Rafael Paiva Luciano

Histochemical analysis of paraspinal rotator muscles from patients with adolescent idiopathic scoliosis: a cross-sectional study.

Abstract Morphological, biochemical, and histopathological alterations in the paraspinal skeletal muscle of patients with adolescent idiopathic scoliosis (AIS) have been extensively reported. We evaluated rotator muscle fibers from the apex vertebra of AIS patients through histological and immunohistochemical analysis. A population of 21 female AIS patients who underwent corrective surgery between 2010 and 2013 had biopsies taken from the paraspinal muscle in the convex and concave sides of the thoracic curve apical vertebra. Serial sections were stained following routine protocols for hematoxylin and eosin (HE), Sudan red, Gomori trichrome, NADH, ATPase, and cytochrome oxidase. We assessed muscular atrophy and hypertrophy, fatty proliferation, endomysial and perimysial fibrosis, the presence of hyaline fibers, mitochondrial proliferation, muscular necrosis, nuclear centralization, and inflammation. Two independent professionals evaluated the slices. The thoracic curves had an average Cobb angle of 68 degree. Comparative analysis of the concave and convex sides was performed with McNemar test at a significance level of 5%. Results showed significant differences in both endomysial and perimysial fibrosis and fatty involution between the two sides of the apex vertebra. Paraspinal muscles in the concave side of the scoliosis apex had significantly more fibrosis and fatty involution. However, both sides showed signs of myopathy, muscular atrophy due to necrosis, presence of hyaline fibers, and mitochondrial proliferation.

Polymorphism of the ace gene and the α-actinin-3 gene in adolescent idiopathic scoliosis

OBJECTIVE : The I/D polymorphism of angiotensin-converting enzyme (ACE) and R577X of the α-actinin-3 (ACTN3) is related to changes in skeletal muscle function. The aim of this study was to evaluate the distribution of these polymorphisms in a family with multiple members with adolescent idiopathic scoliosis (AIS). METHODS : Evaluated 25 subjects from a family with multiple members with AIS, by collecting 10mL of blood for DNA isolation. The genotyping of the I/D polymorphism of the ACE gene and the R577X of the ACTN3 gene was performed using two specific primers to classify individuals as homozygous or heterozygous. RESULTS : Regarding the ACE polymorphism it was found that 19 (76%) subjects were DD and 6 (24%) ID. The prevalence of the D allele was 88% and the I allele was 12%. Regarding the ACTN3 polymorphism there were 6 subjects RR (24%), 11 RX (44%) and 8 XX (32%). The prevalence of the R allele was 23 (46%) and the X allele was 27 (54%). CONCLUSION : There was a difference between the distribution of the polymorphism of ACE and ACTN3 in the family studied. When assessing the ACE polymorphism a higher prevalence of the D allele was observed as compared with the I allele. Level of Evidence III, Cross-sectional, Clinical Trial.

Correlação entre as classificações de Pfirrmann e Modic na degeneração do disco intervertebral lombar

OBJETIVO: correlacionar as alteracoes encontradas nas ressonâncias magneticas lombares quanto as classificacoes de Pfirrmann e Modic. METODOS: foram selecionadas 54 ressonâncias lombossacras de pacientes ambulatoriais (23 homens e 31 mulheres) que ja se encontravam em investigacao por sua comorbidade. Foram classificados 264 discos intervertebrais (L1 a S1) quanto ao grau de degeneracao segundo Pfirrmann. A presenca de alteracoes de sinal de corpo vertebral foi registrada quanto a classificacao de Modic. Foi aplicado teste χ2, adotando niveis de significância inferiores a 0,05 (a=5%). RESULTADOS: a media de idade pesquisada foi de 48,4 anos (26 a 77 anos). Observou-se maior prevalencia de Pfirrmann tipo IV (31,1%). Em 88,3% da amostra o sinal de Modic estava ausente, assim como Modic 3; 60% das alteracoes Modic 2 foram relacionadas ao Pfirrmann tipo V, e 36,4% das alteracoes Modic 1 foram igualmente distribuidas entre Pfirrmann tipo IV e V. Encontrou-se associacao estatisticamente significante entre as alteracoes de Modic e de Pfirrmann (p<0,001). CONCLUSAO: houve uma clara associacao entre as classificacoes estudadas ao se comparar os estagios mais avancados de Pfirrmann (IV e V) com Modic tipo 1 e 2.OBJECTIVE: to correlate the changes found in the lumbar magnetic resonance imaging according to Modic and Pfirrmann classifications. METHODS: lumbar spine resonances of 54 outpatients were selected (23 men and 31 women), who were already under investigation because of their comorbidity. According to their degree of Pfirrmann classification, 264 intervertebral discs (L1 to S1) were classified. The presence of signal abnormalities of the vertebral body was recorded as Modic classification. The χ2 mwas applied, adopting significance levels below 0.05 (a=5%). RESULTS: The mean age studied was of 48.4 years (26-77 years). A higher prevalence of Pfirrmann type IV (31.1%) was observed. In 88.3% of the sample, Modic was absent, and also Modic 3; 60% of Modic 2 was related to Pfirrmann type V, and 36.4% of Modic 1 was equally distributed among Pfirrmann type IV and V. Statistically significant association between Modic changes and Pfirrmann (p<0.001) was found. CONCLUSION: there was a clear association between the classifications studied, comparing the stages of Pfirrmann (IV and V) with Modic type 1 and 2.

Adolescent idiopathic scoliosis without limb weakness: a differential diagnosis of core myopathy?

BackgroundCore myopathies are a clinically and genetically heterogeneous group of congenital myopathies with the common defined histopathological feature of focally reduced oxidative activity on muscle biopsy. It has a low incidence, however, recent articles show broad clinical spectrum, suggesting that the real incidence should be considerably larger than previously described. Due to the important association between scoliosis and paravertebral muscle imbalance, numerous authors study, by biopsy of the spinal rotator muscles, potential changes that may elucidate the etiology of adolescent idiopathic scoliosis.Case presentationTwo patients have been followed at Spine Group of Department of Orthopedics at Federal University of São Paulo, with an initial diagnosis of idiopathic scoliosis. Both patients had clinical and radiological findings compatible with it. The patients authorized, through the Term of Consent, intraoperative biopsy of muscle multifidus from the apex of the thoracic curve on concave and convex sides. After muscle biopsy was performed a histopathological analysis. As regard to the histopathological features: in both patients were identified, the presence of core structures in extensive areas with reduced oxidative activity running along the muscle fiber.ConclusionsAll patients with ‘idiopathic’ scoliosis deserve a careful neurological evaluation, even if they have minimal muscle symptoms in the extremities. The frequent occurrence of scoliosis in patients with CORE Myopathies, supports the thesis that the change in the paravertebral muscle fiber must be the underlying pathogenic factor in scoliosis and may help us understand the onset and progression of curves in patients previously diagnosed with idiopathic scoliosis.

Hystological paraspinal muscle comparison between curve concavity and convexity in adolescent idiopathic scoliosis

Background Several studies have presented morphological, biochemical and histopathological changes in the paraspinal skeletal muscle of patients with adolescent idiopathic scoliosis (AIS). Some abnormalities have been demonstrated such as an increased amount of type I fibers in the concavity and the decreased number of type II in the convexity, an increase in the intracellular concentration of glycogen and lipids, structural changes in the sarcolemma and myotendinous junction, changes in the activity muscle enzyme, an increase in intracellular calcium concentration.

Study of Spine Rotator Muscles in Adolescent Idiopathic Scoliosis Patients

Introduction Several studies have presented morphological, biochemical, and histopathological changes in the paraspinal skeletal muscle of patients with adolescent idiopathic scoliosis (AIS). Some abnormalities, such as an increased amount of type I fibers in the concavity and the decreased number of type II in the convexity, an increase in the intracellular concentration of glycogen and lipids, structural changes in the sarcolemma and myotendinous junction, changes in the activity muscle enzyme, and an increase in intracellular calcium concentration, have been demonstrated. The aim of this article is to evaluate the rotator muscle fibers at the apical vertebra of curves of patients with AIS by histological and immunohistochemical analysis. Materials and Methods Twenty-one patients with AIS submitted to surgical correction between 2010 and 2013 had the spinal rotator muscles biopsied in the concavity and convexity of the apical vertebra of the thoracic curve during the surgery. Serial cryosections were stained with hematoxylin and eosin (HE), Sudan Red, NADH, ATPase, and Cytochrome oxidase. We evaluated muscle atrophy and hypertrophy, fatty proliferation, presence of endomysial and perimysial fibrosis, presence of hyaline fibers, mitochondrial proliferation, muscle necrosis, nuclear centralization, and inflammation. Two independent observers evaluated the sections. Results The average value of the angle of the main thoracic curve was 68 degrees Cobb. For analysis of nonparametric paired variables between the concave and convex sides, McNemar test was used with a significance level of 5%. The results of relative frequency and “p” values showed significant differences in both endomysial and perimysial fibrosis and fatty involution when compared with both sides of the apical vertebra. Conclusion The paraspinal muscles at the apex of the deformity had a higher involvement in the concavity when analyzing the fatty involution and fibrosis. However, both sides showed signs of myopathy, muscle atrophy through areas of necrosis, presence of hyaline fibers, and mitochondrial proliferation.

Influence of surgical trauma on the behavior of serum albumin after spine surgery

OBJETIVO: evaluar la variacion de la concentracion de albumina en las cirugias de la columna vertebral y relacionarla con los efectos clinicos en el periodo postoperatorio. METODOS: estudio observacional prospectivo sobre los valores de los niveles de la albumina de suero de 55 pacientes sometidos a cirugia de la columna vertebral. Muestras de sangre fueron tomadas un dia antes de la cirugia y 24 horas despues del procedimiento. Se aplico la prueba de t para muestras apareadas para evaluar el cambio (pre versus post) en los parametros albumina, la hemoglobina y el hematocrito. La presencia de asociacion entre el grado de variacion en los niveles de albumina ( 1g/dL) y las variables de interes: la presencia de complicaciones, la necesidad de transfusion, el procedimiento realizado, la edad y el sexo del paciente y el diagnostico fueron evaluados por el test del χ2 de Pearson o el cociente de probabilidad χ2, cuando necesario. RESULTADOS: la reduccion media de esta proteina fue de 0,58 g/dL, que varia de 0 a 1,8 g/dL. De los pacientes, 78,2% tuvieron valores de albumina en el postoperatorio por debajo del rango normal. Solo dos pacientes presentaron complicaciones durante los 30 dias de seguimiento. El grupo con la correccion de las deformidades presento el 100% de pacientes con mayor o > 1g/dL. CONCLUSION: hubo una influencia del trauma quirurgico en la reduccion de la albumina serica, en promedio, de 0,58 g/dL en las cirugias de la columna vertebral. No se puede asociar esta caida a las complicaciones en el postoperatorio despues de 30 dias de seguimiento de esos pacientes.ABSTRACT Objective: to evaluate the variation of serum albumin concentration in surgery of the spine and its relation to clinical effects in the postoperative. Methods: prospective observational study on the values of serum albumin of 55 patients undergoing spine surgery. Blood samples were collected one day before and 24 hours after the procedure. The paired t test was performed to evaluate the change parameters albumin, hemoglobin and hematocrit. The presence of association between the degree of variation in levels of albumin (<1 g/dL or ≥ 1 g/dL) and the variables of interest: complications, transfusions, procedures performed, patients’ age and sex and diagnosis were assessed by c 2 test or the c 2 likelihood ratio when appropriate. Results: the average reduction of this protein was of 0.58 g/dL, ranging from 0 to 1.8 g/dL. 2 Of the patients, 78.2% showed RESUMEN Objetivo: evaluar la variacion de la concentracion de albumina en las ci-rugias de la columna vertebral y rela-cionarla con los efectos clinicos en el periodo postoperatorio.

Influência do Trauma Cirúrgico no Comportamento dos Níveis Séricos de Albumina após Cirurgia da Coluna Vertebral

OBJETIVO: evaluar la variacion de la concentracion de albumina en las cirugias de la columna vertebral y relacionarla con los efectos clinicos en el periodo postoperatorio. METODOS: estudio observacional prospectivo sobre los valores de los niveles de la albumina de suero de 55 pacientes sometidos a cirugia de la columna vertebral. Muestras de sangre fueron tomadas un dia antes de la cirugia y 24 horas despues del procedimiento. Se aplico la prueba de t para muestras apareadas para evaluar el cambio (pre versus post) en los parametros albumina, la hemoglobina y el hematocrito. La presencia de asociacion entre el grado de variacion en los niveles de albumina ( 1g/dL) y las variables de interes: la presencia de complicaciones, la necesidad de transfusion, el procedimiento realizado, la edad y el sexo del paciente y el diagnostico fueron evaluados por el test del χ2 de Pearson o el cociente de probabilidad χ2, cuando necesario. RESULTADOS: la reduccion media de esta proteina fue de 0,58 g/dL, que varia de 0 a 1,8 g/dL. De los pacientes, 78,2% tuvieron valores de albumina en el postoperatorio por debajo del rango normal. Solo dos pacientes presentaron complicaciones durante los 30 dias de seguimiento. El grupo con la correccion de las deformidades presento el 100% de pacientes con mayor o > 1g/dL. CONCLUSION: hubo una influencia del trauma quirurgico en la reduccion de la albumina serica, en promedio, de 0,58 g/dL en las cirugias de la columna vertebral. No se puede asociar esta caida a las complicaciones en el postoperatorio despues de 30 dias de seguimiento de esos pacientes.ABSTRACT Objective: to evaluate the variation of serum albumin concentration in surgery of the spine and its relation to clinical effects in the postoperative. Methods: prospective observational study on the values of serum albumin of 55 patients undergoing spine surgery. Blood samples were collected one day before and 24 hours after the procedure. The paired t test was performed to evaluate the change parameters albumin, hemoglobin and hematocrit. The presence of association between the degree of variation in levels of albumin (<1 g/dL or ≥ 1 g/dL) and the variables of interest: complications, transfusions, procedures performed, patients’ age and sex and diagnosis were assessed by c 2 test or the c 2 likelihood ratio when appropriate. Results: the average reduction of this protein was of 0.58 g/dL, ranging from 0 to 1.8 g/dL. 2 Of the patients, 78.2% showed RESUMEN Objetivo: evaluar la variacion de la concentracion de albumina en las ci-rugias de la columna vertebral y rela-cionarla con los efectos clinicos en el periodo postoperatorio.

Influencia del trauma quirúrgico sobre el comportamiento de los niveles de albúmina sérica después de cirugía de columna vertebral

OBJETIVO: evaluar la variacion de la concentracion de albumina en las cirugias de la columna vertebral y relacionarla con los efectos clinicos en el periodo postoperatorio. METODOS: estudio observacional prospectivo sobre los valores de los niveles de la albumina de suero de 55 pacientes sometidos a cirugia de la columna vertebral. Muestras de sangre fueron tomadas un dia antes de la cirugia y 24 horas despues del procedimiento. Se aplico la prueba de t para muestras apareadas para evaluar el cambio (pre versus post) en los parametros albumina, la hemoglobina y el hematocrito. La presencia de asociacion entre el grado de variacion en los niveles de albumina ( 1g/dL) y las variables de interes: la presencia de complicaciones, la necesidad de transfusion, el procedimiento realizado, la edad y el sexo del paciente y el diagnostico fueron evaluados por el test del χ2 de Pearson o el cociente de probabilidad χ2, cuando necesario. RESULTADOS: la reduccion media de esta proteina fue de 0,58 g/dL, que varia de 0 a 1,8 g/dL. De los pacientes, 78,2% tuvieron valores de albumina en el postoperatorio por debajo del rango normal. Solo dos pacientes presentaron complicaciones durante los 30 dias de seguimiento. El grupo con la correccion de las deformidades presento el 100% de pacientes con mayor o > 1g/dL. CONCLUSION: hubo una influencia del trauma quirurgico en la reduccion de la albumina serica, en promedio, de 0,58 g/dL en las cirugias de la columna vertebral. No se puede asociar esta caida a las complicaciones en el postoperatorio despues de 30 dias de seguimiento de esos pacientes.ABSTRACT Objective: to evaluate the variation of serum albumin concentration in surgery of the spine and its relation to clinical effects in the postoperative. Methods: prospective observational study on the values of serum albumin of 55 patients undergoing spine surgery. Blood samples were collected one day before and 24 hours after the procedure. The paired t test was performed to evaluate the change parameters albumin, hemoglobin and hematocrit. The presence of association between the degree of variation in levels of albumin (<1 g/dL or ≥ 1 g/dL) and the variables of interest: complications, transfusions, procedures performed, patients’ age and sex and diagnosis were assessed by c 2 test or the c 2 likelihood ratio when appropriate. Results: the average reduction of this protein was of 0.58 g/dL, ranging from 0 to 1.8 g/dL. 2 Of the patients, 78.2% showed RESUMEN Objetivo: evaluar la variacion de la concentracion de albumina en las ci-rugias de la columna vertebral y rela-cionarla con los efectos clinicos en el periodo postoperatorio.

Correlation between Pfirrmann and Modic classifications in the degeneration of lumbar intervertebral disc

OBJETIVO: correlacionar as alteracoes encontradas nas ressonâncias magneticas lombares quanto as classificacoes de Pfirrmann e Modic. METODOS: foram selecionadas 54 ressonâncias lombossacras de pacientes ambulatoriais (23 homens e 31 mulheres) que ja se encontravam em investigacao por sua comorbidade. Foram classificados 264 discos intervertebrais (L1 a S1) quanto ao grau de degeneracao segundo Pfirrmann. A presenca de alteracoes de sinal de corpo vertebral foi registrada quanto a classificacao de Modic. Foi aplicado teste χ2, adotando niveis de significância inferiores a 0,05 (a=5%). RESULTADOS: a media de idade pesquisada foi de 48,4 anos (26 a 77 anos). Observou-se maior prevalencia de Pfirrmann tipo IV (31,1%). Em 88,3% da amostra o sinal de Modic estava ausente, assim como Modic 3; 60% das alteracoes Modic 2 foram relacionadas ao Pfirrmann tipo V, e 36,4% das alteracoes Modic 1 foram igualmente distribuidas entre Pfirrmann tipo IV e V. Encontrou-se associacao estatisticamente significante entre as alteracoes de Modic e de Pfirrmann (p<0,001). CONCLUSAO: houve uma clara associacao entre as classificacoes estudadas ao se comparar os estagios mais avancados de Pfirrmann (IV e V) com Modic tipo 1 e 2.OBJECTIVE: to correlate the changes found in the lumbar magnetic resonance imaging according to Modic and Pfirrmann classifications. METHODS: lumbar spine resonances of 54 outpatients were selected (23 men and 31 women), who were already under investigation because of their comorbidity. According to their degree of Pfirrmann classification, 264 intervertebral discs (L1 to S1) were classified. The presence of signal abnormalities of the vertebral body was recorded as Modic classification. The χ2 mwas applied, adopting significance levels below 0.05 (a=5%). RESULTS: The mean age studied was of 48.4 years (26-77 years). A higher prevalence of Pfirrmann type IV (31.1%) was observed. In 88.3% of the sample, Modic was absent, and also Modic 3; 60% of Modic 2 was related to Pfirrmann type V, and 36.4% of Modic 1 was equally distributed among Pfirrmann type IV and V. Statistically significant association between Modic changes and Pfirrmann (p<0.001) was found. CONCLUSION: there was a clear association between the classifications studied, comparing the stages of Pfirrmann (IV and V) with Modic type 1 and 2.