Browsing by Author "Ricciardi, Guillermo"
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Publication [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico(2024) Ricciardi, Guillermo; Cabrera, Juan; Martinez, Oscar; Matta, Javier; Jimenez, Jose; Vilchis, Hugo; Tejerina, Veronica; Yurac, RatkoIntroducción y objetivo: Describir las características clínico-demográficas y el tratamiento de pacientes con heridas vertebrales por proyectil de arma de fuego en una cohorte retrospectiva de centros de Iberoamérica. Materiales y métodos: Estudio de cohorte, multicéntrico, retrospectivo de pacientes tratados por lesiones vertebrales por proyectil de arma de fuego en 12 instituciones entre enero de 2015 y enero de 2022. Se registraron datos demográficos y clínicos, incluidos tiempo de la lesión, evaluación inicial, variables balísticas y tratamiento. Resultados: Se analizó a 423 pacientes con lesiones vertebrales por arma de fuego de instituciones en México (82%), Argentina, Brasil, Colombia y Venezuela. Predominaban los varones, civiles, con profesiones con bajo riesgo de violencia y estatus social medio/bajo. La mayoría, por disparos de armas de fuego de baja energía. Lesiones frecuentemente torácicas y lumbares. Lesión neurológica en 320 (76%) pacientes, con lesión medular en 269 (63%). El tratamiento solía ser conservador, con solo 90 (21%) casos quirúrgicos. Las características que distinguieron los casos quirúrgicos de los no quirúrgicos fueron el compromiso neurológico (p = 0,004), compromiso del canal (p < 0,001), heridas sucias (p < 0,001), restos de fragmentos de bala o hueso en el canal espinal (p < 0,001) y el patrón de la lesión (p < 0,001). Las variables mencionadas se mantuvieron estadísticamente significativas, luego del análisis multivariado, excepto el compromiso neurológico. Conclusiones: En este estudio multicéntrico de víctimas de lesiones vertebrales por proyectil de arma de fuego, la mayoría recibió tratamiento no quirúrgico, a pesar de la lesión neurológica en el 76% y la lesión en la columna en el 63% de los pacientes. Introduction and objective: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. Material and methods: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. Results: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. Conclusions: In this multicenter study of spinal gunshot victims, most were treated nonsurgically, despite neurological injury in 76% and spinal injury in 63% of patientsPublication Predicting early complications in patients with spinal gunshot wounds: A multicenter study(2024) Ricciardi, Guillermo; Cabrera, Juan; Martínez, Oscar; Matta, Javier; Vilchis, Hugo; Perez, Jeasson; Carazzo, Charles; Dittmar, Michael; Yurac, Ratko; AO Spine Latin America Trauma Study GroupIntroduction: There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research question: we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methods: This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. Results: Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67). Discussion and conclusion: Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.Publication Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm(2024) Cirillo, Juan; Ricciardi, Guillermo; Alvarez, Facundo; Guiroy, Alfredo; Yurac, Ratko; Schnake, KlausIsolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.