The document discusses anterior lumbar interbody fusion (ALIF) for treating lumbar conditions such as degenerative disc disease and spondylolisthesis. It provides several key points in 3 sentences:
ALIF is superior to transforaminal lumbar interbody fusion (TLIF) in restoring foraminal height, local disc angle, and lumbar lordosis. However, clinical outcomes are similar between ALIF and TLIF. While ALIF provides advantages, it also has risks such as vascular injury that require preoperative evaluation and careful technique to avoid complications.
Ejercicios en un Sindrome de Hombro DolorosoPablo Vollmar
Ejercicios De Codman y de Estiramientos en un cuadro de SX doloroso del Hombro ya sea por lesióen de algún músculo del Manguito Rotador, en especial del supraespinoso que es el que más se afecta.
Por la Dra. María Valdazo, Especilista en Traumatología y Medicina Física y Rehabilitación.
Ejercicios en un Sindrome de Hombro DolorosoPablo Vollmar
Ejercicios De Codman y de Estiramientos en un cuadro de SX doloroso del Hombro ya sea por lesióen de algún músculo del Manguito Rotador, en especial del supraespinoso que es el que más se afecta.
Por la Dra. María Valdazo, Especilista en Traumatología y Medicina Física y Rehabilitación.
Programa del miercoles 26 de Septiembre de 2012
Subiremos aqui las ponencias del dia, estan protegidas por contraseña por lo que sólo los asistentes al Congreso tienen acceso. Puedes inscribirte aqui:
http://www.seeic2012.com/index.php/inscripcion-y-alojamiento/inscripcion
XLIF is a minimally invasive approach towards removing degenerated discs in the lumbar spine and fusing them in a minimally invasive manner. If you or someone you know may benefit from a XLIF feel free to contact us 1-8SPINECAL-1, doctor@beverlyspine.com, doctor@santamonicaspine.com or via the internet www.santamonicaspine.com or www.beverlyspine.com
Case Review #24: 67 year old female with Degenerative ScoliosisRobert Pashman
67 year old female presented with DeNovo Scoliosis, with significant rotation due to Adolescent Idiopathic Scoliosis. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. KIM/SRP Classification 2.
Treatment of spinal tuberculosis - presented at the Postgraduate teaching course held at KEM Hospital, Mumbai in March 2016.
The talk highlights steps in diagnostic workup and treatment algorithm for management of spinal tuberculosis.
Please see notes attached to clinical slides. They contain details about clinical presentation and treatment approach chosen for the case presented
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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2. 100 millones de pacientes al año en
u.s.a.
La causa es el disco intervertebral en un
40 %
Entre 1,5 a 4 millones de pacientes con
enfermedad discal
degenerativa(DDD)tienen dolor lumbar
que fallan al manejo conservador y
requieren cirugia
3. MANEJO EFECTIVO PARA DOLOR
LUMBAR
SE ELIMINA EL DISCO COMO CAUSA DE
DOLOR.
RESTAURA ANATOMIA NORMAL(ALTURA
DISCAL,DIAMETRO FORAMINAL,BALANCE
SAGITAL)
7. Journal of Neurosurgery: Spine
October 2007 / Vol. 7 / No. 4 / Pages 379-386
CLINICAL ARTICLESAnterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the
restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance
Patrick C. Hsieh, M.D.,
Tyler R. Koski, M.D.,
Brian A. O'Shaughnessy, M.D.,
Patrick Sugrue, M.D.,
SeanSalehi, M.D.,
Stephen Ondra, M.D., and
John C. Liu, M.D.
CONCLUSIONS
The ALIF procedure is superior to TLIF in its capacity to
restore foraminal height, local disc angle, and lumbar
lordosis. The improved radiographic outcomes may
be an indication of improved sagittal balance
correction, which may lead to better long-term
outcomes as shown by other studies. Our data,
however, demonstrated no difference in clinical
outcome between the two groups at the 2-year
follow-up.
8.
9. Journal of Neurosurgery: Spine
February 2010 / Vol. 12 / No. 2 / Pages 171-177
ARTICLEWhich lumbar interbody fusion technique is better in terms of level for the
treatment of unstable isthmic spondylolisthesis?
Clinical article
CONCLUSIONS
Considering the clinical and radiological
outcomes in both groups, the authors
recommend that instrumented mini-TLIF is
preferable at the L4–5 level, whereas
instrumented mini-ALIF might be preferable at
the L5–S1 level for the treatment of unstable
isthmic spondylolisthesis.
10. Journal of Neurosurgery: Spine
July 2007 / Vol. 7 / No. 1 / Pages 21-26
CLINICAL ARTICLESComparison of anterior- and posterior-approach
instrumented lumbar interbody fusion for spondylolisthesis
Jun-Hong Min, M.D., Ph.D.1,
Jee-Soo Jang, M.D., Ph.D.1, and
Sang-Ho Lee, M.D., Ph.D.2
CONCLUSIONS
Both ALIF and PLIF can produce good
outcomes in treating lumbar
spondylolisthesis, but ALIF is more
advantageous in preventing the
development of ASD.
11.
12. MAYOR EXPOSICION DE LA COLUMNA ANTERIOR.
MENOS SANGRADO CON MENOR RETRACCION
MUSCULAR.
REDUCCION TIEMPO QUIRURGICO
POSIBILIDAD DE MAYOR DISTRACCION Y CORRECION
DE DEFORMIDADES
USO DE CAJAS DE MAYOR DIAMETRO
MEJOR BALANCE SAGITAL .
NO SE MANEJA DIRECTAMENTE ESTRUCTURAS
NERVIOSAS
DESCOMPRESION INDIRECTA
SE RESPETA BANDA DE TENSION POSTERIOR
13. Incision pequeña
Diseccion roma con preservacion de
musculos abdominales
Retractores fijos que protegen las
estructuras
Se puede obtener exposicion mayor de
forma rapida en caso de emergencia
Buena tasa de fusion
Buenos resultados clinicos
Menor taza de complicaciones
14. Curva de aprendizaje
Se requiere entrenamiento microquirurgico
Limitado a l2-s1
Limitado a patologia mono o
bisegmentarias
Abordage lateral a l5-s1 no es posible
Riesgo de lesion a estructuras cerca del
area quirurgica
No posibilidad de reduccion activa
Instrumentacion por via anterior limitada
15. ENFERMEDAD DEGENERATIVA DISCAL
ESPONDILOLISTESIS DEGENERATIVA
SINDROME DE CIRUGIA LUMBAR FALLIDA
ESPONDILOLISTESIS ITSMICA
ESTENOSIS LUMBAR CON INESTABILIDAD
SEGMENTARIA
FRACTURAS
ESPONDILODISCITIS
REMOCION DE UN IMPLANTE
PSEUDOARTROSIS
16. NO HAY CONTRAINDICACION ABSOLUTA
CONTRAINDICACION RELATIVAS:
-CIRUGIA GINECOLOGICA O ABDOMINAL PREVIA
-CONFLUENCIA VENOSA O ARTERIAL EN FRENTE DE
SEGMENTO A TRABAJAR
-ABCESO EN PSOAS CON TEJIDO DEGRANULACION
PREVERTEBRAL
-OBESIDAD MORBIDA
-ENFERMEDADES DEL TRACTO GASTROINTESTINAL
-CIRUJANO VASCULAR
LOCALIZABLE,FUNDAMENTALMENTE EN CASO DE
REVISION
17.
18. ESTUDIOS BIOMECANICOS SUGIEREN QUE CAJAS TIPO ALIF STAND
ALONE NO PROPORCIONAN ADECUADA ESTABILIDAD.
LA ESTABILIDAD INICIAL ES PROPORCIONADA POR LAS FUERZAS
COMPRESIVAS DEL ANILLO FIBROSO RESTANTE.
LA FUERZA COMPRESIVA SOBRE LA CAJA ES PROPORCIONAL A
LA DISTRACCION QUE SE OBTIENE,PERO ESTA FUERZA DE
DISTRACCION DISMINUYE RAPIDAMENTE EN MAS DE UN 20 % EN
LOS PRIMEROS 15 MINUTOS POR LA RELAJACION DE TEJIDOS
BLANDOS.
EXCESIVA DISTRACCION DEL ESPACIO DISCAL AFECTA LA UNION
FACETARIA Y LA ALINEACION ESPINAL RESULTANDO EN PERDIDA
DE LA RIGIDEZ SEGMENTARIA E HIPERMOVILIDAD EN EXTENSION.
LAS CARGAS COMPRESIVAS EXTERNAS SOBRE LA CAJA
DEPENDEN DEL PESO CORPORAL Y LA ACTIVIDAD MUSCULAR Y
VARIAN A LO LARGO DEL DIA POR LO QUE ES RECOMENDABLE
UNA ESTABILIZACION ADICIONAL PARA PERMITIR UNA MAYOR
ESTABILIDAD DE LAS CAJAS
19. DESARROLLO DE CAJAS CON PLACAS
Y/0 TORNILLOS PARA REFORZAR BANDA
DE TENSION ANTERIOR,CON RESULTADOS
SIMILARES EN FLEXION,EXTENSION Y
MOVIMIENTOS LATERALES Y SUPERIORES
EN ROTACION
1-2 NIVELES
ENFERMEDAD DEGENERATIVA DISCAL
ESPONDILOLISTESIS GRADO 1
20. NO USAR PLACA ANTERIOR SI BIFURCACION DE LOS
VASOS ILIACOS ES MUY BAJA O LOS GRANDES
VASOS ESTAN DIRECTAMENTE FRENTE A LA
COLUMNA(L1-L2,L3-L4).
SE PUEDE COMBINAR LA PLACA ANTERIOR CON
INSTRUMENTACIONPOSTERIOR PARA HACER MAS
RIGIDA LA FIJACION(INESTABILIDAD LUMBOSACRA
IMPORTANTE,CON IMPORTANTE DESPLAZAMIENTO
DE LISTESIS EN RADIOGRAFIAS
DINAMICAS,PSEUDOARTROSIS,LISTESIS GRADO 1)
NO USAR PLACAS ANTERIORES EN
ESPONDILOLISTESIS GRADO II-V Y EN OSTEOPOROSIS
21.
22.
23.
24.
25.
26.
27.
28.
29.
30. MOVILIZACION A LAS 8 HORAS
NO CORSET
FAJA LUMBAR
PUEDE SENTARSE
ALIMENTACION CUANDO PRESENTE
RUIDOS HIDROAEREOS.
EVITAR FLEXION
35. Sacral fractures following stand-alone L5–S1 anterior lumbar interbody fusion for
isthmic spondylolisthesis Report of 3 cases Jeffrey F. Lastfogel, B.S., Thomas J.
Altstadt, M.D., Rich
Report of 3 cases
Treatment of Grade I isthmic spondylolisthesis
at L5–S1 with stand-alone ALIF and fixation can
lead to sacral fracture from high stress loads at
that level in the spine, and consideration
should be made either for supplemental
pedicle screw fixation or a completely posterior
approach. (DOI: 10.3171/2010.3.SPINE09366)
ard B. Rodgers, M.D., and Eric M. Horn, M.D.,
Ph.D.
36.
37.
38.
39. CONOCER LAS POSIBLES COMPLICACIONES Y COMO
EVITARLAS.
EL USO DE CAJAS TIENE MAYOR INDICE DE FUSION QUE LOS
ALOINJERTOS.VALORAR USO DE PROTEINA MORFOGENETICA.
LA LESION VENOSA ES LA MAS FRECUENTE,AUNQUE LA MAS
PELIGROSA ES LA ARTERIAL.DESCARTAR
PREOPERATORIAMENTE CLAUDICACION VASCULAR.
EVITAR ILEO POSQUIRURGICO INICIANDO ALIMENTACION
CON PRESENCIA DE RUIDOS HIDROAEREOS Y EXPULSION DE
GASES.EVITAR NARCOTICOS .
INCLUIR EL ALIF DENTRO DE NUESTRO PORTAFOLIO
QUIRURGICO YA QUE ES UN METODO SUPERIOR PARA
RESTAURAR ALTURA FORAMINAL Y LORDOSIS FOCAL.