bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of “Burst” Fractures of Dorsal and Lumbar Spine, with Circumferential Arthrodesis and Only Single Posterior Approach
Authors: Viola Aldo , Melo Marcelo , Ferrero Andres , Rodriguez Juan , Pearson Lucas
Published: May 2015

Introduction

This work is a retrospective analysis of our experience, from 2004 to date in the treatment of “Burst” type fractures of the dorsal and lumbar spine, with or without involvement of the spinal canal, posterior column injury, and/or neurological injury.

Patients and Methods

A total of 20 cases of types A2, A3, A4, and B fractures were retrospectively evaluated, with or without involvement of the spinal canal, posterior column injury, and/or neurological injury, the minimum follow-up was 1 year. All patients were treated only by posterior approach with anterior contribution (interbody autologous anterior strut bone and mesh cell type) and pedicle screws, one level above and one level below the injury.

Results

All patients had a satisfactory clinical result, with a free spinal channel, without added neurological injury.

Conclusion

We intend to show that it is a safe treatment, saving fusion levels, and reproducible results.
Radiological Results of Treatment of Thoracolumbar Fractures with Bony Failure of the Posterior Tension Band by Percutaneous Pedicle Fixation
Authors: Valencia Manuel , Leiva Andres , Riera Jose Antonio , Thibaut Carlos , Novoa Felipe , Bravo Oscar
Published: May 2015

Introduction

Currently, we have multiple options for surgical treatment of thoracolumbar fractures. Among these, percutaneous pedicle fixation raises several advantages, particularly in terms of reduced soft tissue injury and the ability to recover motion segments in cases with consolidation potential as type B1 and some type B2 fractures. Our objective is to analyze the radiological results of treatment of these fractures by percutaneous pedicle fixation and the preservation of motion segments after implant removal.

Patients and Methods

Prospective, observational, and descriptive study of radiological follow-up case series of patients with thoracolumbar spine fractures with bony failure of the posterior tension band and without neurological involvement treated by percutaneous pedicle fixation surgery. Radiological results were evaluated by measurement of preoperative regional kyphosis, correction achieved, correction preservation, bone healing, and recovery of mobile segments post removal of fixation. For statistical analysis, the Student t test for paired samples was used.

Results

A total of 13 patients, 12 men and 1 woman, with a mean age of 40 years. Overall, five type B1 and eight type B2 fractures between T9 and L2. Fixation for two levels was performed in all of them. An average correction of 8 degrees ( p = 0.0036), reaching normal levels in 10 patients was achieved. At 6 months' follow-up, loss of correction was observed in all patients. The average loss was 7 degrees ( p = 0.0021), a regional kyphosis remained within the normal range in eight patients. Consolidation was observed at 8 months' follow-up in all the patients. Material removal was performed in seven patients. Of these, five had a preservation of mobility within normal ranges. No intra- or postoperative complications occurred. Overall, two patients had partial loosening of the fixation system.

Conclusion

Percutaneous pedicle fixation presents an effective alternative in treating thoracolumbar fractures with the bony failure of posterior tension band with consolidation potential. The results in our experience are comparable to those described for both minimally invasive and traditional techniques. The possibility of removal of material for preserving mobile levels presents an important advantage compared with techniques involving fusion.
Combination of Upper Thoracic Fracture and Sternum Fracture
Authors: Bazan Pedro , Betemps Alejandro , Ciccioli Nicolas , Borri Alvaro , Medina Marin
Published: May 2015

Introduction

The upper thoracic spine differs from other regions of the spine for extra stability given by the complex rib sternum. Isolated fractures of the sternum are considered harmless. The association between sternum and spine fracture was first described by Fowler and more recently by Park. This association may increase the instability of the spinal injury. The objectives of this presentation are as follows: (1) analyze the kinematics causing this association; (2) describe the impact of the injury; (3) and evaluate the treatment performed.

Patients and Methods

Four cases are analyzed, quantifying displacement, and angulation of the sternum, and the characteristics of the spinal injury and deformity.

Results

Most of vertebral lesions were classified as type A, the most affected region was T5 and T10. Three patients with neurological symptoms ASIA E. The majority of the sternum injuries were caused by direct trauma.

Conclusion

The association of sternum and spine fracture was seen in patients who had suffered high-energy trauma during a car accident. We found no relationship between the angulation of the sternum and its translation to the degree of kyphosis in the thoracic spine. It is important to do good radiographic studies involving the sternum to suspect this relationship.
Incomplete Neurological Injury Secondary to High Energy Asia B L3L4 Fracture Dislocation by Trauma in the Lumbar Region: A Case Report
Authors: Caldera Gustavo
Published: May 2015

Introduction

In fracture dislocations of the lumbar region, two anatomical facts can help patients preserve neurological damage in comparison less trauma to the cervical or thoracic region. First place in adults, the spinal cord extends only to the level of the lower border of the first lumbar vertebra, second, the vertebral hole large in this region gives ample space to the roots of the cauda equina, so both nerve injury may be minimal in this region because in this area are housed nerve roots with great space, less content, and more continent.

Patients and Methods

We present the case of a 48-year-old male, construction worker, who suffered a fall from a height of approximately 15 m beating directly on the lumbar region against a beam, presenting pain and inability to move the legs, brought to the emergency room 1 hour after the accident, is assessed clinically, X-rays and CT scan are taken, and diagnosed as L3–L4 fracture dislocation with ASIA B. The patient was surgically intervened 3 hours after the accident with reduction via posterior transpedicular fixation. One week later anterior approach was performed with intersomatic vertebral cage.

Results

The patient progressed to ASIA C 24 hours after the first surgery. Three months later, he became a functional patient with ASIA D and control of sphincters.

Conclusion

The author's purpose is to show the results obtained by an intervention in the early hours of the trauma which helped promote a nonfunctional injury to a functional lesion, and almost total recovery.
A Model of Metastatic Bone Cancer Pain in the Lumbar Spine
Authors: Sarabia-Estrada Rachel , Goodwin C. Rory , Ruiz-Valls Alejandro , L Gokaslan Ziya , Sciubba Daniel M
Published: May 2015

Introduction

Bone is the third most common site for metastasis representing a poor prognosis in patients with cancer. Metastases to the spine are a common source of pain. Its secondary effects such as fractures, hypercalcemia, and neurological deficits significantly reduce patient's quality of life. Microfractures occur in metastatic regions of cancerous bone that can no longer handle ordinary loading, causing deformation of the spine and impingement of nerves. As the disease progresses, pain severity increases and it becomes more difficult to treat, causing further decrease in the quality of life of the patients. A key obstacle in the study of this disease is the lack of reliable, practical, and reproducible animal models to study spine metastatic pain.

Materials and Methods

Behavioral evaluation was conducted in a group of 30 athymic rats: 10 tumor-implanted (human mammary adenocarcinoma, L5 vertebral body); 10 sham (surgery performed, no tumor implanted), and 10 control rats (nontumor or surgery). Randall–Selitto and pincher tests were used to evaluate the nociceptive response in rats. Tumor growth was monitored by bioluminescent imaging (BLI) and CT.

Results

The mechanic nociceptive response was significantly reduced (day 45) in time and pressure applied in tumor rats compared with control or sham; a slight nonsignificant reduction was observed in the paw withdrawal in tumor-implanted rats. BLI revealed severe tumor invasion in the lower spine that was qualitatively related with lytic lesions in two or three vertebral bodies. These lesions were characterized by a decrease in the density of the bone in lumbar spine consistent with tumor location on bioluminescence. There was near-complete ablation of the posterior elements of the spine. Locomotion gait analysis showed a disruption in the normal pattern of the rat's gait.

Conclusions

Our intraspinal metastatic tumor model animals showed locomotor and sensory signs that are in accordance with some of the clinical manifestations in humans. These signs included a locomotor deficit and an increase in noxious sensation. Our model offers a reliable method to evaluate alternative approaches to treat pain in patients with metastatic spine disease.
Effects of Spinal Blocks in Patients with Chronic Sciatica
Authors: Reyes Luis , Davila Victor , Morillo Olga
Published: May 2015

Introduction

The pain interventionism is the fourth step in the pharmacological treatment of back pain, being used longer than the spinal blocks. The purpose of this study is to evaluate the effects of spinal blockade in patients with chronic sciatica.

Patients and Methods

A total of 29 patients with chronic sciatica spine surgery unit of the University Hospital “Dr. Manuel Nunez Tovar” were evaluated by identifying the degree of pain and functional disability by visual analog scale (VAS) and Oswestry Disability Index (ODI), underwent spinal block procedure, according to the affected level and subsequently performed feedbacks to the first and fourth week.

Results

The mean VAS score was 8.59 at baseline and 5.21 and 4.72 for the first and fourth week, showing an improvement in the perception of moderate-to-severe pain. The ODI was 56.21% at start and 39.45% and 32.38% at the first and fourth week, obtaining a reduction of severe functional disability to moderate. The patient's history was not a determining factor in the perception of pain and functional capacity. No evidence of significant statistical relationships between the results of the VAS and ODI application type, number of injection, and corticosteroid use were observed.

Conclusion

Spinal blocks are an effective method per se for the management of chronic low back pain with radicular commitment and its effects are not altered by the type of corticosteroid, number, and type of injection.
Major Vertebral Resections (Vertebrectomy) and Reconstruction with Massive Allografts: A Review of 13 Cases (Follow-Up: From 3 to 16 Years)
Authors: Luzzati Alessandro , Perrucchini Giuseppe , Scotto Gennaro , Mauri Orietta
Published: May 2015

Introduction

Spine surgery allografts show a lower fusion rate than autografts in posterior arthrodesis, but they demonstrated their full effect in reconstructions of the anterior column, probably for biomechanical reasons (load compression forces on the graft).

Patients and Methods

We report our experience in 13 patients affected by spine tumors and treated with total vertebrectomy (12 patients one level, 2 patients two levels, and 1 patient three levels) and reconstruction with massive bone bank graft (femoral diaphysis rings) filled in 2 cases with acrylic cement and in 12 cases with fresh iliac autografts. The demographic was five metastasis, three hemangioendotheliomas, one chordoma, two germ cell tumors, and one multiple endocrine neoplasia. The follow-up ranges from 192 to 36 months, with a mean of 97, the mean age 49 years, the levels treated from D1 to L5, the length of the vertebral resection ranges from 30 to 75 mm. All patients were monitored with X-ray standard at 3, 6, 9, and 12 months after surgery, spiral CT, and standard X-rays on an annual basis from the first year.

Results

X-ray revealed excellent stability with complete interbody fusion in all patients after 12 to 15 months from surgery. We have found lines of radiolucency in 15% of patients at the proximal and distal screws but without any associated clinical sign.

Discussion

Although the small series, the mean follow-up of 8.1 years allows us to say that this technique could be useful in clinical treatment of complex diseases of the spine where a circumferential reconstruction is required, achieving to a final, complete, and stable interbody fusion.
Evolution and Analysis of 445 Cases of Lumbar Discal Hernia Treated with Hemilaminoforaminotomy and Discectomy
Authors: Gardea Loera Gilberto
Published: May 2015

Introduction

The purpose of this study is to show the good results, we can obtain by making hemilaminectomy with foraminotomy and discectomy for herniated lumbar disc disease. Lumbar disc disease is a common affliction. Surgical intervention provides excellent results in carefully selected patients. Discectomy with hemilaminoforaminotomy through a small incision with surgery loupes or microscope permits an accurate decompression of the root with results from good to excellent.

Methods

The surgical records of 445 patients, who underwent surgical intervention for herniated lumbar disc disease in an 18.5-year period between March 1996 and September 2014, were checked. A total 202 were women and 243 men. The range age was 14 to 83 years with an average of 48.5 years. All the patients had root pain in a dermatome pattern because of herniated lumbar disc disease with or without foramen stenosis and they were evaluated with imaging studies as: MRI and some of them with CT. Patients older than 60 years (128 patients) had foramen stenosis and they had the same procedure. They were treated with hemilaminoforaminotomy and discectomy through a small incision: 236 patients were operated on one level, 169 were operated on two levels and the other 40 patients were underwent more than two levels. The outcome results were collected at a range from 2 months to 18 years. Over 293 patients have a 10-year follow-up. The procedure was hemilaminectomy with foraminotomy and discectomy using microscope or surgery loupes. Hospitalization was from 12 to 24 hours.

Results

The results were defined according to Macnab scale as excellent 84, good 10, regular 4, and poor 2% (Fig. 1).

Conclusion

The results of these series indicate that most patients do well after hemilaminoforaminotomy with discectomy and root decompression. It is safe and it does not have destabilization risk. With this procedure, the outcomes are from good to excellent, although the patients had to be well selected by examination and radiological findings. This kind of minimal invasion surgery allows patients to have a fast recovery with low cost, it enables a quick reincorporate to work and esthetically pleasant.
Our Experiences in Complications in Spinal Disk Herniation Surgery
Authors: Giménez Carlos , Laconich Diego , Ucedo Oscar , Marin Elio
Published: May 2015

Introduction

In the teaching hospital of the National University of Asuncion, approximately 85% of patients presenting to the query in the neurosurgery service, do so for back pain radiating to the lower limbs. In the time period spanning from January 2013 to September 2014, 43 were operated herniated discs. We discuss our experience on postoperative complications.

Material and Methods

This study is an observational retrospective study. We used the medical records registered in the office of Neurosurgery Hospital of Clinics of the National University of Asuncion and records of surgical techniques in patients undergoing herniated discs from January 2013 to September 2014. Excel is a form of USU to record data. The variables observed were satisfactory or postsurgical evolution, age, sex, and job occupation.

Results

Of the 43 patients operated, we had the following six complications: two infections of surgical wounds, an error of level, two reherniation, and one seroma. These complications occurred in five of 43 patients, 11.6% of them.

Conclusion

We conclude that our rate of complication is not low considering the number of patients operated. We had infection in 4.6%, error of level in 2.3%, rehernation in 4.6%, and seroma in 2.3%. We had complications whose origin could have been avoided as infections in which we find the probably fault in the line of asepsis during surgery and in the postoperative care.
Aseptic Spondylodiscitis after Lumbar Discectomy: Case Report and Literature Review
Authors: Molina Marcelo , Delgado Matias , Campos Mauricio , Román Javier
Published: May 2015

Introduction

Aseptic inflammatory changes in the vertebral bone marrow, end plates and intervertebral discs have been described as part of different entities such as Modic changes (MCs). MCs are classified in three types according to the formation of vascularized fibrous, fatty, or cicatricial bone tissue. Radiologically, each type is distinguished by particular magnetic resonance imaging (MRI) findings. MCs can be seen as part of normal spinal degeneration or secondary to spine surgical procedures such as lumbar discectomy. Even though their prevalence varies between studies, in clinical practice they generally are infrequent radiological findings. Patient and Methods: A case report of a 26-year-old man with 10 days of postoperative intense low back pain refractory to oral analgesia after L4–L5 lumbar discectomy is presented. A nonsystematic literature review about postoperative MCs was conducted.

Results

The patient evolved with difficult pain management needing to be hospitalized and studied with laboratory examinations and spinal images. Elevation of inflammatory parameters and lumbar spine MRI with T1-weighted image hypointensity, T2-weighted image hyperintensity, and increased signal with gadolinium at vertebral bone marrow and end plates adjacent to L4–L5 disc were the main findings. Septic spondylodiscitis was suspected as differential diagnosis, but conservative treatment was followed by clinical observation and evaluation of inflammatory parameters. The patient evolved with a progressive decrease of back pain and slight elevation of control inflammatory parameters but neither antibiotic treatment nor surgery was needed. At 9th day of hospitalization, the patient was discharged given positive clinical response with no pain at rest and slight pain with movement. Ambulatory follow-up with laboratory and imaging study exhibited normalization of inflammatory parameters and resolution of vertebral bone marrow and end plates changes accompanied by remission of patient's pain.

Conclusion

MCs are infrequent radiological findings. Type 1 MCs show similar MRI findings to those seen in the infectious process of the spine, which turns septic discitis/spondylodiscitis the main differential diagnosis to discard. When MCs are present, laboratory and imaging evaluation has to be performed to rule out an infectious etiology. Evaluation of inflammatory parameters, diffusion-enhanced MRI, and analysis of MRI contrast enhancement patterns are useful tools for this purpose. Because of the significant association between MCs and low back pain, symptomatic MCs must be treated with a first-line conservative treatment of analgesia and physical activity restriction.
Idiopathic Scoliosis: Correction and Fusion with Pedicle Screws, without Instrumentation at the Apex
Authors: Rizzi Pablo , Bruzzone Mauro , Maldonado Dante , Canteros Leyes Daniel , Bernis Joaquin , Benedetto Abel , Reartes Mauricio
Published: May 2015

Introduction

Vertebrae of the scoliosis apex are more difficult to instrument with pedicle screws, because they are commonly the most rotated and dystrophic. We evaluated the postoperative radiographical results of scoliosis surgery with pedicle screws, without instrumenting the apex vertebra or its adjacent vertebrae.

Patients and Methods

This study is a radiographical retrospective study. A total of 24 patients with diagnosis of idiopathic scoliosis, with a minimum of 2 years' follow-up, were treated with correction and fusion, using pedicle screws. The apex vertebrae or its adjacent vertebrae were not instrumented (one to four levels). The correction index, sagittal and coronal alignment, clavicle angle, and rotation of the apex were measured at the immediate postoperative period and 2 years after surgery. The correlation between correction and apical levels without instrumentation was also calculated.

Results

The correlation between correction and the noninstrumented levels around the apex was not significant ( r =  − 0.18; p = 0.41). Radiographical parameters of correction were acceptable at the immediate postoperative and 2 years after surgery.

Conclusion

There was no correlation between correction and noninstrumented levels around the apex. Not instrumenting the apex could be an option that shows some potential benefits. The correction indexes and both sagittal and coronal balance were acceptable. There was no correction loss at 2 years after surgery.
Sacroiliac Joint Pain: Analysis of Results in Ecatepec ISSEMyM Medical Center and Hospital Ruber Madrid, Spain
Authors: Valencia Carlos Tariacuri , Fuentes Rivera Miguel Angel , Gonzalez Moga Amado , Guzman Carranza Juan Enrique
Published: May 2015

Introduction

Low back pain originates in the sacroiliac joints in 15 to 20% of cases. The special configuration and joint anatomy of the determined morphological suffering throughout life produce a degeneration transformations which can act in extrinsic (trauma and stress) or intrinsic (inflammatory or infectious) factors. The clinical parameters, tests of physical examination, and imaging studies are often nonspecific, causing a big problem at diagnosis.

Objective

This study aims to present the treatment and outcome of patients diagnosed with sacroiliitis on CMIE and Ruber hospital in Madrid, Spain.

Methods

A total of 74 patients with sacroiliitis, in whom 136 were performed diathermocoagulation treatments, frequency of presentation, gender, number of repeat treatment, age, and patient improvement with the Oswestry scale was analyzed and reviewed.

Results

A total of 26 patients with sacroiliitis associated with L4–S1 fusion mainly, average age 55 years, 75.6% female, presentation box pain between 6 and 18 months after the transpedicular fixation, 40% received two diatermocoagulaciones, improvements were reported in scale Oswestry 28%. Sacroiliac fusion is presented as an alternative treatment in cases of difficult management.

Conclusion

The challenge in treating sacroiliitis is to reach a proper diagnosis. The key to achieve maximum effectiveness with these tests and avoid mistakes is to have knowledge of the causes of pain, even as adjacent segment disease and effectiveness of treatments. Sacroiliac fusion is presented as an alternative treatment in cases of difficult management.
Surgical Treatment for Degenerative Lumbar Spinal Stenosis, Experience at Cartagena Colombia
Authors: Santiago-Rubio Gabriel Eduardo , Herazo-Bustos Mariana Isabel , Medina-Carmona Wanda Lorena , Miranda-Machado Pablo Andres , Carmona-Lorduy Carlos Alberto
Published: May 2015

Introduction

The primary objective of the surgical treatment is to relieve patient's symptoms, reduce the disability, correct deformities, stabilize the column, diminish the fixed segments, protect neurological organs, and decrease rehabilitation time in patients where conservative treatment had failed. Aims: This study aims to compare the percentage of functional limitation and pain intensity in the presurgical and postsurgical period in patients with lumbar spinal stenosis with surgical treatment with decompressive laminectomy, transpedicular instrumentation, and arthrodesis, by the column surgery team in the Universidad de Cartagena in three hospitals in Cartagena city, Colombia between January 2008 and January 2013.

Methods

Descriptive, comparative longitudinal study of 30 records of patients with clinical and immunological diagnosis, where the Oswestry Disability Index and Visual Analogue Scale were applied in the presurgical and 3 months' postsurgical treatments.

Results

The most of the patients had canal defects in two or more levels (69.9%), mainly between L4–L5 (28 of 30 patients). Most of the patients needed instrumentation of two or more levels (79.9%). There were intrasurgical complications in three patients (13.3%), all were dural tears; it was only one case of fistula as postsurgical complication (3.3%). About postsurgical results, it was observed a median difference of visual analog scale between presurgical and postsurgical of 5.1 points, and the difference in the median and standard deviation. In the pre- and postsurgical Oswestry Disability Index of 33.3%, which indicates, in our study, all of the patients submitted to surgical treatment by this technique had relevant postsurgical clinical relevance according to the FDA definition (≥ 15% in the Oswestry Disability Index) during a postsurgical following of 18.6 + 11.8 months.

Conclusion

The decompressive laminectomy technique, transpedicular instrumentation, and arthrodesis was effective to accomplish a clinical relevant benefit in patients with degenerative lumbar spinal stenosis.
The Importance of 360-Degree Stabilization and Fusion in Lytic Spondylolisthesis. A Minimally Invasive Technique to Revision and Complete the Final Construction after Broken Screw
Authors: Arias Pesantez Carlos Fernando , Arias Solano Carlos Reinaldo
Published: May 2015

Introduction

The spondylolisthesis lytic is a very unstable pathology and a reduction with a 360-degree stabilization improve solid fusion, only a posterior approach is not enough, is possible to see a broken transpedicular screw. Patient and Methods: We present a case of a 36-year-old woman with a spondylolisthesis lytic grade 2 who underwent just a posterior screw fixation; 6 months after surgery she feels lumbar and radicular pain, the rx shows a left S1 broke screw.

Results

We present a minimally invasive anterior lumbar interbody fusion plus a revision by posterior way to achieve reduction and circumferential fixation with percutaneous transpedicular screws preserving the muscular and ligamentous posterior tension band. The surgical time was 70 minutes, the blood loos 50 mL, time to discharge 23 hours after surgery and the return to normal activities in 5 days. The VAS pre-op was 8 and post-op 2, oswestry disability index post-op was 4.

Conclusion

The spondylolisthesis lytic needs a 360-degree approach to produce safe stabilization and possibility of solid fusion and a minimally invasive techniques allow to preserve muscular and ligament injuries and help the patient to return to normal activities shortly.
Outcomes of Vancomycin Associated to Bone Graft to Prevent Deep Spinal Infection, 573 Consecutive Posterior Spinal Surgical Patients
Authors: Scheverin Nicolas , Steverlynck Alejandro , Castelli Roberto , Falavigna Asdrubal , Videla Nicolas , Sobrero Diego , Dinelli Dino
Published: May 2015

Introduction

Infections in spinal surgeries with instrumentation is a complication that not only increases the cost of treatment but also the morbidity and mortality of patients. The rates of surgical site infection in spinal surgery with instrumentation published vary from 2.8 to 6%. The most commonly isolated organism in this kind of surgery is Staphylococcus aureus and methicillin sensitive or resistant.

Objective

This study aims to assess whether vancomycin decreases infection rates when is associated with bone graft in patients undergoing fusion.

Patients and Methods

This study is a retrospective study on spinal surgeries with instrumentation performed from January 2011 to December 2013 on 573 patients, using 1 g of vancomycin-associated with bone graft in 205 patients.

Results

With the use of vancomycin associated to bone graft a reduction in the rate of infection of 4.8 to 1.4 was achieved.

Conclusion

We found that the use of 1 g of vancomycin added to the bone graft in the posterior spinal fusion is associated with lower rates of infection and we found this result statistically significant ( p < 0.03782).
Spinal Neurocysticercosis: A Case Report
Authors: Laos Plasier Eduardo
Published: May 2015

Introduction

Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system. In endemic areas, the incidence of the NCC was approximately 4% of the general population. Although cerebral NCC is common, only 1 to 5% of cases demonstrate the involvement of the spinal canal. Great neurological morbidity can occur if spinal NCC is not adequate and opportunely. Patient and Methods: Male 70 years' old, with a history of cerebral NCC confirmed, DVP carrier, comes to our hospital emergency, with time of 5 months' duration disease, begins with paresthesias in the lower limbs, progressive loss of sphincter control, decreased strength in members inferiors difficult ambulation to prevent it. On admission, the patient lucid, sensitive level D6, paraplegia, hyperreflexia in the lower limbs, and sphincters unchecked. Dorsal spine MRI shows cystic lesion of 22 × 11 × 8 mm at D5 intradural extramedullary back and left side, which determines medullar compression. Surgery is performed consisting of laminectomy and partial D4, D5, D6, and more microsurgical resection of multiple cysts.

Results

Histopathological examination confirmed cysticercosis. Patient in postoperatorio is stable but unchanged in neurologic status despite the images confirmed decompression. Patient's motor weakness in the lower extremities and urinary function did not improve.

Conclusion

Spinal NCC can occur through direct hematogenous dissemination from the gastrointestinal tract. Spinal NCC may also be shown through the circulation of CSF. Doctors treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. MRI with contrast is recommended ELISA serum study in the diagnosis of these cases. Although spinal NCC is relatively rare, representing a distinct clinical entity that can have devastating consequences for the patient. Because of the limited size of the spinal canal, the effect of the mass of these lesions is not well tolerated.
Diagnosis and Treatment Options for Cervical Spondylodiscitis
Authors: Servidio Mariano , Petracchi Matias , Valacco Marcelo , Sola Carlos , Gruenberg Marcelo
Published: May 2015

Introduction

Cervical spondylodiscitis can present through a variety of unspecific signs and symptoms usually associated with a delay diagnosis. The close anatomic relation of the infection process with the spinal cord at this mobile area leads to a serious medical situation. Its low incidence and the lack of papers with high level of evidence in the literature explain why there are no well-established treatment protocols. Our objective was to evaluate retrospectively the treatment of a consecutive series of 19 adult patients treated for cervical spondylodiscitis.

Material and Methods

19 patients were evaluated with an average of 4 years of follow up. Eleven patients with a diagnosis of mechanical instability, neurologic compromise, or abscess formation were treated surgically; the remaining 8 were managed conservatively with external immobilization while all received intravenous antibiotics. Staphylococcus aureus, identified in 9 patients, was the most frequent etiologic agent.

Results

At final follow up all patients presented resolution of signs and symptoms of infection; a solid fusion was obtained in every case. In 5 patients with incomplete spinal cord compromise the remission was complete. Only 1 of the 5 patients with radicular compromise remains with paresthesias.

Conclusion

According to our selection guidelines, the combination of parenteral antibiotic treatment and external immobilization or surgery proved to be an adequate treatment in our small series of patients with cervical spondilodiscitis.
Spine Injuries from Diving Accidents: Our experience in Los Angeles, Chile
Authors: González Guerra Oscar , Saavedra Palma Tatiana , Canessa Aguila Gustavo , Segovia Mera Ramon , Avaria Ossandon Days , Medina Barra Luis
Published: May 2015

Introduction

In our country, amateur diving is a frequent summer activity in young people. Spinal injuries after diving in recreational context can lead to catastrophic consequences, mostly in young and economically active population.

Patients and Methods

We reviewed 34 patients hospitalized in our center who were admitted to the neurosurgery unit between 2006 and 2014, with spinal injuries because of driving accidents. Data were collected from their initial admission and from follow-up records. Statistical analysis was performed using Microsoft Excel 2010 and STATA v10.

Results

Of the total number of patients evaluated, 97% (33/34) sustained injuries. Mean age was 30 (SD, 15–54) years. All reported injuries occurred during summer. Alcohol consumption was present in 44% of cases. The most affected segment was cervical (88%), and the most common injuries were C4–C5 dislocation and fracture (18%) and C5–C6 dislocation and fracture (12%). Overall, 32% of patients presented severe neurological compromise (ASIA A, B, and C) at time of admission. Surgical treatment was required in 50% of cases, the majority using an anterior cervical approach. The other 50% underwent orthopedic management. NASCIS 2 methylprednisolone protocol was used in 18% of cases. Overall, 29% of patients received steroid therapy. Thirty-day mortality for the cohort was 8.8%, all ASIA A. Mean hospital stay was 22 (SD, 1–354) days.

Conclusion

Driving accidents in Los Angeles, Chile, while uncommon can result in spinal injuries with drastic consequences, including permanent physical disability, mortality, and a profound socioeconomic impact. In our experience, early surgical and orthopedic management resulted in best clinical results. The consumption of alcohol worsen the outcomes prevention strategies should be implemented to reduce the incidence and impact of this problem.
Vertebroplasty and Kyphoplasty. Complications, Avoidance, and Technical Notes in our 7 Years' Experience
Authors: Marcelo Markarian Pablo Lehrner , Moriones Silvia , Zilio Alberto , Galati Alejandro , Belchior Sebastian , Galante Jose , Sacher Fabio , Sole Horacio , Monti Alfredo
Published: May 2015

Introduction

The vertebroplasty (VP) and kyphoplasty (KP) are well known methods for the treatment of vertebral bodies fractures, due osteoporosis, primary, and metastatic tumor. The major complications are the cord and root compression, due cement leakage, epidural and subdural hematomas, and pulmonary emboli. These complications are most described in VP. In this retrospective study, the authors describe the way they find to avoid major complications with KP and a modification of de VP technique.

Patients and Methods

Between January 2007 and July 2014, 138 patients with 184 levels were treated in the three institutions. In 124 levels, KP was performed and in 60 levels VP. Balloon KP with pressure manometer was used. The VP were performed using de bone feelers and the cannulas of the KP set, without the insufflation of the balloon. A retrospective analysis of the cases was made and a review of the literature.

Results

A total of 102 patients (73.9%) were females and 36 patients (26.1%) were males. The 69% of the total of patients were single fractures and 31% were double level fractures. The etiology was 92% osteoporotic fractures, four patients (2.9%) underwent KP due multiple myeloma, five patients (3.6%) for hemangioma, and two patients (1.4%) for spinal metastasis. Pain relief was reported in all the patients with a media of VAS 8 of 10 in pre-op and VAS 2 of 10 in post-op. Neither major complications nor post-op infections were reported. Overall, 3 patients with cement leakage in the spinal canal, 14 patients with interbody disc space leakage, and 9 patients with lateral and anterior extravasations were described without symptoms.

Conclusion

The cement injection with the bone fillers provides more control in the cement infusion in the VP as well as in the KP, avoiding the leakage of cement in great quantity and preventing major complications.
Uncommon Intradural–Extramedullary Lesions Removed by Uniportal Minimally Invasive Technique. Clinical and Radiological Results: A Study with 12 Months of Follow-Up
Authors: Arias Pesantez Carlos Fernando , Peña Pablo
Published: May 2015

Introduction

Intradural extramedullary cervical lesions usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes standard fashion cut incision, open laminectomy, and some cases fusion.

Patients and Methods

We present four patients (one woman and three men) with symptoms including radicular pain and/or neurological deficit, due intradural extramedullary cervical lesion. All the patients underwent total resection with minimally invasive uniportal technique using a tree blade MAXCESS retractor system (Nuvasive, Inc.). We measured a VAS, Nurick scales pre-op, and with follow-up of 6 weeks, 3.6 and 12 months post-op. Surgical time, blood loss and time to discharge. All the patients underwent control MRI postoperatively.

Results

One patient neurenteric cyst, two patients: underwent neurocysticercosis, and the last epidermoid cyst. The VAS and Nurick scales were decreased over the time line. The surgical time was 140 minutes (mean), blood loss 30 mL (mean). All the patients were discharged at 47 hours mean, and return to daily activities 10 days (mean).

Conclusion

Intradural–extramedullary lesions can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization, disruption to local tissues, and return to daily activities suggest that this technique may present an alternative to traditional open resection.
Free-Hand Placement of C7 Pedicle Screws: A Cadaveric Study
Authors: Vialle Emiliano , Vialle Luiz Roberto , Herrera Luis
Published: May 2015

Introduction

This study aims to evaluate the accuracy of free-hand pedicle screws placement at seventh cervical (C7) vertebra.

Methods

The authors have exposed the cervicothoracic junction. Overall, nine adult cadavers (seven males and two females) preserved in formalin from the Faculty of Medicine, locating the C7 vertebra based on anatomical parameters. According to previous publications, the entry point for the C7 pedicle was determined as 3 to 4 mm lateral and 5 to 6 mm superior to the center of the lateral mass, and the pedicle was drilled manually and instrumented with 3.5 mm. After the screws placement, of the screws we removed, the C7 vertebrae were removed for radiographic analysis.

Results

The authors were able to adequately locate the C7 entry point in 12 pedicles (66.6% accuracy), finding a great variability both laterally (2–5 mm) and cranially (3–10 mm). The angulation in the coronal plane was correct in 13 pedicles (72.3%), despite the incorrect location of the entry point. Angle values in the coronal plane ranged from 38 to 62 degrees. In the sagittal plane angulation, two screws were placed in the C6–C7 disc. The midtransversal diameter of the 18 pedicles ranged from 4 to 7 mm.

Conclusion

The location of the entry point for placement of C7 pedicle screws with pure free-hand technique is very variable because of the anatomical differences and the authors recommend guidance for increased safety and accuracy.
Anthropometry of the Vertebral Pedicles of the Thoracic Spine without Pathology in Mexican Patients of a Public Institution in the Metropolitan Area
Authors: Garcia Su·Rez Adrian , Cabrera Escamila Jorge Arturo , Elizalde Eulalio
Published: May 2015

Introduction

The anatomy of the pedicles is complex and vary according to the region valued. For proper placement of a transpedicular screw requires a high knowledge of the anatomy of the pedicle and the different surgical techniques for placement. Tomography is the best radiological tool for measuring various parameters of the pedicles. The purpose of this study was to determine, through tomography, thoracic pedicle anthropometry of the Mexican population and its variations according to sex, with the aim of providing irrefutable anatomical information for the development of techniques, materials, and tools more specific to our population pedicle fixation.

Methods

This study is a descriptive, retrospective, and observational study. The source collection and measurement were performed on CT chest scan of Unit Trauma Hospital “Dr. Victorio de la Fuente Narv·ez,” between January 2012 and June 2013, on computer tomographic Siemens Somatom and General Electric of 16 cuts, which were made in Mexican patients without lesions in the thoracic spine, with an age range of 18 and 60 years, who had axial, sagittal, and coronal to no more than 3 mm in T1 to T12 levels in the left and right pedicles. The sample size was calculated using tables Hulley, given a universe of 1,620 thoracic CT, with a confidence level of 95% amplitude interval 0.15, an expected ratio of 0.15, and a β 0.20, determined a sample of 122 scans. Measurements (axial and sagittal diameter, coronal morphology, axial, and sagittal angulation) were performed by two observers and the involvement of a third when discordance of more than 10% between the first two was found. Data analysis was performed with SPSS version XVII, using descriptive statistics and weighted Kappa.

Results

The pedicles were of smaller diameter T5, with 2.03 ± 0.94 mm in men and 1.66 ± 0.77 mm in women. The smallest sagittal diameter was found in T2, with 1.95 and 10.15 ± 9.27 ± 2.60 mm, respectively. The angle was increased axial T1, averaging 32.70 ± 4.37ʃ. The sagittal angle of thoracic pedicle showed greater angles from T4 to T10. Predominated teardrop at T1–T3, the elongated drop in T4–T5 and T11–T12, and kidney-shaped in T6–T10.

Conclusions

Women may be less than the male population values. From T3 to T9 pedicles are smaller than the diameter of the screws that are included in the market. Therefore, anteroposterior, lateral, and axial assessment of each vertebral body to the pedicle screws placement necessary; we also seek new screw placement techniques as described in-out-in, and use technology such as neuronavigation, to continue to benefit from the biomechanical properties of transpedicular instrumentation both to the surgeon and the patient.
Magnitude, Location, and Factors Related to Regional and Global Correction Loss in Long Adult Deformity Constructs: Report of 183 Patients with 2-Year Follow-Up
Authors: Ames Christopher , Lafage Virginie , Scheer Justin , Kelly Michael , Hostin Richard , Hart Robert , Klineberg Eric , Protopsaltis Themistocles , Deviren Vedat , Sciubba Daniel , Bess Shay , Shaffrey Christopher , Schwab Frank , Smith Justin
Published: May 2015

Introduction

Adult deformity patients (pts) have previously been shown to lose spino-pelvic correction over time especially in the sagittal plane. The goal of this study was to analyze the source of this correction loss and specifically to quantitate the change that occurs in fused verses unfused segments. Variables examined include presence of interbody fusion, rod diameter, rod material, age, and pre-op sagittal alignment.

Materials and Methods

A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria were age ≥ 18 years, ASD, no revisions between > 6 weeks and < 2 years postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2–T12) and lumbar lordosis (LL:L1–S1) were both measured overall as well as within and outside the instrumented segments. Overall, SVA, PT, Pi-LL change, and TK and LL change between 6 weeks and 2 years post-op was calculated. Of these pts, the amount of TH loss and TL loss within and outside of the instrumented segments was also determined as well as a percentage of the total loss for each region.

Results

A total of 183 pts met criteria. Between 6 weeks and 2 years post-op 61.7% of pts lost SVA (4.4 ± 4.3 cm), 65.0% lost PT (4.7 ± 4.0 deg), and 40.4% lost PI–LL (16.2 ± 9.3 deg). Overall, 63.9% had TH loss (8.0 ± 8.9 deg) and 56.8% had LL loss (5.8 ± 4.5 deg). Overall, 41.5% lost > 2 cm SVA. Of the pts with > 2 cm SVA loss, 60.5% had LL loss, and of those, 82.6% was within instrumented segments. Of the pts with LL loss, 13.8% had > 10 deg loss. Pts with an interbody fusion have a 2.3 times ( p = 0.0076) likelihood of having any LL loss, but the interbody fusion was protective against > 10 deg change (7.1%). Pts ≥ 65 years' old are 9.4 times ( p < 0.0001) more likely to have LL loss than pts ≤ 45 years' old (4.4%). Pts with pre-op C7 SVA > 5 cm are 2.4 times ( p = 0.0035) more likely to have LL loss.

Conclusion

Loss of initial regional and global sagittal correction is common in ASD surgery and also occurs inside the instrumented segments between 6 weeks and 2 years postop. Older age and pre-op sagittal deformity are risk factors for overall loss of correction and for loss of correction within the instrumented segments. In our study, interbody fusion was only protective for LL loss > 10 deg.
Cervical Lordosis Increases with Age in Adult Spinal Deformity: A Cross-Sectional Study of Nonoperative Patients
Authors: Kim Han Jo , Scheer Justin , Lafage Virginie , Smith Justin , Shaffrey Christopher , Schwab Frank , Mundis Gregory , Klineberg Eric , Gupta Munish , Cunningham Matthew , Hart Robert , Burton Douglas , Bess Shay , Ames Christopher
Published: May 2015

Introduction

It is theorized that with age and degeneration, the cervical spine becomes progressively more kyphotic; however, there are no studies which support these conclusions. We performed a radiographic analysis of patients with adult spinal deformity (ASD) and hypothesized that cervical lordosis would decrease with aging.

Patients and Methods

The nonoperative arm of a prospective multicenter database of patients with ASD was analyzed. Inclusion criteria were patients > 18 years old meeting any one of the following criteria: Coronal Cobb > 20 degrees, C7-S1 sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25 degrees, or thoracic kyphosis (TK) > 60 degrees, and the patients who did not undergo surgery. Nonidiopathic causes of scoliosis, history of spine surgery, and age < 18 years were excluded. Coronal and sagittal radiographic parameters were collected with particular interest to cervical sagittal parameters. Curves were classified into Schwab type. Age groups were separated into group 1: < 40 years, group 2: 41 to 60 years, and group 3: > 60 years. Statistical analysis was performed with Wilcoxon rank sum test for continuous variables with a p value < 0.05 as significant.

Results

Of the 491 patients in the database, 373 met inclusion criteria for the study and 269 had complete radiographic data for analysis. With increasing age, there were an overall slight increase in body mass index and a statistically significant increase in the Charlson Comorbidity Index. There were no differences in Schwab curve type prevalence between groups. The mean cervical lordosis (CL) increased with age (1.6 ± 10.6, 7.1 ± 13.3, and 11.8 ± 13.2 in groups 1, 2, and 3, respectively, p = 0.04,< 0.01, and < 0.01. Interestingly, there was a corresponding increase in T1 slope between groups 1, 2, and 3 without an increase in thoracic kyphosis. Meanwhile, the C2–7 SVA remained the same (3.0 ± 1.2, 2.7 ± 1.6, and 2.7 ± 1.8, groups 1, 2, and 3, respectively, p = 0.17, 0.88, 0.32). With increasing age, there was a decrease in lumbar lordosis (LL), increase in PT, and increase in SVA.

Conclusion

CL actually increases with age in nonoperative ASD patients while the thoracic kyphosis remained the same. The LL decreased whereas the PT and SVA increased. The types of curve distributions were similar between all the age groups.