The dimensions of the posterior arch of C2 for instrumented screw fixation. A radiological study in the Spanish population / Dimensiones del arco posterior de C2 para el guiado de tornillos translaminares. Estudio radiológico en población española

BACKGROUND: To describe the feasibility of the posterior arch of C2 accepting two crossing screws in the Spanish population. METHODS: One hundred and fifty patients who underwent a routine neck CT scan for non-cervical pathology were enrolled. Submillimeter slices (thickness 0.7 mm) every 0.4 mm were performed with a 64 multi-detector CT scan, which allows isometric measurements. We measured the length and height of the cortical and cancellous (endomedullar) region of the lamina and the spinous process, inclination, maximal screw length and spinolaminar angle. RESULTS: The average (standard deviation) measurements of the lamina were: width of the left cortical 7.2 (1.5) mm, right cortical 6.9 (1.3) mm, width of the cancellous part of the left lamina 4.8 (1.5) mm, right side 4.6 (1.4) mm. The mean left cortical height was 13.0 (1.5) mm and 13.1 (1.6) mm for the right. The mean height of the cancellous part was 9.0 mm for both sides. The average measurements of the spinous process were: cortical length 15.7 (3.5) mm, endomedullar length 12.5 (3.9) mm; cortical height 11.9 (2.2) mm, endomedullar height 8.4 (2.1) mm; spinolaminar angle 49º (4); the maximum screw length 3.18 cm, and the inclination angle 143º. CONCLUSION: A CT scan with submillimeter slices is necessary in order to avoid malpositioning of the screws. The outer cortical measurements are 2 to 4 mm bigger than the endomedullar ones. Taking into account the dimensions of the spinous process, 24% of the population would not be candidates for this crossing screw technique

FUNDAMENTO: Describir la capacidad del arco posterior de C2 en población española para colocar dos tornillos cruzados translaminares. MÉTODO: Se reclutaron 150 pacientes a los que se les realizó un escáner del cuello por patología no cervical. Para el estudio se utilizó un 64 multi-detector TAC realizando cortes submilimétricos (0,7 mm de grosor) cada 0,4 mm, permitiendo obtener medidas isométricas. Se midieron anchura y altura cortical y endomedular de la lámina y de la espinosa, inclinación de la lámina, máxima longitud de tornillo y ángulo espinolaminar. RESULTADOS: Las media (desviación estándar) de las medidas de la lámina fueron: anchura cortical izquierda 7.2 (1,5) mm, cortical derecho 6,9 (1,3) mm, anchura endomedular izquierda 4,8 (1,5) mm, derecha 4,6 (1,4) mm La altura media cortical izquierda fue 13,0 (1,5) mm y de 13,1 (1,6) mm para la derecha. La altura media endomedular fue de 9,0 mm en ambos lados. Las medidas medias de la espinosa fueron: longitud media cortical 15,7 (3,5) mm, longitud endomedular 12,5 (3,9) mm; altura cortical 11,9 (2,2) mm, altura endomedular de 8,4 (2,1) mm; ángulo espinolaminar 49º (4); la longitud máxima de tornillo 3,18 cm; y el ángulo de inclinación 143º. CONCLUSIONES: Para evitar la colocación errónea de los tornillos es necesario un estudio de TAC con cortes submilimétricos. La diferencia entre las medidas corticales y endomedulares oscila entre 2 y 4 mm. Teniendo en cuenta las dimensiones de la espinosa, un 24% de la población no sería candidato a esta técnica de tornillos cruzados translaminares

The dimensions of the posterior arch of C2 for instrumented screw fixation. A radiological study in the Spanish population.

BACKGROUND: To describe the feasibility of the posterior arch of C2 accepting two crossing screws in the Spanish population. METHODS: One hundred and fifty patients who underwent a routine neck CT scan for non-cervical pathology were enrolled. Submillimeter slices (thickness 0.7 mm) every 0.4 mm were performed with a 64 multi-detector CT scan, which allows isometric measurements. We measured the length and height of the cortical and cancellous (endomedullar) region of the lamina and the spinous process, inclination, maximal screw length and spinolaminar angle. RESULTS: The average (standard deviation) measurements of the lamina were: width of the left cortical 7.2 (1.5) mm, right cortical 6.9 (1.3) mm, width of the cancellous part of the left lamina 4.8 (1.5) mm, right side 4.6 (1.4) mm. The mean left cortical height was 13.0 (1.5) mm and 13.1 (1.6) mm for the right. The mean height of the cancellous part was 9.0 mm for both sides. The average measurements of the spinous process were: cortical length 15.7 (3.5) mm, endomedullar length 12.5 (3.9) mm; cortical height 11.9 (2.2) mm, endomedullar height 8.4 (2.1) mm; spinolaminar angle 49º (4); the maximum screw length 3.18 cm, and the inclination angle 143º. CONCLUSION: A CT scan with submillimeter slices is necessary in order to avoid malpositioning of the screws. The outer cortical measurements are 2 to 4 mm bigger than the endomedullar ones. Taking into account the dimensions of the spinous process, 24% of the population would not be candidates for this crossing screw technique.

Fractura bilateral de cadera en un paciente con síndrome de Down / Bilateral hip fracture in a patient with Down syndrome

Existen pocos datos publicados de fracturas de cadera bilaterales simultáneas. Presentamos el caso de un varón de 56 años con síndrome de Down y demencia tipo Alzheimer afecto de fractura bilateral de cadera y cuyo tratamiento fue la artroplastia parcial de cadera cementada bilateral. Con ella se intentó evitar el periodo de carga parcial que podría derivarse del tratamiento mediante osteosíntesis, ya que se trataba de un paciente poco cooperador debido a su falta de independencia para las actividades básicas de la vida diaria y a su deterioro mental. Hasta el momento de su fallecimiento, cuatro años después de la cirugía, pudo caminar sin ayuda, con total autonomía. En nuestra experiencia, la cirugía en un solo tiempo, mediante prótesis de cadera bilateral, es segura y proporciona buenos resultados en pacientes con deficiencia mental severa

There are few published data available about simultaneous bilateral hip fractures. We present the case of a 56-year-old man with Down syndrome and Alzheimer-like dementia with simultaneous bilateral hip fracture. A bilateral partial hip cemented arthroplasty was performed on this patient. The aim was to avoid the partial burden that could be caused by ostheosynthesis, due to the patient's lack of cooperation arising from his mental deterioration and his problems realizing everyday activities. He was able to walk unaided with complete autonomy until his death fourth years later. In our experience, one stage surgery for bilateral hip prosthesis is safe and provides good results in patients with severe mental impairment

[Bilateral hip fracture in a patient with Down syndrome]. / Fractura bilateral de cadera en un paciente con síndrome de Down.

There are few published data available about simultaneous bilateral hip fractures. We present the case of a 56-year-old man with Down syndrome and Alzheimer-like dementia with simultaneous bilateral hip fracture. A bilateral partial hip cemented arthroplasty was performed on this patient. The aim was to avoid the partial burden that could be caused by ostheosynthesis, due to the patient's lack of cooperation arising from his mental deterioration and his problems realizing everyday activities. He was able to walk unaided with complete autonomy until his death fourth years later. In our experience, one stage surgery for bilateral hip prosthesis is safe and provides good results in patients with severe mental impairment.

Medial and lateral exostoses of the distal phalanx of the hallux: A potentially painful bunion-like structure. Part 1: Incidence and clinical application.

BACKGROUND: Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. METHODS: Two hundred and fifty-four feet of patients (average age 41.7y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. RESULTS: Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p<0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. CONCLUSIONS: Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases.

Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results.

PURPOSE: To determine if blastocyst transfer increases the ongoing and cumulative pregnancy rates, compared with day 3 embryo transfer, in women of all ages when at least 4 zygotes are obtained. METHODS: Prospective study including patients undergoing a first IVF/ICSI treatment and assigned to cleavage stage (n = 46) or blastocyst (n = 58) embryo transfer. Supernumerary embryos were vitrified and patients failing to achieve an ongoing pregnancy after fresh embryo transfer would go through cryopreserved cycles. The main outcome measure was the ongoing pregnancy rate after the fresh IVF/ICSI transfer and the cumulative ongoing pregnancy rate. Results were also analyzed according to age (under 35 and 35 or older). RESULTS: A majority of patients (96.6 %) had a blastocyst transfer when at least 4 zygotes were obtained. The ongoing pregnancy rate was significantly higher in the day-5 group compared with the day-3 group (43.1 % vs. 24 %, p = 0.041). The cumulative ongoing pregnancy rate was higher (but not significantly) with blastocyst than with cleavage stage embryos (56.8 % vs. 43.4 %, p = 0.174). When analysed by age, patients 35 or older showed significantly higher ongoing pregnancy rate (48.4 % vs. 19.3 %, p = 0.016) and cumulative ongoing pregnancy rate (58 % vs. 25.8 %, p = 0.01) in the day-5 group compared to the day-3 group, while no such differences were observed in women under 35. CONCLUSIONS: Blastocyst transfer can be suggested whenever there are at least 4 zygotes. While there are no differences in women under 35, the benefit of this option over cleavage stage transfer could be significant in women 35 or older.

Effect of brightness in the evaluation of lumbar pedicular screws position: clinical study.

Artifact may lead to confusion when evaluating postoperative CT scans of lumbar pedicle screws. The aim of our study was to develop a specific metal artifact reduction image protocol, in order to reduce metal artifact caused by titanium pedicular screw in patients undergoing lumbar pathology by lumbar fusion. Therefore, the reduction in metal artifacts in lumbar pedicle screws allows surgeons to do an accurate diagnosis of the exact placement of inserted pedicle screws, minimizes false reexploration, and maximizes proper and prompt treatment of misplaced screw. In a first step, we performed a retrospective study of 103 titanium alloy pedicle screws in patients undergoing a lumbar instrumented fusion for treatment for degenerative disease. CT scan was performed postoperatively evaluating the possible overdimension caused by artifact. In a second step, a prospective study was performed using a 64-slice multidetector-row computed tomography (MDCT) in 104 titanium alloy pedicle screws in patients undergoing a lumbar instrumented fusion for treatment for degenerative disease. Our results show that on the group of sequential CT scan, mean overdimension (on each side) due to brightness was 1.045 mm (SD 0.45). On the group of 64-slice multichannel CT, mean overdimension (on each side) due to brightness was 0.005 mm at the proximal part of the screw and 0.025 mm at the distal part of the screw. The results observed suggest that beam-hardening artifacts caused by the screw on CT after lumbar fusion are dramatically reduced by using specific metal artifact reduction image protocol in a 64-slice MDCT.

Vitrification can modify embryo cleavage stage after warming. Should we change endometrial preparation?

PURPOSE: Studies have shown that embryo metabolism and cell cleavage after warming vitrified embryos is faster than after thawing frozen embryos. We study vitrified embryo transfer (VET) results depending on the developmental stage of warmed embryos and the duration of progesterone treatment before embryo transfer. METHODS: We designed a prospective study, patients were randomized in two groups, starting progesterone three (D + 3) or four days (D + 4) before embryo transfer. We recruited 88 patients with embryos vitrified on day 3. RESULTS: We didn't find statitistical differences in pregnancy rate when we transferred embryos in D + 3 vs D + 4 (38.2 % vs 40.5 % p ≥ 0.05). The day after warming, 54.6 % of embryos had developed to morula or early blastocyst, 32.4 % to cleavage stage and 13 % didn't cleave. Transfers were with morula/blastocysts stage embryos (52.1 %; n:37), cleavage stage embryos (18.3 %; n:13) or mixed (29.6 %; n:21). Implantation rate was significantly higher in morula/blastocyst stage than in cleavage stage or mixed transfers (44 %, 22 % and 16.3 %; p = 0.011). Pregnancy and implantation rates were significantly higher in morula/blastocyst transfers on D + 4 than on D + 3 (68.7 % and 64.7 % vs 33.3 %, and 33.3 %, p = 0.033 and p = 0.034). CONCLUSIONS: Our findings suggest that a majority of embryos will develop to morula/blastocyst stage after warming. VET results with morula/blastocysts, and after four days of progesterone supplementation, are better than with cleavage stage embryos.

Iliac bone Candida albicans osteomyelitis in a patient with iliac crest bone autograft: a case report and review of the literature.

Candida osteomyelitis is a well recognized but infrequent entity. We describe an interesting case of iliac bone C. albicans osteomyelitis as a result of a surgical trauma of an iliac bone for the auto-grafting of a fracture in the lumbar spine. The peri-operative acquisition of Candida was by the inoculation of a yeast colonizing the skin. Remarkably, several risk factors described for Candida infection and candidemia were absent. The patient also presented with a local fistula. The iliac crest was the only bone affected and local pain was the only symptom present in our case. Diagnosis was made by multiple-specimen biopsy obtained by surgery. Treatment with fluconazole was successful.

Falta de correlación entre artrosis plantar del primer metatarsiano y sesamoideos y dolor en pacientes intervenidos de hallux valgus / Lack of correlation between plantar arthrosis of the first metatarsal joint and sesamoids and pain in patients after hallux valgus surgery

Objetivos. Valorar la aparición de artrosis en la zona plantar de la primera articulación metatarsofalángica (primera MTTF) en pacientes operados de hallux valgus y correlacionarla con la existencia de dolor preoperatorio. Material y métodos. Se valoraron 28 pacientes a intervenir de hallux valgus mediante osteotomía en «Scarf». Se observó si presentaban dolor en la zona plantar de la primera MTTF (área de los sesamoideos) en la anamnesis y la exploración. Se buscaron signos radiográficos de artrosis metatarsofalángica y se midieron el PASA preoperatorio y el grado de desplazamiento del metatarsiano respecto al sesamoideo medial. En la intervención se observó el grado de artrosis de la cabeza del primer metatarsiano y se valoró por la escala ICRS. Resultados. Dieciocho pacientes no tenían dolor, 7 tenían dolor leve (EVA 1-3) y 3 moderado (EVA 4-6). Macroscópicamente todos los pacientes presentaban artrosis en la cara plantar del primer metatarsiano. En las radiografías solo 5 pacientes mostraban signos de artrosis metatarsofalángica. No hubo correlación significativa (p=0,44) entre dolor y artrosis plantar del primer metatarsiano. Se observó cierta relación entre aumento del PASA y mayor grado de artrosis, pero no se encontraron diferencias significativas (p=0,06). Se encontró una correlación débil, pero significativa (p=0,04) entre la edad de los pacientes y la artrosis del primer metatarsiano. Conclusión. La artrosis en la articulación de la cabeza del primer MTT con los sesamoideos no se corresponde con la existencia de síntomas o la intensidad del dolor en esa zona en pacientes con hallux valgus (AU)

Objectives. To determine the relationship between osteoarthritis in the plantar region of the first metatarsophalangeal joint of the foot and patient pain after hallux valgus surgery. Material and methods. A total of 28 patients undergoing hallux valgus surgery were examined. The patients were examined for pain in the plantar region of the metatarsophalangeal joint (sesamoid bones area), by looking into their medical records and by means of palpation during the physical exam. X-rays were taken to look for metatarsophalangeal arthritis, and PASA and sesamoid displacement were measured. During the surgical procedure, the metatarsal head was macroscopically assessed for arthritis according to the ICRS Score. Results. Of the 28 patients, 18 had no pain, 7 had mild pain (VAS 1-3) and 3 had moderate pain (VAS 4-6). Macroscopically, all the patients had some degree of plantar osteoarthritis. Only 5 patients had radiological signs of metatarsophalangeal arthritis. There was no correlation (P=.44) between pain and plantar osteoarthritis. There was a mild but non-significant correlation between PASA and osteoarthritis (P=.06). There was a weak but significant correlation between patient age and arthritis (P=.04). Conclusion. Osteoarthritis in the plantar aspect of the first metatarsal head does not correlate with patient symptoms or with pain intensity in patients undergoing hallux valgus surgery (AU)

[Lack of correlation between plantar arthrosis of the first metatarsal joint and sesamoids and pain in patients after hallux valgus surgery]. / Falta de correlación entre artrosis plantar del primer metatarsiano y sesamoideos y dolor en pacientes intervenidos de hallux valgus.

OBJECTIVES: To determine the relationship between osteoarthritis in the plantar region of the first metatarsophalangeal joint of the foot and patient pain after hallux valgus surgery. MATERIAL AND METHODS: A total of 28 patients undergoing hallux valgus surgery were examined. The patients were examined for pain in the plantar region of the metatarsophalangeal joint (sesamoid bones area), by looking into their medical records and by means of palpation during the physical exam. X-rays were taken to look for metatarsophalangeal arthritis, and PASA and sesamoid displacement were measured. During the surgical procedure, the metatarsal head was macroscopically assessed for arthritis according to the ICRS Score. RESULTS: Of the 28 patients, 18 had no pain, 7 had mild pain (VAS 1-3) and 3 had moderate pain (VAS 4-6). Macroscopically, all the patients had some degree of plantar osteoarthritis. Only 5 patients had radiological signs of metatarsophalangeal arthritis. There was no correlation (P=.44) between pain and plantar osteoarthritis. There was a mild but non-significant correlation between PASA and osteoarthritis (P=.06). There was a weak but significant correlation between patient age and arthritis (P=.04). CONCLUSION: Osteoarthritis in the plantar aspect of the first metatarsal head does not correlate with patient symptoms or with pain intensity in patients undergoing hallux valgus surgery.

Embolización arterial selectiva de tumores del sacro / Selective arterial enbolization of sacral tumors

Objetivos. El objetivo de este estudio es valorar las posibilidades de la embolización arterial selectiva en el tratamiento coadyuvante y curativo de lesiones tumorales y pseudotumorales del sacro, su repercusión en la cirugía y en la evolución del paciente. Material y método. Revisión retrospectiva de 8 pacientes portadores de lesiones tumorales o pseudotumorales embolizados en nuestro centro con objetivo curativo en uno y coadyuvante a la cirugía en 7, entre los años 1986 y 2004 (3 tumores de células gigantes, 2 quistes óseos aneurismáticos, un cordoma, un condroblastoma, un schwanoma y una metástasis de carcinoma tiroideo). Resultados. El seguimiento fue de 6 años y 5 meses de promedio. Sólo un paciente presentó dolor postembolización como complicación. Se intervinieron 5 de los 7 pacientes cuyo objetivo fue disminuir el riesgo de hemorragia intraoperatoria. Un paciente portador de un quiste óseo aneurismático requirió dos embolizaciones con objetivo curativo y no presentó recurrencia de la enfermedad a los tres años. Conclusiones. Creemos que la embolización arterial selectiva es un método recomendable en el tratamiento curativo de lesiones pseudotumorales de difícil acceso quirúrgico. También es un método eficaz para disminuir el riesgo de hemorragia durante la cirugía de lesiones hipervasculares tumorales o pseudotumorales del sacro (AU)

Objectives. The aim of this study is to analyse the therapeutic possibilities of the selective arterial embolization for curative, palliative or adyuvant treatment of malignant or non malignant tumoral lesions of the sacrum, the repercussion in the surgery and in the evolution of the patients. Materials and methods. Retrospective review of eight patients with tumors or pseudotumoral lesions of the sacrum that were embolizated in our centre between 1986 and 2004. The embolization was done with curative aim in one and like adyuvant treatment to the surgery in seven, (3 giant cells tumors, 2 aneurysmal bone cysts, 1 cordoma, 1 condroblastoma, 1 shwanoma and 1 metastasis of a thyroid carcinoma). Results. The follow-up was six years and five months in average. Only one patient presented a minor complication (pain) after the embolization. Five of seven patients in whom the aim was to reduce the risk of surgical bleeding were finally operated on. The patient with an aneurysmal bone cyst that received embolization with curative aim did not present recurrence of the disease after three years of follow up. Conclusions. We believe that the selective arterial embolization is an advisable method in the curative treatment of pseudotumoral lesions of difficult surgical access. The arterial embolization is an effective method to reduce the risk of intraoperative bleeding in case of hipervascular, tumoral or pseudotumoral lesions in the sacrum (AU)

Cervicobrachialgia and pancoast tumor: value of standard anteroposterior cervical radiographs in early diagnosis.

Ten patients diagnosed with Pancoast tumor were studied retrospectively. The definitive diagnosis was made between 2 and 24 months after the onset of pain. Pain localization was hard to pinpoint; some patients reported pain in four different sites (neck, shoulder, arm, and scapula). Five patients had previously been diagnosed with degenerative, inflammatory, or infectious diseases of the cervical spine or shoulder. In the remaining five patients, the diagnosis was made during the first clinical visit. In three patients, an orthopedic surgeon made the diagnosis by viewing a standard anteroposterior (AP) cervical radiograph. The radiographic evidence arousing suspicion of a Pancoast tumor was the lack of pulmonary air at the top of the affected lung. Furthermore, a parallel study was conducted on 100 consecutive patients seeking treatment for neck pain. By examining the AP radiographs of their cervical spines, the third rib and the top of both lungs were observed in all cases. This study stresses the value of standard AP cervical radiographs in the diagnosis of Pancoast tumor.

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine.

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.

[Radiologic evaluation of idiopathic congenital clubfoot and its clinical correlation in Codivilla's surgical technique]. / Valoración radiológica del pie zambo congénito idiopático y su correlación clínica en la operación de Codivilla.

Thirty-seven patients (52 idiopathic clubfeet) were treated with Codivilla's technique between 1971 and 1985. Radiological measurements and clinical evaluation before and after surgery were performed; a correlation was carried out between these evaluations and personal satisfaction. The results were rated as follows: poor in 4 feet (7.7%), fair in 18 feet (34.6%), good in 24 feet (46.2%) and excellent in 6 feet (11.5%) with a total percentage of satisfactory results amounting to 57.7%. Our conclusion is that when the indications are properly established, Codivilla's technique is a good procedure to correct clubfoot.

Síndrome de cauda equina por hernia discal gigante / Cauda equina syndrome due to a gigantic disc herniation

La aparición de forma aguda o rápidamente progresiva de un cuadro de ciatalgia bilateral, con disminución completa de la fuerza de los pies y ocasionalmente del cuádriceps acompañado de retención y/o incontinencia urinaria e hipoestesia en silla de montar debe hacernos sospechar de la existencia de un síndrome de compresión de la cola de caballo, generalmente a causa de una hernia discal. Se trata de una urgencia quirúrgica absoluta en la patología del raquis. La identificación del síndrome por el médico de Urgencias y la confirmación de la lesión mediante resonancia magnética permiten una cirugía mediante descompresión en las primeras 24-48 horas que es el único factor pronóstico en la recuperación de las lesiones neurológicas y urológicas que presentan estos pacientes que, si existe demora en la descompresión, pueden llegar a ser permanentes. Presentamos el caso de un paciente afecto de síndrome de cauda equina agudo por hernia discal gigante visto unos días antes en consulta por lumbalgia mecánica y realizamos una revisión bibliográfica sobre el tema (AU)

[Cauda equina syndrome due to giant disc herniation]. / Síndrome de cauda equina por hernia discal gigante.

In cases of acute or progressive development in a few hours of bilateral sciatica, severe foot and occasional quadriceps weakness and/or retention or incontinence of urine with perineal hypalgesia or anesthesia, acute compression of the cauda equina should be suspected, which is usually due to a lumbar disc herniation. Cauda equina syndrome requires emergency spinal surgery. To identify and confirm this syndrome by MR, Ismanoatory. Early surgical decompression must be achieved. Decompression within 24-48 hours significantly improves the neurological and urological outcome. We present the case of a patient who had previously been treated for low back pain who developed a cauda equina syndrome a few days later.

Espondilodiscitis cervicales / Cervical spondylodiscitis

Se revisaron nueve casos de discitis infecciosas de localización cervical de una serie de ochenta pacientes con espondilodiscitis (10 por ciento). Se valoraron mediante historia clínica, analítica y radiología simple todos ellos. Además, seis de ellos se valoraron por Resonancia Magnética, tres por gammagrafía ósea, y un caso por punción-biopsia. Los factores predisponentes eran claros en seis de los pacientes, encontrando entre ellos tres sepsis por Stafilococcus aureus, dos intervenciones quirúrgicas previas sobre columna cervical y una insuficiencia renal crónica terminal en tratamiento con hemodiálisis. Sólo uno de los pacientes se complicó al presentar secundariamente afectación neurológica con resultado de tetraplejía flácida. Se llevó a cabo tratamiento médico con antibioterapia e inmovilización con collarín en siete casos; en dos casos se realizó tratamiento quirúrgico mediante limpieza del foco y artrodesis (uno de ellos con descompresión medular) además del tratamiento médico. En aquellos pacientes tratados conservado ramente mediante tratamiento médico y ortopédico la evolución fue hacia la curación con anquilosis vertebral (fusión) en cinco de ellos, y en uno hacia discopatía artrósica crónica. Los pacientes tratados quirurgicamente evolucionaron hacia artrodesis estable, aunque uno de ellos, el que tenía comprometida la función neurológica con tetraplejía, no la recuperó.Mediante esta revisión pretendemos plantear la dificultad diagnóstica y el riesgo potencial de las infecciones cervicales (AU)

[Congenital synostoses of the tarsus. Concept, classification, diagnosis and therapeutic approach]. / Sinostosis congénitas del tarso. Concepto, clasificación, diagnóstico y planteamiento terapéutico.

The incidence of congenital tarsal coalition is about 1%. It is recognized as the main etiology of painful, rigid flatfoot in the pediatric population. Talonavicular (50%) and talocalcaneal (40%) coalition are the most common presentation. We must suspect a tarsal coalition in a child with mechanical pain and shoes deformity. Rigid and painful planovalgus deformity are found in physical exam which led to describe in the pass this entity as peroneal spastic flatfoot. Lateral and oblique (35 degrees-45 degrees) radiographs must be practice to observe the coalition. The presence of a beak in the head of the talus or a half moon condensation image as the result of the superposition of the talus over the calcaneus are commonly described. CT-scan is also useful to delineate the size of the coalition and its location. Resection of the bar is the surgical treatment of choice. Excision of the coalition and interposition of fat or a graft must be tried in young patients in order to preserve foot biomechanical properties and to avoid long term problems associated with arthrodesis. Triple arthrodesis or subtalar arthrodesis must be used in older patients with degenerative signs in radiographs or in those cases of multiple coalition or if resection has failed.