Diario de columna vertebral

Background: Minimally invasive spine surgery (MIS) is associated with less blood loss, faster recovery, and less perioperative morbidity while yielding similar results as those achieved with open procedures. The risk of periand postoperative complications in the elderly and obese patients is a much debated issue. MIS has been poorly investigated in aged and obese patients.

Objective: The aim of the present study is to establish whether MIS techniques are a safe and adequate tool in these patients.

Methods: A retrospective analysis of 33 patients aged 65 years or older, undergoing minimally invasive spinal fusion techniques, in order to identify the risk of peri- and postoperative morbidity in the obese. Obesity was classified according to the body mass index (BMI).

Results: Any harmful event was noted and included in the statistical analysis. The median blood loss and drainage in the postoperative monitoring period was 200 ml.  significant differences in blood loss were observed in relation to preoperative administration of NSAIDs. Patients using NSAIDs preoperatively had more frequent (p=0.055)  and greater (p= 0.014) blood loss. No difference in blood loss was noted with reference to age or BMI groups. No severe wound healing disorder was observed. We encountered 5 major complications, which consisted of one patient with a neurogenic deficit, one with a transient ischemic attack, one with cardiac ischemia, one with a  malpositioned rod, and one with an epidural hematoma. Minor complications included one patient with urinary tract infection, one with respiratory tract infection, and one with fever. No association was observed between complications and obesity.

Conclusion: This study confirms the low soft tissue damage resulting from minimally invasive surgery techniques, which is an important factor in elderly and obese patients. The smaller approach helps to minimize infections and wound healing disorders. Moreover, deeper regions of wounds are clearly visualized with the aid of tubular retractors.

Objective: Cervical Total Disc Replacement (CTDR) has recently been developed as an alternative to Anterior Cervical Discectomy and Fusion (ACDF) in cervical degenerative disease to preserve the motion at the treated level. The aim of this study is to investigate the safety and efficacy of CTDR by comparing it with ACDF in the treatment of
single-level cervical degenerative disease, retrospectively.

Methods: This study included 61 patients, who underwent either stand-alone single-level ACDF (n = 33) or singlelevel CTDR (Bryan cervical artificial disc, n = 28) at C3 to C7 for degenerative cervical disease between June 2007 and December 2009. Cervical radiographs were obtained to measure overall and regional cervical angle and Range
of Motion (ROM). For evaluation for patient’s pain, visual analogue scale and Japanese Orthopedic Association score was measured.

Results: The changes of the overall Cervical Sagittal Angle (CSA) were not significantly different between the two groups. The Segmental Angle (SA) was maintained at a significantly higher in the CTDR group compared to the ACDF group during the follow-up period (p < 0.05). The ROM of the upper adjacent segment was significantly increased in the ACDF group compared to the CTDR group.

Conclusions: Clinically, CTDR is at least as efficient as ACDF. CTDR using a Bryan artificial disc provided a significant maintenance of the SA and the ROM at the treated level, and prevented the hyper-mobility at the upper adjacent segment compared to the ACDF. In the Future, prospective, randomized, long-term follow-up study with
large-number will be required to clarify the efficacy of CTDR.

Introducción: Los pacientes con dolor de cuello suelen tener quejas subjetivas de rigidez, tensión o rigidez muscular además del dolor. Se ha afirmado que en el dolor de cuello hay rigidez del trapecio superior que conduce a debilidad del trapecio medio e inferior, por lo que este estudio compara la fuerza del músculo trapecio superior, medio e inferior en el lado del dolor y el lado contralateral.

Método: Se evaluó y comparó la fuerza del trapecio superior, medio e inferior en el lado ipsilateral y contralateral al dolor en personas con dolor de cuello unilateral utilizando la unidad de biorretroalimentación Stabilizer Pressure.

Resultados: Se ha demostrado que no existe una diferencia significativa en la fuerza del trapecio superior mientras que existe una diferencia significativa en la fuerza del músculo trapecio medio e inferior en el lado del dolor y el lado opuesto.

Conclusión: El estudio respalda que la evaluación y el fortalecimiento del trapecio superior, medio e inferior es necesario en personas con dolor de cuello unilateral.

Un hombre de 39 años se presentó con lumbociática. La tomografía computarizada mostró un aspecto de hernia discal a nivel de L5. Se le realizó una laminectomía de emergencia y se encontró un tumor y se realizó una biopsia. El diagnóstico histológico inicial fue linfoma maligno. La resonancia magnética reveló una masa epidural lumbar a nivel de L5 y las vértebras sacras. El diagnóstico correcto de masa linfoblástica epidural y leucemia linfoblástica aguda (LLA) se estableció con base en un estudio de las células de la médula ósea. Se estableció el tratamiento con quimioterapia.

La masa leucémica debe considerarse en el diagnóstico diferencial de la masa epidural espinal, incluso en pacientes con LLA.