Guía para la valoración multiaxial del "esguince cervical" y la patología discal asociada / Multiaxial guideline for evaluation of whiplash and associated disk disorders

Se aporta un enfoque de la valoración del esguince cervical basado en un modelo multidimensional. A modo de checklist se consideran aspectos relativos al accidente, las lesiones cervicales, el estado anterior, las lesiones extracervicales y aspectos psicológicos, incluyendo la simulación. Ya que el esguince cervical es no sólo, ni a veces principalmente, un cuadro médico, sino derivado de factores no médicos, se considera este modelo multiaxial como la mejor manera de abordar su valoración y tratamiento. Se insiste en la necesidad de valorar pericialmente las pruebas complementarias, en la importancia de algunas patologías asociadas y en la utilidad de un lenguaje común al hablar de la simulación o la exageración (AU)

A multiaxial approach to whiplash assessment is proposed. Following a checklist-like model, the accident, cervical and extra-cervical injuries, premorbid spine status, and psychological-malingering factors are, consecutively, considered. Provided that whiplash is not only a medical condition, but derived also from non-biological elements, the multiaxial model is presented as the best way to approach the forensic and therapeutic problems of whiplash. Remarks are made on the assessment of complementary tests under an expertise point of view, the importance of several whiplash-associated conditions, and the usefulness of using a unified terminology when facing malingering or simulation (AU)

[Biological cement extravasation into the spinal canal following kyphoplasty. Long-term follow-up. Report of one case and review of the literature]. / Fuga intrarraquídea de cemento biológico tras cifoplastia. Evolución a largo plazo.Presentación de un caso y revisión de la literatura.

BACKGROUND: Vertebroplasty and kyphoplasty are minimally invasive percutaneous techniques indicated in the treatment of some somatic vertebral fractures. Both are based on the introduction of a substance, called cement, inside the vertebral body. We can choose acrylic or biological cement. These techniques are not risk-free, cement extravasation being the main complication. Due to the short experience in the use of the biological cements, nowadays there are a lot of unresolved doubts about the long-term behaviour of these materials, especially in the case of leakage. PURPOSE: We report a case of biologic cement extravasation into the spinal canal during a kyphoplasty in a 23 year old man and its long-term follow-up (3 years), performing a review of the scientific literature related to the topic. CONCLUSIONS: Most of the papers in the literature discuss the behaviour of the reinforcement material inside a bony environment, but they do not refer to the evolution of the cement outside the vertebral space. We have appreciated in our case that the leaked cement is not being substituted for bone but it suffers a process of progressive resorption. The extravasation of the vertebral reinforcement material is an important and potentially serious complication of the vertebral augmentation techniques. To avoid this, a very precise chirurgical technique is necessary, under radiological guidance. Biocompatibility, biodegradability and osteoconductivity are the main advantages of biological cements. We base the choice of the cement on the balloon/trabeculae interaction.

[Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases]. / Regresión espontánea de hernias discales intervertebrales. A propósito de una serie de 37 casos.

INTRODUCTION: The intervertebral disc disease (IDD) is one of the most common muscle-skeletal disorders, causing both high work disability and elevated healthcare costs. There are two specific origins of disk disease that should be kept in mind: degenerative (DDD) and traumatic (TDD). Concerning the TDD, nowadays it has not been determined which patients could gradually improve and which ones will require surgery. Some studies indicate that about 85% of lumbar and 90% cervical acute disc herniation will get better in an average of 6 weeks. MATERIALS AND METHODS: We conducted an observational, prospective study, over a group of 858 patients, with the following inclusion criteria: 1. MRI imaging indicating TDD, 2. No signs or symptoms requiring urgent surgical treatment (cauda equina syndrome, progressive or serious motor deficit or unbearable pain) and 3. Development of progressively spontaneous symptoms remission. All of the patients included in our study were treated in our Department of Neurosurgery from 2006 to 2007. Patients were tested for disc herniation regression with a second MRI study. RESULTS: A spontaneous regression of their hernia was appreciated as follow: 33 cases of lumbar hernia (29 male, 4 female), 3 cervical hernia (1 male, 2 female) and 1 dorsal hernia (male). DISCUSSION: Research about other reported series was done, and the different factors that could take place in disc spontaneous regression were analyzed: a) lodgement of the herniated disc back into the intervertebral space; b) disappearance of the herniated fragment due to dehydration and retraction mechanisms; c) gradual resorption of the herniated tissue by phagocytosis and enzymatic degradation induced by an inflammatory reaction that appeared as the disc (acting the extrusion itself as an foreign body) and, d) pulsion of cephaloarchidian liquid against the herniated portion. CONCLUSIONS: Disc herniation can regress, or even disappear, in a number of patients, rendering the radiological findings not to be taken as the only surgical indication criterium. We consider that the best treatment is the one relying on a good doctor-patient relationship, suspended in a balance between conservative and surgical treatment. According to clinical data, the first one (conservative) should not exceed the estimated time beyond which the surgical result would be unsatisfactory. The second one (operative), excepting "need-to operate" situations (such as cauda equina compression, progressive or serious motor déficit, or unbearable pain), should be prudently supedited to MRI regresión control, in particular in patients in which a clinical improvement is observed. Thus, the disc herniation conservative healing, both clinical as radiological, do exist, being a concept to widespread among clinicians and patients also.

Regresión espontánea de hernias discales intervertebrales. A propósito de una serie de 37 casos / Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases

Introducción. La enfermedad discal intervertebral(EDI) es uno de los trastornos musculoesqueléticos máscomunes, que induce tanto una elevada proporción dediscapacidad laboral como un gran coste sanitario.Dentro de la EDI cabría considerar dos modalidades,la enfermedad discal de origen degenerativo (EDD) yla de origen traumático (hernias discales traumáticas- HDT). Con respecto a las HDT no se ha podido determinar,a día de hoy, qué pacientes son susceptiblesde mejorar espontáneamente y cuales lo harán si sesometen a tratamiento quirúrgico. Algunos estudioshan determinado, que hasta el 85% de los pacientescon una hernia discal lumbar aguda y hasta el 90% conuna hernia discal cervical aguda, mejorarán en el plazomedio de 6 semanas.Material y método. Durante el bienio 2006-2007,realizamos un estudio observacional, prospectivo en858 pacientes diagnosticados clínica y radiológicamentede HDT, que no cumplimentaban los criterios de unacirugía urgente -síndrome de la cola de caballo, déficitmotor progresivo/grave, o dolor incoercible-. Un grupode pacientes evolucionaron de forma progresiva a laremisión espontánea de la clínica que motivara su asistenciamédica. Se solicitó, en aquellos pacientes que asílo aceptaron, un nuevo estudio de neuroimagen.Resultados. Se ha apreciado una regresión espontáneade la herniación en 33 casos a nivel lumbar (29varones y 4 mujeres), en 3 casos a nivel cervical (1 varóny 2 mujeres) y en 1 caso a nivel dorsal (1 varón).Discusión. Se lleva acabo una revisión de otrasseries publicadas y se analizan los distintos factoresque pueden intervenir en la regresión espontánea delas mismas: a) el realojo del disco herniado en el espaciointervertebral; b) la desaparición del fragmento(..) (AU)

Introduction. The intervertebral disc disease (IDD)is one of the most common muscle-skeletic disorders,causing both high work disability and elevated healthcarecosts. There are two specific origins of disk diseasethat should be kept in mind: degenerative (DDD) andtraumatic (TDD). Concerning the TDD, nowadays ithas not been determined which patients could graduallyimprove and which ones will requiere surgery.Some studies indicate that about 85% of lumbar and90% cervical acute disc herniation will get better in anaverage of 6 weeks.Materials and methods. We conducted an observational,prospective study, over a group of 858 patients,with the following inclusion criteria: 1. MRI imaging (..) (AU)

Refuerzo vertebral percutáneo: vertebroplastia y cifoplastia. Procedimiento técnico / Percutaneous vertebral augmentation: vertebroplasty and kyphoplasty. Operative technique

Las técnicas de refuerzo vertebral, vertebroplastia y cifoplastia, consisten básicamente en la introducción de un cemento óseo -polimetilmetacrilato (PMMA)- en un cuerpo vertebral fracturado, para aliviar el dolor mediante la estabilización de la fractura vertebral. En ocasiones, previamente a la administración del cemento, a nivel de la vértebra colapsada, se inserta un balón que se insufla con la finalidad de restaurar la altura del cuerpo vertebral y reducir la deformidad cifótica; en estos casos hablamos de cifoplastia o de vertebroplastia mediante balón. Las indicaciones de la vertebroplastia y cifoplastia han ido evolucionando, pasando de la estabilización de una fractura vertebral osteoporótica dolorosa, al refuerzo de un colapso vertebral secundario a metástasis.En el presente trabajo se revisan los principales aspectos técnicos de la vertebroplastia y de la cifoplastia,a la luz de nuestra experiencia en el tratamiento de las fracturas vertebrales. Se necesitan más estudios que permitan definir el papel de cada procedimiento dentro del arsenal terapéuticode la cirugía de columna

The intravertebral injection of acrylic resin cement -usually polymethylmethacrylate (PMMA)- into a fractured vertebral body, constitutes the basis of the so called “vertebral augmentation techniques”, “vertebroplasty”and “kyphoplasty”, to manage pain and to strengthen and stabilize the compromised vertebra. In some ocassion, prior to the PMMA injection, an inflatable bone tamp was inserted into both pedicles of the fractured vertebra with the aim of restoring vertebralheight to correct the kyphosis deformation. This procedure is called kyphoplasty (balloon-assisted vertebroplasty).The indications for vertebroplasty and kyphoplasty are evolving, from stabilization of painful osteoporotic vertebral fractures to vertebral collapse secondary to spinal metastases. In this paper we review the technical basis of both procedures, according to our experience in the treatmentof vertebral fractures. Further studies are requiredto define the role for each techniques in the spinal surgery’s armamentarium

Distrofia simpático refleja en el post-parto / Algodystrophie in the post-partum

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