Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump, shoulder and trunk imbalance and cardiorespiratory complications related to neglected scoliosis. Severe rigid idiopathic scoliosis has <25 % of correction on bending films and major curve over 90°. Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications. Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results. Indications must be tailored by surgeons considering resources, deformity characteristics and patient’s profile. Vertebral resection procedures may have potential neurological and clinical risks and should be one of the last treatment options performed by experienced surgical team. Neuromonitoring is essential during these procedures.

Objective : To develop a consensus for translation of the most relevant terms used in the study of Adult Spinal Deformity, from their original languages into Brazilian Portuguese. Methods : A panel of 12 experts in spine surgery from the five Brazilian regions was constituted. To obtain the standardization of terminology, the Delphi method with an electronic questionnaire was administered to participants about their opinion on the translation of 13 relevant terms chosen by literature review. Each term was considered standard when there was consensus, that is, concordance higher than 80% among participants as to the suggestion to be adopted, and then on the acceptance of the term and its abbreviation in Portuguese. Results : Initially there was consensus (over 80% concordance) on the translation of seven terms in the electronic questionnaire. The other six terms that have not reached consensus were discussed at a meeting among the participants, relying on the opinion of a specialized professional in simultaneous translation of orthopedic terms in Portuguese and other professional majored in Portuguese language. It was decided how these terms should be translated and there was a consensus among all participants regarding their acceptance. Finally, there was consensus among the participants, who agreed with the translation and abbreviation of the 13 propose terms, defining its standardization for Brazilian Portuguese. Conclusion : We present a standard terminology used in the study of Adult Spinal Deformity through consensus among experts, seeking uniformity in the use of these terms in Brazilian Portuguese.

Objective To evaluate the correlation between global sagittal alignment variables and pain improvement after surgery for High-Grade Spondylolisthesis (HGS). Methods A sample with 20 patients with L5-S1 HGS, submitted to arthrodesis with instrumentation from 01/2004 to 12/2016. Patients’ demographic data, types of surgeries, complications, sagittal alignment parameters, and Visual Analog Scale (VAS) score (ranging from 0 to 4) were recorded before surgery and at the last follow-up. The data were processed in SPSS 22.0. The confidence level was 0.05. Results The majority of the sample were women, 17 (85%); age at surgery: 52.60 ± 17.15 years; mean follow-up: 3.58 ± 1.62 years; isthmic etiology, 16 (80%) and dysplastic, 4 (20%); Meyerding Grading 3: 12 (60%), Grading 4: 3 (15%) and Grading 5: 5 (25%); SDSG type 4: 6 (30%), type 5a: 3 (15%), 5b: 3 (15%), type 6: 7 (35%) and not classified 1 (5%); surgery: in situ fusion 3 (15%) and reduction 17 (85%); fusion levels: L3-S1: 1 (5%), L3-Iliac: 1 (5%), L4-S1: 1 (5%), L4-Iliac: 6 (30%) and L5-S1: 11 (55%). Comparing the pre- and postoperative parameters, a significant improvement (p <0.05) was seen in the VAS, T1 slope, T1 pelvic angle (TPA), slip angle, Dubousset’s lumbosacral angle and slip %. Evaluating the correlation between the variation in sagittal parameters and the improvement in VAS scale, it was found that the TPA showed a strong correlation (r = 0.709, p = 0.032). Conclusions the present study found a strong correlation between the improvement/reduction in TPA values and the reduction in pain intensity in the VAS. Level of evidence IV; Case Series.

OBJETIVO: A proposta do estudo foi determinar nossos resultados clínicos e radiográficos de pacientes com deformidades congênitas da coluna vertebral submetidos à ressecção de hemivértebra por via posterior isolada e correção com instrumentação posterior e fusão. MÉTODOS: Registros de 31 pacientes submetidos à ressecção de hemivértebra no período de 2003 a 2010 foram revistos para identificar idade e sexo, grau de correção, níveis da artrodese, quadro neurológico, perda sanguínea, tempo cirúrgico e complicações. RESULTADOS: Foram identificados 22 pacientes com escoliose e Cobb pré-operatório médio de 46.66°(20-88°) e 9 pacientes com cifose e média angular de 83.54°(13-137°). Vinte e quatro pacientes eram do sexo feminino e 7 do sexo masculino. Foram 13 pacientes adolescentes e 18 crianças (1-19 anos). A ressecção de hemivértebra foi realizada em 1 nível (64%), 2 níveis (32%) e 3 níveis (4%). As taxas de correção da escoliose e cifose foram 63.8 e 40.1% e as médias angulares pós-operatórias foram 16.88° e 50°, respectivamente. Complicações ocorreram em 7 pacientes: pseudartrose, cifose juncional, neurite óptica, déficit neurológico, infecção de ferida operatória e óbito. A média de perda sanguínea foi de 1132ml (300ml-3500ml) e o tempo cirúrgico foi de 7.15 horas (4-13 horas). CONCLUSÕES: A ressecção de hemivértebra é uma valiosa técnica no tratamento das deformidades congênitas angulares e uma alternativa eficiente que oferece correção satisfatória nos planos coronal e sagital sem a necessidade de uma abordagem anterior.

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OBJETIVO: Comparar a incidência de fraturas de vértebras adjacentes nos pacientes submetidos à vertebroplastia e cifoplastia. MÉTODOS: Estudo retrospectivo baseado na análise de prontuários e exames radiográficos pré e pós-operatórios de janeiro de 2002 a janeiro de 2009. O seguimento mínimo foi de três meses. Os pacientes foram divididos em dois grupos distintos: Vertebroplastia (V) e Cifoplastia (C), de acordo com o procedimento realizado. Foram comparadas entre os dois grupos, a altura dos corpos vertebrais e a cifose angular antes e depois de cada procedimento e correlacionadas com a incidência de fraturas vertebrais adjacentes. A análise estatística foi feita pelos testes qui-quadrado, t de Student e ANOVA de dois fatores seguida por teste post-hoc de Bonferroni. RESULTADOS: Foram analisados os prontuários de 55 pacientes. Dez pacientes foram excluídos do estudo. Vinte e seis pacientes realizaram vertebroplastia e dezenove pacientes realizaram cifoplastia. Foi observada redução da cifose angular média nos pacientes do grupo C de 1,81 graus quando comparados aos pacientes do grupo V. Não houve diferença estatística entre os dois grupos quanto à altura média do corpo vertebral pré- e pós-operatória. Três pacientes do grupo V e dois pacientes do grupo C apresentaram fratura vertebral adjacente. Os dois pacientes com fraturas adjacentes do grupo C estavam em uso de corticosteroides. Os três pacientes do grupo V com fraturas adjacentes apresentaram extravasamento de cimento. CONCLUSÃO: Não houve diferença na incidência de fraturas vertebrais adjacentes entre os dois grupos.

Objective: To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods: Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results: All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions: Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series. RESUMOObjetivo: Avaliação dos resultados clínicos e radiológicos da vertebrectomia posterior multinível no tratamento da cifose por tuberculose vertebral em crianças menores de 9 anos apresentando déficit neurológico. Métodos: Estudo retrospectivo de uma série de 5 casos, sendo 4 do sexo feminino e 1 do sexo masculino, média de idade de 4,7 anos na época da cirurgia, portadoras de tuberculose vertebral múltiplos níveis, com média de cifose de 89°. Resultados: Todos os pacientes foram submetidos ao tratamento cirúrgico com RCVP múltiplos níveis, com número médio de 3,6 vértebras ressecadas, média de tempo cirúrgico de 359 minutos, período médio de internação pós-operatória de 21,2 dias. O seguimento médio foi de 29 meses. A média de correção da cifose foi de 62,6%. Antes da cirurgia, todos os pacientes tinham sinais de sofrimento medular, sendo que um deles não apresentava déficit de força ou sensibilidade (ASIA E), porém havia a presença de sinais piramidais e história de quedas. Os outros 4 possuíam algum grau de disfunção sensitivo-motora, com escore ASIA variando de A a D. Como complicações pós-operatórias ocorreram duas deiscências de sutura, um pneumotórax e uma pneumonia, todas com evolução favorável. Quatro pacientes evoluíram com melhora neurológica e um deles apresentou manutenção do déficit neurológico até o último seguimento. Conclusão: A RCVP múltiplos níveis se mostrou uma opção segura e eficaz no tratando da cifose na TB vertebral em crianças com déficit neurológico. Nível de evidência IV; Série de Casos. Descritores: Tuberculose da Coluna Vertebral; Compressão da Medula Espinhal;...

Objectives Although Watanabe morphological classification is well known, there is no consensus of its use among spine surgeons. We propose an analysis of the Watanabe classification by three observers, one senior and two recently graduated orthopedic spine surgeons, and its applicability in pre-operative evaluation. Methods An intraobserver and interobserver analysis of the classifications of 937 thoracic pedicles among 55 scoliosis patients treated surgically in two institutions. The average age at time of surgery was 16.3 years (10- 50 years). The etiologies of the scoliosis were: idiopathic (n= 47), congenital (n=4), syndromic (n= 3) and neuromuscular (n=1). The mean Cobb angle was 67 degrees (41- 120º). The evaluation of the thoracic pedicle was performed using pre-operative CT images. Results A total of 937 pedicles were classified by three observers with percentages of 47.5% type A, 28.6% type B, 17.1% type C and 6.9% type D for the total pedicles, convex and concave. Intraobserver agreement was fair to almost perfect (kappa 0.34 to 0.92) and interobserver agreement was fair to moderate (kappa 0.33 to 0.59) with statistical significance of p<0.001. Conclusion Watanabe classification remains a good method for predicting intraoperative difficulties, and has better agreement as the surgeon becomes more experienced. Level of evidence II; Prognostic Studies.