RESUMO
ABSTRACT: Multilevel spinal epidural empyema (SEE) is a rare and serious infection of the spine with a high rate of morbidity and mortality. Although abscesses or empyema of the spine sector are well studied, this pathology is surprising due to its rarity and diagnostic and therapeutic challenge. It stands out for being more common in adulthood and in males and is associated with predisposing pathologies. The bacteriological agent responsible in most cases is Staphylococcus aureus. Early treatment is essential and is based on two pillars: antibiotic therapy and decompressive surgery. We present two clinical cases with multilevel involvement that evolved favorably both infectiously and neurologically without causing spine instability and we carried out a bibliographic review of the subject. Level of Evidence IV; Case Report.
RESUMO: O empiema epidural espinhal multinível (EEE) e uma infecção rara e grave da coluna vertebral, com alta taxa de morbidade e mortalidade. Embora os abscessos ou empiemas de um setor da coluna vertebral sejam bem estudados, esta patologia surpreende pela sua raridade e desafio diagnóstico e terapêutico. Destaca-se por ser mais comum na idade adulta, no sexo masculino, e estar associada a patologias predisponentes. O agente bacteriológico responsável na maioria dos casos e o Staphylococcus aureus. O tratamento precoce e essencial e baseia-se em dois pilares: antibioticoterapia e cirurgia descompressiva. Apresentamos dois casos clínicos com envolvimento multinível que evoluíram favoravelmente tanto infecciosa quanto neurologicamente sem causar instabilidade da coluna vertebral e realizamos uma revisão bibliográfica do assunto. Nível de Evidencia IV; Estudo de Caso-controle.
RESUMEN: El empiema epidural espinal (EEE) multinivel es una infección rara y grave de la columna vertebral con alta tasa de morbimortalidad. Si bien los abscesos o empiemas de un sector de la columna están bien estudiados, esta patología sorprende por su rareza, reto diagnóstico y terapeutico. Se destaca por ser más frecuente en la edad adulta, en el sexo masculino y se ve asociada a patologías predisponentes. El agente bacteriológico responsable en la mayoría de los casos es el Staphylococcus aureus. El tratamiento precoz es fundamental y está basado en dos pilares: antibioticoterapia y quirúrgico descompresivo Presentamos dos casos clínicos con afectación multinivel que evolucionaron favorablemente tanto en lo infeccioso como en lo neurológico sin provocar una inestabilidad del raquis y realizamos revisión bibliográfica del tema. Nivel de Evidencia IV; Estudio de Caso-control.
Assuntos
Procedimentos Ortopédicos , Empiema , LaminectomiaRESUMO
PURPOSE: To evaluate the possibility to access the anatomic femoral insertion of the anterior cruciate ligament (ACL) through trans-tibial (TT) and trans-portal technique, for ACL reconstruction in an independent way. To register anatomical characteristics of the TT tunnels. METHODS: Ten formaldehyde preserved knee anatomic articular specimens were dissected. Femoral tunnels were confectioned reproducing the original topography of the ACL. First, the femoral tunnel was made with the independent trans-portal technique. Then, utilizing the tibial stump of the ACL and tibial guides at 45°, the TT tunnels were confectioned trying to match the previously made femoral tunnel by trans-portal technique. RESULTS: In all specimens, match between the TT tunnel with the independent trans-portal tunnel was achieved. Mean values for TT coronal angle was 53,0°, for transversal angle 43,3° and for distance from tunnel to joint line 2,55 cm. A horizontalization and medialization of the TT tunnels had to be made to adequately match with the femoral tunnel made by the independent trans-portal technique. CONCLUSIONS: By macroscopic anatomic and independent means, an anatomic femoral tunnel was confectioned with the TT technique matching with the anatomic femoral tunnel made in an independent way. As clinical relevance, the present study allows to anatomically assess the possibility to perform an anatomic femoral tunnel through the TT technique. LEVEL OF EVIDENCE: V.
RESUMO
Las luxofracturas son poco frecuentes, pero revisten mucha importancia a la hora de considerar el diagnóstico, el tratamiento y las posibles secuelas. Presentamos una revisión bibliográfica sobre luxofracturas cervicales en niños y el caso de una niña de 10 años que sufrió una luxofractura de C3-C4. La paciente fue sometida a una reducción abierta y una artrodesis de C3-C4, y controlada durante 2 años.
Fracture-dislocations are a rare presentation, but their knowledge is critical in terms of diagnosis, treatment, and potential seque-lae. We report a literature review on cervical spine fracture-dislocations in children and a case of a 10-year-old girl who sustained a C3-C4 fracture-dislocation. The patient underwent open reduction and arthrodesis at C3-C4, and a 2-year follow-up.