Artrodesis por vía posterior en las luxaciones cervicales altas en pacientes con artritis reumatoide
Posterior arthrodesis of the unstable upper cervical spine in rheumatoid arthritis
S. Pardo, J. Molet, J.M. Fernández Villa, P. Tresserras, B. Oliver, P. Parés, F. Bartumeus
Servicio de Neurocirugía. Hospital de la Santa Creu i Sant Pau. Universidad Autónoma de Barcelona
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Molet, J.M. Fernández Villa, P. Tresserras, B. Oliver, P. Parés, F. Bartumeus" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Pardo" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Molet" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Fernández Villa" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Tresserras" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Oliver" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Parés" ] 6 => array:2 [ "nombre" => "F." "apellidos" => "Bartumeus" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía. Hospital de la Santa Creu i Sant Pau. Universidad Autónoma de Barcelona" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Posterior arthrodesis of the unstable upper cervical spine in rheumatoid arthritis" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec163332" "palabras" => array:5 [ 0 => "Artritis reumatoide" 1 => "Subluxación atlantoaxial" 2 => "Fijación columna" 3 => "Columna cervical" 4 => "Cirugía transoral" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec163333" "palabras" => array:5 [ 0 => "Rheumatoid arthritis" 1 => "Atlantoaxial subluxation" 2 => "Spinal fusion" 3 => "Cervical spine" 4 => "Transoral surgery" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La inestabilidad en los segmentos superiores de la columna cervical es un hecho común en pacientes con artritis reumatoide (A.R) de larga evolución. Presentamos 8 pacientes con historia de A.R grave e inestabilidad cervical que han sido tratados con artrodesis posterior. En el momento del tratamiento la duración media de la A.R era de 16.6 años y la de los síntomas 5.7 meses.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En todos los pacientes se evidenció subluxación atlantoaxial reducible, uno de ellos presentaba además impresión basilar.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las indicaciones quirúrgicas fueron deterioro neurológico progresivo en seis pacientes y subluxación atlantoaxial mayor de 8<span class="elsevierStyleHsp" style=""></span>mm sin signos de compresión medular en dos pacientes.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En cinco casos se realizó artrodesis atlanto-axial; en uno fijación atlanto-C3 y en dos la unión fue occipitocervical. En un paciente se realizó además una odontoidectomía transoral.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El seguimiento medio tras la cirugía fue de 21.1 meses (mínimo 5 meses y máximo 43 meses).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En todos los pacientes mejoraron las parestesias y el dolor cervical. De los seis pacientes que presentaban síntomas neurológicos en el preoperatorio, cinco (83.3%) mejoraron un grado después de la cirugía según la clasificación de Ranawat et al. En siete casos (87.5%) se produjo asimilación del injerto y en uno se constató la reabsorción de éste.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Entre las complicaciones encontramos dos casos de infección de herida quirúrgica; en un paciente se produjo la rotura de los alambres. La mortalidad quirúrgica fue nula.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Upper cervical instability is a relatively common problem in patients with long-standing rheumatoid disease. Eight patients with severe rheumatoid arthritis (R.A.) and cervical instability treated with a posterior arthrodesis are presented. At the time of treatment, the mean duration of the R.A. was 16.6 years and the mean duration of symptoms was 5.7 months.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">All patients had reducible atlanto-axial subluxation, one of them with penetration of the dens.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Indications for operative therapy included progressive neurological impairment in six patients and mobile atlantoaxial subluxation greater than 8<span class="elsevierStyleHsp" style=""></span>mm without signs or symptoms of cord compression in two patients.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The surgical treatment was an atlanto-axial arthrodesis in five patients, an atlanto-C3 fusion in one patient and an occipital-cervical arthrodesis in two cases. One patient was in addition submitted to a transoral odontoidectomy.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The average follow-up was 21.1 months (range, five to forty-three months).</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Pain and paresthesias were relieved in all patients. Of the six patients with neurologic symptoms, five (83.3%) improved one class level after surgery following the neurological classification of Ranawat et al. Seven (87.5%) of the patients had osseous union, and one had a non-union.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Complications included a superficial wound infection in two cases and a broken wire in one. No patient died postoperatively.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Pardo, S.; Molet, J.; Fernández Villa, J.M.; Tresserras, P.; Oliver, B.; Parés, P.; Bartumeus, F.: Artrodesis por vía posterior en las luxaciones cervicales altas en pacientes con artritis reumatoide. Neurocirugía 1998; 9: 209–219.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrence of cervical spine instability in rheumatoid arthritis fallowing previous fusion: Can disease progression be prevented by early surgery?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.K. Agarwal" 1 => "W.C. Peppelman" 2 => "D.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 2 | 3 |
| 2019 November | 0 | 2 | 2 |
| 2018 February | 14 | 11 | 25 |
| 2018 January | 16 | 12 | 28 |
| 2017 December | 12 | 26 | 38 |
| 2017 November | 46 | 34 | 80 |
| 2017 October | 9 | 14 | 23 |
| 2017 September | 18 | 40 | 58 |
| 2017 August | 13 | 39 | 52 |
| 2017 July | 11 | 31 | 42 |
| 2017 June | 18 | 53 | 71 |
| 2017 May | 22 | 36 | 58 |
| 2017 April | 13 | 31 | 44 |
| 2017 March | 12 | 58 | 70 |
| 2017 February | 8 | 34 | 42 |
| 2017 January | 12 | 26 | 38 |
| 2016 December | 25 | 22 | 47 |
| 2016 November | 25 | 36 | 61 |
| 2016 October | 36 | 43 | 79 |
| 2016 September | 55 | 87 | 142 |
| 2016 August | 78 | 73 | 151 |
| 2016 July | 44 | 61 | 105 |
| 2015 December | 2 | 0 | 2 |
| 2015 July | 1 | 8 | 9 |
| 2015 June | 17 | 50 | 67 |
| 2015 May | 15 | 47 | 62 |
| 2015 April | 16 | 43 | 59 |
| 2015 March | 20 | 48 | 68 |
| 2015 February | 14 | 29 | 43 |
| 2015 January | 16 | 32 | 48 |
| 2014 December | 15 | 29 | 44 |
| 2014 November | 12 | 44 | 56 |
| 2014 October | 18 | 46 | 64 |
| 2014 September | 16 | 60 | 76 |
| 2014 August | 15 | 40 | 55 |
| 2014 July | 11 | 38 | 49 |
| 2014 June | 28 | 41 | 69 |
| 2014 May | 20 | 49 | 69 |
| 2014 April | 22 | 48 | 70 |
| 2014 March | 23 | 46 | 69 |
| 2014 February | 16 | 39 | 55 |
| 2014 January | 16 | 27 | 43 |
| 2013 December | 14 | 32 | 46 |
| 2013 November | 15 | 30 | 45 |
| 2013 October | 25 | 40 | 65 |
| 2013 September | 17 | 47 | 64 |
| 2013 August | 20 | 52 | 72 |
| 2013 July | 27 | 55 | 82 |
| 2013 June | 14 | 54 | 68 |
| 2013 May | 18 | 33 | 51 |
| 2013 April | 20 | 42 | 62 |
| 2013 March | 11 | 42 | 53 |
| 2013 February | 9 | 30 | 39 |
| 2013 January | 11 | 19 | 30 |
| 2012 December | 7 | 14 | 21 |
| 2012 November | 1 | 5 | 6 |
| 2012 October | 0 | 4 | 4 |
| 2012 September | 0 | 2 | 2 |
| 2012 January | 12 | 0 | 12 |
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