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Spine trauma is an ominous event with a high morbidity, frequent mortality, and significant psychological, social, and financial consequences for patients, their relatives and society. On average three out of four spinal fractures involve the thoracolumbar spine and up to one-third are complicated by spinal cord injury. Spinal cord injuries (SCI) are a significant cause of disability in US and in all western countries. Knowledge of the main principles of biomechanics is essential in understanding the patho-morphology of spinal injuries, and the evolution of the various classification systems. Classification systems should be able to create a common language between specialists in order to improve patients' prognosis, guide treatment and compare treatment outcomes. Imaging has always been crucial in the evaluation of the injury type and accompanied the development of different classification systems. Thoracolumbar spine (TLS) trauma has a wide spectrum ranging from minor isolated fractures to highly unstable fracture-dislocations. Early classification systems were based on the analysis of the pattern of bony injuries on radiographs and CT. Traditionally, conventional radiographs are performed to confirm the clinical suspicion and to depict the level and type of bone injury. However, because of their inherent limitations, radiographs are often more helpful in proving the existence of a suspected bony spinal injury rather than excluding it. Multidetector computed tomography (MDCT) is superior in evaluating bone anatomy and, especially in polytrauma patients, it is the first line imaging modality. Morphological bone damage may be accurately shown and classified on CT. the most recent classifications also incorporate the integrity of soft tissues structures, which is considered equally relevant to spinal stability. Injuries to ligaments and discs can only be suspected on radiographs and conventional CT, although dual-energy CT is offering new insights on collagen mapping of damaged discs. Magnetic resonance imaging (MRI) may directly assess disc and ligamentous injuries, but also subtle osseous injuries, playing a complementary role in defining the whole spinal damage and an eventual instability. MRI is the only valid modality to assess the spinal cord (SC) and is indicated whenever a neurologic injury is suspected. Advanced MRI techniques, such as diffusion weighted imaging (DWI) and tractography, may provide further information regarding the integrity of the white matter which may improve outcome prognostication. Despite challenges in terms of costs, availability, accessibility and specificity, MRI and advanced MRI techniques are increasingly being used in spinal injuries. We present a review on TLS traumas discussing on the development of different classification system used in their evaluation, the role of imaging for their detection and the correlation to the patients' outcomes and treatment options.

This review talks about the principal imaging investigations in traumatic brain injury (TBI). Physiopathological mechanisms are briefly discussed. The article will focus on the major brain lesions and their imaging appearance with also reference to the most recent techniques that can correlate with prognosis. Neuroimaging plays a principal role in the evaluation of TBI. CT and MRI are used for the evaluation of pathological findings after the trauma and for the follow-up. Several classification systems have been proposed to correlate neuroimaging findings and patients’ outcome. Novel functional imaging techniques, such as diffusion tensor imaging, may provide further important information for the prediction of prognosis. CT is the best imaging tool for the acute evaluation of patients with TBI. MRI has higher sensibility in the detection of brain lesions, but currently is mostly used in the follow-up. Functional imaging techniques are very promising, but still are not currently included in the clinical evaluation.

Neurotoxicity of drugs is a pathological entity in growth for the wider use of specific antiblastic therapies and also for better clinical and neuroradiological performance that allow early and specific diagnosis.

48-year-old patient with breast lesion secondary to previous breast cancer. Morphofunctional MR follow-up performed with morphologic imaging, diffusion, and spectroscopy at 1 year from stereotactic therapy of metastasis from breast cancer.

The craniovertebral junction represents a particular anatomical complex, being at the same time highly flexible and stiff. These features support its threefold role: (a) allowing a wide range of movements on three orthogonal planes; (b) supporting the head weight; (c) protecting spinal cord and vertebral arteries.

18-year-old patient with pilocytic astrocytoma. MR follow-up at 1, 4, and 7 months after surgery and radiotherapy.

Spinal traumas represent a significant proportion of muscle-skeletal injuries worldwide. Spinal injuries involve a complex structure with components having different traumatic susceptibility and variable healing capabilities. The interaction of numerous variables at time of trauma creates a great variety of lesions which makes challenging the creation and comparison of homogeneous groups, with difficulties in classifying spinal lesions, in assessing their instability, and in defining the indication and outcome of different treatment strategies. The evolution of concepts on instability has accompanied that of traumas classification schemes and treatment strategies. The assessment of instability in a spinal injury is actually crucial in front of newer surgical techniques and hardwares. Despite a long history of attempts to classify spinal traumas, it remains some degree of controversy in describing imaging data and a wide variety of treatment strategies. Acute cervical spine injuries affect from 1.9% to 4.6% of subjects reporting a blunt trauma, and up to 5.9% of multiple-injured patients. Most of spinal cord injuries are a consequence of unstable fractures of the cervical spine. An accurate and early diagnosis is mandatory to prevent neurological damage in unstable fractures. Classic and newer classifications are primarily based on features identifiable by using conventional imaging and CT scan, which are the most available modalities at most trauma centers. Even though multidetector-CT remains superior in assessing with high accuracy bone injuries, MRI is the most sensitive modality for detecting soft tissues injuries and spinal cord damage.

The human spine is a complex biomechanical system composed of multiple articular structures controlled by muscles. Spine diseases are frequently related to a loss of stability. Dedicated imaging protocols have been developed to evaluate spinal instability. Dynamic radiography with lumbar flexion-extension is used most often; however, in traumatic instability, computerized tomography provides better diagnostic accuracy for fracture detection. Novel technology improvements allow acquisition of dynamic MRI with axial load or upright standing techniques to simulate a more pathologic condition compared with conventional supine scans. This article reviews the basic concepts of spinal instability and describes the role of different imaging techniques in its assessment.

The craniocervical junction (CCJ) or upper cervical spine (UCS) has anatomic features and a biomechanics completely different from the other spinal segment of the spine. Several ligaments and muscles control its motion and function and ensure the maximum mobility and the visual and auditory spatial exploration. UCS traumas represent approximately one-third of all cervical spine injuries. Most of UCS traumas results from blows to the head and sudden deceleration of the body. Thanks to the improvement of the Advanced Trauma Life Support protocols dissociative injuries of CCJ have become less lethal onsite. In other less severe but unstable injuries, patients are neurologically intact at presentation, but they may deteriorate during the stay in hospital, with important clinical and medico-legal consequences. Knowing the peculiarities of UCS is fundamental for the early detection of imaging findings that influences the patient management and outcome. The classification of UCS traumas is mechanistic. More than in any other spinal segment, fractures of CCJ bones can occur without generating instability; on the contrary highly unstable injuries may not be associated with bone fractures. An early and correct diagnosis of occipito-cervical instability may prevent secondary neurological injury. The goal of imaging is to identify which patients can benefit of surgical stabilization and prevent secondary neurologic damage. Actual helical multidetector-CT (MDCT) offers high sensitivity and specificity for bone lesions and displacements in cervical spine traumas, but magnetic resonance imaging (MRI) is increasingly being used to evaluate soft tissues and ligaments, and mainly to identify possible spinal cord injury.

Isolated sphenoid sinus fungus ball is a very rare condition. CT is the most used imaging investigation for diagnosis. In some cases, MRI may provide further information to evaluate the extracompartmental invasion. We report the case of an elderly female patient who presented with headache and a soft tissue mass filling the right sphenoid sinus on CT, misdiagnosed as simple sinusitis. After 1 year, with recrudescence of symptoms, brain MRI showed a hyperintense soft tissue mass on T1 weighted images within the right sphenoidal sinus; a new CT examination revealed calcifications within the mass. Surgical histological examination showed fungus ball. Fungal ball should be included in the differential diagnosis of T1 hyperintense lesions in the sphenoid sinus.

The spine is a frequent localization of primary tumours or metastasis involving posterior arch, pedicles and vertebra body, and often causing unsustainable pain. The management of spinal metastasis remains complex, including medical therapy (corticosteroids, chemotherapy), radiotherapy and surgical treatment, or the recent percutaneous mini-invasive approach. The target of all these treatments is to improve the quality of life of patients affected by this type of lesion. Diagnosis of spinal metastasis and then its treatment should be based on the combination of different elements: clinical evaluation, CT, MRI and nuclear medicine patterns, considering the age of the patient, known primary tumour, location of the lesions, single/multiple lesions, pattern of morphology (border, matrix, expansile character, soft tissue extension), density or signal intensity, oncologic instability and expectancy of life. The percutaneous mini-invasive approach for patients affected by secondary lesions involving the spine has as treatment goal of: (1) pain relief improving the quality of life; (2) stability treatment re-establishing the spinal biomechanics, alterated by bone destruction or deformity, preventing pathological fracture; and (3) an anti-neoplastic effect. The aim of this paper is to provide a comprehensive diagnostic and percutaneous approach to the bone metastatic spine lesions, identifying which metamer should be treated to improve patient quality of life, showing the importance of a multi-disciplinary approach to this problem.

SUMMARY The concern about the maintenance of the human species has existed since the earliest civilizations. Progress in the diagnosis and treatment of infertility has led to the development of assisted reproductive techniques (ART) which, along with the evolution of genetics and molecular biology studies, have contributed in a concrete way to the management of infertile couples. Classic in vitro fertilization was initially developed 35 years ago for the treatment of women with tubal blockage, however, it remains inaccessible to a significant proportion of infertile couples around the world. This can be explained by the lack of specialized clinics in some countries and by the high cost of the procedures. Efforts have been employed to increase the number of treatment cycles for assisted reproduction, as for example, the creation of low-cost programs. Even today, infertility remains a problem of global proportions, affecting millions of couples. The estimate of the incidence of infertility is uncertain, mainly because of the criteria used for its definition. This article aims to review the most important aspects, succinctly, regarding the incidence, etiology, and treatment options available to infertile couples. RESUMO A preocupação com a procriação e a manutenção da espécie humana existe desde as civilizações mais antigas. O progresso no diagnóstico e no tratamento da infertilidade teve como consequência o desenvolvimento de técnicas de reprodução assistida (TRA) que, conjuntamente com a evolução dos estudos em genética e biologia molecular, têm contribuído de maneira real no manejo dos casais inférteis. A fertilização in vitro clássica foi inicialmente desenvolvida há mais de 35 anos para o tratamento de mulheres com obstrução tubária, no entanto, essa terapêutica permanece ainda inacessível para uma considerável parte dos casais inférteis ao redor do mundo. Isso pode ser explicado pela falta de clínicas especializadas em alguns países e pelo alto custo dos procedimentos. Esforços têm sido empregados para aumentar o número de ciclos de tratamento em reprodução assistida, como, por exemplo, a criação de programas de baixo custo. Ainda nos dias atuais, a infertilidade permanece como um problema de proporções mundiais, acometendo milhões de casais. A estimativa da incidência da infertilidade é incerta, principalmente por causa dos critérios utilizados para sua definição. Este artigo tem como objetivo revisar os aspectos mais importantes, de forma sucinta, referentes a incidência, etiologia e alternativas terapêuticas disponíveis para os casais inférteis.

Augmentation techniques (AT) include different percutaneous mini-invasive procedures such as vertebroplasty (VP) and assisted technique (AT) (kyphoplasty or kyphoplasty-like technique) for the treatment of symptomatic vertebral compression fractures (VCFs) due to osteoporosis diseases, primary or secondary vertebral tumors, and vertebral trauma. The major target of all those techniques is pain relief, thanks to the simple cement injection (polymethylmethacrylate, PMMA) in the collapsed or abnormal soma stabilizing the movements of the trabecular and spongious microfractures (responsible for the pain), making more compact and resistant the vertebral body, improving life quality. While VP consists in the simple cement injection, AT combines this analgesic and vertebral consolidation effect with the restoration of the physiological height of the collapsed vertebral body, reducing the kyphotic deformity and improving vertebral statics and trying to restore the physiologic curvature and biomechanics. Reduction of the kyphotic deformity is the major target of all AT, thanks to the capacity of the system to restore the vertebral height. The aim of this chapter is to explain indication/contraindication treatment, limits, and benefits of the different devices developed by the industry for obtaining vertebral augmentation effect.

Spine is a multiarticular system formed by column, muscles and tendons and central nervous system. It supports the head and trunk during posture and movements and at the same time it protects the spinal cord and the nerve roots. Its function presupposes stability which is obtained with bony and soft movement restraints.

Ependymoma has been described typically as an intramedullary tumour derived from ependymal cells with a predominance in women in the fifth decade of life. Pain is the most frequent symptom. Intradural extramedullary presentation is rarely described and almost always as a unique lesion. We describe a 53-year-old man with multi-segmental diffuse intradural extramedullary ependymoma with progressive lower leg hypoesthesia with regular motility. The patient's neurologic condition improved after surgery.

Biomechanics, the application of mechanical principles to living organisms, helps us to understand how all the bony and soft spinal components contribute individually and together to ensure spinal stability, and how traumas, tumours and degenerative disorders exert destabilizing effects. Spine stability is the basic requirement to protect nervous structures and prevent the early mechanical deterioration of spinal components. The literature reports a number of biomechanical and clinical definitions of spinal stability, but a consensus definition is lacking. Any vertebra in each spinal motion segment, the smallest functional unit of the spine, can perform various combinations of the main and coupled movements during which a number of bony and soft restraints maintain spine stability. Bones, disks and ligaments contribute by playing a structural role and by acting as transducers through their mechanoreceptors. Mechanoreceptors send proprioceptive impulses to the central nervous system which coordinates muscle tone, movement and reflexes. Damage to any spinal structure gives rise to some degree of instability. Instability is classically considered as a global increase in the movements associated with the occurrence of back and/or nerve root pain. The assessment of spinal instability remains a major challenge for diagnostic imaging experts. Knowledge of biomechanics is essential in view of the increasing involvement of radiologists and neuroradiologists in spinal interventional procedures and the ongoing development of new techniques and devices. Bioengineers and surgeons are currently focusing on mobile stabilization systems. These systems represent a new frontier in the treatment of painful degenerative spine and aim to neutralize noxious forces, restore the normal function of spinal segments and protect the adjacent segments. This review discusses the current concepts of spine stability.

Spine stability is the basic requirement to protect nervous structures and prevent the early deterioration of spinal components. All bony and soft spinal components contribute to stability, so any degenerative, traumatic or destructive lesion to any spinal structure gives rise to some degree of instability. Degenerative instability is considered a major cause of axial and radicular pain and is a frequent indication for surgery. Nevertheless the assessment of instability remains difficult in both clinical and imaging settings. All static imaging modalities, even conventional MR, the most accurate technique, are unreliable in assessing instability and chronic pain due to degenerative spine. Dynamic-positional MR is considered the most sophisticated imaging modality to evaluate abnormal spinal motion and instability. In spinal traumas, as multi-detector CT yields high-resolution reconstructions in every spatial plane, it will detect even the tiniest fractures revealing potentially unstable lesions, often avoid the routine use of MR. Nevertheless, MR remains the only modality that will directly and routinely assess soft tissue changes. Unfortunately the objectivity of MR in assessing the integrity of ligaments is not rigorously defined and its use in routine protocols to clear blunt spinal injuries remains controversial. There are no evidence-based guidelines currently available to assess the risk of spinal instability in the setting of neoplastic spinal disease, so predicting the risk of a pathological fracture or the timing of a collapse remains challenging even when the lesions are well-characterized by neuroimaging. Diagnostic difficulties lead to controversy in the choice of the best treatment in all forms of spinal instability.

This paper illustrates the validity of vertebroplasty (VP) in patients with primary benign or metastatic lesion in the cervical spine. From January 2006 to December 2007, ten consecutive patients were treated with VP for a total of ten vertebral bodies: two symptomatic vertebral haemangiomas at C5 and C4.3, multiple myeloma at C2 (two cases) and one case at C4, five patients with vertebral metastasis from breast or lung cancer at C2, C4 (three cases) and C5. All the patients complained of pain resistant to continuous medical management. All procedures were performed under general anaesthesia by anterolateral approach under CT or fluoroscopy control with manual dislocation of the carotid axis. A transoral approach under fluoroscopy was performed to treat the C2 lesion. Bone biopsy was never performed. VP was performed to prevent fracture after implantation of a double discal prothesis in two patients. For patients with multiple myeloma, VP was performed to prevent new vertebral fracture. VP was performed before of radiotherapy in three patients with metastasis, and just after radiotherapy in two. Two metastatic patients were lost at one year follow-up due to death from systematic diffusion. Results were evaluated on the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODS). A successful outcome was observed with a complete resolution or partial reduction of pain in 90% of patients 24–72 hours after VP. At 12 months follow-up, we recorded a reduction of four points in the VAS evaluation and a 45% reduction in the ODS score. No extravertebral vascular or discal cement leakage was observed. At 12 months, X-ray follow-up showed a stable result. Percutaneous treatment with VP for benign or malignant cervical spine lesions is a valuable, mini-invasive and quick method that allows a complete and enduring resolution of painful vertebral symptoms without fracture of the adjacent or distal vertebral bodies.

Low back pain is the commonest spine disease causing absence from work in developed countries. Low back pain with classical irradiation along the course of the nerve root affected is more frequently due to disc disease. In 60–80% of patients with herniated disc, radicular symptoms disappear with conservative treatment after about six weeks, the remainder are treated surgically with a 2–6% of incidence of true recurrence of herniation post-intervention and with failed back surgery syndrome in 15% of cases. Recently minimally invasive techniques have developed as “alternative” treatments to surgical intervention. This review aimed to assess the pathogenesis of low back pain caused by lumbar disc hernia as a basis for action of minimally invasive techniques; to illustrate the techniques already used or currently in use, to compare them in technical guidance, indications and complications, exposing for each of them the inclusion/exclusion criteria in enrolling patients and the imaging guide technique of choice. Minimally invasive techniques can be a valuable alternative to traditional surgery with low cost, low risk of complications, easy feasibility, and in the event of failure they do not exclude subsequent surgery.

By virtue of its unique anatomy and functions the cranial-cervical junction was excluded in previous reviews on the general biomechanics of the spine, being a world apart. The special design of the cranial-cervical (CCJ) junction responds to seemingly opposed necessities being at same time loose enough to allow a great variety of movements and strong enough to preserve the spinal cord and vertebral arteries and to resist the head weight and muscular action. The primary goal of the CCJ is to ensure the maximal mobility of the head for visual and auditory exploration of space. Like a cardan joint the CCJ allows simultaneous independent movements about three axes in order to repeat and extend eye movements under the control of vestibular receptors. Several muscular groups and a number of ligaments control the movements of the CCJ and ensure its stability. Although composed of two seemingly distinct joints the CCJ forms a unique functional complex whose stability is ensured by ligaments and bony restraints often operating on both joint components: the occipitoatlantal and atlantoaxial joints.

The spine is a complex structure formed by motion segments (MSs) which, by working together, create a mobile, elastic and resistant ensemble, able to support the head and trunk and protect the spinal cord, the nerve roots and the vertebral arteries.

Spine biomechanics represents a traditional area of research by orthopaedists, neurosurgeons, bioengineers and physicists. Working in an emergency setting and managing spinal traumas every day we began a study on extended literature devoted to biomechanics of the spine, to see beyond the usual static evaluation of neuroimaging patterns. After our earlier paper on biomechanics of the spine16, we have reviewed and broadened some topics such as the role of the ligaments and introduced the main mechanisms of primary spinal traumas and deformations. The spine is a multiarticular complex structure controlled by the muscles whose correct function presupposes its stability. Several “stability factors” ensure spinal stability and correct movements. A number of biomechanical studies analysed the contribution of individual bony and soft spinal elements to stability and the effects of traumas. Several theories have been derived from these studies to account for the distribution of loads and vector forces, including failure-producing loads, among the components of functional spinal units (FSU). Holdsworth's initial two column concept, the three column models by Louis and Denis up to most recent four column theory by Cartolari all represent evolutions in assessing the distribution of loads and the presence and degree of instability in spinal traumas. Whether acute or chronic spinal instability means a partial or complete loss of one or both functions of the spine: load-bearing and cord protection. The diagnosis of spinal instability is crucial to establish the most appropriate strategy of management, namely in acute conditions. Biomechanical concepts are fundamental to understand the factors deciding the type, location and extent of spinal traumas, possible instability and the primary mechanism of the main types of injuries.

We describe a 20-year-old man presenting intraperitoneal metastases from medulloblastoma following surgical insertion of a spinoperitoneal shunt. Medulloblastomas are highly malignant primary tumou...

Biomechanics of the spine is a vast area of research that has generated numerous studiesin recent years on the part of doctors (mainly orthopaedic surgeons), bioengineers and physicists. This paper is a short introduction to some of the topics of major interest in spine biomechanics. The first topic is the development of the spine with a “mechanical” explanation of the physiological curvatures. As the spine is a multiarticular complex structure, understanding the mechanism responsible for its dynamics requires in-depth knowledge of the spine's basic components: the vertebrae and their architecture, the intervertebral joints, the ligaments and muscles. A short morphofunctional description of each of these anatomical parts is given mentioning their biomechanical features. Of particular interest, in relation to spinal trauma, is the architecture of the cancellous bone of the vertebrae responsible for most resistance to compressive weight loads. This specific characteristic is gradually lost over the years either due to disease or to a progressive resorption of the horizontal lamellae and thinning of the vertical columns typical of osteoporosis. Numerous studies have been conducted in vivo and in vitro to shed light on the mechanisms leading to particular traumatic lesions or degenerative arthrosis. These have given rise to various theories formulated to account for the distribution of loads and strength in the elements making up the functional spinal unit. These theories include the old “two vertical columns” theory, subsequently replaced by the “three columns theory”, and the latest “four columns” model which divides the spine longitudinally depending on carrying strength. The latest theory was formulated in the wake of in vivo CT studies using an axial loading device which allows axial loads to be applied even though patients are in a supine position. A short mention is made of the possible biomechanical applications of neuroradiological techniques, namely cine-MR scans, which allow detailed study of the ligaments, muscles and disc, especially the cervical spine under dynamic conditions. Lastly, the controversial concept of spinal stability and instability is discussed. Further studies are necessary to establish appropriate criteria for treatment of traumatic or degenerative lesions since an impairment to spine statics can result in permanent neurological damage.

Objetivos: avaliar as taxas de gravidez apos realizacao de reversao laparoscopica de obstrucao tubaria por laqueadura previa. Metodos: entre dezembro de 1998 e dezembro de 2001, realizamos estudo prospectivo no qual foram incluidas 26 pacientes previamente submetidas a esterilizacao tubaria. As pacientes tinham idades entre 28 e 37 anos e a reanastomose foi efetuada por via laparoscopica. O periodo de seguimento variou entre 150 e 425 dias e as taxas de permeabilidade tubaria (estudada por meio da histerossalpingografia) e as taxas de gestacao foram avaliadas. Resultados: a reversao laparoscopica pode ser realizada em 23 pacientes, sendo bilateral em 21. Duas pacientes apresentavam uma tuba extremamente danificada e tres haviam sido submetidas a fimbriectomia bilateral. O tempo cirurgico variou de 95 a 155 minutos e a alta hospitalar ocorreu na manha seguinte em todos os casos. Constatou-se permeabilidade tubaria em 15 pacientes (15/23) e a taxa de gestacao foi 56,5% (13/23), sem gestacoes ectopicas. O intervalo entre a interrupcao do uso do condom e a gravidez foi de ate quatro meses em nove pacientes e de ate 10 meses em quatro pacientes. Conclusao: em casos selecionados, a reversao tubaria videolaparoscopica pode ser oferecida a pacientes laqueadas que desejam novas gestacoes. A selecao adequada das pacientes, assim como tecnica cirurgica meticulosa, sao os fatores-chave para atingir taxas de gestacao satisfatorias.

This study assessed the one-year clinical and radiographic outcomes, in terms of pain-relief, vertebral re-fracture and complications, after vertebroplasty (VP) using a new osteoconductive cement (calcium triglyceride bone cement - Kryptonite™ bone cement, Doctors Research Group Inc., Southbury, CT, USA) to treat osteoporotic vertebral compression fractures. Sixteen consecutive osteoporotic patients (12 women and four men, mean age 68+/-10.5) were treated with VP using Kryptonite™ bone cement for a total of 20 vertebral fractures. All the patients complained of a pain syndrome resistant to medical therapy and all procedures were performed under fluoroscopy control with neuroleptoanalgesia using a monopedicular approach in 12 patients and bipedicular approach in four patients. All patients were studied by MR and MDCT and were evaluated with the visual analogue scale (VAS) and the Oswestry disability index (ODI) before treatment and at one and 12 months after the procedure. A successful outcome was observed in 80% of patients, with a complete resolution of pain. Differences in pre and post treatment VAS and ODI at one-year follow-up were significant (P VP using Kryptonite bone cement is a helpful procedure that allows complete and long-lasting resolution of painful vertebral symptoms. The cost of the material is very high and the rate of disk and venous leakage is too high compared to standard cement.

Objetivos: analisar as taxas de gravidez após realização de correção laparoscópica e microcirúrgica de hidrossalpinge. Métodos: no período de julho de 1996 a maio de 1999, foram tratadas 39 pacientes com hidrossalpinge, segundo protocolo de pesquisa previamente aprovado. As pacientes foram distribuídas, por sorteio, em dois grupos, de acordo com o tipo de acesso cirúrgico a ser utilizado: salpingostomia laparoscópica ou por laparotomia. Para análise dos resultados, as pacientes foram estratificadas de acordo com o grau de lesão tubária e as taxas de gestação nos dois grupos foram anotadas durante um intervalo de 24 meses. Resultados: as taxas de gravidez foram de 35,3 e 33,3%, respectivamente, após laparoscopia e microcirurgia. Em relação à gravidade da lesão tubária, 66,7% das pacientes com lesões leves e 21,7% das pacientes com lesões moderadas obtiveram sucesso na concepção. As taxas cumulativas de gravidez em um e dois anos, respectivamente, foram de 25,0 e 34,4%. Houve um caso de gestação ectópica, correspondendo a 9,1% de todas as gestações. Conclusões: pacientes com lesão tubária leve ou moderada podem ser tratadas inicialmente por cirurgia e o sucesso na concepção é inversamente proporcional ao grau de acometimento tubário. Purpose: to analyze the pregnancy rates after laparoscopic and microsurgical treatment of hydrosalpinx. Methods: from July 1996 to May 1999 thirty-nine infertile patients with hydrosalpinx were treated according to a previously approved research protocol. They were randomly divided into two groups, according to the previously proposed surgical approach: laparoscopic or open microsurgical salpingostomy. To analyze the results, patients were stratified according to tubal damage, and pregnancy rates in both groups were determined for 24 months. Results: pregnancy rates in our series were 35.3 and 33.3% after laparoscopic and microsurgical salpingostomy, respectively. According to the severity of tubal damage, patients with mildly and moderately damaged tubes got pregnant in 66.7 and 21.7% of the cases, respectively. Cumulative pregnancy rates in one and two years were 25.0 and 34.4%, respectively. There was a single case of ectopic pregnancy, corresponding to 9.1% of all pregnancies. Conclusion: patients with mild and moderate lesions may be initially treated with surgery, and conception success is inversely proportional to the degree of tubal damage.

Patient with D7 collapse by vertebroplasty. Recurrence of pain (ESR and PCR increase, fever).

Patient with abdominal pain following percutaneous treatment in diskal hernia with right posterolateral CT -guided approach

Patient with incremented low back pain, fever, ESR and PCR high levels after percutaneous L4–L5 intra-discal treatment through left posterolateral approach under CT guide

Patient with D9 osteoporotic collapse (ESR and PCR increase, fever) treated by vertebroplastica at D8–D9.

Patient with previous low back pain due to herniated disk treated by diskectomy and left laminectomy at L5-S1.

Patient with low back pain in degenerative L4–L5 anterolisthesis and following canal stenosis treated by interspinous device and percutaneous procedure.

Low back pain (LBP) and neck pain (NP) are the most common spine diseases and the cause of absence from work in developed countries. Around 80 % of adults suffer from back pain or low back pain during a lifetime. Fifty-five percent suffer from radicular pain, of these 44 % in the cervical region, 15 % thoracic, and 66 % lumbar level. Most symptoms revolve spontaneously within few days or weeks with medical/conservative therapy, while about one-third of patients progress to chronic pain. The causes of chronic LBP or NP include vertebral body pathology, vertebral disc disease, spinal stenosis, nerve entrapment syndrome, and facet joint disease. The diagnosis of LBP or NP is difficult and should be done by a multidisciplinary team including clinical evaluation, imaging (CT, MRI, EMG), and multi-specialist approach (radiologist, neuroradiologist, neurosurgeons, and neurologist).

The human spine is a multi-joint system controlled by muscles which supports the head and trunk and encloses and protects the spinal cord, the nerve roots and, at the cervical level, the vertebral arteries. Twenty-four highly specialized cervical, dorsal and lumbar motion segments (MS) together provide the significant range of motion (ROM) and load-bearing capacity needed for the physiological activities of daily life. Fused sacral vertebrae form a solid, tilted wedgeshaped base which transmits vertical spinal loads through the pelvic bones and hip joints to the lower extremities.

Vertebral augmentation methods are minimally invasive and aim to reduce spinal pain in patients with porotic fractures. This is achieved thanks to endovertebral injection of cement that elicits a metameric stabilization effect. Vertebroplasty (VP) and kyphoplasty (KP) are image-guided, percutaneous minimally invasive therapies employed to reduce spinal pain. Each method has a different approach. VP involves metameric injection of cement (polymethylmethacrylate, PMMA) through a needle. KP involves inflation of a small balloon in the vertebral body (VB) to create a void within cancellous bone before the delivery of cement.

Spinal trauma is very frequent injury with different severity and prognosis varying from asymptomatic condition to temporary neurological dysfunction, focal deficit or fatal event. The major causes of spinal trauma are high- and low-energy fall, traffic accident, sport and blunt impact. The radiologist has a role of great responsibility to establish the presence or absence of lesions, to define the characteristics, to assess the prognostic influence and therefore treatment. Imaging has an important role in the management of spinal trauma. The aim of this paper was to describe: incidence and type of vertebral fracture; imaging indication and guidelines for cervical trauma; imaging indication and guidelines for thoracolumbar trauma; multidetector CT indication for trauma spine; MRI indication and protocol for trauma spine.

Spinal trauma is a very frequent injury that differs in severity and prognosis, varying from an asymptomatic condition to temporary neurological dysfunction, a focal deficit, or even a fatal event. Cervical spine injuries are estimated to occur in 2–10% of such cases, with more than 10,000 new cases each year. The major causes of spinal trauma are high- and low-energy falls, traffic accidents, sport-related, and blunt impact. In all such cases, the associated costs of these injuries are high [1]. Clinical evaluation involves different specialties, including emergency medicine, trauma surgery, orthopedics, neurosurgery, and radiology or neuroradiology [2].