[ Symptomatic Triple-Region Spinal Stenosis (TRSS): case report and narrative Literature Review] / Estenosis Espinal de Triple Región Sintomática (EETRS): reporte de un caso y revisión narrativa de la literatura.

Introduction: Simultaneous spinal stenosis in three regions of the spine is an unusual condition that demands proper clinical evaluation and imaging. Currently, there are no established guidelines for its diagnostic and therapeutic approach. Objective: The objective of this study is to describe, based on a case report, the clinical presentation, treatment, and patient progression concerning triple stenosis, contrasting it with available evidence through a narrative review of the literature. Case Presentation: A 69-year-old woman presented with a progressive paraparesis accompanied by right sciatica and positive signs of upper motor neuron involvement. Imaging confirmed triple stenosis: cervical, dorsal, and lumbar. Dorsal decompression and tumor resection were performed in association with conservative treatment for cervical and lumbar stenosis, resulting in a favorable evolution one year post-surgery. Conclusion: Symptomatic triple-region spinal stenosis is an unusual condition. Proper clinical and radiological assessments will enable accurate diagnosis and timely management.

Introducción: La estenosis espinal de las tres regiones de la columna en simultáneo es una entidad infrecuente, que requiere una adecuada valoración clínica e imagenológica. Actualmente no existen guías establecidas para su abordaje diagnóstico y terapéutico. Objetivo: El objetivo de este trabajo es describir, partiendo del reporte de un caso, la presentación clínica, el tratamiento y la evolución en un paciente con triple estenosis y contrastarlo con la evidencia disponible a través de una revisión narrativa de la literatura. Presentación del caso: Mujer de 69 años de edad que consultó con un cuadro de paraparesia progresiva asociado a ciatalgia derecha y signos de motoneurona superior positivos. Imagenologicamente se constató una triple estenosis: cervical, dorsal y lumbar, realizándose una descompresión y resección tumoral dorsal asociado al tratamiento conservador de las estenosis cervical y lumbar, con una evolución favorable al año postquirúrgico. Conclusión: La estenosis espinal de triple región sintomática es una condición rara, las valoraciones clínicas y radiológicas adecuadas permitirán un diagnóstico correcto con un abordaje adecuado y oportuno.

Comparison of complication rates between anterior versus posterior approaches for treating unstable Hangman's fracture. A systematic review and meta-analysis.

Study design: Systematic Review and Meta-analysis. Objective: To compare the complication rates associated with anterior and posterior approaches for the surgical treatment of unstable hangman's fractures. Methods: A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting complications of anterior versus posterior approaches for the treatment of unstable hangman's fractures. Results: The search yielded 1163 papers from which 5 studies were fully included. One hundred fifteen (115) patients were operated on using an anterior approach versus 65 through a posterior approach. The average complication rates for the anterior and posterior approaches were 26.1 % and 13.8 %, respectively. No complications following the anterior approach required pharmacological or surgical intervention (Clavien-Dindo, Grade 1), while 88.9 % of complications following the posterior approach did (Clavien-Dindo, Grade 2). Conclusion: No significant differences in the complication rates were found when comparing anterior versus posterior surgery for treating a C2 traumatic spondylolisthesis. However, most of the complications presented in the posterior surgery group were more severe.

Estenosis espinal de triple región sintomática: reporte de un caso y revisión narrativa de la bibliografía / Symptomatic triple-region spinal stenosis: Case report and narrative literature review

La estenosis espinal de las tres regiones de la columna en simultáneo es un cuadro infrecuente que requiere una adecuada valoración clínica y de las imágenes. En la actualidad, no existen guías establecidas para su abordaje diagnóstico y terapéutico. El objetivo de este artículo es describir la presentación clínica, el tratamiento y la evolución en un paciente con triple estenosis y contrastarlos con la evidencia disponible a través de una revisión narrativa de la bibliografía. Se presenta a una mujer de 69 años de edad que consultó con un cuadro de paraparesia progresiva asociado a ciatalgia derecha y signos de motoneurona superior positivos. En los estudios por imágenes, se constató una triple estenosis: cervical, torácica y lumbar. Se procedió a la descompresión y la resección tumoral torácica asociadas al tratamiento conservador de las estenosis cervical y lumbar. La evolución era favorable al año de la cirugía. La estenosis espinal de triple región sintomática es una condición rara, las valoraciones clínicas y radiológicas adecuadas permitirán un diagnóstico correcto con un abordaje adecuado y oportuno. Nivel de Evidencia: IV

Simultaneous spinal stenosis across all three regions of the spine is an uncommon condition that requires proper clinical and imaging assessment. There are currently no established guidelines for its diagnosis and treatment. The objective of this paper is to describe, based on a case report, the clinical presentation, treatment, and progression of triple stenosis in a patient and compare it with available evidence through a narrative literature review. A 69-year-old woman presented with progressive paraparesis associated with right sciatica and positive signs of upper motor neuron involvement. Imaging confirmed triple stenosis: cervical, thoracic, and lumbar. She underwent thoracic decompression and tumor resection, as well as conservative treatment for cervical and lumbar stenoses, and showed favorable progress one year after surgery. Symptomatic triple-region spinal stenosis is an uncommon condition. Proper clinical and radiological assessments will enable an accurate diagnosis with appropriate and timely intervention. Level of Evidence: IV

Complicaciones asociadas a la artrodesis intersomática lumbar por vía lateral. Revisión narrativa de la bibliografía / Complications of lateral lumbar interbody fusion (XLIF). Narrative literature review

Introducción: El abordaje lateral de la columna lumbar en la artrodesis intersomática está descrito para tratar varias enfermedades. Si bien es un procedimiento seguro, a medida que la técnica ha ganado popularidad, se han publicado diversas complicaciones asociadas. El objetivo de este artículo es presentar una revisión narrativa de la bibliografía para proveer al lector de un resumen organizado de las complicaciones comunicadas más frecuentes relacionadas con esta técnica. Materiales y métodos: Se llevó a cabo una revisión narrativa de la bibliografía obtenida en las bases de datos PubMed, Web of Science, Scopus y LILACS para identificar artículos que detallen complicaciones relacionadas con el abordaje lateral de la columna lumbar. Resultados: Luego del análisis de los resultados de la búsqueda bibliográfica, se seleccionaron 18 artículos para esta revisión. Conclusiones: Las complicaciones más frecuentes directamente relacionadas con este abordaje son la cruralgia y el déficit motor para la flexión de la cadera o la extensión de la pierna que, en su gran mayoría, son transitorias y reversibles. Hay escasos reportes de lesiones vasculares severas o fatales. Nivel de Evidencia: III

Introduction: The lateral approach for lumbar interbody fusion has been described for the treatment of diverse pathologies. Although it is a safe procedure, its popularity has led to an increase in reports of complications associated with it. The objective of this work is to conduct a narrative review of the literature on the most frequently reported complications associated with this surgical approach. Materials and methods: We performed a narrative review of the literature based on the publications obtained from the following databases: PubMed.gov, Web of Science, Scopus and Lilacs to identify published articles that detail complications related to the lateral approach to the lumbar spine. Results: After analyzing the results of the bibliographic search, 18 articles were selected to carry out this review. Conclusions: The most frequent complications directly related to this approach are thigh pain and motor deficit for hip flexion and/or leg extension, which are mostly temporary and reversible. Severe or fatal vascular injuries have rarely been reported. Level of Evidence: III

Pre-operative parameters influencing vertebral body tethering outcomes: patient's characteristics play an important role in determining the outcomes at a minimum of 2 years post-op.

PURPOSE: The aim of this study is to determine preoperative predictors of good radiographic outcomes in VBT patients at a minimum 2-year follow-up. METHODS: From a single-center dataset, we reviewed patients who underwent VBT from January 2014 to November 2018. Data analysis included age, gender, Risser grade and biometric data. Radiographically, maximum Cobb angle, C-DAR and apical vertebral and disc wedging were measured preop and at a minimum 2-year follow-up. Patients were divided into two cohorts following two different outcome measures: (1) vertebral growth modulation, those patients that growth modulated or corrected ≥ 5° and those who did not; and (2) Maximum Cobb angle at 2 years, < and ≥ 40°. Student T and Chi2 tests were used for comparison and a multiple linear correlation test was implemented between statistically significant variables. RESULTS: 79 patients were recruited. 26 patients (33%) did growth modulate their spine at 2-year follow-up. These patients were significantly younger, and more skeletally immature with less height (147 cm vs 155 cm; p < 0.0001), weight (38 kg vs. 45 kg; p = 0.0009) and BMI (17 vs 18.8; p = 0.0229) as those who did not. Multiple linear regression model with these variables resulted in a moderate correlation (r2 = 0.234). 67 patients (85%) finished at a 2-year follow-up with a maximum Cobb angle < 40°. These patients were also younger and skeletally immature. We found significant differences in outcome 2 regarding the average preoperative maximum Cobb angle (48.5° ± 9.5 vs. 59.1° ± 10), average C-DAR (7 ± 1.5 vs. 8.5 ± 2.1), average apical vertebral wedging (6.5° vs. 8.3°), average vertebral/disc wedging ratio (1.5 vs. 2.4) and the average immediate postoperative Cobb angle (25° vs. 38°). These variables predicted a 36% of the variation in final Cobb angle measurement at a 2-year follow-up (r2 = 0.362). CONCLUSION: Curve severity determined by a preoperative C-DAR, preoperative Cobb angles and immediate postoperative Cobb angle are significantly related to curves < 40° at a minimum 2-year follow-up, while the potential to growth modulate the spine is more dependent on skeletal maturity, lower body weight and lower BMI. These patients' characteristics should be considered preoperatively.

Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review.

Introduction: Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject. Case Presentation: An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy. We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae. Conclusion: Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients.

Introducción: Los bloqueos perirradiculares son una práctica habitual y segura. Las complicaciones severas, como los abscesos epidurales, son infrecuentes y han sido reportadas en pacientes añosos con comorbilidades o factores predisponentes. El objetivo de este trabajo es presentar un paciente joven sin antecedentes con diagnóstico de absceso epidural posterior a un bloqueo terapéutico y la revisión de la literatura al respecto. Presentación del caso: Un hombre de 24 años, previamente sano, presenta un caso de absceso epidural lumbar extenso, luego de un bloqueo perirradicular por una hernia de disco. Tras 7 días de fiebre y lumbalgia, precisó dos intervenciones quirúrgicas y antibioticoterapia intravenosa. Recabamos la información de 18 casos junto al nuestro, de pacientes con diagnóstico de absceso epidural como consecuencia de una infiltración espinal. El promedio de edad de los pacientes fue de 54,5 años, 66,5% fueron de sexo masculino y 66,5% presentaba al menos un factor de riesgo predisponente. La aparición de síntomas luego del bloqueo ocurrió en promedio a los 8 días, pero el diagnóstico de absceso se realizó a los 24 días en promedio. La tríada diagnóstica clásica solo estuvo presente en el 22%, el germen más frecuentemente aislado fue el Staph. aureus (66%) y un 89% fue tratado de manera quirúrgica con una tasa del 33% de recuperación completa, 17% de mortalidad y 28% de secuela neurológica. Conclusión: Los abscesos epidurales son una complicación infrecuente, grave y rara de los procedimientos diagnósticos y terapéuticos espinales, incluso en pacientes jóvenes sin comorbilidades. Consideramos menester mantener la sospecha diagnóstica, incluso en este subgrupo de pacientes.

Why are frailty indices not used systematically during preoperative spine consultations?

INTRODUCTION: Frailty indices are highly predictive of major medical and mechanical complications, lengths of hospital stay, and mortality rates after spine procedures. However, several barriers limit the extent to which spine surgeons employ these indices. The main purposes of the current study were to assess the use of frailty indices by Latin-American spine surgeons and identify the main barriers perceived to restrict their clinical application. METHODS: For this cross-sectional survey, a questionnaire evaluating the demographic characteristics of participating surgeons and their utilization of frailty indices were created in Google form and sent by e-mail to every registered member of AO Spine Latin America between October and November 2020. RESULTS: Of the 1047 surgeons sent the survey, 293 responded (response rate=28%). Half of the surgeons (51.7%) said they were unfamiliar with the terms ¨frailty´ and ¨frailty index", while 70.3% claimed not to use any frailty scale during their pre-operative assessments. The most frequently utilized index was the modified Frailty Index (mFI) (18%). The most important perceived barrier was the excessive amount of time required to calculate each patient's frailty score. Ninety-two percent of the spine surgeons felt sure that these scores could influence their therapeutic decisions, while 91% desired an easier-to-use risk-prevention scale. CONCLUSION: The main perceived barriers restricting the use of frailty indices were the time required to complete them, lack of index validation, and need for specific instruments to calculate the index score.

A Dangerous Curve: Impact of the COVID-19 Pandemic on Brace Treatment in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Observational Cohort study. OBJECTIVES: We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression. METHODS: We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi2 were used for comparison. RESULTS: 152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5°±8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery. CONCLUSION: The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates. LEVEL OF EVIDENCE: III.

Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty.

Introduction: Percutaneous cement discoplasty is a minimally invasive procedure to treat low back pain due to advanced degenerative disc disease in elderly patients. Complications of this procedure has been described such as infection, vertebral fracture, cement leakage and nerve injury. Intraoperative neuromonitoring is used to detect the latter. The objective of this study was to assess the usefulness of neuromonitoring during discoplasty to detect new neurological compromise. Methods: 100 consecutive patients were included in this retrospective study, (30 males and 70 females, mean age of 76.3 ± 5.71 years) with mechanical low back pain who underwent percutaneous cement discoplasty. Results: Sensitivity to detect neurological injury was 82% (CI 95% 66-98), specificity was of 99% (CI 95%98-100) with a positive predictive value of 0.95 (CI 95% 85-100) and a negative predictive value of 0.97 (CI 95% 95-99). In 5 patients neurological compromise was not detected by neuromonitoring. Discussion: Our study showed high sensitivity and specificity of neuromonitoring to detect neurological irritation during percutaneous discoplasty. Intraoperative neuromonitoring resulted an effective assistance during this minimally invasive procedure.

Introducción: La Discoplastia percutánea con cemento es un procedimiento mínimamente invasivo para tratar el dolor lumbar debido a la enfermedad degenerativa del disco avanzada en pacientes ancianos. Se han descrito complicaciones de este procedimiento como infección, fractura vertebral, fuga de cemento y lesión nerviosa. El neuromonitoreo intraoperatorio se utiliza para detectar este último. El objetivo de este estudio fue evaluar la utilidad del neuromonitoreo intraoperatorio durante la Discoplastia para detectar un nuevo compromiso neurológico. Material y métodos: se incluyeron en este estudio retrospectivo 100 pacientes consecutivos (30 varones y 70 mujeres, edad media 76,3 ± 5,71 años) con lumbalgia mecánica sometidos a Discoplastia percutánea con cemento. Resultados: La sensibilidad para detectar lesión neurológica fue del 82% (IC 95% 66-98), la especificidad fue del 99% (IC 95% 98-100) con un valor predictivo positivo de 0,95 (IC 95% 85-100) y un valor predictivo negativo. valor predictivo de 0,97 (IC 95% 95-99). En 5 pacientes no se detectó compromiso neurológico mediante neuromonitoreo. Discusión: Nuestro estudio mostró una alta sensibilidad y especificidad del neuromonitoreo intraoperatorio para detectar irritación neurológica durante la discoplastia percutánea. El neuromonitoreo intraoperatorio resultó una ayuda eficaz durante este procedimiento mínimamente invasivo.

Percutaneous Cement Discoplasty for Degenerative Low Back Pain with Vacuum Phenomenon: A Multicentric Study with a Minimum of 2 Years of Follow-Up.

BACKGROUND: To report clinical results after percutaneous cement discoplasty (PCD) in a multicentric case series with a minimum of 2 years of follow-up. METHODS: Between December 2014 and January 2019, 180 patients with low back pain and advanced degeneration were treated with percutaneous discoplasty in 2 centers. The inclusion criteria were as follows: patients 65 years or older, with mechanical low back pain with or without spinal stenosis, who did not respond to conservative management. Patients were divided into 3 groups: group 1: patients without previous spine surgeries who underwent PCD, group 2: patients with previous spine surgeries who underwent PCD, and group 3: patients with/without previous surgery who underwent PCD plus decompression surgery. Clinical and radiological analyses were performed as well as complication and readmission rates. RESULTS: A total of 156 patients (74% female; mean age, 75.8 ± 5.7 years; mean body mass index, 29.9 ± 5.2) were included in our study. Overall preoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were 7.8 ± 0.9 and 68.1 ± 9.6, respectively. At 2 years of follow-up, mean VAS improvement was 3.56 (95% confidence interval: 3.92-3.20; P < 0.0001) and mean ODI improvement was 17.18 (95% confidence interval: 19.52-14.85; P < 0.0001), showing a significant and sustained improvement in both scores. In addition, 84% of patients reached both VAS and ODI minimum important clinical difference at the final follow-up. Finally, 5.7% of patients suffered major complications 30 days postoperatively. CONCLUSIONS: PCD showed significant improvement of VAS and ODI scores at 2 years of follow-up with relatively low rate of complications.

Symptomatic Atlas Hypoplasia in a Latin-American Patient: Case Report and Literature Review.

BACKGROUND: Atlas hypoplasia is an infrequent cause of upper cervical stenosis. Only 24 cases in nonsyndromic adult population have been published. We are not aware of previous reports describing isolated fully formed atlas hypoplasia in a Latin-American patient. The purpose of this work was to report a case of an 80-year-old Argentinian woman with cervical myelopathy because of atlas hypoplasia and a literature review about this subject. METHODS: A clinical case and an extended review of the literature are presented. We assessed from each case: age, sex, posterior atlanto-dens interval, surgical treatment, outcomes, and follow-up period. RESULTS: Neurologic symptoms markedly improved after posterior decompression from severe to moderate in the Japanese Orthopaedic Association Scoring System and from four to three on the Nurick scale. Twenty-five patients were analyzed (mean 58.4 years, 32% female). The mean posterior atlanto-dens interval was 8.8 mm. Twenty-three patients underwent decompression alone, and two needed posterior fusion. All patients reported clinical improvement at an average follow-up of 13 months. CONCLUSION: Cervical myelopathy caused by fully formed atlas hypoplasia is not an exclusive pathology of far east population, and it may present in nonsyndromic patients. Surgical treatment by C1 laminectomy improved neurologic impairment. STUDY DESIGN: Case report and literature review.

La Frailty as a predictor index in spine surgery / [La fragilidad como índice predictor en cirugía de columna]

Introduction: Frailty is a term used to quantify the physiological age of patients. Higher levels of frailty correlate with higher complications and mortality rates after different surgical procedures. The objective of this work is to evaluate the relationship between frailty and the complications and mortality rates after elective spinal surgeries within 90 days. Material and Methods: A retrospective observational analytical study of patients older than 18 years with elective spine surgery was performed. The following variables were analyzed differentially according to their Modified Frailty Index (mFI) with a cut-off point of 0,18: age, sex, body mass index, ASA score, details of the procedures, length of stay, complications, unscheduled rehospitalizations, reoperations, and mortality within 90 postoperative days. Results: 257 patients were included. Within the 30 complications, 16 occurred in the non-frail group (8%) and 14 in frail patients (24.5%), (p = 0.02). Six complications were infectious in the group of frail patients (10.5%) and 4 in the non-frail patients (2%), (p = 0.009). No significant differences were detected regarding the duration of surgeries, the length of stay or the reoperations, re-hospitalizations or mortality rates. Conclusion: Patients with a modified Frailty Index ≥0,18 who underwent elective spine surgery were 3 times more likely to present complications, particularly, infectious ones.

Introducción: La fragilidad es un término utilizado para cuantificar la edad fisiológica de los pacientes. Niveles más altos de fragilidad se correlacionan con mayores tasas de complicaciones y mortalidad luego diferentes procedimientos quirúrgicos. El objetivo de este trabajo es evaluar la relación entre la fragilidad y la tasa de complicaciones y mortalidad posterior a cirugías columna electivas dentro de los 90 días. Material y Métodos: Se realizó un estudio analítico observacional retrospectivo de pacientes mayores de 18 años operados de manera electiva en su columna vertebral. Se analizaron las siguientes variables de manera diferencial según su Índice de Fragilidad modificado (IFm) con punto de corte en 0,18: edad, sexo, índice de masa corporal, score de ASA, detalles de los procedimientos, días de internación, complicaciones, reinternaciones, reoperaciones, y mortalidad dentro de los 90 días postoperatorios. Resultados: Se incluyeron 257 pacientes. De las 30 complicaciones, 16 ocurrieron en el grupo de los no frágiles (8%) y 14 a pacientes frágiles (24,5%), (p= 0,02). Seis complicaciones fueron infecciosas en el grupo de pacientes frágiles (10,5%) y 4 en los no frágiles (2%), (p= 0,009). No se detectaron diferencias significativas en cuanto a la duración de las cirugías, los días de internación, en la tasa de reoperaciones, reinternaciones ni en la mortalidad. Conclusión: Los pacientes operados electivamente de columna con un Índice de Fragilidad Modificado ≥0,18 presentaron una probabilidad 3 veces mayor de presentar complicaciones, particularmente infecciosas.

Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients.

PURPOSE: The authors describe a percutaneous technique to treat advanced degenerative disk disease in elderly patients. METHOD: A step-by-step technical description based on our experience in selected cases. RESULT: Postoperative imaging results are presented as well as indications and recommendations. CONCLUSION: Percutaneous discoplasty can result as an alternative minimal invasive strategy for the treatment of advanced degenerative disk disease.

Paraparesia aguda por hemangioma vertebral agresivo. Reporte de dos casos y revisión bibliográfica / Acute paraparesis due to aggressive vertebral hemangioma. Report of two cases and literature review

Introducción: Los hemangiomas agresivos constituyen el 1% del total de los hemangiomas vertebrales. Pueden producir dolor, fracturas, deformidad y compromiso neurológico, generalmente de larga evolución. Se han descrito diferentes opciones terapéuticas, pero el manejo óptimo sigue sin estar claro. Comunicamos dos casos de paraparesia aguda secundaria a un hemangioma torácico agresivo, describimos su tratamiento y evolución. Realizamos una revisión narrativa de la bibliografía. Conclusión: Mediante la descompresión y la artrodesis tempranas seguidas de radioterapia, se logró la recuperación neurológica completa y el control de la enfermedad en un seguimiento a mediano plazo. Nivel de Evidencia: IV

Introduction: Aggressive hemangiomas make up 1% of all vertebral hemangiomas. They can produce pain, fractures, deformity and slowly progressive neurological compromise. Different treatment approaches have been described, but optimal management remains unclear. We report two cases of acute paraparesis secondary to aggressive thoracic hemangioma, we describe their treatment and evolution. We carry out a narrative review of the literature on vertebral hemangiomas. Conclusion: Through early decompression and arthrodesis followed by local adjuvant radiotherapy, we obtained complete neurological recovery and disease control in a medium-term follow-up. Level of Evidence: IV

Tratamiento mínimamente invasivo para fracturas toracolumbares / Minimally invasive treatment for traumatic thoracolumbar fractures

Introducción: Las técnicas mínimamente invasivas para tratar las fracturas toracolumbares se han desarrollado con el objetivo de reducir, al mínimo, la morbilidad perioperatoria. El objetivo primario de este estudio fue evaluar los resultados clínicos y radio-lógicos de una serie de pacientes con diagnóstico de fractura toracolumbar por causa traumática tratados con procedimientos mínimamente invasivos. materiales y métodos: Se llevó a cabo un análisis retrospectivo de los datos demográficos, radiológicos pre y posoperatorios, y funcionales posoperatorios mediante el índice de Oswestry y la escala analógica visual para dolor, en una serie de pacientes que cumplían los criterios de inclusión. Se registraron las complicaciones y la estancia hospitalaria. Resultados: Se analizaron 15 pacientes (10 hombres) con una edad promedio de 59 años y un seguimiento promedio de 32.9 meses. Los pacientes tenían un dolor promedio posoperatorio de 2/10 y un valor promedio del índice de Oswestry de 14/100. El análisis radiológico mostró un valor promedio preoperatorio de cifosis de 16°, que se corrigió a 10° (p = 0,01). La altura promedio de la vértebra comprometida fue de 18 mm en el preoperatorio y de 21 mm en el último seguimiento (p = 0,02).Hubo tres complicaciones (20%) en tres pacientes. La estancia hospitalaria promedio fue de 9 días. Tres pacientes fueron internados nuevamente dentro de los 90 días de la cirugía. Conclusión: El tratamiento de las fracturas toracolumbares por causa traumática mediante técnicas mínimamente invasivas fue un procedimiento seguro y logró buenos resultados clínicos y radiológicos en el seguimiento a mediano plazo. Nivel de Evidencia: IV

Introduction: Minimally invasive techniques for the treatment of thoracolumbar fractures have been developed to reduce peri-operative morbidity. The primary purpose of this work is to evaluate the clinical and radiological outcomes in a group of patients with traumatic thoracolumbar fracture treated with minimally invasive procedures. materials and methods: Taking a group of patients within the inclusion criteria, we retrospectively analyzed demographic data, along with pre and postoperative radiographic measurements and postoperative functional scores, using the Oswestry Disability Index and the Visual Analog Scale for pain. We recorded the complications and the hospital stay. Results: 15 patients were analyzed (10 of them were male). The average age was 59 years, and the average follow-up was 32.9 months. The patients presented an average postoperative pain score of 2/10 and an average Oswestry Disability Index score of 14/100. The radiographic analysis showed an average preoperative segmental kyphosis value of 16° that was corrected to 10° (p = 0.01). The preoperative average height for compromised vertebrae was 18 mm, with an average height of 21 mm at the last follow-up (p = 0.02). There were 3 complications (20%) in 3 patients. Hospital stay was 9 days long on average. Three patients were rehospitalized within 90 days after surgery. Conclusion: The treatment of traumatic thoracolumbar fractures by minimally invasive techniques was a safe procedure, with good clinical and radiological results in the medium term of follow-up. Level of Evidence: IV

Chylothorax, a rare complication after anterior lumbar interbody fusion. Case report

Introduction: Chylous leakage into the retroperitoneum is a rare complication after spinal surgery using an anterior retroperitoneal approach. Chylothorax is the presence of lymphatic fluid in the pleural cavity and it is even less frequent during these surgeries. The aim of this work is to report the first case of isolated left chylothorax after a retroperitoneal Left Oblique Lumbar Interbody Fusion in supine position in an adult female patient. Case: A female 30-years-old patient underwent L4-L5 anterior interbody fusion. Four days after the intervention she was diagnosed with isolated left chylothorax that was drained and treated conservatively with good outcomes. Conclusion: Chylothorax is an extremely rare complication after anterior lumbar spine procedures, and it is usually secondary to a chyloretroperitoneum. We present a unique case of isolated chylothorax after anterior retroperitoneal lumbar approach successfully treated in a conservative manner. Key Words chylothorax; spine; lumbosacral region; arthrodesis.

Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis.

STUDY DESIGN: Retrospective analysis. Level of evidence III. OBJECTIVES: To describe the results after a minimum 1-year follow-up in patients treated with percutaneous discoplasty (PD), a minimally invasive technique to treat low back pain in elderly patients with advanced degenerative disc disease. The procedure consists in improving stability by injecting bone cement in a severely degenerated pneumodisc. There are few reports in the literature about this technique. METHODS: Fifty-four patients with advanced disc disease with/without degenerative scoliosis treated with PD with at least 1 year follow-up were studied, variables included clinical (visual analogue scale [VAS] and Owestry Disability Index [ODI]) and radiological parameters (lumbar lordosis and Cobb angle), as well as hospital length of stay and complications. RESULTS: At 1-year postoperation, significant pain reduction (VAS: preoperative 7.8 ± 0.90; postoperative 4.4 ± 2.18) and improvement in the ODI (preoperative 62 ± 7.12; postoperative 36.2 ± 15.47) were observed with partial correction of radiological parameters (5° mean increase in lumbar lordosis and decrease in Cobb angle). Mean surgical time was 38 minutes, and the mean length of hospital stay was 1.2 days. CONCLUSION: PD, currently not a very well-known technique, appears to be-at least in the short-term follow-up-an effective treatment option in selected cases with low back pain due to advanced degenerative disc disease.

[Vertebral cryptococosis. Case report and literature review]. / Criptococosis vertebral. Comunicación de un caso y revisión bibliográfica.

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.

Criptococosis vertebral: comunicación de un caso y revisión bibliográfica / Vertebral cryptococosis: case report and literature review

Resumen La criptococosis es una micosis sistémica producida por un hongo levaduriforme encapsulado denominado Cryptococcus neoformans. Es una enfermedad universal, que ocurre con mayor frecuencia en pacientes inmunocomprometidos, manifestándose principalmente como una enfermedad diseminada con compromiso meníngeo o pulmonar. Sin embargo, la osteomielitis ocurre solo en 5-10% de los casos, siendo el compromiso vertebral el más frecuente. Presentamos un caso de criptococosis vertebral aislada y una búsqueda bibliográfica sobre el tema. Se recomienda realizar una terapia antifúngica de inducción intravenosa y continuar con una fase de consolidación, vía oral, de duración variable. La indicación quirúrgica se considera en lesiones que comprometen la estabilidad vertebral y aquellas que presentan un compromiso neurológico, producen deformidad y para reducir el inóculo infeccioso.

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.