ObjectiveScoliosis surgery involves major blood loss and frequently requires blood transfusion. The cost and risks involved in using allogeneic blood have motivated investigation of methods capable of reducing patients’ bleeding during operations. One of these methods is to use antifibrinolytic drugs, and tranexamic acid is among these. The aim of this study was to assess the use of this drug for controlling bleeding in surgery to treat idiopathic scoliosis.MethodsThis was a retrospective study in which the medical files of 40 patients who underwent thoracolumbar arthrodesis by means of a posterior route were analyzed. Of these cases, 21 used tranexamic acid and were placed in the test group. The others were placed in the control group. The mean volumes of bleeding during and after the operation and the need for blood transfusion were compared between the two groups.ResultsThe group that used tranexamic acid had significantly less bleeding during the operation than the control group. There was no significant difference between the groups regarding postoperative bleeding and the need for blood transfusion.ConclusionsTranexamic acid was effective in reducing bleeding during the operation, as demonstrated in other studies. The correlation between its use and the reduction in the need for blood transfusion is multifactorial and could not be established in this study. We believe that tranexamic acid may be a useful resource and that it deserves greater attention in randomized double-blind prospective series, with proper control over variables that directly influence blood loss.

Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump, shoulder and trunk imbalance and cardiorespiratory complications related to neglected scoliosis. Severe rigid idiopathic scoliosis has <25 % of correction on bending films and major curve over 90°. Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications. Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results. Indications must be tailored by surgeons considering resources, deformity characteristics and patient’s profile. Vertebral resection procedures may have potential neurological and clinical risks and should be one of the last treatment options performed by experienced surgical team. Neuromonitoring is essential during these procedures.

Objective: Adolescent idiopathic scoliosis (AIS) is a spinal deformity that can cause cardiorespiratory dysfunction, contributing to decreases in tolerance for aerobic exercise (TAE) and in functionality. The objective is to assess the TAE and lung capacity of patients who underwent corrective AIS surgery in the pre- (PRE) and postoperative (POST) periods. Methods: Sixty individuals, PRE (n=30, age: 18.5±2.4 years) and POST (n=30, age: 24.5±4.5 years), participated in the study. The forced vital capacity (FVC), the forced expiratory volume in the first second (FEV1) and the FEV1/FVC ratio, as well as the maximum inspiratory and expiratory pressure were verified. The TAE was assessed by the distance travelled in the 6-minute walk test (6MWT), together with blood pressure, heart rate, respiratory rate and peripheral oxygen saturation measured at the beginning and at the end of the test. Results: A mild restrictive pattern in lung function and reduced expiratory muscle strength were observed in both groups, but with no difference between the PRE and POST groups. No difference was found between the PRE (534±67.1 m) and POST (541± 69.5 m) groups for the distance travelled in the 6MWT, though both were below the predicted percentage (82.8±10.0% and 84.8±10.9%, respectively). Hemodynamic and respiratory changes caused by the 6MWT were observed, except for the peripheral oxygen saturation. Conclusion: The results suggest that even after surgical correction, patients with AIS continue to have low TAE. Level of evidence III; Therapeutics Study - Investigation of Treatment Results / Case-control study.

Objective: Analysis of the use of polyetheretherketone (PEEK) cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS) of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.Keywords: Platybasia; Skull base; Atlanto-axial joint. RESUMO

OBJECTIVE: To evaluate the effects of interleukin-6 (IL-6) and erythropoietin (EPO) in experimental acute spinal cord injury (SCI) in rats. METHODS: Using standardized equipment, namely, a New York University (NYU) Impactor, a SCI was produced in 50 Wistar rats using a 10-g weight drop from a 12.5-mm height. The rats were divided into the following 5 groups of 10 animals each: “Group EPO”, treated with erythropoietin only; “Group EPO + IL-6”, treated with both substances; “Group IL-6”, receiving IL-6 administration only; “Group Placebo”, receiving a placebo solution; and “Group Sham”, submitted to an incomplete procedure (only laminectomy, without SCI). All drugs and the placebo solution were administered intraperitoneally for three weeks. The animals were followed up for 42 days. Functional motor recovery was monitored by the Basso, Beattie, and Bresnahan (BBB) scale on days 2, 7, 14, 21, 28, 35 and 42. Motor-evoked potential tests were performed on the 42nd day. Histological analysis was performed after euthanasia. RESULTS: The group receiving EPO exhibited superior functional motor results on the BBB scale. IL-6 administration alone was not superior to the placebo treatment, and the IL-6 combination with EPO yielded worse results than did EPO alone. CONCLUSIONS: Using EPO after acute SCI in rats yielded benefits in functional recovery. The combination of EPO and IL-6 showed benefits, but with inferior results compared to those of isolated EPO; moreover, isolated use of IL-6 resulted in no benefit.