Diário da Espinha

Background: Minimally invasive spine surgery (MIS) is associated with less blood loss, faster recovery, and less perioperative morbidity while yielding similar results as those achieved with open procedures. The risk of periand postoperative complications in the elderly and obese patients is a much debated issue. MIS has been poorly investigated in aged and obese patients.

Objective: The aim of the present study is to establish whether MIS techniques are a safe and adequate tool in these patients.

Methods: A retrospective analysis of 33 patients aged 65 years or older, undergoing minimally invasive spinal fusion techniques, in order to identify the risk of peri- and postoperative morbidity in the obese. Obesity was classified according to the body mass index (BMI).

Results: Any harmful event was noted and included in the statistical analysis. The median blood loss and drainage in the postoperative monitoring period was 200 ml.  significant differences in blood loss were observed in relation to preoperative administration of NSAIDs. Patients using NSAIDs preoperatively had more frequent (p=0.055)  and greater (p= 0.014) blood loss. No difference in blood loss was noted with reference to age or BMI groups. No severe wound healing disorder was observed. We encountered 5 major complications, which consisted of one patient with a neurogenic deficit, one with a transient ischemic attack, one with cardiac ischemia, one with a  malpositioned rod, and one with an epidural hematoma. Minor complications included one patient with urinary tract infection, one with respiratory tract infection, and one with fever. No association was observed between complications and obesity.

Conclusion: This study confirms the low soft tissue damage resulting from minimally invasive surgery techniques, which is an important factor in elderly and obese patients. The smaller approach helps to minimize infections and wound healing disorders. Moreover, deeper regions of wounds are clearly visualized with the aid of tubular retractors.

Objective: Cervical Total Disc Replacement (CTDR) has recently been developed as an alternative to Anterior Cervical Discectomy and Fusion (ACDF) in cervical degenerative disease to preserve the motion at the treated level. The aim of this study is to investigate the safety and efficacy of CTDR by comparing it with ACDF in the treatment of
single-level cervical degenerative disease, retrospectively.

Methods: This study included 61 patients, who underwent either stand-alone single-level ACDF (n = 33) or singlelevel CTDR (Bryan cervical artificial disc, n = 28) at C3 to C7 for degenerative cervical disease between June 2007 and December 2009. Cervical radiographs were obtained to measure overall and regional cervical angle and Range
of Motion (ROM). For evaluation for patient’s pain, visual analogue scale and Japanese Orthopedic Association score was measured.

Results: The changes of the overall Cervical Sagittal Angle (CSA) were not significantly different between the two groups. The Segmental Angle (SA) was maintained at a significantly higher in the CTDR group compared to the ACDF group during the follow-up period (p < 0.05). The ROM of the upper adjacent segment was significantly increased in the ACDF group compared to the CTDR group.

Conclusions: Clinically, CTDR is at least as efficient as ACDF. CTDR using a Bryan artificial disc provided a significant maintenance of the SA and the ROM at the treated level, and prevented the hyper-mobility at the upper adjacent segment compared to the ACDF. In the Future, prospective, randomized, long-term follow-up study with
large-number will be required to clarify the efficacy of CTDR.

Introduction: Patients with neck pain often have subjective complaints of muscle stiffness, tension, or tightness in addition to their pain. It has been stated that in neck pain there is tightness of Upper Trapezius leading to weakness of Middle and Lower Trapezius, so this study compares the strength of Upper, Middle and Lower Trapezius muscle on the side of pain and the contralateral side.

Method: The strength of Upper, Middle, and Lower Trapezius were assessed and compared on the side ipsilateral and contralateral to the pain in individuals with unilateral neck pain using Stabilizer Pressure bio feedback unit.

Results: It has been shown that there is no significant difference in the strength of Upper Trapezius while there is a significant difference in the strength of Middle, And Lower Trapezius muscle on the side of pain and opposite side.

Conclusion: The study supports that assessment and strengthening of Upper, Middle, and Lower Trapezius is necessary in individuals with unilateral neck pain.

A 39-year-old man presented with lumbo-sciatica. C-Scan shows an aspect of herniated disc at the L5 level. He underwent emergent laminectomy and a tumor was found and biopsy made. The initial histological diagnosis was malignant lymphoma. Magnetic Resonance Imaging (MRI) revealed a lumbar epidural mass at the level of L5 and the sacral vertebrae. The correct diagnosis of epidural lymphoblastic mass and Acute Lymphoblastic Leukemia (ALL) was established based on a study of the bone marrow cells. Treatment by chemotherapy has been established.

Leukemic mass must be considered in the differential diagnosis of spinal epidural mass, even in patients with ALL.