Clinical and Radiological Outcome in a Series of Patients Treated by Anterior Cervical Discectomy and Fusion: Retrospective Controlled Study With 2 Different Stand-Alone Cages.

BACKGROUND: Cervical spine balance and alignment targets after cervical spine surgery are poorly established in patients with cervical spine degenerative disease surgically treated by anterior cervical discectomy and fusion (ACDF). The objective of the study is to determine the correlation between radiological and clinical outcomes in patients surgically treated by ACDF with 2 different stand-alone cervical cages. METHODS: Clinical outcomes were evaluated using visual analog scale (VAS), Neck Disability Index (NDI), Nurick Scale, and Japanese Orthopedic Association score for myelopathy. Radiological evaluation included cervical and segmental Cobb angles, cervical sagittal vertical axis (cSVA), T1 slope (T1s), C0-C2 angle, fusion rates, adjacent segment degeneration, and cage subsidence. RESULTS: A total of 80 patients were included with an average age of 53 years. There was a statistically significant improvement in both clinical and radiological evaluations. There was a statistical significant correlation between cervical pain on cervical VAS and cSVA. There was a significant correlation between postoperative T1s and cSVA, related to the improvement in cervical angles. There was no significant difference in rates of fusion, adjacent segment changes, or reoperation between both cervical cages, and there was a higher rate of subsidence in the Aleutian group. There were significant differences between both groups on postoperative NDI and VAS, but this difference is not maintained during follow-up. CONCLUSIONS: Cervical sagittal balance is directly related to clinical outcome in patients with cervical spine degenerative disease. Both cervical implants analyzed were comparable in clinical and radiological outcomes. CLINICAL RELEVANCE: There are important clinical and radiological parameters that should be taken into account for the analysis of the surgical outcome of patients treated by ACDF; this is one of the few studies that report the results with 2 different cervical cage designs.

Equations to establish a regression between current units with respect to patient`s age and the use time of cochlear implants.

OBJECTIVE: Propose a system of multivariate multiple regression equations in order to establish a mathematical association that allows estimating the current units needed during the adjustment phase with respect to age and time that were used the implants. METHOD: Descriptive cross-sectional study. A total of 41 pediatric patients with a unilateral cochlear implant participated. Three groups were formed and multivariable multiple regression equations were constructed. RESULTS: For Group 1, in electrode Groups 3 and 4, there is a lower standard deviation and a similar index of asymmetry of the current units; in Group 2, the groups of electrodes with similar index of asymmetry were 2 and 4, while group of electrodes 3 presented average of 21.54 and dispersion smaller (16.25); in Group 3, groups of electrodes 3 and 4 presented similar standard deviation and average and smaller standard deviation. With respect to the standard estimation error, the lowest variability of current units was obtained in Group 2 for electrode Group 3. CONCLUSION: The proposed equations could be used in the clinical area by knowing the units current needed with respect to age and time of use the implant.

OBJETIVO: Proponer un sistema de ecuaciones de regresión múltiple multivariable para establecer una asociación matemática que permita estimar las unidades de corriente necesarias durante la fase de ajuste con respecto a la edad y el tiempo de uso del implante coclear. MÉTODO: Estudio transversal descriptivo. Participaron 41 pacientes pediátricos con implante coclear unilateral. Se conformaron tres grupos y se construyeron ecuaciones de regresión múltiple multivariable. RESULTADOS: Para el grupo 1 se observa en los grupos de electrodos 3 y 4 menor desviación estándar y similar índice de asimetría de las unidades de corriente; en el grupo 2, los grupos de electrodos con similar índice de asimetría fueron el 2 y el 4, y el grupo de electrodos 3 presentó un promedio de 21.54 y una dispersión más pequeña (16,25); en el grupo 3, los grupos de electrodos 3 y 4 presentaron similar desviación estándar y promedio y desviación estándar más pequeños. Con respecto al error estándar de estimación, se obtuvo una menor variabilidad de unidades de corriente en el grupo 2 para el grupo de electrodos 3. CONCLUSIÓN: Las ecuaciones propuestas son de utilidad clínica al conocer las unidades de corriente necesarias considerando la edad y el tiempo de uso del implante coclear.

Propuesta para la determinación del cambio de velocidad, velocidad instantánea y aceleración con base en el puntaje APACHE II en pacientes en estado crítico / Proposal for the determination of velocity change, instantaneous velocity and aceleration from the APACHE II score in critically ill patients / Proposta para a determinação da mudança de velocidade, velocidade instantânea e aceleração baseada no escore APACHE II em pacientes críticos

Resumen: Las herramientas de evaluación de la gravedad en el enfermo grave proporcionan información objetiva intra e interobservador relacionada con la gravedad de la enfermedad, su evolución en relación al tiempo y la estratificación de riesgo son parte fundamental en la toma de decisiones. El objetivo de este trabajo es presentar una nueva propuesta de la evaluación del APACHE II basada en un modelo matemático de cambio en el tiempo/velocidad, velocidad instantánea y aceleración.

Abstract: The illness severity scoring systems provide objetive measures for inter and intra comparisons with time, provide useful information for comparing the severity of illness are an essencial part of the improvment in clinical decisions and in stratifying patients. Appropiated application of these models helps in decision making at the right time. The aim of this paper is to submit a proposal for the evaluation of the APACHE II score based on a vectorial mathematical model of chance in time/velocity, instant velocity and aceleration.

Resumo: Os instrumentos de avaliação da gravidade do paciente grave fornecem informações objetivas intra e interobservadores relacionadas à gravidade da doença, sua evolução em relação ao tempo, estratificação de risco são fundamentais para tomada de decisão. O objetivo deste trabalho é apresentar uma nova proposta para a avaliação do APACHE II baseada em um modelo matemático de mudança de tempo/velocidade, velocidade instantânea e aceleração.

Vigilancia neurofisiológica transoperatoria multimodal en cirugía de columna / Neurophysiological monitoring in spinal cord surgery

Introducción: La vigilancia neurofisiológica durante la cirugía de columna vertebral y de la médula espinal consiste en pruebas de potenciales evocados somatosensoriales, potenciales motores musculares, potenciales dermatomales y electromiografía. El riesgo de daño neurológico permanente después de una cirugía medular sin monitorización es significativo y el costo alto. El objetivo de la vigilancia neurofisiológica es identificar, prevenir y corregir de forma inmediata el daño neurológico que puede pasar inadvertido durante la cirugía de columna vertebral y médula espinal. Material y métodos: Estudio transversal, observacional y descriptivo de los pacientes sometidos a cirugía de columna entre 2007 y 2008 con vigilancia neurofisiológica transoperatoria. Resultados: La muestra estuvo integrada por 351 pacientes, 135 del sexo masculino (38.46 %) y 216 del femenino (61.54 %); 82 % correspondió a patología osteodiscal con o sin afectación medular, 12 % a etiología traumática, 4 % a corrección de escoliosis y 2 % a tumores medulares; por localización, 62.1 % a patología lumbar, 33 % a cervical, 4.3 % a nivel dorsal y 0.5 % a nivel sacro. El 12.4 % de los pacientes presentó mejoría de la respuesta basal de sus potenciales evocados somatosensoriales; 56.8 % los mantuvo similares a sus controles prequirúrgicos, 28.4 % requirió llamada de alerta al cirujano por riesgo de daño y 2.4 % caída severa de respuesta. En ningún caso hubo pérdida permanente. Conclusiones: La vigilancia neurofisiológica constituye una herramienta de gran valor que evita daños que pueden producirse durante esta cirugía.

BACKGROUND: Intraoperative neurophysiological monitoring (IOM) during spine surgery consists of several functional tests including somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), dermatomal potentials (DPs) and EMG (electromyography). Permanent neurological damage after spine surgery performed without intraoperative neurophysiological monitoring is frequent and often very costly. The main goal of IOM is the immediate detection, prevention and correction of neurological damage during surgery, which may go unnoticed without using these tests. METHODS: A total of 351 clinical files of patients with spinal surgery and continuous neurophysiological monitoring were transversally and descriptively reviewed from 2007 to 2008. RESULTS: There were 135 male patients (38.46%) and 216 female patients (61.54%); 82% of the cases were osteodiscal pathology with or without medullar involvement, 12% were patients with traumatic injuries, 4% with scoliosis and 2% had medullary tumors. Regarding localization, 62.1% were lumbar, 33% cervical, 4.3% thoracic and 0.5% sacral involvement; 12.4% of our cases showed significant improvement of the basal responses on SSEPs, and 56.8% showed no significant change during the procedure. In 28.4% of the cases, the surgical team had to be advised of potential neurological damage and in 2.4% there was absence of neurophysiological responses. No patient showed complete loss of any neurophysiological response. All patients reported clinical improvement after hospital discharge. CONCLUSIONS: Intraoperative neurophysiological monitoring may help avoid certain neurological risks during spine surgery, which may go unnoticed without the use of this technique.