Diferencias clínicas entre los pacientes con dolor crónico primario y secundario atendidos por una unidad multidisciplinar de dolor crónico infantil / Clinical differences in a multidisciplinary pediatric pain unit between primary and secondary chronic pain

Introducción: El dolor crónico afecta a un porcentaje significativo de la población pediátrica en los países desarrollados, y puede tener una causa médica bien definida en el dolor crónico secundario (DCS), o desconocida en el dolor crónico primario (DCP). En España, hasta el momento, no existe información acerca de las diferencias clínicas de los pacientes atendidos en unidades multidisciplinarias. Métodos: Análisis retrospectivo de las historias clínicas de los pacientes atendidos en 2018 por la Unidad de Dolor Crónico Infantil del Hospital Universitario La Paz. Resultados: Se incluyeron los 92 pacientes atendidos, con edades comprendidas entre 2 y 19 años, y una edad media de 12,4 (SD=4,1) años, mayoritariamente de sexo femenino (55%) y una duración media del dolor de 11,3 (SD=10,4) meses. Los resultados de comparar pacientes con DCP (n=31) y DCS (n=61) mostraron que ambos grupos presentaban dolor medio con una gran intensidad (x=5,9; SD=2,2; rango=0-10), con duración y repercusión funcional similares, aunque el DCP se asoció menos a descriptores de tipo neuropático que el DCS (p=0,040) y era más extenso en su localización (p<0,001). Ambos grupos recibieron similar tratamiento basado en rehabilitación, psicoterapia, técnicas invasivas y tratamiento con medicación analgésica, aunque los pacientes del grupo DCP recibieron menos medicaciones analgésicas (gabapentinoides y opiáceos) que el DCS (p=0,011). Conclusión: Los pacientes con DCP o DCS, aunque tengan un perfil clínico similar, presentan diferencias en el número y tipo de analgésicos empleados, lo que avalaría la importancia del diagnóstico de la causa para adecuar el tratamiento farmacológico subsiguiente.(AU)

Introduction: Chronic pain affects an important part of the pediatric population in developed countries. secondary chronic pain (SCP) can have a well-defined medical cause, but primary chronic pain (PCP) can have an unknown etiology. In Spain, there is as yet no information on the clinical differences between patients treated in multidisciplinary units. Methods: Retrospective analysis of the clinical records of patients seen in 2018 at the Children's Chronic Pain Unit in University La Paz Hospital. Results: A total of 92 patients were included (age between 3 and 19 years), with a mean age of 12.4 (SD=4.1) years, mostly female (55%), with a mean duration of pain of 11.3 (SD=10.4) months. A comparison of patients with PCP (n=31) and SCP (n=61) showed that both groups, on average, presented intense pain (X=5.9; SD=2.2; range=0-10), with similar duration and functional repercussions, although PCP was less likely to be associated with neuropathic descriptors than SCP (p=.040), and was more extensive (p<.001). Both groups received similar treatment, based on rehabilitation, psychotherapy, invasive techniques and analgesic medication, although patients in the PCP group received less analgesic medication (gabapentinoids and opioids) than the SCP (p=.011). Conclusion: Patients treated in a multidisciplinary Child Pain Unit for PCP or SCP present a very similar clinical profile, though with differences in the number and type of analgesic drugs used. This shows the importance of etiologic diagnosis for adequate pharmacological treatment.(AU)

Clinical differences in a multidisciplinary pediatric pain unit between primary and secondary chronic pain.

INTRODUCTION: Chronic pain affects an important part of the pediatric population in developed countries. secondary chronic pain (SCP) can have a well-defined medical cause, but primary chronic pain (PCP) can have an unknown etiology. In Spain, there is as yet no information on the clinical differences between patients treated in multidisciplinary units. METHODS: Retrospective analysis of the clinical records of patients seen in 2018 at the Children's Chronic Pain Unit in University La Paz Hospital. RESULTS: A total of 92 patients were included, (age between 3 and 19 years), with a mean age of 12.4 (SD = 4.1) years, mostly female (55%), with a mean duration of pain of 11.3 (SD = 10.4) months. A comparison of patients with PCP (n = 31) and SCP (n = 61) showed that both groups, on average, presented intense pain (X = 5.9; SD = 2.2; range = 0-10), with similar duration and functional repercussions, although PCP was less likely to be associated with neuropathic descriptors than SCP (p = 0.040), and was more extensive (p < 0.001). Both groups received similar treatment, based on rehabilitation, psychotherapy, invasive techniques and analgesic medication, although patients in the PCP group received less analgesic medication (gabapentinoids and opioids) than the SCP (p = 0.011). CONCLUSION: Patients treated in a multidisciplinary Child Pain Unit for PCP or SCP present a very similar clinical profile, though with differences in the number and type of analgesic drugs used. This shows the importance of etiologic diagnosis for adequate pharmacological treatment.

Effects of ATLAS 2030 gait exoskeleton on strength and range of motion in children with spinal muscular atrophy II: a case series.

BACKGROUND: Children with spinal muscular atrophy (SMA) present muscle weakness and atrophy that results in a number of complications affecting their mobility, hindering their independence and the development of activities of daily living. Walking has well-recognized physiological and functional benefits. The ATLAS 2030 exoskeleton is a paediatric device that allows gait rehabilitation in children with either neurological or neuromuscular pathologies with gait disorders. The purpose is to assess the effects in range of motion (ROM) and maximal isometric strength in hips, knees and ankles of children with SMA type II after the use of ATLAS 2030 exoskeleton. METHODS: Three children (mean age 5.7 ± 0.6) received nine sessions bi-weekly of 60 min with ATLAS 2030. ROM was assessed by goniometry and strength by hand-held dynamometer. All modes of use of the exoskeleton were tested: stand up and sit down, forward and backward walking, and gait in automatic and active-assisted modes. In addition, different activities were performed during the gait session. A descriptive analysis of all variables was carried out. RESULTS: The average time of use was 53.5 ± 12.0 min in all sessions, and all participants were able to carry out all the proposed activities as well as to complete the study. Regarding isometric strength, all the measurements increased compared to the initial state, obtaining the greatest improvements for the hip flexors (60.2%) and extensors muscles (48.0%). The ROM increased 12.6% in hip and 34.1% in the ankle after the study, while knee ROM remained stable after the study. CONCLUSION: Improvements were showed in ROM and maximal isometric strength in hips, knees and ankles after using ATLAS 2030 paediatric gait exoskeleton in all three children. This research could serve as a preliminary support for future clinical integration of ATLAS 2030 as a part of a long-term rehabilitation of children with SMA. TRIAL REGISTRATION: The approval was obtained (reference 47/370329.9/19) by Comunidad de Madrid Regional Research Ethics Committee with Medical Products and the clinical trial has been registered on Clinical Trials.gov: NCT04837157.

Delphi consensus on recommendations for the treatment of spinal muscular atrophy in Spain (RET-AME consensus).

INTRODUCTION: Spinal muscular atrophy (SMA) is a neurodegenerative disease caused by a biallelic mutation of the SMN1 gene, located on the long arm of chromosome 5, and predominantly affects the motor neurons of the anterior horn of the spinal cord, causing progressive muscle weakness and atrophy. The development of disease-modifying treatments is significantly changing the natural history of SMA, but uncertainty remains about which patients can benefit from these treatments and how that benefit should be measured. METHODOLOGY: A group of experts specialised in neurology, neuropediatrics, and rehabilitation and representatives of the Spanish association of patients with SMA followed the Delphi method to reach a consensus on 5 issues related to the use of these new treatments: general aspects, treatment objectives, outcome assessment tools, requirements of the treating centres, and regulation of their use. Consensus was considered to be achieved when a response received at least 80% of votes. RESULTS: Treatment protocols are useful for regulating the use of high-impact medications and should guide treatment, but should be updated regularly to take into account the most recent evidence available, and their implementation should be assessed on an individual basis. Age, baseline functional status, and, in the case of children, the type of SMA and the number of copies of SMN2 are characteristics that should be considered when establishing therapeutic objectives, assessment tools, and the use of such treatments. The cost-effectiveness of these treatments in paediatric patients is mainly influenced by early treatment onset; therefore, the implementation of neonatal screening is recommended. CONCLUSIONS: The RET-AME consensus recommendations provide a frame of reference for the appropriate use of disease-modifying treatments in patients with SMA.

Multiple red blood cell transfusions and iron overload in very low birthweight infants.

BACKGROUND AND OBJECTIVES: To estimate the risk of iron overload in very low birthweight (VLBW) infants who receive more than two red blood cell (RBC) transfusions, in comparison with those who receive two or less during their hospital stay. MATERIALS AND METHODS: Prospective open cohort study in VLBW infants with >2 (exposed) and ≤2 (non-exposed) RBC transfusions. Ferritin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at birth and after each RBC transfusion. The incidence of iron overload was determined. Risk factors were analysed using a logistic regression model. RBC transfusion volume correlations with ferritin, ALT and AST were calculated with Spearman's rank correlation coefficient, as well as correlations between ferritin and aminotransferases. RESULTS: A total of 63 patients were enrolled, 18 of which were exposed and 45 non-exposed. Twelve patients developed severe iron overload, eight exposed (44·5%) vs. four (8·8%) non-exposed (RR: 5, 95% CI: 1·7-14·6). Multivariate analysis showed that the number of transfusions increased the risk of iron overload (OR: 2·07, 95% CI: 1·36-2·14) while a higher one-minute Apgar score was associated with a lower risk (OR: 0·56, 95% CI: 0·32-0·99). Severe iron overload mainly occurred with a transfusion volume higher than 120 ml/kg. There was a positive correlation between ferritin and transfusion (r = 0·53; P < 0·001). CONCLUSION: There was a higher risk of iron overload in exposed infants in comparison with non-exposed infants. Severe iron overload in VLBW infants may occur with a total transfusion volume >120 ml/kg.

[Clinical guidelines for infantile-onset Pompe disease]. / Guia clinica de la enfermedad de Pompe infantil.

Infantile-onset Pompe disease has a fatal prognosis in the short term unless it is diagnosed at an early stage and enzyme replacement therapy is not started as soon as possible. A group of specialists from different disciplines involved in this disease have reviewed the current scientific evidence and have drawn up an agreed series of recommendations on the diagnosis, treatment and follow-up of patients. We recommend establishing enzyme treatment in any patient with symptomatic Pompe disease with onset within the first year of life, with a clinical and enzymatic diagnosis, and once the CRIM (cross-reactive immunological material) status is known.

TITLE: Guia clinica de la enfermedad de Pompe infantil.La enfermedad de Pompe infantil tiene un pronostico fatal a corto plazo si no se diagnostica precozmente ni se inicia un tratamiento enzimatico sustitutivo lo antes posible. Un grupo de especialistas de las diferentes disciplinas involucradas en esta enfermedad ha revisado la evidencia cientifica actual y ha elaborado por consenso una serie de recomendaciones para el diagnostico, el tratamiento y el seguimiento de los pacientes. Se recomienda instaurar tratamiento enzimatico en todo paciente con enfermedad de Pompe sintomatica de comienzo en el primer año de vida, con diagnostico clinico y enzimatico, y una vez conocido el estado CRIM (material inmunologico con reactividad cruzada).

Diazoxide enhances excitotoxicity-induced neurogenesis and attenuates neurodegeneration in the rat non-neurogenic hippocampus.

Diazoxide, a well-known mitochondrial KATP channel opener with neuroprotective effects, has been proposed for the effective and safe treatment of neuroinflammation. To test whether diazoxide affects the neurogenesis associated with excitotoxicity in brain injury, we induced lesions by injecting excitotoxic N-methyl-d-aspartate (NMDA) into the rat hippocampus and analyzed the effects of a daily oral administration of diazoxide on the induced lesion. Specific glial and neuronal staining showed that NMDA elicited a strong glial reaction associated with progressive neuronal loss in the whole hippocampal formation. Doublecortin immunohistochemistry and bromo-deoxyuridine (BrdU)-NeuN double immunohistochemistry revealed that NMDA also induced cell proliferation and neurogenesis in the lesioned non-neurogenic hippocampus. Furthermore, glial fibrillary acidic protein (GFAP)-positive cells in the injured hippocampus expressed transcription factor Sp8 indicating that the excitotoxic lesion elicited the migration of progenitors from the subventricular zone and/or the reprograming of reactive astrocytes. Diazoxide treatment attenuated the NMDA-induced hippocampal injury in rats, as demonstrated by decreases in the size of the lesion, neuronal loss and microglial reaction. Diazoxide also increased the number of BrdU/NeuN double-stained cells and elevated the number of Sp8-positive cells in the lesioned hippocampus. These results indicate a role for KATP channel activation in regulating excitotoxicity-induced neurogenesis in brain injury.

In vivo adhesion of malignant B cells to bone marrow microvasculature is regulated by α4ß1 cytoplasmic-binding proteins.

Multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) cells must attach to the bone marrow (BM) microvasculature before lodging in the BM microenvironment. Using intravital microscopy (IVM) of the BM calvariae we demonstrate that the α4ß1 integrin is required for MM and CLL cell firm arrest onto the BM microvasculature, while endothelial P-selectin and E-selectin mediate cell rolling. Talin, kindlin-3 and ICAP-1 are ß1-integrin-binding partners that regulate ß1-mediated cell adhesion. We show that talin and kindlin-3 cooperatively stimulate high affinity and strength of α4ß1-dependent MM and CLL cell attachment, whereas ICAP-1 negatively regulates this adhesion. A functional connection between talin/kindlin-3 and Rac1 was found to be required for MM cell attachment mediated by α4ß1. Importantly, IVM analyses with talin- and kindlin-3-silenced MM cells indicate that these proteins are needed for cell arrest on the BM microvasculature. Instead, MM cell arrest is repressed by ICAP-1. Moreover, MM cells silenced for talin and kindlin-3, and cultured on α4ß1 ligands showed higher susceptibility to bortezomib-mediated cell apoptosis. Our results highlight the requirement of α4ß1 and selectins for the in vivo attachment of MM and CLL cells to the BM microvasculature, and indicate that talin, kindlin-3 and ICAP-1 differentially control physiological adhesion by regulating α4ß1 activity.

The L-type voltage-gated calcium channel modulates microglial pro-inflammatory activity.

Under pathological conditions, microglia, the resident CNS immune cells, become reactive and release pro-inflammatory cytokines and neurotoxic factors. We investigated whether this phenotypic switch includes changes in the expression of the L-type voltage-gated calcium channel (VGCC) in a rat model of N-methyl-D-aspartate-induced hippocampal neurodegeneration. Double immunohistochemistry and confocal microscopy evidenced that activated microglia express the L-type VGCC. We then analyzed whether BV2 microglia express functional L-type VGCC, and investigated the latter's role in microglial cytokine release and phagocytic capacity. Activated BV2 microglia express the CaV1.2 and CaV1.3 subunits of the L-type VGCC determined by reverse transcription-polymerase chain reaction, Western blot and immunocytochemistry. Depolarization with KCl induced a Ca2+ entry facilitated by Bay k8644 and partially blocked with nifedipine, which also reduced TNF-α and NO release by 40%. However, no nifedipine effect on BV2 microglia viability or phagocytic capacity was observed. Our results suggest that in CNS inflammatory processes, the L-type VGCC plays a specific role in the control of microglial secretory activity.

Síndrome de Kabuki: una enfermedad con pronóstico heterogéneo / Kabuki syndrome: a disease with a heterogeneous prognosis

El síndrome de Kabuki es una enfermedad poco frecuente y de presentación clínica muy variable. Su diagnóstico se basa fundamentalmente en los hallazgos clínicos. El objetivo de este trabajo es presentar 2 casos clínicos del mismo síndrome con diferencias clínicas, evolutivas y pronósticas. El primer caso se trata de una niña evaluada en nuestro servicio con casi 10 años de edad, sin tratamiento médico previo, antecedentes de una cardiopatía compleja severa, fenotipo característico e hipotonía severa generalizada. El segundo caso es una niña en seguimiento por nuestro servicio desde los 5 meses, con fenotipo característico, hipotonía leve-moderada y retraso del desarrollo psicomotor. En ambos casos el tratamiento rehabilitador consigue mejorar su situación clínica aunque tienen una evolución muy diferente. El tratamiento debe ser individualizado, la intervención terapéutica precoz condicionará su evolución y pronóstico (AU)

Kabuki syndrome is a rare disease with a highly variable clinical presentation. Diagnosis is mainly based on clinical findings. This report aims to present two cases of the same syndrome with different clinical presentation and outcome. The first case was a girl first evaluated in our department when she was nearly 10 years old, with no previous medical treatment. She had a severe complex heart disease, characteristic phenotype and severe generalized hypotonia. The second case was a girl who had been followed-up in our department since she was 5 months old, with characteristic phenotype, mild-moderate hypotonia and developmental delay. In both patients, rehabilitation improved their clinical status, although outcome differed in each. Treatment of Kabuki syndrome should be individualized and early therapeutic intervention will affect its clinical course and outcome (AU)

Enfermedad de Gorham como causa de lesión medular en la infancia: a propósito de un caso / Gorham's disease as a cause of spinal cord injury in childhood: a case report

Se presenta el caso de un niño de 11 años de edad, diagnosticado un año antes de enfermedad de Gorham con afectación ósea múltiple a nivel de tórax y columna dorsal. En el curso de la enfermedad apareció daño medular secundario. Fue intervenido quirúrgicamente realizándose una fusión vertebral para detener la progresión del cuadro clínico y la deformidad de columna. En el postoperatorio inmediato se evidenció cuadro de lesión medular completa motora e incompleta sensitiva precisando tratamiento rehabilitador precoz. En el síndrome de Gorham-Stout la afectación vertebral es infrecuente, siendo la mielopatía una grave complicación. La recuperación de las secuelas neurológicas precisa un programa de rehabilitación adecuado a la gravedad de las mismas. El síndrome de Gorham-Stout es un trastorno esquelético raro de etiología y patogénesis desconocidas. Puede afectar a cualquier hueso del esqueleto, siendo la afectación de la columna vertebral un hallazgo raro. Cuando aparece como complicación una mielopatía, esta se considera una complicación grave (AU)

Gorham-Stout syndrome is a rare skeletal disorder of unknown etiology and pathogenesis. It can affect any bone of the skeleton, involvement of the spine being a rare finding. Myelopathy, when it appears, is considered a serious complication. The case is presented of an 11- year old boy who had been diagnosed 1 year earlier of Gorham disease with multiple bone involvement on the chest and spine level. Secondary bone marrow damage appeared during the course of the disease. He was referred to our hospital where was underwent surgery, performing spinal fusion to halt the spinal deformity progression and the clinical course. In the immediate postoperative period, a complete motor and incomplete sensory spinal cord injury was observed, which required early rehabilitation treatment. In Gorham-Stout syndrome, vertebral involvement is uncommon, myelopathy being a serious complication. Neurologic recovery requires a comprehensive rehabilitation program adapted to its severity (AU)

Resultados funcionales de la simbraquidactilia tratada quirúrgicamente / Functional results of surgery treated symbrachydactyly

La agenesia digital es una malformación congénita, también conocida como simbraquidactilia. Clínicamente varía desde aplasia de una o varias falanges intermedias hasta fragmento de mano con adactilia. El objetivo final del tratamiento es la funcionalidad de la mano, realizar pinza fina, permitiendo la integración escolar, familiar y social del niño. Mostramos los resultados funcionales de algunos casos tratados en nuestro Servicio de Rehabilitación tras ser intervenidos por el Departamento de Cirugía Plástica, y analizamos algunos aspectos como función de la mano, edad de la cirugía, función del pie/marcha, factores psicológicos y estética de la mano(AU)

Digital agenesia is a congenital malformation also known as symbrachydactyly. Clinical features may vary from one o more medium phalanx aplasia to one hand fragment with adactyly. The final goal of the treatment is to achieve hand function with grasp improving thus permitting the child academic, family and social integration. We show the functional results archieved by the cases treated in our Rehabilitation Unit after surgery repair has been done by Plastic Surgery department, and we have analysed several aspects such as: hand function, age of surgery, toe function/walking, psychological factors and appearance of the hand(AU)

¿Dónde queda reflejada la actividad enfermera desarrollada en los hospitales? / Where the nursing activity is reflected

Antecedentes y Objetivos: El Conjunto Mínimo Básico de Datos recoge información sobre la actividad hospitalaria. A través de la codificación se traduce la información del episodio clínico a un lenguaje numérico que clasifica cada paciente en un Grupo Relacionado por el Diagnóstico o GRD. En la codificación se emplea el Manual de la Clasificación Internacional de Enfermedades que recoge entre sus procedimientos algunas actividades propias del trabajo independiente que realiza enfermería. Nos propusimos describir el impacto del trabajo de enfermería en el Informe de Alta Médico, a través de los GRDs de episodios codificados, averiguar qué servicios registran mejor la actividad que realizan los profesionales de enfermería y analizar cómo influyen sobre el registro de actividades de enfermería variables como la entidad de afiliación y el motivo del alta. Material y Métodos: Procedimos a la extracción de las actividades de enfermería incluidas en el Manual de Codificación de la Clasificación Internacional de Enfermedades, encontrando 192 actividades propias de enfermería. Se empleó la Base de Datos de la actividad hospitalaria del año 2006 que se remite a la Consejería de Sanidad de la Comunidad Autónoma de Madrid, con 13.544 episodios codificados. Mediante el programa «Estación Clínica» de 3M®, se incluyeron las actividades de enfermería obtenidas, para conocer los GRDs en los que aparecía al menos una de las actividades de enfermería. Resultados y Discusión: Se analizaron y relacionaron los informes que describían al menos una actividad de enfermería con el total de episodios codificados. Se comparó la descripción de actividades de enfermería entre informes de servicios médicos y quirúrgicos. Se analizó la información en función de la entidad de afiliación y del motivo de alta. Se exponen las limitaciones del trabajo y se discuten los resultados obtenidos. Conclusiones: El Informe de Alta Médico es un documento que apenas refleja el trabajo del personal de enfermería en los hospitales. Los Servicios Médicos reflejan en mayor medida que los Servicios Quirúrgicos la actividad que realizan los profesionales de enfermería. La Clasificación Internacional de Enfermedades describe vagamente las actividades propias de enfermería, siendo necesarios estudios de contabilidad analítica que ponderen el peso que aportan las intervenciones de enfermería a los Grupos Relacionados por el Diagnóstico (AU)

Antecedents and Objectives: The Minimum Basic Data Set compiles information on hospital activity. Through its codification the clinical information is translated into a numerical language that classifies each patient into a Diagnosis-Related Group (DRG). This codification is based on the Manual of the International Classification of Diseases (ICD) that includes among its procedures some activities from the independent work carried out by nurses. Our purpose was to describe the impact of the nursing work on the medical discharge report through the DRG,s of codified clinical episodes, find out what departments have a better control of the work performed by the nursing professionals and analyze how variablessuch as health insurance entity and discharge reason influence the logging of nursing activities. Material and Methods: we proceeded to extract the nursing activities included in the Manual of the International Classification of Diseases, finding 192 nursing activities. The database of the hospital activity of 2006 that is sent to the Health Regional Ministry of the Autonomous Community of Madrid, including 13.544 codified episodes, was utilized. The nursing activities so obtained were included in the 3M“ software “Estación Clínica” in order to determine the DRG,s in which at least one nursing activity was identified. Results and Discussion: the reports that described at least one nursing activity were analyzed and correlated to the total of codified reports. The description of nursing activities in medical reports was compared in medical and surgical departments. The information was analyzed in accordance with the health insurance entity and the discharge reason. The limitations of this article are presented and the results discussed. Conclusions: the Medical Discharge Report is a document that hardly reflects the nursing personnel work in the hospitals. The medical departments tend to reflect to a greater extent than the surgical departments the activity of the nursing personnel. The International Classification of Diseases barely describes the nursing activities making necessary analytical accountancy methods in order to have a measure of the share of the nursing activities in the DRG,s (AU)

[Anterior approach in low cervical fractures prodited by hyperflexion or tear drop]. / Abordaje anterior de las fracturas cervicales bajas por mecanismo de hiperflexión o en gota de lágrima.

Hyperflexion or teardrop fracture of low cervical vertebrae is characterised by ligament affectation of the entire intervertebral segment, the vertebral body, primarily its anteroinferior third and, frequently, spinal medullar affectation. This series presents the clinical symptoms, diagnosis, surgical approach, and post surgical evolution in 30 patients with tear drop fractures. Over the last 30 years, thirty patients with tear drop fractures at the low cervical spine (C3-C7) were admitted to our Neurosurgical Service. Diagnostic studies included simple radiographs, computerised axial tomography (CT), and magnetic resonance imaging (MRI), all of which evidenced the instability of the damaged segment due to osteoligamentous affectation, and a primarily vertebral body fracture. Patients' neurological status was according to the Frankel' scale adapted to the American Spinal Injury Association scale (ASIA). 11 patients were included in grade A, 5 in B, 3 in grade C, 2 in grade D and 9 grade E of neurological affectation. Surgery through an anterior approach was performed, an average of 5 days after placement of halo traction, which had been placed on admission to the hospital. Surgery consisted in vertebral corporectomy and placement of a plate and a graft from the iliac crest. The patients' neurological evolution was favourable in all cases with incomplete medullar lesions. There were 11 patients with complete lesions, or Frankel grade A affectation; two died due to other associated lesions and the other nine showed no neurological improvement after surgery. The degree of arthrodesis was good and only one patient required an a combined anterior-posterior approach. We conclude that teardrop fractures were associated with severe neurological affectation in more than 50% of our patients, and that these fractures provoke instability requiring arthrodesis, generally via an anterior approach.