¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria / How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialised paediatric and adolescent spine unit of a referral centre, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low-cost, accessible, reproducible and with an educational character.

Manejo de las metástasis vertebrales en la charnela cervico-occipital / Management of vertebral metastases in the cervico-occipital junction

Las metástasis a nivel occipito-cervical corresponden solo al 0,5% de las metástasis del raquis. El manejo de estas lesiones es complejo y conlleva múltiples estudios radiológicos, tales como la radiología simple, la tomografía computarizada (TAC) o la resonancia magnética (RM). Ante la sospecha de afectación vascular también será recomendable la realización de pruebas que valoren la permeabilidad vascular (angio-TC, angio-RM). Este tipo de lesiones, debido a su compleja localización, puede precisar distintos tipos de vías de abordaje; comúnmente será el abordaje posterior, pero en ocasiones se necesitarán abordajes anteriores o anterolaterales asistidos por cirujanos maxilofaciales u otorrinolaringólogos para una correcta exéresis de la tumoración. El dolor con los giros puede orientarnos al diagnóstico en una columna inestable. La RM es la prueba de elección para diagnosticar y estudiar estas lesiones. La presencia de inestabilidad o de clínica neurológica progresiva es indicación de cirugía.(AU)

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.(AU)

[Translated article] Management of vertebral metastases in the cervico-occipital junction / Manejo de las metástasis vertebrales en la charnela cervicooccipital

Las metástasis a nivel occipito-cervical corresponden solo al 0,5% de las metástasis del raquis. El manejo de estas lesiones es complejo y conlleva múltiples estudios radiológicos, tales como la radiología simple, la tomografía computarizada (TAC) o la resonancia magnética (RM). Ante la sospecha de afectación vascular también será recomendable la realización de pruebas que valoren la permeabilidad vascular (angio-TC, angio-RM). Este tipo de lesiones, debido a su compleja localización, puede precisar distintos tipos de vías de abordaje; comúnmente será el abordaje posterior, pero en ocasiones se necesitarán abordajes anteriores o anterolaterales asistidos por cirujanos maxilofaciales u otorrinolaringólogos para una correcta exéresis de la tumoración. El dolor con los giros puede orientarnos al diagnóstico en una columna inestable. La RM es la prueba de elección para diagnosticar y estudiar estas lesiones. La presencia de inestabilidad o de clínica neurológica progresiva es indicación de cirugía.(AU)

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.(AU)

[Translated article] Management of vertebral metastases in the cervico-occipital junction.

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or antero-lateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumour. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms is an indication for surgery.

Management of vertebral metastases in the cervico-occipital junction. / Manejo de las metástasis vertebrales en la charnela cervico-occipital.

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.

How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method. / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.

Osteosarcoma lumbar en edad pediátrica: reporte de casos y revisión de la literatura / Spinal osteosarcoma in the paediatric age group: case series and literature review

Introducción y objetivo: El tumor maligno de raquis más frecuente en la edad pediátrica es el osteosarcoma, su diagnóstico y tratamiento precoces son esenciales. El objetivo del presente trabajo es el presentar los resultados obtenidos en el tratamiento de pacientes pediátricos con osteosarcoma lumbar y realizar una revisión de la literatura. Material y métodos: Se incluyeron aquellos pacientes pediátricos intervenidos de osteosarcoma de columna móvil entre 2012 y 2014 en el mismo centro. Se analizaron datos demográficos, radiológicos (clasificaciones Enneking, WBB y Tomita) y anatomopatológicos (Broders). Todos fueron tratados mediante resección quirúrgica, asociada a distintos protocolos oncológicos (radioterapia y/o quimioterapia) según consenso del comité de tumores. El seguimiento medio fue de 62,53 meses (47-70 meses). Resultados: Se presentan un total de 3 pacientes, dos niñas de 9 y 11 años con osteosarcoma en L5 y un niño de 15 años con osteosarcoma en L4. En dos de los casos se trató inicialmente como un osteoblastoma, ya que las imágenes radiológicas y anatomopatológicas así lo apoyaban. Ninguno de los pacientes presentó recidivas locales ni metástasis tras la cirugía definitiva. Conclusiones: Los casos descritos en la literatura sobre manejo de osteosarcoma vertebral en columna móvil en la infancia son escasos, por lo que el tratamiento óptimo y pronóstico en estos pacientes es incierto. La resección en bloque mejora el control local de la enfermedad, sin demostrar que mejore la supervivencia global. La resección intralesional se asocia a mayor índice de recidivas. Un correcto diagnóstico diferencial del tumor (osteosarcoma vs. osteoblastoma) es vital para su tratamiento

Introduction and objective: Osteosarcoma is the most frequent malignant spinal tumour in the paediatric age group. Diagnosis and early treatment of this pathology is essential for a good prognosis. The aim of this study was to present the results of treatment of paediatric patients with lumbar osteosarcoma and conduct a literature review. Material and methods: All the patients with lumbar osteosarcoma who were operated between 2012 and 2014 in the same centre were included. Demographic and radiological data (Enneking, WBB and Tomita classification), as well as anatomopathological (Broders classification) variables were analysed. All the patients were treated by surgical resection associated with adjuvant therapies (chemotherapy and radiotherapy); according to consensus with the tumour committee. The average follow-up was 62.53 months (47-70 months). Results: A total of 3 patients were studied, two girls of 9 and 11, with L5 osteosarcoma, and a 15-year-old boy with L4 osteosarcoma. Two of the cases were initially treated as an osteoblastoma, supported by radiological and anatomopathological images. None of the patients had local recurrences or metastases during follow-up. Conclusions: Due to a lack of long series of cases of osteosarcoma in the mobile spine during childhood, the optimal treatment and prognosis in these patients is uncertain. Block resection improves local control of the disease, without demonstrating improvement in overall survival. Intralesional resection is associated with a higher rate of local recurrence. Oncological treatment is essential in the treatment of this pathology. A correct differential diagnosis of the tumour (osteosarcoma vs. osteoblastoma) is vital for its correct treatment

Spinal osteosarcoma in the paediatric age group: case series and literature review. / Osteosarcoma lumbar en edad pediátrica: reporte de casos y revisión de la literatura.

INTRODUCTION AND OBJECTIVE: Osteosarcoma is the most frequent malignant spinal tumour in the paediatric age group. Diagnosis and early treatment of this pathology is essential for a good prognosis. The aim of this study was to present the results of treatment of paediatric patients with lumbar osteosarcoma and conduct a literature review. MATERIAL AND METHODS: All the patients with lumbar osteosarcoma who were operated between 2012 and 2014 in the same centre were included. Demographic and radiological data (Enneking, WBB and Tomita classification), as well as anatomopathological (Broders classification) variables were analysed. All the patients were treated by surgical resection associated with adjuvant therapies (chemotherapy and radiotherapy); according to consensus with the tumour committee. The average follow-up was 62.53 months (47-70 months). RESULTS: A total of 3 patients were studied, two girls of 9 and 11, with L5 osteosarcoma, and a 15-year-old boy with L4 osteosarcoma. Two of the cases were initially treated as an osteoblastoma, supported by radiological and anatomopathological images. None of the patients had local recurrences or metastases during follow-up. CONCLUSIONS: Due to a lack of long series of cases of osteosarcoma in the mobile spine during childhood, the optimal treatment and prognosis in these patients is uncertain. Block resection improves local control of the disease, without demonstrating improvement in overall survival. Intralesional resection is associated with a higher rate of local recurrence. Oncological treatment is essential in the treatment of this pathology. A correct differential diagnosis of the tumour (osteosarcoma vs. osteoblastoma) is vital for its correct treatment.

Artrodesis cervical anterior con empleo de autoinjerto de cuerpo vertebral / Anterior cervical arthrodesis using a vertebral body autograft

Objetivo: Evaluar tasas de fusión y resultados funcionales en pacientes intervenidos de discectomía y fusión cervical anterior empleando autoinjerto de cuerpo vertebral para el relleno del dispositivo intersomático, y fijación anterior con placa cervical. Material y métodos: Ciento dos enfermos, 54 varones y 48 mujeres, intervenidos entre 2006 y 2010. Se incluyeron pacientes con patología degenerativa, hernia discal cervical y radiculopatía, en los que había fracasado el tratamiento conservador habitual (3 meses). Se incluyeron pacientes con fusión de 1-3 niveles. El seguimiento medio fue de 44 (24-96) meses. Su edad media era de 48,8 años. Resultados: Las variables clínicas analizadas fueron: tiempo de evolución de los síntomas (> 12 meses), tabaquismo (31% fumadores), situación laboral (76% activos), estancia hospitalaria (2,2 días), tiempo quirúrgico (62 minutos), causa de la cirugía (100%, patología degenerativa), comorbilidades destacables (en el 28%), niveles fusionados (42% 1, 49% 2, 9% 3), clínica asociada (radiculalgia o dolor axial). Variables funcionales analizadas (puntuación pre y postoperatoria): EVA (8,6-1,32), Neck Disability Index (37,7-5,8), criterios de Odom (76% reflejaron resultados excelentes tras la cirugía). Variables radiológicas analizadas: osteofitosis reactiva (16%), colapso (0%), tasa de fusión (98%). Se produjeron 4 complicaciones agudas postoperatorias y 4 crónicas, ninguna relacionada con la técnica quirúrgica. Discusión: El empleo de autoinjerto óseo del propio cuerpo vertebral reduce las comorbilidades asociadas al uso de cresta ilíaca del propio enfermo. Nuestros resultados son comparables a la literatura, con una tasa de fusión del 98% y un promedio de 62 minutos de tiempo quirúrgico (AU)

Objective: To assess fusion rates and functional outcomes in patients undergoing anterior cervical discectomy and fusion by using a vertebral body autograft for interbody filling and anterior cervical plate fixation. Material and methods: The study included a total of 102 patients, 54 men and 48 women, who underwent surgery between 2006 and 2010 patients with degenerative disease, cervical disc herniation and radiculopathy, and who had failed standard conservative treatment (3 months). The study was limited to patients with fusion levels 1-3. The mean patient follow-up was 44 (24-96) months. Their mean age was 48.8 years. Results: The clinical variables analyzed were: duration of symptoms (> 12 months), smoking (31% smokers), employment status (76% active), average days of hospitalization (2.2 days), operation time (62 minutes), etiology (100%, degenerative disease), notable comorbidities (28%), fusion levels (42% 1, 49% 2, 9% 3), symptoms (radiculalgia or axial pain). The functional variables analyzed (score pre-and post-operative scores) were: VAS (8.6-1.32), Neck Disability Index (37.7-5.8), and Odom criteria (76% reflected excellent results after surgery). Finally, radiological variables were also analyzed: anterior reactive osteophytosis (16%), significant collapse (0%), and fusion rate (98%). There were 4 cases of acute postoperative complications, and 4 chronic, none of them were related to the surgical technique. Discussion: The use of autograft bone of the vertebral body itself reduces comorbidities associated with the use of the iliac crest of the patient. Our results using the technique described are comparable to those in the literature, with a fusion rate of 98% and a mean of 62 minutes duration of the procedure (AU)

Anterior cervical arthrodesis using a vertebral body autograft.

OBJECTIVE: To assess fusion rates and functional outcomes in patients undergoing anterior cervical discectomy and fusion by using a vertebral body autograft for interbody filling and anterior cervical plate fixation. MATERIAL AND METHODS: The study included a total of 102 patients, 54 men and 48 women, who underwent surgery between 2006 and 2010 patients with degenerative disease, cervical disc herniation and radiculopathy, and who had failed standard conservative treatment (3 months). The study was limited to patients with fusion levels 1-3. The mean patient follow-up was 44 (24-96) months. Their mean age was 48.8 years. RESULTS: The clinical variables analyzed were: duration of symptoms (> 12 months), smoking (31% smokers), employment status (76% active), average days of hospitalization (2.2 days), operation time (62 min), etiology (100%, degenerative disease), notable comorbidities (28%), fusion levels (42% 1, 49% 2, 9% 3), symptoms (radiculalgia or axial pain). The functional variables analyzed (score pre-and post-operative scores) were: VAS (8.6-1.32), Neck Disability Index (37.7-5.8), and Odom criteria (76% reflected excellent results after surgery). Finally, radiological variables were also analyzed: anterior reactive osteophytosis (16%), significant collapse (0%), and fusion rate (98%). There were 4 cases of acute postoperative complications, and 4 chronic, none of them were related to the surgical technique. DISCUSSION: The use of autograft bone of the vertebral body itself reduces comorbidities associated with the use of the iliac crest of the patient. Our results using the technique described are comparable to those in the literature, with a fusion rate of 98% and a mean of 62 min duration of the procedure.

Caracterización de células madre de núcleo pulposo de disco intervertebral cervical y comparación con células de médula ósea de los mismos pacientes / Characterization of stem cells from nucleus pulposus of cervical intervertebral disc and compared with bone marrow cells from the same patients

Objetivo: Evaluar la presencia de células mesenquimales en el núcleo pulposo de disco intervertebral cervical y caracterizarlas comparativamente con las obtenidas de médula ósea de los mismos sujetos. Pacientes y metodología: Hemos realizado un estudio descriptivo con 14 pacientes que precisaron cirugía de artrodesis cervical. Se analizó la presencia de células mesenquimales (CSM) en el núcleo pulposo (NP) del disco, comparándolas cualitativamente con las de médula ósea (MO) de los mismos pacientes. Se aislaron y expandieron CSM, tanto de NP como de MO. Se realizaron los estudios de diferenciación multilineal in vitro de las células mesenquimales de ambas fuentes, hacia osteoblasto y adipocito, y caracterización inmunofenotípica por citometría de flujo. Resultados: Las células de ambos orígenes se diferencian in vitro hacia ambos tipos celulares, si bien la diferenciación adipocítica de las células procedentes del disco fue menor que las procedentes de MO. Tampoco se han demostrado diferencias en los marcadores inmunofenotípicos. Las células de ambas fuentes poseen los marcadores inmunofenotípicos característicos de las células mesenquimales. Conclusión: El NP de disco vertebral cervical degenerado contiene células troncales mesenquimales. Estas células son similares a las células de MO, con la excepción de su capacidad disminuida de diferenciación adipogénica (AU)

Objective: To evaluate the presence of mesenchymal cells in the nucleus pulposus (NP) of cervical discs and characterize them in comparison ot those obtained from the bone marrow of the same subjects. Patients and methods: We have performed a descriptive study with 14 patients requiring cervical fusion surgery. The presence of mesenchymal stem cells (MSCs) were analyzed in the NP from the disk and compared qualitatively with the bone marrow (BM) of the same patients. MSC were isolated and expanded for both NP and MO. We performed in vitro differentiation studies of mesenchymal cells from both sources, into osteogenic and adipogenic lines, and flow cytometric immunophenotyping. Results: We got differentiation towards both cell types, although adipocyte differentiation of disc-derived cells was decreased compared to those from BM. There were no differences in immunophenotypic markers. Cells from both sources have immunophenotypic markers characteristic of mesenchymal cells. Conclusion: The NP of degenerated cervical disc contains mesenchymal stem cells. These cells are quite similar to BM cells, with the exception of a diminished adipogenic differentiation capacity (AU)

Artrodesis lumbar circunferencial: autoinjerto frente a injerto liofilizado / Transforaminal lumbar interbody fusion: autograft vs freeze-dried allograft

Objetivo: Analizar y comparar los resultados radiográficos y clínicos de la fusión lumbar mediante autoinjerto frente a injerto liofilizado. Material y metodología: Se realizó un estudio prospectivo cuasi-experimental, con un seguimiento mínimo de 13 meses. Se incluyeron 72 pacientes, con una edad media de 48 años, siendo el 52,8%mujeres. Todos fueron intervenidos de artrodesis lumbar circunferencial de un nivel, que se dividieron en dos grupos: en uno se utilizó autoinjerto de cresta iliaca (AU) (n=41; 57,7%) y en el otro injerto liofilizado de banco (LI) (n=30; 42,3%). Se evaluaron factores sociodemográficos, la existencia o no de fusión tras la intervención y resultados clínicos mediante la escala EVA, antes y después de la cirugía. Resultados: El dolor lumbar medio fue de 7,5 en autoinjertos y de 8 en injertos liofilizados (p=0,146); tras la intervención el dolor lumbar medio mejoró en 4 puntos o más (AU = 3; LI = 1) (p= 0,196). No encontramos diferencias en los resultados de EVA, al igual que tampoco se encontraron diferencias con respecto a la fusión obtenida en los niveles intervenidos (p= 0,112). Conclusión: El injerto liofilizado, en la artrodesis circunferencial de un nivel, nos proporciona fusiones y resultado funcional similar al autoinjerto (AU)

Objective: The purpose of this study is to analyze and compare the radiographic and clinical results of lumbar fusion using autograft versus lyophilized graft. Methods: This was a prospective study quasi-experimental, with a minimum follow-up of 13 months. It included patients undergoing circumferential lumbar fusion level. We started with a population of 96 patients, of which, we had 8 losses and 16 were excluded, so the sample size was 72 patients, 52.8% of them women, with an average age of 48 years. They were divided into two groups: one that was used in the iliac crest autograft (AU) (n = 41; 57.7%) and other bank lyophilized graft (LI) (n = 30; 42.3%). We evaluated socio-demographic factors, the existence of fusion after surgery and clinical outcomes by VAS before and after surgery. Results: Low back pain in a scale of 1 to 10 was UA: 7.5, LI: 8 (p=0.146). After surgery, back pain improved in 4 points or more, AU: 3, LI: 1, (p=0.196). Then we found no statistically significant differences in the results of the visual analog scale, and we also found no differences with respect to the levels obtained in fusion surgery (p=0.112). Conclusion: The lyophilized graft in the circumferential fusion provides fusion and functional results similar to autograft (AU)

Formación en cirugía de columna en España. Estado actual y futuro / Training in spine surgery in Spain: Current state and the future

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Fibrodisplasia osificante progresiva / Progressive ossifying fibrodysplasia

Se presenta un caso de Fibrodisplasia Osificante Progresiva en un paciente de 8 años de edad valorado por servicio de ortopedia. La ausencia de tratamientos que modifiquen el curso de esta rara enfermedad hace que su reconocimiento temprano sea importante para evitar procedimientos quirúrgicos y biopsias innecesarias que aumenten el número de lesiones y limitación de estos niños

We presented an 8 year-old male patient with progressive fibrodysplasia ossificans which suffered multiple ossfications in the cervical and lumbar spine, increase of the lumbar spine and short hallux valgus and mobility limitations

Gemelismo del pie / Mirror image duplication of feet

Se presenta una paciente de un año de edad con una anomalía congénita del miembro inferior izquierdo conocido como gemelismo del pie. Se revisa la literatura médica sobre esta deformidad extremadamente infrecuente

A review of the medical literature of the case of a one year patient with a left food congenital anomaly (mirror foot), an extremely unfrecuent deformity

Comentario. Estudios sobre la escoliosis idiopática / Commentary. Studies on idiopathic scoliosis

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The role of shoulder fusion in the era of arthroplasty.

The indications, surgical techniques, results and complications of shoulder fusion are described. The indications are bacterial infection, paralytic disorders in infancy, combined deltoid and rotator cuff paralysis, post-traumatic brachial plexus lesions, inflammatory arthritis with severe rotator cuff involvement, failed arthroplasty, recurrent dislocation, after resection of tumours, irreparable rotator cuff tear, painful arthritis in a patient whose activities require power but not movement, the immunocompromised patient, and tuberculosis. Satisfactory results are achieved in children with isolated shoulder paralysis, but in adults loss of glenohumeral movement is associated with about 50% loss of function. The best results are obtained in cases of isolated shoulder paralysis with a normal arm and hand distally. The most frequent complications are nonunion (5-20%), fracture of the ipsilateral humerus (10-15%) and infection (3-5%). Other causes of failure are functional limitation, fusion in malposition, functional involvement of the distal joints, acromioclavicular dislocation, suprascapular traction neuritis, failure or migration of an internal fixation device, epiphyseal problems, and the complications of using an allograft. Shoulder replacement is most likely to be chosen for most destructive shoulder disorders, but fusion is useful in certain cases.