Alexandre Sadao Iutaka

Spinal cord regeneration: the action of neurotrophin-3 in spinal cord injury in rats

OBJECTIVE For many years, it was believed that medullary regeneration could not occur, although currently there are many trials using neurotrophic factors, stem cells, fetal medulla grafts, peripheral nerve grafts, and antibodies against myelin-associated proteins that demonstrate the existence of the possibility of spinal cord regeneration. The purpose of this study was to investigate the action of neurotrophin-3, a novel neurotrophic factor. METHODS The New York University impactor, a standardized device for delivery of spinal cord injuries was used on 33 rats, which were divided into 2 groups: a control group receiving distilled water intraperitoneally and a treatment group receiving neurotrophin-3 intraperitoneally. RESULTS Using the Basso, Beattie, and Bresnahan scale, the locomotor recovery curve for the neurotrophin-3 treated group was superior to that of the control group (P < 0.05); the administration of neurotrophin-3 was associated with the absence of deaths, while the control group showed a 28.5% (P = 0.026) mortality rate. Other parameters (hematuria rate and histological analysis) showed no significant differences. CONCLUSIONS Based on these results, it appears that a strong relationship exists between the use of neurotrophin-3 in rats with spinal cord injury and better functional recovery.

Espondilolistese traumática do áxis: epidemiologia, conduta e evolução

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.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.

Estudo anatômico do trajeto da artéria vertebral na coluna cervical inferior humana

SUMMARY The increasing use of new techniques and materials for surgical treatment of lower cervical spine conditions has come along with an increasing concern regarding potential complications that might occur. The transpedicular fixation technique, frequently used in other spine levels, is used on the cervical spine, while providing more stability than other techniques, it may cause serious complications such as vertebral artery injury, nervous root injury, or facet joint in- juries. However, the C7 vertebra is considered safer for performing this procedure, since, in the vast majority of people, according to available anatomical studies, does not have a vertebral artery passing through its cross-sectional foramen, because that vessel is inserted into such structure only on C6 vertebra. As there are only imaging studies available today for assessing the path of this artery and its anatomical variables, we conducted this anatomical study by dissecting 40 cadavers vertebral arteries in order to assess the incidence of anatomical variations. We found 3 cases where the vertebral artery penetrated into cross-sectional foramen at C7 (7.5%), a fact that enhances the risk of an undesired injury with a transpedicular technique at this level. The other remaining specimens showed a usual anatomy.

Estudo anatômico dimensional do arco posterior de C2 para a instrumentação com parafuso intralaminar

INTRODUCTION: The atlantoaxial joint has stabilizing mechanisms (bones, ligaments and capsules) keeping the anatomic relation between C1-C2. When one or more of those mechanisms fail, in a traumatic or non-traumatic way, an instability atlantoaxial occurs leading to neurologic impairment, pain and cervical mobility limitation. Neurologic impairment and moderate to severe instability may need surgical treatment. Since 1910, a great number of C1-C2 stabilization techniques have been developed, and, even recently, new methods have been developed. New techniques using bilateral screws on C1 lateral mass and C2 laminar screws connected by rods were developed OBJECTIVE: To measure C2 lamina size in order to evaluate the safety and the dimension of the screw used in Wright´s technique. METODS: We conducted an anatomic study with 29 human adult cadavers whose C2 laminas were dissected and measured, in sagittal, coronal and axial planes. RESULTS: The average measure of the external middle portion of C2 lamina was 5,83mm, and 8,93% were below 3,5mm. CONCLUSION: We suggest a tomographic study prior to surgery in order to identify patients with smaller laminas, thus presenting a higher risk.

Tratamento da tuberculose da coluna vertebral: conservador ou cirúrgico?

SUMMARY Much has evolved since Percivall Potts first description of vertebral tuberculosis. However, there still is much controversy regarding the best approaches to prevent deformities. The objectives of this study were to evaluate the clinical and X-ray characteristics of patients with vertebral tuberculosis and to compare the conservative treat- ment alone to the surgical one associated with antibiotic therapy, particularly regarding residual deformity and neurological deficit. A retrospective evaluation of baseline and end-point X-ray studies and of the medical files was performed. The neurological status was evaluated by using the ASIA scale and the deformities were measured using the Cobb method. Thirty-eight patients were evaluated: 11 were surgically treated and 27 received only antibiotics. Fifteen patients presenting neurological deficit showed improvement regardless of the treatment method employed. The mean focal and regional thoracic kyphosis at baseline was 48.8o and 47.86o, respectively. An increased incidence of thoracic deformity was found, also being the most affected segment, from 6.3o focal and 9.8o regional after 5 years. The type of treatment has not interfered on kyphosis pro- gression. Patients below the age of 15 and with kyphosis above 30o had worse prognosis regarding deformity progression.

Estudo retrospectivo das infecções pós-operatórias em cirurgia de coluna: correlação com o número de limpezas cirúrgicas realizadas

OBJECTIVE: To evaluate the characteristics of post-operative infections and determine their resolution in relation to the number of surgical debridement and infectious agents. METHOD: We collected all records of patients who developed post-operative infection for 30 months and several variables were analyzed and correlated. In those 30 months, 40 patients developed post-operative infection of a total of 410 surgeries. We excluded cases of primary infection of the spine (osteomyelitis or spondylodiscitis) totaling 3 cases. Variables related to the patient, procedure and outcome were evaluated and correlated with the key variables: number of surgical debridement and infectious agents isolated from cultures. RESULTS: The rate of infection after surgery was 9.83%. Several variables were related to the number of surgical debridement performed and it was not possible to establish any relationship. However, it was found that patients with higher number of surgical procedures had a higher rate of post-operative pain. CONCLUSION: Patients receiving a greater number of procedures had more post-operative pain . There was no statistically significant correlation between the number of debridement or infectious agents or with other variables. A study with a larger number of patients may be needed to identify other relationships.

Estudo retrospectivo dos resultados da utilização do halo craniano nas fraturas-luxações subaxiais

OBJETIVO: evaluar el uso de halo craneal en fracturas cervicales y luxaciones de los cuidados iniciales, en relacion con el porcentaje de reduccion cerrada con exito de las lesiones cervicales en los diferentes tipos de fracturas. METODOS: investigacion retrospectiva de los informes de los pacientes ingresados y tratados desde enero de 2004 hasta marzo de 2009, en un total de 222 pacientes, las lesiones se clasificaron segun la clasificacion AO. RESULTADOS: se encontro un alto porcentaje de exito de la reduccion cerrada en pacientes con lesiones cervicales por compresion axial (AO tipo A), en el uso de halo craneal; en las lesiones por distraccion (AO tipo B) y el movimiento de rotacion (AO tipo C) se observo aproximadamente el 50% de la reduccion cerrada de la luxacion. Por otra parte, las lesiones en los niveles mas craneales tienen una tasa de exito mayor en su reduccion. CONCLUSION: el uso del halo craneal es alentado porque, ademas de realizar un papel en la atencion inicial inmovilizador, produce resultados satisfactorios en el intento de reduccion cerrada de la lesion cervical, mejorando la comodidad del paciente, facilitando el abordaje quirurgico y los cuidados posteriores del equipo de enfermeria.ABSTRACT Objective: to evaluate the use of cranial halo cervical fractures and dislocations in the initial care related to the rate of successful closed reduction of cervical lesions in different types of fractures. Methods: retrospective investigation of reports of patients admitted and treated from January 2004 to March 2009, a total of 222 patients. The lesions were categorized according to the AO classification. Results: a high success rate of closed reduction in patients with cervical lesions by axial compression (AO type A) in the use of cranial halo; in distraction injuries (AO type B) and rotational motion (AO type C) we observed approximately 50% of closed reduction of dislocation; furthermore, lesions in more cranial levels have a higher RESUMEN Objetivo: evaluar el uso de halo craneal en fracturas cervicales y luxaciones de los cuidados iniciales, en relacion con el porcentaje de reduccion cerrada con exito de las lesiones cervicales en los diferentes tipos de fracturas. Metodos:

The choice of surgical approach for treatment of cervical fractures

OBJETIVO: definir las caracteristicas epidemiologicas de la poblacion victima, clasificar las fracturas subaxiales, y analizar como los tratamientos quirurgicos fueron realizados, teniendo ellos mismos como resultado la manera quirurgica elegida - anterior, posterior o combinada -, y juntar estos datos para observar estandares del tratamiento para el cuidado optimo de esta gente enferma. METODOS: analisis retrospectiva en prontuarios medicos de 222 pacientes atendidos y tratados, entre 2004 y Marzo de 2009 con fracturas, fracturas-luxaciones y luxaciones cervicales. De estos 222 pacientes, 163 correspondieron a los que tenian fracturas subaxiales clasificables por el metodo AO, es decir, aproximadamente un 73.4% del total. RESULTADOS: los 83% de los pacientes eran hombres y el aproximadamente 78% tenian entre 21 y 60 anos de la edad. Habian sido clasificados como Tipo A, 54 pacientes, el 50% habian sido operados - el 85.18%, via anterior, con corpectomia asociada o no a la artrodese; fueron clasificados como Tipo B, 77 pacientes, y el 85.7% que habian sido operados - el 77.3% via posterior, teniendo en cuenta el lesion ligamentar; como Tipo C, 21 pacientes fueron clasificados, y el 81% que habian sido operados - el 94.1% de la via posterior; y como Niveles Multiples, 11 pacientes fueron considerados, 54.5% fueron operados - el 83.3% de la via posterior, ningun por la via anterior sola. CONCLUSION: los datos obtenidos pueden contribuir con la normalizacion del cuidado del paciente con traumatismo cervical y tornar los resultados mas predecibles. La experiencia acumulada y invertida en numeros facilitara la eleccion de los medios quirurgicos.

Retrospective results analysis of the use of cranial fractures halo subaxial dislocations

OBJETIVO: evaluar el uso de halo craneal en fracturas cervicales y luxaciones de los cuidados iniciales, en relacion con el porcentaje de reduccion cerrada con exito de las lesiones cervicales en los diferentes tipos de fracturas. METODOS: investigacion retrospectiva de los informes de los pacientes ingresados y tratados desde enero de 2004 hasta marzo de 2009, en un total de 222 pacientes, las lesiones se clasificaron segun la clasificacion AO. RESULTADOS: se encontro un alto porcentaje de exito de la reduccion cerrada en pacientes con lesiones cervicales por compresion axial (AO tipo A), en el uso de halo craneal; en las lesiones por distraccion (AO tipo B) y el movimiento de rotacion (AO tipo C) se observo aproximadamente el 50% de la reduccion cerrada de la luxacion. Por otra parte, las lesiones en los niveles mas craneales tienen una tasa de exito mayor en su reduccion. CONCLUSION: el uso del halo craneal es alentado porque, ademas de realizar un papel en la atencion inicial inmovilizador, produce resultados satisfactorios en el intento de reduccion cerrada de la lesion cervical, mejorando la comodidad del paciente, facilitando el abordaje quirurgico y los cuidados posteriores del equipo de enfermeria.ABSTRACT Objective: to evaluate the use of cranial halo cervical fractures and dislocations in the initial care related to the rate of successful closed reduction of cervical lesions in different types of fractures. Methods: retrospective investigation of reports of patients admitted and treated from January 2004 to March 2009, a total of 222 patients. The lesions were categorized according to the AO classification. Results: a high success rate of closed reduction in patients with cervical lesions by axial compression (AO type A) in the use of cranial halo; in distraction injuries (AO type B) and rotational motion (AO type C) we observed approximately 50% of closed reduction of dislocation; furthermore, lesions in more cranial levels have a higher RESUMEN Objetivo: evaluar el uso de halo craneal en fracturas cervicales y luxaciones de los cuidados iniciales, en relacion con el porcentaje de reduccion cerrada con exito de las lesiones cervicales en los diferentes tipos de fracturas. Metodos:

Escolha da via cirúrgica para tratamento das fraturas cervicais

OBJETIVO: definir las caracteristicas epidemiologicas de la poblacion victima, clasificar las fracturas subaxiales, y analizar como los tratamientos quirurgicos fueron realizados, teniendo ellos mismos como resultado la manera quirurgica elegida - anterior, posterior o combinada -, y juntar estos datos para observar estandares del tratamiento para el cuidado optimo de esta gente enferma. METODOS: analisis retrospectiva en prontuarios medicos de 222 pacientes atendidos y tratados, entre 2004 y Marzo de 2009 con fracturas, fracturas-luxaciones y luxaciones cervicales. De estos 222 pacientes, 163 correspondieron a los que tenian fracturas subaxiales clasificables por el metodo AO, es decir, aproximadamente un 73.4% del total. RESULTADOS: los 83% de los pacientes eran hombres y el aproximadamente 78% tenian entre 21 y 60 anos de la edad. Habian sido clasificados como Tipo A, 54 pacientes, el 50% habian sido operados - el 85.18%, via anterior, con corpectomia asociada o no a la artrodese; fueron clasificados como Tipo B, 77 pacientes, y el 85.7% que habian sido operados - el 77.3% via posterior, teniendo en cuenta el lesion ligamentar; como Tipo C, 21 pacientes fueron clasificados, y el 81% que habian sido operados - el 94.1% de la via posterior; y como Niveles Multiples, 11 pacientes fueron considerados, 54.5% fueron operados - el 83.3% de la via posterior, ningun por la via anterior sola. CONCLUSION: los datos obtenidos pueden contribuir con la normalizacion del cuidado del paciente con traumatismo cervical y tornar los resultados mas predecibles. La experiencia acumulada y invertida en numeros facilitara la eleccion de los medios quirurgicos.