CONSERVATIVE IDIOPATHIC SCOLIOSIS TREATMENT WITH BRACE PRODUCED USING 3D TECHNOLOGY

ABSTRACT Objective To evaluate the immediate correction capacity of the Wood-Chêneau-Rigo brace (WCR), produced using digital technological resources and robotic engineering, in primary and secondary curves of adolescent idiopathic scoliosis (AIS). Methods A retrospective study was conducted of 138 patients with a diagnosis of AIS and who received a WCR brace from a laboratory that makes orthoses and orthopedic prostheses between 2019 and 2021. These individuals were submitted to an independent analysis of the radiographic parameters by a single researcher, the main outcome of which was the standardized measurement of the main and secondary curves using the Cobb method. The radiographs analyzed were performed in orthostasis before and immediately after the adaptation of the brace on the patient. The correction capacity was calculated as the ratio of the difference between the pre- and post-brace curves to the pre-brace curve. Results The mean correction with the WCR was 48.4% for the main curve and 41.0% for the secondary curve. The level of correction of the main curve was significantly higher in patients with a main curve with the apex of convexity in the thoracolumbar region (p = 0.004), especially in the left thoracolumbar region (p = 0.010); curves of magnitude between 10º and 24.9º (p <0.001); and curves classified as simple (p <0.001). Conclusion The use of the WCR, which is produced using modern technological resources, was effective in the immediate correction of AIS. Long-term studies on this new modality of conservative scoliosis treatment are necessary. Level of evidence III; Retrospective study.

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ADOLESCENT IDIOPATHIC SCOLIOSIS AND SIMILAR CONDITIONS: NEW TOOL TO MEASURE THE CORONAL PLANE

Coluna/Columna ◽

10.1590/s1808-185120181704191820 ◽

2018 ◽

Vol 17 (4) ◽

pp. 281-285

Author(s):

Enguer Beraldo Garcia ◽

Guilherme Brescia Payão ◽

Liliane Faria Garcia ◽

Enguer Beraldo Garcia Jr ◽

Marcos Felipe Camarinha ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Postoperative Period ◽

Central Line ◽

Coronal Plane ◽

Fixation Method ◽

Preoperative Period ◽

Level Of Evidence ◽

Proximal Extension ◽

The Difference ◽

Third Line

ABSTRACT Objective: To create a method to measure the overall coronal plane of the spine, called the sacral clavicular angle (SCA). Methods: A line is drawn at the base of the sacrum; a second central line is drawn perpendicular to the first one in the proximal extension of the spine. A third line is drawn passing through the intersections of the superior points of the clavicles with the two second ribs, forming two angles, the greater of which is measured. Therefore, the degrees exceeding 90° are the SCA values. This tool was tested retrospectively in a study of 46 patients with idiopathic scoliosis who underwent short, apical, single or multiple fixations. Third generation instrumentation was used and the SCA was evaluated in the pre- and postoperative periods, which were compared with another group of 46 patients treated with the traditional technique. Results: Patients submitted to the traditional fixation method presented a median SCA of 3° in the preoperative period, and in the postoperative period, the SCA remained in 3°. Therefore, there was a 0% reduction. Patients submitted to short, apical, single or multiple fixation method presented a median preoperative SCA of 6°, and a postoperative median SCA of 1°, a reduction of approximately 83%. Conclusions: The group treated with short, apical, single or multiple instrumentation presented a reduction in the SCA of approximately 83% in the postoperative period compared to the preoperative period. The difference between preoperative and postoperative values was considered statistically significant. Level of Evidence II; Retrospective study.

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ADOLESCENT IDIOPATHIC SCOLIOSIS: EVALUATION ON THE EFFECT OF SCREW DENSITY IN THE CORRECTION

Coluna/Columna ◽

10.1590/s1808-185120161501153510 ◽

2016 ◽

Vol 15 (1) ◽

pp. 17-21

Author(s):

Enguer Beraldo Garcia ◽

Liliane Faria Garcia ◽

Enguer Beraldo Garcia Jr ◽

Roberto Garcia Gonçalves ◽

Saulo Terror Giesbrecht ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Medical Records ◽

Transpedicular Fixation ◽

Correction Rate ◽

Screw Density ◽

The Difference ◽

Implant Density ◽

Biostatistical Analysis ◽

Main Curve

ABSTRACT Objective: The objective was to investigate implant density or the number of screws correlated with the correction of the main curve in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Methods: We evaluated 112 medical records: 33 patients with screw density of up to 50%, and 79 patients with a density of 100%; all patients underwent surgical correction by posterior approach with transpedicular fixation. Results: In the group of patients with screw density of up to 50% the residual Cobb median was 10°; in the group with 100% density, the median was 7°. Conclusion: Biostatistical analysis showed that the group with up to 50% of screw density presented correction rate of 82.1% and the group with 100% density had correction of about 86.8%. It is therefore concluded that the difference is statistically significant in favor of the fixation with 100% density (p =0.010).

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COSTAL MALFORMATION RELATED TO THORACOLUMBAR SCOLIOSIS IN ADOLESCENTS - CASE REPORT

Coluna/Columna ◽

10.1590/s1808-185120181701175991 ◽

2018 ◽

Vol 17 (1) ◽

pp. 66-68

Author(s):

NILZA NASCIMENTO GUIMARÃES ◽

JÚLIO CESAR CALDAS PINHEIRO ◽

UBIRATAN MAIA RODRIGUES DE VASCONCELOS ◽

CAROLINA RODRIGUES DE MENDONÇA

Keyword(s):

Idiopathic Scoliosis ◽

Clinical Picture ◽

Skeletal Maturity ◽

Case Series ◽

Congenital Scoliosis ◽

Point Of View ◽

Spine Deformity ◽

Level Of Evidence ◽

Lateral Curvature ◽

Cobb Method

ABSTRACT Congenital scoliosis associated with costal malformation is well known. However, there are no reports of idiopathic scoliosis associated with the fusion of the costal arcs in the literature. This report describes a case of idiopathic scoliosis with fusion of the 1st and 2nd costal arches in a female patient and reports changes in the deformity due to scoliosis because of the treatment. The analysis was performed from a morphological and clinical point of view, and by complementary tests. Radiographs and CT scans were obtained and evaluated from the first consultation in 2012 and during the period in which the patient was followed in a private clinic, until the stabilization of the condition, in 2014. The evolution was favorable with the use of a Milwaukee vest and there was improvement of the clinical picture after the skeletal maturity, and the angle of lateral curvature, measured by the Cobb method, initially of 20 degrees, was reduced and stabilized in nine degrees, measure which is currently maintained. The analysis showed concomitant pathologies, and the fusion of costal arches did not influence the spine deformity, since there was regression with the clinical treatment. This evolution leads us to conclude that adolescent idiopathic scoliosis should be imputed as the sole responsible for the clinical picture of the patient, and that the fusion of the costal arches does not interfere with the biomechanics of the spine. Level of Evidence: IV. Type of study: Case series.

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ADOLESCENT IDIOPATHIC SCOLIOSIS AND SIMILAR CONDITIONS: SHORT, APICAL, SINGLE OR MULTIPLE FIXATION

Coluna/Columna ◽

10.1590/s1808-185120181704191817 ◽

2018 ◽

Vol 17 (4) ◽

pp. 275-280

Author(s):

Enguer Beraldo Garcia ◽

Liliane Faria Garcia ◽

Enguer Beraldo Garcia Jr ◽

Juliana Garcia Camarinha ◽

Marcos Felipe Camarinha ◽

...

Keyword(s):

Retrospective Study ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Statistical Difference ◽

Scoliotic Curve ◽

Level Of Evidence ◽

Curvature Correction ◽

Significant Statistical Difference ◽

New Instrumentation ◽

Thoracolumbar Curve

ABSTRACT Objective: To create a new instrumentation principle for the treatment of adolescent idiopathic scoliosis (AIS) and similar conditions. Methods: A new fixation format was created for the treatment of AIS using 3rd generation instrumentation in short, apical and single or multiple fixations. In patients presenting one scoliotic curve, one fixation is performed. In patients with two curves, two fixations are performed, and in those with three curves, three fixations are performed. To evaluate the new method, a retrospective study of 54 patients who had already undergone surgery for AIS and similar conditions using this innovation was conducted. Results: In this series, average corrections of 72% in the proximal curve, of 83% in the thoracic curve, and of 85% in the thoracolumbar curve were verified. Conclusions: It was concluded that the new fixation principle in the treatment of AIS and similar conditions using short, apical and multiple fixations presented excellent correction, better still in the curves that were more distal in relation to the spine. There was a significant statistical difference between the percentages of curvature correction. Level of Evidence III; Retrospective study.

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APPLICABILITY OF THE COBB ANGLE MEASUREMENT IN IDIOPATHIC SCOLIOSIS USING SCANNED IMAGING

Coluna/Columna ◽

10.1590/s1808-185120171601153058 ◽

2017 ◽

Vol 16 (1) ◽

pp. 22-24

Author(s):

ERASMO DE ABREU ZARDO ◽

MARCUS SOFIA ZIEGLER ◽

AFRANE SERDEIRA ◽

CARLOS MARCELO DONAZAR SEVERO ◽

RODRIGO VALENTE FRAST ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Cobb Angle ◽

Intraclass Correlation ◽

Angle Measurement ◽

Average Variation ◽

Cobb Angle Measurement ◽

Spine Surgeon ◽

Cobb Method ◽

Main Curve ◽

Excellent Reproducibility

ABSTRACT Objectives: To compare the measurement of the Cobb angle on printed radiographs and on scanned radiographs viewed through the software "PixViewer". Methods: Preoperative radiographs of 23 patients were evaluated on printed films and through the software "PixViewer". The same evaluator, a spine surgeon, chose the proximal and distal limiting vertebrae of the main curve on printed radiographs, without identification of patients, and measured the Cobb angle based on these parameters. The same parameters and measurements were applied to scanned radiographs. The measurements were compared, as well as the choice of limiting vertebrae. Results: The average variation of the Cobb angle between methods was 1.48 ± 1.73°. The intraclass correlation coefficient (ICC) was 0.99, demonstrating excellent reproducibility. Conclusion: The Cobb method can be used to evaluate scoliosis through the "PixViewer" tool with the same reliability as the classic method on printed radiographs.

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ROTATION ASSESSMENT IN ADOLESCENT IDIOPATHIC SCOLIOSIS WITH ROD DEROTATION

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192701191874 ◽

2019 ◽

Vol 27 (1) ◽

pp. 42-45

Author(s):

Fernando Flores de Araujo ◽

Raphael Martus Marcon ◽

Alexandre Fogaça Cristante ◽

Tarcísio Eloy Pessoa de Barros Filho ◽

Olavo Biraghi Letaif

Keyword(s):

Surgical Treatment ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Case Series ◽

Deformity Correction ◽

Vertebral Rotation ◽

Level Of Evidence ◽

Apical Vertebra ◽

Screw Density ◽

Cobb Method

ABSTRACT Objective: Adolescent idiopathic scoliosis (AIS) is characterized by rotational and lateral deformity of the spine. The measurement of vertebral rotation is important for prognosis and treatment. Our objective was to evaluate whether the Nash-Moe method can be used to measure axial deformity correction with surgical treatment using the rod derotation maneuver at both the apex and extremities of the deformity in patients with AIS. Methods: Rotation was assessed using the Nash and Moe criteria, on preoperative and postoperative radiographs. We also evaluated the severity on the coronal plane using the Cobb method, ratio of correction achieved, screw density, and number of vertebrae involved in the instrumentation. Results: The Cobb method correction average was 54.8%. When we disregarded vertebrae that presented preoperative Nash-Moe grade 0, the average measurable correction was 54.5% in the first non-instrumented vertebra above, 69.2% in the first instrumented vertebra, 32.2% in the apical vertebra, 36.8% in the last instrumented vertebra, and 30% in the first non-instrumented vertebra below. In our study, 32.14% of the patients presented a measurable correction in the apical vertebra. Conclusion: On the axial plane, correction can be satisfactorily evaluated using the Nash-Moe method. Level of Evidence VI. Case Series.

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COMPARATIVE STUDY OF THE TYPES OF FIXATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

Coluna/Columna ◽

10.1590/s1808-185120212001232530 ◽

2021 ◽

Vol 20 (1) ◽

pp. 14-19

Author(s):

Enguer Beraldo Garcia ◽

Liliane Faria Garcia ◽

Enguer Beraldo Garcia Júnior ◽

André de Sá ◽

Victor de Oliveira Matos ◽

...

Keyword(s):

Retrospective Study ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Comparative Study ◽

Cobb Angle ◽

Frontal Plane ◽

Angular Deformity ◽

Level Of Evidence ◽

Different Types

ABSTRACT Objective: To conduct a comparative study of the results obtained in the treatment of adolescent idiopathic scoliosis (AIS) with different types of fixations (traditional, selective and multiple), and to evaluate the correction of angular deformity in the frontal plane by the Cobb and sacral clavicular angle (SCA) methods. Methods: A study of a group of 278 patients with AIS who underwent selective, traditional, and multiple fixation surgeries. Results: Significant corrections of both the Cobb angle and the SCA were observed. Conclusions: In the multiple fixation surgeries there was a 100% correction between the preoperative and postoperative SCA values and a 50% correction in the traditional and selective fixations, a difference considered significant. Regarding the Cobb angle, the three fixations presented corrections between preop and postop with significant differences. Level of evidence III; Retrospective Study.

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Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

Journal of Wrist Surgery ◽

10.1055/s-0040-1721435 ◽

2021 ◽

Author(s):

J. Terrence Jose Jerome

Keyword(s):

Retrospective Study ◽

Natural History ◽

Functional Outcome ◽

Grip Strength ◽

Scaphoid Nonunion ◽

Proximal Pole ◽

Degenerative Arthritis ◽

Level Of Evidence ◽

History Of ◽

The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

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Influence of preoperative corticosteroid treatment on rate of diagnostic surgeries in primary central nervous system lymphoma: a multicenter retrospective study

BMC Cancer ◽

10.1186/s12885-021-08515-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Florian Scheichel ◽

Franz Marhold ◽

Daniel Pinggera ◽

Barbara Kiesel ◽

Tobias Rossmann ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Diagnostic Delay ◽

Central Nervous System Lymphoma ◽

Corticosteroid Treatment ◽

Histopathological Diagnosis ◽

Significant Difference ◽

The Difference ◽

Immunocompetent Patients

Abstract Background Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. Methods A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. Results A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7–6.4). Conclusions Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.

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A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm10112390 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2390

Author(s):

Zineb Assili ◽

Gilles Dolivet ◽

Julia Salleron ◽

Claire Griffaton-Tallandier ◽

Claire Egloff-Juras ◽

...

Keyword(s):

Retrospective Study ◽

Cumulative Incidence ◽

Side Effect ◽

Osteonecrosis Of The Jaw ◽

Exposed Group ◽

Severe Side Effect ◽

Dental Arch ◽

P Value ◽

The Difference ◽

Bone Exposure

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

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