Publications by authors named "Andrei Fernandes-Joaquim"

Article Synopsis
  • * Out of 17 patients, 47.1% were pain-free after surgery, with 70% of those who had preoperative neurological deficits showing improvement.
  • * Results suggest that surgery for spinal metastases can significantly enhance quality of life while maintaining low complication rates.
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Introduction: Classifications are helpful for surgeons as they can be a resource for decision-making, often providing the individual indicators that may deem a case necessary for surgery. However, when there are multiple classifications, the decision-making might be compromised. That is the case with C2 fractures.

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Background: Thoracolumbar spinal fractures (TLSF) can cause pain, neurological deficits, and functional disability. Operative treatments aim to preserve neurological function, improve functional status, and restore spinal alignment and stability. In this review, we evaluate the relationship between spinal alignment and functional impairment in patients with TLSF.

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Article Synopsis
  • Osteoporotic vertebral fractures lead to pain and diminished quality of life, and there’s ongoing debate on how best to manage them, particularly comparing percutaneous vertebroplasty (PV) to non-operative treatments (non-OT).* -
  • The analysis of randomized controlled trials showed PV provided significant pain relief at multiple time points, and notable improvements in quality of life were seen in the short term, but not consistently in the long term.* -
  • A substantial risk of cement leakage (42%) was noted with PV, but it did not increase the risk of new fractures; thus, careful patient selection is vital due to variability among studies.*
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Objective: We aim to report the epidemiology, surgical outcomes, and survival rates of pediatric patients with posterior fossa tumors in a large single-center case series.

Methods: A retrospective analysis was conducted on pediatric patients who underwent surgical treatment for posterior fossa tumors between January 2011 and January 2019.

Results: A total of 135 pediatric patients, with an average age of 7.

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Study Design: A prospective study.

Objective: to evaluate the impact of vertebral body comminution and Posterior Ligamentous Complex (PLC) integrity on the treatment recommendations of thoracolumbar fractures among an expert panel of 22 spine surgeons.

Methods: A review of 183 prospectively collected thoracolumbar burst fracture computed tomography (CT) scans by an expert panel of 22 trauma spine surgeons to assess vertebral body comminution and PLC integrity.

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Study Design: Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations.

Objectives: To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier.

Methods: Kappa and Intraclass correlation coefficients were produced.

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Article Synopsis
  • This study analyzed data from 183 cases of thoracolumbar burst fractures to understand factors affecting treatment agreement among experts.
  • Only 4.4% of cases reached full expert consensus, with 44.3% in the agreement group and 55.7% in the equipoise group, indicating significant uncertainty among the panel.
  • The agreement group showed greater certainty regarding PLC disruption and more usage of the M1 modifier, while the equipoise group had a higher proportion of more severe A3/A4 fractures, suggesting a need for further research on how comminution influences treatment decisions.
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Study Design: This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue.

Objectives: Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures.

Methods: We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making.

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Study Design: Predictive algorithm via decision tree.

Objectives: Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations.

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Posterior fossa tumors are the most common pediatric brain tumors, and present unique challenges in terms of their location and surgical management. The posterior fossa comprehends complex anatomy and represents the smallest and deepest of the three cranial base fossae. An in-depth understanding of posterior fossa anatomy is crucial when it comes to the surgical resection of pediatric brain tumors.

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Objective: The aim of this study was to evaluate the outcome and surgical complications in patients with spinal schwannoma or neurofibroma surgically treated at the Hospital das Clínicas of the State University of Campinas.

Methods: This was a retrospective cohort study, using medical records of patients operated between 2011 and 2021. The sample distribution was verified using the Kolmogorov-Smirnov test.

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While in adults most intracranial tumors develop around the cerebral hemispheres, 45 to 60% of pediatric lesions are found in the posterior fossa, although this anatomical region represents only 10% of the intracranial volume. The latest edition of the WHO classification for CNS tumors presented some fundamental paradigm shifts that particularly affected the classification of pediatric tumors, also influencing those that affect posterior fossa. Molecular biomarkers play an important role in the diagnosis, prognosis, and treatment of childhood posterior fossa tumors and can be used to predict patient outcomes and response to treatment and monitor its effectiveness.

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Introduction: Growing skull fracture (GSF) is a rare complication of head trauma in the pediatric population, commonly observed in children younger than 3 years.

Discussion: In this report, the authors describe a case of a 3-year-old male child, with clinical features of Ehlers-Danlos syndrome (EDS), who developed a GSF in frontal bone after a crib fall, treated with duraplasty and cranioplasty with autologous craft. Here, pertinent literature was reviewed with an emphasis on surgical techniques, and correlation with the mentioned syndrome.

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Mesial temporal lobe epilepsy is the most frequent type of focal epilepsy in young adults and the most commonly reported in surgical series worldwide. When seizures become refractory to drug therapy, they are unlikely to remit spontaneously, and for the 30% of patients with epilepsy that is refractory to antiepileptic drugs, resection of the mesial temporal lobe structures provides seizure control rates of 70%-80%. The transsylvian route for amygdalohippocampectomy has been used at our institution for many years, evolving from the first description of Yasargil through the inferior circular sulcus of insula to the most recent one through the amygdala trying to preserve the temporal stem.

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Objective: The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery).

Methods: A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval.

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Background: Traumatic facet dislocations in the subaxial cervical spine, also known as locked facets, are commonly associated with neurological deficits. The fear of the presence of an associated traumatic disc herniation and consequent neurological worsening usually causes a delay in the spinal realignment. This study's aim is an analysis of safety and efficacy when treating acute cervical traumatic facet dislocations using cranial-cervical traction or posterior open reduction and fixation in the presence of disc herniations.

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Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae's facets, leading to loss of joint congruence. Reduction requires either cranial traction or open surgical procedures. This study aims to appraise the effects of different surgical techniques in the treatment of subaxial cervical spine acute traumatic facet blocks in adults.

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Anaplastic gangliogliomas (AGG) are rare tumors of the central nervous system (CNS) that commonly affect children and young adults, with an unusual infratentorial presentation, which is related to hydrocephalus and a worse prognosis. We report a case of a brainstem AGG in a 2-year-old boy who underwent a ventriculoperitoneal shunting (VPS) and later presented peritoneal metastasis. We also reviewed the related literature.

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Study Design: Cross-sectional, international survey.

Objectives: To evaluate the knowledge of spine surgeons regarding the use of electromyography (EMG) and nerve conduction studies (NCS) for degenerative cervical spine conditions (DCC).

Methods: All members of AO Spine International were emailed an anonymous survey to evaluate their clinical knowledge about the use of EMG and nerve conduction studies for DCC.

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Article Synopsis
  • The study investigates the link between the angioarchitecture of brain arteriovenous malformations (bAVMs) and how they present clinically, as this relationship has been debated in the medical community.
  • A total of 183 patients were reviewed, categorized by their clinical symptoms such as hemorrhage, seizure, headache, progressive neurological deficits, or incidental findings.
  • Significant correlations were found, such as hemorrhage being more common in females and linked to specific angioarchitectural features, highlighting the potential for developing predictive models to identify clinical presentations based on these characteristics.*
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Background: Reporting complications and/or adverse events after spinal surgical procedures enables the estimation of their prevalence and of their impact on patient outcomes. However, the documentation of complications is relatively infrequent and highly heterogeneous. The purpose of this study was to evaluate the quality of complication and adverse event reporting in spinal surgery literature.

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