Epidemiological and radiological profile of patients with degenerative scoliosis: 20 year experience at a referral institute.

BACKGROUND: Adult degenerative scoliosis is a complex three-dimensional rotational deformity, in a previously straight spine, resulting in sagittal and axial disbalance. MATERIAL AND METHODS: This retrospective study presents the casuistry of patients 40 to 80 years old with adult degenerative scoliosis who underwent surgery in a referral institute from January 1994 to December 2013. RESULTS: The prevalence was 0.087% (CI 95% 67.8-111), with a median age of 64.9 ± 9.4 years old, increased frequency in women and older adults. The prevalence of spondylolisthesis associated with degenerative scoliosis was 21%. The estimated risk for scoliosis in women was OR = 2.37 (CI 95% 1.35-4.15), while men showed OR = 0.4 (CI95% 0.24-0.73). The risk for spondylolisthesis associated to degenerative scoliosis was in men OR = 1.87. CONCLUSIONS: The prevalence in our experience is low and the sample age was higher; while gender, severity of the curve and presence of spondylolisthesis and olistesis were similar to the reviewed literature.

ANTECEDENTES: La escoliosis degenerativa del adulto es una deformidad rotacional tridimensional compleja, en una columna recta previamente, dando por resultado desequilibrio sagital y axial. MATERIAL Y MÉTODOS: Este estudio retrospectivo presenta la casuística de los pacientes de 40 a 80 años de edad con escoliosis degenerativa del adulto que experimentaron la cirugía en un instituto de referencia desde enero de 1994 a diciembre de 2013. RESULTADOS: La prevalencia fue de 0.087% (IC 95% 67.8-111), con una edad media de 64.9 ± 9.4 años, mayor frecuencia en mujeres y adultos mayores. La prevalencia de la espondilolistesis asociada a escoliosis degenerativa fue de 21%. El riesgo estimado para la escoliosis en las mujeres fue = 2.37 (IC 95% 1.35-4.15), mientras que los hombres mostraron OR = 0.4 (IC95% 0.24-0.73). El riesgo de espondilolistesis asociada a escoliosis degenerativa fue en hombres OR = 1.87. CONCLUSIONES: La prevalencia en nuestra experiencia es baja y la edad de la muestra fue mayor; mientras que el género, la gravedad de la curva y la presencia de espondilolistesis y olistesis eran similares a la literatura consultada.

[Degenerative adult scoliosis]. / Escoliosis degenerativa del adulto.

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10° in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and/ or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

[Surgical treatment of carpal tunnel syndrome and its correlation with preoperative nerve conduction tests]. / El tratamiento quirúrgico del síndrome del túnel del carpo y su correlación con estudios prequirúrgicos de conducción nerviosa.

INTRODUCTION: Carpal tunnel syndrome is the most prevalent compressive neuropathy and its medical costs in the United States exceed one billion dollars per year. Occurrence increases with age; prevalence is 0.6% in males and as much as 5.8% in females, in ages between 45 and 54 years. Besides a thorough case history, there are other more reliable diagnostic methods such as electrophysiological tests that include electromyography and conduction velocity tests. MATERIAL AND METHODS: A prospective, longitudinal analysis was conducted of patients with a diagnosis of Carpal tunnel syndrome confirmed with electromyography and evoked potentials. They were treated at Hospital Español de México in 2008-2009. RESULTS: Forty-seven patients were detected, representing 60 cases of carpal tunnel syndrome; 36 females, 11 males. In forty-seven percent of patients the right hand was involved; in 15% the left hand; 38% of patients had bilateral involvement. They underwent medical treatment and the results of the electrodiagnostic tests were good (61%), moderate (33%), and poor (6%). DISCUSSION: Isolated electromyography does not measure the true magnitude of the damage; however, motor conduction velocity becomes a relevant diagnostic method as it detects almost 50% of the patients at the time diagnosis. Patients with motor abnormalities had very favorable postoperative results compared to those with sensory abnormalities.

[Infection prevention during the perioperative period of primary hip and knee arthroplasty]. / Prevención de infecciones en el perioperatorio de la artroplastía primaria de cadera y rodilla.

All surgical wounds are at risk of contamination by pathogens that may get in through the incision. The pre-surgical bath with a skin antiseptic agent 24 hours prior to the surgery, the timing of administration of prophylactic antibiotics, the choice and postoperative duration of the latter, the number of individuals within the OR and the movement inside it, the choice of chlorhexidine gluconate for its long duration against gram-positive and gram-negative organisms, and the use of a hair remover or an electric razor, all of the former concepts, some new and others not so new, led to performing an extensive bibliographic review with the idea of starting a standardization process that could change the way in which institutions operate when performing primary joint replacement, trying to reduce the annual infection rate and upgrade the quality of life of patients.

[Periprosthetic femur fractures. Experience at hospital Español de México with a 2-year follow-up]. / Fracturas periprotésicas del fémur. Experiencia en el hospital Español de México a 2 años de seguimiento.

UNLABELLED: Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to their better characterization and therapeutic guidance. The purpose of this paper is to make a review of the most recent advances on the topic and present our experience in the treatment of these fractures. MATERIAL AND METHODS: We describe the characteristics of a sample of 20 patients with periprosthetic femur fractures treated at our hospital from March 2008 to March 2010 and typed according to the Vancouver classification. RESULTS: Mean age was 74.5 years with a range of 65-87 years. Females were predominant (70%). Five cases were type A in the classification, 10 cases type B, and 5 cases type C. Nineteen underwent surgical treatment. The mean total length of stay was 7 days, with a range of 5-12. The mean healing time for types B and C was 4 months (range 3-6 months). Four patients had complications. The resolution was assessed as excellent in 5 cases (25%), good in 11 cases (55%), and poor in 4 cases (20%). CONCLUSIONS: A thorough individual assessment based on the Vancouver classification, age and the patient's functional requirements are the major parameters for treatment success.