Evaluation of the Reliability and Reproducibility of the Roussouly Classification for Lumbar Lordosis Types / Avaliação da confiabilidade e reprodutibilidade da classificação de Roussouly para os tipos de lordose lombar

Abstract Objective The present study aims to determine the intra- and inter-rater reliability and reproducibility of the Roussouly classification for lumbar lordosis types. Methods A database of 104 panoramic, lateral radiographs of the spine of male individuals aged between 18 and 40 years old was used. Six examiners with different expertise levels measured spinopelvic angles and classified lordosis types according to the Roussouly classification using the Surgimap software (Nemaris Inc., New York, NY, USA). After a 1-month interval, the measurements were repeated, and the intra- and inter-rater agreement were calculated using the Fleiss Kappa test. Results The study revealed positive evidence regarding the reproducibility of the Roussouly classification, with reasonable to virtually perfect (0.307-0.827) intra-rater agreement, and moderate (0.43) to reasonable (0.369) inter-rater agreement according to the Fleiss kappa test. The most experienced examiners showed greater inter-rater agreement, ranging from substantial (0.619) to moderate (0.439). Conclusion The Roussouly classification demonstrated good reliability and reproducibility, with intra- and inter-rater agreements at least reasonable, and reaching substantial to virtually perfect levels in some situations. Evaluators with highest expertise levels showed greater intra and inter-rater agreement.

Resumo Objetivo Determinar a confiabilidade e reprodutibilidade intra- e interavaliadores da classificação dos tipos de lordose lombar de Roussouly. Métodos Foram utilizadas 104 radiografias panorâmicas da coluna vertebral em incidência de perfil, de banco de dados, de indivíduos do sexo masculino com idade entre 18 e 40 anos. Utilizando o software Surgimap (Nemaris Inc., Nova York, NY, EUA), seis examinadores com diferentes níveis de experiência aferiram os ângulos espinopélvicos e classificaram o tipo de lordose de acordo com a classificação de Roussouly. Após um intervalo de 1 mês, as mensurações foram realizadas novamente, sendo calculadas as concordâncias intra- e interavaliadores através do teste Kappa de Fleiss. Resultados O estudo demonstrou evidências positivas em relação à reprodutibilidade da classificação de Roussouly, com teste Kappa de Fleiss para concordância intraavaliador entre razoável à quase perfeita (0,307-0,827), e interavaliador entre moderada (0,43) e razoável (0,369). Os examinadores mais experientes apresentaram maior concordância interavaliador, variando entre substancial (0,619) e moderada (0,439). Conclusão A classificação de Roussouly, demonstrou boa confiabilidade e reprodutibilidade, tendo em vista que a concordância intra- e interavaliadores foi considerada no mínimo razoável, podendo atingir os níveis de substanciais à quase perfeitos em algumas situações. Os avaliadores com maior nível de experiência apresentaram maior concordância intra- e interavaliadores.

Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.

Vertebral column deformity and hypoxia in Salmo salar / Hipoxia relacionada a deformidad de columna vertebral en Salmo salar

Vertebral Column Deformity (VCD) is a common pathology in Chilean salmon farms, lowering the quality and commercialization of the product. Hypoxia has been related to other musculoskeletal deformities, but not to VCD. This work analyzes the morphology of the vertebral column of Salmo salar alevins, cultured under hypoxic conditions (60 percent O2 saturation in the water tanks) for different time periods after hatching (2, 4, 6 and 8 days). They are compared with their normoxic controls (100 percent O2 saturation). Using histological (H/E), and morphometric techniques, it was found that the time of exposure to hypoxia is inversely proportional to the body length, notochordal diameter and thickness of its sheath. The organic response to hypoxia was quantified by immunohistochemistry for HIF-1a as the sensor of hypoxia. Its expression increased significantly (p<0.05) in the experimental groups that exhibit VCD. Although etiology for VCD is probably multifactorial, this study allows for the conclusion that hypoxia by itself, produces VCD.

La deformidad de columna vertebral (DCV) es una patología que se presenta frecuentemente en la salmonicultura chilena, disminuyendo la calidad y comercialización del producto. La hipoxia ha sido relacionada a otras deformidades musculoesqueléticas pero no a DCV. Este trabajo analiza la morfología de la columna vertebral en alevines Salmo salar cultivados en condiciones de hipoxia (60 por ciento de saturación de O2) en diferentes momentos después de la eclosión (2, 4, 6 y 8 días) y son comparados con sus respectivos controles en normóxia (100 por ciento de saturación de O2). Utilizando técnica histológica (H/E) y morfométrica, se determinó que el tiempo de exposición a hipoxia es inversamente proporcional a la longitud corporal, diámetro notocordal y grosor de su vaina. La respuesta orgánica a hipoxia fue cuantificada mediante inmunohistoquímica contra HIF-1a como censor de hipoxia. Su expresión incrementó significativamente (p<0,05) en los grupos experimentales que presentaron DCV. Aunque la etiología de DCV es probablemente multifactorial, este estudio permite concluir que la exposición a hipoxia puede provocar DCV por sí sola.

Comparación entre dos métodos utilizados para medir la curva lumbar / Comparison of two method for measuring the lumbar curve

Las alteraciones posturales tales como hiperlordosis, aumento de la cifosis, cifolordosis y escoliosis en columna, producen complicaciones a nivel músculo-esquelético y articular. Debido a esto, es que en el último tiempo ha aumentado el número de atenciones kinésicas por patologías de la columna lumbar, he aquí la importancia de un test clínico que cuente con la confiabilidad necesaria para determinar la curvatura lumbar. El objetivo de este estudio es determinar si existen diferencias en los resultados entre los dos métodos utilizados para medir la curva lumbar: el test clínico de las flechas sagitales y el ángulo de la columna lumbar mediante radiografías. En una muestra de 32 pacientes de edad promedio 44,93 (+/- 12,67 años) evaluados en el Servicio de Kinesiología del Centro Médico Megasalud de Viña del Mar entre los meses de Marzo y Agosto del 2008. El procedimiento utilizado fue el examen clínico, en el cual se usó una plomada que va desde C7, pasando por la línea ínterglútea. En el plano sagital se mide la curvatura lumbar a nivel de L3. Para la medición del ángulo de la curvatura lumbar se utilizó una radiografía proyección lateral en la cual se proyectan las mesetas superior de L1 e inferior de L5 para la conformación del ángulo lumbar y su posterior medición. El resultado obtenido por medio del examen clínico entre el test de las flechas sagitales y las radiografías del ángulo de la lordosis lumbar para un índice de concordancia de Kappa, fue mayor o igual a un 95 por ciento. De esta manera, se obtuvo que el test de las flechas sagitales es una herramienta válida para la pesquisa de patologías lumbares, al igual que la radiografía, con una marcada diferencia en el costo económico entre ambas.

The altered posture, such as hiperlordosis, increase in kyphosis, and scoliosis in cifolordosis column complications occur at the muscular, skeletal and articulate. Because of this, is that in recent times to increase the number of benefits for kinesics pathologies of the lumbar spine, and here the importance of a clinical test that has the confidence necessary to determine lumbar curvature. The objective of the study seeks to determine whether there are differences in outcomes between the two methods used to measure the lumbar curve, the test of the arrows sagitales and the angle of the lumbar spine using x-rays in patients greater than or equal to 21 years, as assessed the service kinesiology of Centro Médico Megasalud of Viña del Mar, between the months of March and August 2008. The procedure used was by means of physical examination, which uses a plumb line that runs from C7 through inter gluteal line in the sagittal plane was measured at the lumbar curvature of L3 and compared with the measurement of the angle curvature of the lumbar measured by radiographic position in bipedal in a side view in 32 adults, measures of kinesiology at the service of the Medical Center Megasalud of Viña del Mar, Chile. The result obtained by means of physical examination between the test of the arrows sagitales versus the angle of the lumbar lordosis measured by X-rays, reached a record of correlation between the two diagnostic tests greater than or equal to 95 percent. In conclusion we can say that the test of the arrows sagitales is a valid tool for the investigation of lumbar pathologies, like radiography, with a marked difference in cost between the two.

Incidência de osteófitos na coluna vertebral / Osteophyte incidence on vertebral column

Ao longo do processo de evolução o homem adquiriu a postura ereta. Devido à ação da gravidade surgiram algumas complicações decorrentes dessa postura; entre elas o aparecimento de osteófitos. O objetivo do presente estudo foi verificar a incidência de osteófitos em exames laudados da coluna vertebral e qual a região da coluna mais acometida. Para isso foram utilizados 1089 laudos de 636 indivíduos, sendo 55,5% mulheres e 44,5% homens, atendidos em um intervalo de 6 meses, de janeiro a junho de 2006 em uma Clínica de Radiologia particular do Alto Tietê. Os resultados encontrados foram que dos laudos,26,9% foram considerados anormais. Das três regiões da coluna vertebral, foram encontrados osteófitos respectivamente para mulheres e homens: 15,4% e 5,7% região cervical; 13,6% e 12,4% região torácica e 17,9% e 13,7% região lombar. O grau de osteófito mais encontrado foiosteófito marginal para as regiões cervical e lombar e labiação marginal predominou na região torácica. Concluiu-se que a incidência de osteófitos do total de laudos analisados foi 26,9% ea região da coluna mais acometida foi a lombar. Além disso, as mulheres apresentaram mais casos de osteófitos que homens.

With the evolution of mankind appeared the erect posture. Due to gravity actioncomplications appeared because of this posture, like the osteophytes. The aim of this study was to investigate osteophyte incidence on vertebral column and the most affected column region. For this were used 1089 reports of 636 patients: 55.5% women and 44.5% men, attended between january and june of 2006 in a privet Clinic on Alto do Tietê, region of São Paulo. Resultsrevealed that 26.9% of reports had alterations. Region’s analysis revealed osteophytes in men and women, respectively: 15.4% and 5.7% on cervical region; 13.6% and 12.4% on thoracic region and 17.9% and 13.7% on lumbar region. The most common kind of osteophyte was marginal osteophyte on cervical and lumbar regions and marginal labium was predominant on thoracic region. The incidence of osteophytes on vertebral column was 26.9% and lumbar region was the most affected. Besides, women have more osteophytes cases than men.