Browsing by Author "Bravo, Oscar"

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    Low Implant Failure Rate of Percutaneous Fixation for Spinal Metastases: A Multicenter Retrospective Study
    (2021) Silva, Álvaro; Yurac, Ratko; Guiroy, Alfredo; Bravo, Oscar; Morales, Alejandro; Landriel, Federico; Hem, Santiago
    OBJECTIVE: To evaluate incidence and types of implant failure observed in a series of patients with spinal metastases (SM) treated with minimally invasive stabilizationsurgery without fusion. METHODS: In this multicenter, retrospective, observational study, we reviewed the files of patients >18 years old who underwent surgery for SM using percutaneous spinal stabilization without fusion with a minimum 3-month followup. The following variables were included: demographics,clinical findings, prior radiation history, SM location, epidural spinal cord compression scale, Spinal Instability Neoplastic Scale, neurological examination, and surgeryrelated data. Primary outcome measure was implant failure rate, as observed in patients’ last computed tomography scan. Multivariable analysis was performed to identify baseline factors and factors associated with implant failure. RESULTS: Analysis included 72 patients. Mean age of patients was 62 years, 39 patients were men, and 75% of patients had an intermediate Spinal Instability Neoplastic Scale score. Tumor separation surgery was performed in 48.6% of patients. Short instrumentation was indicated in 54.2% of patients. Three patients (4.2%) experienced implant failure (2 screw loosening, 1 screw cut-out); none of them required revision surgery. In 73.6% of cases, survival was >6 months. No significant predictors of failure were identified in the multivariate analysis. CONCLUSIONS: A low implant failure rate was observed over the short and medium term, even when short instrumentations without fusion were performed. These findings suggest that minimally invasive stabilization surgery without fusion may be an effective and safe way to treat complicated SM.
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    Manejo actual de las metástasis vertebrales: un trabajo en equipo
    (2021) Silva, Álvaro; Bravo, Oscar; Salas, Claudio; Yurac, Ratko; Valencia, Javiera; Goset, Karen; Harbst, Hans; Córdova, Andrés
    La enfermedad metastásica vertebral es frecuente en los pacientes con cáncer avanzado, y conlleva a complicaciones inherentes a su progresión, como lo son la fractura patológica vertebral y la compresión neural metastásica. Se realizó una revisión de los aspectos terapéuticos actuales del manejo de la progresión y de las complicaciones de la enfermedad metastásica vertebral, enfatizando su enfrentamiento sistémico y personalizado. Nuestro objetivo principal es proporcionar información sobre el tratamiento actual de esta afección y la utilidad del manejo sistémico y multidisciplinario.
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    Preoperative and Postoperative Sagittal Alignment and Compensatory Mechanisms in Patients With Posttraumatic Thoracolumbar Deformities Who Undergo Corrective Surgeries
    (2021) Bravo, Oscar; Valencia, Manuel; Izquierdo, Guillermo; Novoa, Felipe; Riera, José; Silva, Álvaro
    Background: Secondary posttraumatic spinal kyphosis is a fixed deformity that has an asymptomatic presentation in most patients, but in some, persistent pain and disability can develop refractory to conservative treatment, which may result in the need for corrective surgery. Our aim was to analyze the modification of sagittal alignment and the variation in compensation mechanisms of spinal-pelvic segments before and after surgical correction in a group of patients with symptomatic posttraumatic kyphosis. Methods: A retrospective cohort study of 16 consecutive patients from the beginning of 2007 until the beginning of 2017 who underwent surgery due to thoracolumbar sagittal deformities was performed. Regional kyphosis (RK), thoracic kyphosis (TK), lumbar lordosis (LL), lower lumbar lordosis (LLL), lumbar lordosis under the deformity (LLUD), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL were measured in preoperative and postoperative lateral full spine x rays. Statistical analysis was performed with the nonparametric Wilcoxon test to compare preoperative and postoperative radiologic variables. Results: Sixteen patients were included with a median age of 47.5 years (32–62 years), the median time elapsed from the accident until corrective surgery was 7 months (2–33 months), the median follow-up time was 16.5 months (6–80 months), and the most used corrective strategy was pedicle subtraction osteotomy (11/16 patients). Statistically and radiologically significant improvements were observed in RK (33.58 versus 128, P , .001) and LLUD (68.58 versus 618, P ¼ .017), with a noticeable decrease in PI-LL (158 versus 9.58, P ¼ .233). There were no statistically significant results regarding TK, LL, LLL, PI, PT, or SVA. Conclusions: Osteotomies are an effective tool to correct angular deformities at a local level after spine trauma. Posttraumatic kyphosis results in the compensation of sagittal imbalance through modification of segmental alignment of the mobile spine under the e deformity.

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