No abstract

According to our results, the anatomical reduction of the articular surface in acetabular fractures is the most important factor in hip osteoarthritis prevention. This factor is strongly associated with early surgical treatment, preferably done within seven days. The timing surgery it is not a factor associated with post-traumatic osteoarthritis.

Bertolotti’s syndrome refers to the presence of pain associated to the anatomical variant of sacralization of the last lumbar vertebra. It is often a factor that is not addressed in the evaluation and treatment of lower back pain. The presence of a lumbosacral transitional vertebra is a common finding among general population with a prevalence that ranges between 4 and 30%, however, this finding is rarely associated to the cause of lower back pain and thus, the prevalence of Bertolotti’s syndrome in general population is unknown doe to underdiagnosis. The sacralization of the fifth lumbar vertebra has been related to changes in the anatomy and biomechanics of the spine with no general agreement to its clinical significance, however Bertolotti’s syndrome should be considered as a differential diagnosis for lower back pain, therefore, its pathophysiology, epidemiology and treatment must be a topic of general knowledge to physicians that often treat this condition.

The incidence of gunshot wounds to the spine on civilians has increased alarmingly and accounts for 13% to 17% of all traumatic spinal injuries, placing them in third place among the most frequent mechanisms. However, the management of these injuries is still controversial. At present there is little information on the management of these lesions, conservative treatment (non-surgical) being recommended in most publications. Based on the current literature, we propose a procedural protocol aimed at improving the quickness of management, as well as the prognosis of the patient. For this purpose, once the patient is hemodynamically stabilized, the following should be assessed: 1) Stability; 2) Compressive extrusion; 3) Accommodation or not in the discal space, and 4) Contact with CSF. These points are relevant to make the best decision.

The term cervical spondylotic myelopathy (CSM) was published in 1952, Brain et al. discovered the neurological signs and symptoms associated to medullar lesions secondary to vascular compromise. 1 CSM is caused by the chronic compression of neurological elements, which together with spinal canal stenosis by ossification of the posterior longitudinal ligament forms the 2 most frequent causes of CSM. Patients with progressive neurological deterioration have surgical treatment indication, 50-75% will show neurological recovery in the first 6 months follow-up. 2,3 The choice of treatment in CSM can be anterior, posterior or combined approaches. The decision to choose an approach will depend on important factors: the cause of neurological compression (anterior structures, posterior structures or both), the number of affected segments, sagittal cervical balance and the surgeons experience in the surgical approach. Traditionally the anterior compression pathologies, either by disc herniation or bone spur formation in the posterior wall of the vertebral body, have been managed by anterior approach with corpectomy and fusion or discoidectomy and fusion. When there are 2 or 3 segments affected the posterior approach is recommended with laminectomy or laminoplasty. Realizing anterior approach, when there are 2 or more segments affected, raises the risk of no-union, stress in adjacent segments, cervical degeneration is augmented and swallowing can be difficult. 2,4 Regarding cervical sagittal balance, there is evidence that the anterior approach offers better results than the posterior approach. There are various scales available to measure neurological function in patients with SCM, of which the most relevant are the modified Japanese Orthopedic Association scale and Nurick's scale (Tables 1 and 2). These scales can be used to evaluate results in neurological function after a posterior and anterior cervical decompression, comparing them at 1.4-year follow-up (Table 3). 2,4-6