60 research outputs found
Congenital absence of the pedicles and the neural arch of L2
Congenital pedicle abnormalities are rare. Unilateral aplastic and hypoplastic
lumbar pedicles have been reported, but these were usually discovered
incidentally and did not need surgical treatment. We present a case of absence of
both pedicles and the neural arch of L2, with associated kyphoscoliosis with
neurological involvement, that needed a two-stage corrective surgery. An L1-L4
fusion was achieved with relief of the symptom
Síndrome de cauda equina por hernia discal gigante
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.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
Quiste sinovial en articulación interapofisaria lumbar. Una causa infrecuente de lumbociática
Los quistes
sinoviales de las articulaciones facetarias pueden ser asintomáticos o
provocar dolor lumbar, con o sin clínica radicular.
Se considera que son secundarios a traumatismos o a degeneración articular, y ocurren
con mayor frecuencia en pacientes con espondi
lolistesis.
El diagnóstico se establece con la tomografía axial computarizada o la
resonancia
magnética, que mues
tran una lesión quísti
ca adyacente a la faceta articu
lar.
Realizamos una revis
ión de la literatura y presenta
mos un paciente con radiculopatí
a S1
izquierda cau
sada por un quiste sinovial de la articulación facetaria L5
-
S1. El tratamiento fue curativo y consistió en la resección del quiste
Bone lengthening by physial distraction. An experimental study.
Experimental physial distraction was carried out in the distal part of the femur
in 45 two-month old lambs in order to study the basic mechanisms of lengthening
as well as the viability of the growth cartilage after using this method. The
animals were divided into three groups (A, B and C), and each group into three
subgroups (1, 2 and 3) according to the rate of distraction used (2 mm/day, 1
mm/day, 0.5 mm/day) and the time of sacrifice. The results obtained show that the
basic lengthening mechanisms consists, firstly, in the production of a fracture
between the metaphysis and the epiphysis and, secondly, that the lower the
distraction speed employed, the greater is the short-term and long-term viability
of the growth cartilage. Optimum viability was observed at a distraction rate of
0.5 mm/day. On this basis we conclude that in clinical practice physical
distraction could be indicated for children at an early stage of skeletal growth
and repeated later provided that the rate of distraction is kept within
reasonable limits
Pure cervical radiculopathy due to spontaneous spinal epidural haematoma (SSEH): report of a case solved conservatively
Abstract Introduction: Spontaneous
spinal epidural haematoma (SSEH)
is widely recognised throughout the
literature as a cause of myelopathy,
radicular compression being very
rarely reported. Surgical management
is almost always recommended,
especially in the cases of
spinal cord compression. Conservative
treatment is reported as a curiosity
and only in the case of
spontaneous improvement. This
report presents the particular case of
a 64-year-old patient undergoing
anticoagulant therapy that had a
cervical radiculopathy due to a
SSEH confirmed by MRI. The
patient improved spontaneously and
symptoms were solved with unconventional
conservative treatment
and without stopping the anticoagulant
therapy. Conclusions: Spontaneous
epidural haematoma must be
kept in mind when patients undergoing
anticoagulant therapy have a
sudden onset of cervicobrachialgia.
Even though most spinal surgeons
advocate surgical treatment, a conservative
approach may lead to a
complete recovery and may be considered
as a good option in the case
of radicular involvement. Discontinuation
of the anticoagulant therapy
may not always be needed,
especially when the clinical
syndrome improves spontaneously
Empleo de aloinjerto óseo en la reparación quirúrgica de fracturas del platillo tibial
Cada vez es mayor el número de indicaciones posibles en el uso de aloinjertos en patología osteoarticular. Muchas veces supone una alternativa válida frente al uso de autoinjerto, evitando así la morbilidad que conlleva la extracción del injerto del propio paciente. Presentamos 6 casos de frac
tura de platillo tibial externo en las que existía depresión central y hundimiento de la superficie articular (tipo B3 según la clasificación AO) en cuyo tratamiento quirúrgico se ha utilizado el injerto óseo de banco (fragmento de cabeza femoral tallada a medida) para el soporte del platillo tibial deprimido una vez
levantado y conseguida la congruencia articular. En todos los casos se obtuvo un
resultado satisfactorio en cuanto a la función de soporte y a la consolidación sin existir complicaciones per o postoperatorias
Union after multiple anterior cervical fusion 21 cases followed for 1-6 years
With a mean follow-up of 3 (1-6) years, we report on 21 patients who underwent
multiple level cervical fusion, using autologous iliac crest grafts. Dissectomies
were performed in 14 patients and corpectomies in another 7. Instrumentation was
used in all patients with corpectomies and in 2 patients who underwent 2-level
and 3-level dissectomies. Non-union occurred in 1 patient at 1 level. Graft
displacement requiring reoperation was observed in 2 patients with massive
corpectomies, in 1 of them as a consequence of trauma. In both patients complete
bony fusion was obtained after reoperation and no other complications were
observed. We conclude that the success rate with multiple-level fusion is
comparable to that of single-level fusion when adequate fixation is achieve
Symptomatic Medial Exostosis of the Great Toe Distal Phalanx: A Complication Due to Over-correction Following Akin Osteotomy for Hallux Valgus Repair
The authors present the case of a 54-year-old female who developed a painful
compression lesion localized to the medial aspect of the base of the distal
phalanx of the great toe as a complication of hallux valgus surgery. Preoperative
radiographic evaluation of the patient's foot revealed the first ray to be longer
than the second, a 12 degrees first intermetatarsal angle, a 33 degrees hallux
abductus angle, and an exostosis at the medial aspect of the base of the hallux
that was not considered by the surgeon to be important. Correction of the hallux
valgus deformity was performed with a combination of scarf and Akin osteotomies,
and the intermetatarsal and hallux abductus angles reduced to 2 degrees and 8
degrees , respectively. By 2 months postoperative, the patient was complaining of
pain at the medial aspect of the distal phalanx of the hallux associated with
shoe pressure. The pain correlated both clinically and radiologically with the
exostosis at the base of the distal phalanx, and had become symptomatic only
after the hallux had been operatively realigned. At 6 months postoperative,
percutaneous exostectomy was undertaken to remove the exostosis. Pain relief was
complete, thereafter, and after 2 years of postoperative follow-up the patient
remained pain free. The clinical importance of a medial exostosis localized to
the base of the distal phalanx of the hallux must be taken into consideration
whenever hallux valgus correction is undertaken, and this is particularly
important whenever an Akin osteotomy is being considered. Level of Clinical
Evidence: 4
Adhesive capsulitis. Is it possible in childhood?
Adhesive capsulitis affecting shoulders has been extensively studied by orthopedic surgeons, but few reports have been published on this condition when it affects other joints (hips, ankles). To our knowledge no pediatric cases have been reported. As its treatment requires prolonged physiotherapy and sometimes manipulation, a correct diagnosis is essential. We would like to emphasize the importance of having this condition in mind when one is regarding a differential diagnosis, also in children
Infected Vertebroplasty Due to Uncommon Bacteria Solved Surgically: A Rare and Threatening Life Complication of a Common Procedure
Case report. OBJECTIVE: The aim of this work is to describe a case
of infected vertebroplasty due to uncommon bacteria solved surgically with 2
years of follow-up and to discuss 6 other cases found in literature. SUMMARY OF
BACKGROUND DATA: Vertebroplasty is a well-known and useful technique for the
treatment of painful osteoporotic vertebral fractures. Complications, such as
cord or root compression or pulmonary embolisms, are infrequent and are mainly
related with the frequent escape of cement throughout the vertebral veins.
Infection is even more rare, but when it occurs is difficult to manage and can be
a life-threatening complication. METHODS: A 63-year-old-man had a spondylitis of
L2 after vertebroplasty. The patient was initially managed with antibiotics
without clinical improvement. Surgical treatment by anterior debridement and
anterior and posterior stabilization was done. The bacteria isolated from the
intraoperative cultures were Serratia marcescens, Stenotrophomonas maltophilia,
and Burkholderia cepacia. After surgery, the patient was treated with antibiotics
for 3 month. RESULTS: After 2 years of follow-up, the patient was free of pain,
without signs of infection, and a correct fusion was achieved. CONCLUSION: When
facing an infected vertebroplasty, initial conservative treatment with needle
biopsy culture and antibiotic administration are a rational option to start. If
this treatment fails, surgical debridement is then indicated in order to remove
the infected tissue and the acrylic cement and to stabilize the spine. Although
this can be an effective treatment, it could be a difficult and hazardous
surgical procedure
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