OBJETIVO: fazer uma análise prospectiva de cem pacientes com fratura da coluna toracolombar submetidos a tratamento cirúrgico em um hospital terciário da zona leste de São Paulo. MÉTODOS: estudo prospectivo com início em Janeiro de 2006 até Julho de 2009, sendo incluído um total de 100 pacientes com fratura da coluna toracolombar submetidos a tratamento cirúrgico. Avaliou-se o sexo, a idade, o mecanismo de trauma, o déficit neurológico e o tipo de fratura. RESULTADOS: foi observado que queda de altura foi o principal fator causador deste tipo de fratura seguido de acidentes com veículos automotores. O sexo masculino foi responsável por 66% dos casos, porém não foi observada diferença entre o mecanismo de trauma e o sexo. Observamos também que a lesão neurológica apresenta relação direta com a gravidade de fratura e que a junção toracolombar é a região mais acometida. CONCLUSÃO: concluímos que a incidência de fraturas na zona leste de São Paulo é elevada e associam-se a quedas acidentais. Verifica-se que estes dados são importantes para que medidas de prevenção possam ser tomadas com vistas a diminuir a morbidade deste grave tipo de trauma.

Objective: To verify whether spinal surgery causes relevant changes in the blood clotting process and define which factors have the greatest influence on changes found. Method: This is a not randomized, cross-sectional study, Forty seven patients were evaluated between August 2011 and February 2013, whose clinical, surgical, laboratory and image daata were collected. The data obtained were crossed with the epidemiological data of each patient in a moment prior to and another after surgery searching which variables have been directly influenced. Result: Our analysis showed that the most important changes occurred in patients with BMI classified, according to the World Health Organization (WHO) as out of healthy range. Other smaller correlations were also found. Another important consideration was the tendency to observe hypercoagulability in smoker patients, a fact that is not influenced by spinal procedures. Conclusion: We concluded that spinal surgeries cause few relevant changes in the blood clotting process and that among the factors studied, BMI (when out of the healthy range, according to the WHO classification) showed closer relationship with changes in laboratory coagulation tests. Level of Evidence III, Cross-Sectional Study.

Objective To evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis. Methods Sixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale). Results No significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group. Conclusions Lumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment. Trial registration Clinicaltrials.gov (NCT02879461).

Objective: To evaluate whether performing surgery in degenerative diseases of the lumbar spine modify the spinopelvic balance and influences the clinical outcome and the quality of life of patients. Methods: The spinopelvic balance was evaluated in 25 patients using plain radiographs of the lumbosacral region including the proximal femur, as well as evaluating the quality of life on two separated occasions. Results: The measure of spinopelvic balance was obtained by averaging the angles of sacral slope, pelvic version and pelvic incidence. Mean preoperative angles were 59.88º, 22.84º, and 37.44º, respectively, and the mean postoperative values were 61.56º, 24.64º, and 37.32º, respectively. Regarding the questionnaires on quality of life, the Oswestry index showed mean preoperative values of 46.24, characterized as severe disability and mean postoperative values of 13.29 denoting satisfactory response after surgical treatment. The SF-36 questionnaire showed important and significant improvement in quality of life in different domains, with the exception of physical limitation and social aspects, with a p-value of 0.02 and 0.025, respectively. Conclusion: Patients undergoing surgical treatment of degenerative lumbar diseases showed no significant changes in the spinopelvic balance, but showed significant improvement in quality of life after surgery.

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RESUMOObjetivo: Avaliar os resultados cirúrgicos dos pacientes com metástase vertebral secundária ao carcinoma de mama. Métodos: Vinte e duas pacientes operadas com doença metastática vertebral secundária ao carcinoma de mama foram avaliadas no pré-operatório, pós-operatório imediato e depois de 1 mês e 6 meses do procedimento cirúrgico, usando a escala numérica da dor e o índice de incapacidade de Oswestry (ODI). Resultados: As medidas para dor produziram valor de p de 0,0001 para a diferença entre o pré-operatório e o pós-operatório imediato, 0,0005 entre o pós-operatório imediato e 1 mês de pós-operatório, e 0,0908 entre 1 mês de pós-operatório e 6 meses de pós-operatório, portanto, encontram-se evidências de diferenças entre o pré-operatório e o pós-operatório imediato, assim como entre o pós-operatório imediato e após o 1º mês, mas não há tal evidência entre o 1º e o 6º mês de pós-operatório. Quanto ao ODI, a diferença foi significativa em todos os períodos. Conclusão: A cirurgia melhora a dor e diminui a incapacidade dos pacientes com doença metastática secundária ao carcinoma de mama.Descritores: Neoplasias da mama; Metástase neoplásica; Coluna vertebral; Qualidade de vida; Neoplasias ósseas. ABSTRACTObjective: to evaluate the surgical outcomes of patients with spinal metastasis secondary to breast carcinoma. Methods: twenty-two patients operated spinal metastatic disease secondary to breast carcinoma were assessed preoperatively, immediately postoperatively and after 1 and 6 months of surgery, using the numerical scale of pain and Oswestry Disability Index (ODI). Results: the measures for pain produced a p-value of 0.0001 for the difference between the preoperative and postoperative, 0.0005 between the immediate postoperative period and 1 month postoperatively, and 0.0908 between 1 month and six months postoperatively, therefore, there is evidence of differences between the preoperative and postoperative periods, as well as between the immediate postoperative and after the 1 st month, but there is no such evidence between 1 st and 6 th month postoperatively. As for the ODI, the difference was significant in all periods. Conclusion: the procedure improves pain and reduces disability in patients with metastatic disease secondary to breast cancer. Keywords: breast neoplasms; neoplasm metastasis; Spine; Quality of life; bone neoplasms. RESUMEnObjetivo: Evaluar los resultados quirúrgicos de los pacientes con metástasis vertebrales secundarias a carcinoma de mama. Métodos: Veintidós pacientes operados con enfermedad metastásica espinal secundaria a carcinoma de mama fueron evaluadas antes de la cirugía, inmediatamente después de la operación y después de 1 mes y 6 meses de la cirugía, mediante la escala numérica del dolor y el índice de discapacidad de Oswestry. Resultados: Las medidas para el dolor produjeron un valor de "p" de 0,0001 para la diferencia entre el pre y postoperatorio, 0,0005 entre el postoperatorio inmediato y un mes después de la operación, y 0,0908 entre 1 mes después de la cirugía y el posto...

This study reports on a case of lymphoma in a 13-year-old patient who came to a consultation with lumbar pain. The patient had suffered low-intensity trauma in the lumbar region that resulted in persistent pain of progressive nature. In an emergency evaluation, radiographic examination showed a spinal fracture. The patient was then sent to the specialist outpatient clinic of the same hospital. The initial examinations confirmed the diagnosis of a pathological fracture surrounded by a tissue mass, thus indicating the presence of a tumor. Subsequently, the patient evolved with lower-limb paresthesia and urine retention, without any pathological diagnosis for the lesion. The patient then underwent emergency surgery to achieve stabilization and neurological decompression, and material from the lesion was sent for anatomopathological examination. The result from the anatomopathological examination suggested that the lesion was a small-cell tumor, although leaving some doubt. Immunohistochemistry defined the diagnosis of lymphoma. The patient was then sent for oncological treatment. The aim of this study was to report on a rare case of lymphoma in a child with an initial diagnosis of a pathological fracture in the lumbar spine. It is important to investigate fractures associated with mild trauma in children. Precise diagnosis results in effective attendance with better results for these patients.This patient underwent chemotherapy and achieved a good response, with positive repercussions for his prognosis.

Objective: To analyze the results obtained by open-door laminoplasty using the Newbridge  /Blackstone plate, in cases of myelopathy associated with cervical lordosis. Methods: From December 2010 to October 2012, eight patients between the ages of 49 and 68 underwent open-door laminoplasty with the use of the Newbridge  fixation system for maintenance and stabilization of the cervical laminoplasty. Minimum follow-up was four months. For the evaluation of quality of life the questionnaire SF-36 was applied at the following times: preoperative, one month and three months after surgery associated with the subjective assessment of the patient regarding satisfaction with the procedure and with the Nurick neurological scale applied prior to surgery and three months later. Results: According to the SF-36, there was significant improvement in the domains functional ability, general health perceptions and emotional aspects over time; regarding physical limitations and social aspects there was no improvement in the first postoperative month, only in the third month. There were no statistically significant changes observed during the period covered by this study related to pain, vitality and mental health. According to Nurick scale, there was evidence of improvement in symptoms of cervical myelopathy. Based on the subjective evaluation of the patients, surprisingly, all patients were satisfied with the surgical procedure and the results. Conclusion: The open-door laminoplasty technique with rigid fixation to maintain the opening is useful in improving the symptoms of cervical myelopathy associated with lordosis, leading to improved quality of life and with a high degree of patient satisfaction and fewer complications.Keywords: Spinal cord diseases; Laminoplasty; Spine/surgery; Quality of life. RESUMO Objetivo: Analisar os resultados obtidos pela laminoplastia open-door com o uso da placa Newbridge