ABSTRACT
El neumoencéfalo es una complicación poco frecuente pero grave de la cirugía de la columna vertebral, su manejo y fisiopatología no es ampliamente conocida. La incidencia de neumoencéfalo sintomático a tensión, secundario a una artrodesis vertebral posterior es desconocida. Caso clínico. Presentamos el caso de una paciente mujer de 41 años de edad, con diagnóstico de discopatía L3-L4, L4-L5 y hernia discal izquierda L4-L5. Se realizó una artrodesis vertebral posterior L3-L5, discectomías L3-L4 y L4-L5 y liberación de la raíz L5 izquierda, sin complicaciones aparentes. Transcurridas 24 h después de la cirugía, la paciente inicia cuadro de cefalea generalizada de fuerte intensidad, rigidez de nuca y disartria. Se realizan TAC y RMN que muestran un enorme neumoencéfalo en el espacio subaracnoideo, a predominio del lóbulo frontal izquierdo, sin desplazamiento de la línea media, con origen en el conducto raquídeo lumbar. La paciente fue tratada de forma conservadora, presentando a partir de las 72 h mejoría neurológica progresiva, hasta la normalización clínica y radiológica después de 7 días. Discusión. El neumoencéfalo es una complicación rara pero potencialmente grave de la cirugía de columna, relacionada en la mayoría de los casos con desgarro dural accidental durante la cirugía. La mayoría de las colecciones son pequeñas, se comportan de forma benigna, y responden al tratamiento conservador. En un gran número de pacientes, puede comportarse como cualquier lesión ocupante de espacio, por lo que se necesita un alto grado de sospecha clínica para hacer el diagnóstico y tratamiento oportuno, y prevenir la morbimortalidad no deseadas (AU)
Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology is not widely recognized. The incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown. Case report. The case is reported of a rare case of a 41 year old woman with diagnosis of L3-L4, L4-L5 disc disease and left disc herniation L4-L5. A posterior spinal arthrodesis L3-L5, L3-L4 and L4-L5 discectomies and release of the left L5 root, was performed without apparent complications. Twenty-four hours after surgery the patient developed generalized headache, neck stiffness, and dysarthria. MRI and CT scans revealed a huge pneumocephalus in the subarachnoid space, predominantly in the left frontal lobe without midline shift, which originated in the lumbar spinal canal. The patient was treated conservatively, with progressive neurological improvement after 72 hours, and clinical and radiological normalization after 7 days. Discussion. Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during the operation. Most collections are small, behave benign, and respond to conservative therapy. In the present case, an inadvertent dural tear, produced a pneumocephalus. A high degree of suspicion is needed to make the diagnosis, prompt treatment, as well as remedying the source of air to prevent unwanted morbidity and mortality (AU)
Subject(s)
Adult , Female , Humans , Pneumoencephalography/methods , Pneumoencephalography , Arthrodesis , Brain/pathology , Brain Diseases, Metabolic/complications , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Magnetic Resonance Imaging/methodsABSTRACT
UNLABELLED: Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology is not widely recognized. The incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown. CASE REPORT: The case is reported of a rare case of a 41 year old woman with diagnosis of L3-L4, L4-L5 disc disease and left disc herniation L4-L5. A posterior spinal arthrodesis L3-L5, L3-L4 and L4-L5 discectomies and release of the left L5 root, was performed without apparent complications. Twenty-four hours after surgery the patient developed generalized headache, neck stiffness, and dysarthria. MRI and CT scans revealed a huge pneumocephalus in the subarachnoid space, predominantly in the left frontal lobe without midline shift, which originated in the lumbar spinal canal. The patient was treated conservatively, with progressive neurological improvement after 72 hours, and clinical and radiological normalization after 7 days. DISCUSSION: Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during the operation. Most collections are small, behave benign, and respond to conservative therapy. In the present case, an inadvertent dural tear, produced a pneumocephalus. A high degree of suspicion is needed to make the diagnosis, prompt treatment, as well as remedying the source of air to prevent unwanted morbidity and mortality.
Subject(s)
Lumbar Vertebrae/surgery , Pneumocephalus/etiology , Postoperative Complications , Spinal Fusion , Adult , Female , Humans , Pneumocephalus/diagnostic imaging , Postoperative Complications/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Introducción. El hallux rigidus es la artrosis más frecuente en el pie y tobillo. Existen numerosas revisiones respecto al tratamiento quirúrgico, pero escasas publicaciones que aborden la eficacia del tratamiento conservador. Objetivo. Presentar un algoritmo global de tratamiento completo para todos los grados de esta enfermedad. Métodos. Revisión sistemática de la evidencia disponible hasta octubre de 2013 utilizando las siguientes fuentes: Pubmed y PEDro database (physiotherapy evidence database) de artículos sobre tratamiento de hallux rigidus que comuniquen sus resultados y de los que pudieran obtenerse grados de recomendación. Resultados. Obtuvimos 112 artículos sobre tratamiento conservador y 609 sobre tratamiento quirúrgico. Finalmente solo 4 cumplían los criterios de inclusión. Conclusiones. El uso de ortesis a medida o modificaciones del calzado, la infiltración con hialuronato, la queilectomía en grados moderados y la artrodesis metatarsofalángica en grados avanzados, son los únicos procedimientos contrastados con grado de evidencia B o moderada en el tratamiento del hallux rigidus (AU)
Introduction. Hallux rigidus is the most common arthritis of the foot and ankle. There are numerous reviews on the surgical treatment, but few publications that address the effectiveness of conservative treatment. Objective. To present a comprehensive algorithm for treatment of all grades of this disease. Methods. Literature search in the following sources: Pubmed and PEDro database (physiotherapy evidence database) until October 2013 for articles on treatment hallux rigidus to record levels of evidence. Results. A total of 112 articles were obtained on conservative treatment and 609 on surgical treatment. Finally, only 4 met the inclusion criteria. Conclusions. The use of orthoses or footwear modifications, infiltration with hyaluronate, cheilectomy in moderate degrees and the metatarsophalangeal arthrodesis for advanced degrees, are the only procedures contrasted with grade B or moderate evidence in the treatment of hallux rigidus (AU)
Subject(s)
Humans , Male , Female , Hallux Rigidus/epidemiology , Evidence-Based Practice/statistics & numerical data , Evidence-Based Practice/trends , Evidence-Based Nursing/methods , Evidence-Based Nursing/statistics & numerical data , Arthrodesis/methods , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Algorithms , Hallux Rigidus/complications , Hallux Rigidus/diagnosis , Hallux Rigidus/surgery , Orthotic Devices/trends , Orthotic Devices , Hyaluronan Receptors/therapeutic use , Arthroscopy/methods , Osteotomy/methodsABSTRACT
INTRODUCTION: Hallux rigidus is the most common arthritis of the foot and ankle. There are numerous reviews on the surgical treatment, but few publications that address the effectiveness of conservative treatment. OBJECTIVE: To present a comprehensive algorithm for treatment of all grades of this disease. METHODS: Literature search in the following sources: Pubmed and PEDro database (physiotherapy evidence database) until October 2013 for articles on treatment hallux rigidus to record levels of evidence. RESULTS: A total of 112 articles were obtained on conservative treatment and 609 on surgical treatment. Finally, only 4 met the inclusion criteria. CONCLUSIONS: The use of orthoses or footwear modifications, infiltration with hyaluronate, cheilectomy in moderate degrees and the metatarsophalangeal arthrodesis for advanced degrees, are the only procedures contrasted with grade B or moderate evidence in the treatment of hallux rigidus.
Subject(s)
Algorithms , Clinical Decision-Making/methods , Decision Support Techniques , Hallux Rigidus/therapy , Arthrodesis , Combined Modality Therapy , Evidence-Based Medicine , Foot Orthoses , Humans , Hyaluronic Acid/therapeutic use , Viscosupplements/therapeutic useABSTRACT
High-energy tibial pylon fractures represent some of the most severe injuries of the ankle joint and currently represent a challenge for the orthopedic surgeon. These are usually polytraumatized patients and before admitting them into the traumatology unit, spinal cord, pelvic or thoracoabdominal injuries should be ruled out. Due to the special anatomy of the area, its thin skin cover and subcutaneous location, soft tissues are usually severely affected and this is key when choosing the time for a surgical intervention. Although the definitive treatment of these injuries is controversial, the so called two-stage treatment seems to predominate in order to minimize soft tissue iatrogenic injuries applying the concept of orthopedic damage control of the limb. We present the preliminary results of 10 patients operated with this method at our center.
