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- Intravertebral expandable implants in thoracolumbar vertebral compression fracturesPublication . Moura, DL; Gabriel, JPCurrent scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.
- Stent-armed kyphoplasty in osteoporotic thoracolumbar fractures—clinical and functional results and a center experience over 10 yearsPublication . Moura, DL; Isidoro, D; Lourenço, P; Jardim, CBackground: The optimal treatment of osteoporotic vertebral fractures is still a controversial and under discussion topic. Armed kyphoplasty with expansive intravertebral implants is an emerging procedure, which, in theory, it not only makes it possible to achieve instant analgesia, and to get stabilization gains of benefits of kyphoplasty and vertebroplasty, but also, allows for a more effective maintenance of the restored vertebral height. Methods: A retrospective observational study is presented, in which 30 patients participated, including a total of 33 osteoporotic thoracolumbar compression burst vertebral fractures with involvement of one or both vertebral platforms and of more than one fifth of the posterior wall. These individuals underwent armed kyphoplasty with VBS® stents (or stentoplasty) filled with bone cement over 10 years (between 2012 and 2022) at the same center. Clinical (visual analogue scale, Oswestry Disability Index and Patient Global Impression of Change) and imaging results (restoration and maintenance of vertebral body heights) achieved were investigated. The mean follow-up time was 4.5 years (range, 1-10 years). Results: There was a statistically significant improvement in all clinical and functional parameters evaluated, as well as a statistically significant difference in the various vertebral body heights between preoperative and end of follow-up time [increase of 10.7-15.2-5.0 mm (anterior-median-posterior) in the sagittal plane and 6.7-11.6-9.7 mm (right-median-left) in the coronal plane]. There was a statistically significant direct correlation between vertebral heights in the coronal plane, and between the Beck index assessed at the end of the follow-up period and the improvement in functional disability. Conclusions: The percutaneous transpedicular posterior approach, the ability to anatomically restore the fractured vertebra and to maintain it in the medium-long term, as well as the reduced risk of adverse effects, make stent-armed kyphoplasty a very attractive treatment option for osteoporotic compressive thoracolumbar fractures. A clinical-morphological correlation was demonstrated regarding the surgical treatment of these fractures, it was found that a more effective morphological restoration of vertebral heights in both the sagittal and coronal planes is associated with superior satisfactory clinical functional parameters.
- Lesões Cervicais no MergulhoPublication . Moura, DL; Farinha, PM; Lourenço, P; Jardim, CAs lesões da coluna cervical associadas a atividades aquáticas, tais como o mergulho, ocorrem principalmente em indivíduos jovens e saudáveis. As lesões mais comuns são as fraturas e luxações das vértebras cervicais, habitualmente de C5, C6 e C7, podendo estar associadas a lesão da medula espinhal, mais frequentemente no nível C5 e C6. São causa primária de tetraplegia associada a atividades recreativas, caracterizando-se por dependência funcional grave com condicionantes familiares e socioeconómicas importantes. A antecipação do risco e a prática prudente do mergulho, associados a campanhas de sensibilização para as potenciais consequências, devem estar na linha da frente na prevenção da ocorrência destas lesões.
- Surgical Treatment of Multiple Osteoporotic Fractures of the Dorsolumbar Spine: Case ReportPublication . Marques, RR; Moura, DL; Lourenço, POsteoporotic vertebral fractures are a common type of fracture and affect a significant number of subjects with osteoporosis. Despite the high fracture risk, the concomitant occurrence of vertebral fractures at non-contiguous levels is very rare. We report the case of a patient with three burst dorsolumbar spine fractures at non-contiguous levels who was treated with percutaneous kyphoplasty and transpedicular posterior fixation. Six months after the surgery, the patient walks autonomously and without pain; in addition, there is no radiological evidence of fracture reduction loss.
- Sequelas da COVID-19 Evidência AtualPublication . Moura, DL; Dias, A; Farinha, PM; Farinha, JM; Robalo-Cordeiro, CA epidemia de Coronavirus Disease 2019 disseminou-se pelo mundo em poucos meses, levando à sua designação de pandemia. Múltiplas medidas de saúde pública foram implementadas nos países afetados para conter e mitigar a disseminação da doença. A necessidade de distanciamento físico leva a que esta pandemia tenha um impacto importante na sociedade e particularmente no desporto, provocando cancelamento e adiamento de treinos, competições e eventos. No entanto, o início da pandemia data já de 2019, com preocupações globais, não só na fase aguda da doença com as suas consequências imediatas, mas também com as eventuais sequelas a médio e a longo prazo e o risco de cronicidade de alguns sintomas, em particular na população jovem. Neste artigo revemos a limitada evidência científica atual acerca da relevância clínica das sequelas da COVID-19, em particular do foro respiratório e cardíaco, e finalizamos com recomendações de avaliação das sequelas em atletas e com indicações para regresso seguro à prática desportiva.
- Uso de protetor solar nos adolescentes Portugueses: conceitos e preconceitosPublication . Pinheiro-Torres, J; Macedo, J; Abreu, N; Moura, DL
- Traumatologia da Articulação de LisfrancPublication . Moura, DL; Gaspar, AR; Fonseca, FAs lesões do complexo articular de Lisfranc são frequentes e muitas vezes subdiagnosticadas em desportistas. São lesões com tempo prolongado de recuperação e que muitas vezes colocam a carreira desportiva em risco, na medida em que a maioria evolui rapidamente para osteoartrose sintomática. Um nível elevado de suspeita de reconhecimento dos sinais clínicos de lesão e uso dos exames de imagem adequados são críticos para um diagnóstico correto e precoce, de modo a se conseguir um tratamento adequado e garantir rápido regresso à atividade desportiva. Os tratamentos ideais para as lesões de Lisfranc são controversos e devem ser adequados ao tipo de lesão, estadio e características do atleta. Este artigo apresenta uma revisão da atual evidência científica em relação aos princípios de diagnóstico e tratamento das lesões do complexo articular de Lisfranc na população praticante de desporto.
- Sinovite vilonodular pigmentada do joelho. Tratamento da recidivaPublication . Farinha-Martins, P; Moura, DL; Freitas, JP; Casanova, JOs autores apresentam um raro caso de Sinovite Vilonodular Pigmentada do joelho, difusa, recidivada numa paciente jovem, com grave repercussão nas suas atividades diárias. Houve a necessidade de efetuar um tratamento localmente agressivo, com substituição total da articulação do joelho utilizando componentes de revisão. O tratamento revelou-se eficaz sob ponto de vista clínico e funcional
- Why are Diverticula of the Rectum Uncommon? Angiomorphological HypothesisPublication . Bernardes, A; Melo, C; Moura, DL; Pinheiro, S
- Subacute L5 Paresis Following a Capoeira PresentationPublication . Marques, JP; Moura, DL; Cordeiro, A; Páscoa-Pinheiro, JA young female suffered minor low back trauma during a capoeira presentation. She was initially diagnosed with an acute episode of uncomplicated low back and radicular pain. She kept training and competing until developing paresthesia and weakness of the right leg six weeks later. Physical examination revealed sensory and motor deficits compatible with L5 nerve root compression. The MRI revealed an L5-S1 disc extrusion compressing the right L5 nerve root. Nerve root decompression and partial discectomy were performed, and seven months later she was competing without restrictions. We present our approach and discuss possible pathological mechanisms that may explain this unusual presentation.