OLAVO BIRAGHI LETAIF
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LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Epidemiology of cauda equina syndrome. What changed until 2015(2018) DIAS, André Luiz Natálio; ARAÚJO, Fernando Flores de; CRISTANTE, Alexandre Fogaça; MARCON, Raphael Martus; BARROS FILHO, Tarcísio Eloy Pessoa de; LETAIF, Olavo BiraghiABSTRACT Objective: The primary objective of this study was to analyze the characteristics and outcomes of cases admitted to hospital with cauda equina syndrome (CES) at the Institute of Orthopedics and Traumatology (IOT) from 2005 to 2015. Secondly, this article is a continuation of the epidemiological work of the same base published in 2013, and will be important for other comparative studies to a greater understanding of the disease and its epidemiology. Methods: This was a retrospective study of the medical records of admissions due to CES at IOT in the period 2005-2015 with diagnosis of CES and neuropathic bladder. The following variables were analyzed: gender, age, etiology of the disease, topographic level of the injury, time interval between injury and diagnosis, presence of neurogenic bladder, time interval between diagnosis of the CES and surgery, and reversal of the deficit or of the neurogenic bladder. Results: Since this is a rare disease, with a low global incidence, it was not possible, just with the current study to establish statistically significant correlations between the variables and outcomes of the disease. However, this study demonstrates the shortcomings of the Brazilian public health system, both with the initial management of these patients and the need for urgent surgical treatment. Conclusion: The study shows that despite well-defined basis for the conduct of CES, a higher number of sequelae caused by the pathology is observed in Brazil. The delay in diagnosis and, therefore, for definitive treatment, remains as the major cause for the high number of sequelae. Level of evidence: 4, case series.
- TOMOGRAPHIC STUDY OF THE S2-ALAR-ILIAC SCREW TECHNIQUE IN BRAZILIAN MEN(2019) SOMBRA, LUIS PIMENTEL; SILVA, RICARDO TEIXEIRA E; ARAÚJO, THIEGO PEDRO FREITAS; BIRAGHI, OLAVO LETAIF; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA; BARROS FILHO, TARCÍSIO ELOY PESSOA DEABSTRACT Objective The use of pedicle screws was a milestone for modern spinal surgery. This type of fixation, due to its superior biomechanics, gave greater fixation power, greater capacity to withstand the pulling forces and, therefore, greater stability and lower rates of pseudoarthrosis. Fixation of the lumbosacral junction, even with the development of these new implants, remains a challenge mainly because the considerable rates of pseudoarthrosis. The use of iliac screws solves the biomechanical difficulties. However, its use shows high rates of surgical wound problems. The S2-Alar-Iliac screw (S2AI) came as a solution to these complications. The lack of studies about anatomical and anthropometric parameters in the Brazilian population justifies the study. Methods Eleven hip tomographies of Brazilian adult males were analyzed by four evaluators. The right and left sides were considered. In each patient, measurements were made of greater and shorter bone length, greater and smaller bone diameter, distance from the entry point to the skin, sagittal and axial angles related to the hypothetical insertion of an S2AI screw and compared to the same measurements obtained with the iliac screw. Results The mean bone length was 136.7 mm, the greatest bone diameter was 24.8 mm, the smallest bone diameter was 19.7 mm and the distance from the screw to the skin was 42.1 mm for the S2AI screw. Conclusions The obtained data present an average of the sample that can be useful in the decision of the surgical technique in the studied group. Level of evidence I; Diagnostic Studies (Anatomical Investigation).
- Fraturas do côndilo occipital: atualização da experiência em nosso serviço e revisão da literatura(2013) NORONHA, Henrique Gomes; LETAIF, Olavo Biraghi; ROCHA, Ivan Dias da; IUTAKA, Alexandre Sadao; CRISTANTE, Alexandre Fogaça; OLIVEIRA, Reginaldo Perilo de; BARROS FILHO, Tarcísio Eloy Pessoa deWe present a series of occipital condyle fractures diagnosed and treated in our hospital during the past 10 years. The present study continues an epidemiologic survey already performed in the period 1993-2000. From 2001 to 2011, six cases of fracture of the occipital condyle were diagnosed and all of them were treated conservatively, except one, in which a halo was initially placed. In the five cases treated conservatively, there were good results, with stable segment in functional radiographs, absence of limitation of motion and no pain. The patient treated with halo had FRANKEL C partial quadriplegia and associated fractures (C5, C6, L1, and L2), showing no neurological improvement, besides observing cervical motion limitation. We also highlight the importance of active research on lesions in the occipital-cervical transition, particularly in cases resulting from high-energy trauma, because in addition to the clinical implications of early detection of fracture, the best use of ancillary tests have been an important factor for the increased incidence of fractures of the occipital condyle. As is historically reported, conservative treatment is still effective and has a low rate of complications, and surgical treatment should be indicated in cases with established instability.
- TOMOGRAPHIC ANALYSIS OF T-1 VERTEBRA TO INSERT LAMINAR SCREWS IN CHILDREN FROM 0 TO 12 YEARS(2015) MARCHESE, Luiz Roberto Delboni; LETAIF, Olavo Biraghi; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaça; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcísio Eloy Pessoa deObjective : Tomographic analysis of the T1 vertebra in children from 0 to 12 years of age, in order to obtain anatomical parameters that assist intralaminar fixation in this pediatric population. Methods : Retrospectively analysis of the spine with CT (cervical and thoracic) of individuals aged between 0 and 12 years old, of both sexes, without anatomical deformities. The CT scans were evaluated separately, on each side, for length and thickness of the laminas as well as spinolaminar angle. The morphometric analysis was performed with iSite PACS Philips Healthcare Informatics(r) program and the values were expressed in millimeters (mm). The variables were correlated with age groups and sex of individuals. Statistical analysis was performed using t test and the results were considered significant when p<0.05. Results : By means of tomographic analysis of 24 patients it was found that age has no correlation with the angle of attack for intralaminar screws T1. However, the length and thickness of the T1 lamina increase proportionally with age. The total average length of the laminas was 28.62 ± 4.42 mm. The total average thickness was 4.75 ± 0.95 mm (3.2 to 6.5). Conclusion : This study shows relevant data on the use of Tran laminar screws currently commercially available with a minimum thickness of 3.5 mm. It is thus possible to say in this sample, they can be used in 87.5% of all laminas, being applicable in all lamina in patients older than 44 months of age.
- Avaliação de série de pacientes com artrodese C1-C2(2012) GHILARDI, Cesar Salge; LETAIF, Olavo Biraghi; IUTAKA, Alexandre Sadao; CRISTANTE, Alexandre Fogaça; ROCHA, Ivan Dias; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcísio Eloy Pessoa deOBJECTIVE: Retrospective record analysis of patients with C1-C2 instability of traumatic and nontraumatic causes who underwent C1-C2 arthrodesis. METHODS: We performed retrospective analysis of medical records of 20 outpatients from the column of IOT-FMUSP aged between 7 and 83 years (mean 43 years) of both sexes. The radiographic parameters for instability were based on measurement of atlanto-axial interval greater than 3 mm in adults and 5 mm in children, using measures obtained from lateral plain X-rays. RESULTS: We operated 20 patients with high cervical instability, mostly due to trauma. The surgical technique used was that described by Magerl. There were no vascular injuries. Infectious complications were reported in two patients. We achieved a solid fusion rate of 85% and no revision surgeries were required. CONCLUSIONS: All techniques produced satisfactory bone healing and were excellent for the control of atlanto-axial instability.
- TOMOGRAPHIC ANALYSIS OF SUBAXIAL CERVICAL VERTEBRAE IN CHILDREN BETWEEN 0 AND 12 YEARS(2017) MACHADO, LUCAS CASTRILLON CARMO; LETAIF, OLAVO BIRAGHI; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA; OLIVEIRA, REGINALDO PERILO; BARROS FILHO, TARCÍSIO ELOY PESSOA DEABSTRACT Objective: Tomographic and anatomic analysis of cervical vertebrae in children from 0 to 12 years of age to verify the possibility of utilization of lateral mass screws. Methods: Twenty-five cervical spine tomographies of children between 0 and 12 years of age, admitted to the emergency room of Hospital das Clínicas of São Paulo were retrospectively analyzed. The following distances were measured: width and length of the lateral masses in the axial section; width and height in the coronal section; height, length and diagonal diameter in the sagittal section. The variables studied were correlated with age and sex and submitted to statistical analysis. Results: The analysis of tomographic measurements of 20 patients showed a correlation between age and dimensions of the lateral mass, which were higher after 6 years of age. In relation to sex, greater measures were observed in males in all axes. With regard to the passage of the screws, we only had 22 masses (11%) that prevented their use. However, when stratified by age, we noticed that no patients had restrictions on the use of the lateral mass screw after the age of 6. Conclusion: This study analyzed the measurements of 200 lateral masses, making it possible to infer that there is an increase of dimensions with age and in males. Through the data, it was possible to affirm that in this sample, considering the implants available in the market, the lateral mass screws could be used in 89% of the lateral masses.
- Cervical disc prosthesis: 2-year follow-up(2015) BILHAR, Romero Pinto de Oliveira; CRISTANTE, Alexandre Fogaça; MARCON, Raphael Martus; ROCHA, Ivan Dias da; LETAIF, Olavo Biraghi; BARROS FILHO, Tarcísio Eloy deTo review the medical records of patients who underwent surgery for placement of cervical disc prosthesis after two years of postoperative follow-up, showing the basic epidemiological data, the technical aspects and the incidence of complications. METHODS: Medical records of seven patients who underwent surgery for placement of cervical disc prosthesis were reviewed after two years of follow-up, at the Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo. RESULTS: The average age of patients participating in this study was 43.86 years. Six patients (85.7%) had one level approached while one patient (14.3%) had two levels addressed. The level C5-C6 has been approached in one patient (14.3%) while the C6-C7 level was addressed in five patients (71.4%). One patient (14.3%) had these two levels being addressed, C5-C6 and C6-C7. The mean operative time was 164.29±40 minutes. Three patients were hospitalized for 2 days and four for 3 days making an average of 2.57±0.535 days. Two patients (28.6%) underwent a new surgical intervention due to loosening of the prosthesis. The mean follow-up was 28.14±5.178 months (23-35 months). CONCLUSIONS: Although cervical arthroplasty appears to be a safe procedure and present promising results in our study as well as in many other studies, it requires long-term studies.
- CHANGES IN THE SAGITTAL BALANCE IN CONGENITAL SCOLIOSIS CORRECTION SURGERY(2016) MANCUSO FILHO, José Antonio; BORGES, Paulo Alvim; TSUCHIYA, Eduardo Hideo; LETAIF, Olavo Biraghi; MARCON, Raphael Martus; CRISTANTE, Alexandre FogaçaABSTRACT Objective: This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis. Methods: We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis were measured, using the Cobb method, and spinopelvic parameters: pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Results A hundred and eleven medical records were analyzed, but the sample resulted in 10 patients, six of whom were females (60%). The average age was 13.4 years. In the comparative analysis between pre and postoperative, only the coronal deformity (12.37; CI 95% [7.88-16.86]; p<0.001), the sagittal deformity (12.71; CI 95% [4.21-21.22]; p=0.011), and the lumbar lordosis (9.9; CI 95% [0.38-19.42]; p=0.043) showed significant change. Conclusion: There was no change in the spinopelvic parameters of patients with congenital scoliosis undergoing surgery at IOF-FMUSP between 2009 and 2013; however, it was observed decrease in lumbar lordosis, and deformity angle in the sagittal and coronal planes.
- Anatomical and radiological characteristics in adolescent idiopathic scoliosis with surgical indication(2017) TAVARES JUNIOR, Mauro Costa Morais; LEDUR, Felipe Ribeiro; LETAIF, Olavo Biraghi; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaça; BARROS FILHO, Tarcisio Eloy Pessoa deABSTRACT OBJECTIVE: This study aims to analyze the anatomical and radiological characteristics of adolescent idiopathic scoliosis patients with surgical indication. METHODS: Retrospective, descriptive study of 100 medical records pertaining to patients included in the group of scoliosis with surgical indication from the years 2008 to 2015. Descriptive statistics were used for statistical analysis. RESULTS: 28 patients met the inclusion and exclusion criteria, and were selected for the study. The average age was 15.4 (SD ± 1.2 years); in the selected sample, the female/male ratio was 6:1; the kyphosis measured in degrees by Cobb angle between T5-T12 had an average 32.10 (SD ± 13.37); according to the Lenke classification, the most prevalent type was type 2, representing 28.6% of cases. CONCLUSION: The mean patient age in the present study was 15.4 (SD ± 1.2 years); the most prevalent type was type 2 in the Lenke classification. There is a need for new anatomical and radiological studies to elucidate the morphological characteristics common in adolescent idiopathic scoliosis patients.
- TOMOGRAPHIC STUDY OF THE S2-ALAR-ILIAC SCREW TECHNIQUE IN BRAZILIAN WOMEN(2018) ARAÚJO, Thiego Pedro Freitas; SOUZA, João Paz Vaz de; MUNHOZ, Diego Ubrig; TAVARES, Mauro Costa Morais; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaça; BARROS FILHO, Tarcísio Eloy Pessoa de; BIRAGHI, Olavo LetaifABSTRACT Objective: Lumbosacral fixation presents problems in its arthrodesis, mainly due to pseudoarthrosis. Iliac screws minimize this problem, however, they show problems in the operative wound. The S2-Alar-iliac (S2AI) screw presents a lower rate of these complications. The anatomical differences between the populations and the sexes analyzed in the literature justify the study of the S2AI screw technique in Brazilian women. Methods: A total of 14 adult female CT scans were analyzed by 4 evaluators. Results: The mean bone length was 131.8 mm, the largest bone diameter was 22.6 mm, and the smallest bone diameter was 22.6 mm. Conclusions: The data presented are compatible with the literature and may assist spine surgeons in choosing the best implant and surgical technique. Level of Evidence I; Diagnostic Studies — Investigating a Diagnostic Test (anatomical investigation).