Los «fitos» de la columna

Gustavo Francisco Zerón Calva

columna lumbar, osteofitos, sindesmofitos, etc...

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Los «fitos» de la columna.

Osteofito es el nombre de la excrecencia ósea formada en la enfermedad degenerativa, o artrosis, de la columna vertebral (espondilosis deformante). El origen es la osificación de las fibras de Sharpey. Se visualiza en la radiología simple como una excrecencia triangular que nace unos milímetros por encima del borde del cuerpo vertebral, extendiéndose entre una vértebra y la siguiente con una trayectoria inicialmente horizontal y luego vertical.

especimen de OSTEOFITO

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-Osificación ondulante. 

Al extenso crecimiento óseo en la cara anterolateral de la columna vertebral, asociada a la hiperostosis esquelética idiopática difusa, se le llama osificación ondulante. La causa es una osificación del ligamento vertebral longitudinal anterior, del disco intervertebral y del tejido paraverterbal.

Se han descrito 2 tipos de sindesmofitos; el típico y el atípico. El sindesmofito típico es el propio de la espondilitis anquilosante y las enfermedades inflamatorias intestinales. Se debe a la osificación de las fibras externas del anillo fibroso del disco intervertebral. Esta excrecencia ósea es fina y vertical, y se extiende entre un cuerpo vertebral y el siguiente.

Sin embargo, el sindesmofito atípico es el que encontramos en la psoriasis y el síndrome de Reiter. Este se caracteriza por su apariencia radiográfica gruesa, separada del borde del cuerpo verterbal, pudiendo ser unilateral o asimétrica, y se debe a la osificación de los tejidos paravertebrales.

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CAPSULA COLEGIO MEDICO DE TEPATITLAN SOBRE HERNIAS DE DISCO

http://youtu.be/vJr40zAtIac

Understanding an MRI of the Normal Lumbar Spine

una publicación de Medical Talks.

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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 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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 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

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

Radiofrequency-targeted vertebral augmentation versus traditional ball

Back to Dovepress Journal: Clinical Interventions in Aging

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,1 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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#‎vertebral‬ compression fractures

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una publicación de Pain.