RESUMO
Osteoporosis, and the consequences derived from it, such as fragility fractures, constitute a growing public health problem. Suffering from a fracture of this nature is the main risk factor for suffering a new fracture. It is documented that vertebral compression fractures lead to significant morbidity and mortality, in the short and long term, as well as other complications, such as sagittal imbalance and hyperkyphosis of the segment. However, we have not found documentation that analyzes the medium and long-term consequences of these injuries, assessing the type of treatment used, and the economic impact they represent. The purpose of this review is to analyze the main recent literature on the subject and make a breakdown of the consequences of these fractures in various spheres, such as economic, quality of life, sagittal balance and radiographic parameters, pain or mortality; as well as a brief analysis of epidemiology and natural history. Conclusion: Osteoporotic fractures constitute an emerging problem, both in the medical and economic fields. The consequences and sequelae on the patient are multiple and although surgical options offer good long-term results, it is necessary to properly select the patient, through multidisciplinary teams, to try to minimize potential complications.
RESUMO
Introducción: Las metástasis vertebrales son un problema muy frecuente y asocian un deterioro importante de la calidad de vida en los pacientes oncológicos. El objetivo de esta revisión es determinar el encaje de las técnicas quirúrgicas mínimamente invasivas dentro del manejo de esta entidad. Métodos: Se realizó una revisión bibliográfica en las bases de datos Google Scholar, PubMed, Scopus y Cochrane. Se revisaron los artículos publicados en los últimos 10 años que fueran de una relevancia y calidad adecuadas. Resultados: Tras el cribado de los 2.184 trabajos identificados inicialmente en las distintas bases de datos, se incluyeron un total de 24 artículos en esta revisión. Conclusión: La cirugía mínimamente invasiva de columna es especialmente útil en pacientes oncológicos frágiles con metástasis vertebrales por la reducida comorbilidad que presentan las técnicas que se engloban en ella en comparación con la de la cirugía abierta convencional. Los avances en tecnología aplicada a la cirugía, como la navegación y la robótica, mejoran la precisión y reducen las complicaciones de esta técnica.(AU)
Background: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. Methods: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. Results: After screening the 2184 initially identified registers, a total of 24 articles were included for review. Conclusion: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.(AU)
Assuntos
Humanos , Masculino , Feminino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Coluna Vertebral/cirurgia , Metástase Neoplásica/tratamento farmacológico , Neoplasias da Coluna Vertebral/cirurgia , Procedimentos Ortopédicos , Ortopedia , TraumatologiaRESUMO
Introducción: Las metástasis vertebrales son un problema muy frecuente y asocian un deterioro importante de la calidad de vida en los pacientes oncológicos. El objetivo de esta revisión es determinar el encaje de las técnicas quirúrgicas mínimamente invasivas dentro del manejo de esta entidad. Métodos: Se realizó una revisión bibliográfica en las bases de datos Google Scholar, PubMed, Scopus y Cochrane. Se revisaron los artículos publicados en los últimos 10 años que fueran de una relevancia y calidad adecuadas. Resultados: Tras el cribado de los 2.184 trabajos identificados inicialmente en las distintas bases de datos, se incluyeron un total de 24 artículos en esta revisión. Conclusión: La cirugía mínimamente invasiva de columna es especialmente útil en pacientes oncológicos frágiles con metástasis vertebrales por la reducida comorbilidad que presentan las técnicas que se engloban en ella en comparación con la de la cirugía abierta convencional. Los avances en tecnología aplicada a la cirugía, como la navegación y la robótica, mejoran la precisión y reducen las complicaciones de esta técnica.(AU)
Background: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. Methods: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. Results: After screening the 2184 initially identified registers, a total of 24 articles were included for review. Conclusion: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.(AU)
Assuntos
Humanos , Masculino , Feminino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Coluna Vertebral/cirurgia , Metástase Neoplásica/tratamento farmacológico , Neoplasias da Coluna Vertebral/cirurgia , Procedimentos Ortopédicos , Ortopedia , TraumatologiaRESUMO
BACKGROUND: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS: After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.
RESUMO
Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.
RESUMO
Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.
RESUMO
BACKGROUND: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS: After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.
RESUMO
El abordaje lateral transpsoas a la columna lumbar es una técnica mínimamente invasiva cada vez más usada debido a sus buenos resultados y a su tasa de complicaciones baja. El sangrado de este tipo de cirugía es escaso ya que la disección de partes blandas es mínima comparada con la cirugía vertebral tradicional, pero las arterias segmentarias y los grandes vasos pueden ser lesionados. Hasta ahora, hay muy pocos casos descritos de hematoma retroperitoneal mediante este abordaje pero este es el primero en una fusión lumbar intersomática mediante abordaje lateral transpsoas (XLIF) sin instrumentación añadida y el primero con shock hemorrágico. Los síntomas del hematoma retroperitoneal son inespecíficos, siendo los más prevalentes la taquicardia, la hipotensión y la anemia. Con este caso pretendemos mostrar que, a pesar de los buenos resultados de esta técnica, no está exenta de complicaciones graves (AU)
The transpsoas approach, also known as extreme lateral interbody fusion (XLIF), to the lumbar spine is a novel minimally invasive technique with positive clinical outcomes and a low complication rate. There is a low risk of bleeding, due to this approach causing less soft tissue disruption than traditional spine surgery, but segmental arteries and great vessels can be damaged. Retroperitoneal haematoma is a major complication, with few cases reported. This is the first case reported in a Stand-alone XLIF and also the first case reported with haemorrhagic shock. Non-specific symptoms such tachycardia, hypotension, and anaemia are the most prevalent in this complication. With this case, our aim is to describe serious complications related to XLIF (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Coluna Vertebral/cirurgia , Coluna Vertebral , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Enoxaparina/uso terapêutico , Dor Lombar/complicações , Dor Lombar/terapia , Artrodese/instrumentação , Artrodese/métodos , Exame Físico/métodos , Neurofisiologia/métodos , Neurofisiologia/normas , Osteoartrite da Coluna Vertebral/epidemiologia , Região Lombossacral/patologia , Região Lombossacral/cirurgia , Região Lombossacral , Angiografia/métodosRESUMO
The transpsoas approach, also known as extreme lateral interbody fusion (XLIF), to the lumbar spine is a novel minimally invasive technique with positive clinical outcomes and a low complication rate. There is a low risk of bleeding, due to this approach causing less soft tissue disruption than traditional spine surgery, but segmental arteries and great vessels can be damaged. Retroperitoneal haematoma is a major complication, with few cases reported. This is the first case reported in a Stand-alone XLIF and also the first case reported with haemorrhagic shock. Non-specific symptoms such tachycardia, hypotension, and anaemia are the most prevalent in this complication. With this case, our aim is to describe serious complications related to XLIF.
Assuntos
Hematoma/diagnóstico por imagem , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/diagnóstico por imagem , Hemorragia Pós-Operatória/diagnóstico por imagem , Fusão Vertebral , Idoso , Feminino , Hematoma/etiologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Espaço Retroperitoneal , Fusão Vertebral/métodosRESUMO
Se presenta un estudio retrospectivo efectuado entre los años 1988 a 1998 sobre la experiencia en nuestro hospital con el clavo de bloqueo Gamma®.Se han revisado un total de 348 fracturas trocantéreas femorales tratadas con este dispositivo en pacientes mayores de 60 años, excluyendo las fracturas patológicas. La edad media de los pacientes fue de 83,5 años, habiendo sido el tipo A1 de la clasificación de la AO el más frecuente (40 por ciento). El tiempo medio de intervención fue de 52 minutos, habiéndose conseguido una reducción anatómica en el 66 por ciento de los pacientes. Se registraron complicaciones técnicas en el 8 por ciento de los casos, siendo la más frecuente la fractura diafisaria femoral, que se produjo en 12 pacientes (2,5 por ciento). El tiempo medio de consolidación fue de 11 semanas. Evolucionaron a pseudoartrosis dos pacientes (1,8 por ciento). Fueron reintervenidos 28 pacientes (8 por ciento), siendo la causa más frecuente la protrusión del tornillo cefálico (21 casos). El 89 por ciento de los pacientes lograron la deambulación independiente o con distintos grados de soporte externo, frente al 95 por ciento de los que lo hacían previamente. Únicamente dos pacientes (0,8 por ciento) refirieron dolor importante durante su seguimiento. Los principales factores pronósticos observados han sido el tipo de fractura, la correcta técnica quirúrgica y las condiciones previas del paciente (AU)
