Cirugía de escoliosis en pacientes con mielomeningocele / Scoliosis surgery in patients with myelomeningocele

Resumen: Objetivo: Evaluar en forma retrospectiva los resultados obtenidos y las complicaciones presentadas en el tratamiento quirúrgico de pacientes con escoliosis neuropática secundaria a mielomeningocele. Material y métodos: Entre Julio de 1991 y Julio de 2018 fueron tratados quirúrgicamente 40 pacientes consecutivos con diagnóstico de escoliosis neuropática secundaria a mielomeningocele, a quienes se les realizó artrodesis vertebral. Resultados: El promedio de observación fue de 10 años (rango de 2-27 años). Fueron 19 pacientes masculinos y 21 femeninos, con un promedio de edad de 13 años. La magnitud promedio de la curva escoliótica fue de 90o en el prequirúrgico y de 43o en el último control. Corrección promedio de 52%. La magnitud promedio de la oblicuidad pélvica fue de 19o en el prequirúrgico y de 9o en el último control. Corrección promedio de 53%. La magnitud preoperativa del balance coronal fue de 28.4 mm, al último control fue de 17 mm. Corrección promedio de 40%. La magnitud promedio de la cifosis fue de 50o en el prequirúrgico y de 41o en el último control. Corrección promedio de 18%. El balance sagital prequirúrgico fue de 63.3 mm, al último control fue de 38.3 mm. Corrección promedio de 40%. Hubo 13 complicaciones (32.5%), la infección fue la complicación observada con mayor frecuencia. Conclusión: Los principales objetivos de la estabilización quirúrgica en pacientes con mielomeningocele son obtener una columna estable, balanceada y sin dolor. Sin embargo, el tratamiento quirúrgico de estos pacientes continúa siendo difícil y está asociado a un alto porcentaje de complicaciones.

Abstract: Objective: The aim of the study was to evaluate the outcomes and complications in patients with myelomeningocele who have undergone spinal fusion for neuromuscular scoliosis. Material and methods: Retrospective study of 40 consecutive patients with myelomeningocele with neuromuscular scoliosis who underwent spinal arthrodesis, treated at our center between July 1991 and July 2028. Results: Mean follow up was 10 years. There were 19 male and 21 females. The average age at operation was 13 years. The mean preoperative scoliosis curve was 90o. At last follow up, the mean scoliosis curve was 43o. Mean correction of 52%. The average of pelvic obliquity was 19o. At last follow up de obliquity was 9o. Mean correction of 53%. The mean preoperative coronal balance was 28.4 mm. At the last follow up it was 17 mm. Mean correction of 40%. The mean preoperative kyphosis was 50o. At the last follow up it was 41o. Mean correction of 18%. The mean preoperative sagittal balance was 63.3 mm. At the last follow up it was 38.3 mm. Mean correction of 40%. There were 13 complications (32.5%), with infection being the most frequently observed complication. Conclusions: The goals of the spinal surgery in patients with MMC are to obtain a stable, balanced and painless spinal fusion. Although the surgical treatment of these patients remains difficult, it is associated with high complication rate.

Surgical fixation of displaced midshaft clavicular fractures with precontoured plates in adolescents. / Tratamiento de fracturas mediodiafisarias de clavícula con placas precontorneadas en adolescentes.

BACKGROUND: The use of plate fixation to treat displaced midshaft clavicular fractures in adults reduces complications and residual shoulder disability. New features of the precontoured locking plates have been shown to reduce the need for hardware removal in adults. There is a lack of studies evaluating surgical fixation of displaced clavicular fractures with precontoured plates in adolescents. We evaluate outcomes and complications of adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates. MATERIALS AND METHODS: 40 adolescents with displaced midshaft clavicular fractures were surgically treated from January 2010 to May 2017. Outcomes were evaluated using the Constant score, the 11- item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaires, and radiographs, and a visual analog scale. Return-to-sport rate, level achieved, and complications were recorded. RESULTS: Mean follow-up was 50 months (18 - 108 months). Constant, Quick-DASH, and visual analog scale scores were 95.6, 2.8 and 0.5 points, respectively. 100% of adolescents returned to sports at the same level they had before injury. Mean time to return was 69 days and 95% of patients were able to return before 12 weeks. Complication rate was 12.5%, 3 patients (7.5%) required hardware removal. CONCLUSIONS: Adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates exhibited satisfactory outcomes and low complication rate. Compared to other reports, this study had lower rates, anatomic plates might reduce hardware-related complications.

[Scoliosis surgery in patients with myelomeningocele]. / Cirugía de escoliosis en pacientes con mielomeningocele.

OBJECTIVE: The aim of the study was to evaluate the outcomes and complications in patients with myelomeningocele who have undergone spinal fusion for neuromuscular scoliosis. MATERIAL AND METHODS: Retrospective study of 40 consecutive patients with myelomeningocele with neuromuscular scoliosis who underwent spinal arthrodesis, treated at our center between July 1991 and July 2028. RESULTS: Mean follow up was 10 years. There were 19 male and 21 females. The average age at operation was 13 years. The mean preoperative scoliosis curve was 90o. At last follow up, the mean scoliosis curve was 43o. Mean correction of 52%. The average of pelvic obliquity was 19o. At last follow up de obliquity was 9o. Mean correction of 53%. The mean preoperative coronal balance was 28.4 mm. At the last follow up it was 17 mm. Mean correction of 40%. The mean preoperative kyphosis was 50o. At the last follow up it was 41o. Mean correction of 18%. The mean preoperative sagittal balance was 63.3 mm. At the last follow up it was 38.3 mm. Mean correction of 40%. There were 13 complications (32.5%), with infection being the most frequently observed complication. CONCLUSIONS: The goals of the spinal surgery in patients with MMC are to obtain a stable, balanced and painless spinal fusion. Although the surgical treatment of these patients remains difficult, it is associated with high complication rate.

OBJETIVO: Evaluar en forma retrospectiva los resultados obtenidos y las complicaciones presentadas en el tratamiento quirúrgico de pacientes con escoliosis neuropática secundaria a mielomeningocele. MATERIAL Y MÉTODOS: Entre Julio de 1991 y Julio de 2018 fueron tratados quirúrgicamente 40 pacientes consecutivos con diagnóstico de escoliosis neuropática secundaria a mielomeningocele, a quienes se les realizó artrodesis vertebral. RESULTADOS: El promedio de observación fue de 10 años (rango de 2-27 años). Fueron 19 pacientes masculinos y 21 femeninos, con un promedio de edad de 13 años. La magnitud promedio de la curva escoliótica fue de 90o en el prequirúrgico y de 43o en el último control. Corrección promedio de 52%. La magnitud promedio de la oblicuidad pélvica fue de 19o en el prequirúrgico y de 9o en el último control. Corrección promedio de 53%. La magnitud preoperativa del balance coronal fue de 28.4 mm, al último control fue de 17 mm. Corrección promedio de 40%. La magnitud promedio de la cifosis fue de 50o en el prequirúrgico y de 41o en el último control. Corrección promedio de 18%. El balance sagital prequirúrgico fue de 63.3 mm, al último control fue de 38.3 mm. Corrección promedio de 40%. Hubo 13 complicaciones (32.5%), la infección fue la complicación observada con mayor frecuencia. CONCLUSIÓN: Los principales objetivos de la estabilización quirúrgica en pacientes con mielomeningocele son obtener una columna estable, balanceada y sin dolor. Sin embargo, el tratamiento quirúrgico de estos pacientes continúa siendo difícil y está asociado a un alto porcentaje de complicaciones.

[Results of valvuloplasties with balloon catheter in children. Follow-up using pulsed Doppler. Experience with our first cases]. / Evolución de las valvuloplastias con catéter balón en la edad pediátrica. Seguimiento mediante Doppler pulsado. Experiencia en nuestros primeros casos.

Our series includes the first 19 consecutive patients with pulmonary valvar stenosis who underwent balloon valvuloplasty in our hospital. All of them have been evaluated by an echo-Doppler study at different follow-up times, and in 10 patients the study was also performed prior to the dilatation. The ages ranged between 0.4 and 10 years (mean 3.5 years; standard deviation [SD] 2.53 years). The prevalvuloplasty degree of pulmonic stenosis found at catheterization was quantified as severe in 8 cases (42.11%) with a right ventricular systolic pressure (RVSP) in excess of 90 mmHg, and moderate in 11 cases (57.89%) with an RVSP from 70 to 90 mmHg. Transvalvular gradients were registered between 38 and 110 mmHg (m: 69 mmHg and SD: 15 mmHg). According to catheterization data obtained at the time of valvuloplasty, the procedure was considered ineffective in 2 cases (10.52%), scarcely effective in four (21.05%), and successful in the remaining 13 cases (68.42%). Doppler follow-up was carried out between 1.6 and 31.9 months after valvuloplasty (mean 12.9 months and SD: 10 months). Residual stenoses were estimated by Doppler as mild in 13 cases (68.42%), moderate in four (21.05%) and severe in two (10.52%). Mild pulmonary regurgitation was detected in 10 patients (52%). The 13 patients with a satisfactory result had slight residual gradients at the valvular level that had not been modified with the course of time. Of the 4 cases with a poorly effective dilatation the gradients noted by Doppler increased in three of them, being valvular in all but one in whom the obstruction was catalogued as infundibular.(ABSTRACT TRUNCATED AT 250 WORDS)