Quiste óseo aneurismático sólido del raquis dorsal / Solid aneurysmal bone cyst of dorsal spine

El quiste óseo aneurismático sólido es un tumor de naturaleza neoplásica indefinida, de comportamiento benigno, crecimiento rápido y agresivo. Representa menos del 8 % de todos los quistes óseos aneurismáticos. Se presenta un caso de quiste óseo aneurismático sólido de mediastino posterior con toma espinal torácica. La ausencia de signos característicos en las pruebas de imagen y la presencia de rasgos similares al tumor de células gigantes y el osteosarcoma, hacen imprescindible la confirmación anatomopatológica para un tratamiento adecuado de la enfermedad. La exéresis quirúrgica total de la tumoración, el aporte de injerto óseo y la fijación del segmento afecto constituyen el procedimiento de elección.

The solid aneurysmal bone cyst is a malignant tumor of undefined nature, benign behavior; it has fast and aggressive growth. It represents less than 8 % of all aneurysmal bone cysts. A case of posterior mediastinum solid aneurysmal bone cyst with thoracic spinal making is presented here. The absence of characteristic signs in the imaging and the presence of similar features of giant cell tumor and osteosarcoma, make it imperative the pathologic confirmation for proper treatment of the disease. Total surgical excision of the tumor, the bone grafting and fixation segment affection are the procedures of choice.

Le kyste osseux anévrismal solide est une tumeur de nature néoplasique indéfinie, caractérisée par un comportement bénin et une croissance rapide et agressive. Il représente moins de 8 % de tous les kystes osseux anévrismaux. Un cas de kyste osseux anévrismal solide au niveau de médiastin postérieur (d’atteinte spinale thoracique) est présenté. L’absence de signes caractéristiques dans l’imagerie RM et la présence de traits similaires à la tumeur à cellules géantes et à l’ostéosarcome rendent nécessaire la confirmation anatomopathologique pour un traitement approprié de cette pathologie. L’exérèse totale de la tumeur, la greffe osseuse et la fixation du segment affecté constituent la technique opératoire de choix.

Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation / Tratamento de fraturas sacrais instáveis com reconstrução percutânea com fixação de placa interna

PURPOSE: To study the effects of percutaneous reconstruction plate internal fixation in the treatment of unstable sacral fractures. METHODS: Percutaneous reconstruction plate internal fixation was applied on 21 cases of unstable sacral fracture (15 males and six females, at age range of 16-65 years, mean 38.3 years) including four cases of Denis Zone I, 14 cases of Zone II and three cases of Zone III. In operation, an arc incision (about 3-5 cm long) was made along the iliac crest on the outside border of posterior superior iliac spine (PSIS) on both sides, and then the plate was transported from the wounded side to the opposite one through the subcutaneous tunnel. RESULTS: The mean incision length, operation time, intraoperative blood loss was 4.3cm, 45.2min, and 160.8ml respectively. All these patients were followed up for 12-33 months (average 16.3 months), which showed no incision infection, intraoperative neurovascular injury, internal fixation loose or breakage, disunion, or obvious lower limb length inequality. The function result was rated as excellent in six cases, good in 12 and fair in 3, with excellence rate of 85.7%, according to the Majeed scoring system. CONCLUSION: Percutaneous reconstruction plate internal fixation is an ideal surgical approach to unstable sacral fractures, as it is easy, safe, causing less trauma and fewer complications, and conducive to quicker recovery.

OBJETIVO: Estudar os efeitos da reconstrução percutânea com fixação de placa interna no tratamento de fraturas sacrais instáveis. MÉTODOS: A reconstrução percutânea com fixação de placa interna foi aplicada em 21 casos de fratura sacral instável (15 homens e seis mulheres, com idade variando entre 16 e 65 anos, média de 38,3 anos) incluindo quatro casos de Zona I de Denis, 14 casos de Zona II e três casos de Zona III. No ato operatório, uma incisão arqueada (cerca de 3 a 5cm de comprimento) foi feita ao longo da crista ilíaca na borda externa da espinha ilíaca supero-posterior (PSIS) em ambos os lados, e então a placa foi transportada do lado da ferida para o lado oposto através do túnel subcutâneo. RESULTADOS: O comprimento médio da incisão, tempo operatório e perda sanguínea intra-operatória foram, respectivamente, 4,3cm, 45,2min e 160,8ml. Todos estes pacientes foram acompanhados por 12 a 33 meses (média 16,3 meses), o que mostrou nenhuma infecção de ferida operatória, lesão neurovascular intraoperatória, perda da fixação interna ou quebra, desunião ou desigualdade nos comprimentos dos membros inferiores. O resultado funcional foi excelente em seis casos, bom em doze e falho em três, com taxa excelente de 85,7%, de acordo com o sistema de escore de Majeed. CONCLUSÃO: Reconstrução percutânea com fixação de placa interna é uma abordagem cirúrgica ideal para fraturas sacrais instáveis, sendo fácil e segura, causando menos trauma e poucas complicações, conduzindo a uma recuperação mais rápida.

Técnica quirúrgica para facilitar lacolocación de tornillos sacroilíacospercutáneos / Percutaneous iliosacral screw fixation

Percutaneous iliosacral screw fixation is a useful technique for fixation of posterior pelvis ring injuries but it has potential complications. We describe a surgical technique modification of the original technique described by Routt etal. Using the surface of the C-arm as a guide in the inlet and outlet views, exact positioning of the guide wire is easier and surgical time as radiation exposure are decreased. We hope that this modification, in addition to a better understanding of sacral anatomical variations and risk factors for misplacement of iliosacral screws would reduce complications related to this procedure.

La fijación percutánea con tornillos sacroilíacos es una técnica de utilidad demostrada para la fijación de las fracturas de la pelvis posterior, sin embargo, no está exenta de riesgos. Describimos una modificación de la técnica quirúrgica original descrita por Routt et al. Utilizando las superficies del fluoroscopio como referencia en las vistas inlet y outlet, se facilita la orientación de la aguja guía disminuyendo el tiempo operatorio y el tiempo de radiación necesaria para la colocación de este tipo de osteosíntesis. Esperamos que esta modificación, asociado a un mejor conocimiento de la anatomía del sacro y los factores asociados a mal posición de los tornillos sacroilíacos permita disminuir los riesgos asociados a este procedimiento.

Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report

BACKGROUND: U-shaped sacral fractures are highly unstable, can cause significant neurological deficits, lead to progressive deformity and chronic pain if not treated appropriately. OBJECTIVE: To report a case of a U-shaped sacral fracture treated with lumbopelvic fixation and decompression of sacral roots in a 23-years-old man. METHOD: Decompression of the sacral roots combined with internal reduction and lumbopelvic fixation using iliac screws. RESULTS: Restitution of lumbosacropelvic stability and recovery of sphincter function. CONCLUSION: Lumbopelvic fixation is effective in restoring lumbosacralpelvic stability and allows full mobilization in the postoperative period. Good neurological recovery can be expected in the absence of discontinuity of the sacral roots.

INTRODUÇÃO: As fraturas sacrais em U são instáveis e podem causar significativa lesão neurológica, deformidade progressiva e dor crônica se não tratadas apropriadamente. OBJETIVO: Relatar caso de um homem de 23 anos com fratura em U do sacro tratada com fixação lombopélvica e descompressão das raízes sacrais. MÉTODO: Descompressão da cauda equina associada a redução interna e fixação lombopélvica usando parafusos ilíacos. RESULTADOS: Reconstituição da estabilidade lombosacropélvica e recuperação da continência esfincteriana CONCLUSÃO: A fixação lombopélvica é eficaz em restaurar a estabilidade lombo-sacro-pélvica e permite mobilização imediata no pós-operatório. Recuperação neurológica pode ser esperada na ausência de neurotmese das raízes sacrais.

Acute sacrococcygeal dislocation (anterior type): a case report.

Sacrococcygeal dislocation is a rare injury. A twenty nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics.

Traumatic transverse fracture of sacrum with cauda equina injury--a case report and review of literature.

Fractures of the sacrum are rare and generally associated with fracture of the pelvis. Transverse fractures of the sacrum are even less frequent and neurological deficit may accompany these fractures. A case of transverse fracture sacrum with cauda equina injury treated by sacral laminectomy and root decompression, is reported.

Fracture sacrum.

An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.

Fraturas do sacro / Fractures of the sacrum

As fraturas do sacro sao relativamente freqüentes e comumente nao sao diagnosticadas. Nao raramente implicam em alteraçoes neurológicas nos membros inferiores e disfunçoes urinárias, fecais e sexuais, dependendo da localizaçao e nível da fratura. Foi feito estudo retrospectivo em 16 pacientes com fratura do sacro tratados no Pavilhao "Fernandinho Simonsen" da Santa Casa de Sao Paulo, no período de abril de 1989 a julho de 1994. Nestes pacientes, 75,0 por cento das fraturas do sacro estavam associadas com fratura da pélvis. Utilizando a classificaçao proposta por Denis & col., as alteraçoes neurológicas nas zonas 1 e 2 foram unilaterais nas lesoes radiculares lombares e sacrais e com comprometimento vesicointestinal na zona 3. As dificuldades na opçao de tratamento e os resultados sao sicutidos e comprados com os de outros autores.

Natural course of spontaneously reduced lumbo-sacral fracture-dislocation--a case report

We present a case of lumbosacral fracture-dislocation, which was spontaneously reduced during radiological examination. Such rapid reduction is, however, not reliable for long-term stability. We would like to report this case briefly because spontaneous reduction of lumbosacral fracture-dislocation has not been reported previously.