ALEX OLIVEIRA DE ARAUJO
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3
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
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- PROFILE OF SPINAL CORD TRAUMA VICTIMS TREATED AT A REFERENCE UNIT IN SÃO PAULO(2018) ARAUJO, ALEX OLIVEIRA DE; FERRONATO, DANILO DE SOUZA; ROCHA, IVAN DIAS DA; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA; BARROS FILHO, TARCÍSIO ELOY PESSOA DEABSTRACT Introduction: Spinal cord trauma (SCT) is an important cause of morbidity and mortality around the world. It affects different age groups, especially young adults who are victims of high-energy trauma. The most effective way to reduce the incidence of spinal cord trauma and its consequences is through preventive campaigns and control and surveillance measures through public agencies. The objective of this study is to outline the epidemiological profile of patients with spinal cord trauma attended at a tertiary care center in the city of São Paulo. Methods: Retrospective, cross-sectional study performed at a reference center for the care of patients with spinal cord injury in the State of São Paulo. Data were collected from the medical records of patients with spinal cord trauma between 2012 and 2016. Results: Of the 515 patients with spinal trauma, 153 (29.7%) had spinal cord injury of which 131 (85.62%) were male, and 22 (14.37%) were female, in a ratio of approximately 6:1. The mean age was 39.45 years. The main cause of spinal cord trauma observed was the fall from heights, with 72 cases (47.05%), and 52.94% were classified as Frankel A. Conclusions: The results showed that the majority of the patients were young, economically active, with low educational level, exposed to accidents that could be largely avoided. Most of these patients also had severe disabling injuries, which usually bring considerable psychological sequelae and economic consequences to the individual and to society. Level of evidence: IV. Type of study: Case series.
- En bloc vertebrectomy for the treatment of spinal lesions. Five years of experience in a single institution: a case series(2018) ARAUJO, Alex Oliveira de; NARAZAKI, Douglas Kenji; TEIXEIRA, William Gemio Jacobsen; GHILARDI, Cesar Salge; ARAUJO, Pedro Henrique Xavier Nabuco de; ZERATI, Antonio Eduardo; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa deOBJECTIVES: The objective of this study is to describe the experience of a Brazilian public university hospital regarding the treatment of metastatic or benign spine lesions with en bloc vertebrectomy of the thoracic and lumbar spines. METHODS: This study was a retrospective case series and included all medical records of patients with benign aggressive, primary malignant, or metastatic spine lesions who underwent en bloc vertebrectomy from 2010 to 2015. RESULTS: A total of 17 patients were included in the analysis. Most of them (71%) were indicated for surgery based on an oncologic resection for localized disease cure. Overall, 10 of the 17 patients (59%) underwent vertebrectomy via an isolated posterior approach using the technique described by Roy-Camille et al. and Tomita et al., while 7 patients (41%) underwent double approach surgeries. Of the 17 patients who underwent the en bloc resection, 8 are still alive and in the outpatient follow-up (47%), and almost all patients with metastatic lesions (8/9) died. The average survival time following the surgical procedure was 23.8 months. Considering the cases of metastatic lesions and the cases of localized disease (malignant or benign aggressive disease) separately, we observed an average survival time of 15 months and 47.6 months respectively. CONCLUSION: This study demonstrates and reinforces the reproducibility of the en bloc vertebrectomy technique described by Tomita et al.
- Assessment of the Accuracy of the AO Spine-TL Classification for Thoracolumbar Spine Fractures Using the AO Surgery Reference Mobile App(2021) ONO, Allan Hiroshi de Araujo; CHANG, Veronica Yulin Prieto; RODENBECK, Erico Myung; ARAUJO, Alex Oliveira de; OLIVEIRA, Rafael Garcia de; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy PessoaStudy Design: Cohort study. Objectives: This study aimed to evaluate the accuracy of the AO Surgery Reference mobile app in the diagnosis of thoracolumbar fractures of the spine according to the AO TL classification, and to discuss the usefulness of this app in the teaching and training of the resident physicians in orthopedics and traumatology area. Methods: The 24 residents of Orthopedic and Traumatology program assessed 20 cases of thoracolumbar fractures selected from the hospital database on 2 different occasions, with a 30-day interval, and they classified these cases with and without using the AO Surgery Reference app. A group of spine experts previously established the gold standard and the answers were statistically compared, with the inter- and intraobserver reliability evaluated by the kappa index. Results: The use of the AO Surgery Reference app increased the classification success rate of the fracture morphology (from 53.4% to 72.5%), of the comorbidity modifier (from 61.4% to 77.9%) and of the neurological status modifier (from 55.1% to 72.9%). In addition, the mobile app raised the classification agreement and accuracy. The kappa index increased from 0.30 to 0.53 regarding the morphological classification of fractures. Conclusions: The residents improved their ability to recognize and classify thoracolumbar spine fractures, which reinforces the importance of this tool in medical education and clinical practice.
- COMPARISON BETWEEN START BACK SCREENING TOOL AND DRAM FOR DETECTION OF PSYCHOSOCIAL FACTORS IN LOW BACK PAIN(2021) TUCCI, Carlos; ARAUJO, Alex Oliveira de; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaça; BARROS FILHO, Tarcísio Eloy Pessoa deABSTRACT Objective: To correlate the results of the STarT Back Screening Tool and DRAM questionnaires, applied simultaneously, in a population with low back pain. Methods: Comparative cross-sectional study with 84 participants with low back pain assessed by both STarT Back Screening Tool (SBST) and DRAM questionnaires. The degree of correlation between the two questionnaires was analyzed through the evaluation of individualized data and using the Spearman correlation coefficient. Results: According to the DRAM, 19% of the patients were classified as “normal”, 32.1% as “at risk” and 48.8% as “distressed”. According to SBST, 59.5% of patients were classified as “low risk”, 31% as “medium risk” and 9.5% as “high risk”. Applying the Spearman's coefficient to evaluate the degree of correlation between the two questionnaires, a value of 0.4 was obtained. This shows that there is a positive, but weak, correlation (p <0.001) between the two questionnaires. Conclusion: There is a positive correlation between the two questionnaires, but the DRAM showed a greater tendency to classify patients with some degree of psychological distress when compared to the SBST. Both questionnaires are effective in identifying these factors, but the data suggest that the DRAM may be more effective as a screening tool in patients with low back pain, in view of the higher number of patients identified. Level of evidence III; Diagnostic test study.
- Full-thickness supraspinatus tendon tears: correlation of findings by arthroscopy and magnetic resonance imaging(2015) MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; ARAUJO, Alex Oliveira de; SEITO, Carlos Augusto; GRACITELLI, Mauro Emilio Conforto; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo AmadoThe main aim of this study was to correlate measurements of the width and retraction of isolated full-thickness supraspinatus tendon tears determined by magnetic resonance imaging (MRI) with measurements recorded by arthroscopy using a continuous millimetre scale. A total of 53 individuals with isolated supraspinatus tears and retraction < 30 mm underwent arthroscopy at our centre. Tear width and retraction measured by arthroscopy (reference standard) and MRI (index test) on a continuous millimetre scale were compared. All measurements were performed by a single radiologist blinded to intra-operative findings and one surgeon who had previous access to MRI results. The average tear retraction was 12.60 +/- 4.89 mm by arthroscopy and 16.81 +/- 6.29 mm by MRI. Those measures exhibited moderate correlation (r = 0.643, p < 0.001) and an average difference of 4.21 mm (p < 0.001). Average tear width was 12.87 +/- 4.15 mm by arthroscopy and 14.19 +/- 5.20 by MRI. Those measures exhibited moderate correlation (r = 0.526, p < 0.001) and an average difference of 1.32 mm, which was not statistically significant (p = 0.109). Measures of retraction and width obtained by MRI and arthroscopy exhibited moderate correlation in small- or medium-sized supraspinatus tears.
- Translation, Cross-cultural Adaptation and Reliability of Brazilian portuguese version of the DRAM Questionnaire for Psychometric Evaluation in Low Back Pain(2020) TUCCI NETO, Carlos; JACOB, Alberto; DE AMORIM, Thiago Bonato; ARAÚJO, Alex Oliveira de; CRISTANTE, Alexandre FogaçaAbstract Objective Based on studies regarding pain physiology and its relation to emotional distress conditions, psychological evaluation became essential to determine the most favorable patient profiles to distinct therapeutic approaches. The Distress Risk Assessment Method (DRAM) has been developed as a screening instrument for patients with lumbar pain, classifying them in subgroups as normal, at risk, distressed somatic and distressed depressive, based on the two components of DRAM scores (Modified Somatic Perception Questionnaire [MSPQ] and Zung questionnaires). The objective of the present study is to translate and culturally adapt the DRAM to the Brazilian Portuguese language, and to determine the reliability of the final version. Methods As proposed by the International Quality of Life Assessment (IQOLA) method, a Brazilian Portuguese version of the DRAM has been applied to a sample of 85 individuals from 3 participant centers. Results The results confirmed the reliability and reproducibility of the DRAM in its Brazilian Portuguese final version: Cronbach alpha of 0.815 (MSPQ) and 0.794 (Zung) and intraclass correlation coefficient (ICC) of 0.688 (MSPQ) and 0.659 (Zung). Conclusion The presented DRAM version in Brazilian Portuguese is reliable and is available to clinical practice use.
- COMPLICATED LUMBAR TUBERCULOUS SPONDYLODISCITIS IN DISSEMINATED TUBERCULOSIS, TREATED USING A NON-CONVENTIONAL ANTERIOR SUPPORT SYSTEM FOR HYDROSTATIC DISTRACTION: A CASE REPORT(2018) ARAUJO, Alex Oliveira de; SOARES, Thiago Queiroz; TORELLI, Alessandro Gonzalez; ONO, Allan Hiroshi de Araujo; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa deObjective: To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system. Background: Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. A surgical procedure is also indicated when a biopsy is required. With the development of new methods for reconstruction and fixation of the spine, complete debridement of the tuberculous foci has become an increasingly common approach, but there is a lack consensus on the best technique. Methods and results: The patient suffered from disseminated tuberculosis affecting the lumbar region of the spine, with an abscess in the psoas muscle. He underwent extensive debridement via both anterior and posterior approaches, using a non-conventional anterior support system that promotes hydrostatic distraction. Conclusions: Treatment using the hydrostatic distraction system was able to reestablish both the stability and anatomy of the lumbar curve.