CLINICAL OUTCOMES OF PATIENTS UNDERGOING CORRECTION OF NEUROMUSCULAR SCOLIOSIS WITH A CONTROLLED HOSPITAL PROTOCOL – PRELIMINAR OUTCOMES

ABSTRACT Objectives: To identify the main hospital outcomes of patients undergoing surgical correction of neuromuscular scoliosis and to assess complication rates and achievement of mobility goals after the use of a managed protocol. Methods: This is a longitudinal, retrospective study, with data obtained six months after the application of a protocol in 103 patients of both sexes submitted to surgical correction of neuromuscular scoliosis, at a tertiary level hospital in São Paulo, between June and December 2018 (pre-protocol) and between May and September 2019 (post-protocol). Data from patients who had previously undergone other orthopedic spine surgeries were excluded. In addition to the data for epidemiological characterization of the underlying diseases, the clinical characteristics and complications were analyzed. Results: Of the 103 patients evaluated, there was a predominance of females (53.4%) and a mean age of 14.9 years. The most frequent diagnosis was cerebral palsy, the mean angle of curvature was 75°, and the most frequently observed comorbidities were lung diseases (25%). The protocol was partially adhered to by professionals and after its implementation, there was a significant decrease in pain and the systemic inflammatory response syndrome (SIRS), prevention of immobility and a low rate of infection. Conclusions: The use of a protocol focused on patients undergoing correction of neuromuscular scoliosis led to reduced complications of SIRS and reduced pain; kept the surgical site infection rate low, and prevented short-term immobility. Level of evidence III; Retrospective study.

CORRELATION BETWEEN LOW BACK PAIN DUE TO FATTY DEGENERATION AND SEX AND AGE: STUDY BY MRI

ABSTRACT Objective: To correlate low back pain caused by fatty degeneration, visualized by magnetic resonance imaging (MRI), with sex and age. Methods: With a timeframe of 2015 to 2020, data on sex and age of fifty symptomatic patients with low back pain were collected from medical records and correlated with MRI analyses showing the occurrence of fatty infiltration in the paraspinal and erector muscles. Three trained observers, using the classification of Goutallier et al. (1994), analyzed five lumbar levels and the degree of injury. The Kolmogorov-Smirnov, Shapiro Wilk, Student's t, Mann-Whitney and Spearman correlation tests were used, all with a 5% significance level. Results: Among the cases, the L5-S1 level was found in all the images, with a prevalence of 46% of grades 1 and 2 and 24% in the five lumbar levels. Severity was present in a small portion (8%) of the injuries. There was a predominance of 78% women, with significantly more severe injuries in relation to the number of levels (p < 0.001) and injuries of a higher degree (p < 0.001). The age range was 14 to 38 years (mean = 26.70 ± 5.70 years), showing a significant and moderate correlation between the number of levels reached and a greater degree of degeneration (p < 0.001). Conclusion: Fatty degeneration as a cause of low back pain was significantly more severe in women in terms to the number of levels and the higher degree of injury. The number of levels and the severity of fatty degeneration were not correlated with the patient's age. Level of evidence II; Retrospective Study.

COMPARISON BETWEEN START BACK SCREENING TOOL AND DRAM FOR DETECTION OF PSYCHOSOCIAL FACTORS IN LOW BACK PAIN

ABSTRACT Objective: To correlate the results of the STarT Back Screening Tool and DRAM questionnaires, applied simultaneously, in a population with low back pain. Methods: Comparative cross-sectional study with 84 participants with low back pain assessed by both STarT Back Screening Tool (SBST) and DRAM questionnaires. The degree of correlation between the two questionnaires was analyzed through the evaluation of individualized data and using the Spearman correlation coefficient. Results: According to the DRAM, 19% of the patients were classified as “normal”, 32.1% as “at risk” and 48.8% as “distressed”. According to SBST, 59.5% of patients were classified as “low risk”, 31% as “medium risk” and 9.5% as “high risk”. Applying the Spearman's coefficient to evaluate the degree of correlation between the two questionnaires, a value of 0.4 was obtained. This shows that there is a positive, but weak, correlation (p <0.001) between the two questionnaires. Conclusion: There is a positive correlation between the two questionnaires, but the DRAM showed a greater tendency to classify patients with some degree of psychological distress when compared to the SBST. Both questionnaires are effective in identifying these factors, but the data suggest that the DRAM may be more effective as a screening tool in patients with low back pain, in view of the higher number of patients identified. Level of evidence III; Diagnostic test study.

PERCUTANEOUS INSTRUMENTATION WITHOUT ARTHRODESIS FOR THORACOLUMBAR BURST FRACTURES (A3/A4, B): A RETROSPECTIVE STUDY

ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.

EPIDEMIOLOGY OF VERTEBRAL SPINE FRACTURES IN A HOSPITAL IN SÃO PAULO IN THE TWO-YEAR PERIOD 2017-2018

ABSTRACT Objectives: To evaluate the epidemiological profile of patients with spinal fractures over a two-year period (2017 and 2018) in a quaternary hospital in the city of São Paulo. Methods: A cross-sectional study was carried out through the analysis of the electronic medical records of patients treated by the Spine group of the Department of Orthopedics and Traumatology at the Orthopedics and Traumatology Emergency Room of Hospital das Clínicas de São Paulo in the years 2017 and 2018. Results: A total of 185 patients were evaluated over two years. Males were the gender most frequently evaluated (69.19%), and the mean patient age was 43.95 years. The most common trauma mechanisms were falls from a height (45.95%) and traffic accidents (29.73%). The cervical spine, affected in 28.65%, was the most affected region, followed by the thoracolumbar region (26.56%). Most patients did not present deficits at the initial moment (71.89%) and 54.05% of patients underwent surgery for treatment. Conclusion: Most traumas involving the spine affect adults of working age (from 20 to 60 years old), with a predominance of males. Most injuries occurred in the cervical region, which is the region most commonly associated with severe trauma and neurological injuries. This study can help in planning prevention and precaution strategies for spinal trauma. Level of evidence III; Cross-sectional study.

THE PREVALENCE OF HETEROTOPIC OSSIFICATION AMONG PATIENTS AFTER CERVICAL DISK ARTHROPLASTY AT 5 YEARS

ABSTRACT Objective: This study was designed to evaluate the prevalence and grading of heterotopic ossification (HO) at five years, among patients after cervical disk arthroplasty (CDA). Methods: The CDA procedure with Activ C and M6-C prostheses was performed on 127 patients. The mean age of the cohort of patients was 38.4 years (range 18-49). The mean follow-up time was 58.4 months, ranging from 51 to 66 months. Results: Grade 1 ossifications were present in 11 (8.6 %) levels. A total of 45 (35.4 %) segments showed grade 2 HO. HO that led to restrictions in range of motion were present in 13 (10.2 %) cases. Five years after surgery, 9 (7.0 %) patients with grade 4 ossifications were found only in the M6-C artificial disk prosthesis group. In the analysis of patient survival following the occurrence of HO, all patients showed median survival of 28.3±5.6 months. The group that received the Activ C artificial disk prosthesis showed statistically longer survival (49.5±7.8 months) than the M6-C disk group. Conclusions: In our study 61.4% of patients exhibited HO after a mean follow-up of 58.4 months. In the analysis of patient survival after HO, all patients showed median survival of 28.3±5.6 months. The group that received the Activ C artificial disk prosthesis showed statistically longer survival (49.5±7.8 months) than the M6-C disk group. Level of evidence III; Cross-sectional Observational Study.

SPINAL DEFORMITY INDEX AND QUALITY OF LIFE OF PATIENTS WITH A DENSITOMETRIC DIAGNOSIS OF OSTEOPOROSIS

ABSTRACT Objective: To evaluate the existence of a possible significant correlation between the quality of life of outpatients with osteoporosis and the Spinal Deformity Index (SDI), a radiographic method for semiquantitative assessment of the spine that enables the identification of prevalent and incident fractures. Methods: A cross-sectional observational study carried out with female patients, Caucasians, over 50 years of age, with a densitometric diagnosis of osteoporosis and in an outpatient follow-up, who were submitted to the Oswestry Disability Index (ODI) and SF-36 questionnaires to measure the direct and indirect damage of vertebral fragility fractures on quality of life. The scores obtained in these questionnaires were correlated with the SDI scores, calculated from the radiographs of the lumbar and thoracic spine. Results: 48 patients completed the study, with a mean age of 69.6±6.7 years, mean body mass index (BMI) of 25.4±3.4 kg/m2, mean ODI of 25.1±17.9%, mean SF- 36 of 428.7±192.4 and mean SDI of 4.3±3. For the statistical analysis, Spearman's coefficient was used (p ≤ 0.05). Conclusion: There is no statistically significant correlation between the SDI and the scores obtained on the ODI and SF-36 quality of life questionnaires. Level of evidence: III. Study of non-consecutive patients, without gold standard, applied uniformly.

SEVERE CERVICAL MYELOPATHY: APPROACHES AND POSTOPERATIVE EVALUATION

ABSTRACT Objectives: To evaluate and compare the clinical evolution of surgical approaches used in patients with severe cervical myelopathy. Methods: Retrospective observational study in which 19 patients with myelopathy who underwent surgery were evaluated. Neurological assessments using the Frankel scale were conducted both preoperatively and one year following surgery, and the modified Japanese Orthopedic Association (JOA), Nurick, and Visual Analog Scale for pain (VAS) questionnaires were applied 1 year after the surgical procedure. Results: 89% of the participants were male and the average age was 63.9 years. No patient had postoperative neurological worsening, 12 patients (63.16%) had mild pain, and seven (36.84%) had moderate pain. The group with degenerative disease showed neurological improvement after surgery and the exclusively anterior approach was used in 84% of the cases, the exclusively posterior approach in 10% of the cases, and the dual approach in 6% of the cases. Conclusion: Surgical treatment has good results for inhibiting the unfavorable natural evolution of myelopathy within 1 year following surgery and promotes neurological improvement in degenerative cases, making it possible to use the anterior access route in most cases. Level of evidence III; Retrospective Study.

COMPLICATIONS OF SURGICAL TREATMENT OF SPINAL METASTASES

ABSTRACT Objectives: To evaluate the complications of surgical treatment in a group of patients with spinal metastasis with epidural compression, undergoing surgical treatment. Methods: This is a comparative retrospective study (level of evidence III), which evaluated 96 patients with spinal metastases undergoing surgical treatment. Intra- and postoperative complications were obtained from the patients’ medical records and correlated with the following clinical characteristics: tumor type, tumor location, neurological deficit, age, number of affected vertebrae, Tokuhashi scale, Tomita scale, Karnofsky performance scale, and type of approach. Results: Complications of surgical treatment were observed in 29 (30.20%) patients. Surgical wound infection was the most frequent complication, observed in 15% of patients. Conclusions: Surgical treatment of spinal metastases presents complications in about 30% of patients and their occurrence should be considered in the treatment planning, weighing the risks and benefits for achieving the treatment goals. Level III evidence; Retrospective Study.

ANATOMICAL STUDY OF THE IDEAL POSITIONING OF THE S2 ILIAC SCREW

ABSTRACT Objective: To evaluate the morphometry of the pelvis to determine the safe trajectory for the insertion of the S2-iliac screw, and to correlate it with studies reported in the literature for other populations. Method: The computed tomography (CT) pelvic exams of 36 Brazilian patients without congenital malformations, tumors, pelvic ring fractures or dysplasias were selected from the database of a radiological clinic. To define the ideal trajectory of the S2-iliac screw, the following variables were measured: 1- maximum sacroiliac screw length; 2- thickness of the iliac dipole for planning the choice of screw dimensions (length and diameter); 3 - distance between the insertion point of the iliac S2 screw and the posterior sacral cortex; 4 - angulation for insertion of the screw in the mediolateral direction, representing the angle formed between the “iliac line” and the anatomical sagittal plane; 5- Angulation for insertion of the screw in the craniocaudal direction. The Pearson's chi squared and student's t tests were used for statistical analysis. Results: The sample consisted of 36 patients, 50% (18/36) of whom were women. The mean age was 63.7 years, ranging from 23 to 96 years. All the pelvic morphometric variables analyzed presented values similar to those described in the literature for other populations. Conclusion: Prior evaluation of the tomography exams was important for preoperative planning, and there was a statistically significant difference between the sexes only in relation to the variables left craniocaudal and length of the left internal table. Level of evidence III; Observational cross-sectional study.