[Vertebral reinforcement by means of kyphoplasty in the treatment of non-osteoporotic thoraco-lumbar fractures. Study of 40 cases and review of the literature]. / Papel del refuerzo vertebral mediante cifoplastia en el tratamiento de las fracturas dorsolumbares de índole no osteoporótico. Revisión del tema y análisis de 40 casos.

OBJECT: We present a series of patients with acute thoraco-lumbar fractures in whom we performed balloon vertebroplasty (kyphoplasty), either alone (percutaneous) or combined to posterior transpedicular fusion (open kyphoplasty). We emphasize the possibility of extending the use of kyphoplasty to non-osteoporotic vertebral fractures, and combining this method with traditional posterior fusion procedures. METHODS: Between 2003 and 2005, 138 patients suffering from thoraco-lumbar acute fractures, were treated in our Department. 87 corresponded to one vertebral level fractures; 34 to two levels, and the remaining 17 patients had more than two vertebrae affected. 65 patients (47%) received conservative therapy (rest in bed, physiotherapy, and subsequent progressive mobilization with cast). The remaining ones (73 cases; 43%) were treated invasively, performing balloon vertebroplasty alone (n=25), or kyphoplasty associated to posterior fusion in 15 cases (11%). Different kinds of screw posterior fusions were performed in the remaining patients (n=33; 24%). The latter group was not included in the present study. In the conservatively treated group (CTG), seven patients (11%) had a bad outcome, showing a persistency of hyperintensity in MRI-T2 sequences of the vertebral body, suggesting local edema. Mean hospitalization rate was 29 days in CTG. None of the 40 patients treated with kyphoplasty alone or combined with fusion showed abnormalities in neurological examination. They were classified in two groups: "Group a": Kyphoplasty alone (n=25). Mean of sagittal index in this group was 11 degrees (range: 6 degrees -15 degrees). In 9 patients, vertebral body collapse exceeded 25%. Mean hospitalization rate was 14 days. "Group b": Kyphoplasty and posterior fusion techniques (n=15): Mean sagittal index was 23 degrees (range: 13 degrees - 40 degrees). All the patients presented with a vertebral body collapse superior to 25%. All of them had posterior body wall involvement. This group was treated by surgery (decompression and fusion) and open vertebral body kyphoplasty. Mean hospitalization rate was 35 days. Clinical results of these 40 patients were measured by means of work status, restriction of physical activities and analgesic drug intake. Except for four patients of "Group b", 36 returned to their work. In 11 cases a slight reduction of physical activity was registered. Average "Group a" follow-up was 47 months (range: 10-72 months). A mean kyphosis correction of 5,3 degrees (sagittal index) was reached in this group. Average "Group b" follow-up was 26 months (range: 9-54). Mean kyphosis correction was 10,3 degrees . As for complications, we registered three balloon disruptions and five leakages into the disc. CONCLUSIONS: Kyphoplasty could constitute an alternative and/or complementary treatment of traditional spinal stabilization-fusion procedures in non osteoporotic vertebral fractures. Therefore, it should be offered, when indicated, as a substantial possible part of the treatment, to the patients suffering from vertebral fractures. Additional advantages of combining kyphoplasty and posterior fusion are the possibility of reducing the number of fused levels (shorter instrumentations), and to perform a 360 degree stabilization-remodeling through a single posterior approach.

Papel del refuerzo vertebral mediante cifoplastia en el tratamiento de las fracturasdorsolumbares de índole no osteoporótico. Revisión del tema y análisis de 40 casos / Vertebral reinforcement by means of kyphoplasty in the treatment of non-osteoporotic thoraco-lumbar fractures. Study of 40 cases and review of the literature

Objetivo. Presentamos una serie de pacientes confracturas toraco-lumbares agudas en los que se hapracticado un refuerzo vertebral mediante cifoplastia,bien de forma aislada (cifoplastia percutánea) biencombinada con una fijación transpedicular posterior(cifoplastia abierta). Analizamos la posibilidad deampliar el uso de la cifoplastia a las fracturas vertebralesde causa no osteoporótica, así como combinarla a losmétodos tradicionales de fusión posterior.Método. En nuestro servicio, entre los años 2003 y2005, se trataron 138 pacientes afectos de una fracturaaguda toraco-lumbar. En 87 casos se apreció una fracturaa un nivel; en 34 a 2 niveles y, en los 17 restantesen más de dos. Un tratamiento conservador (reposo encama, fisioterapia y movilización progresiva con corsé),fue realizado en 65 pacientes (47%). Los 73 pacientesrestantes fueron tratados quirúrgicamente, realizándoseun refuerzo mediante cifoplastia percutánea en25 casos (18%), ó una cifoplastia asociada a fusiónvertebral posterior en otros 15 (11%). Diferentes modalidadesde fijaciones atornilladas se realizaron en los 33pacientes restantes (24%). Este último grupo no ha sidoobjeto del presente estudio.La estancia media hospitalaria de los pacientes tratadosconservadoramente fue de 29 días. Siete de ellos(11%) experimentaron una mala evolución, mostrandoen las secuencias T2 del control de resonancia magnéticauna persistencia de hiperintensidad en el somavertebral, sugerente de edema local.Todos los pacientes que fueron tratados mediantecifoplastia aislada (percutánea) o combinada (abierta)mantenían una integridad neurológica; fueron clasificadosen dos grupos:• "Grupo a": Tratados mediante cifoplastia percutánea(n=25). El índice medio sagital de este grupo fue de11° (6°-15°). En 9 pacientes, el acuñamiento vertebralsuperaba el 25%. La estancia media hospitalaria(..) (AU)

Object. We present a series of patients with acutethoraco-lumbar fractures in whom we performedballoon vertebroplasty (kyphoplasty), either alone(percutaneous) or combined to posterior transpedicularfusion (open kyphoplasty). We emphasize the possibilityof extending the use of kyphoplasty to non-osteoporoticvertebral fractures, and combining this method withtraditional posterior fusion procedures.Methods. Between 2003 and 2005, 138 patients sufferingfrom thoraco-lumbar acute fractures, were treatedin our Department. 87 corresponded to one vertebrallevel fractures; 34 to two levels, and the remaining17 patients had more than two vertebrae affected. 65patients (47%) received conservative therapy (restin bed, physiotherapy, and subsequent progressivemobilization with cast). The remaining ones (73 cases;43%) were treated invasively, performing balloon vertebroplastyalone (n=25), or kyphoplasty associated toposterior fusion in 15 cases (11%). Different kinds ofscrew posterior fusions were performed in the remaninigpacients (n=33; 24%). The latter group was notincluded in the present study.In the conservatively treated group (CTG), sevenpatients (11%) had a bad outcome, showing a persistencyof hyperintensity in MRI-T2 sequences of thevertebral body, suggesting local edema. Mean hospitalizationrate was 29 days in CTG.None of the 40 patients treated with kyphoplasty aloneor combined with fusion showed abnormalities inneurological examination. They were classified in twogroups:• "Group a": Kyphoplasty alone (n=25). Mean ofsagital index in this group was 11° (range: 6°-15°).In 9 patients, vertebral body collapse exceeded25%. Mean hospitalization rate was 14 days.• "Group b": Kyphoplasty and posterior fusiontechniques (n=15): Mean sagital index was 23°(range: 13°- 40° ). All the patients presented witha vertebral body collapse superior to 25%. (..) (AU)

Virtopsia. Aplicaciones de un nuevo método de inspección corporal no invasiva en ciencias forenses / Virtopsy. Applications of a new method of non-invasive body inspection in forensic sciences

Los modernos métodos de imagen, como la CT y la RNM proporcionan datos reales y tridimensionales de la superficie y las estructuras internas corporales. Esta información se almacena en ficheros DICOM (un protocolo estándar en adquisición de imagen radiológica). Sobre esos ficheros pueden realizarse muchos procedimientos de análisis de imagen, tales como visualización interactiva, morfometría, reconstrucciones tridimensionales, etc. Estas tareas son realizadas de una manera no invasiva y no destructiva, pudiéndose almacenar los resultados para documentación del caso. El presente trabajo describe las bases de los procedimientos de análisis de imagen sobre ficheros DICOM dirigidos a propósitos forenses (la llamada "virtopsia"), enfatizando la utilidad del método en Patología, Traumatología Forense y otros campos. La "virtopsia" debe ser considerada no sólo como un procedimientos post-mortem (complementando pero no sustituyendo a la autopsia tradicional), sino como un modo de examinar partes corporales de una manera interactiva, sea en el fallecido o en el sujeto vivo. Ello amplia su utilidad y hace apropiado el procedimiento siempre que se requiera un examen anatómico forense reproducible, preciso, interactivo y en tiempo real

Modern imaging methods, such as radiological CT/MRI scanning provides real, full 3D data of the body surface and internal structures. This information is stored in DICOM files (a standard protocol in radiology image acquisition). Many image-analysis procedures, such as interactive visualization, morphometry, densitometry, three dimensional reconstruction, etc., can be carried-out on these files. These tasks are performed in a non-invasive and non-destructive manner, and the results can be stored in order to document the case. The present paper describes the basis of imageanalysis procedures on DICOM files directed to forensic purposes (socalled "virtopsy"), emphasizing the utility of the method in Pathology, Forensic Traumatology and other fields. The virtopsy must be considered not only as a postmortem procedure (complementing but not substituting the traditional autopsy), but a way to examine body parts in an interactive manner, whatever the subject is dead or alive. That spreads its utility and makes the method appropriate whenever an accurate, real-time, interactive and reproducible forensic anatomic examination is required