Orlando Righesso Neto

Avaliação clínica e funcional no pré-operatório de doenças degenerativas da coluna vertebral

OBJETIVO: la utilizacion de instrumentos de evaluacion clinica y funcional de patologias vertebrales, ademas de determinar la evolucion despues del tratamiento, puede predecir el resultado postoperatorio. El objetivo de este estudio es describir la metodologia de evaluacion de patologias degenerativas de la columna y verificar los resultados. METODOS: luego de la indicacion del tratamiento quirurgico, los pacientes son invitados a participar del estudio mediante firma de un termino de consentimiento libre y claro. Los pacientes responden los cuestionarios en el consultorio medico y son auxiliados cuanto a dudas al completarlo por una persona no involucrada con la cirugia. Todos los instrumentos de evaluacion utilizados son auto-aplicativos. Se utilizan: escala numerica del dolor (NRS), Cuestionario SF-36, Cuestionario de Evitacion por Miedos y Creencias (FABq), Inventario de Depresion de Beck (BDI), Escala de Depresion y Ansiedad Hospitalaria (HAD), Indice de Discapacidad Oswestry (ODI), Indice de Disfuncion Relacionado al Cuello (NDI). RESULTADOS: se evaluaron 220 pacientes con patologias de la columna lumbar y 32 de la cervical. La prevalencia de depresion segun el BDI fue del 28,0 y 31,2% en pacientes con enfermedad quirurgica lumbar y cervical, y la prevalencia de ansiedad por el HAD-A del 40,1 y 46,9%, respectivamente. El promedio de ODI fue de 46,5 y del NDI de 25,4. Cuanto a la viabilidad de completar los cuestionarios, se observo que la mayoria de los pacientes, una vez instruidos cuanto a la manera de completarlos, no presenta dificultades para hacerlo. El tiempo promedio para completar todos los instrumentos es de 25 a 35 minutos. CONCLUSION: la utilizacion de instrumentos validados para evaluacion de los pacientes con enfermedades degenerativas vertebrales es viable y debe ser estimulada entre los cirujanos de columna.OBJETIVO: a utilizacao de instrumentos de avaliacao clinica e funcional nos pacientes com doencas da coluna vertebral pode determinar a evolucao e predizer o desfecho pos-operatorio. O objetivo deste estudo foi descrever a metodologia de avaliacao de doencas degenerativas espinhais e verificar os resultados. METODOS: apos a indicacao de tratamento cirurgico nos pacientes com doencas das colunas lombar e cervical, os mesmos foram informados dos objetivos do estudo e convidados a participar. Os questionarios foram respondidos no consultorio medico, onde possiveis duvidas surgidas durante o preenchimento eram esclarecidas por uma pessoa treinada nao envolvida com a cirurgia. Todos os instrumentos de avaliacao usados eram autoaplicativos. Foram utilizados a escala numerica de dor, o Questionario de Qualidade de Vida SF-36, o Questionario de Evitacao por Medos e Crencas (FABq), o Inventario de Depressao de Beck (BDI), a Escala de Depressao e Ansiedade Hospitalar (HAD), o Indice de Incapacidade Oswestry (ODI) e o Indice de Disfuncao Relacionado ao Pescoco (NDI). RESULTADOS: foram avaliados 220 pacientes com doencas da coluna lombar e 32 da cervical. A prevalencia de depressao segundo o BDI foi de 28,0% e de 31,2% em pacientes com doenca cirurgica lombar e cervical, e a prevalencia de ansiedade pelo HAD-A de 40,1% e 46,9%, respectivamente. A media do ODI foi de 46,5, e a do NDI, de 25,4. Quanto ao preenchimento dos questionarios, a maioria dos pacientes, uma vez instruidos, nao apresentou dificuldades em finaliza-los. O tempo medio de preenchimento de todos os instrumentos foi de 25 a 35 minutos. CONCLUSOES: a utilizacao de instrumentos validados para avaliacao dos pacientes com doencas degenerativas vertebrais e exequivel e deve ser estimulada entre os cirurgioes que atuam no âmbito da coluna vertebral.OBJECTIVE: the use of clinical and functional evaluation instruments for vertebral pathologies, besides determining how the situation evolves after treatment, can predict the postoperative outcome. The objective of this study was to describe the methodology to evaluate spinal degenerative pathologies and verify the results. METHODS: after the indication of surgical treatment, the patients were invited to participate in the study by signing a letter of free and informed consent. The patients completed the questionnaires at the doctors office, and were helped regarding doubts in filling them out by a person who was not involved in the surgery. All the evaluation instruments used are self-applied. The following were used: numerical rating scale of pain (NRS), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABq), Beck Depression Inventory (BDI), Hospital Anxiety and Depression (HAD) Scale, Oswestry Disability Index (ODI) and Neck Disability Index (NDI). RESULTS: 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. The prevalence of depression, according to the BDI, was 28.0% and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A was 40.1% and 46.9%, respectively. The mean of ODI was 46.5, and of NDI, 25.4. As to the feasibility of completing the questionnaires, it was observed that most of the patients, when they have been instructed about completing them, did not have any difficulty in finishing them. The mean time for the completion of all instruments was 25 to 35 minutes. CONCLUSION: the use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons.

Cavernous angioma of the cauda equina: case report

We present a rare case of cavernous angioma of the cauda equina and review the eleven cases available in the literature. A 44-year-old woman presented with low back pain and sciatica associated with bowel and bladder dysfunction and motor weakness of the lower extremity. The MRI revealed an enhancing, heterogeneous and hyperintense intradural lesion compressing the cauda equina roots at the L4 level. Laminectomy at L3-L4 and total removal of the tumor were performed without additional neurological deficit. Pathology revealed a cavernous angioma. The literature, clinical presentation, technical examinations, and treatment are reviewed.

Metástases do segmento torácico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirúrgico e radioterápico com a imobilização externa e radioterapia

Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patients decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation longer and significant reduction of pain.

Clinical and functional evaluation in preoperative period of degenerative disease spine surgery

OBJETIVO: la utilizacion de instrumentos de evaluacion clinica y funcional de patologias vertebrales, ademas de determinar la evolucion despues del tratamiento, puede predecir el resultado postoperatorio. El objetivo de este estudio es describir la metodologia de evaluacion de patologias degenerativas de la columna y verificar los resultados. METODOS: luego de la indicacion del tratamiento quirurgico, los pacientes son invitados a participar del estudio mediante firma de un termino de consentimiento libre y claro. Los pacientes responden los cuestionarios en el consultorio medico y son auxiliados cuanto a dudas al completarlo por una persona no involucrada con la cirugia. Todos los instrumentos de evaluacion utilizados son auto-aplicativos. Se utilizan: escala numerica del dolor (NRS), Cuestionario SF-36, Cuestionario de Evitacion por Miedos y Creencias (FABq), Inventario de Depresion de Beck (BDI), Escala de Depresion y Ansiedad Hospitalaria (HAD), Indice de Discapacidad Oswestry (ODI), Indice de Disfuncion Relacionado al Cuello (NDI). RESULTADOS: se evaluaron 220 pacientes con patologias de la columna lumbar y 32 de la cervical. La prevalencia de depresion segun el BDI fue del 28,0 y 31,2% en pacientes con enfermedad quirurgica lumbar y cervical, y la prevalencia de ansiedad por el HAD-A del 40,1 y 46,9%, respectivamente. El promedio de ODI fue de 46,5 y del NDI de 25,4. Cuanto a la viabilidad de completar los cuestionarios, se observo que la mayoria de los pacientes, una vez instruidos cuanto a la manera de completarlos, no presenta dificultades para hacerlo. El tiempo promedio para completar todos los instrumentos es de 25 a 35 minutos. CONCLUSION: la utilizacion de instrumentos validados para evaluacion de los pacientes con enfermedades degenerativas vertebrales es viable y debe ser estimulada entre los cirujanos de columna.OBJETIVO: a utilizacao de instrumentos de avaliacao clinica e funcional nos pacientes com doencas da coluna vertebral pode determinar a evolucao e predizer o desfecho pos-operatorio. O objetivo deste estudo foi descrever a metodologia de avaliacao de doencas degenerativas espinhais e verificar os resultados. METODOS: apos a indicacao de tratamento cirurgico nos pacientes com doencas das colunas lombar e cervical, os mesmos foram informados dos objetivos do estudo e convidados a participar. Os questionarios foram respondidos no consultorio medico, onde possiveis duvidas surgidas durante o preenchimento eram esclarecidas por uma pessoa treinada nao envolvida com a cirurgia. Todos os instrumentos de avaliacao usados eram autoaplicativos. Foram utilizados a escala numerica de dor, o Questionario de Qualidade de Vida SF-36, o Questionario de Evitacao por Medos e Crencas (FABq), o Inventario de Depressao de Beck (BDI), a Escala de Depressao e Ansiedade Hospitalar (HAD), o Indice de Incapacidade Oswestry (ODI) e o Indice de Disfuncao Relacionado ao Pescoco (NDI). RESULTADOS: foram avaliados 220 pacientes com doencas da coluna lombar e 32 da cervical. A prevalencia de depressao segundo o BDI foi de 28,0% e de 31,2% em pacientes com doenca cirurgica lombar e cervical, e a prevalencia de ansiedade pelo HAD-A de 40,1% e 46,9%, respectivamente. A media do ODI foi de 46,5, e a do NDI, de 25,4. Quanto ao preenchimento dos questionarios, a maioria dos pacientes, uma vez instruidos, nao apresentou dificuldades em finaliza-los. O tempo medio de preenchimento de todos os instrumentos foi de 25 a 35 minutos. CONCLUSOES: a utilizacao de instrumentos validados para avaliacao dos pacientes com doencas degenerativas vertebrais e exequivel e deve ser estimulada entre os cirurgioes que atuam no âmbito da coluna vertebral.OBJECTIVE: the use of clinical and functional evaluation instruments for vertebral pathologies, besides determining how the situation evolves after treatment, can predict the postoperative outcome. The objective of this study was to describe the methodology to evaluate spinal degenerative pathologies and verify the results. METHODS: after the indication of surgical treatment, the patients were invited to participate in the study by signing a letter of free and informed consent. The patients completed the questionnaires at the doctors office, and were helped regarding doubts in filling them out by a person who was not involved in the surgery. All the evaluation instruments used are self-applied. The following were used: numerical rating scale of pain (NRS), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABq), Beck Depression Inventory (BDI), Hospital Anxiety and Depression (HAD) Scale, Oswestry Disability Index (ODI) and Neck Disability Index (NDI). RESULTS: 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. The prevalence of depression, according to the BDI, was 28.0% and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A was 40.1% and 46.9%, respectively. The mean of ODI was 46.5, and of NDI, 25.4. As to the feasibility of completing the questionnaires, it was observed that most of the patients, when they have been instructed about completing them, did not have any difficulty in finishing them. The mean time for the completion of all instruments was 25 to 35 minutes. CONCLUSION: the use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons.

Manejo da infecção após cirurgia de fixação interna da coluna lombar

The rate of deep wound infections in spinal lumbar fusions is around 0.7% to 11.6%, being one of the causes of morbidity in acute phase. The aim of this study was to evaluate the management of spinal infection after internal lumbar fusions. Two hundred and sixty patients, who underwent to spinal surgery with lumbar fusion and iliac bone grafting, were analized, from January 1997 to January 2005. Wound infection was observed in eight (3%) cases. The average of age was 56 years, with a higher prevalence in males (5 patients). Most prevalent was Staphylococcus aureus in 6 patients. The treatment was done by intravenous antibiotic therapy folowed by oral therapy and local irrigation. The average time of hospitalization was 35.8 days. It was possible to erradicate infection without removal of instrumentation in all patients.

Acesso anterior para pacientes com fraturas traumáticas do tipo compressão do segmento toracolombar (T11 a L2) da coluna vertebral

ABsTRACT - Objective: To describe experience with anterior access in compression fractures of thoracolum-bar segment (T11 to L2) traumatic fractures that undergone anterior access surgery. Method: A prospec-tive study was conducted between January 1994 and January 2004 with 32 patients. The bone fusion and thoracolumbar alignment were analyzed 6 months and 12 months after the surgery. Results: The ave-rage age was 36.53 years old with 23 male patients. The most compromised vertebrae was L1 (n=12). The 23 patients that was AsIA/ImsoP C and AsIA/ImsoP D turned to AsIA/ImsoP e after 1 month (n=12) and 12 months (n=5) of surgery. The preoperative angular deformity average was 14.9°±7.5°. statistical signi-ficance was found (p<0.0001) when compared to the 30 days postoperative value. Conclusion: The ante-rior access permits a better spinal canal decompression and angular deformity correction when compared with the posterior access alone.Key WoRDs: thoracolumbar fracture, anterior access, stabilization.

Fratura traumática de coluna torácica T1-T10

We describe the incidence, causes, management and prognosis of traumatic fractures of the thoracic spine from T1 to T10 in surgical cases of traumatic fractures of spine during the period from June 1994 to June 2003 studied retrospectively. The type of fracture was determined according to the Gertzbein classification, and the degree of stability using the Denis classification. The neurological picture at admission and 30 days after surgery was evaluated using the ASIA/IMSOP classification. Surgery was performed in patients with complete spinal cord injury (n=7) for the purpose of stabilization using the posterior approach. In cases without spinal cord injury or incomplete injury (n=12), the surgical procedure was performed aiming to decompress the nerve tissue, to correct the alignment of the spine and to stabilize the spine.

Abordagem cirúrgica posterior e posterolateral para neurinomas cervicais em ampulheta da raiz de C2

OBJETIVO: os autores describen la experiencia quirurgica de 11 neurinomas en reloj de arena de la raiz de C2 comparando el camino de acceso posterior y el postero-lateral. METODOS: se trataron con cirugia 11 pacientes con neurinoma en reloj de arena de raiz cervical de C2. El camino de acceso utilizado para la retirada de los tumores fue la aproximacion posterior en siete pacientes, y la aproximacion postero-lateral, en 4. RESULTADOS: hubo predominio del sexo femenino (n=6), siendo la edad promedio de 55,9 ± 8,16 anos. El tiempo medio de los sintomas hasta su diagnostico fue de 16,3 meses (±8,02 meses). Hubo reseccion completa del tumor en todos los pacientes. El tiempo quirurgico promedio en el abordaje posterior fue de 180 minutos (± 39.15) y 192 minutos (± 22,17) a traves de posterolateral (p = 0,52). No hubo diferencia del volumen de sangrado transoperatorio entre los grupos (posterior: 70,71±16,93; posterolateral: 65,00±24,15; p=0.64). Hubo una complicacion por el camino posterior que fue la presencia de fistula licuorica, siendo necesaria reintervencion y colocacion de fascia lata. CONCLUSION: la eliminacion completa del tumor en la raiz de reloj de arena C2 es posible mediante el abordaje posterior y posterolateral, sin embargo, el abordaje posterior se demostro preferible por ser un camino de acceso de mayor familiaridad para el cirujano.

Qual a relevância dos sinais e sintomas no prognóstico de pacientes com hérnia de disco lombar

INTRODUCTION: lumbar disc herniation (LDH) is currently a prevalent pathology which leads to physical, psychological and social limitations for the patient. The most frequent signs and symptoms are lumbocyatalgia, motor and sensitive disorders and Lasegues sign. In patients with LDH refractory to medical treatment, discectomy is the standard procedure to improve the symptoms. OBJECTIVES: to study the prognostic relevance of signs and symptoms in patients with LDH refractory to medical treatment. METHODS: a survey was performed, in the main biomedical databases, for articles that studied the percentage of improvement and prognostic value of the preoperative signs and symptoms of patients with LDH. The signs and symptoms evaluated were lumbar pain, leg pain, motor and sensitive disorders and Lasegues sign. CONCLUSION: the success rate in surgery of patients with LDH refractory to medical treatment is correlated with the absence of lumbalgia, the presence of cyatalgia over up to six months, the sensitive deficit present alone or associated with motor deficit and the presence of positive Lasegues sign during the preoperative period.INTRODUCAO: a hernia de disco lombar (HDL) e uma patologia prevalente na atualidade, que acarreta limitacoes fisicas, psiquicas e sociais ao paciente. Os sinais e sintomas mais frequentes sao lombociatalgia, disturbios motores e sensitivos e sinal de Lasegue. Nos pacientes com HDL refratarios ao tratamento clinico, microdiscectomia e o procedimento padrao para a melhora dos sintomas. OBJETIVOS: estudar a relevância prognostica dos sinais e sintomas nos pacientes com HDL refratarios ao tratamento clinico. METODOS: foram pesquisados, nas principais bases de dados biomedicas, os artigos que estudaram a percentagem de melhora e o valor prognostico dos sinais e sintomas pre-operatorios dos pacientes com HDL. Os sinais e os sintomas avaliados foram dor lombar, dor na perna, disturbios motores e sensitivos e sinal de Lasegue. CONCLUSAO: o indice de sucesso da cirurgia dos pacientes com HDL refratarios ao tratamento clinico correlaciona-se com a ausencia de lombalgia, a presenca de ciatalgia com tempo de evolucao de ate 6 meses, o deficit sensitivo presente de forma isolada ou associado ao deficit motor e a presenca de sinal de Lasegue positivo no periodo pre-operatorio.

Disfagia como complicação da cirurgia da coluna cervical via anterior

Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varie depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery.