Person: Yurac, Ratko
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Yurac
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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 Spinal gunshot wounds: A retrospective, multicenter, cohort study(2023) Ricciardi, G.; Martinez, O.; Cabrera, J.; Matta, J.; Davila, V.; Jiménez, J.M.; Vilchis, H.; Tejerina, V.; Pérez, J.; Cabrera, J.P.; Yurac, RatkoIntroduction 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 n=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 (n=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 non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.Publication Time to Surgery for Subaxial Cervical Fractures: A Multicenter Study(2025) Quinteros, Guisela; Ricciardi, Guillermo; Cirillo, Ignacio; Marquez, Edgar; Cabrera, Juan; Carazzo, Charles; Yurac, Ratko; Guiroy, AlfredoObjective: To identify delays for surgery to stabilize subaxial cervical fractures and the main reasons for them across Latin America. Methods: This is a retrospective multicenter cohort study of patients surgically treated for subaxial cervical fractures from 13 spine centers across Latin America from January 1, 2014 to January 1, 2023. Causes of delay to surgery beyond 24 hours were documented. Results: We included 529 patients from 13 institutions in Latin American countries; 408 (77.1%) males and 121 (22.9%) females with a mean age of 43.4 (standard deviation = ±16.2). Predominantly caused by traffic accident (n = 256; 48.4%), followed by fall from height (n = 233; 44%). Mostly, suffered type C fractures (n = 348; 65.8%) and/or neurological injury (n = 384; 72.6%). The time from admission to surgery was >72 hours in 70% of the patients included (n = 375; 70.9%). More than 45% waited longer than a week (n = 257; 48.6%) for spine surgery. Only 12.5% (n = 66) of the patients received surgery in the first 24 hours from admission. The primary reasons for the surgical delay were the necessity for other surgical procedures (n = 161; 34.8%), the unavailability of surgical implants (n = 60; 13.0%), patient clinical instability (n = 55; 11.9%), and delays in referral (n = 38; 8.2%). Conclusions: We documented significant and concerning delays in providing spinal decompression and stabilization surgery to patients with cervical spine fractures. Only 17% of patients have surgery in the recommended time <24 hours, more than half of the patients must wait for more than 72 hours, and nearly half of patients wait for longer than a week.