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- ItemAcesso aberto (Open Access)Clinical complications in patients with severe cervical spinal trauma: a ten-year prospective study(Academia Brasileira de Neurologia - ABNEURO, 2012-07-01) Santos, Egmond Alves Silva; Santos Filho, Wenner Jorzino; Possatti, Lucas Loss; Bittencourt, Lia Rita Azeredo [UNIFESP]; Fontoura, Emílio Afonso França; Botelho, Ricardo Vieira; Conjunto Hospitalar do Mandaqui; Universidade Federal de São Paulo (UNIFESP); Instituto de Assistência Médica ao Servidor Público Estadual Hospital do Servidor Público EstadualOBJECTIVE: To determine the complications due to severe acrescentar sigla após o nome (CST). METHODS: Between 1997 and 2006, 217 patients (191 men and 26 women) were prospectively evaluated. The mean age was 36.75±1.06 years. RESULTS: Forty-five percent of the patients had medical complications. The most important risk factor was alcoholic beverage use. The most important associated injury was head trauma (HT). Patients with American Spine Injury Association (ASIA) A or B had a 2.3-fold greater relative risk of developing complications. Thirty-three patients (15.2%) died. Patients with neurological deficit had a 16.9-fold higher risk of death. There was no influence of age and time between trauma and surgery on the presence of complications. CONCLUSIONS: Of the patients, 45% had clinical complications and 7.5% had associated injuries; pneumonia was the most important complication; patient age and time between trauma and surgery did not influence the development of medical complications; neurological status was the most important factor in determining morbidity and mortality.
- ItemAcesso aberto (Open Access)Contribuição dos métodos de diagnóstico por imagem na avaliação da espondilólise(Sociedade Brasileira de Reumatologia, 2006-08-01) Zoner, Cristiane Soares [UNIFESP]; Amaral, Denise Tokechi do [UNIFESP]; Natour, Jamil [UNIFESP]; Fernandes, Artur da Rocha Correa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)Estudo de artrodese lombar minimamente invasiva lateral transpsoas: análise de parâmetros radiológicos, afundamento do espaçador intersomático e suas correspondências clínicas(Universidade Federal de São Paulo (UNIFESP), 2016-06-28) Marchi, Luis Henrique Larcher [UNIFESP]; Abdala, Nitamar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)To investigate the event of sinking of the intersomatic spacer in lumbar fusion procedures by the XLIF method without the use of transpedicular screw supplementation. Methods: In the investigation of time of onset, clinical significance and protective factors, we used a retrospective analysis of a first cohort: 74 cases treated with XLIF. The cases were divided into two groups according to the spacer that was used 18mm and 22mm. Radiological and clinical parameters were evaluated up to one year postoperatively. In lateral radiographs we used a gradation of sinking of the spacer (degree 0-III). In a second cohort, we investigated risk factors and selected cases with low predisposition to sink. We used a case-control study with 86 cases divided by the outcomes: sinking grade II / III or grade 0 / I. Demographic, pathological and surgical data were analyzed. A score of factors correlated with sinking was tested. Results: In the first study, we found that sags of more advanced degrees were found in the 18mm group (p = 0.01). The event was detected at the point six weeks after surgery and did not progress significantly. The occurrence of more advanced degrees was correlated with transient low back pain at the six-week point. At the last point of analysis, we observed that in the 22mm group, 14% of the cases had grade II / III dip as opposed to 30% in the 18mm group. In the second study, the following risk factors were correlated with sinking group II / III: spondylolisthesis (92% vs 21%, p <0.001); Scoliosis (33% vs 12%, p = 0.033); Female (75% vs 42%, p = 0.007); Age (57.3 vs 67.7, p <0.001). These factors were used in a score (from 0-4) to assess the risk of each case. Scores ?2 were predictors of sinking with 92% sensitivity and 72% specificity. Conclusions: The occurrence of sinking is precocious, it should be carefully evaluated at the beginning of the follow-up because it reflects clinically and in loss of surgical correction. The use of wider spacers may decrease the occurrence. In addition, in the selection of eligible cases using predictive sinking factors found the probability of favorable evolution is 98%.
- ItemAcesso aberto (Open Access)Metástases do segmento torácico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirúrgico e radioterápico com a imobilização externa e radioterapia(Academia Brasileira de Neurologia - ABNEURO, 2007-09-01) Falavigna, Asdrubal [UNIFESP]; Righesso Neto, Orlando; Ioppi, Ana Elisa Empinotti; Grasselli, Juliana; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade Federal de Ciências Médicas; UCSBone 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 patient's 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.
- ItemAcesso aberto (Open Access)Relação entre a excursão do músculo diafragma e as curvaturas da coluna vertebral em crianças respiradoras bucais(Sociedade Brasileira de Pediatria, 2008-04-01) Yi, Liu Chiao [UNIFESP]; Jardim, José Roberto [UNIFESP]; Inoue, Daniel Paganini [UNIFESP]; Pignatari, Shirley Shizue Nagata [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To investigate the relationship between excursion of the diaphragm muscle and spinal curvatures in mouth breathing children. METHODS: A total of 52 children of both sexes, aged from 5 to 12 years, were studied. After otorhinolaryngological assessment, the children were divided into two groups: mouth breathers and nose breathers. All of the children underwent videofluoroscopic examination of the diaphragm muscle and postural assessment. Diaphragm excursion was analyzed using Adobe Photoshop® software, and postural assessment was recorded using photographs in left lateral view, which were then analyzed using SAPO postural assessment software. RESULTS: The groups studied exhibited statistically significant differences in terms of spinal curvatures (cervical lordosis: p = 0.003; lumbar lordosis: p = 0.001; thoracic kyphosis: p = 0.002; position of the pelvis: p = 0.001) and diaphragm excursion (right side diaphragm: p = 0.001; left side diaphragm: p = 0.001). The mouth breathing group exhibited reduced cervical lordosis, increased thoracic kyphosis, increased lumbar lordosis and the position of the pelvis was tilted forward. The distance traveled outwards by the diaphragm muscles of mouth breathing children was shorter than that traveled by the muscles of nose breathing children. The relationship between the behavior of spinal curvatures and diaphragm excursion had no statistical significance. CONCLUSION: There was no relationship between spinal curvatures and diaphragm excursion in the groups studied here.
- ItemAcesso aberto (Open Access)Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome(Academia Brasileira de Neurologia - ABNEURO, 2009-06-01) Almeida, Daniel Benzecry de; Mattei, Tobias Alécio; Sória, Marília Grando; Prandini, Mirto Nelso [UNIFESP]; Leal, André Giacomelli; Milano, Jerônimo Buzzeti; Ramina, Ricardo; Instituto de Neurologia de Curitiba Department of Neurosurgery; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. METHOD: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. RESULTS: Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. CONCLUSION: There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.