The Berbeo-Sardi Angle (BSA): An Innovative Method to Effectively Estimate Pelvic Retroversion in Anteroposterior Radiographs-A Correlation With Traditional Parameters.

STUDY: Design: Diagnostic studies-concordance between diagnostic tests. OBJECTIVES: The purpose of this study was to develop a novel spinopelvic parameter (Berbeo-Sardi angle [BSA], the angle formed at the intersection of a line that connects the inferior margin of the sacroiliac joint to the midpoint of a horizontal line joining both femoral heads) measurable in anteroposterior radiographs that indirectly estimates pelvic retroversion and correlates with traditional measurements like pelvic tilt (PT). SUMMARY: Sagittal balance appraisal and surgical planning rely on the interpretation of spinopelvic parameters. An increased PT reflects pelvic retroversion as a compensatory mechanism to limit sagittal imbalance and correlates with increased pain and disability. However, poor imaging techniques and incorrect patient positioning frequently hamper landmark identification in lateral radiographs, and with no measurable angles in anteroposterior radiographs, it is often impossible to determine PT and pelvic retroversion. METHODS: Whole-spine radiographs from 105 consecutive patients were used to retrospectively measure conventional spinopelvic parameters and the BSA. Intraclass correlation coefficient was used to assess a quantitative correlation between the PT and BSA as indirect measures of pelvic retroversion. RESULTS: Average values for pelvic incidence, lumbar lordosis, sacral slope, PT, and BSA were 46.5° (±10.23), 48.56° (±12.30), 29.97° (±9.77), 16.94° (±8.03), and 54.47° (±4.05), respectively. We encountered a moderately strong correlation (r = -0.66) between PT and BSA. Receiver operating characteristic plot analysis revealed that a BSA threshold of 46° has a sensitivity of 90% to identify pathologic PT values (>20°), whereas a BSA ≥60° has a specificity of 90% to rule out pelvic retroversion using anteroposterior radiographs. CONCLUSIONS: There is a moderately strong correlation between the BSA, an innovative spinopelvic parameter measurable in anteroposterior radiographs, and PT. BSA seems to show great promise in simplifying spinopelvic appraisal by easily estimating pelvic retroversion associated with sagittal imbalance, while avoiding image-quality issues often encountered in lateral radiographs. LEVEL OF EVIDENCE: Level III.

Minimally Invasive Posterior Trans-muscular C1-C2 Screw Fixation Through an Anatomical Corridor to Preserve Occipitocervical Tension Band: Surgical Anatomy and Clinical Experience.

The C1-C2 joint is affected by multiple entities that may produce biomechanical instability. Optimal management for atlantoaxial instability has been searched by ways of different surgical techniques with different results, generating discussion between second effects of a particular treatment. Lateral dissections can place the axial neck musculature and ligaments at risk of neural denervations or vascular compromise. Either of these entities may result in significant postoperative atrophy, pain, and instability. Minimally invasive techniques for the treatment of spinal disorders allow to our patients less morbid procedures with equal or better results compared to conventional surgery. In the following paper, we review the anatomy of the atlantoaxial joint and propose a minimally invasive trans-muscular C1-C2 fusion technique using C1 lateral-mass screws and C2 pedicular screws. We describe cases with surgical, clinical, and radiographic follow-up.

Monitoreo y manejo del trauma craneoencefalico severo / Severe Head injury: Monitoring and treatmet

Uno de los objetivos del tratamiento del TCE severo es optimizar la PPC así sea a través de llevar al paciente a una hipertensión hipervolémica. La base de este manejo es la cascada de la vasoconstricción donde una PPC adecuada disminuye el VSC y por consiguiente la PIC, mostrando que la autorregulación sigue funcionando en estos pacientes. Los pacientes con TCE severo necesitan un monitoreo completo que idealmente debe incluir línea arterial, PVC o PCP, SVjO, o PtiO, ETCO, SaO, y PPC. El drenaje de LCR se constituye como la primera medida para disminuir rápidamente las elevaciones espontáneas de la PIC. Los bolos de manitol tienen efectos hemodinámicos y reológicos beneficiosos en mejorar la PPC al disminuir la PIC. La posición de la cabecera, el uso de barbitúricos y la hipotermia siguen siendo controvertidos. El uso de estos métodos debe limitarse a la experiencia del grupo tratante del paciente