Retrospective study on the incidence of cats and dogs' spinal injuries by computed tomographic scan. Part I: Cervical and Cervicothoracic / Estudo retrospectivo sobre incidência de injúrias em coluna vertebral de cães e gatos por meio de exame tomográfico. Parte I: Cervical e Cervicotorácica

Injuries involving the spine are frequent in dogs and knowledge of them is important to define the patient's treatment and prognosis. The objective of this retrospective study was to describe the epidemiological profile of animals and lesions in the cervical (C1-5) and cervicothoracic (C6-T2) spine diagnosed through tomographic examination. Compilation of computed tomography (CT) reports for the referred regions was carried out in a diagnostic center between 01/04/2017 and 30/04/2020, with or without contrast, from the clinical routine, in order to relate the most common lesions and their locations, as well as the species, breeds and ages most affected. A total of 1164 CT scans were performed in the period, 57.56% (n=670/1164) for the spine, with 89.7% (n=601/670) reports accessed, where both regions referred to here totaled 26.95% of the studies (n=162/601). Male mixed-breed dogs (MBD) showed the most lesions. For the cervical spine, the most identified lesion was disk extrusion and the site was C3-C4, while the mean age for lesions was 8.09±3.55 years. As for cervicothoracic, disk mineralization was more frequent and the mean age for lesions was 6.96±2.93 years. It was concluded that the spine is the main target of CT scans, that lesions related to the intervertebral disk were the main ones identified, and older MBD animals are the main ones affected.

As lesões envolvendo coluna vertebral são frequentes em animais de companhia, podendo ocorrer à nível vertebral, medula espinal, disco intervertebral, meninges ou raízes nervosas, e o conhecimento das mesmas é importante para definir o tratamento e prognóstico do animal. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral cervical (C1-5) e cervicotorácica (C6-T2) diagnosticadas por meio de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina clínica, a fim de relacionar as lesões, raças e locais mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670/1164) para a coluna, com 89,7% dos laudos acessados (n=601/670), sendo que as regiões cervical e cervicotorácica somaram 26,95% dos estudos (n=162/601). Em ambas regiões, os cães sem raça definida (SRD) machos foram os que mais demonstraram lesões. Para a coluna cervical, a lesão mais identificada foi extrusão de disco e o local mais afetado foi C3-C4, enquanto a média de idade para lesões foi 8,09±3,55 anos. Já para cervicotorácica, a mineralização de disco foi mais frequente e média de idade para ocorrência de lesões foi de 6,96±2,93 anos. Concluiu-se que a coluna vertebral foi o principal alvo de tomografias, as lesões relacionadas ao disco intervertebral foram as mais identificadas, sendo animais SRD com idade avançada os mais acometidos.

Retrospective study on the incidence of cats and dogs' spinal injuries by computed tomographic scan. Part II: Thoracolumbar and lumbosacral / Estudo retrospectivo sobre incidência de injúrias em coluna vertebral de cães e gatos por meio de exame tomográfico. Parte II: Toracolombar e Lombossacral

For vertebromedullary injuries, epidemiological knowledge is essential to guide the choice of the most effective diagnostic method. The objective of this retrospective study was to describe the epidemiological profile of animals and thoracolumbar and lumbosacral spine lesions diagnosed by computed tomography scan. A compilation of CT scan reports for the aforementioned regions performed in a comercial diagnostic center from 04/01/2017 to 04/30/2020, contrasted and non-contrasted, from routine, was performed in order to list the most common lesions and their locations, as well as the species, breeds and ages most affected. There were 1164 CT scans performed in the period evaluated, all of them in dogs, 57,56% (n=670) for the spine, with 89,7% reports accessed (n=601), where the regions mentioned here added up to 73,05% studies (n=439). In both regions, male French Bulldog dogs had the most injuries. For the thoracolumbar region, disk mineralization, followed by extrusion, were the most frequent injuries, while the site was T12-13 and the mean age 6,5±3,63 years old. In the lumbosacral, disk protrusion was most frequent, the most affected site was L7-S1 and age 6,65±3,79 years. It was concluded that the spine is the main target of CT scans, and that lesions related to the intervertebral disk were the main ones identified, with chondrodystrophic animals being more predisposed to injury.

Para lesões vertebromedulares é indispensável o conhecimento epidemiológico para direcionar a escolha do método diagnóstico mais eficaz. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral toracolombar e lombossacral diagnosticadas através de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina, a fim de relacionar as lesões e seus locais de ocorrência, bem como a espécie, raças e idades mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670) para a coluna, com 89,7% laudos acessados (n=601), nos quais as regiões toracolombar e lombossacral somaram 73,05% dos estudos (n=439). Em ambas as regiões, os cães Bulldog Francês machos foram os que mais apresentaram lesões. Para a região toracolombar, a mineralização de disco, seguida pela extrusão, foram as lesões mais frequentes, enquanto o local foi T12-13 e a média de idade 6,5±3,63 anos. Na lombossacral, a protusão de disco foi mais frequente, o local mais afetado foi L7-S1 e idade de 6,65±3,79 anos. Concluiu-se que a coluna vertebral é o principal alvo de tomografias, e que as lesões relacionadas ao disco intervertebral foram as principais identificadas, sendo os animais condrodistróficos mais predispostos a lesões.

Improved biological image tracking algorithm of athlete's cervical spine health / Algoritmo aprimorado de rastreamento de imagens biológicas da saúde da coluna cervical do atleta / Algoritmo mejorado de seguimiento de imágenes biológicas de la salud de la columna cervical del atleta

ABSTRACT Introduction This paper research an improved biological image tracking algorithm of athlete's cervical spine health under color feedback. Objective A new algorithm is proposed to improve the accuracy of detection and tracking. Methods In this study, the first thing is to apply the color feedback algorithm to improve and optimize the Improved Camshift algorithm. The optimized algorithm was used to track the center of the image, and the video was processed frame by frame. The center position of the tracking frame was obtained. Results The average number of head twists per person is 39 times. Among the three groups, children twisted the least, and older adults twisted the most. Conclusion The algorithm proposed in this study has certain effectiveness and superiority and can be well applied to detecting the number of head twists during exercise. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução Este artigo investiga um algoritmo aprimorado para rastrear imagens biológicas da saúde da coluna cervical do atleta sob feedback de cores. Objetivo Um novo algoritmo é proposto para melhorar a precisão de detecção e monitoramento. Métodos neste estudo, primeiro aplicamos o algoritmo de feedback de cores para otimizar o algoritmo Camshift aprimorado. O algoritmo otimizado foi usado para rastrear o centro da imagem e o vídeo foi processado quadro a quadro. A posição central do quadro de rastreamento foi obtida. Resultados o número médio de voltas da cabeça por pessoa é 39 vezes. Entre os três grupos, as crianças viraram menos e os adultos mais velhos viraram mais. Conclusão O algoritmo proposto neste estudo tem alguma eficácia e superioridade e pode ser bem aplicado para detectar o número de giros da cabeça durante o exercício. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Este artículo investiga un algoritmo mejorado de seguimiento de imágenes biológicas de la salud de la columna cervical del atleta bajo retroalimentación de color. Objetivo Se propone un nuevo algoritmo para mejorar la precisión de la detección y el seguimiento. Métodos En este estudio, lo primero es aplicar el algoritmo de retroalimentación de color para optimizar el algoritmo Camshift mejorado. El algoritmo optimizado se utilizó para rastrear el centro de la imagen y el video se procesó cuadro por cuadro. Se obtuvo la posición central del marco de seguimiento. Resultados El número medio de giros de cabeza por persona es 39 veces. Entre los tres grupos, los niños eran los que menos giraban y los adultos mayores eran los que más. Conclusión El algoritmo propuesto en este estudio tiene cierta efectividad y superioridad y se puede aplicar bien para detectar el número de giros de cabeza durante el ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Occult Andersson lesions in patients with ankylosing spondylitis: undetectable destructive lesions on plain radiographs / 中华医学杂志(英文版)

BACKGROUND@#Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.@*METHODS@#A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate.@*RESULTS@#Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001).@*CONCLUSIONS@#Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.

Ex-vivo evaluation of the three-column concept in canine thoracolumbar fractures / [Avaliação em ex-vivo do conceito dos três compartimentos em fraturas toracolombares da coluna]

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.(AU)

Eventos traumáticos, como acidentes automobilísticos ou quedas, são muito comuns na medicina veterinária e, frequentemente, levam a fraturas ou luxações vertebrais, associadas a lesões medulares concomitantes, mais frequentemente na coluna toracolombar. O propósito deste estudo biomecânico em cadáveres foi determinar a viabilidade da teoria dos três compartimentos em fraturas induzidas em segmentos toracolombares de cães. Dezoito unidades espinhais funcionais (UEF) de segmentos toracolombares (T12-L2) foram coletadas de 18 cadáveres de cães adultos de médio porte e submetidas a testes de flexão-extensão e curvamento lateral, de modo que a amplitude de movimento (ADM) foi registrada com um goniômetro. Fraturas foram induzidas por meio de cargas compressivas aplicadas por uma máquina universal de ensaios (EMIC®). As amostras foram submetidas à tomografia computadorizada (TC), e as fraturas foram classificadas como afetando um, dois ou três compartimentos e divididas nos grupos A, B e C, respectivamente. A ADM pós-fratura foi comparada com os resultados prévios. Os grupos B e C (com fraturas em dois ou três compartimentos) apresentaram instabilidade nos dois eixos avaliados (P<0,05). Os resultados deste estudo corroboram a aplicabilidade da teoria dos três compartimentos para segmentos de coluna toracolombar em cães, uma vez que as UEF que sofreram as fraturas em dois ou mais compartimentos apresentaram instabilidade axial.(AU)

Comparative tomographic study of the iliac screw and the S2-alar-iliac screw in children

OBJECTIVES: The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS: An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS: The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS: Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.

Three-dimensional spine morphology measuring technology for daily surface monitoring / 生物医学工程学杂志

In order to conduct surface monitoring of the three-dimensional spine morphology of the human body in daily life, a spine morphology measuring method using "single camera, multi-view" to construct stereo vision is proposed. The images of the back of the human body with landmarks of spinous process are captured from multiple angles by moving a single camera, and based on the "Zhang Zhengyou calibration method" and the triangulation principle of binocular stereo vision, the spatial conversion matrices corresponding to each other between all images and the 3D coordinates of the landmarks are calculated. Then the spine evaluation angle used to evaluate the spine morphology is further calculated. The tests' results showed that the spine evaluation angle error of this method is within ±3°, and the correlation between the results and the X-ray film Cobb angles is 0.871. The visual detection algorithm used in this paper is non-radioactive, and because only one camera is used in the measurement process and there is no need to pre-set the camera's shooting pose, the operation is simple. The research results of this article can be used in a mobile phone-based intelligent detection system, which will be suitable for the group survey of scoliosis in communities, schools, families and other occasions, as well as for the long-term follow-up of confirmed patients. This will provide a reference for doctors to diagnose the condition, predict the development trend of the condition, and formulate treatment plans.

Diagnóstico prenatal ultrasonográfico de hemivértebra / Prenatal Ultrasonographic Diagnosis of Hemivertebrae

Introducción: La hemivértebra es un raro defecto congénito de la columna vertebral fetal en la que solo se desarrolla el cuerpo vertebral de un lado, lo cual provoca su deformidad. Objetivo: Presentar un caso con diagnóstico ecográfico tridimensional prenatal de hemivértebra, como único defecto. Método: Se realizó evaluación ecográfica prenatal y examen anátomo patológico y radiológico posmortem al feto con escoliosis congénita provocado por hemivértebra. Se revisó la literatura sobre este defecto congénito, su diagnóstico prenatal y otros aspectos genéticos que deben tenerse en cuenta para el asesoramiento a la familia. Presentación de caso: Gestante de 28 años remitida a la consulta provincial de Genética Médica en la ciudad de Camagüey, Cuba, el 25 de septiembre del 2018, por sospecha ultrasonográfica de hemivértebra fetal con 20 semanas de gestación. Se confirma diagnóstico a esta instancia, mediante ultrasonografía tridimensional. Con el consentimiento familiar informado se realiza interrupción de la gestación y se comprueba el diagnóstico prenatal realizado por estudios radiológicos y anátomo patológico de la región dorso lumbar. Conclusiones: Se concluye como un defecto congénito múltiple, aislado, de posible etiología multifactorial. Se destacó el valor de la ecografía tridimensional, vista sagital coronal, como método no invasivo más empleado para el diagnóstico prenatal(AU)

Introduction: The hemivertebrae is a rare congenital defect of the fetal spine in which only the vertebral body develops on one side, resulting in deformity. Objective: To present a case with three-dimensional prenatal ultrasound diagnosis of hemivertebrae, as the only defect. Method: Prenatal ultrasound evaluation, postmortem anatomopathological and radiological examination were performed in a fetus with congenital scoliosis caused by hemivertebrae. The literature on this congenital defect, the prenatal diagnosis and other genetic aspects that should be taken into account for family counseling was reviewed. Case report: A 28-year-old pregnant woman referred to the provincial office of Medical Genetics in Camagüey, Cuba, on September 25, 2018, due to ultrasonographic suspicion of fetal hemivertebrae. She was 20 weeks of gestation. Diagnosis is confirmed by three-dimensional ultrasonography. After the informed family consent, the pregnancy was interrupted. The prenatal diagnosis was verified by radiological and pathological studies of the lumbar back region. Conclusions: It is concluded as a multiple congenital defect, isolated, of possible multifactorial etiology. The value of three-dimensional ultrasound, coronal sagittal view, was highlighted as the most commonly used, non-invasive method for prenatal diagnosis(AU)

Grading scale of lumbar degenerative disease in full spine x-ray / Escala de graduação da doença degenerativa lombar em exames de radiografia panorâmica da coluna vertebral / Escala de graduación de la enfermedad degenerativa lumbar en exámenes de radiografía panorámica de la columna vertebral

ABSTRACT Objective: To present a new lumbar degenerative disease grading scale considering full spine radiography and to evaluate its inter- and intraobserver reproducibility. Methods: A total of 132 full spine radiographies in the anterior and lateral views were analyzed. The cases were independently graded by two examiners. The radiographic parameters observed were osteophytosis, loss of disc height, sclerosis and subchondral cysts, number of affected segments, deformities, and signs of instability. The grading scale was proposed as follows: Degree zero corresponded to the absence of signs of degenerative disease in the lumbar spine; Grade I - presence of signs of degenerative disease up to two segments; Grade II - involvement of three or more segments; Grade III - associated deformity or signs of instability. The intra- and interobserver reproducibility was determined by the Kappa coefficient (κ) in general and according to the age group. Results: Kappa coefficient obtained for interobserver and intraobserver analysis showed excellent overall correlation (0.855 and 0.902, respectively). When analyzed according to age, results obtained in intraobserver correlation remained excellent (κ >0.8) in all age groups. The interobserver correlation remained excellent, except in the age range of 40-59 years (κ = 0.773), although maintaining a substantial reproducibility. Conclusion: The grading scale of lumbar degenerative disease observed in full spine x-rays showed excellent inter- and intraobserver reproducibility. Level of Evidence I; Diagnostic study.

RESUMO Objetivo: Apresentar uma nova escala de graduação da doença degenerativa lombar observada em exames de radiografia panorâmica da coluna vertebral e avaliar sua reprodutibilidade inter e intraobservador. Métodos: Foram avaliados 132 exames de radiografia total da coluna vertebral (panorâmica) nas incidências frente e perfil. Os casos foram graduados de maneira independente por dois examinadores. Os parâmetros radiográficos observados foram osteofitose, perda da altura discal, esclerose e cistos subcondrais, número de segmentos acometidos, deformidades e sinais de instabilidade. A escala de graduação foi proposta da seguinte maneira: Grau zero como ausência de sinais de doença degenerativa na coluna lombar; Grau I apresentando sinais de doença degenerativa até 2 segmentos; Grau II apresentando acometimento de três segmentos ou mais; Grau III quando associado com deformidade ou instabilidade. A reprodutibilidade intra e interobservador foi determinada pelo coeficiente Kappa (κ) de forma geral e conforme a faixa etária. Resultados: O Coeficiente Kappa obtido para a análise interobservador e intraobservador, mostrou excelente correlação geral (0,855 e 0,902, respectivamente). Quando analisados conforme a faixa etária, os resultados obtidos na correlação intraobservador mantiveram-se como excelente (κ > 0,8) em todas as faixas etárias. Na correlação interobservador, os resultados mantiveram-se excelentes, exceto na faixa etária de 40-59 anos (κ = 0,773), mas mantendo uma reprodutibilidade substancial. Conclusão: A escala de graduação da doença degenerativa lombar observada em exames de radiografia total (panorâmica) da coluna vertebral apresentou excelente reprodutibilidade tanto inter quanto intraobservador. Nível de Evidência I; Estudo diagnóstico.

RESUMEN Objetivo: Presentar una escala de graduación de la enfermedad degenerativa lumbar en radiografías panorámicas de columna vertebral y evaluar su reproducibilidad inter e intraobservador. Métodos: Se evaluaron 132 radiografías panorámicas anteriores y laterales de columna vertebral. Los casos fueron graduados de manera independiente por dos examinadores. Los parámetros radiográficos observados fueron osteofitosis, pérdida de la altura discal, esclerosis y quistes subcondrales, número de segmentos afectados, deformidades y signos de inestabilidad. La escala de graduación que se propuso fue la siguiente: Grado cero - ausencia de signos de enfermedad degenerativa en la columna lumbar; Grado I - signos de enfermedad degenerativa hasta 2 segmentos; Grado II - compromiso de tres segmentos o más; Grado II I - deformidad asociada o signos de inestabilidad. La reproducibilidad intra e inter-observador fue determinada por el coeficiente Kappa (κ) de forma general y conforme al grupo de edad. Resultados: El coeficiente Kappa obtenido en los análisis interobservador e intraobservador mostró excelente correlación general (0,855 y 0,902, respectivamente). Cuando se analizaron según el grupo de edad, los resultados de la correlación intraobservadores se mantuve excelente (κ > 0,8) en todas las edades. En la correlación interobservadores, los resultados se mantuvieron excelentes, excepto en el edad de 40-59 años (κ = 0,773), pero manteniendo reproducibilidad sustancial. Conclusión: La escala de graduación de la enfermedad degenerativa lumbar observada en exámenes de radiografía total (panorámica) de la columna vertebral presentó excelente reproducibilidad tanto inter como intraobservador. Nivel de evidencia I; Estudio diagnóstico.

Resolución quirúrgica de escoliosis congénita: reporte de caso / Surgical resolution of congenital scoliosis: case report

Las deformidades congénitas de la columna vertebral, constituyen uno de los trastornos musculoesqueléticos no traumáticos de difícil manejo clínico quirúrgico, por el alto grado de deformidad que producen y porque su incidencia es menor que las idiopáticas. Se presenta el caso de una paciente de 14 años de edad, quien fue valorada en una consulta externa del Hospital Carlos Andrade Marín de la ciudad de Quito, Ecuador, con una deformidad severa toracolumbar, presente desde el nacimiento, que ha ido progresando hasta causar dolor a la movilidad y limitando sus actividades diarias, impidiendo un desarrollo social adecuado, por lo que, se decide su resolución quirúrgica mediante artrodesis posterior instrumentada, osteotomías correctivas y resección de hemivértebra y barra espinal, posterior a lo cual se realizó fisioterapia y un seguimiento por consulta externa de un año. Su evolución fue favorable, mejorando su sintomatología y movilidad.

Congenital deformities of the spine constitute one of the non-traumatic musculoskeletal disorders of difficult clinical surgical management, due to the high degree of deformity they produce and their incidence is lower than idiopathic ones. We present the case of a 14-year-old patient who was evaluated in the outpatient clinic of the Carlos Andrade Marín Hospital in the city of Quito, Ecuador, with a severe thoracolumbar deformity, present from birth, which has progressed to cause pain to mobility, limiting daily activities, preventing an adequate social development, for which, surgical resolution was decided through instrumented posterior arthrodesis, corrective osteotomies, and resection of hemivertebra and spinal rod, after which physiotherapy was performed and follow-up by external consultation for 1 year. Its evolution was favorable, improving its symptomatology and mobility.

Spine surgery in patients with ankylosing spondylitis

SUMMARY INTRODUCTION: Ankylosing spondylitis (AS) is an idiopathic seronegative spondyloartropathy that involves mainly the axial skeleton and the sacroiliac joints. AS promotes biomechanical changes in the spine that predispose to fractures, spinal deformity and spondylodiscitis. The aim of this article is to report the clinical and laboratorial characteristics of patients with AS who underwent spinal surgery at our Institution. METHODS: Retrospective review of medical charts of patients who had AS and underwent spinal interventions. RESULTS: Nine patients were found and eight were included in the present study. There were three men and six women and the patients' mean age was 57 years old. All patients had pain at the involved spinal level and one patient had tetraparesis due to cervical myelopathy. Acute-phase proteins were positive in six patients (75%), and HLA-B27 was found in two patients (25%). Four patients had the radiological diagnosis of spondylodiscitis (50%) and underwent a spinal disc biopsy. They were all characterized as having aseptic spondylodiscitis. Three patients were free of pain with analgesics in their last follow-up and one patient had only partial solution of his pain. Three additional patients had spinal fractures surgically treated (37.5%) and one patient was operated because of a cervical kyphotic deformity (12.5%). There were no deaths or surgical complications in this series. CONCLUSIONS: the majority of our clinical and laboratories findings were discrepant with the medical literature. These differences may be secondary to regional characteristics or by the fact that our population included only those patients who underwent spinal surgery.

RESUMO INTRODUÇÃO: A espondilite anquilosante (EA) é uma espondiloartropatia soronegativa, caracterizada principalmente pelo envolvimento do esqueleto axial e das articulações sacroilíacas. A EA promove alterações biomecânicas que predispõem a coluna a fraturas, deformidades e à espondilodiscite. O objetivo do presente estudo é reportar as características clínicas e laboratoriais dos pacientes com EA que foram submetidos a procedimentos cirúrgicos na coluna vertebral em nossa instituição. MÉTODOS: Estudo retrospectivo com revisão de dados médicos dos pacientes com EA que foram submetidos a intervenções na coluna vertebral. RESULTADOS: Nove pacientes foram encontrados e oito incluídos no presente estudo. Três pacientes eram homens e seis mulheres, com média de 57 anos de idade. Todos os pacientes apresentavam dor no segmento da coluna acometido pela doença e um paciente tinha tetraparesia por mielopatia cervical. Seis pacientes (75%) apresentaram proteínas de fase aguda com níveis séricos elevados e dois eram HLA-B27 positivos. Em quatro pacientes houve o diagnóstico radiológico presumido de espondilodiscite e estes foram submetidos à biópsia de disco (três por via percutânea e um com biópsia aberta) - em nenhum deles houve identificação de agente infeccioso. Desses, três pacientes tiveram melhora total da dor durante o seguimento, enquanto um deles mantinha dores leves. Houve três casos de fraturas tratadas cirurgicamente (37,5%) e um caso de deformidade cervical cifótica grave (12,5%). Não houve mortes ou complicações relacionadas às cirurgias nessa série. CONCLUSÕES: A maioria dos dados clínicos e laboratoriais de nosso estudo divergiu da literatura. Essas diferenças podem ser atribuídas às características regionais de nossa população ou pelo fato de incluirmos apenas pacientes que foram submetidos à intervenção cirúrgica.

Normal values for sagittal spinal alignment: a study of Brazilian subjects

OBJECTIVES: The purpose of this study is to investigate the normal values of and chain of correlations between spinopelvic parameters in a Brazilian population. METHODS: This is a prospective observational study including asymptomatic adult subjects who had full spinal radiographs performed. The subjects were stratified by age into 3 groups (18-39 years old, 40-59 years old, and >60 years old), and radiographic parameters were compared across age groups and gender using ANOVA and Student's t-test, respectively. The relationships between various radiographic parameters were evaluated with Pearson correlation coefficients. RESULTS: One hundred and thirty asymptomatic volunteers (mean age, 48 years) met the inclusion criteria. The mean sagittal parameters in a normal Brazilian population were as follows: lumbar lordosis (LL) of 56.8°, pelvic tilt (PT) of 12.4°, pelvic incidence (PI) of 49.4°, PI-LL of -7.4°, T1 pelvic angle (TPA) of 8°, sagittal vertical axis (SVA) of -0.54 cm and T1 slope of 25.2°. Subjects ≥60 years old had significantly higher values of SVA (p=0.024) and TPA (p=0.009) than the two younger age groups. The TPA was significantly correlated with the following spinopelvic parameters: LL (r=-0.172, p=0.005), PT (r=0.776, p<0.001), PI (r=0.508, p<0.001), PI-LL (r=0.717, p<0.001), SVA (r=0.409, p<0.001) and T1 slope (r=0.172, p=0.050). CONCLUSION: This study demonstrated significant physiologic trunk inclination with increasing age. The TPA, an angular parameter of global spinal alignment, presented a chain of correlations with different spinal segments.

A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis

OBJECTIVES: Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. METHODS: Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. RESULTS: Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. CONCLUSIONS: Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

Resonancia magnética de columna cervical con secuencia en flexión para el diagnóstico de la enfermedad de Hirayama / Magnetic resonance of the cervical spine with sequence in flexion for the diagnosis of Hirayama disease

La enfermedad de Hirayama o atrofia muscular espinal juvenil no progresiva de las extremidades superiores es una clase de mielopatía relacionada con la flexión del cuello. Afecta principalmente a hombres jóvenes (entre 15 y 25 años) y se caracteriza por una debilidad muscular asimétrica y unilateral de miembros superiores con atrofia. Suele presentarse de manera insidiosa, con curso progresivo y autolimitado a los 3-4 años del inicio del cuadro. Se cree que es producida por trastornos isquémicos en la microcirculación de las astas anteriores del segmento medular cervical entre C8 y T1 por la compresión en el segmento medular anterior debido al desplazamiento anterior de la duramadre al flexionar el cuello. Si bien existen varias teorías sobre la causa de este deslizamiento, la más aceptada se relaciona con la falta de crecimiento de la duramadre con respecto a la columna durante la pubertad. Esto provocaría un aumento de la tensión de la dura posteriory, como consecuencia, el desplazamiento anterior durante la flexión. Dado su excelente contraste tisular y la posibilidad de realizar adquisiciones en distintos planos, la resonancia magnética es el estudio de elección. Las imágenes deben ser obtenidas en posición neutra y en flexión cervical máxima para poner de manifiesto el desplazamiento de la dura, con el consiguiente aumento de la sensibilidad y especificidad de la prueba. Así, se logra mayor confianza en el diagnóstico y menor cantidad de falsos positivos, en comparación con la posición neutra como única adquisición.

Hirayama disease is a type of myelopathy related to neck flexion. It affects young male adults between 15 and 25 years, and is characterised by unilateral and asymmetric upper limb muscle weakness with atrophy. It usually presents insidiously, with a progressive course and self-limits in 3-4 years. It is believed that it could be produced by ischaemic disorders in the microcirculation of the anterior horns of the cervical spine segment C8 and T1 due to anterior displacement of the dura. There are several theories for the cause of this displacement, with the most accepted being the relationship between the lack of growth of the dura mater and the spine during puberty. This increases the tension of the posterior dura mater and consequently the anterior displacement during flexion. Due to its excellent tissue contrast and the possibility of acquisitions in different planes, magnetic resonance imaging is the study of choice. Images must be obtained in both neutral and cervical flexion to highlight the displacement of the dura mater. This increases the sensitivity and specificity of the test, giving greater confidence in the diagnosis, and reducing false positives compared to neutral as a single acquisition.

Accuracy of chest radiography for positioning of the umbilical venous catheter / Acurácia da radiografia de tórax para o posicionamento do cateter venoso umbilical

Abstract Objectives: To evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks - diaphragm, cardiac silhouette, and vertebral bodies - in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. Methods: This was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Of the 162 newborns assessed by echocardiography, only 44 (27.16%) had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33%) newborns, in the right atrium in 26 (16.05%), intra-hepatic in 37 (22.84%), and intra-aortic in-one newborn (0.62%). The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. Conclusion: Anteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter.

Resumo Objetivos: Avaliar a acurácia da análise simultânea dos três marcos anatômicos radiográficos - diafragma, silhueta cardíaca e corpos vertebrais - na determinação da posição da extremidade distal do cateter venoso umbilical com a ecocardiografia como padrão de referência. Métodos: Estudo transversal, observacional, com inclusão prospectiva de dados de todos os neonatos nascidos em uma maternidade pública de referência, entre abril de 2012 e setembro de 2013, submetidos à inserção de cateter venoso umbilical como parte do atendimento clínico. A posição da extremidade distal do cateter, determinada pela análise simultânea dos três marcos anatômicos radiográficos, foi comparada com a posição anatômica obtida pela ecocardiografia. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia foram calculados. Resultados: Dos 162 recém-nascidos avaliados por ecocardiografia, somente 44 (27,16%) estavam com o cateter em posição ótima, na porção torácica da veia cava inferior ou na junção da veia cava inferior com o átrio direito. Os cateteres foram localizados no átrio esquerdo e no septo interatrial em 54 (33,33%), no átrio direito em 26 (16,05%), no intra-hepático em 37 (22,84%) e na aorta em um recém-nascido (0,62%). A sensibilidade, especificidade e acurácia da radiografia para detectar cateter na zona-alvo foram de 56%, 71% e 67,28%, respectivamente. Conclusão: A radiografia anteroposterior de tórax isolada não é capaz de definir com segurança a posição do cateter venoso umbilical. A ecocardiografia permite a visibilização direta da ponta do cateter em relação às estruturas vasculares e, sempre que possível, deve ser considerada para localização do cateter venoso umbilical.

Kyphosis index obtained in X-ray and with flexicurve assessment in children and young people / Índice de cifose obtido em radiografia e com o flexicurva na avaliação de crianças e jovens

Abstract Objectives: to assess the concurrent validity of kyphosis index measured in the flexicurve from the correlation of X-rays exams, identifying its accuracy and to assess the thoracic spine in children and young people. Methods: 31 young people at an average age of 11.1±3.4 years were evaluated by digital x-rays: (1) Cobb angle (ÂngCobb), (2) Kyphosis index (KIX), and (3) KIX angle (ÂngKIX). These were measured from the flexicurve design on the millimetric graph paper: (1) Kyphosis index (KIFint), obtained from C7 the intersection of kyphosis-lordosis, (2) Kyphosis index (KIFT12), obtained between C7 and T12, and (3) Kyphosis angle (ÂngKIFint and ÂngKIFT12). Statistical analysis: Correlation to Pearson Moment-Product and t test (α<0.05). Results: the angular values (ÂngKIFint, ÂngKIFT12, ÂngKIX) were underestimated in relation to Cobb angle (p<0.05), correlating only to KIX angle and Cobb angle [r=0.698, p<0.001]. The linear values (KIFint, KIFT12, KIX) were similar ( p>0.05) among themselves, correlating only to KIX and Cobb angle [r=0.698, p<0.001] and KIX angle and KIX [r=1; p<0.001]. Conclusions: the KIX and KIX angle presented as an accurate method and valid to be used in the thoracic kyphosis assessment, although KIFint, KIFT12, KIFint angle and KIFT12 angle showed no correlation to the gold standard and not being indicated to assess the thoracic kyphosis in children and young people.

Resumo Objetivos: avaliar a validade concorrente do índice de cifose mensurado no flexicurva a partir da correlação com exames de Raios-X, identificando sua acurácia, para avaliação da coluna torácica de crianças e jovens. Métodos: 31 jovens com idade média de 11,1±3,4 anos foram avaliados em radiografias digitais: (1) ângulo Cobb (ÂngCobb), (2) índice de cifose (KIX), e (3) ângulo do KIX (ÂngKIX). Foram mensurados a partir do desenho do flexicurva no papel milimetrado: (1) índice de cifose (KIFint), obtido de C7 à intersecção cifose-lordose, (2) índice de cifose (KIFT12), obtido entre C7 e T12, e (3) ângulo dos índices de cifose (ÂngKIFint e ÂngKIFT12). Análise estatística: Correlação Produto-Momento de Pearson e Teste t (α<0,05). Resultados: os valores angulares (ÂngKIFint, ÂngKIFT12, ÂngKIX) foram subestimados em relação ao ÂngCobb (p<0,05), sendo correlacionados apenas o ÂngKIX e ÂngCobb [r=0,698; p<0,001]. Os valores lineares (KIFint, KIFT12, KIX) foram semelhantes (p>0,05) entre si, sendo correlacionados apenas KIX e ÂngCobb [r=0,698; p<0,001] e ÂngKIX e KIX [r=1; p <0,001]. Conclusões: o KIX e ÂngKIX apresentaram-se como um método acurado e válido para ser utilizado na avaliação da cifose torácica, embora os KIFint, KIFT12, ÂngKIFint e ÂngKIFT12 não apresentaram correlação com o padrão ouro, não sendo indicados para a avaliação da cifose torácica de crianças e jovens.

Langerhans cell histiocytosis on fine needle aspiration cytology

Langerhans cell histiocytosis [LCH] is a rare disease characterized by clonal proliferation of Langerhans cells

We report a case of a five-year-old female presented with back pain and scoliosis. Radiological studies revealed lytic swelling with paravertebral soft tissue extension. Reports on cytology of paravertebral soft tissue extension of LCH are rare

CT scan guided fine needle aspiration from the spine was performed. A diagnosis of LCH was made based on the cytological and radiological findings. Subsequent histology and immunohistochemical stains also confirmed the diagnosis of LCH

Conus medullaris position in an adult population: analysis of magnetic resonance imaging / Posición del cono medular en una población adulta: análisis con imágenes de resonancia magnética

The objective of this study was to evaluate the variation in position of the conus medullaris (CM) in male and female patients without spinal deformity, to correlate the termination level in magnetic resonance (MR) images of the lumbar spine. 921 patients consisted of 607 men and 314 women were evaluated by MRI. The strength of T1 weighted MRI device was 1.5 Tesla. The patients were in supine position when measured. The termination level of the conus medullaris was recorded in relation to the upper, middle or lower third of the adjacent vertebra and the adjacent intervertebral disc. The patients in our study group were examined for low back pain. The members with spinal deformity were excluded. The distribution of conus medullaris localization was measured to range from T12 to L2-L3. There was a statistically significant difference in the mean conus medullaris position related to gender also a significant difference between increasing age and conus position in female patients. These findings suggest that the distribution of CM location in a large adult population was shown to range from the upper third of T12 to the lower third of L2-L3 disc space both in women and men.

El objetivo de este estudio consistió en evaluar la variación en la posición del cono medular (CM) en pacientes masculinos y femeninos sin deformidad espinal, para correlacionar el nivel de terminación en imágenes de resonancia magnética (RM) de la columna lumbar. Fueron evaluados por RM un total de 921 pacientes, 607 hombres y 314 mujeres. La fuerza ponderada del dispositivo de RM en T1 fue 1,5 Tesla. Los pacientes se ubicaron en posición supina al momento de la medición. El nivel de terminación del cono medular se registró en relación con el tercio superior, medio o inferior de la vértebra adyacente y el disco intervertebral adyacente. Los pacientes de nuestro grupo de estudio fueron examinados por dolor lumbar. Se excluyeron los individuos con deformidad espinal. La distribución de la localización del cono medular se midió, con variaciones entre T12 a L2-L3. Hubo una diferencia estadísticamente significativa en la posición media del cono medular relacionada con el sexo y también una diferencia significativa entre el aumento de la edad y la posición del cono medular en las mujeres. Estos hallazgos sugieren que la distribución de la ubicación del CM en una población adulta se encontró en un rango que se extendió desde el tercio superior de T12 al tercio inferior del espacio discal L2-L3, tanto en mujeres como en hombres.

Reproducibility and equivalence of cobbmeter application in the sagittal evaluation of the spine / Reprodutibilidade e equivalência do aplicativo cobbmeter na avaliação sagital da coluna / Reproducibilidad y equivalencia de la aplicación cobbmeter en la evaluación sagital de la columna vertebral

ABSTRACT Objective: This study aims to evaluate the reliability and equivalency of using the Cobbmeter application for iPhone compared to the manual measurement method in the analysis of the sagittal spinal alignment. Methods: Cross-sectional, prospective, single-center study that had 20 panoramic radiographs of the spine in lateral view, in a neutral standing position, analyzed blindly and randomly by three independent examiners in three different times. The parameters were pelvic incidence (PI), pelvic tilt (PT) and lumbar lordosis (LL). The statistical analysis was performed to measure the intraclass correlation coefficient (ICC) between the two measurement methods, in addition to measuring the intra and inter-evaluators reliability. Results: For reproducibility analysis, the intra-evaluators ICC using the application resulted in a Kappa (K) of 0.975 for the evaluation of pelvic incidence (PI) evaluation. For pelvic tilt (PT), the K value obtained was 0.981 and the K measured for lumbar lordosis (LL) analysis was 0.987. The inter-evaluators evaluation of reproducibility using the application resulted in a K value of 0.917 for PI, 0.930 for PT and 0.951 for LL. For the assessment of equivalency of methods, comparing the application to the standard method, with a goniometer and dermographic pencil, the K value found for PI was 0.873, for PV was 0.939 and for LL was 0.914. All values were significant (p<0.001) against the null hypothesis. Conclusion: This smartphone application is a valid and reliable instrument for measuring the angle involved in the sagittal balance of the spine. Furthermore, the results show that its applicability is not inferior to the manual method with goniometer and dermographic pencil.

RESUMEN Objetivo: Este trabajo tiene como objetivo evaluar la fiabilidad y la equivalencia de utilizar la aplicación Cobbmeter para iPhone en comparación con el método de medición manual en el análisis de la alineación sagital de la columna. Métodos: Estudio transversal, prospectivo, en un solo centro, donde fueron analizadas a ciegas y aleatoriamente 20 radiografías panorámicas de la columna vertebral en vista lateral, en posición ortostática neutra, por tres examinadores independientes en tres ocasiones diferentes. Los parámetros obtenidos fueran: incidencia pélvica (IP), versión pélvica (VP) y lordosis lumbar (LL). Se aplicó análisis estadístico para medir el coeficiente de correlación intraclase (CCI) entre los dos métodos de medición, además de medir la fiabilidad intra e inter-observador. Resultados: Para el análisis de la reproducibilidad, el CCI intra-observador, con el uso de la aplicación, resultó en un Kappa (K) de 0,975 para la evaluación de la incidencia pélvica (IP). Para la versión pélvica (VP), el K encontrado fue de 0,981 y el K medido para el análisis de la lordosis lumbar (LL) fue 0,987. La evaluación de la reproducibilidad intra-evaluador, utilizando la aplicación, resultó en K de 0,917 para la evaluación de IP, de 0,930 para VP y de 0,951 para la LL. Para la evaluación de la equivalencia de los métodos, comparándose la aplicación con el método estándar con goniómetro y lápiz dermográfico, el K encontrado en la medición de IP fue 0,873, de la VP fue 0,939 y de la LL fue 0,914. Todos los valores fueran significativos (p < 0,001) contra la hipótesis nula. Conclusión: Esta aplicación para smartphones es un instrumento válido y fiable para medir los ángulos que intervienen en el equilibrio sagital de la columna vertebral. Además, los resultados muestran que su aplicabilidad es no inferior que el método manual con goniómetro y lápiz dermográfico.

RESUMO Objetivo: Este trabalho visa avaliar a confiabilidade e a equivalência da utilização do aplicativo Cobbmeter para iPhone em comparação com o método de medição manual na análise do alinhamento sagital da coluna vertebral. Métodos: Estudo transversal, prospectivo, de centro único, em que foram analisadas, de forma cega e aleatória, 20 radiografias panorâmicas de coluna vertebral em incidência lateral, em posição ortostática neutra, por três examinadores independentes, em três momentos diferentes. Os parâmetros encontrados foram: incidência pélvica (IP), versão pélvica (VP) e lordose lombar (LL). A análise estatística foi aplicada para medir o coeficiente de correlação intraclasse (CCI) entre os dois métodos de medição, além de medir a confiabilidade intra e interavaliador. Resultados: Para análise de reprodutibilidade, o CCI intra-avaliador, utilizando-se o aplicativo, resultou em um Kappa (K) de 0,975 para a avaliação de incidência pélvica (IP). Para versão pélvica (VP), o K encontrado foi 0,981 e o K medido para a análise de lordose lombar (LL) foi 0,987. A avaliação da reprodutibilidade interavaliador, utilizando-se o aplicativo, resultou em um K de 0,917 para a avaliação da IP, de 0,930 para a VP e de 0,951 para a LL. Para a avaliação de equivalência dos métodos, comparando-se o aplicativo ao método padrão, com goniômetro e lápis dermatográfico, o K encontrado na medição de IP foi 0,873, 0,939 para VP e 0,914 para LL. Todos os valores foram significativos (p < 0,001) contra a hipótese nula. Conclusões: Esse aplicativo para smartphone é um instrumento válido e confiável para a medição dos ângulos envolvidos no equilíbrio sagital da coluna vertebral. Além disso, os resultados mostram que sua aplicabilidade é não inferior ao método manual com goniômetro e lápis dermatográfico.

Actualidades en infecciones vertebrales / Actualités sur les infections vertébrales / News on Vertebral Infections

Introducción: las infecciones vertebrales constituyen una afección de baja incidencia, pero con incremento importante en años recientes, el cual está en relación con una población más susceptible por diversas razones. A pesar de nuevos métodos para el diagnóstico, la demora constituye un importante problema. Propósito: revisar y discutir algunos temas actuales acerca de las infecciones vertebrales, la epidemiologia, etiología, fisiopatología, diagnóstico y tipos de tratamientos. Método: se seleccionó la literatura apropiada usando las bases de datos Pubmed, Hinari y Clinical Key. Resultados: la literatura muestra la importancia del correcto y rápido diagnóstico; determinar el agente causal es de primordial importancia para aplicar una adecuada terapia antimicrobiana. El tratamiento conservador produce, generalmente, buenos resultados y el quirúrgico está indicado en déficit o sepsis neurológicos, inestabilidad espinal y/o deformidad y fallo del tratamiento conservador. Se muestra algoritmo para diagnóstico y tratamiento. Conclusiones: aplicar una metodología correcta para el diagnóstico y tratamiento de las infecciones vertebrales, logra resultados satisfactorios(AU)

Introduction: vertebral infections are a disease of low incidence, but with significant increase in recent years. This increase is related to a more susceptible population due to various reasons. Despite the new methods for diagnosis, its delay is a major problem. Objective: review and discuss some current issues about the spine infections, epidemiology, etiology, pathophysiology, diagnosis and types of treatment. Method: select the appropriate literature using PubMed database, Hinari and Clinical Key. Results: the literature shows the importance of correct and rapid diagnosis, which determine the causal agent, is primordial to implement appropriate antimicrobial therapy. Conservative treatment generally produces good results and surgery is indicated in neurological deficit or sepsis, spinal instability and / or deformity and failure of conservative treatment. Diagnostic and treatment algorithm is shown. Conclusions: applying correct methodology for the diagnosis and treatment of spinal infection, satisfactory results are achieved(AU)

Introduction: les infections vertébrales sont des affections à faible incidence, mais d'un récent accroissement important. Cette augmentation est associée à une population plus sensible pour des raisons diverses. Malgré les nouvelles méthodes diagnostiques, le retard constitue un problème important. Objectif: le but de cette étude est d'examiner et discuter des questions actuelles sur les infections vertébrales, leur épidémiologie, leur étiologie, leur physiopathologie, leur diagnostic, et les types de traitement. Méthode: on a sélectionné une littérature appropriée au moyen des bases de données de PubMed, Hinari et Clinical Key. Résultats: la littérature montre l'importance d'un diagnostic correct et précoce; la définition de l'agent causal est d'une importance essentielle pour appliquer une adéquate thérapie antimicrobienne. En général, le traitement conservateur a de bons résultats, mais le traitement chirurgical est indiqué en cas de déficit ou sepsis neurologiques, d'instabilité et/ou déformation rachidienne, et d'échec du traitement conservateur. Un algorithme est présenté pour le diagnostic et le traitement. Conclusions: l'application d'une correcte méthodologie pour le diagnostic et le traitement des infections vertébrales assure des résultats satisfaisants(AU)