REGINALDO PERILO OLIVEIRA

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Instituto de Ortopedia e Traumatologia, 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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Autor: MARCON, Raphael Martus ×

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  • article 26 Citação(ões) na Scopus
    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 de
    BACKGROUND: 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.
  • article 0 Citação(ões) na Scopus
    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 de
    OBJECTIVE: 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.
  • article 1 Citação(ões) na Scopus
    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 de
    Objective : 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.
  • article 12 Citação(ões) na Scopus
    Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up
    (2014) ROCHA, Ivan Dias da; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; LETAIF, Olavo Biraghi; BARROS FILHO, Tarcisio Eloy Pessoa de
    OBJECTIVES: To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables. METHODS: Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients. RESULTS: A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05). CONCLUSION: Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.
  • article 52 Citação(ões) na Scopus
    Fractures of the cervical spine
    (2013) MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; TEIXEIRA, William Jacobsen; NARASAKI, Douglas Kenji; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcisio Eloy Pessoa de
    OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.
  • article 8 Citação(ões) na Scopus
    TREATMENT OF ODONTOID FRACTURES
    (2011) PONTIN, Pedro Augusto; BUMLAI, Renam Urt Mansur; LETAIF, Olavo Biraghi; DAMASCENO, Marcelo Loquette; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; IUTAKA, Alexandre Sadao; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcisio Eloy Pessoa de
    Objective: This article describes a clinical and radiologic retrospective analysis of odontoid fractures in 20 patients accompanied by the IOT-HCFMUSP, from 2004 to 2010. Methods: These fractures were stratified according to their classification (AO/Anderson and D'Alonzo), epidemiologic profile, type of treatment, time to consolidation of the fracture, and complications. Results: It was observed that there was a higher number of odontoid fractures in males (4: 1), between the third and fourth decades of life (60%), and that the main causes of the trauma were falling from heights (60%) and car accidents (25%). Also, 15% of the cases presented neurological deficits. The most prevalent type of odontoid fracture was Type II (55%) followed by Type III (40%). The most prevalent type of treatment used for Type II and III fractures was surgical (73%) and non-surgical (87.5%), respectively. Consolidation of the fracture took place within 16 weeks in 87.5% of surgically treated cases, and in 54.5% of those treated non-surgically. No cases of pseudoarthrosis were found. Conclusion: The surgical treatment of Type II odontoid fractures showed satisfactory results in relation to time to consolidation of the fracture and low incidence of complications, as did the non-surgical treatment used for the Type III fractures. Level of Evidence: Level IV, case series.
  • article 0 Citação(ões) na Scopus
    Avaliação de seis anos de fraturas cervicais subaxiais
    (2013) GAIA, Leonardo Franco Pinheiro; MIYAHARA, Helder de Souza; LETAIF, Olavo Biraghi; IUTAKA, Alexandre Sadao; CRISTANTE, Alexandre Fogaça; ROCHA, Ivan Dias; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcísio Eloy Pessoa de
    OBJECTIVE: Retrospectively assess the factors related to cervical trauma, according to the type of fracture based on the AO classification, taking into account etiological and epidemiological aspects of the event. METHODS: Records of patients with cervical fractures were retrospectively reviewed, from 2004 to 2009. The sub-axial fractures (C3-C7) were studied because they fit into only one classification (AO). Frontal and lateral x-rays were used as well as CTs to divide the fractures into A (compression), B (distraction) and C (rotation), in accordance with the presented pattern. The following parameters were assessed: gender, age, AO classification, trauma mechanism, presence of neurological deficit, and conservative or surgical treatment. RESULTS: The study included 264 records from the spine, where 216 patients were male and 48 female. The average age of these patients was 38.55 years. The most common mechanism of injury of the cervical sub-axial fractures was car accident with 84 cases. Regarding the type of fracture by the AO classification, the most frequent was type B. Out of the assessed cases, 136 patients presented complete or partial neurological deficit. The surgical treatment was performed in 166 cases. CONCLUSION: It is clear, based on the data presented, that cervical fractures are a major problem to the public and private health in Brazil. The prevention of the cervical fractures presents the most cost-effective approach to these injuries.
  • article 0 Citação(ões) na Scopus
    SUBAXIAL CERVICAL FRACTURE: APPLICATION AND CORRELATION OF AO AND SLIC
    (2015) ONO, Allan Hiroshi de Araujo; ROCHA, Ivan Dias da; CRISTANTE, Alexandre Fogaça; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcísio Eloy Pessoa
    Objective:To evaluate the AO/Magerl classification and the SLIC (Subaxial Cervical Spine Injury Classification), used in the cervical spine fractures and assess whether they are correlated to the neurological severity of patients, the choice of approach to be used, de duration of surgery an between themselves.Method:Retrospective analysis of medical records and radiological image files of 77 patients surgically treated of subaxial cervical fracture or dislocation from August 2010 to September 2012.Results:The SLIC classification showed a strong correlation with neurological deficit and Pearson correlation value of -0.600. The AO classification was not correlated with the Frankel scale and the value of Pearson was 0.06 with a statistical significance of 0.682 (p<0.05), that is, unable to determine or suggest the severity of the deficit. When compared to each other the two classifications showed statistical correlation and the value of Pearson was 0.282 with a significance value of 0.022 (p<0.05).Conclusion:Among the most used classifications, the SLIC has been able to statistically define the need for surgical treatment and the severity of the neurological status, but was unable to predict the approach or the time of the surgery; the classification AO failed to predict the severity of neurological injury, surgical time, and did not help to choose the approach, just being a morphological classification.
  • article 2 Citação(ões) na Scopus
    Functional assessment of patients with cervical myelopathy who underwent surgical treatment
    (2014) COUTINHO, Thiago Pereira; IUTAKA, Alexandre Sadao; CRISTANTE, Alexandre Fogaça; ROCHA, Ivan Dias; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcísio Eloy Pessoa de
    OBJECTIVE: Evaluate and correlate the functional response of patients with cervical myelopathy with the current clinical scores in patients who underwent surgical treatment. METHODS: We analyzed medical records of 34 patients with cervical myelopathy who underwent four different types of surgery. All patients were evaluated preoperatively and postoperatively with the application of the JOA and Nurick questionnaires. RESULTS: Functional clinical improvement was statistically significant. The mean preoperative JOA was 8.5 ± 3.06 and 10.7 ± 3.9 in the postoperative; Nurick was 3.2 ± 1.1 preoperatively and 2.8 ± 1.3 postoperatively. CONCLUSION: There is benefit with the surgical procedure in patients with cervical myelopathy. The neurological function after surgery depends on the previous function (the higher the duration of the previous symptoms, the greater the progression of the disease and, therefore, worse the neurological function) and the age is not a relevant factor of improvement, as already shown in other series. The clinical functional improvement of patients is visible with surgical treatment, regardless of surgical technique.