cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.14288992
title: MINIMALLY INVASIVE LATERAL RETROPLEURAL APPROACH TO THE THORACOLUMBAR JUNCTION – REVIEW & EXPERIENCE

description: ABSTRACT Objective To describe the minimally invasive technique for the lateral retropleural approach to the thoracolumbar spine and its viability in several affections of the region, demonstrating its indications, potential advantages, and necessary precautions, with an emphasis on the local anatomy, especially the diaphragm. Methods After a review of the literature, the initial experience of the Service is reported, comparing it to the published results. The surgical technique used is described with emphasis on the surgical anatomy of the diaphragm. Results The minimally invasive lateral retropleural approach to the thoracolumbar junction with the application of an expandable tubular retractor was described step-by-step in this study, with emphasis on the crucial points of technical execution, such as preoperative planning, access to the retropleural plane, and an orthogonal approach for adequate discectomy and/or corpectomy and subsequent implant placement. It can be used in the treatment of deformities, degenerative diseases, trauma, tumors, and infections and it allows for adequate interbody arthrodesis fusion rates associated with a smaller skin incision and less soft tissue damage, blood loss, and postoperative pain. Thus, it results in better postoperative mobility and a shorter hospital stay, which can also be observed in the data from initial experience of this Service. Conclusions The minimally invasive technique for the lateral retropleural approach to the thoracolumbar spine with the application of an expandable tubular retractor was shown to be promising and safe for the treatment of several spinal diseases despite the complex and challenging local anatomy and it presents advantages over the morbidity rates observed in the traditional approach. Level of evidence IV; Case series.
DOI: 10.6084/m9.figshare.14288990
title: MECHANICAL BEHAVIOR OF THORACOLUMBAR CORONAL SPLIT FRACTURES: FINITE ELEMENT ANALYSIS

description: ABSTRACT Objective To analyze the behavior of thoracolumbar fractures of the coronal split type using the finite element method. Methods Two comparative studies were conducted through simulation of coronal split fractures in a finite model in which the first lumbar vertebra (L1) was considered to be fractured. In the first case, the fracture line was considered to have occurred in the middle of the vertebral body (50%), while in the second model, the fracture line occurred in the anterior quarter of the vertebral body (25%). The maximum von Mises stress values were compared, as well as the axial displacement between fragments of the fractured vertebra. Results The stress levels found for the fracture located at half of the vertebral body were 43% higher (264.88 MPa x 151.16 MPa) than those for the fracture located at the anterior 25% of the vertebra, and the axial displacement of the 50% fractured body was also greater (1.19 mm x 1.10 mm). Conclusions Coronal split fractures located in the anterior quarter of the vertebral body incurred less stress and displacements and are more amenable to conservative treatment than 50% fractures occurring in the middle of the vertebral body. Level of Evidence III; Experimental study.
DOI: 10.6084/m9.figshare.14288987
title: CREATION OF A LOW-COST ENDOSCOPIC FLAVECTOMY TRAINING MODEL

description: ABSTRACT Objective The objective of the study was the development of a low cost simulator of the endoscopic lumbar spine flavectomy technique for use as a teaching method in order to make endoscopic training more accessible. Methods The study was a descriptive research project conducted at the Orthopedic Skills Laboratory of the Health Sciences Department of the Federal University of Paraná. Easily accessible, low cost materials, such as a commercial-use mannequin, EVA plastic, PVC and copper tubing were used to develop the simulator.. Results At the end of the project, it was possible to build a simulator of the endoscopic lumbar spine flavectomy technique with a budget of approximately 464 BRL, or approximately 140 USD. Conclusions We concluded that it was possible to build an endoscopic lumbar spine flavectomy technique simulator on a budget of less than half a Brazilian minimum monthly wage, which makes training more accessible to academics, residents and surgeons. Level of Evidence V; Expert opinion.
DOI: 10.6084/m9.figshare.14288985
title: ANALYSIS OF THE RELIABILITY OF THE LEE CLASSIFICATION FOR LUMBAR DISC HERNIATIONS

description: ABSTRACT Objective To evaluate the intra- and interobserver reliability of the Lee et al. classification for migrated lumbar disc herniations. Methods In 2018, Ahn Y. et al. demonstrated the accuracy of this classification for radiologists. However, magnetic resonance images are often interpreted by orthopedists. Thus, a cross-sectional study was conducted by evaluating the magnetic resonance images of 82 patients diagnosed with lumbar disc herniation. The images were evaluated by 4 physicians, 3 of whom were spinal orthopedic specialists and 1 of whom was a radiologist. The intra- and interobserver analysis was conducted using the percentage of concordance and the Kappa method. Results The report of the classifications used by the four observers had a higher proportion of “zone 3” and “zone 4” type classifications in both evaluation moments. The most affected anatomical levels were L5-S1 (48.2%) and L4-L5 (41.4%). The intra- and interobserver concordance, when comparing both moments evaluation of the complementary examinations of the participants involved, was classified as moderate and very good. Conclusions Lee’s classification presented moderate to very good intra- and interobserver reliability for the evaluation of migrated lumbar disc herniation. Level of evidence II; Retrospective Study.
DOI: 10.6084/m9.figshare.14288982
title: LLIF IN THE CORRECTION OF DEGENERATIVE SCOLIOSIS IN ELDERLY PATIENTS

description: ABSTRACT Objective The incidence of adult degenerative scoliosis (ADS) among individuals over 50 years old can be as high as 68%. Surgical interventions aimed at correcting the spinal deformity in elderly patients are accompanied by a high risk of complications. The use of lateral lumbar interbody fusion (LLIF) is associated with lower rates of complications when compared with open anterior or posterior fusions. Methods Ninety-three patients with ADS (23 men, 70 women) were operated at the Federal Neurosurgical Center. The average age was 63 (52 to 73 years). Results Back pain, measured according to the Visual Analogue Scale (VAS), decreased from 5.9/6 (4;8) (format – mean/median (1;3 quartile)) to 2.6/3 (1;3) points (p &lt;0.0001). Leg pain according to the VAS decreased from 4.6/4 (3;7) to 1.4/1 (0;2) points (p &lt; 0.0001). Functional adaptation according to the Oswestry Disability Index (ODI) improved from 47.8±17.4 to 38.5±14.5 (p &lt; 0.0273). Pelvic tilt (PT) before the surgery was 23.9±12.2° whereas at 12 months follow-up it was 16.8±5.9° (p &lt; 0.0001). PI-LL mismatch pre surgery was 12.1/13 (9;16)° whereas 12 months later it was 7.9/8 (6;10)° (p = 0.0002). Conclusions Restoration of local sagittal balance in ADS patients by short-segment fixation using LLIF technology leads to a statistically significant improvement in quality of life and increased functional adaptation. A lower incidence of early and late postoperative complications, less intraoperative blood loss and shorter hospital stay makes LLIF, in combination with minimally invasive transpedicular fixation, the method of choice to correct ADS in elderly patients. Level of evidence IV; Case series.
DOI: 10.6084/m9.figshare.14288981
title: DOES DECUBITUS AFFECT NEURAL ELEMENTS POSITIONING? A MRI STUDY COMPARING DORSAL AND LATERAL POSITION

description: ABSTRACT Objective To evaluate the displacement of nerve structures according to the decubitus position of the patient in a magnetic resonance imaging (MRI) study. Methods MRI was performed at a radiology clinic in 20 patients in dorsal and right lateral decubitus. The measurement considered was the shortest distance between the dura mater and the medial wall of the pedicle. Results The largest measurement was 11.6 mm in left lateral decubitus, 12.2 mm in right lateral decubitus, 10.5 mm in right dorsal decubitus, and 9.2 mm in left dorsal decubitus. In some patients the space between the medial wall of the pedicle and the dura mater was larger when in lateral decubitus, while in others when in dorsal decubitus. The mean displacement of the measurements on the left was 1.14 mm and on the right 1.355 mm. Conclusions The structures moved on average little more than 1 mm in the positions studied. The positioning of the patient for surgery does not change the space to be approached, being the surgeon’s choice according to his learning curve. Level of evidence II; Prospective study of lower quality.
DOI: 10.6084/m9.figshare.14288979
title: ASSOCIATION OF LOW BACK PAIN AND SCIATICA WITH SIGNAL CHANGES IN THE VERTEBRAL ENDPLATE

description: ABSTRACT Objective To evaluate whether vertebral endplate signal changes (VESCs) influence the prognosis of patients submitted to conservative or surgical treatment for low back pain and lumbosciatica. Methods Study with 241 patients who underwent conservative treatment, infiltration or surgery with 12 months of follow-up. They were evaluated for pain by the Visual Analog Scale for Pain (VAS), for function by the Roland Morris questionnaire and for quality of life by the EuroQoI5 (EQ-5D). Results The VESCs did not have a significant effect on the treatment responses for the VAS (F = 0.03; P = 0.97), Roland Morris (F = 0.51; P = 0.60) and EQ-5D (F = 2.67; P = 0.07) variables, nor was there any interaction between VESC and treatment for VAS (F = 2.15; P = 0.08), Roland Morris (F = 1.55; P = 0.19) and EQ-5D (F = 2.15; P = 0.08). There was a significant effect for all treatments, however, the effect of the surgical procedure was superior when compared to the others (P &lt;0.001). The VESC frequency was 48.33% for type 0, 29.17% for type I and 22.50% for type II. Conclusions The presence of VESC and its different types is not associated with a worse prognosis, nor was a higher prevalence of VESC observed in the patients with low back pain and lumbosciatica. Level of Evidence II; Retrospective cohort study.
DOI: 10.6084/m9.figshare.14288978
title: INFLUENCE OF THE CONGRUENCE OF PILOT HOLE TAPPING ON THE ANCHORAGE OF THE PEDICLE SCREW

description: ABSTRACT Objectives To observe the influence of the congruence of the tapping of the pilot hole on the anchorage of the pedicle screws. Methods 5.5 and 6.5 mm screws from two vertebral fixation systems (Pedicol and Safe) were inserted into polyurethane blocks. Experimental groups were formed according to the pilot hole preparation: A- drilling with a 2.7 mm drill bit, B- Tapping of the pilot hole with a tap of lesser diameter than the diameter of the screw with a congruent thread design, C- Tapping of the pilot hole with a tap of lesser diameter than the diameter of the screw and an incongruous thread design. The polyurethane blocks with the screws were subjected to a tensile strength test to evaluate the pullout resistance of the screws. Results Using congruent pilot hole tapping of a lesser diameter and congruent thread design increased the pullout resistance of the rough-surface screws (Safe). The screws with a smooth surface (Pedicol) presented greater pullout resistance with tapping of a lesser diameter and incongruous thread design. Conclusions The congruence of the tap used to prepare the pilot hole increased the pullout resistance of the rough-surfaced screws. Level of Evidence III; Therapeutic Study.
DOI: 10.6084/m9.figshare.14288976
title: LUMBAR MICRODISCECTOMY WITH INTRASPINE® – A CASE SERIES

description: ABSTRACT Objective To assess postoperative outcomes following lumbar microdiscectomy (LMD) with and without the use of a dynamic intralaminar device IntraSPINE ® . Methods A non-randomized single-surgeon retrospective analysis. Consecutive elective surgery was performed on patients with lumbar disc disease over a 16-month period. The study group was determined by electronic theatre database. Ninety-two (62 LMD and 30 ILD) of the 95 eligible patients were included in the study, with three being excluded due to incomplete data sets. The pain scores were assessed pre- and postoperatively using a 4-point scale (0 – pain free; 1 – mild; 2- moderate; 3 – severe). Results The reduction in postoperative leg pain was similar (LMD 1.9 vs. IntraSPINE® 1.8) but the reduction in postoperative back pain was greater in the IntraSPINE® group (LMD 0.5 vs. IntraSPINE® 1.0; p = 0.17). Early recurrence of disc herniation (&lt; 8 months) was lower in the IntraSPINE® group (6.7% vs. 19.4%; p = 0.097). The need for revision surgery was significantly lower in the IntraSPINE® group (p = 0.015). None of the IntraSPINE® recurrences required revision surgery, compared to 97% of the recurrences in the LMD group. Conclusions This case series raises the possibility that in selected patients, the use of the IntraSPINE® may improve back pain and reduce recurrent disc herniation/revision surgery rates in lumbar microdiscectomy. A prospective randomized trial on the use of the IntraSPINE® should be considered, given the clinical and cost implications of revision surgery. Level of Evidence IV; Case series.
DOI: 10.6084/m9.figshare.14288975
title: CORRELATION BETWEEN THE SCHANZ SCREW INSERTION ANGLE AND THE LOSS OF KYPHOSIS CORRECTION IN THORACOLUMBAR FRACTURES

description: ABSTRACT Objective To compare the Schanz screw insertion angle and the loss of the regional kyphosis correction in thoracolumbar burst fractures following posterior short instrumentation surgery. Methods Patients with a thoracolumbar burst fracture between levels T11-L2 were divided into two groups (parallel and divergent) according to the angle formed between the Schanz screw and the vertebral plateau. Regional kyphosis was evaluated in preoperative, immediate postoperative and last follow-up radiographs. Results Of the 58 patients evaluated, 31 had a parallel assembly and 27 had a divergent assembly. When we analyzed the angle of kyphosis, no statistical difference was observed between the pre- and postoperative radiographs. However, a statistical difference in the last follow-up radiographs and in the final loss of the kyphosis correction was confirmed. Conclusion The insertion of Schanz screws with a divergent assembly presents better radiographic results with less loss of kyphosis correction angle when compared with the parallel assembly technique. Level of Evidence III; Retrospective cohort study.
DOI: 10.6084/m9.figshare.14288973
title: HIP-SPINE SYNDROME, RADIOGRAPHIC EVALUATION OF THE SAGITTAL BALANCE

description: ABSTRACT Objectives The hip-spine syndrome (HSS) is defined as the simultaneous degeneration of the hip and lumbar spine. The objective of this study is to quantify the sagittal balance values in the population with HSS and to compare them with the normal sagittal balance parameters. Methods A retrospective study was conducted in which 30 patients with HSS who were waiting for total hip arthroplasty (THA) were evaluated. The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and spinopelvic harmony (SH) angles and the BMI of these patients were measured. Results Seventeen women and 13 men participated in the study, with a mean LL of 39.55°, a mean SS of 36.92°, a mean PT of 25.77°, a mean PI of 62.72°, a mean SH of 23.17° and a mean BMI of 25.55. Only the SS did not present a changed value when compared to the normal values of the population. Conclusions HSS is increasingly present in our environment due to the aging population. Sagittal balance is gaining more and more attention in studies related to spinal pathologies. All the parameters measured in this study, except for SS, presented altered values when compared to the populational means. Evidence Level II. Observational and retrospective study.
DOI: 10.6084/m9.figshare.14288972
title: INTRA- AND INTEROBSERVER ANALYSIS OF PEDICLE SCREW PLACEMENT IN SCOLIOSIS CORRECTION

description: ABSTRACT Objective To establish the statistical interobserver and intraobserver concordance of thoracic pedicle screw placement in scoliosis surgery, with a 4-week interval between the two analyses. Methods Of 55 patients that evaluated the intra- and interobserver concordances of the screw positions (according to the Abul-Kasim classification) using the Kappa coefficient. Results The intraobserver concordance ranged from a Kappa coefficient of 0.516 to 0.889 (“moderate” to “almost perfect”) between the two analyses performed four weeks apart. Interobserver concordance ranged from 0.379 to 0.633 (“reasonable” to “strong”). Conclusion The intraobserver concordance was always greater than the interobserver concordance. No concordance coefficient was classified as “insignificant” or “weak”. Level of Evidence III; Retrospective study.
DOI: 10.6084/m9.figshare.14288969
title: DOES THE USE OF DYNAMIC SURGICAL GUIDANCE ASSIST ACCURATE PEDICLE SCREW PLACEMENT IN PATIENTS WITH OSTEOPOROSIS OR OSTEOPENIA?

description: ABSTRACT Objective To compare the use of a dynamic surgical guide (PediGuard®) and pilot hole preparation, with the use of a probe and the aid of fluoroscopy in osteoporotic or osteopenic patients undergoing pedicular fixation of the thoracic or lumbar spine. Methods One hundred and eight patients were randomized. A pilot hole was prepared with the dynamic surgical guide (PediGuard®), or with a probe with the aid of fluoroscopy. A total of 657 vertebral pedicles (120 thoracic and 180 lumbar) were included in the study. The parameters used for the comparison were: accuracy of the pedicular screw, number of fluoroscopic shots, and change in intraoperative trajectory of the perforation after detecting pedicle wall rupture. Results In the group with use of the dynamic surgical guide, malpositioning of the pedicle screws was observed in 8 (2.6%) patients and intraoperative change of perforation trajectory in 12 (4%) patients, and there were 52 fluoroscopic shots. In the group without use of the dynamic surgical guide (PediGuard®), misplacement of the pedicle screws was observed in 33 (11%) patients and intraoperative change of perforation trajectory in 47 (13.2%) patients, and there were 136 fluoroscopic shots. Conclusion The use of the dynamic surgical guide (PediGuard®) in patients with osteoporosis or osteopenia enabled more accurate placement of pedicular screws, with less change in the intraoperative course of the perforation and less intraoperative radiation. Level of Evidence II; Randomized clinical trial of lesser quality.
DOI: 10.6084/m9.figshare.14288967
title: EVALUATION OF INTERBODY FUSION TWO YEARS AFTER LLIF PROCEDURE

description: ABSTRACT Objectives The LLIF technique, extreme lateral interbody fusion, reaches the disc laterally through the psoas muscle, offering adequate access to the disc space with the added benefit of preventing iatrogenic injury to abdominal vascular structures (aorta and vena cava), the sympathetic plexus (reduces incidence of retrograde ejaculation) and neural structures, that is, preservation of the spinal nerves that cross the posterior aspect of the muscle. The objective of this study is to verify the rates of interbody fusion with the LLIF technique. Methods Retrospective, single center, comparative, non-randomized study. The presence of bone mass with increased hypotransparency in the areas of fusion will be analyzed. For the evaluation of the fusion, the Classification of interbody fusion success: Brantigan, Steffee, Fraser (BSF) will be used. Results Fifty-nine (86%) patients presented complete fusion of the approached level (BSF-3) six months after the procedure. One year after the procedure, 87% of the patients had complete fusion. Similar results were confirmed at two years. Conclusions We conclude that the technique of lateral interbody arthrodesis is safe and effective for the treatment of low back pain, with a fusion rate of 90% in two years. Level of Evidence III. Retrospective study, single center, non-randomized.
DOI: 10.6084/m9.figshare.14288966
title: PREVALENCE OF PJK AFTER ARTHRODESIS IN PATIENTS WITH NEUROMUSCULAR SCOLIOSIS IN THE SECOND POSTOPERATIVE YEAR

description: ABSTRACT Objective The primary objective of this study was to analyze the prevalence of PJK in patients with neuromuscular scoliosis submitted to posterior spinal arthrodesis with instrumentation. Proximal junctional kyphosis (PJK) is a frequent phenomenon that, due to its importance, began to be studied by several authors, who laid the foundations for the radiographic definition and possible risk factors for its occurrence after long spinal arthrodesis with instrumentation. Despite the large number of PJK studies, most were related to the occurrence of adolescent idiopathic scoliosis, adult deformity and early-onset scoliosis, with few being targeted to patients with congenital and neuromuscular scoliosis. Methods In this study, data from electronic medical records of patients with neuromuscular scoliosis who underwent posterior arthrodesis with instrumentation between the years 2014 and 2016 were analyzed. Information on age, gender, pathology and radiographic measurements were extracted from this sample at the 2nd and 24th postoperative months. Results A total of 39 patients with neuromuscular scoliosis were analyzed. The sample was predominantly male (58.87%) and the mean age was 14.05 years. PJK occurred in 18 patients during the two years following surgery, with a prevalence of 46.15%. The incidence of PJK in the 2nd and 24th postoperative months was 23.1% and 30%, respectively. Conclusions A prevalence of PJK of 46.15% was found in patients with neuromuscular scoliosis treated surgically with posterior instrumentation after two years of follow-up, as compared to previous results . Level of Evidence III; Cross-sectional observational study.