Review article
Headless compression screw in the neuronavigation-guided and microscope-assisted treatment of spondylolysis
Tornillo de compresión sin cabeza en el tratamiento de la espondilolisis guiada por neuronavegación y asistida por microscopio
Leído
27
Vecesse ha leído el artículo
9
Total PDF
18
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1130147317300921" "issn" => "11301473" "doi" => "10.1016/j.neucir.2017.07.008" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "294" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Neurocirugia. 2018;29:122-30" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 16 "formatos" => array:2 [ "HTML" => 10 "PDF" => 6 ] ] "itemSiguiente" => array:19 [ "pii" => "S1130147318300186" "issn" => "11301473" "doi" => "10.1016/j.neucir.2018.02.001" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "317" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Neurocirugia. 2018;29:131-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 40 "formatos" => array:2 [ "HTML" => 30 "PDF" => 10 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo de revisión</span>" "titulo" => "Ausencia de conflicto neurovascular durante la microdescompresión vascular en el manejo de la neuralgia trigeminal esencial: ¿qué hacer? Revisión sistemática de la literatura" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "137" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Absence of neurovascular conflict during microvascular decompression while treating essential trigeminal neuralgia. How to proceed? Systematic review of literature" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andreas Leidinger, Fernando Muñoz-Hernandez, Joan Molet-Teixidó" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Andreas" "apellidos" => "Leidinger" ] 1 => array:2 [ "nombre" => "Fernando" "apellidos" => "Muñoz-Hernandez" ] 2 => array:2 [ "nombre" => "Joan" "apellidos" => "Molet-Teixidó" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529849618300145" "doi" => "10.1016/j.neucie.2018.02.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849618300145?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147318300186?idApp=UINPBA00004B" "url" => "/11301473/0000002900000003/v1_201805090428/S1130147318300186/v1_201805090428/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1130147317301379" "issn" => "11301473" "doi" => "10.1016/j.neucir.2017.11.001" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "309" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Neurocirugia. 2018;29:116-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 13 "formatos" => array:2 [ "HTML" => 8 "PDF" => 5 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo de revisión</span>" "titulo" => "Resultados quirúrgicos de fracturas cervicales traumáticas en pacientes con espondilitis anquilosante" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "121" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Surgical outcomes of traumatic cervical fractures in patients with ankylosing spondylitis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2085 "Ancho" => 2500 "Tamanyo" => 449750 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A) (Caso 4). Estudio de radiología simple en proyección lateral con característica de espondilitis anquilopoyética en un paciente de 53 años con paraparesia, y con antecedente de caída, donde no se visualiza fractura. B, C y D) TAC y RM en T1 y T2 en proyección sagital donde se evidencia subluxación y compromiso de la médula espinal a nivel de C6-C7.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alberto Isla Guerrero, Beatriz Mansilla Fernández, Borja Hernández Garcia, Álvaro Gómez de la Riva, María Luisa Gandía González, Elena Isla Paredes" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Alberto" "apellidos" => "Isla Guerrero" ] 1 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Mansilla Fernández" ] 2 => array:2 [ "nombre" => "Borja" "apellidos" => "Hernández Garcia" ] 3 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Gómez de la Riva" ] 4 => array:2 [ "nombre" => "María Luisa" "apellidos" => "Gandía González" ] 5 => array:2 [ "nombre" => "Elena" "apellidos" => "Isla Paredes" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S252984961830011X" "doi" => "10.1016/j.neucie.2017.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S252984961830011X?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147317301379?idApp=UINPBA00004B" "url" => "/11301473/0000002900000003/v1_201805090428/S1130147317301379/v1_201805090428/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Headless compression screw in the neuronavigation-guided and microscope-assisted treatment of spondylolysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "130" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco Javier Goncalves-Ramírez, Manel Tardaguila Serrano, Sherman H. Lee, Carlos Javier Dominguez, Jordi Manuel-Rimbau" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Francisco Javier" "apellidos" => "Goncalves-Ramírez" "email" => array:1 [ 0 => "ncrfranc@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Manel Tardaguila" "apellidos" => "Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Sherman H." "apellidos" => "Lee" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Carlos Javier" "apellidos" => "Dominguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Jordi" "apellidos" => "Manuel-Rimbau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Neurocirugía, Hospital Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tornillo de compresión sin cabeza en el tratamiento de la espondilolisis guiada por neuronavegación y asistida por microscopio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3759 "Ancho" => 2500 "Tamanyo" => 418142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Post-operative X-ray, (A and B): (Case 1), (C and D): (Case 2), in an anterior-posterior view and lateral view respectively, showing the correct position of the screw, crossing the fracture focus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Spondylolysis is a fracture that occurs in the pars interarticularis of the vertebra, frequently L5, and in 25% of cases it tends to displaced.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1–3</span></a> It is currently attributed to the overload phenomenon, which occurs mostly in sports, and has been classified by different authors as: type I congenital or dysplastic; type II isthmic; type III degenerative; type IV traumatic and type V pathological.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a> Meyerding classified them radiologically according to the displacement of the L5 body over the first sacral vertebra: grade I displacement below 25%, grade II displacement between 25 and 50%, grade III displacement between 50 and 75% and grade IV displacement greater than 75%.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a> Clinically, spondylolysis is characterized by pain, attributed to nerve stimulation, and instability produced in the injured vertebral segment.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> It is usually treated conservatively, with surgical criterion being met when the pain is disabling, hinders activities of daily living, and does not respond to drug therapy, physical therapy or orthoses.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Many techniques have been proposed to repair the defect in the pars interarticularis. In 1968 Kimura proposed repairing the defect with bone graft, without any osteosynthetic material, and confining the patient to bed rest for a period of two months; with further use of a brace until full fusion occurs.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5–7</span></a> Scott first proposed the use of wires to provide stability to the fracture site while using autologous bone graft in 1968. He proposed cerclage, which required extensive spine dissection to allow the wire to surround the vertebra, passing in front of the transverse processes and below the spinous process of the same level.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5,7</span></a> In 1970 Buck described an internal approach to the fracture, which involved less aggressive dissection, debridement of the fracture focus, placement of a 4.5<span class="elsevierStyleHsp" style=""></span>mm cortical screw and placement of an autologous iliac crest graft.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6–10</span></a> In 1984 Morscher published a variation of the Buck technique in which the screw is incorporated with a claw which holds the lamina.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> In 1998 Songer proposed the placement of pedicular screws in the lytic vertebra and a cerclage system similar to the Scott technique that does not require exposure of the transverse processes.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> In 1996 Tokuhashi and Matsuzaki proposed the use of rod-hook associated pedicle screws with an iliac crest autograft at the fracture focus.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a> In 1999 Petit and Gillett described the placement of pedicle screws associated with a “U” shaped rod that passes under the spinous process at the relevant level.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Few studies have biomechanically compared each of the existing techniques and their outcome. Deguchi reported better biomechanical behaviour in the screw-rod-hook technique and Buck's technique, where least movement is achieved at the site of injury.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11,12</span></a> Gadiucci compared Buck's technique with the Scott wiring technique and the Songer's modification with pedicular screw. The direct approach showed a better outcome in young patients, with Songer's technique resulting in the best outcome in the general population.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a> J. Fan reported greater stability in the screw-rod-hook and screw-rod techniques.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> Minimally invasive variants of Buck's technique, in which the screw is placed through neuronavigation without fracture debridement have been described as an alternative for young patients,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a> including variants of the technique described for young athletes that allow direct endoscopic observation while lysis repair is done.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14,15</span></a> Traditionally, cortical screws were used in the treatment of spondylolysis in lumbar vertebrae,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3,6,7,10,11</span></a> with the use of partially threaded screws such as AO screws being reported by some authors.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">4,9,15</span></a> We propose a minimally invasive and effective treatment for spondylolysis, using hardware that has never been previously considered for this purpose.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Surgical planning</span><p id="par0020" class="elsevierStylePara elsevierViewall">To plan our surgeries we used iPlanNet<span class="elsevierStyleSup">®</span> developed by Brainlab. This software allowed us to calculate the individual morphometric parameters in each case, which was necessary to find an optimal size, trajectory and location for the hardware.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Screw selection</span><p id="par0025" class="elsevierStylePara elsevierViewall">We believe that to achieve optimal repair of the injury, it is necessary to use a trans-fracturary fixation technique with compression at the focus of the structural lesion. Therefore we decided to use the second generation of headless compression screws, HCS 4.5 (Synthes). The superiority of this screw has been clearly demonstrated when compared with the Herbert–Whipple screw and traditional cortical screws for treatment of small bone fractures and joints.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">16–19</span></a> We prefer titanium to steel, not only for its hardness and strength, but also for its better biocompatibility, osseo-integration, corrosion resistance, and fewer artefacts in future MRIs. The characteristics of the tip thread and head thread as well as the length of the unthreaded shank is fully conditioned by individual patient anatomy; specifically the size of the fragments. We use the following basic principles:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0030" class="elsevierStylePara elsevierViewall">The fracture focus must be crossed in a completely perpendicular trajectory.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Pre-drilling of the trajectory should be avoided to achieve a higher final compression force at the fracture focus.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> The trajectory is therefore established by placing a Kirschner wire.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0040" class="elsevierStylePara elsevierViewall">The tip thread of the screw should be cancellous, not cortical, and self-tapping/self-drilling to reduce resistance to the screw when it comes into contact with the distal fragment. This reduces the possibility of pushing the distal fragment, and ensures that the screw is contained entirely in the distal fragment; slightly surpassing the cortex of the distal fragment is an optimal position of the screw.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0045" class="elsevierStylePara elsevierViewall">The fracture focus should coincide with the middle of the screw, or failing that, in the proximal half, where in vitro measurements have shown that there is a greater compressive force,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0050" class="elsevierStylePara elsevierViewall">The head thread of the screw should be cortical to decrease the natural tendency of the screw to pull out and reduce the inevitable loss of compression commonly observed when it is placed. The head of the screw should preferably not be buried beyond 2<span class="elsevierStyleHsp" style=""></span>mm below the proximal cortex<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Surgical details</span><p id="par0055" class="elsevierStylePara elsevierViewall">The patient is put under general anaesthesia and placed in a prone position with slight flexion of the spine. Through a 2.5–3.0<span class="elsevierStyleHsp" style=""></span>cm midline incision at the lower edge of the spinous process of L5, bilateral paravertebral access is gained to the spinous base of L5; lamina and pars interarticularis must be exposed. By neuronavigation, Kirschner wire is placed to a depth of 4.0<span class="elsevierStyleHsp" style=""></span>cm, exact depth depending on the anatomy of the patient. The wire passes through the fracture focus with a medial to lateral trajectory (15–18°) and in the sagittal plane with a caudal to cranial trajectory, parallel to the plane of the spinous process. The next step is the removal of the outer wall of the fibrous pseudocapsule and decortication of the inner side of the fracture and the outer surface of the pars interarticularis with a carbide mill/drill, and further percutaneous HCS 4.5 (Synthes) screws are laid. During this procedure, which is performed by direct microscope visualization, the screw can be seen passing through the fracture. Once the fracture has been debrided, the selected bone substitute is placed and final tightening of the screw is done. Finally, the fascia and skin are sutured (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Case report</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Case 1</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">History and examination</span><p id="par0060" class="elsevierStylePara elsevierViewall">An otherwise healthy 49-year-old male athlete presented with a 13-month history of lower back pain, EVA 6, which did not respond to medical treatment, typically worsening with sudden movements, Valsalva manoeuver and sudden changes in posture. Once diagnosed, the patient was treated medically, with physiotherapy, postural hygiene, and his condition was monitored.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Complementary tests</span><p id="par0065" class="elsevierStylePara elsevierViewall">Static and functional lumbar radiographs did not show spondylolisthesis. Lumbar spine MRI revealed mild degeneration of intervertebral discs in the last three lumbar segments. The scanner showed spondylolysis in L5, without spondylolisthesis.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Operation</span><p id="par0070" class="elsevierStylePara elsevierViewall">The patient's bone fragments were almost equal, so both screws had the same measurements: total length 38<span class="elsevierStyleHsp" style=""></span>mm, tip length 7<span class="elsevierStyleHsp" style=""></span>mm self-tapping, self-tapping head with 3.5<span class="elsevierStyleHsp" style=""></span>mm length, 27.5<span class="elsevierStyleHsp" style=""></span>mm stem length, diameter 4.5<span class="elsevierStyleHsp" style=""></span>mm, thread pitch of the tips and head of the screw, cancellous and cortical respectively, titanium alloy material.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The patient was operated on in a time of 93<span class="elsevierStyleHsp" style=""></span>min, blood loss was estimated at less than 30<span class="elsevierStyleHsp" style=""></span>cc, minimal skeletonisation was done.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Case 2</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">History and examination</span><p id="par0080" class="elsevierStylePara elsevierViewall">A 54-year-old gentleman, a smoker with dyslipidaemia, whose job required strenuous weight-lifting, had been suffering from severe lower back pain (EVA 5) for longer than 5 years with occasional referred pain in the gluteal region. The pain was resistant to conservative treatment and had worsened in the past year.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Complementary tests</span><p id="par0085" class="elsevierStylePara elsevierViewall">CT scan revealed L5 spondylolysis without spondylolisthesis. There was mild foraminal stenosis of L5-S1 with no lumbar canal stenosis. Although a functional radiograph did not reveal any instability, MRI showed mild disc degeneration.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Operation</span><p id="par0090" class="elsevierStylePara elsevierViewall">The features of the screw in this case were different: total length 38<span class="elsevierStyleHsp" style=""></span>mm, tip length 14<span class="elsevierStyleHsp" style=""></span>mm self-tapping, self-tapping head with 3.5<span class="elsevierStyleHsp" style=""></span>mm length, 20.5<span class="elsevierStyleHsp" style=""></span>mm stem length, diameter 4.5<span class="elsevierStyleHsp" style=""></span>mm, thread pitch of the tips and head of the screw, cancellous and cortical respectively, titanium alloy material.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The patient was operated on in a time of 85<span class="elsevierStyleHsp" style=""></span>min, blood loss was estimated at less than 20<span class="elsevierStyleHsp" style=""></span>cc, the skin wound reach was 2.5<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Postoperative course</span><p id="par0100" class="elsevierStylePara elsevierViewall">Both of our patients had post-operative pain controlled by oral analgesics and were discharged one day after surgery. There was good wound healing of the incision at first follow up (14 days). A lumbar support girdle was given to the patients from the first day, X-ray showed the correct position of the implants. Six months after surgery, a follow up CT scan was performed (<a class="elsevierStyleCrossRefs" href="#fig0020">Figs. 4 and 5</a>), in which the screws were observed crossing the fracture focus in concurrence with preoperative planning, and although no fusion was observed, ossification points began to appear and there was no increase in the degree of spondylolisthesis. Three months post-surgery, case 1 improved to a lumbar EVA of 3, remaining on analgesics. 7 months post-surgery the EVA was 2 with eventual episodes of pain that resolved easily with analgesics. Case 2 presented with improvement of the lumbar EVA at the third month in 3 points, 7 months post-surgery the EVA was 2 with sporadic pain. Both patients have returned to work, and resumed their usual activities of daily life.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Different techniques have been designed for the repair of spondylolysis: the simple placement of a bone graft without osteosynthetic material, fusing one or more vertebrae to achieve stability and fusion through cerclage, a screw placed in the pars interarticularis defect, pedicle screws or laminar hooks, or a rod-screw construct amongst others.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3,5,6,9,11,21–23</span></a> All these techniques involve a large skin incision and deep tissue exposure with its concomitant comorbidities.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> Other authors have described percutaneous placement of a pedicle screw systems with rods and hooks, achieving excellent clinical results.<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">23,24</span></a> In the era of minimally invasive spinal surgery, the microscope allows direct observation of the fracture focus, its curettage, bone graft and osteosynthetic material placement with minimal dissection.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14,15</span></a> Neuronavigation has also been described as a resource for screw placement trans pars interarticularis.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">We believe that after conservative treatment with a prudent follow up time, the cause of refractory pain probably comes from a non-union fracture characterized by inter-fragmentary movement and reduced local blood flow. Repair of this injury aims to resolve the focus of pseudarthrosis. Historically it has been considered a bone healing disorder requiring mandatory surgical treatment.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">25,26</span></a> Fracture of the pars is often not initially considered a surgical lesion, but after the failure of conservative treatment and having reached the bone healing time with union failure, a more aggressive strategy must be adopted,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3,5–9,11</span></a> There have been some reports in literature of rapidly progressive spondylolisthesis which requires two-level fusion,<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a> while more insidious cases allow timely planning of less aggressive techniques. Bilateral pars defects not only biomechanically compromises a fracture's level but a level overlying this could also be affected.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6,9,22</span></a> We agree with some authors that fixation screws through the fracture without intervertebral fusion theoretically preserves segment mobility and the vitality of the intervertebral disk.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a> Planned surgery for this case includes the use of minimally invasive techniques, microscope to approach the focus of non-union and the placement of a HCS percutaneous compression screw guided by neuronavigation; in an attempt to optimize the technique first described by Buck in 1970. En nuestra experiencia, los pacientes que presentan espondilolisis sin espondilolistesis, con dolor refractario a tratamiento conservador, podrían ser candidatos a esta técnica, menos invasiva y costosa que la arthrodesis transpedicular típica, la reparación de la fractura evita la progression de la listesis, degeneración del disco intervertebral de dicho nivel y produce alivio efectivo del el dolor, en nuestra serie el control del dolor y grado de fusion tras un año de seguimiento es satisfactorio, aunque sera necesario un número mayor de pacientes para valorar a mediano y largo plazo el grado de fusion y evolución clínica tras la intervención.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In our experience, patients who present with spondylolysis without spondylolisthesis and with pain refractory to conservative treatment may be candidates for this technique. It is less invasive and costly when compared with a typical transpedicular arthrodesis. The repair of the fracture prevents further progression of the listhesis, further degeneration of the intervertebral disc of the same level and provides effective relief of pain. In our series, control of pain and degree of fusion after one year of follow-up is satisfactory, however, a greater number of patients will be necessary to assess the degree of fusion and clinical evolution after intervention.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding the selection of the screw, we decided to use the second generation headless compression screw at the fracture focus, as its design provides increased stability, compression and regeneration.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> Some studies of the second generation screws support better performance in partially threaded screws,<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> while others prefer fully threaded ones.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">16,18,19</span></a> It is important to note that the use of this screw for this purpose has not been previously reported. When assessing the potential risks of the chosen device, there is no literature available that reveals fracture or rupture of the material used. We found reports of proximal migration of the screw when it was used to repair scaphoid fractures.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> In our case, the tendency of the screw to pull out, would theoretically result in loss of compression on the fracture focus and cause screw migration in an extreme case, therefore the selection of our screw threads ensures resistance to pull-out on the tip of 178<span class="elsevierStyleHsp" style=""></span>N (18<span class="elsevierStyleHsp" style=""></span>kg) and head 274<span class="elsevierStyleHsp" style=""></span>N (27<span class="elsevierStyleHsp" style=""></span>kg). In odontoid screws or classic cortical screws, over fastening produces structural lesions of the bone matrix that is in contact with the thread, which results in a loss of screw attachment, loss of pull out resistance, and loss of compression. The HCS screw with a concealable head does not involve this risk.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">When considering the placement technique, we decided to avoid pre-drilling to ensure maximum compression force and reduce the possibility of hardware movement.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> The bibliographic data for the HCS 4.5 screw, demonstrates that peak compression is achieved 1.5<span class="elsevierStyleHsp" style=""></span>mm from the proximal cortex, and it is recommended to deepen it to −2<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a> We consider 0<span class="elsevierStyleHsp" style=""></span>mm to −2<span class="elsevierStyleHsp" style=""></span>mm to be the ideal range relative to the cortex of the distal fragment, because this depth allows the screw head to be hidden, thus reducing the possibility of damage to nearby structures. Additionally the cortical thread is contained in the place where it better fulfils its function of conserving forces. We know that the compressive force on the fracture focus, described in literature to be around 90<span class="elsevierStyleHsp" style=""></span>N, can be up to one third of the initial compression force just minutes after completion of the implementation.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a> Some studies report the final force as half the registered compressive force when implanting the screw.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> However, this screw still exceeds the compression force produced by the cortical screw or AO cortical bone screw, traditionally used to repair L5 spondylolysis.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">30–34</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">For the election of the graft, we agree with most authors that the ideal graft should be preferably autologous iliac crest.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a> However, in designing a minimally damaging technique, we decided that synthetic HAp provides an easy-to-implement and effective presentation to achieve consolidation of the fracture focus. Once the bone surfaces in pseudarthrosis have been debrided and fibroids removed, HAp has the theoretical ability to induce osteoid formation during the second week, achieving maximum proliferation until the 4th week. Nevertheless in our case the pars interarticularis being a poorly vascularized structure and sclerosed by the scar of a fracture in pseudarthrosis, could lengthen the fusion process. The placement of an autologous graft will be reserved for any future rescue surgery if needed. The possibility of future surgery is not ruled out. In fact, the position of our hardware does not hinder the best trajectory of pedicle screws in that vertebra, the final trajectory trans pars interarticularis in this case, remains at least 2.8<span class="elsevierStyleHsp" style=""></span>mm away from the nearest point of the ideal path of a transpedicular screw.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">Spondylolysis refractory to conservative treatment is presented as pseudarthrosis. Surgical treatment should be aimed at the removal of the fibrous tissue and curettage of edges at the fracture focus, with bone grafting and compression application also at the focus.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The HCS second generation implant is an easy and effective alternative in the treatment of spondylolysis without spondylolisthesis.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The use of neuronavigation and microscope optimises the surgery in terms of invasiveness, recovery time, hospital stay, post-surgical recovery and reduces the possibility of complication.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1023368" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec981522" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1023367" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec981523" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical planning" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Screw selection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Surgical details" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Case report" "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0035" "titulo" => "Case 1" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "History and examination" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Complementary tests" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Operation" ] ] ] 1 => array:3 [ "identificador" => "sec0055" "titulo" => "Case 2" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "History and examination" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Complementary tests" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Operation" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Postoperative course" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0080" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-07" "fechaAceptado" => "2017-07-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec981522" "palabras" => array:5 [ 0 => "Buck's technique" 1 => "Minimally invasive spinal surgery" 2 => "Headless compression screw" 3 => "Spondylolysis" 4 => "Neuronavigation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec981523" "palabras" => array:5 [ 0 => "Técnica de Buck" 1 => "Cirugía espinal minimamente invasiva" 2 => "Tornillo de compresión sin cabeza" 3 => "Espondilolisis" 4 => "Neuronavegación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Since 1968, many surgical techniques used in repairing the pars defect of the vertebra have been reported. Technological advances are giving rise to new ways of obtaining the best outcome using less invasive methods, which are more accurate, simple and effective. To treat cases of spondylolysis such as pseudarthrosis, we used neuro-navigation and microscopy through a 2.5-cm skin incision to approach the pars defect, freshen the fracture and place a type of screw that, until now, has never been used for this purpose. This is a novel technique, which guarantees prolonged compression and sufficient stability to facilitate the prompt healing of the vertebra. We present 2 cases of L5 spondylolysis treated with our technique, a modification of Buck's technique. A detailed description of the screw selection, surgical technical details, follow-up and outcome are discussed.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Desde 1968 se han descrito muchas técnicas quirúrgicas utilizadas para reparar el defecto en la <span class="elsevierStyleItalic">pars</span> de la vértebra. Los avances tecnológicos están dando lugar a nuevas formas de obtener el mejor resultado utilizando métodos menos invasivos que son más precisos, simples y eficaces. Para tratar los casos de espondilolisis como una unión en seudoartrosis, se utilizó la neuronavegación y la microscopía a través de una incisión cutánea de 2,5<span class="elsevierStyleHsp" style=""></span>cm para abordar el defecto de la <span class="elsevierStyleItalic">pars</span>, refrescar la fractura y colocar un tipo de tornillo que no se ha utilizado previamente con ese fin. Esta es una técnica novedosa, que garantiza una compresión prolongada y suficiente estabilidad para lograr la curación oportuna de la vértebra. Presentamos 2 casos de espondilolisis de L5 tratados con nuestra técnica, una modificación de la técnica de Buck. Se realiza una descripción detallada de la selección del tornillo, detalles técnicos quirúrgicos, seguimiento y resultado.</p></span>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 886 "Ancho" => 2083 "Tamanyo" => 181011 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Illustration showing the relation of the fracture and the different parts of the screw, trying to find the ideal location for maximal compression in the fracture focus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1869 "Ancho" => 2500 "Tamanyo" => 480278 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Surgical pictures showing: (A) Kirschner wire insertion through the fracture focus, (B) use of neuronavigation to guide the procedure, (C) screw insertion guided by neuronavigation and the Kirschner wire and (D) screw tightening.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3759 "Ancho" => 2500 "Tamanyo" => 418142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Post-operative X-ray, (A and B): (Case 1), (C and D): (Case 2), in an anterior-posterior view and lateral view respectively, showing the correct position of the screw, crossing the fracture focus.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2016 "Ancho" => 1500 "Tamanyo" => 290857 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Case 1 six-month follow up CT scan. The first two images are an axial view of L5, and the rest of the images are in the sagittal view showing the left screw (on the left sided images) and the right screw (on the right sided images).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 3441 "Ancho" => 2500 "Tamanyo" => 527603 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Case 2 six-month follow up CT scan. The first two images axial view of L5, and the rest of the images are in the sagittal view showing the left screw (on the left sided images) and the right screw (on the right sided images).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progression of lumbosacral isthmic spondylolisthesis in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y. Floman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2000" "volumen" => "25" "paginaInicial" => "342" "paginaFinal" => "347" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0180" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New concepts on the pathogenesis and classification of spondylolisthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.W. Hammerberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2005" "volumen" => "30" "paginaInicial" => "S4" "paginaFinal" => "S11" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0185" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.P. Brennan" 1 => "P.Y. Smucker" 2 => "E.M. Horn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/FOC.2008.25.11.E13" "Revista" => array:5 [ "tituloSerie" => "Neurosurg Focus" "fecha" => "2008" "volumen" => "25" "paginaInicial" => "E13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18980473" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0190" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reparación de la espondilolisis en columna lumbar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Matta Ibarra" 1 => "R. Cabrales Vladimir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rev Colomb Ortop Traumatol" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "6" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0195" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Drazin" 1 => "A. Shirzadi" 2 => "S. Jeswani" 3 => "H. Ching" 4 => "J. Rosner" 5 => "A. Rasouli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2011.9.FOCUS11206" "Revista" => array:5 [ "tituloSerie" => "Neurosurg Focus" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "E9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22133168" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0200" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.Y. Dai" 1 => "L.S. Jia" 2 => "W. Yuan" 3 => "B. Ni" 4 => "H.B. Zhu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2001" "volumen" => "10" "paginaInicial" => "78" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11276840" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0205" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of the direct repair of spondylolisthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Giudici" 1 => "L. Minoia" 2 => "M. Archetti" 3 => "A.S. Corriero" 4 => "A. Zagra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2011" "volumen" => "1" "numero" => "Suppl." "paginaInicial" => "S115" "paginaFinal" => "S120" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0210" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct repair of the pars interarticularis for spondylolysis and spondylolisthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.A. Lundin" 1 => "D. Wiseman" 2 => "R.G. Ellenbogen" 3 => "C.I. Shaffrey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000072471" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurosurg" "fecha" => "2003" "volumen" => "39" "paginaInicial" => "195" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12944700" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0215" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamento da espondilólise sintomática com reparo direto pela técnica de Buck modificada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.P.M. Coelho" 1 => "C. Moreira" 2 => "R. D’Alessandro" 3 => "L. García" 4 => "J. Soares" 5 => "R. Chaves" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "COLUNA/COLUMNA" "fecha" => "2009" "volumen" => "8" "paginaInicial" => "32" "paginaFinal" => "37" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0220" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct repair of lumbar spondylolysis by Buck's technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Rajasekaran" 1 => "M. Subbiah" 2 => "A.P. Shetty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5413.77133" "Revista" => array:6 [ "tituloSerie" => "Indian J Orthop" "fecha" => "2011" "volumen" => "45" "paginaInicial" => "136" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21430868" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0225" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Debusscher" 1 => "S. Troussel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-007-0392-0" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2007" "volumen" => "16" "paginaInicial" => "1650" "paginaFinal" => "1658" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17520298" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0230" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomechanical comparison of spondylolysis fixation techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Deguchi" 1 => "A.J. Rapoff" 2 => "T.A. Zdeblick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "1999" "volumen" => "24" "paginaInicial" => "328" "paginaFinal" => "333" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0235" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A biomechanical study on the direct repair of spondylolysis by different techniques of fixation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Fan" 1 => "G.R. Yu" 2 => "F. Liu" 3 => "J. Zhao" 4 => "W.D. Zhao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1757-7861.2009.00064.x" "Revista" => array:6 [ "tituloSerie" => "Orthop Surg" "fecha" => "2010" "volumen" => "2" "paginaInicial" => "46" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009907" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0240" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive technique for direct repair of the pars defect in young adults using a spinal endoscope: a technical note" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Higashino" 1 => "S.K. Katoh" 2 => "S. Sakai t" 3 => "H. Kosaka" 4 => "N. Yasui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Minim Invasive Neurosurg" "fecha" => "2007" "volumen" => "2007" "paginaInicial" => "182" "paginaFinal" => "186" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0245" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive direct repair of bilateral lumbar spine pars defects in athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.A. Widi" 1 => "S.K. Williams" 2 => "A.D. Levi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2013/659078" "Revista" => array:5 [ "tituloSerie" => "Case Rep Med" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "659078" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23737800" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0250" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of two headless compression screws for operative treatment of scaphoid fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Grewal" 1 => "J. Assini" 2 => "D. Sauder" 3 => "L. Ferreira" 4 => "J. Johnson" 5 => "K. Faber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-799X-6-27" "Revista" => array:5 [ "tituloSerie" => "J Orthop Surg Res" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21645410" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0255" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A biomechanical study on variation of compressive force along the Acutrak 2 screw" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.K.K.M. Sugathan" 1 => "T.J. Joyce" 2 => "J.W. Harrison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2011.07.011" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "205" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21839443" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0260" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The durability of the intrascaphoid compression of headless compression screws: in vitro study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.S.B.K. Gruszka" 1 => "T.E. Nowak" 2 => "T. Achenbach" 3 => "P.M. Rommens" 4 => "L.P. Muller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hand Surg" "fecha" => "2012" "volumen" => "37" "paginaInicial" => "1142" "paginaFinal" => "1150" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0265" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insertion profiles of 4 headless compression screws" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Hart" 1 => "E.J. Harvey" 2 => "L.P. Lefebvre" 3 => "F. Barthelat" 4 => "R. Rabiei" 5 => "P.A. Martineau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhsa.2013.04.027" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "1728" "paginaFinal" => "1734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23809468" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0270" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomechanical analysis of second-generation headless compression screw" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.D.K. Assari" 1 => "A.M. Llyas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2012.03.015" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "1159" "paginaFinal" => "1165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22482931" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0275" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Scott wiring technique for direct repair of lumbar spondylolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.V. Johnson" 1 => "A.G. Thompson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1992" "volumen" => "74" "paginaInicial" => "426" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1587895" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0280" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The biomechanical effects of spondylolysis and its treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.O.K. Mihara" 1 => "B.C. Cheng" 2 => "S.M. David" 3 => "T.A. Zdeblick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.BRS.0000042226.59713.0E" "Revista" => array:6 [ "tituloSerie" => "Spine" "fecha" => "2003" "volumen" => "28" "paginaInicial" => "235" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12567023" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0285" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcome of minimally invasive repair of pars defect using percutaneous pedicle screw and hook-rod system in adults with lumbar spondylolisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.T.S. Yoichiro" 1 => "T. Fumitake" 2 => "G. Yuichiro" 3 => "H. Kosaku" 4 => "S. Koichi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Orthop Rheumatol" "fecha" => "2014" "volumen" => "2" "paginaInicial" => "1013" "paginaFinal" => "1018" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0290" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Sairyo" 1 => "T. Sakai" 2 => "N. Yasui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2009.2.SPINE08594" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg Spine" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "492" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19442013" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0295" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of symptomatic lumbar pseudoarthrosis with anteroposterior fusion. A functional and radiographic outcome study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.J.P.M Albert" 1 => "F. Denis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Spine" "fecha" => "2000" "volumen" => "25" "paginaInicial" => "123" "paginaFinal" => "129" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10647170" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0300" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revision strategies for lumbar pseudoarthrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Stephen" 1 => "M.D. Ondra" 2 => "M.D. Shaden Marzouk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/foc.2003.15.6.8" "Revista" => array:6 [ "tituloSerie" => "Neurosurg Focus" "fecha" => "2003" "volumen" => "15" "paginaInicial" => "1" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15376362" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0305" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute progression of spondylolysis to isthmic spondylolisthesis in an adult" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.T.T.C. Stone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2016.8.SPINE16527" "Revista" => array:6 [ "tituloSerie" => "Spine" "fecha" => "2002" "volumen" => "27" "paginaInicial" => "370" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28498069" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0310" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A central threadless shaft screw is better than a fully threaded variable pitch screw for unstable scaphoid nonunion: a biomechanical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.H.K.H. Koh" 1 => "J.S. Kim" 2 => "S.J. Park" 3 => "Y.R. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2015.01.018" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2015" "volumen" => "46" "paginaInicial" => "638" "paginaFinal" => "642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25666203" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0315" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.D.A.E. Shifflett" 1 => "S.K. Lee" 2 => "A.J. Weiland" 3 => "S.W. Wolfe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Wrist Surg" "fecha" => "2014" "volumen" => "03" "paginaInicial" => "250" "paginaFinal" => "261" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0320" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A biomechanical comparison of headless tapered variable pitch and AO cortical bone screws for fixation of a simulated slab fracture in equine third carpal bones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.C. Bueno" 1 => "L.D. Galuppo" 2 => "K.T. Taylor" 3 => "D.G. Jensen" 4 => "S.M. Stover" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jvet.2003.50019" "Revista" => array:6 [ "tituloSerie" => "Vet Surg" "fecha" => "2003" "volumen" => "32" "paginaInicial" => "167" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12692762" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0325" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomechanical criterion for selecting cancellous bone screws: arthrodesis in the hindfoot" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Reihsner" 1 => "W.O. Huber" 2 => "R. Beer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Bioeng Biomech" "fecha" => "2007" "volumen" => "9" "paginaInicial" => "27" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18421940" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0330" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In-vitro comparison of biomechanical efficiency of three cannulated screws for arthrodesis of the hindfoot" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.O. Huber" 1 => "R. Reihsner" 2 => "K. Trieb" 3 => "A.H. Wanivenhaus" 4 => "R. Beer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3113/FAI.2008.0225" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Int" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "225" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18315980" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0335" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A biomechanical study comparing the compressive forces generated by a conventional 4.5 AO/ASIF cortical lag screw with a differentially pitched cortical compression screw" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Lenehan" 1 => "J. Street" 2 => "B. Murphy" 3 => "L. Brennan" 4 => "P. McHugh" 5 => "W. Curtin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Bioeng Biomech" "fecha" => "2009" "volumen" => "11" "paginaInicial" => "31" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19839562" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0340" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A biomechanical comparison of Acutrak headless compression screw and AO cannulated lag screw for the fixation of Hoffa fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Peng" 1 => "S.L. Zhang" 2 => "P. Feng" 3 => "Y. Jiang" 4 => "C. Zou" 5 => "H. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sichuan Da Xue Xue Bao Yi Xue Ban" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "226" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23745261" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/11301473/0000002900000003/v1_201805090428/S1130147317300921/v1_201805090428/en/main.assets" "Apartado" => array:4 [ "identificador" => "49641" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Artículos de revisión" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301473/0000002900000003/v1_201805090428/S1130147317300921/v1_201805090428/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147317300921?idApp=UINPBA00004B" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 7 | 3 | 10 |
| 2020 Abril | 1 | 0 | 1 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Enero | 2 | 4 | 6 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Octubre | 1 | 2 | 3 |
