conteúdo e do Coeficiente Kappa Modificado; 3) Pré-teste com estudantes de Enfermagem; e 4) Medida da confiabilidade pela consistência interna (alfa de Cronbach). Resultados: a primeira versão do instrumento apresentou 13 itens. Após validação, os itens receberam valores acima de 0,80 e 0,76 para o Índice de Validade de Conteúdo e Coeficiente Kappa Modificado, e sugeriu-se separar três itens para contemplar aspectos específicos do sexo. Após pré-teste, recomendou-se a revisão da escrita de dois itens. A escala final, com 16 itens, apresentou alfa de Cronbach igual a 0,93. Conclusões: a escala construída apresentou conteúdo válido e mostrou-se confiável para aplicação com estudantes de Enfermagem.

Magnetic resonance imaging evaluation of spinal cord lesions: what can we find? - Part 2. Inflammatory and infectious injuries / Avaliação por ressonância magnética das lesões intramedulares: o que podemos encontrar? - Parte 2. Lesões inflamatórias e infecciosas

Abstract Diseases involving the spinal cord include a heterogeneous group of abnormalities, including those of inflammatory, infectious, neoplastic, vascular, metabolic, and traumatic origin. Making the clinical differentiation between different entities is often difficult, magnetic resonance imaging being the diagnostic method of choice. Although the neuroimaging findings are not pathognomonic, many are quite suggestive, and the radiologist can assist in the diagnosis and, consequently, in the therapeutic guidance. In this second part of our article, the objective is to review the magnetic resonance imaging findings of the main inflammatory and infectious spinal cord injuries.

Resumo As doenças que envolvem a medula espinal incluem um grupo heterogêneo de anomalias, englobando causas inflamatórias, infecciosas, neoplásicas, vasculares, metabólicas e traumáticas. Muitas vezes a diferenciação clínica entre as diversas entidades é difícil, sendo a ressonância magnética a modalidade de escolha na investigação diagnóstica. Apesar de os achados de neuroimagem não serem patognomônicos, muitos são bastante sugestivos, podendo o radiologista auxiliar no diagnóstico e, consequentemente, na orientação terapêutica. O objetivo desta segunda parte do artigo é revisar os achados de ressonância magnética das principais lesões medulares inflamatórias e infecciosas.

Cervical spondylotic myelopathy: is a combined approach necessary? / Mielopatia cervical espondilótica: a abordagem combinada é necessária? / Mielopatía cervical espondilótica: ¿el abordaje combinado es necesario?

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.

RESUMO Objetivo: A mielopatia cervical espondilótica (MCE) é a principal causa de disfunção medular nos adultos. O tipo de abordagem cirúrgica para o tratamento não é bem definido na literatura. O objetivo é relatar os resultados obtidos por meio da descompressão posterior isolada nos pacientes com indicação prévia da abordagem combinada para o tratamento da mielopatia cervical espondilótica. Métodos: Trata-se de um estudo terapêutico com nível de evidência II, conforme a tabela de classificação Oxford. Dez pacientes submetidos apenas à abordagem cirúrgica posterior para tratamento de mielopatia cervical espondilótica foram avaliados por meio de exames de imagem e de questionários (escala visual analógica, escala mJOA-Br - Versão em Português da Escala Modificada da Sociedade Japonesa de Ortopedia e escala de incapacidade cervical - Neck Disability Index - NDI), comparando os resultados pré e pós-operatórios. Resultados: A avaliação tardia dos 10 pacientes foi realizada no período que variou de 24 a 36 meses (média de 30,3 meses ± 7,25) de pós-operatório. A comparação dos parâmetros clínicos e radiológicos em todos os pacientes mostrou diferença estatística com relação ao pré-operatório para as escalas aplicadas e para o grau de lordose cervical (p < 0,05), evidenciando a melhora depois da descompressão e da fixação posterior da coluna cervical. Conclusões: A abordagem posterior isolada (descompressão, fixação e artrodese) permitiu a melhora clínica e radiológica de pacientes com mielopatia cervical espondilótica e que tinham indicação da abordagem anterior complementar. Nível de evidência II; Estudo retrospectivo.

RESUMEN Objetivo: La mielopatía cervical espondilótica (MCE) es la principal causa de disfunción medular en los adultos. El tipo de abordaje quirúrgico para el tratamiento no está bien definido en la literatura. El objetivo es relatar los resultados obtenidos por medio de la descompresión posterior aislada en los pacientes con indicación previa del abordaje combinado para el tratamiento de la mielopatía cervical espondilótica. Métodos: Se trata de un estudio terapéutico con nivel de evidencia II, conforme a la tabla de clasificación Oxford. Diez pacientes sometidos únicamente al abordaje quirúrgico posterior para el tratamiento de la mielopatía cervical espondilótica fueron evaluados mediante exámenes de imagen y cuestionarios (escala analógica visual, escala mJOA-Br - versión en portugués de la escala modificada de la Sociedad Japonesa de Ortopedia y escala de incapacidad cervical - Neck Disability Index - NDI), comparando los resultados pre y postoperatorios. Resultados: La evaluación tardía de los 10 pacientes fue realizada en el período que varió de 24 a 36 meses (promedio de 30,3 meses ± 7,25) de postoperatorio. La comparación de los parámetros clínicos y radiológicos en todos los pacientes mostró diferencia estadística con relación al preoperatorio para las escalas aplicadas y para el grado de lordosis cervical (p <0,05), evidenciando la mejora después de la descompresión y de la fijación posterior de la columna cervical. Conclusiones: El abordaje posterior aislado (descompresión, fijación y artrodesis) permitió la mejora clínica y radiológica de pacientes con mielopatía cervical espondilótica y que tenían indicación del abordaje anterior complementario. Nivel de evidencia II; Estudio retrospectivo.

Atrofia monomiélica distal de extremidad superior. Caso clínico

Monomelic amyotrophy, also known as Hirayama disease, is a rare lower motor neuron syndrome due to localized lower motor neuron loss in the spinal cord at the cervical level. Clinically, monomelic amyotrophy is defined by the insidious onset of unilateral atrophy and weakness involving the hand and forearm, typically beginning in the second or third decade of life. We report 19-year-old man with a two years history of slowly progressive unilateral weakness and atrophy of his right-hand muscles. Neurological examination revealed weakness and atrophy in his intrinsic hand muscles, with sparing of the abductor pollicis brevis muscle. Also, mild atrophy of the ulnar aspect of the forearm was detected with sparing of the brachioradialis muscle. Electromyography showed active and chronic neurogenic changes affecting C8 and T1 myotomes, with mild chronic neurogenic changes on C7 myotome. Magnetic resonance imaging of his cervical spine revealed spinal cord atrophy involving C5 to C7 segments, associated with forward displacement of the posterior wall of the dura in cervical spine flexion. The clinical features associated with the imaging and electrophysiological findings support the diagnosis of monomelic amyotrophy.

Enfermedad de motoneurona inferior asociada al signo ojos de serpiente: una nueva entidad clínico-radiológica / Lower motor neuron disease with snake eyes sign: a new clinical-radiological entity

Las enfermedades de la moto neurona inferior constituyen un grupo heterogéneo de entidades con pronósticos diferentes. El signo radiológico "ojos de serpiente" hace referencia a la hiperintensidad bilateral en el asta anterior de la médula espinal en los cortes axiales de las imágenes por resonancia magnética, generalmente asociada a afecciones como infartos espinales, amiotrofia espondilótica, enfermedad de Hirayama y esclerosis lateral amiotrófica. Se ha descripto recientemente un reducido número de casos de enfermedad de moto neurona inferior asociada a "ojos de serpiente" con características clínicas y pronóstico distintivos. Presentamos dos casos de enfermedad de moto neurona inferior asociada al signo "ojos de serpiente" en pacientes jóvenes. El curso clínico fue progresivo con períodos prolongados de estabilidad clínica y ausencia de compromiso de moto neurona superior durante la evolución. Los pacientes presentaron debilidad segmentaria y asimétrica de miembros superiores con predominio distal en el primer caso y proximal en el segundo. Los casos presentados se corresponden en gran parte con lo comunicado en la literatura, dando apoyo a la existencia de una nueva entidad con pronóstico relativamente benigno denominada enfermedad de moto neurona inferior esporádica con signo de ojos de serpiente en las imágenes por resonancia magnética y cuya identificación debiera obviar tratamientos innecesarios (AU)

Lower motor neuron diseases are a heterogeneous group of entities with different prognosis. The "snake eyes" sign refers to bilateral hyper intensity of the anterior horns on axial magnetic resonance imaging of the spinal cord. It has been associated with ischemia, cervical spondylosis, Hirayama disease, and amyotrophic lateral sclerosis. Recently, a small number of cases of lower motor neuron disease associated with the "snake eyes" sign have been described as having distinctive clinical manifestations and prognosis. Two young patients with "snake eyes" sign associated with lower motor neuron disease had a progressive initial course followed by a stabilization of symptoms without involvement of upper motor neuron. They presented with asymmetric segmental arm weakness with distal predominance in the first a case and proximal predominance in the second. These cases match with those reported in the literature giving support to lower motor neuron disease with "snake eyes" as a pathological entity with a relatively good prognosis. This diagnosis should avoid unnecessary treatments (AU)

Complicaciones de la radioterapia: fenómeno de Lhermitte gatillado por calor: caso clínico / Complications of radiotherapy: Lhermitte phenomenon triggered by heat: report of one case

Lhermitte phenomenon is a neurological symptom described as a sensation of electric shock that radiates from the back towards the extremities, which appears when a patient flexes the neck. A transient myelopathy as a late complication of radiotherapy is associated with this symptom. It appears two to four months after treatment and disappears spontaneously. We report a 45 years old female with a neck malignant melanoma treated with surgery and adjuvant radiotherapy. She experienced the Lhermitte phenomenon that was triggered by heat. This phenomenon must be differentiated from the Uhthoff phenomenon.

Enfermedad descompresiva espinal: mielopatía isquémica secundaria a un accidente de buceo / Spinal cord decompression sickness: Ischemic myelopathy secondary to a diving accident

Se reporta el caso de un paciente de 34 años, buzo de profesión, hospitalizado por presentar de forma súbita confusión, debilidad generalizada, dolor intenso seguido de paraplejía y retención urinaria luego de emerger rápidamente desde una profundidad aproximada de 42 metros. El paciente fue admitido 48 horas después del evento habiendo completado dos sesiones de terapia de descompresión. Al examen se evidenció paraplejía flácida arrefléxica con nivel sensitivo a nivel de D5 global, reflejo plantar extensor bilateral y retención urinaria. En la resonancia magnética se evidenció incremento del calibre medular con alteración de señal en su diámetro anteroposterior, el cual es visto como hiperintensidad heterogénea en la secuencia T2 y STIR desde D2 hasta D11, sin dilatación del canal medular, compatible con lesión isquémica secundaria a enfermedad descompresiva. Recibió tratamiento con sesiones de cámara hiperbárica y corticoterapia (metilprednisolona 1g EV por 5días) con respuesta parcial.Se comenta la baja incidencia de esta patología enfermedad descompresiva secundaria a un accidente de buceo) y las peculiaridades de su presentación clínica.

We report the case of a 34-year-old male patient, a professional diver hospitalized in connection with a clinical picture characterized by sudden onset of disorientation, generalized weakness, intense body pain followed by sudden paraplegia and urinary retention. These manifestations occurred after a rapid ascent (10 minutes) from a depth of about 42 meters. He was admitted after having received two sessions of decompression therapy. Physical examination revealed flaccid paraplegia, bilateral extensor plantar reflex, a D5 sensitive level. Magnetic resonance imaging showed an increase in the medullar gauge with alteration of its signal, both in anterior and posterior areas, seen as a heterogeneous hyperintensity in the sequence T2 and STIR from D2 to D11, without dilatation of the spinal canal, compatible with ischemic injury. The diagnosis of ischemic myelopathy secondary to decompressive disease was made, and the patient received treatment with a hyperbaric chamber and a short course of steroids (Methylprednisolone 1g EV for 5 days) with partial response.The case is presented, and comments are made regarding the low incidence of this pathology and the variety of clinical peculiarities in its presentation.

Idiopathic Spinal Cord Herniation­Case Report

Idiopathic spinal cord herniation is a rare cause of progressivemyelopathy, especially in the absence of a history of spinal or surgical trauma. The radiological diagnosis ismade through a myelography or an MRI exam. The spinal cord is pushed anteriorly, buffering the dural defect and leading inmost cases to Brown-Séquard syndrome. The present study describes the case of a male patient with a clinical picture of progressive thoracicmyelopathy. In the clinical and radiological investigation, an idiopathic spinal cord herniation on the chest level was identified. During the surgery, the spinal cord was reduced to the natural site, taking its usual elliptical shape, and the dural defect was repaired with a dural substitute. The numbness of the patient improved, and the shocks in the lower limbs disappeared. A postoperative MRI confirmed the surgical reduction of the herniation and the restoration of the anterior cerebrospinal fluid (CSF) column to the spinal cord. The authors describe the clinical, radiological, intraoperative, and postoperative evolution.

Minimally invasive single-door plate laminoplasty with lateral mass screw fixation for the unstable segment. report of two cases with long follow-up / Laminoplastia em porta aberta minimamente invasiva com fixação com parafusos de massa lateral para o segmento instável. relato de dois casos com acompanhamento prolongado / Laminoplastía en puerta abierta mínimamente invasiva y fijación com tornillo de masa lateral para o segmento inestable. reporte de dos casos con seguimiento a largo plazo

ABSTRACT Objective: To report two cases of multilevel cervical spondylotic myelopathy with monosegmental instability, in which we performed a minimally invasive microsurgical transmuscular approach with tubular retractors to create a single-door plate laminoplasty combined with fixation of the unstable segment with lateral mass screws. Methods: The surgical procedures were performed by the senior author. In both patients, the follow-up was performed using the Oswestry Disability Index (ODI), the Visual Analogue Scale for neck and radicular pain (radVAS, neckVAS), the Neck Disability Index (NDI) and the Short Form 36 (SF-36), in the preoperative (preop) and postoperative (postop) periods, and at 1, 3, 6, 12, 18 and 24 months. A radiological evaluation also was performed, which included AP, lateral and flexion-extension films at 6, 12 and 24 months and CT-scan at 12 months. Results: Case 1 - preop ODI: 40%, 24 months postop ODI: 4%; preop radVAS: 7, 24 months radVAS: 0; preop neckVAS: 8, postop 24 months neckVAS: 0; preopNDI: 43%, 24 months PostopNDI: 8%; SF-36 - preop Physical Functioning (PF): 40, preop Vitality (VT): 40, preop Emotional role functioning (RE): 33.3, Bodily pain (BP): 51, General Health (GH): 57, Social Functioning (SF): 75; postop PF: 95, VT: 95, RE: 100, BP: 74, GH: 87, SF: 100. Case 2 - preopODI: 46%, 24 months postopODI: 10%; preop radVAS: 7, 24m radVAS: 0; preop neckVAS: 9, postop 24 months neckVAS: 0; preopNDI: 56%, 24 months PostopNDI: 15%; SF-36 - preop PF: 39, VT: 45, RE: 33.3, BP: 50, GH: 49, SF: 70; postop PF: 90, VT: 100, RE: 100, BP: 82, GH: 87, SF: 100. No complications, cervical instability or signs of failed surgery were found trough and at final follow-up at 24 months. We found significant clinical improvement in both patients. Conclusions: Minimally invasive cervical laminoplasty combined with lateral mass screw fixation for the unstable segment is a useful technique in cases with multilevel cervical spondylotic myelopathy associated with monosegmental instability. Additional comparative studies are needed to establish its efficacy.

RESUMO Objetivo: Relatar dois casos de mielopatia espondilótica cervical em múltiplos níveis com instabilidade de um só segmento, nos quais realizamos uma microcirurgia minimamente invasiva por via transmuscular com retratores tubulares para criar uma laminoplastia em porta aberta com fixação do segmento instável com parafusos de massa lateral. Métodos: Os procedimentos cirúrgicos foram realizados pelo autor principal. Em ambos os pacientes, o acompanhamento foi realizado usando Índice de Incapacidade de Oswestry (ODI), Escala Visual Analógica para dor cervical e radicular (EVAc e EVArad), Índice de Incapacidade Relacionada ao Pescoço (NDI) e o Short Form 36 (SF-36) nos períodos pré-operatório (pré-op) e pós-operatório (pós-op) e em 1, 3, 6, 9, 12, 18 e 24 meses. Realizou-se também a avaliação radiológica, que incluiu vistas AP, laterais e de flexão-extensão aos 6, 12 e 24 meses e TC aos 12 meses. Resultados: Caso 1 - ODI pré-op: 40%, ODI 24 meses pós-op: 4%; pré-op EVArad: 7, EVArad 4 meses: 0; EVAc pré-op: 8, EVAc pós-op 24 meses: 0; NDI pré-op: 43%, NDI pós-op 24 meses: 8%; SF-36 - capacidade funcional (CF) pré-op: 40, vitalidade (VT) pré-op: 40, aspectos emocionais (AE) pré-op: 33,3, dor (D): 51, estado geral da saúde (ES): 57, aspectos sociais (AS): 75; CF : 95, VT: 95, AE: 100, D: 74, ES: 87, AS: 100 pós-op. Caso 2 - ODI pré-op: 46%, ODI 24 meses pós-op: 10%; EVArad pré-op : 7, EVArad 24 meses: 0; EVAc pré-op: 9, EVAc 24 meses pós-op: 0; NDI pré-op: 56%, NDI 24 meses pós-op: 15%; SF-36 pré-op: CF: 39, VT: 45, AE: 33,3, D: 50, ES: 49, AS: 70; CF: 90, VT: 100, AE: 100, D: 82, ES: 87, AS: 100 pós-op. Não houve complicações, instabilidade cervical ou sinais de falha da cirurgia durante o acompanhamento de 24 meses. Ambos os pacientes apresentaram melhoras significativas. Conclusões: A laminoplastia cervical minimamente invasiva combinada com fixação de parafuso de massa lateral do segmento instável é uma técnica útil nos casos com mielopatia espondilótica cervical em vários níveis associada à instabilidade de um só segmento. É necessário realizar estudos comparativos adicionais para estabelecer a eficácia do procedimento.

RESUMEN Objetivo: Relatar dos casos de mielopatía espondilótica cervical en múltiples niveles con inestabilidad de un solo segmento, en los que realizamos una microcirugía mínimamente invasiva por vía transmuscular con retractores tubulares para crear una laminoplastia en puerta abierta con fijación del segmento inestable con tornillos de masa lateral. Métodos: Los procedimientos quirúrgicos fueron realizados por el autor principal. En ambos pacientes, el seguimiento fue realizado usando Índice de Discapacidad de Oswestry (ODI), Escala Visual Analógica para dolor en el cuello y radicular (EVAc y EVArad), Índice de Discapacidad Cervical (NDI) y el Short Form 36 (SF-36) en los períodos preoperatorio (preop) y postoperatorio (posop) y en 1, 3, 6, 9, 12, 18 y 24 meses. Se realizó también la evaluación radiológica, que incluyó proyecciones AP, laterales y de flexión-extensión a los 6, 12 y 24 meses y TC a los 12 meses. Resultados: Caso 1 - ODI preop: 40%, ODI 24 meses posop: 4%; EVArad preop: 7, EVArad 4 meses: 0; EVAc preop: 8, EVAc posop 24 meses: 0; NDI preop: 43%, NDI posop 24 meses: 8%; SF-36 - función física (FF) preop: 40, vitalidad (VT) preop: 40, rol emocional (RE) preop: 33,3, dolor corporal (DC): 51, salud general (SG): 57, función social (FS): 75; FF: 95, VT: 95, RE: 100, DC: 74, SG: 87, FS: 100 posop. Caso 2 - ODI preop: 46%, ODI 24 meses posop: 10%; EVArad preop: 7, EVArad 24 meses: 0; EVAc preop: 9, EVAc 24 meses posop: 0; NDI preop: 56%, NDI 24 meses posop: 15%; SF-36 preop: FF: 39, VT: 45, RE: 33,3, D: 50, SG: 49, FS: 70 preop; FF: 90, VT 100, RE 100, DC 82, SG: 87, FS: 100 posop. No hubo complicaciones, inestabilidad cervical o signos de falla de la cirugía durante el seguimiento de 24 meses. Ambos pacientes presentaron mejoras significativas. Conclusiones: La laminoplastia cervical mínimamente invasiva combinada con fijación de tornillo de masa lateral del segmento inestable es una técnica útil en los casos con mielopatía espondilótica cervical en múltiples niveles asociada a la inestabilidad de un solo segmento. Es necesario realizar estudios comparativos adicionales para establecer la eficacia del procedimiento.

Post-surgical complications in patients with cervical spondylotic myelopathy / Complicações pós-cirúrgicas em pacientes com mielopatia espondilótica cervical / Complicaciones posquirúrgicas en pacientes con mielopatíaespondilótica cervical

ABSTRACT Objective: To identify the incidence and type of postoperative hospital complications in patients with cervical spondylotic myelopathy (CSM) treated by anterior approach, and to describe comorbidities present in patients who had complications. Methods: Retrospective, observational, descriptive cohort study of secondary sources (medical records), over a period of 3 years. We included 180 cases treated by anterior approach, excluding revision surgeries. Results: There was an incidence of complications of 11.11% (20 cases), with no statistically significant difference between sexes. The main complication was pneumonia (50%), associated to prolonged intubation (40%), followed by neurological impairment (20%). In the hospital outcome he was found most often to another hospital discharge (65%, 13 cases). The main comorbidity was systemic arterial hypertension (31.58%, p = 0.46), followed by smoking (26.32%, p 0.10). Conclusions: The highest hospital incidence of postoperative complications was found in patients with CSM treated by anterior approach in relation to that reported in the literature. There was a high incidence of airway complications not correlated with soft tissue edema or hematoma in more than half of the cases. The incidence of airway complications shows an area of opportunity to improve extubation protocols and management of the airways in post-surgical special care unit. Level of Evidence III. SIRELCIS Registry: R-2014-3401-5. Study conducted without commercial support.

RESUMO Objetivo: Identificar a incidência e o tipo de complicações pós-operatórias hospitalares em pacientes com mielopatia espondilótica cervical (MEC) tratados por acesso anterior e descrever as comorbidades presentes em pacientes que tiveram complicações. Métodos: Estudo de coorte, retrospectivo, observacional, e descritivo de fontes secundárias (prontuários médicos), em um período de três anos. Foram incluídos 180 casos tratados por acesso anterior, excluindo cirurgias de revisão. Resultados: Verificou-se incidência de complicações de 11,11% (20 casos), sem diferença estatisticamente significativa entre sexos. A principal complicação foi pneumonia (50%), associada à intubação prolongada (40%), seguida de comprometimento neurológico (20%). No momento da alta, ele foi encontrado na maioria das vezes para outra alta hospitalar (65% dos casos). A principal comorbidade presente foi hipertensão arterial sistêmica (31,58%, p = 0,46), seguida por tabagismo (26,32%, p 0,10). Conclusões: A maior incidência hospitalar de complicações pós-operatórias foi encontrada em pacientes com MEC tratados por acesso anterior com relação ao relatado na literatura. Constatou-se alta incidência de complicações nas vias aéreas não correlacionadas a edema de tecidos moles ou hematoma em mais da metade dos casos. A incidência de complicações nas vias respiratórias mostra uma área de oportunidade para melhorar os protocolos de extubação e manejo das vias aéreas na unidade de cuidados especiais pós-cirúrgicos. Nível de evidência III. Registro SIRELCIS: R-2014-3401-5. Estudo realizado sem apoio comercial.

RESUMEN Objetivo: Identificar la incidencia y el tipo de complicaciones posquirúrgicas intrahospitalarias en pacientes con mielopatía espondilótica cervical (MEC) tratados por vía anterior y describir las comorbilidades presentes en los pacientes que desarrollaron complicaciones. Métodos: Estudio de cohorte retrospectivo, observacional, descriptivo de fuentes secundarias (expediente clínico), en un período de 3 años. Se incluyeron 180 casos de MEC tratados por vía anterior, excluyendo cirugías de revisión. Resultados: Se encontró una incidencia de complicaciones del 11,11% (20 casos), sin diferencia estadísticamente significativa entre sexos. La principal complicación fue neumonía (50%), asociada en 40% a intubación prolongada, seguida por deterioro neurológico (20%). En el desenlace hospitalario se encontró con mayor frecuencia el egreso a otro hospital (65% de los casos complicados). La principal comorbilidad presente fue la hipertensión arterial sistémica (31,58%, p = 0,46), seguida por tabaquismo (26,32%, p 0,10). Conclusiones: Se encontró mayor incidencia de complicaciones posquirúrgicas intrahospitalarias en pacientes con MEC tratados por vía anterior, en relación con lo reportado en la literatura. Se encontró incidencia elevada de complicaciones de vías aéreas, sin relación con edema de partes blandas o hematoma en más de la mitad de los casos. La incidencia de complicaciones de vías respiratorias muestra un área de oportunidad para la mejora de los protocolos de extubación y manejo de vías respiratorias en la unidad de cuidados especiales posquirúrgicos. Nivel de evidencia III. Registro SIRELCIS: R-2014-3401-5. Estudio realizado sin apoyo comercial.

Progression of myelopathy treated with corpectomy, autologous graft and plate / Evolução da mielopatia tratada com corpectomia, enxerto autólogo e placa / Evolución de la mielopatía manejada con corpectomía, injerto autólogo y placa

ABSTRACT Introduction: Cervical myelopathy is a degenerative pathology of spinal and/or root involvement. Caused by hypertrophy of the yellow ligament, osteophytes in the medullary canal and disc herniation. It affects the upper and lower motor neurons. The treatment of myelopathy diagnosed by magnetic resonance and electromyography consists of decompression by corpectomy. Methods: Autologous graft integration with cervical plate placement was evaluated in 31 patients, from January 1, 2013 to December 31, 2015. The procedure consisted of a Smith Robinson approach, anterior corpectomy, iliac crest autograft, anterior stabilization with cervical plate (Vectra, Synthes). Statistical analysis was performed with EPIINFO 3.5.1. Results: Age 64.6% (45-65 years), Sex: 41.9% (women), 58.1% (men). Segments treated: 38.7% (C5-C6), 35.5% (C4-C5), graft separation in sections <0.5 cm, sagittal, and <0.5 cm, axial at 12 months. Bleeding 61.3% (100-500 ml), 32.3% (501-100 ml), 6.5% (1,001-1,500 ml). Time 32.3% (> 249 min), 32.3% (121-180 min), 32.3% (181-240 min), 3.2% (91-120 min). Discussion: In this series, Querétaro is similar to other cities in the world with respect to sex, age, levels affected, number of complications, surgical time and bleeding, as well as graft integration in the evaluation at 12 months. Conclusions: Increased frequency in adult men, C4-C6 affected levels; Complications: recurrent laryngeal nerve injury, bleeding greater than 500 ml.

RESUMO Introdução: Cervical mielopatia é uma doença degenerativa do envolvimento da medula e/ou radicular. Causado pela hipertrofia do ligamento amarelo, osteófitos na medular canal e hérnia de disco. Ela afeta o neurônio motor superior e inferior. Tratar mielopatia diagnosticado por ressonância magnética e eletroneuromiografia é corpectomia descompressão completamente. Métodos: Foi estudada a integração de colocação de enxerto autólogo placa cervical em 31 pacientes, a partir de 01 de janeiro de 2013 a 31 de Dezembro de 2015. O procedimento foi abordar Smith Robinson, corpectomia anterior, crista ilíaca auto-enxerto, a estabilização anterior com placa cervical (Vectra, Synthes). A análise estatística foi realizada com EPIINFO 3.5.1. Resultados: Idade 64,6% (45-65 anos) Sexo: 41,9% (mulheres), 58,1% (homens). segmentos tratados: 38,7% (C5-C6), 35,5% (C4-C5), cortes de separação de enxerto <0,5 cm, sagital e <0,5 cm, axiais em 12 meses. Sangramento 61,3% (100-500 ml), 32,3% (501-100 ml), 6,5% (1001-1500 ml). Tempo de 32,3% (> 249 minutos), 32,3% (121- 180 min), 32,3% (181-240 min), 3,2% (91-120 min). Discussão: Nesta casuística, Querétaro é semelhante a outras cidades do mundo com relação a sexo, idade, níveis afetadas, número de complicações, tempo cirúrgico e sangramento e integração dos enxertos na avaliação aos 12 meses. Conclusões: O aumento da frequência em homens adultos, níveis afetados C4-C6; ocorreram complicações: lesão do nervo laríngeo recorrente, sangramento mais de 500 ml.

RESUMEN Introducción: La mielopatía cervical es una patología degenerativa de compromiso medular y/o radicular. Causada por hipertrofia del ligamento amarillo, osteofitos en el canal medular y herniación discal. Afecta la neurona motora superior e inferior. El tratamiento de la mielopatía diagnosticada por resonancia magnética y electromiografía consiste en descompresión por medio de corpectomía. Métodos: Fue evaluada la integración de injerto autólogo con colocación de placa cervical en 31 pacientes, del 1 de enero del 2013 al 31 de diciembre de 2015. El procedimiento consistió en abordaje de Smith Robinson, corpectomía anterior, autoinjerto de cresta ilíaca, estabilización anterior con placa cervical (Vectra, Synthes). El análisis estadístico se realizó con EPIINFO 3.5.1. Resultados: Edad 64,6% (45-65 años), Sexo: 41,9% (mujeres), 58,1% (hombres). Segmentos tratados: 38,7% (C5-C6), 35,5% (C4-C5), separación del injerto en cortes <0,5 cm, sagital, y <0,5 cm, axial a los 12 meses. Sangrado 61,3% (100-500 ml), 32,3% (501-100 ml), 6,5% (1.001-1.500 ml). Tiempo 32,3% (> 249 min), 32,3% (121- 180 min), 32,3% (181-240 min), 3,2% (91-120 min). Discusión: En esta casuística, Querétaro es similar a otras ciudades del mundo con respecto a sexo, edad, niveles afectados, número de complicaciones, tiempo quirúrgico y sangrado, así como la integración del injerto en la evaluación a los 12 meses. Conclusiones: Mayor frecuencia en hombres de edad adulta, niveles afectados C4-C6; complicaciones ocurridas: lesión del nervio laríngeo recurrente, sangrado mayor de 500 ml.

Significance of Stabilometry for Assessing Postoperative Body Sway in Patients with Cervical Myelopathy

STUDY DESIGN: Prospective study. PURPOSE: To examine the changes in body sway using stabilometry in patients who underwent cervical laminoplasty for cervical myelopathy. OVERVIEW OF LITERATURE: Although the patients of cervical myelopathy complain body sway there are few report to examine body sway objectively. METHODS: Patients who received treatment for cervical myelopathy between October 2010 and February 2013 were included. Twenty-one patients underwent cervical laminoplasty (myelopathy group). Body sway was assessed using stabilometry, wherein patients stood on a stabilometer with their eyes closed for 30 seconds. The Romberg ratio, outer peripheral area (OPA) with eyes closed (cm²), and total locus length per unit area (L/A) with eyes closed (/cm) were examined. Examinations were performed preoperatively (at baseline) and at 8 weeks postoperatively. Examination results of patients in the myelopathy group were compared with those of 17 healthy individuals (control group). Clinical symptoms were evaluated using the Japanese Orthopaedic Association scale score (JOA score) and the timed up and go (TUG) test. RESULTS: In the myelopathy and control groups, the mean baseline Romberg ratio, OPA, and L/A were 2.3±1.2, 8.9±5.5 cm², and 14.2±5.3/cm and 1.4±1.0, 4.3±2.8 cm², and 23.7±10.1/cm, respectively. Eight weeks after laminoplasty, only L/A showed significant improvement from baseline in the myelopathy group (23.2±10.1 to 16.8±7.9; p=0.03). The Romberg ratio and OPA showed improvement in the myelopathy group, but the changes were not statistically significant. JOA scores and TUG test results in this group significantly improved from baseline to 8 weeks after laminoplasty (12.7 to 13.4 and 10.8 to 8.0 seconds, respectively; both p<0.05). CONCLUSIONS: L/A is a useful parameter for measuring body sway to assess the recovery of body sway after laminoplasty.

The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty

OBJECTIVE: Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. METHODS: We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows: 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2–C7 Cobb angles, T1 slope, C2–C7 sagittal vertical axis (SVA), range of motion (ROM) from C2–C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. RESULTS: Mean preoperative sagittal alignment was 13.01° lordotic; 6.94° lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than 5° kyphotic angle change postoperatively. There were no differences in age, sex, C2–C7 Cobb angle, T1 slope, C2–C7 SVA, ROM from C2–C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2–C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. CONCLUSION: Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2–C7 SVA.

Results of surgical treatment in the craniocervical junction in mucopolysaccharidosis / Resultados do tratamento cirúrgico na junção craniocervical nas mucopolissacaridoses / Resultados del tratamiento quirúrgico en la unión craneocervical en las mucopolisacaridosis

ABSTRACT Objective: Evaluate the results after decompression and stabilization of craniocervical junction in patients with mucopolysaccharidosis (MPS). Method: Retrospective study of 10 patients with MPS through the analysis of medical records and additional tests. Result: All patients with mid-term and long-term follow-up achieved consolidation of the arthrodesis and 87.5% had neurological improvement of Nurick score. Conclusion: Early diagnosis and intervention in cases of stenosis and/or craniocervical instability of patients with MPS provide patients a good recovery of neurological function, despite the great technical difficulty and risk of complications.

RESUMO Objetivo: Avaliar os resultados após a descompressão e estabilização da junção craniocervical em pacientes portadores de mucopolissacaridose (MPS). Método: Estudo retrospectivo de 10 pacientes portadores de MPS, por meio da análise de prontuário e de exames complementares. Resultado: Todos os pacientes com acompanhamento a médio e longo prazo atingiram a consolidação da artrodese e 87,5% tiveram melhora neurológica no escore Nurick. Conclusão: O diagnóstico e a intervenção precoces em casos de estenose e/ou instabilidade craniocervical em pacientes com MPS proporcionam aos pacientes uma boa recuperação da função neurológica, apesar da grande dificuldade técnica e do risco de complicações.

RESUMEN Objetivo: Evaluar los resultados después de la descompresión y estabilización de la unión craneocervical en pacientes con mucopolisacaridosis (MPS). Método: Estudio retrospectivo con 10 pacientes con mucopolisacaridosis, a través del análisis de las historias clínicas y de pruebas complementarias. Resultado: Todos los pacientes con seguimiento a medio y largo plazo alcanzaron la consolidación de la artrodesis y 87,5% presentaron mejoría neurológica de la puntuación Nurick. Conclusión: El diagnóstico e intervención temprana en casos de estenosis y/o inestabilidad craneocervical en pacientes con MPS proporcionan a los pacientes una buena recuperación de la función neurológica, a pesar de la gran dificultad técnica y el riesgo de complicaciones.

Clinical and epidemiological profiles of non-traumatic myelopathies / Perfil clínico e epidemiológico das mielopatias não-traumáticas

ABSTRACT Non-traumatic myelopathies represent a heterogeneous group of neurological conditions. Few studies report clinical and epidemiological profiles regarding the experience of referral services. Objective To describe clinical characteristics of a non-traumatic myelopathy cohort. Method Epidemiological, clinical, and radiological variables from 166 charts of patients assisted between 2001 and 2012 were compiled. Results The most prevalent diagnosis was subacute combined degeneration (11.4%), followed by cervical spondylotic myelopathy (9.6%), demyelinating disease (9%), tropical spastic paraparesis (8.4%) and hereditary spastic paraparesis (8.4%). Up to 20% of the patients presented non-traumatic myelopathy of undetermined etiology, despite the broad clinical, neuroimaging and laboratorial investigations. Conclusion Regardless an extensive evaluation, many patients with non-traumatic myelopathy of uncertain etiology. Compressive causes and nutritional deficiencies are important etiologies of non-traumatic myelopathies in our population.

RESUMO As mielopatias não-traumáticas representam um grupo heterogêneo de doenças neurológicas. Poucos estudos descrevem os perfis clínico e epidemiológico sobre a experiência de serviços de referência. Objetivo Descrever as características clínicas de uma coorte de mielopatia não-traumática. Método Os registros clínicos de 166 pacientes atendidos entre 2001 e 2012 foram revisados e variáveis epidemiológicas, clínicas e radiológicas foram compiladas. Resultados O diagnóstico mais prevalente foi o de degeneração combinada subaguda (11,4%), seguido por mielopatia espondilótica cervical (9,6%), doenças desmielinizantes (9%), paraparesia espástica tropical (8,4%) e paraparesia espástica hereditária (8.4%). Aproximadamente 20% dos pacientes apresentaram mielopatia não-traumática de etiologia indeterminada, apesar da ampla investigação clínica, laboratorial e de neuroimagem. Conclusão Independentemente da ampla avaliação, muitos pacientes com mielopatia não-traumática apresentam etiologia incerta. Causas compressivas e deficiências nutricionais permanecem como etiologias importantes de mielopatias não-traumáticas.

Imaging features of split cord malformation associated with scoliosis and its correlation with neurologic symptoms / 中华骨科杂志

Objective To analyze the imaging features of congenital spinal deformity (CSD) associated with split cord malformation (SCM) and other intraspinal abnormalities, and to investigate the relationship to neurological symptoms. Methods 105 cases CSD with SCM were retrospectively studied. Analysis the imaging features of SCM (including type of SCM, location of SCM, location and apical vertebrae, symmetry of divided cord) and other intraspinal abnormalities. To investigate the relationship of the factors and neurological symptoms using Chi?square test of one factor and multiple factors logistic regression analysis. Re?sults 28 cases (26.7%) were formation failure, 33 cases (31.4%) were segmentation failure, and 44 cases (41.9%) were combina?tion of 2 disorders. 41 cases had neurological symptoms, 64 cases were asymptomatic. The distribution of SCM combined with spi?nal deformities:thoracic (11 cases), thoracolumbar (18 cases) and lumbar (20 cases) in type I SCM, thoracic (31 cases), thoracolum?bar (20 cases) and lumbar (5 cases) in type II, none was in cervical. The location of SCM upper than apical vertebrae 29 cases, on apical vertebrae 25 cases, lower than apical vertebrae 51 cases. Spinal cord was splitted symmetric 27 cases and asymmetric 78 cases. 66 cases combined with other intraspinal abnormalities, lower conus 42 cases, syringomyelia 38 cases, meningocele 10 cas?es and sakrale zyste 5 cases. Associated with intraspinal abnormalities, the rate of neural symptoms was different. According to Chi?square test of one factor and multiple factors logistic regression analysis, lumbar SCM, spinal cord asymmetric and lower conus were related with neurological symptoms. Conclusion The predilection spinal deformity of type I is combination, type II SCM is segmentation failure. When SCM patients associated with other intraspinal abnormalities, the incidence of neurologic symptoms is increased. The lumbar SCM, hemicords asymmetry and lower lying conus have significant relationship with neurologic symptoms.