Diario de columna vertebral

Primary spinal canal tumors are a diverse group of neoplasms constituting 4% of all central nervous system tumors. They can be broadly classified into intradural and extradural tumors. MRI is the most useful neuroimaging modality. A histopathology is mandatory in most of the cases. The primary modality of treatment is surgery. No adjuvant treatment is required if a complete excision can be done. However, in a significant number of patients, complete excision may not be feasible in view of the possibility of significant neurological complications. Hence, external radiotherapy plays an important role in the management of these neoplasms. Radiotherapy may be given as a definitive treatment or more commonly as an adjuvant. Advancements in technology have made the delivery of high precision radiotherapy like three-dimensional conformal radiotherapy, intensity modulated radiotherapy and stereotactic radiosurgery feasible and safe. The favourable prognostic features are feasibility of achieving a complete resection, low grade, caudal location, small volume disease and histology.

Abstract Study design : This study was a cross sectional, controlled trial.

Objectives: To examine the performance of repetitive circle drawing on dynamic sitting balance between subject with spinal cord injury (SCI) and age-matched able-bodied (AB) adults.

Summary of background data : Previous studies showed that the dynamic sitting balance is impaired in SCI. However, the arm-trunk coordinated movement for different directions in seated SCI has not been examined yet.

Methods: Twelve subjects with complete T7-T12 thoracic cord injury (mean age: 36.3 ± 3.0 years) and 12 age- matched AB adults were recruited. Subjects performed 10 repetitive circle drawing at seated position. The three- dimensional motion system (Vicon) was used to measure shoulder, trunk and pelvic angles at sitting position.

Results : The SCI group displayed an arm-trunk movement with a significantly larger shoulder adduction/ abduction angle (p<0.001), but less trunk flexion/extension, pelvic anterior/posteriortilt and pelvic rotation angles than AB controls (p<0.05, p<0.001, and p<0.001, respectively).

Conclusions: The small circle drawing is feasible to detect the compensatory movement of shoulder for the impairment of trunk and pelvic control in thoracic SCI. Furthermore, the assistance and guidance of trunk and pelvic movements is important for the arm-trunk coordinated movement in thoracic SCI.

Objective: To obtain an equation for the prediction of radiofrequency induced ablation volumes.

Summary of Background Data: Radiofrequency ablation of tumor masses is an established procedure and is increasingly used as pain therapy of unresectable spine tumors. The bipolar radiofrequency ablation potentially minimizes the risk of injury to adjacent structures. Predictability of the extent of the induced ablation zosne has been hown on an ex-vivo model. There has been no investigation examining the parameters of radiofrequency ablation in an in-vivo model.

Methods: 38 lesions of the spine in 36 patients were treated using bipolar radiofrequency ablation. Extent of ablated tissue, amount of administered energy, average power and total duration of ablation were recorded.

Results: Induced Volume of Necrosis (VN) correlates with Average Power (AP) following the equation VN=-3.579+0.998*AP.

Conclusion: Average power can be used as the most predictive parameter for calculation of the induced necrosis volume in an in-vivo model too.

Background: In the last two decades lumbar interspinous decompression systems have gained a wide and often uncontrolled diffusion. Such devices, usually made of titanium or PEEK (polyetheretherketone), are currently implanted in different lumbar spine degenerative disorders, and clinical indications to their use are often
confounding.

Methods: This is a single center, single arm, 2-year prospective study of 50 patients undergoing lumbar surgical interspinous decompression, in which the BacJac all-PEEK device was implanted. Preoperative diagnosis was: central (CLS) or foraminal (FLS) spinal stenosis, degenerative antero/retro listhesis
Results: The 2-year follow-up examination was performed in 47 patients (94%); three patients were lost. Thirty-nine out of forty-seven (83%) patients improved, and the remaining eight were considered unchanged. The VAS score improved from 7.5 preoperatively to 3.0 postoperatively; the IGEA-L score improved from 3.0 to 1.7; the IGEA-
R score passed from 2.93 to 1.5; the IGEA-Cl improved from 3.5 to 1.5. No major complications were observed; in five cases rupture of a spinous process was observed.

Conclusions: Our series is the first prospective study concerning the use of a PEEK interspinous device in the treatment of lumbar spine degenerative disorders. We think the BacJac interspinous spacer, as stand-alone implant or following uni or bilateral decompression, may provide mid-term relief of low-back and radicular pain, as assessed
by VAS and IGEA scales, and improvement of neurogenic intermittent claudication, in some lumbar spine degenerative disorders, mainly in central and foraminal stenosis.

Fractures of the odontoid process comprise 10–15% of all cervical fractures. Almost two thirds of all dens fractures are classified as type II according to Anderson and D’Alonso classification system. Currently, the direct anterior odontoid screw fixation provides the best anatomical and functional results for this type of fracture and it is considered as the treatment of choice. Regarding the approach to the C2 vertebra, about 80% of authors usually make a skin incision at the lower cervical level (C4-C5 or C5-C6) for creating a working corridor. However, the required exposure and the relatively blind passage of the screw can damage the surrounding soft tissue. The direct approach at the C2- C3 level could be a shorter and safer working corridor to the odontoid screw fixation with less soft tissue retraction. Here we present a case report of a 62-year-old man who presented with Type II odontoid fracture and subsequently underwent a direct anterior odontoid screw fixation through a mini-open approach at the C2-C3 level. The literature available in the English language on related-approach complications of anterior odontoid screw fixation is reviewed.

Las fracturas-luxaciones toracolumbares suelen causar una disfunción neurológica completa a nivel del traumatismo. Sin embargo, algunos pacientes pueden no tener déficits neurológicos. Se cree que es responsable del mecanismo del traumatismo espinal. El objetivo del tratamiento quirúrgico es restaurar la estabilidad biomecánica. En este estudio presentamos tres casos de fracturas traumáticas toracolumbares y luxaciones laterales sin déficit neurológico. Ambos casos tenían un grado E según la escala de Frankel y obtuvieron 6 puntos según la Escala de Gravedad de Clasificación de Lesiones Toracolumbares (TLICS). Los pacientes fueron tratados con instrumentación posterior de segmento largo a través de un abordaje posterior. La fractura-luxación se redujo y estabilizó con éxito con estabilización posterior de segmento largo a través de un abordaje posterior. Seguimos al primer paciente durante 8 meses y al segundo paciente durante 4 años y al tercer paciente durante 3 meses. No se desarrolló deformidad cifótica secundaria en ningún paciente durante el seguimiento. La estabilización posterior del segmento largo es un tratamiento seguro y eficaz para la fractura-luxación toracolumbar. Ha habido dudas sobre si la cirugía posterior independiente puede prevenir la deformidad cifótica secundaria en el seguimiento a mediano o largo plazo.

Diseño del estudio: Estudio prospectivo.

Objetivos del estudio: Evaluar los resultados de la laminoplastia recaptadora con instrumentación posterior y fusión en el tratamiento de la espondilolistesis ístmica de bajo grado en adultos.

Antecedentes: La espondilolistesis ístmica es una condición en la que hay un desplazamiento traslacional del cuerpo vertebral superior en comparación con el inferior secundario a un defecto en la pars interarticularis.

Métodos: Se trataron 10 pacientes, 3 hombres y 7 mujeres con una edad media de 42,6 años mediante la técnica de laminoplastia recapante y fijación y fusión transpedicular posterior. El deslizamiento vertebral medio fue de 33,5% (14-47%) preoperatorio, 6% (0-12%) postoperatorio directo y 7,4% (0-14%) al año.

Resultados: En la última visita de seguimiento realizada al cabo de un año, 9 pacientes lograron la fusión y 1 paciente no tuvo consolidación. El índice de discapacidad de Oswestry fue leve en 8 pacientes y moderado en 2 pacientes.

Conclusión: La laminoplastia recaptadora se puede utilizar de forma segura y eficaz en la reconstrucción anatómica de las estructuras posteriores para el tratamiento de la espondilolistesis ístmica de bajo grado en adultos.

Introduction: The long-term results after surgery for symptomatic lumbar herniated disc have been found to have a low success rate in about one third of patients (30% to 40% according to different Authors) who report low back pain rather uncomfortable and restrictive. Nevertheless the long-term results have been scarcely investigated. The aim of this paper is to investigate the long-term results after surgery for lumbar herniated disc in two groups of patients receiving different surgical treatments.

Material and method: A retrospective study has been performed, on a series of 89 consecutive patients, affected by lumbar herniated disc, receiving different surgical treatments: a simple microdiscectomy (Group A: 45 cases) or a microdiscectomy associated with the implantation of an interlaminar prosthesis (Group B:44 cases). General and clinical data resulted homogeneously distributed in both Study Groups.

Results: The follow-up ranged from 3 to 5 years. An independent observer was able to evaluate all patients but one, out of the Group B, who resulted lost to follow-up. Two recurrences resulted in Group A (4,4%) and 1 in Group B (2,2%). The comparison between the 2 Study Groups showed the absence of low back pain during the follow-up period in 74% of patients who received the implant while patients treated by means of simple standard microdiscectomy remained pain free only in 41%. Furthermore uncomfortable low back pain was registered in 21% of patients of Group B against 51% out of Group A. As regards to Macnab Criteria evaluation, that expresses the Quality of Life, 71% of patients resulted Excellent and 22% Good in the Group B, while in the Group A 40% were Excellent and 20% Good. In both groups no poor results were observed.

Conclusion: The number of patients included in this experience is limited and there is a need for a larger series to confirm observations and results, nevertheless we can affirm the goodness of the path undertaken.

Antecedentes: El éxito inicial de las proteínas morfogenéticas óseas humanas recombinantes (rhBMP) en la cirugía de la columna lumbar condujo a su uso fuera de la indicación inicial. A medida que las complicaciones del uso de rhBMP-2 en la cirugía de la columna cervical continuaron aumentando, la necesidad de una alternativa más segura se hizo evidente. El descubrimiento de una nueva técnica de procesamiento de tejido alogénico ha proporcionado una forma de acceder a los factores de crecimiento que se encuentran naturalmente dentro de las células de la médula ósea. Esta evaluación se realizó para evaluar los resultados clínicos asociados con el uso de la proteína morfogenética alogénica en la fusión de la columna cervical.

Métodos: Se realizó un análisis retrospectivo de ciento cuarenta pacientes consecutivos (228 niveles) que se sometieron a fusiones de la columna cervical entre C3 y T3. Los pacientes recibieron radiografías (rayos X y/o TC) en los puntos de seguimiento posoperatorios estándar, que generalmente fueron a los tres, seis, doce y dieciocho meses después de la intervención quirúrgica. La fusión se definió como cualquier evidencia radiográfica de puentes a través de las placas terminales, o puentes desde las placas terminales hasta los tapones discales del espacio intervertebral.

Resultados: El ochenta por ciento (80%) de los pacientes tuvieron evidencia de fusiones a los 6 meses, el noventa y ocho por ciento (98%) de los pacientes tuvieron evidencia de fusiones a los 12 meses y el cien por ciento (100%) de los pacientes tuvieron evidencia de fusiones a los 18 meses.

Conclusiones: Los resultados de alta tasa de fusión en este informe demuestran los beneficios de utilizar una variedad de factores de crecimiento en la cirugía de la columna cervical y respaldan la proteína morfogenética alogénica como una posible opción alternativa a la rhBMP-2.