RESUMEN
Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.
Asunto(s)
Criptococosis/patología , Osteomielitis/microbiología , Osteomielitis/patología , Enfermedades de la Columna Vertebral/microbiología , Enfermedades de la Columna Vertebral/patología , Anciano , Biopsia , Criptococosis/diagnóstico por imagen , Cryptococcus/aislamiento & purificación , Humanos , Imagen por Resonancia Magnética , Masculino , Osteomielitis/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
STUDY DESIGN: A case series of dual time-point F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) for the diagnosis of spinal cord sarcoidosis. OBJECTIVE: The aim of this study was to illustrate three cases of spinal sarcoidosis with occult presentation and subsequent identification with the use of dual time-point F-FDG PET/CT. SUMMARY OF BACKGROUND DATA: Sarcoidosis of the spinal cord is very rare and when it occurs without systemic manifestations of disease can be a challenging diagnostic dilemma frequently resulting in the need for spinal cord biopsy in order to establish a diagnosis. METHODS: Case series presentation and report. RESULTS: This manuscript presents a case series experience of dual time-point F-FDG PET/CT for the diagnosis of spinal cord sarcoidosis. We review the cases of three patients who presented with myelopathy and underwent F-FDG DTPI as part of the evaluation for enhancing spinal cord lesions of unknown etiology for 2 years at a university-based cancer hospital. F-FDG DTPI was vital in making the diagnosis of sarcoidosis, and in two of the cases, the patients were able to avoid biopsy, thereby avoiding potential morbidity from an invasive procedure. CONCLUSION: F-FDG PET/CT imaging is a noninvasive imaging technique that can be crucial in the diagnosis of sarcoidosis of the spinal cord and help avoid unnecessary procedures. LEVEL OF EVIDENCE: 4.
Asunto(s)
Fluorodesoxiglucosa F18 , Radiofármacos , Sarcoidosis/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Sarcoidosis/patología , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/patología , Enfermedades de la Columna Vertebral/patologíaRESUMEN
Resumen La criptococosis es una micosis sistémica producida por un hongo levaduriforme encapsulado denominado Cryptococcus neoformans. Es una enfermedad universal, que ocurre con mayor frecuencia en pacientes inmunocomprometidos, manifestándose principalmente como una enfermedad diseminada con compromiso meníngeo o pulmonar. Sin embargo, la osteomielitis ocurre solo en 5-10% de los casos, siendo el compromiso vertebral el más frecuente. Presentamos un caso de criptococosis vertebral aislada y una búsqueda bibliográfica sobre el tema. Se recomienda realizar una terapia antifúngica de inducción intravenosa y continuar con una fase de consolidación, vía oral, de duración variable. La indicación quirúrgica se considera en lesiones que comprometen la estabilidad vertebral y aquellas que presentan un compromiso neurológico, producen deformidad y para reducir el inóculo infeccioso.
Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.
Asunto(s)
Humanos , Masculino , Anciano , Osteomielitis/microbiología , Osteomielitis/patología , Enfermedades de la Columna Vertebral/microbiología , Enfermedades de la Columna Vertebral/patología , Criptococosis/patología , Osteomielitis/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Biopsia , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Criptococosis/diagnóstico por imagen , Cryptococcus/aislamiento & purificaciónRESUMEN
ABSTRACT Objective: To determine the epidemiology of orthopedic spine pathology in a national reference hospital in Mexico. Methods: Retrospective, observational and cross-sectional study, using the database and hospitalization census of the orthopedic spine service from January 2009 to December 2016. The data analysis was performed with SPSS version 22 measuring the central frequency and percentages. The demographic variables age and sex, and those related to the diagnosis, type of pathology, affected segment and degrees of affection were obtained. The sampling technique was non-probabilistic sampling by convenience of consecutive cases. Results: We analyzed 7,771 cases: 50.34% males, with a mean age of 53.51 years. The prevalence of the most frequent diseases in hospitalized patients was stenosis of the lumbar canal with 25.85% (1,834 patients), followed by lumbar disc herniation (23.12%), spondylolisthesis (22.63%), cervical spondylotic myelopathy (8.76%), lumbar pain and lumbosciatalgia (4.10%), cervical disc herniation (3.96%), primary infection (3.80%), loosening of material (3.16%), spinal tumors (2.53%) and cervical instability (2.04%). Conclusions: This is the largest series of cases of spinal pathology treated in a hospital in Latin America. The most frequent condition was the stenosis of the lumbar canal, the most affected segment was the lumbar, and the most affected age group was 51 to 60 years. The estimate is an increase in the incidence of spinal diseases, so it is necessary to identify the risk factors and the behavior of each disease for its prevention. Level of Evidence IV; Retrospective, observational and descriptive study.
RESUMO Objetivo: Determinar a epidemiología da patologia da coluna ortopédica em um hospital de referência nacional no México. Métodos: Um estudo retrospectivo, observacional e transversal, utilizando o banco de dados e o recenseamento hospitalar do serviço de orelha ortopédica de janeiro de 2009 a dezembro de 2016. A análise de dados foi realizada através da SPSS versão 22 usando medidas de frequência central e porcentagens. As variáveis demográficas idade e gênero, e aqueles relacionados ao diagnóstico, tipo de patologia, segmento afetado e graus de carinho foram obtidos. A técnica de amostragem foi por conveniência e não probabilística de casos consecutivos. Resultados: Analisamos 7771 casos: 50,34% do sexo masculino, com idade média de 53,51 anos. A prevalência das doenças mais frequentes em pacientes hospitalizados foi a conduta lombar estreita, com 25,85% (1834 pacientes), seguida de hérnia de disco lombar (23,12%), espondilolistese (22,63%), mielopatia espondilótica cervical (8,76%), lombo e lomossocialgia (4,10%), hérnia de disco e infecção primária cervical (3,96%, 3,80%), afrouxamento do material (3,16%), tumores espinhais (2,53%) e instabilidade cervical (2,04%). Conclusões: Este é o maior número de casos da patologia da coluna com tratamento hospitalar na América Latina. O estado mais comum era o canal lombar da coluna vertebral, o segmento lombar é o mais afetado e o grupo de idade mais afetado é de 51 a 60 anos. Um aumento na incidência de doenças da coluna vertebral está previsto, de modo que é necessário identificar os fatores de risco e o comportamento de cada condição para a prevenção. Nível de Evidência IV; Estudo retrospectivo, observacional e descritivo.
RESUMEN Objetivo: Conocer la epidemiologia de la patología ortopédica de columna vertebral en un hospital de referencia nacional en México. Métodos: Se realizó un estudio retrospectivo, observacional y transversal, utilizando la base de datos y censos de hospitalización del servicio de columna ortopédica de enero de 2009 a diciembre de 2016. Se realizó el análisis de datos mediante SPSS versión 22, utilizando medidas de frecuencia central y porcentajes. Se obtuvieron las variables demográficas edad y sexo, y las relacionadas con el diagnóstico, tipo de patología, segmento afectado y grados de afección. La técnica de muestreo fue por conveniencia y no probabilística de casos consecutivos. Resultados: Se analizaron 7.771 casos: 50,34% del sexo masculino, con un promedio de edad de 53,51 años. La prevalencia de las enfermedades más frecuentes en los pacientes hospitalizados fue el conducto lumbar estrecho con 25,85% (1.834 pacientes), seguido de hernia discal lumbar (23,12%), espondilolistesis (22,63%), mielopatía espondilótica cervical (8,76%), lumbalgias y lumbociatalgias (4,10%), hernia discal cervical (3,96%), infección primaria (3,80%), aflojamiento de material (3,16%), tumores espinales (2,53%) e inestabilidad cervical (2,04%). Conclusiones: Esta es la mayor serie de casos de patología de columna con tratamiento hospitalario en América Latina. El padecimiento más frecuente fue el conducto lumbar estrecho, el segmento más afectado el lumbar, y el grupo etario más aquejado el de 51 a 60 años. Se predice un incremento en la incidencia de las enfermedades de columna vertebral, por lo que es necesario identificar los factores de riesgo y el comportamiento de cada padecimiento para su prevención. Nivel de Evidencia IV; Estudio retrospectivo, observacional y descriptivo.
Asunto(s)
Enfermedades de la Columna Vertebral/epidemiología , Enfermedades de la Columna Vertebral/patología , Enfermedades de la Columna Vertebral/prevención & control , Traumatismos Vertebrales/epidemiologíaRESUMEN
STUDY DESIGN: A systematic review with meta-analysis. OBJECTIVE: To combine published data, focusing on the development of optimal spinopelvic parameters in adult asymptomatic subjects without spine deformity while taking into consideration the impact of potential confounders. SUMMARY OF BACKGROUND DATA: A well-grounded approach to define the optimal spinopelvic parameters is necessary for planning surgical correction of spine deformity. MATERIALS: Selection criteria: (1) randomized and nonrandomized prospective, cross-sectional, and retrospective studies; (2) participants: asymptomatic subjects without spine deformity aged above 18 years; (3) studied parameters: lumbar lordosis (LL), pelvic incidence, sacral slope, and pelvic tilt; (4) potential confounders: method of measurement, sex, age, ethnicity, weight, height, and body mass index. Search method: Ovid MEDLINE (1946-current) and EMBASE (1980-current), all years through October 2015 were included. Data were collected: number of enrolled subjects, means of the studied characteristics, SD, SE of the means, 95% confidence intervals. A meta-analysis was performed to evaluate the pooled means and range of optimal values (pooled mean±pooled SD) taking into consideration the impact of confounders. The GRADE approach was applied to evaluate the level of evidence. RESULTS: Seventeen of 1018 studies were included (2926 subjects from 9 countries). The pooled means and the optimal ranges were: LL (L1-S1), 54.6 (42-67) degrees; LL (L1-L5), 37.0 (22-53) degrees; pelvic incidence, 50.6 (39-62) degrees; sacral slope, 37.7 (28-48) degrees; pelvic tilt, 12.6 (3-22) degrees. The pooled results were statistically significant (P<0.001), but heterogeneous. Impact of the following confounders was revealed: method of measurement, ethnicity, age, and body mass index. A methodology was created to define an individualized optimal value and range of each studied parameter taking into consideration the influence of confounders. CONCLUSIONS: The pooled results and developed methodology can be used as diagnostic criteria for evaluation of the spinopelvic parameters, planning of surgical interventions and evaluation of the treatment effect.
Asunto(s)
Pelvis/patología , Enfermedades de la Columna Vertebral/patología , Columna Vertebral/anomalías , Humanos , Sesgo de Publicación , Análisis de RegresiónAsunto(s)
Alopecia/patología , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/patología , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/patología , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/patología , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/patología , Alopecia/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen/métodosRESUMEN
PURPOSE: The purpose of this paper was to comprehensively review hemivertebrae in regard to their classification, embryology, etiology, diagnosis, clinical manifestations, and management of this developmental anomaly. METHODS: This subject review of hemivertebrae was composed after conducting a thorough review of the available literature on this topic using PubMed and other standard search engines. RESULTS: Hemivertebrae are incomplete vertebral column segments that can result in congenital scoliosis and be associated with a range of other structural anomalies. Presentations may differ and based on location and classification, treatments may vary. CONCLUSION: Hemivertebrae are structural anomalies of the vertebral column that can potentially disrupt the spine's normal curvature. Their clinical impact depends on factors such as degree of segmentation and concurrence with other structural anomalies. It is hoped that this review will provide the clinician who treats patients with hemivertebrae a resource in better understanding this finding and its subsequent pathological effects.
Asunto(s)
Enfermedades de la Columna Vertebral/congénito , Enfermedades de la Columna Vertebral/patología , Columna Vertebral/anomalías , Humanos , Curvaturas de la Columna Vertebral/patologíaRESUMEN
Vertebral osteomyelitis (VO) is a worldwide emerging disease that affects broilers. The objective of this study was to determine the frequency and aetiology of VO in broilers in a highly productive broiler region. For this, 608 broilers with locomotory problems were analysed from 18 farms. Clinical signs were recorded, necropsy was performed and samples were collected from vertebral bodies with gross changes for molecular and histopathological analysis and for bacterial isolation. From broilers with locomotory changes, 5.1% (31/608) had VO and, of these, 93.5% were 40 days old or older and 89.7% were males. The birds with VO presented varying degrees of limited mobility and this was related to the level of compression to the spinal cord. Bacterial species of the genus Enterococcus (DNA detected in 53.6%) were the aetiological agents involved in most VO cases. Enterococcus faecalis was detected most frequently (35.7%), but Enterococcus hirae was also present in some lesions (7.1%). Escherichia coli was detected in 35.7% of vertebral lesions and co-infection with E. faecalis was confirmed in 7.1% cases. Staphylococcus aureus was involved in 14.3% of the cases, being 7.1% in co-infection with Enterococcus spp. or E. hirae. Our study has indicated that, in Brazil, VO in broilers may not be caused by a single infectious agent and has a lower frequency than recently reported in other countries. This study suggests that there are geographical differences between Brazil and other countries concerning the frequency and aetiology of VO.
Asunto(s)
Infecciones Bacterianas/veterinaria , Pollos/microbiología , Osteomielitis/veterinaria , Enfermedades de las Aves de Corral/microbiología , Enfermedades de la Columna Vertebral/veterinaria , Animales , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Brasil/epidemiología , Coinfección/veterinaria , Enterococcus/genética , Enterococcus/aislamiento & purificación , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Femenino , Geografía , Masculino , Osteomielitis/microbiología , Osteomielitis/patología , Patología Molecular , Enfermedades de las Aves de Corral/patología , Enfermedades de la Columna Vertebral/microbiología , Enfermedades de la Columna Vertebral/patología , Columna Vertebral/microbiología , Columna Vertebral/patología , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
OBJECTIVE: To establish the real incidence of adjacent segment disease after fusion, and to identify the levels and predisposing factors for the pathology, as well as the functional results. METHODS: a retrospective case series study with level of evidence IIB, in a sample of 179 patients diagnosed with stenosis of the lumbar spine, spondylolisthesis and degenerative scoliosis, submitted to surgery in the period 2005 to December 2013, with posterior instrumentation and posterolateral fusion, with follow-up from 2007 until May 2014, in which the symptomology and radiographic findings were evaluated, to establish the diagnosis and treatment. RESULTS: the study included 179 patients diagnosed with stenosis of the lumbar spine (n=116), isthmic and degenerative spondylolisthesis (n=50) and degenerative scoliosis (n=13); during the study, 20 cases of adjacent level segment were identified, 80% of which were treated surgically with extension of the instrumentation, while 20% were treated conservatively with NSAIDs and therapeutic blocks. CONCLUSION: An incidence of 11% was found, with an average of 3.25 years in diagnosis and treatment, a prevalence of females and diagnosis of stenosis of the lumbar canal on posterior instrumentation, a predominance of levels L4-L5; 80% were treated with extension of the instrumentation. The complications were persistent radiculopathy, infection of the surgical wound, and one death due to causes not related to the lumbar pathology. .
OBJETIVO: Estabelecer a incidência real da doença do segmento adjacente após fusão e identificação dos níveis e fatores predisponentes à patologia, assim como os resultados funcionais. MÉTODOS: Estudo retrospectivo de série de casos, com nível de evidência IIB, em amostra de 179 pacientes com diagnósticos de estenose de canal lombar, espondilolistese e escoliose degenerativa, submetidos a cirurgia no período de 2005 a dezembro de 2013, com instrumentação posterior e fusão posterolateral, com acompanhamento de 2007 até maio de 2014, no qual se avaliaram a sintomatologia e os achados radiográficos para estabelecer o diagnóstico e tratamento. RESULTADOS: O estudo incluiu 179 pacientes com diagnóstico de estenose de canal lombar (n=116), espondilolistese ístmica e degenerativa (n=50) e escoliose degenerativa (n=13); durante o estudo foram identificados 20 casos de segmento de nível adjacente, sendo que 80% foram tratados cirurgicamente com extensão da instrumentação, enquanto 20% foram tratados de modo conservador com AINE e bloqueios terapêuticos. CONCLUSÃO: Verificou-se uma incidência de 11%, com média de 3,25 anos no diagnóstico e tratamento, maior prevalência do sexo feminino e diagnóstico de estenose de canal lombar à instrumentação posterior, com predomínio dos níveis L4-L5; 80% foram tratados com extensão da instrumentação. As complicações foram radiculopatia persistente, infecção da ferida cirúrgica e um óbito decorrente de causas não relacionadas com a patologia lombar. .
OBJETIVO: Establecer la incidencia real de la enfermedad de segmento adyacente tras la fusión e identificación de los niveles y factores predisponentes a esta patología, así como los resultados funcionales. MÉTODOS: Se realizó un estudio retrospectivo de serie de casos, con nivel de evidencia IIB, con una muestra de 179 pacientes con diagnósticos de canal lumbar estrecho, espondilolistesis y escoliosis degenerativa, intervenidos quirúrgicamente en el periodo de 2005 a diciembre del 2013, con instrumentación posterior y fusión posterolateral, bajo seguimiento desde 2007 hasta mayo de 2014 en el cual se evaluó la sintomatología y hallazgos radiográficos para establecer el diagnóstico y manejo. RESULTADOS: Se incluyeron en el estudio 179 pacientes con diagnóstico de canal lumbar estrecho (n=116), espondilolistesis ístmica y degenerativa (n=50), escoliosis degenerativa (n=13); durante el estudio se identificaron 20 casos de segmento de nivel adyacente, siendo que el 80% se trataron de manera quirúrgica con extensión de la instrumentación, mientras que el 20% se manejaron de modo conservador con AINE y bloqueos terapéuticos. CONCLUSIÓN: Se identificó una incidencia del 11%, con un promedio de 3.25 años en el diagnóstico y tratamiento, mayor prevalencia del sexo femenino y diagnóstico de canal lumbar estrecho en instrumentación posterior con predominio en los niveles L4-L5; el 80% se trataron con extensión de la instrumentación. Las complicaciones fueron radiculopatía persistente, infección de la herida quirúrgica y un fallecimiento debido a causas no relacionadas con la patología lumbar. .
Asunto(s)
Humanos , Enfermedades de la Columna Vertebral/patología , Artrodesis , Fusión Vertebral , Estenosis EspinalRESUMEN
Lumbar and radicular pain due to HNP has been described since 1934. It is thought that the pain is caused by compression and by other local chemical mediators that are present in the area of interaction between the root and the disc.With the objective of treating patients suffering from this syndrome and with a percutaneous minimally invasive approach, we designed a mixed technique: percutaneous automated nucleotomy plus nucleolysis and periradicular infiltration with ozone.A retrospective study of 105 patients was conducted, including 60 men and 45 women with an average age of 43 years. All patients were treated with that technique between November 2006 and August 2008. Clinical follow-up of 15.2 months was provided by telephone, utilizing a modified Mac Nab scale. The results were as follows: 60% excellent, 22.8% good (82.8% success), 9.6% acceptable, 7.6% poor. From the eight patients that reported poor results, five were considered to have recurrent symptoms (4.8%), because they had initially shown a period of significant improvement post operatively. Morbidity was manifested by transient pain and muscle spasms in the post operative area (2.8%).We conclude that this new mixed technique, compared to automated percutaneous nucleotomy alone, may be more widely utilized by broadening the indications, with acceptable results.
Asunto(s)
Discectomía Percutánea/métodos , Quimiólisis del Disco Intervertebral/métodos , Ozono/uso terapéutico , Enfermedades de la Columna Vertebral/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Estudios Retrospectivos , Enfermedades de la Columna Vertebral/patología , Adulto JovenAsunto(s)
Histiocitosis de Células de Langerhans/terapia , Enfermedades de la Columna Vertebral/terapia , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Niño , Preescolar , Femenino , Histiocitosis de Células de Langerhans/diagnóstico por imagen , Histiocitosis de Células de Langerhans/patología , Humanos , Masculino , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/patología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The vertebral destruction syndrome is defined as those pathologies affecting the integrity of the vertebral structure, modifying its normal architecture and resulting in neurological deficit. Correct diagnosis is essential to define appropriate treatment. Biopsy, in addition to histopathological study, is a vital element for definitive diagnosis. METHODS: We carried out a descriptive, deliberate interventional study in 20 patients with a diagnosis of vertebral destruction in whom a percutaneous transpendicular biopsy was done between January 2005 and July 2006. Variables analyzed were age, sex, affected segment, neurological condition, neurological deficit type, results of the biopsy and specific diagnosis. RESULTS: There was a predominance of males (55%). The lumbar spine was the most affected region in 80% of patients. Of the biopsies performed, 10% were reported as normal tissue, 20% with degenerative changes, 15% with inflammatory changes, 15% with primary tumoral lesion, 5% with chronic osteomyelitis, 10% with tuberculosis, 15% with tumoral metastasis and 10% necrotic devitalized bone tissue. Of these patients, 55% were treated nonsurgically, and the remaining 45% were treated surgically. No complications were reported. CONCLUSIONS: Percutaneous transpedicular biopsy has only 55% specificity in diagnosis and for that reason is a less useful diagnostic method in our setting for destructive lesion diagnosis from the vertebral body.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades de la Columna Vertebral/patología , Vértebras Lumbares/patología , Vértebras Torácicas/patología , Biopsia/métodos , Estudios Prospectivos , SíndromeRESUMEN
BACKGROUND: The vertebral destruction syndrome is defined as those pathologies affecting the integrity of the vertebral structure, modifying its normal architecture and resulting in neurological deficit. Correct diagnosis is essential to define appropriate treatment. Biopsy, in addition to histopathological study, is a vital element for definitive diagnosis. METHODS: We carried out a descriptive, deliberate interventional study in 20 patients with a diagnosis of vertebral destruction in whom a percutaneous transpendicular biopsy was done between January 2005 and July 2006. Variables analyzed were age, sex, affected segment, neurological condition, neurological deficit type, results of the biopsy and specific diagnosis. RESULTS: There was a predominance of males (55%). The lumbar spine was the most affected region in 80% of patients. Of the biopsies performed, 10% were reported as normal tissue, 20% with degenerative changes, 15% with inflammatory changes, 15% with primary tumoral lesion, 5% with chronic osteomyelitis, 10% with tuberculosis, 15% with tumoral metastasis and 10% necrotic devitalized bone tissue. Of these patients, 55% were treated nonsurgically, and the remaining 45% were treated surgically. No complications were reported. CONCLUSIONS: Percutaneous transpedicular biopsy has only 55% specificity in diagnosis and for that reason is a less useful diagnostic method in our setting for destructive lesion diagnosis from the vertebral body.
Asunto(s)
Vértebras Lumbares/patología , Enfermedades de la Columna Vertebral/patología , Vértebras Torácicas/patología , Adulto , Biopsia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SíndromeRESUMEN
La discopatía aguda y el dolor por estenosis del canal espinal son los diagnósticos más frecuentes de dolor lumbar bajo sin y con irradiación (lumbociatalgia o lumbocruralgia) y de dolor cervical sin y con irradiación (cervicobraquialgia). La postura tradicional ha sido la de administrar antiinflamatorios no esteroides (AINEs) para estas lumbalgias o cervicalgias agudas y crónicas... En este trabajo presentamos la experiencia clínica con una asociación a dosis fija de diclofenac, betametasona y ciánocobalamina administrada por vía oral en el tratamiento de la patología dolorosa de la columna lumbar y cervical aasociada a compresión neural en 200 pacientes ambulatorios. La asociación demostró ser muy eficaz en controlar el dolor y mejorar la funcionalidad de los pacientes y se asoció a escasos efectos colaterales digestivos.(AU)
Asunto(s)
Humanos , Adolescente , Adulto , Enfermedades de la Columna Vertebral/patología , Dolor de la Región Lumbar/patología , Vértebras Cervicales/patología , /administración & dosificación , Betametasona/uso terapéutico , Diclofenaco/uso terapéutico , Vitamina B 12/uso terapéutico , Resultado del Tratamiento , DolorRESUMEN
El quiste óseo aneurismático es un tumor de naturaleza neoplásica indefinida, de comportamiento benigno, crecimiento rápido y ocasionalmente de comportamiento agresivo, cuyo tratamiento de elección es la resección completa, aunque existe el riesgo de sangrado transquirúrgico excesivo. Se presenta el caso de una paciente con deformidad en columna torácica, con parestesias y debilidad muscular progresivas en extremidades inferiores, que evolucionó hasta la parálisis de dichas extremidades e incontinencia de ambos esfínteres. Mediante estudios de gabinete se localizaron lesiones líticas en cuerpos vetebrales T7 a T9 e invasión a conducto raquídeo. Los estudios electrofisiológicos identificaron bloqueo completo de la vía somatosensorial. Previa biopsia incisional, se realizó resección de la lesión y estabilización de la columna toracolumbar. La paciente evolucionó sin mejoría de la función medular. Los hallazgos morfológicos correspondieron a quiste óseo aneurismático en T8. Esta lesión se localiza principalmente en huesos largos y con mucho menor frecuencia en la columna vertebral, donde puede provocar inestabilidad y compresión de la médula espinal. Es posible confundirla con otras neoplasias, por lo que el diagnóstico definitivo mediante biopsia es imprescindible a fin de establecer el plan terapéutico adecuado, que elimine el riesgo de recurrencia o secuelas neurológicas asociadas, y lograr la estabilidad adecuada de los segmentos vertebrales afectados.
The aneurysmal bone cyst (ABC) is a fast-growing tumor of undefined neoplastic nature. It is occasionally an aggressive benign lesion whose treatment of choice is a complete resection, even though the risk of profuse transoperative bleeding exists. We present a female patient with thoracic spine deformity, with progressive paresthesias and muscle weakness of lower extremities that evolved to paralysis of both lower extremities and sphincter incontinence. Based on radiographic films, lytic lesions were identified at T7 to T9 vertebrae as well as medullary space invasion. In electrophysiologic tests, a complete somatosensorial pathway block was reported. Prior to resection of the neoplastic lesion and thoracolumbar stabilization, an incisional biopsy was performed. There was no postoperative medullary functional improvement. Morphological findings corresponded to an aneurysmal bone cyst at T8. This lesion is mainly located in the long bones and less frequently of the spine, where instability and medullary compression may occur. It is possible to confuse this neoplasia with other lesions. Hence, definite diagnosis with biopsy is necessary for determining an adequate therapeutic plan to eradicate recurrence risk or associated neurologic sequelae, as well as to gain proper stability at the involved vertebral segments.
Asunto(s)
Humanos , Femenino , Adolescente , Quistes Óseos Aneurismáticos/cirugía , Compresión de la Médula Espinal/etiología , Descompresión Quirúrgica/métodos , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Progresión de la Enfermedad , Trasplante Óseo , Cifosis/etiología , Quistes Óseos Aneurismáticos/complicaciones , Quistes Óseos Aneurismáticos/patología , Diagnóstico Diferencial , Descompresión Quirúrgica/instrumentación , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/patología , Dolor de Espalda/etiología , Fijadores Internos , Incontinencia Fecal/etiología , Incontinencia Urinaria/etiología , Osteólisis/etiología , Paraplejía/etiología , Parestesia/etiología , Vértebras Torácicas/patologíaRESUMEN
The purpose of this study was to determine the effect of cellulose membrane or free fat grafts (FFG) on laminectomy membrane (LM) formation. Eighteen dogs were randomly divided into three groups of six dogs. All dogs underwent a modified dorsal laminectomy on T(13)-L(1). The laminectomy defect was left uncovered in the control group but either a FFG or a cellulose membrane implant was provided in the other two groups. The dogs were evaluated through neurological examination, myelography, macroscopic roundness index of spinal cord and histological evaluations of epidural fibrosis and spinal cord. The results showed a significant difference between the control and the FFG group, with the FFG causing neurological deficits and spinal cord compression as assessed by the roundness index of the spinal cord. Both FFG and cellulose membrane were partially effective in preventing LM formation. The use of FFG was associated with a high rate of significant neurological complications and spinal cord lesions.
Asunto(s)
Enfermedades de los Perros/cirugía , Laminectomía/veterinaria , Enfermedades de la Columna Vertebral/veterinaria , Mallas Quirúrgicas , Tejido Adiposo , Animales , Celulosa , Enfermedades de los Perros/patología , Perros , Laminectomía/métodos , Mielografía/veterinaria , Complicaciones Posoperatorias/veterinaria , Prótesis e Implantes/veterinaria , Distribución Aleatoria , Médula Espinal/patología , Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/patología , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/veterinaria , Enfermedades de la Columna Vertebral/patología , Enfermedades de la Columna Vertebral/cirugíaRESUMEN
The aneurysmal bone cyst (ABC) is a fast-growing tumor of undefined neoplastic nature. It is occasionally an aggressive benign lesion whose treatment of choice is a complete resection, even though the risk of profuse transoperative bleeding exists. We present a female patient with thoracic spine deformity, with progressive paresthesias and muscle weakness of lower extremities that evolved to paralysis of both lower extremities and sphincter incontinence. Based on radiographic films, lytic lesions were identified at T7 to T9 vertebrae as well as medullary space invasion. In electrophysiologic tests, a complete somatosensorial pathway block was reported. Prior to resection of the neoplastic lesion and thoracolumbar stabilization, an incisional biopsy was performed. There was no postoperative medullary functional improvement. Morphological findings corresponded to an aneurysmal bone cyst at T8. This lesion is mainly located in the long bones and less frequently of the spine, where instability and medullary compression may occur. It is possible to confuse this neoplasia with other lesions. Hence, definite diagnosis with biopsy is necessary for determining an adequate therapeutic plan to eradicate recurrence risk or associated neurologic sequelae, as well as to gain proper stability at the involved vertebral segments.
Asunto(s)
Quistes Óseos Aneurismáticos/cirugía , Descompresión Quirúrgica/métodos , Compresión de la Médula Espinal/etiología , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Adolescente , Dolor de Espalda/etiología , Quistes Óseos Aneurismáticos/complicaciones , Quistes Óseos Aneurismáticos/patología , Trasplante Óseo , Descompresión Quirúrgica/instrumentación , Diagnóstico Diferencial , Progresión de la Enfermedad , Incontinencia Fecal/etiología , Femenino , Humanos , Fijadores Internos , Cifosis/etiología , Osteólisis/etiología , Paraplejía/etiología , Parestesia/etiología , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/patología , Vértebras Torácicas/patología , Incontinencia Urinaria/etiologíaRESUMEN
The aim of this report was to present the authors experience with the treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and the interbody fusion,comparing the safety and effectiveness of ProDisc-C to anterior cervical discectomy and fusion surgery in the treatment of symptomatic cervical disc disease. The results obtained are discussed (AU)
Asunto(s)
Humanos , Disco Intervertebral/lesiones , Disco Intervertebral/cirugía , Prótesis e Implantes , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/patología , Enfermedades de la Columna Vertebral/cirugía , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/cirugíaRESUMEN
Propósito: Comunicar nuestra experiencia en 25 casos de punciones biopsias dirigidas al sector atloaxoideo de la columna vertebral cervical. Material y método: Se realizaron 25 procedimientos de punciones biopsias en 15 pacientes masculinos y 10 femeninos con rango etario entre 3 y 86 años y una edad media de 49, 4 años. Todas las biopsias fueron guiadas bajo TC con equipos CTMAX 640, Picker 6000 y Philips Secura. Se utilizaron agujas tipo Franseen 20 y 18 G y tipo Jamshidi 11, 13 y 16 G dependiendo de las características osteolíticas u osteoblásticos de las lesiones. Se obtuvo material para su examen anatomopatológico y bacteriológico. Todos los procedimientos se realizaron en pacientes ambulatorios. Resultados: Se alcanzaron resultados satisfactorios en 22 casos (88 por cientos) siendo tres exámenes insatisfactorios. Cinco de los casos correspondieron a metástasis de tumores epiteliales, 4 a mielomas 3, 3 a granulomas eosinófilos, 2 a espondilitis, 6 a cambios reparativos secundarios a artrosis o artritis, 2 a esclerosis ósea y 3 insatisfactorios. No se registraron complicaciones. Conclusión: La biopsia percutánea es un procedimiento eficáz para el diagnóstico de las lesiones vertebrales. Llama la atención la escasa mención atloaxoideo resulta de difícil abordaje por la interposición de estructuras viscerales. Llama la atención la escasa mención bibliográfica sobre este tema, lo que podría estar relacionado a que probablemente estos procedimientos habitualmente no se encuentran en manos de radiólogos. Pensamos que con radiólogos intervencionistas entrenados puede ser realizada de manera satisfactoria y con escasas o ninguna complicación (AU)