OBJETIVO: O objetivo deste trabalho é estudar, em peças anatômicas; a relação entre os parafusos bicorticais pela técnica de Harms e Melcher e a artéria carótida interna. MÉTODOS: Nossa amostra consiste em cinco cadáveres. RESULTADOS: Os resultados encontrados foram: a média da menor distância entre o orifício de saída do parafuso e a borda medial da artéria carótida interna direita foi de 11,55 mm (com variação de 10,05 a 14,23 mm), enquanto do lado esquerdo a média foi de 7,50 mm (variando de 2,75 a 12,42 mm). A média da menor distância entre a borda posterior da artéria carótida interna e a cortical anterior da massa lateral de C1 à direita foi de 4,24 mm (variando de 2,08 a 7,48 mm), enquanto do lado esquerdo a média obtida foi de 2,98 mm (com variação de 1,83 a 3,83 mm). CONCLUSÃO: Os resultados encontrados estão de acordo com os estudos similares existentes na literatura que enfatizam a necessidade de uma avaliação imaginológica criteriosa da posição anatômica da artéria carótida interna antes da utilização de parafusos bicorticais na massa lateral de C1 por via posterior.

Objective: Evaluate the neurological recovery with a follow-up of 06 (six) months in victims of thoracic and lumbar fractures who underwent spinal decompression in less than 24 hours, between 24 and 48 hours, and more than 48 hours after the trauma. Methods: Data were collected on patients seen at a large public hospital in Belo Horizonte, between 2014 and 2018, who were victims of SCI who presented with neurological deficits at initial care, and the neurological recovery presented. Results: 41 SCI patients were evaluated, whose mean age was 34 years. There was a predominance of thoracic spine fractures (65.9% of the cases) and classified as AO Spine type C (75%). Regarding the time variable, about 68% of the patients were submitted to surgical treatment more than 48 hours after the trauma. It was observed that both the patients submitted to surgical decompression within less than 24 hours, and those operated on more than 48 hours after the trauma showed a slight neurological improvement at the 6-month follow-up. However, no statistical significance was found. It is worth noting that even when analyzing the 41 patients of the study, regardless of the surgical interval, it was impossible to observe a statistically significant neurological improvement at the 6-month follow-up. Conclusion: Our study could not demonstrate significant differences between those patients who operated early in less than 24 hours and those who operated after more than 48 hours. Level of Evidence III; Comparative retrospective study.

RESUMODescreve-se um suporte de cabeça para cirurgia da coluna vertebral, que permite a colocação da cabeça do paciente em alinhamento neutro com o corpo e monitorização da posição de olhos, boca, nariz e tubo orotraqueal, evitando danos decorrentes de mau posicionamento durante a cirurgia. ABSTRACTWe describe a head support for spinal surgery that allows the placement of the patient's head in neutral alignment with the body and monitoring the position of the eyes, mouth, nose and orotracheal tube, preventing damages from poor positioning during surgery. FIGURa 1 -Suporte de cabeça: A) vista lateral, B) vista anterior, C) vista superior.FIGURa 2 -A) Paciente posicionado para cirurgia da coluna torácica, nota-se o alinhamento neutro da cabeça em relação ao eixo do corpo. B) visão de olhos boca e nariz pelo espelho inclinado.

Introduction Incidence of deep surgical site infection (SSI) in spinal fusion varies from 0.3 to 20% according to the international literature. Instrumentation is a well-established risk factor for this complication. Higher morbidity and mortality rates and increased cost of treatment up to fourfold are associated with this complication. Prophylaxis with intravenous antibiotic is consensual, but few studies have evaluated the efficacy of topical agents in the surgical site with prophylactic intent. Irrigation with 3.5% povidone iodine and application of lyophilized vancomycin powder in surgical site have shown benefit, but there are no studies comparing these two methods. A comparative study using topic povidone iodine and vancomycin powder was conducted to reduce this knowledge gap. Patients and Methods The medical records of 439 patients who underwent spinal fusion with instrumentation for traumatic spinal lesion treatment were analyzed. Procedures were consecutively performed at Joao XXIII Hospital (level 1 trauma center). Patients were combined in the following two groups, according to the prophylactic agent used: Povidone iodine (PVPI) historical series ( n = 181), performed from January 2009 to April 2012 and vancomycin (VANCO) cohort study ( n = 239) conducted from May 2012 to December 2013. The surgical site in PVPI group was irrigated with 5% topic iodine solution during 3 minutes, before deep lumbar fascia closure. One gram of vancomycin powder was applied directly to the hardware in VANCO group. Both the groups received 2 g of intravenous cefazolin 30 minutes before surgery and had surgical site exhaustively washed with saline 0.9%, before closure in PVPI group and prior to apply vancomycin powder in VANCO group. Results No difference according to mean age, sex, and lesion level distribution (cervical × thoracolumbar) was observed between the two groups. Number of levels instrumented, coexisting infection, and surgical access were not compared because of a lack of information in medical records, especially those from PVPI series. SSI rate was lower in VANCO group (1.67%) compared with PVPI group (6.62%), this difference was statistically significant (chi-square test with Yates correction = 5.618; p = 0.018; IC 0.069–0.824). Conclusion The application of 1 g vancomycin powder in surgical site was superior to irrigation with 5% povidone iodine in the prophylaxis of deep surgical site infection. These results are valid for patients with spinal trauma who underwent instrumented fusion. Variability in surgical team, difference in the interval admission surgery (patients recently are being operated earlier), and number of levels instrumented are possible bias to this study. The low cost and easy applicability of topic prophylactic measures justify new studies with better statistical power (multicenter and randomized).

Introduction Penetrating spinal cord injury (SCI) by gunshot is relatively common in Brazil, and the literature available is scarce. This study aims to report the experience of a level I trauma center, exploring epidemiological data, clinical features, treatment, and outcomes of victims of gunshot wound to the spine. Material and Methods A retrospective study was performed and included all victims of gunshot wound to the spine at João XXIII Hospital from April 2011 to March 2014 (36-month period). The epidemiological profile, topography of the injury, neurological status, treatment, and in-hospital morbidity and mortality are reported. Statistical analysis was performed on Epi Info 7.0 with Fisher exact test. Correlation with the current literature was conducted. Results A total of 1,088 patients were admitted with blunt and penetrating spinal injury in the 36 months evaluated. A total of 87 cases were gunshot wounds (8% of the 1,088 cases). A majority of the patients were men (93.1%) and young (76.1% are under 30 years). Topographically, 48% affected the cervical spine, followed by 32% in the thoracic spine. The motor status had a dichotomous presentation, with complete neurological deficit (ASIA A, 58.6%) and no neurological deficit (ASIA E, 27.6%). Incomplete neurological deficits represented a small number of cases. The vertebral instability, defined as the presence of acute or delayed deformity, was unusual (three cases, 3.4%). Almost 50% ( n = 44) of the patients had isolated spinal trauma and the remaining presented with associated traumas. Thoracic trauma was the most prevalent, followed by abdominal and facial injury. Only 10 patients (11.5%) required surgical treatment: laminectomy with bullet removal in 7 cases and instrumented fixation in the remaining 3. Infection was present in five cases: four postoperative infections and one in a patient with nonoperative management. Surgical treatment was associated with a 50-fold increase risk of infection ( p = 0.0004). CSF fistula was observed in only one case after surgical treatment and because of the rarity of the event, a statistical analysis could not be performed. Overall mortality was 14.9% (13 patients) and was more common in patients with cervical lesions (10 patients). Associated trauma was present in 70% of the patients who died, but did not acquire statistical significance ( p = 0.1) with mortality risk. Conclusion Gunshot wound to the spine is common in our population, affecting especially young men, associated with neurological deficit in two-thirds of the patients. Instability is a rare event in these patients (3.4%) and surgical treatment was associated with a significant risk of infection.