ABSTRACT
Introducción. Existen diversos abordajes para la columna toracolumbar: anterior, lateral, posterior y combinados. Cada uno de ellos presenta sus ventajas y desventajas. La corporectomía fragmentaria progresiva posterior (CFPP) o corporectomía transpedicular puede ser realizada en un solo tiempo quirúrgico, permitiendo además disminuir los riesgos de los otros abordajes y lograr una adecuada estabilización del raquis. En este trabajo analizamos la experiencia de nuestro Servicio en este abordaje. Material y método: Análisis de la técnica utilizada y realización del abordaje en un espécimen anatómico donde se jerarquizan algunos detalles de importancia según nuestra experiencia. Estudio retrospectivo entre los años 2001-2005. Se analizaron diversas variables epidemiológicas, preoperatorios y postoperatorias a partir de los datos de las historias clínicas de 27 pacientes intervenidos durante ese período. Resultados: Localización: 10 a nivel dorsal y 17 a nivel lumbar. Etiología: 3 patologías infecciosas, 10 traumáticas y 17 tumorales. Se fijaron 24 pacientes en el primer acto quirúrgico y tres en un segundo acto (dada su etiología infecciosa). Sólo un paciente presentó como complicación una fístula de líquido cefalorraquídeo. Ningún paciente presentó agravación de su estado neurológico. Todos los casos presentaron buena estabilidad raquídea. Conclusiones: Esta técnica permite maximizar una región anatómica, otorgando un amplio y seguro campo quirúrgico. Consideramos esta vía como una opción para el tratamiento de patología del cuerpo vertebral.
Objetive: There are many approaches to the thoracolumbar spine: anterior, lateral, posterior and combined. Each one of them present advantages and disadvantages. The posterior progressive fragmentary corporectomy (PPFC) or transpedicular corporectomy offers the advantage to be made in a single surgical time, allowing in addition to lessen the risks of the other approaches and to obtain a suitable stabilization of the spine. Material and Methods: Analysis of the technique and practice of an apprach in a cadaveric specimen giving importance to theremark of certain details of the technique. Restrospective study between years 2001-2005. Diverse epidemiologic preoperating and postoperative variables were analyzed from data of the of 27 operated patients with this procedure. Results: Localization: 10 at lumbar and 17 at dorsal spine. Etiology: 3 infectious, 10 traumatic and 17 tumoral pathologies.Twenty four patients were stabilized in an unique operation, and three in a second time (given its infectious etiology). Only one patient presented a CSF leak as a complication. No patientpresented aggravation of inicial neurological state. All the cases showed good spine stability. Conclusion: The amount of operative exposure achived using this technique is wide and safe. We consider this approach as an option for the treatment of vertebral body pathology.
Subject(s)
Arthrodesis , Laminectomy , Lumbar Vertebrae , Spinal NeoplasmsABSTRACT
Objective: To present two cases of leptomeningeal carcinomatosis, their management, and a bibliographical revision. Description: case 1: patient of 48 years, who enters by sensory abnormalities, with CT that demotrated tetraventricular hydrocephalus. The CSF was positive for neoplasic cells. Primary tumor was found in bladder. Case 2: patient of 55 years, who entered by progressive cuadriparesia. He presented sensory abnormalities by acute hydrocephalus. The autopsy informed meningeal affectation by gastric carcinoma. Discussion: Although patognomonic signs do not exist, the more frequent clinical manifestations are affectation of cranial nerves, headache and alterations of the mental functions. The RNM with gadolinium is the best method, with a sensitivity of 70. In the infrequent cases of acute hydrocephalus, the CT is the first study to perform. Conclusion: Before the unspecific signs, the diagnosis of certainty of meningeal carcinomatosis is based on the help of radiological investigations and the findings of the LCR, on an oncologic context.