Objective: The thoracolumbar spine trauma represents 30% of spinal diseases. To compare the minimally invasive technique with the open technique in lumbar fractures. Method: A prospective, cross-sectional, comparative observational study, which evaluated the following variables: surgery time, length of hospital stay, transoperative bleeding, postoperative pain, analyzed by SPSS software using Student's t test with statistical significance of p ≥ 0.05, with 24 patients with single-level thoracolumbar fractures, randomly treated with percutaneous pedicle screws and by open technique with a transpedicular system. Results: The surgery time was 90 minutes for the minimally invasive technique and 60 minutes for the open technique, the bleeding was on average 50 cm3 vs. 400 cm3. The mean visual analogue scale for pain at 24 hours of surgery was 5 for the minimally invasive group vs. 8 for the open group. The number of fluoroscopic projections of pedicle screws was 220 in the minimally invasive technique vs. 100 in the traditional technique. Quantified bleeding was minimal for percutaneous access vs. 340 cm3 for the traditional system. The hospital discharge for the minimally invasive group was at 24 hours and at 72 hours for those treated with open surgery. Conclusions: It is a technique that requires longer surgical time, with reports of less bleeding, less postoperative pain and less time for hospital discharge, reasons why it is supposed to be a procedure that requires a learning curve, statistical significance with respect to bleeding, visual analogue scale for pain and showed no significant difference in the variables of surgical time.
Objective: The objective of this study was to determine the factors associated with the persistence of pain in patients operated on for lumbar stenosis. Method: One hundred and fifty-three patients were studied, divided into two groups: 1) Patients with persistent pain in varying degrees, 2) Patients without pain. Age, sex, affected levels, comorbidities, surgical risk, and type of surgical procedure were evaluated. Results: There were 108 patients in the group with pain and 45 in the group without pain. In the group with pain, there were 28 patients with diabetes mellitus, 31 smokers, and 28 alcohol-dependent patients, with a significant difference of p = 0.001 and an RR = 1.1. A simple widening procedure was performed in 48 patients in the group with pain and 12 patients in the group without pain, with RR = 0.8, and widening plus instrumentation was performed in 7 patients in both the with and without pain groups. Conclusion: The indication of a surgical procedure in patients with spinal stenosis must take many factors into account in addition to clinical factors and the segments affected, since these factors impact patient prognosis. In the multivariate analysis, the variable most closely associated with persistent pain was the procedure performed. Level of Evidence III; Case-control study.g
Objective: To know the clinical and radiographic results of patients with L4-L5 degenerative spondylolisthesis grade I, II, and III surgically treated with minimally invasive 360-degree arthrodesis. To determine the clinical and radiographic results according to the Oswestry Index 6 months after surgery and the percentage of postsurgical reduction in these patients. Methods: The present study was developed in the Department of Spinal Surgery of the Unidad Médica de Alta Especialidad Lomas Verdes, from October 2016 to August 2017. It is a prospective, cross-sectional, comparative observational study. We evaluated the reduction of the listhesis using pre and post-operative radiographs, as well as the Oswestry Disability Index. Results: The sample was composed of 12 patients, eight females and four males, showing a statistical significance in the Student’s t test, with p=0.05 for both variables. Conclusions: Degenerative spondylolisthesis of the 4th lumbar level is a very frequent pathology that affects groups of productive age and represents a burden not only for the patient, but also for the community. This surgical technique showed a high level of security and confidence for its resolution, showing results comparable to the literature. However, it requires certain technical resources and training to be performed. Evidence Level II; Prospective comparative study.
Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.
Objective: To describe the epidemiology of 111 patients to determine the age group affected, the level of fracture, fracture classification, and type of treatment. Methods: Descriptive study of 111 cases of cervical spine fracture treated at the Hospital of Traumatology and Orthopedics Lomas Verdes - IMSS from March 2009 to October 2014. Results: The condition appeared in 88% of men. The age range was 16-81 years, with an average of 40 years. The most common fracture according to the AO classification was type A (57%). The segments most affected were C5-C6, C6-C7, C6 and C4-C5 (24.32%, 17.1%, 9.9% and 8.1%). Neurological involvement occurred in 46.8%. The most common mechanism of injury was high energy. Surgical treatment was performed in 78.4% of patients, being one-level corpectomy with placement of mesh and plate, and posterior fixation with facet screws the most appropriate procedures (31.5% and 27.9%, respectively). Conclusions: Males were the most affected, the highest incidence was in C5-C6 and C6-C7 levels and the surgical procedure was the most used.
Objective: To identify the factors associated with postoperative infections in spinal surgery. Methods: Descriptive, retrospective, cross-sectional study conducted in the spine surgery department of the Medical Unit of High Specialty (UMAE) at the Hospital of Traumatology and Orthopedics Lomas Verdes, Mexican Institute of Social Security (IMSS) between January 01, 2013 and June 30, 2014 through medical records of the service and the records of clinical care. Data were gathered in accordance with the records of patients with infection after spinal surgery. The factors considered were age group, etiologic agent, surgical site, type of treatment, bleeding volume and pharmacotherapy. Frequency and descriptive statistic was conducted. The rank sum test with the Wilcoxon test for a single sample was performed in different measurements; Pearson's correlation was calculated and all p<0.05 values were considered significant. Results: The sample was composed of 14 patients of which 11 were female (78.6%) and 3 male (21.4%) with predominance of surgical area in the lumbar and dorsolumbar region. There was a significant correlation between the surgical time and the amount of bleeding with p<0.001. Conclusions: It was clear that the infections present in patients after spinal surgery are multifactorial. However, in this study the correlation between time of surgery and bleeding amount had the highest importance and relevance.
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