No abstract

Introduction: Denosumab is a human monoclonal antibody that binds to the receptor activator of nuclear factor kB (RANKL), it is used in the treatment of Osteoporosis. The Giant Cell Tumor (GCT) and the Aneurysmal Bone Cyst (ABC) use the same RANKL, and for this reason this drug began to be used for its treatment. There is consensus on the use, dose-time and 12-month duration for Denosumab treatment of GCT. Not so for ABC. In unresectable, disabling or recurrent tumors, its use could be for life. The adverse events of the habitual use of the drug are known, but it is not known if these increase with time. The objective of the present work is to identify the possible adverse events of treatment with Denosumab for more than 12 months. Material and Method: Series of cases with a diagnosis of GCT or ABC in spine, treated with Denosumab for more than 12 months. Adverse events are: arthralgia, fatigue, spinal pain, pain in extremities, headache, hypokalaemia, hypocalcemia, osteonecrosis of the jaw, malignant transformation, pathological fractures. Results: Eight patients, 6 TCG and 2 ABC, with a mean age at diagnosis of 25,6 years; presenting a mean treatment of 4.18 years (range 1.7 - 8.7). Of 6 operated patients, 4 had recurrence (2 to 36 months after surgery). One patient had to suspend treatment due to necrosis of the jaw, another hypocalcemia, both returned to treatment when stabilized. Conclusions: A minor adverse event (hypocalcemia) and a major adverse event (jaw bone necrosis) were observed. Level of Evidence IV; Original.

Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients.Results:513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG.Conclusion:The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

Objective: To present the philosophy used, and demonstrate how and why we decided to protect the level adjacent to a bone union. Methods: In the selection criteria of 620 patients who had undergone surgery between January 2007 and August 2011 due to degenerative pathology, instability and stenosis of the lumbosacral canal, 30 patients were selected with Pfirmann grades 3 and 4, from which six were lost to follow-up and four refused surgery, leaving 20 patients who underwent surgery. The mean age of the patients was 46 years (range: 22 to 71), with 11 men (55%) and 9 women (45%). Results: The follow-up of the cases was 6 months to 2 years, and so far, no clinical or radiological worsening has been observed, or loosening of the instrumentation in any case. Conclusions: we understand that protection of the adjacent level through the use of semi-rigid rods in PEEK is a good alternative, as it is not necessary to approach the ligament or pedicles of the level adjacent to the fusion.Keywords: Hybrid cells; Vertebral spine; Intervertebral disc degeneration. RESUMO Objetivo: Apresentar a filosofia utilizada e como e por que decidimos proteger o nível adjacente a uma fusão. Métodos: No critério de seleção de 620 pacientes operados entre janeiro de 2007 e agosto de 2011 devido a patologia degenerativa, instabilidade e estenose do canal lombossacral, foram escolhidos 30 pacientes com estágios 3 e 4 de Pfirmann, dos quais seis foram perdidos na consulta pós-operatória e quatro recusaram a cirurgia, restando 20 pacientes que foram submetidos à cirurgia. A idade média dos pacientes era 46 anos (faixa: 22 a 71), sendo 11 homens (55%) e 9 mulheres (45%). Resultados: O acompanhamento dos casos é de 6 meses a 2 anos e, até o momento, não se evidenciou piora clínica ou radiológica, nem afrouxamento da instrumentação em nenhum caso. Conclusões: Entendemos que a proteção do nível adjacente por meio do emprego de hastes semirrígidas em PEEK seria uma boa alternativa de proteção, devido ao fato de não ser necessário abordar o ligamento ou os pedículos do nível adjacente à fusão. Descritores: Células híbridas; Coluna vertebral; Degeneração do disco intervertebral. RESUMENObjetivo: Presentar la filosofía utilizada y como y por qué decidimos proteger el nivel adyacente a una fusión. Métodos: En el criterio de selección de 620 pacientes operados entre enero de 2007 y agosto de 2011 por patología degenerativa, inestabilidad y estenosis del conducto lumbosacro, se seleccionaron 30 pacientes con estadios de Pfirmann 3 y 4, de los cuales seis se perdieron en la consulta postoperatoria y cuatro rechazaron la terapéutica quirúrgica, quedando 20 pacientes que fueron intervenidos quirúrgicamente. La edad promedio de los pacientes fue de 46 años (rango: 22 a 71 años), siendo 11 hombres (55%) y 9 mujeres (45%). Resultados: El seguimiento de los casos es de 6 meses a 2 años y hasta el momento no se evidenció empeoramiento clínicoo radiológico, ni aflojamiento de la instrumentación en ningún caso. Conclusiones: Entendemos que la protección de...

Multiple alternate fractures are those that present injuries at several levels of the spine separated by at least one healthy vertebral body. A posttraumatic prevalence of up to 23% is reported. 3-5 There are no reports in Argentina. The purpose of this study is to report the prevalence of multiple alternate spine fractures in five hospitals of the City of Buenos Aires, Argentina, and evaluate its connection to other relevant characteristics. Inclusion criteria involve acute fractures of the spine. Classifications used were the following: cervical subaxial 8 and thoracolumbar 9 AO, Anderson for odontoids, 15, 16 Effendi Laurin 17 and Geweiler, 18, 19 ASIA, 20, 21 and Frankel. 22 Statistical analysis consists of two groups: "Alternate" and "Contiguous." Sample distribution, Shapiro-Wilk or Kolmogorov Smirnov test, was used. In comparison of continuous variables, "Student's t-test or the Mann-Whitney U test" was used. To compare the categorical variables, Chi2 test or Fisher's exact test was used. In data analysis, IBM SPSS Macintosh software, version 24.0 (IBM Corp., Armonk, NY, USA), was used. From the five hospitals of Buenos Aires, 514 medical records were reviewed, and 120 patients included, from April 2007 to April 2017. Of the total of spine fractures, 56 (46.7%) were simple, 35 (29.2%) were multiple contiguous, and 29 (24.1%) were multiple alternate. Fifty-four (45%) patients were women, average age of the sample: 40 years old. Within the group of multiple alternate fractures, the cervical area was the most affected in 16 (55.1%) patients. Fractures of nine (31%) patients of the Alternate group were related to a labor accident (9.9% contiguous, significant p = 0.02). Fourteen (48.3%) patients of the Alternate group presented an associated injury (23 patients [25.3%] of the contiguous fractures, with significance p = 0.02). As regards the International Publications, the prevalence of multiple alternate fractures was 24.1% (17 or 19%) 4, 5, 23, 24 with similar production mechanism, male predominance, and an average of 40 years old. 3, 5, 23 The location was similar: cervico-thoracic 24.1%. One in four patients admitted in our centers, with a spine fracture, had at least other vertebrae fractured at a distance. These were associated with neurological alterations, extraspinal injuries, and labor accidents.