>Cirugía y Cirujanos
>Year 2008, Issue 3
Alpízar-Aguirre A, Elías-Escobedo A, Rosales-Olivares LM, Miramontes-Martínez V, Reyes-Sánchez A
Vertebral destruction syndrome. Evaluation systems in diagnosis
Cir Cir 2008; 76 (3)
PDF: 111.02 Kb.
Background: Vertebral Destruction Syndrome (VDS) is a pathology of multiple etiologies causing structural alterations of the rachis, producing deformity with neurological and mechanical alterations. In order to study VDS, a diagnostic process is carried out, sometimes with unexpected results. We undertook this study to validate the systematization of a series of studies to arrive at the diagnosis of VDS.
Methods: We included 105 patients in the study with diagnosis of VDS from January 1998 to December 2005, taking into consideration specificity, sensitivity and predictive value of each integrated study in order to determine its diagnostic value.
Results: The most frequent etiology was Pott’s Disease (24 cases) followed by osteomyelitis (20 cases), metastasis (18 cases) and multiple myeloma and plasmacytoma (16 cases each). The higher sensitivity in Pott’s Disease was obtained with bone scan and polymerase chain reaction (PCR); for multiple myeloma, computerized axial tomography (CAT) and bone scan; CAT and bone scan for infections; MRI for primary tumors; and MRI and bone scan for secondary tumors.
Conclusions: To reduce false positives to 2% and to reduce the maximum number of false negatives, studies such as CAT, MRI, bone scan, PCR, ESR, C-reactive protein and determination of alkaline and acid phosphatase must be included in the VDS study protocol. Other studies have very low diagnostic sensitivity and specificity.
||Spine tumors, osteoporosis, spine infections, Pott’s disease.
1. Manual de Procedimientos del Servicio de Cirugía de Columna Vertebral. Instituto Nacional de Rehabilitación “Dr. Luis Miguel Rosales Olivares”, México, D.F.;2006.
2. Chen TJ, Benzel E. Primary tumors of the spine. Contemp Neurosurg 2006;28:1-8.
3. Aisen AM, Martell W, Braunstein ET. MRI and CT evaluation of primary bone and soft-tissue tumors. AM J Roentgenol 1986;146:749-756.
4. Bloomer CW, Ackerman A, Bhatia RG. Imaging for spine tumors and new applications. Top Magn Reson Imaging 2006;17:69-87.
5. Harrington KD. Metastatic disease of the spine. In Harrington KD, ed. Orthopedic Management of Metastatic Bone Disease. St. Louis: CV Mosby;1988. pp. 309-386.
6. Walker MP, Yaszemski MJ, Kim CW, Talac R, Currier BL. Axial metastatic bone disease. Metastatic disease of the spine: evaluation and treatment. Clin Orthop Relat Res 2003;415(Suppl):S165-S175.
7. Edelstyn GA, Palmer P, Grebell E. The radiologic demonstration of osseous metastases. Exp Observ Clin Radiol 1967;18:158-164.
8. Citrin DL, Bessent R, Greig, W. A comparison of sensitivity and accuracy of the 99mTc phosphate bone scan and skeletal radiograph in the diagnosis of bone metastases. Clin Radiol 1977;28:107-111.
9. An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 2006;444:27-33.
10. Alothman A, Memish ZA, Mahmood SA. Tuberculous spondylitis. Analysis of 69 cases from Saudi Arabia. Spine 2001;26:E565-570.
11. Carragee EJ. The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine 2004;22:780-785.
12. Howard SA, Tae-Hong L, Renner MS, Brebach TG. Biomechanical evaluation of vertebroplasty using injectable calcium phosphate cement. Spine J 2002;2(suppl 1):40.
13. Morten S, Gimsing P, Nielsen LB. Simple method for quantification of Bence Jones proteins. Clin Chem 2002;48:2202-2207.
14. Rosales-Olivares LM, Valle-Cerna I, Alpízar-Aguirre A, Miramontes-Martínez V, Arenas-Sordo ML, Reyes-Sánchez A. Percutaneous biopsy evaluation in the diagnosis of thoracic and lumbar vertebral destruction syndrome. Cir Ciruj 2007;75:459-463.
15. Tali ET. Spinal infections. Eur J Radiol 2004;50:120-133.
16. Jevtic V. Vertebral infection. Eur Radiol 2004;14(suppl 3):E43-52.
17. Bradwell AR, Smith Hug D, Mead PG. Serum test for assessment of patients with Bence Jones myeloma. Lancet 2003;361:489-491.
>Cirugía y Cirujanos
>Year 2008, Issue 3