Subaxial spine trauma: radiological approach and practical implications.

The cervical spine is part of the axial skeleton and is responsible for protecting vital structures, such as the spinal cord and the vertebral arteries and veins. Traumatic injury to the cervical spine occurs in approximately 3% of blunt trauma injuries, and approximately 80% are below the level of C2. The AO Spine society divides the spine into four segments: the upper cervical spine (C0-C2), subaxial spine (C3-C7), thoracolumbar spine, and sacral spine. Various classifications have been proposed for the subaxial segment since that of Allen and Ferguson in 1982; however, none is universally accepted, and treatment remains controversial. The complex anatomy and biomechanics of the subaxial spine and the lack of a widely accepted classification system make these injuries difficult to evaluate on imaging. The Subaxial Injury Classification System (SLIC) uses fracture morphology, the integrity of discoligamentous complex, and neurological status to score the patient and determine between operative and non-operative management; however, other factors may influence management, such as time for immobilisation, osteoporosis, surgeon's experience, and hospital circumstances. SLIC classifies fracture morphology in a crescent order of severity based on Allen and Ferguson's classification. Compression fractures are the simpler ones, while both distraction injuries and translation/rotation are severe injuries, which are always associated with some degree of discoligamentous complex (DLC) injury. This article will review the indications for imaging, the basis of the SLIC classification, the different types of fracture morphology, evaluation of the DLC, and other features important in decision making in subaxial spine trauma.

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this reviewis to discuss the AOSTSIC systemand its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperativemanagement,with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

Reliability of the New AOSpine Classification System for Upper Cervical Traumatic Injuries.

BACKGROUND: The new AOSpine Upper Cervical Classification System (UCCS) was recently proposed by the AOSpine Knowledge Forum Trauma team to standardize the treatment of upper cervical traumatic injuries (UCI). In this context, evaluating its reliability is paramount prior to clinical use. OBJECTIVE: To evaluate the reliability of the new AOSpine UCCS. METHODS: A total of 32 patients with UCI treated either nonoperatively or with surgery by one of the authors were included in the study. Injuries were classified based on the new AO UCCS according to site and injury type using computed tomography scan images in 3 planes by 8 researchers at 2 different times, with a minimum interval of 4 wk between assessments. Intra- and interobserver reliability was assessed using the kappa index (K). Treatment options suggested by the evaluators were also assessed. RESULTS: Intraobserver agreement for sites ranged from 0.830 to 0.999, 0.691 to 0.983 for types, and 0.679 to 0.982 for the recommended treatment. Interobserver analysis at the first assessment was 0.862 for injury sites, 0.660 for types, and 0.585 for the treatment, and at the second assessment, it was 0.883 for injury sites, 0.603 for types, and 0.580 for the treatment. These results correspond to a high level of agreement of answers for the site and type analysis and a moderate agreement for the recommended treatment. CONCLUSION: This study reported an acceptable reproducibility of the new AO UCCS and safety in recommending the treatment. Further clinical studies with a larger patient sample, multicenter and international, are necessary to sustain the universal and homogeneity quality of the new AO UCCS.

Caracterización del trauma raquimedular en el Servicio de Neurocirugía, Guantánamo 2013-2018 / Caracterização do trauma raquimedular no Serviço de Neurocirurgia, Guantanamo 2013-2018 / Characterization of spinal cord trauma in the Neurosurgery Service, Guantanamo 2013-2018

Introducción: en el Hospital General Docente Dr Agostinho Neto no se ha caracterizado el trauma raquimedular. Objetivo: caracterizar el trauma raquimedular en el Servicio de Neurocirugía del Hospital General Docente Dr Agostinho Neto durante los años 2013-2018. Método: se realizó un estudio descriptivo, retrospectivo y longitudinal. La población se constituyó por 230 pacientes, de los que se escogió una muestra aleatoria (n=92). Se estudiaron las siguientes variables: edad, sexo, tiempo entre el trauma y la atención médica especializada, tipo de lesión, causas del trauma. Resultados: los pacientes fueron sobre todo hombres (69,6 por ciento), tenían entre 39 y 48 años (23,9 por ciento), fracturas vertebrales (59,8 por ciento), sobrevivió el 95,7 por ciento y el 56,5 por ciento fue atendido en las primeras 6 horas postrauma. Conclusiones: los traumas raquimedulares afectan a pacientes en la etapa productiva de la vida, lo que muestra la pertinencia social de su estudio(AU)

Introduction: in the General Teaching Hospital Dr Agostinho Neto has not been characterized by spinal cord trauma. Objective: to characterize spinal cord trauma in the Neurosurgery Service of the General Teaching Hospital Dr Agostinho Neto during the years 2013- 2018. Method: a descriptive, retrospective and longitudinal study was carried out. The population consisted of 230 patients, from which a random sample was chosen (n=92). The following variables were studied: age, sex, time between trauma and specialized medical care, type of injury, causes of trauma. Results: the patients were mostly men (69.6per cent), were between 39 and 48 years (23.9per cent), vertebral fractures (59.8per cent), survived 95.7per cent and 56.5per cent were attended in the first 6 hours post trauma. Conclusions: spinal cord traumas affect patients in the productive stage of life, which shows the social relevance of their study(AU)

Introdução: no Hospital Geral de Ensino Dr Agostinho Neto não se caracterizou por trauma medular. Objetivo: caracterizar o trauma medular no Serviço de Neurocirurgia do Hospital Geral de Ensino Dr Agostinho Neto durante os anos 2013-2018. Método: estudo descritivo, retrospectivo e longitudinal. A população foi composta por 230 pacientes, dos quais foi escolhida uma amostra aleatória (n=92). Foram estudadas as seguintes variáveis: idade, sexo, tempo entre trauma e atendimento médico especializado, tipo de lesão, causas do trauma. Resultados: os pacientes eram majoritariamente homens (69,6 por cento), tinham entre 39 e 48 anos (23,9 por cento), fraturas vertebrais (59,8 por cento), sobreviveram 95,7per cent e 56,5per cent foram compareceu nas primeiras 6 horas pós-trauma. Conclusões: os traumas da medula espinhal afetam os pacientes na fase produtiva da vida, o que mostra a relevância social de seu estudo(AU)

Reliability and safety of a new upper cervical spine injury treatment algorithm.

METHODS: Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index. RESULTS: The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons' personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. CONCLUSION: The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

Reliability and safety of a new upper cervical spine injury treatment algorithm / Avaliação de reprodutibilidade e segurança de um novo algoritmo de tratamento das lesões cervicais altas

ABSTRACT In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index. Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

RESUMO Avaliamos a reprodutibilidade e segurança do algoritmo Upper Cervical Spine Injuries Treatment Algorithm (UCITA) recém proposto para a escolha do tratamento das lesões traumáticas da junção crânio-cervical. Métodos Trinta casos previamente tratados de acordo com o algoritmo foram apresentados a quatro cirurgiões de coluna, sendo questionada a conduta pessoal dos mesmos e a conduta segundo a aplicação do algoritmo. Após 4 semanas, foram refeitas as mesmas perguntas para avaliar a reprodutibilidade (intra e interobservador) do algoritmo, através do índice estatístico “Kappa”. Resultados A reprodutibilidade da conduta com o uso do algoritmo foi superior a reprodutibilidade da conduta pessoal dos cirurgiões. Com o uso do UCITA, a concordância do tratamento realmente efetivado foi encontrada em mais de 89% dos casos. Conclusão O uso do UCITA foi seguro e reprodutível, podendo ser usado como ferramenta auxiliar na tomada de decisão entre tratamento cirúrgico versus conservador dos traumatismos da junção crâniocervical.

A comparative agreement evaluation of two subaxial cervical spine injury classification systems: the AOSpine and the Allen and Ferguson schemes.

PURPOSE: We performed an agreement study using two subaxial cervical spine classification systems: the AOSpine and the Allen and Ferguson (A&F) classifications. We sought to determine which scheme allows better agreement by different evaluators and by the same evaluator on different occasions. METHODS: Complete imaging studies of 65 patients with subaxial cervical spine injuries were classified by six evaluators (three spine sub-specialists and three senior orthopaedic surgery residents) using the AOSpine subaxial cervical spine classification system and the A&F scheme. The cases were displayed in a random sequence after a 6-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. RESULTS: Inter-observer: considering the main AO injury types, the agreement was substantial for the AOSpine classification [κ = 0.61 (0.57-0.64)]; using AO sub-types, the agreement was moderate [κ = 0.57 (0.54-0.60)]. For the A&F classification, the agreement [κ = 0.46 (0.42-0.49)] was significantly lower than using the AOSpine scheme. Intra-observer: the agreement was substantial considering injury types [κ = 0.68 (0.62-0.74)] and considering sub-types [κ = 0.62 (0.57-0.66)]. Using the A&F classification, the agreement was also substantial [κ = 0.66 (0.61-0.71)]. No significant differences were observed between spine surgeons and orthopaedic residents in the overall inter- and intra-observer agreement, or in the inter- and intra-observer agreement of specific type of injuries. CONCLUSION: The AOSpine classification (using the four main injury types or at the sub-types level) allows a significantly better agreement than the A&F classification. The A&F scheme does not allow reliable communication between medical professionals.

Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries.

UNLABELLED: The SLICS (Sub-axial Cervical Spine Injury Classification System) was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST), even though the literature assessing its safety and efficacy is scarce. METHOD: We compared a cohort series of patients surgically treated based on surgeon's preference with patients treated based on the SLICS. RESULTS: From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5). Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6). There was no neurological deterioration in any group. CONCLUSION: After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment.

Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries / Avaliação do SLICS no tratamento das lesões da coluna cervical sub-axial

The SLICS (Sub-axial Cervical Spine Injury Classification System) was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST), even though the literature assessing its safety and efficacy is scarce. Method We compared a cohort series of patients surgically treated based on surgeon’s preference with patients treated based on the SLICS. Results From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5). Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6). There was no neurological deterioration in any group. Conclusion After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment. .

O SLICS (Sub-axial Cervical Spine Injury Classification System) foi proposto para auxílio na tomada de decisão no tratamento do traumatismo da coluna cervical sub-axial. Contudo, existem poucos trabalhos que avaliem sua segurança e eficácia. Método Realizamos estudo comparativo de série histórica de pacientes operados baseados na indicação pessoal do cirurgião com pacientes tratados baseados na aplicação do SLICS. Resultados Entre 2009-10, 12 pacientes foram incluídos. O SLICS escore variou de 2 a 9 pontos (média de 5,5) com dois pacientes com escore menor que 4. Entre 2011-13, 28 pacientes foram incluídos. O escore de SLICS variou de 4 a 9 pontos, com média de 6. Conclusão Observamos que após o uso do SLICS houve uma diminuição do número de pacientes operados com lesões mais estáveis. Isso sugere que o SLICS pode ser útil para auxiliar a diferenciação de lesões leves das graves, eventualmente melhorando os resultados do tratamento. .

Classificação AO e conceito de Dennis na indicação cirúrgica dos traumatismos raquidianos e raquimedulares. Todas as situações são contempladas? / Spinal trauma and spinal cord injury: The AO classification. The Denis concept. The surgical indication. Are all situations addressed?

Os autores discutem a aplicação da classificação AO e do conceito de Denis na qualificação dos traumatismos raquimedular e raquidiano, com ênfase nas indicações de cirurgia da coluna vertebral, expondo um quadro prático para tomada de decisão, que engloba todas as situações. Citam que embora tais classificações, as mais usadas na atualidade, sejam úteis para alicerçar o raciocínio clínico e cirúrgico dos casos de traumatismo raquimedular (TRM) e traumatismo raquidiano (TR), independente da forma de classificação empregada, ou mesmo que surjam outras classificações para os mesmos propósitos, duas questões serão sempre as mais importantes a serem respondidas pelos médicos assistentes na tomada de decisão: Há déficit neurológico? Há instabilidade da coluna vertebral?

The authors discuss the application of the AO classification and the concept of Denis, in qualifying of spinal cord injury, with emphasis on indications of spine surgery, exposing a practical framework for decision making, which includes all situations. Although these ratings, the most used are useful to support the clinical reasoning and surgical cases, two questions must always be answered by attending physicians for making decisions: Is there neurological deficit? Is there instability of the spine?

Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma.

STUDY DESIGN: Retrospective study. OBJECTIVE: Evaluate the relationship among the neurologic status, the Thoracolumbar Injury Classification System (TLICS) score, and the Magerl/AO classification system. SUMMARY OF THE BACKGROUND DATA: A wide range of classification schemes for thoracic and lumbar spine trauma have been described, but none has achieved widespread acceptance. A recent system proposed by Vaccaro et al has been developed to improve injury classification and guide surgical decision making. METHODS: Analysis of 49 patients treated surgically for thoracic and lumbar spine trauma from 2003 to 2009 in 2 spine trauma centers. Clinical and radiologic data were evaluated, classifying the trauma according to American Spinal Injury Association status, the Magerl/AO classification for fractures, and the TLICS score. RESULTS: The mean age was 37 years (range, 17-72). Thirty-five (71%) patients had a thoracolumbar fracture (T11-L2). A posterior approach was used in all the cases. American Spinal Injury Association status remained unchanged in 44 (4 had some improvement and 1 worsened). A total of 61.1% of the patients with a type A fracture were neurologically intact compared with 80% with complete neurologic deficit for type C fractures. The TLICS score range from 2 to 9 (average of 6.2). Forty-seven of 49 (96%) patients had a TLICS score greater than 4, suggesting surgical treatment. Seventy percentage of the patients with a TLICS score from 4 to 6 were neurologically intact compared with 87.5% of complete neurologic deficits in patients with TLICS 7 to 9. A statistic correlation was established between the neurologic status and AO type fracture (P = 0.0041) and the TLICS score (P < 0.0001). An association between the AO type fracture and the TLICS score was also found (P = 0.0088). CONCLUSION: The TLICS score treatment recommendation matched surgical treatment in 47 of 49 patients (96%). The TLICS was found to correlate to the AO classification. This suggests that the TLICS can be used to classify thoracolumbar trauma and can accurately predict surgical management.

Fratura traumática da coluna torácica limitada entre T1 e T10 / Traumatic thoracic spine fractures limited between T1 and T10

Objetivo: Estudo retrospectivo de uma série de 79 pacientes com fratura traumática da coluna torácica,limitada entre T1 e T10,hospitalizados entre 1995 e 2004 no Serviço de Neurocirurgia do Centro Hospitalar Universitário(CHU), Norte de Marseille, França.Métodos:As fraturas foram classificadas de acordo com a classificação da AO(Arbeitsgemeinschaft für Osteosynthesefragen)e o quadro neurológico por meio da classificação de Frankel na hospitalização,aos seis meses e um ano.Resultados:A etiologia mais frequente das fraturas foram os acidentes automobilísticos(68,3 por cento), e o tipo de fratura, o B(54,4 por cento); 57 pacientes foram considerados politraumatizados e 82,3 por cento apresentavam lesão medular. O tratamento cirúrgico foi empregado em 96,2 por cento dos casos, sendo a via posterior a mais utilizada com objetivo de estabilização,descompressão medular, correção do alinhamento da coluna, diminuição da dor e mobilização precoce.Conclusão:As incidências, as causas, os tipos de fraturas e os manejos destas foram analisados e comparados com a literatura e os resultados confirmaram a gravidade das lesões neste segmento da coluna, o número elevado de lesões associadas, a raridade de recuperação neurológica, assim como o benefício do tratamento cirúrgico por via posterior.

Trauma raquimedular craniocervical: revisão de literatura / Spinal trauma at the craniocervical junction: literature review

Objetivo: Revisão da literatura sobre o trauma craniocervical. Métodos:Com base em revisão eletrônica da literatura nos dados da PubMed, em revisões sistemáticas e em diretrizes internacionais na língua inglesa. A revisão abrangeu os temas "deslocamento atlanto-occipital","fraturas do côndilo occipital","fraturas do atlas","lesões do ligamento transverso","instabilidade vertical atlantoaxial traumática" e "fraturas do áxis". Resultado:A avaliação da literatura utilizando-se de técnicas de análise da qualidade da publicação,eliminando vícios e tendenciosidades de interpretação, permitindo a comparação matemática de resultados, propiciou o surgimento de conclusões menos discutíveis da eficiência dos vários métodos de tratamento.

Resultados del tratamiento quirúrgico de las fracturas toracolumbares tipo C de la AO / Results of the surgical treatment of type C AO thoracolumbar fractures

AO Type C Thoracolumbar fractures are the most complex and unstable spine injuries, with a high frecuency of neurological impairment. The goal of this study is to describe the clinical characteristics, management and outcome in worker’s compensation patients with type C AO thoracolumbar fractures that were surgically treated in our hospital between January 1994 and December 2004. We collected 88 patients, 68 of them had work related accidents. Four patients were discarded because of insufficient data. The median follow up was 58 months. Of the 64 patients evaluated (mean age 35.7 years), 94 percent were men. The most common mechanism of injury was height fall (41 percent). Associated injuries occurred in 80 percent of the patients (23 percent had another spine fracture). Neurological impairment was present in 64 percent, 22 percent had incomplete, while 42 percent had complete impairment. The majority of the patients presented a C3 AO thoracolumbar fracture (50 percent). The average preoperative time was 6 days (range 0-64). The mean time of surgery was 224 minutes (range 80-640). Only 9.3 percent of the patients required a complementary anterior approach. The median hospitalization time was 61 days (6-275) and the mean postoperative rest was 9.8 months (1.4-34). We had 11 acute complications and 6 delayed complications. Return to work occurred in 64 percent of the patients, while 59 percent was compensated. Among the patients presenting partial neurological impairment, 50 percent improved at least one degree in the Frankel scale.

Las fracturas tóracolumbares tipo C de la AO corresponden a las lesiones espinales más complejas e inestables, con una alta incidencia de compromiso neurológico. El objetivo del presente estudio es describir las características clínicas, manejo y evolución de los pacientes accidentados del trabajo, con fracturas tóracolumbares tipo C de la AO, operados en nuestro hospital. Revisamos en forma retrospectiva los casos entre enero de 1994 y diciembre de 2004. Recolectamos 88 pacientes, 68 de los cuales correspondían a accidentados del trabajo. Cuatro casos fueron eliminados por información incompleta. La mediana de seguimiento fue de 58 meses. De los 64 pacientes evaluados (edad promedio 35,7 años),el 94 por ciento eran hombres. El mecanismo de lesión más común fue caída de altura (41 por ciento). Un 80 por ciento de los pacientes presentaron lesiones asociadas (23 por ciento con fractura de columna a otro nivel). Un 64 por ciento ingresó con compromiso neurológico, de los cuales, el 22 por ciento fue parcial y 42 por ciento completo. La mayoría de las fracturas fueron tipo C3 de la clasificación AO (50 por ciento). El tiempo promedio preoperatorio fue de 6 días (0-64). La duración promedio de la cirugía fue de 224 minutos (80-640). Un 9,3 por ciento de los pacientes requirió de una vía anterior complementaria. La mediana de hospitalización fue de 61 días (6-275) y el tiempo promedio de reposo post operatorio fue de 9,8 meses (1,4-34 meses). Hubo 11 complicaciones precoces y 6 tardías. Un 64 por ciento retornó al trabajo y un 59 por ciento fue indemnizado. De los pacientes con compromiso neurológico parcial, un 50 por ciento recuperó al menos un grado en la escala de Frankel.

Fusion precoz C1-C2 en la artritis reumatoide de columna cervical alta (C0-C1-C2) / Early C1-C2 fusion in upper cervical spine rheumatoid arthritis

Introduccion: El compromiso de raquis cervical alto en la artritis reumatoide (AR) no es una entidad estatica; por el contrario, es una afeccion dinamica y progresiva. Esta cadena lesional comienza con la subluxacion C1-C2 anterior reducible hasta la rigidez, con la consiguiente migracion de la odontoides hacia el foramen magno, que ocasiona invalidez o la muerte del paciente. La subluxacion C1-C2 se encuentra en el 80 por ciento de los pacientes a los 24 meses del diagnostico y en el 100 por ciento de ellos a los 5 años de la aparicion de la enfermedad. El hecho de que las lesiones neurologicas no esten presentes en todos los pacientes con luxaciones genera la discusion si se debe o no artrodesar tempranamente esta articulacion. Materiales y metodos: Se evaluaron 17 pacientes mujeres con artritis reumatoide con compromiso de la columna cervical alta.Todas fueron estudiadas en forma clinica y electrofisiologica con EMG y PESS, radiografias y resonancia magnetica (RM). Se solicitaron radiografias transoral, anteroposterior, perfil neutro, en flexion y en extension. Resultados: Todos los pacientes intervenidos quirurgicamente y evaluados en esta serie fueron mujeres, con un promedio de edad de 59 años (45-72). El seguimiento medio fue de 18 meses (5-36). Todas las pacientes del grupo A fueron ambulatorias y se les realizo una fusion C1-C2 con tornillos transarticulares segun Magerl. Al final del seguimiento no evidenciaron progresion de las lesiones radiologicas ni del compromiso clinico-neurologico. Todas las pacientes del grupo B fueron no ambulatorias. En todos los casos se trato de lesiones cervicales altas rigidas con migracion de la odontoides. Todas las fijaciones fueron hasta el occipital. Todas las pacientes del grupo B presentaron complicaciones intraoperatorias y posoperatorias que requirieron, en algunos casos, asistencia respiratoria mecanica (ARM) posoperatoria. La tasa de mortalidad de este grupo fue del 40 por ciento. Conclusiones: La fusion pre...(AU)

Fusion precoz C1-C2 en la artritis reumatoide de columna cervical alta (C0-C1-C2) / Early C1-C2 fusion in upper cervical spine rheumatoid arthritis

Introduccion: El compromiso de raquis cervical alto en la artritis reumatoide (AR) no es una entidad estatica; por el contrario, es una afeccion dinamica y progresiva. Esta cadena lesional comienza con la subluxacion C1-C2 anterior reducible hasta la rigidez, con la consiguiente migracion de la odontoides hacia el foramen magno, que ocasiona invalidez o la muerte del paciente. La subluxacion C1-C2 se encuentra en el 80 por ciento de los pacientes a los 24 meses del diagnostico y en el 100 por ciento de ellos a los 5 años de la aparicion de la enfermedad. El hecho de que las lesiones neurologicas no esten presentes en todos los pacientes con luxaciones genera la discusion si se debe o no artrodesar tempranamente esta articulacion. Materiales y metodos: Se evaluaron 17 pacientes mujeres con artritis reumatoide con compromiso de la columna cervical alta.Todas fueron estudiadas en forma clinica y electrofisiologica con EMG y PESS, radiografias y resonancia magnetica (RM). Se solicitaron radiografias transoral, anteroposterior, perfil neutro, en flexion y en extension. Resultados: Todos los pacientes intervenidos quirurgicamente y evaluados en esta serie fueron mujeres, con un promedio de edad de 59 años (45-72). El seguimiento medio fue de 18 meses (5-36). Todas las pacientes del grupo A fueron ambulatorias y se les realizo una fusion C1-C2 con tornillos transarticulares segun Magerl. Al final del seguimiento no evidenciaron progresion de las lesiones radiologicas ni del compromiso clinico-neurologico. Todas las pacientes del grupo B fueron no ambulatorias. En todos los casos se trato de lesiones cervicales altas rigidas con migracion de la odontoides. Todas las fijaciones fueron hasta el occipital. Todas las pacientes del grupo B presentaron complicaciones intraoperatorias y posoperatorias que requirieron, en algunos casos, asistencia respiratoria mecanica (ARM) posoperatoria. La tasa de mortalidad de este grupo fue del 40 por ciento. Conclusiones: La fusion pre...(AU)

Fusion precoz C1-C2 en la artritis reumatoide de columna cervical alta (C0-C1-C2) / Early C1-C2 fusion in upper cervical spine rheumatoid arthritis

Introduccion: El compromiso de raquis cervical alto en la artritis reumatoide (AR) no es una entidad estatica; por el contrario, es una afeccion dinamica y progresiva. Esta cadena lesional comienza con la subluxacion C1-C2 anterior reducible hasta la rigidez, con la consiguiente migracion de la odontoides hacia el foramen magno, que ocasiona invalidez o la muerte del paciente. La subluxacion C1-C2 se encuentra en el 80 por ciento de los pacientes a los 24 meses del diagnostico y en el 100 por ciento de ellos a los 5 años de la aparicion de la enfermedad. El hecho de que las lesiones neurologicas no esten presentes en todos los pacientes con luxaciones genera la discusion si se debe o no artrodesar tempranamente esta articulacion. Materiales y metodos: Se evaluaron 17 pacientes mujeres con artritis reumatoide con compromiso de la columna cervical alta.Todas fueron estudiadas en forma clinica y electrofisiologica con EMG y PESS, radiografias y resonancia magnetica (RM). Se solicitaron radiografias transoral, anteroposterior, perfil neutro, en flexion y en extension. Resultados: Todos los pacientes intervenidos quirurgicamente y evaluados en esta serie fueron mujeres, con un promedio de edad de 59 años (45-72). El seguimiento medio fue de 18 meses (5-36). Todas las pacientes del grupo A fueron ambulatorias y se les realizo una fusion C1-C2 con tornillos transarticulares segun Magerl. Al final del seguimiento no evidenciaron progresion de las lesiones radiologicas ni del compromiso clinico-neurologico. Todas las pacientes del grupo B fueron no ambulatorias. En todos los casos se trato de lesiones cervicales altas rigidas con migracion de la odontoides. Todas las fijaciones fueron hasta el occipital. Todas las pacientes del grupo B presentaron complicaciones intraoperatorias y posoperatorias que requirieron, en algunos casos, asistencia respiratoria mecanica (ARM) posoperatoria. La tasa de mortalidad de este grupo fue del 40 por ciento. Conclusiones: La fusion pre...

Pediatric spine injuries.

Pediatric spine injuries are rare, not only due to the plasticity of the pediatric spine, but also due to the difficulty of diagnosis and the usually severe, if not fatal, associated injuries. Mechanisms of injury, transportation, initial management, diagnostic exams, and management of such lesions are different from those of the adult, and an individualized approach to each case, looking for specific injury patterns, avoids misdiagnosis. The goal of this manuscripts is to summarize the specific spinal injury patterns of the pediatric population, as well as the present literature regarding their diagnosis and treatment.