Diário da Espinha

Purpose: Pediatric spinal cord tumors are rare accounting for 4-6% of all primary CNS tumors in this age group. Collecting large number of cases has always been difficult due to their scarcity. SEER database provides a source on varioustumors.

Methods: We performed analysis on tumors of the spinal cord in patients between births to 20 years of age using the SEER data available for the period 1973-2005. Analysis of the incidence rate, the frequency of the most common types, the age, gender, treatment modality including radiotherapy and surgery is provided. In addition; the overall survival and the median survival has been analyzed for each tumor type and comparison between various types is performed.

Results: There were 483 cases of spinal cord tumors with available data, representing 4.7% of all pediatric central nervous system tumors diagnosed over the same period. They predominated in males and in whites. The median age for diagnosis was 10 years, with two age peaks noted; in <3 years old and in adolescents 12 to 17 years old. Of intramedullary tumors astrocytoma was the most common histology followed by ependymoma. Low grade tumors predominated. Of all variables examined; histologic type, grade, gross total resection and not receiving radiotherapy showed significant association with outcome.

Conclusions: Low- grade astrocytoma is the most common intramedullary tumor in first 2 decades of life, while ependymoma is mostly seen in the second decade of life. Assigning the appropriate histologic type and grade is important in determining the outcome of the patients.

Objective: To discuss our experience beside others in order to get a better view about these cases and their management.

Summary of background data: Fibrous dysplasia (FD) is a developmental abnormality of the bone and it represents about 7% of the benign bone tumors; hence vertebral involvement is reported in only 2.5% of all cases. An agreed method of treatment has not been established yet.

Methods: A 33 year old woman with a history of non specific chronic low back pain for more than 3 years, presented with sudden onset of an acute and severe low back pain with normal examination except for a local tenderness on lumbar vertebrae. Encountering a patient presenting red flags, spine radiography, bone scan, spinal CT scan and MRI was done and the patient underwent CT-guided biopsy afterward. When the diagnosis of fibrous dysplasia was done, she was treated with curettage and fixation with cage, screw and allograft insertion.

Results: The patient was followed for one year investigating spine stability, neurological deficit or any other symptoms which represent a one year good follow up outcome.

Conclusion: Based on our experience, here we recommend curettage, cage fixation and allograft insertion in cases of monostotic fibrous dysplasia of the spine when pain, fracture or instability exists.

In present time, pain and stiffness in the cervical region of spine has become quite a common phenomena owing to the urbanized lifestyle of people which involves watching television or working on desktop computer for long hours without changing sitting postures. This pain and stiffness most often results from degeneration which takes place in the spinal discs which are located in between the vertebrae. However, the concept of establishing spinal pain as being caused by Degenerative Disc Disease is still problematic and unclear. Result of analysis on an anatomically accurate and validated intact finite element model of the spine indicated that the strain energy density and stress (internal responses) in the bony vertebra adjacent to the degenerated disc increased. During last few decades, biomedical engineers have been closely working with physicians for developing effective biomechanical techniques for relieving such pain. With conventional methods of spinal arthrodesis, the adjacent-segment ROM was significantly increased but with cervical disc arthroplasty, it has been reported to be preserved at the preoperative level. Artificial inter-vertebral disc has been in use for almost two decades in mainly European and some Asian countries. However, insertion of artificial cervical disc also has many technical issues and is not without risk. Complications, including the need for resurgery, device migration and physiological bodily response to the wear debris of the implant have been reported. An in-depth knowledge about the morphological and kinematic aspects of the spine is very much essential for designing and developing any such instrumentation. These include: - (a) shape and dimensions of bone vertebrae, (b) type and estimated values of loads to which the implants will be subjected, (c) motion patterns of vertebrae at the location where degeneration has taken place. Lastly, the choice of available materials that can be safely used for developing such implants is to be finalized. After these design inputs are obtained, computational stress analysis for bone and implants and also tribological characterization is to be done for investigating the wear rate of different combinations of materials in contact – that are planned for use as implants.

Introduction: Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, affecting 70% to 80% of adults at some time during their lives. Recent evidence suggests that psychosocial factors especially fear-avoidance beliefs (FAB) are important in predicting patients who will progress from an acute to a chronic stage as well as failure of interventions. The aim of this study is to review the Relationship between Fear Avoidance Beliefs and Postural stability in non specific Chronic Low Back Pain (CLBP).

Methods: In this narrative article we have searched PubMed, CINHAL, APTA and MEDLINE data bases. The key words included: chronic low back pain, fear avoidance beliefs, posture, stability, balance, motor control, center of pressure and force plate. The inclusion criteria were being related to FAB and postural stability and adults with non specific CLBP, in English language, up to 2013, regardless of their study design.

Results: The results showed that psychological factors such as FAB influence the chronicity of LBP, a group of studies indicated that FAB is related to pain and disability. Another group of studies indicated that postural stability is related to pain and disability. The only study on the relationship between postural stability and FAB did not found any significant relationship.

Conclusion: FAB is related to pain and disability. Postural stability is related to pain and disability. More studies with stronger methodology such as larger population with control group are needed for evaluating the relationship of FAB and postural control.