Traumatic Injuries of the Dorso-lumbar Spine, Review of Surgical Approaches

In this review we supply information on medical methods for thoraco-lumbar spine fracture management, their efficiency and complication rates, based on previously published researches and also give background information on epidemiology and classification of thoraco-lumbar fractures. We conducted a narrative review over the literature using electronic databases as; MEDLINE, and EMBASE for studies involving data on Dorso-lumbar Spine traumatic injuries, published in September 2019. Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of back cracks is essential in order to establish a typical language for therapy indicators and results. Clinical exam, mechanism of injury, and imaging are heavily trusted to choose regarding medical versus non-surgical management.

Compresión medular por sarcoma granulocítico primario / Spinal cord compression due to nonleukemic granulocytic sarcoma

El sarcoma granulocítico (SG) es una lesión poco frecuente asociada a síndromes mielodisplásicos, mieloproliferativos o leucemias, aunque puede ser el primer hallazgo en un paciente previamente sano. Presentamos un SG que comenzó como compresión medular, en un paciente sin patología hematológica previa. Las imágenes radiológicas demostraron una lesión lítica en L1 que precisó cirugía urgente. Fue preciso realizar inmunohistoquímica de la muestra para llegar al diagnóstico. El aspirado medular no mostró evidencia de patología hematológica, siendo el SG la primera manifestación. El paciente recibió posteriormente tratamiento con quimioterapia y radioterapia, falleciendo 20 meses después del diagnóstico de una sepsis Pseudomonas aeruginosa intratratamiento de una leucemia mieloblástica. En resumen, el SG primario es un tumor infrecuente de difícil diagnóstico. Es necesario tener un alto grado de sospecha y solicitar amplios estudios inmunohistoquímicos para un diagnóstico correcto. El tratamiento debe ser precoz, agresivo e individualizado, ya que tiene mal pronóstico.

Granulocytic sarcoma (GS) is an infrequent lesion associated with myelodysplastic or myeloproliferative disorders or leukemia, although it may be the first finding in an otherwise healthy patient. A case of GS is described that presented as spinal cord compression, in a patient with no underlying hematological disorder. Imaging studies disclosed a single lytic lesion in L1, which required emergency surgery. Immunohistochemical staining of the surgical biopsy sample was needed for diagnosis. Bone marrow aspirate was unremarkable. The patient received chemo-radiotherapy, dying 20 months after diagnosis of Pseudomonas aeruginosa sepsis during treatment of acute myelogenous leukemia. In short, primary GS is an infrequent and difficult to diagnose tumor. A high degree of suspicion, along with extensive immunohistochemical studies are necessary for diagnosis. Treatment should be prompt, aggressive and individualized, since the prognosis is very poor.

Abordajes toracolumbares anteriores en lesiones requimedulares: experiencia en 72 casos / Anterior thoraco lumbar approches for spino medular injuries. About 72 cases

Objetivo: revisar nuestra experiencia en dos centros de la provincia de Buenos Aires, en el manejo de 72 casos con lesiones vertebrales y/o vertebromedulares de diferentes etiologías y topografías, utilizando abordajes anteriores y anterolaterales al raquis dorsolumbar. Material y método: analizamos retrospectivamente las indicaciones, técnica quirúrgica, resultados y complicaciones en 72 pacientes que requirieron un abordaje torácico o toracolumbar, en el período que va de enero de 1996 a junio de 2009. La vía de abordaje fue determinada de acuerdo al nivel afectado y a la extensión de la lesión. Las lesiones entre T2 y T10 se abordaron mediante estereotomía o toracotomía derecha; con lesiones T11 a L1, preferimos una toracotomía con o sin manipulación del diafragma desde la izquierda. Para las lesiones L2- L3, se utilizó una lumbotomía izquierda. En la inmensa mayoría de los casos, la artrodesis se acompañó de una osteosíntesis segmentaria con distintos sistemas de fijación (placa atornillada, barras y placas atornilladas). En todas las intervenciones, contamos con la asistencia de un equipo de cirugía general, cardiovascular o urológica, tanto en peri como postoperatorio. Resultados: la mayoría de las lesiones (50,6% del total), se ubicaron en los segmentos T10 a L2. Catorce casos correspondieron a lesiones exclusivamente lumbares, en un paciente se requirió del equipo de cirugía cardiovascular (estereotomía para el abordaje T2-T3). La etiología más frecuente fue traumática, seguida por los tumores primitivos o secundarios, en tercer lugar se ubicaron las patologías degenerativas y en último término, las infecciones (5 casos). Un porcentaje similar de pacientes se presentó con y sin déficit neurológico asociado. Veintiún enfermos (casi 1 de cada 3 operados) requirieron de una doble vía de abordaje, en general diferida a la primera cirugía...

Objective To analyse retrospectively our experience in two surgical centers in Buenos Aires, managing 72 cases of spinal lesions of different ethiologies, using anterior surgical approaches to the thoracolumbar spine. Material and method. Indications, surgical techniques and results, as well as complications in 72 cases requiring a thorcolumbar anterior approach performed between 1996 and 2009 were analised. Surgical route was chosen according to the level and extension of the injuries. Those between T4 and T10 were approached using a right thoracotomy: for lesions between T11 and L1, we used a left thoracotomy, with or without diaphragmatic section. For levels L2 L3, a left lumbotomy was performed. In most cases, arthtodesis was followed by segemental stabilisation with different devices. In all cases, we were assisted intra and postoperatively by a surgical team (general surgeons, cardiovascular surgeons and urologic surgeons). Results. Almost 50% of the cases were located between T10 and L2. 14 cases were exclusively lumbar lesions: in one case, the cardiovascular surgical team was required (sternotomy to expose T2T3). Trauma was the most common ethiological agent, followed by tumors: degenerative and infectious causes were uncommon. 21 patients required a combined anterior and posterior approach. Morbidity related to surgery was of 14% in our series, superficial infections being the most frequent finding (6 cases). Mortality related to surgery reached 1.33% (1 case). Conclusions. In our experience (72 cases operated on during the last 13 years), and with an adequate patient selection, the anterior approach resulted safe and effective, with an acceptable morbidity grossly equal to that described in the literature.

Successful introduction of modified dorsolumbar epidural anesthesia in a bovine referral center

This study describes the successful use of modified dorsolumbar epidural anesthesia with a fixed volume of anesthetic in a bovine referral center. Among the 130 Holstein cattle scheduled for flank surgery, 90 cattle received a mixed anesthetic consisting of 1 ml of xylazine hydrochloride and 3 ml of lidocaine hydrochloride by modified dorsolumbar epidural anesthesia. Eighteen cattle with dehydration and/or lameness received a mixed anesthetic containing 0.5 ml of xylazine and 3 ml of lidocaine. Infiltration anesthesia was performed in 22 cattle whose epidural space could not be reached in order to perform the flank surgery. The surgeries began about 12 min after the administration of the anesthetic and lasted for about 36 min. The modified method using a fixed volume of anesthetic was successfully introduced and effectively used in a bovine referral center. This modified method will allow veterinarians to save time and effort, thus lowering the cost of each surgery.

Practical tips for modified dorsolumbar epidural anesthesia in cattle

Segmental dorsolumbar epidural anesthesia has been considered difficult to perform. The purpose of this study was to determine whether or not it is difficult for beginners to learn how to do modified dorsolumbar epidural anesthesia of cattle. Thirty cattle were divided into two groups, young (n = 8) and adult (n = 22), according to their age and body weight, and 0.12% new methylene blue (NMB) was injected into the first interlumbar (L1.L2) epidural space by four fifth-year veterinary school students who had never performed this method. After a 1 hour lecture on the modified dorsolumbar epidural anesthesia procedure which included basic anatomy and skills, each student successfully performed the procedure. In the young group, the NMB solution was distributed between the periosteum and the epidural fat (BPF) in one half and between the epidural fat and the dura mater (BFD) in the other half of the cattle. In about 60% (13/22) of the adult group, the NMB solution distributed as BFD type. This study showed that the modified dorsolumbar epidural anesthesia procedure is easy for beginners to perform if they overcome their fear about the deeper insertion of the epidural needle with basic anatomical knowledge and a little experience.