Délio Eulálio Martins Filho

Variações na apresentação fenotípica da escoliose idiopática do adolescente

OBJECTIVE: to discuss which elements, according to literature, are responsible for phenotypic discordance in monozygotic twins. METHODS: the data from a pair of female monozygotic twins were gathered. These data included their age at the time of the diagnosis, type of curve, Cobb angle of the deformity at the time of the initial consultation, dates of the start of treatment and the last follow-up, the apex of the curve and Cobb angle measured from radiological images in lateral view. RESULTS: child I: major lumbar curve to the left, with a Cobb angle of 17° between T11 and L4, and a thoracic curve to the right, with an angle of 14° between T5 and T11. The apices were at the L1-L2 disc and at the T8 vertebra, respectively. One year after the first consultation, there had been significant progression of the deformity, with the lumbar curve of 24° (T11-L4) and the thoracic curve of 23° (T5-T11). Child II: small thoracolumbar deformity to the right, which was confirmed radiographically with a Cobb angle of 18° between T9 and L3. The apex was located at the T12 vertebra. One year later, it was observed that the curve had increased, and the Cobb angle had become 40°. CONCLUSION: notwithstanding the evidence for a genetic origin for the development of scoliosis, it is accepted that other factors influence its manifestation and progression. In literature, the development of this disease has been explained in terms of the structural tissue deficiencies found in specific syndromes and conditions, asymmetrical growth of limbs and trunk, changes in sagittal configuration of the spine and factors relating to the environment, such as nutrition.

Variations in the phenotypic presentation of adolescent idiopathic scoliosis

OBJECTIVE: to discuss which elements, according to literature, are responsible for phenotypic discordance in monozygotic twins. METHODS: the data from a pair of female monozygotic twins were gathered. These data included their age at the time of the diagnosis, type of curve, Cobb angle of the deformity at the time of the initial consultation, dates of the start of treatment and the last follow-up, the apex of the curve and Cobb angle measured from radiological images in lateral view. RESULTS: child I: major lumbar curve to the left, with a Cobb angle of 17° between T11 and L4, and a thoracic curve to the right, with an angle of 14° between T5 and T11. The apices were at the L1-L2 disc and at the T8 vertebra, respectively. One year after the first consultation, there had been significant progression of the deformity, with the lumbar curve of 24° (T11-L4) and the thoracic curve of 23° (T5-T11). Child II: small thoracolumbar deformity to the right, which was confirmed radiographically with a Cobb angle of 18° between T9 and L3. The apex was located at the T12 vertebra. One year later, it was observed that the curve had increased, and the Cobb angle had become 40°. CONCLUSION: notwithstanding the evidence for a genetic origin for the development of scoliosis, it is accepted that other factors influence its manifestation and progression. In literature, the development of this disease has been explained in terms of the structural tissue deficiencies found in specific syndromes and conditions, asymmetrical growth of limbs and trunk, changes in sagittal configuration of the spine and factors relating to the environment, such as nutrition.

Discordancia fenotípica en gemelos monocigóticos

OBJECTIVE: to discuss which elements, according to literature, are responsible for phenotypic discordance in monozygotic twins. METHODS: the data from a pair of female monozygotic twins were gathered. These data included their age at the time of the diagnosis, type of curve, Cobb angle of the deformity at the time of the initial consultation, dates of the start of treatment and the last follow-up, the apex of the curve and Cobb angle measured from radiological images in lateral view. RESULTS: child I: major lumbar curve to the left, with a Cobb angle of 17° between T11 and L4, and a thoracic curve to the right, with an angle of 14° between T5 and T11. The apices were at the L1-L2 disc and at the T8 vertebra, respectively. One year after the first consultation, there had been significant progression of the deformity, with the lumbar curve of 24° (T11-L4) and the thoracic curve of 23° (T5-T11). Child II: small thoracolumbar deformity to the right, which was confirmed radiographically with a Cobb angle of 18° between T9 and L3. The apex was located at the T12 vertebra. One year later, it was observed that the curve had increased, and the Cobb angle had become 40°. CONCLUSION: notwithstanding the evidence for a genetic origin for the development of scoliosis, it is accepted that other factors influence its manifestation and progression. In literature, the development of this disease has been explained in terms of the structural tissue deficiencies found in specific syndromes and conditions, asymmetrical growth of limbs and trunk, changes in sagittal configuration of the spine and factors relating to the environment, such as nutrition.

Comparação das alterações do potencial evocado somatosensorial no tratamento cirúrgico da escoliose idiopática entre técnicas com e sem amarrilha sublaminar

OBJECTIVE: to compare the number of events with alteration in the somatosensory evoked potentials (SSEP) and its repercussion between different techniques of surgical treatment for idiopathic scoliosis, with and without sublaminar wiring. METHODS: twenty-five surgical procedures with flexible curves for treatment of idiopathic scoliosis were reviewed in the period of November 1996 to September 1999. They were divided into two groups: without sublaminar wiring (Cotrel-Duboussets system) (Group I); and with sublaminar wiring (Harrington-Luques system and rectangle of Hartshill) (Group II). In all surgeries, the intraoperative neurophysiologic monitoring with Somatosensory Evoked Potentials (SSEPs) was used. RESULTS: according to the findings, a bigger frequency of monitoring changes was observed during and at the end of the surgery in Group II. A high incidence of false-negative changes was also verified. No patient with neurological damages was observed. CONCLUSION: There are still doubts about the safest method for the surgical treatment of idiopathic scoliosis. The results presented in this study suggest a smaller incidence of SSEPs changes in the patients treated with Cotrel-Duboussets system.OBJETIVO: comparar el numero de eventos con alteracion en el potencial evocado somatosensorial (PESS) y su repercusion entre tecnicas de tratamiento quirurgico de la escoliosis idiopatica, con y sin amarilla sublaminar. METODOS: analisis retrospectivo de 25 cirugias de correccion de escoliosis idiopatica, flexibles, realizadas en el periodo de noviembre de 1996 a septiembre de 1999, en las cuales fueron utilizadas tecnicas sin amarilla sublaminar (sistema de Cotrel-Dubousset) (Grupo I) y con amarilla (sistema de Harrington-Luque y asta de Hartshill) (Grupo II). Todas las cirugias fueron realizadas con monitorizacion neurofisiologica de la funcion medular por medio de PESS. RESULTADOS: en el Grupo II fue observada una frecuencia mayor de alteraciones del PESS, tanto en la amplitud como en la latencia de onda, durante y al final de la cirugia. En la serie revista, se constato un elevado porcentaje de resultados falsos-positivos. En ningun paciente fue observada cualquier alteracion neurologica en el postoperatorio. CONCLUSION: esta en discusion cual es el metodo mas seguro para el tratamiento quirurgico de la escoliosis idiopatica. Los resultados presentados en este trabajo sugieren una menor incidencia de alteraciones en la monitorizacion neurofisiologica de la medula en los pacientes tratados por el sistema de Cotrel-Dubousset.

Comparison of the somatosensory evoked potentials changes in the surgical treatment of idiopathic scoliosis between two techniques with and without sublaminar wiring

OBJECTIVE: to compare the number of events with alteration in the somatosensory evoked potentials (SSEP) and its repercussion between different techniques of surgical treatment for idiopathic scoliosis, with and without sublaminar wiring. METHODS: twenty-five surgical procedures with flexible curves for treatment of idiopathic scoliosis were reviewed in the period of November 1996 to September 1999. They were divided into two groups: without sublaminar wiring (Cotrel-Duboussets system) (Group I); and with sublaminar wiring (Harrington-Luques system and rectangle of Hartshill) (Group II). In all surgeries, the intraoperative neurophysiologic monitoring with Somatosensory Evoked Potentials (SSEPs) was used. RESULTS: according to the findings, a bigger frequency of monitoring changes was observed during and at the end of the surgery in Group II. A high incidence of false-negative changes was also verified. No patient with neurological damages was observed. CONCLUSION: There are still doubts about the safest method for the surgical treatment of idiopathic scoliosis. The results presented in this study suggest a smaller incidence of SSEPs changes in the patients treated with Cotrel-Duboussets system.OBJETIVO: comparar el numero de eventos con alteracion en el potencial evocado somatosensorial (PESS) y su repercusion entre tecnicas de tratamiento quirurgico de la escoliosis idiopatica, con y sin amarilla sublaminar. METODOS: analisis retrospectivo de 25 cirugias de correccion de escoliosis idiopatica, flexibles, realizadas en el periodo de noviembre de 1996 a septiembre de 1999, en las cuales fueron utilizadas tecnicas sin amarilla sublaminar (sistema de Cotrel-Dubousset) (Grupo I) y con amarilla (sistema de Harrington-Luque y asta de Hartshill) (Grupo II). Todas las cirugias fueron realizadas con monitorizacion neurofisiologica de la funcion medular por medio de PESS. RESULTADOS: en el Grupo II fue observada una frecuencia mayor de alteraciones del PESS, tanto en la amplitud como en la latencia de onda, durante y al final de la cirugia. En la serie revista, se constato un elevado porcentaje de resultados falsos-positivos. En ningun paciente fue observada cualquier alteracion neurologica en el postoperatorio. CONCLUSION: esta en discusion cual es el metodo mas seguro para el tratamiento quirurgico de la escoliosis idiopatica. Los resultados presentados en este trabajo sugieren una menor incidencia de alteraciones en la monitorizacion neurofisiologica de la medula en los pacientes tratados por el sistema de Cotrel-Dubousset.

Comparación de las alteraciones del potencial evocado somatosensorial en el tratamiento quirúrgico de la escoliosis idiopática entre técnicas con y sin amarilla sublaminar

OBJECTIVE: to compare the number of events with alteration in the somatosensory evoked potentials (SSEP) and its repercussion between different techniques of surgical treatment for idiopathic scoliosis, with and without sublaminar wiring. METHODS: twenty-five surgical procedures with flexible curves for treatment of idiopathic scoliosis were reviewed in the period of November 1996 to September 1999. They were divided into two groups: without sublaminar wiring (Cotrel-Duboussets system) (Group I); and with sublaminar wiring (Harrington-Luques system and rectangle of Hartshill) (Group II). In all surgeries, the intraoperative neurophysiologic monitoring with Somatosensory Evoked Potentials (SSEPs) was used. RESULTS: according to the findings, a bigger frequency of monitoring changes was observed during and at the end of the surgery in Group II. A high incidence of false-negative changes was also verified. No patient with neurological damages was observed. CONCLUSION: There are still doubts about the safest method for the surgical treatment of idiopathic scoliosis. The results presented in this study suggest a smaller incidence of SSEPs changes in the patients treated with Cotrel-Duboussets system.OBJETIVO: comparar el numero de eventos con alteracion en el potencial evocado somatosensorial (PESS) y su repercusion entre tecnicas de tratamiento quirurgico de la escoliosis idiopatica, con y sin amarilla sublaminar. METODOS: analisis retrospectivo de 25 cirugias de correccion de escoliosis idiopatica, flexibles, realizadas en el periodo de noviembre de 1996 a septiembre de 1999, en las cuales fueron utilizadas tecnicas sin amarilla sublaminar (sistema de Cotrel-Dubousset) (Grupo I) y con amarilla (sistema de Harrington-Luque y asta de Hartshill) (Grupo II). Todas las cirugias fueron realizadas con monitorizacion neurofisiologica de la funcion medular por medio de PESS. RESULTADOS: en el Grupo II fue observada una frecuencia mayor de alteraciones del PESS, tanto en la amplitud como en la latencia de onda, durante y al final de la cirugia. En la serie revista, se constato un elevado porcentaje de resultados falsos-positivos. En ningun paciente fue observada cualquier alteracion neurologica en el postoperatorio. CONCLUSION: esta en discusion cual es el metodo mas seguro para el tratamiento quirurgico de la escoliosis idiopatica. Los resultados presentados en este trabajo sugieren una menor incidencia de alteraciones en la monitorizacion neurofisiologica de la medula en los pacientes tratados por el sistema de Cotrel-Dubousset.

Short term results of surgical correction of adolescents' idiopathic scoliosis by posterior approach instrumentation following videothoracoscopic anterior release

OBJETIVO: descrever os resultados imediatos da aplicacao da liberacao anterior por videotoracoscopia, seguida de instrumentacao por via posterior para correcao cirurgica da escoliose idiopatica do adolescente. METODOS: foram selecionados 20 pacientes, no periodo de agosto de 1989 a maio de 2001, com escoliose idiopatica do adolescente, padrao de curva toracica direita rigida, King III. Inicialmente realizou-se a abordagem pela via anterior com liberacao por videotoracoscopia e depois a via posterior para correcao e fixacao com instrumental de Hartshill, em um mesmo tempo cirurgico. RESULTADOS: todos os procedimentos foram completados com sucesso com videotoracoscopia, sem necessidade de conversao para toracotomia. A media de idade dos pacientes foi de 15,7 anos (12 a 21 anos). Em relacao aos dias de internacao, obteve-se um tempo medio de permanencia de 9,45 dias (5 a 26 dias). A media entre os valores angulares foi, no pre-operatorio, de 66,25o Cobb (48o a 92o Cobb), e no pos-operatorio, de 31,2o Cobb (15o a 45o Cobb). Como complicacoes, quatro pacientes tiveram nevralgia intercostal (20%) e um caso de atelectasia (5%). CONCLUSOES: a discectomia por videotoracoscopia e um metodo efetivo e seguro para tornar flexiveis as curvas escolioticas rigidas. No entanto, trata-se de um procedimento tecnicamente dificil, que requer treinamento arduo e prolongado, com curva de aprendizado extensa.

Resultados imediatos da correção cirúrgica de escoliose idiopática do adolescente por via posterior com instrumentação após liberação anterior por videotoracoscopia

OBJETIVO: descrever os resultados imediatos da aplicacao da liberacao anterior por videotoracoscopia, seguida de instrumentacao por via posterior para correcao cirurgica da escoliose idiopatica do adolescente. METODOS: foram selecionados 20 pacientes, no periodo de agosto de 1989 a maio de 2001, com escoliose idiopatica do adolescente, padrao de curva toracica direita rigida, King III. Inicialmente realizou-se a abordagem pela via anterior com liberacao por videotoracoscopia e depois a via posterior para correcao e fixacao com instrumental de Hartshill, em um mesmo tempo cirurgico. RESULTADOS: todos os procedimentos foram completados com sucesso com videotoracoscopia, sem necessidade de conversao para toracotomia. A media de idade dos pacientes foi de 15,7 anos (12 a 21 anos). Em relacao aos dias de internacao, obteve-se um tempo medio de permanencia de 9,45 dias (5 a 26 dias). A media entre os valores angulares foi, no pre-operatorio, de 66,25o Cobb (48o a 92o Cobb), e no pos-operatorio, de 31,2o Cobb (15o a 45o Cobb). Como complicacoes, quatro pacientes tiveram nevralgia intercostal (20%) e um caso de atelectasia (5%). CONCLUSOES: a discectomia por videotoracoscopia e um metodo efetivo e seguro para tornar flexiveis as curvas escolioticas rigidas. No entanto, trata-se de um procedimento tecnicamente dificil, que requer treinamento arduo e prolongado, com curva de aprendizado extensa.

Resultados inmediatos de la corrección quirúrgica de escoliosis idiopática del adolescente por vía posterior con instrumentación después de liberación anterior por videotoracoscopia

OBJETIVO: descrever os resultados imediatos da aplicacao da liberacao anterior por videotoracoscopia, seguida de instrumentacao por via posterior para correcao cirurgica da escoliose idiopatica do adolescente. METODOS: foram selecionados 20 pacientes, no periodo de agosto de 1989 a maio de 2001, com escoliose idiopatica do adolescente, padrao de curva toracica direita rigida, King III. Inicialmente realizou-se a abordagem pela via anterior com liberacao por videotoracoscopia e depois a via posterior para correcao e fixacao com instrumental de Hartshill, em um mesmo tempo cirurgico. RESULTADOS: todos os procedimentos foram completados com sucesso com videotoracoscopia, sem necessidade de conversao para toracotomia. A media de idade dos pacientes foi de 15,7 anos (12 a 21 anos). Em relacao aos dias de internacao, obteve-se um tempo medio de permanencia de 9,45 dias (5 a 26 dias). A media entre os valores angulares foi, no pre-operatorio, de 66,25o Cobb (48o a 92o Cobb), e no pos-operatorio, de 31,2o Cobb (15o a 45o Cobb). Como complicacoes, quatro pacientes tiveram nevralgia intercostal (20%) e um caso de atelectasia (5%). CONCLUSOES: a discectomia por videotoracoscopia e um metodo efetivo e seguro para tornar flexiveis as curvas escolioticas rigidas. No entanto, trata-se de um procedimento tecnicamente dificil, que requer treinamento arduo e prolongado, com curva de aprendizado extensa.