Publications by authors named "Matías Pereira-Duarte"

13 Publications

  • Page 1 of 1

Symptomatic Atlas Hypoplasia in a Latin-American Patient: Case Report and Literature Review.

J Am Acad Orthop Surg Glob Res Rev 2021 05 4;5(5):e21.00041. Epub 2021 May 4.

From the Hospital Italiano de Buenos Aires, Spinal Pathology Service, Almagro, CABA, Argentina. Orthopedic Institute "Prof. Dr. Carlos E. Ottolengui", Adult Spine Pathology Service, Hospital Italiano de Buenos Aires, CABA, Argentina.

Background: Atlas hypoplasia is an infrequent cause of upper cervical stenosis. Only 24 cases in nonsyndromic adult population have been published. We are not aware of previous reports describing isolated fully formed atlas hypoplasia in a Latin-American patient. The purpose of this work was to report a case of an 80-year-old Argentinian woman with cervical myelopathy because of atlas hypoplasia and a literature review about this subject.

Methods: A clinical case and an extended review of the literature are presented. We assessed from each case: age, sex, posterior atlanto-dens interval, surgical treatment, outcomes, and follow-up period.

Results: Neurologic symptoms markedly improved after posterior decompression from severe to moderate in the Japanese Orthopaedic Association Scoring System and from four to three on the Nurick scale. Twenty-five patients were analyzed (mean 58.4 years, 32% female). The mean posterior atlanto-dens interval was 8.8 mm. Twenty-three patients underwent decompression alone, and two needed posterior fusion. All patients reported clinical improvement at an average follow-up of 13 months.

Conclusion: Cervical myelopathy caused by fully formed atlas hypoplasia is not an exclusive pathology of far east population, and it may present in nonsyndromic patients. Surgical treatment by C1 laminectomy improved neurologic impairment.

Study Design: Case report and literature review.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099396PMC
May 2021

La Frailty as a predictor index in spine surgery

Rev Fac Cien Med Univ Nac Cordoba 2021 03 12;78(1):9-16. Epub 2021 Mar 12.

Hospita Italiano de Buenos Aires.

Introduction: Frailty is a term used to quantify the physiological age of patients. Higher levels of frailty correlate with higher complications and mortality rates after different surgical procedures. The objective of this work is to evaluate the relationship between frailty and the complications and mortality rates after elective spinal surgeries within 90 days.

Material And Methods: A retrospective observational analytical study of patients older than 18 years with elective spine surgery was performed. The following variables were analyzed differentially according to their Modified Frailty Index (mFI) with a cut-off point of 0,18: age, sex, body mass index, ASA score, details of the procedures, length of stay, complications, unscheduled rehospitalizations, reoperations, and mortality within 90 postoperative days.

Results: 257 patients were included. Within the 30 complications, 16 occurred in the non-frail group (8%) and 14 in frail patients (24.5%), (p = 0.02). Six complications were infectious in the group of frail patients (10.5%) and 4 in the non-frail patients (2%), (p = 0.009). No significant differences were detected regarding the duration of surgeries, the length of stay or the reoperations, re-hospitalizations or mortality rates.

Conclusion: Patients with a modified Frailty Index ≥0,18 who underwent elective spine surgery were 3 times more likely to present complications, particularly, infectious ones.
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http://dx.doi.org/10.31053/1853.0605.v78.n1.30371DOI Listing
March 2021

Neurosurgery versus orthopedic surgery: Who has better access to minimally invasive spinal technology?

Surg Neurol Int 2020 11;11:385. Epub 2020 Nov 11.

Department of Medicine, University of Caxias do Sul, Rio Grande do Sul, Brasil.

Background: Our aim was to evaluate differences in neurosurgeons versus orthopedists access to technologies needed to perform minimally invasive spine surgeries (MISS) in Latin America.

Methods: We sent a survey to members of AO Spine Latin America (January 2020), and assessed the following variables; nationality, level of hospital (primary, secondary, and tertiary), number of spinal operations performed per year, spinal pathologies addressed, the number of minimally invasive spine operations performed/year, and differences in access to MISS spinal technology between neurosurgeons and orthopedists.

Results: Responses were returned from 306 (25.6) members of AO Spine Latin America representing 20 different countries; 57.8% of respondents were orthopedic surgeons and 42.4% had over 10 years of experience. Although both specialties reported a lack of access to most of the technologies, the main difference between the two was greater utilization/access of neurosurgeons to operating microscope (e.g., 84% of the neurosurgeons vs. 39% of orthopedic spine surgeons).

Conclusion: Although both specialties have limited access to MISS spinal technologies, orthopedic spine surgeons reported significantly lower access to operating microscopes versus neurosurgeons ( < 0.01).
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http://dx.doi.org/10.25259/SNI_600_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771484PMC
November 2020

Chylothorax, a rare complication after anterior lumbar interbody fusion. Case report

Rev Fac Cien Med Univ Nac Cordoba 2020 12 21;77(4):381-384. Epub 2020 Dec 21.

Hospital Italiano de Buenos Aires.

Introduction: Chylous leakage into the retroperitoneum is a rare complication after spinal surgery using an anterior retroperitoneal approach. Chylothorax is the presence of lymphatic fluid in the pleural cavity and it is even less frequent during these surgeries. The aim of this work is to report the first case of isolated left chylothorax after a retroperitoneal Left Oblique Lumbar Interbody Fusion in supine position in an adult female patient.

Case: A female 30-years-old patient underwent L4-L5 anterior interbody fusion. Four days after the intervention she was diagnosed with isolated left chylothorax that was drained and treated conservatively with good outcomes.

Conclusion: Chylothorax is an extremely rare complication after anterior lumbar spine procedures, and it is usually secondary to a chyloretroperitoneum. We present a unique case of isolated chylothorax after anterior retroperitoneal lumbar approach successfully treated in a conservative manner. Key Words chylothorax; spine; lumbosacral region; arthrodesis.
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http://dx.doi.org/10.31053/1853.0605.v77.n4.27982DOI Listing
December 2020

Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities.

Global Spine J 2021 May 13;11(4):480-487. Epub 2020 Mar 13.

Institute of Orthopedics "Carlos E. Ottolenghi" 37533Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Study Design: Diagnostic study, level of evidence III.

Objectives: Low back pain is a common cause of disability among elderly patients. Percutaneous discoplasty has been developed as a tool to treat degenerative disease when conservative management is not successful. Indications for this procedure include low back pain and the presence of vacuum phenomenon. The objective of this study was to describe a new classification of vacuum phenomenon based on computed tomography scan in order to improve the indications for percutaneous discoplasty.

Methods: We developed a classification of vacuum phenomenon based on computed tomography scan images. We describe 3 types of vacuum based on the relationship between vacuum and the superior/inferior endplates and 2 subtypes based on the presence of significant subchondral sclerosis. A validation study was conducted selecting 10 orthopedic residents with spine surgery training to analyze 25 vacuum scenarios. Inter- and intraobserver reliabilities were assessed through the Fleiss's and Cohen's kappa statistics, respectively.

Results: The overall Fleiss's κ value for interobserver reliability was 0.85 (95% CI 0.82-0.86) in the first reading and 0.93 (95% CI 0.92-0.95) in the second reading. Cohen's κ for intraobserver reliability was 0.88 (95% CI 0.77-0.99).

Conclusion: The new classification has shown almost perfect inter- and intraobserver reliabilities for grading the vacuum phenomenon and could be an important tool to improve the indications for percutaneous cement discoplasty.
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http://dx.doi.org/10.1177/2192568220913006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119922PMC
May 2021

Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis.

Global Spine J 2020 Sep 6;10(6):729-734. Epub 2019 Sep 6.

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Study Design: Retrospective analysis. Level of evidence III.

Objectives: To describe the results after a minimum 1-year follow-up in patients treated with percutaneous discoplasty (PD), a minimally invasive technique to treat low back pain in elderly patients with advanced degenerative disc disease. The procedure consists in improving stability by injecting bone cement in a severely degenerated pneumodisc. There are few reports in the literature about this technique.

Methods: Fifty-four patients with advanced disc disease with/without degenerative scoliosis treated with PD with at least 1 year follow-up were studied, variables included clinical (visual analogue scale [VAS] and Owestry Disability Index [ODI]) and radiological parameters (lumbar lordosis and Cobb angle), as well as hospital length of stay and complications.

Results: At 1-year postoperation, significant pain reduction (VAS: preoperative 7.8 ± 0.90; postoperative 4.4 ± 2.18) and improvement in the ODI (preoperative 62 ± 7.12; postoperative 36.2 ± 15.47) were observed with partial correction of radiological parameters (5° mean increase in lumbar lordosis and decrease in Cobb angle). Mean surgical time was 38 minutes, and the mean length of hospital stay was 1.2 days.

Conclusion: PD, currently not a very well-known technique, appears to be-at least in the short-term follow-up-an effective treatment option in selected cases with low back pain due to advanced degenerative disc disease.
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http://dx.doi.org/10.1177/2192568219873885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383797PMC
September 2020

[Vertebral cryptococosis. Case report and literature review].

Rev Chilena Infectol 2019 Oct;36(5):656-662

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.
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http://dx.doi.org/10.4067/S0716-10182019000500656DOI Listing
October 2019

Preliminary outcomes of proximal femur megaspacers.

Arthroplast Today 2019 Jun 16;5(2):164-171. Epub 2019 Mar 16.

Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, CABA, Argentina.

There are very few therapeutic alternatives for patients with proximal femoral epiphyseal bone deficit combined with a fracture at another level and signs of infection. This combination can be successfully managed with a proximal femur megaspacer. This article is intended to review our variation of this technique and to show the initial results obtained from 11 cases. Of these 11 cases, there were 6 women and 5 men. The mean age was 66 years. The average number of previous surgeries was 3. Definitive prosthetic reconstructive treatment was achieved in 7 of these 11 subjects. The average time to reimplantation was 11.7 months. Fractures or nonunion healed uneventfully. Bone union and infection control were achieved in 10 of the 11 patients.
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http://dx.doi.org/10.1016/j.artd.2018.09.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588803PMC
June 2019

Infected Baker's Cyst: A New Classification, Diagnosis and Treatment Recommendations.

J Orthop Case Rep 2018 Nov-Dec;8(6):16-23

Department of Orthopaedics, Hospital Italiano de Buenos Aires, Servicio de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi", Ciudad Autónoma de Buenos Aires, Argentina.

Introduction: Baker's cyst has a high prevalence in adult population. Despite being usually asymptomatic, cyst complications may develop, such as an infection, rupture and content dissemination into the calf. This clinical presentation has a low incidence with few reports in the literature. We have not found any publication describing a systematic approach for its treatment. The purpose of this study is to propose a new classification, diagnosis, and treatment recommendations based on a case report and a literature review to guide physicians on the best course of treatment.

Case Report: A 53-year-old man presented with sudden left popliteal pain associated with progressive knee and calf swelling and limited knee flexion. After the initial evaluation, a Baker's cyst rupture and dissemination into the calf, associated with a septic arthritis, were diagnosed. An arthroscopic surgical irrigation of the knee and open debridement of the calf collection were performed.

Conclusion: Our classification may allow an accurate and structured description of the different stages of Baker's cyst presentations, with simplification of the clinical description, diagnosis, and treatment approaches.
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http://dx.doi.org/10.13107/jocr.2250-0685.1238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424320PMC
March 2019

Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients.

Eur Spine J 2018 Mar 23. Epub 2018 Mar 23.

Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Potosi, 4215, Buenos Aires, Argentina.

Purpose: The authors describe a percutaneous technique to treat advanced degenerative disk disease in elderly patients.

Method: A step-by-step technical description based on our experience in selected cases.

Result: Postoperative imaging results are presented as well as indications and recommendations.

Conclusion: Percutaneous discoplasty can result as an alternative minimal invasive strategy for the treatment of advanced degenerative disk disease.
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http://dx.doi.org/10.1007/s00586-018-5547-7DOI Listing
March 2018

Volar Plate Fixation in Patients Older Than 70 Years with AO Type C Distal Radial Fractures: Clinical and Radiologic Outcomes.

J Wrist Surg 2017 Aug 6;6(3):194-200. Epub 2017 Jan 6.

Department of the Hand and Upper Extremity, Instituto de Ortopedia y Traumatología "Dr. Prof. Carlos Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

 Treatment of unstable distal radial fractures (DRFs) in elderly patients is controversial, and considering the increasing life expectancy, their appropriate treatment is of growing importance. Our aim was to analyze the clinical and radiologic outcomes in the elderly patients with AO type C DRF treated with volar locking plate (VLP).  Between 2007 and 2011, 572 DRFs were operated on in our hospital with open reduction and internal fixation with VLP. Of these, only 64 patients (66 DRFs) met the selection criteria (AO type C DRF, age > 70 years, minimum 12-month follow-up). Mean follow-up was 28 months. Outcome assessment included range of motion, grip strength, VAS pain, Mayo Clinic Score, and DASH score. Analysis of pre- and postoperative radiographs was performed. Complications were recorded. Statistical analysis was performed comparing the results with the contralateral side.  Mean postoperative range of motion of the injured wrist compared with the control contralateral side was 86% for flexion (  < 0.001), 92% for extension (  < 0.001). The average DASH was 12. Mayo Clinic Wrist Score showed 43 excellent results, 15 good, 4 satisfactory, and 4 poor. Articular step-offs were reduced in 34 of 38 wrists. Five (7%) patients required plate removal.  The treatment of articular DRF (AO type C) with VLP in the elderly patients achieved greater than 90% of the wrist range of motion and grip strength with no residual pain in greater than 90% of the patients.  Therapeutic IV, case series.
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http://dx.doi.org/10.1055/s-0036-1597923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515619PMC
August 2017