[et_pb_section fb_built=\u00bb1″ custom_padding_last_edited=\u00bbon|desktop\u00bb admin_label=\u00bbHeader\u00bb _builder_version=\u00bb4.16″ background_enable_image=\u00bboff\u00bb background_size=\u00bbcontain\u00bb background_position=\u00bbtop_right\u00bb custom_padding=\u00bb11px||31px||false|false\u00bb custom_padding_tablet=\u00bb2px|0px|50px|0px|false|false\u00bb custom_padding_phone=\u00bb3px|0px|50px|0px|false|false\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row _builder_version=\u00bb4.16″ max_width=\u00bb1280px\u00bb custom_margin=\u00bb-11px|auto||auto||\u00bb custom_padding=\u00bb8px||2px|||\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb collapsed=\u00bbon\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.20.1″ _module_preset=\u00bbdefault\u00bb text_font=\u00bb|700|||||||\u00bb text_font_size=\u00bb16px\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Acceso abierto<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=\u00bb4.16.0″ _dynamic_attributes=\u00bbcontent\u00bb text_font=\u00bbEB Garamond||||||||\u00bb text_text_color=\u00bb#000000″ text_font_size=\u00bb50px\u00bb text_line_height=\u00bb1.3em\u00bb header_font=\u00bbEB Garamond||||||||\u00bb header_font_size=\u00bb54px\u00bb header_line_height=\u00bb1.3em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_font_size=\u00bb16px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb max_width=\u00bb900px\u00bb text_font_size_tablet=\u00bb\u00bb text_font_size_phone=\u00bb15px\u00bb text_font_size_last_edited=\u00bbon|tablet\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb header_font_size_tablet=\u00bb50px\u00bb header_font_size_phone=\u00bb32px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF90aXRsZSIsInNldHRpbmdzIjp7ImJlZm9yZSI6IiIsImFmdGVyIjoiIn19@[\/et_pb_text][et_pb_blurb title=\u00bbPablo Fiorillo (1), Marcelo Mogliani (1), Rom\u00e1n Ruiz (1), Franco Passacantando (1)\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bb||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.24.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb custom_margin=\u00bb||8px|||\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
(1)<\/sup> M\u00e9dico especialista en cirug\u00eda de columna [\/et_pb_blurb][et_pb_text _builder_version=\u00bb4.24.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb13px\u00bb text_line_height=\u00bb1.6em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb hover_enabled=\u00bb0″ text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb sticky_enabled=\u00bb0″]<\/p>\n Citaci\u00f3n sugerida:<\/strong> Fiorillo P, Mogliani M, Ruiz R y col. Inestabilidad craneo cervical con lesi\u00f3n medular aguda. Anuario (Fund. Dr. J. R. Villavicencio) 2024;31. Disponible en: https:\/\/villavicencio.org.ar\/anuario\/31-inestabilidad-craneo-cervical<\/a>. <\/span>ARK: http:\/\/id.caicyt.gov.ar\/ark:\/\/kcfrrakmr<\/a> <\/span><\/p>\n Este es un art\u00edculo de acceso abierto distribuido bajo los t\u00e9rminos de Creative Commons Attribution License (https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/deed.es), esto permite que Ud. lo use, lo distribuya y lo adapte, sin prop\u00f3sitos comerciales, siempre que se cite correctamente el trabajo original. Si crea un nuevo material con \u00e9l, debe distribuirlo con la misma licencia.<\/p>\n [\/et_pb_text][et_pb_button button_url=\u00bb\/anuario\/31\/inestabilidad-craneo-cervical.pdf\u00bb url_new_window=\u00bbon\u00bb button_text=\u00bbDescargar art\u00edculo\u00bb button_alignment=\u00bbright\u00bb _builder_version=\u00bb4.24.1″ custom_button=\u00bbon\u00bb button_text_size=\u00bb12px\u00bb button_text_color=\u00bb#3cbebe\u00bb button_bg_color=\u00bbrgba(60,190,190,0.1)\u00bb button_border_width=\u00bb10px\u00bb button_border_color=\u00bbrgba(0,0,0,0)\u00bb button_border_radius=\u00bb100px\u00bb button_letter_spacing=\u00bb1px\u00bb button_font=\u00bb|700||on|||||\u00bb custom_padding=\u00bb10px|20px|10px|20px|true|true\u00bb button_letter_spacing_hover=\u00bb1px\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb button_text_size__hover_enabled=\u00bboff\u00bb button_one_text_size__hover_enabled=\u00bboff\u00bb button_two_text_size__hover_enabled=\u00bboff\u00bb button_text_color__hover_enabled=\u00bboff\u00bb button_one_text_color__hover_enabled=\u00bboff\u00bb button_two_text_color__hover_enabled=\u00bboff\u00bb button_border_width__hover_enabled=\u00bboff\u00bb button_one_border_width__hover_enabled=\u00bboff\u00bb button_two_border_width__hover_enabled=\u00bboff\u00bb button_border_color__hover_enabled=\u00bboff\u00bb button_one_border_color__hover_enabled=\u00bboff\u00bb button_two_border_color__hover_enabled=\u00bboff\u00bb button_border_radius__hover_enabled=\u00bboff\u00bb button_one_border_radius__hover_enabled=\u00bboff\u00bb button_two_border_radius__hover_enabled=\u00bboff\u00bb button_letter_spacing__hover_enabled=\u00bbon\u00bb button_letter_spacing__hover=\u00bb1px\u00bb button_one_letter_spacing__hover_enabled=\u00bboff\u00bb button_two_letter_spacing__hover_enabled=\u00bboff\u00bb button_bg_color__hover_enabled=\u00bboff\u00bb button_one_bg_color__hover_enabled=\u00bboff\u00bb button_two_bg_color__hover_enabled=\u00bboff\u00bb][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbCourses\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb collapsed=\u00bbon\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.24.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Introducci\u00f3n<\/strong><\/p>\n La uni\u00f3n cr\u00e1neo cervical es un sector donde existen complejas estructuras ligamentarias, musculo esquel\u00e9ticas y neurol\u00f3gicas, interacciones esenciales para funciones b\u00e1sicas del ser humano, como el movimiento, respiraci\u00f3n y funci\u00f3n cardiovascular. Las deformidades en este sector anat\u00f3mico pueden da\u00f1ar estructuras importantes como los n\u00facleos de la protuberancia, bulbo y m\u00e9dula espinal, generando alto riesgo de morbilidad y mortalidad. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.23.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Charnela craneocervical, lesi\u00f3n medular aguda, tratamiento quir\u00fargico.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.24.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.24.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Introduction: The craniocervical junction is a region where complex ligamentary, musculoskeletal and neurological structures exist; all of which are essential interactions for basic human functions such as movement, breathing and cardiovascular function. Deformities in this anatomical region can damage important structures such as the nuclei of the pons, medulla oblongata and spinal cord, generating high risk of morbidity and mortality. Results: No perioperative complications were observed, with immediate improvement of the neurological motor status.<\/p>\n Discussion: The incidence of this pathology is very low, and its presentation is usually progressive. It is frequently associated with other pathologies such as skeletal dysplasia, Down syndrome, among others. In these cases it is important to know the family history and to perform thorough follow-up evaluating risk factors, as well as a multidisciplinary approach. The surgical treatment presents important limitations that make fixation and fusion difficult, being the design of the construction a challenge.<\/p>\n Conclusion: A timely diagnosis and treatment of a case of malformation of the craniocervical hinge, which presented urgently with acute spinal cord injury, was performed. An instrumented posterior arthrodesis was chosen for its resolution.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.24.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Occipitocervical joint, acute spinal cord injury, surgical treatment.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.23.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La uni\u00f3n cr\u00e1neo cervical es un sector donde existen complejas estructuras ligamentarias, musculo esquel\u00e9ticas y neurol\u00f3gicas, cuyas interacciones son esenciales para las funciones b\u00e1sicas del ser humano, como el movimiento, la respiraci\u00f3n y funci\u00f3n cardiovascular. Las alteraciones y mal formaciones en este sector anat\u00f3mico pueden da\u00f1ar estructuras importantes como los n\u00facleos de la protuberancia, bulbo raqu\u00eddeo y medula espinal, generando alto riesgo de morbilidad y mortalidad en pacientes que lo presentan.1<\/sup> [\/et_pb_text][et_pb_text _builder_version=\u00bb4.23.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Presentaci\u00f3n de caso cl\u00ednico quir\u00fargico de nuestro servicio, resultados a los 6 meses de la cirug\u00eda.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.23.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Ingresa por guardia de urgencias una paciente de 6 a\u00f1os de edad, por cuadro agudo de hemiparesia izquierda, con mayor compromiso en mano. Antecedente de cirug\u00eda por platibasia los 7 meses de vida. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.23.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La incidencia de esta patolog\u00eda es muy baja, y su presentaci\u00f3n suele ser de forma progresiva. Con frecuencia se asocia a otras patolog\u00edas como displasia esquel\u00e9tica, s\u00edndrome de Down, Goldenhar, Conradi, etc\u00e9tera.2<\/sup> [\/et_pb_text][et_pb_text _builder_version=\u00bb4.23.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se realiz\u00f3 diagn\u00f3stico y tratamiento oportuno de un cuadro de mal formaci\u00f3n en la charnela craneocervical, el cual se present\u00f3 de forma urgente con da\u00f1o medular agudo. Opt\u00e1ndose para la resoluci\u00f3n del mismo una artrodesis posterior instrumentada. Con muy buenos resultados a los 6 meses de la cirug\u00eda.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Los autores declaran no tener conflicto de intereses.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00bb4.16″ locked=\u00bboff\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bbEB Garamond|700|||||||\u00bb text_text_color=\u00bbrgba(0,0,0,0.02)\u00bb text_font_size=\u00bb80px\u00bb text_line_height=\u00bb0em\u00bb header_2_font=\u00bbEB Garamond||||||||\u00bb header_2_font_size=\u00bb50px\u00bb header_2_line_height=\u00bb1.3em\u00bb text_orientation=\u00bbcenter\u00bb text_font_size_tablet=\u00bb50px\u00bb text_font_size_phone=\u00bb30px\u00bb text_font_size_last_edited=\u00bbon|desktop\u00bb header_2_font_size_tablet=\u00bb40px\u00bb header_2_font_size_phone=\u00bb30px\u00bb header_2_font_size_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n FIGURAS<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00bb4.16″ locked=\u00bboff\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_blurb title=\u00bbFigura 1: Radiograf\u00eda cervical perfil din\u00e1mica\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.24.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2024\/03\/inestabilidad-craneo-cervical1.jpg\u00bb title_text=\u00bbinestabilidad-craneo-cervical1″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.24.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bb Figura 2: Resonancia sagital preoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.24.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2024\/03\/inestabilidad-craneo-cervical2.jpg\u00bb title_text=\u00bbinestabilidad-craneo-cervical2″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.24.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bb 1.\tSteinmetz MP, Mroz TE. Craniovertebral junction: biomechanical considerations. Neurosurgery. 2010;66: 7-12. La uni\u00f3n cr\u00e1neo cervical es un sector donde existen complejas estructuras ligamentarias, musculo esquel\u00e9ticas y neurol\u00f3gicas, interacciones esenciales para funciones b\u00e1sicas del ser humano, como el movimiento, respiraci\u00f3n y funci\u00f3n cardiovascular. <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[28,31],"tags":[27],"class_list":["post-1504","post","type-post","status-publish","format-standard","hentry","category-28","category-a31-presentacion-de-casos-clinicos","tag-anuario-31-2024"],"_links":{"self":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/1504","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/comments?post=1504"}],"version-history":[{"count":6,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/1504\/revisions"}],"predecessor-version":[{"id":1529,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/1504\/revisions\/1529"}],"wp:attachment":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/media?parent=1504"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/categories?post=1504"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/tags?post=1504"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Sanatorio de Ni\u00f1os
Alvear 863, (2000) Rosario, Argentina
Correspondencia a<\/strong>: franco_passa@hotmail.com<\/a>
Fecha de publicaci\u00f3n:<\/strong> 04\/03\/2024<\/p>\nResumen<\/h3>\n
Objetivo: Presentaci\u00f3n de caso cl\u00ednico quir\u00fargico de nuestro servicio y sus resultados a los 6 meses.
Caso cl\u00ednico: Paciente de 6 a\u00f1os de edad, ingresa por hemiparesia izquierda. Antecedente de cirug\u00eda por platibasia los 7 meses de vida.
Presenta diagn\u00f3stico de trastorno gen\u00e9tico indeterminado.
Se decide internaci\u00f3n, y se realizan estudios por im\u00e1genes donde se observa lesi\u00f3n medular, inestabilidad craneo cervical y estrechamiento del foramen.
Tratamiento quir\u00fargico, abordaje posterior y artrodesis, de occipital a cuarta v\u00e9rtebra cervical con tornillos y barras bilateral m\u00e1s injerto ant\u00f3logo.
Resultados: Sin complicaciones en el perioperatorio, con mejor\u00eda de su estado neurol\u00f3gico motor inmediatamente.
Discusi\u00f3n: La incidencia de esta patolog\u00eda es muy baja, y su presentaci\u00f3n suele ser de forma progresiva. Con frecuencia se asocia a otras patolog\u00edas como displasia esquel\u00e9tica, s\u00edndrome de Down, etc\u00e9tera.
En estos casos resulta importante la historia familiar y un seguimiento minucioso, evaluando factores de riesgo. As\u00ed como el abordaje multidisciplinario.
Para el tratamiento quir\u00fargico de las mismas, existen importantes limitaciones que dificultan la fijaci\u00f3n y la fusi\u00f3n, siendo el dise\u00f1o de la construcci\u00f3n un desaf\u00edo.
Conclusi\u00f3n: Se realiz\u00f3 diagn\u00f3stico y tratamiento oportuno de un cuadro de mal formaci\u00f3n en la charnela craneo cervical, el cual se present\u00f3 de forma urgente con da\u00f1o medular agudo. Opt\u00e1ndose para la resoluci\u00f3n del mismo una artrodesis posterior instrumentada.<\/p>\nPalabras clave<\/h3>\n
Craniocervical Instability with Acute Spinal Cord Injury<\/strong><\/h2>\n
Abstract<\/h3>\n
Purpose. Presentation of a clinical surgical case from our service, and its results 6 months after surgery.
Case Report: A 6-year-old patient with a history of surgery for platybasia at 7 months of age was admitted for left hemiparesis. The patient was diagnosed with an undetermined genetic disorder. Hospitalization was decided. Imaging studies were performed showing spinal cord injury, craniocervical instability and narrowing of the foramen. Surgical treatment, posterior approach and arthrodesis, from occipital to fourth cervical vertebra with screws and bilateral bars plus autologous graft, were carried out.<\/p>\nKeywords<\/h3>\n
Introducci\u00f3n<\/h3>\n
Su incidencia es muy baja y la etiolog\u00eda es habitualmente cong\u00e9nita, asoci\u00e1ndose en muchos casos a malformaciones a nivel cardiovascular y renal.
Para el diagn\u00f3stico contamos con radiograf\u00eda, con carga y en movimiento, tomograf\u00eda y resonancia magn\u00e9tica. Indispensables para la planificaci\u00f3n terap\u00e9utica que depender\u00e1 de cada caso. Se cuenta actualmente con t\u00e9cnicas modernas para estabilizaci\u00f3n.2<\/sup><\/p>\nObjetivos<\/h3>\n
Presentaci\u00f3n del caso<\/h3>\n
Presenta diagn\u00f3stico de trastorno gen\u00e9tico indeterminado. Los \u00faltimos meses se encontraba en tratamiento ortop\u00e9dico por pie cavo y trastorno motriz.
Se decide internaci\u00f3n por s\u00edndrome medular agudo, y se realizan estudios por im\u00e1genes donde se observa lesi\u00f3n medular con mielomalacia debido a mal formaci\u00f3n en charnela con inestabilidad atlanto axoidea y estrechamiento del foramen (Figuras 1, 2 y 3). En tomograf\u00eda se observa agenesia del arco posterior del atlas con displasia de macizos laterales (Figura 4).
Se decide en la misma internaci\u00f3n planificaci\u00f3n y tratamiento quir\u00fargico, cirug\u00eda con monitoreo medular intraquir\u00fargico, previo al abordaje se coloca el halo chaleco y observa reducci\u00f3n con radioscopia intraquir\u00fargica. Por abordaje posterior se realiza artrodesis instrumentada: desde occipital a cuarta v\u00e9rtebra cervical con tornillos y barras bilaterales adem\u00e1s de injerto aut\u00f3logo (Figura 5).
En el postoperatorio permaneci\u00f3 en terapia intensiva durante 48 horas y luego continu\u00f3 su internaci\u00f3n en sala de cuidados generales por 5 d\u00edas. Sin complicaciones en el perioperatorio, con mejor\u00eda de su estado neurol\u00f3gico motor inmediatamente. Se retira halo chaleco a los 2 meses. Controles cl\u00ednicos y radiogr\u00e1ficos satisfactorios. En tomograf\u00eda a los 6 meses se observan signos de fusi\u00f3n (Figuras 6 y 7).<\/p>\nDiscusi\u00f3n<\/h3>\n
Las anomal\u00edas en el arco posterior del atlas se presentan como hendiduras o hipoplasia. Existe un sistema de clasificaci\u00f3n para estos defectos, donde en grados leves se presentan de forma asintom\u00e1tica siendo su diagn\u00f3stico incidental, mientras que casos donde el defecto es mayor pueden presentar dolor cervical, deformidades y trastornos neurol\u00f3gicos graves, incluso muerte s\u00fabita del lactante y otras complicaciones cardiorespiratorias. Se eval\u00faa en ciertas malformaciones que a\u00fan no presentan s\u00edntomas, la posible intervenci\u00f3n para prevenir las mismas.3<\/sup>
En estos casos resulta importante la historia familiar y un seguimiento minucioso, evaluando factores de riesgo. As\u00ed como el abordaje multidisciplinario de pediatr\u00eda, neurolog\u00eda, cirug\u00eda espinal, rehabilitaci\u00f3n, gen\u00e9tica.
Para el tratamiento quir\u00fargico de las mismas, existen importantes limitaciones que dificultan la fijaci\u00f3n y la fusi\u00f3n, siendo el dise\u00f1o de la construcci\u00f3n un desaf\u00edo cuando hay que fijar a la columna el occipital. Suele utilizarse en la mayor\u00eda de los casos halo chaleco tanto en el preoperatorio como intraquir\u00fargico para mantener la tracci\u00f3n y reducci\u00f3n. No estando exento el riesgo de da\u00f1o neurol\u00f3gico.
Existe una amplia variedad de t\u00e9cnicas de instrumentaci\u00f3n que pueden aplicarse, la fijaci\u00f3n puede lograrse mediante tornillos y barras, alambre, cable o ganchos, generalmente sujetos a taco \u00f3seos para favorecer la artrodesis.
Las modernas construcciones ofrecen tornillos poliaxiales los cuales pueden unirse mediante barras y a placas que se dirigen al occipucio.
En distintas bibliograf\u00edas hacen referencia que construcciones con tornillos en el occipucio y el complejo atlantoaxial es mejor para limitar el rango de movimiento y ofrece mayor rigidez.4<\/sup><\/p>\nConclusiones<\/h3>\n
Conflicto de intereses<\/h3>\n
Figuras<\/h2>\n
\nFigura 3: Resonancia columna completa preoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.23.4″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2024\/03\/inestabilidad-craneo-cervical3.jpg\u00bb title_text=\u00bbinestabilidad-craneo-cervical3″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.24.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 4: Tomograf\u00eda sagital preoperatoria\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.24.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2024\/03\/inestabilidad-craneo-cervical4.jpg\u00bb title_text=\u00bbinestabilidad-craneo-cervical4″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.24.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 5: Radiograf\u00eda cervical postoperatoria\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb 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\n 2.\tHaque A, Price AV, Sklar F, et al. Screw fixation of the upper cervical spine in the pediatric population. Clinical article. J Neurosurg Pediatr. 2009;3: 529-533.
\n 3.\tRoss JS, Bendok BR, Jamal Mc Clendon J. Imaging in spine surgery. 9th ed. Phoenix: Elsevier; 2017.
\n 4.\tMenezes AH, Vogel TW. Specific entities affecting the craniocervical region: syndromes affecting the craniocervical junction. Childs Nerv Syst. 2008;24: 1155-1163.[\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"