Rodrigo Rezende

Fratura toracolombar do tipo explosão: o que o radiologista deve conhecer

Thoracolumbar burst fractures are defined as those fractures involving compromise of the anterior, middle and posterior vertebral columns. The treatment for such vertebral fractures still remains undefined, raising questions about the best form of intervention in these cases. Because of these doubts, imaging methods play a key role in the preoperative workup. However, several tests and measurements are performed by spine surgeons before deciding on the best approach to be adopted, with no standardization and neither consensus. The present review was aimed at standardizing and describing the main techniques and radiological findings on the basis of instability criteria adopted by surgeons in the assessment of thoracolumbar burst fractures, namely extent of height loss of the anterior wall of the fractured vertebra, level of spinal canal compromise by bone fragments and degree of widening of interspinous and interpedicular distance. It is the authors’ opinion that the standardization of the main measurements in the evaluation of thoracolumbar burst fractures by radiological methods will provide the information required for a better interpretation of tests results and consequently aiding in the decision making about the most appropriate treatment.

The importance of Injury Severity Score (ISS) in the management of thoracolumbar burst fracture

OBJECTIVES There are few publications which relate the injury severity score (ISS) to the thoracolumbar burst fractures. For that reason and for the frequency in which they occur, we have evaluated the severity of the trauma in these patients. METHODS We have evaluated 190 burst fractures in the spinal cord according to Denis, using the codes of Abbreviated Injury Scales (AIS) for the calculation of the ISS, which uses the three parts of the human body with major severity. These lesions are a squared number and the results are summed up. RESULTS Among 190 cases evaluated, the median value of the ISS was 13 and the average was 14,4. Males presented a higher ISS than females. The young adult patients presented an average and a median value of the ISS higher than the old patients. The higher the ISS is, the longer the hospitalization period is, except for the patients with the ISS over 35. The fractures in thoracic level show the ISS higher than the rest. The ISS is directly related to surgical treatment and mortality. CONCLUSION The ISS values which were found show that a less severe trauma can cause a burst thoracic or lumbar spinal cord fracture. The value of the ISS has not shown correlation to the sex and the fracture level, but it is proportional to the hospitalization period, the surgical treatment and the mortality rate. This result shows a value which is inversely proportional to the age of the patients.

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.

Classificação de McCormack e colapso sagital na fratura toracolombar explosão

The increasing incidence of thoracolumbar kyphosis after conservative treatment of burst fractures is a complication reported by several authors. We performed a retrospective study on a consecutive series of 33 patients with thoracolumbar burst fractures treated with cast or brace immobilization between 1992 and 2004 to check for a correlation between thoracolumbar kyphosis and Load Sharing Classification, which provides fracture severity scores according to body comminution, vertebral body fragments displacement and the amount of kyphosis correction delivered after treatment. After an average of 30 months of follow-up we found a correlation between Load Sharing Classification scores (also known as McCormacks Classification), and the sagittal kyphotic deformity on these patients (p<0.05;r=0.65). Despite of being described for assessing sagittal deformity after surgical treatment, the applicability of this Classification can be considered for patients with thoracolumbar burst fractures submitted to conservative treatment.

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.

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.

Síndrome de parsonage-turner: relato de caso em paciente HIV soropositivo

The Parsonage-Turner Syndrome is a rare disease that affects the muscles of the scapular girdle, leading to muscular atrophy and a large motor deficit. The etiology is unknown, but it is believed that infectious and autoimmune factors are involved. The diagnosis is made by exclusion, and the main differential diagnoses are cervical disc hernias, rotator cuff injuries and rheumatic diseases. During diagnostic research, we conducted laboratory tests, radiographs and MRI of the shoulder and cervical spine, with particular reference to electroneuromyography to help generate a definitive diagnosis. This case report is presented because it shows a disease that is rarely associated with HIV seropositivity and the importance of early diagnosis for better treatment of these patients.

Schwannoma melanótico de la columna lumbar: reporte de un caso y revisión de la literatura

Los schwannomas son tumores benignos, generalmente solitarios, encapsulados y de crecimiento lento, que tienen su origen en las celulas de Schwann neoplasicas diferenciadas con desarrollo habitual intradural extramedular relacionado con las raices nerviosas. El schwannoma melanotico es una variante de estos tumores cuya localizacion en casi un tercio de los casos se encuentra en la raiz nerviosa posterior, con presentacion clinica no especifica. La resonancia magnetica es el examen mas ampliamente utilizado en el diagnostico, con hiperintensidad en secuencias T1 e hiposenal en T2. La confirmacion del diagnostico se obtiene por el estudio histologico e inmunohistoquimico, en el que existe una intensa pigmentacion citoplasmica. Hay dos tipos distintos de schwannoma melanotico: el esporadico y el psamomatoso, este ultimo relacionado con el llamado complejo de Carney, una forma de neoplasia endocrina multiple de caracter familiar. En la literatura encontramos pocos casos de estos tumores, la serie mas grande consta de cinco casos. El objetivo de este trabajo es presentar un caso raro de schwannoma melanotico lumbar del tipo esporadico y de localizacion extramedular. Tambien presentamos una breve revision de la literatura que contiene las principales caracteristicas del tumor, incluyendo sus diferentes formas, los diagnosticos diferenciales, los datos del estudio histologico e inmunohistoquimico, asi como el tratamiento recomendado actualmente, a fin de contribuir a una mejor comprension de esta neoplasia.Os schwannomas sao tumores benignos, geralmente solitarios, encapsulados e de crescimento lento, que tem sua origem nas celulas de Schwann neoplasicas diferenciadas, com desenvolvimento habitual extramedular intradural relacionado a raizes nervosas. O schwannoma melanocitico e uma variante dessas neoplasias cuja localizacao em quase um terco dos casos esta na raiz nervosa posterior, com uma apresentacao clinica inespecifica. A ressonância magnetica e o exame de imagem mais utilizado no diagnostico, revelando imagens hiperintensas em T1 e hipointensas em T2. A confirmacao diagnostica e obtida atraves do estudo histologico e imuno-histoquimico, em que se observa intensa pigmentacao citoplasmatica. Existem dois tipos distintos de schwannomas melanociticos: o esporadico e o psammomatoso, este ultimo relacionado ao chamado complexo de Carney, uma forma de neoplasia endocrina multipla de carater familiar. Na literatura encontramos poucos casos dessas neoplasias, sendo a maior serie composta por cinco casos. Assim, o objetivo deste trabalho e relatar um raro caso de schwannoma melanocitico da coluna lombar do tipo esporadico de localizacao extramedular. Apresentamos ainda uma breve revisao de literatura contendo as principais caracteristicas do tumor, incluindo suas diferentes formas, diagnosticos diferenciais, dados do estudo histologico e imuno-histoquimico, bem como a abordagem atualmente preconizada, a fim de colaborar ao melhor entendimento desta neoplasia.

Melanotic schwannoma of the lumbar spine: a case report and literature review

Los schwannomas son tumores benignos, generalmente solitarios, encapsulados y de crecimiento lento, que tienen su origen en las celulas de Schwann neoplasicas diferenciadas con desarrollo habitual intradural extramedular relacionado con las raices nerviosas. El schwannoma melanotico es una variante de estos tumores cuya localizacion en casi un tercio de los casos se encuentra en la raiz nerviosa posterior, con presentacion clinica no especifica. La resonancia magnetica es el examen mas ampliamente utilizado en el diagnostico, con hiperintensidad en secuencias T1 e hiposenal en T2. La confirmacion del diagnostico se obtiene por el estudio histologico e inmunohistoquimico, en el que existe una intensa pigmentacion citoplasmica. Hay dos tipos distintos de schwannoma melanotico: el esporadico y el psamomatoso, este ultimo relacionado con el llamado complejo de Carney, una forma de neoplasia endocrina multiple de caracter familiar. En la literatura encontramos pocos casos de estos tumores, la serie mas grande consta de cinco casos. El objetivo de este trabajo es presentar un caso raro de schwannoma melanotico lumbar del tipo esporadico y de localizacion extramedular. Tambien presentamos una breve revision de la literatura que contiene las principales caracteristicas del tumor, incluyendo sus diferentes formas, los diagnosticos diferenciales, los datos del estudio histologico e inmunohistoquimico, asi como el tratamiento recomendado actualmente, a fin de contribuir a una mejor comprension de esta neoplasia.Os schwannomas sao tumores benignos, geralmente solitarios, encapsulados e de crescimento lento, que tem sua origem nas celulas de Schwann neoplasicas diferenciadas, com desenvolvimento habitual extramedular intradural relacionado a raizes nervosas. O schwannoma melanocitico e uma variante dessas neoplasias cuja localizacao em quase um terco dos casos esta na raiz nervosa posterior, com uma apresentacao clinica inespecifica. A ressonância magnetica e o exame de imagem mais utilizado no diagnostico, revelando imagens hiperintensas em T1 e hipointensas em T2. A confirmacao diagnostica e obtida atraves do estudo histologico e imuno-histoquimico, em que se observa intensa pigmentacao citoplasmatica. Existem dois tipos distintos de schwannomas melanociticos: o esporadico e o psammomatoso, este ultimo relacionado ao chamado complexo de Carney, uma forma de neoplasia endocrina multipla de carater familiar. Na literatura encontramos poucos casos dessas neoplasias, sendo a maior serie composta por cinco casos. Assim, o objetivo deste trabalho e relatar um raro caso de schwannoma melanocitico da coluna lombar do tipo esporadico de localizacao extramedular. Apresentamos ainda uma breve revisao de literatura contendo as principais caracteristicas do tumor, incluindo suas diferentes formas, diagnosticos diferenciais, dados do estudo histologico e imuno-histoquimico, bem como a abordagem atualmente preconizada, a fim de colaborar ao melhor entendimento desta neoplasia.