Traumatismos de la columna cervical alta: Clasificación tipológica, indicaciones terapéuticas y abordajes quirúrgicos (a propósito de 286 casos)
High cervical spine injuries: classification, therapeutic indications, and surgical approaches: 286 consecutive cases
S. Martín-Ferrer
Servicio de Neurocirugía. Hospital Universitario Josep Trueta. Girona
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Martín-Ferrer" "autores" => array:1 [ 0 => array:3 [ "nombre" => "S." "apellidos" => "Martín-Ferrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía. Hospital Universitario Josep Trueta. Girona" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía. Hospital Universitario Josep Trueta. 17007 Girona." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "High cervical spine injuries: classification, therapeutic indications, and surgical approaches: 286 consecutive cases" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-09-12" "fechaAceptado" => "2006-01-15" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159372" "palabras" => array:5 [ 0 => "Traumatismos columna cervical" 1 => "Complejo occipitoatloaxoideo" 2 => "Fijación transarticular C1-C2" 3 => "Fijación interarticular C1-C2" 4 => "Atornillado anterior odontoides" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159374" "palabras" => array:3 [ 0 => "AO" 1 => "FCO" 2 => "LRAA" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159373" "palabras" => array:5 [ 0 => "Cervical injury" 1 => "Occipitoatloaxial complex" 2 => "Transarticular fixation C1-C2" 3 => "Interarticular fixation C1-C2" 4 => "Transodontoid screws" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sobre la columna cervical alta (C0-C1-C2) recae más del 60% de todas las lesiones traumáticas de la columna cervical; así, un 4–15% de todas las fracturas cervicales afectan al atlas y un 15–25% al axis. Hoy en día las técnicas de neuroimagen permiten ver las lesiones anatómicas y funcionales producidas en el accidente, comprender los mecanismos patomecánicos de estas lesiones, establecer una correlación clínico-radiológica y funcional de la patología producida, clasificar todas las lesiones, predecir su posible comportamiento y evolución y establecer pautas terapéuticas adecuadas.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La clasificación de las lesiones traumáticas de C0-C1-C2 es imprescindible para tipificar la lesión y así definir los distintos tipos posibles de lesiones traumáticas producidas. En el contexto individual de cada paciente, cada tipo de lesión nos permite elegir el proceso terapéutico, médico o quirúrgico, más adecuado. De ello resulta una clara indicación terapéutica correcta para cada caso concreto.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En los casos con indicación quirúrgica, la finalidad de la intervención será: a) liberar elementos radiculomedulares atrapados mediante discectomías, corpectomías, laminectomías, evacuación de colecciones o ampliación de espacios; b) alinear segmentos vertebrales mediante tracción con compás, o con halo, manipulación o cirugía; c) estabilizar elementos vertebrales con técnicas quirúrgicas vía anterior, posterior o con dobles abordajes 360° surgery; d) detener la evolución clínico-radiológica y, e) permitir la máxima recuperación funcional.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A pesar de que en los últimos años todas las posibles lesiones traumáticas del segmento occipitoatloaxoideo están correctamente clasificadas y tipificadas, las pautas de tratamiento no son uniformes ni todavía aceptadas o aplicadas de forma unánime.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En este trabajo se presenta la experiencia del autor en el manejo de este tipo de lesiones traumáticas. Se analizan 286 lesiones del segmento C0-C1-C2 y se correlaciona su clasificación y tipología con las pautas de tratamiento establecidas. Poner orden en la selección de casos para una indicación terapéutica concreta, correcta y eficaz de la instrumentación cervical junto a una ejecución terapéutica meticulosa y precisa, es un reto actual de los cirujanos que tratamos a estos pacientes.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Around 60% of all cervical fractures occur in the high cervical segment (C0-C1-C2); 4–15% occurs in C1, and between 15–25% in the axis.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Nowadays, with high resolution imaging, we can see both anatomic and functional aspects of the fractures, as well as understand the mechanisms of injury. This can also allow us to study the evolution of the soft tissue lesions and fractures.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The classification of traumatic injuries in C0-C1-C2 is basic in order to understand the mechanism of injury and natural history of these lesions. This also allow us to choose the correct or most adequate form of treatment.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In the cases where surgery is indicated we must: a) release of the cord or nerves, using standard techniques such as laminectomy, discectomy or corpectomy; b) align vertebral segments using traction, halo vest or surgery; c) estabilize the vertebral segments, using anterior, posterior or 360° surgical approaches; d) stop the natural history of disease and e) allow maximal functional recovery.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Although there are good classifications that typify the fractures in the C0-C1-C2 segments, there are not clear or standard treatments for them.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">This paper shows the personal experience of the author in the management of this type of fractures. The 286 patients with lesions in the high cervical segment C0-C1-C2 have been treated according to the classifications and recommendations already established in the literature. Selection of this cases and appropiate surgical approach is still a challenge for surgeons who deal with this problems.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Martín-Ferrer, S.: Traumatismos de la columna cervical alta: Clasificación tipológica, indicaciones terapéuticas y abordajes quirúrgicos (a propósito de 286 casos). Neurocirugía 2006; 17: 391–419.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:91 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neck injuries: II. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 7 | 1 | 8 |
| 2022 Noviembre | 3 | 2 | 5 |
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| 2017 Septiembre | 42 | 11 | 53 |
| 2017 Agosto | 47 | 11 | 58 |
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