Luxación pura de facetas articulares T11-T12 sin secuelas neurológicas. Caso clínico
Bilateral pure T11-T12 facet dislocation without neurologic residual deficit
F. Ugarriza
, L.M. Bernal-García, L.M. Lorenzana, M. Ortega-Martínez, L.F. Porras, J.M. Cabezudo
Servicio de Neurocirugía. Complejo Hospitalario Infanta Cristina. Badajoz
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Caso clínico" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "261" "paginaFinal" => "265" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Ugarriza, L.M. Bernal-García, L.M. Lorenzana, M. Ortega-Martínez, L.F. Porras, J.M. Cabezudo" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Ugarriza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L.M." "apellidos" => "Bernal-García" ] 2 => array:2 [ "nombre" => "L.M." "apellidos" => "Lorenzana" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Ortega-Martínez" ] 4 => array:2 [ "nombre" => "L.F." "apellidos" => "Porras" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Cabezudo" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía. Complejo Hospitalario Infanta Cristina. Badajoz" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: c/ Castillo de Rena 43. Puerta 2. 6006 Badajoz." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bilateral pure T11-T12 facet dislocation without neurologic residual deficit" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-05-09" "fechaAceptado" => "2005-06-06" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159298" "palabras" => array:4 [ 0 => "Luxación bilateral de facetas articulares" 1 => "Traumatismo raquídeo" 2 => "Columna torácica" 3 => "TC con reconstrucción sagital" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159299" "palabras" => array:9 [ 0 => "CPL" 1 => "FA" 2 => "LFA" 3 => "Proyección AP" 4 => "RM" 5 => "Rx" 6 => "TC" 7 => "TCE" 8 => "UCI" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159297" "palabras" => array:4 [ 0 => "Bilateral facets dislocation" 1 => "Spinal injury" 2 => "Thoracic spine" 3 => "CT sagittal reconstruction" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La luxación bilateral pura de facetas articulares (LFA) a nivel de la columna torácica, es una entidad rara pero que da lugar a graves lesiones medulares en un alto porcentaje de casos. En la gran mayoría de los casos se produce por un mecanismo de flexióndistraccion.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un varón que sufrió un politraumatismo con importantes lesiones toraco-abdominales y esqueléticas, por lo que estuvo ingresado en un hospital comarcal, y al que, un mes después, se le diagnosticó una luxación bilateral de facetas articulares a nivel T11-T12, que en un principio pasó desapercibida. El diagnóstico se obtuvo mediante las radiografías simples y la TC con reconstrucción sagital. Fue intervenido quirúrgicamente para realizar la reducción de la luxación y fijación instrumentada a nivel T11-T12. La recuperación fue completa en la primera semana postoperatoria.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La LFA pura a nivel torácico, en un elevado porcentaje, se asocia a lesiones toracoabdominales que agravan el proceso y pueden contribuir a que las LFA pasen inadvertidas inicialmente, sobre todo en pacientes sin afectación neurológica, con riesgo de provocar un daño neurológico secundario. La TC con reconstrucción sagital nos permite realizar un diagnostico adecuado y precoz. El tratamiento es quirúrgico, tanto para la reducción como para la fijación posterior, ya que se trata de una lesión altamente inestable. El pronóstico es malo en pacientes con lesiones medulares completas, mientras que la mejoría es frecuente en los casos de lesión incompleta.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Bilateral pure facets dislocation in the thoracic spine is rare, but when it does occur in almost every istance produces a severe spinal cord lesion. It is thought to be caused by a flexion distraction mechanisms in most of the cases.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuries that worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Ugarriza, F.; Bernal-García, L.M.; Lorenzana, L.M.; Ortega-Martínez, M.; Porras, L.F.; Cabezudo, J.M.: Luxación pura de facetas articulares T11-T12 sin secuelas neurológicas. Cso clínico. Neurocirugía 2006; 17: 261–266.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The three columns spine and its significance in the classification of acute thoracolumbar spinal injuries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. 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| 2014 Septiembre | 16 | 12 | 28 |
| 2014 Agosto | 15 | 17 | 32 |
| 2014 Julio | 12 | 20 | 32 |
| 2014 Junio | 17 | 23 | 40 |
| 2014 Mayo | 21 | 19 | 40 |
| 2014 Abril | 11 | 13 | 24 |
| 2014 Marzo | 19 | 28 | 47 |
| 2014 Febrero | 14 | 32 | 46 |
| 2014 Enero | 14 | 21 | 35 |
| 2013 Diciembre | 15 | 22 | 37 |
| 2013 Noviembre | 20 | 28 | 48 |
| 2013 Octubre | 17 | 47 | 64 |
| 2013 Septiembre | 27 | 31 | 58 |
| 2013 Agosto | 27 | 37 | 64 |
| 2013 Julio | 32 | 17 | 49 |
| 2013 Junio | 19 | 26 | 45 |
| 2013 Mayo | 16 | 21 | 37 |
| 2013 Abril | 11 | 16 | 27 |
| 2013 Marzo | 10 | 19 | 29 |
| 2013 Febrero | 10 | 18 | 28 |
| 2013 Enero | 13 | 12 | 25 |
| 2012 Diciembre | 8 | 15 | 23 |
| 2012 Noviembre | 1 | 7 | 8 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Septiembre | 0 | 1 | 1 |
| 2012 Enero | 16 | 0 | 16 |
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