André Luiz Passos Cardoso

Evaluation of the quality of life after vertebroplasty to treat compressive osteoporotic fractures.

Objective with increasing life expectancy around the world, fractures due to osteoporosis have become more common and the expenditure for treating them has also increased. The aim here was to evaluate the improvement in pain and quality of life among patients with compressive osteoporotic vertebral fractures undergoing vertebroplasty. Methods eighteen patients with 27 fractured vertebrae underwent vertebroplasty and were evaluated using the Oswestry 2.0 limitations questionnaire before the operation and 24 h and six months after the operation. Results there was a 75% improvement in pain and quality of life, going from a mean preoperative Oswestry of 40% to 10% 24 h after the operation and 9% six months after the operation (p ≤ 0.05). Conclusion vertebroplasty is effective in managing compressive osteoporotic vertebral fractures, with improvement in pain and quality of life in the immediate postoperative period and over the medium term.

Primary liposarcoma of the lumbar spine: case report

We report a rare case of primary bone liposarcoma of the lumbar spine, for which only one case has been reported. A female patient, 60 years of age, with lumbar pain and left sciatalgy for six months. In the imaging exams, a destructive tumor was found in the L4 vertebral body, and magnetic resonance imaging (MRI) revealed a tumoral lesion with T1 hiposignal and T2 hypersignal. Histological diagnosis was difficult, and immunohistochemistry confirmed the diagnosis. Surgical treatment was performed with wide ressection, spinal cord decompression, and anterior and posterior fusion of L3 to L5 complemented by radiotherapy and chemotherapy. After three years, a computed tomography (CT) scan evidenced an expansive injury in the lung. Despite its rarity, liposarcoma should be considered in the differential diagnosis of sciatica and primary tumors of the spine.

Lipossarcoma primário ósseo da coluna lombar: relato de caso

Relatamos um caso raro de lipossarcoma primario osseo da coluna lombar, do qual encontramos apenas um relato semelhante na literatura. Paciente do sexo feminino, 60 anos de idade, com clinica de lombociatalgia a esquerda ha aproximadamente seis meses. Nos exames de imagem foi encontrado um tumor destrutivo do corpo vertebral de L4 e a ressonância nuclear magnetica (RNM) revelou uma lesao tumoral com hipossinal em T1 e hipersinal em T2. O diagnostico histologico foi dificil e a imuno-histoquimica confirmou o diagnostico. O tratamento cirurgico foi realizado com resseccao ampla, descompressao da medula espinhal, fusao anterior e posterior de L3 a L5, complementada pela radioterapia e quimioterapia. Apos tres anos, uma tomografia computadorizada (TC) evidenciou lesao expansiva no pulmao. Apesar de sua raridade, o lipossarcoma deve ser considerado no diagnostico diferencial de ciatalgia e dos tumores primarios da coluna vertebral.

Avaliação clínica e radiográfica da cifoplastia no tratamento das fraturas vertebrais por osteoporose

RESUMO Objetivo: analisar os resultados clínicos, radiológico e possíveis complicações de pacientes submetidos à cifoplastia no tratamento das fraturas por osteoporose dolorosas que não respondem ao tratamento conservador. Métodos: foram avaliados 24 pacientes com fraturas osteoporóticas tratados através da cifoplastia. Destes, 19 (76%) eram do sexo feminino e 5 (24%) do masculino. A média de idade foi de 71,3 anos. A média de seguimento foi de 19 meses, variando de 3 a 29 meses. Os pacientes foram avaliados em relação à dor por meio da escala visual analógica (EVA) no pré-operatório e no último dia de seguimento. Também foi realizada uma análise radiográfica na qual se comABSTRACT Objective: to evaluate clinical and radiological results and complications of patients undergoing kyphoplasty in the treatment of painful osteoporotic fractures. Methods: twenty-four patients with painful osteoporotic fractures were submitted do Kyphoplasty. Out of these, 19 (74%) were female and 5 (24%) were male. Mean age was of 71.3 years. The average follow-up (FU) was of 19 months (3 to 29). The pain was analyzed through visual analogic scale (VAS) in the pre-operative and the last follow-up visit. Radiographic analyses were made in the preop and the last FU visit using the amount of improvement in anterior vertebral body height (A), medium RESUMEN Objetivo: analizar los resultados clínicos, radiológicos y posibles complicaciones de pacientes sometidos a la cifoplastia en el tratamiento de las fracturas por osteoporosis dolorosas que no responden al tratamiento conservador. Métodos: fueron evaluados 24 pacientes con fracturas osteoporóticas tratados por medio de la cifoplastia. De éstos, 19 (el 76%) fueron del sexo femenino y cinco (el 24%) del masculino. La edad promedio fue de 71.3 años. El promedio de seguimiento fue de 19 meses, variando de 3 a 29 meses. Los pacientes fueron evaluados en relación al dolor por medio de la escala visual analógica (EVA) en el pre operatorio y en el último día de seguimiento. También fue realizado un análisis radiográfico en el cual seOBJETIVO: analisar os resultados clinicos, radiologico e possiveis complicacoes de pacientes submetidos a cifoplastia no tratamento das fraturas por osteoporose dolorosas que nao respondem ao tratamento conservador. METODOS: foram avaliados 24 pacientes com fraturas osteoporoticas tratados atraves da cifoplastia. Destes, 19 (76%) eram do sexo feminino e 5 (24%) do masculino. A media de idade foi de 71,3 anos. A media de seguimento foi de 19 meses, variando de 3 a 29 meses. Os pacientes foram avaliados em relacao a dor por meio da escala visual analogica (EVA) no pre-operatorio e no ultimo dia de seguimento. Tambem foi realizada uma analise radiografica na qual se comparou o ganho de altura do muro anterior (A), terco medio do corpo vertebral (M), muro posterior (P) e ganho de cifose local (C). RESULTADOS: foram analisados 24 pacientes com 34 fraturas. Destes, 15 (62,5%) apresentavam fratura unica e 9 (37,5%) apresentavam fraturas multiplas. Dessas fraturas, 20 (58,8%) eram na coluna toracica e 14 (42,2%) lombares. A media do EVA no pre-operatorio era de 9,3, passando para 3,2 no ultimo seguimento (melhora de 6,1 pontos). O ganho medio de altura do corpo vertebral foi de 0,73 mm na porcao anterior, 1,3 mm na porcao media e 0,5 mm na porcao posterior. A melhora da cifose foi, em media, de 1,32o - de 11,06o no pre para 12,4o no pos-operatorio. Em relacao a complicacoes, houve um caso de extravasamento do cimento para o espaco discal superior, assintomatico e um caso de fratura do nivel adjacente tratado com nova cifoplastia. CONCLUSAO: a cifoplastia se mostrou uma tecnica cirurgica segura e efetiva para o tratamento da dor. Nao foi observado ganho significativo da altura vertebral e da cifose vertebral.

Deformidade de Sprengel: tratamento cirúrgico pela técnica de green modificada

aBSTRaCT Objective: To evaluate the cosmetic and functional results of pa-tients submitted to surgical correction of Congenital High Scap-ula (Sprengel’s Deformity) using modified Green’s Procedure, as well as patients’ satisfaction and complications. Methods: Nine patients submitted to surgical treatment from September 1993 to April 2008 have been assessed. The modification from original technique was: subperiosteal muscle detachment, resection of superomedial scapular portion and fixation of medial portion of scapular spine to contralateral posterior iliac crest instead of skeletal traction, with subcutaneous wire. The mean age was 7 years and 3 months. The mean follow-up time was 3 years and 7 months. Results: The mean improvement in forward elevation was 39o (range 0 to 80o). According to the Cavendish Clas-sification, cosmetic improvement of two degrees was achieved in eight cases, and three degrees in one. All patients were satis-fied with results. Conclusions: Surgical correction of Sprengel’s Deformity by a modified Green’s procedure with contralateral posterior iliac crest fixation instead of skeletal traction, showed both cosmetic and functional improvements; all patients and/or family members were satisfied with the results, and the compli-cations associated to the surgical technique did not interfere on end results.

Resultados y complicaciones de la vertebrectomía por vía posterior después de 2 años seguimiento

OBJECTIVE: To describe the surgical technique for vertebrectomy by posterior single approach in the thoracic and thoracolumbar spine with circumferential reconstruction and arthrodesis, and evaluate retrospectively the results and complications after 2 years of follow-up in patients undergoing this technique.METHODS: Retrospective analysis of medical records and imaging studies of 12 patients with vertebrectomy indication for various pathologies, undergoing this surgical technique.RESULTS: Eight (66.67%) patients were male and four patients (33.33%) were females aged 13-66 years (mean 40 years). There were nine patients with involvement of the thoracic spine and three of the lumbar, and one patient with two consecutive vertebrae affected. All patients had improved or remained with the neurological condition. Surgical complications were two cases of hemothorax, two cases of loosening of the screws, one of them requiring surgical revision, and a case of material failure and pseudarthrosis.CONCLUSION: Vertebrectomy by posterior approach in thoracolumbar spine with circumferential reconstruction and fusion can be performed safely for a variety of indications.

Resultados e complicações da vertebrectomia por via posterior após 2 anos de seguimento

OBJECTIVE: To describe the surgical technique for vertebrectomy by posterior single approach in the thoracic and thoracolumbar spine with circumferential reconstruction and arthrodesis, and evaluate retrospectively the results and complications after 2 years of follow-up in patients undergoing this technique.METHODS: Retrospective analysis of medical records and imaging studies of 12 patients with vertebrectomy indication for various pathologies, undergoing this surgical technique.RESULTS: Eight (66.67%) patients were male and four patients (33.33%) were females aged 13-66 years (mean 40 years). There were nine patients with involvement of the thoracic spine and three of the lumbar, and one patient with two consecutive vertebrae affected. All patients had improved or remained with the neurological condition. Surgical complications were two cases of hemothorax, two cases of loosening of the screws, one of them requiring surgical revision, and a case of material failure and pseudarthrosis.CONCLUSION: Vertebrectomy by posterior approach in thoracolumbar spine with circumferential reconstruction and fusion can be performed safely for a variety of indications.

Results and complications of vertebrectomy with posterior approach after 2-year follow-up

OBJECTIVE: To describe the surgical technique for vertebrectomy by posterior single approach in the thoracic and thoracolumbar spine with circumferential reconstruction and arthrodesis, and evaluate retrospectively the results and complications after 2 years of follow-up in patients undergoing this technique.METHODS: Retrospective analysis of medical records and imaging studies of 12 patients with vertebrectomy indication for various pathologies, undergoing this surgical technique.RESULTS: Eight (66.67%) patients were male and four patients (33.33%) were females aged 13-66 years (mean 40 years). There were nine patients with involvement of the thoracic spine and three of the lumbar, and one patient with two consecutive vertebrae affected. All patients had improved or remained with the neurological condition. Surgical complications were two cases of hemothorax, two cases of loosening of the screws, one of them requiring surgical revision, and a case of material failure and pseudarthrosis.CONCLUSION: Vertebrectomy by posterior approach in thoracolumbar spine with circumferential reconstruction and fusion can be performed safely for a variety of indications.

Pattern of involvement of the cervical column in rheumatoid arthritis: a 6 year follow up

OBJETIVOS: Fue evaluado el cuadrode afectacion cervical en pacientes con diagnostico de artritis reumatoidea, correlacionando los hallazgos de imagen con cuadro neurologico, medicacion utilizada, tiempo de evolucion de la enfermedad, edad del paciente alinicio de la enfermedad, examenes de laboratorio y cuadro clinico. METODOS: Ese mismo grupo de pacientes habia sido estudiado 6 anos antes, y esos datos recolectados fueron comparados para evaluar si hubo un empeoramiento del cuadrode afectaciona lo largo del tiempo. Se hicieron radiografias simples de la columna cervical, en las incidencias antero posterior, perfil neutro y dinamico. La clasificacion de Ranawat fue utilizada para evaluar la sintomatologia dolorosa y la involucracion neurologica. Se utilizaron las pruebas de regresion logistica univariada (p<0,05). RESULTADOS: Evaluados 24 de los 35 pacientes que formaron parte de la muestra anterior, habiendo perdida de seguimiento de 7. Encontramos algunas correlaciones estadisticamente significativas: reflejo bicipital (p=0,049) y metodo de Ranawat (p=0,023, en el Rayo X en extension a p=0,034, en el Rayo X neutro) con columna estable, erosion del odontoide (p=0,048) y subluxacion lateral (p=0,022) con inestabilidad atlanto-axial y senal de Lhermithe (p=0,025) con invaginacion basilar. Se ha encontrado inestabilidad cervical en un 66,6% (16/24), habiendo un aumento significativamente estadistico de la inestabilidad subaxial en los ultimos 6 anos p=0,032). CONCLUSIONES: En orden decreciente, las inestabilidades han sido estas: subluxacion atlantoaxial con un 50%, subluxacion subaxial, con un 41,6% e invaginacion basilar, con un 16,6%. Hubo un aumento en el numero de pacientes con inestabilidad subaxial, aunque no se ha observado correlacion de ese tipo de inestabilidad con el nivel de edad de afectacion. Tampoco se ha observado correlacion del reflejo bicipital con cualquier tipo de inestabilidad, sino con la columna cervical estable, resultado distinto del que habia sido encontrado en la serie anterior.

Padrão de acometimento da coluna cervical na artrite reumatoide: seguimento de 6 anos

OBJETIVOS: Fue evaluado el cuadrode afectacion cervical en pacientes con diagnostico de artritis reumatoidea, correlacionando los hallazgos de imagen con cuadro neurologico, medicacion utilizada, tiempo de evolucion de la enfermedad, edad del paciente alinicio de la enfermedad, examenes de laboratorio y cuadro clinico. METODOS: Ese mismo grupo de pacientes habia sido estudiado 6 anos antes, y esos datos recolectados fueron comparados para evaluar si hubo un empeoramiento del cuadrode afectaciona lo largo del tiempo. Se hicieron radiografias simples de la columna cervical, en las incidencias antero posterior, perfil neutro y dinamico. La clasificacion de Ranawat fue utilizada para evaluar la sintomatologia dolorosa y la involucracion neurologica. Se utilizaron las pruebas de regresion logistica univariada (p<0,05). RESULTADOS: Evaluados 24 de los 35 pacientes que formaron parte de la muestra anterior, habiendo perdida de seguimiento de 7. Encontramos algunas correlaciones estadisticamente significativas: reflejo bicipital (p=0,049) y metodo de Ranawat (p=0,023, en el Rayo X en extension a p=0,034, en el Rayo X neutro) con columna estable, erosion del odontoide (p=0,048) y subluxacion lateral (p=0,022) con inestabilidad atlanto-axial y senal de Lhermithe (p=0,025) con invaginacion basilar. Se ha encontrado inestabilidad cervical en un 66,6% (16/24), habiendo un aumento significativamente estadistico de la inestabilidad subaxial en los ultimos 6 anos p=0,032). CONCLUSIONES: En orden decreciente, las inestabilidades han sido estas: subluxacion atlantoaxial con un 50%, subluxacion subaxial, con un 41,6% e invaginacion basilar, con un 16,6%. Hubo un aumento en el numero de pacientes con inestabilidad subaxial, aunque no se ha observado correlacion de ese tipo de inestabilidad con el nivel de edad de afectacion. Tampoco se ha observado correlacion del reflejo bicipital con cualquier tipo de inestabilidad, sino con la columna cervical estable, resultado distinto del que habia sido encontrado en la serie anterior.