[Incidence of Modic degenerative changes in patients with chronic lumbar pain at Monterrey Regional ISSSTE Hospital]. / Incidencia de cambios degenerativos tipo Modic en pacientes con dolor lumbar crónico en el Hospital Regional ISSSTE Monterrey.

BACKGROUND: Several papers have studied the degenerative changes of endplates, but there are no publications referring to the Mexican population. OBJECTIVE: The purpose of the study is to report the incidence of Modic degenerative changes in the patients seen at the Spine Service, Monterrey Regional ISSSTE Hospital. Specific objectives are: to describe the type of Modic change and the most frequent location, to describe the degeneration patterns and to report the incidence of the various diagnoses made during 2009. METHODS: Incidence study using the MRI records at the Radiology Department, Monterrey Regional ISSSTE Hospital, interpreted blindly and independently by two observers. RESULTS: A total of 240 lumbar spine MRIs were reviewed, for a total of 1,200 intervertebral spaces. They were divided by age groups. Group I included 16 patients, Group II 32, Group III 80, and Group IV 112. No patients in Group I had Modic changes. Four patients (12.5%) in Group II had type II Modic changes with < 25% of endplate involvement. Eight patients in Group III had Modic changes with > 25% involvement of L4-L5 (10%); 32% of Group IV patients had changes, with L5-S1 as the most affected level. Most Modic changes (85%) were located in L4-L5 and L5-S1, with the latter as the most frequently affected level. Type I represented 5%, Type II 30%, and Type III 65%. The percentage of patients with Modic changes increased with age, which confirms that degenerative changes are age related. Morphologic disc changes are expressed as the percentage of affected patients in each group. Besides the severity of degeneration, the number of affected levels also increases with age. Thirty percent of patients ages 30-39 years have one or two degenerated levels, while 50% of those over age 50 have 3 or more degenerated levels. The most frequently degenerated level was L5-S1, followed by L4-L5 and L3-L4. The most frequent degeneration pattern was lower segment degeneration (L4-L5, L5-S1). A small proportion of patients over age 50 (4%) did not have disc degeneration, suggesting that age is not the only factor that determines their occurrence. CONCLUSIONS: The prevalence of Modic changes was 22% (52 patients). Eight patients had Type II Modic changes at two levels. The most affected levels were L4-L5 and L5-S1, in 85% of cases. Patients over 50 years of age were the most affected age group; frequency increased with age. The most frequent disc degeneration pattern was degeneration of the lower lumbar levels. Risk factors need to be further studied and the correlation with the degree of pain needs to be determined to obtain more information.

[Application of the ubiquicidin 29-41 scan in the diagnosis of pyogenic vertebral osteomyelitis]. / Utilidad de la gammagrafía con ubiquicidina 29-41 en el diagnóstico de osteomielitis piógena de columna vertebral.

BACKGROUND: The non-invasive diagnosis of vertebral osteomyelitis is a difficult one. Studies confirm MRI as the gold standard with 92% sensitivity and 94% specificity. Scintigraphy combined with Tc99-Ga67 used to be the procedure of choice before the advent of PET with labeled glucose, which has a high sensitivity and specificity, but cannot distinguish a focus of infection from inflammation. Scintigraphy with UBI29-41 is an infection-specific study that was recently described in the literature. There are no studies showing its value in the diagnosis of vertebral osteomyelitis. OBJECTIVE: The purpose of the study is to show that the Tc99-UBI29-41 scan has 99% sensitivity for vertebral osteomyelitis. METHODS: This is a study of a diagnostic test. The case series was composed of the records of UBI scans performed at the Nuclear Medicine Department, HcHMAE. The scans were interpreted in a blind and independent fashion by 2 experienced observers. The final diagnosis was obtained with the histopathologic study or a microbiologic culture or with the clinical findings after a follow-up of at least 6 months. The sensitivity, specificity, positive and negative predictive values, and the positive and negative probability ratio were determined, always using a 95% confidence interval (CI). The sample size necessary to show 99% sensitivity with a 95% CI and a statistical power of 80% was 15 patients. The concordance with the kappa index was determined. RESULTS: Twenty-seven patients with suspected vertebral osteomyelitis were included; 15 males and 12 females, with a mean age of 50 years (SD = 16). Fourteen patients had a history of surgery and 12 had metallic implants. Nine patients had a history if spinal infiltrations. The number of patients with a positive scan was 20. The sensitivity for detecting pyogenic vertebral osteomyelitis was 100% (CI: 0.901-1) and the specificity was 87.5% (CI: 0.647-0.875). The positive predictive value was 0.95 (CI: 0.859-0.950), and the negative predictive value was 1 (CI: 0.739-1). The intra- and interobserver kappa value was 1. CONCLUSIONS: The UBI scan showed 100% sensitivity and 88% specificity for vertebral osteomyelitis. Although the role of this method in the diagnostic protocol of the patient with suspected vertebral osteomyelitis has not yet been defined, the scan was useful in this group of patients to arrive at a certain diagnosis.

[Inveterate unilateral lumbosacral dislocation in children. Case report and literature review]. / Luxación lumbosacra unilateral inveterada en niños. Caso clínico y revisión de literatura.

Lumbosacral facet dislocation, whether associated with a fracture or not, is an infrequent lesion in children. The mechanism is hyperflexion due to high energy trauma. We present the case of an 8 year-old patient whose condition began when a soccer goal collapsed and fell on her lumbar area. She was seen at the emergency room and the diagnosis was lumbar sprain. At month 3 she went to the emergency room with persistent pain, lumbosacral deformity and functional impairment. The spine AP and lateral X-rays showed traumatic spondylolisthesis secondary to facet dislocation and fracture of L4 and L5 transverse processes. The neurologic exam was normal. Instrumentation with L4-S1 posterolateral arthrodesis was performed and her postoperative course was appropriate. Proper fusion was achieved at 3 months. At postoperative month 13 the patient was asymptomatic.