ABSTRACT Objective: To define which laminoplasty technique provides the greatest increase in spinal canal dimensions. Methods: This was an experimental clinical trial. A patient diagnosed with multilevel degenerative cervical spinal canal stenosis causing myelopathy was initially identified. Magnetic resonance imaging and computed tomography of the patient’s cervical spine were imported to a software program to print the anatomical model. A total of 20 identical cervical spine biomodels were printed, equally distributed into four groups: control, Open-door (OD), French-door (FD), and Two-open-doors (TOD) laminoplasty. The biomodels of the experimental groups underwent the laminoplasty surgical procedure, from C3 to C6, according to each technique. All specimens underwent computed tomography, and the cross-sectional area and anteroposterior diameter of the spinal canal were measured. The data were subjected to statistical analyses, and p-values < 0.05 were considered statistically significant. Results: All techniques increased the dimensions of the spinal canal. OD laminoplasty was superior to FD in the area evaluation (OD: 2.17 cm2; FD: 1.92 cm2), and there was no statistically significant difference in the increase in anteroposterior diameter (OD: 10.97 mm; FD: 10.42 mm). TOD laminoplasty (area: 2.30 cm2; diameter: 11.94 mm) was superior to FD in both variables. There was no statistical difference between OD and TOD laminoplasty. Conclusions: The OD technique expands the cross-sectional area of the spinal canal more than FD laminoplasty, with no significant difference in diameter. TOD laminoplasty increases the dimensions of the spinal canal more than FD, and it tends to be superior to OD laminoplasty. Level of Evidence I, Therapeutic Studies.
ABSTRACT Objective: To evaluate the effects of the frequency of physiotherapeutic intervention on quality of life, anxiety, and depression in patients with chronic low back pain. Methods: A randomized clinical trial was conducted with 40 patients undergoing treatment at the Physiotherapy Outpatient Clinic of a teaching hospital. Participants were divided into two groups: Group 1 received the physiotherapeutic protocol once a week for four weeks (totaling four sessions); Group 2 received the protocol three times a week for four weeks (totaling twelve sessions). The protocol included mat and studio Pilates, myofascial release, and elastic functional bandaging. Assessments were performed at the beginning and end of treatment using a visual analog scale for pain, the WHOQOL-PAIN quality of life questionnaire validated for Portuguese, the Beck Anxiety Inventory, and the Beck Depression Inventory. Results: Group 2 showed significantly greater improvement compared to the group that underwent the protocol once a week, confirming that more frequent physiotherapy ensures better psychophysical outcomes and functional-clinical improvement. Conclusion: Physiotherapy administered three times per week was more effective in improving quality of life, anxiety, and depression in patients with chronic low back pain. Level of evidence I; Therapeutic studies - Investigation of treatment outcomes.
ABSTRACT Three-dimensional (3D) printing has rapidly advanced in the healthcare field over the past decades, becoming more accessible due to the wide variety of technologies and materials available. This has secured 3D printing a prominent place in medical specialties, such as spinal surgery, due to its ability to create complex objects, including anatomical models of the spine and its adjacent structures, based on medical imaging. In this specialty, the technology can be used for both preoperative planning and intraoperative support through biomodels and surgical guides. To recognize and explore the use of 3D printing in spinal surgeries, a systematic review was conducted in two databases, focusing on its applications and cost reports. Of the 142 studies identified, only 13 were included in the review due to their strict relevance to the topic. Although scientific studies on the impact of 3D printing in healthcare remain scarce, largely due to a lack of broad, robust research, it was possible to detail the financial impact in the surgical field throughout the entire process of producing 3D-printed objects, from planning and printing to the surgical center. Economic and decision analyses were also conducted. Level of evidence II; review article.
ABSTRACT Objective: To describe the clinical profile and postoperative outcomes of patients undergoing instrumented spinal arthrodesis under a preemptive antibiotic therapy protocol with vancomycin and ciprofloxacin. Methods: A retrospective, consecutive, and single-center case series was conducted involving 88 patients operated on between January 2021 and December 2022. The protocol consisted of intravenous vancomycin (1 g) and ciprofloxacin (400 mg) administered 60 minutes before incision, with postoperative maintenance for five days. The minimum clinical follow-up was 24 months. Results: The mean age was 45.2 years, with a male predominance (60.2%). Trauma was the most frequent surgical indication (38.9%), followed by neoplasms (25%). The overall arthrodesis infection rate was 4.5% (4/88 patients), with 75% of these cases occurring in patients with oncological etiology. Only one adverse event (1.1%) related to vancomycin was recorded. Conclusions: The preemptive antibiotic therapy protocol showed favorable infection rates (4.5%) and good pharmacological tolerability in the studied sample, suggesting it is a viable strategy for high-complexity spine surgeries. Level of Evidence IV; Case series.
ABSTRACT Cervical radiculopathy is a common condition affecting the cervical spine. Few trials with a small number of patients tried to establish the most efficient treatment in the literature that varies between surgical and nonsurgical approaches. We conducted a systematic review and meta-analysis to evaluate surgical versus nonsurgical treatment efficacy for cervical radiculopathy PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to July 2025 to identify randomized controlled trials (RCTs) studies comparing surgical and nonsurgical treatment on adult patients with cervical radiculopathy. Outcomes of interest included Neck Disability Index (NDI), Arm pain and Neck pain (pain grade measured by Visual Analogue Scale and Numeric Rating Scale). We calculated the mean difference for each comparison and did a conventional random effects meta-analysis. We included 4 RCTs with 323 total patients with 161 randomized to surgery group and 162 to nonsurgery group. Mean difference NDI score of surgical vs. nonsurgical group at 12 months follow-up has no statistically significant difference (MD: -2.54 95% CI: -6.33 to 1.24; I2=52%; P=0.19). Short-term outcomes were also analyzed, resulting in a rapid efficacy of surgical treatment and a progressive efficacy of nonsurgical therapy on 3 months follow-up (MD: -7.61 95% CI: -12.48 to -2.74; I2=0%; P=0.002) and 6 months follow-up (MD: -5.87 95% CI: -9.59 to -2.15; I2=0%; P=0.002). Surgical group was associated with a considerable reduction of arm pain (MD: -1.17; 95% CI: -1.66 to -0.68; I2=0%; P<0.00001) and neck pain (MD: -0.84; 95% CI: -1.38 to -0.31; I2=23%; P=0.002) on the comparative analysis of both groups. These findings suggest a mid-term association of quality of life and pain reduction in patients with cervical radiculopathy who underwent surgery compared to nonsurgical treatments. The long-term comparison between surgical and nonsurgical therapy showed no statistically significant difference. Level of Evidence: II; Systematic Review/Meta-analysis.
