Response to botulinum toxin in a case of rigid spine syndrome.
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Adolescent↗
Biomedical subjects
J Bagó
Publications and source records attributed to J Bagó.
Traumatic lumbosacral dislocation.
STUDY DESIGN: Case report of a patient with lumbosacral dislocation. OBJECTIVES: To report a case of traumatic lumbosacral dislocation treated nonoperatively, with 10 years of follow-up. SUMMARY OF BACKGROUND DATA: Lumbosacral dislocation is rare, with only 48 cases reported in the literature. Surgical treatment by means of open reduction and fusion is advisable. However, the literature shows six cases of patients with complete lumbosacral dislocation treated nonoperatively with good results. METHODS: A 38-year-old man was involved in a highspeed vehicle accident. The lumbosacral dislocation (anterior displacement of L5 on S1, 44% slippage) was initially missed, and the patient was treated conservatively. RESULTS: Slippage did not progress, and the patient returned to full, normal activity. Ten years later he is asymptomatic and is able to work and play sports. CONCLUSIONS: This study reports a rare injury of the lumbosacral junction that was detected 3 months after injury. Satisfactory results were obtained with nonoperative treatment in this case. Although a surgical approach is advisable in acute cases to decompress the neurologic structures and to stabilize the lumbosacral junction, conservative management may be the treatment of choice in inveterate lesions.
Accidents, Traffic↗
Isolated thrombosis of the external jugular vein.
Thrombosis of the external jugular vein (EJV) is an infrequent clinical condition that has been associated with central venous catheterization, head and neck infections, intravenous drug abuse, and compression at the affected site. The authors report a case of thrombotic obstruction of the EJV in the late postoperative period after laparoscopic anterior lumbar interbody fusion. A 40-year-old morbidly obese woman with a depressive syndrome was diagnosed with L5-S1 discopathy and was submitted to laparoscopic anterior isthmic fusion. The operation lasted approximately 6 hours, during which the patient remained in a supine decubitus and Trendelenburg position. The left radial artery, peripheral veins, and right internal jugular vein were canalized. The internal jugular vein catheter was electively withdrawn 24 hours after the intervention. The postoperative period was satisfactory, and the patient was started on prophylaxis with low-molecular-weight heparin. She sat up and began walking at 24 hours and was discharged to her home 4 days after the procedure. Eight days after discharge she returned, experiencing right cervical pain. Palpation revealed a painful induration and erythematous area under the anterior edge of the sternocleidomastoid muscle. Results of otoscopy and laryngoscopy were normal. Cervical echo-Doppler disclosed an image consistent with EJV thrombosis. The most frequent causes of jugular vein thrombosis are mentioned above. A higher incidence has been described after upper abdomen and pelvic surgery; other contributing factors are age, obesity, and associated illness. There are few references in the literature to position-induced EJV thrombosis in the late postoperative period. The authors' patient presented signs and symptoms of EJV thrombosis (probably because of various factors), which was confirmed by echo-Doppler study and treated with 10 days of calcic heparin.
Adult↗
Clinical and CT scan evaluation after direct defect repair in spondylolysis using segmental pedicular screw hook fixation.
Direct defect repair using segmental pedicular screw hook fixation was carried out in nine patients with spondylolysis and a mean age of 24.2 years. One patient was fused 3 years after isthmic reconstruction. In the remaining eight patients, after a mean follow-up of 41 months (range, 12-78), three self-evaluation scales revealed a significant (p < 0.05) improvement in clinical status. Computed tomography scans were carried out in seven patients. There was bilateral bony union in two cases, in three pars healing was unilateral, and in two the isthmic defect persisted bilaterally. No correlation was observed between the status of the pars and follow-up. We conclude that repair of defects in spondylolysis may result in a favorable clinical outcome even when anatomic reconstruction of pars interarticularis is not successful.
Adolescent↗
Vertebral fracture in a fused spine for scoliosis. A case report.
STUDY DESIGN: A case report. OBJECTIVES: To document a fracture of the 11th thoracic vertebra after spine fusion for adult idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Three cases of vertebral fractures associated with spine fusion for scoliosis were found in the literature. METHODS: Medical and radiologic records and related literature were reviewed. RESULTS: A 30-year-old woman had undergone anterior and posterior fusion with Cotrel-Dubousset instrumentation for progressive idiopathic scoliosis. Two years after surgery, she was in a car accident. A radiographic study and computer tomographic scanning depicted a fracture of T11 and bending of the rods. Observation was instituted and symptoms resolved. CONCLUSIONS: Fracture of a vertebra within an extensive spine fusion for scoliosis is rare. The 360 degrees solid fusion together with strong posterior instrumentation may have had some protective effect in this patient.
Adult↗
Four radiological measures to estimate shoulder balance in scoliosis.
We studied four indirect radiological measures of shoulder balance, their correlation with true shoulder balance, and measurement error of each method. Thirty-three consecutive patients with idiopathic scoliosis requiring surgical treatment were selected. Actual shoulder level was determined from a line in the top margin of the acromion clearly visualized in the wide chart. Indirect references used to assess shoulder balance were tilting of cephalic end-plate of T1, inclination of a line through superior border of both first ribs, the level of top margin of coracoid processes, and the level of two specific points where the clavicle intersects the rib cage. All radiographs were assessed by three independent observers. Correlation coefficients between each measurement and true shoulder level were 0.54 for T1 tilting (p = 0.001), 0.63 for first rib inclination (p < 0.001), 0.96 for coracoid process (p = 0.0001), and 0.93 for clavicle-rib cage intersection (p = 0.0001).
Adolescent↗
Lateral distraction injury to the lumbar spine. Report of spontaneous reduction.
STUDY DESIGN: A patient with a lateral distraction injury of the lumbar spine that reduced spontaneously and not associated with any thoracic or abdominal injury is reported. SUMMARY OF BACKGROUND DATA: A brief summary of the clinical presentation is given as is the surgical technique employed. Lateral distraction injuries of the thoracolumbar spine associate a distraction injury with lateral bending in the frontal plane, causing unilateral disruption of the ligamentous and osseous restraints. The have been associated with life-threatening thoracic and abdominal injuries. Closed reduction of this spine injury is not believed to be feasible. CONCLUSIONS: This case introduces interesting new features to this spine lesion. It is the first reported case with documented spontaneous reduction.
Adult↗
[Total parenteral nutrition in major surgery of the spine].
This paper presents clinical experience with the use of total parenteral nutrition (TPN) in patients undergoing major spinal surgery, as well as the identification of possible risk factors involved in the extended duration of TPN. Although TPN is an expensive therapy, it may even represent a cost saving in patients with a high risk of developing malnutrition. Therefore, it is necessary to identify those patients with the greatest likelihood of presenting nutritional deterioration in order to select those who would benefit from post-operative TPN. During the period under analysis (1995-1998), 137 patients were operated on and could be analyzed retrospectively. The variable considered were: age, sex, weight, body mass index, height, diagnosis, type and time of surgery involved, bleeding, duration of TPN and number of days admitted. The statistical analysis was carried out using the SPSS 6.1 for Windows software package. It comprised a descriptive univariate study, a bivariate comparative means analysis using Student's t test and multi-variant analysis using multiple regression. In the bivariate analysis, a greater duration of TPN was found in those patients subjected to circumferential arthrodesis (p = 0.0001), as well as in patients diagnosed as having kyphoscoliosis following neuromuscular disease (p = 0.0041). The multi-variant analysis gave a correlation statistically significant duration of TPN and surgery time (p = 0.00001), intra-operative bleeding (p = 0.01) and weight (p = 0.0002). No link was found between the duration of TPN and age, nor with the number of days spent in hospital.
Adolescent↗
[Bone leiomyosarcoma of the pelvis].
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Adult↗