«Banderas rojas» de amiloidosis cardiaca en pacientes con estenosis de canal lumbar e hipertrofia de ligamento amarillo / Red flags of cardiac amyloidosis in patients with spinal stenosis and yellow ligament hypertrophy

Introducción Carecemos de estudios que evalúen la presencia de amiloidosis cardiaca (AC) en pacientes con estenosis de canal lumbar (ECL). La identificación de banderas rojas (BR) asociadas a la enfermedad podría identificar casos de AC. Nuestro objetivo principal fue determinar la prevalencia de BR de AC. Métodos Estudio transversal de casos consecutivos que presentaban ECL e hipertrofia del ligamento amarillo (HLA). Se realizó una valoración que incluía electrocardiograma, ecocardiograma y análisis de sangre y orina. Se definió como sospecha de AC la presencia de hipertrofia ventricular y alguna BR. Resultados Se evaluaron 103 pacientes con ECL y HLA. La prevalencia de BR de AC fue elevada: insuficiencia cardiaca, 18,4%; estenosis aórtica, 1,9%; síndrome del túnel carpiano, 7,8%; rotura tendinosa bicipital, 1,9%; hipotensión arterial, 17,4%; clínica de neuropatía, 51,5%; patrón de pseudoinfarto, 3,9%; bajos voltajes, 15,5%; trastorno de la conducción, 15,5%; disminución del strain longitudinal, 25,3%; preservación apical del strain, 3,9%. El 57,3% de los pacientes presentaron sospecha de AC. Conclusión La prevalencia de BR de AC en pacientes con ECL es alta. Un elevado número de pacientes presentaron criterios de sospecha de AC. (AU)

Introduction Studies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. Methods Transversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment that included electrocardiogram, echocardiogram and urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. Results One hundred and three patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction pattern: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. Conclusion The prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria. (AU)

«Banderas rojas» de amiloidosis cardiaca en pacientes con estenosis de canal lumbar e hipertrofia de ligamento amarillo / Red flags of cardiac amyloidosis in patients with spinal stenosis and yellow ligament hypertrophy

Introducción Carecemos de estudios que evalúen la presencia de amiloidosis cardiaca (AC) en pacientes con estenosis de canal lumbar (ECL). La identificación de banderas rojas (BR) asociadas a la enfermedad podría identificar casos de AC. Nuestro objetivo principal fue determinar la prevalencia de BR de AC. Métodos Estudio transversal de casos consecutivos que presentaban ECL e hipertrofia del ligamento amarillo (HLA). Se realizó una valoración que incluía electrocardiograma, ecocardiograma y análisis de sangre y orina. Se definió como sospecha de AC la presencia de hipertrofia ventricular y alguna BR. Resultados Se evaluaron 103 pacientes con ECL y HLA. La prevalencia de BR de AC fue elevada: insuficiencia cardiaca, 18,4%; estenosis aórtica, 1,9%; síndrome del túnel carpiano, 7,8%; rotura tendinosa bicipital, 1,9%; hipotensión arterial, 17,4%; clínica de neuropatía, 51,5%; patrón de pseudoinfarto, 3,9%; bajos voltajes, 15,5%; trastorno de la conducción, 15,5%; disminución del strain longitudinal, 25,3%; preservación apical del strain, 3,9%. El 57,3% de los pacientes presentaron sospecha de AC. Conclusión La prevalencia de BR de AC en pacientes con ECL es alta. Un elevado número de pacientes presentaron criterios de sospecha de AC. (AU)

Introduction Studies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. Methods Transversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment that included electrocardiogram, echocardiogram and urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. Results One hundred and three patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction pattern: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. Conclusion The prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria. (AU)

[Red flags of cardiac amyloidosis in patients with spinal stenosis and yellow ligament hypertrophy]. / «Banderas rojas¼ de amiloidosis cardiaca en pacientes con estenosis de canal lumbar e hipertrofia de ligamento amarillo.

INTRODUCTION: Studies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. METHODS: Transversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment that included electrocardiogram, echocardiogram and urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. RESULTS: One hundred and three patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction pattern: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. CONCLUSION: The prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria.

Estenosis de canal lumbar: comorbilidades y análisis morfométrico / Lumbar canal stenosis: comorbidities and morphometric analysis

Introducción: La Estenosis de Canal Lumbar (ECL) refiere al estrechamiento central del canal raquídeo, recesos laterales o agujeros de conjunción. Comúnmente, causa lumbalgia crónica en quienes la padecen afectando gravemente su calidad de vida. Sin embargo, su pronóstico, incidencia sigue siendo incierta en nuestra región. Objetivo: El presente trabajo tiene como propósito, determinar la frecuencia local de la ECL y su relación con distintos parámetros morfométricos, comorbilidades y el cuestionario CSI. Material y Método: Se realizó un estudio prospectivo, analítico, asociativo y de corte transversal de las consultas atendidas por el servicio de Neurocirugía del Hospital Enrique Vera Barros de la ciudad de La Rioja Capital, Argentina durante el período agosto-diciembre 2018. Se aplicó el cuestionario "Central Sensitization Inventory" (CSI). Resultados: La ECL fue diagnosticada en 42.9% de hombres que consultaron por lumbalgia y en el 33.3% en el caso de las mujeres. La media de la edad de los pacientes con ECL fue 57 años. El 100% de pacientes presentaron comorbilidades, siendo la más prevalente la artrosis. La dorsopatía más asociada fue la Hernia de Disco Lumbar (27.3%). La intensidad del dolor y los diámetros antero-posterior (DAP) y laterales (DL), fueron inversamente significativos (DAP= -,813 p=0,09; DL= -,967 p=0,007). El puntaje en el CSI fue significativamente mayor en pacientes con ECL (37 vs. 24,62 pts.) (p=,028). Finalmente, la correlación entre los DAP y DL con el puntaje del CSI mostró una correlación inversa (DAP= -,733 p>0,05; DL= -,639 p>0,05). Conclusión: En nuestro estudio encontramos que la prevalencia de ECL es más alta en hombres de edad media y que presentan comorbilidades asociadas, además el análisis morfométrico del canal raquídeo se asocia con la intensidad del dolor y el puntaje en el CSI. Por lo cual estas variables podrían ser utilidad clínica al momento de decidir el manejo adecuado para pacientes con ECL.

Introduction: Lumbar Spinal Stenosis (LSS) anatomically can involve the central canal, lateral recess, neural foramen or any combination of these locations. Although, LSS has been consider a common cause of chronic low back pain. Only few studies had explored the prevalence, incidence and associated variables in non-Caucasian populations. Therefore, the aim of this study is to determine the local frequency of LSS and its relationship with different morphometric parameters, comorbidities and the Central Sensitization Inventory (CSI). Methods: A prospective, analytical, associative and cross-sectional study of patients With LSS by single academic center was carried out. Diagnoses were done by clinical and MRI assessment. Results: LSS was diagnosed in 42.9% of males and 33.3% of females who consulted for low back pain. The average age of the patients with LSS was 57 years. 100% of LSS patients presented comorbidities, the most prevalent being osteoarthritis. Lumbar Disc Hernia was associated in 27.3% of patients with LSS. Pain intensity was inversely correlated (AP= -,813 p=0,09; L= -,967 p=0,007) with anteroposterior (AP), and lateral (L) diameters. The score in the CSI was significantly higher in patients with LSS (37 vs. 24,62 pts.) (p=,028). Finally, the correlation between the AP and L diameters with the CSI score was inverse (AP= -,733 58 p>0,05; L= -,639 p>0,05). Conclusions: In our study, we found that the prevalence of LSS is higher in middle-aged men with associated comorbidities. In addition, morphometric analysis of the spinal canal is associated with pain intensity and CSI scores. Therefore, these variables could be clinical applicable when deciding the appropriate management for patients with LSS.

[Pedicular dynamic stabilization system. Functional outcomes and implant-related complications for the treatment of degenerative lumbar disc disease with a minimum follow-up of 4 years]. / Sistema pedicular de estabilización dinámica. Resultados funcionales y complicaciones del implante en pacientes con enfermedad degenerativa discal lumbar, tras un seguimiento mínimo de 4 años.

INTRODUCTION: The Dynesys(®) system is a non-fusion pedicular dynamic stabilization system. The aim of our study is to evaluate the clinical outcomes in patients with degenerative disc disease and/or stenosis, and to measure the prevalence of screw loosening and breakage after 4 years of follow up. MATERIAL AND METHODS: All patients who underwent surgery with Dynesys(®) system in 2008 were reviewed. The surgery was performed in cases of low back pain of more than 6 months duration and a positive MRI for degenerative disc disease and/or stenosis. RESULTS: A total of 22 patients (11 females, 11 males) with a mean age of 44.40 ± 11 years were included, 20 patients (91%) underwent Dynesys(®) without any associated decompression maneuver. The evaluation of back and leg pain (0-10mm) showed a mean decrease of 2.4 ± 2.06 mm (P=.0001). The preoperative value of the Oswestry disability index was 52.36 ± 16.56% (severe functional limitation). After surgery, this value was 34.27 ± 17.87% (moderate functional limitation) (P=.001) with a decrease of 18.09 ± 16.03% (P=.001). A total of 4 (18%) patients showed signs of loosening screws. One patient (4.5%) had a screw breakage. CONCLUSIONS: Surgery with Dynesys(®) shows favorable long term clinical results, however the range of improvement in our series is lower than those reported in other studies. Comparative studies between Dynesys(®) and decompression need to be performed in order to isolate the benefit of the dynamic stabilization system. Implant-related complications are not uncommon.