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Study design: Systematic Review and Meta-analysis. Objective: To compare the complication rates associated with anterior and posterior approaches for the surgical treatment of unstable hangman's fractures. Methods: A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting complications of anterior versus posterior approaches for the treatment of unstable hangman's fractures. Results: The search yielded 1163 papers from which 5 studies were fully included. One hundred fifteen (115) patients were operated on using an anterior approach versus 65 through a posterior approach. The average complication rates for the anterior and posterior approaches were 26.1 % and 13.8 %, respectively. No complications following the anterior approach required pharmacological or surgical intervention (Clavien-Dindo, Grade 1), while 88.9 % of complications following the posterior approach did (Clavien-Dindo, Grade 2). Conclusion: No significant differences in the complication rates were found when comparing anterior versus posterior surgery for treating a C2 traumatic spondylolisthesis. However, most of the complications presented in the posterior surgery group were more severe.

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Scoliosis is a pathology with multiple etiologies that leads to aesthetic changes, increased morbidity and, especially, psychological damage. Objective: This work aims to compare two mindset types (fixed and growth) and assess levels of quality of life in individuals with scoliosis. Methods: Two questionnaires, Scoliosis Research Society-30 (SRS-30) and Early-Onset Scoliosis-24 Questionnaire (EOSQ-24), associated with the "Health Mindset Scale," were used. We applied the SRS-30 to patients who were independent or whose diagnosis of spinal deformity occurred after the age of 10 years. For patients diagnosed before the age of 10 or who presented dependence due to cognitive impairment, caregivers were subjected to the "Health Mindset Scale" and EOSQ-24 questionnaires. Results: The sample consisted of 35 patients aged from 4 to 46 years, the majority aged from 15 to 18 years old (42.9%), female (71.4%), and with neuromuscular scoliosis (28.6%). The only significant result (p = 0.060) was the increase in pain/discomfort scores in the EOSQ-24 for a patient with a growth mindset. Lastly, there was no statistical difference between groups, however, in patients with a growth mindset, there was a tendency (p = 0.060) to have a higher pain/discomfort score, assessed via the EOSQ-24 score, reported by the caregiver. Level of Evidence III, Retrospective Comparative Study.

A escoliose é uma patologia com múltiplas etiologias e que acarreta alterações estéticas, aumento de morbidade e principalmente danos psicológicos. Objetivo: Comparar dois tipos de mindset (fixo e construtivo) e o nível de qualidade de vida. Métodos: Foram utilizados dois questionários, o Scoliosis Research Society-30 (SRS-30) e o Early-Onset Scoliosis-24 Questionnaire (EOSQ-24), associados à escala Health Mindset Scale. Aplicamos o SRS-30 em pacientes independentes ou cujo diagnóstico de deformidade na coluna ocorreu após os 10 anos. Já no caso de pacientes com diagnóstico antes dos 10 anos ou que apresentassem dependência devido a dificuldades cognitivas, os cuidadores foram submetidos à Health Mindset Scale e ao EOSQ-24. Resultados: A amostra foi composta por 35 pacientes com idades entre 4 e 46 anos, sendo a maioria entre 15 e 18 anos (42,9%), do sexo feminino (71,4%) e com escoliose do tipo neuromuscular (28,6%). O único resultado com significância (p = 0,060) foi o aumento dos escores de dor/desconforto nos questionários EOSQ-24 em paciente com mindset de crescimento. Por fim, não houve diferença estatisticamente significante entre os grupos, porém, em pacientes com mindset construtivo, houve tendência (p = 0,060) de maior escore de dor/desconforto avaliado por meio do EOSQ-24 e referido pelo cuidador. Nível de Evidência III, Estudo Retrospectivo Comparativo.

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BACKGROUND: Assessing the quality of life (QOL) of children with early onset scoliosis (EOS) has been discussed recently. Therefore, the study aimed to apply and correlate the 24-item Early Onset Scoliosis Questionnaire (EOSQ-24) with the 50-item Childhood Health Questionnaire (CHQ-PF50) to find predictive factors impacting QOL. METHODS: Cross-sectional study involving a population of caregivers of patients with EOS. The sample consisted of 72 patients. Two research assistants applied the Portuguese version of the EOSQ-24 and CHQ-PF50 in 3 treatment centers. The EOSQ-24 assesses the subjective response of children with EOS from the parent's point of view. The CHQ is a self-administered questionnaire or parental proxy assessment of the psychological and social status of children aged 5 to 18 years. RESULTS: Of 72 patients, 41 (56.9%) were females, mean age of 11.9 ± 4.2 years. The most common scoliosis was of neuromuscular origin (32%). The CHQ-PF50 showed that family-related items had significant scores. The most affected subcategory was physical function (45.5), and the least affected was mental health (90.8). Thus, the CHQ-PF50 PhS summary index was 27, and the CHQ-PF50 PsS was 71.7. Moreover, the critical categories for the EOSQ-24 questionnaire were daily life and physical function (45.1 and 47.8, respectively), and the least affected categories were transfer and pulmonary function (70.8 and 68.9, respectively). Four subcategories showed a strong correlation between both questionnaires: general health (r = 0.749, P < 0.001), physical function (r = 0.645, P < 0.001), bodily pain (r = 0.714, P < 0.001), and mental health (r = 0.424, P < 0.001). Using CHQ-PF50 as a dependent variable in multiple regression analysis (P = 0.028), the only variable affecting the scores was syndromic scoliosis (P = 0.019; 95% CI -27.4 to -2.5). CONCLUSION: A strong correlation between both questionnaires was seen for general health, physical function, bodily pain, and mental health. Syndromic scoliosis was a predictor of worse QOL according to the CHQ-PF50.

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Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. Therefore, it helps the surgeon in the appropriate management of cases. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. KEY POINTS: Plain radiographs remain the main modality for baseline, dynamic evaluation, and follow-ups. CT is the method of choice for assessing bone fusion, hardware integrity and loosening. MRI should be used to evaluate bone marrow and soft tissue complications. Radiologists should be familiar with most performed spinal procedures in order to differentiate normal and abnormal. CRITICAL RELEVANCE STATEMENT: This article discusses the main surgical procedures involved in the spine, which can be didactically divided into decompression, stabilization-fusion, and miscellaneous, as well as the role of diagnostic imaging methods and their main findings in this context.

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ABSTRACT: Objective: To carry out registration of patients with scoliosis under 18 years old, followed in a quarternary hospital of high complexity, who need surgical treatment, aiming to identify the reasons for the delay in treatment. Methods: Data collection was carried out in person and by spontaneous demand at the spinal orthopedic specialty outpatient clinic in a tertiary hospital of high complexity from January 2021 to December 2022. The results were compiled in the networked database (Red Cap®). Result: 59 patients were evaluated, 45 female (77.9%) and 14 male (22.1%), with a mean age of 13.7 years. Etiology: 30 idiopathic (50.8%), eight syndromic (13.5%), 11 neuromuscular (18.6%), and ten congenital (16.9%). Of the total, 46 (77.9%) were awaiting surgery and 13 (22.1%) were undergoing conservative treatment. The main causes of treatment delay: unavailability of intraoperative neurophysiological monitoring (19 - 41.3%); unavailability of specific surgical material (16 - 34.8%); difficulty of referral to our institution (6 - 13.1%); loss to follow-up (3 - 6.5%) and limitation in casting making (2 - 4.3%). The mean time between diagnosis and the first consultation is 17.25 months (0 - 140). The average surgical wait until December/2022 was 38.4 months (1 - 156). Conclusion: There is a lack of assistance in the steps of monitoring and treatment in the public health system, from directing the patient with scoliosis to the specialized center to performing the surgical procedure, mainly due to limitations in the use of intraoperative neurophysiological monitoring and the unavailability of specific materials to perform highly complex surgeries. Therapeutic Studies - Investigating the Results of Treatment.

RESUMO: Objetivo: Descrever a epidemiologia de pacientes, menores de 18 anos, com escoliose que aguardam cirurgia em hospital quaternário de alta complexidade e observar os motivos que acarretam atrasos no tratamento. Métodos: Coleta de dados presencial e espontaneamente no ambulatório de ortopedia da coluna vertebral num hospital de alta complexidade, de janeiro de 2021 a dezembro de 2022. Os resultados foram compilados no banco de dados (Red Cap®). Resultados: Foram avaliados 59 pacientes, 45 mulheres (77,9%) e 14 homens (22,1%), com média etária de 13,7 anos. Etiologia: 30 idiopáticas (50,8%), 8 sindrômicas (13,5%), 11 neuromusculares (18,6%) e 10 congênitas (16,9%). Do total, 46 (77,9%) aguardam cirurgia e 13 (22,1%) estavam em tratamento conservador. As principais causas de atraso do tratamento cirúrgico foram: indisponibilidade de monitoração neurofisiológica intraoperatória (19 - 41,3%); indisponibilidade de implantes para escoliose (16 - 34,8%); dificuldade no referenciamento para instituição (6 - 13,1%); perda de seguimento (3 - 6,5%) e limitação na confecção de colete (2 - 4,3%). Tempo médio entre diagnóstico e primeiro atendimento de 17,25 meses (0 - 140). A média de espera cirúrgica até dezembro/2022 era 38,4 meses (1 - 156). Conclusão: Há carência assistencial nas etapas do acompanhamento e no tratamento no Sistema Único de Saúde, desde o direcionamento do paciente com escoliose ao centro especializado até a realização do procedimento cirúrgico, sobretudo devido à limitação na utilização de monitoração neurofisiológica intraoperatória e indisponibilidade de materiais específicos para realização de cirurgias de alta complexidade. Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN: Objetivo: Describir la epidemiología de los pacientes menores de 18 años con escoliosis en un hospital cuaternario de alta complejidad y observar los motivos que llevan a retrasos en el tratamiento. Métodos: Recolección de datos presencial y espontánea en el ambulatorio de ortopedia de columna, de enero 2021 a diciembre 2022. Los resultados fueron recopilados en la base de datos (Red Cap®). Resultado: Se evaluaron 59 pacientes, 45 mujeres (77,9%) y 14 hombres (22,1%), con una edad promedio de 13,7 años. Etiología: 30 idiopáticas (50,8%), 8 sindrómicas (13,5%), 11 neuromusculares (18,6%) y 10 congénitas (16,9%). Del total, 46 (77,9%) estaban pendientes de cirugía y 13 (22,1%) estaban en tratamiento conservador. Las principales causas de retraso en el tratamiento quirúrgico fueron: indisponibilidad de monitorización neurofisiológica intraoperatoria (19 - 41,3%); indisponibilidad de implantes para escoliosis (16 - 34,8%); dificultad para hacer referencia a la institución (6 - 13,1%); pérdida de seguimiento (3 - 6,5%) y limitación en la confección de un chaleco (2 - 4,3%). Tiempo promedio diagnóstico y primera atención de 17,25 meses (0 - 140). Espera quirúrgica promedio: hasta diciembre/2022 fue de 38,4 meses (1 - 156). Conclusión: Existe falta de asistencia en las etapas de seguimiento y tratamiento en el Sistema Único de Salud, desde la dirección del paciente con escoliosis al centro especializado hasta la realización del procedimiento quirúrgico, debido principalmente a la limitación en el uso de instrumentos neurofisiológicos intraoperatorios. Estudios terapéuticos - Investigación de los resultados del tratamiento.

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ABSTRACT Scoliosis is a pathology with multiple etiologies that leads to aesthetic changes, increased morbidity and, especially, psychological damage. Objective: This work aims to compare two mindset types (fixed and growth) and assess levels of quality of life in individuals with scoliosis. Methods: Two questionnaires, Scoliosis Research Society-30 (SRS-30) and Early-Onset Scoliosis-24 Questionnaire (EOSQ-24), associated with the "Health Mindset Scale," were used. We applied the SRS-30 to patients who were independent or whose diagnosis of spinal deformity occurred after the age of 10 years. For patients diagnosed before the age of 10 or who presented dependence due to cognitive impairment, caregivers were subjected to the "Health Mindset Scale" and EOSQ-24 questionnaires. Results: The sample consisted of 35 patients aged from 4 to 46 years, the majority aged from 15 to 18 years old (42.9%), female (71.4%), and with neuromuscular scoliosis (28.6%). The only significant result (p = 0.060) was the increase in pain/discomfort scores in the EOSQ-24 for a patient with a growth mindset. Lastly, there was no statistical difference between groups, however, in patients with a growth mindset, there was a tendency (p = 0.060) to have a higher pain/discomfort score, assessed via the EOSQ-24 score, reported by the caregiver. Level of Evidence III, Retrospective Comparative Study.

RESUMO A escoliose é uma patologia com múltiplas etiologias e que acarreta alterações estéticas, aumento de morbidade e principalmente danos psicológicos. Objetivo: Comparar dois tipos de mindset (fixo e construtivo) e o nível de qualidade de vida. Métodos: Foram utilizados dois questionários, o Scoliosis Research Society-30 (SRS-30) e o Early-Onset Scoliosis-24 Questionnaire (EOSQ-24), associados à escala Health Mindset Scale. Aplicamos o SRS-30 em pacientes independentes ou cujo diagnóstico de deformidade na coluna ocorreu após os 10 anos. Já no caso de pacientes com diagnóstico antes dos 10 anos ou que apresentassem dependência devido a dificuldades cognitivas, os cuidadores foram submetidos à Health Mindset Scale e ao EOSQ-24. Resultados: A amostra foi composta por 35 pacientes com idades entre 4 e 46 anos, sendo a maioria entre 15 e 18 anos (42,9%), do sexo feminino (71,4%) e com escoliose do tipo neuromuscular (28,6%). O único resultado com significância (p = 0,060) foi o aumento dos escores de dor/desconforto nos questionários EOSQ-24 em paciente com mindset de crescimento. Por fim, não houve diferença estatisticamente significante entre os grupos, porém, em pacientes com mindset construtivo, houve tendência (p = 0,060) de maior escore de dor/desconforto avaliado por meio do EOSQ-24 e referido pelo cuidador. Nível de Evidência III, Estudo Retrospectivo Comparativo.

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OBJECTIVE: To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. METHODS: A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. RESULTS: Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. CONCLUSION: A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.

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ABSTRACT Objective: The objective was to conduct an analytical epidemiological study to understand the profile, treatment, and outcome of patients with spinal tumors in a Brazilian Quaternary Hospital of the SUS. Methods: A retrospective cohort analysis of data from the last five years was performed. It was described qualitative characteristics evaluated by absolute and relative frequencies and quantitative characteristics by sintetized measures. Associations between characteristics were verified using chi-square tests or exact tests. Results: 92 patients met the eligibility criteria. The mean age was 56.1 years (±14.7), with 48 men (52.2%) and 44 women (47.8%). The types of tumors organized in the three proposed groups had 19 multiple myelomas (20.7%), 62 metastases (67.3%), and 11 other tumors (12%). The neurological status measured through the ASIA score was A: 5.4%, B: 22.8%, C: 26.1%, D: 35.9%, E: 9.8%. Karnofsky was prevalent in the 50-70 range with 65.2%. The total hospitalization period had a mean of 22.8±18 days, preoperatively 11.9±9.2 days, and postoperatively 10.9±14 days. Karnofsky presented lower values according to the worst ASIA (p < 0.001). A total of 12 patients (13%) died during hospitalization. The total and postoperative length of stay was longer in patients who died (p = 0.002 and p < 0.001). Conclusions: This study provides epidemiological data that allow an understanding of the profile of patients with spinal tumors in the Brazilian Public Health System. The severity of the patients is higher when compared to most of the series cases in the literature. The patients with longer hospitalization stay died. Level of evidence IV; Case series.

RESUMO Objetivo: Realizar um estudo epidemiológico analítico a fim de compreender o perfil, tratamento e desfecho dos pacientes com tumor na coluna operados em hospital quaternário brasileiro do SUS. Métodos: Foi realizado uma análise por estudo de coorte retrospectivo com os dados do prontuário correspondentes aos últimos 5 anos. Foram descritas as características qualitativas avaliadas por frequências absoluta e relativa, além das características quantitativas por medidas sumárias. Foram verificadas associações entre características com uso de testes qui-quadrado ou testes exatos. Resultados: 92 pacientes preencheram critérios de elegibilidade. A média etária foi de 56,1 anos (±14,7) com 48 homens (52,2%) e 44 mulheres (47,8%). Os tipos de tumores organizados nos três grupos propostos apresentaram 19 mielomas múltiplos (20,7%), 62 metástases (67,3%) e 11 outros tumores (12%). O status neurológico aferido através do escore ASIA teve distribuição de A: 5,4%, B: 22,8%, C: 26,1%, D: 35,9%, E: 9,8%. O Karnofsky foi prevalente na faixa de 50-70 com 65,2%. O período de internação total obteve média de 22,8±18 dias, pré-operatório 11,9±9,2 dias e pós-operatório 10,9±14 dias. O Karnofsky apresentou menores valores conforme pior ASIA (p < 0,001). Um total de 12 pacientes (13%) faleceram durante a internação. O tempo total de internação e o tempo de internação pós-operatório foram maiores nos pacientes que faleceram (p = 0,002 e p < 0,001). Conclusões: Este estudo traz dados epidemiológicos que permitem compreensão do perfil do paciente com tumor da coluna vertebral operado no Sistema Público de Saúde Brasileiro. A gravidade dos pacientes é maior quando comparada a maioria das séries de casos da literatura. Pacientes com maior tempo de internação foram a óbito. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: Realizar un estudio epidemiológico analítico para comprender el perfil, el tratamiento y la evolución de los pacientes con tumores en la columna vertebral operados en un Hospital brasileño cuaternario del SUS. Métodos: Se realizó un análisis de cohorte retrospectivo de los datos de los últimos 5 años. Fueron descriptas características cualitativas evaluadas por frecuencias absolutas y relativas y características cuantitativas por medidas sumarias. Las asociaciones entre las características se verificaron mediante pruebas de chi-cuadrado o pruebas exactas. Resultados: 92 pacientes cumplieron con los criterios de elegibilidad. La edad promedio fue de 56,1 años (±14,7) con 48 hombres (52,2%) y 44 mujeres (47,8%). Los tipos de tumores organizados en los tres grupos propuestos fueron: 19 mielomas múltiples (20,7%), 62 metástasis (67,3%) y otros tumores 11 (12%). El estado neurológico medido a través del puntaje ASIA tuvo la siguiente distribución A: 5,4%, B: 22,8%, C: 26,1%, D: 35,9%, E: 9,8%. Karnofsky prevaleció en el rango 50-70 con 65,2%. El tiempo total de hospitalización tuvo un promedio de 22,8±18 días, preoperatorio 11,9±9,2 días y postoperatorio 10,9±14 días. Karnofsky presentó valores más bajos según el peor ASIA (p < 0,001). Un total de 12 pacientes (13%) fallecieron durante la hospitalización. La duración total de la estadía y la duración de la estancia postoperatoria fueron más largas en los pacientes que fallecieron (p = 0,002 y p < 0,001). Conclusiones: Este estudio proporciona datos epidemiológicos que permiten comprender el perfil de los pacientes con tumores de columna operados en el Sistema Público de Salud brasileño. La gravedad de los pacientes es mayor en comparación con la mayoría de las series de casos en la literatura. Los pacientes con estancias hospitalarias más prolongadas fallecieron. Nivel de evidencia IV; Serie de casos.

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ABSTRACT Objective: To relate the radiographic fusion rate and the surgical results in patients undergoing posterolateral arthrodesis with instrumentation of the lumbar spine for the treatment of degenerative disorders. Method: A descriptive, retrospective, case series, observational study, based on medical records and imaging studies of 76 patients over 18 years of age (39 to 88 years) who underwent posterolateral lumbar arthrodesis. Data related to the presence of comorbidities were compiled and clinical outcomes were measured using specific questionnaires collected pre-surgical and 1 year after surgery. Fusion quality, as described by Christensen, was assessed from radiographic images by two examiners. The VAS, EQ-5D and Roland Morris questionnaires were used preoperatively and 1 year after surgery to assess pain, quality of life and function, respectively. Result: It was observed improvement in pain, function and quality of life after 1 year post-surgical. Pain, measured by VAS, had a reduction from 7.92 to 3.16 (p-value <0.001), the function evaluated by the Roland Morris score, also showed a reduction from 14.90 to 7.06 (p-value <0.001) . Culminating with the improvement in quality of life, measured by the EQ-5D, where there was a median increase in the score from 0.5672 to 0.7002 (p-value = 0.002). Conclusion: The absence of radiographic fusion has no direct correlation with worse results in clinical outcomes at 01 year after surgery. Most patients showed clinical improvement with no statistical difference in relation to cases in which bone fusion was obtained. Level of evidence IV; retrospective observation.

RESUMO: Objetivo: Relacionar a taxa de fusão radiográfica e os resultados cirúrgicos nos pacientes submetidos a artrodese posterolateral com instrumentação da coluna lombar para tratamento de afecções degenerativas. Método: Estudo observacional retrospectivo descritivo, tipo série de casos, com base em prontuários médicos e exames de imagem de 76 pacientes maiores de 18 anos (39 a 88 anos), submetidos a artrodese lombar posterolateral. Dados relacionados a presença de comorbidades foram compilados e os desfechos clínicos mensurados por meio de questionários específicos coletados no pré-cirúrgico e após um ano pós-cirúrgico. A qualidade da fusão, conforme descrita por Christensen, foi avaliada a partir de imagens radiográficas por dois examinadores. Os questionários de EVA, EQ-5D e Roland Morris foram utilizados no pré-cirúrgico e um ano pós-cirúrgico para avaliar dor, qualidade de vida e função, respectivamente. Resultado: Observou se melhora na dor, função e qualidade de vida após um ano pós-cirúrgico. A dor, mensurada pelo EVA teve uma redução de 7,92 para 3,16 (p-valor <0,001), a função avaliada pelo escore Roland Morris, também apresentou redução de 14,90 para 7,06 (p-valor <0,001). Culminando com a melhora na qualidade de vida, mensurada pelo EQ-5D, onde observou-se um aumento mediano escore de 0,5672 para 0,7002 (p-valor = 0,002). Conclusão: A ausência de fusão radiográfica não tem correlação direta com piores resultados nos desfechos clínicos em um ano de pós-cirúrgico. Maioritariamente, os pacientes apresentaram melhora clínica sem diferença estatística em relação aos casos em que foi obtido fusão óssea. Nível de evidência IV; Observacional retrospectivo.

RESUMEN: Objetivo: Relacionar ei índice de fusión radiográfica y los resultados quirúrgicos en pacientes sometidos a artrodesis posterolateral con instrumentación de columna lumbar para el tratamiento de trastornos degenerativos. Método: Estudio descriptivo, retrospectivo, serie de casos, observacional, basado en historias clínicas y estudios de imagen de 76 pacientes may ores de 18 anos (39 a 88 anos) a quienes se les realizó artrodesis lumbar posterolateral. Se recopilaron datos relacionados con la presencia de comorbilidades y se midieron los resultados clínicos mediante cuestionarios específicos recogidos antes de la cirugía y al año de la cirugía. La calidad de la fusión, según lo descrito por Christensen, fue evaluada a partir de imágenes radiográficas por dos examinadores. Los cuestionarios VAS, EQ-5D y Roland Morris se utilizaron en el preoperatorio y 1 año después de la cirugía para evaluar el dolor, la calidad de vida y la función, respectivamente. Resultado: Se observó mejoría en el dolor, función y calidad de vida después de 1 año posquirúrgico. El dolor, medido por EVA, tuvo una reducción de 7,92 a 3,16 (p-valor <0,001), la función evaluada por el puntaje de Roland Morris, también mostró una reducción de 14,90 a 7,06 (p-valor <0,001). Culminando con la mejora en la calidad de vida, medida por el EQ-5D, donde hubo un aumento mediano en el puntaje de 0,5672 a 0,7002 (p-valor = 0,002). Conclusión: La ausencia de fusión radiográfica no tiene correlación directa con peores resultados en los resultados clínicos al 01 año de la cirugía. La mayoría de los pacientes presentaron mejoría clínica sin diferencia estadística en relación a los casos en los que se obtuvo fusión ósea. Nivel de evidencia IV; observación retrospectiva.

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ABSTRACT Objective: To evaluateboth the correlation between lumbar accommodation and pelvic parametersin different types of lordosis and the participation of different lumbar segments in the accommodation of lordosis in the standing and sitting positions. Methods: A retrospective study analyzingpatient images in standing and sitting positions. Correlations were conducted among the measured data: Cobb angle of the lumbar lordosis (LL,type of lordosis, pelvic incidence (PI),sacral slope (SS),pelvic tilt (PT), and the angulation of the L1-L2/L2-L3/L3-L4/L4-L5/L5-S1 segments. Results: Fortypatients were included, 20 men and 20 women. The mean age was 60.8 (±11.5). Of these patients, 10.3% were classified as Roussouly type 2, 35.9% as type 3, 25.6% as type 3A, and 28.2%as type 4.There was a weakcorrelation between LL and PT, however, an inverse correlation between the two (r=-0.183 and p=0.264) was observed. SS hadthe strongest correlation with LL (r> 0.75). Only the correlation between LL and PI was stronger when sitting than standing (p=0.014). The pelvic parameters and angulations of the segments and lumbar discs when standing and sitting were different (p<0.05). In both positions, there was a difference in the contribution of the segments to the LL (p<0.001). On average, the differences in LL between standing and sitting wereequal among theRoussouly classifications (p=0.332). Conclusions: There was a correlation between the LL and the pelvic parameters, being more evident with the SS than with the other parameters. There was no difference in the accommodation of the LL in the different Roussouly types either standing or sitting. Regardless of the position,the L4-S1 segments were predominant in the composition of LL. Level of evidence IV; Retrospective.

RESUMO Objetivo: Avaliar a correlação entre a acomodação lombar eos parâmetros pélvicosem diferentes tipos de lordose coma participação dos seguimentos lombares na acomodação da lordose nas posições ortostáticae sentada. Métodos: Estudo retrospectivo de análise de imagens de pacientes em ortostasia e sentados. Foi realizada correlação entre os dados mensurados: ângulo de Cobb da lordose lombar (LL); tipo de lordose; incidência pélvica (IP); inclinação sacral (IS); versão pélvica (VP) e angulação dos seguimentos L1-L2, L2-L3/L3-L4/L4-L5, L5-S1. Resultados: Foram incluídos 40 pacientes, 20 homens e 20 mulheres. Média de idade 60,8 anos (±11,5). Desses pacientes, 10,3% foram classificados como tipo 2 de Roussouly, 35,9% como tipo 3, 25,6% como tipo 3A e 28,2% como tipo 4. Observou-se baixa correlação entreLL eVP que, no entanto, apresentou correlação inversa entre as duas (r=-0,183 e p=0,264). A IS apresentou maior correlação com a LL (r>0,75). Apenas a correlação da LL com IPfoi maior na posição sentadado que na ortostática (p=0,014). Os parâmetros pélvicos, as angulações dos seguimentos e discos lombares em ortostasia e sentado apresentaram diferença entre si (p<0,05). Em ambas as posições houve diferença na contribuição dos seguimentos na LL (p<0,001). As diferenças da LL entre ortostasia e sentado foram em média iguais entre as classificações de Roussouly (p=0,332). Conclusões: Houve correlação da LL com os parâmetros pélvicos, sendo mais evidente com a IS do que com os demais parâmetros. Não houve diferença na acomodação da LL nos diferentes tipos de Roussouly em ortostasia ou sentado. Independentementeda posição, L4-S1 são predominantes na composição da LL. Nível de Evidência IV; Estudo Retrospectivo.

RESUMEN Objetivo: Evaluar la correlación entre la acomodación lumbar y los parámetros pélvicos en diferentes tipos de lordosis con la participación de los segmentos lumbares en la acomodación de la lordosis en posición ortostática y sentada. Métodos: Estudio retrospectivo de análisis de imágenes de pacientes en ortostasis y sentados. Se realizó la correlación entre los datos medidos: ángulo de Cobb de la lordosis lumbar (LL); tipo de lordosis; incidencia pélvica (IP); pendiente sacra (PS); versión pélvica (VP) y angulación de los segmentos L1-L2/L2-L3/L3-L4/L4-L5/L5-S1. Resultados: Se incluyeron 40 pacientes, 20 hombres y 20 mujeres. La edad media fue de 60,8 (±11,5). De estos pacientes, el 10,3% fueron clasificados como tipo 2 de Roussouly, el 35,9% tipo 3, el 25,6% tipo 3A y el 28,2% como tipo 4. Se observó baja correlación de LL con VP, que, sin embargo,presentó una correlación inversa entre ambas (r= -0,183 y p=0,264). La PSpresentó la mayor correlación con la LL (r> 0,75). Solo la correlación de la LL con IP fue mayor en la posición sentada que en la ortostática (p=0,014). Los parámetros pélvicos, las angulaciones de los segmentos y los discos lumbares en ortostasis y posición sentadapresentaron una diferenciaentre ellos (p<0,05). En ambas posiciones, hubo una diferencia en la contribución de los segmentos a la LL (p<0,001). Las diferencias de LL entre ortostasis y posición sentada fueron, en promedio, iguales entre las clasificaciones de Roussouly (p=0,332). Conclusiones: Hubo una correlación entre la LL y los parámetros pélvicos, siendo más evidente con la PS que con los demás parámetros. No hubo diferencia en la acomodación de la LL en los diferentes tipos de Roussouly en ortostasis o posición sentada. Independientemente de la posición, L4-S1 predominan en la composición de la LL. Nivel de Evidencia IV; Estudio Retrospectivo.

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