Tratamiento endoscópico de la espondilodiscitis lumbar. Reporte de un caso y revisión bibliográfica / Endoscopic treatment of lumbar spondylodiscitis. Case report and literature review

Se describe el caso de un hombre de 62 años de edad, con múltiples comorbilidades que concurre a la consulta por dolor lumbar severo compatible con espondilodiscitis de T12-L1-L2. Se realizó una endoscopia con abordaje posterolateral izquierdo con técnica adentro-adentro para fines diagnóstico y terapéutico. Se aisló un germen y se administró un tratamiento antibiótico específico. Dada la buena evolución clínica del paciente, fue dado de alta a los 7 días de la cirugía, con buen manejo del dolor y antibióticos intravenosos en el domicilio. Se presenta una breve revisión bibliográfica. Nivel de Evidencia: IV

We describe the case of a 62-year-old male patient with multiple comorbidities who attended the outpatient clinic due to severe low back pain compatible with T12-L1-L2 spondylodiscitis. Endoscopy was performed with a left posterolateral approach and an all-inside technique for diagnostic and therapeutic purposes. A germ was isolated and treated with specific antibiotics. Due to the good clinical evolution, the patient was discharged 7 days after surgery with good pain management and home intravenous antibiotic therapy. A brief literature review is presented. Level of Evidence: IV

Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature.

Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity.

The fate of facet joint and adjacent level disc degeneration following total lumbar disc replacement: a prospective clinical, X-ray, and magnetic resonance imaging investigation.

STUDY DESIGN: Prospective clinical, x-ray, and magnetic resonance imaging investigation following total lumbar disc replacement (TDR) with ProDisc II (Synthes, Paoli, PA). OBJECTIVE: To examine the progression of adjacent level degeneration (ALD), facet joint degeneration (FJD) as well as associated risk factors following TDR. SUMMARY OF BACKGROUND DATA: Fusion procedures have been associated with adjacent level morbidities and facet joint pathologies in a considerable number of patients. Whether the incidence of these negative side effects can be reduced with TDR remains unestablished. METHODS: Clinical outcome scores Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and patient satisfaction rates were acquired within the framework of an ongoing prospective study with ProDisc II. The mean index-level ROM was established for every patient over the entire postoperative period from multiple flexion/extension x-ray images. The progression of ALD and FJD was evaluated from pre- and postoperative magnetic resonance images by 2 independent radiologists. RESULTS: Results from 93 patients with an average follow-up of 53.4 months (range, 24.1-98.7 months) were included in this study. The overall results revealed a significant improvement from preoperative VAS and ODI levels (P < 0.0001).The incidence of ALD was 10.2% (n = 11/108 levels). The degenerative changes were mild and occurred late after surgery (mean, 65.2 months; range, 37.9-85.6 months). There was no significant correlation between index-level ROM and the occurrence of ALD (P > 0.05).Progression of FJD was observed in 20.0% of all facet joints (n = 44/220). FJD occurred significantly more often following TDR at the lumbosacral junction in comparison to the level above the lumbosacral junction (P < 0.02) and was observed more frequently at index-levels than at nonindex levels (P < 0.001).The degenerative changes were associated with a negative influence on postoperative outcome parameters VAS and ODI (P < 0.03) that were already detected early after surgery. The mean postoperative ROM was significantly lower in patients with progression of FJD in comparison to the remaining cohort (P < 0.0001). CONCLUSION: TDR proved to have a beneficial effect with respect to adjacent level disc preservation. The degenerative changes were mild, occurred late after surgery and did not reveal a negative effect on postoperative clinical outcome. There was no significant correlation between index-level ROM and the occurrence of ALD (P > 0.05).TDR was, however, associated with a progression of index-level FJD in a considerable number of patients, particularly at the lumbosacral junction. Lower segmental mobility and less favorable clinical results point to the fact that a particular cohort of patients may predominantly be affected in which TDR shows inferior compatibility with the index-segment's biomechanics.

[Sex and age associated to femur and rotula fractures]. / Fracturas del fémur y rodilla. Asociación con edad y sexo.

OBJECTIVE: To identify specific fractures risks of the following bones: distal femur, patella and tibia plateau, according to sex and age, with special interest in women >or= 50 y.o. MATERIAL AND METHODS: An epidemiologic case-control study was done between January 2002 and December 2005. The incidence rate for fractures were got by year, sex and age. The group exposed to the risk factors, was represented by female patients >or=50 y.o. The cases with fracture's worst prognosis were: distal femur (supracondylar, supraintercondylar or condylar), tibial plateau (Schatzker IV-VI); the control group was made with patients which fractures were in: proximal femur (Subtrocantheric, diaphysis), tibial plateau (Schatzker I-III). Descriptive and inferential analysis were done separately and together. RESULTS: 1578 Patients were studied. Incidence of fractures in the studied regions was of 5.9 per 10 000 persons/year (py), being of 5.7 and 4.9 per 10,000 py for men and women, respectively (p < 0.001). In subjects with age >or=50 y.o. the incidence rate was of 10.5 and 6.6 per 10 000 py for men and women, respectively. In the study patients less than 50 y.o. the incidence rate was of 1.6 per 10 000 py for both sexes (p < 0.001). The women >or=50 y.o. presented an OR of 5.1 (95% CI: 2.7-9.8, p < 0.001). CONCLUSIONS: In this study sample, the risk of fracture of the femur and the knee was greater in men than in women. In the >or= 50 y.o. age group, the ratio was inverted, with special interest in distal femur fractures. According to sex and age, no differences were identified in tibia plateau fractures.