Study design: Registry study with prospectively collected dataObjective: To determine risk factors for pulmonary complications in spine surgery.Methods: The Spine End Results Registry 2003–2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, and comorbidities, surgical invasiveness and adverse outcomes were prospectively recorded. The primary outcome measure was the occurrence of a pulmonary complication following surgery. Univariate relative risks and 95% confidence intervals for each of the risk factors were determined. Multivariate log binomial regression analysis was performed to investigate the association between each risk factor and a pulmonary complication, while controlling for other important risk factors.Results: Altogether, there were 199 pulmonary complications after spine surgery. The cumulative incidence of a respiratory complication after spine surgery was 9% (144 patients). Multivariate analysis suggested gender, chronic obstructive pulmonary disease, congestive heart failure, diabetes, age, diagnosis, surgical invasiveness and surgery in the thoracic spine are significant risk factors for pulmonary complications after spinal surgery.Conclusions: The results of the present study suggest numerous statistically significant risk factors for pulmonary complications after spine surgery. These results may aid the clinician with preoperative risk stratification and patient counseling.Methods evaluation and class of evidence (CoE)Methodological principle:Study design: Prospective cohort Retrospective cohort (registry)• Case control Case seriesMethods Patients at similar point in course of treatment• Follow-up ≥85%• Similarity of treatment protocols for patient groups• Patients followed for long enough for outcomes to occur• Control for extraneous risk factors•Evidence class:IIThe definiton of the different classes of evidence is available on page 73.
Introducción: Los hemangiomas agresivos constituyen el 1% del total de los hemangiomas vertebrales. Pueden producir dolor, fracturas, deformidad y compromiso neurológico, generalmente de larga evolución. Se han descrito diferentes opciones terapéuticas, pero el manejo óptimo sigue sin estar claro. Comunicamos dos casos de paraparesia aguda secundaria a un hemangioma torácico agresivo, describimos su tratamiento y evolución. Realizamos una revisión narrativa de la bibliografía. Conclusión: Mediante la descompresión y la artrodesis tempranas seguidas de radioterapia, se logró la recuperación neurológica completa y el control de la enfermedad en un seguimiento a mediano plazo.
<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><strong>Introducción: </strong><span>La fotografía digital de radiografías puede generar distorsiones angulares en las imágenes. No está publicado si estas alteraciones pueden afectar las mediciones de los ángulos de Cobb.<br /> </span><strong>Objetivo: </strong><span>Evaluar la reproducibilidad del ángulo de Cobb con la fotografía digital de espinogramas de 30 x 90 cm en escoliosis del adulto.<br /> </span></p><p><strong>Materiales y Métodos: </strong><span>Se eligieron al azar 20 espinogramas preoperatorios de pacientes con escoliosis del adulto para evaluar prospectivamente. Los espinogramas fueron escaneados y sus imágenes digitales se consideraron como controles. Se analizó la discrepancia intraobservador, interobservador, intercámara e intracámara, con tres cámaras digitales y dos observadores que realizaron ocho sesiones fotográficas a cada espinograma. Se midieron los ángulos con Adobe Photoshop® sobre las imágenes digitales y se los analizó con el coeficiente de correlación de Pearson.<br /> </span></p><p><strong>Resultados: </strong><span>El promedio de los ángulos de Cobb torácicos y lumbares del escáner, las cámaras 1, 2 y 3 fue de 37,9; 37,8; 37,7; 37,5; 53,2; 53,1; 53,3; 52,9, respectivamente. La correlación interobservador e intraobservador fue extremadamente alta, así como entre las cámaras y el escáner.<br /> </span><strong> </strong></p><p><strong>Conclusión: </strong><span>El ángulo de Cobb se puede medir luego de la fotografía digital de espinogramas de 30 x 90 cm, con </span>alta reproducibilidad entre diferentes cámaras y observadores.</p><p> </p><p> </p></div></div></div>
Introduction Symptomatic ossification of the anterior longitudinal ligament is rarely pathology. Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH, also called with the eponym Forestier's disease, is a clinical syndrome characterized by the abnormal formation of osteopytes involving the spine. These are largely asymptomatic, however are recognized as an unusual cause of dysphagia, which may occur secondary to the mechanical compression with partial obstruction or perioesophageal inflammation caused by pharyngo- esophageal motion over the osteophytes. Dysphagia is reported in up to 28% of patients. Surgical treatment is advocated only after failure of conservative therapies. Conversely, in absence of relevant clinical signs due to the presence of DISH, surgery is not considered mandatory. However, surgical resection of the osteophyte has been reported to be an effective treatment for severe cases. Therefore, from 1995, we started to observe long-term postoperative courses of DISH patients with recalcitrant dysphagia who underwent surgical resection of osteophytes. The purpose of this study was to examine these surgical outcomes and literature review. Material and Methods Case 1. A 70-year-old man referred to our clinic because of progressive dysphagia for solids and liquids and cervical pain. A lateral cervical spinal X-ray and cervical MRI revealed giant cervical osteophytes at the ventral portion of the C 2/3/4 vertebral bodies and contiguous calcification of the anterolateral cervical vertebral bodies. Case 2. A 57-year-old man presented with a 1.5-year history of increased difficulty swallowing. A plain lateral radiograph revealed OALL ventral to the C3–5 vertebral bodies. Three- dimensional computerized tomography studies further demonstrated extensive C3–5 OALL. Case 3. A 75-year-old white man was seen at Hospital with the main complain of increased difficulty in swallowing solid food over the past two years. Routine cervical spine films revealed prodigious osteophytes of the cervical spine involving the bodies of C-2, C-3, C-4, C-5 and C-6 consistent with DISH. A magnetic resonance imaging (MRI) scan of the cervical spine revealed an elongated ossification of the frontal planes of the vertebral bodies, with spurs projecting into the soft tissues of the neck. Results The three patients underwent uneventful operative excision of the anterior cervical osteophytes. Surgery was performed with an anterolateral approach. They had marked improvement in swallowing function and were able to resume a normal diet after one to two months. Conclusion Diffuse idiopathic skeletal hyperostosis or Forestier's disease is an uncommon etiology of progressive dysphagia. This unrecognized condition may provide a new challenge for spine surgeons who are not as familiar with DISH as rheumatologists. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment
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