Esclerosis temporomesial en adultos: revisión del síndrome y evalución de resultados / Mesial temporal sclerosis in adults: Revision of the syndrome and assessment of results

Objective: To describe the presentation and the management of the Mesial Temporal Sclerosis (ETM) in adult patients and to evaluate the results of the presented series. Description: the authors selectioned 3 cases among 53 adults who underwent surgical treatment with ETM diagnosis. Case 1: female patient, 32 years old. Antecedents of complex partial crisis since 6 years old, some of the crisis related to febrile episodes. Aura related like unpleasent gastroesophageal sensation, break of contact, right hand dystonia, cephalic turn to right and oroalimentary and manual automatism. RMI and EEG-video: injury compatible with left ETM. Case 2: male patient, 24 years old. Antecedents of complex partial crisis since 13 years old. Breack of contact, verbal automatisms (repeats unintelligible sounds) and sensation of postictal sikness. RMI: increase of signal (FLAIR) in both hippocampus, impressing right atrophy. EEG-video with profund electrodes implanted: start of the crisis on a right mesial temporal level. Case 3: female patient, 21 years old. Antecedents of complex partial crisis since 12 years old. Complex partial crisis with bimanual and oroalimentary automatisms with an episode of generalization. RMI and EEG-video: injury compatible with right ETM. Intervention: case 1 and 2 were resolved by the realization of an anteromesial resection of Spencer. In case 3 a selective amygdalo hippocampectomy was practiced. Conclusion: ETM is the paradigm of the refractory epilepsy in an adult population. Precocious diagnosys and treatment allow to obtain a high index of cure with small amount of significant sequels.

Subluxacion cervical espondiloartrosica / Degenerative cervical subluxation

Objective: To analyze the biomechanical and anatomical factors and the surgical treatment and outcome in cervical degenerative spondylolisthesis. Method: Between 1978 and 2003, 223 patients underwent surgery for cervical spondylotic myelopathy, 41 patients presented with degenerative subaxial subluxation. According to the Nurick scale, 26 were grade 2, 14 were grade 3 and 1 was grade 4. Those with degenerative subluxation were older compared to those who had only spondylotic myelopathy (63 vs 13 years). The former also corresponded to higher grades of the Nurick scale. All patients underwent static and dynamic plain radiographs, and MRI. We found 29 subluxations of one level, 11 patients with affection of two levels and 1 with three levels. 33 patients had unstable subluxations. The most commonly affected levels were C3-C4 and C4-C5. In all the cases, an anterior approach with autogenous bone graft and locking plate was performed. REsults: After surgical teatment, 21 grade 2 patients improved one grade, while 5 improved two grades; 9 grade 3 patients improved one grade and 1 two grades; the grade 4 patient improved one grade. Conclusion: Cervical degenerative subluxation is seen in older patients, usually associated with severe myelopathy and spondylotic changes. The cervical instability is more common in the C3-C4 and C4-C5 segments. In all the cases of our group there was a loss of cervical lordosis or kyphosis with ankylosis of the lower cervical spine. The anterior approach with autogenous bone graft and locking plate, allowed spinal cor decompression and cervical fusion

Artritis reumatoidea del raquis cervical. Algoritmo de tratamiento / Cervical rheumatoid arthritis. Treatment algoritm

Objective: To describe an algorithm for surgical management of cervical spine RA. Methods: RA cases treated by the senior authors from 1978 to 2003 have been analyzed. An algorithm for surgical management of the different forms of this pathology is proposed. Results: Cervical spine involvement by RA includes atlantoaxial subluxation, settling of the odonteid process, and suaxial subluxation. Surgical treatment should be established immediately after is radiological diagnosis. The optimal approach is a posterior one in every case, followed by an anterior approach when periodontal pannus, superior migration of the odontoid process, or subaxial subluxation are associated with an anterior compression. Conclusion: This algorithm is a useful guide to the treatment of spine RA

Experiencia con el uso de jaulas intersomáticas cervicales con placa incorporada / Experience in the use of intersomatic cage plates in cervical spine

Las jaulas intersomáticas cervicales con placa incorporada han aportado innegables ventajas respecto de los elementos de osteosíntesis tradicionales cumpliendo, asimismo, con todos los objetivos del tratamiento de la patología degenerativa: estabilidad de la prótesis, artrodesis ósea y diastasis definitiva del espacio y de los forámenes. Las ventajas observadas pueden resumir en: menor tiempo quirúrgico, simplificitad del método y mayor confort para el paciente (menores trastornos deglutorios, ausencia de hipertrófia muscular y de limitación de movimientos por el uso prolongado de collar cervical. Su indicación precisa es el tratamiento de la hernia de disco blanda y de la enfermedad discal degenerativa; su utilización no es aplicable a la patología traumática y a los casos de inestabilidad cervical de cualquier etiología, porque su diseño (un solo tornillo para cada cuerpo con disposición excéntrica de los mismos), la estabilidad inmediata que confiere es débil.