Fabrício Hidetoshi Ueno

Pain and quality of life in patients undergoing radiotherapy for spinal metastatic disease treatment

Background Radiotherapy is an important tool in the control of pain in patients with spinal metastatic disease. We aimed to evaluate pain and of quality of life of patients with spinal metastatic disease undergoing radiotherapy with supportive treatment. Methods The study enrolled 30 patients. From January 2008 to January 2010, patients selection included those treated with a 20 Gy tumour dose in five fractions. Patients completed the visual analogue scale for pain assessment and the SF-36 questionnaire for quality of life assessment. Results The most frequent primary sites were breast, multiple myeloma, prostate and lymphoma. It was found that 14 spinal metastatic disease patients (46.66%) had restricted involvement of three or fewer vertebrae, while 16 patients (53.33%) had cases involving more than three vertebrae. The data from the visual analogue scale evaluation of pain showed that the average initial score was 5.7 points, the value 30 days after the end of radiotherapy was 4.60 points and the average value 6 months after treatment was 4.25 points. Notably, this final value was 25.43% lower than the value from the initial analysis. With regard to the quality of life evaluation, only the values for the functional capability and social aspects categories of the questionnaire showed significant improvement. Conclusion Radiotherapy with supportive treatment appears to be an important tool for the treatment of pain in patients with spinal metastatic disease.

Estudo prospectivo de avaliação de dor e incapacidade de pacientes operados de estenose de canal lombar com seguimento mínimo de dois anos

OBJETIVO: realizar uma analise prospectiva de dor e incapacidade em pacientes operados de estenose de canal lombar apos dois anos do procedimento atraves da escala VAS e Roland Morris. METODOS: trinta e oito pacientes foram avaliados por meio dos questionarios em um momento pre-operatorio, pos-operatorio um mes, seis meses, um ano e dois anos, tendo sido realizada descompressao e artrodese com instrumentacao pedicular associada. RESULTADOS: foi observado melhora nas analises comparativas de dor e incapacidade no decorrer do seguimento em relacao aos valores iniciais, porem uma tendencia a estabilizacao do quadro com sua evolucao. CONCLUSAO: o tratamento cirurgico da estenose do canal lombar, quando criteriosamente indicado, melhora a dor e a incapacidade apos dois anos de seguimento.

Avaliação da qualidade de vida em pacientes com escoliose idiopática do adolescente após tratamento cirúrgico pelo questionário SF-36

OBJETIVO: avaliar os pacientes com escoliose idiopatica do adolescente apos tratamento cirurgico, pelo questionario SF-36, comparando-os com questionario realizado no pre-operatorio. METODOS: entre Fevereiro de 2004 a Marco de 2006 foram selecionados 28 pacientes com escoliose idiopatica do adolescente, tratados cirurgicamente pela equipe de cirurgia da coluna do Hospital Mario Covas, em Santo Andre. Todos os pacientes foram submetidos ao tratamento cirurgico por via posterior e artrodese com instrumentacao de terceira geracao. Estes pacientes possuiam descompensacao do tronco e mensuracao do ângulo de Cobb maior que 50o para indicacao cirurgica. Todos eles foram submetidos ao questionario SF-36 no pre-operatorio, este foi repetido em um mes, seis meses, um ano e dois anos apos o tratamento cirurgico. Foi utilizado o programa SPSS (Statistical Package for Social Sciences), versao 13.0, para a analise estatistica dos casos. RESULTADOS: houve diferenca estatistica significante em quatro dominios do SF-36: capacidade funcional, dor, aspecto social e limitacao por aspectos fisicos. Nos dominios saude mental, limitacao por aspectos emocionais, vitalidade e estado geral de saude nao houve diferenca estatistica entre os momentos observados. CONCLUSAO: neste estudo, os pacientes com escoliose idiopatica do adolescente, submetidos a tratamento cirurgico para correcao da deformidade, obtiveram melhora da qualidade de vida em aspectos fisicos avaliados por meio do questionario SF-36.

SACRAL STRESS FRACTURE IN A RUNNER: A CASE REPORT

INTRODUCTION Stress fractures result from cyclic overload and usually affect the bones of the lower extremities. These stress fractures occur most often in athletes and in members of the military. These fractures, which are also known as fatigue fractures, are susceptible to repeated trauma and typically involve the metatarsal bones, femur, tibia, fibula, pelvis or spine. The few cases of sacral stress fractures that have been described in the literature involve young, physically active patients, usually females. Sacral stress fractures [...]

Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar

OBJECTIVE: Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis METHODS: 38 patients operated on for lumbar spinal stenosis and submitted to arthrodesis were evaluated by the Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire. Radiographs were requested to evaluate spinal fusion. RESULTS: An effective improvement was observed between the preoperative period and one year after the operation, in relation to VAS, both in the group that received a bone fusion and in the group with pseudarthrosis. With regard to the Roland Morris questionnaire, there was a tendency towards an improvement in the bone fusion group and a significant improvement in the pseudarthrosis group. CONCLUSION: There was no difference between the groups (bone fusion and pseudarthrosis) in relation to pain and disability. . Level of Evidence: Level II, longitudinal prospective study.

Herniated lumbar disc surgery in triathlon athletes with intraoperative neurophysiologic monitoring.

Intraoperative neurophysiologic monitoring was performed in a patient by somatosensory evoked potential, motor evoked potential and free-running electromyography with intraoperative stimulation. It was verified that after decompression, there was an increase in the amplitude of motor evoked potential responses, showing an immediate improvement of the treated levels. Intraoperative neurophysiologic monitoring for surgical lumbar disc herniation in an athlete allowed a dynamic neurophysiological diagnosis, differentiation of the involvement of compression at the central or foraminal levels, and clinical awareness of the iatrogenic damage, thereby increasing safety.

Biomechanical study of the sacroiliac fracture fixation with titanium rods and pedicle screws

OBJECTIVES: To assess biomechanically different fixations means of the sacroiliac joint with pedicle screws and to compare the traditional head height with reduced ones. METHODS: We used a polyethylene model representing the pelvic ring and simulated a unilateral sacroiliac dislocation. We set up three different constructions: 1) two screws attached to a rod; 2) two rods connected to two small head screws each; and 3) two rods connected to two average headed screws each. We conducted tests in a biomechanical testing and a mechanized processing laboratory. RESULTS: Group 1 supported an average maximum load of 99.70 N. Group 2 supported an average maximum load of 362.46 N. Group 3 endured an average maximum load of 404.15 N. In the assembly with one rod, the resistance decreased as compared with the one with two bars: 72.5 % compared to small-headed screws and 75.3 % to the traditional screw. CONCLUSION: The assembly with a single bar presented inferior results when compared to the double bar assembly. There was no statistical difference in the results between the screws used. Experimental Study.

Análise comparativa histopatológica entre a hérnia de disco contida e extrusa

OBJECTIVE: to investigate histopathological changes such as neovascularization, inflammatory infiltrate, cellularity, apoptosis, mucoid degeneration, granular changes, and calcification in contained and extruded disc herniations, and to compare these differences in the nucleus pulposus and annulus fibrosus. METHODS: 65 lumbar discs were evaluated. These were divided in three groups: 25 cases of extruded herniated discs, 28 cases of contained herniated discs, and 12 cases of discs without degenerative changes. Fragments were removed and separated into annulus fibrosus and nucleus pulposus. Semi-quantitative analysis of histopathologic changes was carried out, using a microscope. RESULTS: in the comparative analysis between annulus fibrosus and nucleus pulposus, no statistical differences were obtained between these groups, showing that both regions are similar. The extruded disc herniation presented a higher proportion of inflammatory infiltrate and neovascularization. Degenerative changes did not present significant variation in relation to disc herniation type. CONCLUSION: There is a relation in disc herniation between neovascularitazion, inflammatory infiltrate and type of disc herniation. There is no histopathologic difference in relation of the portion of intervertebral disc analyzed.

Prospective analysis of pain and disability of patients operated on lumbar spinal stenosis with a minimum two-year follow-up

OBJETIVO: realizar uma analise prospectiva de dor e incapacidade em pacientes operados de estenose de canal lombar apos dois anos do procedimento atraves da escala VAS e Roland Morris. METODOS: trinta e oito pacientes foram avaliados por meio dos questionarios em um momento pre-operatorio, pos-operatorio um mes, seis meses, um ano e dois anos, tendo sido realizada descompressao e artrodese com instrumentacao pedicular associada. RESULTADOS: foi observado melhora nas analises comparativas de dor e incapacidade no decorrer do seguimento em relacao aos valores iniciais, porem uma tendencia a estabilizacao do quadro com sua evolucao. CONCLUSAO: o tratamento cirurgico da estenose do canal lombar, quando criteriosamente indicado, melhora a dor e a incapacidade apos dois anos de seguimento.

Avaliação do posicionamento da aorta em pacientes com escoliose idiopática do adolescente

OBJETIVO: Avaliar o posicionamento da aorta em pacientes com escoliose. METODOS: Foram realizados exames de imagem em pacientes ambulatoriais com escoliose idiopatica do adolescente e em um grupo formado por pacientes higidos, sendo analisados seis parâmetros: comprimento do corpo vertebral, largura, distância aorta-corpo, diâmetro da aorta, distância aorta-canal e ângulo corpo-aorta. RESULTADOS: As curvas variaram entre T3 e L2 com ângulos de Cobb de 46° e 114°. Pela classificacao de Lenke os tipos 1AN e 1BN ocorreram em 20% dos casos, alem de 1CN, 3BN, 3C+ com 13,3 % e 1B+, 3C- com 6,7 %. As vertebras proximas ao apice da curva no grupo escoliose apresentam valores superiores as do grupo controle (em T8 com media de 86,93° no grupo escoliose e media 49,07 no grupo controle (p < 0,0001). CONCLUSAO: Quanto mais proximo do apice da deformidade, maior a postero-lateralizacao da aorta.