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Objective: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. Methods: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. Results: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). Conclusions: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies. Resumen: Objetivo: Determinar, mediante una revisión sistemática, los efectos de la tracción de halo-gravedad (HGT) en las deformidades de columna. Métodos: Se incluyeron estudios prospectivos o series de casos de pacientes con escoliosis o cifosis tratados con HGT. Los resultados radiológicos se midieron en los planos sagital y/o coronal. También se evaluó la función pulmonar. Finalmente, se recogieron las complicaciones perioperatorias. Resultados: Se incluyeron 13 estudios. La etiología congénita fue la más frecuente. La mayoría de los estudios proporcionaron valores de corrección de la curva clínicamente relevantes en los planos sagital y coronal. Los valores pulmonares mejoraron significativamente tras el uso de HGT. Por último, existieron 83 complicaciones en 356 pacientes, siendo la infección la más frecuente (38 casos). Conclusiones: La HGT mostró ser una intervención segura y eficaz para la deformidad, que permite la corrección antes de la cirugía. Sin embargo, existe una falta de homogeneidad en los estudios publicados.

Abstract Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications

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Introducción: El uso del sistema de barras magnéticas para el tratamiento de la escoliosis de comienzo temprano es un método utilizado en los últimos 10 años; su eficacia está respaldada por la bibliografía, pero no está exento de complicaciones. Objetivo: Analizar retrospectivamente una serie de 37 pacientes tratados con barras magnéticas en escoliosis de comienzo temprano. Materiales y Métodos: Se realizó un estudio retrospectivo entre 2014 y 2019. Se dividió a los pacientes en: grupo 1 (procedimientos primarios con barras magnéticas) y grupo 2 (conversiones de sistema tradicional a barras magnéticas). Resultados: Se incluyó a 19 niñas y 18 niños (edad promedio 8 años al operarse), las etiologías fueron variadas. Entre el grupo 1 (n = 28) y el grupo 2 (n = 9), el seguimiento promedio posoperatorio fue de 3.6 años. El valor angular promedio preoperatorio de escoliosis era de 64° (rango 39°-101°) y el de cifosis, de 51° (rango 7°-81°). El valor angular promedio de escoliosis en el posoperatorio inmediato fue de 41° (rango 17°-80°) y el de cifosis, de 34° (rango 7°-82°). Se produjeron 2 roturas de barra y una cifosis de unión proximal, 2 aflojamientos de tornillos proximales, una falla del sistema de distracción de barras magnéticas y una infección del sitio quirúrgico. Conclusiones: Nuestros resultados preliminares, aunque son a corto plazo, sugieren que la barra magnética podría ser un método eficaz en este tipo de enfermedad.

Adolescent Idiophatic Scoliosis (AIS) has na insidious onset and its early diagnosis is importante to control the evolution and avoid negative consequences for some physiological systems as well as surgical processes. Updating its incidence is importante to gain knowledge about this population and outiline health actions. The aim of this study was to carry out a survey on the prevalence of scoliosis in students from a municipality in Minas Gerais, Brazil. A clinical evaluation of the students was carried out through the measurement of gibosity, cut triangle and radiographic evaluation when clinical alteration was detected. Data were initially presented descriptively and analyzed using the Pearson Chi-Square Test considering p=0.05. In the evaluated sample, it was observed that 3.89% of the students had scoliosis since it is in accordance with the world literature. It was also observed that when compared to the male and female school population, there was a difference, a statistic being more prevalent in the female sex. The social impact of this study meets the need to verify the prevalence of AIS, which awakens in children and Young people the importance of health care and brings health professionals, health staaf and academics closer to the school environment. These are relevant for the public health system in order to improve deformity prevention programs. [ABSTRACT FROM AUTHOR]

Background: Scoliosis is a spinal deformity that usually manifests as a structural curve determining a variable deformity of the trunk. According to some published series, 4 to 26% of scoliosis initially classified as idiopathic show neurological alterations when studied with nuclear magnetic resonance, such as syringomyelia and Chiari malformation, among the most frequent. Chiari malformations are characterized by descending herniation of the cerebellar tonsils, brainstem, and IV ventricle into the spinal canal. Case report: We present the case of a patient whose first symptomatic manifestation was early-onset scoliosis. The overlapping of some physical examination signs, such as postural lateralization and scoliosis, reinforced the active suspicion of neuroaxis alterations. Conclusions: Early childhood-onset scoliosis should raise a high degree of suspicion for association with neuro-spinal diseases. Although the frequency of Chiari malformation is low, its early approach could reduce the progression of associated comorbidities. An early detection could change the prognosis of the disease. [ABSTRACT FROM AUTHOR]

Early-onset scoliosis corresponds to a group of heterogeneous spinal conditions that present before 10 years of age with a curvature in the coronal plane of 10o or more. Regardless of the etiology, adequate control of the deformity is required to avoid cardiopulmonary deterioration and preserve quality and life expectancy. Diagnosis can be difficult and is usually incidental at a young age. To choose the best treatment, it is important to consider the patient's age, etiology, and rate of progression. Among the non-operative treatments, the most effective are the use of serial casts or brace, whose main objective is to stop the progression of the deformity and thus delay surgical treatment. Among the surgical treatments the distraction based systems and definitive arthrodesis have proven to be most effective. Early surgery leads to multiple complications, which is why, if feasible, non surgical management should be sought and fusion postponed till skeletal maturity. Due to the life-threatening risks associated with the deformity and treatment, it is important to educate the patient and family members about the importance of treatment adherence and follow-up. [ABSTRACT FROM AUTHOR]

Objetivo: El riesgo de desarrollar escoliosis de comienzo temprano es alto en niños con parálisis cerebral espástica, nivel IV y V del GMFCS. No hay acuerdo sobre el tratamiento para niños

La Escoliosis, compleja deformidad tridimensional de la columna vertebral de causa desconocida. El tratamiento es conservador y quirúrgico. Es prioridad de la Organización Mundial de la Salud con la intervención de la Ciencia y la Técnica y constituye uno de los fenómenos que asume im - portante influencia en la sociedad. En el Hospital Pediátrico “ Paquito González Cueto”, Cienfuegos, la incorporación de nuevas técnicas quirúrgicas, ha traído consigo un avance de impacto en la salud pública y la sociedad. Este trabajo posee como objetivo Valorar el impacto de los estudios de la ciencia y la tecnología en el tratamiento quirúrgico de la escoliosis idiopática del adolescente. Para la ejecución del mismo se realizó una revisión bibliográfica que arrojó resul - tados que evidencian la relación de la ciencia y la tecnolo - gía con el tratamiento quirúrgico de la escoliosis idiopática del adolescente. Se concluyó que las nuevas tecnologías proporcionan una elevada calidad de vida, poseen gran impacto a través del tratamiento quirúrgico de la escoliosis idiopática del adolescente, para la sociedad y el individuo porque: contribuyen al desarrollo científico- técnico de los profesionales, del país, al ahorro de recursos por el tiempo de ingreso e insumos hospitalarios y la reincorporación del paciente a la sociedad.

A health technology assessment (HTA) was carried out to critically analyze the evidence on the efficacy and safety of the surgical correction of spinal deformities using the coplanar technique, compared to the conventional derotation techniques, in children, adolescents and adults. A systematic search of the literature was carried out in the PubMed, Cochrane Library and LILACS databases. In addition, a manual search was carried out in the reference lists of the included studies, on Google and on the websites of specialized societies and groups that produce clinical practice guidelines (CPG) and HTA. In addition, we searched ClinicalTrials.gov and the International Clinical Trial Registry Platform (ICTRP) for clinical trial records in progress or not completed. Five documents were selected for evaluation, including two CPG, a randomized clinical trial, and two observational studies. After a critical evaluation of the evidence, it was concluded that both techniques showed a similar efficacy profile in terms of relevant outcomes such as correction of curvatures in the coronal and sagittal planes, quality of life and surgical time. Likewise, the rates of screw malposition, complications and volume of blood loss did not show significant differences between both techniques. However, the profile of opportunity cost of the systems that allow the application of the coplanar technique is not favorable in the context of the evaluation, due to its high cost concerning conventional systems. [ABSTRACT FROM AUTHOR]

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Background: the correction and stabilization of the deformity have developed a lot since the incorporation of lumbar pedicle screws, which are the gold standard of spinal instrumentation today.Objective: to describe the results of the modifications made to the hybrid instrumentation technique for the treatment of adolescent idiopathic scoliosis.Methods: a case series intervention study was carried out with 50 patients operated on for scoliosis in adolescence, divided into two groups. Group A composed of 31 patients, operated on with three different instrumentation techniques and group B composed of 19 patients operated with a hybrid instrumentation technique, modified by the author, in the province of Cienfuegos, in the period between January of 2013 and December 2017.Results: The 96% of the patients were female; the average age was 14 years old. In group A, the best results were achieved with full pedicle fixation with the 89.4% post-surgical correction; the 81.9% was achieved with the technique modified by the author, with minimal complications. Patient satisfaction was the 96% in group A and in patients in whom the author's modification was used, satisfaction was the 100%.Conclusions: the hybrid instrumentation system modified by the author achieves an excellent correction of the curve with a high degree of patient satisfaction.

Background: adolescent idiopathic scoliosis is a three-dimensional deformity of the spine. Its surgical treatment is necessary to prevent the progression of the deformity, cardiorespiratory conditions and improve aesthetics.Objective: to characterize adolescent idiopathic scoliosis patients operated on Cienfuegos province, with a modified hybrid system Methods: a case series study of 15 patients operated on for adolescent idiopathic scoliosis with a hybrid instrumentation system modified by the author, taking into account the preoperative Cobb angle, immediate postoperative and one year after surgery, as well as its complications.Results: 14 girls and one boy were studied, with an average age of 13.9 years; Lenke's classification was used with eight patients of type 1, two of type 3, four of type 5 and one type 6 (there were no patients of types 2 and 4). The average preoperative curve was 59.1o at the immediate postoperative period, the average curve was 12.2o; with an average correction of 79.4%; the loss in degrees per year was 2.9o. The average surgical time was 190 minutes and a bleeding of 750ml. There were two complications, a radiculopathy and a superficial wound infection.Conclusions: the modified hybrid instrumentation system has a very good effectiveness in correcting the curve in adolescent idiopathic scoliosis.

La escoliosis distrófica de la neurofibromatosis se caracteriza por ser una cifoescoliosis de ángulo agudo que compromete un segmento corto de la columna vertebral y genera una gran deformidad que, sumada a los cambios distróficos de la columna, convierte a los gestos quirúrgicos para su corrección en verdaderos retos. Se presenta a un varón de 15 años con cifoescoliosis toracolumbar distrófica severa con ápice en T9, ángulo de Cobb 107° de escoliosis y 110,7° de cifosis segmentaria. Se realiza una cirugía por vía posterior en tres tiempos, mediante una resección de la columna vertebral y reemplazo con malla de titanio; se logra una corrección de la cifosis y la escoliosis del 56% y 59,8%, respectivamente. El paciente no tuvo complicaciones mayores, ni secuelas, y la evolución fue favorable. La resección de la columna vertebral es una técnica quirúrgica potente y desafiante para el manejo de la deformidad cifoescoliótica compleja necesaria para lograr el equilibrio espinal, aunque no está exenta de complicaciones, sobre todo neurológicas y pulmonares, a veces, inevitables. La calidad de vida de nuestro paciente tuvo una mejoría importante. Palabras clave: Neurofibromatosis; escoliosis; resección; columna vertebral. Nivel de Evidencia: IV

Introduction: Scoliosis is a complex deformity that affects all three planes of the axis of the spine. The association between neuromuscular pathology and vertebral alignment was initially described in 1960. Neuromuscular pathology is progressive and results in postural abnormalities. Surgical goals in patients with neuromuscular deformity include anatomical correction for sedation and ambulation, as well as functional improvement. The gold standard of treatment is by posterior approach with transpedicular screws. The «hands-free» technique saves surgical time, decreases radiation by reducing the use of fluoroscopy. The advent of 3D printing technology allows precise study of the anatomical area and detail of the deformity in its three planes. This model can be sterilized for transoperative guidance. A 13-year-old female patient who develops thoracolumbar neuromuscular scoliosis secondary to spastic cerebral palsy (CP), with previous instrumentation T11-L3 of which he develops severe proximal curve. After the segmentation of the three-dimensional model, pedicle violation greater than 2 mm towards bilateral medullary canal was detected in the pedicles of L1 and L2 of previous instrumentation, pedicle dysplasia and the morphological characteristics of the pedicles were observed. Threedimensional planning and the use of surgical guides represent a tool for surgical planning, especially in severe cases and with pedicle dysplasia. It helps as a surgical guide for the placement of hands-free transpedicular screws with possible reduction of radiation and anesthetic time. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic Scoliosis (IE) is one of the most frequent problems of the child-adolescent population. Few studies investigate the physiotherapy treatments used to reduce curves.Objective: to verify the effectiveness of four treatments (exercises, three-dimensional corsets, Spinecor corset and Cotrel traction) in subjects with IE. Material and method: a non-randomized controlled trial was carried out with four intervention groups, including 80 subjects (20 per group). The treatment according to its classification curve was applied to each group. The curve was assessed using the Cobb angle before and after the treatment, calculating the difference between both measurements and the percentage change (PC). Results: in all groups the curve decreased significantly (p < 0.001). Both in the decrease of the curve and in the CP there was a significant difference (p < 0.001) between the group of three-dimensional corsets and the traction group, with no significant differences between the other groups. There was a reduction in the curve and a lower CP in the group of three-dimensional corsets compared to the other groups, these variables not being influenced by the initial value of the curve. Conclusions: the four Physiotherapy treatments carried out show effectiveness in reducing the curve in children/adolescents with IE. The decrease in the curve was less in the three-dimensional corsets group compared to the traction group. [ABSTRACT FROM AUTHOR]

Background: the correction and stabilization of the deformity have developed a lot since the incorporation of lumbar pedicle screws, which are the gold standard of spinal instrumentation today. Objective: to describe the results of the modifications made to the hybrid instrumentation technique for the treatment of adolescent idiopathic scoliosis. Methods: a case series intervention study was carried out with 50 patients operated on for scoliosis in adolescence, divided into two groups. Group A composed of 31 patients, operated on with three different instrumentation techniques and group B composed of 19 patients operated with a hybrid instrumentation technique, modified by the author, in the province of Cienfuegos, in the period between January of 2013 and December 2017. Results: The 96% of the patients were female; the average age was 14 years old. In group A, the best results were achieved with full pedicle fixation with the 89.4% post-surgical correction; the 81.9% was achieved with the technique modified by the author, with minimal complications. Patient satisfaction was the 96% in group A and in patients in whom the author's modification was used, satisfaction was the 100%. Conclusions: the hybrid instrumentation system modified by the author achieves an excellent correction of the curve with a high degree of patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity., Methods: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected., Results: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases)., Conclusions: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies., (Copyright © 2023 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: adolescent idiopathic scoliosis is a three-dimensional deformity of the spine. Its surgical treatment is necessary to prevent the progression of the deformity, cardiorespiratory conditions and improve aesthetics. Objective: to characterize adolescent idiopathic scoliosis patients operated on Cienfuegos province, with a modified hybrid system Methods: a case series study of 15 patients operated on for adolescent idiopathic scoliosis with a hybrid instrumentation system modified by the author, taking into account the preoperative Cobb angle, immediate postoperative and one year after surgery, as well as its complications. Results: 14 girls and one boy were studied, with an average age of 13.9 years; Lenke's classification was used with eight patients of type 1, two of type 3, four of type 5 and one type 6 (there were no patients of types 2 and 4). The average preoperative curve was 59.1o at the immediate postoperative period, the average curve was 12.2o; with an average correction of 79.4%; the loss in degrees per year was 2.9o. The average surgical time was 190 minutes and a bleeding of 750ml. There were two complications, a radiculopathy and a superficial wound infection. Conclusions: the modified hybrid instrumentation system has a very good effectiveness in correcting the curve in adolescent idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

Objetivo: Determinar la frecuencia de escoliosis idiopática del adolescente y su asociación con factores como edad y sexo en alumnos de secundaria en seis colegios de Lima Norte. Materiales y métodos: Se diseñó un estudio observacional, analítico y de corte transversal en seis colegios de la Red Diocesana de Lima Norte. Evaluamos la deformidad de la columna vertebral en alumnos de 1.° a 5.° año de secundaria de entre 11 a 18 años de edad con la Escala visual de Walter Reed (EVWR). El análisis estadístico se realizó con el software STATA versión 15.0 para Windows, y el análisis bivariado se calculó mediante las técnicas ji cuadrado y t de Student. Un valor de p ≤ 0,05 fue considerado como significativo. Resultados: Se incluyeron 191 participantes, 119 varones (62,30 %) y 72 mujeres (37,70 %). El promedio de edad fue de 14,46 ± 1,43 años (rango: 12 - 18 años). Tras la evaluación con la EVWR, 106 participantes (55,50 %) tuvieron un resultado negativo; 33 participantes (17,28 %), un resultado dudoso, y 52 (27,23 %) tuvieron un resultado positivo. Los hombres representaron el 86,56 % de los resultados positivos y la edad promedio de los participantes fue 14 años. Conclusiones: Tras la evaluación con la prueba de tamizaje, la frecuencia de escoliosis idiopática del adolescente fue del 27,23 % (52 participantes). Su asociación con factores como sexo mostró resultados novedosos y la relación con la edad correspondió a lo publicado en estudios previos.

En ortopedia maxilofacial y ortodoncia se ha demostrado la relación de los desequilibrios oclusales del sistema estomatognático y su influencia sobre la ergonomía corporal, sobre todo en la columna vertebral en pacientes con problemas dento-maxilares; por lo tanto, el objetivo de este estudio fue comprobar si un desequilibrio oclusal inducido, afecta en la alineación de la columna vertebral en ratones de laboratorio. Materiales y métodos: La muestra consistió en 10 ratones (Mus musculus) de 14 semanas de edad, divididas en dos grupos. Se tomaron radiografías iniciales a ambos grupos (tratamiento y control), para este procedimiento se sedaron a los ratones, se fijaron a las varillas de una caja metálica utilizando líneas de referencia y se pusieron en ligera tracción. Después de obtenidas las radiografías iniciales se colocó al primer grupo (tratamiento) un botón de resina de color azul, el cuál utilizaron por una semana y al segundo grupo (control) no se colocó nada. Posteriormente se procedió a la toma de una radiografía a ambos grupos para verificar la presencia o ausencia de desviación en la columna vertebral. Resultados: Para la evaluación radiográfica se midió la línea vertical o plomada en relación con la línea centro-sacra. Los resultados del estudio revelaron que aquellos ratones en los que se colocó el botón oclusal, la columna vertebral presentó desviación significativa al paso de una semana. Conclusiones: Se ha demostrado que un desequilibrio oclusal puede influir en la alineación vertebral en ratones induciendo como resultado una escoliosis leve.

Objetivo El objetivo de nuestro trabajo es estudiar las complicaciones de la cirugía en las escoliosis neuromusculares operadas en nuestro centro, así como la funcionalidad y calidad de vida de los pacientes luego del tratamiento quirúrgico. Métodos Se realizó un estudio retrospectivo, tipo serie de casos. Se revisó la historia clínica y se entrevistó a paciente y cuidador principal. Se valoró los resultados luego de la cirugía en cuanto a las complicaciones, funcionabilidad, calidad de vida y grado de satisfacción de los cuidadores. Resultados Obtuvimos un 26,7% de complicaciones, debidas a infección y alteraciones hemodinámicas. En cuanto a la funcionabilidad y calidad de vida de estos pacientes obtuvimos resultados positivos, siendo más significativos en cuanto a la capacidad de estar sentado y las actividades de la vida diaria. Conclusiones La cirugía de los pacientes con escoliosis neuromuscular mejora la capacidad y el equilibrio de estar sentado, favoreciendo con esto la capacidad digestiva, respiratoria y de vida social del paciente. Si bien se trata de cirugías con altos indices de complicaciones muestra indices elevados de satisfacción por parte de los cuidadores. Abstract Introduction: The objective of this study was to evaluate surgical complications in patients with scoliosis operated on in our Center, as well as their functionality and quality of life after surgical treatment. Methods: A retrospective case series study was carried out. Medical history was reviewed and the patient and primary caregiver were interviewed. Results after surgery were assessed for complications, function, quality of life and caregivers´ degree of satisfaction. Results: Complication rate was 26.7%, due to infection and hemodynamic alterations. Positive results were obtained regarding function and quality of life of these patients, being more significant in terms of the ability to be seated and activities of daily living. Conclusions: Surgery of patients with neuromuscular scoliosis improves the capacity and balance of sitting, favoring digestive, respiratory and social life capacity. Although rate of complications is high, satisfaction rates on the part of the caregivers are elevated.

Objective: To determine the frequency of adolescent idiopathic scoliosis and its association with factors such as age and sex among high school students from six Northern Lima schools. Materials and methods: An observational, analytical and cross-sectional study was conducted in six schools of the Northern Lima Diocesan Network. It assessed the spine deformity among students from the first to fifth years of high school aged between 11 and 18 years old using the Walter Reed Visual Assessment Scale (WRVAS). The statistical analysis was performed using Stata 15 for Windows and the bivariate analysis was conducted using the chi-square test and Student's t-test. A value of p = 0.05 was considered significant. Results: A total of 191 participants were included in the study: 119 males (62.30 %) and 72 females (37.70 %). The average age was 14.46 ± 1.43 years (range: 12 - 18 years). According to the assessment conducted with the WRVAS, 106 participants (55.50 %) had a negative result, 33 (17.28 %) had a dubious result and 52 (27.23 %) had a positive result. Males accounted for 86.56 % of the positive results and the average age of the participants was 14 years. Conclusions: The frequency of adolescent idiopathic scoliosis was 27.23 % (52 participants) according to the assessment conducted with the screening test. Its association with factors such as the sex showed novel results, and its relationship with the age matched those published in previous studies. [ABSTRACT FROM AUTHOR]

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ABSTRACT Objective: The objective was to investigate implant density or the number of screws correlated with the correction of the main curve in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Methods: We evaluated 112 medical records: 33 patients with screw density of up to 50%, and 79 patients with a density of 100%; all patients underwent surgical correction by posterior approach with transpedicular fixation. Results: In the group of patients with screw density of up to 50% the residual Cobb median was 10°; in the group with 100% density, the median was 7°. Conclusion: Biostatistical analysis showed that the group with up to 50% of screw density presented correction rate of 82.1% and the group with 100% density had correction of about 86.8%. It is therefore concluded that the difference is statistically significant in favor of the fixation with 100% density (p =0.010).

ABSTRACT Objectives: To compare the outcomes of surgical treatment with lumbar fixation using nitinol rods without fusion and with standard lumbar fixation with titanium rods and interbody fusion. Methods: Treatment results of 70 patients with degenerative lumbar scoliosis aged 40 to 82 were analyzed. In all cases pedicle screws and nitinol rods with a diameter of 5.5 mm were used. Thirty patients underwent fixation at L1-S1 and 40 patients underwent fixation at L1-L5. Spinal fusion was not performed. All patients had radiography, CT and MRI performed. The results were assessed according to the Oswestry scale, SRS 22, SF 36 and VAS. The minimum follow-up period for all patients was 2.5 years. For the control group, consisting of 72 patients, pedicle fixation with titanium rods and interbody fusion in the lumbosacral region were performed. Results: The average level of deformity correction equaled 25° (10° - 38°). The analysis of X-ray and CT-scans revealed a single patient with implant instability, two patients with bone resorption around the screws and one patient with rod fractures. Functional radiography 2.5 years after surgery showed an average mobility of the lumbar spine of 21° (15° - 30°). There were no problems at the adjacent levels. Conclusions: The use of nitinol rods in spinal deformity surgery is promising. This technology is an alternative to rigid fixation. Continued gathering of clinical data and its further evaluation is necessary.

ABSTRACT Scoliosis is characterized by three-dimensional changes of the spine and is estimated to be present in 4% of the population worldwide. The most common form is the adolescent idiopathic. The purpose of this study is to identify the major muscle abnormalities found in patients with adolescent idiopathic scoliosis through a literature review. We conducted an electronic search of the national databases PubMed, Lilacs, PEDro, and EMBASE using the keywords "scoliosis", "biomechanics", "exercise", "physical therapy specialty", "idiopathic", and "muscles", from January 2003 to April 2015. The most relevant articles in English, Portuguese and Spanish were selected by title and abstract. It was also performed a manual search of the references of the selected articles. From a total of 4,319 articles, 11 were selected. We conclude that individuals with AIS have changes in the paraspinal muscles, with a difference in activation between the concave and convex sides, suggesting an increase in EMG activity on the convex side, although there is still no consensus among the authors.

ABSTRACT Objective: The adolescent idiopathic scoliosis (AIS) is a spine deformity that occurs in both the coronal plane and the sagittal plane of patients between 10 and 17 years. The Cobb method is the most widely used to determine the angular value of scoliosis and it is defined as the "gold standard". The goal is to verify the reproducibility of the measured angles between orthopedic residents and spinal pathologies specialists, comparing the variability of the angles measured by professionals with greater and lesser experience. Method: A total of 10 radiographs of patients diagnosed with AIS were assessed. Radiographs were handed over to 7 orthopedists specialized in spine and 14 orthopedic residents. The measurement of the angles for each of the examiners was described using means and standard deviations and intraclass correlations were calculated, as well as the measure of repeatability, and Bland-Altman plots were designed with the results of the measurements of each group of examiners, according to experience, to assess the agreement/reproducibility of Cobb angle measurements. Results: Each examiner obtained a resulting average of 10 cases summation. In order to assess trends in variability of the measurements of the angles of each group graphs were plotted based on the arithmetic mean of each of the 10 cases by the total number of participants in the group versus the standard deviation in each case. Conclusion: There was a poor correlation (ICC=0.4) in the measurement of Cobb in both groups, demonstrating difficulties in the method, which cannot be overcome by the expertise.

Objective : To develop a consensus for translation of the most relevant terms used in the study of Adult Spinal Deformity, from their original languages into Brazilian Portuguese. Methods : A panel of 12 experts in spine surgery from the five Brazilian regions was constituted. To obtain the standardization of terminology, the Delphi method with an electronic questionnaire was administered to participants about their opinion on the translation of 13 relevant terms chosen by literature review. Each term was considered standard when there was consensus, that is, concordance higher than 80% among participants as to the suggestion to be adopted, and then on the acceptance of the term and its abbreviation in Portuguese. Results : Initially there was consensus (over 80% concordance) on the translation of seven terms in the electronic questionnaire. The other six terms that have not reached consensus were discussed at a meeting among the participants, relying on the opinion of a specialized professional in simultaneous translation of orthopedic terms in Portuguese and other professional majored in Portuguese language. It was decided how these terms should be translated and there was a consensus among all participants regarding their acceptance. Finally, there was consensus among the participants, who agreed with the translation and abbreviation of the 13 propose terms, defining its standardization for Brazilian Portuguese. Conclusion : We present a standard terminology used in the study of Adult Spinal Deformity through consensus among experts, seeking uniformity in the use of these terms in Brazilian Portuguese.

Los ejercicios hipopresivos son una técnica de fortalecimiento muscular beneficiosa para la faja abdominal pero sin efectos negativos sobre el suelo pélvico, que persigue mejorar el control y las cualidades musculares de los programas de reeducación del periné incluidos en la llamada Fisioterapia del Suelo Pélvico (SP) o Fisioterapia Uroginecológica. Este tipo de terapia beneficia a las patologías de disfunción del suelo pélvico o como una medida preventiva del mismo. La realización de ellos durante un período de aprendizaje estructurado, dan como resultado, descenso de la presión intraabdominal y la activación refleja de los músculos abdominales y del suelo pélvico, consiguiendo a largo plazo un aumento del tono en ambos grupos musculares; siendo beneficioso para la faja abdominal. El objetivo del presente artículo es realizar una revisión bibliográfica del tema e indicaciones generales para la prescipción de la terapia hipopresiva.

OBJECTIVE: To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.METHODS: The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.RESULTS: The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels), and Group II presented an average of 6.36 vertebrae (5-11 levels). Complications did not show statistically significant difference.CONCLUSION: Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.

OBJECTIVE: To analyze the occurrence of poor positioning of pedicle screws inserted with the aid of intraoperative electromyographic stimulation in the treatment of Adolescent Idiopathic Scoliosis (AIS).METHODS: This is a prospective observational study including all patients undergoing surgical treatment for AIS, between March and December 2013 at a single institution. All procedures were monitored by electromyography of the inserted pedicle screws. The position of the screws was evaluated by assessment of postoperative CT and classified according to the specific AIS classification system.RESULTS: Sixteen patients were included in the study, totalizing 281 instrumented pedicles (17.5 per patient). No patient had any neurological deficit or complaint after surgery. In the axial plane, 195 screws were found in ideal position (69.4%) while in the sagittal plane, 226 screws were found in ideal position (80.4%). Considering both the axial and the sagittal planes, it was observed that 59.1% (166/281) of the screws did not violate any cortical wall.CONCLUSION: The use of pedicle screws proved to be a safe technique without causing neurological damage in AIS surgeries, even with the occurrence of poor positioning of some implants.

OBJECTIVE: To evaluate the incidence of spinal deformity in adults, as well as its distribution according the curve type and the occurrence of sagittal modifiers of the SRS-Schwab classification..METHODS: Radiographs in frontal and lateral views of the entire column were performed and radiographic parameters were used to diagnose the vertebral deformity for the classification according to the SRS-Schwab system.RESULTS: We included 302 patients in the study, 236 (78.1%) women and 66 (21.9%) men. Fifty-six of the participants were diagnosed with ASD, 50 women and 6 men. The incidence of ASD was 18.5% in the total population, ranging from 9.1% in males and 21.2% in females (p=0.04). As to age group, the incidence was 11.9% in patients between 18 and 39 years, 12% between 40 and 59 years and 28.8% in patients with 60 years of age or older, significantly higher in the oldest group (p=0.002). When analyzing the correlation between age and progression of sagittal modifiers, there was no significant difference in the PI-LL and PT modifiers, but there was significant difference of SVA modifier (p=0.008), with a higher age in individuals "++".CONCLUSION: This study presented demographic data on ASD in a Brazilian population sample. There was a higher incidence of ASD in females and individuals aged ≥ 60 years. As for the sagittal modifiers of SRS-Schwab classification, there was a correlation between increasing age and degree of progression of SVA.

La escoliosis es una deformidad de la columna que se presenta como una curva estructural que determina un grado variable de deformidad del tronco. La forma más común es la escoliosis idiopática del adolescente, que se desarrolla en la columna, en la fase de crecimiento y puede tener importantes efectos cosméticos y funcionales, pero es siempre un diagnóstico de exclusión. La escoliosis puede ser tratada con observación seriada, uso de ortesis o cirugía, según su magnitud y potencial evolución de severidad. Sin embargo, el comportamiento de la curva es frecuentemente difícil de predecir durante el desarrollo, por lo que el seguimiento clínico y radiológico seriado es clave en la decisión de tratamiento. Aparte de la cirugía, sólo el tratamiento con corset puede frenar la progresión de una curva, si bien no corregirla. Las curvas severas o que progresen dentro del corset tienen indicación de corrección y fusión quirúrgica. Las curvas noidiopáticas se comportan en forma diferente y su manejo es también distinto. El objetivo de este artículo es presentar los aspectos clave de la evaluación inicial de un paciente con escoliosis y entregar una visión actualizada del tratamiento de las distintas formas de presentación de esta afección.

Objective  To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods  We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results  In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion  The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To know the process experienced by adolescents suffering from idiopathic scoliosis when undergoing surgery to correct the physical deformity., Method: Qualitative study with a symbolic interactionism approach. 22 semi-structured interviews were conducted with adolescents who underwent posterior spinal fusion in a third-level hospital in Madrid between May 2019 and January 2021. Taylor and Bogdan's analysis in progress was carried out., Results: Patients with adolescent idiopathic scoliosis present with a complex simultaneous health/illness and developmental transition. The main inhibitory conditions of the transition are the meanings about: their identity, social, beliefs about surgery, ignorance about the pathology, the surgical process, and their recovery. As facilitating conditions, we find: a positive attitude towards physical, aesthetic, and social change, socioeconomic level, and family support., Conclusions: The informants of this study refer that aesthetic affectation and physical limitations are the main elements that cause them discomfort. Surgical intervention is presented as the solution to this situation. Recovery is a critical point in the transition process mainly due to pain. They accept the discomfort suffered during the recovery because they hope to obtain an improvement in the image and physical limitations. The changes and differences they experience during the transition make them think that they will be able to lead a «normal life» to which they constantly refer in their speeches., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

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Background: Reconstruction of the anterior cruciate ligament (ACL) aims to restore the original anatomy. The clinical outcome could be imperfect when graft placement is not in an anatomical position; moreover, the conventional transtibial reconstruction of the ACL often locates the graft away from the anatomical site, leading to abnormal biomechanical behavior and kinematics of the knee. The objective of this work was to assess the importance of the angular reconstruction of the anterior cruciate ligament during arthroscopic replacement and to compare the postoperative functional results. Material and methods: We studied 21 patients to whom the IKDC 2000 form of objective and subjective evaluation was applied; radiographic evaluation in anteroposterior and lateral bending at 30o. We made an statistical analysis with Pearson P, correlating the anteroposterior and lateral angulation of the graft direction and the subjective projection of the operated knee function, as well as age and time of evolution with the operated knee. Results: We included 21 patients of 18 to 56 years of age; follow-up: one to three years. Objective evaluation: 95.24% normal and 4.76% almost normal. Subjective assessment: average 84.31% (range 70.93 to 97.99%), CI 95%. AP angle: 68.8o, range: 62o to 77o. Average sagittal angle: 64.9o, range: 58o to 75o. Correlations: AP angle and subjective function -0.19, angle in sagittal and subjective function -0.54, age and subjective function -0.77, duration and subjective function -0.74. Function average: 84.31%. Discussion: The anatomical angular reconstruction of the ACL graft is key to the stability of the knee; the evaluated patients got a more similar direction to that of the native ACL, better stability and knee function. [ABSTRACT FROM AUTHOR]

Introduction: The technique of placement of pedicle screws has gradually improved, but even misplacement observed in 1.2 to 20% of cases, have appeared techniques fluoroscopic, tomographic and electromagnetic navigation, which led it to 1.3 to 4.3%, but nevertheless they are expensive and complex technologies. Present technique pedicle screw placement by using templates with a modification in the art, performing tomography and reconstruction in the same surgical position and with the templates of 3 or more levels. Methods: Five cases of idiopathic scoliosis were performed, with correction and instrumentation with pedicular screws, where a three-dimensional model of the spine was performed with a tomography in a surgical position, whose images were exported to a 3D printer to reconstruct the desired trajectory of the screws in a template using cylinders resting on the inverse surface of the vertebrae. The direction of the screw was planned in the center of the pedicle and parallel to the upper platform of the vertebra. Each template was of several levels and transoperative X-rays were not used. Results: Under electrophysiologic monitoring transoperative «red alerts» were not reported, the placement of the screws in postoperative CT scan was evaluated, showing a standard deviation in placement of 1.9 and 2.2 mm on the right and left respectively pedicles, with respect to their planning. Discussion: This technique is simple and safe, besides not requiring great technology, its use is suggested in beginner spine surgeons and in severe deformities, it can be performed in any hospital where spinal surgery is performed. [ABSTRACT FROM AUTHOR]