Traumatic Atlantoaxial Rotatory Subluxation in Adult: Case Report

Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits.We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommontraumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Caracterización del trauma raquimedular en el Servicio de Neurocirugía, Guantánamo 2013-2018 / Caracterização do trauma raquimedular no Serviço de Neurocirurgia, Guantanamo 2013-2018 / Characterization of spinal cord trauma in the Neurosurgery Service, Guantanamo 2013-2018

Introducción: en el Hospital General Docente Dr Agostinho Neto no se ha caracterizado el trauma raquimedular. Objetivo: caracterizar el trauma raquimedular en el Servicio de Neurocirugía del Hospital General Docente Dr Agostinho Neto durante los años 2013-2018. Método: se realizó un estudio descriptivo, retrospectivo y longitudinal. La población se constituyó por 230 pacientes, de los que se escogió una muestra aleatoria (n=92). Se estudiaron las siguientes variables: edad, sexo, tiempo entre el trauma y la atención médica especializada, tipo de lesión, causas del trauma. Resultados: los pacientes fueron sobre todo hombres (69,6 por ciento), tenían entre 39 y 48 años (23,9 por ciento), fracturas vertebrales (59,8 por ciento), sobrevivió el 95,7 por ciento y el 56,5 por ciento fue atendido en las primeras 6 horas postrauma. Conclusiones: los traumas raquimedulares afectan a pacientes en la etapa productiva de la vida, lo que muestra la pertinencia social de su estudio(AU)

Introduction: in the General Teaching Hospital Dr Agostinho Neto has not been characterized by spinal cord trauma. Objective: to characterize spinal cord trauma in the Neurosurgery Service of the General Teaching Hospital Dr Agostinho Neto during the years 2013- 2018. Method: a descriptive, retrospective and longitudinal study was carried out. The population consisted of 230 patients, from which a random sample was chosen (n=92). The following variables were studied: age, sex, time between trauma and specialized medical care, type of injury, causes of trauma. Results: the patients were mostly men (69.6per cent), were between 39 and 48 years (23.9per cent), vertebral fractures (59.8per cent), survived 95.7per cent and 56.5per cent were attended in the first 6 hours post trauma. Conclusions: spinal cord traumas affect patients in the productive stage of life, which shows the social relevance of their study(AU)

Introdução: no Hospital Geral de Ensino Dr Agostinho Neto não se caracterizou por trauma medular. Objetivo: caracterizar o trauma medular no Serviço de Neurocirurgia do Hospital Geral de Ensino Dr Agostinho Neto durante os anos 2013-2018. Método: estudo descritivo, retrospectivo e longitudinal. A população foi composta por 230 pacientes, dos quais foi escolhida uma amostra aleatória (n=92). Foram estudadas as seguintes variáveis: idade, sexo, tempo entre trauma e atendimento médico especializado, tipo de lesão, causas do trauma. Resultados: os pacientes eram majoritariamente homens (69,6 por cento), tinham entre 39 e 48 anos (23,9 por cento), fraturas vertebrais (59,8 por cento), sobreviveram 95,7per cent e 56,5per cent foram compareceu nas primeiras 6 horas pós-trauma. Conclusões: os traumas da medula espinhal afetam os pacientes na fase produtiva da vida, o que mostra a relevância social de seu estudo(AU)

Fratura do processo transverso da vértebra lombar: valor diagnóstico / Lumbar vertebra transverse process fracture: diagnostic value

As fraturas isoladas do processo transverso são consideradas lesões menores. Em geral, são causadas por trauma direto ou avulsão resultante da contração muscular. Radiografias simples são pouco sensíveis para a detecção dessas fraturas, portanto a verdadeira frequência dessas fraturas pode ser subestimada. Com o advento da tomografia computadorizada (TC) helicoidal, tem aumentado à frequência dessa lesão. GS, 53 anos, masculino. Vítima de sequestro e colocado no porta-malas do carro. No setor de emergência, apresentou queixa de dores generalizadas, mais intensa na região lombar. Exame neurológico: normal. Rx simples de abdome: normal. Tomografia da coluna lombar: fratura do processo transverso esquerdo de L5. Tratamento conservador, com evolução satisfatória. Apesar de ser considerada um traumatismo leve, a fratura do processo transverso da vértebra lombar ocorre como resultado de forças intensas. Geralmente, está associado com lesão de vísceras abdominais ou geniturinárias. Seu diagnóstico tem sido feito por meio de exame de TC helicoidal. Seu tratamento inicial é conservador. Fraturas do processo transverso das vértebras lombares cada vez mais têm sido diagnosticadas. Existe associação com lesões de vísceras abdominais e geniturinárias. O tratamento inicial é conservador e cursa com bom prognóstico.

Isolated fractures of the transverse process are considered minor injuries usually are caused by direct trauma or avulsion resulting from muscle contraction. Plain radiographs are insensitive for the detection of these fractures, so the true frequency of these fractures may be underestimated. With the advent of helical computed tomography, has increased the frequency of this injury. GS, age 53, male. Victim of kidnapping and placed in the trunk of the car. In the emergency room complaining of aches, more severe in the lumbar region. Neurological examination: normal. Simple X-ray of the abdomen: normal. Tomography of the lumbar spine: fracture of the left transverse process of L5. Conservative treatment with a favorable outcome. Although considered a mild injury, the fracture of the transverse process of lumbar vertebra occurs as a result of strong forces. It is usually associated with injury to abdominal viscera or genitourinary. Its diagnosis has been made by helical CT. His initial treatment is conservative. Fracture of transverse process of lumbar vertebrae has been increasingly diagnosed. There is an association with lesions of the abdominal viscera and genitourinary. Initial treatment is conservative and runs with good prognosis.

Máscara laríngea proseal, una alternativa en el trauma cervical quirúrgico / ProSeal laryngeal mask, an alternative in the surgical cervical trauma

Introducción: la intubación endotraqueal es el método que más se indica para permeabilizar la vía aérea en el paciente con traumatismo raquimedular que requiere ventilación mecánica. Objetivo: comparar los resultados del uso de la máscara laríngea proseal vs. tubo endotraqueal, en pacientes con lesión cervical traumática con cirugía de columna cervical electiva. Métodos: se realizó un estudio analítico de casos y controles, en un período de 5 años. Se obtuvo una muestra de 158 pacientes con lesión cervical que acudieron al centro de trauma con criterios de fijación de columna cervical y corrección quirúrgica electiva. Se crearon 2 grupos mediante un muestreo aleatorio: un grupo estudio (máscara laríngea proseal), y un grupo control (tubo orotraqueal). El procesamiento de los datos incluyó el cálculo de medidas de resumen para variables cualitativas, y para el contraste de hipótesis de homogeneidad entre los grupos de estudio se empleó el chi cuadrado, con un nivel de significación p< 0,05. Resultados: predominaron pacientes entre 20 y 30 años de edad, del sexo masculino. Con el uso de la máscara laríngea se logró permeabilizar la vía aérea en más del 90 por ciento de los casos durante el primer intento; con la colocación del tubo endotraqueal solo se logró en el 70 por ciento de los pacientes. Los tiempos requeridos para establecer una ventilación adecuada fueron menores en los que se utilizó la máscara laríngea, que en los que se utilizó el tubo endotraqueal, con diferencias significativas desde el punto de vista estadístico, y mínimas complicaciones tras el uso de la máscara laríngea proseal. Conclusiones: se demostró que la máscara laríngea proseal resultó más efectiva para el tratamiento de la vía aérea en pacientes con trauma cervica(AU)

Introduction: the endotracheal intubation is the more used method for airways permeability in the patient presenting with rachimedullary requiring mechanical ventilation. Objective: to compare the use of the ProSeal laryngeal mask versus endotracheal tube in patients presenting with traumatic cervical injury with elective cervical spine surgery. Methods: a case/control and analytical study was conducted over 5 years. The sample included 158 patients presenting with cervical injury who came to our trauma center with criteria of cervical spine fixation and elective surgical correction. Two groups were created by randomized sampling: a study group (ProSeal laryngeal mask) and a control group (orotracheal tube). Data processing included the estimation of summary measures for qualitative variables and for the contrast of homogeneity hypothesis among the study groups authors used the Chi² test with a significance level of p< 0,05. Results: there was predominance of patients aged 20 and 30 and of male sex. With the use of laryngeal mask it was achieved the permeation of airway in more than 90 percent of cases during the first attempt; with the placement of endotracheal tube only it was achieved in the 70 percent of patients. Times required to establish appropriate ventilation were less in those where we used laryngeal mask than in those with endotracheal tube with significant differences from the statistical point of view and less complications after the use of the above mentioned mask. Conclusions: it was demonstrated that theis type of mask was more effective for airway treatment in patients presenting with cervical trauma(AU)

Estudio comparativo del tratamiento ortésico en las fracturas toracolumbosacras según la severidad del trauma / Comparative study of orthotic treatment in thoracolumbar fractures according to severity

Introducción: En el presente trabajo se evalúan los resultados del tratamiento ortopédico seleccionando el tipo de ortesis según la energía del traumatismo toracolumbosacro estable. Materiales y métodos: Se incluyeron pacientes sin litigios tratados con TLSO a medida o con ortesis prefabricadas, con seguimiento mínimo de 2 años. Observadores independientes evaluaron los parámetros geométricos en radiografías iniciales y finales, y los parámetros funcionales. Se subdividieron las fracturas (AO y Denis) en alta (grupo A) y baja energía (grupo B), según su energía cinética y se utilizó un grupo de control comparativo. Se incluyeron 44 fracturas correspondientes a 41 pacientes: 25 en el grupo A y 19 en el B, con una edad promedio de 46 años (rango 12 a 83). El seguimiento promedio fue de 4,5 años (rango 2,2 a 15,5). Los tipos predominantes fueron: tipo A (AO) o por compresión y por estallido (Denis). Resultados: No se observaron diferencias significativas entre las mediciones iniciales y finales, salvo en la cifosis vertebral inicial. Siempre hubo diferencias significativas al comparar los parámetros geométricos entre el grupo de control y los grupos A y B, y entre el grupo de control y cada subtipo subdivididos en alta o baja energía. Los puntajes funcionales finales fueron siempre buenos, con variaciones significativas entre los grupos A y B. Conclusiones: Se obtuvo un resultado funcional bueno en las lesiones estables seleccionando la ortesis según la energía cinética del traumatismo. Los resultados parecen mejores en los de alta energía con ortesis a medida. Ningún tratamiento normalizó los parámetros radiológicos.

Background: To determine whether the severity of stable thoraco-lumbosacral trauma is useful to decide on bracetype in orthopedic treatment. Methods: Retrospective study (16 years). Inclusion criteria: 1) Minimum follow-up: 2 years. 2) Complete plain radiological studies. 3) No Litigation. 4) TLSO custommade treatment for high kinetic energy trauma and prefabricatedorthoses for low energy lesions. 5) Treatment performed or supervised by the senior author. Evaluation by independent observers of Geometric Parameters (sagittal Cobb, vertebral kyphosis, anterior vertebral collapse) initially and at follow-up, and FunctionalParameters (SRS pain scale, Oswestry Index, Return to PreviousActivity). Subdivision of different fracture types(AO and Denis classifications) in High (Group A) and Low Energy (Group B) according to the amount of kineticenergy. Comparison with a control group. Statistical analysis: Chi square and Student t-test. 41 patients were studied (44 fractures, 23 females/18males), 25 fractures were Group A and 19 Group B. Average age: 46 years (12-83). Average follow-up: 4.5 years (2.2-15.5). Predominant site: T11 - L2; predominant types: A (AO), or compression and burst (Denis). Results: There were no significant differences between the initial and follow-up measurements. The only significantdifference between groups was found in the initial vertebral kyphosis. However, differences always existed when comparing the geometric parameters between the control group and groups A and B, and between the control group and each type of fracture (AO / Denis) subdivided into high and low energy. The final functional parameters’ scores were always good, with significant variationsbetween groups A and B...

Análise evolutiva da dor e função neurológica de pacientes submetidos à descompressão medular por lesão vertebral metastática / Pain and neurological function analysis of patients submitted to decompression and stabilization due to metastatic vertebral lesion

Objetivo: Avaliar a evolução da dor e função neurológica em pacientes com lesão metastática em coluna vertebral operados por abordagem posterior. Material e método: Foram avaliados 32 pacientes (17 do gênero feminino e 15 do masculino), idade média de 56,46 anos, com diagnóstico de metástase em coluna vertebral. Os critérios para indicação cirúrgica foram a presença de alteração neurológica progressiva (6 pacientes - 18,75%) dor incapacitante (23 pacientes - 71,87%) ou, ainda, pacientes que sofriam destas condições combinadas (3 pacientes - 9,37%). Foi aplicado o questionário VAS para avaliação de dor e escala de Frankel modificada para avaliação de função neurológica no período pré-operatório, um e seis meses após a cirurgia. Resultado: Foi observada uma variação estatística significante na análise comparativa entre os valores de escala de dor (VAS), com valores finais médios de 5,29 pontos e iniciais de 8,48 pontos. Na avaliação da função neurológica observamos diferenças na análise do nível neurológico através de escala Frankel nos diversos momentos de observação, entretanto não foi possível comprovar estatisticamente quais as principais variações quando comparadas individualmente nesta evolução. Na avaliação inicial, um mês após o procedimento, dos 29 pacientes avaliados, 17 (58,62%) mantiveram o mesmo nível neurológico pré-operatório 7 pacientes (24,13%) apresentaram melhora em ao menos um nível na escala Frankel e em 5 pacientes (17,24%) foi observada piora de ao menos um nível na escala Frankel.

Management of thoracolumbar spine injuries at a tertiary care hospital

The purpose of descriptive case series study was to see the conservative and surgical outcome in respect of neurological improvement, sphincter functions and early ambulation in cases of traumatic thoracolumbar injuries in a tertiary care hospital. This was a hospital based prospective study comprised of 50 thoracolumbar injury cases registered during the period of 1 year from September 2005 to September 2006. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using Frankle grades. Operative and postoperative record with x-rays and MRI were maintained. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. A total of 50 cases were registered, 43 [86%] were males and 7 [14%] were females. Fall was the most common cause of injury [92%]. The most common level involved was L[1] [46%]. The 2[nd] common site of injury was T[12] [12%]. The treatment given was conservative in 42.55%, and surgery was performed on 57.44%. Three [6.38%] patients were left against medical advice. Thoracolumbar injuries occur in young population and creates socio-economic burden to the society. Patients with partial neurological deficit benefit from surgery

Optimal Use of the Halo-Vest Orthosis for Upper Cervical Spine Injuries

PURPOSE: Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI. MATERIALS AND METHODS: From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire. RESULTS: The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%. CONCLUSION: The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

Abordaje extraperitoneal de la columna lumbar: experiencia en 192 casos / Extraperitoneal approach of lumbar spine: a 192 cases experience

Exponer nuestra experiencia en el abordaje extraperitoneal de la columna lumbar y comparar con la literatura relacionada. Estudio realizado en el Hospital de Clínicas Caracas y en el Centro Médico Docente La Trinidad. Estudio retrospectivo, basado en la revisión de historias clínicas de 131 pacientes sometidos a 192 abordajes de columna lumbar en el perìodo comprendido entre mayo de 2004 y noviembre 2009. 47,5% de los pacientes son masculinos y 52,5% femeninos. La edad promedio fue de 42,78%. El tiempo quirúrgico promedio fue de 138,56 minutos. La tasa global de complicaciones postoperatorias fue de 18,32%. La estancia hospitalaria promedio fue de 2,33 días. Para el reemplazo de discos intervertebrales se han utilizado múltiples abordajes, siendo el extraperitoneal el más recomendado, ya que permite una amplia exposición de la anatomía, disminuye la incidencia de daño nervioso, evita el trauma muscular paraespinal y disminuye la estancia hospitalaria.

Inform our experience with extraperitoneal approach of lumbar disc compare with literature. Study performed at Hospital de Clinicas Caracas and Centro Médico Docente La Trinidad. Retrospective study based on history review ofr 131 patients with 192 lumbar approaches between May 2004 and November 2009. 47,5% males, 52,5 females, mean age was 42,78%. Mean surgical time was 138,56 minutes. Postoperative complications rate was 18,32%. Mean hospital stay was 2,33 days. Extraperitoneal approach for disc replacement is the recommended operation. It permits better anatomy identification, less trauma to muscles and nerves, and less hospital stay.

Fracturas vertebrales por osteoporosis: tratamiento incruento / Osteoporotic vertebral fractures: conservative treatment

El tratamiento inicial de las fracturas vertebrales por osteoporosis es conservador. Su objetivo es calmar el dolor con drogas analgésicas y diferentes tipos de ortesis como el corsé en extensión de Jewett. El reposo en cama está indicado solamente al comienzo y se debe evitar la inmovilización prolongada. La fisioterapia (ejercicios) es una gran ayuda porque disminuye la pérdida ósea y mejora el estado del raquis disminuyendo el dolor y las deformaciones.

Fratura traumática da coluna torácica limitada entre T1 e T10 / Traumatic thoracic spine fractures limited between T1 and T10

Objetivo: Estudo retrospectivo de uma série de 79 pacientes com fratura traumática da coluna torácica,limitada entre T1 e T10,hospitalizados entre 1995 e 2004 no Serviço de Neurocirurgia do Centro Hospitalar Universitário(CHU), Norte de Marseille, França.Métodos:As fraturas foram classificadas de acordo com a classificação da AO(Arbeitsgemeinschaft für Osteosynthesefragen)e o quadro neurológico por meio da classificação de Frankel na hospitalização,aos seis meses e um ano.Resultados:A etiologia mais frequente das fraturas foram os acidentes automobilísticos(68,3 por cento), e o tipo de fratura, o B(54,4 por cento); 57 pacientes foram considerados politraumatizados e 82,3 por cento apresentavam lesão medular. O tratamento cirúrgico foi empregado em 96,2 por cento dos casos, sendo a via posterior a mais utilizada com objetivo de estabilização,descompressão medular, correção do alinhamento da coluna, diminuição da dor e mobilização precoce.Conclusão:As incidências, as causas, os tipos de fraturas e os manejos destas foram analisados e comparados com a literatura e os resultados confirmaram a gravidade das lesões neste segmento da coluna, o número elevado de lesões associadas, a raridade de recuperação neurológica, assim como o benefício do tratamento cirúrgico por via posterior.

Trauma raquimedular craniocervical: revisão de literatura / Spinal trauma at the craniocervical junction: literature review

Objetivo: Revisão da literatura sobre o trauma craniocervical. Métodos:Com base em revisão eletrônica da literatura nos dados da PubMed, em revisões sistemáticas e em diretrizes internacionais na língua inglesa. A revisão abrangeu os temas "deslocamento atlanto-occipital","fraturas do côndilo occipital","fraturas do atlas","lesões do ligamento transverso","instabilidade vertical atlantoaxial traumática" e "fraturas do áxis". Resultado:A avaliação da literatura utilizando-se de técnicas de análise da qualidade da publicação,eliminando vícios e tendenciosidades de interpretação, permitindo a comparação matemática de resultados, propiciou o surgimento de conclusões menos discutíveis da eficiência dos vários métodos de tratamento.

Spinal injuries: experience of a local neurosurgical centre

To find out the pattern of traumatic spinal injuries and their management in patients admitted to a neurosurgical unit of a tertiary care hospital in a developing country. All patients admitted with spinal injuries between July, 2003 and June, 2007, in the Department of Neurosurgery, Civil Hospital, Karachi, were included. Information was recorded and analysed with respect to demographic data, mechanism of injury, level of bony injury, neurological degree [complete, incomplete and intact], duration between injury and admission, associated injuries, management, hospital stay and outcome. A total of 214 patients were admitted. These included 189 males [88.3%] and 25 females [11.7%]. Most affected patients [72/214 - 33.6%] were in their third decade of life, followed by second and fourth decades, 38 /214 [17.7%] in each decade. The commonest cause of injury was fall from height in 122 patients, [57.0%], followed by fall while carrying weight in 23 [10.7%], road accidents in 50 [23.4%] and gunshot injuries in 10 [4.7%] cases. Cervical spine was affected in the majority 101 [47.2%] cases followed by thoracic spinal injury, 64 cases and lumbar spine with 59 cases [27.6%]. Seventy seven patients [36%] had complete neurological loss, 119 [55.6%] had partial deficit while 18 patients [8.4%] were neurologically intact. Surgery [decompression and fixation] was performed in 50 cases. Long bone fracture was the commonest associated injury. The average time between injury and admission was 6.2 days [range 0-60]. Mean hospital stay was 8.4 +/- 7.6 days. Twenty three [10.7%] patients died during hospitalization. This study shows that young adults, predominantly males in their most productive years of life, are especially prone to spinal cord injury. Fall from height is the most common preventable cause of spinal injury. Recognizing the pattern of spinal injury helps to identify high-risk groups which will then help us to design more appropriate preventive measures

Comparison of outcome of surgical and nonsurgical methods in the treatment of unstable traumatic lesions of the lower cervical spine

To compare the success rate and capacities of nonsurgical [halo cast] versus surgical management of lower cervical spine injury. Forty patients admitted to hospitals affiliated with Shiraz University of Medical Sciences in Shiraz, Iran, from August 2002 to August 2004 with unstable cervical injuries were divided into 2 equal groups [halo versus surgery], and in each group, patients were divided into 3 categories based on the type of lesion. The percentage of sagittal subluxation and degree of sagittal angulation were chosen as criteria for treatment outcome, and each was measured on radiological images and recorded at the time of admission and after 6 months. Members of both groups showed significant improvements in the criteria after treatment. The amount of correction in subluxation was not significantly different between the 2 groups; however, the surgical approach resulted in a significantly better correction of angulation. The nonsurgical approach can be an acceptable alternative to surgical correction in selected patients with various lower cervical spine injuries and yielded comparable results; however, a larger sample size and longer follow-up may be necessary for verification

Lesões traumáticas da coluna cervical / Cervical spine traumatic injury

Os autores fazem uma revisão bibliográfica sobre as lesões traumáticas da coluna cervical: sua epidemiologia, classificação, métodos diagnósticos e tratamento

Fraturas da coluna toracolombar / Spinal fractures

Nos dias atuais, temos um número, cada vez maior, de lesões complexas e graves da coluna vertebral, devido ao crescente aumento de acidentes industriais e automobilísticos graves. Nos politraumatizados existe também a freqüente associação neurológica, gerando muitas vezes seqüelas permanentes. Assim, é de extrema importância o conhecimento quanto ao diagnóstico e tratamento dos traumatismos da coluna dorsal

Artrodesis cervical anterior con placa de Caspar. Experiencia en el Centro Médico Nacional 20 de Noviembre, ISSSTE / Cervical anterior Caspar plate fixation. Centro Médico Nacional 20 de Noviembre experience

Informamos la experiencia que se obtuvo con el uso de placas de titanio tipo Caspar para artrodesis cervical anterior, en el Servicio de Neurocirugía del Centro Médico Nacional 20 de Noviembre, ISSSTE, México, en pacientes con alteraciones cervicales diversas de origen degenerativo, traumático o neoplásico, que condicionaron síndrome de compresión radicular cervical. Se tuvieron 85 casos, 49 mujeres y 36 varones, edad de 15 a 78 años con una media de 52. Hubo antecedentes de traumatismo cervical en 63, 78 pacientes presentaron hernias de disco cervical, un caso de Schwannoma de C6, dos fracturas del arco posterior de C2, un caso con fractura del cuerpo de C5, uno con listesis C6-7 y el último con cirugía cervical previa e injerto intersomático migrado al canal. El síntoma preoperatorio principal fue: dolor radicular en 54 casos; disminución de la fuerza muscular en 23 y parestesias en miembros superiores en seis; hubo dos casos asintomáticos. La evolución posoperatoria fue satisfactoria, puesto que en 52 casos el dolor disminuyó o desapareció y mejoró la fuerza muscular; se logró la desparición de las parestesias en 37 casos. El procedimiento mostró su utilidad como método de fijación y de descompresión radiculomedular cervical. En casos con canal cervical estrecho, compresión posterior y persistencia de las parestesis, se recomienda un abordaje por vía posterir para descomprimir la porción dorsal de la médula y sus raíces, que permite al paciente alivio de su sintomatología