Dr Luis Rodrigo Díaz Iñiguez

Dr Luis Rodrigo Díaz Iñiguez
Cirugía de Columna

sábado, 31 de mayo de 2014

A new device used in the restoration of kinematics after total facet arthroplasty / Un nuevo dispositivo que se utiliza en la restauración de la cinemática después de la artroplastia total de faceta

http://www.dovepress.com/articles.php?article_id=17068


A new device used in the restoration of kinematics after total facet arthroplasty

Case Series

Authors: Vermesan D, Prejbeanu R, Daliborca CV, Haragus H, Magureanu M, Marrelli M, Promenzio L, Caprio M, Cagiano R, Tatullo M

Published Date May 2014 Volume 2014:7 Pages 157 - 163
DOI: http://dx.doi.org/10.2147/MDER.S60945

Received:17 January 2014
Accepted:26 March 2014
Published:29 May 2014
D Vermesan,1 R Prejbeanu,1 C Vlad Daliborca,1 H Haragus,1 M Magureanu,2 M Marrelli,3–5 L Promenzio,4 M Caprio,6 R Cagiano,6,* M Tatullo3,5,

1Victor Babes University of Medicine and Pharmacy, Timisoara, 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Maxillofacial Unit, Dental Center Calabrodental, 4Orthopedics and Traumatology Unit, Marrelli Hospital, 5Biomedical Section, Tecnologica Research Institute, Crotone,6Department of Biomedical Sciences and Human Oncology, Medical Faculty, Aldo Moro University of Bari, Bari, Italy

*These authors contributed equally to this work

Resumen: la degeneración facetaria puede conducir a estenosis espinal y la inestabilidad, ya menudo requiere la estabilización. Fusión intersomática se realiza con frecuencia , pero puede conducir a la enfermedad del segmento adyacente . Estabilización posterior dinámica se realizó con un sistema de artroplastia total de faceta . El sistema de artroplastia total faceta inicialmente estaba destinado a restaurar el movimiento natural de los estabilizadores posteriores , pero los estudios de seguimiento se carece debido a un uso clínico limitado . Estudiamos los primeros 14 casos ( a largo plazo de seguimiento ) tratados con este nuevo dispositivo en nuestra clínica. Todos los pacientes fueron diagnosticados de estenosis lumbar debido a la hipertrofia de las facetas articulares de una a tres niveles (máximo). El espacio de disco era de estatura normal. El diseño de este implante permite su uso sólo en los niveles L3- L4 y L4- L5 . Implantamos nueve pacientes en el nivel L4 -L5 y cuatro pacientes en el nivel L3- L4 . El seguimiento postoperatorio de los pacientes se obtuvo un promedio de 3,7 años . Todos los pacientes reportaron una mejoría persistente de síntomas , la puntuación de la escala analógica visual, y la puntuación de Oswestry Disability Index . Puntuaciones funcionales y formación de imágenes radiográficas dinámico demostraron la eficacia funcional de este nuevo implante , lo que representa una técnica alternativa y un nuevo enfoque para la estabilización dinámica de la columna vertebral después de las intervenciones para la descompresión columna vertebral . El sistema de artroplastia total faceta representa una opción viable para la estabilización posterior dinámica después de la descompresión espinal. Por lo observado seguimiento , conservó el movimiento sin complicaciones significativas o intradisk aparente o degeneración adyacente disco .


Palabras clave : Estenosis lumbar, artroplastia faceta dinámico, la estabilización dinámica , la fusión vertebral

Abstract: Facet degeneration can lead to spinal stenosis and instability, and often requires stabilization. Interbody fusion is commonly performed, but it can lead to adjacent-segment disease. Dynamic posterior stabilization was performed using a total facet arthroplasty system. The total facet arthroplasty system was originally intended to restore the natural motion of the posterior stabilizers, but follow-up studies are lacking due to limited clinical use. We studied the first 14 cases (long-term follow-up) treated with this new device in our clinic. All patients were diagnosed with lumbar stenosis due to hypertrophy of the articular facets on one to three levels (maximum). Disk space was of normal height. The design of this implant allows its use only at levels L3–L4 and L4–L5. We implanted nine patients at the L4–L5 level and four patients at level L3–L4. Postoperative follow-up of the patients was obtained for an average of 3.7 years. All patients reported persistent improvement of symptoms, visual analog scale score, and Oswestry Disability Index score. Functional scores and dynamic radiographic imaging demonstrated the functional efficacy of this new implant, which represents an alternative technique and a new approach to dynamic stabilization of the vertebral column after interventions for spine decompression. The total facet arthroplasty system represents a viable option for dynamic posterior stabilization after spinal decompression. For the observed follow-up, it preserved motion without significant complications or apparent intradisk or adjacent-disk degeneration.

Keywords: lumbar stenosis, dynamic facet arthroplasty, dynamic stabilization, vertebral fusion

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Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available athttp://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:http://www.dovepress.com/permissions.php

Bone loss following spinal cord injury / La pérdida de hueso después de una lesión de la médula espinal

http://www.dovepress.com/articles.php?article_id=16955


Bone loss following spinal cord injury

Original Research

Authors: Otom AH, Al-Ahmar MR

Published Date May 2014 Volume 2014:2 Pages 81 - 84
DOI: http://dx.doi.org/10.2147/JN.S49438

Received:11 January 2014
Accepted:01 April 2014
Published:23 May 2014
Ali H Otom, M Rami Al-Ahmar

Rheumatology and Rehabilitation Department, Royal Rehabilitation Centre, King Hussein Medical Centre, Amman, Jordan

Antecedentes: El objetivo de este estudio fue evaluar el patrón de pérdida ósea y sus consecuencias en un grupo de lesiones de la médula espinal ( SCI ) de los pacientes lograron en la Unidad -Royal Centro de rehabilitación espinal , el rey Hussein Centro Médico , y su correlación con el nivel y extensión de la lesión , la edad , y el tiempo desde la lesión .
Métodos : La densidad mineral ósea ( DMO ) se midió mediante absorciometría dual de rayos X en la columna lumbar y cuello femoral en un grupo de pacientes que habían sufrido una SCI una media de 8,6 (rango 1-31 ) años antes y había terminado su médico y programa de rehabilitación durante el período julio 2003 a diciembre 2013 . los pacientes fueron diagnosticados de osteoporosis según criterios de la Organización Mundial de la Salud y su riesgo de fractura fue estimado a partir de esta puntuación a partir de datos publicados. La gravedad de sus lesiones en la columna varió de clase A a D de acuerdo con criterios de la American Spinal Injury Association .
Resultados: De los 55 pacientes incluidos en el estudio , 45 eran hombres y diez eran mujeres, con una razón hombre-mujer de 4,5:1 . Su edad media fue de 39,5 (rango 13-61 ) años . La pérdida de hueso se indica por una baja DMO reveló que la región femoral se vio afectada principalmente , con relativa preservación de la columna lumbar . Se detectaron valores de DMO anormal en el 83,6 % de los sujetos , y las fracturas ocurrieron en el 16,4% después de un trauma menor. Una correlación positiva se observó entre el tiempo transcurrido desde la lesión y el grado de osteoporosis. Las personas con lesiones completas mostraron valores de DMO más bajos que aquellos con lesiones incompletas . No se encontró correlación significativa con la edad o el sexo.

Conclusión : Los pacientes con SCI tienen un alto riesgo de desarrollar osteoporosis , que puede conducir a una significativa morbilidad , fracturas de extremidades inferiores sobre todo sin un trauma importante . La prevención y el tratamiento precoz de la pérdida de hueso son importantes en este grupo de pacientes para evitar el deterioro funcional adicional .

Background: The purpose of this study was to evaluate the pattern of bone loss and its consequences in a group of spinal cord injury (SCI) patients managed at the Spinal Unit-Royal Rehabilitation Centre, King Hussein Medical Centre, and its correlation with level and extent of injury, age, and time since injury.
Methods: Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry at the lumbar spine and femoral neck in a group of patients who had suffered an SCI a mean of 8.6 (range 1–31) years earlier and had completed their medical and rehabilitation program during the period July 2003 to December 2013. The patients were diagnosed to have osteoporosis according to World Health Organization criteria and their fracture risk was estimated from this score using published data. The severity of their spinal injuries ranged from class A to D according to American Spinal Injury Association criteria.
Results: Of the 55 patients included in the study, 45 were male and ten were female, with a male to female ratio of 4.5:1. Their mean age was 39.5 (range 13–61) years. Bone loss indicated by low BMD revealed that the femoral region was predominantly affected, with relative preservation of the lumbar spine. Abnormal BMD values were detected in 83.6% of subjects, and fractures occurred in 16.4% following minor trauma. A positive correlation was noted between time since injury and degree of osteoporosis. Individuals with complete lesions showed lower BMD values than those with incomplete lesions. No significant correlation was found with age or sex.
Conclusion: SCI patients are at high risk of developing osteoporosis, which can lead to significant morbidity, particularly lower extremity fractures without significant trauma. Prevention and early treatment of bone loss are important in this patient group to avoid further functional impairment.

Keywords: osteoporosis, spinal cord injury, bone loss, bone mineral density, American Spinal Injury Association

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Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available athttp://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:http://www.dovepress.com/permissions.php

Radiofrequency-targeted vertebral augmentation versus traditional ball

http://www.dovepress.com/radiofrequency-targeted-vertebral-augmentation-versus-traditional-ball-peer-reviewed-article-CIA


Radiofrequency-targeted vertebral augmentation versus traditional ball

Radiofrequency-targeted vertebral augmentation versus traditional balloon kyphoplasty: radiographic and morphologic outcomes of an ex vivo biomechanical pilot study

Original Research

(3306) Total Article Views

Authors: Dalton BE, Kohm AC, Miller LE, Block JE, Poser RD

Published Date November 2012 Volume 2012:7 Pages 525 - 531
DOI: http://dx.doi.org/10.2147/CIA.S37025

Received:15 August 2012
Accepted:25 September 2012
Published:19 November 2012
Brian E Dalton,Andrew C Kohm,2 Larry E Miller,3,4 Jon E Block,4 Robert D Poser2
1Tri-State Neurological Surgeons, Erie, PA, 2DFINE, Inc, San Jose, CA, 3Miller Scientific Consulting, Inc, Arden, NC, 4The Jon Block Group, San Francisco, CA, USA

Purpose: Traditional balloon kyphoplasty (BK) is a common treatment for symptomatic vertebral compression fractures. The purpose of this study was to compare a novel vertebral augmentation technique, radiofrequency-targeted vertebral augmentation (RF-TVA), to BK for restoration of vertebral height, cavity creation, and polymethylmethacrylate (PMMA) delivery and interdigitation into the surrounding trabeculae.
Methods: This ex vivo biomechanical pilot study utilized 16 osteoporotic cadaveric vertebral bodies in a standardized fracture model to compare unipedicular RF-TVA (n = 8) to bipedicular BK (n = 8). Four specimens from each group were tested in loaded and unloaded conditions. All specimens were imaged, assessed for height restoration, and sectioned to observe PMMA distribution. A subset of specimens underwent computed tomography scanning to assess cavity creation and trabecular architecture prior to cement delivery.
Results: Anterior height restoration was greater with RF-TVA (median: 84%, interquartile range: 62%–95%) compared to BK (median: 69%, interquartile range: 60%–81%), although the difference did not achieve statistical significance (P = 0.16). Anterior height restoration was numerically greater under loaded (median: 70% versus 66%) and unloaded (median: 94% versus 77%) conditions with RF-TVA versus BK. RF-TVA produced more discrete cavities and less native trabecular destruction compared to marked trabecular destruction observed with BK. RF-TVA consistently showed a well-identified focal area of PMMA with an extensive peripheral zone of PMMA interdigitation, providing mechanical interlock into the adjacent intact trabecular matrix. In contrast, BK yielded little evidence of PMMA interdigitation beyond the boundaries created by the balloon tamp due to the crushed trabecular bone peripherally.
Conclusion: RF-TVA achieves favorable vertebral height restoration with targeted PMMA delivery and less trabecular destruction compared to BK. RF-TVA has potential clinical utility in the aging population with painful osteoporotic vertebral fracture.

Keywords: balloon kyphoplasty, fracture, polymethylmethacrylate, radiofrequency targeted, vertebral augmentation

Erratum for this paper has been published


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Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available athttp://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:http://www.dovepress.com/permissions.php

#‎vertebral‬ compression fractures

https://www.facebook.com/permalink.php?story_fbid=723921701005469&id=159990887398556

viernes, 30 de mayo de 2014

Luxación de codo


Lumbrical Plus Finger - Everything You Need To Know - Dr. Nabil Ebraheim

http://youtu.be/HqfIsKcSfXc


Lumbrical Plus Finger - Everything You Need To Know - Dr. Nabil Ebraheim


Publicado el 30/5/2014
Educational video describing the condition of Lumbrical Plus Finger in the hand.

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http://www.facebook.com/drebraheim



lunes, 26 de mayo de 2014

Fratura de fêmur / luxação da falange

Exames Realizados pelo Técnico Eduardo (Leleco) Fratura de fêmur de uma criança e luxação da falange médias! !

dislocación de la cabeza del cúbito

Acabou de chegar! Imagem do Professor Danilo, Fratura do Radio com Luxação da cabeça da Ulna !!
Acaba de llegar! Imagen del profesor Danilo, fractura del radio con dislocación de la cabeza del cúbito!! 

viernes, 23 de mayo de 2014

El Dr. Del Piñal entre los conferenciantes principales del Encuentro Científico de Primavera de la Sociedad Británica de Cirugía de la Mano


Treat Your Own Neck Pain DVD

Treat Your Own Neck Pain DVD


Publicado el 30/5/2013
http://www.boquetemassage.com Here is my Neck Pain DVD FREE to you. This is based on the Mckenzie method of neck exercises.
I hope this helps so many of you who are suffering with neck pain. www.boquetemassage.com

The McKenzie System

http://www.spineuniverse.com/treatments/physical-therapy/mckenzie-system


The McKenzie Method®: Three Steps To Success
The McKenzie system is a method of evaluating and treating spinal disorders developed by New Zealand Physiotherapist Robin McKenzie.
SPINEUNIVERSE.COM

miércoles, 21 de mayo de 2014

Ankylosing Spondylitis

 Ankylosing Spondylitis
Also called: Rheumatoid spondylitis
Ankylosing spondylitis is a type of arthritis of the spine. It causes swelling between your vertebrae, which are the disks that make up your spine, and in the joints between your spine and pelvis. Ankylosing spondylitis is an immune disease. The disease is more common and more severe in men. It often runs in families.
Early symptoms include back pain and stiffness. These problems often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse your vertebrae together, limiting movement. Symptoms can worsen or improve or stop altogether. The disease has no cure, but medicines can relieve the pain, swelling and other symptoms. Exercise can also help.
NIH: National Institute of Arthritis and Musculoskeletal and Skin Disease
Much more info here: http://1.usa.gov/HRd3yh


viernes, 16 de mayo de 2014

Arthroscopic Treatment of Femoral Nerve Paresthesia Caused by an Acetabular Paralabral Cyst

http://www.healio.com/orthopedics/journals/ortho/%7Bed3307d9-6681-4f3e-b2cd-21e3b2a2d20a%7D/arthroscopic-treatment-of-femoral-nerve-paresthesia-caused-by-an-acetabular-paralabral-cyst


CASE REPORT 

Arthroscopic Treatment of Femoral Nerve Paresthesia Caused by an Acetabular Paralabral Cyst

Taira Kanauchi, MD; Jun Suganuma, MD; Ryuta Mochizuki, MD; Shinichi Uchikawa, MD
  • Orthopedics
  • May 2014 - Volume 37 · Issue 5: e496-e499
  • DOI: 10.3928/01477447-20140430-62

Abstract

Este informe describe un raro caso de parestesia del nervio femoral causada por un quiste paralabral acetabular de la articulación de la cadera . Una mujer de 68 años de edad se presentó con una historia de 6 meses de dolor en la cadera derecha y parestesias a lo largo de la cara anterior del muslo y se irradia a la cara anterior de la rodilla. La radiografía mostró la artrosis con un espacio articular estrechado en la articulación de la cadera derecha. La resonancia magnética mostró un quiste con baja intensidad en T1 y alta señal en T2 que surge de un desgarre en el labrum de la cara anterior del acetábulo. El quiste fue conectado con el espacio de la articulación y se desplaza el nervio femoral en el lado anteromedial . La lesión fue diagnosticada como un quiste paralabral acetabular causando la neuropatía femoral. Debido a que el síntoma principal era la parestesia del nervio femoral y el paciente desea un procedimiento menos invasivo , se llevó a cabo la reparación del labrum artroscópica para detener el flujo de líquido sinovial con el quiste paralabral que estaba causando la parestesia del nervio femoral. Después de la cirugía , el quiste y el nervio femoral parestesia desapareció. A los 18 meses de seguimiento, la paciente no tenía recurrencia. Ha habido varios informes de compresión neurovascular causados ​​por el quiste en torno a la articulación de la cadera . Para el conocimiento de los autores, sólo se han descrito 3 casos de quistes paralabrales acetabular causando ciática. El paciente actual parece representar un caso raro de un quiste paralabral acetabular causando parestesia del nervio femoral. Los autores sugieren que la reparación del labrum artroscópica de un quiste paralabral acetabular causando la neuropatía puede ser una opción para los pacientes que desean un procedimiento menos invasivo 

This report describes a rare case of femoral nerve paresthesia caused by an acetabular paralabral cyst of the hip joint. A 68-year-old woman presented with a 6-month history of right hip pain and paresthesia along the anterior thigh and radiating down to the anterior aspect of the knee. Radiography showed osteoarthritis with a narrowed joint space in the right hip joint. Magnetic resonance imaging showed a cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum. The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. Because the main symptom was femoral nerve paresthesia and the patient desired a less invasive procedure, arthroscopic labral repair was performed to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia. After surgery, the cyst and femoral nerve paresthesia disappeared. At the 18-month follow-up, the patient had no recurrence. There have been several reports of neurovascular compression caused by the cyst around the hip joint. To the authors’ knowledge, only 3 cases of acetabular paralabral cysts causing sciatica have been reported. The current patient appears to represent a rare case of an acetabular paralabral cyst causing femoral nerve paresthesia. The authors suggest that arthroscopic labral repair for an acetabular paralabral cyst causing neuropathy can be an option for patients who desire a less invasive procedure.
The authors are from the Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.
The authors have no relevant financial relationships to disclose.
Correspondence should be addressed to: Taira Kanauchi, MD, Department of Orthopaedic Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa 254-0065, Japan ( tairakanauchifriend@yahoo.co.jp).
Received: April 02, 2013
Accepted: October 09, 2013