Diario de columna vertebral

Objectives: To present an awake, fully endoscopic surgical approach for treating radiculopathy that results from L5/ S1 foraminal stenosis in a patient who had prior interbody fusion and posterolateral fusion.

Methods: The patient underwent an awake, endoscopic decompression procedure utilizing two different sized cannula and high-speed drill system under direct visualization. Fully endoscopic revision laminotomy was done first through contralateral interlaminar approach. This was followed by endoscopic inside-out foraminotomy.

Results: The operative time was 108 minutes, estimated blood loss was negligible, and the surgery was done as outpatient. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that Oswestry Disability Index (ODI) improved from 56 to 28. VAS-L improved from 8 to 2. The ODI and VAS-B scores at the last follow-up showed 73% and 78% improvement from the preoperative period respectively, which showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability.

Conclusion: Fully endoscopic contralateral laminotomy and inside-out lumbar foraminotomy is a safe, effective technique for addressing lumbar foraminal stenosis, especially for patients with lumbar foraminal stenosis that are difficult for ipsilateral transforaminal approach.

Introduction: Sagittal spino-pelvic instability is the most common cause for chronic low back pain. Legaye stated that the pelvic incidence (PI) is an anatomical parameter for assessing spinal stability. Pelvic incidence can be calculated by adding pelvic tilt and sacral slope. Sacral table angle (STA) is the angle between the superior sacral endplate and the trailing edge line of sacrum.

Objective: To prove the temporal association of pelvic incidence and sacral table angle and lumbar instability in patients with chronic low back pain.

Materials and methods: A total of 191 cases with nonspecific low back pain with or without lumbar instability were analysed with spinal radiographs. The pelvic incidence and sacral table angle were calculated for L3 – L4, L4 – L5 and L5 – S1 levels.

Results: Out of 191 cases, the levels of L5 – S1 cases showed 5% translation and 10° angulation. We observed a significantly statistical difference between two groups in terms of pelvic incidence (p=0.01) and sacral table angle (p<0.01). The lumbar instability of L5 – S1 segment is associated with lower pelvic incidence and increased sacral table angle. The Spearman’s Rank correlation coefficient (rho ρ) for the study was 0.745 which imply highly positive correlation between pelvic incidence and sacral table angle and lumbar instability.

Conclusion: The spino-pelvic parameters influence the evolution of spinal degenerative disease. We observed that the patients with chronic low back pain without lumbar instability showed normal or decreased PI and increased STA whereas patients with chronic low back pain with lumbar instability showed increased PI and decreased STA. The cases with increased PI and decreased STA are prone to develop degenerative spinal pathology or discogenic pathology which alters the postural balance of spinal column.

Purpose: A disease specific Brace Questionnaires (BrQ) has been developed for measuring the quality of life of patients with adolescent idiopathic scoliosis (AIS) who were under brace treatment. The aim of this study was to translate and validate the Chinese version of BrQ from its original Greek version.

Methods: Forward and backward translations of BrQ were performed according to the cross-cultural adaptation process. After translation, 120 subjects with AIS were recruited and asked to fill out the Chinese translated BrQ and the Chinese refined 22-item Scoliosis Research Society questionnaire (SRS-22r). Subjects completed the Chinese translated BrQ again in 1-2 weeks. Demographic data as well as other parameters were collected such as brace wearing duration, brace wearing hours per day (self-reported), in-brace Cobb angles and curve patterns. The reliability and validity were checked by internal consistency and test-retest reliability using Cronbach’s alpha, Intraclass correlation as well as Pearson correlation coefficient.

Results: The internal consistency and test-retest reproducibility of the translated BrQ were 0.89 and 0.83 respectively. The Chinese translated BrQ demonstrated concurrent validity as reflected by the significant correlation between the BrQ domains and the relevant SRS-22r domains. The Chinese translated BrQ showed its discriminant validity too. Significant differences were found in the BrQ school activity mean score (p=0.042) and social functioning mean score (p=0.047) between subject groups: age 12 or below and age 13 or above. Significant differences were also detected in the BrQ domain score including physical functioning (p<0.001), emotional functioning (p=0.002), vitality (p=0.004), bodily pain (p<0.001) and social functioning (p=0.018) between subject groups with different brace wearing hours (0-8 hours, 9-16 hours and 17-23 hours).

Conclusion: The Chinese translated BrQ showed good validity and reliability. It demonstrated its concurrent validity and discriminatory validity in the AIS population studied.

Antecedentes: En los últimos años se han introducido espaciadores intercorporales de titanio expandibles integrados para su uso en procedimientos de fusión intercorporal lumbar lateral mínimamente invasivos (MIS LLIF). Estos dispositivos ofrecen expansión in situ que les permite adaptarse a la anatomía intervertebral con una posible menor alteración de la placa terminal y una mayor descompresión indirecta. Este estudio describe los resultados radiográficos en pacientes que se sometieron a MIS LLIF utilizando espaciadores intercorporales expandibles de titanio con una placa integrada.

Método: Se trata de una revisión retrospectiva de historias clínicas realizada por un solo cirujano, exenta de la Junta de Revisión Institucional, realizada entre junio de 2015 y diciembre de 2017 en pacientes consecutivos con diagnóstico de espondilolistesis que se sometieron a MIS LLIF en 1 o 2 niveles contiguos utilizando un espaciador intercorporal expandible de titanio integrado lateralmente. Se recopilaron los resultados radiográficos y se compararon entre el preoperatorio y el posoperatorio a las 2 y 6 semanas, y a los 3, 6, 9 y 12 meses de seguimiento. Los resultados estadísticos fueron significativos cuando P < 0,05.

Resultados: Se evaluaron diecisiete pacientes consecutivos con una edad promedio de 69,2 ± 7,9 años (rango: 51-82 años), y el 58,8% eran mujeres. La altura media del disco anterior mejoró significativamente con respecto al valor inicial en un 68,3% (7,7 ± 4,5 mm), 58,4% (6,9 ± 5,0 mm), 59,4% (7,0 ± 4,6 mm), 56,4% (6,1 ± 5,0 mm), 52,5% (5,7 ± 4,8 mm) y 51,5% (4,2 ± 4,0 mm) a las 2 y 6 semanas, 3, 6, 9 y 12 meses, respectivamente (P < 0,001). La altura media del disco posterior mejoró significativamente desde el inicio en un 78,0 % (4,9 ± 2,9 mm), 67,8 % (4,3 ± 2,9 mm), 66,1 % (4,3 ± 2,9 mm), 69,5 % (4,3 ± 3,0 mm), 57,6 % (3,8 ± 2,7 mm) y 61,0 % (3,2 ± 2,5 mm) a las 2 y 6 semanas, 3, 6, 9 y 12 meses, respectivamente (P < 0,001). La lordosis segmentaria y lumbar se mantuvo constante en todos los puntos temporales posoperatorios (P > 0,05).

Conclusión: Este estudio mostró resultados radiográficos positivos significativos para los pacientes que se sometieron a MIS LLIF utilizando nuevos espaciadores intercorporales expandibles de titanio integrados, basados ??en cambios posoperatorios significativos en la lordosis intervertebral y la altura del disco anterior y posterior observados durante un seguimiento de 12 meses.

Introducción: Se ha demostrado que la fusión intercorporal lumbar lateral mínimamente invasiva (MIS LLIF) minimiza la disección de tejidos blandos y la pérdida de sangre en comparación con la fusión intercorporal lumbar posterior abierta. Este estudio describe los resultados clínicos y radiográficos de pacientes tratados con espaciadores intercorporales expandibles con lordosis ajustable para MIS LLIF.
Métodos: Revisión retrospectiva de historias clínicas exenta de la Junta de Revisión Institucional por un solo cirujano en 57 pacientes consecutivos que se sometieron a MIS LLIF en 1-2 niveles contiguos utilizando espaciadores expandibles con lordosis ajustable, que permiten la expansión en altura y lordosis. Se recopilaron y compararon los resultados funcionales clínicos y radiográficos en los puntos de tiempo preoperatorios y posoperatorios hasta 12 meses. Los resultados estadísticos fueron significativos si P < 0,05.
Resultados: Se evaluaron cincuenta y siete pacientes consecutivos con una edad promedio de 58 ± 12,3 años y el 49,1% eran mujeres. La escala visual analógica (EVA) para el dolor de espalda y las puntuaciones del índice de discapacidad de Oswestry (ODI) disminuyeron significativamente a los 12 meses. La lordosis lumbar mejoró en una media de 5,1° a los 12 meses (P < 0,001). La altura del disco anterior, medio y posterior aumentó significativamente a los 12 meses en 5,2 mm, 4,6 mm y 2,6 mm respectivamente (P < 0,001). La altura neuroforaminal aumentó en una media de 3,7 mm (P < 0,001) mientras que la lordosis segmentaria mejoró en 3,7° a los 12 meses.
Discusión y conclusión: Este estudio mostró resultados clínicos y radiográficos positivos significativos para los pacientes que se sometieron a MIS LLIF utilizando espaciadores intercorporales expandibles con lordosis ajustable basados ??en la disminución del dolor de espalda en la EVA y las puntuaciones del ODI en el seguimiento de 1 año. El uso de espaciadores expandibles con lordosis ajustable demostró ser seguro y eficaz para la cohorte estudiada.