Pseudoaneurisma de arteria segmentaria lumbar tras introducción de tornillo transpedicular L5. Una rara complicación vascular / Lumbar segmental artery pseudoaneurysm after L5 pedicle screw placement. A rare vascular complication

La fusión instrumentada lumbar por vía posterior se realiza de manera habitual hoy en día, aunque en algunas ocasiones puede inducir complicaciones que pueden llegar a ser devastadoras. Una de las causas, aunque poco frecuentes, de complicación mayor es la malposición de los tornillos pediculares, de ahí la importancia de ser metódicos a la hora de su colocación, comprobando el correcto labrado del trayecto y su introducción. Presentamos un caso de sangrado masivo tras la introducción de un tornillo pedicular lumbar durante una cirugía por estenosis de canal. La malposición del tornillo conllevó la inestabilidad hemodinámica intraoperatoria de la paciente tras el fracaso de los métodos habituales de control de sangrado en el campo quirúrgico. La realización de una TAC con contraste evidenció lesión de la arteria intersegmentaria lumbar que fue finalmente controlada mediante embolización e implantación de coil vascular (AU)

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation (AU)

Lumbar segmental artery pseudoaneurysm after L5 pedicle screw placement. A rare vascular complication. / Pseudoaneurisma de arteria segmentaria lumbar tras introducción de tornillo transpedicular L5. Una rara complicación vascular.

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation.

Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis / Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle

Objetivos. Evaluar la validez clínica en EA de 2 nuevos parámetros (ASS y ST) descritos recientemente para la evaluación del perfil sagital espinopélvicos, y cuyo papel en EA no está aún definido. Material y método. Análisis prospectivo (no concurrente) radiográfico y clínico de 59 cirugías primarias de EA (Cobb > 40°), mínimo 2 años de seguimiento. Para este trabajo dispusimos de radiografías y cuestionarios de salud de 49 pacientes. Se evaluó el cambio de los parámetros radiográficos tras cirugía (test Wilcoxon) y la correlación resultados clínicos-radiográficos-edad (test de Spearman y regresión lineal múltiple). Resultados. Mediana de seguimiento postoperatorio 8,5 años. Mediana edad 49,5 años. Hubo cambio estadísticamente significativo con la cirugía en ASS y ST (en ambos inferior a 5°), cifosis torácica (CT), lordosis lumbar (LL), rotación pélvica (RP), balance sagital (BS) y Cobb frontal. No hubo correlación entre dolor y ASS-ST. Hubo correlación significativa entre actividad y ASS, ST, LL, BS) y edad. Tras análisis multivariante solo la edad (ni ASS ni ST) persistió como posible predictor de menor actividad. Discusión. Cuando predomina la deformidad frontal, los parámetros radiográficos sagitales, incluidos los más novedosos ángulos, si bien sí influyen en la actividad del paciente cuando se analizan de forma aislada, pierden esta influencia cuando se analizan en conjunto y junto a otros parámetros clínicos. Conclusiones. Los valores de SSA y ST varían escasamente con la cirugía. Solo se correlacionan con la actividad pero no pueden considerarse predictores de la misma. No parecen pues medidas de utilidad en EA (AU)

Objectives. To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. Material and method. A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). Results. The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. Discussion. When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. Conclusions. The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS (AU)

[Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle]. / Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis.

OBJECTIVES: To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. MATERIAL AND METHOD: A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). RESULTS: The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. DISCUSSION: When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. CONCLUSIONS: The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.

Estudio comparativo radiológico y funcional de TLIF frente a PLIF en el dolor lumbar / Comparative radiologic and functional study of Transforaminal Lumbar Interbody Fusion (TLIF) versus Posterior Lumbar Interbody Fusion (PLIF) for low back pain

Objetivo. Comparar los resultados radiológicos y funcionales de las técnicas de fusión circunferencial PLIF frente a TLIF en casos de dolor lumbar crónico. Pacientes y método. Se realizaron 20 PLIF y 20 TLIF (2 y 4 a doble nivel respectivamente). Se compararon valores de: lordosis total y local, inclinación sacra, altura del espacio discal y listesis pre y postoperatorias, así como pérdida de sangre, tiempo quirúrgico y estancia hospitalaria. Se evaluaron la Escala analógica visual para el dolor lumbar y en miembros inferiores, el test de Oswestry, el SF-36, la situación laboral y el grado de satisfacción. Resultados. El tiempo de seguimiento medio fue de 2,5 años. No hubo diferencias estadísticamente significativas en cuanto a pérdida de sangre, tiempo quirúrgico, estancia hospitalaria, valores radiológicos ni funcionales. La lordosis total y local aumentó (PLIF 4,3° y 2,3° y TLIF 2,1° y 0,8°) respectivamente. El espacio discal aumentó en ambas técnicas un 40 por ciento (p < 0,01). La listesis disminuyó 0,7 mm en PLIF y 0,5 mm en TLIF. Los resultados funcionales mejoraron en ambos grupos (p < 0,01). Hubo dos complicaciones en PLIF (una rotura de dura intraoperatoria y un caso de íleo paralítico), y otras dos en TLIF (un caso de compresión radicular por un osteofito marginal y un caso de migración de una de las cajas). Conclusiones. En este estudio no se objetivaron diferencias significativas entre ambas técnicas, a pesar de la tendencia actual del empleo de TLIF por ser menos agresiva en el sentido de que preserva el ligamento interespinoso y la lámina contralateral, evitando la exposición amplia de la dura (AU)

Osteochondroma of the thoracic spine and scoliosis.

STUDY DESIGN: The case of a 16-year-old patient with an osteochondroma in T11 and scoliosis is reported. OBJECTIVE: To describe the treatment of an osteochondroma with scoliotic deformity and the imaging methods used for the diagnosis. SUMMARY OF BACKGROUND DATA: Osteochondromas arising in the vertebral column are rare. However, spinal involvement is found with some regularity because osteochondromas are among the most common benign tumors of bone. METHODS: The clinical history, plain radiographs, computed tomography, and magnetic resonance imaging, and pathologic findings of the reported patient were reviewed. The medical literature also was reviewed. RESULTS: The patient was treated with surgery in an attempt to remove the tumor and correct the aesthetic deformity. The results were satisfactory, with an improvement of the thoracolumbar scoliosis from 45 degrees to 18 degrees. CONCLUSIONS: Osteochondromas of the vertebral column may cause scoliosis. Computed tomography and magnetic resonance imaging are necessary for evaluating the origin, size, and characteristics of the tumor. In this case, surgical management involved resection of the tumor and correction of the scoliotic deformity.