RESUMO
BACKGROUND: We undertook this study to determine the surgical treatments results performed often to correct scoliosis in the Spinal Surgery Service in the INR/Orthopedics (National Institute of Rehabilitation/Orthopedics), Mexico City. METHODS: We conducted a longitudinal, prospective, descriptive, and clinical study with a deliberated intervention controlled from a historical cohort. One hundred twenty patients with scoliosis were reviewed in whom surgery was performed during 1990-1999. For quantitative variables, pre- vs. postoperative measures were compared using non-parametric means with chi(2) or in this case with ANOVA by Kruskall-Wallis test. Differences are considered significant if p <0.05. RESULTS: Age average of patients was 12 years. There were 75 females and 45 males. There were 59 idiopathic scoliosis cases and 54 congenital scoliosis cases. Anterior approach was accomplished in 61 cases with posterior fixation. Posterior approach was used in 54 cases. There were 76 cases of Luque segmental instrumentation. Pre-operatively, scoliosis was ranked (18 to 110 grades) and postoperatively (5 to 90 grades) (p = 0.00001). There were 21 complications, 9 due to injuries or infection. In 76 patients, different fixation techniques were used, obtaining a correction average of 14.47 grades. Forty four patients were structured with bars, four distal screws, two compression screws, proximal hooks with sublaminar wire, and the angle was reduced on average 23.11 grades. CONCLUSIONS. Average reduction of scoliosis was higher with the modified Luque III instrumentation (p <0.045). There was no difference between etiology and preoperative angle.
Assuntos
Fixadores Internos , Escoliose/cirurgia , Fusão Vertebral/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Fusão Vertebral/métodos , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
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.
Assuntos
Humanos , Feminino , Adolescente , Cistos Ósseos Aneurismáticos/cirurgia , Compressão da Medula Espinal/etiologia , Descompressão Cirúrgica/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Progressão da Doença , Transplante Ósseo , Cifose/etiologia , Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/patologia , Diagnóstico Diferencial , Descompressão Cirúrgica/instrumentação , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/patologia , Dor nas Costas/etiologia , Fixadores Internos , Incontinência Fecal/etiologia , Incontinência Urinária/etiologia , Osteólise/etiologia , Paraplegia/etiologia , Parestesia/etiologia , Vértebras Torácicas/patologiaRESUMO
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.
Assuntos
Cistos Ósseos Aneurismáticos/cirurgia , Descompressão Cirúrgica/métodos , Compressão da Medula Espinal/etiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Dor nas Costas/etiologia , Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/patologia , Transplante Ósseo , Descompressão Cirúrgica/instrumentação , Diagnóstico Diferencial , Progressão da Doença , Incontinência Fecal/etiologia , Feminino , Humanos , Fixadores Internos , Cifose/etiologia , Osteólise/etiologia , Paraplegia/etiologia , Parestesia/etiologia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/patologia , Vértebras Torácicas/patologia , Incontinência Urinária/etiologiaRESUMO
BACKGROUND: This study was undertaken to evaluate vertebral stability after two different types of fusion fixation (rigid and semirigid) in spondylolisthesis. MATERIAL AND METHODS: Ambispective study of a dynamic cohort constituted by 42 patients that underwent surgery between 1990 and 2000 for a spondilolistesis treatment. According to the fixing type, they were divided into two follow-up groups: to group 1, plate INO (semirigid system) was placed + posterolateral fusion (PLF), 20 cases; to group 2, plate INO was installed + intersomatic screw + PLF, 22 cases. RESULTS: Both groups achieved better listhesis, reduced pain according to Oswestry and SF36 Index (p <0.05), and less intervertebral height was lost. Group 1 lost the least amount (-0.61 mm) of invertebral height if grades of presurgical listhesis were 1-2, and higher (-2.0 mm) if grades of presurgical listhesis were 3-4. Inversely, group 2 lost the least (0.50 mm) if grade of listhesis was 3 or 4, and higher (-1.25 mm) if grades of listhesis were 1-2. From 4 to 7 years, in group 2 there was altered bending of 5.8 degrees to 8.3 degrees (p = 0.05), a significant difference from group 1. Group 2 showed higher flexion grades (p = 0.01) at 4-7 years postoperatively and a significant reduction in EVA (p = 0.04) at more than 7 years. The remaining patients showed no significant differences between groups. But loss of intervertebral height was higher in group 2 (-1.18 mm) than group 1 (-0.75 mm). Plate INO + PLF favored flexibility and reduced loss of intervertebral height in grades 1-2 of presurgical listhesis, INO + screw + PLF showed reduced listhesis and decrease of height lost in grades 3-4 of presurgical listhesis. CONCLUSIONS: We recommended the use of INO + PLF in grades 1-2 of presurgical listhesis and INO + screw + PLF in grades 3-4 of listhesis presurgically.
Assuntos
Fusão Vertebral/métodos , Espondilolistese/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
El uso de un sistema semirrígido o rígido de fijación con placas y tornillos transpediculares proporciona una sujeción inmediata, no requiere la presencia de láminas para la fijación y no invade el canal medular. En el INO, se ha desarrollado un sistema transpedicular que cumple estos requisitos; el propósito de este trabajo es conocer y evaluar los resultados y complicaciones del uso de las placas y tornillos INO, en la columna vertebral de las regiones torácicas, lumbar y sacra. Se presentaron 19 casos iniciales. De acuerdo con la escala de valoración de Thalgott para consolidación, dolor y compliciones se obtuvo un buen resultado en 82.4 por ciento de los casos después de un año
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Ortopedia , Radiculopatia/diagnóstico , Procedimentos Cirúrgicos Operatórios , Espondilolistese/terapia , Placas Ósseas , Parafusos ÓsseosRESUMO
Debido a los efectos tardíos de la tuberculosis vertebral y a su frecuencia en países en vías de desarrollo, se realizó un estudio retrospectivo en el Servicio de Cirugía de Columna Vertebral del Instituto Nacional de Ortopedia, de 1987 a 1991, para establecer un protocolo de estudio y seguimiento. Se revisaron los expedientes clínico-radiogáficos de 43 pacientes, incluyéndose sólo 19 expedientes completos. Se evaluó: el tiempo de evolucipon para su diagnóstico, el número de vértebras afectadas, daño neurológico (clasificación de Frankel), tipo de imagen radiográfica, grado de pérdida de corrección, tiempo de hospitalización, tipo de injerto óseo utilizando y tiempo de integración, y complicaciones. Se encontró que el tiempo promedio de evolución fue de 7.4 años; el promedio de vértebras afectadas fue de 2.7; sólo dos pacientes tuvieron mejoría en la alteración neurológica, 17 permanecieron igual pero con una función adecuada. El tipo de imagen radiográfica fue de destrucción geográfica en 15 casos. El promedio de pérdida de corrección fue de 4.4 grados al finalizar el tratamiento; y el tiempo promedio de hospitalización fue de 100 días. El tipo de injerto óseo más utilizado fue el de costilla en ocho casos, con un promedio de integración de 9.1 meses. Las complicaciones fueron: un caso sin integración del injerto, dos colapsos del injerto óseo, uno con artritis de la rodilla, un absceso de psoas ilíaco, una radiculopatía, un paciente con protrusión de la barra, una dehiscencia de la herida y dos recidivas de infección corroboradas con BAAR después del tratamiento antifímico.