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Study Design: Multicentric retrospective study, Level of evidence III. Objective: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. Methods: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. Results: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). Conclusion: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

Study Design: Cohort study. Objectives: This study aimed to evaluate the accuracy of the AO Surgery Reference mobile app in the diagnosis of thoracolumbar fractures of the spine according to the AO TL classification, and to discuss the usefulness of this app in the teaching and training of the resident physicians in orthopedics and traumatology area. Methods: The 24 residents of Orthopedic and Traumatology program assessed 20 cases of thoracolumbar fractures selected from the hospital database on 2 different occasions, with a 30-day interval, and they classified these cases with and without using the AO Surgery Reference app. A group of spine experts previously established the gold standard and the answers were statistically compared, with the inter- and intraobserver reliability evaluated by the kappa index. Results: The use of the AO Surgery Reference app increased the classification success rate of the fracture morphology (from 53.4% to 72.5%), of the comorbidity modifier (from 61.4% to 77.9%) and of the neurological status modifier (from 55.1% to 72.9%). In addition, the mobile app raised the classification agreement and accuracy. The kappa index increased from 0.30 to 0.53 regarding the morphological classification of fractures. Conclusions: The residents improved their ability to recognize and classify thoracolumbar spine fractures, which reinforces the importance of this tool in medical education and clinical practice.

Study Design: Prospective cohort study. Objective: The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters. Methods: Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded. Results: In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% ( P < .001). The canal area increased from 109 to 149 mm2 ( P < .001) and from 9.3 to 12.2 mm ( P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides ( P < .001). The height of the foramen showed significant average increase of 2.8 mm ( P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression. Conclusion: We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.

INTRODUÇÃO: A evolução natural da escoliose idiopática do adolescente (EIA) foi extensamente estudada e já foram identificados diversos fatores que podem determinar a gravidade e a progressão da doença em diferentes populações. Apesar dos esforços, ainda não existe uma ferramenta prática que englobe conjuntamente os principais fatores que determinam a gravidade da doença. OBJETIVOS: Elaborar uma escala de pontuação simples, baseada em evidências, que apresente correlação com a qualidade de vida do paciente e que seja capaz de estratificar os pacientes com escoliose idiopática, priorizando os fatores de risco de progressão e de gravidade. MATERIAL E MÉTODOS: Foi desenvolvida, a partir de revisão narrativa da literatura, uma escala de pontuação possível de ser aplicada em todos os pacientes portadores de escoliose idiopática que se encontram em fila de espera para tratamento cirúrgico, no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, centro de referência de tratamento da EIA do Brasil. Numa segunda etapa, foi aplicada a escala desenvolvida em conjunto com o questionário de qualidade de vida SRS30. Foram correlacionadas estatisticamente as duas escalas através do teste de Pearson, assim como os valores do Cobb, o escore obtido pela escala proposta e os domínios do questionário de qualidade de vida. RESULTADOS: Verificou-se um grupo homogêneo com relação à idade e sexo, com média de idade de 15,29 + 2,47 anos, 86,7% do sexo feminino. A média do ângulo de Cobb inicial (momento de entrada na fila) foi de 55,4 graus e a média do Cobb atual (data da análise) 74,54 graus, com evolução média de 19,12 graus. A escala desenvolvida apresentou pontuação mínima de 6 e máxima de 16 com média de 11,27. O teste de Pearson entre as escalas SSS-IOT e o ângulo de Cobb mostrou significância estatística (p = 0,005), com P=0,434 demonstrando correlação entre a escala e progressão das curvas. CONCLUSÃO: A escala proposta foi diretamente proporcional ao risco para progressão de curvas principais na escoliose idiopática do adolescente e apresentou correlação clínica com o questionário de qualidade de vida SRS-30, sendo maior seu valor de progressão correlacionado a pior qualidade de vida. Mais estudos são necessários para validação e aplicação em ampla escala da classificação INTRODUCTION: The natural evolution of adolescent idiopathic scoliosis (AIS) has been extensively studied and several factors have been identified that may determine the severity and progression of the disease in different populations. Despite efforts, there is still no practical tool that collectively encompasses the key factors that determine the severity of the disease. OBJECTIVES: To develop a simple, evidence-based score scale that correlates with the patient\'s quality of life and is capable of stratifying patients with idiopathic scoliosis, prioritizing risk factors for progression and severity. MATERIAL AND METHODS: From a literature review, a scoring scale was developed that could be applied to all patients with idiopathic scoliosis who are waiting for surgical treatment at the Orthopedic and Traumatology Institute of Clinics Hospital at Faculdade de Medicina from São Paulo University a large reference center for the treatment of AIS in Brazil. In a second step, the developed scale and the SRS30 quality of life questionnaire were applied. The two scales were statistically correlated through the Pearson correlation test, as well as the Cobb values, the score obtained by the proposed scale and the domains of the quality of life questionnaire. RESULTS: There was a homogeneous group with respect to age and sex, with a mean age of 15.29 + 2.47 years, 86.7% female. The mean Cobb angle (queue entry time) was 55.4 degrees and the current Cobb average (date of analysis) was 74.54 degrees, with an average evolution of 19.12 degrees. The developed scale had a minimum score of 6 and a maximum of 16 with an average of 11.27. The Pearson correlation test between the SSS-IOT scales and the Cobb angle showed statistical significance (p = 0.005), with a magnitude of P=0.434, demonstrating the evolutionary character of the scale. CONCLUSIONS: The proposed scale is directly proportional to the risk for progression of major curves in adolescent idiopathic scoliosis and presents a clinical correlation with the SRS-30 quality of life questionnaire, with a higher progression value is correlated with worse quality of life. More studies are needed for validation and wide-scale application of the classification

Objective: To evaluate the hormonal profile of patients with adolescent idiopathic scoliosis (AIS) and its relationship to the severity of the curvature and quality of life . Method: Patients with scoliosis (Cobb angle above 10°), of both genders, diagnosed after 10 years of age were included, excluding those who presented other condition that could lead to scoliosis. Serum levels of 25-hydroxyvitamin D (25-OHD), cortisol and gastrin were correlated with Cobb angle and quality of life, measured by the SRS-30 questionnaire . Results: The levels of 25-OHD decreased in 97% of patients. There was an inverse relationship between gastrin levels and quality of life (p = 0.016). Moreover, there was an inverse correlation between the value of Cobb angle and quality of life (p = 0.036). There were no changes in cortisol levels. There was no correlation between Cobb angle and any of the hormones measured . Conclusion: The patients had levels of 25-OHD diminished, strengthening the hypothesis of its involvement in the development of AIS. This study also suggests that increased gastrin levels may be associated with a worse quality of life in patients with AIS. Level of Evidence II, Diagnostic Study. RESUMO Objetivo: Avaliar o perfil hormonal dos pacientes com escoliose idiopática do adolescente (EIA) e sua relação com a gravidade da curvatura e qualidade de vida. Método: Foram incluídos pacientes com escoliose (ângulo de Cobb acima de 10°), de ambos os sexos, diagnosticados após 10 anos de idade e foram excluídos aqueles que apresentassem outra condição que pudesse acarretar em escoliose. Os valores séricos da 25-hidroxivitamina D (25-OHD), cortisol e gastrina foram correlacionados com o ângulo de Cobb e a qualidade de vida, mensurada através do questionário SRS-30. Resultados: Os níveos de 25-OHD estavam reduzidos em 97% dos pacientes. Observou-se uma relação inversa entre níveis de gastrina e a qualidade de vida (p=0,016). Ademais, constatou-se correlação inversa entre o valor do ângulo de Cobb e a qualidade de vida (p=0,036). Não foram observadas alterações nos níveis de cortisol. Não houve correlação do ângulo de Cobb com o nível de nenhum dos hormônios dosados. Conclusão: Os pacientes apresentaram níveis de 25-OHD diminuídos, fortalecendo a hipótese da sua implicação no desenvolvimento da EIA. O presente estudo também sugere que o aumento dos níveis de gastrina possa estar relacionado com pior qualidade de vida nos pacientes com EIA. Nível de Evidência II, Estudo Diagnóstico.

Objetivo:Evaluar las clasificaciones AO/Magerl y SLIC (Subaxial Cervical Spine Injury Classification) utilizadas en las fracturas de la columna cervical y evaluar si tienen correlacion con la gravedad neurologica de los pacientes, la eleccion de la via de acceso, la duracion de la cirugia y si estan correlacionados entre si.Metodo:Analisis retrospectivo de registros medicos y coleccion de imagenes radiologicas de 77 pacientes tratados quirurgicamente de fractura o dislocacion de la columna cervical subaxial, desde agosto 2010 a septiembre 2012.Resultados:La clasificacion SLIC mostro una fuerte correlacion con deficit neurologico y el valor de correlacion de Pearson de -0,600. La clasificacion AO no se correlaciono con la escala de Frankel y el valor de Pearson fue 0,06, con una significacion estadistica de 0,682 (p < 0,05), es decir, incapaz de determinar o sugerir la gravedad del deficit. Cuando se compararon entre si, las dos clasificaciones mostraron correlacion estadistica y el valor de Pearson fue de 0,282, con valor de significacion de 0,022 (p < 0,05).Conclusion:Entre las clasificaciones mas utilizadas, la calificacion SLIC ha sido capaz de definir estadisticamente la necesidad de tratamiento quirurgico y la gravedad del estado neurologico, pero fue incapaz de predecir la via de acceso o la duracion de la cirugia; la clasificacion AO no logro predecir la gravedad de la lesion neurologica, el tiempo quirurgico ni auxilio a elegir la via de acceso, siendo solo una clasificacion morfologica.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:44:19Z No. of bitstreams: 1 S1808-18512012000400013.pdf: 263129 bytes, checksum: 5507a4a543328a4e3fa5783919edb1a0 (MD5) Made available in DSpace on 2013-08-22T18:44:19Z (GMT). No. of bitstreams: 1 S1808-18512012000400013.pdf: 263129 bytes, checksum: 5507a4a543328a4e3fa5783919edb1a0 (MD5) Previous issue date: 2012-12-01 Made available in DSpace on 2013-09-30T19:32:22Z (GMT). No. of bitstreams: 2 S1808-18512012000400013.pdf: 263129 bytes, checksum: 5507a4a543328a4e3fa5783919edb1a0 (MD5) S1808-18512012000400013.pdf.txt: 18787 bytes, checksum: 2a3f5a9347a706d55df9d83bcde54bf7 (MD5) Previous issue date: 2012-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:08:49Z No. of bitstreams: 2 S1808-18512012000400013.pdf: 263129 bytes, checksum: 5507a4a543328a4e3fa5783919edb1a0 (MD5) S1808-18512012000400013.pdf.txt: 18787 bytes, checksum: 2a3f5a9347a706d55df9d83bcde54bf7 (MD5) Made available in DSpace on 2014-05-20T15:08:49Z (GMT). No. of bitstreams: 2 S1808-18512012000400013.pdf: 263129 bytes, checksum: 5507a4a543328a4e3fa5783919edb1a0 (MD5) S1808-18512012000400013.pdf.txt: 18787 bytes, checksum: 2a3f5a9347a706d55df9d83bcde54bf7 (MD5) Previous issue date: 2012-12-01 OBJETIVO: Determinar através de cortes tomográficos e reconstrução tridimensional a incidência de mal posicionamento de parafusos em pacientes submetidos ao tratamento cirúrgico da Escoliose idiopática do adolescente. MÉTODOS: Foram analisados exames tomográficos de 8 pacientes, tratados cirurgicamente no Hospital de Base de São José do Rio Preto-SP, realizada instrumentação posterior partindo de T2 /T4 a L4/L5 totalizando 164 parafusos. RESULTADOS: 32,9% (n=54) apresentavam posicionamento com risco potencial,ou seja desvio acima de 2 milímetros, sendo 20,1% (n=33) com invasão lateral, 9,1% (n=15) com invasão medial, 3,6 %(n=6) com invasão anterior. Dos parafusos que ofereciam risco potencial a relação com aspecto da curva foi de 46% (n=25) na concavidade, 35% (n=19) na convexidade e 19% (n=10) em vértebras adjacentes a curva. CONCLUSÃO: Os limites de penetração aceitáveis, assim como os métodos de mensuração ainda não foram padronizados, a técnica free hand' mostrou-se segura, apesar da violação dos pedículos. A tomografia computadorizada pré-operatória, auxilia no planejamento cirúrgico e na redução das complicações. OBJECTIVE: To Evaluate by CT scan tridimensional reconstruction, malpositioning of pedicle screws in adolescent idiopathic scoliosis patients. METHODS: It was analyzed CT scan cuts of 8 patients submitted to surgical treatment in Hospital de Base de São José do Rio Preto- SP, which were performed posterior spinal fusion from T2/T4 to L4/L5, 164 screws were inserted. RESULTS: 32,9% (n=54) were malpositioned offering potential risk, which was considered 2mm deviation, 20,1% (n=33) lateral invasion, 9,1% (n=15) medial invasion, 3,6% (n= 6) anterior invasion. From those malpositioned screws 46% (n=25) were in concavity, 35% (n=19) in convexity and 19% (n=10) were nearby curve. CONCLUSION: Acceptable invasion boundaries were not well determined, and also measurements methods are not standardized. The free hand technique proved safe, besides pedicle violation. Pre-Op CT Scan showed helpful in surgery planning and avoiding complications. OBJETIVO: Evaluar mediante tomografía computarizada tridimensional de reconstrucción, una mala posición de los tornillos de pedículo en pacientes con escoliosis idiopática del adolescente. MÉTODOS: Se analizó cortes de tomografía computarizada de 8 pacientes sometidos a tratamiento quirúrgico en el Hospital de Base de São José do Rio Preto-SP, que se llevaron a cabo la fusión vertebral posterior de T2/T4 a L4/L5, 164 tornillos se insertaron. RESULTADOS: 32,9% (n = 54) fueron mal colocados que ofrecen riesgo potencial, que se consideraba una desviación de 2 mm, 20,1% (n = 33), la invasión lateral, el 9,1% (n = 15) invasión medial, 3,6 % (n = 6) la invasión anterior. de los tornillos mal colocados el 46% (n = 25) fueron en la concavidad, el 35% (n = 19) en la convexidad y el 19% (n = 10) se curva cerca. CONCLUSIÓN: Los límites aceptables invasión no se determinaron también, y también los métodos de medición no están estandarizados. La técnica free hand resultó segura, además de violación pedículo. Pre-Op CT Scan mostró útil en la cirugía de la planificación y evitar complicaciones. FAMERP FAMERP Departamento Neurocirurgia UNESP UNESP

OBJETIVO: Conhecer a prevalência de obesidade e sua distribuição por sexo e idade em pacientes com diabetes melito tipo 1 (DM1), em acompanhamento em Serviço de Endocrinologia Pediátrica. MÉTODOS: Estudo transversal descritivo de pacientes em acompanhamento no Serviço de Endocrinologia Pediátrica do Hospital de Base de São José do Rio Preto, avaliando as seguintes variáveis: sexo, idade, dose e número de aplicações diárias de insulina, hemoglobina glicada (HbA1c), peso, estatura e índice de massa corpórea (IMC). A definição de sobrepeso e obesidade baseou-se nas curvas de IMC para a idade do Centers for Disease Control and Prevention (CDC, 2000). RESULTADOS: Foram incluídos 77 portadores de DM1 (44 meninas e 33 meninos) com idade entre três e 18 anos (média: 13,4). A determinação de HbA1c variou de 4,1 a 10,6% (média: 7,7%) e o IMC, de 15,1 a 28,6 kg/m² (média: 23,2). Conforme critérios do CDC, 8% dos pacientes (três meninas e três meninos) apresentavam obesidade e 8% (duas meninas e quatro meninos), sobrepeso. CONCLUSÕES: Nesta casuística de pacientes diabéticos, a prevalência de sobrepeso e obesidade não se mostrou diferente de populações não diabéticas. OBJECTIVE: To describe the prevalence of obesity according to gender and age in patients with type 1 diabetes mellitus of a pediatric endocrinology follow-up clinic. METHODS: This cross-sectional descriptive study enrolled patients of the follow-up clinic of the Pediatric Endocrinology Unit of Hospital de Base of São José do Rio Preto, São Paulo, Brazil. The following data were collected: gender, age, insulin dosage, glycated hemoglobin (HbA1c), weight, height and body mass index (BMI). The cutoff criteria for overweight and obesity were based on BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC, 2000). RESULTS: 77 patients with type 1 diabetes mellitus were included (44 females and 33 males), with three to 18 years old (mean: 13.4). The value of HbA1c varied from 4.1 to 10.6% (mean: 7.7%) and the BMI ranged from 15.1 to 28.6 kg/m² (average: 23.2). Based on BMI charts, 8% (three girls and three boys) were obese and 8% (two girls and four boys) had overweight. CONCLUSION: Compared to the prevalence of obesity and overweight in non-diabetic pediatric population, the presence of these nutritional disturbances in the studied children was not significantly different.

Introduction Camptocormia (bent spine syndrome) is an acquired postural disease characterized by forward flexion of the thoracolumbar spine. Camptocormia leads to lumbar kyphosis and increases during walking or standing. Management of Camptocormia is still a challenge and the literature on this topic is limited. There is no specific pharmacologic treatment for primary axial myopathy. Patients and Methods Our patient is a 68-year-old man, diagnosed in 2009 with a base tongue squamous cell carcinoma, surgically removed in September 2010. By May 2011, it was diagnosed with local recurrence, submitted to radiosensitive chemotherapy, and followed by radical radiotherapy 35 fractions of 70 Gy. Results After general anesthesia, and neuromonitoring a median incision was made from C3 to the sacrum, former instrumentation C3–T3 were tested, and no loosening or breakage was detected. Pedicle screws were inserted by free hand technic except C7 and T1 because the small space for rod connectors and T6, T10, L2, and L5 were osteotomies were performed total of 28 screws until S2 with sacropelvic fixation. In T6 and T10, Ponte osteotomies were made, and closing wedge pedicle subtraction in L2 and laminectomy of L3. Patient presented good outcome, receiving discharge at 7th postoperatory day, and initiated naturotherapy, fonotherapy, and physiotherapy, and nasoenteral catheter were maintained until 3 weeks and some swallowing improvement reported by the 6th week. In the follow-up, patient maintained satisfied with procedure and returned to work by 3rd month, screening showed no recurrence of the tumor or distant metastasis. Conclusion This is the first case described where dropped head syndrome and camptocormia occurred in the same patient because of radiosensibilizing chemotherapy for a nasopharyngeal carcinoma. We only found a single case report of a patient with dropped head syndrome associated with chemoradiotherapy for a nasopharyngeal carcinoma in a 59-year-old Japanese patient, described by Hashimoto (2012), treated without surgery who developed symptoms 2 years after chemoradiotherapy.