Paraplejia por contusión lumbar / Paraplegia due to low back strain

Un traumatismo dorsal, en una columna afectada por espondilitis anquilosante (EA), debe tratarse inicialmente por defecto como una fractura y el paciente se considerará potencialmente inestable hasta que se normalicen todas las pruebas complementarias. Se expone un caso de contusión lumbar en un paciente con historia conocida de EA, que sufre un deterioro neurológico tardío y paraplejia de miembros inferiores. En este artículo queremos enfatizar el manejo inicial y las complicaciones derivadas de la enfermedad, que todo médico en la puerta de urgencias debe conocer (AU)

Dorsal injury in a spine affected by ankylosing spondylitis (AS) must be treated initially by default as a fracture and the patient will be considered potentially unstable until all supplemental investigations show normal results. We report a case of low back strain in a patient with known history of AS, suffering late neurological impairment and paraplegia of the lower limbs. This article intends to highlight the initial management and complications resulting of the disease that any physician at the emergency room should know (AU)

Necrosis aséptica bilateral de cabeza femoral / Bilateral avascular femoral head necrosis

Se presenta el caso de un varón de edad media, emigrante de raza caucásica, sin antecedentes de interés salvo llevar tratamiento con hidroxiurea desde años «por tener poco oxígeno en la sangre» y episodio autolimitado de cefalea y afasia. Acude por dolor en ambas regiones inguinales con limitación de la movilidad de cadera en todos los arcos predominantemente para la rotación. El diagnóstico de la RM fue osteonecrosis bilateral e cabeza femoral. Se establece diagnóstico etiológico diferencial de las necrosis asépticas concluyendo se trata de un caso secundario a anemia drepanocítica y se analizan las características fisiopatológicas y clínicas de esta hemoglobinopatía (AU)

We present the case of a caucasian middle-aged male without clinical antecedents, except for having received hydroxiurea treatment for some years because of «having less oxygen in blood than normally» and some episodes of headache and aphasia. He comes with pain in both groin regions and hip movility limitation principally in rotation. The RM study diagnosis was bilateral osteonecrosis of femoral head. We stablished the differential diagnosis etiologycal of avascular necrosis,concluding that is a case of sickle cell anemia and we analysed the clinical and physiopathologycal characteristics of this hemoglobinopathy (AU)

Experiencia con el sistema gravitational platelet separation (GPS) en el tratamiento de las pseudoartrosis diafisarias de huesos largos / Experience with Gravitational Platelet Separation System in the treatment of diaphyseal non unions of long bones

El Sistema Gravitational Platelet Separation (GPS) permite mediante una sencilla técnica, la obtención de un concentrado autólogo de plaquetas que puede ser aplicado de diversas formas para favorecer la consolidación ósea. Se ha realizado un estudio retrospectivo clínico y radiográfico de 21 pacientes consecutivos diagnosticados de pseudoartrosis diafisaria no infectada tratados con GPS y con un seguimiento mínimo de 12 meses. Se ha comprobado la consolidación clínica y radiológica en todos los casos excepto en 2 en un tiempo medio de 12 semanas (rango: 5 - 30 semanas). La adición de plasma rico en plaquetas a las técnicas quirúrgicas tradicionales en el tratamiento de las pseudoartrosis puede favorecer y acelerar la consolidación ósea

Gravitational Platelet Separation System (GPS) allows the surgeon to obtain easily an autologous concentrate of platelets that can be applied in different ways to promote bone healing. A retrospective clinical and radiological study on 21 consecutive patients diagnosed of non infected diaphyseal nonunion treated with GPS with a minimum follow-up of 12 months is presented In all cases but in 2 clinical and radiological healing of the fracture was reported in a mean time of 12 weeks (5-30 weeks).Addition of Platelet Rich Plasma to traditional surgical techniques of treatment of nonunions can enhance and accelerate bone healing

[Anterior cervical fusion with tantalum interbody implants. Clinical and radiological results in a prospective study]. / Artrodesis cervical anterior mediante implante de tantalio. Resultados clínicos y radiológicos.

Anterior cervical discectomy and interbody fusion (ACDF) is a widely accepted surgical technique in the treatment of cervical disc disease. Tantalum cages have been recently introduced in spine surgery for interbody fusion because of the advantages of their mechanical properties. We present the results of a prospective clinical and radiological study on 24 consecutive patients who underwent an ACDF with tantalum cages. Clinical evaluation was assessed preoperatively and after surgery by a questionnaire that included a Visual Analogic Scale (VAS) of neck and arm pain, the Oswestry Disability Index and the Zung Depression Scale. Results were classified by Odom's criteria. Radiological evaluation included flexion-extension X-rays, and changes in distance between spinous processes and Cobb angle were measured. Postoperatively patients were reviewed 3 and 12 months after surgery. A statistical significative improvement in all clinical data was reported. According to Odom's criteria in 75% of patients the results were considered like excellent or good. Only one case of radiological and clinical pseudoarthrosis was confirmed. No significative differences were reported 3 and 12 months after surgery. Tantalum cages are a very promising and usefull alternative among implants available for ACDF. Compatibility with MRI postoperative studies and the unnecessariness of autograft are some of their advantages.

Artrodesis cervical anterior mediante implante de tantalio. Resultados clínicos y radiológicos / Anterior cervical fusion with tantalum interbody implants. Clinical and radiological results in a prospective study

La discectomía cervical anterior con artrodesisintersomática (DCAA) es una técnica quirúrgica ampliamente aceptada en el tratamiento de la enfermedad discal cervical. Recientemente se han introducido con esta indicación las cajas de tantalio debido a sus excelentes propiedades mecánicas y biológicas. Presentamos los resultados iniciales clínicos y radiológicos de un estudio prospectivo de 24 pacientes intervenidos en nuestro servicio tras el empleo de cajas de tantalio en la DCAA. La evaluación clínica pre y postoperatoria se realizó mediante cuestionario que incluía una Escala Visual Analógica de dolor, el Índice de Oswestry, y la Escala de Zung. Los resultados fueron clasificados mediante los criterios de Odom. La evaluación radiológica incluyó radiografías dinámicas en las que se midieron las variaciones del ángulo de Cobb y la distancia interespinosa. Postoperatoriamente los pacientes fueron revisados en el tercer mes y al año dela intervención. Todos los parámetros clínicos mejoraron de forma estadísticamente significativa. Según con los criterios de Odom, el 75% de los casos fueron considerados como excelentes o buenos. Sólo se confirmó clínica y radiológicamente un caso de pseudo-artrosis. No se observaron diferencias significativas en las revisiones al año y a los 3 meses. Conclusión: Las cajas de tantalio constituyen un implante prometedor y pensamos que útil entre las diversas opciones quirúrgicas para la DCAA, por sus buenos resultados clínicos, por la no necesidad de autoinjerto, y por su excelente compatibilidad con la resonancia nuclear magnética

Anterior cervical discectomy and interbody fusión (ACDF) is a widely accepted surgical technique in the treatment of cervical disc disease. Tantalum cages have been recently introduced in spine surgery for interbody fusion because of the advantages of their mechanical properties. We present the results of a prospective clinical and radiological study on 24 consecutive patients whounder went an ACDF with tantalum cages. Clinical evaluation was assessed preoperatively and after surgery by a questionnaire that included a Visual Analogic Scale(VAS) of neck and arm pain, the Os westry Dissability Index and the Zung Depression Scale. Results were classified by Odom’s criteria. Radiological evaluation included flexion-extension X-rays, and changes in distance between spinous processes and Cobb angle were measured. Postoperatively patients were reviewed 3and 12 months after surgery. A statisitical significative improvement in all clinical data was reported. According to Odom’s criteria in75% of patients the results were considered like excellent or good. Only one case of radiological and clinical pseudoarthrosis was confirmed. No significative differences were reported 3 and 12 months after surgery. Tantalum cages are a very promising and usefull alternative among implants available for ACDF. Compatibility with MRI postoperative studies and the unnecessariness of autograft are some of their advantages

Absceso piógeno del psoas secundario a espondilodiscitis postartrodesis lumbar. Revisión y comentario, a propósito de un caso / Piogenic abscess in the psoas muscle after lumbar spondylodiskitis postartrodesis. A case report, comentary and revision

Se presenta el caso de un paciente inmunocompetentesometido a artrodesis vertebral que sufre infección quirúrgicapor Staph. Aureus multisensible con evolución tórpiday múltiples recidivas locales pese antibioterapia e intervencionesquirúrgicas de drenaje.A los 3 meses de la artrodesis se retiró el material de fijación,y evoluciona a espondilodiscitis crónica con fístulacutánea lumbar. Aparece absceso del músculo psoas iliacoa los 5 años.Se establece el diagnóstico diferencial entre las entidadesresponsables de afectación del espacio retroperitoneal.Se analizan las imágenes evolutivas desde espondilodiscitisa absceso del psoas y la progresión hasta la resolución

We report a case of a immunocompromised patient withvertebral artrodesis that presented an infection by Staphylococcusaureus with torpid evolution and several local recidivain spite of antibiotic therapy and surgical drainage.After 3 months the artrodesis instrumental was extirpatedand the patient developed a chronic spondylodiskitisand cutaneous lumbar fistula. Appeared an abscess in thepsoas iliac musculature after 5 years.The differential diagnosis is established among the differententities responsible for the affectation of the retroperitonealcompartment.The evolutionary images are analyzed from the spondylodiskitisto psoas abscess and the progression until its resolution

Comparison of three techniques of anterior fusion in single-level cervical disc herniation.

This study compared the clinical and radiographic outcome of three techniques of anterior fusion for cervical disc herniation: Cloward fusion with autograft, Cloward fusion with freeze-dried bone, and BAK-C device fusion. In a cohort of 84 consecutive patients, 34 were treated by classic autograft Cloward's technique, in 26 patients freeze-dried xenograft Surgibone was used and in the last 24 patients a BAK-C titanium device was implanted. The mean follow-up period of this last group was 14.6 months. All patients were operated by the same surgeon at the same hospital and all underwent single-level surgery. Results were evaluated on the basis of patient satisfaction and postoperative capacity to work. There was no significant difference between the three groups related to the preoperative assessment. The analysis revealed that BAK-C patients had significantly shorter hospital stays. No postoperative cervical collar was worn by BAK-C patients and they had the highest percentage of excellent clinical results. Concerning radiographic evaluation, BAK-C achieved a more stable fixation of the involved segment without complications in contrast with the two others, which presented a significant incidence of extrusion, collapse, kyphosis and pseudarthrosis. Measurement of the progressive kyphosis grade shows statistically significant differences between the three groups. BAK-C patients had the lowest kyphosis grade at the end of the follow-up. There is an important correlation between collapse, collapse with kyphosis and pseudarthrosis with bad clinical results. In conclusion, the BAK-C device showed significant advantages, including higher patient satisfaction, unnecessary postoperative collar, early rehabilitation and a lower rate of complications. Furthermore, BAK-C is cost effective because of it shortens postoperative hospital stay and allows an earlier return to work.