Sistema pedicular de estabilización dinámica. Resultados funcionales y complicaciones del implante en pacientes con enfermedad degenerativa discal lumbar, tras un seguimiento mínimo de 4 años / Pedicular dynamic stabilization system. Functional outcomes and implant-related complications for the treatment of degenerative lumbar disc disease with a minimum follow-up of 4 years

Introducción: El sistema de estabilización Dynesys® es un sistema pedicular de estabilización dinámica sin fusión. El objetivo de nuestro estudio es evaluar los resultados clínicos en pacientes con enfermedad degenerativa discal y/o estenosis, así como medir la prevalencia de aflojamiento de tornillos tras 4 años de seguimiento. Material y métodos: Se trata de un estudio de serie de casos retrospectivo donde fueron incluidos todos los pacientes intervenidos desde enero a diciembre de 2008 con Dynesys®. Se indicó la cirugía si presentaban dolor lumbar de más de 6 meses de evolución y una RM positiva para enfermedad degenerativa discal y/o estenosis. Resultados: Veintidós pacientes (11 mujeres y 11 varones) con una edad media de 44,40 ± 11 años fueron evaluados. Veinte pacientes (91%) recibieron el implante Dynesys® sin ninguna maniobra de descompresión asociada. La evaluación del dolor de espalda y piernas (0-10 mm) registró una disminución media de 2,4 ± 2,06 mm (p = 0,0001). El valor preoperatorio del índice de discapacidad de Oswestry fue de 52,36 ± 16,56% (limitación funcional severa). Tras la cirugía este valor fue de 34,27 ± 17,87% (limitación funcional moderada) con una disminución de 18,09 ± 16,03% (p = 0,001). Cuatro pacientes (18%) mostraron signos de aflojamiento de tornillos. Un paciente (4,5%) presentó rotura de tornillo. Conclusiones: La cirugía con Dynesys® muestra resultados clínicos favorables, sin embargo el rango de mejoría en nuestra serie es menor a los comunicados por otros autores. Estudios comparativos entre Dynesys® y descompresión deberían realizarse para poder aislar el beneficio de la estabilización dinámica del obtenido por la descompresión. Las complicaciones relacionadas con el implante no son infrecuentes (AU)

Introduction: The Dynesys® system is a non-fusion pedicular dynamic stabilization system. The aim of our study is to evaluate the clinical outcomes in patients with degenerative disc disease and/or stenosis, and to measure the prevalence of screw loosening and breakage after 4 years of follow up. Material and methods: All patients who underwent surgery with Dynesys® system in 2008 were reviewed. The surgery was performed in cases of low back pain of more than 6 months duration and a positive MRI for degenerative disc disease and/or stenosis. Results: A total of 22 patients (11 females, 11 males) with a mean age of 44.40 ± 11 years were included, 20 patients (91%) underwent Dynesys® without any associated decompression maneuver. The evaluation of back and leg pain (0–10 mm) showed a mean decrease of 2.4 ± 2.06 mm (P = .0001). The preoperative value of the Oswestry disability index was 52.36 ± 16.56% (severe functional limitation). After surgery, this value was 34.27 ± 17.87% (moderate functional limitation) (P = .001) with a decrease of 18.09 ± 16.03% (P = .001). A total of 4 (18%) patients showed signs of loosening screws. One patient (4.5%) had a screw breakage. Conclusions: Surgery with Dynesys® shows favorable long term clinical results, however the range of improvement in our series is lower than those reported in other studies. Comparative studies between Dynesys® and decompression need to be performed in order to isolate the benefit of the dynamic stabilization system. Implant-related complications are not uncommon (AU)

[Pedicular dynamic stabilization system. Functional outcomes and implant-related complications for the treatment of degenerative lumbar disc disease with a minimum follow-up of 4 years]. / Sistema pedicular de estabilización dinámica. Resultados funcionales y complicaciones del implante en pacientes con enfermedad degenerativa discal lumbar, tras un seguimiento mínimo de 4 años.

INTRODUCTION: The Dynesys(®) system is a non-fusion pedicular dynamic stabilization system. The aim of our study is to evaluate the clinical outcomes in patients with degenerative disc disease and/or stenosis, and to measure the prevalence of screw loosening and breakage after 4 years of follow up. MATERIAL AND METHODS: All patients who underwent surgery with Dynesys(®) system in 2008 were reviewed. The surgery was performed in cases of low back pain of more than 6 months duration and a positive MRI for degenerative disc disease and/or stenosis. RESULTS: A total of 22 patients (11 females, 11 males) with a mean age of 44.40 ± 11 years were included, 20 patients (91%) underwent Dynesys(®) without any associated decompression maneuver. The evaluation of back and leg pain (0-10mm) showed a mean decrease of 2.4 ± 2.06 mm (P=.0001). The preoperative value of the Oswestry disability index was 52.36 ± 16.56% (severe functional limitation). After surgery, this value was 34.27 ± 17.87% (moderate functional limitation) (P=.001) with a decrease of 18.09 ± 16.03% (P=.001). A total of 4 (18%) patients showed signs of loosening screws. One patient (4.5%) had a screw breakage. CONCLUSIONS: Surgery with Dynesys(®) shows favorable long term clinical results, however the range of improvement in our series is lower than those reported in other studies. Comparative studies between Dynesys(®) and decompression need to be performed in order to isolate the benefit of the dynamic stabilization system. Implant-related complications are not uncommon.

Patient with resected anaplastic astrocytoma and an image suggestive of relapse.

The main treatment of asctrocytomas is surgery, which serves a double purpose: diagnosis and treatment. Surgery can be complemented with radiotherapy. With respect to chemotherapy, there continues to be a controversy as to whether it has the capacity to overcome the blood-brain barrier. An interesting option has been the implantation of biodegradable polymers of carmustine that are placed in the cavity left by the surgical procedure. With respect to the cerebral edema that can be associated with the carmustine implants, there can appear images in follow-up that are suggestive of relapse.

Patient with resected anaplastic astrocytoma and an image suggestive of relapse

The main treatment of asctrocytomas is surgery, which serves a double purpose: diagnosis and treatment. Surgery can be complemented with radiotherapy. With respect to chemotherapy, there continues to be a controversy as to whether it has the capacity to overcome the blood-brain barrier. An interesting option has been the implantation of biodegradable polymers of carmustine that are placed in the cavity left by the surgical procedure. With respect to the cerebral edema that can be associated with the carmustine implants, there can appear images in follow-up that are suggestive of relapse (AU)