OLAVO BIRAGHI LETAIF
Projetos de Pesquisa
Unidades Organizacionais
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Feasibility of Intralaminar, Lateral Mass, or Pedicle Axis Vertebra Screws in Children Under 10 Years of Age: A Tomographic Study(2012) CRISTANTE, Alexandre Fogaca; TORELLI, Alessandro Gonzalez; KOHLMANN, Rafael Bellucci; ROCHA, Ivan Dias da; BIRAGHI, Olavo Letaif; IUTAKA, Alexandre Sadao; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcisio Eloy Pessoa deBACKGROUND: There are several techniques for screw insertion in upper cervical spine surgery, and the use of the 3.5-mm screw is usually the standard. However, there is no consensus regarding the feasibility of using these screws in the pediatric population. OBJECTIVE: To determine the measurement of the lamina angle, lamina and pedicle length and thickness, and lateral mass length of the topographic axial view of the axis vertebra of 2- to 10-year-old children to guide the use of surgical screws. METHODS: Seventy-five computed tomography scans from 24- to 120-month-old patients were studied. Measurements were taken in an axial view of C2 and correlated with 2 age groups and both sexes. Statistical analysis was performed with the Student t test. RESULTS: In the 24- to 48-month age group, only 5.5% of the lamina and 8.3% of the pedicles had thicknesses < 3.5 mm. In the 49- to 120-month age group, there were no lamina thickness values < 3.5 mm, and 1.2% of pedicle thicknesses were < 3.5 mm. Both age groups had no lamina and pedicle lengths < 12 mm and no lateral mass lengths > 12 mm. CONCLUSION: In the majority of cases, the use of 3.5-mm lamina and pedicle screws in children is feasible. A base value of 45 degrees for the spinolaminar angle can be adopted as a reference for insertion of screws in the C2 lamina. This information can be particularly useful for decision making during preoperative planning for C1-C2 or craniocervical arthrodesis in children.
- Effects of estrogen on functional and neurological recovery after spinal cord injury: An experimental study with rats(2015) LETAIF, Olavo Biraghi; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa de; FERREIRA, Ricardo; SANTOS, Gustavo Bispo dos; ROCHA, Ivan Dias da; MARCON, Raphael MartusOBJECTIVES: To evaluate the functional and histological effects of estrogen as a neuroprotective agent after a standard experimentally induced spinal cord lesion. METHODS: In this experimental study, 20 male Wistar rats were divided into two groups: one group with rats undergoing spinal cord injury (SCI) at T10 and receiving estrogen therapy with 17-beta estradiol (4mg/kg) immediately following the injury and after the placement of skin sutures and a control group with rats only subjected to SCI. A moderate standard experimentally induced SCI was produced using a computerized device that dropped a weight on the rat's spine from a height of 12.5 mm. Functional recovery was verified with the Basso, Beattie and Bresnahan scale on the 2nd, 7th, 14th, 21st, 28th, 35th and 42nd days after injury and by quantifying the motor-evoked potential on the 42nd day after injury. Histopathological evaluation of the SCI area was performed after euthanasia on the 42nd day. RESULTS: The experimental group showed a significantly greater functional improvement from the 28th to the 42nd day of observation compared to the control group. The experimental group showed statistically significant improvements in the motor-evoked potential compared with the control group. The results of pathological histomorphometry evaluations showed a better neurological recovery in the experimental group, with respect to the proportion and diameter of the quantified nerve fibers. CONCLUSIONS: Estrogen administration provided benefits in neurological and functional motor recovery in rats with SCI beginning at the 28th day after injury.
- Scoliosis Research Society survey: brace management in adolescent idiopathic scoliosis(2021) HALSEY, Matthew; DOLAN, Lori A.; HOSTIN, Richard A.; ADOBOR, Raphael D.; DAYER, Romain; DEMA, Eugenio; LETAIF, Olavo B.Purpose While the Scoliosis Research Society (SRS) has established criteria for brace initiation in adolescent idiopathic scoliosis (AIS), there are no recommendations concerning other management issues. As the BrAIST study reinforced the utility of bracing, the SRS Non-Operative Management Committee decided to evaluate the consensus or discord in AIS brace management. Methods 1200 SRS members were sent an online survey in 2017, which included 21 items concerning demographics, bracing indications, management, and monitoring. Free-text responses were analyzed and collated into common themes. Data were analyzed using Microsoft Excel 2013. Results Of 218 respondents; 207 regularly evaluate and manage patients with AIS, and 205 currently prescribe bracing. 99% of respondents use bracing for AIS and the majority (89%) use the published SRS criteria, or a modified version, to initiate bracing. 85% do not use brace monitoring and 66% use both %-Cobb correction and fit criteria to evaluate brace adequacy. In contrast, other aspects of brace management demonstrated a high degree of practice variability. This was seen with a radiographic assessment of maturity level, hours prescribed, timing and frequency of radiographic evaluation, the use of nighttime bracing only, and the method and timing of brace discontinuation. Conclusion Although there is consensus in brace management amongst SRS members with respect to brace initiation and evaluation of adequacy, there is striking variability in how bracing for AIS is used. This variability may impact the overall efficacy of brace treatment and may be decreased with more robust guidelines from the SRS.
- 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 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).
- 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.
- 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.
- Standardization of an experimental model of intradural injection after spinal cord injury in rats(2021) LETAIF, Olavo B.; TAVARES-JUNIOR, Mauro C. M.; SANTOS, Gustavo B. dos; FERREIRA, Ricardo J. R.; MARCON, Raphael M.; CRISTANTE, Alexandre F.; BARROS-FILHO, Tarcisio E. P. deOBJECTIVES: The intrathecal route has not yet been thoroughly standardized and evaluated in an experimental model of spinal cord injury (SCI) in Wistar rats. The objective of this study was to standardize and evaluate the effect of intradural injection in this animal model. METHOD: The animals were divided into 6 groups: 1) laminectomy and intradural catheter; 2) laminectomy, intradural catheter and infusion; 3) only SCI; 4) SCI and intradural catheter; 5) SCI, intradural catheter and infusion; and 6) control (laminectomy only). Motor evaluations were performed using the Basso, Beattie and Bresnahan (BBB) scale and the horizontal ladder test; motor evoked potentials were measured for functional evaluation, and histological evaluation was performed as well. All experimental data underwent statistical analysis. RESULTS: Regarding motor evoked potentials, the groups with experimental SCI had worse results than those without, but neither dural puncture nor the injection of intrathecal solution aggravated the effects of isolated SCI. Regarding histology, adverse tissue effects were observed in animals with SCI. On average, the BBB scores had the same statistical behaviour as the horizontal ladder results, and at every evaluated timepoint, the groups without SCI presented scored significantly better than those with SCI (p<0.05). The difference in performance on motor tests between rats with and without experimental SCI persisted from the first to the last test. CONCLUSIONS: The present work standardizes the model of intradural injection in experimental SCI in rats. Intrathecal puncture and injection did not independently cause significant functional or histological changes.
- Correlation between the degree of correction of neuromuscular scoliosis and patient quality of life(2017) NORDON, David Goncalves; LUGAO, Ariel Falbel; MACHADO, Lucas Castrillon Carmo; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa de; LETAIF, Olavo BiraghiOBJECTIVE: There are few data on patient satisfaction with surgery for the correction of neuromuscular scoliosis or on the correlation between patient satisfaction and the degree of curve correction achieved by surgery. Our aim was to determine the correlations between both patient satisfaction and perception of quality of life and the degree of curve correction. METHODS: We interviewed 18 patients and administered a questionnaire that collected social and economic data and information about functional ability, comorbidities and satisfaction. Statistical analysis was performed using chi-square tests, Pearson correlation and paired t-tests. RESULTS: The mean correction achieved was 42.8%, i.e., 34.17 degrees. Early and late complication rates were low (11.1% each). Almost all of the patients (94.4%) were satisfied with the surgery, and expectations were met for 61.1% of them. Quality of life and aesthetics were improved in 83.4% and 94.4% of cases, respectively. No correlation was found between satisfaction and degree of correction. CONCLUSION: Our surgical results are similar to those of other studies with respect to the degree of correction and patient satisfaction. The disparity between satisfaction and fulfillment of expectations may be due to unrealistic initial expectations or misunderstanding of the objective of surgery. Our findings corroborate the hypothesis that satisfaction is multifactorial and not restricted to a quantitative goal. The satisfaction of patients who undergo operation for neuromuscular scoliosis does not depend directly on the degree of deformity correction. The relationship between satisfaction and the success of the correction procedure is complex and multifactorial.