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