Systematic review and meta-analysis. To compare early (24 h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the «forest plot» graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events.Five studies showed significant differences in favour of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. There is scientific evidence to recommend early decompression in the first 24 h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). The average vertebra volume was 26.1 cc, the average volume of the injected cement was 2.0 cc and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

Post-operative lumbar pain is related to alterations in the sagittal and spinopelvic parameters. A lumbar fusion that fails to maintain, or that worsens the physiological lordosis alters the sagittal balance. Objective: To analyze spinopelvic variation in different surgical positions. Methods: A prospective, analytical and comparative study of spinograms, lumbosacral radiographs in the surgical position over a 4-pole quadratus lumborum, and lumbosacral radiographs with quadratus lumborum and support in the knees. A sample of 129 patients, of both sexes, aged between 18 and 60 years, and presenting with lower back pain. Lumbar Lordosis (LL), Pelvic Tilt (PT), Pelvic Incidence (PI) and Sacral Slope (SS) were measured. Results: PI was the most stable parameter. With quadratus lumborum, a slight increase in PT, a decrease in SS and a significant reduction in LL were found. With quadratus lumborum and support in the knees, a decrease in PT and a slight increase in SS were found, while the LL value remained similar to that of the spinogram. Conclusion: The intraoperative position with hip flexion of between 40° and 45° over quadratus lumborum reduced LL to 10.52° in men and 16.21° in women, increased PT, and decreased SS. The intraoperative position with hip flexion of between 0° and 10° showed the same values as the reference spinogram. Level of Evidence II; Prospective comparative study.

Diseño de Estudio: Revisión sistemática y metaanálisis. Objetivo: Comparar descompresión medular precoz (< 24 horas) versus tardía (> 24 horas) en la recuperación neurológica de pacientes con lesión medular aguda. Métodos: Se realizó una revisión sistemática según el protocolo de PRISMA para identificar estudios publicados hasta diciembre de 2022. Se incluyeron sólo estudios de cohorte prospectivos y ensayos controlados que comparan la descompresión precoz versus tardía en la recuperación neurológica. Como variables se incluyeron el número de pacientes, nivel lesionado, tiempo de tratamiento, grado de ASIA, recuperación neurológica, uso de corticoesteroides y complicaciones. Para el metaanálisis se desarrolló el gráfico “forest plot”. El riesgo de sesgo de los estudios incluídos se evaluó utilizando la herramienta ROBINS-I22 y Rob223. Resultados: Seis de los siete estudios seleccionados para nuestra revisión fueron incluídos en el metaanálisis, con un total de 1.188 pacientes (592 pacientes en el grupo de descompresión precoz y 596 en el grupo de descompresión tardía), el promedio de seguimiento fue de 8 meses, en 5 estudios utilizaron metilprednisolona, las complicaciones mayormente reportadas fueron los eventos cardiopulmonares tromboembólicos. Cinco estudios mostraron diferencias significativas a favor de la descompresión precoz (diferencia de riesgo 0.10, intervalo de confianza 95% 0.07-0.14, heterogeneidad 46%). El beneficio fue mayor en las lesiones cervicales e incompletas. Conclusiones: Existe evidencia científica para recomendar la descompresión precoz en las primeras 24 horas tras la lesión medular traumática al mejorar la recuperación neurológica final, y debe recomendarse siempre que las condiciones del paciente y el hospital permitan hacerlo con seguridad. Study Design: Systematic review and meta-analysis. Objective: To compare early (24 hours) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. Methods: A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. Prospective cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the “forest plot” graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. Results: Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1,188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events. Five studies showed significant differences in favor of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. Conclusion: There is scientific evidence to recommend early decompression in the first 24 hours after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

IntroducciónLa infección posquirúrgica en la columna lumbar es desafortunadamente común, multifactorial y una complicación potencialmente devastadora, que se asocia a un incremento de la morbilidad y la necesidad de futuras cirugías, y en última instancia, puede ser mortal. Con la intención de disminuir la morbilidad posquirúrgica, la medicación y los días de internación, comenzamos a utilizar aloinjerto fresco congelado de cabeza femoral de donantes vivos, en la artrodesis lumbar corta. El objetivo de este estudio fue comparar el índice de infección en la artrodesis lumbar corta en pacientes con aloinjerto fresco congelado y con autoinjerto.Materiales y MétodosEstudio retrospectivo de 153 pacientes divididos en dos grupos: grupo A: 84 pacientes con autoinjerto de cresta ilíaca y grupo B: 69 pacientes con aloinjerto fresco congelado, desde marzo de 2009 hasta enero 2014, sometidos cirugía instrumentada de fusión espinal lumbar posterolateral.ResultadosTres de los 153 pacientes operados se perdieron en el seguimiento (2 del grupo A y 1 del grupo B) y la muestra incluyó 150 pacientes (82 del grupo A y 68 del grupo B). Se produjeron tres infecciones por Staphylococcus aureus sensible a la meticilina, todas en el grupo A (4,5%). Ningún paciente de los dos grupos necesitó transfusión.ConclusionesEl uso de aloinjerto fresco congelado en las cirugías de columna lumbar posterolateral de causa degenerativa no se asocia a un aumento en la tasa de infección. Consideramos que el aloinjerto fresco congelado es una excelente alternativa, porque disminuye el tiempo quirúrgico y de hospitalización.