Objective To evaluate coronal alignment in patients with idiopathic adolescent scoliosis with structured lumbar curves submitted to surgical treatment by comparing coronal alignment in the group fusion up to L3 and the group fusion up to L4. Methods Retrospective cohort study. We evaluated patients submitted to surgical treatment with arthrodesis of the lumbar curve with high density of screws with at least 6 months of follow-up. Radiographically, coronal alignment, shoulder height and functional outcome were analyzed through SRS30 questionnaire. Results A total of 25 patients were analyzed, of which 23 were female and 2 were male, with a mean age of 15.2 years (12 to 29 years) at the time of surgery. The patients were divided into two groups. Group A, n = 15: Distal level of fusion in L3 and Group B, n = 10: distal level of fusion in L4. There was no statistically significant difference between Groups A and B when compared to coronal alignment (balanced vs. unbalanced). However, when compared with the coronal alignment (CA) values, lower values of CA were observed in Group A, with statistical significance. No difference was observed between Groups A and B with respect to the SRS30 questionnaire. Conclusions Patients with idiopathic adolescent scoliosis submitted to arthrodesis of the lumbar curve have a better coronal alignment when the distal fusion level is L3. Level of evidence III; Comparative Retrospective Study (based on prospectively collected data).

Objectives: To evaluate the cervical alignment after the correction of idiopathic scoliosis using high screw density and direct vertebral derotation (DVD) and to correlate it with thoracic kyphosis, spinopelvic parameters, and quality of life. Methods: Retrospective cohort study. We assessed the medical records and radiographs of patients submitted to idiopathic scoliosis surgery using high density of pedicular screws (80%) and DVD with at least 6 months of follow-up. All the radiographic parameters were evaluated in the preoperative period and in the last postoperative visit. Results: A total of 43 patients were evaluated, of which 35 (81%) were female. The mean age was 15 years (11 to 30 years) with a mean follow-up of one year and four months. Regarding Lenke's classification, 14 were of group 1, five of group 2, 10 of group 3, eight of group 4, four of group 5 and two of group 6. Only four patients had sagittal modifier (+) and two sagittal modifier (-).There was no significant difference between pre and postoperative thoracic kyphosis. When we evaluated the groups with +, N and -thoracic modifiers, we observed hypokyphotic and normokyphotic patients (-and N) had an increase in kyphosis, whereas hyperkyphotic patients (+)had a decrease. There was no statistical difference in relation to the radiographic parameters of the cervical spine in the pre and postoperative periods. There was a significant improvement in most of the parameters of the quality of life questionnaires, but no correlation with the cervical radiographic parameters. Conclusion: Correction of idiopathic scoliosis using a high density of pedicular screws and a direct vertebral derotation technique failed to improve thoracic kyphosis or change the cervical sagittal alignment, despite promoting a significant improvement in the parameters of quality of life questionnaires.Keywords: Scoliosis; Treatment outcome; Quality of life; Orthopedic fixation devices. RESUMO Objetivos: Avaliar o alinhamento cervical após a correção da escoliose idiopática utilizando alta densidade de parafusos e derrotação vertebral direta (DVD) e correlacionar com a cifose torácica, parâmetros espinopélvicos e qualidade de vida. Métodos: Estudo retrospectivo de coorte. Foram avaliados prontuários e radiografias de pacientes submetidos à cirurgia de escoliose idiopática utilizando alta densidade de parafusos pediculares (80%) e DVD com pelo menos seis meses de seguimento. Todos os parâmetros radiográficos foram avaliados no pré-operatório RESUMEN Objetivos: Evaluar la alineación cervical después de la corrección de la escoliosis idiopática utilizando alta densidad de tornillos y desrotación vertebral directa (DVD) y correlacionar con la cifosis torácica, parámetros espinopélvicos y calidad de vida. Métodos: Estudio retrospectivo de cohorte. Se evaluaron los historiales médicos y radiografías de pacientes sometidos a la cirugía de escoliosis idiopática utilizando alta densidad de tornillos pediculares (80%) y DVD con al menos seis meses de seguimiento. Todos los pará...

Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.

Objective In 2003, Mazda et al. introduced a new device for surgical correction of Adolescent Idiopathic Scoliosis (AIS) called sublaminar bands (SB). The reduction principle that SBs use is posteromedial spinal translation, similar to Luque’s wiring, but using polyester bands. Methods We performed a systematic review of the literature on this subject, evaluating the technique in terms of coronal correction, sagittal correction, bleeding, mean surgical time, loss of correction, infection, pseudoarthrosis, and neurological and other complications. The total search resulted in 14 articles published over the last 10 years. We found that the use of SBs in hybrid AIS correction instrumentations provides an average correction of 69% in the frontal plane, a 5° increase in thoracic kyphosis (average increase of 55%), overall complications of 4.5%, and no neurological complications were reported in any of the studies analyzed.. The mean blood loss was 682.5 mL and the mean surgical time was 228.6 minutes. Conclusions We conclude that the literature suggests that this instrumentation is safe, allows good correction in the frontal plane and great correction in the sagittal plane. As for complications, mean surgical time, and blood loss, their averages are lower than those of other constructions used for AIS. Level of evidence IIA; Systematic review.

Objective To compare radiographic findings of patients who underwent laminoplasty and laminectomy with arthrodesis for spondylotic cervical myelopathy. Methods Who were submitted to laminectomy with arthrodesis or laminoplasty to treat cervical spondylotic myelopathy with minimum follow-up of 6 months. The radiographic parameters related to the cervical spine evaluated were C0C2 lordosis (C0C2), cervical lordosis (CL), T1 slope (T1S), thoracic inlet angle (TIA), neck tilt (NT), cervical sagittal vertical axis (CSVA), and T1S – CL mismatch (T1S-CL). Results We evaluated 34 patients, 23 (68%) of whom were men. The mean age was 65 years (SD ± 13). There was no statistical difference in any of the preoperative radiographic parameters. Considering the patients submitted to laminectomy alone, a significant difference was observed for C0C2 (P = 0.045), CSVA (P = 0.0008), with differences between IPO and POS times (P = 0.026) and between PRE and POS (P = 0.0013) and T1S – CL mismatch (P = 0.0004), with a difference between IPO and POS (P = 0.0076) and between PRE and POS (P=0.001). Considering the patients submitted to laminoplasty alone, there was no difference over time for any radiographic parameters considered. Comparing the radiographic parameters between the laminectomy and laminoplasty groups in the three time periods, there was no significant difference for any of them. Conclusion This study suggests that patients with cervical spondylotic myelopathy who underwent laminectomy with instrumentation may present worse radiographic evolution as regards cervical sagittal alignment over time when compared to patients who underwent laminoplasty. Level of evidence III; Retrospective case series.