EPIDEMIOLOGIA DO TRAUMATISMO RAQUIMEDULAR TRATADO CIRURGICAMENTE NO HOSPITAL DAS CLÍNICAS DA UNICAMP

SILVA, OTÁVIO TUROLO DA; GHIZONI, ENRICO; TEDESCHI, HELDER; JOAQUIM, ANDREI FERNANDES

doi:10.1590/S1808-185120181701179262

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REVISION ARTICLE • Coluna/Columna 17 (01) • Jan-Mar 2018 • https://doi.org/10.1590/S1808-185120181701179262 copiar

EPIDEMIOLOGIA DO TRAUMATISMO RAQUIMEDULAR TRATADO CIRURGICAMENTE NO HOSPITAL DAS CLÍNICAS DA UNICAMP

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Reportar o perfil epidemiológico dos pacientes operados para tratamento do TRM no Hospital das Clínicas da UNICAMP.

Métodos:

Pacientes maiores de 14 anos, com TRM operados no serviço no período de 2012 a 2017, com dados radiológicos e clínicos completos foram avaliados.

Resultados:

143 pacientes foram incluídos, sendo 120 homens e 23 mulheres, com idade média de 37,8 anos. Quedas (32%), acidentes de motocicletas (26%) e de automóveis (24%) foram os mecanismos de trauma mais comuns. O nível vertebral mais acometido foi o de C6 (11%) e a maioria dos pacientes tinha algum déficit neurológico (55%). A taxa geral de complicação pós-operatória foi de 23%.

Conclusões:

O Traumatismo Raquimedular (TRM) tem alto impacto sócio-econômico devido sua alta morbi-mortalidade, sendo que é necessário estudar sua epidemiologia para o desenvolvimento de políticas públicas de prevenção e financiamento do tratamento do mesmo. Nível de evidência III. Tipo de estudo: Estudo Retrospectivo.

Descritores:
Traumatismos da medula espinal; Coluna vertebral; Cirurgia; Tratamento; Epidemiologia

Autoria

OTÁVIO TUROLO DA SILVA

. Department of Neurology, division of Neurosurgery of Unicamp - Campinas, SP, Brazil.UnicampBrazilCampinas, SP, Brazil. Department of Neurology, division of Neurosurgery of Unicamp - Campinas, SP, Brazil.

https://orcid.org/0000-0001-6015-0199

ENRICO GHIZONI

https://orcid.org/0000-0001-8684-1780

HELDER TEDESCHI

https://orcid.org/0000-0003-3347-3886

ANDREI FERNANDES JOAQUIM

https://orcid.org/0000-0003-2645-0483

Correspondence: Universidade Estadual de Campinas. Rua: Tessália Vieira de Camargo, 126, Departamento Neurologia, Cidade Universitária. Campinas, SP, Brasil. 13083-887. andjoaquim@yahoo.com

All authors declare no potential conflict of interest related to this article.

CONTRIBUTION OF THE AUTHORS:

Each author made significant individual contributions to this manuscript. Patient data was evaluated by AFJ (0000-0003-2645-0483)* and OTS (0000-0001-6015-0199)*. The article was written by) OTS and AFJ. The final review was done by AFJ, HT(0000-0003-3347-3886)*, and EG (0000-0001-8684-1780)*. *ORCID (Open Researcher and Contributor ID).

SCIMAGO INSTITUTIONS RANKINGS

Figuras | Tabelas

Figuras (3)
Tabelas (3)

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Figure 1
Shows the distribution of the 143 patients in relation to neurological damage according to the AIS. Most patients (45%) had no neurological deficits in the initial evaluation (E), followed by 35% with partial deficits (D, C, and B), and 20% with full sensory and motor deficit (A).

Thumbnail

Figure 2
The figure shows the distribution of the 204 fractures found in these patients. Most of the fractures (53.9%) were in the thoracolumbar region, L1 being the most affected level (9%) in this segment. However, of the total number of fractures, those of C6 were the most predominant at 11%, even though subaxial fractures accounted for 36% of all the fractures.

Thumbnail

Figure 3
Flowchart for the evaluation of the instability of high cervical lesions. Adapted from Joaquim et al.²³23 Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro, AR, et al. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med. 2014;37(2):139-51.^-²⁴24 Joaquim AF, Ghizoni E, Tedeschi H, Yacoub AR, Brodke DS, Vaccaro AR, et al. Upper cervical injuries: Clinical results using a new treatment algorithm. J Craniovertebr Junction Spine. 2015;6(1):16-20.

Thumbnail

Table 1
Neurological grading according to the AIS (ASIA Impairment Scale).⁸8 Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017;475(5):1499-504.

Thumbnail

Table 2
Subaxial Cervical Spine Injury Classification System (SLICS). Adapted from Patel et al.²¹21 Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR. Classification and surgical decision making in acute subaxial cervical spine trauma. Spine (Phila Pa 1976). 2010;35(21 Suppl):S228-34.

Thumbnail

Table 3
Thoracolumbar Injury Classification System and Injury Severity Score (TLICS). Adapted from Patel et al.²²22 Patel AA, Dailey A, Brodke DS, Daubs M, Harrop J, Whang PG, et al. Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples. J Neurosurg Spine. 2009;10(3):201-6.

Figure 1 Shows the distribution of the 143 patients in relation to neurological damage according to the AIS. Most patients (45%) had no neurological deficits in the initial evaluation (E), followed by 35% with partial deficits (D, C, and B), and 20% with full sensory and motor deficit (A).

Figure 2 The figure shows the distribution of the 204 fractures found in these patients. Most of the fractures (53.9%) were in the thoracolumbar region, L1 being the most affected level (9%) in this segment. However, of the total number of fractures, those of C6 were the most predominant at 11%, even though subaxial fractures accounted for 36% of all the fractures.

Figure 3 Flowchart for the evaluation of the instability of high cervical lesions. Adapted from Joaquim et al.²³23 Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro, AR, et al. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med. 2014;37(2):139-51.^-²⁴24 Joaquim AF, Ghizoni E, Tedeschi H, Yacoub AR, Brodke DS, Vaccaro AR, et al. Upper cervical injuries: Clinical results using a new treatment algorithm. J Craniovertebr Junction Spine. 2015;6(1):16-20.

Table 1 Neurological grading according to the AIS (ASIA Impairment Scale).⁸8 Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017;475(5):1499-504.

A	Full neurological deficit, including the sacral segment.
B	Full motor deficit, feeling preserved (sacral segments present).
C	Partial motor deficit, loss of >50% (or <3/5).
D	Partial motor deficit, loss of <50% (or >3/5).
E	No deficit, however presented a temporary deficit, including nerve root deficit.

Table 2 Subaxial Cervical Spine Injury Classification System (SLICS). Adapted from Patel et al.²¹21 Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR. Classification and surgical decision making in acute subaxial cervical spine trauma. Spine (Phila Pa 1976). 2010;35(21 Suppl):S228-34.

Morphology	Points
Without changes	0
Compression (A)	1
Burst (A +1)	+1
Distraction (B)	3
Translation/Rotation (C)	4
Posterior ligament complex integrity
Intact	0
Undetermined	1
Ruptured	2
Neurological status
Intact	0
Radicular lesion	1
Full deficit	2
Partial deficit	3
Persistent compression of the canal*	+1

Table 3 Thoracolumbar Injury Classification System and Injury Severity Score (TLICS). Adapted from Patel et al.²²22 Patel AA, Dailey A, Brodke DS, Daubs M, Harrop J, Whang PG, et al. Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples. J Neurosurg Spine. 2009;10(3):201-6.

Morphology	Points
Without changes	0
Compression (A)	1
Burst (A +1)	+1
Translation/Rotation (C)	3
Distraction (B)	4
Posterior ligament complex integrity
Intact	0
Undetermined	2
Ruptured	3
Neurological status
Intact	0
Radicular lesion	2
Full deficit	2
Partial deficit	3
Cauda Equina Syndrome	3

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[1] Correspondence: Universidade Estadual de Campinas. Rua: Tessália Vieira de Camargo, 126, Departamento Neurologia, Cidade Universitária. Campinas, SP, Brasil. 13083-887. andjoaquim@yahoo.com