DSpace Repository :: Browsing by Author "Marré, Bartolomé"

Browsing by Author "Marré, Bartolomé"

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Espondilodiscitis por Haemophilus parainfluenzae: Un reporte de caso
(2022) Yurac, Ratko; Santorcuato, Macarena; Quinteros, Guisela; Zamorano, Juan; Marré, Bartolomé
Introduction Haemophilus parainfluenzae (HP) is a gram-negative coccobacillus andan opportunistic pathogen. It is rarely associated with spinal- and musculoskeletal-site infections, and very little reported in the literature. Case Presentation An otherwise healthy, 45-year-old woman who presented with a two-week history of progressive low back pain, fever, coryza and nasal congestion, was found to have intervertebral discitis caused by HP, confirmed by two positive blood cultures and progressive lumbar spine magnetic resonance imaging (MRI) findings. The MRI findings were atypical, consisting of a psoas abscess and small anterior epidural and intraspinal fluid collections associated with spondylodiscitis. The initial diagnosis was delayed because the initial MRI failed to reveal findings suggestive of an infectious process. The treatment consisted of a long course of intravenous followed by oral antibiotics, ultimately yielding a good clinical response. Discussion and Conclusion Haemophilus parainfluenzae is a very rare pathogen inspondylodiscitis. Nonetheless, it should be considered, especially in patients presenting with low back pain and fever and/or gram negative bacteremia. Theinitial work-up should include contrast-enhanced MRI of the spine. Although rare, spondylodiscitis and a psoas abscess can present concomitantly. Prolonged antibiotics are the mainstay of treatment.
Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey
(2021) Quinteros, Guisela; Yurac, Ratko; Zamorano, Juan; Díez, Máximo; Pudles, Edson; Marré, Bartolomé
Background: Lumbar disc herniation (LDH)/radiculopathy is the most frequent cause of lost workdays in people under 50 years of age. Although there is consensus about how to assess these patients, the optimal management strategy is still debated. Methods: An online survey was sent to spine surgeons who are members of the Iberian-Latin American Spine Society to assess how they treat LDH with radiculopathy. Results: There were 718 surgeons who answered the survey; 66% reported that 76-100% of their monthly clinic work was due to spine issues. The most frequently used conservative treatment modalities included non-opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (90.5%), followed by physical therapy (55.2%) and pregabalin (41.4%). Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6-12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3-6 weeks. Of interest, 78% utilized epidural steroid injections (ESI); 51.7% preferred the transforaminal, 27.2% the interlaminar, and 7.5% the caudal approaches. The most frequent indications for surgery included: cauda equina syndrome, progressive neurological deficits, and intractable pain. Traditional microdiscectomy was the most common technique (68.5%) utilized, followed by 7.5% advocating endoscopic disc resection, and just 6.4% favoring the tubular discectomy. Conclusion: There is considerable heterogeneity among Iberian and Latin American spine surgeons in the treatment of LDH/radiculopathy. Although most begin with the utilization of NSAIDs and non-opioid analgesics, followed by ESI (88%), surgery was recommended for persistent symptoms/signs for those failing between 3 and 6 weeks (private sector) versus 6-12 weeks (public sector) of conservative therapy.
Resection of a sacral chordoma aided by neuronavigation: A case report
(2021) Silva, Álvaro; Quinteros, Guisela; Calvo, Rafael; Yurac, Ratko; Marré, Bartolomé
Background Chordomas are rare malignant neoplasms that are resistant to chemotherapy and conventional radiation therapy. The main factor that determines whether a localized tumor recurs is en-bloc resection with tumor-free margins. Intraoperative navigation is useful in this scenario, allowing for preoperative planning of the osteotomy. Presentation of the case A 60-year-old patient, who had been previously operated on for prostate cancer, presented with back pain after a minor accident. He was examined, and a sacral tumor that had been classified as positive for chordoma via biopsy was found. A neuronavigation-aided en bloc resection was carried out, with both S2 nerves, both sacroiliac joints and the coccyx all preserved. Two years after the operation, the patient was asymptomatic, without tumor recurrence shown on MRI. Conclusion The use of intraoperative navigation is a useful tool for guiding osteotomies during bone tumor en-bloc resection.
Spondylolysis Repair Using a Minimally Invasive Modified Buck Technique with Neuronavigation and Neuromonitoring in High School and Professional Athletes: Technical Notes, Case Series, and Literature Review
(2021) Yurac, Ratko; Bravo, José; Silva, Álvaro; Marré, Bartolomé
Background: Spondylolysis is a defect in the pars interarticularis of the vertebra that occurs frequently in high-performance young athletes. Although nonsurgical management is the mainstay of treatment, surgery is an option for patients with persistent symptoms despite multiple cycles of nonsurgical treatment. Performing a minimally invasive technique reduces complications, postsurgery pain, and hospitalization time and leads to a quick recovery. The aim of this study was to report the clinical results of a series of 3 patients treated with a modification of the Buck technique with a minimally invasive approach. Methods: Three high-performance athletes between 17 and 18 years old who were managed nonsurgically for at least 6 months underwent a modified Buck technique repair with a minimally invasive approach using cannulated compression screws, with neuronavigation and neuromonitoring. Patients were followed at least 6 months with computed tomography scans to assess consolidation and fixation status. Following rehabilitation and in the absence of pain, all 3 athletes returned to their respective sports. No complications were reported. Results: All patients presented with bilateral spondylolysis, at L3 in 1 case and at L5 in 2 cases. Patients received conservative management for 12-36 months before surgery. After surgery, consolidation was obtained at 4 months in all patients, who returned to their sports activities in <6 months. Conclusions: The proposed technique shows the advantages of performing minimally invasive surgery in young high-performance athletes, ensuring consolidation and early return to sports activity without complications.
Treatment strategies for managing cervical spine injuries in rugby players
(2021) Yurac, Ratko; Zamorano, Juan José; Quinteros, Guisela; Izquierdo, Guillermo; Novoa, Felipe; Brañes, Rocío; Valencia, Manuel; Silva, Álvaro; Marré, Bartolomé
Background: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. Methods: Seven patients sustained cervical spine fracture attributed to rugby (2009–2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). Results: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. Conclusion: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.

Browsing by Author "Marré, Bartolomé"

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