[Cervical vertebral hemangioma with aggressive behavior]. / Hemangioma vertebral cervical con comportamiento agresivo.

INTRODUCTION: Hemangiomas are the most common primary tumors of the spine. Mainly asymptomatic Incidental finding when performing an imaging study. The incidence reported at autopsies is 11% in the spine, multifocal lesions are present in 25 to 30% of cases. CLINICAL CASE: Vertebral cervical hemangioma with benign and stable characteristics that underwent surgical treatment, observing aggressive post-surgical behavior two months later. CONCLUSION: The approach to vertebral pathology is algorithmic and protocolized, it is necessary to determine the treatment based on the overall understanding of the disease and according to the clinical practice guidelines.

INTRODUCCIÓN: Los hemangiomas son los tumores primarios más comunes de la columna, principalmente asintomáticos, de hallazgo incidental al realizar un estudio de imagen. La incidencia reportada en autopsias es de 11% en la columna y lesiones multifocales en 25 a 30% de los casos. CASO CLÍNICO: Hemangioma cervical vertebral con características benignas y estables. Se realizó tratamiento quirúrgico, observando un comportamiento agresivo postquirúrgico dos meses después. CONCLUSIÓN: El abordaje de la patología vertebral es algorítmico y protocolizado, es necesario determinar el tratamiento con base en la comprensión global de la enfermedad y de acuerdo a las guías de práctica clínica.

Retorno laboral en pacientes con lesión medular traumática en un centro hospitalario de México / Return to work in patients with traumatic spinal cord injury in a medical center in Mexico

Antecedentes y objetivo El regreso a un empleo remunerado es uno de los resultados más importantes en cuanto a reintegración social después de una lesión medular traumática y un indicador de éxito de los programas de rehabilitación; a pesar del impacto que tiene, muy pocos estudios en México se han enfocado en medir la reintegración comunitaria de estos pacientes. El objetivo es analizar la situación laboral de los pacientes con medular traumática atendidos en un centro hospitalario en México. Materiales y métodos Estudio descriptivo-transversal. Pacientes trabajadores de 19-55 años con diagnóstico de lesión medular traumática atendidos en un centro hospitalario en México a los cuales se les realizó una encuesta telefónica. Resultados Se incluyeron 18 pacientes (15 hombres, 3 mujeres), con una edad promedio de 38 años (± 10,3). Los niveles de lesión más comunes fueron cervical y torácico; los grados de escala de Asia Impairment Scale más comunes fueron A y E; 17 pacientes recibieron rehabilitación al egreso; la escala Spinal Cord Independence Measure promedio fue de 65,22 (± 35,11). Cinco pacientes fueron recontratados después de la lesión (27,7%), en un periodo medio de tiempo de 7 meses (± 2,9). Principales factores relacionados a la reintegración laboral: edad joven, niveles más bajos de la lesión, ingreso a un programa de rehabilitación, alta puntuación en la escala Spinal Cord Independence Measure y estado civil casado o en unión libre. Conclusiones Este trabajo demuestra la poca reinserción laboral después de una lesión medular traumática, así como los factores que influyen para la misma, destacando la importancia de un programa adecuado de rehabilitación con un enfoque multidisciplinario (AU)

Background and objective One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico. Material and methods Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed. Results Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting. Conclusion This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach (AU)

[Return to work in patients with traumatic spinal cord injury in a medical center in Mexico]. / Retorno laboral en pacientes con lesión medular traumática en un centro hospitalario de México.

BACKGROUND AND OBJECTIVE: One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico. MATERIAL AND METHODS: Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed. RESULTS: Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting. CONCLUSION: This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach.

[Bruns Garland syndrome. Report of a case and differential diagnosis with cauda equina syndrome]. / Síndrome de Bruns Garland. Informe de un caso y diagnóstico diferencial con el síndrome de cauda equina.

BACKGROUND: The Bruns Garland syndrome (diabetic amyotrophy) it is a very rare condition, with few cases reported in the literature. Clinical differentiation of diabetic amyotrophy or cauda equine syndrome may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. We report a case of diabetic amyotrophy that mimics a cauda equina syndrome. CASE DESCRIPTION: A 59 years old man diabetic patient that suddenly begins with weakness of lower extremities and loss of sphincters control. The patient was seen in the emergency room, the anteroposterior and lateral radiographs of the lumbosacral spine evidenced spondylolisthesis L5-S1 level II of Meyerding. However, the MRI show no vertebral canal compression, nerve root compression or disc extrusion. Electrodiagnostic study revealed diabetic amyotrophy (Bruns Garland syndrome). The patient rapidly improves with treatment based in antineuritics, diabetes control, physical therapy and rehabilitation. Four months after the diagnosis he recover his muscle strength, has no alterations in the march, no loss of balance, his sensitive is preserved and has no pain. CONCLUSION: Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from cauda equina syndrome. Treatment of both diseases may be needed for relief of the patients pain.

ANTECEDENTES: El síndrome de Bruns Garland (amiotrofia diabética) es una condición con pocos casos reportados en la literatura. La diferenciación clínica de una amiotrofia diabética o un síndrome de cauda equina puede ser difícil. El problema de un mal diagnóstico ha sido discutido como una razón para un mal resultado después de una cirugía de la columna lumbar. Se presenta un caso de amiotrofia diabética que imita un síndrome de cauda equina. DESCRIPCIÓN DEL CASO: Masculino de 59 años de edad con diabetes, comienza repentinamente con debilidad en las extremidades inferiores y pérdida del control de los esfínteres. Este paciente fue atendido en la sala de urgencias, las radiografías anteroposterior y lateral de la columna lumbosacra evidenciaron espondilolistesis L5-S1 nivel II de Meyerding. Sin embargo, la IRM no mostró ninguna compresión del canal vertebral, compresión de la raíz nerviosa, ni extrusión del disco. El estudio de electrodiagnóstico reveló amiotrofia diabética (síndrome de Bruns Garland). El paciente rápidamente mejoró con el tratamiento basado en antineuríticos, control diabético, terapia física y rehabilitación. Cuatro meses después del diagnóstico, el paciente recuperó su fuerza muscular, no mostró alteraciones en la marcha, ni pérdida del equilibrio, su sensibilidad se conserva y no manifiesta dolor. DISCUSIÓN: Deberán utilizarse estudios de electrodiagnóstico y radiológicos en todo paciente diabético que presente dolor en la pierna y/o debilidad para diferenciar una neuropatía diabética de un síndrome de cauda equina. El tratamiento en ambas enfermedades puede ser necesario para aliviar el dolor del paciente.

[Syndrome of vertebral destruction: understanding to practice]. / Síndrome de destrucción vertebral: del entendimiento a la práctica.

The term «vertebral destruction syndrome¼ comprises pathologies causing structural changes in the spine, mainly in the vertebral body, producing mechanical deformity and neurological involvement. The pathologies found in this definition may be infectious, metabolic or tumoral. Vertebral osteomyelitis is a disease that occurs mainly in adults > 50 years; we speak of spondylodiscitis when the condition affects the disc and vertebral body. The most important organism in vertebral osteomyelitis is Staphylococcus aureus, seen in over 50% of cases. Tumors of the spine can start from local or adjacent spinal injuries or distant ones, and spread through the blood or lymphatic system. Metastases account for about 97% of all tumors of the spine. Primary tumors that most commonly spread to the spine are lung, prostate, breast and kidney. Metabolic bone diseases are a group of disorders that occur as a result of changes in the calcium metabolism. The spine contains large amounts of metabolically active cancellous bone, which must withstand axial loads during stance. Osteoporosis is a metabolic disease that most commonly affects the spine; it is characterized by low bone mass. The diagnosis of these entities is important for the treatment and prognosis of the patient. The term «vertebral destruction syndrome¼ proposes a notarized scheme aimed at improving the patients prognosis and his/her prompt treatment.

El término «síndrome de destrucción vertebral¼ engloba patologías que causan alteraciones estructurales en la columna en particular, en el cuerpo vertebral, produciendo deformidad con afectación neurológica y/o mecánica. Dentro de las patologías que se encuentran en esta definición están la infecciosa, tumoral y metabólica. La osteomielitis vertebral es una enfermedad que se da sobre todo en adultos > 50 años; se habla de espondilodiscitis cuando hay afección del disco y cuerpo vertebral. El más importante organismo en la osteomielitis vertebral es el Staphylococcus aureus, visto en más de 50% de los casos. Los tumores de la columna vertebral pueden iniciar desde lesiones locales o adyacentes a la columna o a distancia, diseminados por vía hematógena o linfática; las lesiones por metástasis abarcan cerca de 97% de todos los tumores de la columna. Los tumores primarios que con mayor frecuencia se diseminan a columna vertebral son pulmonar, de próstata, mama y riñón. Las enfermedades metabólicas óseas son un grupo de desórdenes que ocurren como resultado de cambios en el metabolismo del calcio. La columna vertebral contiene grandes cantidades de hueso esponjoso metabólicamente activo que debe resistir cargas axiales durante la postura. La osteoporosis es la enfermedad metabólica que con más frecuencia afecta la columna vertebral; se caracteriza por disminución en la masa ósea. El diagnóstico de estas entidades es importante para el tratamiento y pronóstico del paciente; el término «síndrome de destrucción vertebral¼ propone un esquema protocolizado encaminado a mejorar el pronóstico del paciente, así como su pronto tratamiento.

[Thoracolumbar spine burst factor. Screw fixation]. / Factor tipo "burst" de columna toracolumbar, fijación con tornillo.

INTRODUCTION: The intermediate screw in a fractured vertebra works as a pressure point with an anterior vector thus creating a lordotic force that corrects kyphosis, provides appropriate three-point fixation and decreases the lever effect. OBJECTIVE: To describe the course of non-pathologic traumatic fractures of the thoracolumbar spine after instrumentation of the fractured vertebra. MATERIAL AND METHODS: A total of 37 patients with a diagnosis of traumatic vertebral fracture in the thoracolumbar area (T9-L4) were operated from January 2008 to December 2012. Patients included 28 males (75.6%) and 9 females (24.4%); mean age was 41.8 years. RESULTS: Correcting the total diameter of the spinal canal results in a 2.11 times higher chance of neurologic improvement; the relative risk of fusion was 0.97 with autologous graft as compared with a heterologous graft (CI 95% = 0.69-1.36) and 1.18 with instrumentation of the fractured vertebra (CI 95% = 0.42-3.31). CONCLUSIONS: Pedicle screw fixation at the fracture level is a safe and effective method to treat thoracolumbar fractures; it provides additional fixation points that assist in fracture reduction and correction of kyphosis, improving at the same time back pain and maintaining the corrective effect. Procedure indications include integrity of the posterior ligament complex and at least one intact pedicle in the fractured vertebra.

[Quality of life of patients after periprosthetic hip fracture surgery]. / Calidad de vida en los pacientes postoperados de fracturas periprotésicas de cadera.

INTRODUCTION: The quality of life of patients with periprosthetic fracture is complex; it interacts with the severity of the lesion, their independence level, and available resources, all of which could cause alterations secondary to their condition. OBJECTIVE: To know the quality of life and clinical course of patients after periprosthetic hip fracture surgery. MATERIAL AND METHODS: Patients with periprosthetic hip fracture were assessed. Physical exam was performed and the SF-36 questionnaire was applied. RESULTS: A total of 15 patients were included, 8 (53.3%) females and 7 (46.7%) males, with mean age 74 years (SD 12.51). Concerning underlying conditions, 5 patients had none (33.3%), one had hypertension (6.7%), one had a neoplasia (epidermoid), and 8 had more than one underlying condition. A predictive variable model was designed. In the overall score a 75.6% positive correlation was found, and a 57.2% determination coefficient. There was no statistical significance (p = 0.162). The same variables as in the previous model were included. Correlation was 0.678 and determination 45.9%, without statistical significance, p = 0.332. CONCLUSIONS: Patients reported feeling fair from the perspective of their overall health, physical function, physical role, emotional role, and social function; mental health wise, 50% reported feeling calm and full of life, and 50% reported anxiety and fear.

[Direct cost of complete cervical spinal cord injury]. / Costo directo de la lesión medular completa de la columna cervical.

OBJECTIVE: To determine the direct cost of complete cervical spinal cord injury. MATERIAL AND METHODS: 34 patients over 16 years of age with a diagnosis of complete cervical spinal cord injury. The cost calculation was done considering nine groups: bed days, specialty consultation, laboratory, X-rays, computed axial tomography, magnetic resonance imaging, anterior surgery, posterior surgery, anterior and posterior surgery. The micro costing technique was used and the mean cost per patient was obtained. RESULTS: 41% of patients had injury at C4-C5; mean age was 36 years; total cost was $8,622,793.00 mexican pesos, and the mean cost in patients who survived was $2,536,115.59 mexican pesos, which represented 29.4% of the total cost; the cost for the patients who died was $6,086,677.41 mexican pesos (70.6%). The percent distribution of the different components analyzed clearly shows that 51% of the total cost corresponded to hospitalization. The estimated annual cost of caring for these patients is $2,155,905.70 Mexican pesos, with an annual increase of $819,905.53 Mexican pesos. CONCLUSIONS: The major cost was hospitalization, so specific clinical management guidelines should be used to optimize economic resources and prevent complications that may increase the costs.

Quadriplegia recovery after hemi-section and transplant model of spinal cord at the level of C5 and C6.

A spinal cord hemi-section with a homologous transplant of medullar tissue at the level of C5-C6 and preservation of the anterior spinal artery was used to evaluate the histological characteristics such as quantity and quality of axons, myelin index and blood vessels after quadriplegia recovery. Vascular changes after spinal injury results in severe endothelial damage, axonal edema, neuronal necrosis and demyelinization as well as cysts and infarction. Preservation of the anterior spinal artery has demonstrated clinical recuperation; therefore, in addition to the lesion we included a homologous transplant to visualize changes at a cellular level. Two groups of dogs (hemi-section and transplant) went through a traumatic spinal cord hemi-section of 50% at the level of C5-C6. The transplant group formed by animals which simultaneously had 4 mm of spinal cord removed and the equal amount substituted from a donor animal at the level of C5-C6 corresponding to the half right side; both preserving the anterior spinal artery. Histological evaluation of all groups took place at days 3 (acute) and 28 (chronic) post-operation. Changes of degeneration and axonal regeneration were found in the hemi-section and transplant groups at acute and chronic time, as well as same quadriplegia recovery at chronic time in the hemi-section and transplant groups which closely related to mechanisms which participate in regeneration and functional recuperation due to the preservation of the anterior spinal artery and presence of new blood vessels.

[Risk factors affecting fusion in the treatment of lumbar spine instability]. / Factores de riesgo que afectan la fusión en el tratamiento de la inestabilidad en la columna lumbar.

BACKGROUND: Risk factors are the endogenous or exogenous factors that may be controlled and they are responsible for disease. The objective of this paper is to describe the risk factors affecting vertebral fusion in patients with lumbar spine instability seen at our hospital and to see how they relate to nutritional factors. MATERIAL AND METHODS: Patients undergoing vertebral fusion due to several diagnoses were analyzed. Different parameters were captured to determine the interaction among them and assess the factors affecting vertebral fusion healing. They were compared with patients with pseudoarthrosis to determine its risk factors. Patients were divided into two groups: the control group, who underwent fusion, and the cases, who had pseudoarthrosis. RESULTS: A total of 59 patients were examined; 15 (25.4%) were cases (pseudoarthrosis) and 44 (74.6%) were controls (fusion). The demographic distribution was 27 (45.8%) females and 32 (54.2%) males; mean age was 51 +/- 12 years, with a minimum age of 20 and a maximum of 85. The diagnostic-based distribution was as follows: 29 (49.1%) spondylolistheses, 21 (35.6%) fractures, 5 (8.5%) herniated discs, 3 (5.1%) infections, and one (1.7%) tumor. Mean body weight was 75.9 kg, height was 160 cm, BMI 24.5, Hb 15.2, Hct 35.9, and Alb 3.5. Various risk factors were analyzed including the following: age over 60 years, which showed a 49% higher chance of pseudoarthrosis compared with the control group, with a 95% CI, 0.12-2.27; body weight over 90 kg, which showed an 82% higher chance of pseudoarthrosis compared with the fusion group, with a 95% CI, 0.03-0.43; BMI, which showed a 25% higher chance of pseudoarthrosis, with a 95% CI, 0.18-3.18; hypoalbuminemia < 3.4 mg/100 ml, which showed a 78% higher chance of pseudoarthrosis, with a 95% CI, 0.06-0.75. CONCLUSIONS: This study found that pseudoarthrosis is caused by risk factors linked to the nutritional profile, i.e., obesity, and hypoalbuminemia; its chance of occurring is 1.5 greater than in individuals with normal values. For this reason it is important to assess these values and correct them early on during the preoperative period with supportive measures allowing for an appropriate metabolic control and the consequent optimum result, i.e., fusion.

[Aneurysmal bone cyst of the lumbar spine. Medico-surgical experience. A case report]. / Quiste óseo aneurismático de columna vertebral lumbar. Experiencia médico-quirúrgica. Reporte de un caso.

The aneurysmal bone cyst (ABC) of the lumbar spine is an infrequent entity, of undefined nature and aggressive behavior; there are only a few reports in Mexico, so we present the case of a patient with radicular and lumbar pain that progressed to pelvic limb paresthesia. Lesions in the vertebral body of L1 were located with imaging studies and confirmed with biopsy; treatment with corticosteroids was started and later resection of the lesion was performed together with stabilization of the spine using first a posterior approach and at a second stage an anterior approach. Corticosteroid therapy led to remission of tumor progression, so only vacuolated areas and destruction of the posterior wall were found, leading to instability and radiculopathy. This type of lesions usually appears in long bones and less often in the spine, but it is even rarer in the lumbar spine. The prognosis of ABC is usually good, with the exception of the rare cases of extremely disseminated cysts located in the spine. It is therefore important to consider this before deciding what the best approach is for each patient, as well as the appropriate medico-surgical measures.