OBJECTIVES:Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification.METHODS:Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test.RESULTS:Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters.CONCLUSIONS:Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

Objective:To describe a successful surgical treatment for the challenging severe and fixed chin-on-chest deformity due to isolated neck extensor myopathy (INEM).Background data:INEM is an idiopathic cause of dropped head syndrome (DHS) that results in severe cervicothoracic kyphosis, defined as chin-on-chest deformity. The existing literature on surgical management is limited, with outcomes ranging from poor to excellent. INEM may present to the spinal surgeon for consideration of surgical management.Methods:The authors present a technique that uses a staged posterior and anterior approach combined with osteotomies and corpectomy to correct the severe and fixed deformity. A state of the art anterior and posterior instrumentation system was used.Results:At the three-months follow-up, there was good deformity correction and the patient's satisfaction was high, with no neurological deterioration occurring.Conclusions:The technique illustrated in this study represents a successful option to treat this debilitating deformity. More evidence is needed to set up a definitive algorithm for the management of this condition. Level of evidence IV, Case Report.

Objective: The anatomical study of the vertebrae C7 and T1 of the cervicothoracic junction aimed to evaluate quantitatively, by axial computerized tomography (CT), the linear and angular dimensions of the anatomical laminae of the vertebrae of the cervicothoracic junction C7 and T1 in adults over 18 years. Methods: We retrospectively analyzed 49 CT of the cervical and thoracic spine (C7 and T1) of individuals over 18 years, of both sexes. We also evaluated the length and thickness of the laminae, as well as spinolaminar angle in axial sections of C7 and T1 at the point of least thickness between the inner cortical layers. The variables were correlated with age groups and sex of the individuals. Statistical analysis was performed using the t test and the results were considered significant when p<0.05. Results: After analyzing tomographic measurements of 49 patients, it was found that men had greater laminae thickness than women, both in C7 and T1, with 71% of C7 laminae and 92% of T1 laminae thicker than 5mm, and 97% of C7 laminae and 100% of T1 thicker than 4mm. The mean spinolaminar angle was 56.40 degrees in C7 and 57.31 degrees in T1. Conclusion: This study brings important anatomical information about the cervicothoracic junction C7 and T1 in the Brazilian population, showing that fixation of C7 and T1 with intralaminar screws is anatomically possible.Keywords: Tomography, x-ray computed; Spine; Cervical vertebrae; Thoracic vertebrae. RESUMO objetivo: o estudo anatômico das vértebras da transição cervicotorácica c7 e t1 teve como objetivo avaliar quantitativamente, por tomografia computadorizada axial (tc), as dimensões anatômicas lineares e angulares de lâminas das vértebras da transição

Background: Camptocormia (bent spine syndrome) is an acquired postural disease characterized by forward flexion of the thoracolumbar spine. Dropped head syndrome is characterized by severe weakness of the cervical paraspinal muscles, resulting in gradual sagging of the head and culminating in the classic chin-on-chest deformity.Objective: To report, for the first time, a case of dropped head syndrome and camptocormia in the same patient. Methods and results:A 68-years-old man was diagnosed with base tongue squamous cell carcinoma, surgically removed. He had local recurrence and underwent radiosensitive chemotherapy and radiotherapy (35 fractions of 70Gy). After 12 months, he developed progressive cervical extensor muscle weakness, and a flexible chin-on-chest deformity, treated with passive reduction and C3-T3 fixation. Three months later, camptocormia was diagnosed, and initially treated conservatively. Ten months later, the deformity became rigid, and he was operated with Ponte and pedicle subtraction osteotomies in thoracic and lumbar spine, and C3 to sacrum arthrodesis with instrumentation. The patient resumed professional activities by the third month. Oncological screening showed no tumoral recurrence or distant metastases, after one year from last surgery. Conclusion:This is the first report of dropped head syndrome and camptocormia in the same patient, due radiosensibilizing chemotherapy for a nasopharyngeal carcinoma.