Dr Damian Muñoz

Dr Damian Muñoz
Curso mínima invasiva south beach

lunes, 29 de diciembre de 2014

Al hablar con un cirujano ortopédico Acerca de estenosis espinal / When to Speak With an Orthopedic Surgeon About Spinal Stenosis

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domingo, 28 de diciembre de 2014

Espolones óseos en la columna vertebral / Bone spurs on the spine

‪#‎Espondilolisis‬ y ‪#‎espondilolistesis‬

viernes, 26 de diciembre de 2014

¿Cómo y cuándo obtener una segunda opinión antes de Cirugía de Columna? / How and When to Get a Second Opinion Before Spine Surgery

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Ankylosing spondylitis


What's a Herniated Disc, Pinched Nerve, Bulging Disc...?

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Cuando te duele la espalda / When Your Back Hurts / The SPORT Value Compass: Do the Extra Costs of Undergoing Spine Surgery Produce Better Health Benefits?

Este artículo es publicado originalmente en:

NIH News in Health, December 2014

When Your Back Hurts
Don’t Let Back Pain Knock You Flat

Illustration of the spinal bones.
Is your back hurting? You’re in good company. In any 3-month period, about 1 in 4 adults in the U.S. has at least one day of back pain, mostly in the lower back.
The back is a complicated structure. Its center is the spine, which is made up of 33 bones called vertebrae, stacked in a column. The nerves of the spinal cord run in a tunnel through the middle of those bones. Spongy discs between the vertebrae act as cushions. Ligaments and tendons hold everything together.
A lot of things can go wrong with your back. A strained muscle or a problem with a disc or a bone can cause pain. Back pain might also arise from a fracture or tumor. Much of the time, though, it’s impossible to tell what’s making your back hurt.
“We rarely find out exactly what it is,” says Dr. Gunnar Andersson, anorthopedic surgeon at Rush University Medical Center in Chicago. “As long as it stays as back pain, we are typically not that concerned.”
Your back naturally changes as you get older. Discs degenerate and arthritis may develop in the small joints of the back. Those changes may show up on an MRI or other types of imaging scans. But such changes to the back are also seen in a lot of people who don’t have back pain. So it’s hard to know if the changes are actually what’s causing the pain.
People with obesity are more likely to have low back pain, as are people who smoke. Back pain is also more common in people who don’t exercise much, or in people who are mostly inactive but have occasional bursts of exercise.
The good news is most back pain goes away by itself. For a new pain in the back, Andersson says he usually advises taking over-the-counter medications for the pain and staying away from activity that is hard on the back—lifting, carrying, bending, and twisting. “Then, wait for the problem to disappear, which it will in the great majority of people over a few weeks,” he says.
But for some people, the pain continues. If your back hurts most of the time for more than 3 months, you have chronic back pain.
What doctors do about chronic pain depends on the source of the pain. Some chronic back pain requires prolonged medical attention. If the pain comes from a fracture or tumor, those problems can be treated. Surgery can help if the pain is caused by a ruptured (herniated) disc or certain other conditions like spinal stenosis (narrowing of the spinal column, which can put pressure on the nerves) or degenerative spondylolisthesis (when one vertebra slips over another). But surgery isn’t the right choice for everyone.
There are many treatment options for back pain, so be sure to talk to your health care provider about which approach is right for you.  For most people, even chronic pain eventually clears up without surgery. The most important thing, Andersson says, is not to let the pain take over. Research has shown that patients who stay active are better off. Just be sure to avoid activities that might strain the back. “It’s important not to succumb to the pain and become afraid of moving,” Andersson says. "It doesn’t seem to make much difference what you do, as long as you stay active.” 
Reference: The SPORT Value Compass: Do the Extra Costs of Undergoing Spine Surgery Produce Better Health Benefits? Weinstein JN, Tosteson AN, Tosteson TD, Lurie JD, et al. Med Care. 2014 Dec;52(12):1055-63. doi: 10.1097/MLR.0000000000000250. PMID:25334052

 2014 Dec;52(12):1055-63. doi: 10.1097/MLR.0000000000000250.

The SPORT Value Compass: Do the Extra Costs of Undergoing Spine Surgery Produce Better Health Benefits?



The Spine Patient Outcomes Research Trial aimed to determine the comparative effectiveness of surgical care versus nonoperative care by measuring longitudinal values: outcomes, satisfaction, and costs.


This paper aims to summarize available evidence from the Spine Patient Outcomes Research Trial by addressing 2 important questions about outcomes and costs for 3 types of spine problem: (1) how do outcomes and costs of spine patients differ depending on whether they are treated surgically compared with nonoperative care? (2) What is the incremental cost per quality adjusted life year for surgical care over nonoperative care?


After 4 years of follow-up, patients with 3 spine conditions that may be treated surgically or nonoperatively have systematic differences in value endpoints. The average surgical patient enjoys better health outcomes and higher treatment satisfaction but incurs higher costs.


Spine care is preference sensitive and because outcomes, satisfaction, and costs vary over time and between patients, data on value can help patients make better-informed decisions and help payers know what their dollars are buying.
[PubMed - in process]

miércoles, 24 de diciembre de 2014

El trabajo con agua fria podría elevar el riesgo de dolor en su espalda y cuello / Cold Weather Work May Raise Your Back and Neck Pain Risk

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domingo, 21 de diciembre de 2014

Síntomas de la distensión lumbar

Este video es originalmente publicado en:

martes, 16 de diciembre de 2014

Chinese Student Receives First 3D Printed Thoracic Vertebrae Implant & the Surgery is a Success

Estudiante chino recibe los primeros implantes de vértebras torácicas impresas en 3D y la cirugía es un éxito

jueves, 11 de diciembre de 2014

Endoscopic spine surgery interest grows overseas — Could it flourish in the United States?

Este artículo es originalmente publicado en:

miércoles, 10 de diciembre de 2014

discectomía mínimamente invasiva asociada con mayores tasas de recurrencia / Minimally invasive discectomy associated with higher recurrence rates

Este artículo es originalmente publicado en:

Int Orthop. 2014 Jun;38(6):1225-34. doi: 10.1007/s00264-014-2331-0. Epub 2014 Apr 11.

The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomised controlled trials.



The objective of this study was to compare the safety and efficacy of minimally invasive discectomy (MID) with standard discectomy (SD) and determine whether the use of the MID technique could decrease the recurrence of lumbar disc herniation (LDH) after the surgery.
El objetivo de este estudio fue comparar la seguridad y eficacia de la discectomíamínimamente invasiva (MID) con discectomía estándar (SD) y determinar si el uso de la técnica MID podría disminuir la recurrencia de la hernia de disco lumbar (LDH) después de la cirugía.


In February 2014, a comprehensive search was performed in PubMed, EMBASE, Web of Science, Cochrane Library and the Chinese Biological Medicine Database. Only randomised controlled trials (RCT) that compared MID with SD for the surgical management of LDH were included. These trials were carefully picked out following the inclusion and exclusion criteria. Using the Cochrane Collaboration guidelines, two authors independently extracted data and assessed these trials' quality. The age of the patients, size of incision, surgical time, blood loss, visual analogue scale (VAS) score after the surgery, hospital stay, disc herniation recurrence, X-ray exposure and surgical costs in these studies were abstracted and synthesised by a meta-analysis with RevMan 5.2.0 software, and the main results (VAS score after the surgery and disc herniation recurrence) of publication bias were examined by Stata 12.0.


Overall, 16 trials involving 2,139 patients meeting our criteria were included and analysed. Comparing MID and SD, the former was more likely to increase disc herniation recurrence [relative risk (RR) = 1.95, 95 % confidence interval (CI) 1.19-3.19, p = 0.008], and it involved a smaller size of incision [mean difference (MD) = -1.91, 95 % CI -3.33 to -0.50, p = 0.008], shorter hospital stay, longer operating time (MD = 11.03, 95 %C I 6.62-15.44, p < 0.00001) and less blood loss (MD = -13.56, 95 % CI -22.26 to -4.87, p = 0.002), while no statistical difference appeared with regard to the age of the patients, VAS score after the surgery, X-ray exposure, hospital stay and surgical costs.


Based on available evidence, MID results in less suffering for patients during the hospital course with a similar clinical efficacy compared to SD. This makes MID a promising procedure for patients with LDH; however, to popularise it greater effort is required to reduce disc herniation recurrence.
[PubMed - in process] 

 [Available on 2015/6/1]

martes, 9 de diciembre de 2014

Acerca de los nervios pinzados / About Pinched Nerves

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About Pinched Nerves

Pinched nerve is a general term that is used to describe the compression of individual nerves or groups of nerves. Pinched nerves are caused by compression or pressure applied to the surrounding tissue, bones, cartilage, muscles or tendons to the nerves along the spinal cord causing neck and back pain. While pinched nerves can occur throughout the body, they are most common in the back. More than 90% of pinched nerves occur in the lower (lumbar) back.
Pinched Nerves in the Lumbar Spine
Pinched nerve in spine.
There are numerous possible causes of pinched nerves, including:
  • Exercise and sports
  • Injuries
  • Poor posture
  • Obestity
  • Genetics
Bulging or herniated discs are a common cause of pinched nerves between the vertebrae of the spine. The discs that are most prone to hernias are those in the cervical spine and the lumbar spine because these are the most flexible vertebrae.
Lumbar disc hernias occur most often between L4/L5 and L5/S1. Hernias at these levels compress the L5 nerve and the S1 nerve. Pinching of the L5 nerve can cause numbness, pain, burning and tingling sensations to radiate out from the affected area down the inner thigh and leg to the big toe. Pinching of the S1 nerve can cause radiating pain down the outer leg to the ankle and the sole and side of the foot.
Cervical disc hernias occur less frequently than lumbar disc hernias because less force is exerted on the cervical spine. Compressed nerve roots in the cervical spine can result in pain that radiates into the arms. If the sensory nerves between the first and second or second and third cervical levels are pinched, severe, chronic headaches can result.
A thoracic herniated disc may lead to myelopathy (spinal cord dysfunction), progressive neurological deficits, or intolerable pain. Typically, these symptoms occur following an acute traumatic disc herniation with myelopathy.
  • The Bonati Spine Procedures – Foraminotomy, which increases the space of the foramen, or the opening where the nerves exit the spine, to relieve pressure on the spinal cord.
  • The Bonati Spine Procedures – Laminectomy, in which the lamina, or the bony arch of the vertebrae covering the nerves of the spine, is completely removed, to widen the spinal canal and relieve pressure on the spinal cord.
  • The Bonati Spine Procedures – Laminotomy, in which a portion of the bony arch of the vertebrae (lamina) covering the nerves of the spine is removed, thus widening the spinal canal and relieving pressure on the spinal cord.

Acerca de los nervios pinzados
El pinzamiento de un nervio es un término general que se utiliza para describir la compresión de los nervios o grupos de nervios individuales. Nervios perforados son causados por compresión o presión aplicada a los tejidos circundantes, huesos, cartílagos, músculos o tendones a los nervios de la médula espinal, causando dolor de cuello y espalda. Aunque pueden ocurrir los nervios pinzados por todo el cuerpo, que son más comunes en la parte de atrás. Más del 90% de los nervios pinzados se produce en la parte inferior (lumbar) de nuevo.

Los nervios en la columna lumbar
Pinzamiento del nervio en la columna vertebral.


Existen numerosas causas posibles de los nervios pellizcados, incluyendo:

Ejercicios y deportes
La mala postura

Discos abultados o herniados son una causa común de la compresión de los nerviosentre las vértebras de la columna vertebral. Los discos que son más propensos a herniasson aquellos en la columna cervical y lumbar de la columna vertebral debido a que estosson las vértebras más flexible.

Las hernias de disco lumbares ocurren con mayor frecuencia entre L4 / L5 y L5 / S1. Las hernias en estos niveles comprimen el nervio L5 y el nervio S1. Pellizcos del nervio L5puede causar entumecimiento, dolor, ardor y sensación de hormigueo a irradiar hacia fuera de la zona afectada por la parte interna del muslo y la pierna al dedo gordo.Pellizcos del nervio S1 puede causar dolor que se irradia hacia la pierna exterior hasta el tobillo y la suela y parte lateral del pie.

Las hernias de disco cervical se producen con menos frecuencia que las hernias de disco lumbar, ya que menos fuerza se ejerce sobre la columna cervical. Raíces nerviosascomprimidas en la columna cervical puede resultar en dolor que irradia hacia los brazos.Si se pellizcan los nervios sensoriales entre los primero y segundo o segundo y terceroniveles cervicales, dolores de cabeza severos, crónicas pueden resultar.

Una hernia discal torácica puede conducir a mielopatía (disfunción de la médula espinal),déficits neurológicos progresivos o dolor intolerable. Por lo general, estos síntomas se producen a raíz de una hernia discal traumática aguda con mielopatía.


Los Procedimientos Bonati Spine - Foraminotomía, lo que aumenta el espacio del agujero, o la apertura por donde los nervios salen de la columna vertebral, para aliviar la presión sobre la médula espinal.
Los procedimientos Bonati Spine - laminectomía, en el que la lámina o el arco óseo de las vértebras que cubre los nervios de la columna vertebral, se elimina por completo, para ampliar el canal espinal y aliviar la presión sobre la médula espinal.
La Columna Vertebral Procedimientos Bonati - Laminotomía, en el cual se extrae unaporción del arco óseo de las vértebras (lámina) que cubre los nervios de la columna vertebral, ampliando así el canal espinal y aliviar la presión sobre la médula espinal.

domingo, 7 de diciembre de 2014

¿Qué señal está presente? ¿Qué condición representa? / What sign is present? What condition does it represent?

jueves, 4 de diciembre de 2014

¿Es un aparato ortopédico necesario para la curación de la fractura vertebral? / Is a brace necessary for spinal fracture healing?

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martes, 2 de diciembre de 2014

Spine Surgeons’ Role in Preventing Failed Back Syndrome

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Do all roads lead back to the operating room when it comes to failed back surgery?

A Young Mother Shares Her Spine Surgery Experience with Spine-health: Part 1

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