ObjectiveThe primary objective of this study was to analyze the characteristics and outcomes of cases admitted to hospital with cauda equina syndrome (CES) at the Institute of Orthopedics and Traumatology (IOT) from 2005 to 2015. Secondly, this article is a continuation of the epidemiological work of the same base published in 2013, and will be important for other comparative studies to a greater understanding of the disease and its epidemiology.MethodsThis was a retrospective study of the medical records of admissions due to CES at IOT in the period 2005–2015 with diagnosis of CES and neuropathic bladder. The following variables were analyzed: gender, age, etiology of the disease, topographic level of the injury, time interval between injury and diagnosis, presence of neurogenic bladder, time interval between diagnosis of the CES and surgery, and reversal of the deficit or of the neurogenic bladder.ResultsSince this is a rare disease, with a low global incidence, it was not possible, just with the current study to establish statistically significant correlations between the variables and outcomes of the disease. However, this study demonstrates the shortcomings of the Brazilian public health system, both with the initial management of these patients and the need for urgent surgical treatment.ConclusionThe study shows that despite well-defined basis for the conduct of CES, a higher number of sequelae caused by the pathology is observed in Brazil. The delay in diagnosis and, therefore, for definitive treatment, remains as the major cause for the high number of sequelae. Level of evidence: 4, case series.

Objective:Adolescent idiopathic scoliosis (AIS) is characterized by rotational and lateral deformity of the spine. The measurement of vertebral rotation is important for prognosis and treatment. Our objective was to evaluate whether the Nash-Moe method can be used to measure axial deformity correction with surgical treatment using the rod derotation maneuver at both the apex and extremities of the deformity in patients with AIS.Methods:Rotation was assessed using the Nash and Moe criteria, on preoperative and postoperative radiographs. We also evaluated the severity on the coronal plane using the Cobb method, ratio of correction achieved, screw density, and number of vertebrae involved in the instrumentation.Results:The Cobb method correction average was 54.8%. When we disregarded vertebrae that presented preoperative Nash-Moe grade 0, the average measurable correction was 54.5% in the first non-instrumented vertebra above, 69.2% in the first instrumented vertebra, 32.2% in the apical vertebra, 36.8% in the last instrumented vertebra, and 30% in the first non-instrumented vertebra below. In our study, 32.14% of the patients presented a measurable correction in the apical vertebra.Conclusion:On the axial plane, correction can be satisfactorily evaluated using the Nash-Moe method. Level of Evidence VI. Case Series.

Objective: To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone.Methods:Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society.Results: The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index.Conclusion: The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series.

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Coluna/Columna. 2016;15(1):33-5 Original article/artigO Original/artículO Original JOse alfredO cOrredOr¹, fernandO flOres de araúJO¹, rOdrigO góes de MendOnça¹, nOel OizerOvici fOni¹, nelsOn astur¹, albertO OfenheiM gOtfryd¹, ricardO shigueaki galhegO uMeta¹, Maria fernanda silber caffarO¹, OsMar avanzi¹, rObert Meves¹ Recebido em 20/08/2015, aceito em 15/12/2015. NoNoperative versus operative treatmeNt of patieNts with degeNerative spoNdylolisthesis TraTamenTo conservador versus cirúrgico de pacienTes com espondilolisTese degeneraTiva TraTamienTo conservador conTra quirúrgico de pacienTes con espondilolisTesis degeneraTiva Original article/artigO Original/artículO Original AbstrActObjective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS), Fischgrund criteria, Short Form-36 (SF-36) function score, and the modified Oswestry Disability Index (ODI). Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 -72) for the nonoperative group and 36 months (range 6-80) for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000), leg VAS (mean 3 versus 6, p = 0.0015), SF-36 function score (mean 77 versus 35, p = 0.000), and ODI (mean 17 versus 46, p = 0.000). On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000). Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.

Objective: To report the use of two techniques (radiosurgery and en bloc vertebrectomy) on the same patient for the treatment of two metastases in different sites of the spine arising from intracranial hemangiopericytoma. Intracranial hemangiopericytomas are rare, comprising approximately 2.4% of meningeal tumors and <1% of all tumors of the central nervous system. Metastases to the spine are even rarer: The largest case series reported in the literature has 5 and 7 cases. Methods: A 37-year-old man diagnosed with intracranial hemangiopericytoma was referred for a metastatic lesion in T12 and underwent en bloc resection using the Tomita technique. Results: The disease evolved with a metastasis to T2 treated by radiosurgery with 1600 cGy. The patient died 1,706 days after the en bloc resection of T12 and 1324 days after the radiosurgery of T2, and no recurrence occurred in these locations due to progression of the systemic diseases (liver and central nervous system). Conclusion: This is the first case reported in the literature in which two different techniques were used to treat metastatic lesions in the spine from an intracranial hemangiopericytoma and is unique for its use of two treatments in the same patient. Level of evidence: V, case report

Introduction. The objective of this study was to describe a surgical technique that uses transforaminal full-endoscopic access, which is different from the existing protocol, and to demonstrate another method of dural tear repair during endoscopic spine surgery. Background. Endoscopic spine surgery was initially described for lumbar disc pathologies. Technical advances and new materials have made it possible to treat cervical and thoracic spinal degenerative disorders. These advances have also made it possible to treat surgical complications, notably dural tears with CSF fistulas. The literature indicates that the incidence of these injuries ranges from 1% to 17%. Materials and Methods. Descriptive technical note of innovative and improved endoscopic surgical procedure exemplified with illustrative clinical case and comparative literature review. Results. There is only one report describing a full-endoscopic suture technique for dural sac repair. The gold standard for treatment of the most significant nonpunctate lesions continues to be a conversion to open surgery for lesion closure. Conversion can be problematic because most surgeries are performed under sedation and local anesthesia. Conclusions. In this case report and the new endoscopic suture technique described here, we show that primary correction of dural tears through endoscopy is possible. In addition to representing a paradigm break in solving one of the main complications of these procedures, it can expand the possibilities of spine endoscopy.

Introduction Nonoperative treatment is the first prerogative for patients with degenerative spondylolisthesis without neurological deficit. In cases where persistent pain or neurological deficit becomes prevalent, surgery becomes an option. In this cross-sectional study, we evaluated clinical and functional results of patients with lumbar degenerative spondylolisthesis treated nonoperatively or surgically. Patients and Methods Patients with degenerative spondylolisthesis treated either nonoperatively or surgically from 2004 to 2014 were selected from databases and a cross-sectional evaluation was applied. Outcome measures included back and leg visual analog scales (VAS), Fischgrund criteria, short form-36 (SF-36) physical function, and the modified oswestry disability index (ODI). Results Of the 85 patients who met the inclusion criteria, we evaluated 43 in total: 20 with nonoperative treatment and 23 with surgical treatment. Baseline characteristics were similar without significant differences. The mean follow-up time was 43 months (range, 10–72 months) for nonsurgically and 36 months (range, 6–80 months) for surgically treated groups. The surgical group displayed better scores in back VAS (8 vs. 4), leg VAS (6 vs. 3), SF-36 physical function (35 vs. 77), and ODI (46 vs. 17). On the basis of the Fischgrund criteria, only 10% of patients reported excellent or good health post nonoperative treatment versus 83% for those treated surgically. Conclusion Symptomatic patients with lumbar degenerative spondylolisthesis treated surgically obtained better clinical and functional scores than patients treated nonoperatively. The limitations of the study do not permit statistical analysis and hence further review is necessary to draw firm conclusions.