ABSTRACT
Aims: Kyphoplasty is a minimally invasive treatment used to reduce pain, restore vertebral height and improve mobility in patients with painful spinal VCF. Pain from vertebral compression fractures (VCF) comprises an important health issue with significant social and economic impact, particularly in elderly patients with osteoporosis where treatment options are limited. We assessed outcomes in patients with VCF who failed conservative management and underwent kyphoplasty. Study Design: Prospective and retrospective case series. Place and Duration of Study: At a single neurosurgical practice February 2003 and September 2012. Methodology: A total of 203 patients with 288 treated vertebral body fractures treated with kyphoplasty were enrolled. The Visual Analog Scale (VAS) was used to prospectively measure back pain before and after surgery. Pre and post operative disability and quality of life were retrospectively measured with the Roland Morris Disability Index (RMDI) and EuroQol 5-Domain scale (EQ5D), respectively, via patient survey. Pre and post-operative narcotic analgesic usage and incidence of subsequent fractures were recorded. Results: There was a statistically significant improvement (P < .001) in each of the assessed measures following surgery. The post-operative rate of narcotic use was reduced from 63% to 17%. Eight patients (4.2%) developed and underwent repair of an adjacent fracture with a mean time between surgeries of 461 days. Conclusion: Following kyphoplasty, patients experienced significant, rapid, and sustained reduction of back pain, improved quality of life, and reduced disability with a low complication rate. Timely repair of VCF is indicated, not only to prevent complications associated with prolonged inactivity but also for effective treatment of severe pain in the acute setting.
ABSTRACT
Las aminoacidopatías son errores innatos del metabolismo intermediario de los aminoácidos. Su confirmación diagnóstica y seguimiento se realiza con la cuantificación de aminoácidos libres en fluidos biológicos por técnicas como la cromatografía líquida de alta eficiencia (HPLC), para lo que es necesario comparar con valores de referencia normales. La población colombiana no cuenta con estos valores disponibles y el diagnóstico es realizado por comparación con los de otras poblaciones. En el presente trabajo se obtuvieron valores de referencia de aminoácidos en plasma en una población de niños (n=36) y adultos no afectados (n=17), mediante HPLC por derivatización postcolumna con ninhidrina. Los valores de referencia obtenidos fueron ligeramente más elevados que los informados para otras poblaciones y permitieron la identificación de doce casos de aminoacidopatías, incluyendo fenilcetonuria clásica, hiperfenilalaninemia, hiperglicinemia no cetósica, desórdenes del ciclo de la urea, tirosinemia. La implementación de la cuantificación de aminoácidos por HPLC y la obtención de los valores de referencia de aminoácidos en plasma permitirán aumentar el conocimiento sobre la incidencia de las aminoacidopatías en el país para garantizar, junto con otros factores, su diagnóstico preciso y oportuno y la implementación de un adecuado seguimiento nutricional.
Aminoacidopathies are inborn errors of the amino acid intermediary metabolism. The benchmark method used for their diagnosis and monitoring is the quanti!cation of free amino acids in biological fluids using High Performance Liquid Chromatography (HPLC), which needs to be compared against normal reference values. However, those amino acid reference values are not available for the Colombian population and the diagnosis is usually made using values from American or European populations. In this work, plasma amino acid reference values in non-affected children (n=36) and adults (n=17) were established, using an HPLC method with a postcolumn derivatization with ninhidrine. Plasma amino acid reference values in a Colombian population were slightly higher compared with those reported for other populations, and enabled the identification of twelve aminoacidopathies including urea cycle disorders, phenylketonuria, hyperphenylalaninemia, nonketotichyperglycinemia, hepatorrenaltyrosinemia and maple syrup urine disease. The implementation of amino acid cuantification by HPLC and the construction of plasma amino acid reference values is very useful for a suitable and precise diagnosis of amino acid disorders, the implementation of proper nutritional treatments, and an increased knowledge of aminoacidopathy incidence in Colombia.