Espondilolistese traumática do áxis: epidemiologia, conduta e evolução / Traumatic spondylolisthesis of the axis: epidemiology, management and outcome

OBJETIVO: Avaliar casos de espondilolistese traumática do áxis e descrevê-los com relação à epidemiologia, classificação, déficit neurológico, tempo de consolidação e tratamento. MÉTODO: Análise retrospectiva dos prontuários dos pacientes tratado de 2002 a 2010 no IOT-HCFMUSP. Critério de inclusão: fratura da pars interarticularis de C2. RESULTADOS: 68% dos pacientes do sexo masculino com idade média de 39,1 anos. Utilizamos a classificação de Effendi, modificada por Levine-Edwards. Observamos fratura do tipo I em cinco pacientes (31,2%) e tipo II em oito pacientes (50%). Apenas três pacientes (18%) apresentaram fratura do tipo IIa. Não houve casos do tipo III. Mecanismo: Oito acidentes automobilísticos e quatro quedas. Outros mecanismos: atropelamento e mergulho. Tratamento: tração com halo craniano em onze pacientes. Foram usados gesso minerva e halo-gesso. Tempo de consolidação: 3,6 meses. Tempo de seguimento: 9,6 meses. DISCUSSÃO: Nossos resultados confirmam que fratura do enforcado apresenta bom prognóstico. Não houve necessidade de cirurgia em nenhum caso. A incidência de déficit neurológico é baixa. Nenhum paciente apresentou fratura instável, tipo III. CONCLUSÃO: Este trabalho sugere que a espondilolistese traumática do áxis continua sendo uma lesão satisfatoriamente tratada de forma conservadora na maioria dos casos. Nível de Evidência IV, Série de casos.

OBJECTIVE: To evaluate cases of traumatic spondylolisthesis of the axis and describe them in relation to epidemiology, classification, neurological deficit, healing time and treatment method. METHOD: A retrospective analysis of the medical records of patients treated between 2002 and 2010 at IOT-FMUSP. Inclusion criteria: pars interarticularis fracture of C2. RESULTS: 68% were male patients, with a mean age of 39.1 years. We used the classification by Effendi, modified by Levine-Edwards. Type I fractures were observed in five patients (31.2%) and type II in eight patients (50%). Only three patients (18%) had type IIa fracture. There were no cases of type III. Mechanism: Eight car accidents and four falls. Other mechanisms: being run over, and diving accidents. Treatment with halo traction was used in eleven patients, using minerva cast and halo-cast. Healing time: 3.6 months. Follow-up time: 9.6 months. DISCUSSION: In general, hangman fracture has a good prognosis, which is confirmed by our results. There was no need for surgery in any of the cases. The incidence of neurological deficit is low. No patient had unstable fracture (type III). CONCLUSION: This paper suggests that traumatic spondylolisthesis of the axis continues to be an injury that is successfully treated by conservative treatment in most cases. Level of Evidence -IV, Case series.

Espondilolistese traumática do áxis? Experiência em 41 casos / Traumatic spondylolistesis of axis? A study of 41 cases

Objetivo: Levantamento epidemiológico retrospectivo da prevalência de espondilolistese traumática do áxis no período de cinco anos em HJXXIII ? FHEMIG. Métodos: Foram avaliados 1.136 casos de traumatismo raquimedular admitidos no período em HJXXIII ? FHEMIG. Resultados: 762 ( 67% ) correspondiam a trauma em segmento cervical, 41 casos ( 5,3% ) a ETA. Predomínio em adultos jovens do sexo masculino. A etiologia mais comum foi acidente automobilístico. Segundo classificação de Levine, o tipo de fratura mais comum foi o tipo I (70,8%), seguido pelo tipo II (16%), tipo IIa (9,6%) e tipo III (3,2%). Conclusão: A espondilolistese traumática do áxis geralmente é uma fratura estável, sendo satisfatoriamente tratada por meio de órtese externa. Os déficits neurológicos são incomuns e, quando presentes, geralmente são decorrentes de lesões associadas.

Objective: Retrospective epidemiological survey of prevalence of traumatic spondylolisthesis of axis in period of five years in HJXXIII ? FHEMIG. Methods: 1,336 admitted spine injury cases were evaluated during the period of HJXXIII ? FHEMIG. Results: 762 (67%) were trauma in neck segment, 41 cases (5,3%) to ETA. Predominance in young males. The most common cause was car accident. According to classification of Levine, the type of fracture was the most common type I (70,8%), followed by type II (16%), type IIa (9,6%), and type III (3,2%). Conclusion: The traumatic spondylolisthesis of the axis is generally a stable fracture and satisfactorily trated by external bracing. The neurological deficits are uncommon and when present are usually due to associated injuries.

Lumbar disc degeneration in Thai elderly: a population-based study.

OBJECTIVE: Determine the prevalence and related factors of lumbar disc degeneration in the Thai elderly. MATERIAL AND METHOD: A population-based study was done at Rom Klao community, Bangkok. Seven hundred and ninety-two cases (306 males, and 486 females) out of 1166 elderly people aged > or =50 (mean age of 61.07 +/- 7.8 years) were assessed. The lateral spinal radiographs were interpreted as spondylosis grade 0-3 according to the degree of severity. RESULTS: Males had more prevalence of grade 2-3 spondylosis than females (58.8% vs. 52.9%), but females had higher prevalence of spinal listhesis (14.4% vs. 8.8%). Age was a strong predicting factor for disc degeneration (OR = 1.088, 95% CI = 1.065-1.111, p = 0.000). Females had more risk to develop spinal listhesis (OR = 1.84, 95% CI = 1.11-3.05, p = 0.020) and low back pain (OR = 1.82, 95% CI = 1.29-2.56, p = 0.001). BMI was a predicting factor for spondylosis (OR = 1.066, 95% CI = 1.02-1.10, p = 0.000). About 27% of the cases reported moderate-severe low back pain and had lower Barthel ADL index (p = 0.018). CONCLUSION: Lumbar disc degeneration and low back pain were highly prevalent among the Thai elderly. Therefore, they need proper health care for disability prevention.

Espondilolistese em frango de corte no Brasil / Spondylolisthesis (\"Kinky Back\") in broiler chickens in Brazil

Eight 28-day-old broiler chickens of both sexes were examined. Clinical signs, gross findings, radiological, and histopathological changes were described. Spondylolisthesis was characterized by dorsal displacement of the sixth and seventh thoracic vertebrae, resulting in compression of the spinal cord. The major clinical manifestation was paraplegia. Risk factors such as genetics, nutrition, stress, rate of growth, and age were discussed.