Retiro de aguja intradural en la columna toracolumbar. Reporte de un caso / Spinal needle removal in the thoracolumbar spine. Case report

La presencia de elementos extraños dentro del canal raquídeo es infrecuente y no hay claro consenso respecto de su tratamiento. Las publicaciones sobre fragmentos de proyectil de arma de fuego intracanal recomiendan la exéresis de los fragmentos ante la posibilidad de migración, sobre todo, cuando están en una zona próxima al cono medular. Se debería proceder del mismo modo ante una aguja dentro del canal espinal. Presentamos a una paciente con dolor radicular invalidante provocado por un fragmento de aguja dentro del canal espinal luego de una cesárea. Nivel de Evidencia: IV

The presence of foreign elements within the spinal canal is rare and there is no clear consensus regarding its treatment. The publications on intracanal firearm projectile fragments recommend exeresis of the fragments due to the possibility of migration, especially when they are in an area close to the medullary cone. The same procedure should be applied to a needle inside the spinal canal. We present a patient with disabling radicular pain caused by a needle fragment within the spinal canal after cesarean section. Level of Evidence: IV

Reproductibilidad del ángulo de Cobb en imágenes digitales obtenidas por fotografía de espinogramas de 30 X 90 cm. en escoliosis del adulto: comparación entre dos observadores y tres cámaras digitales / Reliability analysis for coronal Cobb angle measurements of digitally acquired photograph to the 30 X 90 cm. films in adult scoliosis: comparison among two observers and three digital cameras

Introducción: La fotografía digital de radiografías puede generar distorsiones angulares en las imágenes. No está publicado si estas alteraciones pueden afectar las mediciones de los ángulos de Cobb. Objetivo: Evaluar la reproducibilidad del ángulo de Cobb con la fotografía digital de espinogramas de 30 x 90 cm en escoliosis del adulto. Materiales y Métodos: Se eligieron al azar 20 espinogramas preoperatorios de pacientes con escoliosis del adulto para evaluar prospectivamente. Los espinogramas fueron escaneados y sus imágenes digitales se consideraron como controles. Se analizó la discrepancia intraobservador, interobservador, intercámara e intracámara, con tres cámaras digitales y dos observadores que realizaron ocho sesiones fotográficas a cada espinograma. Se midieron los ángulos con Adobe Photoshop® sobre las imágenes digitales y se los analizó con el coeficiente de correlación de Pearson. Resultados: El promedio de los ángulos de Cobb torácicos y lumbares del escáner, las cámaras 1, 2 y 3 fue de 37,9; 37,8; 37,7; 37,5; 53,2; 53,1; 53,3; 52,9, respectivamente. La correlación interobservador e intraobservador fue extremadamente alta, así como entre las cámaras y el escáner. Conclusión: El ángulo de Cobb se puede medir luego de la fotografía digital de espinogramas de 30 x 90 cm, con alta reproducibilidad entre diferentes cámaras y observadores.

Background: Digital photography to radiographs can generate angular distortions to the images. It is not published if these distortions can affect the lines used for Cobb measurements in routine practice. Objective: To analyze reliability for coronal Cobb angle measurements of digitally acquired photograph to the 30 x 90 cm plain films in adult scoliosis. Methods: Twenty anteroposterior long-cassette scoliosis radiographs from adult patients who were operated on in one institution were randomly selected and prospectively studied. The endplates of the curves were selected and marked by one observer. The radiographs were scanned and the digital images were used as controls. The variability of the measurements was evaluated with three digital cameras and two observers making eight photographic sessions to each long-film. Over the digital images the Cobb angles were measured using Adobe Photoshop® and they were analyzed with the Pearson correlation coefficient. Results: The overall mean thoracic and lumbar Cobb angles for the scanned, camera 1, 2 and 3 were 37.9, 37.8, 37.7, 37.5, 53.2, 53.1, 53.3, 52.9, respectively. The interobserver and intraobserver agreement was extremely high, as well as across cameras and scanner. Conclusion: The Cobb angle can be measured after digitally photographed films with high reliability among different cameras and observers.

Risk factors for pulmonary complications after spine surgery.

STUDY DESIGN: Registry study with prospectively collected data Objective: To determine risk factors for pulmonary complications in spine surgery. METHODS: The Spine End RESULTS Registry 2003-2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, and comorbidities, surgical invasiveness and adverse outcomes were prospectively recorded. The primary outcome measure was the occurrence of a pulmonary complication following surgery. Univariate relative risks and 95% confidence intervals for each of the risk factors were determined. Multivariate log binomial regression analysis was performed to investigate the association between each risk factor and a pulmonary complication, while controlling for other important risk factors. RESULTS: Altogether, there were 199 pulmonary complications after spine surgery. The cumulative incidence of a respiratory complication after spine surgery was 9% (144 patients). Multivariate analysis suggested gender, chronic obstructive pulmonary disease, congestive heart failure, diabetes, age, diagnosis, surgical invasiveness and surgery in the thoracic spine are significant risk factors for pulmonary complications after spinal surgery. CONCLUSIONS: The results of the present study suggest numerous statistically significant risk factors for pulmonary complications after spine surgery. These results may aid the clinician with preoperative risk stratification and patient counseling. [Table: see text] The definiton of the different classes of evidence is available on page 73.