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Rev. bras. ciênc. vet ; 29(1): 27-35, jan./mar. 2022. il.
Article in English | LILACS, VETINDEX | ID: biblio-1393204


For vertebromedullary injuries, epidemiological knowledge is essential to guide the choice of the most effective diagnostic method. The objective of this retrospective study was to describe the epidemiological profile of animals and thoracolumbar and lumbosacral spine lesions diagnosed by computed tomography scan. A compilation of CT scan reports for the aforementioned regions performed in a comercial diagnostic center from 04/01/2017 to 04/30/2020, contrasted and non-contrasted, from routine, was performed in order to list the most common lesions and their locations, as well as the species, breeds and ages most affected. There were 1164 CT scans performed in the period evaluated, all of them in dogs, 57,56% (n=670) for the spine, with 89,7% reports accessed (n=601), where the regions mentioned here added up to 73,05% studies (n=439). In both regions, male French Bulldog dogs had the most injuries. For the thoracolumbar region, disk mineralization, followed by extrusion, were the most frequent injuries, while the site was T12-13 and the mean age 6,5±3,63 years old. In the lumbosacral, disk protrusion was most frequent, the most affected site was L7-S1 and age 6,65±3,79 years. It was concluded that the spine is the main target of CT scans, and that lesions related to the intervertebral disk were the main ones identified, with chondrodystrophic animals being more predisposed to injury.

Para lesões vertebromedulares é indispensável o conhecimento epidemiológico para direcionar a escolha do método diagnóstico mais eficaz. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral toracolombar e lombossacral diagnosticadas através de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina, a fim de relacionar as lesões e seus locais de ocorrência, bem como a espécie, raças e idades mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670) para a coluna, com 89,7% laudos acessados (n=601), nos quais as regiões toracolombar e lombossacral somaram 73,05% dos estudos (n=439). Em ambas as regiões, os cães Bulldog Francês machos foram os que mais apresentaram lesões. Para a região toracolombar, a mineralização de disco, seguida pela extrusão, foram as lesões mais frequentes, enquanto o local foi T12-13 e a média de idade 6,5±3,63 anos. Na lombossacral, a protusão de disco foi mais frequente, o local mais afetado foi L7-S1 e idade de 6,65±3,79 anos. Concluiu-se que a coluna vertebral é o principal alvo de tomografias, e que as lesões relacionadas ao disco intervertebral foram as principais identificadas, sendo os animais condrodistróficos mais predispostos a lesões.

Animals , Cats , Dogs , Spinal Injuries/veterinary , Spine/diagnostic imaging , Tomography, X-Ray Computed/veterinary , Cats/injuries , Dogs/injuries , Intervertebral Disc/injuries , Lumbar Vertebrae/injuries , Lumbosacral Region/abnormalities
Article in Chinese | WPRIM | ID: wpr-888342


OBJECTIVE@#To explore the clinical effects of posterior short-segment pedicle screw internal fixation combined with vertebroplasty for the treatment of Kümmell disease with kyphosis.@*METHODS@#Twenty-four patients with Kümmell disease complicated with kyphosis treated by posterior short-segment pedicle screw internal fixation combined with vertebroplasty from January 2016 to December 2018 were retrospectively analyzed, including 6 males and 18 females, aged 63 to 85 (73.1±6.5) years old. The clinical effect was evaluate by visual analogue scale (VAS), Oswestry Disability Index (ODI), the anterior height of injured vertebral body, and the sagittal Cobb angle of the affected segment beforeoperation, at 3 days and final follow up after operation. And the surgical complications were observed.@*RESULTS@#All 24 patients were followed up from 12 to 24 months with an average of (15.5±3.2) months. The VAS score was decreased from 5.21±1.06 preoperatively to 2.38±0.58 at 3 days postoperatively and 1.71±0.75 at final follow-up;ODI was decreased from (50.4±13.5)% preoperatively to (20.9±8.0)% at 3 days postoperatively and (16.7±9.6)% at final follow-up;the anterior height of injured vertebral body was restored from (8.0±4.2) mm before surgery to (18.1±5.0) mm at 3 days after surgery and (16.8±5.1) mm at final follow up;the sagittal Cobb angle of affected segment was decreased from (19.5±6.3)° preoperatively to (7.6±2.1)° at 3 days after surgery and(8.4±1.7)° at final follow-up. VAS, ODI, anterior height of injured vertebral body, and sagittal Cobb angle of affected segment were significantly improved at 3 days after operation and at final follow-up (@*CONCLUSION@#Posterior short-segment pedicle screw internal fixation combined with vertebroplasty for the treatment of Kümmell disease with kyphosis has relatively small surgical trauma, excellent clinical results, good vertebral height recovery, satisfactory correction of kyphotic angle, and fewer complications, etc. It is a safe and effective surgical method to treat Kümmell disease with kyphosis.

Female , Humans , Kyphosis/surgery , Lumbar Vertebrae/injuries , Male , Pedicle Screws , Retrospective Studies , Spinal Fractures , Thoracic Vertebrae/surgery , Vertebroplasty
Article in Chinese | WPRIM | ID: wpr-879392


OBJECTIVE@#To explore clinical effect of cement-augmented pedicle screw combined with vertebroplasty in treating Kümmell disease with type Ⅲ.@*METHODS@#From January 2015 to December 2018, 37 patients with type Ⅲ Kümmell disease were retrospectively analyzed, including 11 males and 26 females, aged from 61 to 84 years old with an average of (68.6±4.2) years old, and the courses of disease ranged from 2 to 10 months with an average of(6.5±2.3) months. Nine patients were grade C, 20 patients were grade D and 8 patients were grade E according to Frankle grading. All patients were treated by cement-augmented pedicle screw combined with vertebroplasty. Operation time, blood loss, postoperative drainage, hospital stay and complicationswere observed after oeprtaion. Visual analogue scale(VAS), Oswestry Disability Index(ODI), height of anterior vertebral body, Cobb angle before and after operation were compared.@*RESULTS@#All patients were followed up from 12 to 60 months with an average of (22.4±10.9) months. Operation time was (240.9±77.4) min, blood loss was (315.0±149.2) ml, postoperative drainage was (220.8±72.0) ml, hospital stay was (12.6±4.7) days. One patient occurred incision redness and 1 patient occurred infection after opertaion. No loosening of bone cement occurred. Postopertaive VAS and ODI were lower than that of before opertaion(@*CONCLUSION@#Cement-augmented pedicle screw combined with vertebroplasty is a safe and effective method for the tretament of Kümmell disease with type Ⅲ.

Aged , Bone Cements , Female , Fracture Fixation, Internal , Humans , Infant , Lumbar Vertebrae/injuries , Male , Pedicle Screws , Quality of Life , Retrospective Studies , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Treatment Outcome , Vertebroplasty
Arq. bras. neurocir ; 39(3): 181-188, 15/09/2020.
Article in English | LILACS | ID: biblio-1362393


Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this reviewis to discuss the AOSTSIC systemand its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperativemanagement,with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

Spinal Injuries/classification , Thoracic Injuries/classification , Thoracic Vertebrae/surgery , Lumbar Vertebrae/surgery , Thoracic Vertebrae/injuries , Spinal Fractures/surgery , Lumbar Vertebrae , Lumbar Vertebrae/injuries
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 119-124, jun. 2020. []
Article in Spanish | LILACS, BINACIS | ID: biblio-1125548


Introducción: La acrobacia en tela es una práctica circense con muchos adeptos en la población urbana. Consiste en sostenerse en altura tomado por dos extremos de tela, para realizar posturas fijas y cambiar entre ellas mediante deslizamiento y caídas. La práctica profesional no está libre de lesiones. Objetivo: Conocer la naturaleza de la lesión, reconocer los factores predisponentes de lesión y las medidas de prevención utilizadas, evaluar la cinemática, clasificar la lesión y analizar el tratamiento. Materiales y Métodos: Se incluyeron seis pacientes. Se evaluaron la estructura física personal, la cinemática de la caída, los sistemas de protección, la clasificación de las fracturas según la nueva clasificación AO, el cuadro neurológico, el tratamiento y las complicaciones. Resultados: La muestra incluyó a 6 mujeres, con un promedio de edad de 24 años y un índice de masa corporal de 19,29. Caída de 3,08 m de altura, cuatro con colchoneta <5 cm. Las lesiones principales fueron: 6 A1, 4 B2 y 1C. No se observaron déficits neurológicos. Cuatro pacientes fueron sometidas a cirugía. Conclusiones: La práctica de acrobacia en tela es una actividad circense de reciente aparición global. Las mujeres están más expuestas a las lesiones. El entrenamiento riguroso y el empleo de elementos de seguridad son necesarios para evitar las lesiones. No se observó un patrón único de lesión, la causa fue multifactorial. El tratamiento indicado depende de la lesión vertebral. Nivel de Evidencia: IV

Introduction: Aerial silk is a circus practice that has become very popular in urban populations. It involves hanging from two pieces of fabric in order to make fixed positions and change between them by sliding and dropping from different heights. The professional practice is not free of injuries. Objective: To learn the nature of the injury, to recognize the injury predisposing factors and the safety measures used, to study the kinematics, to classify the injury, and to analyze the treatment. Materials and Methods: Six patients were included. The evaluation included individual body structure, drop kinematics, safety measures, classification of fractures according to the new AO classification, neurological symptoms, treatment, and complications. Results: The study included six female patients, averaging 24 years, a body mass index of 19.29 and a fall from 3.08m, 4 of which included mattress <5cm. The main injuries classification resulted in 6 A1, 4 B2 and 1 C. No neurological deficit was found. Four patients underwent surgical treatment. Conclusions: Aerial silk is a circus activity that has recently become a worldwide practice. Women are more exposed. Rigorous training and the use of safety elements are necessary to avoid injuries. We did not observe a unique pattern of injury, because of its multifactorial cause. The therapeutic decision-making is related to the spinal injury. Level of Evidence: IV

Athletic Injuries , Spinal Injuries , Thoracic Vertebrae/injuries , Spinal Fractures , Gymnastics/injuries , Lumbar Vertebrae/injuries
Rev. Asoc. Argent. Ortop. Traumatol ; 84(4): 406-419, dic. 2019. []
Article in Spanish | LILACS, BINACIS | ID: biblio-1057065


Comunicamos dos casos de fracturas lumbares bajas de tipo estallido con compromiso de la cuarta vértebra lumbar (L4), en pacientes que desarrollan la actividad conocida como "jineteada gaucha", quienes sufrieron una caída de tipo "voleo", en la cual el caballo cae hacia atrás sobre su dorso aprisionando al jinete contra el suelo. Nivel de Evidencia: IV

We discuss two cases of lumbar burst fractures at the fourth lumbar spine vertebra (L4), in patients engaging in a type of horseriding activity known as jineteada gaucha, in which the horse falls on its back, holding the rider against the ground. Level of Evidence: IV

Adolescent , Adult , Accidental Falls , Spinal Fractures , Horses , Lumbar Vertebrae/surgery , Lumbar Vertebrae/injuries
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 216-223, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1020336


Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares. Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro. Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017. Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamente significativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente). Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. Nivel de Evidencia: IV

Introduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments. Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center. Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017. Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables-percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures-were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively). Conclusions: This study suggests that traumatic thecal sac injury could be suspected when managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracture type C according to the AOSpine Classification System). Level of Evidence: IV

Adult , Spinal Injuries , Thoracic Vertebrae/injuries , Spinal Fractures/classification , Dura Mater/injuries , Lumbar Vertebrae/injuries
Revista Digital de Postgrado ; 8(3): e173, 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1087901


El tratamiento de las patologías discales y degenerativas que afectan a las articulaciones interfacetarias de la columna vertebral representan entre ambas más del 95% de los objetivos curativos en esta área del cuerpo, en razón de esto, esta investigación evalúa los efectos de los factores de crecimiento ozonizados en pacientes con diagnóstico de síndrome facetario lumbar, así como también, valorar la intensidad del dolor en el síndrome facetario, determinando el grado de movilidad articular previo y posteriora la infiltración. Métodos: la presente investigación se considera un estudio descriptivo y prospectivo, con un diseño es preexperimental, en pacientes que acudieron a la consulta de terapia del dolor del Hospital Dr. Pedro García Clara, en Ciudad Ojeda, estado Zulia-Venezuela. Los resultados se expresaron como valores absolutos, en porcentajes, media ± desviación estándar (M±DE), analizando las diferencias de los resultados mediante la prueba "t" de Student, cuando fueron aplicables, tomando un valor de p<0.05. Resultados: se evidencia, que los factores de crecimiento ozonizados infiltrados en los pacientes con diagnóstico de síndrome facetario lumbar, tienen efectos clínicos significativos, en cuanto a la disminución de la intensidad del dolor y el aumento del grado de movilidad articular. Conclusiones: el uso del plasma rico ozonizado es una técnica efectiva para disminuir la intensidad del dolor cuando es utilizado en el síndrome facetario ya que permite una aumento significativo de los grados de movilidad articulares de la columna lumbar (flexión, extensión e inclinación. Es una técnica sencilla, eficaz, económica y con efectos adversos mínimos(AU)

The treatment of the disc and degenerative pathologies that affect the interfaceative joints of the spine represent between them more than 95% of the healing objectives in this area of the body, because of this, this research evaluates the effects of the growth factors Ozonized in patients with a diagnosis of lumbar facet syndrome, as well as assessing the intensity of pain in facet syndrome, determining the degree of joint mobility before and after infiltration. Methods: the present investigation is considered a descriptive and prospective study, with a pre-experimental design, in patients who attended the pain therapy consultation of the Dr. Pedro García Clara Hospital, in Ciudad Ojeda, Zulia-Venezuela state. thee results were expressed as absolute values, in percentages, mean ± standard deviation (M ± SD), analyzing the differences of the results by means of the Student "t" test, whenapplicable, taking a value of p <0.05. Results: it is evidenced that infiltrated ozonized growth factors in patients with a diagnosis of lumbar facet syndrome, have significant clinical effects, in terms of the decrease in pain intensity and the increase in the degree of joint mobility. Conclusions: the use of ozonated rich plasma is an effective technique to reduce the intensity of pain when used in facet syndrome because it allows a significant increase in the degrees of joint mobility of the lumbar spine (flexion, extension and tilt.) It is a simple, effective technique, economic and with minimal adverse effects(AU)

Humans , Male , Female , Adult , Aged , Low Back Pain/pathology , Low Back Pain/drug therapy , Chronic Pain/therapy , Lumbar Vertebrae/injuries , Infiltration-Percolation/adverse effects , Prospective Studies
Pesqui. vet. bras ; 38(12): 2278-2283, dez. 2018. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-976432


Changes in the spine of dogs are usually detected in clinical and in surgical practice. Few studies exist on musculoskeletal ultrasound anatomy of the thoracolumbar and lumbar segments of the normal spine of dogs. This study aimed to compare the normal musculoskeletal ultrasound anatomy of the T10-S1 vertebral segments with images obtained with magnetic resonance imaging (MRI), computed tomography (CT), and anatomical structures, and to establish the ability to identify structures using these modalities. Ultrasound scans allowed visualization of the muscles of the region, articular processes, spinous process, interspinous ligament, and yellow ligament in the lumbosacral window. Computed tomography images provided better bone details, compared to ultrasound images. Low-field MRI allowed the identification of the same structures identified with ultrasound imaging, and allowed the identification of cerebrospinal fluid, transverse processes, and provided improved detail of the intervertebral discs and spinal cord. Knowledge of ultrasound anatomy of the region may allow the the identification of muscle and ligament injuries. Thus, in cities where CT and MRI are inaccessible, ultrasonography of the region could be a good alternative to identify possible changes not observable with radiographic examination or to complement radiographic examination.(AU)

Alterações na coluna vertebral de cães são comumente encontradas na rotina clínica e cirúrgica veterinária. Existem poucos estudos sobre a anatomia ultrassonográfica musculoesquelética do segmento toracolombar e lombar da coluna vertebral normal de cães. O objetivo deste trabalho foi comparar a anatomia ultrassonográfica musculoesquelética normal dos segmentos vertebrais T10-S1 com imagens obtidas pela ressonância magnética, tomografia computadorizada e peças anatômicas visando demonstrar a sua capacidade de identificação de estruturas. A varredura ultrassonográfica permitiu a visibilização da musculatura da região, processos articulares, processos espinhosos, ligamentos interespinhosos e ligamento amarelo na janela lombossacra. A tomografia computadorizada forneceu imagens com melhor detalhamento ósseo quando comparada ao exame ultrassonográfico. A ressonância magnética de baixo campo permitiu a identificação das mesmas estruturas que o exame ultrassonográfico acrescido da identificação do líquido cerebroespinal, processos transversos e melhor detalhamento dos discos intervertebrais e medula espinhal. Com o conhecimento da anatomia ultrassonográfica da região, acredita-se que lesões musculares e ligamentares possam ser identificadas. Vale salientar que em cidades onde a tomografia computadorizada e a ressonância magnética não estejam acessíveis a ultrassonografia da região pode ser uma boa alternativa para identificar possíveis alterações não visibilizadas ao exame radiográfico, ou complementá-lo.(AU)

Animals , Dogs , Bone and Bones/anatomy & histology , Ultrasonography/veterinary , Dogs/anatomy & histology , Lumbar Vertebrae/injuries , Muscles/anatomy & histology , Lumbar Vertebrae/abnormalities
Arq. bras. neurocir ; 37(4): 304-308, 15/12/2018.
Article in English | LILACS | ID: biblio-1362636


Objective The aim of the present study was to evaluate the outcome of short segment instrumentation in patients affected by burst thoracolumbar fractures. Methods A total of 19 patients with unstable burst fractures of the thoracolumbar spine were eligible for short segment instrumentation. Their functional outcome (by using the Oswestry and Denis scales) and back pain (using the visual analog scale) were evaluated after 12 months. Results Themean age of the patients was 30.7 years old, andmost of them weremale (n » 15). The mean hospital stay was 4.6 days. The mean standard deviation (SD) of the pain score according to the visual analog scale was 1.63 1.25 after 12 months of surgery, and there were no patients classified with grades 4 or 5 on the Denis work scale. The average Oswestry disability index (ODI) was 17% during the follow-ups. Conclusions The outcome of the studied patients, including the clinical pain and the functional outcome of postsurgical patients, suggested that the short-segment instrumentation could be an appropriate method for patients with unstable thoracolumbar junction fractures. However, a long-term follow-up is recommended.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Pain, Postoperative , Spinal Injuries/surgery , Thoracic Injuries/surgery , Fracture Fixation, Internal/rehabilitation , Functional Status , Pain Measurement/statistics & numerical data , Data Interpretation, Statistical , Back Pain , Lumbar Vertebrae/injuries
Clinics ; 72(10): 609-617, Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-890680


OBJECTIVES: No studies have compared monoaxial and polyaxial pedicle screws with regard to the von Mises stress of the instrumentation, intradiscal pressures of the adjacent segment and adjacent segment degeneration. METHODS: Short-segment monoaxial/polyaxial pedicle screw fixation techniques were compared using finite element methods, and the redistributed T11-L1 segment range of motion, largest maximal von Mises stress of the instrumentation, and intradiscal pressures of the adjacent segment under displacement loading were evaluated. Radiographic results of 230 patients with traumatic thoracolumbar fractures treated with these fixations were reviewed, and the sagittal Cobb's angle, vertebral body angle, anterior vertebral body height of the fractured vertebrae and adjacent segment degeneration were calculated and evaluated. RESULTS: The largest maximal values of the von Mises stress were 376.8 MPa for the pedicle screws in the short-segment monoaxial pedicle screw fixation model and 439.9 MPa for the rods in the intermediate monoaxial pedicle screw fixation model. The maximal intradiscal pressures of the upper adjacent segments were all greater than those of the lower adjacent segments. The maximal intradiscal pressures of the monoaxial pedicle screw fixation model were larger than those in the corresponding segments of the normal model. The radiographic results at the final follow-up evaluation showed that the mean loss of correction of the sagittal Cobb's angle, vertebral body angle and anterior vertebral body height were smallest in the intermediate monoaxial pedicle screw fixation group. Adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group but more likely to be observed in the intermediate monoaxial pedicle screw fixation group. CONCLUSION: Smaller von Mises stress in the pedicle screws and lower intradiscal pressure in the adjacent segment were observed in the polyaxial screw model than in the monoaxial pedicle screw fixation spine models. Fracture-level fixation could significantly correct kyphosis and reduce correction loss, and adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group.

Humans , Male , Female , Adult , Middle Aged , Thoracic Vertebrae/injuries , Spinal Fractures/surgery , Pedicle Screws , Fracture Fixation, Internal/instrumentation , Lumbar Vertebrae/injuries , Pressure , Thoracic Vertebrae/physiopathology , Thoracic Vertebrae/diagnostic imaging , Biomechanical Phenomena , Radiography , Trauma Severity Indices , Reproducibility of Results , Retrospective Studies , Analysis of Variance , Range of Motion, Articular , Spinal Fractures/physiopathology , Spinal Fractures/diagnostic imaging , Treatment Outcome , Finite Element Analysis , Equipment Design , Fracture Fixation, Internal/methods , Lumbar Vertebrae/physiopathology , Lumbar Vertebrae/diagnostic imaging
Pesqui. vet. bras ; 37(8): 866-870, Aug. 2017. tab, graf
Article in Portuguese | LILACS, VETINDEX | ID: biblio-895498


Fraturas e luxações vertebrais (FLV) estão dentre as principais afecções que acometem a coluna vertebral em cães, com elevado risco de danos permanentes às estruturas neurais. Objetivou-se estudar as características e implicações associadas às FLV toracolombares em 37 cães, visando auxiliar uma melhor abordagem clínica em pacientes com esta afecção. As FLV foram mais comuns em machos não castrados com acesso a rua. Dentre a etiologia, 32 cães foram acometidos por acidente automobilístico. 14 cães apresentaram lesões não neurológicas em outros sistemas orgânicos. A presença de fraturas instáveis foi a alteração radiográfica mais comum. Em 16,2% dos animais, observaram-se lesões vertebrais fora do foco principal. O tempo até o atendimento neurológico inicial variou de um a 720 dias, no qual a maioria foi encaminhada sem imobilização externa. Houve diferença estatisticamente significante quanto à recuperação neurológica ao se comparar os graus de deslocamento de 0 a 25% e de 76 a 100%.(AU)

Vertebral fractures and luxations (VFL) are one of the most common and severe neurological issues found in clinical practice, with an elevated risk of permanent damage to the spinal cord. Our objective was to study the characteristics and implications associated with thoracolumbar VFL in 37 dogs, aiming assist a better clinical approach to patients with this disease. The VFL were more common in intact males with access to the street. Regarding etiology, 32 dogs were involved in car accidents. Of the dogs included in this research, 14 had non-neurological issues in other systems. The presence of unstable fractures was the most common radiographic change. In 16.2% of the dogs, vertebral lesions were observed outside the main site. Mean time until initial neurologic exam varied between one and 720 days, and most dogs were referred without external coaptation. There was a significant difference in recovery of the dogs when comparing a degree of dislocation of 0 to 25% and 76 to 100%.(AU)

Animals , Dogs , Paraplegia/veterinary , Spinal Cord Injuries/veterinary , Thoracic Injuries/veterinary , Joint Dislocations/veterinary , Lumbar Vertebrae/injuries , Epidemiologic Studies
Rev. cient. Esc. Univ. Cienc. Salud ; 4(1): 34-38, ene.-jun. 2017. tab
Article in Spanish | LILACS | ID: biblio-883127


El dolor lumbar se define como un síndrome mus - culoesquelético cuyo principal síntoma es la pre- sencia de dolor focalizado en el área comprendi - da entre la región costal inferior y la región sacra, y que en ocasiones puede comprometer la región glútea, provocando disminución funcional. Objetivo: Identificar las lesiones lumbares diagnosticadas por medio de estudio radiográfico de columna lumbar. Pacientes y Métodos: Estudio descriptivo, retrospec- tivo, comprendido entre 2014 y 2016, en los pacien - tes que asistieron a Mediscan para la realización de estudio radiográfico de columna lumbosacra con una muestra de 687 pacientes. Resultados: De los 687 pacientes, 309(44.9%) del género masculino, 378(55.1%) del género femenino. 211 tenían en- tre 51-60 años. De los pacientes del género mas- culino 103 (33.33%) tenían espondiloartrosis y 63 (20.39%) tenían canal espinal estrecho, en el gé- nero femenino 162 (42.86%) tenían espondiloartro - sis, 83(21.96%) discopatía lumbar. En 562 pacien - tes, se encontró lesión en el estudio radiológico, 264(46.9%) a nivel de L4- L5 Conclusión: La lum- balgia se presenta más en pacientes del género femenino, con mayor frecuencia entre 51-60 años. La patología más diagnosticada fue la espondi - loartrosis y el segmento más afectado fue L4-L5...(AU)

Humans , Male , Female , Middle Aged , Buttocks/injuries , Low Back Pain , Lumbar Vertebrae/injuries , Sacrococcygeal Region/injuries , Spondylarthropathies
Rev. chil. pediatr ; 88(3): 348-353, jun. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-899986


La Osteogénesis imperfecta (OI) es una enfermedad hereditaria del tejido conectivo, que se caracteriza principalmente por fragilidad ósea, deformidad y alteración del crecimiento. La OI tipo I (OI tipo I) es la más frecuente, leve y clínicamente homogénea. Su mayor complicación es la presencia de fracturas vertebrales, asociadas a morbilidad esquelética y cardiopulmonar. Objetivo: Caracterizar clinicamente una cohorte de niños con OI tipo I. Pacientes y Método: Se examinó una cohorte histórica de pacientes menores de 20 años mediante la revisión de fichas clínicas, rescatando las características demográficas, clínicas, bioquímicas y radiológicas. Resultados: Se incluyeron 67 pacientes, 55% varones, 69% de la Región Metropolitana. La edad media de diagnóstico fue de 2,9 años, el 70% de los pacientes presentó fracturas vertebrales de predominio torácico, y el 50% lo hizo antes de los 5 años. Un 15% presentó fracturas al momento del diagnóstico, siendo en ellos el diagnóstico de OI tipo I cerca de los 5 años. Los parámetros metabólicos óseos estuvieron en rangos adecuados durante el seguimiento, sin cambios significativos al diagnóstico de las fracturas vertebrales, excepto una disminución de la ingesta recomendada de calcio. Conclusiones: En este estudio, la OI tipo I presenta un diagnóstico precoz, principalmente en preescolares, y se asocia a alta frecuencia de fracturas vertebrales. La disminución en la ingesta de calcio demostrada al momento de la primera fractura requiere especial atención en estos pacientes.

Osteogenesis imperfecta (OI) is an hereditary disease affecting conective tissue, mainly associated to growth retardation and pathological fractures. OI type I (OI type I), is the mildest, most often, and homogeneous in its fenotype. Vertebral fractures are the most significant complications, associated to skeletical and cardiopulmonary morbidity. Objectives: To characterize clinically a cohort of children with OI type I. Patients and Methods: A cohort of OI type I children younger than 20 year old was evaluated. Demographic, clinical, biochemical and radiological data were registered. Results: Sixty seven patients were included, 55% male, 69% resident in the Metropolitan Region. The mean age of diagnose was 2.9 years, 70% presented vertebral fractures on follow-up, mostly thoracic, and 50% before the age of 5 years. Fifty percentage presented vertebral fractures at diagnose, which was about the age of 5 years. Bone metabolic parameters were in the normal range, without significant change at the moment of vertebral fractures. Calcium intake was found to be below American Academy of Pediatrics recommendations at the time of the first fracture. Conclusions: In this study OI type I has an early diagnose, and vertebral fractures show a high incidence, mostly in toddlers. Calcium intake was found to be below reccomended values, and should be closely supervised in these patients.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Thoracic Vertebrae/injuries , Spinal Fractures/etiology , Lumbar Vertebrae/injuries , Osteogenesis Imperfecta/complications , Prognosis , Retrospective Studies , Risk Factors , Follow-Up Studies , Spinal Fractures/diagnosis , Spinal Fractures/epidemiology
Rev. bras. anestesiol ; 67(2): 205-209, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-843385


Abstract Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8 mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

Resumo Vertebroplastia percutânea é um procedimento intervencionista relativamente seguro, simples e comumente feito para tratar fraturas por compressão vertebral. No entanto, as complicações graves relacionadas ao procedimento são raramente relatadas, incluindo embolia pulmonar, infecção grave, paraplegia e a ocorrência de uma nova fratura em vértebra adjacente após a vertebroplastia. Complicações agudas são geralmente associadas ao procedimento. Apresentamos o caso de bloqueio neuroaxial, feito após anestesia local com 8 mL de prilocaína a 2%, em uma mulher de 68 anos, submetida à vertebroplastia percutânea após fratura osteoporótica na vértebra L1 devido a trauma. De acordo com nossa pesquisa, este é o primeiro caso na literatura.

Humans , Female , Aged , Spinal Fractures/surgery , Vertebroplasty/adverse effects , Osteoporotic Fractures/surgery , Intraoperative Complications/etiology , Anesthesia, Conduction , Anesthesia, Local , Lumbar Vertebrae/injuries , Vertebroplasty/methods
Acta ortop. mex ; 31(2): 82-85, mar.-abr. 2017. tab
Article in Spanish | LILACS | ID: biblio-886540


Resumen: Objetivo: Evaluar el resultado de la corporectomía por acceso único posterior con colocación de caja expandible y fijación transpedicular en pacientes con fracturas toracolumbares. Material y métodos: Estudio retrospectivo en el que se evaluaron ocho pacientes con fracturas por estallido entre Mayo de 2011 y Mayo de 2014, quienes fueron tratados de manera quirúrgica mediante corporectomía, colocación de caja expandible y fijación transpedicular con abordaje posterior. El estado neurológico fue valorado a través de la escala de ASIA prequirúrgico y postquirúrgico a un año de evolución y se midió la corrección angular de las deformidades. Resultados: El estudio comprendió cinco personas de sexo masculino y tres de sexo femenino, con un promedio de edad de 38 años (de 24 a 58 años). Todos los pacientes presentaron fracturas por estallido del cuerpo vertebral, uno de ellos con componente rotacional. A los ocho se les realizó solamente la corporectomía de un nivel vertebral. El tiempo quirúrgico promedio fue de 236 minutos (rango: 195-330 min). El sangrado quirúrgico en promedio fue de 1,731 ml. Conclusión/Discusión: Los pacientes que se sometieron a corporectomía por vía posterior mostraron resultados clínicos favorables, sin presentar lesiones neurológicas o lesiones asociadas al procedimiento, por lo que esta técnica puede ser una opción terapéutica al disminuir las complicaciones de una vía anterior o de un doble abordaje.

Abstract: Objective: The objective is to evaluate the outcome of vertebral corpectomy and placement of an expandable cage in patients with thoracolumbar fractures, using a posterior-only approach. Material and methods: A retrospective, case series study in the period from May 2011 to May 2014, in which eight patients with thoracolumbar burst fractures were treated surgically with corpectomy of fractured spinal body, placement of expandable box and fixation with transpedicular system, via posterior-only approach. Neurologic examination was done pre- and postoperatively with the ASIA score in a one year span. The angular deformity correction was also measured. Results: The mean age was 38 years (24 to 58 years); five male and three female patients. All the patients had burst fracture, one of them with aggregate rotational component. Only one vertebral level was worked with corpectomy in all patients. Mean surgical time was 236 minutes (195-330 min). Mean surgical bleeding was 1,731 ml. Conclusion/Discussion: Patients who underwent posterior approach corpectomy showed favorable clinical results. None presented neurological damage or surgical-related injury. This technique can be a useful option to avoid complications related to anterior vertebral approach or double approach.

Humans , Male , Female , Adult , Young Adult , Spinal Fractures/surgery , Fracture Fixation, Internal , Thoracic Vertebrae/surgery , Thoracic Vertebrae/injuries , Retrospective Studies , Treatment Outcome , Lumbar Vertebrae/surgery , Lumbar Vertebrae/injuries , Middle Aged
Coluna/Columna ; 16(1): 56-59, Jan.-Mar. 2017. graf
Article in English | LILACS | ID: biblio-840153


ABSTRACT Objective: To test the reliability of the new AO/2013 classification compared with AO/Magerl and TLICS. Methods: Four spine surgeons retrospectively and blindly evaluated imaging and clinical data from 98 patients with thoracolumbar fractures. Results: Using the Kappa coefficient, we obtained the best reproducibility for the AO/2013 classification compared to the other two, represented by Kappa coefficient of 0.690. We could also obtain, with good reproducibility among the evaluators (Kappa 0.690), the most common subtypes of AO/2013 classification with indication for surgery. Conclusion: We believe that the new AO/2013 classification has proven to be a good communication tool among spine surgeons with good reproducibility, but more studies should be conducted in several centers in order to be consolidated and so that the prognosis between the types of injury is better understood.

RESUMO Objetivos: Testar a confiabilidade da nova classificação AO/2013 com relação às classificações AO/Magerl e TLICS. Métodos: Foram avaliados retrospectivamente exames de imagem e dados clínicos de 98 pacientes com fraturas toracolombares por quatro cirurgiões de coluna vertebral, de modo cego. Resultados: Utilizando o coeficiente Kappa, obtivemos a melhor reprodutibilidade para a classificação AO/2013 quando comparada com as outras duas, representada por um índice Kappa de 0,690. Pudemos obter também, com boa reprodutibilidade entre os avaliadores (Kappa 0,690), os subtipos mais comuns da classificação AO/2013 com indicação de cirurgia. Conclusão: Acreditamos que a nova classificação AO/2013 demonstrou ser uma ótima ferramenta de comunicação entre os cirurgiões de coluna, com boa reprodutibilidade, porém mais estudos devem ser realizados em diversos centros para que seja consolidada e que o prognóstico entre os tipos de lesão seja mais bem compreendido.

RESUMEN Objetivos: Comprobar la fiabilidad de la nueva clasificación AO/2013 en relación con las clasificaciones AO/Magerl y TLICS. Métodos: Se evaluaron de forma retrospectiva imágenes y datos clínicos de 98 pacientes con fracturas toracolumbares por cuatro cirujanos de columna, a ciegas. Resultados: Utilizando el coeficiente Kappa, se obtuvo la mejor reproducibilidad para la clasificación AO/2013 en comparación con las otras dos, representada por un índice Kappa de 0,690. Hemos sido capaces de obtener también, con buena reproducibilidad entre evaluadores (Kappa 0,690), los subtipos más comunes de la clasificación AO/2013 con indicación para cirugía. Conclusión: Creemos que la nueva clasificación AO/2013 resultó ser una gran herramienta de comunicación entre los cirujanos de columna, con buena reproducibilidad, pero más estudios deben llevarse a cabo en varios centros para que se consolide y que el pronóstico entre los tipos de lesiones sea más bien comprendido.

Humans , Spinal Fractures , Classification/methods , Lumbar Vertebrae/injuries , Thoracic Vertebrae/injuries
Clinics ; 71(6): 297-301, graf
Article in English | LILACS | ID: lil-787420


OBJECTIVE: To evaluate the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. METHODS: Fifty-six cases of thoracolumbar vertebral fractures treated in our trauma center from October 2012 to October 2013 were included in this study. The fractures were classified by the anteroposterior classification, whereas the severity of intervertebral disc injury was evaluated using magnetic resonance imaging. The Spearman correlation coefficient was used to analyze the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar fractures, whereas a χ2 test was adopted to measure the variability between different fracture types and upper and lower adjacent disc injuries. RESULTS: The Spearman correlation coefficients between fracture types and the severity of the upper and lower adjacent disc injuries were 0.739 (PU<0.001) and 0.368 (PL=0.005), respectively. It means that the more complex Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications are the disc injury is more severe. There was also a significant difference in the severity of injury between the upper and lower adjacent discs near the fractured vertebrae (p<0.001). CONCLUSIONS: In thoracolumbar spinal fractures, the severity of the adjacent intervertebral disc injury is positively correlated with the anteroposterior fracture type. The injury primarily involves intervertebral discs near the fractured end plate, with more frequent and severe injuries observed in the upper than in the lower discs. The presence of intervertebral disc injury, along with its severity, may provide useful information during the clinical decision-making process.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Thoracic Vertebrae/injuries , Injury Severity Score , Spinal Fractures/classification , Intervertebral Disc/injuries , Lumbar Vertebrae/injuries , Magnetic Resonance Imaging/standards , Retrospective Studies , Spinal Fractures/diagnostic imaging , Intervertebral Disc/diagnostic imaging
Einstein (Säo Paulo) ; 14(1): 67-70, Jan.-Mar. 2016. graf
Article in English | LILACS | ID: lil-778487


ABSTRACT We report a rare case of an unstable flexion-distraction spine fracture with ligament involvement that occurred during a professional female soccer game. There were no neurological déficit. The patient had a painful midline gap which suggested ligamentar injury that was not immediately recognized. Despite that, proper immobilization and referral to hospital for further evaluation avoided additional spinal cord damage. The patient underwent a monosegmental posterior instrumentation spine fusion and after 6 months returned to professional soccer activities. This paper alerts to the possibility of occurrence of severe and unstable spine injuries during soccer practice and the importance of an adequate initial care at the game field in order to avoid iatrogenic neurological injuries.

RESUMO Relatamos um caso raro de fratura instável da coluna vertebral com envolvimento ligamentar, ocorrida por mecanismo de flexão-distração, durante jogo de futebol feminino profissional. Não houve déficit neurológico. A paciente apresentava espaçamento doloroso dorsal na linha média, que sugeriu lesão ligamentar, a qual não foi reconhecida imediatamente. Apesar disso, realizaram-se imobilização adequada e encaminhamento para unidade hospitalar, fatos que evitaram a ocorrência de danos adicionais à medula espinal. A paciente foi submetida à fusão monossegmentar, com instrumentação e, após 6 meses, retornou à prática de futebol profissional. O presente estudo alerta para a possibilidade de ocorrência de lesões graves e instáveis na coluna durante a prática de futebol, e para importância da assistência inicial adequada ainda em campo, a fim de evitar lesões neurológicas iatrogênicas.

Humans , Female , Young Adult , Soccer/injuries , Spinal Fractures/surgery , Lumbar Vertebrae/injuries , Spinal Fusion/rehabilitation , Spinal Fractures/diagnosis , Lumbar Vertebrae/surgery