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Vol. 30. Num. 2.
Pages 53-102 (March - April 2019)
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Vol. 30. Num. 2.
Pages 53-102 (March - April 2019)
Clinical research
DOI: 10.1016/j.neucie.2018.11.004
Morphometrical evaluation of decompression obtained through corpectomy. Heading towards to posterior approaches
Evolución morfométrica de descompresión obtenida tras corpectomía. Dirigiéndonos hacia abordajes posteriores
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Juan Delgado-Fernándeza,
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juan.delgado-fernandez@nhs.net

Corresponding author.
, Ricardo Gil Simoesb, María Ángeles García Palleroc, Juan Ramón Penanes Cuestad, Guillermo Blascob, Paloma Pulidob, Rafael G. Solae
a Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College of London Hospitals, NHS Foundation Trust, Queens Square, London, United Kingdom
b Servicio de Neurocirugía, Hospital Universitario de La Princesa, Madrid, Spain
c Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Spain
d Servicio de Neurocirugía, Fundación Jiménez Díaz, Madrid, Spain
e Servicio de Neurocirugía, Hospital Nuestra Señora del Rosario, Madrid, Spain
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Table 1. Clinical characteristics.
Table 2. Clinical and morphometric outcomes.
Table 3. Mean pre- and post-operative clinical and morphometric parameters.
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Abstract
Introduction

We analysed the decompression obtained by dorsal or dorsolumbar corpectomy measured by Cobb angle and the spinal area prior to and after surgery and compared the evolution of the technique over the last five years of the study.

Material and method

A retrospective review of patients operated between 2005 and 2015 through anterior or posterior approaches was performed.

Results

24 patients were studied and a significant improvement was observed between the preoperative and postoperative morphometrical measurement (4.18° correction of the kyphosis and an increase of 130.8mm2 in the spinal canal, p<.001 in both cases) and in clinical parameters (45.8% of patients improved in ASIA, and Karnofsky showed 13 points of improvement, p<.001 in both cases). However, there was no correlation between clinical and morphological parameters. We also observed that in the last five years of the study posterior approaches were more frequently used with good results.

Conclusions

Dorsal corpectomy allows significant spinal decompression, with neurological improvement but this does not correlate with the measurement of decompression. Thanks to technical improvements, less invasive techniques (posterior approaches and MISS) allow good clinical results, which are similar to those obtained by anterior techniques.

Keywords:
Corpectomy
Cobb angle
Spinal canal
Posterior approaches
Resumen
Introducción

Hemos analizado la descompresión obtenida mediante corpectomía dorsal o dorsolumbar medida a través del ángulo de Cobb y el área del canal medular antes y después de la cirugía. Además, se ha comparado la evolución de la técnica entre los primeros 5 años del estudio y los 5 posteriores.

Material y método

Se realizó un estudio retrospectivo de los pacientes operados entre 2005-2015 en nuestro centro mediante abordajes anteriores y posteriores.

Resultados

Se intervinieron 24 pacientes y observamos una mejoría significativa entre los valores preoperatorios y postoperatorios en el análisis morfométrico (corrección de 4,18° de cifosis y un aumento del área del canal medular de 130,8mm2 con una significación de p<0,001 en ambos casos) y mejoría clínica (45,8% de los pacientes presentaron mejoría en la escala ASIA y una mejoría media de 13 puntos en el Karnofsky, p<0,001). Sin embargo, no se observa correlación entre los parámetros clínicos y morfométricos. También hemos observado que en los últimos 5 años del estudio los abordajes posteriores se utilizaron con mayor frecuencia y con buenos resultados.

Conclusiones

La corpectomía dorsal permite una descompresión espinal significativa, con mejoría de la función neurológica sin que se correlacione con las mediciones de la descompresión. Gracias a las mejoras técnicas, las técnicas mínimamente invasivas (abordajes posteriores y técnicas MISS) permiten unos buenos resultados funcionales que son similares a los obtenidos con técnicas anteriores.

Palabras clave:
Corpectomía
Ángulo de Cobb
Canal medular
Abordajes posteriores

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