Neurological injury as a complication of spinal surgery: incidence, risk factors, and prognosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess the rate, injury site, aetiology and outcomes in elective spinal surgery patients who sustained a spinal cord injury (SCI). SETTING: SCI national centre Toledo, Spain. METHODS: The study sample included patients who sustained an SCI after elective spinal surgery from 2013 to 2017. Oncological patients and patients receiving interventional therapies were excluded. Data collected included: demographics, aetiology, precipitating cause, injury mechanism, injury site, neurological status (AIS), SCIMIII at admission and discharge, hypertension, diabetes mellitus, obesity, dyslipidemia, depression and hospital length of stay. RESULTS: One thousand two hundred and eighty-two patients were admitted in this period of whom 114 met the inclusion criteria with a median (IQR) age of 58 (45-69) years; 46% female. The prevalence of SCI as a complication following spinal surgery in the total number of patients admitted to our centre was 9%. In 43%, the injury was to the dorsal spine with T12 being the most common neurological level of injury (20% of cases following laminectomy secondary to spinal canal stenosis). The most frequent precipitating cause was epidural haematoma (38% of cases). The median (IQR) SCIMIII scores at admission and discharge were (31) points (20-54) and (67) points (34-81), respectively. General AIS at admission were C (35%) and D at discharge (54%). The presence of hypertension, diabetes mellitus, obesity and dyslipidemia adjusted by age was not linked to a higher complication rate. The median (IQR) hospital length of stay was 120 days (60-189). CONCLUSION: In total 8.9% of patients admitted with SCI were the result of elective spinal surgery.

Is a specific drinking pattern a consistent feature of the Mediterranean diet in Spain in the XXI century?

BACKGROUND AND AIM: Over the last 50 years, people in Spain have increasingly been eating their main meal away from home and are shifting from the typical Mediterranean diet (MD). In addition, wine consumption has decreased whereas beer intake has risen. Consequently, it is uncertain if the Mediterranean drinking pattern (MDP; moderate alcohol intake mainly from wine and during meals) is a habitual feature of the MD today. METHODS AND RESULTS: Cross-sectional study conducted from 2008 to 2010 among 8894 individuals representative of the Spanish population aged 18-64 years. Consumption of alcoholic beverages and food was collected with a validated diet history. Accordance with the MD was defined as a score ≥8 on the Mediterranean Diet Adherence Screener (MEDAS) or ≥5 in the Trichopoulou index (after excluding alcohol intake from both indices). Among individuals with MEDAS-based MD accordance, only 17.1% had a MDP. After adjustment for potential confounders, this drinking pattern showed a weak association with higher MD accordance (odds ratio (OR) 1.32; 95% confidence interval (CI) 1.12-1.57). Only 14.7% of those with Trichopoulou-based MD accordance had a MDP; this pattern showed an even weaker association with higher MD accordance (OR 1.17; 95% CI 1.01-1.36). Similar results were obtained when this drinking pattern was redefined to include persons who drank wine with or outside of meals, as well as those who were primarily beer drinkers. CONCLUSIONS: The MDP is not a habitual feature of the MD in the early XXI century in Spain.

SCIWORA in children. A rare clinical entity: Ambispective study. / SCIWORA. Una rara entidad clínica en la población pediátrica. Estudio ambispectivo.

INTRODUCTION: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.

[Translated article] SCIWORA in children. A rare clinical entity: Ambispective study.

INTRODUCTION: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P=0.872), age and MRI spinal cord findings (P=0.149) were found in SCIWORA patients.

[Translated article] Effects of duroplasty with bovine pericardium on fibrosis and extent of spinal cord injury: An experimental study in pigs.

INTRODUCTION: Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity. MATERIALS AND METHODS: Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1) control injury with dural reparative microsurgery, (2) duroplasty using bovine pericardium (BPD), and (3) previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods. RESULTS: In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA. CONCLUSIONS: Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair.

[Translated article] Efficacy of early versus delayed spinal cord decompression in neurological recovery after traumatic spinal cord injury: Systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare early (<24h) versus late (>24h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. METHODS: A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. Prospective cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the "forest plot" graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. RESULTS: Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events. Five studies showed significant differences in favour of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. CONCLUSION: There is scientific evidence to recommend early decompression in the first 24h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

Effects of duroplasty with bovine pericardium on fibrosis and extent of spinal cord injury: An experimental study in pigs. / Efecto de la reparación de la duramadre con pericardio bovino sobre la fibrosis y la extensión de la lesión medular: estudio experimental en cerdos.

INTRODUCTION: Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity. MATERIALS AND METHODS: Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1)control injury with dural reparative microsurgery, (2)duroplasty using bovine pericardium (BPD), and (3)previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods. RESULTS: In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA. CONCLUSIONS: Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair.

Efficacy of early versus delayed spinal cord decompression in neurological recovery after traumatic spinal cord injury: Systematic review and meta-analysis. / Eficacia de la descompresión medular precoz versus tardía en la recuperación neurológica tras lesión medular traumática. Revisión sistemática y metaanálisis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare early (<24h) versus late (>24h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. METHODS: A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. Prospective cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the «forest plot¼ graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. RESULTS: Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events. Five studies showed significant differences in favor of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. CONCLUSION: There is scientific evidence to recommend early decompression in the first 24h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

Relation between the volume of injected cement and the vertebral volume in the clinical outcome and in the appearance of leakage after a percutaneous vertebroplasty. / Relación entre el volumen de cemento inyectado y el volumen vertebral en el resultado clínico y en la aparición de fugas tras vertebroplastia percutánea.

OBJECTIVES: To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. MATERIALS AND METHODS: A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). RESULTS: The average vertebra volume was 26.1 cc, the average volume of the injected cement was 2.0 cc and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. CONCLUSIONS: The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

[Translated article] Relation between the volume of injected cement and the vertebral volume in the clinical outcome and in the appearance of leakage after a percutaneous vertebroplasty.

OBJECTIVES: To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. MATERIALS AND METHODS: A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). RESULTS: The average vertebra volume was 26.1cm3, the average volume of the injected cement was 2.0cm3 and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. CONCLUSIONS: The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

Anaesthetic considerations for elective cesarean section in a patient with a giant Tarlov cyst.

Tarlov cysts are a pathological dilatation of the meninges. Their incidence is more frequent in women between 30 and 50 years of age. The imaging test of choice for diagnosis is MRI. Of unknown etiology, most cases are asymptomatic, but symptoms of radicular irritation, among others, may occur. The therapeutic possibilities are multiple, reserving surgical excision as the last option. We report a case of successful spinal anaesthesia for elective cesarean section in a patient with a giant Tarlov cyst but with potential airway compromise, in whom the risks of general anaesthesia would be increased. Anaesthetic management presents a challenge for the anesthesiologist, especially in situations where the patient presents an increased anaesthetic risk for general anaesthesia, as is the case in the obstetric patient.

Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Cross-National Comparison in Six European Countries (2008-2015).

Aims: To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Methods: Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008-2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases. Results: The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases. Conclusion: Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH).

Post-Traumatic Clinodactyly of the Little Finger in Basque Hand-Pelota Players. / Clinodactilia postraumática del meñique en el pelotari manista.

OBJECTIVE: The aim of this study is to measure the DIP joint angle of the little finger and presence of degenerative changes in the DIP joint in Basque hand-pelota players and compare it with the general Spanish population. MATERIAL AND METHODS: Cross-sectional study. We studied both hands of 40 male Basque pelota players (pelotaris) and 20 male controls. The assessment protocol consisted of a questionnaire, physical examination and bilateral plain radiographs. Distal interphalangeal (DIP) joint angle was measured on plain radiographs in both hands. RESULTS: The average DIP joint angle of the little finger in the control group was 2.6° in the dominant hand and 2.9° in the other hand. In the pelota players group we obtained a DIP angle of 6.8° in the dominant hand and 10.9° in the non-dominant hand. The DIP angle was significantly higher in the non-dominant hand (P=.002) in the pelota player group. Non-significant differences were obtained between both hands in the control group (p=.572). Significant differences were obtained in both player and control groups in the dominant hand (P=.001) and in the non-dominant hand (P=.001). Pelota players have a higher DIP angle in the little fingers than the control group. No differences were found in the pelota player group according to their position on the court (P=.742 forward, P=.747 defender) or sport level (P=.345 amateur, P=.346 professional). DISCUSSION: Basque hand-pelota produces post-traumatic acquired clinodactyly of the little finger. The non-dominant hand has a higher DIP joint angle. Clinodactyly poses no functional problems.

SCIWORA. Una rara entidad clínica en la población pediátrica. Estudio ambispectivo / SCIWORA in children. A rare clinical entity: Ambispective study

Introducción: La lesión medular tipo SCIWORA es una entidad clínica con baja incidencia y alta repercusión funcional. El objetivo del estudio es la descripción epidemiológica de esta lesión y su evolución funcional con un seguimiento medio de 10 años. Material y métodos: Estudio analítico, longitudinal, de cohortes ambispectivo. Fueron evaluados 13 pacientes con el diagnóstico de SCIWORA en el periodo de estudio 2001-2022. Variables evaluadas: edad, sexo, días hasta la lesión medular, causa de lesión, imagen medular en la RM postraumatismo, nivel neurológico de lesión, ASIA ingreso/alta/5 años, SCIM III ingreso/alta/3 años, tipo de tratamiento empleado, empleo de terapia NASCIS III ingreso, tiempo de hospitalización, seguimiento medio. En octubre del 2022 fueron nuevamente evaluados en consultas externas mediante: cuestionario de discapacidad cervical (NDI)/Oswestry y cuestionario de calidad de vida validado en castellano para lesionados medulares (SV-QLI/SCI). Resultados: La mediana de edad fue de 4 años, 77% varones. El 54% de las lesiones corresponden a nivel cervical. El ASIA al ingreso fue del 31% A y del 31% C, nivel neurológico: C2 (22%) y T10 (15%), tráfico como causa de lesión (77%), SCIM III ingreso/alta: 28,5/42. La estancia media hospitalaria fue de 115 días. NDI: 11,6 y Oswestry: 15,3. Conclusión: El 77% de los SCIWORA se producen en menores de 8 años. Al año del alta hospitalaria un 31% de los pacientes fueron catalogados como ASIA D y a los 5 años el porcentaje se mantiene constante. No se encontraron diferencias significativas entre la causa de la lesión y tipo de alteración en RM (p = 0,872), ni entre la edad y el tipo de lesión medular objetivada en RM (p = 0,149).(AU)

Introduction: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. Material and methods: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. Results: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. Conclusions: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.(AU)

Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up. / ¿Supone la presencia de cambios Modic en pacientes con dolor lumbar crónico una peor evolución clínica y una mayor posibilidad de precisar cirugía? Evolución a 10 años.

OBJECTIVE: Establish the long-term (10 years) predictive value of Modic changes in the course of lumbar pain and the need for surgical treatment. MATERIAL AND METHOD: Observational longitudinal prospective cohort study. Comparison of progression at 10 years of 2 groups of patients with chronic lumbar pain: group A with Modic changes in MRI and group B with no Modic changes. EXCLUSION CRITERIA: neoplasia, inflammatory or infectious diseases, or previous surgery. Assessment was done with the aid of the VAS for low lumbar and radicular pain and the Oswestry Disability Questionnaire. The need for surgical or medical treatment and occupational disability during the study period was analyzed. For the statistical analyses, the Mann-Whitney U test and logistic regression were applied. RESULTS: Seventy patients, 24 male and 46 female, with a mean age of 56.5 years (35 in each group) were included in the study. No statistically significant differences in the intensity of lumbar pain, degree of impairment, or need for medical or surgical treatment (P>.05) were found in patients with Modic changes types 1, 2, or 3 between the baseline assessment and 10 years after. No statistically significant differences between patients with/without changes in Modic at 10 years of follow-up (P>.05) were determined. CONCLUSIONS: There is no relationship between Modic changes in MRI and greater intensity of lumbar pain or need for medical or surgical treatment at 10 years of follow-up. Modic changes cannot be considered a sign of bad prognosis by themselves, or an indication for surgery.

Surgical treatment of hip ankylosis due to heterotopic ossification secondary to spinal cord injury. / Cirugía de la anquilosis de cadera por osificación heterotópica secundaria a lesión medular.

OBJECTIVES: To expose our experience in the diagnostic and surgical treatment of neurogenic heterotopic ossification of the hip. MATERIAL AND METHODS: We designed an observational retrospective descriptive study including 20 patients (30 hips) with neurogenic heterotopic ossification of the hip secondary to spinal cord injury attended in our institution in the last 10 years, with a minimum of one year follow-up. Medical files and imaging studies were reviewed. The study variables analyzed were: type and localization of neurogenic heterotopic ossification, pre-post excision range of motion, level and aetiology of spinal cord injury, ASIA score, smoking history, surgical approach and complications associated with surgery. RESULTS: A total of 20 patients were treated with resection of heterotopic ossification in 30 hips. 16 patients presented ASIA A spinal cord injury and 4 ASIA B spinal cord injury. Preoperatively all the patients had severe ankylosis in the hip that made sitting in a wheel chair and activities such as repositioning and hygiene difficult. The average postoperative motion at the follow-up evaluation was 90° in flexion, 20° of internal rotation and 40° of external rotation. Immediately after surgery all the patients followed a specific intensive physiotherapy regime for the hip and celecoxib 200 mg was administrated daily orally for a month to prevent recurrence of heterotopic bone formation. None of the patients reviewed suffered a recurrence of heterotopic bone formation. CONCLUSIONS: Surgical excision of hip ossification in order to achieve functional ROM of the hip is the best treatment for patients with neurogenic heterotopic ossification of the hip.

Prevalencia e incidencia de sobrepeso y obesidad en 2, 5 millones de niños y adolescentes en España / The prevalence and incidence rate of overweight and obesity among 2.5 million children and adolescents in Spain

Introducción y objetivos: Las tendencias de la obesidad infantil se están estancando en España, pero hay poca información sobre las diferencias por comunidad autónoma. Este estudio evaluó en 8 comunidades autónomas la prevalencia y la incidencia de sobrepeso y obesidad en niños y adolescentes entre 2005-2017. Métodos: Este estudio longitudinal utilizó las determinaciones de estatura y peso de 2,5 millones de niños de 2-17 años para calcular el sobrepeso y la obesidad según las guías de la OMS. Los datos proceden de 2 bases de datos de historias clínicas electrónicas: la Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria y el Sistema de Información para la Investigación en Atención Primaria. Se calcularon la prevalencia, la tasa de incidencia y las tendencias entre 2005-2017, y se estratificaron por edad, sexo y comunidad autónoma. Resultados: La prevalencia general de obesidad aumentó en niños y niñas desde los 2 años (0,8%; IC95%, 0,8-0,9% en ambos sexos) hasta alcanzar su punto máximo a los 7 años en las niñas (17,3%; IC95%, 17,1-17,5%) y a los 9 años en los niños (24,1%; IC95%, 23,9-24,3%). Las prevalencias de obesidad más altas y más bajas se observaron en Murcia y Navarra respectivamente. Las tendencias generales de la prevalencia de obesidad disminuyeron de 2005 a 2017 en todos los grupos de edad y sexo y en la mayoría de las comunidades autónomas. Las tasas de incidencia de obesidad más altas se encontraron en niños de 6-7 años (4,5 [4,5-4,5] y 3,5 [3,5-3,5] nuevos casos de obesidad cada 100 personas-año en niños y niñas respectivamente). Los niños tenían cifras de prevalencia e incidencia más altas que las niñas en todas las comunidades autónomas. Los valores de prevalencia e incidencia de sobrepeso/obesidad y sus tendencias fueron constantemente mayores que los de obesidad, aunque se observó un patrón similar según edad y sexo. Conclusiones: La prevalencia de sobrepeso y obesidad se redujo ligeramente en España (AU)

Introduction and objectives: Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. Methods: This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. Results: The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age.Conclusions: Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age (AU)

[Metal artifact reduction in post-operative spinal imaging using image acquisition protocol in multidetector computed tomography scans. Cohort study]. / Atenuación del artefacto metálico post cirugía de columna lumbar mediante protocolo de obtención de imagen en tomografía computarizada multicorte. Estudio de cohorts.

BACKGROUND: In postoperative patients with metallic implants, CT scans can become less effective due to metal-related arti-facts. The purpose of our study was to evaluate the effectiveness of a specific metal artifact reduction image protocol, in order to reduce the metal artifact caused by titanium pedicular screws in patients undergoing lumbar pathology by lumbar fusion. This enables surgeons to make an accurate diagnosis of the exact placement of inserted pedicle screws, making this the preferred image modality for assessing screw position after surgery. METHODS: In the first part of the study, CT scans were performed on 23 patients (103 titanium alloy pedicle screws) undergoing a lumbar instrumented fusion for treatment for degenerative disease with a standard image acquisition protocol evaluating the possible overdimension caused by the artifact. In the second part, a prospective study was performed using 64-slice multide-tector-row computed tomography (MDCT) on 18 patients (104 titanium alloy pedicle screws) undergoing a lumbar instrumented fusion using a specific image acquisition protocol. RESULTS: Our results show that in the sequential CT scan group, mean overdimension (on each side) due to brightness was 1.045 mm (SD 0.45). In the 64-slice multichannel CT group, mean overdimension (on each side) due to brightness was 0.005 mm at the proximal part of the screw and 0.025 mm at the distal part of the screw.

Coffee consumption as a factor in iron deficiency anemia among pregnant women and their infants in Costa Rica.

The influence of coffee consumption on hematological and trace element status was studied in two groups of pregnant, low-income Costa Rican women: coffee drinkers (greater than or equal to 450 mL/d, n = 22) and coffee nondrinkers (0 mL/d, n = 26). Groups had similar income, education, prenatal care, age, parity, weight, height, pregnancy weight gain, prenatal iron supplementation, energy, protein, Fe, and vitamin C intake and infant sex and gestational age. Maternal hemoglobin (Hb) and hematocrit (Hct) at 8 mo gestation, cord blood Hb and Hct, infant birth weight and Hb and Hct at 1 mo of age, and breast-milk Fe concentration were significantly lower in the coffee group than in the noncoffee group. The association of coffee with infant Hb and Hct was independent of maternal Fe status and birth weight. These results are consistent with our previously reported data in rats and indicate that maternal coffee intake may contribute to maternal and infant anemia.

[Evolution of the nutritional and food situation of the metropolitan area of San Jose, Costa Rica]. / Evolución de la situación alimentaria nutricional del area metropolitana de San José, Costa Rica.

Evolution of food and nutrient intake patterns in urban San José, Costa Rica, during the last decade, was studied comparing data from the last two national surveys (1978, 1982) and 1987 data obtained from 5 families previously included in the 1982 survey. Total food and nutrient intake was found to be similar to the 1982 results, although the pattern was altered, with a substantial decreased contribution of milk products to both energy and protein intakes. A small but constant decrease in the intake of more than half of the foods registered was also observed. Nevertheless, the nutritional adequacy of energy (from 100 to 78%), retinol (from 83 to 69%), riboflavin (from 94 to 63%), iron (from 106 to 69%) and niacin (from 103 to 81%), were found to be significantly lower than in previous years. The findings herein reported suggest that the effects of the economic crisis initiated in 1980 on food availability, could well be showing a time lag.