Enric Cáceres

Publications of Enric Cáceres

• Recurrent adjacent segment disease and cauda equina syndrome.

  Authors: Xavier Conesa, Ferran Pellisé, Susana Núñez, Carlos Villanueva, Enric Cáceres

  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 12/2010; 20 Suppl 2:S258-61.

  A case of cauda equina lesion as a result of recurrent adjacent segment degeneration (ASD) after multiple lumbar fusions is reported. ASD might be a consequence of biomechanical overload or simply aA case of cauda equina lesion as a result of recurrent adjacent segment degeneration (ASD) after multiple lumbar fusions is reported. ASD might be a consequence of biomechanical overload or simply a normal degenerative process. The reported clinical relevance of ASD is rather low. We describe an unusual case of cauda equina compression at L1-L2 in a patient who had undergone L2-L4 fusion 8 years previously and 2 decompression-fusion surgeries 16 years before. A 72-year-old man, who had two previous lumbar fusion-decompression procedures, underwent a third lumbar surgery in December 2000 to treat symptomatic spinal canal stenosis associated with L3-L4 pseudoarthrosis. After a symptom-free period of 8 years, the patient experienced low back pain radiating to both legs while standing, associated with saddle sensory disturbances and incontinence. Physical examination ruled out significant motor deficits. Plain radiographs showed solid fusion from L2 to L4, good spinal alignment, and low-grade L1-L2 retrolisthesis. Stainless steel pedicular instrumentation distorted magnetic resonance imaging, preventing adequate spinal canal evaluation. Electromyography demonstrated signs of cauda equina compression (bilateral L3-S2). CT myelography showed a stop at L1-L2, due to a severe spinal canal stenosis. L1-L2 decompression and fusion were performed. After an uneventful surgery with no complications, the symptoms abated and incontinence recovered. Even if the reported clinical relevance of ASD is very low, fused patients with a constitutional narrow spinal canal are at risk of developing severe neural compression at the level adjacent to the fusion.

• The visual analog scale and a five-item verbal rating scale are not interchangeable for back pain assessment in lumbar spine disorders.

  Authors: Antònia Matamalas, Manuel Ramírez, Sergi Mojal, Ana García De Frutos, Antonio Molina, Guillem Saló, Andreu Lladó, Enric Cáceres

  Spine. 10/2010; 35(21):E1115-9.

  Prospective study of patients with chronic back pain from lumbar spine disorders. To evaluate the degree of interchangeability of a 100-mm visual analog scale (VAS) and a 5-point verbal rating scaleProspective study of patients with chronic back pain from lumbar spine disorders. To evaluate the degree of interchangeability of a 100-mm visual analog scale (VAS) and a 5-point verbal rating scale (VRS) for the assessment of pain intensity. The fact that VAS and Likert scales are highly intercorrelated does not mean that both types of scales can be used interchangeably. METHODS.: A total of 151 patients (mean age, 52 ± 14.6 years) undergoing elective spine surgery completed a 100-mm VAS and a discrete 5-category VRS corresponding to the first item question of the core set ("How severe was your back pain in the last week?"). Pain intensity on the VAS was rated using the same question than for the VRS. The level of order-consistency (monotonic agreement), disordered pairs (D), percentage of agreement, and systematic disagreement (relative position), and relative concentration ([RC]) were estimated. VAS assessments were transformed into a discrete 5-category, with the cut-off VAS positions being defined by quintiles and equidistantly. For VAS defined equidistantly, monotonic agreement was 0.840, D was 0.080, and the percentage of identical pairs was 53%. The corresponding figures for VAS defined by quintiles were 0.809, 0.096, and 27.8%. Inconsistencies between the VAS and the VRS scales were also demonstrated by the marginal distributions, with PR values of -0.005 (95% confidence interval [CI], -0.011 to -0.002) and RC values of 0.144 (95% CI, 0.137-0.152) for VAS defined equidistantly, and PR values of 0.391 (95% CI, 0.384-0.397) and RC values of 0.265 (95% CI, 0.255-0.275) for VAS defined by quintiles. The order-consistency level was low with overlapping of pain records between the 2 scales, indicating that VAS and VRS are not interchangeable and, therefore, a results obtained with the use of each scale cannot be compared.

• Microindentation for in vivo measurement of bone tissue mechanical properties in humans.

  Authors: Adolfo Diez-Perez, Roberto Güerri, Xavier Nogues, Enric Cáceres, Maria Jesus Peña, Leonardo Mellibovsky, Connor Randall, Daniel Bridges, James C Weaver, Alexander Proctor, Davis Brimer, Kurt J Koester, Robert O Ritchie, Paul K Hansma

  Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 02/2010; 25(8):1877-85.

  Bone tissue mechanical properties are deemed a key component of bone strength, but their assessment requires invasive procedures. Here we validate a new instrument, a reference point indentationBone tissue mechanical properties are deemed a key component of bone strength, but their assessment requires invasive procedures. Here we validate a new instrument, a reference point indentation (RPI) instrument, for measuring these tissue properties in vivo. The RPI instrument performs bone microindentation testing (BMT) by inserting a probe assembly through the skin covering the tibia and, after displacing periosteum, applying 20 indentation cycles at 2 Hz each with a maximum force of 11 N. We assessed 27 women with osteoporosis-related fractures and 8 controls of comparable ages. Measured total indentation distance (46.0 +/- 14 versus 31.7 +/- 3.3 microm, p = .008) and indentation distance increase (18.1 +/- 5.6 versus 12.3 +/- 2.9 microm, p = .008) were significantly greater in fracture patients than in controls. Areas under the receiver operating characteristic (ROC) curve for the two measurements were 93.1% (95% confidence interval [CI] 83.1-100) and 90.3% (95% CI 73.2-100), respectively. Interobserver coefficient of variation ranged from 8.7% to 15.5%, and the procedure was well tolerated. In a separate study of cadaveric human bone samples (n = 5), crack growth toughness and indentation distance increase correlated (r = -0.9036, p = .018), and scanning electron microscope images of cracks induced by indentation and by experimental fractures were similar. We conclude that BMT, by inducing microscopic fractures, directly measures bone mechanical properties at the tissue level. The technique is feasible for use in clinics with good reproducibility. It discriminates precisely between patients with and without fragility fracture and may provide clinicians and researchers with a direct in vivo measurement of bone tissue resistance to fracture.

• [Evaluation of the impact of the introduction of a functional knee arthroplasty unit.]

  Authors: Marta Riu, Josep M Muniesa, Joan Leal, Francesc Cots, Enric Cáceres, Xavier Castells

  Gaceta sanitaria / S.E.S.P.A.S. 06/2009;

  OBJECTIVES: To evaluate the impact of a functional knee arthroplasty unit in Hospital de l'Esperança (Barcelona) on resource consumption, quality indicators and the direct costs of the healthcareOBJECTIVES: To evaluate the impact of a functional knee arthroplasty unit in Hospital de l'Esperança (Barcelona) on resource consumption, quality indicators and the direct costs of the healthcare process. METHOD: We performed a retrospective study based on two cross-sections: the first in 317 patients who underwent surgery in 2004 before the implementation of the functional knee arthroplasty unit and the second in 624 patients who underwent surgery in 2005. Data related to the process, complications and costs were collected. RESULTS: The mean length of hospital stay decreased by 9 days (p <0.001). The number of patients requiring convalescence after the intervention increased by 9.5% (p <0.001). Overall, the total cost of the healthcare process decreased by 16%, from 9,031.34 to 7,591.54 euro (p <0.001). This cost reduction was due to decreases in the length of hospital stay (2,946.0 vs. 1,616.8 euro), surgery costs (2,156.7 vs. 1,776.7 euro) and prosthesis costs (2,730.5 vs. 2,678.1 euro). CONCLUSIONS: The implementation of the functional knee arthroplasty unit reduced overall costs and length of hospital stay and substantially increased activity while maintaining a similar complication rate.

• Computer-assisted surgery can reduce blood loss after total knee arthroplasty.

  Authors: Pedro Hinarejos, Mónica Corrales, Antonia Matamalas, Elvira Bisbe, Enric Cáceres

  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 01/2009;

  The aim of this study was to compare blood loss and transfusion requirements in patients undergoing computer-assisted total knee arthroplasty (TKA) and patients operated with conventionalThe aim of this study was to compare blood loss and transfusion requirements in patients undergoing computer-assisted total knee arthroplasty (TKA) and patients operated with conventional instrumentation with intra-medullar guides. A prospective randomized study of 87 patients undergoing a TKA assigned to conventional technique (n = 44) or computer-assisted surgery (n = 43) was conducted. All patients were operated by the same surgeon and in all cases a cemented arthroplasty and deep recovery drainage were used. Both groups were comparable in all variables except for duration of ischemia, which was 13.7 min higher in the computer-assisted group. Blood loss due to drainage was higher in the conventional technique group (613 vs. 447 ml), as was the number of patients in which blood from the blood recovery system was reinfused (53 vs. 23%). Those patients undergoing computer-assisted surgery experienced less bleeding than those operated with the conventional technique. However, hemoglobin drop and allogenic transfusion rate were not statistically different in both groups.

• Assessment of angle velocity in girls with adolescent idiopathic scoliosis

  Authors: Ferran Escalada, Ester Marco, Esther Duarte, Ma Muniesa Josep, Roser Boza, Marta Tejero, Enric Cáceres

  Scoliosis. 01/2009;

  Abstract Background Although it has been demonstrated that the peak height velocity (PHV) is a predictive factor of progression in adolescent idiopathic scoliosis (AIS), little is known about theAbstract Background Although it has been demonstrated that the peak height velocity (PHV) is a predictive factor of progression in adolescent idiopathic scoliosis (AIS), little is known about the usefulness of angle progression in clinical practice. The purpose of this study was to establish a relationship between height and angle velocities, as well as to determine if peak angle velocity (PAV) occurs at the same time than PHV. Methods A retrospective study of a cohort of girls with idiopathic scoliotic curves greater than 10°. Data of 132 girls who participated in a previous retrospective study about growth in AIS were used to calculate height and angle velocities. Relationship between height and angle velocities was estimated by the use of a Linear Mixed Model. Results PHV and PAV take place simultaneously 1 year before menarche in progressive curves managed with a brace in AIS. Changes in angle velocity are influenced by changes in height growth velocity, in such a way that as from 6 months post-menarche, height growth velocity in this group of girls estimates curve progression velocity (β-coefficient -0.88, p = 0.04). Conclusion As from 6 months post-menarche, there is an inverse relationship between height velocity and curve progression in the group of AIS girls with progressive curves managed with a brace. Because height velocity is decreasing from 1 year before menarche, this finding corroborates that at the end of puberty, there is still a risk of progression in this group of girls despite bracing. The assessment of both height and angle velocity might be useful in clinical practice at the time of assessing brace effectiveness and how long bracing has to be indicated.

• Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature.

  Authors: Xavier Pelfort, Joan C Monllau, Lluís Puig, Enric Cáceres

  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 07/2006; 14(6):586-9.

  The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing furtherThe use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was treated with an autologous hamstring graft for chronic ACL instability brought on by a sport trauma. The patient developed iliotibial band friction syndrome 3 months after the operation. MRI showed incorrect positioning and a rupture of the femoral bio-absorbable cross-pin. The hamstring graft always had good fixation and did not produce instability of the knee. We removed the cross-pin fragment in a second surgery and the patient returned to her daily lifestyle after 3 weeks. The second case is a 52-year-old female with a painful and unstable knee due to a previous lateral meniscectomy and failure of an ACL reconstruction. We performed an ACL reconstruction with an autologous hamstring graft and a lateral meniscus transplantation. Some months after the procedure she also developed this syndrome. MRI showed the same features as shown in the first case and a second surgery was needed. To our knowledge this clinical and technical problem has not been previously described.

• Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings.

  Authors: Lluís Puig, Joan C Monllau, Mónica Corrales, Xavier Pelfort, Elena Melendo, Enric Cáceres

  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 05/2006; 14(4):394-8.

  The existence of meniscal extrusion is well known in the natural history of the osteoarthritic knee. However, extruded menisci are also seen in non-pathologic knees. To ascertain the prevalence ofThe existence of meniscal extrusion is well known in the natural history of the osteoarthritic knee. However, extruded menisci are also seen in non-pathologic knees. To ascertain the prevalence of meniscal extrusion in non-arthritic patients, the MRIs of 100 knees were prospectively studied. The data were correlated both with clinical and operative arthroscopic findings. The results showed 68.5% of the medial menisci to have some degree of extrusion, averaging at 28% of the meniscal size. While the lateral meniscus were extruded in 18.8% of cases at an average of 15% of the meniscal size. Furthermore, a relationship between the anterior insertion variant of the anterior medial meniscus and meniscal extrusion was found (P=0.001) in this series. The results suggest meniscal extrusion to be much more common in non-arthritic knees than previously estimated. The results also suggest that when the anterior horn of the medial meniscus inserts anteriorly in the tibial plateau, the meniscus tends to be extruded. It must be kept in mind that one of the limitations of this work is that the MRIs are taken in a non-weightbearing position.

• Bilateral hypoplasia of the medial meniscus.

  Authors: Joan C Monllau, Gemma González, Lluís Puig, Enric Cáceres

  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 03/2006; 14(2):112-3.

  Only a few cases of the nearly unknown hypoplastic meniscus abnormality have been described. A case report of an incidental finding in a young female with a bilateral hypoplastic medial menisci isOnly a few cases of the nearly unknown hypoplastic meniscus abnormality have been described. A case report of an incidental finding in a young female with a bilateral hypoplastic medial menisci is presented and, as far as we know, is the first report of bilateral hypoplasia of the medial meniscus in the literature.

• Fractures above and below a modular nail for knee arthrodesis. A case report.

  Authors: Pedro Hinarejos, Alberto Ginés, Juan C Monllau, Lluis Puig, Enric Cáceres

  The Knee. 07/2005; 12(3):231-3.

  Several techniques have been advocated for knee arthrodesis, and there has been an increasing interest in modular intramedullary nails in the recent last years. We report a case of femoral and tibialSeveral techniques have been advocated for knee arthrodesis, and there has been an increasing interest in modular intramedullary nails in the recent last years. We report a case of femoral and tibial fractures at each end of a modular nail in a solidly fused knee 8 months after an arthrodesis.

• Growth and curve stabilization in girls with adolescent idiopathic scoliosis.

  Authors: Ferran Escalada, Ester Marco, Esther Duarte, Josep M Muniesa, Roser Belmonte, Marta Tejero, Enric Cáceres

  Spine. 03/2005; 30(4):411-7.

  STUDY DESIGN: A retrospective study of a cohort of 132 girls with adolescent idiopathic scoliosis (AIS). OBJECTIVES: Evaluate the changes in height and scoliosis angle over time by the use of aSTUDY DESIGN: A retrospective study of a cohort of 132 girls with adolescent idiopathic scoliosis (AIS). OBJECTIVES: Evaluate the changes in height and scoliosis angle over time by the use of a mathematical model and determine a relationship between height and angle values in patients with AIS. SUMMARY OF BACKGROUND DATA: The influence of growth on idiopathic scoliosis (IS) is still not fully understood. Although it has not been completely demonstrated, it is accepted that a relationship exists between height growth and curve progression, as well as that curve stabilization occurs when growth ends, but it has not yet been demonstrated whether both occur at the same time. METHOD: One hundred thirty-two girls were included in a retrospective study. Inclusion criteria were: adolescent IS, Cobb angle > or =10 degrees , menarche age well documented, and follow-up of at least 2 years in 6-month controls. Main variables were: menarche age, height, Cobb angle, and treatment. Height and angle changes over the time were adjusted by several curvilinear regression models. Calculations were made of the gradient between each consecutive time point (first derivative function). Growth was considered as tending to stabilize when the function gradient changed its sign or was negligible. Height and Cobb angle correlation coefficients for repeated measures were estimated within patients for curves managed with observation and curves managed with a brace. Comparisons among these correlations were based on the Fisher-Z transformation. RESULTS: Height function gradient changed sign at 1 year postmenarche, and Cobb angle function gradient was negligible around menarche. There was a correlation between mean heights and mean angles, being higher for girls managed only with observation. When comparing mean heights in one semester with the mean heights of the previous one, there were statistically significant differences until 2.5 years postmenarche, although after the first year, these differences were clinically irrelevant. A significant increase for angle values was observed in the same period for the group of girls managed with observation and in the 6 months before menarche for the girls managed with a brace. CONCLUSIONS: A mathematical model was used to demonstrate when height and angle growths tend to stabilize (1 year after menarche for height values and at the time of menarche for angle values) in AIS. In the absence of a brace effect, a significant correlation between both growth rates was noted up until 2.5 years after menarche.

• Analysis of the expectations of elderly patients before undergoing total knee replacement.

  Authors: Josep M Muniesa, Ester Marco, Marta Tejero, Roser Boza, Esther Duarte, Ferran Escalada, Enric Cáceres

  Archives of gerontology and geriatrics. 51(3):e83-7.

  The opinion of patients expressed in terms of satisfaction is extremely important in any evaluation of total knee arthroplasty (TKA) results. The primary endpoint of this study was to determine theThe opinion of patients expressed in terms of satisfaction is extremely important in any evaluation of total knee arthroplasty (TKA) results. The primary endpoint of this study was to determine the quantitative and qualitative expectations of elderly patients before undergoing TKA. Cross-sectional study of 497 patients over 65 years was performed before TKA. Main variables collected: demographic, functioning, pain, comorbidity, depression and expectations assessed with the Hospital for Special Knee Replacement Expectation Survey. Statistical tests used were: Student's t-test, analysis of variance, Spearman's ρ and multivariate regression analysis. The means of the total and maximum expectations were 12.3±1.63 and 9.5±1.78 (±S.D.), respectively. Between 90 and 100% of patients referred expectations to improvement regarding pain, basic functional activities (walking, climbing stairs, knee mobility, general mobility) and general well being. There were statistically significant correlations with age (r=-0.321), pain before operation (r=-0.206), expected pain at 6 months (r=-0.206), depressive symptoms (r=-0.180) and the Barthel index (BI) (r=0.154). One can conclude, that the expectations of improvement among patients before TKA are high and may be classified as expectations of improvement of pain, basic functional activities and general well being. Age, pain intensity and presence of depression correlate inversely with the amount of expectations.