OBJECTIVE: To compare different radiographic methods of spine evaluation to estimate the reducibility and flexibility of the scoliosis curves. METHODS: Twenty one patients with Lenke types I and III adolescent idiopathic scoliosis (AIS) were included. Radiographic evaluations were made preoperatively on the orthostatic, supine decubitus with lateral inclination to the right and left and supine positions with manual reduction, with support in the apex of each curve on the X-ray table. On the day of surgery, when the patient was anesthetized, radiography was taken with longitudinal traction through divergent forces, holding under the arms and ankles, and with translational force at the apex of the deformity for curve correction. After one week, a post-operative radiography was performed in orthostatic position. RESULTS: The correction and flexibility of the main thoracic and thoracic/lumbar curves were statistically different between the supine radiographs, manual reduction, modified traction under general anesthesia, lateral inclination and postoperatively. The modified maneuver for traction under general anesthesia is the one which showed greater flexibility, besides presenting higher radiographic similarity to postoperative aspects. CONCLUSION: Among the radiographic modalities evaluated the study under anesthesia with traction and reduction showed better correlation with postoperative radiographic appearance. Level of Evidence IV, Case Series.

OBJETIVO: Documentar a presença de degeneração de disco e tropismo facetário em pacientes portadores de dor lombar crônica e sua distribuição por sexo e faixa etária. Avaliar também a associação de tropismo facetário e degeneração discal lombar além de avaliar a orientação das facetas de acordo com sexo e faixa etária. MÉTODOS: Estudo retrospectivo de imagens de ressonância magnética obtidas em 288 pacientes (N = 288; 118 homens e 170 mulheres) com média de idade de 53,33 anos, portadores de dor lombar crônica. As imagens foram avaliadas por dois médicos assistentes especialistas em cirurgia da coluna para avaliar e quantificar a orientação das facetas, o tropismo facetário e o grau de degeneração discal dos níveis L3-L4, L4-L5 e L5-S1. Foi analisada a associação entre tropismo facetário e doença degenerativa discal, além de associação com sexo e idade. RESULTADOS: Observa-se que 85,8% dos discos apresentam classificação de Pfirrmann superior ou igual ao Tipo III. Com relação ao grau de degeneração discal, não houve diferença entre os sexos e aumentou com o aumento da faixa etária. Com relação ao grau de tropismo, não difere entre os níveis avaliados e o sexo, aumenta de acordo com a elevação da faixa etária. Houve aumento do grau do degeneração discal com o aumento do grau de tropismo facetário. CONCLUSÃO: A maioria dos discos intervertebrais analisados de pacientes com dor lombar crônica encontram-se degenerados e grau de degeneração aumenta com a idade. O grau de tropismo facetário aumenta com a idade e se relaciona com o grau de degeneração discal.

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.

Artigo Original Diagnóstico precoce e o tratamento cirúrgico do polegar em gatilho congênito na criança utilizando o sistema de internação hospital-dia Early diagnosis and surgical treatment of congenital trigger thumb in children using the day hospital admission system

Introdução: A síndrome do túnel carpal é constituída por um conjunto de sinais e sintomas característicos como parestesia, formigamento, dor e perda da força nas mãos. Inicialmente os sintomas são brandos, progredindo ao longo do tempo. Objetivo: Apresentar os resultados do tratamento cirúrgico com mini-incisão, bem como discutir a relação entre os resultados e a técnica cirúrgica utilizada. Método: Esta pesquisa foi realizada na Faculdade de Medicina do ABC, onde foram avaliados 79 punhos de 71 pacientes, todos submetidos ao tratamento cirúrgico da síndrome do túnel carpal por "miniincisão", entre janeiro de 1996 e maio de 2007. A média de idade entre os pacientes foi de 52,4 anos, sendo a idade mínima 27 e a máxima 80 anos. Sessenta e cinco pacientes eram do sexo feminino e seis do masculino. Quanto ao lado acometido, foram obtidos 36 punhos do lado direito e 27 do lado esquerdo, sendo 8 bilaterais. Resultados: Os resultados clínicos mostraram que 60 pacientes ficaram satisfeitos com os sintomas, com os resultados estéticos e funcionais e com a melhora da força muscular para apreensão. Dois pacientes apresentaram complicações cutâneas com infecção superficial e necessitaram de antibioticoterapia oral. Conclusões: Concluímos que o tratamento cirúrgico por "mini-incisão" é uma técnica segura, com poucas complicações e resultados clínicos e estéticos satisfatórios para o tratamento da síndrome do túnel do carpo.

Objective: This study investigated the thickening of the ligamentum flavum (LF) and its correlation with facet tropism and its severity at different levels of the spine. Method: This retrospective study was performed with patients with chronic back pain consecutively admitted to a specialized spinal surgery service between January 2012 and January 2013. All patients underwent magnetic resonance imaging (MRI) to measure the thickness of the LF and facet tropism severity (severe, moderate or absent) according to the spine levels (L3 -L4, L4-L5, L5-S1). The association between the thickness of LF and facet tropism was analyzed. Results: During the study period, 98 consecutive patients were enrolled with a mean age of 53.6 years, most women (59.2%). There was no significant difference between the thicknesses of the ligament and the presence of tropism in different spinal levels (p > 0.05). The thickness of LF was significantly associated with the severity of tropism only in L5-S1 level (p < 0.03). Conclusions: Our results show that there is a positive relationship between severe facet tropism and increased thickness of the LF in the L5-S1 level.Keywords: Spine; Ligamentum flavum; Intervertebral disc; Intervertebral disc degeneration. L5-S1 (p < 0,03 rEsUMO Objetivo: Este estudo investigou se o espessamento do ligamento amarelo (LA) está correlacionado com a presença de tropismo facetário e sua gravidade nos diferentes níveis da coluna vertebral. Método: Este estudo retrospectivo foi realizado com pacientes com dor lombar crônica, consecutivamente admitidos em serviço especializado em cirurgia da coluna vertebral entre janeiro de 2012 e janeiro de 2013. Todos foram submetidos a exames de ressonância magnética (RM) para mensurar a espessura do LA e a gravidade do tropismo facetário (grave, moderada e ausente) conforme os níveis da coluna (L3-L4, L4-L5, L5-S1). Foi analisada a associação entre a espessura do LA e o tropismo. Resultados: No período do estudo, foram admitidos 98 pacientes, com média de idade de 53,6 anos, maioria de mulheres (59,2%). Não foi verificada diferença significativa entre as espessuras dos ligamentos e a presença de tropismo nos diferentes níveis (p > 0,05). A espessura do LA associou-se significativamente à gravidade do tropismo apenas no nível

Objective: This study investigates whether the thickening of the ligamentum flavum (LF) is correlated with disc degeneration. Methods: This retrospective study was conducted with 98 patients with chronic low back pain treated in a spinal surgery service between January 2012 and January 2013. All patients underwent magnetic resonance imaging (MRI) and the images were evaluated by a spinal surgeon to measure the thickness of the LF and evaluate the degree of disc degeneration by the Pfirrmann grading system, according to the spinal levels (L3 -L4, L4-L5, L5-S1). An association was sought between LF hypertrophy and disc degeneration, age, sex and disc height. Results: The mean age of the patients was 53.6 years, and the majority were women (59.2%). The thickness of the LF and disc height varied according to the spinal level, the greatest LF thickness being found between L4-L5, and the greatest disc height at L5-S1. Women had statistically thicker ligaments in L3/L4 than men. The degree of disc degeneration was inversely correlated with the height at all the levels evaluated, i.e., the greater the degree of degeneration, the lower the disc height. Conclusions: The thickening of LF is not related to disc height or degree of disc degeneration. Therefore, there is no deformation of the LF within the spinal canal secondary to disc degeneration.

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.