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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- 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.
- Gunshot injuries in the spine(2014) BARROS FILHO, T. E. P. de; CRISTANTE, A. F.; MARCON, R. M.; ONO, A.; BILHAR, R.Study design: Review article. Objectives: To review the literature regarding treatment approaches in cases of gunshot wounds (GSWs) affecting the spine. Setting: Brazil. Methods: Narrative review of medical literature. Results: GSWs are an increasing cause of morbidity and mortality. Most patients with spinal GSW have complete neurological deficit. The injury is more common in young men and is frequently immobilizing. The initial approach should follow advanced trauma life support, and broad-spectrum antibiotic therapy should be initiated immediately, especially in patients with perforation of the gastrointestinal tract. The indications for surgery in spinal GSW are deterioration of the neurologic condition in a patient with incomplete neurological deficit, the presence of liquor fistula, spinal instability, intoxication by the metal from the bullet or risk of bullet migration. Conclusion: Surgical treatment is associated with a higher complication rate than conservative treatment. Therefore, the surgeon must know the treatment limitations and recognize patients who would truly benefit from surgery.
- 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.
- 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.
- Effects of tacrolimus and erythropoietin in experimental spinal cord lesion in rats: functional and histological evaluation(2016) COUTINHO, P. R. de Mesquita; CRISTANTE, A. F.; BARROS FILHO, T. E. P. de; FERREIRA, R.; SANTOS, G. B. dosStudy design: Experimental study with rats. Objective: To evaluate functional and histological effects of tacrolimus (FK 506) and erythropoietin (EPO) after experimental spinal cord contusion injury (SCI). Setting: Brazil. Methods: Wistar rats (n=60) were submitted to SCI with the NYU Impactor system. The control group received saline; the EPO group received EPO; the group EPO+FK 506 received EPO associated with tacrolimus and the group FK 506 received tacrolimus only. The Sham group underwent SCI, but did not receive any drug. Locomotor function was evaluated after SCI by BBB (Basso, Beattie and Bresnahan) weekly and by the motor-evoked potential test in 42 days. The spinal cord was histologically evaluated. Results: There was a significant difference between treated and the control groups from the seventh day on for BBB scores, with no difference between the groups EPO and EPO+FK 506 by the end of the study. There were significant differences between groups for necrosis and bleeding, but not for hiperemia, degeneration and cellular infiltrate. Axon neuron count was different between all groups (P=0.001), between EPO+FK 506 and FK 506 (P=0.011) and between EPO+FK 506 and Sham (P=0.002). Amplitude was significantly different between all groups except between control and sham. For latency, there was no difference. Conclusions: This study did not reveal significant differences in the recovery of locomotor function, or in the histological and electrophysiological analysis in animals treated with EPO and tacrolimus after thoracic SCI.
- Comparative tomographic study of the S2-alar-iliac screw versus the iliac screw(2019) TAVARES JUNIOR, Mauro Costa Morais; SOUZA, Joao Paco Vaz de; ARAUJO, Thiego Pedro Freitas; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa de; LETAIF, Olavo BiraghiAimsIliac screws and S2-alar-iliac screws provide adequate mechanical stability for the fixation of lumbosacral spine pathologies, which has led to a significant increase in the use of these techniques in the routine practice of spine surgeons. However, studies on the ideal technical positioning for both techniques are limited.Study designThis is an observational, retrospective, analytical descriptive study.ObjectiveTo analyze, describe and compare the insertion and positioning parameters of the S2-alar-iliac and iliac screw techniques in adult patients without spinal deformities.MethodsThe present study comprises a retrospective analysis of lumbosacral computed tomography images selected continuously in 2016 from 25 patients at a university hospital. Mann-Whitney-Shapiro-Wilk tests were performed. Data reliability was assessed using intraclass correlation.ResultsThe mean length of the iliac screw was greater than that of the S2-alar-iliac screw, and the S2-alar-iliac screw sat 20.5mm deeper than the iliac screw. The mean of the greatest bone thickness for the iliac screw was 20.72mm; that of the S2-alar-iliac screw was 23.24mm. The mean distance from the iliac screw entry point to the skin was 32.46mm, and the mean distance from the S2-alar-iliac screw entry point to the skin was 52.87mm.ConclusionThe trajectory of the S2-alar-iliac screws studied via computed tomography was greater in terms of bone thickness and deeper relative to the skin compared with the iliac screws. The S2-alar-iliac technique may have desirable clinical advantages in terms of the diameter of the screws and reduced protrusion when used in adults. [GRAPHICS]
- Feasibility of anterior screw fixation in children: a tomographic study(2018) FERNANDES, Livia Gaspar; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; BARROS FILHO, Tarcisio Eloy Pessoa de; LETAIF, Olavo BiraghiMorphology measures of the odontoid process in children under 12 years old were carried out to demonstrate the viability of anterior internal fixation in this population once their active profile may not be compatible with successful conservative treatment. During a 6-month period, 36 tomographic examinations of the cervical spine region that provided visualization of the odontoid process were selected. Group 1 included children between 6 and 9 years of age, and group 2 contained children from 9 to 12 years of age. There were 23 (63.8%) male patients and 13 (36.2%) female patients. Patients diagnosed with a tumor, an infection, fracture non-union, or congenital malformation were excluded. Exams were ordered as part of a protocol applied to non-specific neck pain and pediatric trauma entries. The following parameters were analyzed: (1) screw attack angle, (2) height of the odontoid process, and (3) minimal transverse diameter of the odontoid process. In Groups 1 and 2, the average values of the screw attack angle were 55.9A degrees A +/- 2.3A degrees and 54.8A degrees A +/- 4.5A degrees, respectively; the average heights of the odontoid process were 26.58 +/- 3.28 and 29.48 +/- 3 mm, respectively, and the average minimal transverse diameter of the odontoid process were 6.57 +/- 1.08 and 6.23 +/- 0.88 mm, respectively. The minimal transverse diameter of the odontoid process was statistically higher in males than that in females, regardless of age (p = 0.007). In both groups, the minimal transverse diameter of the odontoid process allowed for the use of one 3.5-4.5 mm screw for anterior internal fixation. These slides can be retrieved under Electronic Supplementary Material. [GRAPHICS] .
- Validation of the Brazilian Portuguese Version of the 24-Item Early-Onset Scoliosis Questionnaire(2021) MENDONCA, Rodrigo G. M. De; BERGAMASCKI, Lucas M.; SILVA, Karla C. M. da; LETAIF, Olavo B.; MARCON, Raphael; CRISTANTE, Alexandre F.; MATSUMOTO, Hiroko; VITALE, Michel G.; MEVES, RobertStudy Design: Multicenter prospective study. Objectives: To validate the Early-Onset Scoliosis 24 Questionnaire (EOSQ-24) questionnaire for the Brazilian Portuguese language, a widely used tool for assessing the impact of different treatments and interventions in EOS patients. Methods: The EOSQ-24 questionnaire was cross-culturally adapted following guidelines already published. After language adjustments by a group of experts, the final version of the Brazilian Portuguese EOSQ-24 was applied to a group of 76 patients (35 male and 41 female). Internal consistency was evaluated using the Cronbach alpha coefficient and item-total correlations. Continuous variables were recorded as median values and interquartile ranges and categorical variables as percentages. Results: In the study group, 76 patients were evaluated. The total EOSQ-24 Cronbach alpha coefficient was 0.883, indicating excellent reliability. The internal consistency of EOSQ-24 was assessed in 3 domains: patient quality of Life, parental burden, and satisfaction (Cronbach alpha: 0.816-0.934). The range across all subdomains was 0.473 to 0.934. Floor effects for the 24 items were between 1.3% and 43.4% and ceiling effects, between 3.9% and 42.1%. Conclusions: The Brazilian Portuguese adaptation of the EOSQ-24 shows excellent reliability and can be a valid tool for psychometric assessment of children with EOS.
- Evaluation of the effects of hyperbaric oxygen therapy for spinal cord lesion in correlation with the moment of intervention(2012) CRISTANTE, A. F.; DAMASCENO, M. L.; BARROS FILHO, T. E. P.; OLIVEIRA, R. P. de; MARCON, R. M.; ROCHA, I. D. daStudy design: Experimental, controlled, animal study. Objectives: To evaluate the functional effect of hyperbaric oxygen therapy administered shortly, one day after, and no intervention (control) in standardized experimental spinal cord lesions in Wistar rats. Setting: Sao Paulo, Brazil. Methods: In all, 30 Wistar rats with spinal cord lesions were divided into three groups: one group was submitted to hyperbaric oxygen therapy beginning half an hour after the lesion and with a total of 10 one-hour sessions, one session per day, at 2 atm; the second received the same treatment, but beginning on the day after the lesion; and the third received no treatment (control). The Basso, Beattie and Bresnahan scales were used for functional evaluation on the second day after the lesion and then weekly, until being killed 1 month later. Results: There were no significant differences between the groups in the functional analysis on the second day after the lesion. There was no functional difference comparing Groups 1 and 2 (treated shortly after or one day after) in any evaluation moment. On the 7th day, as well as on the 21st and 28th postoperative days, the evaluation showed that Groups 1 and 2 performed significantly better than the control group (receiving no therapy). Conclusion: Hyperbaric chamber therapy is beneficial in the functional recovery of spinal cord lesions in rats, if it is first administered just after spinal cord injury or within 24 h. Spinal Cord (2012) 50, 502-506; doi: 10.1038/sc.2012.16; published online 6 March 2012
- Effects of antidepressant and treadmill gait training on recovery from spinal cord injury in rats(2013) CRISTANTE, A. F.; FILHO, T. E. P. B.; OLIVEIRA, R. P.; MARCON, R. M.; FERREIRA, R.; SANTOS, G. B.Study design: Experimental, controlled, animal study. Objectives: To evaluate the influences of antidepressant treatment, treadmill gait training and a combination of these therapies in rats with experimental, acute spinal cord injury (SCI). Setting: Brazil. Methods: 48 Wistar rats were given standardized SCI; rats were then randomly assigned to four treatment groups: (1) motor rehabilitation therapy for 1 hour daily (gait training); (2) daily treatment with the antidepressant, fluoxetine (0.3 ml per 100 g intraperitoneally), beginning 24 h after the trauma; (3) combined fluoxetine treatment and gait training, or (4) untreated (controls). Neurological recovery was tested with the Basso, Beattie and Bresnahan (BBB) scale at 2, 7, 14, 21, 28,35 and 42 days after injury. Moreover, on day 42, all rats underwent a motor-evoked potential test (MEP); then, after euthanasia, histopathological evaluation was conducted in the area of SCI. Results: Based on the BBB scale, the combined treatment group showed significantly greater improvement compared with the other three groups, from the 14th to the 42nd day of observation. The MEP revealed that all treated groups showed significant improvement compared with the control group (P<0.02 for latency and P<0.01 for amplitude). Conclusion: Our results indicated that a combination of antidepressant and treadmill gait training was superior to either treatment alone for improving functional deficits in rats with experimental, acute SCI.