-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.Key WorDs: low back pain, lumbosacral region, spine.dor lombar associada à vértebra de transição lombossacra: dificuldades no diagnóstico e manejo da síndrome de bertolotti resumo -Objetivo: A síndrome de Bertolotti é uma desordem congênita da coluna vertebral caracterizada pela ocorrência de uma mega-apófise transversa lombar em uma vértebra de aspecto transicional, que geralmente se articula com o sacro ou com o osso ilíaco. Tal síndrome tem sido considerada possível causa de dor lombar. Método: Análise dos casos de síndrome de Bertolotti que apresentavam dor lombar sem melhora com tratamento conservador e revisão dos artigos publicados. Resultados: Foram revisados cinco pacientes que não apresentaram melhora com o tratamento clínico, sendo que dois foram submetidos à ressecção cirúrgica da mega-apófise transversa. Considerando a experiência adquirida com estes casos, os autores propõem um algoritmo para diagnóstico e tratamento da síndrome de Bertolotti. Conclusão: Ainda não há consenso sobre qual é a terapia mais apropriada para a síndrome de Bertolotti. em pacientes em que a mega-apófise parece ser a origem da lombalgia, a ressecção cirúrgica parece ser um procedimento seguro e efetivo.PAlAvrAs-ChAve: dor lombar, região lombossacral, coluna vertebral.
Cervical spondylotic myelopathy is a degenerative spinal disease which may lead to significant clinical morbidity. The onset of symptoms is usually insidious, with long periods of fixed disability and episodic worsening events. Regarding the pathophysiology of CSM, the repeated injuries to the spinal cord are caused by both static and dynamic mechanical factors. The combination of these factors affects the spinal cord basically through both direct trauma and ischemia. Regarding the diagnosis, both static and dynamics X-rays, as well as magnetic resonance imaging are important for preoperative evaluation as well as individualizing surgical planning. The choice of the most appropriate technique is affected by patient's clinical condition radiologic findings, as well as surgeon's experience. In opposition to the old belief that patients presenting mild myelopathy should be treated conservatively, there has progressively been amount of evidence indicating that the clinical course of this disease is progressive deterioration and that early surgical intervention improves long-term functional recovery and neurological prognosis.
Pedicle screws are widely used for instrumentation of the thoracolumbar spine. The anatomic studies performed in the last two decades, detailing the complex morphometry and three-dimensional anatomy of the thoracolumbar pedicles, have enabled the emergence of the so-called "free-hand" technique of pedicle screw placement based exclusively on anatomical parameters. However, in the thoracic spine, the benefits of pedicle screws have been tempered by its potential risks, such as, spinal canal violation, pedicle fracture, nerve root compression, and vascular lesions. Furthermore, the narrow and inconsistent shape of the thoracic pedicles, especially in spinal deformity, makes their placement technically challenging. In this article, the authors make a critical appraisal of current "state-of-art" of "free-hand" technique of pedicle instrumentation, analyzing its anatomical basis, surgical technique, present indications and limitations as well as the role of adjuvant image-guided and neurophysiological monitoring methods.
Satisfactory clinical outcome can be achieved with an isolated decompression in selected patients, avoiding the additional risks and costs of instrumentation and spinal fusion. Noninstrumented fusion is also an interesting alternative to instrumented fusion for well-selected patients to decrease complications related to instrumentation.
Study DesignPilot test, observational study.ObjectiveTo evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons.MethodsDuring two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course.ResultsAnalysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p = 0.005) and lumbar spine modifier (46.6%, p = 0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p = 0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p = 0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p = 0.121) and sagittal thoracic modifier (12.9%, p = 0.081).ConclusionThis pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer.
Introduction AOSpine educational program was developed to expand knowledge and to promote integration among spine surgeons around the world. Nowadays, however, there are no available data of the effectiveness of the learning process and the level of competence acquired by participants in such activities. The aim of this study is to evaluate, objectively, the knowledge transfer provided thorough theoretical and practical activities during AOSpine courses for spine surgeons. Material and Methods During two principles courses of spine surgery, sixty-two participants underwent to pre-course assessment about their professional experience and preferences of adolescent idiopathic scoliosis (AIS) classification, as well as a test of curves by means of Lenke classification of two AIS clinical cases. Two learning strategies were used during the course: oral lectures and practical exercises. A post-course questionnaire was applied to retest the same deformity cases. Differences of correct answers of clinical cases between pre and post course were analyzed, revealing the number of participants who improve in the accuracy of the classification after the course. Results A total of 62 participants were included in the study, wherein 51 (82%) were orthopedic surgeons and 11 (18%) neurosurgeons. Analysis showed a decrease in the number of participants with wrong answer in both cases, after the course. In the first case, statistical significant differences were observed in both, curve pattern (83.3%, p = 0.005) and lumbar spine modifier (46.6%, p = 0.049). No statistical significant improvement was seen in sagittal thoracic modifier (33.3%, p = 0.309). On the second case, statistical improvement was obtained in curve pattern (27.4%, p = 0.018). No statistical significant improvement was seen regarding lumbar spine modifier (9.8%, p = 0.121) and sagittal thoracic modifier (12.9%, p = 0.081). Conclusion This study showed, objectively, that learning strategies used during AOSpine courses, improved the knowledge of participants. This knowledge acquisition was demonstrated through the decreased number of participants with wrong answers of two clinical cases, after the course. Teaching strategies must to be continually improved to ensure optimal level of knowledge transfer.
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