Anestesia local selectiva frente a infiltración de corticosteroides en el dolor lumbar: ensayo clínico aleatorizado / Selective local anesthesia versus corticosteroid infiltration on low back pain: a randomized clinical trial

ANTECEDENTES Y OBJETIVO: Las infiltraciones locales son utilizadas como segunda línea en el tratamiento del dolor lumbar crónico aunque constituyen una alternativa terapéutica controvertida en la literatura. El objetivo principal del estudio fue comparar la efectividad de la infiltración paravertebral lumbar con corticoides con la anestesia local selectiva mediante la técnica de terapia neural segmentaria (TNS) en pacientes diagnosticados de dolor lumbar. MATERIAL Y MÉTODOS: Se realizó un ensayo clínico doble ciego en 55 pacientes diagnosticados de dolor lumbar en el Hospital Central de la Defensa Gómez Ulla. Los pacientes fueron aleatorizados a recibir bien infiltración paravertebral lumbar con corticoides (Grupo 1) o bien TNS (Grupo 2). Registrándose la puntuación en la escala visual analógica, el Oswestry Disability Index, Short Form-36 y la satisfacción, al inicio, y a los 3 y 12 meses posteriores a la intervención. RESULTADOS: El grupo de tratamiento combinado obtuvo una mejoría estadísticamente significativa para el Oswestry Disability Index a los 3 meses. El grupo de TNS obtuvo una mejora estadísticamente significativa al comparar la escala visual analógica inicial con la escala visual analógica a los 3 meses (1,398cm, p = 0,001) y a los 12 meses (0,791cm, p = 0,007). No se observaron diferencias en el resto de las variables evaluadas. El porcentaje de pacientes que repetirían el tratamiento fue de 81% y 83% respectivamente. CONCLUSIONES: Se obtuvieron resultados significativos para el alivio del dolor con TNS y la discapacidad con el tratamiento combinado. Aunque la mejoría clínica fue limitada, los pacientes estaban satisfechos. Las infiltraciones locales deben considerarse como un tratamiento alternativo para el dolor lumbar crónico. Registro de ensayos clínicos: Este ensayo clínico se registró en el registro de ensayos clínicos de la Unión Europea con el número EUDRA-CT 2015-001146-29

ANTECEDENTS AND OBJECTIVE: Local infiltrations are second line therapy in the treatment of chronic low back pain, although their use is controversial in the literature. Our objective was to compare the effectiveness of 2 types of infiltration at the paravertebral lumbar level in two groups of patients diagnosed with low back pain: corticosteroids, and selective local anaesthetic administered using segmental neural therapy (SNT). MATERIAL AND METHODS: Double-blind clinical trial in 55 patients diagnosed with low back pain in the neurosurgery department of the Hospital Central de la Defensa Gómez Ulla. Patients were randomised to 2 treatment groups to receive either paravertebral injections of corticosteroids or SNT. Outcomes were measured using a visual analogue scale, the Oswestry Disability Index, the Short Form-36, and patient satisfaction at the start of treatment (baseline) and at 3 and 12 months post intervention. RESULTS: The combined treatment group showed a statistically significant improvement in Oswestry Disability Index at 3 months. The SNT group showed a statistically significant improvement in baseline visual analogue scale vs. visual analogue scale at 3 (1.398cm, p = 0.001) and 12 months (0.791cm, p = 0.007). No differences were observed in the remaining variables measured. The percentage of patients that would repeat the treatment was 81% and 83%, respectively. CONCLUSIONS: Significant pain relief was achieved with SNT, and disability improved with the combined treatment. Although clinical improvement was limited, patients were satisfied. Local infiltrations should be considered as an alternative treatment for chronic low back pain. Clinical trial registration: This clinical trial was registered at the European Union Clinical Trials Register with EUDRA-CT number 2015-001146-29

Selective local anesthesia versus corticosteroid infiltration on low back pain: a randomized clinical trial. / Anestesia local selectiva frente a infiltración de corticosteroides en el dolor lumbar: ensayo clínico aleatorizado.

ANTECEDENTS AND OBJECTIVE: Local infiltrations are second line therapy in the treatment of chronic low back pain, although their use is controversial in the literature. Our objective was to compare the effectiveness of 2 types of infiltration at the paravertebral lumbar level in two groups of patients diagnosed with low back pain: corticosteroids, and selective local anaesthetic administered using segmental neural therapy (SNT). MATERIAL AND METHODS: Double-blind clinical trial in 55 patients diagnosed with low back pain in the neurosurgery department of the Hospital Central de la Defensa Gómez Ulla. Patients were randomised to 2 treatment groups to receive either paravertebral injections of corticosteroids or SNT. Outcomes were measured using a visual analogue scale, the Oswestry Disability Index, the Short Form-36, and patient satisfaction at the start of treatment (baseline) and at 3 and 12 months post intervention. RESULTS: The combined treatment group showed a statistically significant improvement in Oswestry Disability Index at 3 months. The SNT group showed a statistically significant improvement in baseline visual analogue scale vs. visual analogue scale at 3 (1.398cm, p=0.001) and 12 months (0.791cm, p=0.007). No differences were observed in the remaining variables measured. The percentage of patients that would repeat the treatment was 81% and 83%, respectively. CONCLUSIONS: Significant pain relief was achieved with SNT, and disability improved with the combined treatment. Although clinical improvement was limited, patients were satisfied. Local infiltrations should be considered as an alternative treatment for chronic low back pain. CLINICAL TRIAL REGISTRATION: This clinical trial was registered at the European Union Clinical Trials Register with EUDRA-CT number 2015-001146-29.

Tratamiento multidisciplinar del traumatismo cervical con fractura de apófisis odontoides en militar, a propósito de un caso / Multidisciplinary treatment for cervical trauma with odontoid apophysis fracture in military member, a case report

La fractura de apófisis odontoides de la segunda vértebra cervical representa entre el 10 y el 15% de todas las fracturas cervicales. En el medio militar, esta lesión puede ser originada por la práctica de deportes, actividades de especial riesgo como el paracaidismo y armas de fuego o artefacto explosivo. Un diagnóstico precoz y un adecuado tratamiento multidisciplinar pueden colaborar para el correcto manejo integral de una baja. Se ha realizado una revisión de la literatura en la base de datos del PUBMED, utilizado la palabra clave «fractura odontoides», «sedación», «Halo-Jacket»

Odontoid fracture of the second cervical vertebra represents between 10 and 15% of all cervical fractures. In a military environment, this injury may be caused by the practice of sports, special risk such as skydiving and firearms or explosive device. Early diagnosis and appropriate multidisciplinary treatment can work for the proper management of a casualty. A literature review has been carried out in PUBMED database, using the keywords «fractura odontoides», «sedación», «Halo-Jacket»

Revisión del traumatismo craneoencefálico / Overview of nead injury

En este artículo se ha realizado una revisión sistemática de los aspectos prácticos más destacables del manejo del traumatismo craneoencefálico en base a la literatura médica que hemos considerado relevante. El trabajo se ha desarrollado en diferentes apartados que comprenden la epidemiología, pronóstico y clasificación, anatomía patológica y fisiopatología, evaluación clínica y tratamiento. Se han tratado con especial énfasis las conexiones entre los rasgos fisiopatológicos con mayor grado de evidencia, de acuerdo con las guías de práctica clínica, y los esquemas de manejo terapéutico (AU)

A systematic revision of the main practical aspects related with the head injury management has been made in this article on the basis of relevant literature. The paper has been developed in different sections consisting of epidemiological factors, prognosis and classification, neuropathology and pathophysiology, clinical evaluation and treatment. According to clinical guidelines, the connections between the pathophysiological features with higher evidence degree and the schemes of therapeutic approahes have been emphasized (AU)

[Overview of head injury]. / Revisión del traumatismo craneoencefálico.

A systematic revision of the main practical aspects related with the head injury management has been made in this article on the basis of relevant literature. The paper has been developed in different sections consisting of epidemiological factors, prognosis and classification, neuropathology and pathophysiology, clinical evaluation and treatment. According to clinical guidelines, the connections between the pathophysiological features with higher evidence degree and the schemes of therapeutic approaches have been emphasized.

[Radiation-induced intracerebral sarcoma]. / Sarcoma intracerebral radioinducido.

We report a case of radiation-induced sarcoma in a 50 year-old male patient who was treated with total resection and radiation for right temporal lobe PNET. He received a dose of 60-Gy. A sequential magnetic resonance image 32 months after the completion of radiation therapy and 34 months after surgery showed a mass in the right temporal cerebral convexity. The postoperative diagnosis was sarcoma. Two years later the patient was operated because of a new lesion with similar characteristics. The follow up from the PNET diagnosis is 5 years and 10 months and the survival from sarcoma diagnosis is now 3 years and there is no evidence of recurrence. The development of sarcoma subsequent to cranial irradiation is an infrequent event but it should be considered in the differential diagnosis of a lesion that progresses several years after radiation therapy or when a new lesion appear.