ALEXANDRE FOGACA CRISTANTE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Clinical and Radiological Results After Minimally Invasive Transpsoas Lateral Access Surgery for Degenerative Lumbar Stenosis(2020) COUTINHO, Thiago Pereira; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; ROCHA, Ivan Dias da; ONO, Allan Hiroshi; MEYER, Guilherme Pereira Correa; BARROS FILHO, Tarcisio Eloy de PessoaStudy Design: Prospective cohort study. Objective: The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters. Methods: Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded. Results: In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% (P < .001). The canal area increased from 109 to 149 mm(2) (P < .001) and from 9.3 to 12.2 mm (P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides (P < .001). The height of the foramen showed significant average increase of 2.8 mm (P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression. Conclusion: We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.
- THE SINS SCALE IN THE EVALUATION OF STABILITY IN PATIENTS WITH SPINAL METASTASIS(2020) LUGÃO, ARIEL FALBEL; SILVEIRA JUNIOR, CLOVIS CASTANHO; TEIXEIRA, WILLIAM GEMIO JACOBSEN; CRISTANTE, ALEXANDRE FOGAÇAABSTRACT Objective To evaluate the distribution of patients seen in the emergency care unit of the Instituto do Câncer do Estado de São Paulo in the categories “stable”, “indeterminate” and “unstable” as classified by the SINS scale. Methods The medical charts of patients treated between May and September 2013 were reviewed. Patients with a diagnosis of spinal metastasis were analyzed and data on age, sex, primary tumor location, neurological status, and the presence and intensity of pain at rest and in movement were obtained. The SINS criteria were used to evaluate the radiological involvement of the spine. Results We included 81 patients with a mean age of 59.57 years; 32 (39.51%) men and 49 (60.49%) women. Breast (19.75%), prostate (18.52%) and lung (17.28%) were the most common primary tumor sites. Only 18 patients (22.22%) had a single lesion and 51 (62.96%) had 3 or more metastatic lesions. Of the total, 56 (69.14%) were of undetermined stability, 19 were stable (23.46%) and 6 were unstable (7.41%). Twenty-two (27.2%) presented neurological deficit in the physical examination. None of the patients with severe deficit, Frankel A or B, were stable according to the SINS classification. All unstable lesions presented with kyphotic and/or scoliotic deviation (p <0.001). Most patients with undetermined lesions (78.6%) and all patients with unstable lesions had mechanical pain (p = 0.001). Conclusion In this case series, there was a high rate of patients classified by the SINS scale as of undetermined instability (69.14%). There was a high number of patients with multiple metastases (62.96%), which was not considered a modifier of the SINS instability criteria and which needs to be the focus of future studies. Level of evidence IV; Case Series.
- Comparative tomographic study of the iliac screw and the S2-alar-iliac screw in children(2020) TAVARES-JUNIOR, Mauro Costa Morais; SANCHEZ, Fernando Barbosa; ITURRALDE, Jaime David Uquillas; FERNANDES, Renan Jose Rodrigues; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS-FILHO, Tarcisio Eloy Pessoa de; LETAIF, Olavo BiraghiOBJECTIVES: The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS: An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS: The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS: Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.
- Management of patients with spinal cord injury during the coronavirus disease pandemic(2020) SILVA, Ricardo Teixeira e; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; BARROS-FILHO, Tarcisio Eloy Pessoa de
- Medical care for spinal diseases during the COVID-19 pandemic(2020) SILVA, Ricardo Teixeira e; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; BARROS-FILHO, Tarcisio Eloy Pessoa de
- 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.
- CRISPR, Prime Editing, Optogenetics, and DREADDs: New Therapeutic Approaches Provided by Emerging Technologies in the Treatment of Spinal Cord Injury(2020) PASCHON, Vera; CORREIA, Felipe Fernandes; MORENA, Beatriz Cintra; SILVA, Victor Allisson da; SANTOS, Gustavo Bispo dos; SILVA, Maria Cristina Carlan da; CRISTANTE, Alexandre Fogaca; WILLERTH, Stephanie Michelle; PERRIN, Florence Evelyne; KIHARA, Alexandre HiroakiSpinal cord injury (SCI) causes temporary disabilities or permanent effects including neuropathic pain and spastiscity. The damage often results from , which in turn triggers the neuroinflammatory process. Neuroinflammation plays essential roles in the structural, biochemical, and cellular changes that take place in the spinal cord after the injury. Indeed, SCI activates many different signaling pathways that coordinate the resulting cellular responses. While neuroinflammation serves as a physiological reaction to harmful stimuli, it is clear that long-lasting inflammatory response leads to aggravation of the neurodegenerative processes, becoming detrimental to recovery post-injury. In this context, we present some possible therapeutic targets in these activated signaling pathways and provide new perspectives for SCI treatment based on recently developed technologies, including clustered regularly interspaced short palindromic repeats (CRISPR)-based methods (including prime editing), optogenetics, and designer receptor exclusively activated by designer drugs (DREADDs). We critically analyze the recent advances in the deployment of these methods focusing on the control of the initial neuroinflammatory response. We then propose alternatives and provide new avenues for SCI treatment based on these emerging technologies.
- Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate-A Randomized Clinical Trial(2020) MEYER, Guilherme; ROCHA, Ivan Dias da; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; COUTINHO, Thiago Pereira; TORELLI, Alessandro Gonzalez; PETERSEN, Pedro Araujo; LETAIF, Olavo Biraghi; BARROS FILHO, Tarcisio Eloy Pessoa dePurpose: The objective was to compare the traditional microdiscectomy with percutaneous endoscopic lumbar discectomy for the treatment of disc herniations regarding pain, disability, and complications. Methods: Randomized clinical trial with 47 patients with disc herniations treated with 2 different surgical techniques: traditional microdiscectomy or percutaneous endoscopic lumbar discectomy. Forty-seven patients were divided into 2 groups and monitored for 12 months. Irradiated and low back pain were evaluated with the visual analog scale. Surgery complications were recorded. Results: After surgery, the sciatica and disability improved significantly but without significant differences between the groups. Improvements in back pain were significant until the third month. There were no statistical differences between groups regarding recurrence, infection, and the need for reoperation. Conclusions: Endoscopic discectomy results are similar to those of conventional microdiscectomy regarding pain and disability improvement. Postoperative lumbar pain is less intense with endoscopic discectomy than conventional microdiscectomy only during the first 3 months. Endoscopic discectomy is a safe and efficient alternative to microdiscectomy.
- Does Kyphectomy Improve the Quality of Life of Patients With Myelomeningocele?(2020) PETERSEN, Pedro Araujo; MARCON, Raphael Martus; LETAIF, Olavo Biraghi; SANTOS, Marcus Alexandre Mello; OLIVEIRA, Rafael Garcia; BARROS FILHO, Tarcisio Eloy Passos de; CRISTANTE, Alexandre FogacaBackground Lumbar kyphosis is a complex spinal deformity occurring in approximately 8% to 20% of patients with myelomeningocele. The resulting gibbosity may cause pressure ulcers, difficulty lying down in the supine position and sitting on the ischia without support, decreasing quality of life (QOL). Surgery is generally performed to correct kyphosis and maintain vertebral alignment, but high complication rates have been reported. Despite satisfactory radiological results, the impact of surgery and its complications on health-related QOL (HRQOL) has not yet been established. Questions/purposes Among children with myelomeningocele undergoing corrective surgery for lumbar kyphosis: (1) What is the risk of complications and reoperation after this procedure? (2) Does this procedure improve HRQOL scores in these patients? Methods Between 2012 and 2013, five surgeons at three centers treated 32 patients for myelomeningocele-related kyphosis with kyphectomy and posterior instrumentation. During that period, all surgeons used the same indications for the procedure, which were progressive postural decompensation and chronic ulceration at the apex of the deformity. Data were prospectively collected, and all patients who underwent surgery were considered in this retrospective study. The legal guardians of one patient declined to sign the informed consent form, resulting in 31 patients included. A total of 9.7% (3 of 31) were lost to follow-up before the 2-year period, and the remaining 90.3% (28 of 31) were seen at a mean of 3 years (+/- 9 months) after surgery. The average age was 10 years, 7 months (+/- 21 months) at the time of surgery. The patients had a mean kyphosis angle of 130 degrees +/- 36 degrees before surgery. This technique involved posterior fixation using S-shaped rods inserted through the foramina of S1 and pedicle screws inserted in the thoracic spine. The patients' caregivers answered both the generic and specific (neuromuscular module) Pediatric Quality of Life Inventory questionnaires preoperatively and 2 years postoperatively. The minimum clinically important difference (MCID) considered for the instruments used was 5. Results Reoperation was performed in 68% of patients (19 of 28), mostly to treat deep infection. In all, 18% of patients (five of 28) underwent implant removal to control infection. Eleven percent (three of 28) had a loss of reduction and pseudarthrosis. The HRQOL increased from 71 +/- 11 preoperatively to 76 +/- 10 postoperatively (p < 0.001), resulting in a 5-point increase (95% CI 3 to 7) in the generic questionnaire score and from 71 +/- 13 to 79 +/- 11 (p < 0.001), resulting in an 8-point increase (95% CI 5 to 10) in the neuromuscular Paediatric Quality of Life Inventory questionnaire score, mainly in the physical health domain on both questionnaires. Conclusions Kyphectomy was associated with a high risk of complications and reoperations and did not seem to deliver a substantial clinical benefit for patients who underwent the procedure. Most of our HRQOL score improvements were below the minimum clinically important difference for the Pediatric Quality of Life Inventory questionnaires. Although it seems that surgeons lack a better surgical alternative when facing the challenging health impairments these patients suffer, efforts should be made to improve the technique and reduce surgical complications. Additionally, patients and caregivers should be advised of the high reoperation rate and notified that the procedure may not result in a better QOL and should thus be avoided when possible. Future studies should verify whether decreasing the complication rate could imply improvement in the HRQOL of these patients after surgery.