La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura estallido toracolumbar / Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture

Objetivo: Ver si, en pacientes añosos con fractura toracolumbar traumática, las radiografías en bipedestación con ortesis a las 24-48h del ingreso permiten predecir el colapso vertebral tras la consolidación. Material y métodos: Estudio prospectivo de 40 pacientes consecutivos con fractura estallido de charnela toracolumbar (T11-L2), mayores de 65 años. Avalado por el Comité Ética Investigación Clínica (CEIC). Criterios de inclusión: edad>65 años, fractura aguda por caída, ingreso hospitalario, tratamiento con corsé. Criterios de exclusión: afectación multinivel, sospecha malignidad, fractura subaguda o sin caída. Variables: índice de Farcy (F), cifosis regional (C: Cobb de vértebra craneal a la caudal a la rota), ambos medidos al ingreso (F0 y C0), a las 24-48h en bipedestación con corsé (F1 y C1) y a los 3 meses, sin corsé (F2 y C2), colapso (incremento de F0 a F1 —F0F1— y de F1 a F2 —F1F2—; así como de C0 a C1 —C0C1— y de C1 a C2 —C1C2—), edad y género. Análisis estadístico: paquete R. Resultados: Serie de 40 pacientes, con una edad media de 75 años (66-87). Nueve varones y 31 mujeres. Ni el género ni la edad se correlacionaron con ninguna variable. Seis requirieron cirugía en el seguimiento. No hubo diferencias en F1, C1, F0F1 ni C0C1 entre los 5 pacientes que requirieron cirugía y los otros 34. Posteriormente se realizó el análisis de los datos solo de aquellos pacientes que no precisaron de cirugía.Los valores obtenidos en el índice de Farcy fueron de 8±7° (F0), de 12±7° (F1) y de 15±8° (F2) y en la cifosis (3 vértebras, Cobb) fueron: C0=8±13°; C1=11,5±14° y C2=13±13°. Hubo correlación de F2 con F0 y F1 (p<0,001), con F0F1 (p=0,038) y F1F2 (p=0,007). La más poderosa fue con F1 (Rho Spearman: 0,889; IC 95%: 0,776-0,947), con una recta de regresión lineal: F2=2,61288+F1×1,01237 (R2=0,79). C2 se correlacionó con C0 y C1 (p<0,001), sobre todo con C1 (Rho de Spearman: 0,952; IC 95%: 0,899-0,977). Regresión lineal: C2=2,23371+C1×0,93758 (R2=0,927)...(AU)

Objective: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24–48h after admission can predict vertebral collapse after consolidation. Material and methods: Prospective cohort study endorsed by the Clinical Research Ethics Committee. Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic. Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) – both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 —F0F1— and from F1 to F2 —F1F2—; as well as from C0 to C1 —C0C1— and from C1 to C2 —C1C2—), age and gender. Statistical analysis: R package. Results: Series of 40 patients, with a mean age of 75 years (66–87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927)...(AU)

[Translated article] Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture / La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura-estallido toracolumbar

Objective: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24–48h after admission can predict vertebral collapse after consolidation. Material and methods: Prospective cohort study endorsed by the Clinical Research Ethics Committee. Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic. Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) – both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 —F0F1— and from F1 to F2 —F1F2—; as well as from C0 to C1 —C0C1— and from C1 to C2 —C1C2—), age and gender. Statistical analysis: R package. Results: Series of 40 patients, with a mean age of 75 years (66–87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927)...(AU)

Objetivo: Ver si, en pacientes añosos con fractura toracolumbar traumática, las radiografías en bipedestación con ortesis a las 24-48h del ingreso permiten predecir el colapso vertebral tras la consolidación. Material y métodos: Estudio prospectivo de 40 pacientes consecutivos con fractura estallido de charnela toracolumbar (T11-L2), mayores de 65 años. Avalado por el Comité Ética Investigación Clínica (CEIC). Criterios de inclusión: edad>65 años, fractura aguda por caída, ingreso hospitalario, tratamiento con corsé. Criterios de exclusión: afectación multinivel, sospecha malignidad, fractura subaguda o sin caída. Variables: índice de Farcy (F), cifosis regional (C: Cobb de vértebra craneal a la caudal a la rota), ambos medidos al ingreso (F0 y C0), a las 24-48h en bipedestación con corsé (F1 y C1) y a los 3 meses, sin corsé (F2 y C2), colapso (incremento de F0 a F1 —F0F1— y de F1 a F2 —F1F2—; así como de C0 a C1 —C0C1— y de C1 a C2 —C1C2—), edad y género. Análisis estadístico: paquete R. Resultados: Serie de 40 pacientes, con una edad media de 75 años (66-87). Nueve varones y 31 mujeres. Ni el género ni la edad se correlacionaron con ninguna variable. Seis requirieron cirugía en el seguimiento. No hubo diferencias en F1, C1, F0F1 ni C0C1 entre los 5 pacientes que requirieron cirugía y los otros 34. Posteriormente se realizó el análisis de los datos solo de aquellos pacientes que no precisaron de cirugía.Los valores obtenidos en el índice de Farcy fueron de 8±7° (F0), de 12±7° (F1) y de 15±8° (F2) y en la cifosis (3 vértebras, Cobb) fueron: C0=8±13°; C1=11,5±14° y C2=13±13°. Hubo correlación de F2 con F0 y F1 (p<0,001), con F0F1 (p=0,038) y F1F2 (p=0,007). La más poderosa fue con F1 (Rho Spearman: 0,889; IC 95%: 0,776-0,947), con una recta de regresión lineal: F2=2,61288+F1×1,01237 (R2=0,79). C2 se correlacionó con C0 y C1 (p<0,001), sobre todo con C1 (Rho de Spearman: 0,952; IC 95%: 0,899-0,977). Regresión lineal: C2=2,23371+C1×0,93758 (R2=0,927)...(AU)

Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture. / La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura estallido toracolumbar.

OBJECTIVE: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24-48h after admission can predict vertebral collapse after consolidation. MATERIAL AND METHODS: Prospective cohort study endorsed by the Clinical Research Ethics Committee. INCLUSION CRITERIA: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. EXCLUSION CRITERIA: various levels, suspected malignancy, non-immediate fracture or atraumatic. VARIABLES: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) - both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 -F0F1- and from F1 to F2 -F1F2-; as well as from C0 to C1 -C0C1- and from C1 to C2 -C1C2-), age and gender. STATISTICAL ANALYSIS: R package. RESULTS: Series of 40 patients, with a mean age of 75 years (66-87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927). CONCLUSIONS: Immediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.

[Translated article] Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture.

OBJECTIVE: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24-48h after admission can predict vertebral collapse after consolidation. MATERIAL AND METHODS: Prospective cohort study endorsed by the Clinical Research Ethics Committee. INCLUSION CRITERIA: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. EXCLUSION CRITERIA: various levels, suspected malignancy, non-immediate fracture or atraumatic. VARIABLES: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) - both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 -F0F1- and from F1 to F2 -F1F2-; as well as from C0 to C1 -C0C1- and from C1 to C2 -C1C2-), age and gender. STATISTICAL ANALYSIS: R package. RESULTS: Series of 40 patients, with a mean age of 75 years (66-87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889, 95% CI=.776-.947), with a linear regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927). CONCLUSIONS: Immediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.

Proximal sacral deformity: a common element in lytic isthmic spondylolisthesis at L5 and in degenerative spondylolisthesis at L4-L5 segment. Two apparently very different etiopathogenic entities. / Deformidad sacra proximal: elemento común a la espondilolistesis ístmica lítica de L5 y a la degenerativa del segmento L4-L5, 2 entidades de etiopatogenia muy diferente, aparentemente.

A radiographic study was carried out to investigate the relationship between proximal sacral sagittal anatomy (either kyphosis or lordosis) and either isthmic or degenerative spondylolisthesis. In addition, we studied whether there is a relationship between proximal sacral kyphosis and the degree of such listhesis in the case of L5 isthmic spondylolisthesis. Lateral standing x-rays were used from 173 patients, ninety of whom had degenerative spondylolisthesis L4-L5, and eighty-three an isthmic spondylolisthesis of L5 (67 low-grade and 16 high-grade) and compared with a control group of 100 patients adjusted by age and gender, without any type of spondylolisthesis. Listhesis was graded using Meyerding's classification and the proximal sacral kyphosis angle (CSP) was measured between S1 and S2 posterior walls, according to Harrison's method. In our series, there was a proximal sacral kyphosis in both types of spondylolisthesis, greater in the lytic type. By contrast, the control group had a proximal sacral lordosis. The differences were statistically significant. Therefore, we concluded that there was a proximal sacral kyphosis in patients with both degenerative and isthmic lytic spondylolisthesis, but with our results, we were not able to ascertain whether it is a cause or a consequence of this listhesis.

Lordosis manoeuvre in the diagnosis of lumbar facet syndrome. / Efectividad de la maniobra lordosante en el diagnóstico del síndrome facetario lumbar.

UNLABELLED: In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. HYPOTHESIS: The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies MATERIALS AND METHODS: A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. EXCLUSION CRITERIA: Deformity and instability. using a physical. OBJECTIVE: To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). STATISTICS: R package software. RESULTS: The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. CONCLUSIONS: A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS.

Prognostic value of an immediate lateral standing X-ray with a TLSO in patients with a thoracolumbar burst fracture.

UNLABELLED: The final collapse of a "stable" thoracolumbar burst fracture is difficult to predict. This collapse was prospectively studied radiologically in patients with T12 or L1 burst fractures who, after evaluating the admission x-rays and the CT scan with the patients themselves, opted for a rigid thoracolumbar brace with support in the sternal manubrium (TLSO). On the other hand, patients with rigid braces sometimes have low back pain on follow-up (due to overload of the L5-S1 joints). HYPOTHESIS: the standing lateral x-ray with only a TLSO for support (intrinsic mechanical stability) provides information on the final collapse and could also provide information on the low back pain. The study included 50 patients (20 males and 30 females, age: 63+14 years) admitted during 2011 and 2012, with 2 losses to follow-up. VARIABLES: Farcy index and local kyphosis (Cobb at 3 vertebrae). X-Rays: admission, with TLSO (immediate: Rx0), and at 3 and 6 months. They were compared with the final clinical and radiological results. It was decided to surgically intervene in 4 patients after Rx0. There were no painful sequelae at the fracture level, and 16/44 (31%) had low back pain. Using linear regression mathematical models, the increase in the Farcy index (Rx0-Rx admission) was associated with the appearance of low back pain and with local kyphosis (Rx0-Rx admission), and with the final kyphosis. It is advisable to perform a lateral standing X-ray after TLSO for information on the final collapse of the fracture and the appearance of accompanying low back pain.

Inestabilidad occipitocervical en la enfermedad de Morquio. Presentación de 2 casos y revisión de la literatura / Occipital-cervical instability in Morquio disease: a presentation of 2 cases and a review of the literature

Introducción. El síndrome de Morquio se produce por un déficit enzimático de herencia autosómica recesiva. Presenta numerosas manifestaciones musculoesqueléticas, entre las que destaca por su riesgo vital la inestabilidad atloaxoidea. En estos casos está indicada la cirugía de artrodesis (y descompresión) occipitocervical Objetivo. Se presentan 2 pacientes con síndrome de Morquio que precisaron de este tipo de cirugía, así como una revisión de la literatura. Pacientes y métodos. Dos pacientes: un niño y una niña, con síndrome de Morquio e inestabilidad cervical alta, con signos y síntomas neurológicos, que fueron intervenidos quirúrgicamente mediante descompresión y artrodesiso occipitocervical instrumentada; con un seguimiento de 6 y un año respectivamente. Resultados. Ambos pacientes mejoraron de sus problemas neurológicos, realizando en al actualidad una vida normal para su edad. Conclusión. La artrodesis occipitocervical con descompresión proporciona un entorno biomecánico seguro que previene de la afectación neurológica. Estaría indicada ante la aparición de sintomatología o de inestabilidad mecánica (AU)

Introduction. Morquio syndrome is caused by an inherited autosomal recessive enzyme deficiency. It presents with numerous musculoskeletal anomalies, among which atlantoaxial instability is highlighted, due it being life-threatening. Occipital-cervical arthrodesis surgery (and decompression) is indicated in these cases. Objective. The cases of 2 patients with Morquio syndrome that required this type of surgery are presented, along with a review of the literature. Patients and methods. Two patients: one boy and one girl, with Morquio syndrome and high cervical instability, with neurological signs and symptoms, who were subjected to surgery using decompression and instrumented occipital-cervical arthrodesis and followed up for 6 months and one year, respectively. Results. The neurological problems of both patients improved, and are currently having a normal life for their age. Conclusion. Occipital-cervical arthrodesis with decompression provides a safe biomechanical environment that prevents neurological involvement. It should be indicated before the appearance of symptoms or mechanical instability (AU)

[Occipital-cervical instability in Morquio disease: a presentation of 2 cases and a review of the literature]. / Inestabilidad occipitocervical en la enfermedad de Morquio. Presentación de 2 casos y revisión de la literatura.

INTRODUCTION: Morquio syndrome is caused by an inherited autosomal recessive enzyme deficiency. It presents with numerous musculoskeletal anomalies, among which atlantoaxial instability is highlighted, due it being life-threatening. Occipital-cervical arthrodesis surgery (and decompression) is indicated in these cases. OBJECTIVE: The cases of 2 patients with Morquio syndrome that required this type of surgery are presented, along with a review of the literature. PATIENTS AND METHODS: Two patients: one boy and one girl, with Morquio syndrome and high cervical instability, with neurological signs and symptoms, who were subjected to surgery using decompression and instrumented occipital-cervical arthrodesis and followed up for 6 months and one year, respectively. RESULTS: The neurological problems of both patients improved, and are currently having a normal life for their age. CONCLUSION: Occipital-cervical arthrodesis with decompression provides a safe biomechanical environment that prevents neurological involvement. It should be indicated before the appearance of symptoms or mechanical instability.

Luxación subaxial cervical inveterada. Discusión de cuál es la mejor estrategia terapéutica / Inveterate subaxial cervical dislocations: a discussion on the best therapeutic strategy

Las luxaciones cervicales inveteradas presentan serias dificultades a la hora de plantear su tratamiento adecuado, por un lado, debido la dificultad de su reducción y, por otro, al riesgo de inducir lesiones iatrogénicas durante su reducción. A este hecho hay que añadir la escasa y controvertida bibliografía existente a la hora de establecer la estrategia quirúrgica más apropiada para su manejo. Presentamos un caso clínico tratado en la Unidad de Raquis del Servicio de Cirugía Ortopédica y Traumatología del Complejo Hospitalario Universitario de Santiago de Compostela, discutiendo las 2 opciones de tratamiento que actualmente se consideran las más utilizadas: el abordaje anterior-posterior-anterior y el posterior-anterior-posterior. Tras el análisis de los datos obtenidos de la revisión de este caso, podríamos concluir que el abordaje quirúrgico de estas lesiones resulta en general difícil, pudiéndose realizar las 2 técnicas anteriormente descritas, pero con la precaución de extirpar siempre la totalidad del disco intervertebral afectado antes de realizar las maniobras de corrección axial, por el riesgo de extrusión del mismo hacia canal medular. Con posterioridad a este gesto quirúrgico, se procedería a una correcta liberación y reducción de las facetas articulares, siendo necesario, en ocasiones, añadir osteotomías en las mismas (AU)

It is difficult to decide the appropriate treatment for inveterate cervical dislocations because of the difficulty of their reduction, as well as due to the risk of inducing iatrogenic injuries during this reduction. The literature on the most appropriate surgical strategy for their management is also limited as well as controversial.We report one clinical case treated in the Spine Unit of the Orthopedic Surgery and Trauma Service of the University Hospital of Santiago de Compostela, discussing the currently most used treatment options, the anterior-posterior-anterior and the posterior-anterior-posterior approach. After analyzing the results, it could be concluded that the surgical approach to these lesions is generally difficult, with any of two techniques described above being suitable, but always with the precaution to remove the entire affected intervertebral disc before axial correction maneuvers, thus avoiding the risk of extrusion into the medullary canal. After the surgical procedure, a proper release and reduction of the joint facets should be performed, sometimes with the need to add osteotomies in them (AU)

[Inveterate subaxial cervical dislocations: a discussion on the best therapeutic strategy]. / Luxación subaxial cervical inveterada. Discusión de cuál es la mejor estrategia terapéutica.

It is difficult to decide the appropriate treatment for inveterate cervical dislocations because of the difficulty of their reduction, as well as due to the risk of inducing iatrogenic injuries during this reduction. The literature on the most appropriate surgical strategy for their management is also limited as well as controversial. We report one clinical case treated in the Spine Unit of the Orthopedic Surgery and Trauma Service of the University Hospital of Santiago de Compostela, discussing the currently most used treatment options, the anterior-posterior-anterior and the posterior-anterior-posterior approach. After analyzing the results, it could be concluded that the surgical approach to these lesions is generally difficult, with any of two techniques described above being suitable, but always with the precaution to remove the entire affected intervertebral disc before axial correction maneuvers, thus avoiding the risk of extrusion into the medullary canal. After the surgical procedure, a proper release and reduction of the joint facets should be performed, sometimes with the need to add osteotomies in them.

Paciente con espondilitis anquilopoyética y fractura cervical: retardo de consolidación en un tratamiento conservador resuelto con teriparatida / A patient with spondylitis ankylopoetica and neck fracture: a delay in consolidation in a conservative treatment resolved with teriparatide

Se presenta el caso de un paciente con antecedentes de espondilitis anquilopoyética que sufrió una fractura cervical a nivel C5-C6 sin lesión neurológica. Debido a sus antecedentes personales pluripatológicos, se optó por un tratamiento con halo-chaleco. En la evolución se observó un retardo de consolidación a los dos meses, por lo que se instauró tratamiento con teriparatida a dosis de 20mg/día. La consolidación se obtuvo a los cuatro meses, dos después del comienzo con tratamiento farmacológico. La teriparatida puede ser un tratamiento farmacológico adyuvante como estimulador de la consolidación de fracturas en situaciones comprometidas (AU)

A case is presented on a patient with a history of spondylitis ankylopoetica who suffered a neck fracture at C5-C6 level, with no neurological injury. Due a personal history of multiple illnesses, it was decided to treat with a halo jacket. A delay in consolidation was observed after two months, so treatment with teriparatide was started at a dose of 20mg/day. Consolidation was achieved at four months (two after starting the pharmacological treatment). Teriparatide can be an adjuvant pharmacological treatment as a stimulator of consolidation of fractures in compromised situations (AU)

Enclavado telescopable de las fracturas patológicas del húmero / Telescopic nails in pathological fractures of the humerus

La mejora en la expectativa de vida de los pacientes con procesos tumorales hace que esta vaya acompañada a su vez en una mejora en la calidad de la misma. El 85 por ciento de los tumores malignos presentaban afectación ósea en su evolución y aproximadamente un 10 por ciento de los pacientes con metástasis óseas presentan fracturas debidas a ellas. El clavo intramedular telescopable está compuesto por dos piezas, una mayor de sección externa hexagonal e interna circular, donde penetra otra cilíndrica menor. La serie revisada consta de 13 casos intervenidos entre 1991 y 2000. La movilidad postoperatoria del hombro fue de 221° ñ 62°, con una antepulsión de 76° ñ 20° y una abducción activa a los 3 meses de 70° ñ 20°. Hasta este momento no hay series clínicas comparativas con el método habitual de referencia que sería el clavo cerrojado con cemento. Esta técnica ha demostrado su eficacia en estos casi 10 años de utilización (AU)

El enclavado medular sin fresar / Unreamed intramedullary nailing

La técnica del enclavado medular fresado origina dos problemas biológicos: la destrucción del sistema vascular endomedular y la generación de episodios de hiperpresión endomedular, origen de intravasación de productos del fresado en el sistema venoso aferente, los cuales se han intentado subsanar con el enclavado endomedular sin fresado. El objetivo del presente trabajo es revisar la bibliografía publicada sobre esta técnica no fresada y analizar la experiencia de nuestro Servicio con ella, para intentar definir aquellas situaciones en las que sea aconsejable no fresar o, por el contrario, aquellas en las que sea recomendable hacerlo (AU)

La giba costal en la escoliosis idiopática / Rib deformity in idiopathic scoliosis

El problema de la giba costal es uno de los de mayor repercusión anímica sobre el paciente escoliótico. La cirugía correctora vertebral consigue mejorarla, aunque suele recidivar con la evolución. Se propone como hipótesis el que una deformación elástica intrínseca de la costilla explicaría tanto la variación tridimensional de la caja torácica con la cirugía como la posterior recidiva. Se realiza un estudio de 16 pacientes con escoliosis idiopática con curva torácica > 70° Cobb tratados mediante artrodesis anterior y posterior, con corrección mediante instrumentación CD, a los que se ha seguido durante un mínimo de 2 años. En el plano anteroposterior no se encontró movilidad costovertebral, sino un reequilibrio de tensiones musculares que no explicaría el comportamiento de la giba. Por tanto, se sugiere que la explicación a la deformidad podría encontrarse en el plano transversal, probablemente con un componente de deformación elástica intrínseca en los arcos costales, por lo que para corregir la deformidad costal, dicho anillo debería romperse en algún punto (AU)