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PURPOSE: Analyze the modifications in the "safe zones" of T4-L4 vertebral bodies relative to aorta according to patient positioning, as well as in the relationship between the aorta and the vertebrae. METHODS: Patients with adolescent idiopathic scoliosis who underwent surgical treatment during 2017 were included. Preoperative whole spine MRI in supine, prone, and LD positions was performed. The safe zone right (SZR) was defined as the angle formed between X-axis (0º) and a line connecting the origin and the edge of the aorta, and the safe zone left (SZL) was the angle between the edge of the aorta to 180º (X-axis). RESULTS: A total of 21 patients were studied, median age was 15.2 years, and 71.4% were female. The mean SZR lied from 0°-86.1º at T4 to 0°-76.9º at L4 in supine, from 0°-84.05º at T4 to 0º-78.5º at L4 in prone, and from 0° to 91.75º at T4 to 0°-80.4º at L4 in LD. While the mean SZL was located from 155.4º-180º at T4 to 107.9º-180º at L4 in supine, from 134°-180° at T4 to 103.9°-180° at L4 in prone, and from 143.8º-180º at T4 to 106º-180º at L4 in LD. Statistically significant differences were found almost at all levels when comparing supine versus prone and LD. CONCLUSIONS: Patient positioning during spinal surgery significantly modifies T4-L4 vertebral safe zones relative to aorta. These variations should be taken into account when analyzing an MRI performed in supine if the patient is undergoing surgery in a different position, to avoid vascular-related injuries.
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Cifose , Escoliose , Adolescente , Aorta/diagnóstico por imagem , Aorta/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Decúbito Ventral , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Decúbito Dorsal , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgiaRESUMO
BACKGROUND: Surgical wound infection is an important complication of spinal surgery. Antibiotic prophylaxis has served to decrease its rates significantly, with the ensuing reduction in hospital stay, costs, and morbidity and mortality. To date, a large assessment of the degree of compliance with antibiotic prophylaxis in spinal fusion surgery has not been undertaken in Spain with large prospective studies. We sought to assess the degree of compliance with our antibiotic prophylaxis protocol among patients who underwent spinal fusion surgery and its effect on surgical wound infection. MATERIAL AND METHODS: A prospective cohort study was carried out. Six hundred and forty patients with at least 1-year clinical followup who underwent spinal fusion surgery were included. Percentage of administration and degree of compliance with protocol was studied. Both overall and the different aspects of prophylaxis received by patients to those stipulated in the protocol in force at our hospital were compared. Percentages of compliance were assessed and the effect of prophylaxis compliance on the incidence of infection was estimated using the Relative Risk. RESULTS: The study covered 640 patients. Overall compliance with the protocol was 71.5% (95% CI = 67.9- 75.1). The most frequent cause of non-compliance with the protocol was the duration of recommended antibiotic prophylaxis (77.8%). Incidence of surgical wound infection was 4.1% (95% CI: 2.5-5.5). No relationship was found between surgical wound infection and antibiotic prophylaxis non-compliance (RR 0.92, 95% CI = 0.38-2.22). CONCLUSIONS: Compliance and administration of antibiotic prophylaxis were high. Surgical wound infection rate was similar to those found in the literature although there is always room for improvement.
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Antibioticoprofilaxia/métodos , Adesão à Medicação , Fusão Vertebral/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
PURPOSE: The aim of this report is to describe the management of a severe spinal deformity in an adolescent with facioscapulohumeral dystrophy (FSHD) and review the available literature on the topic. METHODS: A 14-year-old patient with a genetically confirmed diagnosis of FSHD was evaluated for right thoracolumbar scoliosis (TL) and severe lumbar hyperlordosis. Spinal radiographs showed a right-sided curve of 32° and in the sagittal plane a lordotic curve T10-S1 -143°, TL junction -51.6°, LL -115°, pelvic incidence (PI) 25.5°, pelvic tilt 63.3°, PI-LL mismatch -90°, and a sagittal imbalance of -146 mm. An MRI scan evidenced atrophy of the paraspinal muscles. An instrumental gait analysis revealed significant pelvic anteversion associated with hip flexion and mild equinus. During follow-up, the patient developed a progressive inability to walk and difficulty sitting along with respiratory compromise and pain. RESULTS: At the age of 16 years, a posterior T2-iliac spinal fusion was performed using pedicle screws and four iliac anchors, with a 4-rod system placed at the lumbopelvic level. Significant correction of the hyperlordosis, the PI-LL mismatch, and sagittal imbalance was achieved, and the patient improved her sitting capacity, quality of life (QoL) and self-esteem and reported a decreased perception of disability at 2-year follow-up. CONCLUSIONS: This is the first published case of spinal deformity secondary to FSHD to use gait analysis to supplement the decision of optimal timing for surgery, and the second published case of spine surgery in a pediatric patient. Although spinal fusion surgery is controversial in ambulatory FSHD patients with extensive deformity, when ambulation is impaired, surgery improves function, prevents progression, and restores sagittal balance, increasing patient's QoL.
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Lordose , Distrofia Muscular Facioescapuloumeral , Escoliose , Humanos , Criança , Feminino , Adolescente , Qualidade de Vida , Distrofia Muscular Facioescapuloumeral/complicações , Distrofia Muscular Facioescapuloumeral/cirurgia , Resultado do Tratamento , Lordose/cirurgia , Escoliose/complicações , Escoliose/diagnóstico por imagemRESUMO
STUDY DESIGN: This is a retrospective, observational comparative study. OBJECTIVE: The aim of this study is to determine whether a relationship exists between the functional level and spinal deformity in patients with Down syndrome (DS). SUMMARY OF BACKGROUND DATA: Patients with DS have a higher incidence of scoliosis than the general population; however, it is unknown whether functional level influences the characteristics and severity of the deformity. MATERIALS AND METHODS: Of 649 patients with DS included in a pediatric referral center database, we identified 59 with a diagnosis of scoliosis (59.32% female; mean age, 14.19±1.82 y); the 46 patients who met the inclusion criteria comprised the study cohort. According to their functional gait skills and gross motor skills, they were classified into 2 levels. Different coronal and sagittal parameters were measured using full-spine standing radiographs. The need for surgical treatment and history of thoracotomy were recorded as well. Finally, a multivariate association analysis was performed between radiologic parameters and functional level. RESULTS: Twenty-two patients had a functional level consistent with level I and 24 with level II. Twelve curves were thoracic, 10 thoracolumbar, and 24 lumbar. A statistically significant relationship was found between functional level I and II and curve magnitude: 18.9 degrees (6.8) versus 36.9 degrees (20.3) ( P =0.001) with a cutoff point at 22.3 degrees (area under the curve=0.919, P <0.005, sensitivity=0.917 and specificity=0.818). The relationship between patients who required surgery and level II was also significant ( P =0.016). No relationship was found between functional level and coronal and sagittal balance, nor with other radiologic parameters or with curve location, or between the history of thoracotomy and thoracic curves. CONCLUSIONS: DS adolescents with poorer functional level were associated with larger curves and greater risk for surgery. These findings may provide valuable guidance for the follow-up of scoliosis in patients with DS based on their functional level. LEVEL OF EVIDENCE: Level III-retrospective comparative study.
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Síndrome de Down , Escoliose , Fusão Vertebral , Criança , Humanos , Feminino , Adolescente , Masculino , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Síndrome de Down/complicações , Radiografia , Resultado do Tratamento , Vértebras Lombares/cirurgiaRESUMO
PURPOSE: To present a rare case of a cerebral ischemic lesion of unknown etiology in a pediatric patient following idiopathic scoliosis surgery and to review the current literature regarding this complication in children. METHODS: A 12-year-old female with early-onset scoliosis underwent surgery to correct a 65.6º scoliosis after a normal preoperative study. T4-L1 posterior instrumentation was performed uneventfully. RESULTS: Twelve hours postoperatively, she developed central left facial paresis, diplopia, and gait instability. An urgent MRI scan revealed an acute ischemic lesion in the right parasagittal subthalamic-mesencephalic region, for which she received anticoagulant therapy with close monitoring. The diagnosis of "stroke of undetermined etiology" was made according to the CASCADE (Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation) criteria. Therefore, prophylaxis was changed to antiplatelet therapy for 3 months. Symptoms resolved within a week, except for an occasional diplopia that subsided after 2 months, being asymptomatic at 2 years of follow-up. CONCLUSIONS: Although a rather frequent complication in adults, there are only 2 other reported cases of ischemic stroke in pediatric patients after scoliosis surgery, both related to longer procedures and underlying disease. Even so, it is important to consider this potential perioperative spinal complication due to the importance of early diagnosis and adequate acute treatment for prognosis.
Assuntos
AVC Isquêmico , Escoliose , Fusão Vertebral , Adulto , Criança , Diplopia/complicações , Diagnóstico Precoce , Feminino , Humanos , Escoliose/etiologia , Escoliose/cirurgia , Fusão Vertebral/métodosRESUMO
Background: Although osteosarcoma is the most common primary malignant bone tumor in children, its location in the axial skeleton is rare, particularly at the cervical spine. Early diagnosis, together with multidisciplinary management, improves survival rates. Safe resection and stable reconstruction are complicated by the particular anatomy of the cervical spine, which raises the risks. Case Presentation: A 12-year-old male patient presented with cervical pain for several months and a recent weight loss of 3â kg. The complementary workup revealed a large destructive bone lesion in C7 with vertebral body collapse, subluxation, partial involvement of C6 and T1, large associated anteroposterior soft tissue components, and spinal canal narrowing. A biopsy suggested giant cell-rich osteosarcoma (GCRO). After 10 cycles of neoadjuvant chemotherapy, surgical resection was performed through a double approach: anterior, for tumoral mass resection from C6-7 vertebral bodies and reconstruction placing a mesh cage filled with iliac crest allograft plus anterior plate fixation; and posterior, for C7 complete and C6 partial posterior arch resection, thus completing a total piecemeal spondylectomy preserving the dura intact, added to a C5-T3 posterior fusion with screws and transitional rods. Postoperative chemo and radiotherapy were administered. Clinical and radiological follow-up showed disease-free survival and no neurological involvement at 3 years. Conclusion: An extensive review of the literature did not find any published cases of GCRO of the cervical spine in pediatric patients. This can be explained by the combination of three peculiar conditions: its location at the cervical spine region, the young age, and the GCRO variant.
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BACKGROUND: Spinal tuberculosis (TB), or Pott's disease, is the most common form of osteoarticular TB. Early diagnosis and anti-TB drug therapy are the mainstays of treatment. However, in advanced stages, surgery is essential to correct spinal deformities and avoid neurological damage. Very few cases in young children requiring surgical treatment have been described. We present 2 cases of surgically treated thoracic spinal TB in patients under 2 years of age and review the literature on this entity in young children. CASE DESCRIPTION: Two male toddlers, aged 21 (patient 1) and 23 (patient 2) months, were admitted due to insidious systemic deterioration associated with neck stiffness and nonspecific abdominal pain in patient 1 and limping in patient 2. The findings of laboratory tests were unremarkable despite an increase in acute-phase reactants. After an extensive workup, results of a magnetic resonance imaging were consistent with spinal TB in both patients. Patient 1 underwent costotransversectomy of the left third and fourth ribs, debridement, T3-T4 corpectomy, and T2-T6 posterior fusion, to which an anterior rib autograft was added. Patient 2 had a right-sided thoracotomy performed at the apex in addition to debridement and T8 corpectomy; the resected rib was used as anterior structural autograft. Several samples of purulent, caseous material were sent for study. On follow-up, progression of proximal junctional kyphosis was evidenced in patient 1, requiring revision surgery to restore sagittal alignment; the patient was asymptomatic at 2-year follow-up. Patient 2 evolved satisfactorily without neurological sequelae and was asymptomatic at 4-year follow-up. CONCLUSIONS: Spinal TB in young children requires appropriate surgical treatment when presenting at advanced stages or having severe deformity or neurological compromise. Despite the challenges associated with young age and ongoing growth, surgery can be performed safely provided proper surgical expertise. After extensive debridement and decompression, priority should be given to restoring sagittal alignment and balance with stable and durable spinal reconstructions.
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PURPOSE: Limb-lengthening surgery to treat short stature has undergone great development in recent years with the use of intramedullary telescopic nails (TIMNs). A limited number of studies have explored the impact of lower limb lengthening on the spine, though their conclusions are not consistent. The aim of this research is to analyze changes in spinopelvic sagittal alignment and balance after lower limb lengthening in achondroplastic patients. METHODS: Prospective study of patients with achondroplasia treated with bilateral femoral lengthening using an TIMN. Different sagittal spinal and pelvic plane parameters were measured on pre- and 2 year postoperative lateral spine radiographs: cervical lordosis, thoracic kyphosis, TL junction, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), and sagittal vertebral axis (SVA). Similarly, information regarding the elongation procedure was recorded. RESULTS: A total of 10 patients were included (60% male), with a median age of 13.39 (2.32) years at first surgery and a median height of 120.3 (5.75) cm. A 10 cm elongation was performed in all patients through femoral subtrochanteric osteotomy. Statistically significant changes were found in LL -15.2 (7.4-17.9)º (p = 0.028), PT 11.7 (10.3-13.4)º (p = 0.018), SS - 11.6 (- 13.4 to - 10.4)º (p = 0.018) and |SVA| - 34.3 (- 39.10 to - 1.7) mm (p = 0.043). CONCLUSION: Bilateral lower limb lengthening in patients with achondroplasia not only increases their size, but also improves sagittal spinopelvic alignment and balance. This may be due to retroversion of the pelvis and subsequent decrease in SS and LL as a result of the increased tightness of the gluteus maximus and hamstring muscles after femoral lengthening through subtrochanteric osteotomy. LEVEL OF EVIDENCE: II, prospective comparative cohort study, before and after intervention.
Assuntos
Acondroplasia , Lordose , Humanos , Masculino , Adolescente , Feminino , Lordose/diagnóstico por imagem , Lordose/cirurgia , Estudos Prospectivos , Estudos de Coortes , Acondroplasia/diagnóstico por imagem , Acondroplasia/cirurgia , Osteotomia/métodos , SacroRESUMO
STUDY DESIGN: Quasi-experimental intervention study. OBJECTIVE: To assess the effect of a clinical safety and quality improvement plan for patients undergoing spinal fusion surgery on the incidence of surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: In recent years, infection surveillance and control programs based on care bundles have been included in surgical protocols. These have proven to be essential tools for the prevention and control of SSI, providing indicators for improvement and allowing the characterization of related risk factors. METHODS: A quasi-experimental study was carried out with analysis before and after the introduction of a preventive care bundle (clinical safety and quality improvement plan). Patients who underwent spinal fusion surgery were included. The incidence of SSI up to 90âdays after surgery (maximum incubation period) was assessed. The effect of the intervention was evaluated with the adjusted odds ratio (oR) using a logistic regression model. RESULTS: A total of 1554 patients were included, 690 in the period 2007 to 2011 (before) and 864 during 2012 to 2018 (after). SSI incidence decreased from 4.2% to 1.9% after the plan (OR: 0.43; 95% confidence interval: 0.23-0.80; Pâ =â0.006). There was also an improvement in the adequacy of antibiotic prophylaxis, preoperative preparation, and hair removal procedure after the introduction of the care bundle. CONCLUSION: After implementation of the care bundle, the incidence of SSI in spine fusion surgery decreased significantly. Multivariate analysis showed that the care bundle was an independent protective factor. The implementation of these measures should be reinforced on the routine medical practice to reduce the SSI incidence.Level of Evidence: 3.
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Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica , Antibioticoprofilaxia , Humanos , Incidência , Controle de Infecções/métodos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
BACKGROUND: Proteus syndrome (PS) is a complex genetic disorder, characterized by the sporadic appearance of hamartomatous lesions that follow a mosaic pattern and have a progressive evolution. It affects most of the mesodermal origin tissues, including the bones. Scoliosis is a common manifestation, with great variability and specific peculiarities, but little about it has been published. CASE DESCRIPTION: Presentation of 2 clinical cases of patients with PS that underwent scoliosis surgery and literature review. Two patients aged 17 years, a girl (patient 1) and a boy (patient 2), both diagnosed with PS, were being followed-up for scoliosis. Patient 1 had a right thoracic curve with a Cobb angle of 69.1°, whereas patient 2 also had a right thoracic curve of 106.8°. In both patients a posterior fusion was performed, associating rib and ponte osteotomies at the level of the apex in patient 2. A minimum 2-year follow-up was done. Both patients had a satisfactory evolution without neurologic or other complications, with a high degree of correction of their curves (Cobb angle 29.2° and 55.6°, respectively). Their total SRS-22 (Scoliosis Research Society Outcomes Questionnaire) score at the last visit was 4.77 and 4.64, respectively. CONCLUSIONS: Both PS and scoliosis are conditions associated with deformities and physical limitations that decrease the health-related quality of life of these patients. Because of the severity of the spinal deformities and their risk of progression, early diagnosis and prompt treatment is recommended. Despite being highly complex, scoliosis surgery allows a satisfactory deformity correction and consequently improves the health-related quality of life of patients with PS.
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Síndrome de Proteu/complicações , Escoliose/etiologia , Adolescente , Feminino , Humanos , Masculino , Escoliose/cirurgia , Fusão VertebralRESUMO
OBJECTIVES: We set out to determine the "safe zone" for anterior instrumentation in scoliosis surgery assessing the relationship of the great vessels to the spine. METHODS: A total of 34 children undergoing posterior idiopathic scoliosis surgery were included in the study between 2010 and 2016. The preoperative scans were assessed to identify the position of the great vessels relative to the spine from T4 to L4. A coordinate system was specifically designed to determine safe zones for device locations. The safe zone right (SZR) was defined as the angle formed between X-axis (0°) and a line connecting the origin and the edge of the aorta and the safe zone left (SZL), the angle between the edge of the aorta to 180°. RESULTS: The average age was 14 years, with 30 females (88.2%). Lenke classification, the most common curve was 1BN (20.6%), followed by 1AN, 3C- and 6CN (8.8% each). The Apex was T8 and T9 (29.4 and 23.5% respectively). 58% of the curves were right sided. The mean SZL was from 155.7° to 180° at the T4 level to 104.3°-180° at L4. The mean SZR was from 0 to 110.7° at T4 to 0-76.18° at L4. The side of the curves was correlated at p level with the SZL and SZR. There was a significant correlation in the following levels: from T4 to L2 in the SZL, and from T7 to L2 in the SZR. CONCLUSIONS: Between T4 and T11, the right side of the vertebrae is safe, and from T12 to L4 the safe zones are more lateral and smaller. In a right-sided scoliosis, the danger zone moves more posterolateral at every level. In a left-sided curve, the danger zone is more anteromedial. Knowledge of these safe zones should allow safer placement of anterior devices. LEVEL OF EVIDENCE: Level III.
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Aorta/anatomia & histologia , Aorta/lesões , Complicações Intraoperatórias/prevenção & controle , Margens de Excisão , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/irrigação sanguínea , Vértebras Torácicas/cirurgia , Lesões do Sistema Vascular/prevenção & controle , Feminino , Humanos , Masculino , SegurançaRESUMO
A few descriptions about anterior thoracic arthrodesis causing thoracic aortic pseudoaneurysms due to late screw loosening are mentioned in the literature. We report a case that describes a hybrid approach complicated with an aortic injury when removing a screw from the aortic wall. A 57-year-old man was initially operated on for scoliosis due to poliomyelitis using dorsal thoracolumbar in situ fusion at an early age. At adulthood, the patient complained of spinal cord compression and severe myelopathy due to D9-D10 nonunion, and the patient required a double surgical approach. Almost a year later, he was diagnosed with a thoracic aneurysm caused by late screw loosening from the anterior plate. A hybrid approach was used to treat the aortic pseudoaneurysm (endograft stent) and for anterior vertebral hardware removal (rethoracotomy). Although an aortic stent was covering the aortic lumen, during the open part of the procedure, an aortic injury took place when removing the screw, requiring quick cross clamping and repair. Anterior vertebral hardware removal after a previous anterior spinal approach is a technically highly demanding procedure. As unexpected life-threatening complications can occur, this procedure should be performed in a setting with the capacity for both endovascular and open aortic repair.
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La toxocariasis es una zoonosis prevalente con un importante impacto socioeconómico, particularmente en las comunidades pobres de todo el mundo. Es causada por formas larvarias de especies de nematodos, parásitos del género Toxocara. El espectro de manifestaciones clínicas en la toxocariasis varía ampliamente, desde casos asintomáticos a infecciones generalizadas. En el caso de la toxocariasis ocular, el deterioro de la agudeza visual es la manifestación más común cuando los síntomas están presentes. Las presentaciones oculares incluyen endoftalmitis crónica, granuloma de polo posterior o granuloma periférico. Presentamos el caso de una paciente de 12 años, con toxocariasis ocular en forma de granuloma de polo posterior con bandas traccionales a vítreo, acompañada de una lesión hiperpigmentada en el área macular en fase cicatrizal. El propósito de esta publicación es describir las múltiples complicaciones oculares que pueden concomitar en el paciente con toxocariasis ocular, que finalmente conllevan a una pérdida visual irreversible(AU)
Toxocariasis is a prevalent zoonosis with a significant socioeconomic impact, particularly in poor communities around the world. It is caused by larval forms of nematode species, parasites of the Toxocara genus. The spectrum of clinical manifestations in toxocariasis varies widely from asymptomatic cases to systemic infections. In the case of ocular toxocariasis, impaired visual acuity is the most common manifestation when symptoms are present. Ocular presentations include chronic endophthalmitis, posterior pole granuloma, or a peripheral granuloma. We present the case of a 12-year-old patient with ocular toxocariasis in the form of a posterior pole granuloma with vitreous tractional bands, which is accompanied by a hyperpigmented lesion in the macular area in the healing phase. The purpose of our publication is to highlight the multiple ocular complications that can occur in patients with ocular toxocariasis, which ultimately lead to irreversible visual loss(AU)
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Toxocaríase/complicaçõesRESUMO
El desprendimiento de la capa bacilar de la retina es la separación de los segmentos internos de los fotorreceptores del resto de la retina neurosensorial, o separación entre la zona miode y elipsoide de la retina, que en un hallazgo reciente se puede identificar mediante la tomografía de coherencia óptica de dominio espectral. El objetivo es actualizar los conocimientos sobre el desprendimiento de la capa bacilar de la retina y el uso de la tomografía de coherencia óptica de dominio espectral en las enfermedades oculares que están asociadas con este signo. Se consultaron las fuentes bibliográficas como Google académico, SciELO LAC, Medline y MEDICARIBE. Se limitaron los resultados al idioma español e inglés y a los últimos cinco años. Se recuperaron 54 documentos, de ellos 18 resultaron relevantes a esta investigación. Los autores más mencionados fueron Ramtohul, Metha y Cicinelli. Ellos trabajaron el signo clínico en cuestión y reportaron la experiencia en la atención a los pacientes aquejados con esta enfermedad ocular. El desprendimiento de la capa bacilar de la retina es un signo presente en varias enfermedades asociadas a inflamación del segmento posterior ocular. La tomografía de coherencia óptica de dominio espectral es una técnica efectiva para determinarlo, aunque estos planteamientos aún son escasos en la literatura, lo cual reafirma la importancia científica de continuar los estudios a partir de hipótesis iniciales desde el punto de vista histológico y tomográfico(AU)
Retinal bacillary layer detachment is the separation of the inner segments of the photoreceptors from the rest of the neurosensory retina, or separation between the myode and ellipsoid zone of the retina, which in a recent finding can be identified by spectral-domain optical coherence tomography. The objective is to update the knowledge about the detachment of the bacillary layer of the retina and the use of spectral-domain optical coherence tomography in ocular diseases that are associated with this sign. Bibliographic sources such as academic Google, SciELO LAC, MEDLINE and MEDICARIBE were consulted. Fifty-four documents were retrieved, of which 18 were relevant to this research. The results were limited to the Spanish and English language and to the last five years. The most mentioned authors were Ramtohul, Metha and Cicinelli. They worked on the clinical sign in question and reported the experience in caring for patients afflicted with this ocular disease. Detachment of the bacillary layer of the retina is a sign present in several diseases associated with ocular posterior segment inflammation. Spectral-domain optical coherence tomography is an effective technique to determine it, although it is still scarce in the literature, which reaffirms the scientific validity of continuing studies from initial hypotheses from the histological and tomographic point of view(AU)
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Humanos , Descolamento Retiniano/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Degeneração Macular/etiologia , Literatura de Revisão como Assunto , Bases de Dados BibliográficasRESUMO
La neurorretinopatía macular aguda es una condición rara con patogenia microvascular. Se presenta con un inicio agudo con escotomas paracentrales correspondientes a lesiones paramaculares evidentes. Los avances en las imágenes multimodales permitieron caracterizar este trastorno de retina y crear nuevos conceptos. Serraf, en el 2013, identificó dos formas por medio de la tomografía de coherencia óptica dominio espectral: el tipo 1 conocido como maculopatía paracentral aguda media en la cual se observa una banda hiperreflectiva en la capa nuclear interna, y el tipo 2 en el cual la banda hiperreflectiva se ubica en la capa nuclear externa, que involucra la zona elipsoide y la zona de interdigitación con el epitelio pigmentario de la retina. Hasta el momento no existe cura; pero se puede actuar sobre los factores de riesgo. Por ser una condición rara y por no existir reportes hasta el momento en Cuba es que se presentan a continuación dos pacientes con cuadros clínicos similares de estas dos variantes; concluyendo la importancia que presentan las imágenes multimodales como medio auxiliar diagnóstico(AU)
Acute macular neuroretinopathy is a rare condition with complex pathogenesis and microvascular cause. It appears with acute onset, with paracentral scotomas corresponding to obvious paramacular lesions. Advances in multimodal imaging made it possible to characterize this retinal disorder and to create new concepts. Serraf, in 2013, identified two forms by spectral domain optical coherence tomography: type 1, known as paracentral acute middle maculopathy, in which a hyperreflective band is observed in the inner nuclear layer; and type 2, in which the hyperreflective band is located in the outer nuclear layer, involving the ellipsoid zone and the zone of interdigitation with the retinal pigment epithelium. Up to this moment, there is no cure; but it is possible to act on the risk factors. Because it is a rare condition and because there are no reports so far in Cuba, two patients with similar clinical pictures of these two variants are presented; concluding the importance of multimodal images as an auxiliary diagnostic tool(AU)
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Humanos , Síndrome dos Pontos Brancos/patologiaRESUMO
STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study risk factors linked to spinal fusion surgical wound infection (SWI) incidence and compare the incidence with rates in Madrid Region, Spain and United States as a whole. SUMMARY OF BACKGROUND DATA: SWI is one of the complications posed by spinal surgery. Indeed, spinal surgery has a higher infection rate than do other orthopedic surgeries such as total hip or knee arthroplasty. The study of risk factors that are susceptible to be modified will enable both the incidence of SWI and, by extension, related morbidity, mortality, and costs to be reduced. METHODS: All patients undergoing spinal fusion at a tertiary hospital from June 2011 to June 2014 were included. Infection rate was calculated, and the association between risk factors and SWI incidence was assessed by reference to odds ratio (OR) with univariate and multivariate analysis. RESULTS: The study population (nâ=â892) had a SWI rate of 3.9%. The standardized infection ratio of our hospital was 0.58 with respect to the Madrid Region, 0.76 with respect to Spain's national rate and 2.05 with respect to the US NHSN/CDC. The multivariate analysis showed that predictive factors of SWI were diabetes mellitus (OR 2.81, 95% confidence interval, CI: 1.18-6.72, Pâ<â0.05), chronic obstructive pulmonary disease (COPD) (OR 5.16, 95% CI: 2.04-13.08, Pâ<â0.05), duration of surgery higher than the 75th percentile (OR 5.39, 95% CI: 1.77-110.84, Pâ<â0.05) and dirty surgery (OR 14.01, 95% CI: 1.01-28.88, Pâ<â0.05). CONCLUSION: Independent risk factors for SWI in spinal fusion are existence of diabetes mellitus, COPD, duration of surgery higher than the 75th percentile and dirty surgery. Knowing these risk factors enables action to be taken to reduce the SWI rate. LEVEL OF EVIDENCE: 3.
Assuntos
Fusão Vertebral/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Feminino , Hospitais de Ensino/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Espanha , Fatores de TempoRESUMO
Objetivo: Identificar la relación de los pseudodrusen reticulares con la degeneración macular asociada a la edad mediante imágenes tomográficas. Método: Estudio observacional, descriptivo y transversal en pacientes con pseudodrusen reticulares atendidos en consulta de retina a los que se les realizó tomografía de coherencia óptica espectral desde enero de 2009 hasta diciembre de 2014 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La población estuvo constituida por 69 pacientes de 55 años y más con pseudodrusen reticulares en dichas imágenes. Resultados: Los pseudodrusen predominaron en pacientes con edades comprendidas entre los 70 y 79 años para un 49,3 por ciento. El sexo femenino fue el más numeroso con un 76,8 por ciento. De los 122 ojos con pseudodrusen, 86 presentaron algún signo de degeneración macular asociada a la edad representado por el 70,5 por ciento. El 58,1 por ciento de estos últimos tuvo la forma avanzada. La membrana neovascular tipo II fue la más frecuente con un 58,0 por ciento. El grosor coroideo se estimó disminuido en el 77,9 por ciento de los casos. Conclusiones: Los pseudodrusen reticulares mantienen una relación directa con la degeneración macular asociada a la edad e influyen en la progresión de esta(AU)
Objective: To identify the relationship of reticular pseudodrusen with age-related macular degeneration using tomographic imaging. Methods: An observational, descriptive and cross-sectional study was conducted in patients with reticular pseudodrusen seen in retina consultation who underwent spectral optical coherence tomography from January 2009 to December 2014 at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". The population consisted of 69 patients aged 55 years and older with reticular pseudodrusen in these images. Results: Pseudodrusen predominated in patients between 70 and 79 years of age (49.3 percent). The female gender was the most numerous with 76.8 percent. Out of the 122 eyes with pseudodrusen, 86 showed some sign of age-related macular degeneration (70.5 percent). Out of the latter, 58.1 percent had the advanced form. Type II neovascular membrane was the most frequent with 58.0 percent. Choroidal thickness was estimated decreased in 77.9 percent of cases. Conclusions: Reticular pseudodrusen maintain a direct relationship with age-related macular degeneration and influence its progression(AU)
Assuntos
Humanos , Feminino , Idoso , Envelhecimento , Degeneração Macular/etiologia , Epidemiologia Descritiva , Estudos Observacionais como AssuntoRESUMO
Las membranas neovasculares coroidea representan el crecimiento de nuevos vasos sanguíneos originados de la coriocapilar hacia el epitelio pigmentario de la retina o el espacio subretinal por una disrupción de la membrana de Bruch ocasionado por la inflamación prolongada. El desarrollo de las membranas neovasculares coroidea está estrechamente conectado a la morbilidad asociada con la coroidopatía punteada interna y puede ser su primera forma de presentación. La coroidopatía punteada interna es clasificada como una de las enfermedades de los síndromes de puntos blancos evanescentes, es una enfermedad infrecuente, bilateral y de origen desconocido. Se presenta un caso clínico de un paciente al cual se le diagnostica membranas neovasculares coroidea en el curso de una coroidopatía punteada interna con una presentación atípica o previa a las lesiones de coroiditis. La coroidopatía punteada interna complicada con membranas neovasculares coroidea compromete la visión central de forma considerable en pacientes jóvenes(AU)
Choroidal neovascular membranes represent the growth of new blood vessels originating from the choriocapillaris into the retinal pigment epithelium or subretinal space due to disruption of Bruch's membrane caused by prolonged inflammation. The development of choroidal neovascular membranes is closely connected to the morbidity associated with punctate inner choroidopathy and may be its first form of manifestation. Punctate Inner choroidopathy is classified as one of the evanescent white dot syndromes diseases, is a rare, bilateral disease of unknown origin. We present a case report of a patient diagnosed with choroidal neovascular membranes while suffering from punctate inner choroidopathy with an atypical manifestation or prior to choroiditis lesions. Punctate Inner choroidopathy when complicated with choroidal neovascular membranes compromises significantly the central vision in young patients(AU)
Assuntos
Humanos , Neovascularização de Coroide/diagnósticoRESUMO
STUDY DESIGN: A case report. OBJECTIVE: We describe a technique to drain a thoracic and cervical postoperative epidural hematoma causing paraplegia after anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA: Postoperative compressive spinal epidural hematoma (SEH) is a devastating complication and early diagnosis and treatment is essential. The most commonly accepted treatment is decompression and drainage of hematoma. METHODS: A 65-year-old male with a degenerative disc disease located at C4-C5, C5-C6, and C6-C7 levels with disc herniation underwent a standard anterior cervical decompression and fusion at C4-C5-C6-C7. Three hours after the procedure, the patient started complaining of progressive paraplegia and affectation of upper extremity. A magnetic resonance imaging (MRI) revealed a postoperative SEH extending from C3 to T6, causing compression.To resolve this unusual complication, a new surgery was performed. An anterior approach through the previous one was performed, and a C6 corpectomy was done. The anterior epidural hematoma was drained with an elastic urinary catheter. At the end of the surgery, a tricortical iliac crest autograft was placed between C5-C7 and the plate was placed as previously. RESULTS: The patient recovered tactile and vibratory senses, as well as motor function in both hands 12 hours after the second procedure. The complete drainage of the hematoma was MRI-verified the first postoperative day.The patient was discharged from the hospital presenting a complete sensitive recovery and a 3/5 of muscle recovery. At one year, the patient made a full recovery and was able to walk unassisted. CONCLUSION: The treatment of choice in SEH is the early decompression as complete as possible, usually with the same approach or at the level of major compression. In rare cases like this, we recommend the use of an elastic catheter to complete hematoma drainage, distant from the surgical wound. LEVEL OF EVIDENCE: N/A.
Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Hematoma Epidural Espinal/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Bexiga Urinária/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Drenagem , Hematoma Epidural Espinal/diagnóstico , Humanos , Masculino , Período Pós-OperatórioRESUMO
Objetivo: Determinar las características clínicas y epidemiológicas de la neovascularización coroidea en los pacientes con uveítis. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes con diagnóstico de neovascularización coroidea asociada a uveítis, atendidos en el Servicio de Uveítis e Inflamaciones Oculares del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Resultados: Esta entidad predominó en el sexo femenino, en edad pediátrica y en jóvenes. Se asoció con mayor frecuencia a enfermedades infecciosas, como la toxoplasmosis ocular, y un pequeño número de pacientes desarrolló membrana neovascular coroidea bilateral. Las membranas localizadas con mayor frecuencia fueron las subfoveales. Por angiografía fluoresceínica predominaron las clásicas, mientras el grosor de la membrana neovascular coroidea fue mayor que el grosor foveal central. La agudeza visual mejor corregida en la mayoría de nuestros pacientes fue menor de 85 VAR. Conclusión: La membrana neovascular coroidea asociada a las uveítis es reconocida como una complicación infrecuente, pero compromete de forma severa la visión en estos pacientes(AU)
Objective. To determine the clinical-epidemiological characteristics of choroidal neovascularization in patients with uveitis. Method. An observational, descriptive, cross-sectional study was carried out in patients with a diagnosis of choroidal neovascularization associated with uveitis, attended in the Uveitis and Ocular Inflammations Service of the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". Results. This entity predominated in the female sex, in pediatric age and youth. It was more frequently associated with infectious diseases, such as ocular toxoplasmosis, and a small number of patients developed bilateral choroidal neovascular membrane. The most frequent location of the membranes were the subfoveal ones, by fluorescein angiography the predominantly classic ones and the thickness of the choroidal neovascular membrane was greater than the central foveal thickness. The best corrected visual acuity in most of our patients was less than 85 VAR. Conclusion. CNVM associated with uveitis is recognized as an uncommon complication but one that severely compromises vision in these patients(AU)