O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

Introduction: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal.Material and Methods: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019.Results: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years’ residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with thefinal examination (37.8%).Conclusion: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

efficacy of the therapeutic exercises on Evminov board with use of the Glisson loop in patients with degenerative spine diseases

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Editorial Comment on the Article by Mushkin M.A. et al. “Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases”

The editorial comment evaluates the current state of issue of medical care at urgent states caused by pathological vertebral fractures and spinal cord compression in patients with spine destructive diseases. The rare occurrence of pathology and the deficiency of objective data determine the lack of consensus on the medical care for this category of patients. The article by M.A. Mushkin et al helps to understand how the prehospital pause affects the outcomes of emergency decompression and stabilization procedures in patients with tumor and infectious diseases of the spine, as well as to determine how much time the surgeon has at his disposal. The author of the comment believes that close cooperation of orthopedic surgeons, neurosurgeons, oncologists is necessary to solve this problem. Even despite the absence of oncologists in the staff of emergency hospitals, telemedicine allows to receive methodological support in a timely manner for making a correct decision for each patient. Interaction between clinicians, radiologists and pathologists is equally important. An important aspect is continuity in patient care. An urgently performed spinal cord decompression is only a stage of the complex treatment. Such patients should be provided with accurate routing depending on the diagnosis and the treatment early outcome.

The diamod tip.

This issue 5 is devoted to spine diseases that can be treated or improved by using medical ozone. Dr. Alberto Alexandre compiled during 2015 and 2016 a number of papers from experienced authors in order to prepare a monographic issue but found a lot of difficulty in publishing it. I offered him our Journal to publish these scientific works and he agreed. COVID-19 pandemic has produce a huge increase in publishing time for all journals but we finally have been able to produce this issue. Due to the delay in its publication, some papers have been published by their authors in other journals. We are hardly working in issue 6 that will be opened for different topics and we are preparing issue 7 that we expect to be a monographic on dental applications. All papers are welcomed!

Surgical Treatments for Lumbar Spine Diseases: A Systematic Review and Meta-Analysis

Purpose Surgical treatment is mandatory in some patients with lumbar spine diseases. To obtain spine fusion, many operative techniques were developed with different fusion rates and clinical results. This study aimed to collect randomized controlled trial (RCT) data to compare fusion rate, clinical outcomes, complications among Transforaminal Lumbar Interbody Fusion (TLIF), and other techniques for lumbar spine diseases. Methods A systematic literature search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases was searched for studies up to 13 February 2020. The meta-analysis was done using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complication in TLIF and other techniques for lumbar diseases. Results The literature search identified 3,682 potential studies, 15 RCTs (915 patients) were met our inclusion criteria and were included in the meta-analysis. Compared to other techniques, TLIF had slightly lower fusion rate (RR=0.84 [95% CI 0.72, 0.97], p=0.02, I2=0.0%) at 1-year follow-up while there was no difference on fusion rate at 2-year follow up (RR=1.06 [95% CI 0.96, 1.18], p=0.27, I2=69.0%). The estimated risk ratio of total adverse events (RR=0.90 [95% CI 0.59, 1.38], p=0.63, I2=0.0%) and revision rate (RR=0.78 [95%CI 0.34, 1.79], p=0.56, I2=39.0%) showed no difference. TLIF had approximately half an hour more operative time than other techniques (MD=31.88 [95% CI 5.33, 58.44], p=0.02, I2=92.0%). There was no significant difference between TLIF and other techniques in terms of the blood loss, and clinical outcomes. Conclusions Besides fusion rate at 1-year follow-up and operative time, our study demonstrated similar outcomes of TLIF with other techniques for lumbar diseases in regard to fusion rate, clinical outcomes, and complications.

Pediatric Neurologic Radiology

Chapter 15 examines radiologic images for common pediatric neurologic disorders. These include head and neck disorders such as choanal atresia and congenital piriform aperture stenosis, branchial cleft cysts, thyroglossal duct cyst, fibromatosis colli, and retinoblastoma. The chapter goes on to look at spine diseases such as tethered cord, spinal dysraphism, caudal regression, pars interarticularis defect, and ventriculus terminalis. Brain abnormalities examined include germinal matrix hemorrhage, periventricular leukomalacia, craniosynostosis, and TORCH infection. Intracranial tumors looked at include posterior fossa neoplasms and supratentorial, intraventricular, and suprasellar tumors. Other brain abnormalities include those from trauma, vascular malformations, Dandy-Walker malformation, and migration and proliferation anomalies.

Spectrum of rheumatologic disorders among patients attending with musculoskeletal symptoms: experience from medicine outpatient department of a tertiary care hospital of Bangladesh

Background: Musculoskeletal conditions are prevalent and their impact is pervasive. They are one of the most common causes of long-term pain; affect hundreds of millions of people around the world; they significantly affect the psychosocial status of the affected people as well as their families and carers. This study was done to evaluate the spectrum of rheumatologic disorders among patients attending at medicine outpatient department (OPD) with musculoskeletal symptoms. Methods: This cross-sectional study was done at OPD of Medicine, BIRDEM General Hospital from January 2014 to June 2017. All patients attending at OPD having musculoskeletal symptoms, who fulfilled criteria of definite rheumatologic disease and known rheumatologic disorders were consecutively and purposively included in this study. Results: Total patients were 495 with female predominance (71.31%). Mean age was 48.6 years (range 18-76 years). Among the study population majority had inflammatory joint and spine diseases (69.69%);then degenerative joint and spine diseases (22.02%), connective tissue diseases (2.22).Two-thirds of the patients had rheumatoid arthritis (RA) (76.23%) among inflammatory joint and spine diseases, then ankylosing spondylitis (AS) (13.33%).Regarding connective tissue disease, systemic lupus erythematosus (SLE) was more frequent (45.5%). Among soft tissue rheumatism and metabolic bone disease, all study subjects had fibromyalgia (FM) and osteoporosis respectively. Rheumatoid factor was positive among two-thirds and anti-CCP antibody in twofifths of RA cases, HLA-B27 was positive in 4.3% of AS, antineuclear antibody (ANA) and anti-ds DNA were positive in all SLE patients. Common co-morbidities were diebetes (41.4%), ischaemic heart disease (20.6%) and hypertension (19.1%). Conclusion: RA was the most common inflammatory joint disease. Degenerative diseases were the second most common condition. Common connective tissue disease was SLE. Birdem Med J 2021; 11(2): 116-120

Psoas Major Muscle Volume Does Not Affect the Postoperative Thigh Symptoms in XLIF Surgery

Background: Extreme lateral interbody fusion (XLIF) is a minimally invasive surgery that accesses the lumbar spine through the psoas muscle. This study aimed to evaluate the correlation between the psoas major muscle volume and anterior thigh symptoms after XLIF. Methods: Eighty-one patients (mean age 63 years) with degenerative spine diseases underwent XLIF (total = 94 levels). Thirty-eight patients were female (46.9%), and 24 patients (29.6%) had a history of lumbar surgery. Supplemental pedicle screws were used in 48 patients, and lateral plates were used in 28 patients. Neuromonitoring devices were used in all cases. The patients were classified into two groups (presence of thigh symptoms and no thigh symptoms after the surgery). The psoas major volumes were measured and calculated by CT (computed tomography) scan and compared between the two patient groups. Results: In the first 24 h after surgery, 32 patients (39.5%) had thigh symptoms (20 reported pain, 9 reported numbness, and 18 reported weakness). At one year postoperatively, only 3 of 32 patients (9.4%) had persistent symptoms. Conclusions: As a final observation, no statistically significant difference in the mean psoas major volume was found between the group of patients with new postoperative anterior thigh symptoms and those with no thigh symptoms. Preoperative psoas major muscle volume seems not to correlate with postoperative anterior thigh symptoms after XLIF.