Bruno Brasil Do Couto

Objective: To evaluate the surgical and postoperative outcomes of patients undergoing reverse foraminoplasty via a contralateral endoscopic approach for the treatment of central canal or lateral recess stenosis associated with foraminal stenosis, with a minimum follow-up of two years. Methods: This retrospective, quantitative, and descriptive study was conducted at Porto Dias Hospital, Belém-PA, and approved by the Research Ethics Committee. Thirteen patients who met the inclusion criteria were enrolled. Primary outcomes included pain reduction, assessed by the Visual Analogue Scale (VAS), and functional improvement, measured by the Oswestry Disability Index (ODI). Data normality was tested using the Shapiro-Wilk test, and paired t-tests were used to compare outcomes over time (significance level p < 0.05). Results: The mean patient age was 57.3 ± 13.54 years. The average operative time per level treated was 58.4 minutes (range: 22-117 min). There was a mean ODI reduction of 33.6 points over the follow-up period (p < 0.001). Local pain (VAS) decreased from 6.8 to 1.8, and radicular pain from 7.9 to 1.6 after two years (p < 0.001 for both). One complication was reported (dural tear; 7.69%). Conclusions: Reverse foraminoplasty performed via a contralateral endoscopic approach was safe and effective, providing sustained pain relief, significant functional improvement, and a low complication rate over a two-year follow-up. Level of Evidence III; Retrospective Comparative Study.

The objective of this article was to present an uncommon case of fully endoscopic resection of an osteoid osteoma in the S1 vertebra in a patient with lower back pain and no neurological symptoms. The patient was a 26-year-old male with significant lower back pain, worsening at night and improving with the use of non-steroidal anti-inflammatory drugs (NSAIDs). Lumbar imaging revealed an osteoblastic lesion near the right pedicle in the S1 vertebral body, with no evident nidus or contrast uptake. A biopsy guided by computed tomography confirmed the diagnosis of osteoid osteoma. The patient was treated with a fully endoscopic transcorporeal resection of S1 via a posterolateral extra-foraminal approach. The surgical technique was detailed, and the patient showed immediate clinical symptom improvement. Although there are several surgical techniques for the resection of spinal tumors, there is no consensus in the literature regarding the best surgical technique or conservative treatments. However, fully endoscopic techniques are emerging as a promising method for both diagnosis and treatment, potentially reducing complications and procedural morbidity. Level of Evidence IV; Case Report.

The treatment for symptomatic pars interarticularis spondylolysis remains controversial. Since most affected patients are young, minimally invasive techniques, have been reported to minimize tissue damage and provide an early return to daily activities. We report a clinical case of a patient with a lesion of the pars, a lesion of the contralateral pedicle, and a herniated disc who underwent surgical treatment by endoscopy one time. Due to the low level of evidence of the case report/series, further studies should be carried out to confirm this hypothesis. Level of Evidence IV; Case Report.

Cauda Equina Syndrome (CES) is a severe neurological emergency resulting from the compression of the lumbosacral nerve roots, potentially causing motor and sensory deficits, as well as sphincter dysfunctions. Early surgical intervention is essential to prevent permanent neurological sequelae. Traditionally, open laminectomy has been the treatment of choice for decompression. Still, minimally invasive techniques, such as endoscopic discectomy, are gaining popularity due to lower morbidity, smaller incisions, and faster recovery. This study reports three cases of patients with CES treated with endoscopic discectomy. Two cases were caused by a large, extruded disc herniation and one by an intracanal facet cyst. Pain intensity was assessed using the Visual Analog Scale (VAS), and functional disability was measured with the Oswestry Disability Index (ODI) in the preoperative period and at follow-ups of 1, 6, and 12 months. All three patients showed significant improvement in symptoms, with pain reduction and functional improvement. At 12 months, the patients maintained their functional and neurological recovery without reported complications. The endoscopic technique proved to be a safe and effective method for treating CES in these cases, offering early recovery and fewer postoperative complications. Future studies with larger populations are needed to validate these findings. Level of Evidence IV; Case Report.

Autism Spectrum Disorder (ASD) is a complex neurological condition that can make it difficult to identify symptoms such as pain and neurological changes due to communication limitations. This article reports a case of a 21-year-old autistic patient with cervical disc herniation, treated with posterior endoscopic discectomy. The diagnosis was challenging due to the patient’s inability to clearly express his symptoms, leading to episodes of self-harm. After conservative treatment failed, the endoscopic discectomy was successfully performed using a personalized hospital protocol to minimize the patient’s stress. The procedure was successful, significantly improving quality of life and pain control. This case highlights the importance of considering orthopedic conditions in patients with ASD. It demonstrates the effectiveness of endoscopic discectomy as a minimally invasive option for treating cervical disc herniation in patients with neurological conditions. Level of Evidence IV; Case Report.

OBJETIVO: comparar as imagens radiológicas da espondilodiscite tuberculosa e a inespecífica. MÉTODOS: estudo retrospectivo mediante revisão de prontuários e exames de imagem dos pacientes portadores de discite inespecífica e específica pelo Micobacterium tuberculosis, que realizaram tratamento, pelo Grupo de Coluna do Departamento de Ortopedia e Traumatologia no período de 1989 a Agosto de 2009. RESULTADOS: foram analisados 48 prontuários e arquivos de imagens de pacientes portadores de discite tuberculosa (Tbc) e 31 de pacientes portadores de discite inespecífica. Dos portadores de espondilite tuberculosa, também denominada mal de Pott, 54% eram do sexo masculino. A idade variou de 3 a 87 anos com média de 44,1 anos. Nos pacientes portadores de discite inespecífica, 68% eram do sexo masculino, e a idade variou de 2 meses a 76 anos. O padrão radiográfico predominante na discite por Tbc foi o acunhamento da região anterior do corpo vertebral em 88,2% dos casos. Nos pacientes com discite inespecífica, a diminuição do espaço discal foi o achado mais prevalente, encontrado em 87% dos casos. CONCLUSÃO: A discite por Tbc apresentou nesta série uma maior prevalência de alterações estruturais importantes na coluna vertebral, como a cifose, e reação paravertebral em relação à discite inespecífica. Enquanto a prevalência de infecção inespecífica foi maior em pacientes pediátricos, a discite por Tbc teve prevalência progressivamente maior com o aumento da idade dos pacientes.