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      COMPARATIVE STUDY OF THE TYPES OF FIXATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS Translated title: ESTUDO COMPARATIVO DOS TIPOS DE FIXAÇÃO NA ESCOLIOSE IDIOPÁTICA DO ADOLESCENTE Translated title: ESTUDIO COMPARATIVO DE LOS TIPOS DE FIJACIÓN EN LA ESCOLIOSIS IDIOPÁTICA DEL ADOLESCENTE

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          Abstract

          ABSTRACT Objective: To conduct a comparative study of the results obtained in the treatment of adolescent idiopathic scoliosis (AIS) with different types of fixations (traditional, selective and multiple), and to evaluate the correction of angular deformity in the frontal plane by the Cobb and sacral clavicular angle (SCA) methods. Methods: A study of a group of 278 patients with AIS who underwent selective, traditional, and multiple fixation surgeries. Results: Significant corrections of both the Cobb angle and the SCA were observed. Conclusions: In the multiple fixation surgeries there was a 100% correction between the preoperative and postoperative SCA values and a 50% correction in the traditional and selective fixations, a difference considered significant. Regarding the Cobb angle, the three fixations presented corrections between preop and postop with significant differences. Level of evidence III; Retrospective Study.

          Translated abstract

          RESUMO Objetivo: Realizar um estudo comparativo dos resultados obtidos no tratamento da escoliose idiopática do adolescente (EIA) com diferentes tipos de fixação tradicional, seletiva e múltipla e avaliar a correção da deformidade angular no plano frontal pelo método de Cobb e do â ngulo sacro clavicular (ASC). Métodos: Estudo de um grupo de 278 pacientes com EIA operados com fixações seletiva, tradicional e múltipla. Resultados: Observou-se correção significativa tanto do ângulo de Cobb quanto do ASC. Conclusões: Nas cirurgias com fixação múltipla constatou-se, entre pré-operatório (pré-op) e pós-operatório (pós-op), uma correção de 100% do ASC, e com as fixações tradicional e seletiva a correção foi de 50%, diferença que se considerou significativa. Com relação ao ângulo de Cobb as três fixações resultaram em correções entre o pré-op e o pós-op com diferença considerada significativa. Nível de evidência III; Estudo retrospectivo.

          Translated abstract

          RESUMEN Objetivo: Realizar un estudio comparativo de los resultados obtenidos en el tratamiento de la escoliosis idiopática del adolescente (EIA) con diferentes tipos de fijación: tradicional, selectiva y múltiple, y evaluar la corrección de la deformidad angular en el plano frontal mediante el método de Cobb y del ángulo sacro clavicular (ASC). Métodos: Estudio de un grupo de 278 pacientes con EIA operados con fijaciones selectiva, tradicional y múltiple. Resultados: Se observó corrección significativa tanto del ángulo de Cobb como del ASC. Conclusiones: En las cirugías con fijación múltiple se constató, entre preoperatorio (pre-op) y postoperatorio (post-op), una corrección de 100% del ASC, y con las fijaciones tradicional y selectiva la corrección fue de 50%, diferencia que se consideró significativa. Con relación al ángulo de Cobb las tres fijaciones resultaron en correcciones entre pre-op y post-op con diferencia considerada significativa. Nivel de evidencia III; Estudio Retrospectivo.

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          Most cited references27

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          Outlines for the study of scoliosis

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            Thoracic pedicle screw fixation in spinal deformities: are they really safe?

            A retrospective study. To determine the safety of pedicle screw fixation in thoracic deformity correction. Pedicle screw fixation enables enhanced correction of spinal deformities. However, the technique is still not widely applied for thoracic deformities for fear of neurologic complications. A total of 462 patients subjected to thoracic pedicle screw fixation for spinal deformities were analyzed after a minimum follow-up of 2 years. Etiologic diagnoses were idiopathic scoliosis in 330, congenital kyphoscoliosis in 68, kyphosis in 50, and others in 14. They were reviewed using the medical records and preoperative, intraoperative, and postoperative roentgenograms. Computed tomography was performed when screw position was questionable. A total of 4604 thoracic pedicle screws were inserted (10.1 screws/patient). There were 67 screw malpositions (1.5%) in 48 patients (10.4%). The malpositions were inferior in 33, lateral in 18, superior in 12, and medial in 4. Screw-related neurologic complications occurred in four patients (0.8%); these comprised a transient paraparesis and three dural tears. Other complications comprised 11 intraoperative pedicle fractures, 35 screw loosenings, 9 postoperative infections, and 1 pneumothorax. There were no significant screw-related neurologic or visceral complications that adversely affected the long-term result. The deformity correction was 69.9% for idiopathic scoliosis and 60.7% for congenital scoliosis. The sagittal plane deformity correction was 47 degrees for kyphosis. Thoracic pedicle screw fixation is a reliable method of treating spinal deformities, with an excellent deformity correction and a high margin of safety.
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              Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions.

              The facet joint is a crucial anatomic region of the spine owing to its biomechanical role in facilitating articulation of the vertebrae of the spinal column. It is a diarthrodial joint with opposing articular cartilage surfaces that provide a low friction environment and a ligamentous capsule that encloses the joint space. Together with the disc, the bilateral facet joints transfer loads and guide and constrain motions in the spine due to their geometry and mechanical function. Although a great deal of research has focused on defining the biomechanics of the spine and the form and function of the disc, the facet joint has only recently become the focus of experimental, computational and clinical studies. This mechanical behavior ensures the normal health and function of the spine during physiologic loading but can also lead to its dysfunction when the tissues of the facet joint are altered either by injury, degeneration or as a result of surgical modification of the spine. The anatomical, biomechanical and physiological characteristics of the facet joints in the cervical and lumbar spines have become the focus of increased attention recently with the advent of surgical procedures of the spine, such as disc repair and replacement, which may impact facet responses. Accordingly, this review summarizes the relevant anatomy and biomechanics of the facet joint and the individual tissues that comprise it. In order to better understand the physiological implications of tissue loading in all conditions, a review of mechanotransduction pathways in the cartilage, ligament and bone is also presented ranging from the tissue-level scale to cellular modifications. With this context, experimental studies are summarized as they relate to the most common modifications that alter the biomechanics and health of the spine-injury and degeneration. In addition, many computational and finite element models have been developed that enable more-detailed and specific investigations of the facet joint and its tissues than are provided by experimental approaches and also that expand their utility for the field of biomechanics. These are also reviewed to provide a more complete summary of the current knowledge of facet joint mechanics. Overall, the goal of this review is to present a comprehensive review of the breadth and depth of knowledge regarding the mechanical and adaptive responses of the facet joint and its tissues across a variety of relevant size scales.
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                Author and article information

                Journal
                coluna
                Coluna/Columna
                Coluna/Columna
                Sociedade Brasileira de Coluna (São Paulo, SP, Brazil )
                1808-1851
                2177-014X
                March 2021
                : 20
                : 1
                : 14-19
                Affiliations
                [1] Belo Horizonte MG orgnameSanta Casa de Belo Horizonte orgdiv1Spine Group Brazil
                [4] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais Brazil
                [3] São Paulo SP orgnameSociedade Brasileira de Coluna Brazil
                [2] Belo Horizonte MG orgnameInstituto da Coluna Vertebral de Belo Horizonte Brazil
                Article
                S1808-18512021000100014 S1808-1851(21)02000100014
                10.1590/s1808-185120212001232530
                6069a8ad-3052-43a8-bcc9-d56909da2a18

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 25 December 2019
                : 28 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 6
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Original Articles

                Escoliosis,Global Coronal,Coronal Malalignment,Deformidade da Coluna,Escoliose,Desalinhamento Coronal,Coronal Global,Ângulo de Deformidade,Deformidad de la Columna,Desalineación Coronal,Coronal global,Scoliosis,Spine Deformity,Ángulo de Deformación,Deformity Angle

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