Criptococosis vertebral: comunicación de un caso y revisión bibliográfica / Vertebral cryptococosis: case report and literature review

Resumen La criptococosis es una micosis sistémica producida por un hongo levaduriforme encapsulado denominado Cryptococcus neoformans. Es una enfermedad universal, que ocurre con mayor frecuencia en pacientes inmunocomprometidos, manifestándose principalmente como una enfermedad diseminada con compromiso meníngeo o pulmonar. Sin embargo, la osteomielitis ocurre solo en 5-10% de los casos, siendo el compromiso vertebral el más frecuente. Presentamos un caso de criptococosis vertebral aislada y una búsqueda bibliográfica sobre el tema. Se recomienda realizar una terapia antifúngica de inducción intravenosa y continuar con una fase de consolidación, vía oral, de duración variable. La indicación quirúrgica se considera en lesiones que comprometen la estabilidad vertebral y aquellas que presentan un compromiso neurológico, producen deformidad y para reducir el inóculo infeccioso.

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.

Forensic Analysis of 8 Cases on Assessing Traffic Accident Disability Grade of Kümmell's Disease / 法医学杂志

Objective To provide a reference for the assessment of the disability grade of Kümmell's disease cases, through the analysis of the basic situation, the disability grade and the causality of Kümmell's disease cases. Methods Data of appraised individuals in 8 cases of Kümmell's disease from traffic accident spinal injury cases accepted by the Institute from 2015 to 2017 were collected, and the basic situation, vertebral fracture sites and disability grades of the appraised individuals were analyzed. Results Among 8 cases of appraised individuals, there were 2 males and 6 females, the oldest 75 years and the youngest 50 years, with an average age of 62.5 years, all of whom suffered from single vertebral fracture. Among them, 1 patient had thoracic 11 vertebra fracture, 3 thoracic 12 vertebra fracture, 2 lumbar 1 vertebra fracture, 1 lumbar 2 vertebra fracture, and 1 lumbar 4 vertebra fracture, all of whom were assessed as grade 10 disability. Conclusion In the assessment of disability grade of vertebral fracture, dynamic observation of the vertebral fracture and its recovery should be made based on imaging data. If it is suspected that there is Kümmell's disease, it should be differentiated from other diseases. Also, the disability grade will be assessed according to the corresponding standards when the morphology of the injured vertebral body is relatively stable.

Epidemiological panorama of orthopedic spine pathology in mexico / Panorama epidemiológico da patologia ortopédica da coluna espinal no méxico / Panorama epidemiológico de la patología ortopédica de columna vertebral en méxico

ABSTRACT Objective: To determine the epidemiology of orthopedic spine pathology in a national reference hospital in Mexico. Methods: Retrospective, observational and cross-sectional study, using the database and hospitalization census of the orthopedic spine service from January 2009 to December 2016. The data analysis was performed with SPSS version 22 measuring the central frequency and percentages. The demographic variables age and sex, and those related to the diagnosis, type of pathology, affected segment and degrees of affection were obtained. The sampling technique was non-probabilistic sampling by convenience of consecutive cases. Results: We analyzed 7,771 cases: 50.34% males, with a mean age of 53.51 years. The prevalence of the most frequent diseases in hospitalized patients was stenosis of the lumbar canal with 25.85% (1,834 patients), followed by lumbar disc herniation (23.12%), spondylolisthesis (22.63%), cervical spondylotic myelopathy (8.76%), lumbar pain and lumbosciatalgia (4.10%), cervical disc herniation (3.96%), primary infection (3.80%), loosening of material (3.16%), spinal tumors (2.53%) and cervical instability (2.04%). Conclusions: This is the largest series of cases of spinal pathology treated in a hospital in Latin America. The most frequent condition was the stenosis of the lumbar canal, the most affected segment was the lumbar, and the most affected age group was 51 to 60 years. The estimate is an increase in the incidence of spinal diseases, so it is necessary to identify the risk factors and the behavior of each disease for its prevention. Level of Evidence IV; Retrospective, observational and descriptive study.

RESUMO Objetivo: Determinar a epidemiología da patologia da coluna ortopédica em um hospital de referência nacional no México. Métodos: Um estudo retrospectivo, observacional e transversal, utilizando o banco de dados e o recenseamento hospitalar do serviço de orelha ortopédica de janeiro de 2009 a dezembro de 2016. A análise de dados foi realizada através da SPSS versão 22 usando medidas de frequência central e porcentagens. As variáveis demográficas idade e gênero, e aqueles relacionados ao diagnóstico, tipo de patologia, segmento afetado e graus de carinho foram obtidos. A técnica de amostragem foi por conveniência e não probabilística de casos consecutivos. Resultados: Analisamos 7771 casos: 50,34% do sexo masculino, com idade média de 53,51 anos. A prevalência das doenças mais frequentes em pacientes hospitalizados foi a conduta lombar estreita, com 25,85% (1834 pacientes), seguida de hérnia de disco lombar (23,12%), espondilolistese (22,63%), mielopatia espondilótica cervical (8,76%), lombo e lomossocialgia (4,10%), hérnia de disco e infecção primária cervical (3,96%, 3,80%), afrouxamento do material (3,16%), tumores espinhais (2,53%) e instabilidade cervical (2,04%). Conclusões: Este é o maior número de casos da patologia da coluna com tratamento hospitalar na América Latina. O estado mais comum era o canal lombar da coluna vertebral, o segmento lombar é o mais afetado e o grupo de idade mais afetado é de 51 a 60 anos. Um aumento na incidência de doenças da coluna vertebral está previsto, de modo que é necessário identificar os fatores de risco e o comportamento de cada condição para a prevenção. Nível de Evidência IV; Estudo retrospectivo, observacional e descritivo.

RESUMEN Objetivo: Conocer la epidemiologia de la patología ortopédica de columna vertebral en un hospital de referencia nacional en México. Métodos: Se realizó un estudio retrospectivo, observacional y transversal, utilizando la base de datos y censos de hospitalización del servicio de columna ortopédica de enero de 2009 a diciembre de 2016. Se realizó el análisis de datos mediante SPSS versión 22, utilizando medidas de frecuencia central y porcentajes. Se obtuvieron las variables demográficas edad y sexo, y las relacionadas con el diagnóstico, tipo de patología, segmento afectado y grados de afección. La técnica de muestreo fue por conveniencia y no probabilística de casos consecutivos. Resultados: Se analizaron 7.771 casos: 50,34% del sexo masculino, con un promedio de edad de 53,51 años. La prevalencia de las enfermedades más frecuentes en los pacientes hospitalizados fue el conducto lumbar estrecho con 25,85% (1.834 pacientes), seguido de hernia discal lumbar (23,12%), espondilolistesis (22,63%), mielopatía espondilótica cervical (8,76%), lumbalgias y lumbociatalgias (4,10%), hernia discal cervical (3,96%), infección primaria (3,80%), aflojamiento de material (3,16%), tumores espinales (2,53%) e inestabilidad cervical (2,04%). Conclusiones: Esta es la mayor serie de casos de patología de columna con tratamiento hospitalario en América Latina. El padecimiento más frecuente fue el conducto lumbar estrecho, el segmento más afectado el lumbar, y el grupo etario más aquejado el de 51 a 60 años. Se predice un incremento en la incidencia de las enfermedades de columna vertebral, por lo que es necesario identificar los factores de riesgo y el comportamiento de cada padecimiento para su prevención. Nivel de Evidencia IV; Estudio retrospectivo, observacional y descriptivo.

Adjacent segment disease in degenerative pathologies with posterior instrumentation / Doença de segmento adjacente em patologias degenerativas com instrumentação posterior / Enfermedad de segmento adyacente en patologías degenerativas con instrumentación posterior

OBJECTIVE: To establish the real incidence of adjacent segment disease after fusion, and to identify the levels and predisposing factors for the pathology, as well as the functional results. METHODS: a retrospective case series study with level of evidence IIB, in a sample of 179 patients diagnosed with stenosis of the lumbar spine, spondylolisthesis and degenerative scoliosis, submitted to surgery in the period 2005 to December 2013, with posterior instrumentation and posterolateral fusion, with follow-up from 2007 until May 2014, in which the symptomology and radiographic findings were evaluated, to establish the diagnosis and treatment. RESULTS: the study included 179 patients diagnosed with stenosis of the lumbar spine (n=116), isthmic and degenerative spondylolisthesis (n=50) and degenerative scoliosis (n=13); during the study, 20 cases of adjacent level segment were identified, 80% of which were treated surgically with extension of the instrumentation, while 20% were treated conservatively with NSAIDs and therapeutic blocks. CONCLUSION: An incidence of 11% was found, with an average of 3.25 years in diagnosis and treatment, a prevalence of females and diagnosis of stenosis of the lumbar canal on posterior instrumentation, a predominance of levels L4-L5; 80% were treated with extension of the instrumentation. The complications were persistent radiculopathy, infection of the surgical wound, and one death due to causes not related to the lumbar pathology. .

OBJETIVO: Estabelecer a incidência real da doença do segmento adjacente após fusão e identificação dos níveis e fatores predisponentes à patologia, assim como os resultados funcionais. MÉTODOS: Estudo retrospectivo de série de casos, com nível de evidência IIB, em amostra de 179 pacientes com diagnósticos de estenose de canal lombar, espondilolistese e escoliose degenerativa, submetidos a cirurgia no período de 2005 a dezembro de 2013, com instrumentação posterior e fusão posterolateral, com acompanhamento de 2007 até maio de 2014, no qual se avaliaram a sintomatologia e os achados radiográficos para estabelecer o diagnóstico e tratamento. RESULTADOS: O estudo incluiu 179 pacientes com diagnóstico de estenose de canal lombar (n=116), espondilolistese ístmica e degenerativa (n=50) e escoliose degenerativa (n=13); durante o estudo foram identificados 20 casos de segmento de nível adjacente, sendo que 80% foram tratados cirurgicamente com extensão da instrumentação, enquanto 20% foram tratados de modo conservador com AINE e bloqueios terapêuticos. CONCLUSÃO: Verificou-se uma incidência de 11%, com média de 3,25 anos no diagnóstico e tratamento, maior prevalência do sexo feminino e diagnóstico de estenose de canal lombar à instrumentação posterior, com predomínio dos níveis L4-L5; 80% foram tratados com extensão da instrumentação. As complicações foram radiculopatia persistente, infecção da ferida cirúrgica e um óbito decorrente de causas não relacionadas com a patologia lombar. .

OBJETIVO: Establecer la incidencia real de la enfermedad de segmento adyacente tras la fusión e identificación de los niveles y factores predisponentes a esta patología, así como los resultados funcionales. MÉTODOS: Se realizó un estudio retrospectivo de serie de casos, con nivel de evidencia IIB, con una muestra de 179 pacientes con diagnósticos de canal lumbar estrecho, espondilolistesis y escoliosis degenerativa, intervenidos quirúrgicamente en el periodo de 2005 a diciembre del 2013, con instrumentación posterior y fusión posterolateral, bajo seguimiento desde 2007 hasta mayo de 2014 en el cual se evaluó la sintomatología y hallazgos radiográficos para establecer el diagnóstico y manejo. RESULTADOS: Se incluyeron en el estudio 179 pacientes con diagnóstico de canal lumbar estrecho (n=116), espondilolistesis ístmica y degenerativa (n=50), escoliosis degenerativa (n=13); durante el estudio se identificaron 20 casos de segmento de nivel adyacente, siendo que el 80% se trataron de manera quirúrgica con extensión de la instrumentación, mientras que el 20% se manejaron de modo conservador con AINE y bloqueos terapéuticos. CONCLUSIÓN: Se identificó una incidencia del 11%, con un promedio de 3.25 años en el diagnóstico y tratamiento, mayor prevalencia del sexo femenino y diagnóstico de canal lumbar estrecho en instrumentación posterior con predominio en los niveles L4-L5; el 80% se trataron con extensión de la instrumentación. Las complicaciones fueron radiculopatía persistente, infección de la herida quirúrgica y un fallecimiento debido a causas no relacionadas con la patología lumbar. .

Survival and Prognostic Analysis of Adjacent Segments after Spinal Fusion

BACKGROUND: To examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion. METHODS: This retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author's hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated. RESULTS: One hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041). CONCLUSIONS: The survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.

Evaluación de la biopsia percutánea en el diagnóstico del síndrome de destrucción vertebral tóracico y lumbar / Percutaneous biopsy evaluation in the diagnosis of thoracic and lumbar vertebral destruction syndrome

BACKGROUND: The vertebral destruction syndrome is defined as those pathologies affecting the integrity of the vertebral structure, modifying its normal architecture and resulting in neurological deficit. Correct diagnosis is essential to define appropriate treatment. Biopsy, in addition to histopathological study, is a vital element for definitive diagnosis. METHODS: We carried out a descriptive, deliberate interventional study in 20 patients with a diagnosis of vertebral destruction in whom a percutaneous transpendicular biopsy was done between January 2005 and July 2006. Variables analyzed were age, sex, affected segment, neurological condition, neurological deficit type, results of the biopsy and specific diagnosis. RESULTS: There was a predominance of males (55%). The lumbar spine was the most affected region in 80% of patients. Of the biopsies performed, 10% were reported as normal tissue, 20% with degenerative changes, 15% with inflammatory changes, 15% with primary tumoral lesion, 5% with chronic osteomyelitis, 10% with tuberculosis, 15% with tumoral metastasis and 10% necrotic devitalized bone tissue. Of these patients, 55% were treated nonsurgically, and the remaining 45% were treated surgically. No complications were reported. CONCLUSIONS: Percutaneous transpedicular biopsy has only 55% specificity in diagnosis and for that reason is a less useful diagnostic method in our setting for destructive lesion diagnosis from the vertebral body.

Quiste óseo aneurismático de la columna vertebral: reporte de un caso / Aneurysmal bone cyst of the spine: case report

El quiste óseo aneurismático es un tumor de naturaleza neoplásica indefinida, de comportamiento benigno, crecimiento rápido y ocasionalmente de comportamiento agresivo, cuyo tratamiento de elección es la resección completa, aunque existe el riesgo de sangrado transquirúrgico excesivo. Se presenta el caso de una paciente con deformidad en columna torácica, con parestesias y debilidad muscular progresivas en extremidades inferiores, que evolucionó hasta la parálisis de dichas extremidades e incontinencia de ambos esfínteres. Mediante estudios de gabinete se localizaron lesiones líticas en cuerpos vetebrales T7 a T9 e invasión a conducto raquídeo. Los estudios electrofisiológicos identificaron bloqueo completo de la vía somatosensorial. Previa biopsia incisional, se realizó resección de la lesión y estabilización de la columna toracolumbar. La paciente evolucionó sin mejoría de la función medular. Los hallazgos morfológicos correspondieron a quiste óseo aneurismático en T8. Esta lesión se localiza principalmente en huesos largos y con mucho menor frecuencia en la columna vertebral, donde puede provocar inestabilidad y compresión de la médula espinal. Es posible confundirla con otras neoplasias, por lo que el diagnóstico definitivo mediante biopsia es imprescindible a fin de establecer el plan terapéutico adecuado, que elimine el riesgo de recurrencia o secuelas neurológicas asociadas, y lograr la estabilidad adecuada de los segmentos vertebrales afectados.

The aneurysmal bone cyst (ABC) is a fast-growing tumor of undefined neoplastic nature. It is occasionally an aggressive benign lesion whose treatment of choice is a complete resection, even though the risk of profuse transoperative bleeding exists. We present a female patient with thoracic spine deformity, with progressive paresthesias and muscle weakness of lower extremities that evolved to paralysis of both lower extremities and sphincter incontinence. Based on radiographic films, lytic lesions were identified at T7 to T9 vertebrae as well as medullary space invasion. In electrophysiologic tests, a complete somatosensorial pathway block was reported. Prior to resection of the neoplastic lesion and thoracolumbar stabilization, an incisional biopsy was performed. There was no postoperative medullary functional improvement. Morphological findings corresponded to an aneurysmal bone cyst at T8. This lesion is mainly located in the long bones and less frequently of the spine, where instability and medullary compression may occur. It is possible to confuse this neoplasia with other lesions. Hence, definite diagnosis with biopsy is necessary for determining an adequate therapeutic plan to eradicate recurrence risk or associated neurologic sequelae, as well as to gain proper stability at the involved vertebral segments.

Video assisted thoracoscopic surgery for spinal conditions.

Video-assisted thoracoscopic surgery (VATS) has become an alternative treatment tool for a variety of spinal conditions in the last two decades. This endoscopic or "keyhole" approach minimizes the chest wall morbidity related to the traditional thoracotomy. The current indications for VATS are the same as in any open anterior spinal surgery. This article reviews the outcomes of VATS treatments in thoracic disc diseases, fractures, tumors and vertebral osteomyelitis. In addition, we have described our "learning curve" and surgical techniques using video-assisted thoracoscopic spinal releases and instrumentation in the treatment of 50 patients with adolescent idiopathic scoliosis.

Percutaneous vertebroplasty in the management of vertebral lesions.

BACKGROUND: Debilitating backache due to different types of vertebral lesions is a common cause of morbidity in all age groups. Percutaneous vertebroplasty (PV) gives substantial pain relief and stabilizes the weak vertebrae. Most of the information regarding PV comes from the Western literature. The effect of PV in our population should be studied. AIMS: The primary objective is to assess the therapeutic benefit of PV in alleviating back pain and improving the functional status in patients with painful pathologic vertebrae. The secondary objectives are to study the technical aspects of the procedure and their relation to outcome and complications. SETTINGS AND DESIGN: This is a retrospective hospital-based (tertiary teaching hospital) study. MATERIALS AND METHODS: From January 2001 to December 2004, 46 patients underwent PV procedures. Sixty-five vertebroplasties were done in 13 males and 33 female patients. Twenty-four (36.92%) procedures were done for osteoporotic compression collapse, 26 (40.0%) for hemangioma, and 15 (23.07%) for different vertebral body tumors and metastasis. The Wilcoxon signed rank test was used to evaluate the statistical significance of differences between the preoperative and postoperative levels of pain, mobility and analgesic usage. RESULTS: Most of the patients had pain relief within 48 h. Only minor side effects were encountered. No patient had any deficit related to the procedure. On follow up of 3-48 months, all patients had statistically significant improvement in clinical condition (P < 0.001). CONCLUSION: Percutaneous vertebroplasty is a safe and effective procedure in relieving debilitating backache and can be used to treat vertebral lesions in selected cases.

Tratamento da instabilidade degenerativa da coluna lombar com fixação transpedicular / Transpedicular lumbar fixation for degenerative lumbar instability. An analysis of 53 cases

Os autores apresentam um estudo retrospectivo dos resultados de 53 pacientes, com instabilidade degenerativa da coluna lombar e toracolombar, que foram tratados consecutivamente com fixaçãotranspedicular por via posterior usando material Socon e Spine System da Aesculap. A casuística é constituída por 27 homens e 26 mulheres, com média etária de 53,4 anos (27 a 81 anos). A média do acompanhamento foi de 15 meses. O procedimento foi feito nos casos de espondilolistesedegenerativa (25 casos), instabilidade pós-operatória (12 casos), escoliose degenerativa (7 casos), fraturas degenerativas (5 casos), canal estreito lombar (2 casos) e instabilidade segmentar (2 casos).A cirurgia consistiu em descompressão neural, fixação interna com instrumentação transpedicular e enxerto ósseo. Em 18 casos foi associado o cage metálico. Obtiveram-se 90% de resultados bons e satisfatórios pela escala de Stauffer e Coventry, com 96% de taxa de fusão e 4% de pseudo-artrose. As complicações incluíram quatro casos de radiculalgia pós-operatória em virtude do contato da raiz com o instrumental, dois de fístulas liquóricas com resolução espontânea, duas infecções (uma profunda e outra superficial) e dois casos de estenose acima do nível t ratado. Destes pacientes, sete (14%) necessi taram dereoperação. Não houve óbito nem quebra do instrumental. Os resul tados comprovaram que, apesar do cur to per íodo de acompanhamento, a fixação transpedicular é um bom método para instrumentação e tratamento das instabilidades degenerativas, oferecendo vantagens biomecânicas comparadas com outras formas de tratamento, permitindo montagens curtas, preservando segmentos adjacentes e a lordose fisiológica. A seleção apropriada dos pacientes para a cirurgia é provavelmente o fator mais importante associado com bons resultados.

The authors present the results of the treatment of 53 consecutive patients with lumbar and thoraco-lumbar spine degenerative instability by a posterior transpedicular fixation using Socon and Spine Aesculap instrumentation systems. The mean follow-up was 15 months. Surgery was performed for degenerative spondilolisthesis (25 cases), post-surgical instability (12 cases), degenerative scoliosis (7 cases), degenerative fractures (5 cases), lumbar spine stenosis (2 cases) and segmental instability (2 cases). There were 27 men and 26 women, aging from 27 to 81 years (mean 53,4), all of them complained of back pain.The surgical procedure consisted in neural decompression, transpedicular fixation and instrumentation and bone graft. In eighteen cases we associated the use of a metallic cage. The results were good or fair in 90% of the cases (according to the Stauffer and Coventry?s scale), with 96% of fusion rate and 4% of pseudarthrosis. Complications included: four cases of radiculopaty due the contact of the nerve roots with the instrumentation system; two cases of CSF leak, both clearing spontaneously; two cases of infection (one superficial, the other deep) and two cases of stenosis above the level of instrumentation. Seven (14%) of these complication cases required reoperation. There were no deaths in this series and no problems with the instrumentation device itself. We concluded that, despite the short follow-up period, the transpedicular fixation is a good methodfor treatment of degenerative instability, with biomechanical advantages if compared with other modalities of treatment. It allows short instrumentation, sparing adjacent segments and the physiological lordosis is preserved. Careful selection of the patients for surgery is probably themost important factor associated with good outcome.

Cervico-dorsal spinal enterogenous cyst.

A case of a histologically proven ventrally situated spinal enterogenous cyst of cervico-dorsal region is reported with magnetic resonance (MR) imaging features. A brief review of literature on the subject is discussed.

Intramedullary spinal epidermoid cyst.

Intramedullary epidermoid cysts of the spinal cord are rare tumours, especially those not associated with spinal dysraphism. Around 50 cases have been reported in the literature. Of these, only seven cases have had magnetic resonance imaging studies. We report two cases of spinal intramedullary epidermoid cysts with MR imaging. Both were not associated with spina bifida. In one patient the tumour was located at D4 vertebral level, while in other within the conus medullaris. The clinical features, MR imaging characteristics and surgical treatment of such rare intramedullary benign tumours are discussed, and the relevant literature reviewed.

Rigid spine syndrome: case report

We describe a patient who had difficulty in walking since toddling stage and presented proximal upper and lower member weakness which have evolved to a progressive limitation of neck and trunk flexure, compatible with rigid spine syndrome. The serum muscle enzymes were somewhat elevated and the electromyography showed a myopatic change. The muscle biopsy demonstrated an active and chronic myopathy. The DNA analysis through PCR did not display any abnormality for dystrophin gene. The dystrophin by immnofluorescence was present in all fibers, but some interruptions were found in the plasma membrane giving it the appearance of a rosary. The test for merosin was normal.

CT-guided needle aspiration cytology (FNAC) of 112 vertebral lesions.

Aspiration cytology under CT-guidance was utilised as a diagnostic device in 112 lesions of vertebrae from January, 1985 till August, 1992. The age of the patients ranged from 6 years to 82 years. The materials were spread on glass slides, air-dried and stained by May-Grunwald and Giemsa method. In few cases part of the aspirated material was utilised for special stain and cell block preparation. Analysis of results showed metastatic tumours in 61 cases, Tuberculous lesions in 24 cases, Plasmacytoma in 6 cases, Giant cell lesion in 6 cases, Eosinophilic Granuloma in 3 cases, Chordoma in 3 cases, Ewing's sarcoma in 2 cases, Hodgkin's disease in 2 cases, Chondrosarcoma in 1 case and no definite diagnosis was given in 4 cases. These 4 cases on exploration and biopsy proved to be osteoblastoma (2), haemangioma (1) and undifferentiated sarcoma in the other. The giant cell lesions on histopathology proved to be aneuryamal bone cysts in 4 cases while osteoclastoma in 2 cases. The diagnostic accuracy was 96.4%. No complication was encountered in the present study. Early diagnosis by needle aspiration cytology (NAC) prevented unnecessary surgical exploration in majority of the cases and treatment could be started at the earliest.

Hernia de Grynfelt-Lesshaft triángulo lumbar superior: presentación de un caso / Grynfelt superior lumbar triangle hernia: report of one case

Se presenta el caso de una paciente con una hernia lumbar izquierda, espontánea, del triángulo de Grynfelt-Lesshaft, la cual fue tratada exitosamente mediante la invaginación de la grasa retroperitoneal, no complicada, que contenía, y la reconstrucción del defecto mediante el afrontamiento de los planos musculares y aponeuróticos con puntos separados en polea de Seda O. Se describieron detalladamente la anatomía, etiología, fisiopatología, clínica, diagnóstico y tratamiento de las hernias lumbares