Background: Low back pain can be caused by several pathological entities and its perception can be altered by external factors, for example by some psychological and social factors. The objective of this study was to compare surgical outcomes in patients with or without psychosocial issues.Methods: Single center, retrospective and comparative study. Patients with indication to elective lumbar spine surgery were screened for some psychosocial factors. As a result of the screening, patients were divided in two groups: mild psychosocial issues (green group) or moderate psychosocial issues (yellow group). The Results: A total of 136 patients were included (51% female) in this study. The 62.5% were allocated at the green group, and 37.5% in the yellow group. Similar pain levels were observed at preop, but the green group evolved with superior improvement in pain levels after surgery (P=0.003). In the ODI and EQ-5D scales, the green group had already shown lower clinical disability at preop (P=0.009 and P=0.003, respectively) and evolved with better outcomes at the final evaluation (P=0.049 and P=0.017). VAS, ODI and EQ-5D scores improved from baseline similarly in both groups.Conclusions: Presurgical screening identify the presence of psychological distress. Psychosocial factors are correlated with poorer clinical outcomes, both in the baseline and after the surgery. Despite the differences between found, even patients with mild psychosocial impairment can experience clinical improvement with surgery.

ObjectivesHistorically, anterior lumbar interbody fusion (ALIF) was related to high rates of intraoperative complications and adverse events related to interbody devices. In recent decades, there have been technical adjustments, and cages that are more suitable have emerged. The aim of this study is to evaluate the efficacy and complication rate of the use of stand-alone mini-ALIF using a self-locking cage.MethodsRetrospective single center study. Inclusion criteria: retroperitoneal mini-ALIF for single-level fusion (L5S1); self-locking cage; DDD/stenosis and grade I spondylolisthesis. Exclusion criteria: posterior supplementation, previous fusion/arthroplasty. Endpoints: surgery data, intraoperative and perioperative adverse events related both to surgical access and to the intersomatic device.ResultsEighty-seven cases were enrolled. Median surgical time was 90 min; median blood loss was 100 mL. The median length of stay in the ICU was zero days; median hospital stay was one day. Ten cases had an adverse event (11.5%): four major adverse events (4.6%; 3 L bleeding; DVT; retroperitoneal haematoma; incisional hernia), and seven minor events (8%; peritoneum injury; minor vascular injury; events related to the cage). No cases of retrograde ejaculation were observed. There was improvement in pain, physical restriction, and quality of life (p < 0.001).ConclusionsThe mini-ALIF procedure performed for single-level fusion at the distal lumbar level demonstrated low adverse event rates related to both the surgical approach and to the intersomatic device, with reduced hospital stay and satisfactory perioperative clinical results.

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Objective: This study aims to evaluate the reliability and equivalency of using the Cobbmeter application for iPhone compared to the manual measurement method in the analysis of the sagittal spinal alignment. Methods: Cross-sectional, prospective, single-center study that had 20 panoramic radiographs of the spine in lateral view, in a neutral standing position, analyzed blindly and randomly by three independent examiners in three different times. The parameters were pelvic incidence (PI), pelvic tilt (PT) and lumbar lordosis (LL). The statistical analysis was performed to measure the intraclass correlation coefficient (ICC) between the two measurement methods, in addition to measuring the intra and inter-evaluators reliability. Results: For reproducibility analysis, the intra-evaluators ICC using the application resulted in a Kappa (K) of 0.975 for the evaluation of pelvic incidence (PI) evaluation. For pelvic tilt (PT), the K value obtained was 0.981 and the K measured for lumbar lordosis (LL) analysis was 0.987. The inter-evaluators evaluation of reproducibility using the application resulted in a K value of 0.917 for PI, 0.930 for PT and 0.951 for LL. For the assessment of equivalency of methods, comparing the application to the standard method, with a goniometer and dermographic pencil, the K value found for PI was 0.873, for PV was 0.939 and for LL was 0.914. All values were significant (p<0.001) against the null hypothesis. Conclusion: This smartphone application is a valid and reliable instrument for measuring the angle involved in the sagittal balance of the spine. Furthermore, the results show that its applicability is not inferior to the manual method with goniometer and dermographic pencil.Keywords: Spine; Diagnostic imaging; Postural balance; Lordosis; Kyphosis; Pelvis. RESUMO

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Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p<0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p<0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score <2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%. (93% vs. 18%; p < 0,001); escoliose (31% vs. 12%; p = 0,033); mulheres (79% vs. 38%; p = 0,007); pacientes idosos (média de 57,0 vs. 68,4 anos; p = 0,001 (93% vs. 18%, p <0,001); escoliosis (31% vs. 12%, p = 0,033); mujeres (79% vs. 38%, p = 0,007); ancianos (media de 57,0 a 68,4 años; p = 0,001

Objective: The objective of this study was to evaluate the association of clinical results with preoperative situation of worker compensation (WC) in patients submitted to spine surgery. Methods: This was a retrospective, comparative, single center study. Patients who underwent lumbar spine arthrodesis were included. The outcomes were pain scores (VAS), physical constraint (ODI) and quality of life (EQ-5D). Outcomes were analyzed before surgery and after surgery (minimum follow-up of six months and maximum of 12). Two groups were compared: individuals with or without WC at preoperative visit. Results: A total of 132 cases were analyzed (mean age 54 years and 51% female), 29 (22%) assigned to the WC group. The groups were matched for age, sex, and preoperative depression levels. In the preoperative period, the groups showed equal pain and physical constraint; however the CT group had lower quality of life (p=0.05). Although both groups showed improvement in clinical outcomes after surgery (p<0.05), worse scores were observed for the WC group compared to the non-WC group, respectively: VAS 4.9 vs. 3.2 (p=0.02), ODI 34.7 vs. 23.4 (p=0.002), and EQ-5D 0.56 vs. 0.75 (p=0.01). Conclusion: In this study it was possible to observe that WC is associated with worse clinical results following elective surgical treatment of the lumbar spine.Keywords: Spine/surgery; Working conditions; Quality of life; Work; Arthrodesis; Spinal fusion; Psychology, social. CT, respectivamente: EVA 4,9 vs. 3,2 (p = 0,02), ODI 34,7 vs. 23,4 (p = 0,56 vs. 0,75 (p = 0,01 (p < 0,05), se observaron puntuaciones más bajas en el grupo de CL en comparación con el grupo sin CL, respectivamente: EVA 4,9 vs. 3,2 (p = 0,02), ODI 34,7 vs. 23,4 (p = 0,56 vs. 0,75 (p = 0,01). Conclusión: En el presente estudio fue posible observar que la CL está vinculada a peores resultados clínicos después del tratamiento quirúrgico electivo de la columna lumbar. RESUMO nível de depressão pré-operatória. No pré-operatório os grupos se mostraram iguais quanto a dor e restrição física, porém, o grupo com CT apresentava qualidade de vida inferior (p = 0,05). Apesar de os dois grupos terem mostrado melhora nos desfechos clínicos após a cirurgia (p < 0,05), observaram-se piores escores para o grupo com CT comparado com grupo sem

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