RESUMO
BACKGROUND: Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. MATERIAL AND METHOD: A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. RESULTS: 7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001. CONCLUSIONS: Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI.
Assuntos
Vértebras Cervicais/cirurgia , Fixadores Internos , Estenose Espinal/cirurgia , Adulto , Placas Ósseas , Feminino , Seguimentos , Humanos , Lordose/diagnóstico por imagem , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , TitânioRESUMO
Las alteraciones esqueléticas del macizo facial sin tratamiento quirúrgico o con un manejo inadecuado, pueden resultar en deformidad secundaria importante con implicaciones estéticas y funcionales que deben ser consideradas para su tratamiento. El objetivo de esta presentación fue caracterizar el caso de deformidad facial postraumática asociada a complicación por silastic orbitario, 35 años después de implantado este. Se trata de un paciente masculino de 67 años que refirió haber sido tratado al presentar enrojecimiento de un ojo y secreciones. Refiere que hace 35 años fue intervenido quirúrgicamente por fractura en la zona del ojo izquierdo, que le colocaron silastic, y que no había tenido problemas hasta el momento en esa área. En el examen físico facial se detectó asimetría facial: ligero enoftalmo del ojo izquierdo, con desnivel pupilar, disminución de la apertura palpebral, rasgo antimongoloide, con eritema de la conjuntiva, quémosis, y abundantes secreciones. Se comprobó limitación del movimiento súpero-externo. Se corrobora la presencia de una fístula en el fondo de saco del párpado inferior. Se diagnostica como deformidad facial postraumática complicada por reacción a cuerpo extraño (al silastic). Fue intervenido quirúrgicamente y se realizó la exéresis del material, y la reconstrucción de la antomía ausente en la zona con malla de titanio. Se obtuvo excelentes resultados. Las lesiones postraumáticas de la cara se asocian generalmente con grandes secuelas funcionales y estéticas. Si se añaden las complicaciones por el empleo de implantes de biomateriales, la determinación de la conducta terapéutica puede ser un reto(AU)
Skeletal facial alterations not treated surgically or inappropriately handled may result in considerable secondary deformity with esthetic and functional implications which should be considered for treatment. The purpose of the study was to characterize a case of post-traumatic facial deformity associated with a complication caused by orbital silastic 35 years after implantation. A male 67-year-old patient reported having been treated for redness of one eye and secretion. Thirty-five years before he had been operated on for a fracture in the area of the left eye. Silastic had been implanted and he had not had any problems until now. Physical examination revealed facial asymmetry: slight enophthalmos of the left eye with pupillary unevenness, reduced palpebral opening, antimongoloid feature, conjunctival erythema, chemosis and abundant secretion. Upper-outer movement was limited. A fistula was found in the bottom of the lower palpebral sac. It is diagnosed as post-traumatic facial deformity complicated by reaction to foreign body (silastic). Surgery was performed to remove the material and reconstruct the missing anatomy in the area with titanium mesh. Excellent results were obtained. Post-traumatic facial lesions are generally associated with large functional and esthetic sequelae. When complications are added due to the use of biomaterial implants, determination of the appropriate therapeutic management can be a challenge(AU)
Assuntos
Humanos , Masculino , Idoso , Fraturas Orbitárias/cirurgia , Telas Cirúrgicas/estatística & dados numéricos , Materiais Biocompatíveis/efeitos adversos , Reação a Corpo Estranho/cirurgia , Reação a Corpo Estranho/complicaçõesRESUMO
Maxillary reconstruction is a common procedure in maxillofacial surgery; for this purpose is used autogenous bone, alloplastic bone or another one with different results. In all of them, traditionally the use of computed tomography is used to make the surgical plan, however, 3D models are not used frequently. This report show a new application of the stereolithography to anticipate the surgical treatment of maxillary reconstruction, using a titanium mesh and rhBMP-2 to obtain a predictable surgical result with diminished surgical time.
La reconstrucción maxilar es un procedimiento común en cirugía maxilofacial; para este propósito es utilizado hueso autógeno, hueso aloplástico u otro tipo de hueso con diferentes resultados. En todos ellos, tradicionalmente el uso de tomografía computadorizada se emplea para elaborar el plan quirúrgico, sin embargo, los modelos 3D no son utilizados con frecuencia. Este reporte presenta una nueva aplicación de la estereolitografia para anticipar el tratamiento quirúrgico de la reconstrucción maxilar, usando una malla de titanio y rhBMP-2 para obtener un resultado quirúrgico predecible con disminución del tiempo quirúrgico.