Spinal fractures associated with spinal cord injury rarely affect pregnant patients. The authors present the case of a 20-year-old woman in her 20th week of pregnancy, who suffered fracture-dislocation of the thoracic spine (T4-T5) and underwent decompression, reduction and posterior fusion with pedicle screws. Despite the complete spinal cord injury presented, the pregnancy progressed uneventfully and resulted in birth via normal delivery of a healthy newborn at term. Some particular features of this case, like the care needed in using ionizing radiation, the surgical approach and delivery, use of steroids and pregnancy complications in such patients are discussed here. Only a multidisciplinary team composed by physicians from different specialties (spinal surgeons, obstetricians and physiatrists), nurses and physiotherapists is capable of assisting pregnant patients with spinal cord injuries satisfactorily.

ObjectiveTo analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis.MethodsTwenty patients undergoing instrumented posterolateral fusion were evaluated by anteroposterior and dynamic lateral radiographs in maximal flexion and extension. The images were evaluated initially by 6 orthopedic surgeons, and after 8 weeks, reassessed by 4 of them, totaling 400 radiographic measurements. Intra and interobserver reliability were analyzed using the Kappa coefficient and Landis and Koch criteria.ResultsIntra and interobserver agreement regarding anteroposterior radiographs were, respectively, 76 and 63%. On lateral views, these values were 78 and 84%, respectively. However, the Kappa analysis showed poor intra and interobserver agreement in most cases, regardless of the radiographic method used.ConclusionThere was poor intra and interobserver agreement in the evaluation of lumbosacral fusion by plain film in anteroposterior and dynamic lateral views, with no statistical superiority between the methods.

RESUMOObjetivo: Realizar avaliação clínica e radiográfica de pacientes com escoliose idiopática do adolescente (EIA) submetidos à artrodese por via posterior utilizando parafusos pediculares e correlacionar os resultados por imagem com os escores obtidos através do questionário SRS-24. Métodos: Foram avaliados 25 pacientes com diagnóstico de escoliose idiopática do adolescente, submetidos à artrodese da coluna por via posterior com parafusos pediculares. O seguimento médio foi de 23,7 meses, variando entre 12 e 35. Analisamos critérios radiográficos referentes à correção das deformidades e aplicamos o questionário SRS-24, específico para esta doença, padronizado pela Scoliosis Research Society. Resultados: A amostra foi composta por 92% de pacientes do gênero feminino e a média de idade foi de 14,2 anos. A média do índice de Cobb na radiografia ântero-posterior pré-operatória foi de 24,4° para curva torácica proximal, 54,9° para torácica principal e 38,5° para curva lombar. Os valores angulares médios no pós-operatório foram 11,0°; 16,7° e 12,2° respectivamente, com porcentagem de correção média da curva torácica principal de 69,9%. O valor médio final do questionário SRS-24 foi 98,1 pontos. Dois pacientes apresentaram complicações pós-operatórias, entretanto, nenhuma do tipo neurológica. Conclusão: A técnica se mostrou eficaz para tratamento cirúrgico da EIA, proporcionando alto percentual de correção das deformidades, com baixo risco de complicações e resultado clínico satisfatório. Não foi encontrada relação estatisticamente significante entre a porcentagem de correção da curva (torácica principal ou lombar) ou seu valor angular pós-operatório com o valor final do questionário SRS-24 nem com os domínios "satisfação" e "auto-imagem pós-operatória". RESUMENObjetivo: Evaluar clínica y radiográficamente a pacientes portadores de escoliosis idiopática del adolescente sometidos a artrodesis por vía posterior, utilizando solamente tornillos pediculares, y correlacionar el resultado radiográfico con los valores obtenidos a través del cuestionario SRS-24. Métodos: Fueron evaluados 25 pacientes portadores de escoliosis idiopáticas del adolescente, sometidos a artrodesis de la columna por vía posterior. El seguimiento promedio fue de 23,7 meses, con variación entre 12 y 35. Analizamos criterios radiográficos referentes a la corrección de las deformidades y aplicamos el cuestionario SRS-24, específico para la patología en cuestión, estandarizada por la Scoliosis Research Society. Resultados: La muestra fue compuesta por 92% de pacientes del sexo

This study aimed to assess the impact of the use of an additional iliac bone graft on functional and radiographic results after thoracic spine arthrodesis with pedicle screws in patients with adolescent idiopathic scoliosis. Participants were divided into two groups: a control group that received only local bone (n=19) and a second group that, in addition to this procedure, received an iliac graft (n=22). The evaluations were performed on preoperative, immediate postoperative, and last follow-up (mean 29.7 months; minimum 12 months). Radiographic evaluations included the loss of correction and the presence of nonunion. The functional outcome was evaluated using the Scoliosis Research Society-30 questionnaire. Surgical complications and the presence of iliac donor site pain were also described. There were no significant differences between groups in the pseudoarthrosis rate, loss of correction over time, and quality of life. We concluded that the addition of bone graft from the iliac yielded no benefit in terms of the fusion rate and functional outcomes. The appropriate facetectomy, bed preparation, and filling with a local bone graft must be adequate to achieve an adequate fusion on surgical treatment of adolescent idiopathic scoliosis.

Spinal fractures associated with spinal cord injury rarely affect pregnant patients. The authors present the case of a 20-year-old woman in her 20 th week of pregnancy, who suffered fracture-

RESUMOObjetivo: Definir as características demográficas dos pacientes portadores de deformidades secundárias da coluna vertebral que aguardam em fila de espera para tratamento cirúrgico em hospital terciário de alta complexidade. Métodos: As informações foram obtidas através dos prontuários dos pacientes no período previamente definido. Os dados foram selecionados conforme os critérios já apresentados e manipulados estatisticamente. Resultados: O estudo incluiu um total de 170 pacientes, dos quais 94 eram do sexo feminino com idades entre 1 e 58 anos, e 76 do sexo masculino com idade entre 1 e 26 anos. Entre as deformidades encontradas foram identificadas: escolioses congênitas por segmentação (6 ou 3,5%), formação (39 ou 22,9%), mistas (34 ou 20,0%) e complexas (14 ou 8,2%), escolioses neuromusculares por paralisia cerebral (PC) (54 ou 31,8%), miopatia (11 ou 6,5%), artrogripose (2 ou 1,2%) e escolioses por neurofibromatose (10 ou 5,9%). Conclusão: Existe uma considerável lista de pacientes portadores de deformidades de coluna vertebral que aguardam em fila de espera para tratamento cirúrgico por um período muitas vezes bastante prolongado. Este fato acarreta um problema social de difícil manuseio e quando somadas, escoliose neuromuscular e escoliose congênita são responsáveis pela grande maioria dos casos que aguardam cirurgia. Descritores: Coluna vertebral/anatomia & histologia; Coluna vertebral/cirurgia; Anormalidades congênitas. ABSTRACT Objective: Set the demographic characteristics of patients with secondary deformities of the spine waiting for surgical treatment in a ter

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Introduction This study aimed to assess the impact of the use of an additional iliac bone graft on functional and radiographic results after thoracic spine arthrodesis with pedicle screws in patients with adolescent idiopathic scoliosis. Patients and Methods Participants were divided into two groups: a control group that received only local bone (CG; n = 19) and a second group that, in addition to this procedure, received an iliac graft (IG; n = 22). The evaluations were performed on preoperative, immediate postoperative, and last follow-up (mean 29.7 months; minimum 12 months). Radiographic evaluations included the loss of correction and the presence of nonunion. The functional outcome was evaluated using the Scoliosis Research Society-30 questionnaire. Surgical complications and the presence of iliac donor site pain were also described. Results There were no significant differences between groups in the pseudoarthrosis rate, loss of correction over time, and quality of life. The loss of correction was 5.9% in IG and 7.5% in CG ( p = 0.504). There was one case of pseudoarthrosis on IC and consolidation rate was 95.4% in IG and 100% in the CG ( p = 0.537). Functional evaluation, using the SRS-30 questionnaire, showed no differences between groups. At the end of follow-up, all the patients of both groups presented good scores regarding satisfaction with the treatment. Conclusion We concluded that the addition of bone graft from the iliac yielded no benefit in terms of the fusion rate and functional outcomes. The appropriate facetectomy, bed preparation, and filling with a local bone graft must be adequate to achieve an adequate fusion on surgical treatment of adolescent idiopathic scoliosis.