Incarcerated Bochdalek Hernia in Adults.

In this case report, the diagnostic challenge and emergency management of a Bochdalek hernia in adults in Mexico are outlined. This case report can help the medical community to consider the clinical presentation in adults and the importance of early diagnosis and management. We present a 57-year-old female patient with a history of arterial hypertension who, following a bout of abdominal pain, was diagnosed with a Bochdalek hernia. Following emergency surgery, there was an increase in intra-abdominal pressure, which was continuously monitored due to the possibility of compartment syndrome, potentially necessitating a second emergency surgery.

Synthesis and Characterization of Carbon-Based Quantum Dots and Doped Derivatives for Improved Andrographolide's Hydrophilicity in Drug Delivery Platforms.

Carbon-based quantum dots (CBQDs), sulfur-doped carbon-based quantum dots (S-CBQDs), and nitrogen-doped carbon-based quantum dots (N-CBQDs) have strong potential for drug delivery platforms. They were conjugated with andrographolide, a well-known hydrophobic drug, to study the concomitant changes in hydrophilicity. The interactions between these nanomaterials and the drug were studied by characterizing the optical and structural properties of the nanoparticles before and after coupling with the drug. It was found that the interaction of the drug with these nanomaterials produced noticeable changes in their optical and structural properties. Moreover, the partition coefficient for the nanocomposites was determined by NMR. The results indicate that conjugating the drug with the nanoparticles significantly enhanced its affinity for the aqueous phase, from 2.632 to 0.1117, thereby opening the possibility of using this approach for developing an effective drug delivery platform for this hydrophobic drug.

Dysphagia lusoria in a young patient with a concomitant aortic arch anomaly, successfully treated with surgery: a case report.

Dysphagia is a common condition in clinical practice; however, an unusual type of dysphagia due to compression of the esophagus by an abnormal right subclavian artery may be discovered in a rare subset of patients. The prognosis and treatment will depend on the severity of the symptoms and the compromise of surrounding structures. We present the case of an 18-year-old female who presented with gradually progressive dysphagia. At first, it was treated as gastroesophageal reflux disease; nonetheless, the dysphagia became severe, and after a thorough evaluation, an aberrant right subclavian artery that compressed the esophagus was discovered along with a truncus bicaroticus. She was successfully treated with surgery without any complications. On follow-ups, she's doing well.

Infants expect friends, but not rivals, to be happy for each other when they succeed.

A friend telling you good news earns them a smile while witnessing a rival win an award may make you wrinkle your nose. Emotions arise not just from people's own circumstances, but also from the experiences of friends and rivals. Across three moderated, online looking time studies, we asked if human infants hold expectations about others' vicarious emotions and if they expect those emotions to be guided by social relationships. Ten- and 11-month-old infants (N = 154) expected an observer to be happy rather than sad when the observer watched a friend successfully jump over a wall; infants looked longer at the sad response compared to the happy response. In contrast, infants did not expect the observer to be happy when the friend failed, nor when a different, rival jumper succeeded; infants' looking times to the two emotion responses in these conditions were not reliably different. These results suggest that infants are able to integrate knowledge across social contexts to guide expectations about vicarious emotional responses. Here infants connected an understanding of agents' goals and their outcomes with knowledge of social relationships to infer an emotion response. Biased concern for friends but not adversaries is not just a descriptive feature of human relationships, but an expectation about the social world present from early in development. Further, the successful integration of these information types welcomes the possibility that infants can jointly reason about goals, emotions, and social relationships under an intuitive theory of psychology. RESEARCH HIGHLIGHTS: 11-month-old infants use knowledge of relationships to make inferences about others' vicarious emotions. In Experiment 1 infants expected an observer to respond happily to a friend's success but not their failure. Experiments 2 and 3 varied the relationship between the observer and actor and found that infants' expectation of vicarious happiness is strongest for positive relationships and absent for negative relationships. The results may reflect an intuitive psychology in which infants expect friends to adopt concern for one another's goals and to thus experience one another's successes as rewarding.

Children's Reasoning About Empathy and Social Relationships.

Across the lifespan, empathic and counter-empathic emotions are shaped by social relationships. Here we test the hypothesis that this connection is encoded in children's intuitive theory of psychology, allowing them to predict when others will feel empathy versus counter-empathy and to use vicarious emotion information to infer relationships. We asked 4- to 7-year-old children (N = 79) to make emotion predictions or relationship inferences in response to stories featuring two characters, an experiencer and an observer, and either a positive or negative outcome for the experiencer. In the context of positive outcomes, we found that children engaged in robust joint reasoning about relationships and vicarious emotions. When given information about the characters' relationship, children predicted empathy from a friendly observer and counter-empathy from a rival observer. When given information about the observer's response to the experiencer, children inferred positive and negative relationships from empathic and counter-empathic responses, respectively. In the context of negative outcomes, children predicted that both friendly and rival observers would feel empathy toward the experiencer, but they still used information about empathic versus counter-empathic responses to infer relationship status. Our results suggest that young children in the US have a blanket expectation of empathic concern in response to negative outcomes, but otherwise expect and infer that vicarious emotions are connected to social relationships. Future research should investigate if children use this understanding to select social partners, evaluate their own relationships, or decide when to express empathy toward others.

Volumetric Resection and Complications in Nonfunctioning Pituitary Adenoma by Fully Endoscopic Transsphenoidal Approach along 15 Years of Single-Center Experience.

Objective The aim of this study was to evaluate the rate of complications and the extent of resection (EOR) of nonfunctioning pituitary adenomas by endoscopic endonasal approach (EEA) in a 15-year learning curve. Methods A total of 100 patients operated by the same surgical team were divided chronologically into two, three, and four groups, comparing differences in EOR measured by a semiautomatic software (Smartbrush, Brainlab), rate of immediate postoperative complications, and the visual and hormonal status at 6 months. Results There were no significant differences over the years in rates of postoperative complications and in visual status at 6 months. A significant linear correlation between the EOR and the number of surgeries (rho = 0.259, p = 0.007) was found. The analysis was performed in three groups because of the remarkable differences among them; the EOR were: 87.2% (early group), 93.03% (intermediate group), and 95.1% (late group) ( p = 0.019). Gross total resection was achieved in 30.3, 51.5, and 64%, respectively ( p = 0.017); also, the rate of reoperation and the worsening of at least one new hormonal axis were worse in the early group. Consequently, the early group had a higher risk of incomplete resection compared with the late group (odds ratio: 4.2; 95% confidence interval: 1.5-11.7). The three groups were not different in demographic and volume tumor variables preoperatively. Conclusions The first 33 interventions were associated with a lower EOR, a high volume of residual tumor, a high reoperation rate, and a higher rate of hormonal dysfunction. We did not find differences in terms of postoperative complications and the visual status at 6-month follow-up.

"Yay! Yuck!" toddlers use others' emotional responses to reason about hidden objects.

Young children show sensitivity to others' emotions, discriminating between facial expressions and using them to help guide their behavior. Beyond providing information about how others are feeling, emotional expressions also can support inferences about the non-social world. Here, in four experiments, we investigated 18- to 28-month-old children's ability to use others' emotional responses to reason about physical objects. We found that 24- to 26-month-old children successfully used an agent's incongruent emotional responses ("Yay! Yuck!"), but not congruent emotional responses ("Yay! Wow!") to infer the presence of multiple hidden objects (Experiment 1). When two different agents produced the incongruent emotional responses, children did not infer that multiple objects must be present (Experiment 2), implicating early recognition that different people can have different emotional reactions towards the same entity. Younger, 20-month-old children failed to use incongruent emotional responses to make inferences about hidden objects (Experiment 3), although they succeeded at using contrasting words in an otherwise identical task ("A blick! A fep!"; Experiment 4). These results show that young children can use other people's emotional responses to reason about the physical world-an ability that develops in the second year of life.

Online measures of looking and learning in infancy.

Infants in laboratory settings look longer at events that violate their expectations, learn better about objects that behave unexpectedly, and match utterances to the objects that likely elicited them. The paradigms revealing these behaviors have become cornerstones of research on preverbal cognition. However, little is known about whether these canonical behaviors are observed outside laboratory settings. Here, we describe a series of online protocols that replicate classic laboratory findings, detailing our methods throughout. In Experiment 1a, 15-month-old infants (N = 24) looked longer at an online support event culminating in an Unexpected outcome (i.e., appearing to defy gravity) than an Expected outcome. Infants did not, however, show the same success with an online solidity event. In Experiment 1b, 15-month-old infants (N = 24) showed surprise-induced learning following online events-they were better able to learn a novel object's label when the object had behaved unexpectedly compared to when it behaved expectedly. Finally, in Experiment 2, 16-month-old infants (N = 20) who heard a valenced utterance ("Yum!") showed preferential looking to the object most likely to have generated that utterance. Together, these results suggest that, with some adjustments, online testing is a feasible and promising approach for infant cognition research.

H3K27M-mutant glioma in thoracic spinal cord and conus medullaris with pilocytic astrocytoma morphology: case report and review of the literature.

BACKGROUND: The H3K27M-mutant spinal cord gliomas are very aggressive with a dismal prognosis, very few cases have been reported in the thoracic spinal cord and conus medullaris, and it is extremely rare with morphological features of pilocytic astrocytoma. CASE PRESENTATION: A 20-year-old man presented with thoracolumbar pain, progressive paraparesis, and urinary incontinence. Magnetic resonance imaging revealed an intramedullary solid-cystic lesion from D9 to conus medullaris. Subtotal resection was performed, restricted by the indistinct margins and the decline of the motor evoked potential during the surgery. Pathologic findings revealed a pilocytic astrocytoma with anaplastic features. However, a further assessment determined a diffuse midline glioma H3K27M-mutant, and adjuvant chemoradiotherapy was administered. After seven months of progression-free survival, the paraparesis worsened; at twelve months of follow-up, the patient developed paraplegia, and at 24 months the patient remains alive without any neurologic functions distal to the tumor and he is still under adjuvant treatment. CONCLUSIONS: The H3K27M-mutant spinal cord glioma is a very infrequent tumor with a wide variety of histological presentations even as indolent as pilocytic astrocytoma, which should be considered in spinal cord tumors, especially if there are clinical, histological, or radiological data that suggest aggressiveness. On the other hand, the fast progression led to the loss of complete neurological function distal to the tumor, in spinal tumors could explain a not so poor prognosis as it is in functionally and vital structures.

Serum Amyloid A1/Toll-Like Receptor-4 Axis, an Important Link between Inflammation and Outcome of TBI Patients.

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide without any validated biomarker or set of biomarkers to help the diagnosis and evaluation of the evolution/prognosis of TBI patients. To achieve this aim, a deeper knowledge of the biochemical and pathophysiological processes triggered after the trauma is essential. Here, we identified the serum amyloid A1 protein-Toll-like receptor 4 (SAA1-TLR4) axis as an important link between inflammation and the outcome of TBI patients. Using serum and mRNA from white blood cells (WBC) of TBI patients, we found a positive correlation between serum SAA1 levels and injury severity, as well as with the 6-month outcome of TBI patients. SAA1 levels also correlate with the presence of TLR4 mRNA in WBC. In vitro, we found that SAA1 contributes to inflammation via TLR4 activation that releases inflammatory cytokines, which in turn increases SAA1 levels, establishing a positive proinflammatory loop. In vivo, post-TBI treatment with the TLR4-antagonist TAK242 reduces SAA1 levels, improves neurobehavioral outcome, and prevents blood-brain barrier disruption. Our data support further evaluation of (i) post-TBI treatment in the presence of TLR4 inhibition for limiting TBI-induced damage and (ii) SAA1-TLR4 as a biomarker of injury progression in TBI patients.

Children's understanding of economic demand: A dissociation between inference and choice.

Adults infer that resources that become scarce over time are in higher demand, and use this "demand inference" to guide their own economic decisions. However, it is unclear when children begin to understand and use economic demand. In six experiments, we investigated the development of demand inference and demand-based economic decisions in 4- to 10-year-old children and adults in the United States. In Experiments 1-5, we showed children two boxes with the same number of compartments but containing different numbers of face-down stickers and varied the information provided about how those differences arose (e.g. that other children had taken the stickers). In separate experiments, we asked children to buy or trade to get a sticker for themselves or to predict what other children would do. We also asked them which set of stickers they thought the other children had preferred to assess their ability to make a demand inference separately from their own choice. Across experiments, children were able to make a demand inference about children's past preferences by 6 years of age. However, children did not use this demand information when making choices for themselves or when predicting what another child would select in the future. In Experiment 6, we adapted the task for adults and found that adult participants inferred that the set containing fewer resources was in higher demand, and selected the higher demand resource for themselves at rates significantly above chance. The overall pattern of results suggests a dissociation between economic inference and economic decisions during early-to-middle childhood. We discuss implications for our understanding of the development of economic reasoning.

When Not Choosing Leads to Not Liking: Choice-Induced Preference in Infancy.

The question of how people's preferences are shaped by their choices has generated decades of research. In a classic example, work on cognitive dissonance has found that observers who must choose between two equally attractive options subsequently avoid the unchosen option, suggesting that not choosing the item led them to like it less. However, almost all of the research on such choice-induced preference focuses on adults, leaving open the question of how much experience is necessary for its emergence. Here, we examined the developmental roots of this phenomenon in preverbal infants (N = 189). In a series of seven experiments using a free-choice paradigm, we found that infants experienced choice-induced preference change similar to adults'. Infants' choice patterns reflected genuine preference change and not attraction to novelty or inherent attitudes toward the options. Hence, choice shapes preferences-even without extensive experience making decisions and without a well-developed self-concept.

Assessment of Pre-operative Measurements of Tumor Size by MRI Methods as Survival Predictors in Wild Type IDH Glioblastoma.

Objective: We evaluate the performance of three MRI methods to determine non-invasively tumor size, as overall survival (OS) and Progression Free Survival (PFS) predictors, in a cohort of wild type, IDH negative, glioblastoma patients. Investigated protocols included bidimensional (2D) diameter measurements, and three-dimensional (3D) estimations by the ellipsoid or semi-automatic segmentation methods. Methods: We investigated OS in a cohort of 44 patients diagnosed with wild type IDH glioblastoma (58.2 ± 11.4 years, 1.9/1 male/female) treated with neurosurgical resection followed by adjuvant chemo and radiotherapy. Pre-operative MRI images were evaluated to determine tumor mass area and volume, gadolinium enhancement volume, necrosis volume, and FLAIR-T2 hyper-intensity area and volume. We implemented then multivariate Cox statistical analysis to select optimal predictors for OS and PFS. Results: Median OS was 16 months (1-42 months), ranging from 9 ± 2.4 months in patients over 65 years, to 18 ± 1.6 months in younger ones. Patients with tumors carrying O6-methylguanin-DNA-methyltransferase (MGMT) methylation survived 30 ± 5.2 vs. 13 ± 2.5 months in non-methylated. Our study evidenced high and positive correlations among the results of the three methods to determine tumor size. FLAIR-T2 hyper-intensity areas (2D) and volumes (3D) were also similar as determined by the three methods. Cox proportional hazards analysis with the 2D and 3D methods indicated that OS was associated to age ≥ 65 years (HR 2.70, 2.94, and 3.16), MGMT methylation (HR 2.98, 3.07, and 2.90), and FLAIR-T2 ≥ 2,000 mm2 or ≥60 cm3 (HR 4.16, 3.93, and 3.72), respectively. Other variables including necrosis, tumor mass, necrosis/tumor ratio, and FLAIR/tumor ratio were not significantly correlated with OS. Conclusion: Our results reveal a high correlation among measurements of tumor size performed with the three methods. Pre-operative FLAIR-T2 hyperintensity area and volumes provided, independently of the measurement method, the optimal neuroimaging features predicting OS in primary glioblastoma patients, followed by age ≥ 65 years and MGMT methylation.

Crystal structure, Hirshfeld surface analysis and spectroscopic characterization of the di-enol tautomeric form of the compound 3,3'-[(2-sulf-an-yl-idene-1,3-di-thiole-4,5-di-yl)bis-(sulfane-di-yl)]bis-(pentane-2,4-dione).

The reaction between [TBA]2[Zn(dmit)2] and 3-chloro-2,4-penta-nedione yielded single crystals of the title compound, (3E,3'E)-3,3'-[(2-sulfanylidene-1,3-dithiole-4,5-diyl)bis(sulfanediyl)]bis(4-hydroxypent-3-en-2-one), C13H14O4S5, after solvent evaporation. The title compound crystallizes in the triclinic space group P with two mol-ecules related by an inversion center present in the unit cell. The central thione ring moiety contains a carbon-carbon double bond covalently linked to two sulfoxide substituents located outside of the plane of the ring. The S-C-C-S torsion angles are -176.18 (8) and -0.54 (18)°. Intra-molecular hydrogen bonds occur within the two dione substituents (1.67-1.69 Å). Adjacent asymmetric units are linked by C-H⋯S (2.89-2.90 Å), S⋯S [3.569 (1) Å] and O⋯H [2.56-2.66 Šbetween non-stacked thione rings] short contacts.

Craniectomía descompresiva en el infarto maligno de arteria cerebral media: percepción familiar, resultados y factores pronósticos / Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors

OBJETIVO: El pronóstico en los infartos malignos de un hemisferio siembra dudas entre los neurocirujanos a la hora de indicar una hemicraniectomía descompresiva. ¿Qué resultados a corto y medio plazo se obtienen? ¿Están las familias satisfechas con la cirugía una vez el enfermo se encuentra en su domicilio? En el presente trabajo analizamos nuestra experiencia en esta materia en los últimos 13 años. MATERIAL Y MÉTODOS: Incluimos en nuestra revisión a 21 pacientes intervenidos entre 2004 y 2017 siguiendo la vía clínica de nuestro centro para el ictus. Se entrevistó a los familiares vía telefónica. Se midió el resultado funcional al alta, 3 meses, un año y actual con la escala modificada de Rankin (mRS). RESULTADOS: La edad demostró estar directamente relacionada con la mRS (r = 0,56; p = 0,035) y en el 37,5% se obtuvo un buen resultado (mRS ≤ 3). El 78,9% de los familiares entrevistados repetirían la decisión quirúrgica tomada. CONCLUSIONES: Aportamos un grupo de 21 pacientes intervenidos mediante craniectomía descompresiva por infarto maligno donde los mejores resultados funcionales se han dado entre los < 60 años. Las graves secuelas neurológicas en pacientes con infarto maligno intervenidos mediante hemicraniectomía descompresiva fueron toleradas y aceptadas por la mayoría de familias a favor de su supervivencia. No debemos dejar que esta satisfacción familiar camufle el pronóstico, teniendo que contextualizarla dentro de la situación real ambulatoria de los pacientes

OBJECTIVE: The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years. MATERIAL AND METHODS: In our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1 year, and at present was measured using the modified Rankin scale (mRS). RESULTS: Patient age was shown to be directly related to the mRS (r = 0.56; p = 0.035) and 37.5% achieved a good outcome (mRS ≤ 3); 78.9% of the interviewed relatives would repeat the surgical decision. CONCLUSIONS: We present a 21 patients group where the best outcome was achieved in patients ≤ 60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients

Risk factors associated with conversion of an Ommaya reservoir to a permanent cerebrospinal fluid shunt in preterm posthemorrhagic hydrocephalus.

OBJECTIVE: A considerable percentage of preterm infants with posthemorrhagic hydrocephalus initially managed with an Ommaya reservoir require a permanent CSF shunt. The objective of the study was to analyze possible risk factors associated with the need for converting an Ommaya reservoir to a permanent shunt. METHODS: The authors retrospectively reviewed the clinical records of premature infants weighing 1500 g or less with posthemorrhagic hydrocephalus (Papile grades III and IV) managed with an Ommaya reservoir at their institution between 2002 and 2017. RESULTS: Forty-six patients received an Ommaya reservoir. Five patients (10.9%) were excluded due to intraventricular infection during management with an Ommaya reservoir. Average gestational age and weight for the remaining 41 patients was 27 ± 1.8 weeks and 987 ± 209 grams, respectively. Thirty patients required a permanent shunt and 11 patients did not require a permanent shunt. The conversion rate from an Ommaya reservoir to a permanent shunt was 76.1%. Symptomatic persistent ductus arteriosus (PDA) was more frequent in the nonpermanent shunt group than in the shunt group (88.9% vs 50%, p = 0.04). The need for extraction of more than 10 ml/kg per day of CSF through the Ommaya reservoir was lower in the nonpermanent shunt group than in the shunt group (9.1% vs 51.7%, p = 0.015). CSF lactate was lower in the nonpermanent group than in the shunt group (mean 2.48 mg/dl vs 3.19 mg/dl; p = 0.004). A cutoff value of ≥ 2.8 mg/dl CSF lactate predicted the need for a permanent shunt with sensitivity and specificity of 82.4% and 80%, respectively. There were no significant differences in gestational age, sex, weight, Papile grade, ventricular index, or other biochemical markers. After the multivariate analysis, only CSF lactate ≥ 2.8 mg/dl was associated with a higher conversion rate to a permanent shunt. CONCLUSIONS: This study showed that a high level of CSF lactate, absence of symptomatic PDA, and a higher CSF extraction requirement were associated with a higher likelihood of implanting a permanent CSF shunt. The authors believe these findings should be considered in future studies.

Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors. / Craniectomía descompresiva en el infarto maligno de arteria cerebral media: percepción familiar, resultados y factores pronósticos.

OBJECTIVE: The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years. MATERIAL AND METHODS: In our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1 year, and at present was measured using the modified Rankin scale (mRS). RESULTS: Patient age was shown to be directly related to the mRS (r=0.56; p=0.035) and 37.5% achieved a good outcome (mRS≤3); 78.9% of the interviewed relatives would repeat the surgical decision. CONCLUSIONS: We present a 21 patients group where the best outcome was achieved in patients ≤60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients.

Epidural Lipomatosis and Syringomyelia in Adulthood: Case Report and Literature Review.

BACKGROUND: We review 2 previously published cases of epidural lipomatosis associated with syringomyelia. We also present the case of a 42-year-old woman with a medullary syrinx from C1 to T3, initially only with upper limb paresthesias that presented after 10 years of follow-up for left hemiparesis and paresthesias in the tongue. Chiari malformation and cerebral or spinal space-occupying lesions were ruled out, as were other causes of syrinx except the presence of epidural lipomatosis extending from T1 to T12. CASE DESCRIPTION: Right laminotomies were performed from T1 to T12, removing excessive epidural fat tissue. After surgery the symptoms remained stable. At discharge the patient progressively recovered from the hemiparesis, and in follow-up magnetic resonance imaging the resolution of the syrinx was confirmed. CONCLUSIONS: This is the third case of a patient with a spinal syrinx and no other related causes except from spinal lipomatosis, although with only 3 cases it is not possible to completely state that lipomatosis caused the syrinx. Our case supports the trend established by the 2 previous cases. For treatment, initially patients should be managed conservatively, trying to correct the underlying etiologies of spinal lipomatosis. In case of failed conservative treatment, removal of adipose epidural excess in the most appropriate way is preferred.

Atrofia de la musculatura paraespinal después de cirugía lumbar posterior con y sin fijación transpedicular por la técnica clásica / Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique

Objetivos: La cirugía de columna lumbar produce una lesión muscular durante su abordaje que podría empeorar los resultados funcionales postoperatorios a largo plazo. Este estudio pretende analizar la atrofia paraespinal postoperatoria asociada a dos tipos de intervenciones. Material y métodos: Se recogieron historias clínicas y resonancias magnéticas lumbares pre- y postoperatorias de un grupo de 41 pacientes, 20 se sometieron a laminectomía con fijación lumbar por estenosis de canal (Grupo fijación) y otro grupo de 21 se sometieron a una hemilaminectomía sin fijación por enfermedad discal (Grupo no fijación). En los que se analizó la atrofia muscular de manera cuantitativa. Resultados: Se halló una correlación negativa entre la edad y la musculatura preoperatoria, siendo mayor en el grupo laminectomía con fijación (rho = −0,64 p = 0,002). Observamos también una correlación positiva entre la musculatura preoperatoria y la atrofia postoperatoria (rho = 0,32 p = 0,041). En el modelo de regresión lineal multivariado ajustado por la edad, sexo y tipo de intervención, observamos que la predicción de la atrofia postoperatoria fue del 31% (R2 = 0,31); a la laminectomía con fijación se le atribuye una atrofia del 5,3% (IC95 1,4-9,5%, p = 0,017); a la musculatura preoperatoria > 70% se le atribuye una atrofia del 13,8% (IC95 5,5-22%, p = 0,002). La edad no se correlacionó con la atrofia postoperatoria. Conclusiones: La atrofia muscular paraespinal que se produce después de la cirugía lumbar es mayor si se realiza un abordaje más amplio como la laminectomía completa con facetectomía bilateral y fijación transpedicular. Una mayor musculatura previa independientemente de la edad, el sexo y el tipo de cirugía también predice una mayor atrofia postoperatoria

Objectives: Lumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results. This study aims to analyze the postoperative paraspinal atrophy associated with two types of intervention. Material and methods: Clinical records and lumbar magnetic resonance imaging were collected from a group of 41 patients, 20 underwent laminectomy with lumbar fixation due to lumbar spinal stenosis (fixation group) and another group of 21 underwent hemilaminectomy without fixation due to lumbar disc disease (non-fixation group). In which muscle atrophy was analyzed quantitatively. Results: We found a negative correlation between age and preoperative muscle, which was higher in those who underwent lumbar fixation (rho = −0.64 p = .002). We also found a positive correlation between preoperative muscle and postoperative atrophy (rho = 0.32 p = .041). In the age, sex and fixation adjusted multivariate linear regression model (R2 = 0.31), laminectomy with fixation is attributed to 5.3% atrophy (IC95 1.4-9.5%, p = .017); preoperative musculature > 70% is attributed to atrophy of 13.8% (95% CI 5.5%-22%, p = .002). Age did not correlate with postoperative atrophy. Conclusions: Paraspinal muscle atrophy after lumbar spinal surgery is greater if an extensive approach is performed such as complete laminectomy with bilateral facetectomy and transpedicular fixation. A greater previous musculature regardless of age, sex and type of surgery also predicts greater postoperative atrophy

Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique. / Atrofia de la musculatura paraespinal después de cirugía lumbar posterior con y sin fijación transpedicular por la técnica clásica.

OBJECTIVES: Lumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results. This study aims to analyze the postoperative paraspinal atrophy associated with two types of intervention. MATERIAL AND METHODS: Clinical records and lumbar magnetic resonance imaging were collected from a group of 41 patients, 20 underwent laminectomy with lumbar fixation due to lumbar spinal stenosis (fixation group) and another group of 21 underwent hemilaminectomy without fixation due to lumbar disc disease (non-fixation group). In which muscle atrophy was analyzed quantitatively. RESULTS: We found a negative correlation between age and preoperative muscle, which was higher in those who underwent lumbar fixation (rho = -0.64 p = .002). We also found a positive correlation between preoperative muscle and postoperative atrophy (rho = 0.32 p = .041). In the age, sex and fixation adjusted multivariate linear regression model (R2 = 0.31), laminectomy with fixation is attributed to 5.3% atrophy (IC95 1.4-9.5%, p = .017); preoperative musculature > 70% is attributed to atrophy of 13.8% (95% CI 5.5%-22%, p = .002). Age did not correlate with postoperative atrophy. CONCLUSIONS: Paraspinal muscle atrophy after lumbar spinal surgery is greater if an extensive approach is performed such as complete laminectomy with bilateral facetectomy and transpedicular fixation. A greater previous musculature regardless of age, sex and type of surgery also predicts greater postoperative atrophy.