Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-27T13:57:51Z No. of bitstreams: 1 Vanessa Milanesi Holanda.pdf: 1185275 bytes, checksum: 780810a027a0b0fd0a45e08edaa3f88d (MD5) / Made available in DSpace on 2015-07-27T13:57:51Z (GMT). No. of bitstreams: 1 Vanessa Milanesi Holanda.pdf: 1185275 bytes, checksum: 780810a027a0b0fd0a45e08edaa3f88d (MD5) Previous issue date: 2013-12-18 / Every year, over one million individuals worldwide were submitted to laminectomies, with a rate failure higher than 40%. Post laminectomy epidural adhesion is implicated as a main cause of ‘‘failed back surgery syndrome’’ and associated with high risk of complications during the revision surgery. The postoperative epidural scar can cause extradural compression or dural tethering, which lead to recurrent radicular pain and physical impairment. Several studies in the literature are signalizing that Low-Level-Laser-Therapy (LLLT) is proven to be an effective tool to assist the inflammatory process and wound healing, as well to prevent infection and dehiscence. The objectives of this project are to delineate and evaluate the LLLT effects in spinal surgery. A prospective randomized, controlled trial with a total of 48 patients, who underwent to laminectomy, were divided into 2 groups, as following: in 25 randomized patients, LLLT infrared, Power = 40mW, Fluence= 7.44 J/cm2 was applied during transoperatory phase, on the laminectomy site, on the subcutaneous tissue and surrounding the wound site. In the second group, 23 patients were induced to believe that they were getting the same treatment, avoiding psychological effect, although LLLT was not operating. In those groups, C reactive protein (CRP), lactic dehydrogenase and creatine kinase (CK) were assessed in the second and fifth days after surgery, digital temperature and visual analogue scale were measured, pre and post LLLT application. The drainage output were collected in the first and second days, following surgery in both groups. Interleukins 1, 4, 6, 8 and 10 and tumor necrosis factor alpha (TNF- α) were evaluated. The results indicated temperature decrease, pain relief and accelerated wound healing in laser group. LLLT facilitates the wound cicatrization, due to a prompt resolution while acute inflammation, as suggested by the CRP chiefly drop from second to fifth postoperative day; in which the proliferation phase of healing demonstrated statistically significant values by fast fall in the laser group of CK, suggesting that these markers may guide LLLT treatment evolution. In conclusion, it was demonstrated that only three LLLT applications could assist better wound healing, reduce the lesion inflammation, decrease drainage output and promote analgesia in the PO post laminectomy with cost-effectiveness. / A cada ano, mais de um milhão de pessoas ao redor do mundo são submetidas à cirurgia da coluna vertebral, com uma taxa de insucesso superior a 40%. A fibrose epidural pós-laminectomia é apontada como a principal causa da síndrome do insucesso da cirurgia espinhal e está associada ao aumento do risco de complicações durante a cirurgia de revisão. A cicatriz pós-operatória peridural pode causar compressão extradural, resultando em dor radicular recorrente e déficits neurológico. Inúmeros estudos sinalizam que o laser de baixa intensidade (LBI) tem sido descrito como eficaz no auxílio do decréscimo da inflamação e cicatrização de feridas cirúrgicas. Objetivos: Delinear e analisar os efeitos da laserterapia em cirurgia da coluna vertebral. Metodologia: Estudo prospectivo randomizado e controlado por placebo com 48 pacientes submetidos à laminectomia, divididos aleatoriamente em 2 grupos. No primeiro grupo, 25 pacientes receberam Laser no infravermelho (λ= 804nm), Potência= 40mW, Fluência= 7.44 J/cm2 durante a cirurgia nas seguintes áreas: durante o transoperatório na dura-máter, sobre subcutâneo e sobre a pele; além do leito da ferida cirúrgica em 24h e 72h após a cirurgia. No segundo grupo, 23 pacientes foram induzidos a acreditar que receberam o mesmo tratamento. Antes da cirurgia, além dos dias 2 e 5 pós operatórios (PO), foram coletadas amostras de sangue do paciente para estudo de PCR, DHL e CK. Antes e após a laserterapia, a temperatura corpórea foi medida por meio de termômetro digital e a dor foi avaliada por meio de escala analógica visual. Nos dias 1º e 2º PO, o débito do dreno foi coletado e analisado as citocinas foram avaliadas por ELISA interleucinas 1, 4, 6, 8, 10 e TNF-alfa do exsudato. Resultados: Demonstraram uma diminuição de temperatura, alívio da dor e cicatrização acelerada no grupo laser, além de uma redução do débito do dreno, contribuindo para redução da perda sanguínea e evitando infecção. O LBI facilita a reparação de feridas, devido a uma resolução mais rápida do processo inflamatório agudo, como foi sugerido pela maior queda do PCR do 2º para o 5º dia pós-operatório. A fase de proliferação da cicatrização foi antecipada, já que os valores de CK revelaram uma queda mais rápida no grupo do laser, sugerindo que esses marcadores inflamatórios podem nortear o tratamento com LBI. Conclusão: Demonstramos que três aplicações do LBI podem reduzir a inflamação, auxiliar na drenagem e estimular uma melhor cicatrização de feridas, ajudando no processo de analgesia no pós-operatório na cirurgia de coluna vertebral.

Background: The optimal timing of surgical therapy for traumatic spinal cord injury (TSCI) remains unclear. The purpose of this study is to evaluate the impact of “ultra-early” (<4 h) versus “early” (4–24 h) time from injury to surgery in terms of the likelihood of neurologic recovery. Methods: The effect of surgery on neurological recovery was investigated by comparing the assessed initial and final values of the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A post hoc analysis was performed to gain insight into different subgroup regeneration behaviors concerning neurological injury levels. Results: Datasets from 69 cases with traumatic spinal cord injury were analyzed. Overall, 19/46 (41.3%) patients of the “ultra-early” cohort saw neurological recovery compared to 5/23 (21.7%) patients from the “early” cohort (p = 0.112). The subgroup analysis revealed differences based on the neurological level of injury (NLI) of a patient. An optimal cutpoint for patients with a cervical lesion was estimated at 234 min. Regarding the prediction of neurological improvement, sensitivity was 90.9% with a specificity of 68.4%, resulting in an AUC (area under the curve) of 84.2%. In thoracically and lumbar injured cases, the estimate was lower, ranging from 284 (thoracic) to 245 min (lumbar) with an AUC of 51.6% and 54.3%. Conclusions: Treatment within 24 h after TSCI is associated with neurological recovery. Our hypothesis that intervention within 4 h is related to an improvement in the neurological outcome was not confirmed in our collective. In a clinical context, this suggests that after TSCI there is a time frame to get the right patient to the right hospital according to advanced trauma life support (ATLS) guidelines.

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