Osteocondroma de la columna cervical provocando tortícolis y hemiparesia / Cervical spine osteochondroma presenting with torticollis and hemiparesis

Los osteocondromas son tumores óseos benignos de lento crecimiento que se localizan habitualmente en los huesos largos. Aproximadamente el 1-4% de ellos se localizan en la columna vertebral. Los osteocondromas espinales solitarios pueden producir una gran variedad de síntomas, dependiendo de su localización y de su relación con las estructuras adyacentes. Recogemos el caso de una paciente de 74 años que fue ingresada en nuestro centro tras referir debilidad progresiva en el hemicuerpo izquierdo y dolor cervical. La exploración neurológica mostró hemiparesia izquierda leve y tortícolis izquierda. Los estudios de tomografía computarizada y resonancia magnética de la columna cervical demostraron una lesión expansiva afectando la articulación facetaria C3-C4 izquierda. Se realizó una hemilaminectomía C3 y C4, resección completa de la lesión y fijación cervical posterior instrumentada. El estudio anatomopatológico confirmó el diagnóstico de osteocondroma. Tras la intervención quirúrgica, los síntomas de la paciente mejoraron progresivamente sin secuelas neurológicas

Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels

[Cervical spine osteochondroma presenting with torticollis and hemiparesis]. / Osteocondroma de la columna cervical provocando tortícolis y hemiparesia.

Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels.

Fijación lumbar posterior empleando el sistema de imagen quirúrgica O-arm: experiencia inicial / Posterior lumbar fusion using the O-arm surgical imaging system: initial experience

Objetivo: La fijación con tornillos transpediculares en la columna lumbar es una técnica ampliamente aceptada para el tratamiento de patología traumática y degenerativa. Las complicaciones de la instrumentación espinal pueden ser graves. Sobrepasar caudal o medialmente la cortical del pedículo puede provocar lesiones nerviosas o durotomías incidentales. La cirugía guiada por imagen computarizada ha demostrado tasas más altas de precisión en la colocación de tornillos transpediculares comparada con la fluoroscopia convencional.El O-arm tiene la capacidad de obtener imágenes similares a la tomografía computarizada (TC) y realizar reconstrucciones multiplanares. En este estudio evaluamos una cohorte de pacientes en los que se realizó fijación lumbar posterior con tornillos transpediculares empleando el sistema de imagen quirúrgica O-arm. Métodos Se realizó un estudio retrospectivo de 40 casos consecutivos de fijación lumbar posterior empleando el O-arm. La población a estudio incluía 14 hombres y 26 mujeres. El rango de edad iba de 39 a 85 años, con una media de edad de 63,78 años. Veintiún pacientes presentaban estenosis del canal degenerativa (52,5%) y 19 espondilolistesis (47,5%). Se obtuvieron imágenes con TC intraoperatoria. Se recoge el (..) (AU)

Object: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentationcanbeserious.Screwmisplacementcanresultinunintendeddurotomy,nerveroot and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. Methods: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included (..) (AU)

[Posterior lumbar fusion using the O-arm surgical imaging system: initial experience]. / Fijación lumbar posterior empleando el sistema de imagen quirúrgica O-arm: experiencia inicial.

OBJECTIVES: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentation can be serious. Screw misplacement can result in unintended durotomy, nerve root and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. METHODS: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included 14 males and 26 females. Age range was 39-85 years with an average of 63.8 years. Twenty one patients had degenerative lumbar stenosis (52.5%) and 19 had spondylolisthesis (47.5%). Intraoperative CT-images were obtained. The mean time for surgery and screw placement was assessed. RESULTS: A total of 252 pedicle screws were sited using O-arm navigation system, with a mean of 6.3 screws per patient (range 4-10). On the basis of intraoperative CT, 3 screws were redirected, representing a 98.81% accuracy rate. The mean duration of surgery was 157.2 (90-240) minutes and the mean time for screw placement was 7.13 (3.08-15) minutes per screw. Three patients (7.5%) developed superficial wound infections which were treated conservatively. No patients required a return to the operating room because of screw malposition. CONCLUSION: The use of intraoperative O-arm imaging system with computer-assisted navigation significantly increases the surgical accuracy and safety of pedicle screw placement in lumbar fusion surgery.