ZAMORANO PÉREZ, JUAN JOSÉ
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ZAMORANO PÉREZ, JUAN JOSÉ
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jzamorano@udd.cl
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36661682600

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Independent Reliability Analysis of a New Classification for Pyogenic Spondylodiscitis

2020 , Gaston Camino Willhuber , Alfredo Guiroy , ZAMORANO PÉREZ, JUAN JOSÉ , Nelson Astur , Marcelo Valacco

Study Design: Diagnostic study, level of evidence III. Objective: Pyogenic spondylodiscitis can cause deformity, neurological compromise, disability, and death. Recently, a new classification of spondylodiscitis based on magnetic resonance imaging was published. The objective of this study is to perform an independent reliability analysis of this new classification. Methods: We selected 35 cases from our database of different spine centers in Latin America and from the literature; 8 observers evaluated the classification and graded the scenarios according to the methodological grading of the classification developed by Pola et al. Cases were sent to the observers in a random sequence after 3 weeks to assess intraobserver reliability. The interobserver and intraobserver reliabilities were performed with Fleiss and Cohen statistics, respectively. Results: The overall Fleiss κ value for interobserver agreement was substantial, with 0.67 (95% CI = 0.43-0.91) in the first reading and 0.67 (95% CI = 0.45-0.89) in second reading for the main types of classification. The Cohen κ value for intraobserver agreement was also substantial, with 0.68 (95% CI = 0.45-0.92). The interobserver agreement analysis for the subtypes of this classification was overall substantial, with 0.60 (95% CI = 0.37-0.83) in the first reading and 0.61 (95% CI = 0.41-0.81) in the second reading. The overall intraobserver agreement for subtypes of the classification was also substantial, with 0.63 (95% CI = 0.34-0.93). Conclusion: The new classification developed by Pola et al showed substantial interobserver and intraobserver agreements. More studies are required to validate the usefulness of this classification especially in clinical practice.

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Mielopatía cervical degenerativa: una patología cada vez más frecuente y que requiere diagnóstico y manejo precoz

2022 , YURAC BARRIENTOS, RATKO JOVAN , José Manuel Matamala , ZAMORANO PÉREZ, JUAN JOSÉ , James S. Harrop , Benjamin M. Davies , Aria Nouri , Michael G. Fehlings

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An independent inter- and intra-observer agreement assessment of the AOSpine upper cervical injury classification system

2022 , Julio Urrutia , Byron Delgado , Gaston Camino-Willhuber , Alfredo Guiroy , Nelson Astur , Marcelo Valacco , ZAMORANO PÉREZ, JUAN JOSÉ , Catalina Vidal , YURAC BARRIENTOS, RATKO JOVAN

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Traumatic cervical spine injury due to pole dance accident: A potentially catastrophic unreported injury with a happy ending. Case report and literature review

2022 , YURAC BARRIENTOS, RATKO JOVAN , ZAMORANO PÉREZ, JUAN JOSÉ , Andrea Marre , Cristian Diaz

Background: Pole dancing is a sport that has become very popular. However, there is scarce literature on injuries associated with this sport. Here, we present a 23-year-old female who sustained a traumatic C4-C5 vertex cervical spine injury caused by a fall of 1 m while practicing pole dancing in an inverted position, requiring a 360 decompression/fusion. Case Description: A 23-year-old female sustained a 1 m fall in an inverted position while pole dancing resulting in a direct axial impact to the head. She developed the rapid onset of quadriparesis that was attributed to the emergent CT/MR-documented cervical flexodisruptive luxofracture (AOSpine C4-C5 fracture: C, F4 unilateral, N3, M2). Four hours post injury, she underwent a C4-C5 anterior cervical discectomy and fusion. Four days later, a posterior fusion was performed to add to the stabilization. Six years later, the patient remains neurologically intact. Conclusion: Pole dance is an emerging sport which carries a risk of cervical spine injury.

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CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?

2021 , Juan P. Cabrera , YURAC BARRIENTOS, RATKO JOVAN , Andrei F. Joaquim , Alfredo Guiroy , Charles A. Carazzo , Marcelo Valacco , ZAMORANO PÉREZ, JUAN JOSÉ

Study Design: Cross-sectional survey. Objectives: Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. Methods: A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. Results: There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Conclusions: Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.

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Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures

2023 , Juan Ignacio Cirillo , Ignacio Farias , Cristóbal Del Pino , Marcos Gimbernat , Alejandro Urzúa , Carlos Tapia , ZAMORANO PÉREZ, JUAN JOSÉ

Abstract Background thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial. Methods The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture’s radiologic characteristics and the procedure’s temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson’s correlation coefficient, as required. Results A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture. Conclusion Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.

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Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey

2023 , Jamie F. M. Brannigan , Benjamin M. Davies , Oliver D. Mowforth , YURAC BARRIENTOS, RATKO JOVAN , Vishal Kumar , Joost Dejaegher , ZAMORANO PÉREZ, JUAN JOSÉ , Rory K. J. Murphy , Manjul Tripathi , David B. Anderson , James Harrop , Granit Molliqaj , Guy Wynne-Jones , Jose Joefrey F. Arbatin , So Kato , Manabu Ito , Jefferson Wilson , Ronie Romelean , Nicolas Dea , Daniel Graves , Enrico Tessitore , Allan R. Martin , Aria Nouri

Abstract Study design Cross-sectional survey. Objective Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. Methods Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. Results A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. Conclusions Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.

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