José Lucas Batista Júnior

Quality of life in patients submitted to surgical treatment of idiopathic scoliosis

ABSTRACT OBJECTIVE : To evaluate quality of life, using the SF-36, in patients with adolescent idiopathic scoliosis (AIS) who un-derwent surgery for deformity correction, comparing the results in the pre-and post-operative period. METHODS : We evaluated 29 patients, 24 female, mean age 14.5 years, all patients had measurement of Cobb angle greater than 50º, and responded to the SF-36 questionnaire preope-ratively and on average two years after surgery. RESULTS : There was improvement in all eight domains studied by the SF-36 after surgical treatment, with statistically significant improvement of the domains functional capacity physical aspects, pain and general state. Vitality and mental heal-th were those with the lowest percentage of improvement postoperatively. CONCLUSION : Surgical treatment of defor-mity in all AIS improved the functional aspects assessed by the SF-36, representing, in practice, better quality of life for these patients. Evidence Level II, Prospective Study.

Bone mineral density evaluation among patients with neuromuscular scoliosis secondary to cerebral palsy

Objective To evaluate bone mineral density among patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy. Methods This was a descriptive prospective study in which both bone densitometric and anthropometric data were evaluated. The inclusion criteria used were that the patients should present quadriplegic cerebral palsy, be confined to a wheelchair, be between 10 and 20 years of age and present neuromuscular scoliosis. Results We evaluated 31 patients (20 females) with a mean age of 14.2 years. Their mean biceps circumference, calf circumference and body mass index were 19.4 cm, 18.6 cm and 16.9 kg/m2, respectively. The mean standard deviation from bone densitometry was −3.2 (z-score), which characterizes osteoporosis. Conclusion There is high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.

Comparison of the efficacy of transforaminal and interlaminar radicular block techniques for treating lumbar disk hernia

Objective To compare the interlaminar and transforaminal block techniques with regard to the state of pain and presence or absence of complications. Method This was a randomized double-blind prospective study of descriptive and comparative nature, on 40 patients of both sexes who presented lumbar sciatic pain due to central-lateral or foraminal disk hernias. The patients had failed to respond to 20 physiotherapy sessions, but did not present instability, as diagnosed in dynamic radiographic examinations. The type of block to be used was determined by means of a draw: transforaminal (group 1; 20 patients) or interlaminar (group 2; 20 patients). Results Forty patients were evaluated (17 males), with a mean age of 49 years. There was a significant improvement in the state of pain in all patients who underwent radicular block using both techniques, although the transforaminal technique presented better results than the interlaminar technique. Conclusion Both techniques were effective for pain relief and presented low complication rates, but the transforaminal technique was more effective than the interlaminar technique.

Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia.

Objective to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment. Methods thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that needed to encompass the lumbar spine, sacrum and proximal third of the femur. Results the spinopelvic balance measurements obtained from the mean angles of the population studied, for pelvic incidence, sacral slope and pelvic tilt, were 45°, 36.9° and 8.1°, respectively. The confidence interval for the mean pelvic incidence was from 41.9 to 48.1 (95% CI), thus including a reference value that characterized it as low, for an asymptomatic population, thus confirming that the sample was extracted from a population with this characteristic. Conclusion among these patients with lumbar disk hernias who underwent surgical treatment, the average spinopelvic balance was found to have pelvic incidence lower than what has been reported in the literature for an asymptomatic population.

Assessment of bone density in patients with scoliosis neuromuscular secondary to cerebral palsy

OBJETIVO: Evaluar la densidad mineral osea en pacientes portadores de escoliosis neuromuscular secundaria para paralisis cerebral tetraespastica. METODOS: Estudio prospectivo y descriptivo, en el cual se evaluaron, ademas de la densitometria osea, los datos antropometricos de los pacientes. Como criterio de inclusion adoptamos pacientes con paralisis cerebral tetraespastica, usuarios de silla de ruedas, con edad entre 10 y 20 anos y con escoliosis neuromuscular. RESULTADOS: Evaluamos a 31 pacientes, 20 del sexo femenino, cuyo promedio de edad fue de 14,2 anos. El promedio de la densitometria osea fue -3,2 desvio estandar (Z-score), siendo el promedio de la circunferencia bicipital 19,4 cm, de la pantorrilla 18,6 cm y del IMC, 13,6 kg/m². CONCLUSION: Existe elevada incidencia de osteoporosis en pacientes portadores de escoliosis neuromuscular secundaria para paralisis cerebral tetraespastica.

Correlação clinica entre a mielopatia cervical e o índice de Torg

Objective Cervical myelopathy is a spinal cord dysfunction related to degeneration typical of aging. Its primary pathology is related to ischemia and spinal cord compression. Patients with myelopathy present many clinical problems; more severe cases may lead to quadriplegia if not treated in a timely manner. Because the primary pathology of this disease is caused by compression, thus generating spinal cord ischemia, we believed there must be a correlation between the degree of compression and the clinical assessment of patients with cervical myelopathy, but we did not find any study in the literature that made this correlation. Because there is doubt the literature we aimed, in our study, to analyze the correlation between the degree of clinical impairment of patients with cervical myelopathy and the Torg index. Methods A prospective, descriptive study, evaluating 46 patients, in which radiographic measurements of the Torg index were performed, with clinical analysis through the Nurick and JOA scale. Results Of the 46 study patients included in the study, 100% presented a Torg score <0.8. The decrease in Torg values was directly proportional to clinical worsening on the Nurick and JOA scale. Conclusions The degree of clinical impairment in patients with cervical myelopathy is directly related to the degree of spinal canal stenosis. Level of Evidence I, Prognostic Studies - Investigating the effect of the characteristics of a patient on the outcome of the disease.

Avaliação da qualidade de vida em pacientes submetidos a tratamento cirúrgico de escoliose idiopática

Objetivo: avaliar a qualidade de vida, atraves do questionario SF-36, de pacientes portadores de escoliose idiopatica do adolescente (EIA) submetidos a tratamento cirurgico para correcao da deformidade, comparando os resultados nos periodos pre e pos-operatorio. Metodos: foram avaliados 29 pacientes, sendo 24 do sexo feminino, com media de idade de 14,5 anos, todos com mensuracao do ângulo de Cobb maior que 50o, e que responderam ao questionario SF-36 no periodo pre-operatorio e, em media, dois anos apos a cirurgia. Optamos pelo SF-36 como criterio para avaliacao da qualidade de vida por se tratar de um questionario amplamente utilizado, validado para a lingua portuguesa e de facil entendimento por parte dos pacientes. Alem disso, atraves de seus oito dominios, possibilita uma avaliacao completa dos diversos estados de saude dos pacientes. Resultados: observou-se melhora em todos os oito dominios estudados pelo SF-36 apos o tratamento cirurgico, com significância estatistica nos dominios capacidade funcional, aspectos fisicos, dor e estado geral. Vitalidade e saude mental foram os que apresentaram menor percentual de melhora no pos-operatorio. Conclusao: o tratamento cirurgico da deformidade na EIA melhorou todos os aspectos funcionais avaliados pelo questionario SF-36, representando, na pratica, melhora da qualidade de vida destes pacientes.

Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery

Objective To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. Methods This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4–L5 level and 30 with herniated disk at the L4–L5 level, all of whom underwent Surgical treatment. Results Patients with lumbar disk herniation at L4–L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4–L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. Conclusion This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

Postoperative comparison of the results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis

Objective To compare the postoperative results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis at up to three levels. Methods Forty-three patients who all underwent lumbar arthrodesis due to degenerative disc disease at one, two or three levels were evaluated. They were divided randomly into two groups: one received antibiotic prophylaxis with cefalotin (1 g) and the other received the same antibiotic for five days. After the surgical intervention, the patients were evaluated at the time of hospital discharge, at the first return to the clinic (two weeks later) and 90 days after the date of the surgery with the surgical wound, with clinical examination of the surgical wound and laboratory tests on both groups. Results It was observed that among the patients in the group with one day of antibiotic prophylaxis, 28.6% presented complications in the surgical wound, while in the group with five days, 27.9% presented complications. Conclusion This study demonstrates that a single dose of antibiotic prophylaxis is as effective as a regimen of multiple doses in lumbar arthrodesis surgery at up to three levels. Thus, the costs and risks of subjecting patients to hospitalization under a prolonged drug regimen are unjustifiable.

Spinopelvic Parameters Evaluation in a Brazilian Population Sample: A Systematic Review

Introduction The morphology of the spine is variable within a population and its maintenance in appropriate values implies a decrease in the energy expended. We need to know their normal values in population. This study aims to carry out a literature review and evaluate published papers on spinopelvic parameters in a Brazilian population sample. Methods 11 potentially eligible papers were initially identified for inclusion in this review: 3 papers from Pubmed and 8 from Medicine®. Out of these, only 5 papers contained methodology and relevant significance level, and therefore they were included in the final analytical run. Results According to a Brazilian study, Pratali mentions no significant difference in the average values of spinopelvic balance in the Brazilian population and those found in the literature; there was also no significant difference comparing Brazilian and Korean population, however, was found difference in comparison with European population regarding PI parameters and SS, but the latter with higher values. According to Kulcheski in 2013, the values of pelvic tilt in the Brazilian population evaluated in his research were 19° (10–35°) and the sacral inclination was 38° (30–55°), presenting similar values concerning the European population. In another Brazilian paper, Oliveira reports that the researched population had PI average of 45° (41.9 to 48.1°). Conclusions The values obtained are relatively minor when compared with the European population. However, all of these are within the normal margin considered in the worldwide literature.