<sec><title>OBJECTIVE:</title><p> To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.</p></sec><sec><title>METHODS:</title><p> One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.</p></sec><sec><title>RESULTS:</title><p> The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.</p></sec><sec><title>CONCLUSION:</title><p> Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.</p></sec>

Objective: To evaluate the possible existence of a significant correlation between quality of life and severity classification of lumbar stenosis based on dural sac morphology in outpatients. Methods: Forty patients with a diagnosis of lumbar stenosis followed at a university hospital were submitted to magnetic resonance imaging (MRI) and quality of life questionnaires: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) and EQ-5D. They were classified as type A, B, C or D based on MRI. For the statistical analysis, the Spearman correlation was used. Results: Seventeen female patients and 23 male patients with mean age of 56.5 years constituted the sample. ODI had a mean dysfunction of 44.9%, the PCS score averaged 29.9, the MCS score was 41.3. The general symptoms of SSS presented a mean of 3.2 and the EQ-5D presented an average of 0.491. The patients with the highest severity in the classification were not necessarily those who presented worse scores in the quality of life questionnaires. Conclusion: The classification of severity of the lumbar spinal stenosis based on dural sac morphology does not correlate with the applied quality of life questionnaires. Level of Evidence III; Cross-sectional observational study.

Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl’s technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18–41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783–785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands.

Objective: To evaluate the intra- and inter-observer reproducibility of the evaluation of the pelvic obliquity (PO) in patients with neuro-muscular deformities via the method that uses the iliac crests and the method that uses the upper endplate of S1 and to determine whe ther there is a relationship between the methods. Methods: The digitized panoramic radiographies of thirty patients with cerebral paralysis or myelomeningocelein outpatient monitoring were evaluated by four examiners: two experienced spinal surgeons and two fellows. Two radiographs were excluded because analysis was impossible. All exams were obtained in accordance with the periodic monitoring protocol in the sitting position, using digitized film and a film-focus distance of 110 cm Results: High intra- and inter-observer agreement was observed both for method that uses the iliac crests and the method that evaluates the S1 endplate. However, no significant relationship between the two methods was observed. Conclusions: The methods evaluated had good reproducibility and agreement among the observers. It was confirmed that, on account of the existent linear relation, it is possible to estimate the value of the iliac crest method knowing the value obtained by the S1 plateau multiplied by 0.76. There was no agreement between the iliac crest and S1 plateau PO evaluation methods. Level of evidence IV; Retrospective cross-sectional study.

Objective: To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods: Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index), which assesses the number and severity of fractures. Results: Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion: There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.Objetivo: Avaliar a qualidade de vida relacionada com a coluna vertebral em pacientes com fratura da parte proximal do fêmur. Métodos: Estudo realizado em um hospital público terciário em pacientes com fraturas do fêmur proximal causado por trauma de baixa energia, por meio de aplicação do questionário Oswestry Disability Index, para avaliar as queixas relacionadas com a coluna vertebral no momento de vida prévio à fratura femoral. Avaliaram-se também as colunas torácica e lombar dos pacientes aplicando-se o índice radiográfico descrito por Gennant (Spinal Deformity Index), que avalia o número e a gravidade das fraturas. Resultados: Dezessete sujeitos concluíram o estudo. Todos apresentaram algum grau de fratura vertebral. Os pacientes enquadraram-se nas categorias de incapacidade severa e muito severa do questionário de qualidade de vida. Verificou-se que quanto maior o SDI, melhor a qualidade de vida. Conclusão: Há forte associação de incapacidade relacionada à coluna vertebral em pacientes e fratura do fêmur proximal, devendo esta queixa ser avaliada sistematicamente em pacientes com a fratura apendicular. Descritores: Fratura do fêmur; Qualidade de vida; Osteoporose; Fraturas da coluna vertebral. RESUMENObjetivo: Evaluar la calidad de vida relacionada con la columna vertebral en pacientes con fracturas de la parte proximal del fémur. Métodos: Estudio realizado en un hospital público terciario en pacientes con fracturas femorales proximales causadas por un traumatismo de baja energía, a través del cuestionario Oswestry Disability Index para evaluar las quejas relacionadas con la columna vertebral en el momento de la vida antes de la fractura femoral. También se evaluaron columna torácica y lumbar de los pacientes por el índice radiográfico descrito por Gennant (Índice de deformidad de la columna), que evalúa el número y la gravedad de las fracturas. Resultados: Diecisiete sujetos completaron el estudio. Todos tenían algún grado de fractura vertebral. Los pacient...