Prevención de la aparición de fibrosis epidural post-laminectomía con el empleo de rapamicina y barrera colágeno. Estudio experimental en Conejos / Prevention of post-laminectomy peridural fibrosis with sirolimus and barrier collagen. An experimental rabbit study

Objetivo: La fibrosis epidural resulta una complicación de aparición frecuente tras practicar laminectomía. No disponemos en la actualidad de mecanismos que eviten su formación. Rapamicina posee la capacidad de inhibir la respuesta inflamatoria y fibroblástica, asi como el colageno presenta propiedad hemostática. Este trabajo, pretende valorar la capacidad de ambos agentes utilizados de forma conjunta, en evitar la aparicion de fibrosis epidural tras laminectomía. Material y método: Practicamos laminectomía del espacio intervertebral L4-L5 en 32 conejos, distribuidos en 4 grupos, que se sacrificaron a las 8 semanas. En el espacio epidural creado tras laminectomia en el grupo de casos se instilo 5 ml de rapamicina y se posicionó membrana de colágeno, en el segundo grupo se posiciono membrana de colageno, el tercer grupo recibio instilacion de 5 ml de rapamicina y en el grupo de control lavado con 5 ml de suero fisiologico tras finalizar laminectomía. Las preparaciones histológicas fueron estudiadas mediante microscopía óptica. Se cuantificaron las poblaciones celulares presentes en la reacción inflamatoria, el grosor de la membrana fibrosa y grado de adherencia dural. Resultados: La medida de la superficie fibrosa, el grado de adherencia dural y la celularidad inflamatoria fue siempre menor en los conejos del grupo tratado con rapamicina y membrana de colageno que el resto (p<0.05). Conclusiones: Rapamicina en presencia de colágeno reduce la formación fibrosis y la extensión de adherencia peridural, disminuye la presencia de células inflamatorias y fibroblasticas

Purpose: Epidural fibrosis is a common complication for the patients who underwent laminectomy. No mechanical procedure is known that can prevent its appearance. Sirolimus has been shown to exert its anti-inflammatory, antifibrotic, and antiproliferative multifaceted properties and collagen has hemostatic properties. The object of this study was to investigate the effects of sirolimus and collagen-barrier on the prevention of postlaminectomy epidural fibrosis formation in laminectomy rabbits. Material and methods: We performed a laminectomy in the L4-L5 space in 32 rabbits, distributed into 4 groups, which were put down at 8 weeks. The study group received a 5 ml dose of sirolimus and collagen-barrier, second group a collagenbarrier, third group 5 ml of sirolimus and rabbits in the control groups were injected saline solution. Histologic preparations were studied by means of imaging techniques. The cell populations present in the inflammatory reaction were quantified as well as the thickness of the fibrous membrane and epidural scar adhesion. Results: The mean of the fibrous area, epidural scar adhesion and inflammatory cells was always less in the rabbits of the sirolimus and collagen barrier group compared to the other groups (p<0.05). Conclusions: Sirolimus and collagen-barrier is able to prevent epidural scar adhesion, inhibits the presence of inflammatory cells in the fibrous scar and reduces the extent of its adhesiveness and fibroblast proliferation

[Arthroscopic removal of an intraarticular projectile from the knee]. / Extracción de proyectil intraarticular en rodilla mediante artroscopía.

OBJECTIVE: We present the case of a patient who sustained a gunshot wound; the projectile was located in the knee and was arthroscopically removed. CLINICAL CASE: A 31 year-old patient sustained a gunshot wound in the right thigh, right hand and left knee. X-rays revealed the presence of a projectile in the knee, thigh and hand. The projectile was arthroscopically removed. DISCUSSION: Traumas causing articular wounds of the knee are infrequent. Excluding the most frequent causes of articular wounds, a small percentage of them are due to gunshot wounds. There is consensus around arthroscopy as a technique useful to remove articular foreign bodies; it has advantages over open surgery. This procedure minimizes surgical morbidity, reduces the risk of septic arthritis, synovitis, arthropathy or systemic lead toxicity, and it also hastens the patient's functional recovery. Knee arthroscopy allows physicians to provide a definitive treatment of these injuries, explore the joint, diagnose associated injuries and perform debridement and articular lavage. CONCLUSION: Arthroscopy is an effective tool for the extraction of articular projectiles; it also allows diagnosing and treating associated lesions.

[Spine cord descompresion and instrumentation in a case of solid aneurysmal bone cyst in the lumbar spine]. / Descompresión medular e instrumentación en un caso de variante sólida de quiste óseo aneurismático en raquis lumbar.

We report a 8-year-old boy with two month history of pain and stiffness in his left lower extremity. On x-ray, MRI and scintigraphy examinations a lytic lesion affecting the body and posterior arc of his third lumbar vertebral become evident. The tumour was excised through a double, anterior and posterior approach; spinal fusion with posterior transpedicular instrumentation was also performed in the same procedure; in order to achieve solid fusion tricortical liofilized graft was also inserted. Histological studies evidenced finding compatible with aneurysmal bone cyst solid variant. Five years after surgery the patient is pain free and no recurrence is evident under diagnostic images tools. For the treatment of aneurysmal bone cyst of the spine we recommend complete excision of the tumour in a combined anterior and posterior one staged procedure, together with hardware instrumentation and bone graft, no recurrence or instability is seen after five years followup.

Descompresión medular e instrumentación en un caso de variante sólida de quisteóseo aneurismático en raquis lumbar / Spine cord descompresion and instrumentation in a case of solid aneurysmal bone cyst in the lumbar spine

Se discute el caso de un paciente varón de ochoaños de edad que refería dolor y limitación funcionalen extremidad inferior izquierda. Tras estudios complementariosmediante radiografías, tomografía axialcomputarizada, resonancia magnética y gammagrafíase evidenció la presencia de una lesión osteolítica encuerpo y arco posterior de la tercera vértebra lumbar.La tumoración fue resecada a través de doble abordaje(anterior retroperitoneal y posterior) e instrumentaciónpedicular posterior con aporte estructural de huesotricortical liofilizado en un solo tiempo. El diagnósticohistológico reveló la presencia de variante sólida de unquiste óseo aneurismático. Cinco años tras la cirugía elpaciente no presentó dolor lumbar ni recurrencia de laenfermedad. La resección completa del tumor junto coninstrumentación pedicular previno recidivas y desarrollode inestabilidad (AU)

We report a 8-year-old boy with two month historyof pain and stiffness in his left lower extremity. On xray,MRI and scintigraphy examinations a lytic lesionaffecting the body and posterior arc of his third lumbarvertebral become evident. The tumour was excisedthrough a double, anterior and posterior approach;spinal fusion with posterior transpedicular instrumentationwas also performed in the same procedure; inorder to achieve solid fusion tricortical liofilized graftwas also inserted. Histological studies evidenced findingcompatible with aneurismal bone cyst solid variant.Five years after surgery the patient is pain free and norecurrence is evident under diagnostic images tools. Forthe treatment of aneurismal bone cyst of the spine werecommend complete excision of the tumour in a combinedanterior and posterior one staged procedure, togetherwith hardware instrumentation and bone graft, norecurrence or instability is seen after five years followup (AU)