Tratamiento de la escoliosis juvenil: aumentar el tiempo entre alargamientos con la técnica de barras de crecimiento no debe comprometer necesariamente el crecimiento torácico / Treatment of juvenile scoliosis: increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth

Objetivo. Evaluar el crecimiento longitudinal del tórax y el control de la deformidad en una serie de pacientes con escoliosis juvenil tratados con barras de crecimiento aumentando los intervalos de tiempo entre alargamientos más de seis meses. Material y métodos. Estudio retrospectivo de ocho pacientes midiendo las siguientes variables: el ángulo de Cobb, la traslación vertebral apical, el balance coronal, la longitud torácica T1-L1, la cifosis torácica T5-T12, el ángulo de cifosis de unión proximal (CUP) y la lordosis lumbar. Se registraron las complicaciones. Resultados. Se evaluaron cinco escoliosis idiopáticas y tres casos de sindrómica (media de edad 9,4 ± 1,5 años). Se realizó una cirugía inicial y un promedio de dos retensados por paciente. El tiempo medio entre retensados fue de 15,7 meses. La corrección coronal final de la curva principal fue del 58%. La longitud torácica (T1-L1) preoperatoria fue de 20,8 cm, postoperatoria de 24,4 cm, y final de 26 cm. Al final del seguimiento el crecimiento medio del tórax fue de 5,2 cm. La cifosis preoperatoria (T5-T12) fue 33,5°, y final 32,1°. El cambio en el ángulo CUP fue de 2,5° en el seguimiento final. La mayoría de las complicaciones estuvieron relacionadas con la instrumentación. Se encontraron dos infecciones superficiales de la herida. Conclusión. En pacientes con escoliosis juvenil en formas «menos graves» tratados mediante barras de crecimiento, es posible espaciar los alargamientos más de un año y con ello disminuir el número de cirugías y al mismo tiempo controlar la deformidad y permitir el crecimiento longitudinal torácico (AU)

Objective. Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. Material and methods. Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. Results. Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. Conclusion. For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth (AU)

[Treatment of juvenile scoliosis: Increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth]. / Tratamiento de la escoliosis juvenil: aumentar el tiempo entre alargamientos con la técnica de barras de crecimiento no debe comprometer necesariamente el crecimiento torácico.

OBJECTIVE: Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. MATERIAL AND METHODS: Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. RESULTS: Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. CONCLUSION: For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.

[Prognostic factors of the crankshaft phenomenon in patients with scoliosis and open triradiate cartilage. Is the double approach the solution?]. / Factores pronósticos del fenómeno de crankshaft en los pacientes con escoliosis y cartílago trirradiado abierto. ¿Es el doble abordaje la solución?

OBJECTIVE: To study young patients after scoliosis surgery in order to determine risk and prevention factors for developing a crankshaft phenomenon (CP). MATERIAL AND METHODS: Retrospective study of a cohort of 26 skeletally immature patients. Six were excluded due to progression of various conditions. Crankshaft was defined as an increase in the Cobb angle >10°, or an increase in the Mehta angle (DAVC) >10°, or any decrease in the apex-rib thoracic distance, or increase in the apical vertebral translation (AVT). Patients with and without CP development were compared in order to analyse preoperative, surgical and postoperative risk factors, as well as the influence of different surgical techniques. RESULTS: The mean follow-up was 83.9 months. Nine patients (45%) developed the crankshaft phenomenon. Only immaturity parameters were associated with development of CP. No preoperative or postoperative radiographic parameters appeared to influence its development. The amount of correction may be a protective factor (41.4 vs. 61.4%; P=.06). The double approach was able to prevent the development of CP (0%) compared with single posterior instrumentation (44%), P=.02. DISCUSSION: None of these preoperative factors seemed to predispose to CP: gender or aetiology, T5-T12 kyphosis or apical hypokyphosis, coronal Cobb, vertebral rotation, or DAVC. The residual postoperative Cobb, achieved kyphosis, or wired instrumentation versus hooks, also seemed to have no influence. CONCLUSION: In patients with open triradiate cartilage under 11 years of age, it seems advisable to correct by double approach to avoid the appearance of the crankshaft phenomenon.

Factores pronósticos del fenómeno de crankshaft en los pacientes con escoliosis y cartílago trirradiado abierto. ¿Es el doble abordaje la solución? / Prognostic factors of the crankshaft phenomenon in patients with scoliosis and open triradiate cartilage. Is the double approach the solution?

Objetivo. Estudiar los pacientes inmaduros con cartílago trirradiado abierto, operados de escoliosis, en busca de factores de riesgo y de prevención para desarrollar un fenómeno de crankshaft (CP). Material y métodos. Estudio retrospectivo de una cohorte de 26 pacientes esqueléticamente inmaduros. Seis se excluyeron por progresión de distinta etiología. Se definió crankshaft como un aumento del Cobb mayor de 10°, o un incremento en la diferencia del ángulo de Mehta (diferencia ángulo vértebra-costilla, DAVC) mayor de 10°, o cualquier disminución de la distancia ápex-costilla torácica o aumento de la traslación vertebral apical lumbar (AVT, sigla del inglés apical vertebral translation). Se compararon los pacientes con y sin desarrollo de CP para analizar los factores de riesgo preoperatorios, quirúrgicos y postoperatorios. Se estudió la influencia de las distinta técnicas quirúrgicas. Resultados. El seguimiento medio fue de 83,9 meses. Nueve pacientes (45%) desarrollaron el CP. Solo los parámetros de inmadurez ósea se asociaron al desarrollo de CP. Ningún parámetro radiográfico preoperatorio o postoperatorio parece influir en su desarrollo. La cantidad de corrección podría ser un factor de protección (41,4 vs. 61,4%; p = 0,06). El doble abordaje fue capaz de evitar el desarrollo de CP (0%) en comparación con la instrumentación única posterior (44%), p = 0,02. Discusión. No se ha conseguido demostrar que los siguientes factores preoperatorios predispongan a la aparición de crankshaft: sexo o etiología, cifosis T5-T12, hipocifosis apical, Cobb coronal, rotación vertebral o DAVC. Tampoco parecen influir el Cobb postoperatorio residual, la cifosis conseguida, o la instrumentación con alambres frente a ganchos. Conclusión. En los pacientes con cartílago trirradiado abierto menores de 11 años parece aconsejable corregir la escoliosis mediante doble abordaje para evitar el fenómeno del cigüeñal o CP (progresión de la deformidad tras una artrodesis posterior por crecimiento anterior vertebral) (AU)

Objective. To study young patients after scoliosis surgery in order to determine risk and prevention factors for developing a crankshaft phenomenon (CP). Material and methods. Retrospective study of a cohort of 26 skeletally immature patients. Six were excluded due to progression of various conditions. Crankshaft was defined as an increase in the Cobb angle >10°, or an increase in the Mehta angle (DAVC) >10°, or any decrease in the apex-rib thoracic distance, or increase in the apical vertebral translation (AVT). Patients with and without CP development were compared in order to analyse preoperative, surgical and postoperative risk factors, as well as the influence of different surgical techniques. Results. The mean follow-up was 83.9 months. Nine patients (45%) developed the crankshaft phenomenon. Only immaturity parameters were associated with development of CP. No preoperative or postoperative radiographic parameters appeared to influence its development. The amount of correction may be a protective factor (41.4 vs. 61.4%; P=.06). The double approach was able to prevent the development of CP (0%) compared with single posterior instrumentation (44%), P=.02. Discussion. None of these preoperative factors seemed to predispose to CP: gender or aetiology, T5-T12 kyphosis or apical hypokyphosis, coronal Cobb, vertebral rotation, or DAVC. The residual postoperative Cobb, achieved kyphosis, or wired instrumentation versus hooks, also seemed to have no influence. Conclusion. In patients with open triradiate cartilage under 11 years of age, it seems advisable to correct by double approach to avoid the appearance of the crankshaft phenomenon (AU)

Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis / Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle

Objetivos. Evaluar la validez clínica en EA de 2 nuevos parámetros (ASS y ST) descritos recientemente para la evaluación del perfil sagital espinopélvicos, y cuyo papel en EA no está aún definido. Material y método. Análisis prospectivo (no concurrente) radiográfico y clínico de 59 cirugías primarias de EA (Cobb > 40°), mínimo 2 años de seguimiento. Para este trabajo dispusimos de radiografías y cuestionarios de salud de 49 pacientes. Se evaluó el cambio de los parámetros radiográficos tras cirugía (test Wilcoxon) y la correlación resultados clínicos-radiográficos-edad (test de Spearman y regresión lineal múltiple). Resultados. Mediana de seguimiento postoperatorio 8,5 años. Mediana edad 49,5 años. Hubo cambio estadísticamente significativo con la cirugía en ASS y ST (en ambos inferior a 5°), cifosis torácica (CT), lordosis lumbar (LL), rotación pélvica (RP), balance sagital (BS) y Cobb frontal. No hubo correlación entre dolor y ASS-ST. Hubo correlación significativa entre actividad y ASS, ST, LL, BS) y edad. Tras análisis multivariante solo la edad (ni ASS ni ST) persistió como posible predictor de menor actividad. Discusión. Cuando predomina la deformidad frontal, los parámetros radiográficos sagitales, incluidos los más novedosos ángulos, si bien sí influyen en la actividad del paciente cuando se analizan de forma aislada, pierden esta influencia cuando se analizan en conjunto y junto a otros parámetros clínicos. Conclusiones. Los valores de SSA y ST varían escasamente con la cirugía. Solo se correlacionan con la actividad pero no pueden considerarse predictores de la misma. No parecen pues medidas de utilidad en EA (AU)

Objectives. To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. Material and method. A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). Results. The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. Discussion. When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. Conclusions. The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS (AU)

Escoliosis y anomalías costovertebrales: diagnóstico de síndrome de Jarcho-Levin / Scoliosis and costovertebral anomalies: diagnosis of Jarcho-Levin syndrome

Presentamos un caso de síndrome de Jarcho-Levin, diagnosticado en el periodo neonatal. Este síndrome se debe a una alteración de la segmentación vertebral, y se presenta con malformaciones costovertebrales y asociado a un fenotipo caracterizado por talla baja, cuello corto y escoliosis congénita. Su diagnóstico es clínico y radiológico. El seguimiento de estos pacientes y el tratamiento conservador determinarán su supervivencia a largo plazo, aunque ésta estará fundamentalmente condicionada por el grado de deformidad y las malformaciones asociadas(AU)

We present a case of Jarcho-Levin syndrome, diagnosed at the neonatal stage. This syndrome is due to an alteration in vertebral segmentation, resulting in costovertebral deformities and associated with a phenotype characterised by short stature, a short neck and congenital scoliosis. Diagnosis is clinical and radiological. Monitoring of these patients and conservative treatment will determine their long-term survival, though this will be essentially conditioned by the degree of deformity and the associated malformations(AU)

[Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle]. / Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis.

OBJECTIVES: To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. MATERIAL AND METHOD: A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). RESULTS: The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. DISCUSSION: When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. CONCLUSIONS: The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.

Recambio acetabular. Cementación de núcleo de polietileno sobre cotilo metálico previo no cementado y bien integrado (tres casos) / Acetabular cup replacement. Cementing a polyethylene core to the previous uncemented, integrated metal cup (three cases)

Introducción. Para disminuir la morbilidad asociada a un recambio acetabular total de un cotilo osteointegrado, se propone la cementación de un nuevo núcleo de polietileno sobre el anillo metálico previo. Casos clínicos y resultados. Se exponen tres casos clínicos en los que se empleó esta técnica con un seguimiento medio de dos años, obteniéndose buenos resultados

Introduction. To avoid the morbidity associated with total acetabular replacement of an osteointegrated cup, a new polyethylene core was cemented to the previous metal ring. Clinical cases and results. Three clinical cases are reported in which this technique was used with a mean follow-up of two years. Results were good

Estudio comparativo radiológico y funcional de TLIF frente a PLIF en el dolor lumbar / Comparative radiologic and functional study of Transforaminal Lumbar Interbody Fusion (TLIF) versus Posterior Lumbar Interbody Fusion (PLIF) for low back pain

Objetivo. Comparar los resultados radiológicos y funcionales de las técnicas de fusión circunferencial PLIF frente a TLIF en casos de dolor lumbar crónico. Pacientes y método. Se realizaron 20 PLIF y 20 TLIF (2 y 4 a doble nivel respectivamente). Se compararon valores de: lordosis total y local, inclinación sacra, altura del espacio discal y listesis pre y postoperatorias, así como pérdida de sangre, tiempo quirúrgico y estancia hospitalaria. Se evaluaron la Escala analógica visual para el dolor lumbar y en miembros inferiores, el test de Oswestry, el SF-36, la situación laboral y el grado de satisfacción. Resultados. El tiempo de seguimiento medio fue de 2,5 años. No hubo diferencias estadísticamente significativas en cuanto a pérdida de sangre, tiempo quirúrgico, estancia hospitalaria, valores radiológicos ni funcionales. La lordosis total y local aumentó (PLIF 4,3° y 2,3° y TLIF 2,1° y 0,8°) respectivamente. El espacio discal aumentó en ambas técnicas un 40 por ciento (p < 0,01). La listesis disminuyó 0,7 mm en PLIF y 0,5 mm en TLIF. Los resultados funcionales mejoraron en ambos grupos (p < 0,01). Hubo dos complicaciones en PLIF (una rotura de dura intraoperatoria y un caso de íleo paralítico), y otras dos en TLIF (un caso de compresión radicular por un osteofito marginal y un caso de migración de una de las cajas). Conclusiones. En este estudio no se objetivaron diferencias significativas entre ambas técnicas, a pesar de la tendencia actual del empleo de TLIF por ser menos agresiva en el sentido de que preserva el ligamento interespinoso y la lámina contralateral, evitando la exposición amplia de la dura (AU)