[Tratamiento quirúrgico de la escoliosis idiopática del adolescente. Resultados en el Instituto Nacional de Rehabilitación de México. Seguimiento mínimo de 24 meses]

Antecedentes

La escoliosis idiopática del adolescente se define como una deformidad tridimensional de la columna vertebral que se presenta entre los 10 y los 18 años, y que se manifiesta con una curvatura vertebral en el plano coronal mayor de 10°. Esta deformidad afecta al 2-3% de la población general, pero solo el 10% del total requerirá en algún momento tratamiento quirúrgico. El método de elección para el manejo es el uso de tornillos transpediculares y barras desrotadoras.

Objetivo

Realizar un análisis descriptivo de los pacientes que recibieron manejo quirúrgico en nuestro instituto con tornillos transpediculares y barras.

Método

Se trata de un estudio observacional, retrospectivo, analítico, abierto, de muestreo no probabilístico, en el que se incluyeron los pacientes tratados con manejo quirúrgico entre 2012 y 2013. Las deformidades se estratificaron de acuerdo con la clasificación de Lenke. El ángulo de corrección de la deformidad, los niveles instrumentados, el sangrado transquirúrgico y la presencia de complicaciones fueron las variables analizadas.

Resultados

La mayoría de los pacientes presentaron curvas Lenke IBN, Nash Moe III, Cobb un promedio de 59.4° y cifosis de 47.8. En promedio se siguió a los pacientes por 35.84 meses, detectando un aumento de la curvatura coronal de 2.28° y un aumento de la curvatura sagital de 2.8°.

Conclusión

Al comparar estos resultados y la literatura mundial se concluyó que el tratamiento de la escoliosis idiopática del adolescente es un método seguro y reproducible que ofrece una mayor ventaja biomecánica y biológica sobre el uso de instrumentación mixta utilizada anteriormente.

Background

Adolescent’s idiopathic scoliosis is defined as a three-dimensional deformity of the spine, which occurs between 10 and 18-year-old, has a spinal curvature >10° in the coronal plane. This deformity affects 2–3% of the general population, however, only 10% of the total will require surgery at some point. The method of choice for management is the use of pedicle screws and rods derotational.

Objective

To perform a descriptive analysis of patients who received surgical treatment in our institute with pedicle screws and rods.

Methods

This is an observational, retrospective, analytical, open study, non-probability sampling, in which patients requiring surgical treatment at our institute between 2012 and 2013 were included, the deformities were stratified according to the classification of Lenke. The angle of deformity correction, instrumented levels, amount of bleeding, presence of complications were the variables analyzed.

Results

Lenke classifying mostly IBN, Moe Nash III, an average of 59.4° Cobb and kyphosis of 47.8. On average it was followed patients for 35.84 months, detecting an increase 2.28° coronal curvature and sagittal curvature increase of 2.8°.

Conclusion

Comparing these results and world literature concluded that the treatment of adolescent’s idiopathic scoliosis is a safe and reproducible method that provides greater biomechanical and biological advantage over the use of mixed instrumentation used previously.

Comparative study between Plate-Graff, Plate-Cage and peek cage in cervical spine fusion

OBJECTIVE

To compare results of Plate-Graff, Plate-Cage and PEEK cage in patients with cervical stenosis.

MATERIAL AND METHODS

Prospective, with before and after intervention and comparative study. From January 2005 to October 2011 we included 37 patients (male: 48.6%, female: 51.4%) post-surgery by anterior approach; 3 groups via: Group I, arthrodesis with Plate-Graff n = 12 (M 41.7%, F 58.3%) with 22 levels, group II, Plate-Cage n = 11 (M 63.6% 36.4% F) 19 levels, group III, PEEK cage, n = 14 (M 0% F 50%) with 25 levels. Functional assessment pre- and postoperative with neck disability index (NDI) and visual analogue scale for pain (VAS). The radiological assessment with X-rays only. Descriptive statistics were obtained. Wilcoxon method use according to data distribution, non parametric tests of ranges with sign of Kruskal-Wallis for comparison between more than two groups, and significance level with p 0.05. We used the statistical package SPSS version 15.

RESULTS

The majority of patients was found between the sixth and eighth decade of life. At one year of follow up the NDI and pain with VAS shown improvement with statistical difference in three groups (p = 0.001). However, the radiographic measurements per year of follow-up showed a significant improvement of segmental lordosis (p = 0.02) only in patients with Plate-Graff.

CONCLUSIONS

Using the graft offers best clinical and radiographic results compared with the Plate Cage and box peek to one year of follow-up.

A new technique of pedicle screw placement with the use of sequential multilevel navigation templates based on patient-specific 3D CT reconstruction model: applicability in spine deformity

INTRODUCTION

The technique of placement of pedicle screws has gradually improved, but even misplacement observed in 1.2 to 20% of cases, have appeared techniques fluoroscopic, tomographic and electromagnetic navigation, which led it to 1.3 to 4.3%, but nevertheless they are expensive and complex technologies. Present technique pedicle screw placement by using templates with a modification in the art, performing tomography and reconstruction in the same surgical position and with the templates of 3 or more levels.

METHODS

Five cases of idiopathic scoliosis were performed, with correction and instrumentation with pedicular screws, where a three-dimensional model of the spine was performed with a tomography in a surgical position, whose images were exported to a 3D printer to reconstruct the desired trajectory of the screws in a template using cylinders resting on the inverse surface of the vertebrae. The direction of the screw was planned in the center of the pedicle and parallel to the upper platform of the vertebra. Each template was of several levels and transoperative X-rays were not used.

RESULTS

Under electrophysiologic monitoring transoperative «red alerts» were not reported, the placement of the screws in postoperative CT scan was evaluated, showing a standard deviation in placement of 1.9 and 2.2 mm on the right and left respectively pedicles, with respect to their planning.

DISCUSSION

This technique is simple and safe, besides not requiring great technology, its use is suggested in beginner spine surgeons and in severe deformities, it can be performed in any hospital where spinal surgery is performed.

[Degenerative adult scoliosis]

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10° in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and/ or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

[Comparative study between plate-graft, cage-plate and peek cage in cervical arthrodesis for cervical stenosis]

INTRODUCTION

A variety of systems have been developed to fix and perform arthrodesis of the cervical spine, with the advantages of reducing the risk of pseudoarthrosis, extrusion and graft collapse and achieving a more precise sagittal alignment. We therefore need to compare the results of the following approaches to patients with cervical stenosis: plate-graft, cage-plate and PEEK cage.

MATERIAL AND METHODS

Prospective, interventional, comparative trial involving three groups: group I, arthrodesis with plate-graft; group II, cage-plate, and group III, PEEK cage. The pre- and postoperative assessments included the cervical disability scale, the pain visual analog scale (VAS), and cervical spine X-rays. The results were analyzed with non-parametric tests such as the Wilcoxon sign test and the Kruskal-Wallis test for the comparison of more than two groups. Significance level was 0.05.

RESULTS

The sample included a total of 37 patients: n = 12 in group I, with 22 levels; n = 11 in group II, with 19 levels, and n = 14 in group III, with 25 levels. Patient age ranged between 60 and 80. One year after surgery there was an improvement in cervical disability and the pain VAS score, with a statistically significant difference among the three groups (p = 0.001). However, radiographic measurements at that time showed a significant improvement in segmental lordosis (p = 0.02) only in plate-graft patients.

CONCLUSIONS

The plate-graft approach provides better clinical and radiographic results compared to the cage-plate and PEEK cage techniques, at the one-year follow- up.

[Utility of ligamentoplasty for the prevention of adjacent segment disease above 360 degree arthrodesis in degenerative lumbar spondylosis. Preliminary report]

BACKGROUND

Ligamentoplasty is a dynamic stabilization method used to treat lumbar stenosis and resect lumbar herniated discs with good results. The objective of this paper is to report preliminary results of the utility of ligamentoplasty to prevent adjacent segment disease above the arthrodesis.

MATERIAL AND METHODS

Two groups of patients with degenerative lumbar spondylolisthesis who underwent circumferential arthrodesis. In 23 patients a dynamic stabilization system was placed in the segment above (group L), while this system was not used in 35 patients (group S). Degeneration and disease of the segment above were assessed. The statistical analysis was done with the SPSS 15.0 software.

RESULTS

At the one-year follow-up, the incidence rate of adjacent segment degeneration was 11% for group L and 0% for group S; at the two-year follow-up it was 13% in both groups; at three years, 0% for group L and 19% for group S; at four years, 25% for group L and 0% for group S. At five years, 50% for group L and 0% for group S. Clinically significant radiculopathy occurred in two patients five years after surgery, one of whom also had adjacent segment disease.

CONCLUSIONS

Based on the follow-up, at this moment it is not possible to show the utility of dynamic stabilization through ligamentoplasty to avoid adjacent segment disease above the arthrodesis.

[Functional results of surgery for cervical stenosis]

INTRODUCTION

Cervical stenosis refers to the narrowing of the spinal canal or the intervertebral foramina at different anatomic levels, secondary to pathologic processes of the vertebral elements. Surgical management is used when conservative management fails. The anterior and posterior approaches are the most frequently used ones, and the surgical options resulting from these approaches are: anterior cervical diskectomy plus fusion, anterior corporectomy plus fusion, laminoplasty, laminectomy and arthroplasty.

MATERIAL AND METHOD

This is an ambispective study conducted in 195 patients with a diagnosis of cervical stenosis who required surgical treatment at our hospital from January 1995 to January 2007. The neck disability index questionnaire was applied, as well as the Nurick scale. Descriptive statistics was used with frequency and percentage measures.

RESULTS

The review of the National Rehabilitation Institute electronic records from January 1st 1995 to December 31st 2007 showed that 195 patients underwent surgery for cervical stenosis. Females were predominant. The most affected age group was 46-55 years. The most frequently affected level was C5-C6. A significant improvement was seen in the neck disability index due to pain and the Nurick scale.

CONCLUSION

According to world literature, mean age of patients with cervical stenosis is 57.2 years, and the most compromised levels were C4-C5 and C5-C6. Improvement was evident according to the neck disability index and the Nurick scale.