Abstract Background The aim of this study was to evaluate disease activity among patients with axial spondyloarthritis (AS) treated with tumor necrosis factor inhibitors (TNFi) and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 12 weeks in private outpatient settings in Brazil. Methods This was a cross-sectional, real-world study conducted in 17 Brazilian private health care institutes. Patients were selected if diagnosed with AS or axial radiographic spondyloarthritis (AxSpA) and treated with NSAIDs or TNFi for at least 12 weeks within the last 26 weeks prior to enrollment. The data were collected from interviewed-based and self-administered questionnaires from patients and physicians. Disease activity was defined as active (≥ 4), low /suboptimal (≥ 2 and < 4) and inactive (< 4) by Bath AS Disease Activity Index (BASDAI) and/or very high (≥ 3.5), high (≥ 2.1 to < 3.5), low (≥ 1.3 to < 2.1), and inactive (< 1.3) by AS Disease Activity Score (ASDAS-CRP). Both patients and physicians’ perceptions of disease control were assessed using a numeric rating scale (NRS; 0—inactive to 10—very active disease). Results The cohort included 378 patients with a mean age of 46 years, and the median time since diagnosis until enrollment was 5.4 years (interquartile range 2.7–10.5). Most patients were treated with TNFi alone (74%), followed by TNFi in combination with NSAID (15%), and NSAID alone (11%). About half AS patients showed active disease and 24% of patients showed low activity/suboptimal disease control despite having been treated for at least 12 weeks. Although TNFi showed better disease control than NSAID, inactive disease was experienced by few patients. The NRS (mean [standard deviation]) score for disease perception was 4.24 (3.3) and 2.85 (2.6) for patients and physicians, respectively. Conclusion This real-world study showed that most AS patients on TNFi and/or NSAID had not achieved an adequate disease control, as almost 75% of them exhibited active disease or low activity/suboptimal disease control. There remains a need for improved disease management among patients with AS.

Objetivo : Análise tomográfica da vértebra T1 em crianças de zero a doze anos de idade, obtendo parâmetros anatômicos que auxiliarão a fixação intralaminar nessa população infantil. Métodos : Análise retrospectiva da coluna por TC (cervical e torácica) de indivíduos entre 0 e 12 anos de idade, de ambos os sexos, sem deformidades anatômicas. Foram avaliados, separadamente, em cada lado, o comprimento e a espessura das lâminas, bem como o ângulo espino-laminar. A análise morfométrica foi realizada com o programa iSite PACS Philips Healthcare Informatics(r) e os valores obtidos foram expressos em milímetros (mm). As variáveis estudadas foram correlacionadas com os grupos etários e o sexo dos indivíduos. A análise estatística foi feita pelo teste t e os resultados foram considerados significativos quando p < 0,05. Resultados : Por meio de análises tomográficas de 24 pacientes, verificou-se que a idade não tem correlação com o ângulo de ataque para parafusos intralaminares de T1. Já o comprimento e a espessura da lâmina de T1 aumentam proporcionalmente com a idade. O comprimento médio total das lâminas foi de 28,62 ± 4,42 mm. A média total da espessura 4,75 ± 0,95 mm (3,2 a 6,5). Conclusão : O presente estudo mostra dados relevantes sobre a utilização de parafusos translaminares, que atualmente são disponíveis comercialmente com espessura mínima de 3,5 mm. É possível, assim, afirmar que, nesta amostra, pode ser utilizado em 87,5% do total de lâminas, sendo aplicável em todas as lâminas nos pacientes acima de 44 meses de idade.

Objective : Tomographic analysis of the T1 vertebra in children from 0 to 12 years of age, in order to obtain anatomical parameters that assist intralaminar fixation in this pediatric population. Methods : Retrospectively analysis of the spine with CT (cervical and thoracic) of individuals aged between 0 and 12 years old, of both sexes, without anatomical deformities. The CT scans were evaluated separately, on each side, for length and thickness of the laminas as well as spinolaminar angle. The morphometric analysis was performed with iSite PACS Philips Healthcare Informatics(r) program and the values were expressed in millimeters (mm). The variables were correlated with age groups and sex of individuals. Statistical analysis was performed using t test and the results were considered significant when p<0.05. Results : By means of tomographic analysis of 24 patients it was found that age has no correlation with the angle of attack for intralaminar screws T1. However, the length and thickness of the T1 lamina increase proportionally with age. The total average length of the laminas was 28.62 ± 4.42 mm. The total average thickness was 4.75 ± 0.95 mm (3.2 to 6.5). Conclusion : This study shows relevant data on the use of Tran laminar screws currently commercially available with a minimum thickness of 3.5 mm. It is thus possible to say in this sample, they can be used in 87.5% of all laminas, being applicable in all lamina in patients older than 44 months of age.

Objetivo : Análisis tomográfico de la vértebra T1 en niños de cero a doce años de edad, para obtener parámetros anatómicos que ayudarán la fijación con tornillos intralaminares en esta población infantil. Métodos : Análisis retrospectivo de la columna por TAC (cervical y torácica) de individuos entre 0 y 12 años de edad, de ambos sexos, sin deformidades anatómicas. Se evaluaron por separado, en cada lado, la longitud y el grosor de las láminas, así como el ángulo espinolaminar. El análisis morfométrico se realizó con el programa iSite PACS Philips Healthcare Informatics(r) y los valores se expresaron en milímetros (mm). Las variables se correlacionaron con los grupos de edad y sexo de los individuos. Se realizó un análisis estadístico mediante la prueba t y los resultados se consideraron significativos cuando p < 0,05. Resultados : Por medio de análisis tomográficos de 24 pacientes, se encontró que la edad no se correlaciona con el ángulo de ataque para tornillos intralaminares T1. Sin embargo, la longitud y el grosor de la lámina T1 aumentan proporcionalmente con la edad. La longitud promedio total de las láminas fue 28,62 ± 4,42 mm. El espesor promedio total fue 4,75 ± 0,95 mm (3,2 a 6,5). Conclusión : Este estudio muestra datos relevantes sobre el uso de tornillos translaminares que actualmente están disponibles en el mercado con un espesor mínimo de 3,5 mm. Por tanto, es posible afirmar que, en esta muestra, se puede utilizarlos en el 87,5% de todas las láminas siendo aplicable en todas las láminas de pacientes mayores de 44 meses de edad.

OBJETIVO: Utilizar a análise tomográfica das vértebras C1 e C2 para avaliar a possibilidade do emprego da técnica de Magerl nestes pacientes. Outros objetivos foram obter dados anatômicos para a escolha da técnica cirúrgica de modo geral, estabelecer parâmetros de segurança e obter dados epidemiológicos da população em questão. MÉTODOS: Foram analisados, retrospectivamente, tomografias de 20 pacientes com artrite reumatoide do ambulatório do Grupo de Coluna do IOT-HCFMUSP. Os dados foram analisados estatisticamente para obtenção dos valores médios e da variação de cada medida: do comprimento do pedículo de C2 até a massa lateral de C1, da espessura do pedículo e do ângulo de ataque do parafuso no istmo de C2 com a horizontal. RESULTADOS: Os valores médios encontrados foram respectivamente: lado direito 23,08 mm e esquerdo 23,16 mm; direito 6,46 mm e esquerdo 6,50 mm; direito 44,50O e esquerdo 44,95O. DISCUSSÃO: Os principais fabricantes de parafusos dispõe de implantes compatíveis com as medidas anatômicas encontradas neste trabalho. Considerando a ampla difusão e domínio da técnica de Magerl em nosso meio e no mundo todo, esta é uma opção cirúrgica segura e mecanicamente estável. CONCLUSÃO: A técnica de Magerl, segundo análise tomográfica, pode ser empregada nos pacientes com artrite reumatoide. Nível de Evidência IV. Série de Casos.

OBJECTIVE: To use the tomographic analysis of C1 and C2 vertebrae to assess the possibility of using Magerl's technique in patients with rheumatoid arthritis. Other objectives were to obtain anatomical data for the choice of the surgical technique in general, to establish safety parameters and obtain epidemiological data of the population in question. METHODS: We retrospectively reviewed the CT scans of 20 patients with rheumatoid arthritis of the Outpatient Spine Group, IOT-HCFMUSP. Data were analyzed statistically to obtain the mean values and the variance of each measurement: the length of the C2 pedicle to the C1 lateral mass, the thickness of the pedicle and the angle of attack of the screw in the isthmus of C2 to the horizontal. RESULTS: The mean values were, respectively: right 23.08 mm and left 23.16 mm, right 6.46 mm and left 6.50 mm, right 44.50O and left 44.95O. DISCUSSION: The leading screw's manufacturers have implants compatible with the anatomical measurements found in this work. Considering the wide diffusion and mastery of Magerl's technique in our country and around the world, this is a safe surgical option that provides mechanical stability. CONCLUSION: Magerl's technique, according to tomographic analysis, can be used in patients with rheumatoid arthritis. Levels of Evidence IV, Case Series.

OBJECTIVES: To evaluate the interobserver agreement for the Neoplastic Spine Instability Score (SINS) among spine surgeons with or without experience in vertebral metastasis treatment and physicians in other specialties. METHODS: Case descriptions were produced based on the medical records of 40 patients with vertebral metastases. The descriptions were then published online. Physicians were invited to evaluate the descriptions by answering questions according to the Neoplastic Spine Instability Score (SINS). The agreement among physicians was calculated using the kappa coefficient. RESULTS: Seventeen physicians agreed to participate: three highly experienced spine surgeons, seven less-experienced spine surgeons, three surgeons of other specialties, and four general practitioners (n = 17). The agreement for the final SINS score among all participants was fair, and it varied according to the SINS component. The agreement was substantial for the spine location only. The agreement was higher among experienced surgeons. The agreement was nearly perfect for spinal location among the spine surgeons who were highly experienced in vertebral metastases. CONCLUSIONS: This study demonstrates that the experience of the evaluator has an impact on SINS scale classification. The interobserver agreement was only fair among physicians who were not spine surgeons and among spine surgeons who were not experienced in the treatment of vertebral metastases, which may limit the use of the SINS scale for the screening of unstable lesions by less-experienced evaluators.

OBJETIVO: Analisar a morfologia e as dimensões, por meios tomográficos, das vértebras C1 e C2, nos pacientes pediátricos, avaliar a possibilidade de utilização da técnica de Magerl nesses pacientes, bem como fornecer dados para realização dessa técnica com maior segurança. MÉTODOS: Foram analisadas retrospectivamente 40 tomografias cervicais de pacientes entre 24 e 120 meses de idade de ambos os sexos e sem deformidades cervicais. Os dados foram analisados estatisticamente para obtenção dos valores médios e da variação de cada medida: do comprimento do pedículo de C2 até a massa lateral de C1, da espessura do pedículo de C2, do ângulo de ataque do parafuso no istmo de C2 com a horizontal e da distância do odontoide ao arco anterior de C1. RESULTADOS: Os valores médios encontrados foram respectivamente: lado direito 30,68 mm e esquerdo 31,47 mm; direito 5,28 mm e esquerdo 5,26 mm; direito 46,25(0), esquerdo 44,50(0) e 2,17mm. CONCLUSÃO: A técnica de Magerl, segundo análise tomográfica, parece ser utilizável nos pacientes pediátricos. Nível de Evidência IV, Série de Casos.

OBJECTIVE: To analyze through tomographic studies, the morphology and dimensions of the C1-C2 vertebrae in pediatric patients, to evaluate the possibility of application of Magerl's technique in these patients, and to contribute with data for the usage of the technique in safety. METHOD: Forty normal cervical tomographies, from patients at an age range of 24- 120 months of age and from both genders, were retrospectively analyzed. Data was statistically analyzed to obtain mean value and variations of each measurement: length from the C2's pedicle to C1's lateral mass, thickness of the pedicle of C2, the attack angle of the screw at the C2 isthmus with the horizontal axis and the distance from the odontoid to the anterior arch of C1. RESULTS: The mean values obtained were: length right 30.86mm, left 31.47mm; thickness right 5.28mm, left 5.26mm; attack angle right 46.25(0) , left 44.50(0) ; distance from odontoid to anterior arch of C1 2,17mm. CONCLUSION: The Magerl technique, after tomographic study, seems to be a viable option to be used in pediatric patients. Level of Evidence IV, Case Series.