Browsing by Author "Quinteros, Guisela"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Publication An analytical review of contributory factors in intervertebral disc degeneration(2022) Kumar, Vishal; Neradi, Deepak; Maheshwari, Shivam; Quinteros, Guisela; Yurac, RatkoObjective: To summarize current trends in the pathogenesis and management of disc degeneration and suggest areas where more researchwould be of benefit. Methods: The available literature relevant to Lumbar disc degeneration (LDD) was reviewed. PubMed, MEDLINE, OVID, EMBASE, Cochrane, and Google Scholar databases were used to review the literature. Institutional Review Board approval was not applicable for this study. Results: This article summarizes trends in the pathogenesis and factors associated with disc degeneration. Conclusions: The genetic contribution to lumbar disc degeneration is a newer concept, still being researched in different populations around the world. Investigators have demonstrated a familial predisposition in the etiology of lumbar disc degeneration. The effect sizes of most genetic variants are small and, thus, individual gene-environment studies must have very large sample sizes to provide compelling evidence of any interactionPublication Espondilodiscitis por Haemophilus parainfluenzae: Un reporte de caso(2022) Yurac, Ratko; Santorcuato, Macarena; Quinteros, Guisela; Zamorano, Juan; Marré, BartoloméIntroduction 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.Publication Granuloma eosinofílico cervical en el adolescente: Reporte de un caso y revisión de la literatura(2022) Yurac, Ratko; Zamorano, Juan; Calvo, Rafael; Castoldi, María; De la Barra, Camila; Quinteros, Guisela; Novoa, FelipeIntroducción El granuloma eosinofílico (GE) es una patología infrecuente, sobre todo en adultos, que puede afectar la columna cervical. A pesar de la vasta literatura, esta enfermedad afecta principalmente a la población infantil, y no hay un consenso sobre el manejo en adultos. Con el objetivo de aportar conocimiento respecto a esta patología poco frecuente, se presenta un caso clínico de GE cervical en un paciente de 16 años, a quien se trató de manera conservadora, con buenos resultados y retorno completo a sus actividades. Caso Clínico Un hombre de 16 años, seleccionado de rugby, consultó por dolor cervical axial persistente y nocturno de 6 semanas de evolución, sin trauma evidente. Al examen, destacó dolor a la compresión axial sin compromiso neurológico asociado. Los exámenes de tomografía computarizada (TC) y resonancia magnética (RM) revelaron lesión lítica en el cuerpo de C3 de características agresivas, de presentación monostótica en tomografía por emisión de positrones-tomografía computada (TEPTC) compatible con tumor primario vertebral. Se decidió realizar biopsia percutánea bajo TC, para definir el diagnóstico y manejo adecuado, la cual fue compatible con células de Langerhans. Al no presentar clínica ni imagenología de inestabilidad ósea evidente o compromiso neurológico, se manejó con tratamiento conservador, inmovilización cervical, analgesia oral, y seguimiento estrecho. A los cuatro meses de evolución, se presentó con una TC con cambios reparativos del cuerpo vertebral y sin dolor, y logró retomar sus actividades habituales. Conclusiones El diagnóstico de GE es infrecuente a esta edad, y se debe plantear entre diagnósticos diferenciales de lesiones líticas agresivas primarias vertebrales. Es necesario el uso de imágenes, y la biopsia vertebral es fundamental para confirmar el diagnóstico. Su manejo va a depender de la sintomatología, del compromiso de estructuras vecinas, y de la estabilidad de la vértebra afectada. El manejo conservador con seguimiento clínico e imagenológico es una opción viable.Item 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, BartoloméBackground: 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.Publication Reliability Evaluation of the New AO Spine-DGOU Classification for Osteoporotic Thoracolumbar Fractures(2022) Quinteros, Guisela; Cabrera, Juan; Urrutia, Julio; Carazzo, Charles; Guiroy, Alfredo; Marre, Bartolome; Joaquim, Andrei; Yurac, RatkoObjectives: To perform an interobserver and intraobserver agreement evaluation of the new AO Spine-DGOU classification system for osteoporotic thoracolumbar fractures (OFc). Methods: Complete imaging studies of 97 patients (radiographs, computed tomography scans, and magnetic resonance imaging) with osteoporotic thoracolumbar fractures were selected and classified using the OFc by 6 spine surgeons (3 senior surgeons with more than 15 years of experience and 3 surgeons with less than 15 years). After a 4-week interval, the same cases were presented to the same evaluators in a random sequence for a new classification assessment. The weighted kappa coefficient (wκ) was used to determine the interobserver and intraobserver agreement. Results: The interobserver agreement was moderate, wκ = 0.59 (95% confidence interval 0.54-0.64). The intraobserver agreement was fair, wκ = 0.35 (95% confidence interval 0.29-0.40). Interobserver agreement slightly improved for junior staff between first and second evaluation, suggesting a learning effect. Better agreement was obtained by senior staff at the interobserver and intraobserver agreement. Conclusions: This independent assessment demonstrated that new OFc allows moderate interobserver agreement and fair intraobserver agreement. Further studies are necessary prior to its widespread adoption.Item Resection of a sacral chordoma aided by neuronavigation: A case report(2021) Silva, Álvaro; Quinteros, Guisela; Calvo, Rafael; Yurac, Ratko; Marré, BartoloméBackground 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.Item 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, BartoloméBackground: 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.