Long-term impact of pre-operative physical rehabilitation protocol on the 6-min walk test of patients with adolescent idiopathic scoliosis: A randomized clinical trial.

BACKGROUND: Monitored physical activities in patients with adolescent idiopathic scoliosis (AIS) have been shown to improve physical performance, endurance and cardiopulmonary function and may be assessed by the 6-min walk test (6MWT). We aimed to evaluate the long-term results of the 6MWT after a rehabilitation protocol employed before surgical correction for AIS. METHODS: This prospective randomized clinical trial studied the impact of a 4-month pre-operative physical rehabilitation protocol on post-operative cardiopulmonary function and physical endurance, by using the 6MWT, in patients with AIS submitted to surgical correction, comparing them to matched controls without physical rehabilitation. Studied variables were heart and respiratory rate, systolic and diastolic blood pressure, peripheral blood oxygen saturation, Borg score, and distance walked. Patients were assessed at baseline, after 4 months of rehabilitation, and 3, 6 and 12 months post-operatively. RESULTS: A total of 50 patients with AIS were included in the study and allocated blindly, by simple randomization, into either one of the two groups, with 25 patients each: study group (pre-operative physical rehabilitation) and control group. The physical rehabilitation protocol promoted significant progressive improvement in heart and respiratory rate, peripheral blood oxygen saturation, distance walked, and level of effort assessed by the Borg scale after surgery. CONCLUSIONS: Post-surgical recovery, evaluated by 6MWT, was significantly better in patients who underwent a 4-month pre-operative physical rehabilitation protocol.

Is there a difference between narrowing of the spinal canal and neurological deficits comparing Denis and Magerl classifications?

STUDY DESIGN: Retrospective chart review. OBJECTIVES: The objective of the current study was to evaluate the correlation between neurological deficits and the severity of narrowing of the spinal canal in patients with thoracic, thoracolumbar and lumbar burst-type fractures by comparing the classifications of Denis and Magerl. From 1989 to 2005, a total of 227 patients with burst fractures following Denis' criteria were studied. SETTING: Tertiary teaching institution. METHODS: Computed tomographic scans of the fractured spine were analyzed to assess the narrowing of the spinal canal. Following Magerl's criteria, patients were later subdivided into two groups according to the presence of associated ligament injuries, out of which 185 patients had no such injuries and the remaining 42 patients were classified as Megerl group B. RESULTS: Results were evaluated based on the initial neurological status of patients according to Frankel and based on the midsagittal diameter of the fractured vertebra. A significant correlation was found between the narrowing of the spinal canal and neurological deficits in both classifications, with no significant differences between either. CONCLUSION: The percentage of narrowing of the spinal canal proved to be a pre-disposing factor for the severity of the neurological status in thoracolumbar and lumbar burst-type fractures according to the classifications of Denis and Magerl. The greater the bone fragment in the spinal canal, the greater will be the probability of neurological deficits in both fracture classifications, equally.

Cisto ósseo aneurismático da coluna vertebral / Aneurismal bone cyst of the spine

Os autores apresentam nove pacientes portadores de cisto ósseo aneurismático tratados de 1977 a 1992 no Grupo de Afecçöes da Coluna Vertebral do Departamento de Ortopedia e Traumatologia - Pavilhäo Fernandinho Simonsen, da Santa Casa de Misericórdia de Säo Paulo, Serviço do Prof. Dr. José Soares Hungria Neto.

Tumores benignos e lesöes pseudotumorais da coluna vertebral. Análise de 60 pacientes / Benign tumors and tumorlike lesions of spine. Analysis of 60 patients

Os autores apresentam a experiência do Grupo de Afecçöes da Coluna Vertebral do Departamento de Ortopedia e Traumatologia - Pavilhäo Fernandinho Simonsen, da Santa Casa de Misericórdia de Säo Paulo, com 60 pacientes que apresentaram tumor benigno ou lesäo pseudotumoral da coluna vertebral, atendidos no período de 1975 a 1994. Os autores comentam sua experiência com relaçäo a diagnóstico, tratamento e resultados.

Common sense in the management of adolescent idiopathic scoliosis.

The 25-year experience of Santa Casa Spine Center in treating patients with adolescent idiopathic scoliosis is reported. The orthotic and surgical treatments and their complications are discussed, showing efficient, cost-effective ways of acting on these disorders in countries that lack more expensive and modern instrumentation.

An anterior distractor for the intraoperative correction of angular kyphosis.

A new device for the intraoperative anterior correction of angular kyphoses is presented. It functions on the turnbuckle principle. Preliminary results have shown excellent corrections without complication. It is not an implant.