Clasificación de las fracturas toracolumbares: comparación entre las clasificaciones de AO y Vaccaro

CONSERVATIVE TREATMENT FOR THORACOLUMBAR SPINE BURST FRACTURES

ABSTRACT Objective: To identify the category of evidence and the strength of recommendation for the conservative treatment of thoracolumbar spine burst fractures. Method: A systematic review was conducted from April 2014 to June 2015, selecting articles according to their prospective design, related to thoracolumbar spine burst fractures and their treatment. These studies were published in the electronic bibliographic databases from January 2009 to January 2015. Results: A total of 9,504 articles were found in a free search, of which 7 met the selection criteria and were included for analysis in a study of a total of 435 patients, of whom 72 underwent surgical treatment and 363 received some type of conservative treatment, showing predominantly level of evidence "1b", with strength of recommendation type "A". Conclusions: According to the evidence obtained, the conservative treatment is a choice for patients with stable burst fracture in a single level of thoracolumbar spine and with no neurological injury.

OPEN SURGICAL VS. MINIMALLY INVASIVE TREATMENT OF THORACOLUMBAR AO FRACTURES TYPE A AND B1 IN A REFERENCE HOSPITAL

ABSTRACT Objective: The thoracolumbar spine trauma represents 30% of spinal diseases. To compare the minimally invasive technique with the open technique in lumbar fractures. Method: A prospective, cross-sectional, comparative observational study, which evaluated the following variables: surgery time, length of hospital stay, transoperative bleeding, postoperative pain, analyzed by SPSS software using Student's t test with statistical significance of p ≥ 0.05, with 24 patients with single-level thoracolumbar fractures, randomly treated with percutaneous pedicle screws and by open technique with a transpedicular system. Results: The surgery time was 90 minutes for the minimally invasive technique and 60 minutes for the open technique, the bleeding was on average 50 cm3 vs. 400 cm3. The mean visual analogue scale for pain at 24 hours of surgery was 5 for the minimally invasive group vs. 8 for the open group. The number of fluoroscopic projections of pedicle screws was 220 in the minimally invasive technique vs. 100 in the traditional technique. Quantified bleeding was minimal for percutaneous access vs. 340 cm3 for the traditional system. The hospital discharge for the minimally invasive group was at 24 hours and at 72 hours for those treated with open surgery. Conclusions: It is a technique that requires longer surgical time, with reports of less bleeding, less postoperative pain and less time for hospital discharge, reasons why it is supposed to be a procedure that requires a learning curve, statistical significance with respect to bleeding, visual analogue scale for pain and showed no significant difference in the variables of surgical time.

RELIABILITY OF THE AO CLASSIFICATION OF THORACOLUMBAR FRACTURES COMPARED TO TLICS AND MAGERL

ABSTRACT Objective: To test the reliability of the new AO/2013 classification compared with AO/Magerl and TLICS. Methods: Four spine surgeons retrospectively and blindly evaluated imaging and clinical data from 98 patients with thoracolumbar fractures. Results: Using the Kappa coefficient, we obtained the best reproducibility for the AO/2013 classification compared to the other two, represented by Kappa coefficient of 0.690. We could also obtain, with good reproducibility among the evaluators (Kappa 0.690), the most common subtypes of AO/2013 classification with indication for surgery. Conclusion: We believe that the new AO/2013 classification has proven to be a good communication tool among spine surgeons with good reproducibility, but more studies should be conducted in several centers in order to be consolidated and so that the prognosis between the types of injury is better understood.

Perfil do cirurgião de coluna brasileiro

OBJETIVO: Realizar estudo transversal identificando o perfil do cirurgião de coluna no Brasil. MÉTODOS: Foram coletados dados por meio de questionários com múltiplas alternativas, em dois eventos de relevância para a cirurgia de coluna no âmbito nacional em 2011, o Congresso da Sociedade Brasileira de Coluna (SBC) e o Simpósio Internacional de Coluna (SINCOL). Os dados foram submetidos a análise estatística comparando e estratificando as informações obtidas conforme o perfil encontrado. RESULTADOS: Obtivemos 182 questionários respondidos por ortopedistas e neurocirurgiões com particularidades e semelhanças em suas condutas médicas. CONCLUSÕES: Os dados obtidos nessa pesquisa podem ser importantes para o desenvolvimento de políticas de saúde na área de cirurgia de coluna no Brasil.