Thiago Cardoso Maia

Evaluation of the discal height gain and lumbar lordosis variation obtained by the techniques of transforaminal and posterior lumbar intersomatic fusion

Objective Evaluate the discal height and lumbar lordosis gains, comparatively, according to the two lumbar arthrodesis techniques, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), used in the treatment of spinal degenerative diseases. Methods The present study, retrospective, was done with 60 patients who underwent decompression and 1 level lumbar arthrodesis in the Hospital Santa Casa de Misericórdia de Vitória (HSCMV), between January 2010 and December 2015. The patients were divided in two groups of 30 each, according to the utilized intersomatic arthrodesis technique: TLIF or PLIF. All patients presented pathologies at the L4-L5 level. In this study, the discal height gain and lumbar lordosis variation were evaluated by analyzing spinal radiographies of the pre and post-operatory periods from patients of the two groups, measured by the software Surgimap®. In addition, the pain intensity in the post-operatory period was estimated by the Visual Analog Scale for Pain (VAS Pain). Results Both techniques presented a gain in the discal height in the post-operatory. There was no statistically significant difference between the discal height variation obtained with the PLIF technique when compared to the TLIF technique (p = 0.139). In the same way, there was no statistically significant difference in the lumbar lordosis variation between the two studied groups (p = 0.184). By the EVA Pain analysis, there was no significant difference in the pain intensity in the post-operatory period between both arthrodesis surgeries. Conclusion There is no difference in the discal height gain and lumbar lordosis variation, as well as in the pain intensity in the post-operatory periods, in patients who underwent 1 level intersomatic arthrodesis when comparing the PLIF and TLIF techniques.

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.

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.

Comparative Analysis of Evaluation of Lumbar Lordosis Measured in the Standing Positions Radiography and Magnetic Resonance Imaging

Introduction Research of degenerative diseases of the spine it is recommended performing radiographs and magnetic resonance imaging (MRI). Physiological curvature of the lumbar spine varies from 35 to 50. Changes sagittal alignment can lead to changes in the lumbar spine kinematics, having influence on the support and load distribution on the spine, causing low back pain. Methods 100 patients with chronic low back pain (51 men and 49 women), being evaluated degree of lumbar lordosis by three independent examiners by radiography in the standing position and MRI in supine position with flexed lower limbs. Measurement of lumbar lordosis by the Cobb method (L1 to L5 levels) in lumbar radiographs in profile and in the sagittal plane in lumbar MRI. Results Average of lumbar curvature on X-rays and the MRI cushion was 42,2° and 31,5°, respectively (p value < 0.001). Average angles of lumbar lordosis by MRI underestimates by 25% compared with lumbar radiographs. Conclusion MRI is insufficient for evaluation of lumbar lordosis, it underestimates the true lumbar lordosis. Thus, the lumbar radiological evaluation is essential in assessing the true lumbar lordosis.

Microdiscectomy Reduces Back Pain in Patients with Lumbar Disc Herniation

Introduction It is estimated that ~80% of the population will present back pain, which can be caused by lumbar disc herniation, impairing quality of life of patients. Surgical intervention may be necessary in some cases, although there are discussions about the effectiveness of different interventions possible. We aimed therefore to evaluate the influence of microdiscectomy in quality of life of patients with low back pain and lumbar disc herniation. Methods Prospective and comparative study, in which we compared the results of questionnaires for quality of life (SF-36) and low back pain (Roland Morris) in patients in the pre and postoperative microdiscectomy, through Student t-test, p < 0.05. Results We evaluated 25 patients, 16 men and 9 women, with mean age 32,8 years. Improved quality of life as indicated by the increase in all eight components of the questionnaire SF-36: 1) functional capacity: 15.4 to 82.1; 2) physical aspects: 0 to 83.3; 3) pain: 16.6 to 80.9; 4) general state: 56.2 to 80.3; 5) vitality: 50.6 to 78.8; 6) social aspects: 32.3 to 88.5; 7) emotional aspects: 20.8 to 81.9; 8) mental health: 60.2 to 79.5. Furthermore, there was significant reduction in Roland Morris questionnaire scores (preoperative: 17.5 ± 5.1 versus postoperative: 0.9 ± 2.2), reflecting a reduction of low back pain during the postoperative period. Conclusion: We conclude that low back pain is present and often debilitating for patients with disc herniated and, aftes lumbar microdiscectomy occurs decline or absence of back pain.

COMPARISON OF THE EFFECTIVENESS OF RADICULAR BLOCKING TECHNIQUES IN THE TREATMENT OF LUMBAR DISK HERNIA

Objetivos : Comparar a tecnica de bloqueio interlaminar com a de bloqueio transforaminal, quanto ao quadro algico e a presenca ou nao de complicacoes. Metodos : Estudo prospectivo, de carater descritivo e comparativo, duplo-cego e randomizado, do qual participaram 40 pacientes, de ambos os sexos, portadores de lombociatalgia por hernia discal, do tipo centrolateral ou foraminal, que nao responderam a 20 sessoes de fisioterapia e nao tiveram instabilidade diagnosticada em exame de radiografia dinâmica. O tipo de bloqueio interlaminar ou transforaminal a ser realizado foi determinado por meio de sorteio. Resultados : Foram avaliados 40 pacientes, 17 do sexo masculino, com media de idade de 49 anos, media da EVA pre-bloqueio de 8,85, valores medios na tecnica transforaminal em 24 horas, 7, 21 e 90 dias foram 0,71, 1,04, 2,33 e 3,84, respectivamente; a media da EVA pos-bloqueio pela tecnica interlaminar foi 0,89, 1,52, 3,63 e 4,88. As tecnicas diferem apenas no periodo de 21 dias pos-bloqueio e no pos-bloqueio global, com significâncias p = 0,022 e p = 0,027, respectivamente. Conclusao : Ambas as tecnicas sao eficazes no alivio da dor e apresentam baixa taxa de complicacao, sendo a tecnica transforaminal a de melhores resultados.

ANÁLISIS DE LAS CURVAS SECUNDARIAS EN PACIENTES SOMETIDOS A ARTRODESIS SELECTIVA LENKE I

Objetivo : Evaluar radiograficamente el comportamiento de las curvas secundarias en el plano coronal y sagital en pacientes con EIA clasificados como Lenke I, que se sometieron a tratamiento quirurgico selectivo por artrodesis por via posterior. Metodos : Estudio retrospectivo, que analizaron a 40 pacientes con EIA, siendo 33 del sexo femenino. La medicion de los parametros radiologicos utilizados siguio las recomendaciones de Cobb. Resultados : La correccion media de las curvas toracica proximal, principal y lumbar fue 34,73%, 75,06% y 64,64%, respectivamente. Conclusion : El tratamiento quirurgico mediante artrodesis selectiva de los casos de EIA Lenke tipo I proporciona la correccion de las curvas de compensacion en el plano coronal y el mantenimiento en el plano sagital.Objective: To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods: Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results: The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion: Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.

ANÁLISE DAS CURVAS SECUNDÁRIAS EM PACIENTES SUBMETIDOS A ARTRODESE SELETIVA LENKE I

Objetivo : Evaluar radiograficamente el comportamiento de las curvas secundarias en el plano coronal y sagital en pacientes con EIA clasificados como Lenke I, que se sometieron a tratamiento quirurgico selectivo por artrodesis por via posterior. Metodos : Estudio retrospectivo, que analizaron a 40 pacientes con EIA, siendo 33 del sexo femenino. La medicion de los parametros radiologicos utilizados siguio las recomendaciones de Cobb. Resultados : La correccion media de las curvas toracica proximal, principal y lumbar fue 34,73%, 75,06% y 64,64%, respectivamente. Conclusion : El tratamiento quirurgico mediante artrodesis selectiva de los casos de EIA Lenke tipo I proporciona la correccion de las curvas de compensacion en el plano coronal y el mantenimiento en el plano sagital.Objective: To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods: Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results: The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion: Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.

ANALYSIS OF THE SECONDARY CURVES IN PATIENTS UNDERGOING SELECTIVE ARTHRODESIS LENKE I

Objetivo : Evaluar radiograficamente el comportamiento de las curvas secundarias en el plano coronal y sagital en pacientes con EIA clasificados como Lenke I, que se sometieron a tratamiento quirurgico selectivo por artrodesis por via posterior. Metodos : Estudio retrospectivo, que analizaron a 40 pacientes con EIA, siendo 33 del sexo femenino. La medicion de los parametros radiologicos utilizados siguio las recomendaciones de Cobb. Resultados : La correccion media de las curvas toracica proximal, principal y lumbar fue 34,73%, 75,06% y 64,64%, respectivamente. Conclusion : El tratamiento quirurgico mediante artrodesis selectiva de los casos de EIA Lenke tipo I proporciona la correccion de las curvas de compensacion en el plano coronal y el mantenimiento en el plano sagital.Objective: To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods: Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results: The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion: Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.