Percutaneous vertebroplasty (PVP) has emerged as a key intervention for painful vertebral compression fractures in osteoporotic and metastatic disease, but its safety profile warrants comprehensive evaluation. We conducted a PRISMA-compliant systematic review of studies published between 2009 and 2024, identifying 15 clinical studies (n ≈ 8500 patients) that reported PVP-related complications in adults with osteoporotic or neoplastic fractures. Data extraction focused on complication incidence, presentation, imaging findings, risk factors, and management strategies. Cement leakage was the most frequently detected event (20–70% of levels, higher in neo-plastic lesions), yet symptomatic neural or vascular sequelae occurred in <1%. Pulmonary cement embolism appeared on imaging in 2–26% of cases but was clinically evident in ≤0.5%, with conservative management or brief anticoagulation sufficing for most patients. New vertebral fractures developed in 8–20% of osteoporotic and up to 30% of metastatic cohorts, paralleling underlying bone fragility rather than PVP itself. Postprocedural infection (0.2–0.5%) and neurologic injury (<0.5%) were uncommon but required prompt surgical and antibiotic interventions. Overall, PVP’s benefits—rapid pain relief and mechanical stabilization—outweigh its risks when performed with meticulous technique, vigilant imaging, and multidisciplinary follow-up, confirming its favorable safety profile in both osteoporosis and spinal malignancy.

Objective: Intramedullary melanocytomas are extremely rare spinal cord tumors with distinct histopathological and imaging characteristics. This report reviews the literature on this pathology and presents a representative case study, highlighting aspects of diagnosis and management. Methods: A scoping review of PubMed, Web of Science, and Embase databases was conducted to identify reports on intramedullary melanocytomas, focusing on clinical presentation, imaging features, histopathology, treatment, and outcomes. Case reports and case series were included due to the rarity of these tumors. Results: Twelve manuscripts met the inclusion criteria, including 15 patients. In the majority of patients, intramedullary melanocytomas present with progressive myelopathy and pain. Most common MRI findings include hyperintensity on T1-weighted images, iso- to hypointensity on T2-weighted images, and homogeneous contrast enhancement. Intralesional cysts and associated syrinx are common. Gross total resection (GTR) remains the primary treatment, but complete removal is often challenging due to tumor adherence to neural structures. Conclusions: Intramedullary melanocytomas require careful diagnosis and management due to their diagnostic overlap with malignant melanoma and potential for recurrence. While GTR is the mainstay of treatment, long-term surveillance is warranted due to high recurrence rates. Further research is needed to define the natural history of the disease and establish optimal therapeutic strategies.

Introducción. La COVID-19 se manifiesta en el 80% casos de forma leve, sin embargo, en 5% progresa a enfermedad severa con necesidad de manejo en unidad de cuidados intensivos (UCI). Objetivo. Identificar los factores demográficos, clínicos y de tratamiento asociados a la mortalidad en pacientes con COVID-19 atendidos en la UCI de un hospital de cuarto nivel de atención de Medellín, Colombia. Materiales y métodos. Estudio de cohorte retrospectivo. Se analizaron las historias clínicas de 182 pacientes admitidos en UCI por COVID-19 entre marzo y diciembre de 2020. Se realizaron análisis bivariados (pruebas de chi-cuadrado, exacta de Fisher, t de Student no pareada o U de Mann-Whitney) para evaluar la asociación entre, por un lado, características demográficas, presencia de enfermedades coexistentes, resultados de laboratorios, intervenciones terapéuticas, requerimiento de soporte ventilatorio y hemodinámico, y, por otro, mortalidad. Además, se realizó un análisis multivariado en el que se construyeron regresiones logísticas binarias simples y múltiples, calculando RR crudos y ajustados. Se consideró un nivel de significancia de p<0.05. Resultados. La mortalidad fue de 47.80%. En el análisis multivariado, los siguientes factores se comportaron como factores protectores: edad <60 años (RRa: 0.154, IC95%:0.059-0.401; p=0.000), uso de vasopresores (RRa 0.082, IC95%:0.021–0.319; p<0.001) y uso de terapia de remplazo renal (RRa: 0.205, IC95%:0.059–0.716; p=0.013). La no realización de traqueostomía se asoció como factor de riesgo (RRa: 14.959, IC95%:4.865-45.998; p<0.001). El conteo más bajo de plaquetas registrado durante la estancia en UCI tuvo un efecto neutro pero fue una variable cuantitativa significativamente asociada (RRa: 0.999, IC95%:0.990-0.999; p=0.003). Conclusiones. En el presente estudio, tener menos de 60 años, el uso de vasopresores y de terapia de remplazo renal se comportaron como factores protectores, mientras que la no realización de traqueostomía se comportó como factor de riesgo para mortalidad. Además, el conteo más bajo de plaquetas registrado durante la estancia en UCI fue una variable cuantitativa significativamente asociada.