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INTRODUCTION: Tele-exercise, defined as an intervention that offers physical training provided remotely, represents an alternative for remote care during social isolation and the absence of in-person interventions, considering the difficulties of regular exercise engagement in tetraplegia. The current study aimed to examine whether tele-exercise training in individuals with tetraplegia meets the recommendations proposed by the spinal cord injury (SCI)-specific guidelines, and the adherence. METHODS: Twenty SCI tetraplegia performed tele-exercise training. The weekly training load of the tele-exercise training during the 27 weeks was compared to the estimated training load of SCI-specific guidelines: TW vigorous guideline: vigorous intensity of guideline proposed for Tweedy et al.; MG vigorous guideline: vigorous intensity of guideline proposed for Martin Ginis et al.; MG moderate guideline: moderate intensity of guideline proposed for Martin Ginis et al. Adherence was obtained weekly during 27 weeks. RESULTS: The tele-exercise training load was 22.0% higher than the MG moderate guideline and 21.6% and 47.7% lower than the MG vigorous and TW vigorous guidelines, respectively. The tele-exercise training loads for men and women were, respectively, 2.3% and 35.0% higher than the MG moderate guideline; 34.0% and 13.2% lower than the MG vigorous guideline; and 56.1% and 42.1% lower than the TW vigorous guideline. Adherence was 45.1%. CONCLUSION: The tele-exercise training in men and women with tetraplegia for 7 months met the moderate intensity of recommendation proposed by one SCI exercise guideline. The adherence was 45.1%, with higher values for men compared to women. This finding shows that tele-exercise training may be an alternative exercise training intervention for tetraplegia and prompts reflexion on the inclusion of tele-exercise training in SCI exercise guidelines.

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BACKGROUND: The recent San Diego-Mexico border wall height extension has resulted in an increased injury risk for unauthorized immigrants falling from greater heights. However, the effects of the border wall extension on frequency and morbidity of spinal injuries and related economic costs have yet to be highlighted. METHODS: We retrospectively compared two cohorts who presented to the UC San Diego Health Trauma Center for border wall falls: pre-height extension (12 patients; January 2016-May 2018), and post-height extension (102 patients; January 2020-December 2021). Patients presented during border wall construction (June 2018-December 2019) were excluded. Demographics, clinical data and hospital costs were collected. Spinal injuries were normalized using Customs and Border Protection apprehensions. Costs were adjusted for inflation using the 2021 medical care price index. RESULTS: The increase in spine injuries per month (0.8-4.25) and operative spine injuries per month (0.3- 1.7) was statistically significant (P < 0.001). Increase in median length of stay from 6 [interquartile range (IQR) 2-7] to 9 days (IQR 6-13) was statistically significant (P = 0.006). Median total hospital charges increased from $174 660 to $294 421 and was also significant (P < 0.001). CONCLUSION: The data support that the recent San Diego-Mexico border wall extension is correlated with more frequent, severe and costly spinal injuries. This current infrastructure should be re-evaluated as border-related injuries represent a humanitarian and public health crisis.

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Resumen: Introducción: La histiocitosis de células de Langerhans (HCL) es un trastorno histiocítico raro y su incidencia exacta se mantiene desconocida; se ha diagnosticado en todos los grupos de edad, pero es más común en los primeros 3 años de vida. Se caracteriza por lesiones únicas o múltiples de tipo osteolítico causadas por proliferación clonal de células histológicamente similares a las células de Langerhans; su presentación clínica es heterogénea. Caso clínico: Presentamos el caso de una paciente de sexo femenino de 7 años, con dificultad para la marcha y debilidad progresiva en los miembros inferiores de 5 días de evolución. A la exploración física presenta hallazgos concordantes con síndrome piramidal e hipoes­ tesias de miembros inferiores. Se realizó resonancia magnética (RM) de columna y tomografía computarizada de cráneo simple, que descartó patología intracraneal . En la RM de columna se detectó vertebra plana con extensión epidural y para­ vertebral, por lo que se inició manejo con esteroides y se indicó descompresión quirúrgica. Se realizó resección parcial y biopsia de la lesión. Debido a los hallazgos histológicos y la presencia de marcadores positivos para CD1a y CD207, se confirmó el diagnóstico de HCL. Conclusiones: La HCL es una enfermedad poco frecuente y de difícil diagnóstico por su presentación heterogénea. El granuloma eosinofílico y la vértebra plana como hallazgos imagenológicos pueden orientar el diagnóstico, aunque siempre se debe confirmar histológicamente.

Abstract: Background: Langerhans cell histiocytosis (LCH) is a rare disease, more common in the first three years of lite. lt is characterized by single ar multiple osteolytic lesions due to clonal proliferation of cells histologically similar to Langerhans cells; its clínical presentation is heterogeneous. Case report: 7-year-old female patient with 5 days of progressive lower extremity weakness and difficulty to walk. Physical exam findings were consistent with pyramidal syndrome and lower extremities hypoesthesia. Magnetic resonance imaging (MRI) of spine and cranial computed tomography (CT) were performed. lntracranial pathology was ruled out. The MRI findings showed vertebra plana with epidural and paravertebral involvement, so treatment with steroids and surgical decompression initiated. Partíal resection and biopsy of the lesion was performed. Due to histological findings and positive CD1a and CD207 markers, diagnosis of LCH was confirmed. Conclusions: LCH is an uncommon disease with a challenging diagnosis due to its heterogeneous clinical presentation. Eosinophilic granuloma and vertebra plana as imaging findings may guide the diagnosis. However, it should always be confirmed with histological evidence.

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Introducción: La histiocitosis de células de Langerhans (HCL) es un trastorno histiocítico raro y su incidencia exacta se mantiene desconocida; se ha diagnosticado en todos los grupos de edad, pero es más común en los primeros 3 años de vida. Se caracteriza por lesiones únicas o múltiples de tipo osteolítico causadas por proliferación clonal de células histológicamente similares a las células de Langerhans; su presentación clínica es heterogénea. Caso clínico: Presentamos el caso de una paciente de sexo femenino de 7 años, con dificultad para la marcha y debilidad progresiva en los miembros inferiores de 5 días de evolución. A la exploración física presenta hallazgos concordantes con síndrome piramidal e hipoestesias de miembros inferiores. Se realizó resonancia magnética (RM) de columna y tomografía computarizada de cráneo simple, que descartó patología intracraneal. En la RM de columna se detectó vertebra plana con extensión epidural y paravertebral, por lo que se inició manejo con esteroides y se indicó descompresión quirúrgica. Se realizó resección parcial y biopsia de la lesión. Debido a los hallazgos histológicos y la presencia de marcadores positivos para CD1a y CD207, se confirmó el diagnóstico de HCL. Conclusiones: La HCL es una enfermedad poco frecuente y de difícil diagnóstico por su presentación heterogénea. El granuloma eosinofílico y la vértebra plana como hallazgos imagenológicos pueden orientar el diagnóstico, aunque siempre se debe confirmar histológicamente. Background: Langerhans cell histiocytosis (LCH) is a rare disease, more common in the first three years of life. It is characterized by single or multiple osteolytic lesions due to clonal proliferation of cells histologically similar to Langerhans cells; its clinical presentation is heterogeneous. Case report: 7-year-old female patient with 5 days of progressive lower extremity weakness and difficulty to walk. Physical exam findings were consistent with pyramidal syndrome and lower extremities hypoesthesia. Magnetic resonance imaging (MRI) of spine and cranial computed tomography (CT) were performed. Intracranial pathology was ruled out. The MRI findings showed vertebra plana with epidural and paravertebral involvement, so treatment with steroids and surgical decompression initiated. Partial resection and biopsy of the lesion was performed. Due to histological findings and positive CD1a and CD207 markers, diagnosis of LCH was confirmed. Conclusions: LCH is an uncommon disease with a challenging diagnosis due to its heterogeneous clinical presentation. Eosinophilic granuloma and vertebra plana as imaging findings may guide the diagnosis. However, it should always be confirmed with histological evidence.

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PURPOSE: We performed an agreement study using two subaxial cervical spine classification systems: the AOSpine and the Allen and Ferguson (A&F) classifications. We sought to determine which scheme allows better agreement by different evaluators and by the same evaluator on different occasions. METHODS: Complete imaging studies of 65 patients with subaxial cervical spine injuries were classified by six evaluators (three spine sub-specialists and three senior orthopaedic surgery residents) using the AOSpine subaxial cervical spine classification system and the A&F scheme. The cases were displayed in a random sequence after a 6-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. RESULTS: Inter-observer: considering the main AO injury types, the agreement was substantial for the AOSpine classification [κ = 0.61 (0.57-0.64)]; using AO sub-types, the agreement was moderate [κ = 0.57 (0.54-0.60)]. For the A&F classification, the agreement [κ = 0.46 (0.42-0.49)] was significantly lower than using the AOSpine scheme. Intra-observer: the agreement was substantial considering injury types [κ = 0.68 (0.62-0.74)] and considering sub-types [κ = 0.62 (0.57-0.66)]. Using the A&F classification, the agreement was also substantial [κ = 0.66 (0.61-0.71)]. No significant differences were observed between spine surgeons and orthopaedic residents in the overall inter- and intra-observer agreement, or in the inter- and intra-observer agreement of specific type of injuries. CONCLUSION: The AOSpine classification (using the four main injury types or at the sub-types level) allows a significantly better agreement than the A&F classification. The A&F scheme does not allow reliable communication between medical professionals.

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OBJECT: The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. METHODS: Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. RESULTS: Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. CONCLUSIONS: Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

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Introdução: O trauma raquimedular é uma agressão à medula espinhalque pode ocasionar danos neurológicos, tais como alterações da funçãomotora, sensitiva e autônoma. Acidentes automobilísticos, queda de altura,acidente por mergulho em água rasa e ferimentos por arma de fogo têmsido as principais causas de traumatismo raquimedular.Objetivos: Levantar as principais complicações do traumatismo raquimedularnos pacientes internados na unidade de neurocirurgia do Hospitalde Base do Distrito Federal no ano de 2012.Metodologia: Trata-se de um estudo quantitativo, retrospectivo, descritivo,com corte transversal, realizado por meio de pesquisa de dados secundários.O estudo foi realizado com dados obtidos no banco de dadosdo prontuário eletrônico (TRACK CARE) do Hospital de Base do DistritoFederal.Resultado e discussão: A avaliação dos 36 prontuários eletrônicos de vítimasde traumatismo raquimedular permitiu verificar as complicações demaior incidência, sendo a bexiga neurogênica (intrínseca da patologia) e aúlcera por pressão (decorrente da internação) as mais prevalentes. Mais dametade dos pacientes apresentaram complicações durante a hospitalização,com destaque para a bexiga neurogênica, sendo que as lesões completasforam as que tiveram maior incidência de complicações relacionadasao traumatismo raquimedular.

Introduction: The spinal cord injury is an insult to the spinal cord whichcan cause neurological damage, such as changes in motor function, sensoryand autonomous. Automobile accidents, falls, accidents per dive inshallow water and injury by firearms have been the main causes of SpinalCord Trauma.Objectives: Raise the main complications of spinal cord injury in patientsadmitted to the neurosurgery unit of the Base Hospital District Federal in2012.Methodology: This is a quantitative, retrospective, descriptive, cross-sectionalstudy using secondary data research. The study was conducted withdata from the database of electronic medical records (TRACK CARE) ofthe Hospital de Base do Distrito Federal.Results and discussion: In the evaluation of the electronic medical recordsof 36 victims of spinal cord injury has shown complications, whichthe highest incidence of them was neurogenic bladder (intrinsic of the patology)and pressure ulcers (arising from hospitalization). Over half of thepatients had complications during hospitalization, especially the neurogenicbladder, more prevalent in complete lesions, which had the higherincidence of complications related to spinal cord injury.

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OBJECTIVE: The spinal cord-injured patients begin to present a new configuration of forces on the joints. The hip joint is one of the most affected, because these patients generally use a wheelchair as a means of locomotion. Osteoarticular changes, such as heterotopic ossification, can be found in these patients, as evidenced by radiographic studies. This study aims to identify radiographic changes in hips of spinal cord-injured patients. METHODS: 15 patients (30 hips) were evaluated and followed up at the Laboratory of Biomechanical Rehabilitation of the Musculoskeletal System of HC-Unicamp, through the analysis of radiographs of the pelvis in anterior-posterior and Lowenstein lateral positions. RESULTS: Of the total hips, only seven (23%) had no evidence of articular damage. The prevalence of heterotopic ossification found (16.6%) was similar to the literature. CONCLUSION: The radiographic assessment of these patient's hips is justified by the prevalence of joint changes found. Level of Evidence II, Development of diagnostic criteria in consecutive patients (with universally applied reference "gold" standard).

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El trauma de la columna vertebral trae implicaciones serias tanto para la morbimortalidad del paciente como para el sistema de salud, por lo cual es necesario conocer el enfoque diagnóstico por imágenes, ya que este es fundamental para el manejo de los pacientes. Para ello se debe recordar la anatomía, la biomecánica de la columna y entender muy bien los mecanismos del trauma, ya que de esto dependen las indicaciones de los exámenes radiológicos pertinentes. [Ortiz CJ. Uso de imágenes diagnósticas en trauma raquimedular UNAB 2011; 14:22-31].

The trauma of the spine brings serious implications for the morbimortality of patients and the health system, making it necessary to know the imaging approach, as this is critical to the patient management. For these reason you must remember the anatomy, biomechanics of the spine and understand the mechanisms and causes of the trauma, as this depends on the indications of the relevant radiologic exams. [Ortiz CJ. Imaging approach in spine trauma patients. UNAB 2011; 14:22-31].

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OBJETIVO: Os pacientes lesado-medulares passam a se submeter a uma nova conformação de forças sobre as articulações. O quadril é uma das mais afetadas, por utilizarem a cadeira de rodas como meio de locomoção. Alterações osteoarticulares, como ossificação heterotópica, podem ser encontradas nesses pacientes, sendo evidenciadas por estudos radiográficos. Este estudo visa identificar a incidência das alterações radiográficas em quadris de paciente lesados medulares. MÉTODOS: Foram avaliados 15 pacientes (30 quadris) acompanhados no Laboratório de Reabilitação Biomecânica do Aparelho Locomotor do HC-Unicamp, analisando-se radiografias da bacia em posições antero-posterior e lowenstein. RESULTADOS: Dos quadris avaliados, apenas sete (23 por cento) não possuíam alguma evidência de dano à superfície articular. A prevalência de ossificação heterotópica encontrada (16,6 por cento) aproximou-se a da literatura. CONCLUSÃO: Devido à prevalência de alterações articulares encontradas, justifica-se o acompanhamento radiográfico dos quadris destes pacientes. Nível de Evidência II. Desenvolvimento de critérios diagnósticos em pacientes consecutivo. (com padrão de referência "ouro" aplicado).

OBJECTIVE: The spinal cord-injured patients begin to present a new configuration of forces on the joints. The hip joint is one of the most affected, because these patients generally use a wheelchair as a means of locomotion. Osteoarticular changes, such as heterotopic ossification, can be found in these patients, as evidenced by radiographic studies. This study aims to identify radiographic changes in hips of spinal cord-injured patients.METHODS: 15 patients (30 hips) were evaluated and followed up at the Laboratory of Biomechanical Rehabilitation of the Musculoskeletal System of HC-Unicamp, through the analysis of radiographs of the pelvis in anterior-posterior and Lowenstein lateral positions.RESULTS: Of the total hips, only seven (23%) had no evidence of articular damage. The prevalence of heterotopic ossification found (16.6%) was similar to the literature.CONCLUSION:The radiographic assessment of these patient's hips is justified by the prevalence of joint changes found. Level of Evidence II, Development of diagnostic criteria in consecutive patients (with universally applied reference "gold" standard).

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OBJECTIVE: To evaluate the sensitivity and reproducibility of the Basso, Beattie, Bresnahan functional scale in the assessment of the locomotor capacity of rats after spinal cord injury. METHODS: Thirty male Wistar rats underwent laminectomy and mild, moderate or severe spinal cord contusions using the New York University Weight Drop Impactor. The mice were followed for 28 days, after which time each rat was placed in an 80x80x30 cm³ clear box lined with a blue non-slippery material and stimulated to move. Their movement was video-recorded by three digital cameras operating simultaneously. Identical copies of the edited videos were given to six independent evaluators who were blinded with regards to the degree of injury severity. Each evaluator made a determination of the locomotor capacity of the rats using the Basso, Beattie, Bresnahan functional scale. RESULTS: We determined the sensitivity of the method to differences among the evaluators as well as between the results achieved on the left and right hind paws of rats subjected to either mild, moderate or severe injuries by comparing the functional outcomes and reproducibility using non-parametric correlation tests. CONCLUSIONS: The Basso, Beattie, Bresnahan scale showed high reproducibility and satisfactory sensitivity for identifying mild injuries; satisfactory reproducibility and non-satisfactory sensitivity for moderate injuries; and reduced reproducibility and non-satisfactory sensitivity for severe injuries.

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