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Background: The Bruns Garland syndrome (diabetic amyotrophy) it is a very rare condition, with few cases reported in the literature. Clinical diff erentiation of diabetic amyotrophy or cauda equine syndrome may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. We report a case of diabetic amyotrophy that mimics a cauda equina syndrome. Case description: A 59 years old man diabetic patient that suddenly begins with weakness of lower extremities and loss of sphincters control. The patient was seen in the emergency room, the anteroposterior and lateral radiographs of the lumbosacral spine evidenced spondylolisthesis L5-S1 level II of Meyerding. However, the MRI show no vertebral canal compression, nerve root compression or disc extrusion. Electrodiagnostic study revealed diabetic amyotrophy (Bruns Garland syndrome). The patient rapidly improves with treatment based in antineuritics, diabetes control, physical therapy and rehabilitation. Four months after the diagnosis he recover his muscle strength, has no alterations in the march, no loss of balance, his sensitive is preserved and has no pain. Conclusion: Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to diff erentiate diabetic neuropathy from cauda equina syndrome. Treatment of both diseases may be needed for relief of the patient's pain. [ABSTRACT FROM AUTHOR]

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Introduction: The intermediate screw in a fractured vertebra works as a pressure point with an anterior vector thus creating a lordotic force that corrects kyphosis, provides appropriate three-point fixation and decreases the lever effect. Objective: To describe the course of non-pathologic traumatic fractures of the thoracolumbar spine after instrumentation of the fractured vertebra. Material and methods: A total of 37 patients with a diagnosis of traumatic vertebral fracture in the thoracolumbar area (T9-L4) were operated from January 2008 to December 2012. Patients included 28 males (75.6%) and 9 females (24.4%); mean age was 41.8 years. Results: Correcting the total diameter of the spinal canal results in a 2.11 times higher chance of neurologic improvement; the relative risk of fusion was 0.97 with autologous graft as compared with a heterologous graft (CI 95% = 0.69 - 1.36) and 1.18 with instrumentation of the fractured vertebra (CI 95% = 0.42 - 3.31). Conclusions: Pedicle screw fixation at the fracture level is a safe and effective method to treat thoracolumbar fractures; it provides additional fixation points that assist in fracture reduction and correction of kyphosis, improving at the same time back pain and maintaining the corrective effect. Procedure indications include integrity of the posterior ligament complex and at least one intact pedicle in the fractured vertebra. [ABSTRACT FROM AUTHOR]

Copyright of Acta Ortopédica Mexicana is the property of Sociedad Mexicana de Ortopedia, AC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine the direct cost of complete cervical spinal cord injury. Material and methods: 34 patients over 16 years of age with a diagnosis of complete cervical spinal cord injury. The cost calculation was done considering nine groups: bed days, specialty consultation, laboratory, X-rays, computed axial tomography, magnetic resonance imaging, anterior surgery, posterior surgery, anterior and posterior surgery. The micro costing technique was used and the mean cost per patient was obtained. Results: 41% of patients had injury at C4-C5; mean age was 36 years; total cost was $8,622,793.00 mexican pesos, and the mean cost in patients who survived was $2,536,115.59 mexican pesos, which represented 29.4% of the total cost; the cost for the patients who died was $6,086,677.41 mexican pesos (70.6%). The percent distribution of the different components analyzed clearly shows that 51% of the total cost corresponded to hospitalization. The estimated annual cost of caring for these patients is $2,155,905.70 Mexican pesos, with an annual increase of $819,905.53 Mexican pesos. Conclusions: The major cost was hospitalization, so specific clinical management guidelines should be used to optimize economic resources and prevent complications that may increase the costs. [ABSTRACT FROM AUTHOR]

Background: Risk factors are the endogenous or exogenous factors that may be controlled and they are responsible for disease. The objective of this paper is to describe the risk factors affecting vertebral fusion in patients with lumbar spine instability seen at our hospital and to see how they relate to nutritional factors. Material and methods: Patients undergoing vertebral fusion due to several diagnoses were analyzed. Different parameters were captured to determine the interaction among them and assess the factors affecting vertebral fusion healing. They were compared with patients with pseudoarthrosis to determine its risk factors. Patients were divided into two groups: the control group, who underwent fusion, and the cases, who had pseudoarthrosis. Results: A total of 59 patients were examined; 15 (25.4%) were cases (pseudoarthrosis) and 44 (74.6%) were controls (fusion). The demographic distribution was 27 (45.8%) females and 32 (54.2%) males; mean age was 51 ± 12 years, with a minimum age of 20 and a maximum of 85. The diagnostic-based distribution was as follows: 29 (49.1%) spondylolistheses, 21 (35.6%) fractures, 5 (8.5%) herniated discs, 3 (5.1%) infections, and one (1.7%) tumor. Mean body weight was 75.9 kg, height was 160 cm, BMI 24.5, Hb 15.2, Hct 35.9, and Alb 3.5. Various risk factors were analyzed including the following: age over 60 years, which showed a 49% higher chance of pseudoarthrosis compared with the control group, with a 95% CI, 0.12-2.27; body weight over 90 kg, which showed an 82% higher chance of pseudoarthrosis compared with the fusion group, with a 95% CI, 0.03-0.43; BMI, which showed a 25% higher chance of pseudoarthrosis, with a 95% CI, 0.18-3.18; hypoalbuminemia < 3.4 mg/100 ml, which showed a 78% higher chance of pseudoarthrosis, with a 95% CI, 0.06-0.75. Conclusions: This study found that pseudoarthrosis is caused by risk factors linked to the nutritional pro- file, i.e., obesity, and hypoalbuminemia; its chance of occurring is 1.5 greater than in individuals with normal values. For this reason it is important to assess these values and correct them early on during the preoperative period with supportive measures allowing for an appropriate metabolic control and the consequent optimum result, i.e., fusion. [ABSTRACT FROM AUTHOR]

The aneurysmal bone cyst (ABC) of the lumbar spine is an infrequent entity, of undefined nature and aggressive behavior; there are only a few reports in Mexico, so we present the case of a patient with radicular and lumbar pain that progressed to pelvic limb paresthesia. Lesions in the vertebral body of L1 were located with imaging studies and confirmed with biopsy; treatment with corticosteroids was started and later resection of the lesion was performed together with stabilization of the spine using first a posterior approach and at a second stage an anterior approach. Corticosteroid therapy led to remission of tumor progression, so only vacuolated areas and destruction of the posterior wall were found, leading to instability and radiculopathy. This type of lesions usually appears in long bones and less often in the spine, but it is even rarer in the lumbar spine. The prognosis of ABC is usually good, with the exception of the rare cases of extremely disseminated cysts located in the spine. It is therefore important to consider this before deciding what the best approach is for each patient, as well as the appropriate medico-surgical measures. [ABSTRACT FROM AUTHOR]

Background and Objective: One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico., Material and Methods: Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed., Results: Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting., Conclusion: This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach., (Copyright © 2020 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Hemangiomas are the most common primary tumors of the spine. Mainly asymptomatic Incidental finding when performing an imaging study. The incidence reported at autopsies is 11% in the spine, multifocal lesions are present in 25 to 30% of cases., Clinical Case: Vertebral cervical hemangioma with benign and stable characteristics that underwent surgical treatment, observing aggressive post-surgical behavior two months later., Conclusion: The approach to vertebral pathology is algorithmic and protocolized, it is necessary to determine the treatment based on the overall understanding of the disease and according to the clinical practice guidelines.

Background: The Bruns Garland syndrome (diabetic amyotrophy) it is a very rare condition, with few cases reported in the literature. Clinical differentiation of diabetic amyotrophy or cauda equine syndrome may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. We report a case of diabetic amyotrophy that mimics a cauda equina syndrome., Case Description: A 59 years old man diabetic patient that suddenly begins with weakness of lower extremities and loss of sphincters control. The patient was seen in the emergency room, the anteroposterior and lateral radiographs of the lumbosacral spine evidenced spondylolisthesis L5-S1 level II of Meyerding. However, the MRI show no vertebral canal compression, nerve root compression or disc extrusion. Electrodiagnostic study revealed diabetic amyotrophy (Bruns Garland syndrome). The patient rapidly improves with treatment based in antineuritics, diabetes control, physical therapy and rehabilitation. Four months after the diagnosis he recover his muscle strength, has no alterations in the march, no loss of balance, his sensitive is preserved and has no pain., Conclusion: Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from cauda equina syndrome. Treatment of both diseases may be needed for relief of the patients pain.

The term «vertebral destruction syndrome» comprises pathologies causing structural changes in the spine, mainly in the vertebral body, producing mechanical deformity and neurological involvement. The pathologies found in this definition may be infectious, metabolic or tumoral. Vertebral osteomyelitis is a disease that occurs mainly in adults > 50 years; we speak of spondylodiscitis when the condition affects the disc and vertebral body. The most important organism in vertebral osteomyelitis is Staphylococcus aureus, seen in over 50% of cases. Tumors of the spine can start from local or adjacent spinal injuries or distant ones, and spread through the blood or lymphatic system. Metastases account for about 97% of all tumors of the spine. Primary tumors that most commonly spread to the spine are lung, prostate, breast and kidney. Metabolic bone diseases are a group of disorders that occur as a result of changes in the calcium metabolism. The spine contains large amounts of metabolically active cancellous bone, which must withstand axial loads during stance. Osteoporosis is a metabolic disease that most commonly affects the spine; it is characterized by low bone mass. The diagnosis of these entities is important for the treatment and prognosis of the patient. The term «vertebral destruction syndrome» proposes a notarized scheme aimed at improving the patients prognosis and his/her prompt treatment.