RESUMO
PURPOSE: Main question The aim of this study is to describe and analyze the frequency of acute perioperative (intraoperatively and 30 days after) complications of open/MISS thoracolumbar spine surgery. Secondary questions A) Describe the treatment of choice for every kind of complication mentioned. B) Perform a bibliographic search and compare the complications described and their frequency with those studied in the manuscript. METHODS: A retrospective cohort of 816 patients undergoing spinal surgery over a two year period was analyzed. Acute complications of 59 patients are described whether those with a greater number of levels required longer periods of hospitalization. RESULTS: The frequency of acute complications was 7.2%. The most common was infection (2.7%), followed by dural tear (1.7%), and screw malpositioning (1%), which is consistent with the current literature. No statistically significant results were observed when comparing the mean length of hospital stay among patients operated on a greater number of levels compared to the rest (P: 0.344; 95% CI: -3.88-10.93). CONCLUSIONS: The subsidiary patient of spinal surgery is getting older and has more comorbidities, and therefore, has a higher risk of complications. Although there are models predicting the risk of complications, they are not used in routine clinical practice. It would be necessary to unify the main criteria and establish guidelines for risk detection and therapeutic algorithms based on new high-quality studies.
Assuntos
Fusão Vertebral , Humanos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Procedimentos Neurocirúrgicos/métodos , Descompressão Cirúrgica/métodos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Vértebras Lombares/cirurgiaRESUMO
Cervical spine injury is rare in children. It is seen primarily in those who sustain significant, severe blunt trauma, occurring in 1 to 2 percent of such cases. The interpretation of cervical spine radiographs and the clinical examination in children may be difficult.The objective of this case clinic is to report on a physiological radiographic finding of the cervical spine in childhood that trends to be misjudged as pathologic: C2-C3 pseudosubluxation. We presented a boy, aged 5 years, who came to our Traumatic pediatric emergency center for cervical pain after falling from a height. In lateral radiographs we observed a disruption of the alignment of the anterior and posterior vertebral body line in C2-C3 space. A detailed anamnesis as well as a meticulous radiological and clinical exploration, allow to establish the right diagnosis in most cases, without any other complementary probe. Pseudosubluxation of C2 anterior to C3 is seen in approximately 40 percent of children under the age of 8 years. Pseudosubluxation can be differentiated from true subluxation by evaluating the spinolaminal line (Swischuk), line between the anterior aspects of the C1 and C3 spinous processes. The suitable radiographic interpretation of the cervical spine in children requires the knowledge of the peculiarities of this segment in the pediatric age.
Las lesiones traumáticas de la columna cervical son infrecuentes en los niños, representando el 1% de las fracturas pediátricas y el 2% de todas las lesiones raquídeas.Es importante conocer que la columna cervical en la infancia presenta variaciones anatómicas que en ocasiones pueden interpretarse como patológicas ya que en los niños una adecuada exploración física muchas veces puede ser complicada.El objetivo de este caso clínico es mostrar un hallazgo radiológico fisiológico de la columna cervical infantil que tiende a ser malinterpretado como patológico: la pseudosubluxación C2-C3.Se presenta un caso de un niño de 5 años de edad que acude a urgencias de traumatología pediátrica de nuestro centro por dolor cervical tras caída desde un tobogán. Se realizan radiografías cervicales de urgencias observando una disrupción de la línea cervical anterior y posterior entre C2 y C3. Una adecuada anamnesis junto con un meticuloso examen clínico y radiológico permite su correcto diagnostico sin necesidad de otras pruebas complementarias. La pseudoluxación anterior de C2 sobre C3 se puede estar presente en el 40% de los niños menores de 8 años. Este hallazgo puede diferenciarse de la luxación traumatic valorando la línea espinolaminar o línea de Swischuk, línea entre el borde anterior de las apófisis espinosas de C1 a C3. La interpretación adecuada de las radiografías de la columna cervical en la infancia requiere del conocimiento de estas variantes radiológicas y de las peculiares características de este segmento vertebral en la edad pediátrica.
