{"id":82,"date":"2012-04-15T22:10:32","date_gmt":"2012-04-15T22:10:32","guid":{"rendered":"http:\/\/doctorlinares.com\/?page_id=82"},"modified":"2023-05-08T14:59:43","modified_gmt":"2023-05-08T14:59:43","slug":"patologia-columna-vertebral","status":"publish","type":"page","link":"https:\/\/doctorlinares.com\/trauma\/columna-vertebral\/patologia-columna-vertebral\/","title":{"rendered":"Columna Vertebral"},"content":{"rendered":"<p style=\"text-align: justify;\"><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2014\/09\/Isidro14abc.png\"><img decoding=\"async\" class=\" wp-image-1900 aligncenter\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2014\/09\/Isidro14abc.png\" alt=\"Doctor Linares\" width=\"683\" height=\"594\" \/><\/a><\/p>\n<h5><span style=\"color: #000000;\"><strong><em>La columna vertebral es una de las partes m\u00e1s vitales del cuerpo humano.<\/em><\/strong><\/span><\/h5>\n<a href=\"https:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2023\/04\/Columna-vertebral.pdf\" class=\"pdfemb-viewer\" style=\"\" data-width=\"max\" data-height=\"max\" data-toolbar=\"bottom\" data-toolbar-fixed=\"off\">Columna vertebral<\/a>\n<p><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/TbcMMXHrSxQ\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<h3 style=\"text-align: justify;\">\u00a0<span style=\"color: #ff6600;\"><strong>Tambi\u00e9n denominada espina, tronco, torso o raquis.<\/strong><\/span><\/h3>\n<p style=\"text-align: justify;\"><img decoding=\"async\" class=\"wp-image-1920 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq1.png\" alt=\"Esq1\" width=\"246\" height=\"348\" \/>\u00a0 \u00a0\u00a0<img decoding=\"async\" class=\"wp-image-1916 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq2.png\" alt=\"Esq,2\" width=\"278\" height=\"341\" \/>\u00a0 \u00a0\u00a0<a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F02.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F02.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2520 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F02.jpg\" alt=\"A00616F02\" width=\"221\" height=\"387\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2520 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F02.jpg\" alt=\"A00616F02\" width=\"221\" height=\"387\" \/></noscript><\/a> <a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F03.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F03.jpg\"  decoding=\"async\" class=\"wp-image-2521 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F03.jpg\" alt=\"A00616F03\" width=\"245\" height=\"379\" \/><noscript><img decoding=\"async\" class=\"wp-image-2521 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F03.jpg\" alt=\"A00616F03\" width=\"245\" height=\"379\" \/></noscript><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Comprender c\u00f3mo es y c\u00f3mo funciona su columna le puede ayudar a comprender algunos de los problemas que ocurren con el envejecimiento o las lesiones.<br \/>\nSu columna soporta muchas exigencias. \u00c9sta sostiene su cabeza, sus hombros y la parte superior de su cuerpo. Le da apoyo para permanecer de pie y le da flexibilidad para doblarse y girar su cuerpo.<\/p>\n<p>Su columna tambi\u00e9n protege a su m\u00e9dula espinal<a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F06.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F06.jpg\"  decoding=\"async\" class=\"wp-image-2524 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F06.jpg\" alt=\"A00616F06\" width=\"366\" height=\"281\" \/><noscript><img decoding=\"async\" class=\"wp-image-2524 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/A00616F06.jpg\" alt=\"A00616F06\" width=\"366\" height=\"281\" \/></noscript><\/a><\/p>\n<p style=\"text-align: justify;\">Esta zona del cuerpo aloja los huesos y articulaciones que soportan el peso del cuerpo, los m\u00fasculos, tendones, ligamentos y centros nerviosos que hacen posible el movimiento y la flexibilidad del resto del cuerpo. Debido a la complejidad de todas las tareas que desempe\u00f1a, el tronco esquel\u00e9tico es vulnerable a una enorme cantidad de trastornos y enfermedades.<\/p>\n<p><iframe src=\"https:\/\/www.youtube.com\/embed\/oIcSRyv1Jkc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: justify;\" align=\"left\"><span style=\"color: #000000;\"><strong>Datos b\u00e1sicos acerca de la Columna Vertebral, el Hombro y la Pelvis<\/strong><\/span><\/p>\n<hr \/>\n<h3 style=\"text-align: justify;\"><span style=\"color: #ff0000;\">CARACTER\u00cdSTICAS GENERALES DE LA COLUMNA VERTEBRAL<\/span><\/h3>\n<p><strong style=\"text-align: justify;\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/qn003-30.jpg\"  decoding=\"async\" class=\"alignnone wp-image-95\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/qn003-30.jpg\" alt=\"qn003--30\" width=\"696\" height=\"696\" \/><noscript><img decoding=\"async\" class=\"alignnone wp-image-95\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/qn003-30.jpg\" alt=\"qn003--30\" width=\"696\" height=\"696\" \/></noscript><\/strong><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/qn007-30.jpg\"  decoding=\"async\" class=\"alignnone wp-image-90\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/qn007-30.jpg\" alt=\"qn007--30\" width=\"697\" height=\"697\" \/><noscript><img decoding=\"async\" class=\"alignnone wp-image-90\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/qn007-30.jpg\" alt=\"qn007--30\" width=\"697\" height=\"697\" \/></noscript><\/p>\n<p><strong><span style=\"color: #ff0000;\">La columna vertebral<\/span> <\/strong>constituye el eje longitudinal del esqueleto.<\/p>\n<p>Es m\u00e1s una columna flexible que una r\u00edgida ya que se encuentra segmentada<\/p>\n<p style=\"text-align: justify;\">Cuando vemos la\u00a0columna desde el plano posterior, la columna normal es recta y sim\u00e9trica.<\/p>\n<p style=\"text-align: justify;\">Si la vemos desde la vista lateral, la columna tiene cuatro curvas naturales, cuando est\u00e1n en l\u00ednea.<img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.3.png\"  decoding=\"async\" class=\"wp-image-1917 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.3.png\" alt=\"Esq.3\" width=\"266\" height=\"355\" \/><noscript><img decoding=\"async\" class=\"wp-image-1917 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.3.png\" alt=\"Esq.3\" width=\"266\" height=\"355\" \/></noscript><\/p>\n<p style=\"text-align: justify;\">Una de estas curvaturas es fija, y constituye la llamada zona sacra, que presenta concavidad anterior (cifosis). El resto de curvaturas son m\u00f3viles y quedan formadas por la llamada lordosis cervical (concavidad posterior), cifosis dorsal (concavidad anterior) y lordosis lumbar (concavidad posterior) cuerpo se encuentra en una posici\u00f3n equilibrada.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">La columna tiene <strong>33 h<\/strong><strong>uesos<\/strong><strong> (v\u00e9rtebras)<\/strong> divididas en cinco regiones principales.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Las primeras siete v\u00e9rtebras son conocidas como v\u00e9rtebras <strong>CERVICALES.<\/strong>Se denominan <strong>C1 \u2013 C7.<\/strong><strong> <br style=\"font-family: 'Times New Roman';\" \/><\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Siguiendo hacia abajo, las siguientes 12 v\u00e9rtebras son conocidas como las v\u00e9rtebras<strong> TORACICAS <\/strong>y se denominan<strong> T1 \u2013 T12.<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Debajo de la regi\u00f3n tor\u00e1cica se encuentra la regi\u00f3n<strong> LUMBAR. <\/strong>Esta regi\u00f3n contiene<strong> cinco <\/strong>v\u00e9rtebras denominadas<strong> L1 \u2013 L5. <\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">La regi\u00f3n siguiente es el<strong> SACRO. <\/strong>Esta regi\u00f3n contiene<strong> cinco <\/strong>v\u00e9rtebras fusionadas denominadas<strong> S1 \u2013 S5<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">La \u00faltima de las cinco regiones se llama<strong> COXIS.<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">El <strong>coxis<\/strong> normalmente contiene cuatro huesos y se<strong> denominan c1 &#8211; c4.<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Los puntos de uni\u00f3n entre las v\u00e9rtebras permiten movimientos hacia delante, hacia atr\u00e1s y hacia ambos lados de la columna<\/span><\/p>\n<p><span style=\"color: #ff0000;\">Superficies articulares<\/span><br \/>\nEntre la parte posterior de las v\u00e9rtebras hay peque\u00f1as articulaciones que tambi\u00e9n ayudan a que su columna se mueva. Estas superficies articulares tienen una superficie de cart\u00edlago, muy parecido a lo que ocurre en las articulaciones de la cadera o de la rodilla. Las superficies articulares son importantes para permitir la rotaci\u00f3n de la columna pero pueden desarrollar osteoartritis y se transforman en una fuente de dolor de la parte baja de la espalda (dolor lumbar) o dolor de cuello (dolor cervical).<\/p>\n<p><iframe src=\"https:\/\/www.youtube.com\/embed\/178XnTK5uHk\" width=\"420\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<div class=\"row container-row container-right-column tabs-header-container\">\n<div class=\"col-md-12\"><\/div>\n<\/div>\n<div class=\"tab-content\">\n<div id=\"article-content\" class=\"tab-pane active\">\n<div id=\"article-body\" class=\"row container-row container-right-column\">\n<div class=\"col-md-12 pull-left\">\n<p>&nbsp;<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>COLUMNA VERTEBRAL<\/h1>\n<\/div>\n<div class=\"col-md-3\"><\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p><strong>La columna vertebral\u00a0<\/strong>es\u00a0 la estructura osteofibrocartilaginosa\u00a0\u00a0articulada , en forma de tallo longitudinal, que constituye la porci\u00f3n posterior e inferior del esqueleto axial\u00a0\u00a0y sirve como sost\u00e9n al resto del esqueleto, adem\u00e1s de constituir un importante eje de comunicaci\u00f3n entre el\u00a0sistema nervioso central\u00a0y el\u00a0\u00a0sistema nervioso perif\u00e9rico\u00a0a trav\u00e9s de la\u00a0m\u00e9dula espinal, contenida en el el denominado\u00a0<a class=\"internal-link\" data-internallinks-id=\"4055\" data-internallinks-type=\"category\">canal raqu\u00eddeo\u00a0<\/a>.\u00a0De ella cabe destacar :<\/p>\n<p>1.-\u00a0Est\u00e1 constituida\u00a0por la superposici\u00f3n alternada de unos elementos \u00f3seos llamados\u00a0v\u00e9rtebras\u00a0con otros elementos que est\u00e1n entre ellas llamados\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">discos intervertebrales<\/a>. Estos \u00faltimos\u00a0 elementos\u00a0son\u00a0estructuras\u00a0 cartilaginosas\u00a0\u00a0que amortiguan\u00a0la presi\u00f3n intervertebral y\u00a0 actuan\u00a0como ligamentos que mantienen las v\u00e9rtebras unidas a la vez que permiten el movimiento de la columna, aunque de forma limitada.<\/p>\n<p><strong>Figura 1. Distribuci\u00f3n de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0por regiones<\/strong>\u00a0.\u00a0La\u00a0columna vertebral\u00a0\u00a0consta normalmente de 33 v\u00e9rtebras\u00a0, a saber: siete\u00a0v\u00e9rtebras cervicales, doce\u00a0 \u00a0v\u00e9rtebras tor\u00e1cicas, cinco \u00a0v\u00e9rtebras lumbares\u00a0, cinco \u00a0v\u00e9rtebras sacras\u00a0y cuatro \u00a0v\u00e9rtebras cocc\u00edgeas<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/columna_vertebral_topografia.JPG\" alt=\"\" \/><\/p>\n<div class=\"row container-row container-right-column tabs-header-container\">\n<div class=\"col-md-12\">\n<h1>Anatom\u00eda de la columna cervical<\/h1>\n<\/div>\n<\/div>\n<div class=\"tab-content\">\n<div id=\"article-content\" class=\"tab-pane active\">\n<div id=\"article-body\" class=\"row container-row container-right-column\">\n<div class=\"col-md-12 pull-left\">\n<p><strong>La\u00a0columna cervical<\/strong>\u00a0es la porci\u00f3n\u00a0m\u00e1s alta de\u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>.\u00a0Est\u00e1 formada por siete\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0que se llaman CI, CII,.. CVII\u00a0 localizadas entre la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">cabeza<\/a>\u00a0 y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">\u00a0columna\u00a0 tor\u00e1cica<\/a>\u00a0.\u00a0\u00a0Al igual que el\u00a0resto\u00a0de la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>\u00a0tiene la dif\u00edcil misi\u00f3n de ser una estructura de movilidad y soporte de carga aunque,\u00a0 de\u00a0 estas funciones,\u00a0 destaca la movilidad .<\/p>\n<p><strong>Figura 1. Columna\u00a0 cervical<\/strong><\/p>\n<div class=\"body-spacing\">\n<div class=\"PageHeader_pageHeader__A17Dv\">\n<header class=\"PageHeader_description__bLUxB\">\n<h1 class=\"display-header-1 PageHeader_title__UNAZ1\">Anatom\u00eda de la columna cervical (cuello)<\/h1>\n<\/header>\n<\/div>\n<\/div>\n<div class=\"article-body consumer\">\n<div class=\"body-spacing\">\n<p>La columna cervical comienza en la base del cr\u00e1neo.\u00a0Siete son las v\u00e9rtebras que componen la columna cervical, adem\u00e1s de ocho pares de nervios cervicales.\u00a0Cada v\u00e9rtebra cervical se denomina C1, C2, C3, C4, C5, C6 y C7.\u00a0Los nervios cervicales tambi\u00e9n se abrevian desde C1 hasta C8.<\/p>\n<div class=\"image-wrapper float\">\n<figure class=\"image_figure__i5WaD image-figure\"><picture><source srcset=\"https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=288&amp;h=240 , https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=576&amp;h=480 2x\" type=\"image\/webp\" media=\"(min-width: 1280px)\" \/><source srcset=\"https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=288&amp;h=240 , https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=576&amp;h=480 2x\" type=\"image\/webp\" media=\"(min-width: 768px)\" \/><source srcset=\"https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=350&amp;h=291 , https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=700&amp;h=582 2x\" type=\"image\/webp\" media=\"(min-width: 0px)\" \/><source srcset=\"https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=jpg&amp;fit=thumb&amp;q=65&amp;w=350&amp;h=291&amp;fl=progressive , https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=700&amp;h=582 2x\" type=\"image\/jpeg\" \/><img decoding=\"async\" class=\"image_img__HKr1o\" src=\"https:\/\/images.ctfassets.net\/yixw23k2v6vo\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2\/d795ef62add0d9762fd7099def58c606\/spu_article_asset_e8fbe893407fec82642956c37d4df96e5837e0f2?fm=webp&amp;fit=thumb&amp;q=65&amp;w=350&amp;h=291\" alt=\"C4 (cervical, cuello) v\u00e9rtebra\" width=\"350\" height=\"291\" \/><\/picture><figcaption>\n<div class=\"image-caption Caption_image-caption__TtHBO\"><span class=\"body-smallest\">SpineUniverse<\/span><\/div>\n<\/figcaption><\/figure>\n<\/div>\n<h3><b>V\u00e9rtebras cervicales y estructuras de soporte<\/b><\/h3>\n<p>Los huesos cervicales (las v\u00e9rtebras) son m\u00e1s peque\u00f1os que las dem\u00e1s v\u00e9rtebras espinales.\u00a0La funci\u00f3n de la columna cervical es contener y proteger la m\u00e9dula espinal, soportar el cr\u00e1neo y permitir los diversos movimientos de la cabeza (por ejemplo, rotarla de un lado al otro, inclinarla hacia adelante o hacia atr\u00e1s).<\/p>\n<p>Un sistema complejo de ligamentos, tendones y m\u00fasculos ayuda a soportar y estabilizar la columna cervical.\u00a0Los ligamentos previenen el movimiento excesivo, que podr\u00eda provocar lesiones graves.\u00a0Los m\u00fasculos tambi\u00e9n ayudan a mantener el equilibrio y la estabilidad espinales y permiten el movimiento.\u00a0Los m\u00fasculos se contraen y relajan en respuesta a impulsos nerviosos originados en el cerebro.\u00a0Algunos de ellos funcionan como pares o antagonistas.\u00a0Esto quiere decir que cuando un m\u00fasculo se contrae, el m\u00fasculo opuesto se relaja.\u00a0Existen diferentes tipos de m\u00fasculos: flexores anteriores, flexores laterales, rotatorios y extensores.<\/p>\n<h3><b>M\u00e9dula espinal y ra\u00edces nerviosas cervicales<\/b><\/h3>\n<p>Los impulsos nerviosos circulan desde y hacia el cerebro por la m\u00e9dula espinal hasta una ubicaci\u00f3n espec\u00edfica, a trav\u00e9s del sistema nervioso perif\u00e9rico (SNP).\u00a0El SNP es el sistema complejo de nervios que se desprenden de las ra\u00edces nerviosas espinales.\u00a0Estos nervios circulan fuera del canal o m\u00e9dula espinal hasta los \u00f3rganos, brazos, piernas, dedos\u2026 por todo el cuerpo.<\/p>\n<p>Las lesiones o peque\u00f1os traumatismos de la columna cervical pueden ocasionar emergencias m\u00e9dicas graves o de vida o muerte (por ejemplo, lesi\u00f3n de m\u00e9dula espinal o en ingl\u00e9s, SCI, o fracturas).\u00a0El dolor, adormecimiento o temblores son s\u00edntomas que pueden aparecer cuando uno o m\u00e1s nervios espinales se lesionan, irritan o estiran.\u00a0Los nervios cervicales controlan muchas de las funciones del cuerpo y las actividades sensoriales.<\/p>\n<p>C1: cabeza y cuello<br \/>\nC2: cabeza y cuello<br \/>\nC3: Diafragma<br \/>\nC4: M\u00fasculos de la parte superior del cuerpo (por ejemplo, deltoides, b\u00edceps)<br \/>\nC5: Extensores de la mu\u00f1eca<br \/>\nC6: Extensores de la mu\u00f1eca<br \/>\nC7: Tr\u00edceps<br \/>\nC8: Manos<\/p>\n<\/div>\n<\/div>\n<p>El \u00a0conocimiento\u00a0de la\u00a0anatom\u00eda de la columna cervical\u00a0 es \u00a0fundamental \u00a0 a la \u00a0hora \u00a0de \u00a0realizar\u00a0 diferentes\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-en-el-cuello\" target=\"_self\" rel=\"noopener\">t\u00e9cnicas intervencionistas en el cuello\u00a0<\/a>\u00a0como :<\/p>\n<ol>\n<li>\u00a0BLOQUEO PARAVERTEBRAL CERVICAL<\/li>\n<li>\u00a0BLOQUEO DEL PLEXO CERVICAL PROFUNDO<\/li>\n<li>T\u00c9CNICAS SOBRE RA\u00cdCES ESPINALES PARA EL ALIVIO DEL DOLOR EN EL CUELLOo\u00a0T\u00c9CNICAS SOBRE RA\u00cdCES ESPINALES PARA EL ALIVIO DEL DOLOR EN LAS EXTREMIDADES SUPERIOREs<\/li>\n<li>T\u00c9CNICAS NEUROAXIALES PARA EL ALIVIO DEL DOLOR EN EL CUELLO<\/li>\n<li>T\u00c9CNICAS SOBRE LOS DISCOS INTERVERTEBRALES PARA EL ALIVIO DEL DOLOR EN EL CUELLOo\u00a0T\u00c9CNICAS SOBRE LOS DISCOS INTERVERTEBRALES PARA EL ALIVIO DEL DOLOR EN LAS EXTREMIDADES SUPERIORES<\/li>\n<li>BLOQUEOS DE LAS FACETAS CERVICALES<\/li>\n<li>BLOQUEOS FASCIALES EN EL CUELLO<\/li>\n<\/ol>\n<p>Para\u00a0su\u00a0estudio\u00a0existen\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-de-imagen-para-el-estudio-del-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">t\u00e9cnicas de imagen para el estudio del dolor en el cuello\u00a0<\/a>\u00a0 como son\u00a0 la\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/radiografia-convencional-para-el-estudio-del-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">radiograf\u00eda convencional\u00a0<\/a>\u00a0,\u00a0\u00a0la\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/ecografia-de-la-columna-vertebral-cervical\" target=\"_self\" rel=\"noopener\">ecograf\u00eda de la columna vertebral cervical<\/a>\u00a0y la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/resonancia-magnetica-rm-o-rmn-para-el-estudio-del-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">resonancia magn\u00e9tica -RM O RMN-<\/a><\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>T\u00c9CNICAS DE IMAGEN PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>Se llama\u00a0<strong>imagen<\/strong>\u00a0m\u00e9dica al conjunto de\u00a0<strong>t\u00e9cnicas<\/strong>\u00a0y procesos usados para crear\u00a0<strong>im\u00e1genes<\/strong>\u00a0del cuerpo humano, o partes de \u00e9l, con prop\u00f3sitos cl\u00ednicos (procedimientos m\u00e9dicos que buscan revelar, diagnosticar o examinar enfermedades) o para la ciencia m\u00e9dica (incluyendo el estudio de la anatom\u00eda normal y funci\u00f3n).<\/p>\n<p>En el contexto cl\u00ednico, la imagen m\u00e9dica se equipara generalmente a la\u00a0radiolog\u00eda\u00a0o a la &#8220;imagen cl\u00ednica&#8221; y al profesional de la medicina responsable de interpretar (y a veces de adquirir) las im\u00e1genes, que es el\u00a0radi\u00f3logo. No obstante , existen una variedad de aparatos y t\u00e9cnicas pueden crear im\u00e1genes de las estructuras y actividades dentro de su cuerpo. El tipo de imagen que use el m\u00e9dico depender\u00e1 de sus s\u00edntomas y de la parte del cuerpo que debe examinarse. Estas incluyen: Rayos X, Tomograf\u00edas computarizadas, Estudios de medicina nuclear, Im\u00e1genes por resonancia magn\u00e9tica, Ecograf\u00edas<\/p>\n<p>Este apartado proporciona informaci\u00f3n\u00a0 sobre el uso\u00a0 de las t\u00e9cnicas de imagen\u00a0 para el estudio\u00a0 de los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/sindromes-dolorosos-en-el-cuello\" target=\"_self\" rel=\"noopener\">S\u00cdNDROMES DOLOROSOS EN EL CUELLO<\/a>\u00a0 \u00a0O LA\u00a0 realizaci\u00f3n\u00a0 de\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-en-el-cuello\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO<\/a> .En\u00a0 este sentido , es interesante\u00a0 rese\u00f1ar\u00a0 que\u00a0 La fluoroscopia ,\u00a0\u00a0la\u00a0 TOMOGRAF\u00cdA<\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e4ecc4309e58.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/radiografia-convencional-para-el-estudio-del-dolor-en-el-cuello\">RADIOGRAF\u00cdA CONVENCIONAL PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>La radiograf\u00eda convencional\u00a0 es una t\u00e9cnica exploratoria que consiste en someter un cuerpo o un objeto a la acci\u00f3n de los&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e4ecd80c4240.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/ecografia-para-el-estudio-del-dolor-en-el-cuello\">ECOGRAF\u00cdA PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>La\u00a0\u00a0ecograf\u00eda \u00a0 es una t\u00e9cnica exploratoria no invasiva\u00a0 basada\u00a0 en\u00a0 la emisi\u00f3n de ondas sonoras a una frecuencia superior a&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e4ed3ea7c6bf.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/resonancia-magnetica-rm-o-rmn-para-el-estudio-del-dolor-en-el-cuello\">RESONANCIA MAGN\u00c9TICA-RM O RMN- PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Dentro\u00a0 de las\u00a0\u00a0\u00a0EXPLORACIONES COMPLEMENTARIAS PARA EL DOLOR EN EL CUELLO\u00a0.\u00a0 la Resonancia magn\u00e9tica\u00a0&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e4ed45c87109.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tomografia-computerizada-tc-o-tac-para-el-estudio-del-dolor-en-el-cuello\">TOMOGRAF\u00cdA COMPUTERIZADA -TC O TAC &#8211; PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e4ed51e4bf74.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/gammagrafia-para-el-estudio-del-dolor-en-el-cuello\">GAMMAGRAF\u00cdA PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e4ed56d1a4c5.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/termografia-para-el-estudio-del-dolor-en-el-cuello\">TERMOGRAF\u00cdA PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5cd1d3c3deb1c.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/fluoroscopia-para-el-estudio-del-dolor-en-el-cuello\">FLUOROSCOPIA PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>La fluoroscopia es el m\u00e9todo de obtenci\u00f3n de im\u00e1genes de rayos X en tiempo real, lo que es especialmente \u00fatil para guiar una&#8230;<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>Uno de los criterios a considerar a la hora de realizar \u00a0la \u00a0CLASIFICACI\u00d3N DE LAS T\u00c9CNICAS INTERVENCIONISTAS PARA EL TRATAMIENTO DEL DOLOR\u00a0 es la topograf\u00eda . \u00a0En \u00a0este caso \u00a0se profundiza en los\u00a0procedimientos invasivos\u00a0\u00a0\u00a0que \u00a0se realizan en\u00a0EL\u00a0CUELLO\u00a0\u00a0 con el fin \u00a0de \u00a0aliviar \u00a0el \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/definicion-de-dolor\" target=\"_self\" rel=\"noopener\">dolor\u00a0<\/a>\u00a0de \u00a0ENTIDADES CL\u00cdNICAS EN CUELLO. \u00a0 Para \u00a0ello \u00a0se \u00a0tiene \u00a0en \u00a0cuenta \u00a0:<\/p>\n<ol>\n<li>si\u00a0pueden\u00a0ser\u00a0medidas\u00a0farmacol\u00f3gicas\u00a0(infiltraciones\u00a0por ejemplo)\u00a0\u00a0y \u00a0medidas no \u00a0farmacol\u00f3gicas\u00a0\u00a0\u00a0(\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/radiofrecuencia-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">radiofrecuencia<\/a> \u00a0por \u00a0ejemplo)\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>TRATAMIENTO NO FARMACOL\u00d3GICO DEL DOLOR<\/h1>\n<\/div>\n<\/div>\n<div class=\"col-md-3\"><\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>Aunque el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-farmacologico-del-dolor\" target=\"_self\" rel=\"noopener\">TRATAMIENTO FARMACOL\u00d3GICO DEL DOLOR<\/a>\u00a0sigue siendo el pilar del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-sintomatico-del-dolor\" target=\"_self\" rel=\"noopener\">tratamiento sintom\u00e1tico del dolor<\/a>es\u00a0interesante\u00a0rese\u00f1ar que con\u00a0s\u00f3lo la utilizaci\u00f3n\u00a0de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/farmacos-analgesicos\" target=\"_self\" rel=\"noopener\">f\u00e1rmacos analg\u00e9sicos<\/a>\u00a0no\u00a0 se consigue\u00a0en \u00a0muchas ocasiones\u00a0 alcanzar \u00a0un nivel adecuado\u00a0de alivio del\u00a0<a class=\"external-link\" href=\"http:\/\/sf.dolopedia.com\/articulos\" target=\"_blank\" rel=\"noopener\" data-externallink-href=\"http:\/\/sf.dolopedia.com\/articulos\">dolor<\/a>\u00a0.<\/p>\n<p>Este\u00a0apartado\u00a0enumera\u00a0otras posibilidades \u00a0para \u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">\u00a0tratamiento \u00a0del dolor\u00a0<\/a>\u00a0 diferentes \u00a0al \u00a0t<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-farmacologico-del-dolor\" target=\"_self\" rel=\"noopener\">ratamiento farmacol\u00f3gico \u00a0del dolor<\/a>\u00a0clasific\u00e1ndolas \u00a0seg\u00fan \u00a0sean: \u00a01) \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medidas-encaminadas-a-elevar-el-umbral-del-dolor\" target=\"_self\" rel=\"noopener\">MEDIDAS ENCAMINADAS A ELEVAR EL UMBRAL DEL DOLOR<\/a>\u00a0, \u00f3\u00a0 2)\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medidas-encaminadas-a-modular-la-via-dolorosa\" target=\"_self\" rel=\"noopener\">MEDIDAS ENCAMINADAS A MODULAR LA V\u00cdA DOLOROSA<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d8549fa9677.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/medidas-encaminadas-a-elevar-el-umbral-del-dolor\">MEDIDAS ENCAMINADAS A ELEVAR EL UMBRAL DEL DOLOR<span class=\"page-count\">192<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>En el\u00a0TRATAMIENTO NO FARMACOL\u00d3GICO DEL DOLOR\u00a0 hay una serie de procedimientos capaces de elevar&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d855ada0d19.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/medidas-encaminadas-a-modular-la-via-dolorosa\">MEDIDAS ENCAMINADAS A MODULAR LA V\u00cdA DOLOROSA<span class=\"page-count\">37<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>En el\u00a0TRATAMIENTO NO FARMACOL\u00d3GICO DEL DOLOR\u00a0 hay una serie de procedimientos capaces de&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\"><\/div>\n<\/div>\n<\/li>\n<li>la diana terap\u00e9utica\u00a0sobre las que se \u00a0realizan .<\/li>\n<\/ol>\n<p>Estas \u00a0t\u00e9cnicas \u00a0pueden \u00a0hacerse en el contexto \u00a0de \u00a0 las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-control-del-dolor-agudo\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL CONTROL DEL DOLOR AGUDO<\/a>\u00a0o las\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-control-del-dolor-cronico\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL CONTROL DEL DOLOR CR\u00d3NICO<\/a><\/p>\n<p>Es importante\u00a0 \u00a0rese\u00f1ar\u00a0\u00a0 el fuerte\u00a0v\u00ednculo que existe entre la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna cervical<\/a>, la\u00a0cabeza y la cara en cuanto al mecanismo del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/cefalea-o-dolor-de-cabeza\" target=\"_self\" rel=\"noopener\">dolor de cabeza<\/a>\u00a0y\u00a0 el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-cervical\" target=\"_self\" rel=\"noopener\">dolor cervical<\/a>. Ello\u00a0 se debe\u00a0 a\u00a0 que\u00a0 embriol\u00f3gicamente\u00a0\u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">cabeza<\/a>\u00a0se\u00a0forma desde los dos primeros segmentos cervicales\u00a0y la primera y segunda\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras cervicales\u00a0<\/a>\u00a0tambi\u00e9n se originan de dichos segmentos.\u00a0Por lo tanto, desde bases anat\u00f3micas, las\u00a0lesiones occipito-atlanto-axoideas pueden provocar\u00a0un dolor perceptible en cualquier lugar de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">cabeza<\/a>, la cara o el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>.<\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d4fb5c18fc8.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-el-aparato-musculoesqueletico-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS SOBRE EL APARATO M\u00daSCULOESQUEL\u00c9TICO PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">22<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Un grupo \u00a0de\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0 es el\u00a0que se realiza\u00a0sobre el aparato&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55da04d8212e7.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-nervios-perifericos-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS SOBRE NERVIOS PERIF\u00c9RICOS PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">6<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Un grupo de\u00a0\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0\u00a0 \u00a0es el que se realiza\u00a0 sobre los nervios&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5618069c0a4a1.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-paravertebrales-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS PARAVERTEBRALES PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Un grupo \u00a0de\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0 es el\u00a0que se realiza\u00a0sobre el espacio&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d9e1d960d7a.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-raices-espinales-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS SOBRE RA\u00cdCES ESPINALES PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">8<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Un\u00a0grupo\u00a0de\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0es\u00a0el\u00a0que se realiza\u00a0sobre las\u00a0&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d4fe2c1ce6f.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-neuroaxiales-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS NEUROAXIALES PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">4<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno grupo de\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0es el\u00a0que se realiza\u00a0alrededor del espacio&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d9f5d9c5a6f.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-el-sistema-nervioso-simpatico-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS SOBRE EL SISTEMA NERVIOSO SIMP\u00c1TICO PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">2<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Un\u00a0grupo de\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0es el\u00a0que se realiza\u00a0\u00a0SOBRE EL \u00a0SISTEMA&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d9eee874209.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-los-discos-intervertebrales-para-el-alivio-del-dolor-en-el-cuello\">T\u00c9CNICAS SOBRE LOS DISCOS INTERVERTEBRALES PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">3<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Un grupo \u00a0de\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0 es el\u00a0que se realiza\u00a0sobre los discos&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/55d9fb3276bff.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/otras-tecnicas-para-el-alivio-del-dolor-en-el-cuello\">OTRAS T\u00c9CNICAS PARA EL ALIVIO DEL DOLOR EN EL CUELLO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>En las T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO\u00a0 existen otros \u00a0procedimientos \u00a0que interesa conocer<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h2 id=\"acItem_content\">Contenido del art\u00edculo<\/h2>\n<div class=\"editor-field\">\n<p><strong>La columna cervical\u00a0<\/strong>contiene 7\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>. Cada\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra<\/a>, excepto la primera, constan de un cuerpo vertebral anterior que da estabilidad y soporte,\u00a0 y un anillo posterior que contiene las ap\u00f3fisis articulares que forma la articulaci\u00f3n con la v\u00e9rtebra adyacente. Entre dos v\u00e9rtebras adyacentes hay un disco intervertebral y dos articulaciones intervertebrales que permiten la movilidad guiada y limitada. El canal espinal contiene la m\u00e9dula espinal. La columna cervical soporta la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">cabeza<\/a>\u00a0\u00a0, protege a la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>\u00a0y a los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervios espinales<\/a>\u00a0nervios espinales y limita los movimientos del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a><\/p>\n<h3>Componentes de la columna cervical<\/h3>\n<h4><strong>V\u00e9rtebras cervicales\u00a0<\/strong><\/h4>\n<ul>\n<li>Son las\u00a0v\u00e9rtebras m\u00e1s peque\u00f1as y m\u00f3viles\u00a0 de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>\u00a0 y\u00a0se\u00a0 caracterizan\u00a0por la presencia de un\u00a0<em>foramen en cada proceso transverso\u00a0<\/em>\u00a0y por\u00a0 tener un\u00a0<em>peque\u00f1o pero relativamente ancho cuerpo vertebral\u00a0<\/em><\/li>\n<li>Estos huesos\u00a0 localizados\u00a0 en el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>\u00a0\u00a0forman parte de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>\u00a0 y\u00a0 sirven para\u00a0 sostener la cabeza\u00a0 y proporcionar la flexibilidad necesaria para\u00a0 \u00a0posicionarla<\/li>\n<\/ul>\n<p><strong>Figura 1. Columna cervical.\u00a0<\/strong>\u00a0Las v\u00e9rtebras cervicales t\u00edpicas (CIII-CVII) cuentan con un<em><strong>\u00a0cuerpo<\/strong><\/em>\u00a0m\u00e1s peque\u00f1o, m\u00e1s ancho en sentido lateral que anteroposterior cuya cara anterior es c\u00f3ncava. El\u00a0<em><strong>agujero vertebral<\/strong><\/em>\u00a0es de un tama\u00f1o considerable y de forma triangular. Las\u00a0<em><strong>ap\u00f3fisis transversas<\/strong><\/em>\u00a0tienen\u00a0<em>agujeros transversos<\/em>\u00a0por donde pasan las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arterias vertebrales<\/a>. Las\u00a0<em><strong>ap\u00f3fisis articulares<\/strong><\/em>\u00a0tienen caras superiores dirigidas en forma posterosuperior; las caras inferiores se encuentran dirigidas en sentido anteroinferior. Las\u00a0<em><strong>ap\u00f3fisis espinosas<\/strong><\/em>\u00a0son cortas, b\u00edfidas. En especial las ap\u00f3fisis espinosas de CVI\u00a0y CVII\u00a0son las m\u00e1s largas y se pueden palpar en flexi\u00f3n completa del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>.\u00a0<ins>Las dos primeras v\u00e9rtebras cervicales son diferentes al resto\u00a0<\/ins>y son descritas detalladamente a continuaci\u00f3n por cuanto son v\u00e9rtebras cervicales at\u00edpicas<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/COLUMNA%20_CERVICAL_3.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>\u00bf\u00a0 Qu\u00e9 v\u00e9rtebras la\u00a0 componen ?\u00a0<\/strong>De CI\u00a0a C VII. CI\u00a0y CII\u00a0son at\u00edpicas:<\/li>\n<\/ul>\n<p><strong>&#8211; ATLAS.- Primera v\u00e9rtebra cervical\u00a0 &#8211;<\/strong>\u00a0.\u00a0 Del griego \u00absoportar\u00bb, joven Tit\u00e1n al que Zeus conden\u00f3 a cargar sobre sus hombros el peso de los Cielos. Es una v\u00e9rtebra que que\u00a0sirve de eje. Tiene forma de anillo.\u00a0\u00a0Su dise\u00f1o permite que la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">cabeza<\/a>\u00a0se mueva hacia delante y hacia atr\u00e1s.\u00a0\u00a0<strong><ins><em>No tiene cuerpo vertebral\u00a0\u00a0ni ap\u00f3fisis\u00a0espinosa\u00a0<\/em><\/ins><\/strong>:\u00a0 es una\u00a0 v\u00e9rtebra con\u00a0 dos masas laterales conectadas por los arcos anterior y posterior. En las masas laterales se encuentran las carillas articulares superiores, con una forma c\u00f3ncava que permite que se articulen con los c\u00f3ndilos occipitales, formando la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-atlantooccipitales-1\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlanto-occipital\u00a0<\/a>\u00a0que posibilita la flexi\u00f3n y extensi\u00f3n generando el movimiento de afirmaci\u00f3n o ?SI? de la cabeza y cierto movimiento lateral.\u00a0 Misi\u00f3n : Transporta el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/huesos-del-craneo\" target=\"_self\" rel=\"noopener\">cr\u00e1neo<\/a>\u00a0y rota sobre las carillas articulares superiores planas grandes de CII<\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/atlas.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>&#8211; AXIS.- Segunda v\u00e9rtebra.cervical\u00a0.\u00a0<\/strong>\u00a0Es la v\u00e9rtebra cervical m\u00e1s fuerte. La caracter\u00edstica que la distingue es la<strong>\u00a0<ins><em>ap\u00f3fisis odontoides<\/em><\/ins><\/strong>, que se proyecta superiormente desde su cuerpo \u00a0y proporciona un pivote alrededor del cu\u00e1l gira el atlas y mueve el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/huesos-del-craneo\" target=\"_self\" rel=\"noopener\">cr\u00e1neo<\/a>\u00a0\u00a0(\u00a0 ver\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0 atlantoaxial<\/a>\u00a0: permite el movimiento de la cabeza lateralmente generando la afirmaci\u00f3n ?NO?)\u00a0. Esta v\u00e9rtebra \u00a0se asienta detr\u00e1s del atlas y est\u00e1 dise\u00f1ado para girar.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/axis.JPG\" alt=\"\" \/><\/p>\n<p><strong>&#8211; CIII, CIV,CV,CVI y CVII<\/strong>\u00a0:\u00a0De\u00a0sus caracter\u00edsticas destacar que su\u00a0<em><strong>cuerpo<\/strong><\/em>\u00a0vertebral es m\u00e1s peque\u00f1o y m\u00e1s ancho de lado a lado que anteroposteriormente, la cara superior es c\u00f3ncava y la inferior convexa. Su\u00a0<em><strong>foramen vertebral\u00a0<\/strong><\/em>es grande y triangular. Poseen\u00a0<em><strong>ap\u00f3fisis transversas<\/strong><\/em>\u00a0por donde pasan las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arterias vertebrales<\/a>, excepto en CVII\u00a0donde existe el agujero, pero la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria\u00a0vertebral<\/a>\u00a0no discurre por \u00e9l. Sus\u00a0<em><strong>ap\u00f3fisis articulares superiores<\/strong><\/em>\u00a0tiene direcci\u00f3n superoposterior y las\u00a0<em><strong>ap\u00f3fisis articulares inferiores<\/strong><\/em>\u00a0direcci\u00f3n inferoanterior. Las<strong><em>\u00a0ap\u00f3fisis espinosas<\/em><\/strong>\u00a0de CIII\u00a0a CV\u00a0son cortas y b\u00edfidas; la de CVI\u00a0es larga, pero la de CVII\u00a0es m\u00e1s larga y f\u00e1cilmente palpable<\/p>\n<p><img decoding=\"async\" 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evcqRI0dynovgug0NDSxZsoT\/9\/\/+HwMDA8RiMf79v\/\/3t32dRO5XwZKi03k93TyendQjLiJyF5s7dy4Ap06dGvexQU9h\/rzn6VgfOz9QBQHiJz\/5CX\/3d38HpAu5ZXv66acB+P73v1903fGDBw\/esjDceCxduhSY3udIPe2jC4rijTaHP19DQwPl5eUAmYJ\/wReMFCsLh8Ps3r2bvr4+amtrCYVCmXMEYTU\/hP\/qV7+ivb09p9hZe3s7\/\/RP\/wTAvHnzMvt3dHSQSCQoLy\/PHBcKhYhGowwMDBR9z7711lvs3buXzs5OotEo0WiUzs5O\/umf\/om+vr6CofYnT54Eivf8Bz8nwb8TwWMHCgq1HT9+nN27dxOPxwmHw9TW1nL9+nV++9vf0t7eDpAzQuXMmTMADAwMZG58RKPRzFD0wLlz5wraNdtlB6npDlUyOwXvk5l6v1iWNeNtkPFTj7iIyF2soaGBWCxGPB6nvr6e+vp6gJz1tEcTzM3evn07p0+fZsWKFfzud79j\/\/79RKPRSc+Jbm1t5dVXX2Xt2rWZNcSD+d3f\/e53c\/atq6ujsbExMw+8ubm5YP7qli1bePvtt2lra2PVqlU0NzdTWVlJf38\/e\/bsIR6Pc+DAgZywcCvV1dWsW7eOr371qwCZx97Y2Mj69eun5TkqxhijD0pZjhw5kumdHctru3btWtauXcvOnTsBivbOBsXKgrD77\/7dv8t5vwUBOj\/0vvXWW5kwnH1MdmX1xYsXZ\/b\/7LPPgPSNhGg0yjPPPJPphf6v\/\/W\/0tfXR09PT+ZxdXR0cPjwYSA9bSLoLT9+\/Di\/\/e1v6evrK7iJFQwzX7JkScHjLDYEfbRCbb\/97W9JJBI5Pdo9PT3s27ePeDxOeXl5znMUnDsej9+XveD6GZXxuhveM3dDG2Ts1CMuInKX+8d\/\/EcaGxuJx+McPnw4EyxhpHhZdo9YYMOGDezdu5fGxsZM2IR0qHjqqacK9q+srMz5s5jsYmmrV6+mpqYmc+6dO3eybt069u7dW7CUGuSG8z\/7sz8rev6XX36ZXbt2sW7dOnbu3Mn27dtpa2ujsbGRvXv3smHDhsy+wWMerYDbU089xalTp9i+fTvbt2\/n1KlTNDc35yx1Nt7nSKZe0KM6nvnMowXpQNBTHA6HC0I4jATo7LDa0dHBiRMnih7zjW98I\/P\/2TcLuru7M9f5t\/\/23+YMBc\/vOQb4\/e9\/TyKRoKGhIWfI+urVq1m2bFlBm4DMzaBiNymKDUEvVqgtuMFQW1ubE6hramp4+BJmOz0AACAASURBVOGHASgrK8s5dxDE84\/JF+xX7N8gEREZnXrERUTucg0NDaOuc7x79+5bDqPetGlT0bnPmzZtKjhu69atmarm+TZs2FAwrHq0c49my5YtRQP6RPdraGi45VDvsQ4vH89zJFMv6MF94IEHxnxMEDZHK9QWhMPRlrYLAnT28dnz1POPGW24d9D2devWFQTl69evAyOBuKenJzME\/4knnhi1zdnFz4LK8Pm91bdqU7Fe8g8\/\/BAonDMOcOnSpYL9YeQGQFNTU8Ex2QYGBoBb38ATEZFC6hEXERGRGRMEvuwh37cT9KKPFsSDnuJHH3206PeDAJ0deoMAW6znOZgvPVpvdf51ggAdDodzhqVDOjgXuzkQnCt7znpwTLGe\/9GGoAfnyQ7dwbbHH3981PNkz30PbkrcbrpAT09P0XaLiMjtKYiLiIjIjEkkEkDxADyaYr3Hgeye4tHW0S4WHoPwXqwdJ06cACg6z7zYdbJDd+BWNw\/eeuutomui3+qYY8eO3bJNgexQnS9YNg5yb4QEveTBcPnRvPfee8BI8UMRERk7BXERERGZUUEF9LG6VS9s8L3Rest7enpuOb88P1Tv3bs3M\/w6e\/h2sXnmgVsF6Py54z09PZlQnb9\/cN38Qm0TaVOxOev\/5\/\/8n8z3sm9ABOfO7iUv5sKFCwAsX778lvuJiEghBXERERGZUfmFwm4nCIrFlrkL5n+P1hse9Fbnh9UgqL711luZbUG19OB72cO9b3WdYpXOg3ME88SDtvzqV7\/KPJ7RgnjQQ53dpsDt2lRaWgqke\/yDx97T08M\/\/MM\/ZEYB5N+UCNp\/q+kCPT09md700aYAiIjI6FSsTURERGaVcDhMIpHgf\/7P\/5kJ8c3NzcDInOfRqrCP1lsdi8U4ceIEBw8e5OTJk1y\/fp2BgYHM8oGjFWordp1ilc4\/97nP0d7ezsDAAC+99BJlZWV0dXVRXl5ObW0tXV1dBUPtly1bRldXF0eOHOHs2bM5bQqWZrtdm1avXp1ZGm337t2ZZfmCpczi8XjBY+jq6iroJc\/33nvvZc4x2k0PEREZnXrERURk0lKpFI8++ijPPfccP\/7xj\/nNb37DRx99NNPNklkimCc+VuvWraO8vJyBgQGuX79eUJgsHA4XrRAOI729+cOpv\/71r2fW8O7q6iIUCvG1r30t09tbrKr4aNcpVum8rq6Oxx9\/PNPuvr4+Ghoa+A\/\/4T9kKqznD7X\/0pe+VLRNmzZtIpFIFC3UVqxNX\/va16itrSWRSNDV1UVtbS3PPPNM5vjsnvvRqrHnC4bTf+UrX7nlfiIiUpxlbrX2i4iI3PeMMfi+jzEG27axLCuzbJhtp+\/nvv322\/ybf\/Nvco5buHBhZg7pxC8+ucPHxbqzp8\/+dWtZd\/his8jOnTtJJBL84Ac\/mOmmzIienh7+9m\/\/lvLycr73ve\/NdHPG5K233uLgwYPEYrFbrjF+Pyr2sVo\/7yJSjHrERUTktizLyvmybTsTwoGivd9r1qyZziZOjj4nz5jRiqbdL95++22ATM\/3bKDecBGRydMccRERmbT29vaCbaMNDR4XBeR73sKFCzPzoO\/ltaj\/4R\/+gd7eXhYuXJgp3Hb27Fn6+vqIRqM88cQTM9zCsfnf\/\/t\/MzAwQENDw7iWnBMRkVwK4iIicku+7+cMTTfGkEgksG0b13WxLItTp04VHPfII4\/MQGtltlm1ahXt7e2cO3fung7i4XCY69evZ9Ykh\/RogIaGBp544olZUfCsp6eHEydOEI1G+eY3vznTzRERmdU0R1xEREZljMHzPDzPw\/d9IpEIADdu3MBxHCKRCLZts3z5cs6ePZtz7JEjR2hsbJyJZt+VNEdc5N6nOeIiMlYK4iIi9yFjzJg+HAZB3Pd9ABzHwRhDMpnEcRxCoRD9\/f1F5\/nevHmTkpKSCV97eG9832CMP1worlhpE0P6N9nInyPXSv89fbmROe4jY96DfXPbk\/+rMb+9EwnVCuIis8NkflanIogH55jovxOz+d+ayT52kdlEQ9NFRO4zwQed2wViY0xmn+zCbACu62YqqBcr1LZq1apRQ\/jtrh2EfmA4QPsY42OMhWWZIiE5c3aKhXJj0vukq71b2HY6iGdf3qS3FLQxff7CEB58AZnnQUTuPeO7cTg115upa4vI9FIQFxG5j+SH2LF80Muulu77fiZ4BscdPXq04JiGhoYJXdv3fVKpFMb4WJaF6zr5ZxkO5dkh2RoO2SP7jOwbhOqR6\/m+lXVs5lFisHK23apnJntJN7j7w\/hke8hmcw+bzE56z91fJvK7SWS2UxAXEZFRBR+Egj8dJz8Yw8cff1ywrVihtuz1x0cTDHv3fQ\/btnCcUhwn3Rtv21YmAPu+P9zLHSyjNvyBzQJ7ePh6+lpB73XuNYI\/gyHrmW5zrFGGv4\/eXs\/zhtt3d4dxERERuXsoiIuISFFjDZXBmsLZJr6GeBCefYyxsaz0oPHsofFBwA7+Px3KDVhBlrawMr3bI8PIs+ePj4Tx9D4js8aDx2zl7J8tf031kTYU62kXERERKaQgLiJyn5nqoHj8+PGCbQ8\/\/PCEzmXbDqWlpcO91WZ4PrdHJiZbBte1gXTPvDE+nueRTKbSveG2Q8h1seyRnvtgfng6U1tBFCcnelsAQc+6NRzc03PVg5CdPRw\/e3i+53mZnnHHcRTERURE5LYUxEVE7iNTHRLPnTvHlStXcraVlJSMGsRvNzw9u\/CaIR1uLcvCsu1MMbXgHJ7v4Q9XdDcYbMvGssjM3bYsK91LjpXpLQ+KsqU7u9Pt8DHgg8HHsmwscnvfs+fF5z+WYF314O8iIiIiY6EgLiIiE1ZsWPrq1asnfD5jfFKpJJ6Xwh8u2OY4Dm5Wb7TBkEwlh+eSp0NyOBTO9EYnU0mMb3J6sW3bzi7hBoxUZx8pvAaOY2Pb7nCotzLD2keTLiinX6UiIiIyPvr0ICIiE1Zs6bLJBHFIF2WzLAdwMiHasmwMBt\/3Muua27aF64ZwbAfHCWWKrDlOermzTE94pic96yIGbMvKDFC3bBuDhW3Z2JnwPhL+1dstIiIiU0lBXEREJqy9vb1gW7Gly7KNPjw9WLPcIZi\/HRRZM\/hkF16zLBvXdXCd3H0BHNulsMhaXgq3GF6THLBM1j5B1XQL2wZj7JxzaUkdERERmQoK4iIiMmFTWagtbbgAmm9IpVIkkwmMMTiOSzgUwnFcXCdEulhbuuI5pEgkEulecscmHCob47UMluUTVGpPn2+kYBsEvegjwXtk6bTc4m0iIiIi46EgLiIiE5JKpYoOTW9sbJzkmdNLh\/m+RyqVAhPM9w5hWRa+5zE4dJObN29w4+Z1bt68wdBQAsuyiETClM2pIBQKp880PLQ98+XYOLaD6zo4jjO8LNpIrzqk56mnh7475OfskaXQTM788+B72UPhRUREREajIC4iIhPy0UcfMTg4mLNt3rx5zJs377bH3rp6+vC63paFnV57bPhPSHkJ+vv7uXz5Ml1dXVy+fJmBgQE8zyMSiTBnzhwi4cjwEmZ2utCb6xIOhwlHwkRKIpSWlFJaWsqcOXMoLZlDKFySVSndJ5lMkEr5hMMluK5T2LqsIJ5dNd0Yk67IbhmFcREREbklBXEREZmQO1GoLZgHbtkQCrlZc8ANicQQvb29dMQ7OHnqJJ9++ind3d0kEglKSkqYO7eCkpISrl7tJ5FI4DgOITdEJBKhpLSEsrIy5lbMpaqyimhVlGh1lKpolMqKSiKREmzLJpFIkkgkMcaiqsopCOLW8H9muJ1B5fWsHRTCRURE5LYUxEVEZELeeeedgm1r1qyZxBmt9PJlXgoYqYoOkEgOcuHCBT755BM++OADPv30Uy5fukTKSxGJlBAOh\/C8FNevD3DhwgX6+\/ux7XThN9d1CYVDlJSUMKesjIq5c6morKSqqpJoNEplZSUlJSWE3RC27VISSYf6SMTBdcF1IwQ3AyzLYNuAGZlHnm75SIV2y1goi4uIiMitKIiLiMiEFOsRf+ihh8Z8fLFCZ74xJFND+L6H49iURCwMPtcGrvL+B+\/z+4O\/55OPP2FwaJCKigqWL1\/BokWLiEajOI7DwMAAvu9TWlqK53kkk0mSqSSDQ0MMXL+Of\/ky2Ba26xAOuYQjYcLhMBgonzOHRbULqa+roz5Wh+sksRiiorIa2w4Nt3l4yHyRwm45io66L5bOTd6fo5xPRERE7ikK4iJy35rNS1EF85Jnsv3Hjh0r2DbZQm2WBa7j4tkAhqSfroZ+Y+gG\/3riXzl85AhDQ4M8+OAq1q1dRzQa5dq1AT7++OPhYm0RhoaGMGa46rqXIuklSXhJkl6SlOdhANe42GEbC59kcojrA9e43JviSv8lrl\/rorsrjuvYLKpdxOf+6PMsXV5HWUUtWJHCRhvwkwY\/5WO7NpZjFRR5Sy+XRl5ANxgMVk4IL86Y9PHBnxM3sYNvPad\/+v3f\/\/t\/+au\/+isaGxtpaGigsbGR1atXU15ePtNNkykyk++57GuP99\/Y\/HZP5vjJ\/vs+W3+\/idwvFMRF5L6UU2Brln1Yyf6QN1PtHxgY4PTp0wXbJ7N0mcFPB\/FQCBublJ9kyEtw48Z1Ll2+xKenP+Vi1wVWLF\/Go4+u4atf+2Nu3hzk8KHDvPfuu4RCIZavWIFt24RCIQxghxwiVoQ5GPzhL8txKCktIVodJVJSQspP0X35EgN93QwNDXDu3FUunfuYK7091C6o5VrfRVLJL7NylSEUrkr3jlsGyzjYOFh2COMZvKQHWDiWRab2W1bGNlbxEG2C5dPMyBrmOd83hX+O\/yWf\/Hvkbvo5OXr0KMeOHcu5GfQXf\/EX\/O3f\/u0Mtkqm2ky+5yZz7ZkO0HfTz6qIjE5BXERkFpupD1zFhqXX19dPqkfSwsIzhqSXxHYMWIZUMsXZs50cOnSI6zeu8eBD9Xzly1\/hkUceAQO9vb3cvHmDhYsWMrd8LsuXL6d0zhwc18EH3JBLKBwmFAlhOTbGtjAWuJEQZRXluCGXZDJBb083\/d2XuNF7icG+y1zruURvapDz507zL7\/3uHixi2UrPqSycgEVFdXMnVtFtGoe0er5lFfPxym1cUrTS6bhD39BOl8b8Hwfz\/dwXAfXtYdzcbqsW8r38VIpPM\/DdcKEw0V63W8nu+NwFn4Gzy98F7yvs9dq930\/c+Pp0KFDBedYvnx50fPmU0gREZG7gYK4iIiM29GjRwu2Tb5iOung6ntYTrq32U96XDh3nnePHqW3p4eFtbU89NBD1NTUcKWvjwvnzzN4c5CVy1cwf8ECli5dSqSkBMd1sRyHSGmEktJSIqUlOCEX34KU72Eci0hpBByLZCrJ\/AULuNa7gBu9l7nefZErFysJOQ59Pb1cu3aDUyfjdF++wty51VRURKmsrKFmXi0Lah9g4aKlzKmoIFQSYU7pnHSQduzM47F8wDf4xmAXBEML34dkyieVSGFFCpdLG8tzdi+wLCsnbGcH5uz12qH4tIgpef+JiIhMEwVxEREZt48\/\/rhg22SGpQfSc8QdQlYYz\/fxUx49ly\/zyYmPuXb1KtHKKkoiEZKJJBfOn6fr\/HlSiQTLly1n+YoVLHrggeGB3ukh6OGSEiKlJYRLI9i2TcoYBpNDJI2H4zgYx8YJ+Vg4lLhh\/PIK\/Hm1JBYvY8nilXRdvEhX12UGrl1n4PpNBq5foOtyN6FQJ6Wlc6iorKJmfi3R6nnMm19L3co6ahc+QKSsYvgBATbYloVrW9jDPfLZfbLGszCeje9bGJPznfxnp\/AJKxbCbzvl\/FbJfWZ6i7N7wIPecdu2M+E7ewpGX18fp06dyjnetm0efPDB6W20iIjIJCiIi4jIuBXrkfziF784ybMaLAsc2wFcLJPC93wGb97kSl8f\/Veu0N93haGbg1x3B+jt6eXq1Wu4jkt1dTULFixgXs08Ur5HyvMxFjjhEG44hOO46RHjvkfKMyRSKcAD18ZybGw7RElpOU6olHB5NU71QhbOX84Di7rp\/Owcly5dov\/KFYYSCZLJJIlUkr5rPVy+cpkz589QXj6XBQtquXr1Miv666ieX0tZ+VwiJaVEIhEcJ4xlu6Srthl832CGh60b38K2HEKhMI7jZJ6LwvHmhnEF5aK7558328wO2c4O4fnbYCSMFxuNMX\/+fCKRCQzpFxERmSEK4iIiMm7Hjx8v2DYlPeKMFCxL1xM3GN\/DT6UYvHGT6wMDDN0cJOyGGbxxg8RQAneOS2lJCXNK51BSUpoO4imPlPHBsvA8g2dSpPz0\/PObQ0MMJhP4vsF2HZxwiJDrEHIjuLZFGJtSLCJRh6qqhZTOrSFac4kr\/b0kkkMMDt7k2vVrdPdcpqenm96rl+m72s3VgV4GEwN0912ktnYRNfPmU10zn+rqGsrLo0TCFcO9umZ4zrjBeGCMheM4hGwHxwkCt1\/02Rl3GC9qtCBuGFmSbebkz+vOr0L93nvvFRxTV1eH6+ojjYiIzB76rSUiIuNy8eJFuru7c7aVlJRMSRBPG1lb28LgOA6RcATXdXEdh3AoRNh1cRwHe3i4svENXsrDS6Wwhoc0W\/5wkTTPw8eQMoak7+F5Pr6f7nn1fQvLGCzbTVc\/932Ghjx83+CWRwiXukRrLCKlc6lNLSYUsvFJcXPwOhe7LtB5rpPOc6fT65d7HmfPf8pnXWcpL6tg3vxaFi9eysrlK1m6dCW1C5ZQUlIOOBjj43sGYyxsy8Jx0l\/pkdg+uT3X2cHYyn2KxvpUZv5iivx\/9rmnIuhPXP6KAPnfsyyLw4cPFxzX0NBASUnJHW+fiIjIVFEQFxGRcSk2LP3hhx+eoh7JvKBo0n20jmUTCYcpLysnWhWlvKycOSWl2JaFl0yRTCQwvo9lWaQ8j6Tn4Rkz\/AXGssCysW2LUNjCckOkPB\/fsrBsB8sOY1lueuh6yieZ9AmFIOSEcMLlzHFCWLbPnLIQbsjC8xNUzasmOq+a6gVRrl7t48aN61y+dIm+vitc7u2i90oPFy6e5\/z5c8S6LvLQg3\/E0qV1VFXOw3Hs4eJkww\/TGFKejwNZveJBKJ7qkujFArk1ReeevNtVOi82GuMrX\/kKoVDojrZLRERkKimIi4jIuBQLQneqYrVtwDYWrm1TEo5QXlZGdXU15WXlVFRU4NoOQ0NDXLs2QCKRwLYsEokEQ8kk2A7GssG2sSw73YPuOLiOhW8g4fmkfA\/P+Bjj4BsL49t4vguex41Bg+v66XNYIWzH4OHg2DahcIia+S5z5pZRU1vDzcHr3Lx5ne5Ll\/nss884c\/oM589f4NLpU5w+e4az5zrp7btCyvNZtSpMaaQc1w0DNp7nk0ymSCaShEIOjuMyeo\/4VMgO+vmh\/O5lWRYDAwMFhQIdx+Gxxx7Lml8vIiJy91MQFxGRcfnwww8LtjU0NEzBmYdLjA\/3zlqWheu4VM6tYGFtLdeuXuVq3xX6e\/soL51DtKqKsrIyrl69xqcdHUSj1dTUzCPhefjG4NgOFuD5Bs\/30kPXLQtsG99KB\/GE5+F5HpaVJGS5hK0w4VAJ4bBLyHVxHQtsH88fwksN0j8wiHd1CGOSWJaHZftghwmXWIQipSyqXcKDsYc5s\/IMH338CSdPnaLr4mUudl3C4n2GEikud\/ex5IHlLJhfS0VllFAoTNh2cRyDbQfzw4M54nZWDrfS1d3GUj19tCJtVnD+7D+ze8Sz\/z79bDt9wyS\/QFug2GiMpUuXEolEtD64iIjMKgriIiIyLneqUFsQBo3xsawUeClcy6a6KsrKFSv5rPMcV3r7OHf2LFUVlVRWVDKvuoZLXZc4c+YM5eXlVFVVURGNUlpWRsh1sWyXFOCn0kE86afwLQvfskj6hqSXrrAOBt+xsF0IuQ44IVKA5\/npYnHDvdaDQwmSyUF8fwjbBjdkEQ47GFxs26WqaiElC8KUV1RTOqeS0jkVdJR1cPlSN339\/Rw\/fpzLl3pYvqyOlSvrWL58BbULFlJeNhc7FAI8SLeYkTAcrJ9t0uu7jaXjuliWtvLDd35RuPwe8ukNtkHotm07E8Q9L73MXBCyi1VMX7FihYK4iIjMOgriIiIyLsWCeGNj45Sc2\/d9vMQQlvHwU0nwfWqq5\/HQgw9z4sOP6Om+zKcdHSxatJDFi5ewZMkDdHVdJB7v4PgH72PbNmsee4xlc8spiURwwyV4lo2TTGINJTBDCTwLwMLBYHCwLIPturhOCAuHoVSKwRtDJBNDJFMJPD+JbfmEHJtQ2CFSWkEoZJMeCe3jeymGEjcZGkpwvqufkkgI23KZX7uUcMlcFtYu5VxnJ2fOnOH8ufNcuPAen3zyMcuWLWP16i\/wxccepa7uQUojUdKhe5DcOdvF5ornGXcGLTYk\/VZLm91ZxpjhkQlWJlD7vo8xJl14b3jbO++8U3Ds5z\/\/eRYuXKiq6SIiMqvot5aIiIzZRx99xODgYM62qqoqFi5cOCXnt4YTpWVZ2JYNtpOe322nq6X7ns9n587RdeEii2oXUrtgAStXrODMmTP09l3hxIkPKZkzB2ybRYsXUxGtwYmUYls2tjUS6CzLxrbAxsfDG17T24BtYdkWxrEwto1nDEOpFDYGg4Vrh7BDEZyQC3h4qSTJhMHzwmA5DCVtDBAOuUQiFcyfX8bc8ijRqnlEo\/OYW1ZJZ+cZrvb303XpAu7HNsYM0dfXwwOLVlC7YBFlZRWM9IwHwdgHnOG2D2+61XD0UfP03TkvPOgBD4K4P1x4L1hT3BhDKpUqunTZF77wBYVwERGZdfSbS0RExuyOF2qzLGwnhGODcVzsZIqU53Pz+o1MkO66eJFznZ2sWL6c+fPnUx+ro6e3h\/c\/+ICuS5f48MPjDCUT3Bi8yaIlCSqj87DcUKaH1bLskRnRxmB8H99Pgm9wQw52KEwoFCIUDuGGXKxBG9\/zsB0Hy45gCJHybVIJj2TCJ5U0OE6YcMTFttPnTCYNGJtQKExVVTlVFTUsWriEJYuXcvp0nI74KXp7u+nuvUT\/kV46Ok4Si9XzxUe\/wiN\/tHb4yfAIlnAbnjFNTnC+TSd5Zh9g+E7D8PD0\/DA+84IAnv2Vvd0YQ09PT9H6BKtWrZru5oqIiEyagriIyCyWX8zqTisWxNesWTOl17Bta7jSuUWopITyuRVUV9dQUVkJ585x4fx5Tn7yCQ8sWkR5eRnz5tXwhS98nmQqSSL5Ad3dl0ikEty4eZO+\/qs8sGQZ0XnziMwpJ+ym54wnUj5e0sP3vOECaGAweLaHY\/u4rku4JIQbDuOWhPFSKYyfDvHJFAwOpUgOpfCSPmBT6oRxnRJcx8YYDy85xJDn4XsG13YomzOH6qpqotEo8+ZVU1VZQbzjJGfOnub8Z+foPHeGznNnSSUNZWXpxzSndA62HSJI3L7vYYwPxh+eNz1SyM0YMJ4Z7llOzyW3rGB8gUkfl1WkzbJGgrgZXiYOy8zYAmbB3HAg64aJlRmW7vs+77\/\/fsFxCxcuJBqN3vK82cuhaR65iIjcLRTERURmsekOFu3t7QXbHnrooam9yHAvNYAbilCzYCH1Dz\/Me+3tmA+Pc\/nyZeKnTrGwdgHz58+jftUqli9bxtDQEINDg3x88iS9Pd0kkimuXb\/OwMB1VsRiLFi0mPLKKDZWpggbxuBYdia4Gs8jRRIMRMIRbNchYpfiex6ppIef8kklUyQSPqkEGM\/BdUJAGEx6OTLLpDC+h+f5+J6PY6cIh8LMKQlRUVGJ44Lnp\/DxGEoM0t\/fx7VrVzn3WSfvvHsI13X4\/OovsHTpCiorooRCJcND9tNh3PeGnxs3d+1vz0t\/H8CyLWzHIt3372PwMyHeHg7h6bdOdhg3zGRODUJz8JUdzi3LKhrEV61aRXl5+ZjOqxAuIiJ3EwVxEbkvzeYP5TPZ9o8++qhg21QVagv4qeHQCDiRUmpqH2BuxVx+f\/AgxvPp77\/G2c5OoidOMH\/BAioqK1gZq+Ohh1bhhG2wDCc+Pkn35S6uDVzj+o0BLNsiUlLC3IoKXDeE66TniIccG9cNYSwb30DK80kkhkgkEiSSKUKhEK7rYhkb23bSg8WNg2XAsW0sG1zXwcImOWQwnp+OzL4DvoPnGW6aJL43QGIoQaTEwlge5XMrWfTAEpKpJG7IpaKygosXLvDJqVN0dl7gypVrrF\/nsXz5CqqrawiHSrFtC88D30\/h+xa+P3wDAZt0xvbTNxgw2Ca9droZXg4tE8QxGCt4D430FKcr1dtFXo3g+9PTqxyE8Pxr2bZdsH44wLp166iqqrrteWfzz7uITA+NnpHppiAuIiJjMjg4WDSIT83SZQELbAfbt7AssIbDYjgUznwwipRESKaSXLh4gfinp6h9oJYHli6isqqSupXLGRi4RsrzSH38Cf3XrnH+s04iJaWEImHCJRGqauZTEinFKZ+Dj4VnIJFI4XkeNhaO64Jlk0wmGRocwgIc28WxQ7hOiHA4QiRk43s+xh\/+8jySKQ\/bcnGd9FzxdA82+MYjlTIMJVJg2zghCIVLqaqahzGGuXPnUlu7kM\/OnePD4\/\/KuTOf0f7++3gpn97ePlatepAli5dRUjI3\/TwwhMGQ8pJYWFiWg4WF7YAb9CDbFo5lDc8JHw7rwz3g2T3hmWfdSt9MmGn5veDZii1d9vnPf16F2kREZFbSby8RERmTYvPDV6xYMaYeybGyLAtj2ViOnQ7hvg+2xeDNmziOS0VVFZZjc\/Pmda4OXONM51kWnl7IythyIiVh5s4t5+GHH8R20vXQ4x2n6b82wIXznbghF9uxWbYywfzahZTOKcdyQiQ9Hy+VxMdg2Q5uOASWQzJxg8TgIKlkCtcJU1JSSqg0XcjNtR18zyeVSJJMeKR8D4wPhHDS65rh+Qa84aHflsHzDYmkj2PS8+DDkTnUzFtITc18Fi9extIlKyiJlGNzjN7ePt597z36rvRzoqE6swAAIABJREFU\/foNUimfxYuXUV5Wjm1b+CaYS22ll1+zbWzHHg7i+WXVg787pAehp3vNg0XRgjCfXjptZnqBig1HzzY4OFj0\/ffggw9mKquLiIjMJgriIiIyJne8Yvow3\/j4XrpwmG1bOI7BCYdYGavj0ce+yGfnO\/ns3Fmu9vdxufsSHR2nWLJkEcakWLhoEQ8sXUx5ZQWR0jCVFXM51fEp3X1XOPPpSa7293H+\/DmWr4yxfGU98+bXUlpWTsQtJ5HyGUr6pDxIpVKEbBd7Thm2ZeE6YVwnlB6enhpiKJkkmUiSSqYwxuDYFuFQiFDYwg1ZgI3tpYeH+76F53l4ngcJH8cBx7FwXQvXnUNJJExFxTyqqxZQVlrFvOhC3nv3Xc6cOc17773L+fPn6fj0NI\/80SPE6upZtOgBKiqqsNwQ4GNMajiMpgvHFQbxnGcXz0vh+6n0Kuq2je24w33hVtbx0xvIPc8jkUhg2zau6+YUbnMch+PHj5NKpXKOqa2tZc6cOQwODnLjxg1KSkqKhngREZG7kYK4iIiMSbFCbVM7LD3NGAvf87FtC9uywFhYts2yFSv53COPMHD9Khcu2CS9JNeuXeXChc84ceJDfD+Jb1JUL5jHosW1OLahrGwOVdEqTsU7uHjpMlf6LpNMJRgaGkwvW5ZKsqB2EaVlc5kTCeM6hsGED8bDcm2Mb9Kj5S0LGx\/j+fieh+8lMSaFbXlYjoXrOIRCYNs+WD4WPpYDNhbGWBhDunhbEICd4bXGSxxcx8GNhCkrm8PKleVUlFWBSfcMf\/rpp3Rd7GJwcIirV\/vp7r7MqvpVPLB4GdFoNZGwSygUwnGCAJ3fO5xe\/3wkmg\/PEwcKg3ew18zPjQx6yH3fx7Zt\/vCHPxTss3LlSsrLywmHwzlzO0VERGYDBXER+f\/Ze\/fguM76\/v\/1POe2N2kvkiXZ8l1K4kAcG6IkfPsN9BvmRxwCP4bOBOKU\/tEObYNDh9KWbwxhmA7DxMVpoZ1MiZJMmaGdabEKzDAdcK3QH\/y+xD\/axGqIyT225Lus2+5qtdrrOed5fn8cnbVkyY6dxIQk5zUjr3b1nPM85+x6z3l\/rhERl8RK+eE33HDDGz5PWEZMGAbSNEBolNKsWb2GjRs38Iv\/\/DnlSpmm28Q0YXa2yJEjL+N5dTQenV05Nm7aTFdPJ23tKVav7mHt2jW8cuQoo8eOUypXmJoYx5CSZqNOo16ju6eXtnQO20lgSgtLKOq4NJtN3GYT1w+qkUtpYpgGji2JOc6CfNWgg2JoWrv4vr+Q36yCPHfJQqE1EeSMK4Xv6eDHB8+FZlMRd2zaEnHWrl2HQJDJZOnseI7jx4+RL8zwyiuvMD0zzZkzp9iwYSNr162jp7ub7q4uMpksQeg5gNc6k0F99MXCG4QMQtjFQu54kBt+vif91yvGDcPAcZxW3\/CwhRkE6QorGYGuv\/56uru7SSaTKKWi4koREREREW8pIiEeEREREXFJrFQs60p4xA3TwPU1SIGQgSjzfU2us4PVa9dgmAZKK8TC3xvNOmcnxvH8Bp5q4jgG5bki3T1rSGeyrO7pIB6zSKfbyOQynDo9Tr5QolSYolGrUMxPs6rrNF3dvXT1rCWb6yKVaMMyDOoG1IVHvdEMwtBVE4GJadhYpokhA695s+niuk2UNhaKtYXCdqFVmBQYlokQC63TFtavlIHrgtY+2neRGuKOSWdnF1IaOHaMdLqdEyeOky\/maTTqnDp9ktlSkdPjJ1mzuocNGzawYcMGujq7iMfbAIfAM+7BQrV0pTWCoPK7FOHaAjEeeOx1SwS\/GR5xIUQrtz58vvhxpc\/eddddRywWW7ZtRERERETEW4FIiEdEREREvCozMzPMzMwsec00zSuSIy5l0JZLAf5CeLLSGtNJkcl1kGpvJ5lKobVHzDGRhqBerzI11cTz66CaFAvTbOrrZ\/PmPlavXkNnR5pEKk57Nk1nZ46xseMcO3aCwsxZ8jOTnDl1ku7uXjb3l9jU59Oz2sQQAscSSGEhcKlrF+V7CBRSgyE0hjDw8fH9Gs1mDUvbCKygxVkoakVQxdyUEi0NTCVafbshCFv3PI1WLspzaTYk6VSSzo5VmIZBIhknk81w5sxpZqYnmSuXmJ6eIF+cYiYfPM6W8my5+mp616zDcbILoeo+iCAUXSmFFCBa6zJYHI5+zvv8hr+dl83iwm1aaxqNxor1CbZv3x7lhEdEREREvGWJhHhERERExKvyzDPPLHtty5YtV6R1lBAgDYmvNMr1AY1cmCcWb2Pt+nVMTKxjaspEaB8pfHxf4rkNCvlpXnYbzM4WmJmZZG42T\/XqLWzYuJm2bI6Nm9bR3pYkFY+hvSajY3Ump\/LMTE0xMzVNuVymXq\/TbNRpa8uQSCZIxmxsw8ExNc1mE60VhnBBa7SWKO2hVB3fr2OaLGRk61ZuOCIo2ialgTRNBMZC+HVQWT1og+bjeR7K81AeSC1wHJNEMsm6detJp9vp6u5i4uwZzp49zcTkOKW5IoXCDJVKienps5TLRebKJdb2riOZTGGaJo4TwxAGSohFnvBQbS\/22r85RdpCtNatkP7FIeZCCF566aVlhdq6urrI5XK\/7mVGRERERES8YURCPCIiIiLiVfl1VUwPMQyJ5\/n4nsKQELOCy5UTi7Fx0yZm8hMgfBr1CobwsUxBvTZPrTpPo1EjPz2JwEeiENrHELAWRbpjFV0dGaS\/jmajhiEFpjQYPztJrTrHqRNjeK7HfHmONb1r6enpobMzh2FaOJbAEBKlFwq4GYG32RAKQwYF2CxTYpoLHn2t0b5G64X65UpgyCBMXQiJkCIQ82hUEMGOaZgYEmr1Bq7bIBa3SMQSxGMx2lJJMpk2MpkUmWyKqekJZmeLFIt5Tpwo0GzWKM0VmMlvpqurm2y2g1Wd3SQSKQwZ9AkXYrkHOXj9zc2xVkrheV6rfZmU8qJh6evXr8eyrF\/3MiMiIiIiIt4wIiEeEREREfGqvPzyy8te27Zt2xWbT0oBEnxPI5EYRnC5MkxB77p1TE6dYW6uQHlOYBvQkW3Ha9aYn5ulVquifJ9GvcrU1Fksy8CQAt93Wee5tKez5LLtvGvLNbS3tZPLZBkbO86pM2fJF+Y4fuxlCoUpZgubqc5volnvpb09jR2LIQ2BYcgFsagXIs8Ftm2CcIg5QZ9xpcHzFUortNJopdCIwJuOjxCBx1xp8FUwxhASx7aJOwbzpVka9Tq+byNScRKJGE42SyJp056O0726k3x+ivHx0xw9+gpjx45y7Pgo+cIUZyfOsH79BjZu3IxC09W5mriTwjQWSsvpxeHoYqFN3Jsb4h1WSA894lrr1ppWKtR2zTXXYNv2ku2jYm0REREREW8lIiEeEREREfGq\/LoKtYVIAaZlgpAYC\/niCp96s4E0DSzbxrRMLNMkGbfo6lpF3LHw3Abz8yVqlQpus4FpmjQbdWamJzFNg6bbpKu7h0yuk0xHmmS6je6ebjZuXM\/Y2HFefOkIx0+dppAfR+sGc+UZxs8cI9fRQa4jRzaXI51Ok0y1YdkxpGFimhrDEDi2hWFaCGmilEYjUdoPqpb7Ya67h680CIEmEOJK+aA1UoTHbmLbDoYE2w4Kv\/nKB6UAQSKewHFM2tsTtLfHiSVMYnGLk6dOUJotceRohdnSLOVymVqtQXVjnbVrNtCWymAuFDVTKminhtZIaWAK8aZ2LTMMA9u2W0J8sSBfqXXZ4kJtQCTCIyLe4kT\/hyPeiURCPCIiIiLiVVmpddn27duv2HxaKTylccxAODZ9H7RH0\/dwPT+omi4EQoRh4tCWThGzs5TnHEqlIpW5Er7v43sN5udnmZ4WeMqlWi2zqlJm9br1pDMdJNZ1syrbRmc2TSoVp609xonTZ3A9j2LhLLOFCZLjKTK5LJ2dq8h1dJLN5Ei1t5NIpojF4jixOKlEDC2MQOSKIPdaCIEUCg+NWvjRKIQOmocZQiJNiVgo\/uYrn0azgZQGViyGaQV55k3XBXxAYRgmtm1gOwbSUBimIBGPk0gmOHniJDMzM0xPTVGvNigW5ijm53Cbmg3rN5PN2AhhEXjGg5h5rTTKB2m8eWJcCLFivQHf91dMi9i2bRtSysgTHhERERHxliUS4hERERERF+Xo0aPMz88veS2VSrFx48YrNqchJcWZAuu6goJcc02XmCWRhkGz2cTzfAwpUNqnXJ1jfEIjpEcu2069UaFaLVEq59FKEY\/HicUNmg2Lcgkqc7PMTJ6lMDPB2t619HSvwYklWbu2i0wuxTVbNjE+Mcmx4yc5ceIk42fOMDWRZ\/zMMQzDwo7FSKZSZLI5untWs37DZjZt3Mzq1b1oDS4KoQNha0oDX0p8GfRC9xXohd7dQhpIaSKliRCgfY96dZ7Z+RJtyTimaeNrhe\/7oHxMQ2CYEkNKPL9BvdGk2dQk4mk2b2qju3s1fZsnOPLyEV5++RVOHD\/F6CsnOXHsLPWqjyEc2hJZbCcWhNeLc0Lcd320khiWBKEJ2p9BWMBNiIUi75fIpQ3VrZEi7Mi+EKIOQbj8c889R71eX7JVJpMhFovRaDRwXbcVoh4J8oiIiIiItxKREI+IiIiIuCi\/7kJtIWNHjzFx+gxr1nTT0dmBZRrMui4TkxNMTJ6lXCmjhSbmWFiOgTAVvm7S9Kr4uoHtCKQ0iDkCy\/KAKm7Dxfc0jZqFUPNIv4xqzpFqyxBLpLDtGN2d7STiJpYJjg3JuCSfL1Cam2O+UqU6X6FcniY\/M87M1BkKM2eZmThFT89qHCeBadpIw8Zy4jhOkkQsiRNLYsViIAOPuecq\/KDWG4YQSEMiTIlQDob0SaTiOI6N77s0m3VcLwhptzGQpoHyBZ4raNR8TNMklUqSae8k09ZFKpYj4WSJWy9z4sRpCtMlfvXL53CMJKZ22LCxn1S6PSgWB6AWOorrUBirhR8BWi2EzwfPpZQIjIv2OTsnrwME5wtzvfDvQo91whzxwDAgALFQrG2llIirr76aVatWkUgkWsL9zc5xj4iIiIiIuFwiIR4RERERcVEu1MP5SlOem+M\/n3yFG7Zfx\/\/1251IwHVdzp4d58z4acqlAu1tDulsO6u60qRSMRAuvq5jWopYLI5lSmzLwLJAigZaNUArtG9QqzTIT9fwmyUSyTaSqQzJ9hzxZAbbsOnsaMey1tPVmWZ2dpZCscD09DTT+TzF4izz83NMnp2lmB\/n+NEXSKXayWQ6aGvLEE+00ZbKkM500NnZTUdHF1Z7B5YdQ4kgd1x5QUV1oTWGsLFsAysVR2kD27HQaDzXpVqvUK1WEEIRdxxSyQQg0cqk2QDlg4pZWFaCXDpNKtbJqsxa1vb0cfjwrxgbPcbZk5M8w2GEbyJx2LBpI7FUHBlI8FZxvECABy3jQg+1Vj6+5wMCaVkLHv1zYez6PNV9vhBnyfNzIjwU4hJQC55\/KWRQ4X1B6K9UqO2mm25i\/fr1JBIJPM\/7jQ9P14tO0OWsU58XgvCbfIwREREREZdPJMQjIiIiIi5IvV7nySefXPb6u9\/97is+9\/re1fz84FMcO36KY5vXs2HDWmzLATTNZoNao0p72iKRjNHRkcU0FfVqCdsRGIaNbYognFuCwAflopUCoREiyC\/2PUmzKbBthdcU1Cvg+x7CjCM0tCUdkvFOOrJtdHdl6FqVYWqqnbMTk0xNTTM7W6JaK1OozlIqTFCYbiORaMOJJUnE20ml0rSnO0inO0i350im0iQSbcRibcRjSeKxJLZl4ZgC05T4QtLwNaVygdnSLPnpaQqFPPVajVg8zqrODnpXryGVTBGLJbGtGlop3Iampj0c2yTutLOut51s+yraEhkybZ288OzzlPIlnjv8LCjJ3GyJjRs3kM3msJ0YQgJSAz5auYG4lTKoCi+Dvu6B8l7wPGuWCvGF54u14mIZeW6IWBDg4SMogsJ1QcuyYB6tNArFoUOHln0utm7dSiwWwzTNVqX1dwK\/6QaHK0E+n+fmm2+mUChw5MgROjo63uwlRURERLxhREI8IiIiImIZExMTPPLII3zrW99iZmZm2d8zmcwVX8O6tauJWTbTU9M898ILpDNtxB0b0zQAhe97GIYgmYyTzabxvSqNusaJmaA0lgFSagQK7Ss0Plr7SMCQYBg+Qrigm6Ab+H6VRkNSdz2UcJCmjWnZgVBOOcRjknjcJBk3ScRt2hI2MzMxiqU5arUavqeQUoGq47tQ1z5uo8ZcqciEcRrbipNItNOeztKR7Sab7SSTyZFKtePEYghT0FRNyvUy04UpJqcmmJyYoFAo0my4pNPtzJfXYgiDri5wLAd0kG+ulcR3wRcabUpisRiOHQctUR7UyjWOjY0xcXYcrRT16jxevcbmvj5WdXdhxuNgEISi+x5aKaRhIGTwE5TMC+ZCgwpFoQatzr1nK8nExR7yRcHoC4\/Bc7nQV10svKZ8dcFCbdu3b2+Fokch6W9vvv3tbzM6Osp3v\/vdC4rwfD7PZz\/7WYaGhgDYsWMHBw4cIJ\/P8+KLL3LttddetoAfGxtjfHycW2655XUfw28aBw8eZM2aNWzevPnNXkpExDueSIhHRERERCzh4MGDfPjDH15WoG0xf\/AHf0AsFuPOO++8YuvIZNrpXd3DqdMn+OXT\/801\/RvoXduFZUgMKTAMcGyLVDJOe3uSWs3DmBNI20JoEMJHLBRO04AWAqREAKaUmJbENAXS0Gh8PL+Jq2q4ysVVJkIYmKaF7dg4CwaAmG2Sy6VxbIN0W4Ke7k7mK9WggJzv47kapQRCmChf0GwoKpUG5XKeqfk6YBCLp+jIddGR6yKX7STV1o7tOHgo5hsViuUiU4Vp8oUZZguzzM9XUErT3pamOl9BeR61ao1sOovvK2J2DEMaGNIEDY16A8\/1kFJi2w49PT1cdXUftfo8o2OjnDp9jHq9jO\/XMSxFLGmRTjhIDBCgfB\/f8zA1SMsIwtflgkdcS5QK8rlDCRz2JRdhMvgKajz8k17yyrlHIQTGQkW4oM2b4lfP\/opKpbJkP8lkkp6eniVh21Ge+K+Pw4cPt9JS9u7dy3333XfF5hobG2P37t3cdddd7Ny584LjPvWpTzE8PMxdd93Fe9\/7Xp5++mmAlji\/66672Ldv32XNPTAwQLFY5JFHHuGee+55Xcfxm8Sjjz7KZz7zGbLZLIVC4c1eTkTEO55IiEdEvAM4ePAg73\/\/+1\/3jdPOnTsZGhrimWeeYdu2bW\/gCiN+U7gUEQ7geR533303wBUT41IItlyzianJk5w+dZzJidOkkoK52Txus4ZjmbSlEqSScSzLoNkQGAKUBBBIERQAF3ohvtoAoQMhbkgDaQgUiqbXRNXmMVwfIX20iKG0iesplNYYhsRZEOOWbWFISSLu4Ng5OnJplFrwDguB5ymUCkK4XVdTrbgUC3NMT+WZnJyhNDtPtZynWaswm59mIpkikUhiWBau9pmtzFGYK1Jp1Bbyn8H3fJTSzJcVZ8cVXrNJqViis6OTeCxBNpNDK2hLptC+ietVcV0X3\/ewLQshFN2rO1lX6mW+WmL8zGkKs1McP2GSycVJpWPYbQ7JVDssNFjTLAjs8EcEVc3PVTZfEMIXikW\/BMQKij3chWEYPPvss8v+vnnzZkzTbIVohyJcKYVlWe+40O1fN\/\/6r\/\/a+v3rX\/\/6FRXif\/M3f0M2m+Vb3\/rWBcfk83mGh4fp6+tbJrb7+vqWPF4OfX19jIyMsG7dusve9jeZ8HheyzmJiIh444mEeMTbgksRiKEYfS3W8YiA2dlZAMrl8pu8kogrQSiuX02ELx7\/R3\/0R3z0ox8lFotdkTVtXL+GZ7MJjrxS4uTxI\/heiTOnj9OoVmhri5NLt5OMx\/DcJm6zjlYe56p+L\/hgA\/c4EiMQ50IghUAIgdKaRtOl3vSQ0seyBY4TtBTzvCaNRhOtfaqGxHasIOTbcbBtB9u2SCYcbNvGth0sy0ZpjdKB59jzoV7zmJst05lrJ5NOMjkxQyE\/S6XapF4v0GzMUa04SNPEA2YrZWbn58AQxOIJ2tszGNJEeT71ehOv2WByYpxKeZ7pqSlSyTY6cp2UOkvkMlliTgzP86jX6\/i+SzIZJ5WM05ZOsm7DahruPL6uUSzkKcxNMnr8ZeyExIjBmt71JBLtAEhpLPKCQ8vVreGcfzsU5wu\/LS6Pfhl6OMw+D8S\/blVNf+aZZ5aN3bJlC7ZtLxHivu+jtV4i0COuDENDQ\/T19TEwMMDQ0BD79+\/njjvuuCJzPfzwwzz88MMXHfPiiy8C0N\/fv+xvDzzwAA888MBrmnul2gRvB+64445lRQAjIiLePCIhHvG24HIEYjg2IiJiKT\/60Y84ffr0ZW0zOzvLI488wuc\/\/\/krsqau7g7W9XbxvGPw\/LO\/5IXnfV587jC2BZvWb6Yzl8a2JMXCNPPlPNXqPI4jMYxApGmtQKtA6AmAhRBoIdBC4GtAKTxfIQ2JYSlMy8KJxVA6aOXlecGj7zVp1BWe26QmKxiGxDQNLMvCtmxMy0IpUCrIexYYCEwsU9LdlSGbSbG2t4dSaZ650jyNegOlNJYdw7JjSMui2mwwX6+ipCCWSJLN5pDSpF5rUszPUpiZpVico16tMj83j+t6CC1x7BjZbIZsNku6PU0ylaQtlcSJGQgzTizu0L16FcLwEKbHyZMG+ZlJTp46wuzcJKdOH+P6bQO85z030daexXJsEEZQPE3rRWIcpBQLYeChGA7eq3OynKW6nXN\/P7eXpWj0oh0FRpIwxHgx27dvX1GIh79HXDn279\/P6Ogo999\/P1u3bmVoaIgf\/ehHV0yIR0RERLzdiRKqIiIiIiKAIH\/wtfCP\/\/iPb\/BKzhGLOWTTCRwLjh19icNPP0VtvkQuk2Lj+l5Wd3eSiNnUq\/NUK2VctwFojIU+1GhQSuMrFeQ2a40WAiENpGFi2Bam4+DE4tiOg2EY+Mqj2WiifH8hjF1iGgaGDESp7zVpNKpU5ucozRYoFKaZyU8xMzNJoTBFPj\/B1OQZJsZPMnH2BIXiWRrNMvG4pGd1hr6+Xq7dsoF3vWsTW67dwNVXraW\/fw1X969j63X93PDed7Pt+mvZ+u6r2fquq9l23bW8Z9t13PCe67nhPdezfet1XHvNVazvXUO6LYVAUy7PcfLkCV544Xl+9eyveOmlFzh+YoxTp08wMTFOsZRHSEW2o531G9awYVMvq7qzCNNnOn+Wl155jhdf\/BUnTx6jUi0HfbxlUKJNax\/t+0HFeTRCEhRWW4hYlzKI\/A+d0UKfE+Xn+6fPf32xcFfh\/i\/Suuw973nPgoElNApIDMPAMIzIG36F+dGPfgTAJz\/5ST70oQ8BMDg4SD6fXzb28OHDCCF49NFHyefz3HvvveRyOYQQ9Pf3XzQqbd++fdx4442IBYNMf38\/9957L2NjY0vGCSF4\/\/vfD8Dw8HBrfPg99uijjy55vnhtO3fubI3P5XLLctDDv5\/\/Gdy\/f\/+ytT344IOXcvpa299+++2XtP2lzLV47Q8++CD9\/f2tY3rwwQeXvTfh+3Kh44Xg\/C\/ez5e\/\/OUV32MIIg1XOpcHDx5ccfziNQohuPHGG9m\/f\/+SMWNjY9x7771Lxl1snxERb2Uij3hEREREBAAvvfTSa9ruSkaZCCHRqoHQDfJTZ6hUS\/Su6eJdW\/rZcvVmurozNBrzCO2jfA+0RiKRC8pQCRk0ytKhOpQIYSANC8t2sCwTy7QwpAVY+J6gUW8y32ygtUBI0fJ8G4YENL5ycV0P12vgeR5AMMYyEMLA93yq1Rq1WgPP8zFNi1SqnY5cJ+l0lmQyRXu6HaFFYCTwNVrLwDAQjyEdh1rNRUqLdDpDLJbAEBbeWmg0fKqVBtVqg2JhjlOnxskXipRKc5w5M87MzAxnz56mUJiiUJxiOn+WnkIXa9etoasrRyoVI51NokQ30nQxY5qZmWlq1Rqnx0\/w\/Au\/Ip5qI5lqx7TMIJJAeWgfhNAIucJtg7isSPRlIjysoa71QiV1EfSuPz9FIplM0tvbi+d5KKUwDAPTNJFSviNbe\/06yefzDA4O0tfX10r\/2rVrF4ODg\/zkJz9ZJuzC6LSf\/exnfOlLX6JYLLJjxw7y+TwjIyPcfffdlEqlZYXQbrzxRkZGRoCg+jnAU089xeDgIPv27eNnP\/tZa\/69e\/dy\/Pjx1rr++I\/\/GID3ve99AJRKpSWPEIi8W2+9FYD777+fdDrN8ePHefzxx5esY6Uou\/379\/ORj3yEvr4+9u7dC8DTTz+9YuTGSnz5y19mz5499PX1teb+3ve+x+7du\/npT3\/KgQMHLnuuYrHI6Oho67wNDAywY8cOhoeH2b17N08\/\/fQSo0d4POd\/Z4fP77333tb5DPezZ88eRkdHlxlPwuOBoLhdR0cHR48eZWhoiKGhIb773e8u+VyE43fs2NF6r37605\/y3HPPtaIqDh48yMc+9jEgMA5s3Lix9R4PDQ3xxBNPvC0r2Ue8c4k84hHveN4oS3BorV48PtzPSoRW8fN5PRb3y\/U8LN7mfOvzSt6oyyW0bIfryeVyyzwbDz744IpeCwjOsRBixeMPvRrn73ul9yuXy3H77beTz+db572\/v7+1jtBzcvjw4WXekttvv\/2Clvjzjy8cH9UgeGNQvsvJo7\/ixJEXmS8ViJmC9Wu6ufnG97B967vo7switKJZr2EgsE0L0zRxXZdGvY7n+WgEpmUTiydJJtO0tWVpa8\/R1pYlkWwnFm\/DdpIYVhzTihFPtJHJ5Fi1qpvOzk5y2RzpTJa2tnbi8QSWZSGFRGmN76vgR\/kordAq8Ja7bgOlXDQuSjdpNqtUKrPMFqcpzU5TrRTRfg3LUsRigpgDluWDaCLxsKTGsQRxRxJ3DOKOSTJhk25P0NmRpre3m42b1nHVlj62br2W926\/nvfdNMDtt3+I\/\/tjH+WDH\/og1757C6m2BEpKQ4m0AAAgAElEQVS5VKtzlMuz5IvTTE5PUpjNU61XQGqcmIUds\/D8JpOT47z4wrOcOn6UUnEGtAsiMBAIQyz0GVdhBTy0DoqkabU8JFxwYa\/4SiwuuqbRK7Yt27JlC5lMZklouhCi5RWPhPiV4yc\/+QkAd911V+u1j370owB84xvfuOB2YU756OgoBw4c4NChQ3z3u98F4Etf+tKS7+sHH3ywJSbD8QcOHODIkSPs2rWLYrHI7t27W+Pvu+8+fvd3fxcIcsTvu+8+7rvvvosWEv3+979PsVjk4Ycf5oEHHuC+++7j4Ycf5ujRo696Dh566CEAHn\/88dZc+\/btu6Tv+4MHD7Jnzx4GBgZ48sknW3MfOnSIu+66i+Hh4SX7uZy5RkZGGB0d5YknnuDQoUMcOHCAZ555hmw2y9DQ0GV5kgcHB3nkkUc4evRoaz8QvI+Lr9vh8WSz2SXzHj16lEceeQRg2fU4NEIcOHCgdUzh7yGnT5\/mtttu48iRIzz88MOt9yfc57\/8y79c8rFERLwViIR4xDuexZbgsAr0jh07KBaL7Nmzh89+9rPLttm3bx\/vf\/\/7GRoaalmgC4UCu3fv5tvf\/vaSscVi8ZLXElrBi8Uie\/fuZe\/evQwMDFySxT0UmYODg61jALj77rv5sz\/7sxW3GRsb46qrrmJwcJCBgQH27t3Lrl27ePzxx9m+ffvrCgU7fPgwAwMDDA4Oksvl2LFjB7lcjsHBQe69995l4xd7LV6N\/fv3s337dh5\/\/HF27tzJ3r17ue222xgcHOSqq65aJsaLxWLr\/AwPD7fer\/Hx8SVzP\/roo6397tixg76+PoaHh3n\/+9+\/YohiX1\/fkuMbGBhgeHiYu+++e8Vj\/E3HNF9bkNQbXahNK59y\/gTPP7mf\/+\/\/+SGvPP80lVKeXCbJu7b0MfDebfRtWo9lSOZLs5SKRbSvMKWJIUyajSa1Wp1m0wctMc0YsViSRKKdRCJDPN6O5SSRRgytbVzPoN7Q1Bsa35cYVpx4og0nlsB24lh2DNOKYZo2hmkjTRvDsDEsB9OysaywWJuzUD0dLNsikYzT1pYknrCRQlOvzTNXylMsTjNXLlCrlvDcCr6q4asarleh0ShTr5bxGlW8RpV6bZ5aZY5qZY5GvQLaJeYYtKWTdHblWL9+NVdftYnrr383H\/jtD\/Dhj9zOh+\/Ywf\/4nzdzzTVXsWbtajK5DI5jUatVmSlMky\/kqdaqSEOSaEuRamvDMAzK5RInTx7jxNhRJs6cpFLOg66jJQhDIAxA+IC\/IMI9tPKDRuIr5GefH4J+YVGuW0JcLzQl\/+\/\/\/u9lo7Zu3Uo2m8VxnCWtykIjWMSV4zvf+Q4An\/70p1uv3XHHHWSzWUZGRpaFjYf09fVx6NChJT2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\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\" alt=\"\" \/><\/p>\n<ul>\n<li>Las v\u00e9rtebras cervicales, excepto las dos primeras, est\u00e1n conectadas con la v\u00e9rtebra adyacente por dos<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">\u00a0articulaciones facetarias\u00a0 cervicales\u00a0<\/a>\u00a0en\u00a0 la parte posterior y una en la anterior (disco intervertebral). Los movimientos del cuello est\u00e1n guiados y limitados por estas articulaciones.<\/li>\n<li><strong>Unidad funcional superior\u00a0 e inferior\u00a0 de la columna cervical\u00a0<\/strong>\n<ul>\n<li>La columna vertebral debe ser considerada como un todo, pero para su estudio se divide en unidades funcionales formadas por disco intervertebral, cuerpo vertebral, facetas articulares y ligamentos.<\/li>\n<li>De forma global la unidad funcional de la columna vertebral es el segmento vertebral formado por 2 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0adyacentes y el \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">disco intervertebral\u00a0<\/a>\u00a0que las une.\u00a0 . Dentro de este segmento se describe el complejo triarticular que est\u00e1 constituido por las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">\u00a0facetas cervicales\u00a0<\/a>\u00a0en la parte posterior y el \u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">disco intervertebral\u00a0<\/a>en la parte anterior.\u00a0 Dentro\u00a0 de\u00a0 esre\u00a0 segmento\u00a0\u00a0 existen m\u00fasculos\u00a0 y ligamentos\u00a0 que lo\u00a0 afectan<\/li>\n<li>La movilidad de la columna vertebral se produce\u00a0en la unidad funcional.<\/li>\n<li>A diferencia de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">\u00a0columna dorsal o tor\u00e1cica<\/a>\u00a0columna dorsal y la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">\u00a0columna lumbar<\/a>\u00a0cuyas unidades funcionales son bastante parecidas, la Columna\u00a0 Cervical est\u00e1 compuesta de dos unidades funcionales diferentes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>1.-UNIDAD FUNCIONAL SUPERIOR\u00a0<\/strong><\/p>\n<ul>\n<li>Est\u00e1 formado por el occipucio, CI\u00a0(atlas) y CII\u00a0(axis).<\/li>\n<li>Es la encargada de los movimientos propios de la cabeza sobre el cuello, por eso tambi\u00e9n se denomina a este segmento columna cr\u00e1neo-cervical<\/li>\n<li>Este segmento no tiene\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">discos intervertebrales\u00a0<\/a>.<\/li>\n<li>Esta regi\u00f3n tiene movimientos propios:\n<ul>\n<li>La \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-atlantooccipitales-1\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0atlantooccipital<\/a>\u00a0permite la flexo-extensi\u00f3n cr\u00e1neo-cervical. Sin embargo, a este nivel apenas se producen movimientos laterales o de rotaci\u00f3n.<\/li>\n<li>La \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0 atlantoaxial<\/a>\u00a0permite fundamentalmente movimientos de rotaci\u00f3n. La extensi\u00f3n a este nivel es inviable, ya que el diente del axis incidir\u00eda sobre la m\u00e9dula espinal, lo que conllevar\u00eda un riesgo mortal.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>2.-UNIDAD FUNCIONAL INFERIOR\u00a0<\/strong><\/p>\n<ul>\n<li>Est\u00e1 formado por las v\u00e9rtebras CIII, CIV, CV, CVI\u00a0y CVII. Este segmento es similar al resto de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">COLUMNA VERTEBRAL<\/a>: dos v\u00e9rtebras adyacentes separadas por un disco intervertebral.<\/li>\n<li>El disco intervertebral de las v\u00e9rtebras cervicales tiene el n\u00facleo pulposo situados en la zona anterior del mismo, mientras que en el resto de la columna tienen una localizaci\u00f3n central.<\/li>\n<li>Otra caracter\u00edstica especial del segmento cervical inferior son las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-uncovertebrales\" target=\"_self\" rel=\"noopener\">articulaciones uncovertebrales\u00a0<\/a><\/li>\n<li>El complejo cervical inferior realiza los movimientos de flexi\u00f3n, extensi\u00f3n, rotaciones y lateralizaciones.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Recordar : Las ap\u00f3fisis espinosas desde la\u00a0 \u00a0v\u00e9rtebra\u00a0cervical CV\u00a0\u00a0a\u00a0 la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra tor\u00e1cica T III<\/a>\u00a0son horizontales y m\u00e1s largas que las \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">ap\u00f3fisis espinosas\u00a0 de las v\u00e9rtebras lumbares\u00a0<\/a>\u00a0. Por ello\u00a0 el<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/espacio-epidural-espinal\" target=\"_self\" rel=\"noopener\">\u00a0espacio epidural cervical<\/a>\u00a0est\u00e1 m\u00e1s profundo que\u00a0 en\u00a0 la\u00a0 regi\u00f3n lumbar<\/li>\n<\/ul>\n<p><strong>Figura 2. Secci\u00f3n\u00a0lontudinal\u00a0de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna cervical<\/a>\u00a0visualizando el canal espinal.<\/strong>\u00a0Las l\u00edneas rojas discontinuas muestran d\u00f3nde incide el haz de ultrasonido cuando\u00a0se\u00a0 realiza una ecografia en corte\u00a0 longitudinal\u00a0 paramediano desde las\u00a0\u00a0l\u00e1minas externas desde el lado lejano, produciendo reflejos en el escaneo\u00a0.Las ap\u00f3fisis espinosas desde la\u00a0 \u00a0v\u00e9rtebra\u00a0cervical CV\u00a0\u00a0\u00a0 a\u00a0 la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra tor\u00e1cica T III<\/a>\u00a0son horizontales y m\u00e1s largas que las \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">ap\u00f3fisis espinosas\u00a0 de las v\u00e9rtebras lumbares\u00a0<\/a>\u00a0. Por ello\u00a0 el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/espacio-epidural-espinal\" target=\"_self\" rel=\"noopener\">espacio epidural cervical<\/a>\u00a0est\u00e1 m\u00e1s profundo que\u00a0 en\u00a0 la\u00a0 regi\u00f3n lumbar<\/p>\n<p><strong><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/corte_longitufinal_mediano_columna_cervical.JPG\" alt=\"\" \/><\/strong><\/p>\n<h4><strong>Discos intervertebrales\u00a0<\/strong><\/h4>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>DISCOS INTERVERTEBRALES<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>Los\u00a0<strong>discos intervertebrales<\/strong>\u00a0 son\u00a0 uno\u00a0 de los\u00a0\u00a0componentes de la columna vertebral.\u00a0 M\u00e1s\u00a0 espec\u00edficamente\u00a0 son\u00a0 estructuras cartilaginosas\u00a0 que se sit\u00faan entre las\u00a0\u00a0v\u00e9rtebras\u00a0 cervicales- a excepci\u00f3n de la articulaci\u00f3n atlantoaxoidea\u00a0\u00a0&#8211;<\/p>\n<div class=\"row container-row container-right-column tabs-header-container\">\n<div class=\"col-md-12\">\n<h1>Articulaci\u00f3n atlantoaxial<\/h1>\n<\/div>\n<\/div>\n<div class=\"tab-content\">\n<div id=\"article-content\" class=\"tab-pane active\">\n<div id=\"article-body\" class=\"row container-row container-right-column\">\n<div class=\"col-md-12 pull-left\">\n<p><strong>La articulaci\u00f3n atlantoaxial o atlantoaxoidea\u00a0<\/strong>es una\u00a0 articulaci\u00f3n formada entre \u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0 englobada dentro de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-craneovertebrales\" target=\"_self\" rel=\"noopener\">articulaciones craneovertebrales<\/a><\/p>\n<p><strong>Figura 1. Articulaci\u00f3n atlantoaxoidea<\/strong>\u00a0 .\u00a0 La\u00a0\u00a0articulaci\u00f3n atlantoaxoidea\u00a0consta en realidad\u00a0 de\u00a0 3 articulaciones\u00a0 : 1)\u00a0\u00a0<strong><em>2\u00a0 articulaci\u00f3nes AA laterales\u00a0 (\u00a0 que\u00a0 contienen\u00a0 un menisco\u00a0 )<\/em><\/strong>\u00a0 :\u00a0\u00a0 entre las\u00a0 carillas\u00a0 inferiores de las masas laterales de\u00a0 CI\u00a0 y las\u00a0 carillas\u00a0 superiores de CII\u00a0 .\u00a0 Son articulaciones\u00a0 sinoviales planas\u00a0 tipo\u00a0 artrodia\u00a0 \u00a0;\u00a0 2)\u00a0<strong><em>una\u00a0 articulaci\u00f3n\u00a0 atlantoaxoidea media<\/em><\/strong>\u00a0\u00a0 :\u00a0 entre el\u00a0 proceso\u00a0 odontoide del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0( v\u00e9rtebra cervical\u00a0CII )\u00a0 \u00a0y el arco\u00a0 anterior\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0 (\u00a0 v\u00e9rtebra cervical CI ) .\u00a0 Es una articulaci\u00f3n pivote de tipo trocoide.\u00a0<strong>Funci\u00f3n\u00a0 :<\/strong>\u00a0 \u00a0El movimiento de las\u00a0 3 articulaciones atlantoaxoideas\u00a0 permiten\u00a0 girar la cabeza de lado a lado\u00a0\u00a0 &#8211; como cuando movemos la\u00a0 cabeza para hacer el\u00a0 movimiento\u00a0 de\u00a0 decir\u00a0 ? No\u00a0 ?\u00a0 . Durante\u00a0\u00a0 este movimiento\u00a0, el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/huesos-del-craneo\" target=\"_self\" rel=\"noopener\">\u00a0cr\u00e1neo<\/a>\u00a0y\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0 (\u00a0 v\u00e9rtebra cervical CI )\u00a0rotan\u00a0 en\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0( v\u00e9rtebra cervical\u00a0CII ) como si fueran uno solo\u00a0 .\u00a0\u00a0 La ap\u00f3fisis\u00a0\u00a0odontoides del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0( v\u00e9rtebra cervical\u00a0CII ) es un\u00a0pivote que se mantiene dentro\u00a0 de la\u00a0 cavidad o\u00a0 collar\u00a0 formado por\u00a0\u00a0 delante por\u00a0 el arco\u00a0 anterior\u00a0 del\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0\u00a0 y por\u00a0 detr\u00e1s por el ligamento\u00a0\u00a0\u00a0 transverso\u00a0 del\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/articulacion_atlantoaxoidea_1.JPG\" alt=\"\" \/><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/articulacion_atlantoaxoidea_2.JPG\" alt=\"\" \/><\/p>\n<p><strong>Figura 2. Radiograf\u00eda articulaci\u00f3n atlantoaxoidea .\u00a0<\/strong>En una proyecci\u00f3n AP se extiende el cuello de forma que el occipucio y los dientes superiores se sit\u00faan en el mismo plano .\u00a0 Esta\u00a0 radiograf\u00eda muestra las relaciones\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>. Los ligamentos de la articulaci\u00f3n atlantoaxoidea son radiotransparentes y por lo tanto no ofrecen ninguna sombra. Las masas laterales del atlas son de forma triangular y f\u00e1cilmente reconocibles . En la parte lateral , las largas ap\u00f3fisis transversas del atlas son claramente visibles . Entre las masas laterales se\u00a0 aprecia el diente del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/RX_atlantoaxial_atlantoooccipital.JPG\" alt=\"\" \/><\/p>\n<p>Esta\u00a0articulaci\u00f3n -en\u00a0especial\u00a0las laterales -est\u00e1\u00a0sujeta\u00a0a cambios inflamatorios y degenerativos que pueden provocar\u00a0cefalea\u00a0 cervicog\u00e9nica\u00a0\u00a0&#8211;\u00a0estas\u00a0 articulaciones,\u00a0 en\u00a0 conjunci\u00f3n\u00a0 con\u00a0\u00a0 la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">\u00a0faceta cervical\u00a0\u00a0 C2- C3<\/a>\u00a0 \u00a0&#8211;<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>ANATOM\u00cdA DE LA FACETA CERVICAL<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p><strong>Las facetas cervicales- tambi\u00e9n llamadas\u00a0articulaciones cigapofisarias o\u00a0interapofisarias posteriores-\u00a0 \u00a0<\/strong>son\u00a0las\u00a0articulaciones de los arcos vertebrales (cigoapofisarias)\u00a0\u00a0 de la\u00a0v\u00e9rtebras cervicales.<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>ARTICULACIONES DE LOS ARCOS VERTEBRALES (CIGOAPOFISARIAS)<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p><strong>Las\u00a0articulaciones del arco vertebral (cigoapofisarias)\u00a0de las\u00a0\u00a0<\/strong>v\u00e9rtebras<b>\u00a0&#8211; tambi\u00e9n llamadas articulaciones\u00a0facetarias\u00a0 o articulaciones interapofisarias\u00a0 &#8211;\u00a0\u00a0<\/b>son un\u00a0tipo\u00a0 de<strong>\u00a0<\/strong>\u00a0\u00a0ARTICULACIONES DE LA COLUMNA VERTEBRAL\u00a0 \u00a0.En este\u00a0 caso\u00a0\u00a0son las articulaciones sinoviales que se establecen\u00a0 entre las ap\u00f3fisis articulares superiores e inferiores de\u00a0<strong>\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0adyacentes . Una fina c\u00e1psula articular que se fija a los m\u00e1rgenes de las facetas articulares envuelve cada articulaci\u00f3n<\/p>\n<p><strong>Figura 1. Articulaciones cigoapofisarias<\/strong>\u00a0 . La\u00a0 articulaci\u00f3n cigoapofisaria o facetaria es una articulaci\u00f3n sinovial\u00a0de tipo plana que se encuentra entre la carilla articular superior de las ap\u00f3fisis articular superior de una\u00a0<strong>\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra<\/a>\u00a0y la carilla articular inferior de la ap\u00f3fisis articular inferior de la\u00a0<strong>\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0que se encuentra directamente sobre ella. Son\u00a0\u00a0 artrodias\u00a0 en la\u00a0 regi\u00f3n\u00a0 cervical\u00a0 y\u00a0 tor\u00e1cica\u00a0 , y trocoides\u00a0 en la\u00a0 regi\u00f3n lumbar .<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/articulacion_facetaria.JPG\" alt=\"\" \/><\/p>\n<p>Las\u00a0\u00a0 superficies\u00a0 articulares\u00a0 est\u00e1n\u00a0 conformadas\u00a0 seg\u00fan la direcci\u00f3n y los movimientos que deben de realizar<\/p>\n<p><strong>Figura 2.-\u00a0Orientaci\u00f3n de las facetas :\u00a0<\/strong>\u00a0\u00a01)\u00a0<strong>En la\u00a0columna cervical<\/strong><strong>\u00a0:\u00a0<\/strong>las\u00a0articulaciones cigapofisarias cervicales\u00a0est\u00e1n inclinadas inferiormente de anterior a posterior. Esta orientaci\u00f3n facilita la flexi\u00f3n y la extensi\u00f3n;\u00a02)\u00a0<big><small><strong>En la<\/strong><\/small><\/big><strong>\u00a0columna tor\u00e1cica<\/strong><big><small>:\u00a0las\u00a0<\/small><\/big>articulaciones cigoapofisarias tor\u00e1cicas<big><small>\u00a0 est\u00e1n orientadas verticalmente y limitan la flexi\u00f3n y extensi\u00f3n, pero facilitan la rotaci\u00f3n.<\/small><\/big>; 3)\u00a0<big><small><strong>En la\u00a0<\/strong><\/small><\/big><strong>\u00a0columna lumbar<\/strong><big><small>\u00a0: las\u00a0<\/small><\/big>articulaciones cigoapofisarias lumbares<big><small>\u00a0se\u00a0 caracterizan por tener\u00a0 superficies articulares curvas y las ap\u00f3fisis adyacentes\u00a0encajadas, limit\u00e1ndose, por tanto, el rango de movimiento, aunque la flexi\u00f3n y extensi\u00f3n son a\u00fan movimientos principales en la regi\u00f3n lumbar.<\/small><\/big><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/ORIENTACION_FACETAS_1.JPG\" alt=\"\" \/><\/p>\n<p>La funci\u00f3n de cada par de articulaciones es guiar y limitar el movimiento, estas funciones se pueden ver afectadas por degeneraci\u00f3n, desgaste o vejez.\u00a0luxaci\u00f3n,\u00a0fractura\u00a0y\u00a0osteoartitis.<\/p>\n<p>Para conocer\u00a0 m\u00e1s sobre\u00a0 este tipo\u00a0 de\u00a0 articulaciones\u00a0 hay\u00a0 \u00a0que\u00a0 distinguir\u00a0 en funci\u00f3n de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-columna-vertebral-segun-topografia\" target=\"_self\" rel=\"noopener\">ANATOM\u00cdA DE LA COLUMNA VERTEBRAL SEG\u00daN TOPOGRAF\u00cdA:<\/a><\/p>\n<ol>\n<li>Articulaci\u00f3n cigoapofisaria de la v\u00e9rtebra cervical<\/li>\n<li>Articulaci\u00f3n cigoapofisaria de la v\u00e9rtebra tor\u00e1cica<\/li>\n<li>Articulaci\u00f3n cigoapofisaria de la v\u00e9rtebra lumbar<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<p><strong>Figura\u00a01.\u00a0Articulaci\u00f3n facetaria\u00a0cervical.<\/strong>\u00a0La\u00a0articulaci\u00f3n\u00a0facetaria cervical\u00a0es\u00a0la\u00a0articulaci\u00f3n\u00a0de los arcos vertebrales (cigoapofisarias)\u00a0\u00a0 de la\u00a0v\u00e9rtebras cervicales\u00a0. Esta articulaci\u00f3n diartrodial est\u00e1 formada por el\u00a0proceso articular superior de la v\u00e9rtebra\u00a0cervical inferior\u00a0\u00a0\u00a0y el\u00a0proceso articular inferior de la v\u00e9rtebra\u00a0cervical superior\u00a0, en la conjunci\u00f3n de la l\u00e1mina con el ped\u00edculo.\u00a0Cada superficie\u00a0articular est\u00e1 recubierta por tejido cartilaginoso, y\u00a0 cada articulaci\u00f3n por los ligamentos y la c\u00e1psula articular (esta c\u00e1psula contacta con el\u00a0foramen vertebral\u00a0y\u00a0los\u00a0nervios cervicales o nervios raqu\u00eddeos cervicales)\u00a0.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/anatomia_faceta_cervical_bueno.JPG\" alt=\"\" \/><\/p>\n<p><strong>\u00a0Figura 2. Inervaci\u00f3n de las facetas cervicales.<\/strong>\u00a0La inervaci\u00f3n de las<strong>\u00a0<\/strong>articulaciones facetarias\u00a0cervicales\u00a0corre\u00a0a\u00a0cargo<strong>\u00a0de ramos\u00a0 articulares\u00a0que surgen\u00a0de\u00a0los\u00a0ramos mediales de los\u00a0ramos posteriores de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios cervicales o nervios raqu\u00eddeos cervicales<\/a><\/strong>\u00a0. Estos ramos\u00a0 posteriores\u00a0discurren\u00a0posteriormente desde el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervio\u00a0 espinal<\/a>\u00a0por encima de lo que ser\u00eda el proceso transverso de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra cervical<\/a>, con una relaci\u00f3n bastante constante desde CIII\u00a0a CVII<em>.\u00a0<\/em><strong><em>Su\u00a0inervaci\u00f3n es multisegmentaria,\u00a0 al menos de\u00a02\u00a0 niveles.\u00a0\u00a0<\/em>As\u00ed ,\u00a0<em>de CIII a C VII\u00a0<\/em>\u00a0<\/strong>cada articulaci\u00f3n\u00a0 est\u00e1 inervada\u00a0 por el ramo articular del ramo medial posterior\u00a0de los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios cervicales o nervios raqu\u00eddeos cervicales<\/a>\u00a0 de\u00a0 su\u00a0 nivel\u00a0 \u00a0y el inmediatamente superior\u00a0e inferior.\u00a0<em>Estos\u00a0ramos articulares del ramo medial posterior\u00a0de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios cervicales o nervios raqu\u00eddeos cervicales<\/a><\/em>\u00a0\u00a0discurren posteriormente desde el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervio\u00a0espinal<\/a>\u00a0por encima de lo que ser\u00eda el proceso transverso de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra cervical\u00a0<\/a>, con una relaci\u00f3n bastante constante desde CIII\u00a0a CVII.\u00a0<em>Cada ramo medial posterior emite un nervio para su articulaci\u00f3n, para la inmediatamente superior y para la inferior,<\/em>\u00a0por lo que la informaci\u00f3n de cada articulaci\u00f3n es vehiculizada por tres ramos nerviosos, lo cual es muy importante su conocimiento para entender la necesidad de tratar los ramos mediales posteriores superior e inferior a la articulaci\u00f3n diana.\u00a0<strong><em><ins>Especificaciones\u00a0de la\u00a0inervaci\u00f3n\u00a0de las\u00a0facetas cervicales\u00a0<\/ins>:<\/em><\/strong>\u00a0<ins>1)\u00a0Occipito-\u00a0 C1\u00a0y\u00a0 C1- C2:<\/ins> \u00a0estas\u00a0 articulaciones\u00a0NO\u00a0\u00a0est\u00e1n\u00a0 inervadas por los\u00a0ramos\u00a0 dorsales\u00a0nervios raqu\u00eddeos cervicales\u00a0.<\/p>\n<a href=\"https:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2023\/05\/ORTHOFIX-P.023es-3o-Placa-cervical-TQ-V.2-72ppp.pdf\" class=\"pdfemb-viewer\" style=\"\" data-width=\"max\" data-height=\"max\" data-toolbar=\"bottom\" data-toolbar-fixed=\"off\">ORTHOFIX-P.023es-3\u00ba-Placa-cervical-TQ-V.2-72ppp<\/a>\n<div class=\"row container-row container-right-column tabs-header-container\">\n<div class=\"col-md-12\">\n<h1>Nervios cervicales o nervios raqu\u00eddeos cervicales<\/h1>\n<div class=\"section\">\n<div class=\"user-badge separate-right pull-left\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"tab-content\">\n<div id=\"article-content\" class=\"tab-pane active\">\n<div id=\"article-body\" class=\"row container-row container-right-column\">\n<div class=\"col-md-12 pull-left\">\n<p><strong>Los nervios cervicales o nervios raqu\u00eddeos cervicales<\/strong>\u00a0 son\u00a0los\u00a0nervios espinales\u00a0\u00a0\u00a0de las primeras 7\u00a0v\u00e9rtebras\u00a0cervicales\u00a0\u00a0que\u00a0 nacen\u00a0 de la\u00a0m\u00e9dula espinal.\u00a0,\u00a0 emergen\u00a0 por los\u00a0 agujeros de conjunci\u00f3n \u00a0de la\u00a0\u00a0columna cervical\u00a0\u00a0y\u00a0 se distribuyen por territorios\u00a0 sensitivos y motores espec\u00edficos.<\/p>\n<div>Los\u00a0<strong>nervios raqu\u00eddeos cervicales<\/strong>\u00a0 llevan el n\u00famero de la\u00a0v\u00e9rtebra\u00a0subyacente, salvo en el caso del\u00a0octavo, denominada C8, ya que hay ocho segmentos medulares cervicales para\u00a0v\u00e9rtebras\u00a0cervicales<\/div>\n<p><strong>Figura 1 . Nervios cervicales\u00a0.\u00a0 Los nervios cervicales\u00a0 \u00a0<\/strong>son\u00a0los\u00a0nervios espinales\u00a0\u00a0\u00a0de las primeras 7\u00a0v\u00e9rtebras\u00a0cervicales\u00a0\u00a0 \u00a0que\u00a0 nacen\u00a0 de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal.<\/a>.\u00a0 \u00a0En\u00a0 esta\u00a0 regi\u00f3n\u00a0 los \u00a0nervios espinales\u00a0\u00a0,\u00a0 tras nacer en la\u00a0\u00a0m\u00e9dula espinal\u00a0\u00a0 \u00a0emergen\u00a0 de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna ver<\/a>tebral cervical\u00a0\u00a0 por los\u00a0 agujeros\u00a0 de conjunci\u00f3n\u00a0\u00a0(a\u00a0excepci\u00f3n del primer nervio \u00a0espinal que transcurre entre el\u00a0atlas\u00a0y el proceso yugular del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">hueso occipital<\/a>\u00a0)\u00a0 y\u00a0se distribuyen por territorios\u00a0sensitivos y motores espec\u00edficos de la\u00a0\u00a0cabeza, el\u00a0cuello, \u00a0el\u00a0hombro\u00a0y\u00a0la\u00a0extremidad superior .\u00a0 (*Importante:\u00a01)\u00a0los nervios\u00a0 espinales cervicales \u00a0salen por encima\u00a0 de la\u00a0\u00a0v\u00e9rtebra\u00a0cervical\u00a0 respectiva\u00a0 -excepto\u00a0 el\u00a0nervio\u00a0 C8\u00a0\u00a0que\u00a0\u00a0sale por debajo\u00a0\u00a0de\u00a0 la\u00a0\u00a0v\u00e9rtebra\u00a0cervical CVII\u00a0&#8211;\u00a0 y tienen un recorrido bastante horizontal\u00a0;\u00a02)\u00a0Los primeros nervios cervicales carecen de ra\u00edces posteriores en el 50 % de las personas<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/nervios_espinales_cervicales_bueno.JPG\" alt=\"\" \/><\/p>\n<p>Los<strong>\u00a0nervios cervicales\u00a0<\/strong>\u00a0son\u00a0 responsables\u00a0 de la inervaci\u00f3n\u00a0\u00a0de\u00a0 diversas partes\u00a0del cuerpo :<\/p>\n<p><strong>A.-Los\u00a0 ramos\u00a0 ventrales :\u00a0 I) De los\u00a0 cuatro primeros nervios\u00a0 espinales\u00a0<\/strong>\u00a0forman\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo\u00a0 cervical<\/a>\u00a0\u00a0. Sus ramificaciones principalmente son nervios cut\u00e1neos que inervan la piel del \u00e1rea del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>, el \u00e1rea de la oreja, la parte trasera de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-cabeza\" target=\"_self\" rel=\"noopener\">cabeza<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-hombro\" target=\"_self\" rel=\"noopener\">hombro<\/a>\u00a0transmitiendo los impulsos sensoriales. Tambi\u00e9n hay ramificaciones que suplen los<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-anterior-del-cuello\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculos anteriores del cuello<\/a>. Asimismo,\u00a0de este plexo surge el\u00a0nervio fr\u00e9nico &#8211; \u00a0es una\u00a0 rama\u00a0 descendende\u00a0 de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical-profundo\" target=\"_self\" rel=\"noopener\">plexo cervical profundo<\/a>\u00a0con fibras mayoritariamente procedentes de\u00a0 C3\u00a0y C4, que corre inferiormente a los largo del t\u00f3rax para atender el\u00a0diafragma, el m\u00fasculo m\u00e1s importante en la respiraci\u00f3n-\u00a0<strong>\u00a0II)\u00a0 \u00a0De\u00a0los ramos ventrales de los nervios espinales cervicales C5-C8<\/strong>\u00a0 , junto\u00a0 a la rama primaria anterior del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio\u00a0raqu\u00eddeo\u00a0tor\u00e1cico T1<\/a>\u00a0forman\u00a0 \u00a0el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo\u00a0 braquial\u00a0<\/a>\u00a0. Sus ramificaciones\u00a0 son\u00a0 responsables de la inervaci\u00f3n de los hombros y las\u00a0 extremidades superiores<\/p>\n<p><strong>Figura\u00a0 2.\u00a0 Nervios\u00a0 espinales\u00a0 cervicales y\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/plexos-nerviosos-que-surgen-de-los-nervios-espinales\" target=\"_self\" rel=\"noopener\">\u00a0plexos nerviosos\u00a0<\/a>\u00a0asociados\u00a0 (\u00a0<\/strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo\u00a0 cervical<\/a>\u00a0 y\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo\u00a0 braquial\u00a0<\/a>\u00a0 )<\/p>\n<p><strong><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/nervios_espinales_cervicales.JPG\" alt=\"\" \/><\/strong><\/p>\n<p><strong>B.-Los ramos\u00a0 dorsales<\/strong>\u00a0: Son\u00a0 responsables\u00a0 de\u00a0 la\u00a0 inervaci\u00f3n\u00a0 de las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">facetas cervicales\u00a0<\/a>. Tambi\u00e9n\u00a0 de\u00a0 estos\u00a0 ramos\u00a0 surgen\u00a0 ramificaciones\u00a0 que inervan\u00a0 los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculos\u00a0 de la cabeza<\/a>\u00a0y los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n posterior del\u00a0\u00a0cuello\u00a0 o m\u00fasculos de la nuca\u00a0<\/a>,\u00a0 as\u00ed\u00a0 como de la piel\u00a0 comprendida entre el v\u00e9rtex y los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-hombro\" target=\"_self\" rel=\"noopener\">hombros\u00a0<\/a>\u00a0(\u00a0 ejemplo\u00a0 :\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-del-tercer-nervio-occipital-o-ton-block\" target=\"_self\" rel=\"noopener\">\u00a0tercer nervio occipital\u00a0<\/a>\u00a0y\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-nervio-occipital-mayor\" target=\"_self\" rel=\"noopener\">nervio occipital mayor\u00a0<\/a>) .<\/p>\n<p><strong>Figura 2.\u00a0 \u00c1reas de distribuci\u00f3n sensitiva de las ramas\u00a0cut\u00e1neas\u00a0 de los\u00a0nervios espinales cervicales<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/dermatomas_nervios_espinales_cervicales.JPG\" alt=\"\" \/><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/llave.JPG\" alt=\"\" \/><\/p>\n<p><strong>En\u00a0 el\u00a0 \u00a0cuello\u00a0\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/ramas_plexo_cervical_superficial.JPG\" alt=\"\" \/><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"center\">\n<tbody>\n<tr>\n<td colspan=\"5\"><strong>Ramos anteriores (\u00a0 ventrales\u00a0 )<\/strong><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><strong>Nervios\u00a0 dependientes<\/strong><\/td>\n<td><strong>Funci\u00f3n sensitiva<\/strong><\/td>\n<td><strong>Ramos motores<\/strong><\/td>\n<td><strong>Funci\u00f3n motora<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>C1<\/strong><\/td>\n<td><strong>&#8211;<\/strong><\/td>\n<td><strong>&#8211;<\/strong><\/td>\n<td colspan=\"1\" rowspan=\"5\">Del\u00a0 asa cervical ( parte motora del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo\u00a0 cervical<\/a>\u00a0)<\/p>\n<p>&nbsp;<\/td>\n<td colspan=\"1\" rowspan=\"5\">Inerva los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-infrahioideos\" target=\"_self\" rel=\"noopener\">m\u00fasculos infrahioideos<\/a>\u00a0(\u00a0 excepto el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-tirohioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo tirohioideo<\/a>\u00a0)<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td><strong>C2<\/strong><\/td>\n<td><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervio-occipital-menor-o-nervio-mastoideo\" target=\"_self\" rel=\"noopener\">Nervio occipital menor o nervio mastoideo<\/a><\/td>\n<td rowspan=\"5\">De las partes sensitivas del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo\u00a0 cervical<\/a>\u00a0, inervan las caras anterior y lateral del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\"><strong>C2-C3<\/strong><\/td>\n<td><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervio-auricular-mayor\" target=\"_self\" rel=\"noopener\">Nervio auricular mayor<\/a><\/td>\n<\/tr>\n<tr>\n<td><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervio-cervical-transverso\" target=\"_self\" rel=\"noopener\">Nervio cervical transverso<\/a><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\"><strong>C3-C4<\/strong><\/td>\n<td rowspan=\"2\"><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervio-supraclavicular\" target=\"_self\" rel=\"noopener\">Nervio supraclavicular<\/a><\/td>\n<\/tr>\n<tr>\n<td>Contribuyen con el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical-profundo\" target=\"_self\" rel=\"noopener\">nervio fr\u00e9nico<\/a>\u00a0*<\/td>\n<td>Inervan el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-pared-toracica-inferior-el-diafragma\" target=\"_self\" rel=\"noopener\">diafragma<\/a>\u00a0diafragma y el pericardio *<\/td>\n<\/tr>\n<tr>\n<td><strong>C5-C8<\/strong><\/td>\n<td>ramos\u00a0 del\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo\u00a0 braquial<\/a><\/td>\n<td>\u00a0Inervaci\u00f3n sensitiva\u00a0 de\u00a0los<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-hombro\" target=\"_self\" rel=\"noopener\">\u00a0hombros<\/a>\u00a0y extremidades superiores.<\/td>\n<td colspan=\"2\" rowspan=\"1\">Inervaci\u00f3n sensitiva\u00a0 de\u00a0los\u00a0hombros\u00a0y extremidades superiores.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>*Las ra\u00edces anteriores de C3-C5 se combinan para formar el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical-profundo\" target=\"_self\" rel=\"noopener\">nervio fr\u00e9nico<\/a><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"center\">\n<tbody>\n<tr>\n<td colspan=\"4\"><strong>Ramos posteriores ( dorsales )<\/strong><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>N<strong>ervios dependientes<\/strong><\/td>\n<td><strong>Funci\u00f3n sensitiva<\/strong><\/td>\n<td><strong>Funci\u00f3n motora<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>C1<\/strong><\/td>\n<td><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-radicular-selectivo-cervical-o-bloqueo-sobre-el-ganglio-de-la-raiz-dorsal-de-c1\" target=\"_self\" rel=\"noopener\">Nervio suboccipital<\/a><\/td>\n<td>No hay dermatoma C1<\/td>\n<td colspan=\"1\" rowspan=\"5\">Inerva\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n posterior del\u00a0\u00a0cuello\u00a0 o m\u00fasculos de la nuca\u00a0<\/a><\/td>\n<\/tr>\n<tr>\n<td><strong>C2<\/strong><\/td>\n<td><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-nervio-occipital-mayor\" target=\"_self\" rel=\"noopener\">Nervio occipital Mayor<\/a><\/td>\n<td colspan=\"1\" rowspan=\"4\">Inerva dermatoma\u00a0 correspondientes<\/td>\n<\/tr>\n<tr>\n<td><strong>C3<\/strong><\/td>\n<td><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-del-tercer-nervio-occipital-o-ton-block\" target=\"_self\" rel=\"noopener\">Tercer nervio occipital\u00a0<\/a><\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td><strong>C4-C5<\/strong><\/td>\n<td><strong>&#8212;<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>C6-C7-C8<\/strong><\/td>\n<td>&#8212;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Los\u00a0<strong>nervios cervicales\u00a0<\/strong>son la\u00a0diana\u00a0terap\u00e9utica\u00a0de una\u00a0serie\u00a0de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS INTERVENCIONISTAS PARA EL TRATAMIENTO DEL DOLOR<\/a>\u00a0como \u00a0son \u00a0:<\/p>\n<ol>\n<li><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-paravertebral-cervical\" target=\"_self\" rel=\"noopener\">El BLOQUEO PARAVERTEBRAL CERVICAL\u00a0<\/a><\/li>\n<li><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-radiculares-selectivos-de-las-raices-cervicales\" target=\"_self\" rel=\"noopener\">Los BLOQUEOS RADICULARES SELECTIVOS DE LAS RA\u00cdCES CERVICALES<\/a><\/li>\n<li><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnica-epidural-cervical\" target=\"_self\" rel=\"noopener\">Las T\u00c9CNICAS EPIDURALES CERVICALES<\/a><\/li>\n<li>EL\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-de-las-facetas-cervicales\" target=\"_self\" rel=\"noopener\">BLOQUEO DE LAS FACETAS CERVICALES<\/a>\u00a0(\u00a0 \u00a0en\u00a0 este\u00a0 caso la\u00a0 diana\u00a0 es\u00a0 el\u00a0 ramo\u00a0 posterior\u00a0 del\u00a0 nervio raqu\u00eddeo cervical\u00a0 )<\/li>\n<\/ol>\n<p>Para\u00a0 poder \u00a0ubicar \u00a0el \u00a0territorio \u00a0inervado por las\u00a0 ramas \u00a0terminales y saber\u00a0el tipo de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-en-el-cuello\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS INTERVENCIONISTAS EN EL CUELLO<\/a>\u00a0a\u00a0 utilizar\u00a0\u00a0\u00a0 es \u00a0\u00fatil \u00a0 conocer la\u00a0anatom\u00eda de superficie del cuello<\/p>\n<p><strong>Figura 1 . Dermatomas\u00a0 cervicales\u00a0 \u00a0<\/strong>\u00a0Con la excepci\u00f3n del<em><strong>\u00a0nervio\u00a0raqu\u00eddeo\u00a0cervical\u00a0C1<\/strong><\/em>, que normalmente no tiene ra\u00edz dorsal, cada segmento vertebral se asocia con un dermatoma, que se define como \u00e1rea cut\u00e1nea suministrada por un\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervio espinal\u00a0<\/a><\/strong>.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/DERMATOMAS_CERVICALES2.JPG\" alt=\"\" \/><\/p>\n<p>A este nivel hay que tener en cuenta la presencia de\u00a0 ramas\u00a0 de\u00a0 \u00a0la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral\u00a0<\/a>,\u00a0 \u00a0 de la\u00a0arteria\u00a0 cervical\u00a0 ascendente\u00a0 y\u00a0 de la\u00a0 arteria cervical profunda\u00a0\u00a0que pasan a trav\u00e9s del\u00a0 agujero\u00a0 intervertebral\u00a0 a nivel\u00a0 cervical\u00a0.\u00a0 \u00a0Su presencia\u00a0 puede complicar las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-raices-espinales-para-el-alivio-del-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS SOBRE RA\u00cdCES ESPINALES PARA EL ALIVIO DEL DOLOR EN EL CUELLO<\/a><\/p>\n<p><strong>Figura 6.\u00a0Relaci\u00f3n del\u00a0nervio\u00a0espinal\u00a0cervical\u00a0con\u00a0la<\/strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral<\/a><strong>\u00a0y\u00a0las\u00a0ramas\u00a0de la\u00a0arteria\u00a0cervical\u00a0ascendente\u00a0y\u00a0arteria cervical profunda\u00a0(modificado\u00a0 de\u00a0\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#5e5e0691-3bdc-26f5-590e-d7acf608ee59\" name=\"entry-5e5e0691-3bdc-26f5-590e-d7acf608ee59\" data-bibliography-uid=\"5e5e0691-3bdc-26f5-590e-d7acf608ee59\">1<\/a>\u00a0)\u00a0 \u00a0Las\u00a0<\/strong>\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arterias vertebrales\u00a0<\/a><\/strong><strong>\u00a0\u00a0<\/strong>son\u00a0\u00a0arterias\u00a0del\u00a0cuello\u00a0que\u00a0 se originan en la arteria subclavia\u00a0 y que, junto\u00a0a\u00a0las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arteria-carotida-interna\" target=\"_self\" rel=\"noopener\">arterias car\u00f3tidas internas<\/a>\u00a0,\u00a0 constituyen el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/sistema-arterial-cerebral\" target=\"_self\" rel=\"noopener\">sistema arterial cerebral<\/a>\u00a0.\u00a0 La\u00a0<strong>arteria cervical ascendente<\/strong>\u00a0es una\u00a0arteria\u00a0que se origina como rama colateral del\u00a0tronco tirocervical, que es una de las cuatro ramas colaterales de la\u00a0subclavia.\u00a0 \u00a0Esta\u00a0 \u00a0arteria\u00a0 da peque\u00f1as ramas hacia los<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-del-cuello\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculos del cuello<\/a>, que se\u00a0anastomosan\u00a0con ramas de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral<\/a>, y env\u00eda una o dos ramas espinales hacia el\u00a0canal vertebral\u00a0a trav\u00e9s de los\u00a0agujeros intervertebrales\u00a0que se distribuyen hacia la<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">\u00a0m\u00e9dula espinal<\/a>\u00a0,\u00a0\u00a0las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/duramadre-aracnoides-y-piamadre-espinales\" target=\"_self\" rel=\"noopener\">meninges espinales\u00a0<\/a>\u00a0\u00a0\u00a0y hacia los\u00a0cuerpos vertebrales, del mismo modo que las\u00a0ramas espinales de la arteria vertebral.\u00a0 \u00a0La\u00a0\u00a0<strong>arteria cervical profunda\u00a0<\/strong>\u00a0es una\u00a0 arteria que se origina como\u00a0<em>rama externa<\/em>\u00a0de la\u00a0subclavia; unas veces nace aisladamente y otras por un tronco com\u00fan con la\u00a0intercostal superior\u00a0(<em>tronco cervicointercostal\u00a0<\/em>? o\u00a0<em>costocervical<\/em>). Esta\u00a0 arteria\u00a0 discurre hacia arriba por la parte posterior del\u00a0cuello, entre el<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculo semiespinoso de la cabeza<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculo semiespinoso del cuello<\/a>, llegando hasta la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0axis<\/a>, irrigando estos m\u00fasculos y sus adyacentes, y\u00a0anastomos\u00e1ndose\u00a0con la divisi\u00f3n profunda de la\u00a0rama descendente de la arteria occipital, y con ramas de la\u00a0arteria vertebral.\u00a0y\u00a0anastomos\u00e1ndose\u00a0con la divisi\u00f3n profunda de la\u00a0rama descendente de la arteria occipital, y con ramas de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral\u00a0<\/a>\u00a0 \u00a0 RESE\u00d1AR\u00a0 :\u00a0 \u00a0Las arterias cervicales ascendentes y cervicales profundas se anastomosan\u00a0con la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral\u00a0<\/a>\u00a0<ins>posterior a los nervios espinales<\/ins>. Tener\u00a0en cuenta que la arteria cervical ascendente ingresa al agujero en C3-4 o C4-5, mientras que la arteria cervical profunda ingresa a los agujeros C5-6, C6-7 o C7-T1 m\u00e1s distales. El diagrama de la derecha muestra una aguja transforaminal cervical que canula una arteria segmentaria aportada por la arteria cervical ascendente. Las part\u00edculas de esteroides (p\u00farpura) se muestran uni\u00e9ndose en la arteria espinal anterior.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/arterias_para_foramen_cervical.JPG\" alt=\"\" \/><\/p>\n<h2 id=\"acItem_content\">Contenido del art\u00edculo<\/h2>\n<div class=\"editor-field\">\n<p><strong>Los nervios cervicales o nervios raqu\u00eddeos cervicales<\/strong>\u00a0\u00a0son\u00a0los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervios espinales\u00a0<\/a>\u00a0de las primeras 7<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">\u00a0v\u00e9rtebras\u00a0cervicales<\/a>\u00a0\u00a0 \u00a0que\u00a0 nacen\u00a0de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal.<\/a><\/p>\n<ul>\n<li>Hay\u00a08\u00a0 nervios\u00a0 cervicales,\u00a0 designados\u00a0 C1\u00a0 a C8\n<ul>\n<li><strong><em>C1\u00a0 a C7<\/em><\/strong>\u00a0:\u00a0 emergen por\u00a0<em>encima de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical<\/a>\u00a0correspondiente.<\/em><\/li>\n<li><strong><em>C8<\/em><\/strong>\u00a0 :\u00a0 emerge por\u00a0 debajo\u00a0 de la\u00a0<em><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical CVII<\/a><\/em><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Figura \u00a01.\u00a0Nervios\u00a0 espinales cervicales visi\u00f3n\u00a0 anteroposterior<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/nervio_espinal_cervical_AP.JPG\" alt=\"\" \/><\/p>\n<p><strong>Figura \u00a02.\u00a0Nervios\u00a0 espinales cervicales visi\u00f3n\u00a0 lateral<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/nervio_espinal_cervical_lateral.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Figura 3\u00a0 .\u00a0Nervios\u00a0 espinales cervicales en una visi\u00f3n transversal<\/strong>\u00a0\u00a0Cada nervio est\u00e1 unido a la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>\u00a0por dos ra\u00edces, una anterior o ventral, y una posterior o dorsal, esta \u00faltima caracterizada por la presencia de un ganglio, el ganglio espinal.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/nervio_espinal_cervical_trasnvesal.JPG\" alt=\"\" \/><\/p>\n<h3>Componentes de los nervios cervicales y\u00a0 especificaciones\u00a0 seg\u00fan\u00a0 el\u00a0 nervio\u00a0 cervical<\/h3>\n<ul>\n<li>Al igual que otros\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/definicion-y-caracteristicas-de-los-nervios-espinales-y-raices-de-los-nervios-espinales\" target=\"_self\" rel=\"noopener\">nervios espinales<\/a>\u00a0, los nervios\u00a0 espinales cervicales se\u00a0 dividen en ramos dorsales y\u00a0 ventrales\u00a0 tras abandonar el\u00a0foramen intervertebral\u00a0( detr\u00e1s de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria\u00a0 vertebral<\/a>\u00a0) .\u00a0 \u00a0<em>*\u00a0 No\u00a0 aplicable\u00a0 al\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-radicular-selectivo-cervical-o-bloqueo-sobre-el-ganglio-de-la-raiz-dorsal-de-c1\" target=\"_self\" rel=\"noopener\">nervio cervical\u00a0 \u00a0C1\u00a0<\/a>\u00a0\u00a0en cuanto\u00a0 a\u00a0 no\u00a0 existir\u00a0 foramen\u00a0 intervertebral\u00a0 a\u00a0 este nivel .<\/em><\/li>\n<\/ul>\n<p><strong>Figura 4\u00a0. Agujero\u00a0 intervertebral\u00a0 a nivel\u00a0 cervical .\u00a0<\/strong>El techo y el suelo del\u00a0 foramen intervertebral\u00a0 cervical est\u00e1 formado por los ped\u00edculos de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0<\/a>\u00a0adyacentes.\u00a0\u00a0 Su pared posterolateral la constituye la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">\u00a0articulaci\u00f3n\u00a0 facetaria cervical\u00a0<\/a>\u00a0y\u00a0 el proceso articular superior\u00a0 de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0 inferior. Su pared\u00a0 anteromedial\u00a0 la constituye la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-uncovertebrales\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0 uncovertebral\u00a0<\/a>\u00a0y las porciones adyacentes de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">cuerpos vertebrales<\/a>\u00a0y el\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">disco intervertebral.<\/a>\u00a0\u00a0.\u00a0Recordar\u00a0\u00a0 : 1)\u00a0El nervio espinal cervical ocupa la parte inferior del agujero con las venas epirradiculares en la parte superior.\u00a0 ;\u00a0 2)\u00a0 Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/irrigacion-arterial-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">arterias radiculares<\/a>\u00a0que surgen de las arterias cervicales vertebrales ascendentes y cervicales profundas se encuentran en estrecha aproximaci\u00f3n al nervio espinal.\u00a0 \u00a0 \u00a0En\u00a0 relaci\u00f3n\u00a0 a\u00a0 estas\u00a0 arterias\u00a0 es\u00a0 importante\u00a0 rese\u00f1ar\u00a0 que\u00a0\u00a0 variaciones\u00a0 anat\u00f3micas\u00a0\u00a0a\u00a0 este nivel \u00a0\u00a0\u00a0&#8211;\u00a0 En el 20% de los agujeros intervertebrales disecados, la arteria cervical ascendente o la arteria cervical profunda se ramifican dentro de los 2 mm de la trayectoria de la aguja para un<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-radiculares-selectivos-de-las-raices-cervicales\" target=\"_self\" rel=\"noopener\">\u00a0procedimiento transforaminal cervical.<\/a>\u00a0Un tercio de estos vasos ingresa\u00a0al agujero posterior formando potencialmente un vaso alimentador radicular o segmentario a la m\u00e9dula espinal, lo que lo hace vulnerable a lesiones o inyecciones involuntarias, incluso durante la colocaci\u00f3n correcta de la aguja<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#e76fe525-9eba-87a6-014d-bac9c586871f\" name=\"entry-e76fe525-9eba-87a6-014d-bac9c586871f\" data-bibliography-uid=\"e76fe525-9eba-87a6-014d-bac9c586871f\">2<\/a>.\u00a0Ello implica\u00a0 :\u00a0 a)\u00a0 No existe una zona segura en el abordaje transforaminal debido a la existencia de alteraciones anat\u00f3micas y a las comunicaciones entre la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria\u00a0 vertebral<\/a>\u00a0y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/irrigacion-arterial-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">arteria espinal anterior<\/a>\u00a0 b) La utilizaci\u00f3n de corticoides con part\u00edculas es de alto riesgo . Por otra parte\u00a0 \u00a0 en\u00a0 \u00a0estos procedimientos\u00a0 ,\u00a0 aunque no se utilicen corticoides, se pueden producir disecciones de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria\u00a0 vertebral<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/foramen_intervertebral_cervical.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Figura\u00a0 5.\u00a0 Formaci\u00f3n de los nervios espinales en la regi\u00f3n cervical (\u00a0 modificado\u00a0 de\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#5c15fe33-6b6c-348f-953e-3ee40a93288c\" name=\"entry-5c15fe33-6b6c-348f-953e-3ee40a93288c\" data-bibliography-uid=\"5c15fe33-6b6c-348f-953e-3ee40a93288c\">3<\/a>. )\u00a0 \u00a0<\/strong>Cada nervio est\u00e1 unido a la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>\u00a0por dos ra\u00edces, una anterior o ventral, y una posterior o dorsal, \u00e9sta \u00faltima caracterizada por la presencia de un ganglio, el ganglio espinal.\u00a0\u00a0Distalmente al ganglio raqu\u00eddeo las ra\u00edces se unen para formar el\u00a0<ins><em>nervio espinal o raqu\u00eddeo mixto<\/em><\/ins>, que a su vez\u00a0<em>\u00a0<\/em><strong><em>emite cuatro ramos (men\u00edngeo, comunicante, posterior y anterior:<\/em><\/strong>\u00a01)\u00a0<strong>Los ramos men\u00edngeos<\/strong>\u00a0inervan\u00a0meninges espinales. 2)\u00a0<strong>Los ramos comunicantes<\/strong>\u00a0establecen conexi\u00f3n con los ganglios simp\u00e1ticos del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/cadena-simpatico-cervical-o-tronco-simpatico-cervical\" target=\"_self\" rel=\"noopener\">tronco simp\u00e1tico\u00a0cervical<\/a>\u00a0. 3) \u00a0<strong>Los ramos posteriores &#8211;\u00a0\u00a0<\/strong>\u00a0m\u00e1s largos\u00a0 que\u00a0 los ramos\u00a0 anteriores\u00a0\u00a0excepto\u00a0 el\u00a0 del nervio\u00a0 espinal\u00a0 C1\u00a0 que\u00a0 es\u00a0 m\u00e1s peque\u00f1o\u00a0 e incluso\u00a0 ausente-\u00a0se\u00a0dividen\u00a0en:<strong><em>\u00a0a)\u00a0un\u00a0ramo medial\u00a0<\/em><\/strong>que inerva\u00a0los\u00a0m\u00fasculos\u00a0y aponeurosis (<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-multifido-cervical\" target=\"_self\" rel=\"noopener\">m\u00fasculos mult\u00edfido cervical<\/a>\u00a0y\u00a0el<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-erector-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculo erector de la\u00a0columna cervical<\/a>\u00a0)\u00a0\u00a0as\u00ed\u00a0 como las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">articulaciones interapofisarias o\u00a0 facetarias cervicales\u00a0<\/a>\u00a0;\u00a0 y\u00a0\u00a0<strong><em>b)\u00a0 un\u00a0ramo lateral<\/em>\u00a0<\/strong>que inerva\u00a0 1)\u00a0 los\u00a0que inervan\u00a0 los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculos\u00a0 del dorso\u00a0\u00a0la cabeza<\/a>\u00a0y los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n posterior del\u00a0\u00a0cuello\u00a0 o m\u00fasculos de la nuca\u00a0<\/a>\u00a0; 2 ) la\u00a0 piel comprendida\u00a0 entre el v\u00e9rtex y los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-hombro\" target=\"_self\" rel=\"noopener\">hombros<\/a>\u00a0. 4)<strong>\u00a0Los ramos anteriores<\/strong>\u00a0que se entrecruzan,\u00a0 se dividen\u00a0 y anastomosan\u00a0 con los\u00a0 ramos\u00a0 anteriores de otros\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/definicion-y-caracteristicas-de-los-nervios-espinales-y-raices-de-los-nervios-espinales\" target=\"_self\" rel=\"noopener\">nervios espinales<\/a>\u00a0\u00a0\u00a0para formar el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">\u00a0plexo\u00a0 cervical\u00a0<\/a>\u00a0(<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">ramos anteriores\u00a0de los primeros cuatro\u00a0nervios \u00a0espinales cervicales<\/a>\u00a0) y\u00a0 el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo braquial\u00a0<\/a>\u00a0 (<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">ramos anteriores\u00a0de los nervios \u00a0espinales cervicales C5 a C8\u00a0<\/a>\u00a0 y\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">ramo anterior del\u00a0 \u00a0nervios raqu\u00eddeo\u00a0tor\u00e1cico T1<\/a>)<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/componentes_nervio_cervical.JPG\" alt=\"\" \/><\/p>\n<div><strong>A.- Ramo\u00a0\u00a0anterior\u00a0del\u00a0 nervio cervical\u00a0\u00a0<\/strong><\/div>\n<ul>\n<li>Es un ramo grueso .<\/li>\n<li>Este\u00a0 \u00a0ramo\u00a0 se entrecruza,\u00a0 se divide\u00a0 y anastomosa\u00a0 con los\u00a0 ramos\u00a0 anteriores de otros\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/definicion-y-caracteristicas-de-los-nervios-espinales-y-raices-de-los-nervios-espinales\" target=\"_self\" rel=\"noopener\">nervios espinales<\/a>\u00a0\u00a0\u00a0para formar el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">\u00a0plexo\u00a0 cervical\u00a0<\/a>\u00a0(\u00a0<em>\u00a0<\/em><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">ramos anteriores\u00a0de los primeros cuatro\u00a0nervios\u00a0espinales cervicales<\/a>\u00a0 ) y\u00a0 el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo braquial\u00a0<\/a>\u00a0 (<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">ramos anteriores\u00a0de los nervios \u00a0espinales cervicales C5 a C8\u00a0<\/a>\u00a0 y\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">ramo anterior del\u00a0 \u00a0nervios raqu\u00eddeo\u00a0tor\u00e1cico T1<\/a>)<\/li>\n<\/ul>\n<p><strong>Figura 6.<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">\u00a0Plexo\u00a0 cervical<\/a>\u00a0 y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo braquial\u00a0<\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/plexo_cervical_plexo_braquial.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li>Antes\u00a0 de\u00a0 la\u00a0 formaci\u00f3n de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/plexos-nerviosos-que-surgen-de-los-nervios-espinales\" target=\"_self\" rel=\"noopener\">plexos nerviosos<\/a>\u00a0,\u00a0 estas ramas\u00a0 ventrales dan 2\u00a0 filetes nerviosos , que\u00a0 son :\u00a0 1)\u00a0<strong><em>\u00a0el\u00a0 ramo comunicante gris<\/em><\/strong>\u00a0 : es un ramo\u00a0 que\u00a0 lo une a la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/cadena-simpatico-cervical-o-tronco-simpatico-cervical\" target=\"_self\" rel=\"noopener\">cadena simp\u00e1tico cervical o tronco simp\u00e1tico cervical<\/a>\u00a0\u00a0m\u00e1s cercano\u00a0 y\u00a0 2)\u00a0\u00a0<em><strong>\u00a0el\u00a0 ramo men\u00edngeo ( tambi\u00e9n llamado\u00a0 nervio sinuvertebral\u00a0 de\u00a0 Luschka\u00a0<\/strong><\/em>\u00a0) que\u00a0 a\u00a0 expensas\u00a0 de un trayecto\u00a0 recurrente\u00a0 ,\u00a0 se introduce\u00a0 de nuevo\u00a0 en el canal medular\u00a0 ,\u00a0 inervando las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/duramadre-aracnoides-y-piamadre-espinales\" target=\"_self\" rel=\"noopener\">meninges espinales\u00a0\u00a0<\/a>, los\u00a0 vasos sangu\u00edneos\u00a0 del\u00a0 espacio\u00a0 epidural\u00a0 , la cara posterior de los cuerpos vertebrales\u00a0 , el ligamento vertebral\u00a0 com\u00fan\u00a0 posterior\u00a0 y las\u00a0 capas m\u00e1s perif\u00e9ricas\u00a0 del \u00e1nulus\u00a0 .\u00a0 Forma una red neural\u00a0 dentro del canal vertebral\u00a0 ,\u00a0 siendo la inervaci\u00f3n multisegmentaria\u00a0 y bilateral\u00a0 .\u00a0 Se\u00a0 trata\u00a0 de un nervio\u00a0 sensitivo\u00a0\u00a0 con un importante componente simp\u00e1tico<\/li>\n<li>Especificaciones :<\/li>\n<\/ul>\n<p><strong>1.-Rama anterior del\u00a0 nervio\u00a0cervical\u00a0C1\u00a0.\u00a0<\/strong><\/p>\n<ul>\n<li><strong>\u00a0Este nervio raqu\u00eddeo\u00a0<\/strong>sale\u00a0entre el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/hueso-occipital\" target=\"_self\" rel=\"noopener\">hueso occipital<\/a>\u00a0 y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical\u00a0CI ( atlas )\u00a0<\/a>\u00a0 por el mismo sitio que la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral<\/a>\u00a0<strong>.<\/strong>\u00a0Su\u00a0<strong>rama anterior<\/strong>\u00a0es uno\u00a0de los\u00a0componentes\u00a0 del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervical<\/a>.\u00a0<strong><em>Trayecto<\/em><\/strong>: Pasa detr\u00e1s y justo debajo de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-atlantooccipitales-1\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0atlantooccipital<\/a>, a la que proporciona ramas articulares .\u00a0 Se\u00a0 dirige hacia abajo\u00a0\u00a0despu\u00e9s\u00a0de pasar por fuera del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-anterior-menor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto anterior menor de la cabeza<\/a>.\u00a0\u00a0 Fibras\u00a0 de\u00a0 \u00a0este\u00a0 ramo\u00a0 \u00a0se juntan con las\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervio-hipogloso\" target=\"_self\" rel=\"noopener\">\u00a0nervio\u00a0 hipogloso\u00a0 (\u00a0 XII par craneal )\u00a0<\/a>.<em><strong>\u00a0Funci\u00f3n\u00a0<\/strong><\/em>:\u00a0Contribuye a la inervaci\u00f3n de los m\u00fasculos prevertebrales y a la inervaci\u00f3n sensorial del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternocleidomastoideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo esternocleidomastoideo<\/a>\u00a0y el\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-trapecio\" target=\"_self\" rel=\"noopener\">M\u00fasculo trapecio<\/a>\u00a0La rama ventral inerva la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-atlantooccipitales-1\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0atlantooccipital<\/a>\u00a0.Su rama men\u00edngea recurrente se une a las de los\u00a0\u00a0nervios raqu\u00eddeos cervicales\u00a0\u00a0C2 y C3 para inervar la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial<\/a>\u00a0medial y sus ligamentos y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/duramadre-espinal\" target=\"_self\" rel=\"noopener\">duramadre<\/a>\u00a0\u00a0que protege\u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal cervical superior<\/a>. Las ramas sinuvertebrales C1, C2 y C3 inervan la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/duramadre-espinal\" target=\"_self\" rel=\"noopener\">duramadre<\/a>\u00a0sobre el clivus en la fosa craneal posterior<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#48ee107b-ee26-65b9-feaa-ba84394c5b7d\" name=\"entry-48ee107b-ee26-65b9-feaa-ba84394c5b7d\" data-bibliography-uid=\"48ee107b-ee26-65b9-feaa-ba84394c5b7d\">4<\/a><\/li>\n<\/ul>\n<p><strong>Figura\u00a0 7\u00a0. Rama\u00a0 anterior de C1\u00a0\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/ramo_anterior_c1.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li>Esta\u00a0 estructura\u00a0 nerviosa es la diana terap\u00e9utica\u00a0 de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-radicular-selectivo-cervical-o-bloqueo-sobre-el-ganglio-de-la-raiz-dorsal-de-c1\" target=\"_self\" rel=\"noopener\">Bloqueo radicular selectivo cervical o bloqueo sobre el ganglio de la ra\u00edz dorsal de C1<\/a><\/li>\n<li>Importante : 1)\u00a0\u00a0\u00a0no se ve implicada\u00a0durante la realizaci\u00f3n de un\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">bloqueo de\u00a0plexo cervical<\/a>\u00a0.\u00a0 2)\u00a0 La anestesia del primer nervio cervical es in\u00fatil, ya que no da una rama sensitiva a nivel del cuello<\/li>\n<\/ul>\n<p><strong>2.-Rama\u00a0 anterior del nervio cervical C2 .<\/strong><\/p>\n<ul>\n<li>El\u00a0 nervio\u00a0 C2\u00a0<strong>\u00a0\u00a0<\/strong>sale\u00a0 por encima\u00a0 de\u00a0\u00a0la\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical\u00a0CII ( axis )\u00a0<\/a>. Su\u00a0\u00a0<strong>rama anterior<\/strong>\u00a0es uno\u00a0 \u00a0de los\u00a0 componentes\u00a0 \u00a0del\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervical\u00a0\u00a0<\/a>\u00a0 \u00a0Trayecto :\u00a0\u00a0La rama ventral corre horizontal y lateralmente\u00a0&#8220;adherida&#8221; a\u00a0la c\u00e1psula del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial lateral\u00a0<\/a>\u00a0 por la fascia\u00a0 de inversi\u00f3n\u00a0 . Lateralmente\u00a0 llega a la\u00a0 altura\u00a0 de la arteria vertebral y, sostenida cerca de ella por\u00a0 ila fascia de inversi\u00f3n , se dobla aproximadamente 90 grados anteriormente\u00a0 para\u00a0 \u00a0 unirse al \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervica .\u00a0<\/a>Esta rama es uno\u00a0 de los\u00a0 componentes\u00a0 \u00a0del\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervical\u00a0\u00a0<\/a>, contribuye a la inervaci\u00f3n de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-anterior-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n anterior del cuello<\/a>\u00a0 .\u00a0 \u00a0Tambi\u00e9n\u00a0 \u00a0,\u00a0 \u00a0junto\u00a0 a los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">\u00a0nervios raqu\u00eddeos cervicales<\/a>\u00a0C1 y C3\u00a0 inerva\u00a0la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial<\/a>\u00a0medial y sus ligamentos y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/duramadre-espinal\" target=\"_self\" rel=\"noopener\">duramadre<\/a>\u00a0\u00a0que protege\u00a0 \u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal cervical superior<\/a>. Las ramas sinuvertebrales C1, C2 y C3 inervan la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/duramadre-espinal\" target=\"_self\" rel=\"noopener\">duramadre<\/a>\u00a0sobre el clivus en la fosa craneal posterior\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#ae88ff08-e7a0-b8ab-1dfa-a120a4f08b4b\" name=\"entry-ae88ff08-e7a0-b8ab-1dfa-a120a4f08b4b\" data-bibliography-uid=\"ae88ff08-e7a0-b8ab-1dfa-a120a4f08b4b\">5<\/a>\u00a0 \u00a0.\u00a0 \u00a0Es importante\u00a0 rese\u00f1ar\u00a0 \u00a0que \u00a0El nervio\u00a0 \u00a0est\u00e1\u00a0rodeado\u00a0de una fascia\u00a0 de inversi\u00f3n\u00a0\u00a0y un denso plexo de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/drenaje-venoso-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">venas<\/a>\u00a0que comunican\u00a0el plexo epidural y las venas\u00a0vertebrales .\u00a0 Esta\u00a0 fascia\u00a0 de\u00a0 inversi\u00f3n\u00a0 se continua medialmente\u00a0 con la membrana posterior atlanto-axial, lateralmente con la fascia que rodea la<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/irrigacion-arterial-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">\u00a0arteria vertebral<\/a>,\u00a0 ventralmente con la c\u00e1psula de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial lateral\u00a0<\/a>, y dorsalmente est\u00e1 cubierto por el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0 oblicuo mayor\u00a0 de la cabeza<\/a><a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#91515c4d-2b5b-0740-ce94-774a867777ea\" name=\"entry-91515c4d-2b5b-0740-ce94-774a867777ea\" data-bibliography-uid=\"91515c4d-2b5b-0740-ce94-774a867777ea\">6<\/a><\/li>\n<\/ul>\n<p><strong>Figura\u00a0 8.\u00a0 Rama\u00a0 anterior\u00a0 del\u00a0 nervio\u00a0 cervical\u00a0 C2\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/RAMA_ANTERIOR_C2_BUENA.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li>Esta\u00a0 estructura\u00a0 nerviosa es la diana terap\u00e9utica\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-radicular-selectivo-cervical-o-bloqueo-sobre-el-ganglio-de-la-raiz-dorsal-de-c2\" target=\"_self\" rel=\"noopener\">bloqueo radicular selectivo cervical o bloqueo sobre el ganglio de la ra\u00edz dorsal de C2<\/a><\/li>\n<\/ul>\n<p><strong>3.-Ramas\u00a0 anteriores de los\u00a0\u00a0nervios cervicales C3 &#8211;\u00a0 C7\u00a0 .\u00a0<\/strong><\/p>\n<ul>\n<li>Tras nacer en la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal\u00a0<\/a>\u00a0 \u00a0emergen\u00a0 de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna vertebral cervical<\/a>\u00a0\u00a0 por los\u00a0 agujeros\u00a0de conjunci\u00f3n. Estos\u00a0nervios\u00a0emergen por\u00a0<em>encima de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical<\/a>\u00a0correspondiente.\u00a0\u00a0<\/em>Es importante\u00a0 rese\u00f1ar\u00a0 que :\u00a0 1)\u00a0 \u00a0los\u00a0 ramos\u00a0 anteriores\u00a0 de los\u00a0 nervios\u00a0 cervicales\u00a0 C3\u00a0 y\u00a0 C4\u00a0 \u00a0(\u00a0 \u00a0junto\u00a0 a los\u00a0 ramos\u00a0 anteriores\u00a0 de los\u00a0 nervios\u00a0 \u00a0cervicales\u00a0 C1\u00a0 y\u00a0 C2\u00a0 \u00a0)\u00a0 \u00a0forman\u00a0<em><strong>el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo\u00a0 cervical\u00a0<\/a><\/strong><\/em>\u00a0 \u00a0<em><strong>;\u00a0\u00a0<\/strong><\/em>\u00a01)\u00a0 \u00a0los\u00a0 ramos\u00a0 anteriores\u00a0 de los\u00a0 nervios\u00a0 cervicales\u00a0 C5\u00a0, C6 y\u00a0\u00a0\u00a0C7\u00a0\u00a0 (\u00a0 \u00a0junto\u00a0 a los\u00a0 ramo\u00a0 anterior\u00a0 del\u00a0 nervio\u00a0 \u00a0cervical\u00a0 C8\u00a0 \u00a0forman\u00a0el\u00a0<strong>\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo braquiaL<\/a><\/li>\n<li>Estas\u00a0estructuras\u00a0 nerviosas son\u00a0la diana terap\u00e9utica\u00a0de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-radiculares-selectivos-de-las-raices-cervicales\" target=\"_self\" rel=\"noopener\">BLOQUEOS RADICULARES SELECTIVOS DE LAS RA\u00cdCES CERVICALES<\/a><\/li>\n<\/ul>\n<p><em>4.-<\/em><strong>Rama\u00a0anterior\u00a0del\u00a0 nervio\u00a0cervicales C8\u00a0 :\u00a0<\/strong><\/p>\n<ul>\n<li><strong>\u00a0T<\/strong>ras nacer en la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal\u00a0<\/a>\u00a0 \u00a0emergen\u00a0 de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna vertebral cervical<\/a>\u00a0\u00a0 por los\u00a0 agujeros\u00a0 de conjunci\u00f3n\u00a0 . Este\u00a0\u00a0nervio\u00a0 sale por debajo\u00a0\u00a0del ped\u00edculo\u00a0 de la\u00a0 la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical CVII<\/a>\u00a0&#8211;\u00a0 y tienen un recorrido bastante horizontal<\/li>\n<li>Estas\u00a0 estructuras\u00a0 nerviosas son\u00a0la diana terap\u00e9utica\u00a0de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-radiculares-selectivos-de-las-raices-cervicales\" target=\"_self\" rel=\"noopener\">BLOQUEOS RADICULARES SELECTIVOS DE LAS RA\u00cdCES CERVICALES<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<div><strong>B.-Ramo\u00a0posterior del\u00a0 nervio cervical\u00a0 (o\u00a0 tambi\u00e9n llamado\u00a0 ramo\u00a0 dorsal )\u00a0\u00a0<\/strong><\/div>\n<ul>\n<li>Es la rama posterior del tronco com\u00fan\u00a0 y mucho m\u00e1s delgada que el ramo anterior<\/li>\n<li>A la\u00a0 salida\u00a0 del foramen se dirige hacia atr\u00e1s y\u00a0 se divide\u00a0 en\u00a0 :<\/li>\n<\/ul>\n<p><em><strong>\u00a0 1)\u00a0 un ramo medial\u00a0<\/strong><\/em><\/p>\n<ul>\n<li><em>El\u00a0\u00a0ramo\u00a0medial del\u00a0 ramo\u00a0posterior de los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios cervicales o nervios raqu\u00eddeos cervicales<\/a><\/em>\u00a0se sit\u00faa inicialmente en la cara lateral de las c\u00e1psulas de las articulaciones\u00a0 facetarias, en su margen inferior . Cruzan por un canal formado por las c\u00e1psulas de las articulaciones\u00a0medialmente y los tendones del \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo semiespinoso de la cabeza ( Complexo Mayor)<\/a>\u00a0 en posici\u00f3n lateroposterior.. Antes\u00a0 de continuar su recorrido posteromedial y lateral a los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-multifido-cervical\" target=\"_self\" rel=\"noopener\">m\u00fasculos mult\u00edfido cervical<\/a>\u00a0,\u00a0 dan las ramas articulares en la cara posterolateral de los pilares articulares.\u00a0<em>\u00c9ste\u00a0 es el lugar de punci\u00f3n\u00a0 cl\u00e1sico por\u00a0 radioscopia\u00a0 y\u00a0 que corresponde\u00a0 a la visi\u00f3n\u00a0 ecogr\u00e1fica de &#8221; valle &#8221;\u00a0 en la\u00a0 exploraci\u00f3n\u00a0 longitudinal del\u00a0 eje\u00a0 cervical\u00a0\u00a0<\/em><\/li>\n<li><em>Este\u00a0 ramo\u00a0<\/em>\u00a0inerva los\u00a0\u00a0\u00a0m\u00fasculos\u00a0 y aponeurosis (\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-multifido-cervical\" target=\"_self\" rel=\"noopener\">m\u00fasculos mult\u00edfido cervical<\/a>\u00a0\u00a0 y\u00a0\u00a0el<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-erector-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculo erector de la\u00a0columna cervica<\/a>\u00a0)\u00a0\u00a0as\u00ed\u00a0 como las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">articulaciones interapofisarias o\u00a0 facetarias cervicales\u00a0<\/a>\u00a0.<\/li>\n<\/ul>\n<p><strong><em>2) un ramo lateral\u00a0<\/em><\/strong><\/p>\n<ul>\n<li>Inerva\u00a0 1)\u00a0 los m\u00fasculos del dorso de la cabeza y\u00a0 los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n posterior del cuello o m\u00fasculos de la nuca<\/a>\u00a0; 2 ) la\u00a0 piel comprendida\u00a0 entre el v\u00e9rtex y los\u00a0 hombros<\/li>\n<\/ul>\n<p><strong>Figura\u00a0 9 .\u00a0 Ramo posterior\u00a0 del\u00a0 nervio\u00a0 cervical\u00a0<\/strong>\u00a0.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/inervacion_faceta_cervical_corte_transversal.2.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li>Especificaciones :<\/li>\n<\/ul>\n<p>1.-\u00a0<strong>Rama posterior del primer nervio cervical: nervio suboccipital.<\/strong><\/p>\n<ul>\n<li>\u00a0El primer nervio dorsal espinal se denomina\u00a0<em>nervio suboccipital<\/em>. Es un nervio enteramente motr\u00edz. Nace del primer nervio cervical en el canal del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0. Sale\u00a0del conducto vertebral entre el occipital y el arco posterior del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>. e ingresa en el tri\u00e1ngulo de los\u00a0 oblicuos\u00a0 a los que inerva\u00a0\u00a0es\u00a0 \u00a0m\u00e1s grande que la rama\u00a0ventral\u00a0 debido al mayor tama\u00f1o y n\u00famero de sus raicillas<\/li>\n<\/ul>\n<p><strong>Figura\u00a0 10.\u00a0 Rama posterior\u00a0 del\u00a0 nervio\u00a0 Cervical C1\u00a0<\/strong><\/p>\n<p><strong><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/rama_posterior_C1.JPG\" alt=\"\" \/><\/strong><\/p>\n<ul>\n<li>El ganglio de la ra\u00edz dorsal\u00a0 de C1 puede\u00a0 estar ausente\u00a0 .<\/li>\n<li>\u00a0Inerva los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la nuca<\/a>:\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-posterior-menor\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto posterior menor<\/a>,\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-posterior-mayor\" target=\"_self\" rel=\"noopener\">M\u00fasculo recto posterior mayor.<\/a>\u00a0,\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-menor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo oblicuo menor de la cabeza<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo semiespinoso de la cabeza ( Complexo Mayor)<\/a><\/li>\n<li>Esta\u00a0 estructura\u00a0 nerviosa es la diana terap\u00e9utica\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-radicular-selectivo-cervical-o-bloqueo-sobre-el-ganglio-de-la-raiz-dorsal-de-c1\" target=\"_self\" rel=\"noopener\">Bloqueo radicular selectivo cervical o bloqueo sobre el ganglio de la ra\u00edz dorsal de C1<\/a><\/li>\n<\/ul>\n<p><strong>2.- Rama posterior del segundo nervio cervical\u00a0\u00a0o\u00a0nervio occipital mayor de Arnold\u00a0<\/strong><\/p>\n<ul>\n<li>Es una rama que\u00a0 emerge entre el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas o v\u00e9rtebre cervical CI<\/a>\u00a0y \u00a0el<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculo oblicuo inferior de la cabeza &#8211; tambi\u00e9n llamado\u00a0\u00a0m\u00fasculo \u00a0oblicuo \u00a0Mayor &#8211;\u00a0\u00a0<\/a>\u00a0 , perfora el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esplenio\" target=\"_self\" rel=\"noopener\">m\u00fasculo esplenio<\/a>\u00a0y la aponeurosis del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-trapecio\" target=\"_self\" rel=\"noopener\">m\u00fasculo trapecio<\/a><\/li>\n<\/ul>\n<p><strong>Figura\u00a011.\u00a0 Rama posterior\u00a0del\u00a0 nervio\u00a0Cervical C2 :\u00a0<\/strong>\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-nervio-occipital-mayor\" target=\"_self\" rel=\"noopener\">Nervio occipital mayor de Arnold,\u00a0C2 ,\u00a0<\/a>\u00a0(nervio conocido\u00a0con las \u00a0siglas \u00a0GON\u00a0 &#8211; greater occipital nerve &#8211;\u00a0<\/strong>)<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-nervio-occipital-mayor\" target=\"_self\" rel=\"noopener\">\u00a0)\u00a0<\/a><\/strong>.\u00a0 :\u00a0\u00a0 El\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-nervio-occipital-mayor\" target=\"_self\" rel=\"noopener\">nervio occipital mayor de Arnold,\u00a0C2\u00a0<\/a><\/strong>\u00a0es\u00a0la<em><strong>\u00a0rama posterior del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">segundo nervio\u00a0cervical<\/a><\/strong><\/em>.\u00a0<em><strong>Caracter\u00edstica :<\/strong><\/em>\u00a0Esta rama posterior\u00a0 es la m\u00e1s\u00a0 grande\u00a0\u00a0de los ramos posteriores y anteriores de los\u00a0<strong><em><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervios raqu\u00eddeos\u00a0 cervicales\u00a0<\/a><\/em><\/strong>\u00a0 \u00a0.<em><strong>Trayecto\u00a0 :\u00a0\u00a0<\/strong><\/em>\u00a0El nervio occipital mayor\u00a0\u00a0sale \u00a0entre el arco posterior del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0y el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0 y\u00a0 discurre\u00a0 \u00a0lateral a la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlanto-axial \u00a0lateral<\/a>, profunda al \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo oblicuo Mayor\u00a0 (inferior\u00a0) de la cabeza<\/a>\u00a0 \u00a0. Posteriormente\u00a0\u00a0\u00a0se curva sobre el \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo oblicuo Mayor\u00a0 (inferior\u00a0) de la cabeza<\/a>,\u00a0 y\u00a0 discurre\u00a0 entre\u00a0 este m\u00fasculo\u00a0 \u00a0y\u00a0 \u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo semiespinoso de la cabeza ( Complexo Mayor)<\/a>. Una rama del\u00a0\u00a0<em><strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">tercer nervio\u00a0cervical<\/a><\/strong><\/em>\u00a0C3 puede unirse en este punto,.\u00a0 Luego el nervio\u00a0 \u00a0asciende por el cuello \u00a0sobre la superficie dorsal del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-posterior-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto posterior mayor.<\/a>\u00a0 para perforar el \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo semiespinoso de la cabeza ( Complexo Mayor)<\/a>,\u00a0 \u00a0el\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esplenio\" target=\"_self\" rel=\"noopener\">m\u00fasculo esplenio de la cabeza\u00a0<\/a>\u00a0y la aponeurosis del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-trapecio\" target=\"_self\" rel=\"noopener\">m\u00fasculo trapecio<\/a>\u00a0e inervar la piel del occipucio, as\u00ed como parte de los<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">\u00a0m\u00fasculos de la nuca<\/a>\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#e3fafc18-220b-732d-30b1-2df5661bdeb7\" name=\"entry-e3fafc18-220b-732d-30b1-2df5661bdeb7\" data-bibliography-uid=\"e3fafc18-220b-732d-30b1-2df5661bdeb7\">7<\/a>.\u00a0\u00a0<em><strong>Anastomosis\u00a0 \u00a0con\u00a0 otras\u00a0 estructuras nerviosas :<\/strong><\/em>\u00a0\u00a0Durante su trayecto env\u00eda una rama ascendente que se anastomosa con la rama posterior del primer\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervio raqu\u00eddeo\u00a0\u00a0cervical\u00a0<\/a>\u00a0y\u00a0 una rama descendente que se anastomosa con una rama\u00a0 posterior ascendente del tercer\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervio raqu\u00eddeo\u00a0\u00a0cervical &#8211;\u00a0 tercer nervio occipital &#8211;\u00a0<\/a>. Se forman as\u00ed dos arcos nerviosos a los cuales se les ha dado el nombre de\u00a0<em>plexo cervical posterior de Cruveilhier<\/em>.\u00a0<strong><em>Ramos :\u00a0<\/em><\/strong>el nervio occipital mayor, adem\u00e1s de los ramos sensitivos, da ramas musculares para los \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo oblicuo Mayor\u00a0 (inferior\u00a0) de la cabeza<\/a>, el \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo semiespinoso de la cabeza ( Complexo Mayor)<\/a>\u00a0y \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-longisimo-de-la-cabeza-complexo-menor\" target=\"_self\" rel=\"noopener\">m\u00fasculo long\u00edsimo de la cabeza ( complexo menor )<\/a>,\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esplenio\" target=\"_self\" rel=\"noopener\">m\u00fasculo esplenio de la cabeza\u00a0<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-trapecio\" target=\"_self\" rel=\"noopener\">m\u00fasculo trapecio<\/a>\u00a0 .\u00a0 Por otra parte\u00a0\u00a0se han\u00a0 demostrado conexiones\u00a0 \u00a0con el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervio-occipital-menor-o-nervio-mastoideo\" target=\"_self\" rel=\"noopener\">nervio occipital menor<\/a>\u00a0 \u00a0.\u00a0\u00a0<em><strong>Importante\u00a0<\/strong><\/em>:\u00a0 1.-Su proximidad cercana con la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlanto-axial \u00a0lateral<\/a>\u00a0y el arco posterior lo hacen potencialmente vulnerable a irritaci\u00f3n o compresi\u00f3n;\u00a0 2.-Hay\u00a0una relaci\u00f3n variable entre el nervio occipital mayor y la arteria occipital en la cresta nucal\u00a0 &#8211;\u00a0\u00a0\u00a0esto puede contribuir a la falta de especificidad observada con inyecciones guiadas por puntos de referencia\u00a0 cuado\u00a0 se realiza un\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-del-nervio-occipital-mayor-en-la-linea-nucal-superior\" target=\"_self\" rel=\"noopener\">bloqueo del nervio occipital mayor en la l\u00ednea nucal superior\u00a0<\/a>\u00a0en la cresta nucal. Adem\u00e1s, existe una alta variabilidad en la distancia del este nervio\u00a0 desde la l\u00ednea media en la l\u00ednea intermastoidea, como lo demostraron Loukas et al. (1,5 a 7,5 cm)\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#99968867-1fde-8ac7-9b49-7d15c0292b45\" name=\"entry-99968867-1fde-8ac7-9b49-7d15c0292b45\" data-bibliography-uid=\"99968867-1fde-8ac7-9b49-7d15c0292b45\">8<\/a>y Becser et al. (de 0,5 a 3 cm)<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales#3277b62e-1bde-4a5c-2866-eaedcf31980f\" name=\"entry-3277b62e-1bde-4a5c-2866-eaedcf31980f\" data-bibliography-uid=\"3277b62e-1bde-4a5c-2866-eaedcf31980f\">9<\/a>\u00a0.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/n_occipital_mayor_bueno.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li>Esta\u00a0 \u00a0rama\u00a0 inerva ,adem\u00e1s de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la nuca<\/a>, la piel del occipucio, hasta la coronilla.<\/li>\n<li>Esta\u00a0 estructura\u00a0 nerviosa es la diana terap\u00e9utica\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-del-nervio-occipital-mayor-o-nervio-de-arnold-o-gon-block\" target=\"_self\" rel=\"noopener\">BLOQUEO DEL NERVIO OCCIPITAL MAYOR O NERVIO DE ARNOLD o GON BLOCK<\/a>)<\/li>\n<\/ul>\n<p><strong>3.- Rama posterior del tercero, cuarto quinto, sexto, s\u00e9ptimo y octavo nervios cervicales.<\/strong><\/p>\n<ul>\n<li><strong>\u00a0<\/strong>Las\u00a0<em>ramas posteriores de los seis \u00faltimos nervios cervicales<\/em>\u00a0se distribuyen, primero, por algunos\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la nuca<\/a>( ejm\u00a0 :\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-semiespinoso-de-la-cabeza-complexo-mayor\" target=\"_self\" rel=\"noopener\">M\u00fasculo semiespinoso de la cabeza ( Complexo Mayor)<\/a>, transverso espinoso, espinoso), y, despu\u00e9s, por la piel de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/regiones-del-cuello\" target=\"_self\" rel=\"noopener\">nuca.<\/a><\/li>\n<li>Especificaciones<\/li>\n<\/ul>\n<p><strong>Rama posterior del tercer\u00a0nervio\u00a0cervical\u00a0:\u00a0<\/strong>\u00a0tiene un territorio cut\u00e1neo estrecho, sobre el cr\u00e1neo, y en la nuca.\u00a0 \u00a0 Esta\u00a0 \u00a0 rama se \u00a0divide\u00a0en \u00a02 \u00a0ramas : \u00a0<em><strong>1) \u00a0una profunda<\/strong><\/em>\u00a0:\u00a0 inerva \u00a0parcialmente la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">\u00a0faceta cervical CIII-IV<\/a>\u00a0\u00a0; \u00a0y \u00a0<em><strong>2) \u00a0<\/strong><\/em>\u00a0<em><strong>una superficial<\/strong><\/em>\u00a0\u00a0 (\u00a0<em>e<strong>s el\u00a0 tercer nervio occipital<\/strong><\/em>\u00a0 ) : \u00a0es un ramo\u00a0 m\u00e1s largo\u00a0 que\u00a0 el anterior\u00a0. Este\u00a0 ramo\u00a0sigue\u00a0 \u00a0un\u00a0 trayecto\u00a0 diferente\u00a0 al\u00a0 \u00a0de otros\u00a0 ramos\u00a0 cervicales\u00a0 .\u00a0 En este\u00a0 caso\u00a0 \u00a0se\u00a0 curva lateralmente\u00a0 y posteriormente\u00a0 a la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">faceta cervical CII-III<\/a>\u00a0\u00a0que inerva .\u00a0 En su localizaci\u00f3n\u00a0 lateral\u00a0 y\u00a0 unos\u00a0 2 mm\u00a0 superficial\u00a0 a la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">faceta cervical CIII-IV<\/a>\u00a0 \u00a0se puede\u00a0 visualizar\u00a0 y\u00a0 realizar\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-del-tercer-nervio-occipital-o-ton-block\" target=\"_self\" rel=\"noopener\">bloqueo del tercer nervio occipital o TON BLOCK<\/a>\u00a0\u00a0.\u00a0\u00a0\u00a0Proporciona\u00a0 la inervaci\u00f3n\u00a0 a la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-faceta-cervical\" target=\"_self\" rel=\"noopener\">faceta cervical CII-III<\/a>\u00a0y la piel \u00a0de la nuca en la zona media\u00a0 .<\/p>\n<p><strong>Figura\u00a0 12.\u00a0 Rama posterior\u00a0 del\u00a0 nervio\u00a0 Cervical C3<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/TERCER_NERVIO_OCCIPITAL.JPG\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Rama posterior del cuerto y quinto nervio\u00a0cervical .\u00a0<\/strong>Tienen un territorio muy importante que ocupa la cara posterior del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>\u00a0y se extiende hasta el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-hombro\" target=\"_self\" rel=\"noopener\">hombro<\/a>, donde se encuentra con la rama subacromial del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical-superficial\" target=\"_self\" rel=\"noopener\">plexo cervical superficial<\/a>.\u00a0\u00a0Estas\u00a0 estructuras\u00a0 nerviosas son \u00a0la diana terap\u00e9utica\u00a0 a la hora\u00a0 de\u00a0 realizar\u00a0 \u00a0los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueos-de-los-ramos-mediales-del-ramo-posterior-de-los-nervios-cervicales-c4-c8\" target=\"_self\" rel=\"noopener\">bloqueos de los ramos mediales del ramo posterior de los nervios cervicales C4-C8<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0Rama posterior del 3 \u00faltimos nervios cervicales (sexto, s\u00e9ptimo y octavo nervio cervical )\u00a0 . S<\/strong>on peque\u00f1as y terminan en el\u00a0 semiespinoso de la cabeza, mult\u00edfidus re interespinoso.\u00a0 \u00a0Tambi\u00e9n inervan\u00a0\u00a0el iliocostocervical, el\u00a0 cervical transverso y\u00a0 el complexo menor.\u00a0Estas\u00a0 estructuras\u00a0 nerviosas son \u00a0la diana terap\u00e9utica\u00a0 a la hora\u00a0 de\u00a0 realizar\u00a0 \u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueos-de-los-ramos-mediales-del-ramo-posterior-de-los-nervios-cervicales-c4-c8\" target=\"_self\" rel=\"noopener\">bloqueos de los ramos mediales del ramo posterior de los nervios cervicales C4-C8<\/a><\/p>\n<h3>Exploraci\u00f3n de los nervios cervicales<\/h3>\n<p>V\u00eddeo\u00a0 :\u00a0<a class=\"external-link\" href=\"https:\/\/www.youtube.com\/watch?v=esEWwFq940g\" target=\"_blank\" rel=\"noopener\" data-externallink-href=\"https:\/\/www.youtube.com\/watch?v=esEWwFq940g\">Evaluaci\u00f3n cl\u00ednica de los nervios raqu\u00eddeos cervicales &#8211; Dr Nail Ebraheim<\/a><\/p>\n<p><strong>Tabla 1.\u00a0 Inervaci\u00f3n\u00a0 de los\u00a0ramos anteriores (ventrales) \u00a0de los nervios cervicales\u00a0en\u00a0 la extremidad superior,\u00a0 con los principales m\u00fasculos inervados y los reflejos caracter\u00edsticos<\/strong><\/p>\n<p><img decoding=\"async\" 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\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\" alt=\"\" \/><\/p>\n<p><strong>Tabla 2. Movilidad articular dependiente de los\u00a0ramos anteriores (ventrales)\u00a0 de los nervios cervicales\u00a0en\u00a0 la extremidad superior<\/strong><\/p>\n<p><img decoding=\"async\" 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\" alt=\"\" \/><\/p>\n<h3>T\u00e9cnicas de imagen para\u00a0 la visualizaci\u00f3n de los nervios cervicales<\/h3>\n<ul>\n<li><strong>Radioscopia\u00a0<\/strong>\u00a0:\u00a0 Ver\u00a0 en\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/radiografia-convencional-para-el-estudio-del-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">RADIOGRAF\u00cdA CONVENCIONAL PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<\/a>\u00a0 la\u00a0 radiograf\u00eda en proyecci\u00f3n oblicua<\/li>\n<li><strong>Ecograf\u00eda\u00a0 de los nervios cervicales<\/strong>\u00a0:\u00a0 \u00a0 Ver\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/imagenes-ecograficas-de-las-raices-espinales-cervicales\" target=\"_self\" rel=\"noopener\">Im\u00e1genes ecogr\u00e1ficas de las ra\u00edces espinales cervicales<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>Reciben inervaci\u00f3n\u00a0 de la\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">rama anterior\u00a0 de nervios raqu\u00eddeos cervicales C1 y\u00a0 C2\u00a0\u00a0<\/a>\u00a0.\u00a0Por ello,\u00a0si se quiere\u00a0 actuar\u00a0 sobre\u00a0 estas\u00a0 articulaciones\u00a0se\u00a0 debe\u00a0 de\u00a0 actuar\u00a0 de forma intraarticular-\u00a0 ver\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-atlanto-occipital-y-atlanto-axial\" target=\"_self\" rel=\"noopener\">bloqueo atlanto-occipital y atlanto-axial<\/a>\u00a0&#8211;\u00a0<ins>\u00a0\u00a02)\u00a0 \u00a0 La articulaci\u00f3n CII-CIII<\/ins>\u00a0est\u00e1 inervada por el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-del-tercer-nervio-occipital-o-ton-block\" target=\"_self\" rel=\"noopener\">tercer nervio occipital (TNO<\/a>\u00a0y,\u00a0 en menor medida , de una\u00a0 de las ramas mediales de C2 . Por ello,\u00a0 si\u00a0 quiere\u00a0 actuar\u00a0 sobre\u00a0 esta\u00a0 articulaci\u00f3n\u00a0 se\u00a0 debe\u00a0 de realizar\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-del-tercer-nervio-occipital-o-ton-block\" target=\"_self\" rel=\"noopener\">Bloqueo del tercer nervio occipital o TON BLOCK<\/a>\u00a0 o\u00a0 un\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-de-la-articulacion-cii-ciii\" target=\"_self\" rel=\"noopener\">bloqueo\u00a0 de la\u00a0 artiulaci\u00f3n\u00a0 C2-C3\u00a0<\/a>\u00a0 ;\u00a0\u00a0<ins>3)\u00a0 Las\u00a0 articulaciones\u00a0 de\u00a0 CIII- CIV\u00a0 a\u00a0 CVII-TI\u00a0:<\/ins>\u00a0\u00a0est\u00e1n inervadas por la rama medial del ramo posterior\u00a0\u00a0de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">\u00a0nervios raqu\u00eddeos cervicales<\/a>\u00a0de su nivel\u00a0 y\u00a0 del inmediatamente superior\u00a0\u00a0(Ejm\u00a0 :\u00a0 CIII- CIV\u00a0:\u00a0 inervada por\u00a0 C4\u00a0 y\u00a0 C3 )<\/p>\n<div><strong>\u00a0\u00a0<\/strong>Cada articulaci\u00f3n cigoapofisaria\u00a0est\u00e1 inervada por\u00a0<strong><em>los\u00a0ramos\u00a0 articulares\u00a0 que surgen\u00a0 de\u00a0ramas mediales\u00a0de los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios raqu\u00eddeos cervicales<\/a><\/em><\/strong>\u00a0por encima y por debajo de la\u00a0articulaci\u00f3n cigoapofisaria cervical\u00a0\u00a0, excepto CII-CIII, que est\u00e1 inervada principalmente por el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-del-tercer-nervio-occipital-o-ton-block\" target=\"_self\" rel=\"noopener\">tercer nervio occipital\u00a0<\/a><\/div>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/inervacion_faceta_cervical.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>Para\u00a0su\u00a0estudio\u00a0existen\u00a0diversas\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/exploraciones-complementarias-para-el-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">EXPLORACIONES COMPLEMENTARIAS PARA EL DOLOR EN EL CUELLO<\/a>\u00a0 \u00a0como la\u00a0\u00a0radiograf\u00eda convencional\u00a0 ,\u00a0\u00a0la\u00a0\u00a0ecograf\u00eda\u00a0\u00a0y la\u00a0resonancia magn\u00e9tica nuclear<\/p>\n<p>Las\u00a0<strong>facetas cervicales<em>\u00a0<\/em><\/strong>son\u00a0la diana sobre la que se realizan\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">\u00a0t\u00e9cnicas intervencionistas para el tratamiento del dolor<\/a>\u00a0 \u00a0 como\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-de-las-facetas-cervicales\" target=\"_self\" rel=\"noopener\">bloqueo de las facetas cervicales\u00a0<\/a>\u00a0 y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/radiofrecuencia-de-las-facetas-cervicales\" target=\"_self\" rel=\"noopener\">\u00a0radiofrecuencia de las facetas cervicales<\/a><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<p>inervada\u00a0 \u00a0por\u00a0 el\u00a0 \u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">tercer nervio occipital (TNO)<\/a>.y,\u00a0 en menor medida ,\u00a0 \u00a0por\u00a0las ramas mediales del\u00a0 \u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervio\u00a0 espinal\u00a0 cervial\u00a0 C2\u00a0<\/a>. \u00a0&#8211;\u00a0\u00a0 \u00a0son\u00a0 fuente\u00a0 com\u00fan\u00a0\u00a0 del\u00a0 que\u00a0 se ha\u00a0 dado en llamar\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/cefalea-cervicogenica\" target=\"_self\" rel=\"noopener\">cefalea\u00a0 cervicog\u00e9nica\u00a0\u00a0<\/a>\u00a0&#8211; ,\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-cervical\" target=\"_self\" rel=\"noopener\">\u00a0dolor de cuello<\/a>\u00a0y disminuci\u00f3n del rango de movimiento o sensaci\u00f3n alterada por la compresi\u00f3n del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">ganglio de la ra\u00edz dorsal C2<\/a>\u00a0\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#f180dace-09d6-2105-846d-60d6fdfdbae2\" name=\"entry-f180dace-09d6-2105-846d-60d6fdfdbae2\" data-bibliography-uid=\"f180dace-09d6-2105-846d-60d6fdfdbae2\">1<\/a><\/p>\n<p>Para el alivio\u00a0del\u00a0dolor\u00a0secundario\u00a0 a esta articulaci\u00f3n\u00a0 se han propuesto\u00a0diversas\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">t\u00e9cnicas\u00a0inrvencionistas para el tratamiento del dolor\u00a0<\/a>\u00a0\u00a0debido\u00a0 a que el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-farmacologico-del-dolor\" target=\"_self\" rel=\"noopener\">tratamiento\u00a0 farmacol\u00f3gico\u00a0 del dolor\u00a0<\/a>\u00a0 \u00a0y las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medidas-fisico-rehabilitadoras-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">medidas f\u00edsicorehabilitadoras para el tratamiento del dolor\u00a0<\/a>\u00a0son a menudo\u00a0 no\u00a0 efectivas y , por otra parte , la\u00a0 cirug\u00eda\u00a0 puede entra\u00f1ar\u00a0 grandes complicaciones\u00a0 .\u00a0 De\u00a0 ente\u00a0 ellas\u00a0 cabe\u00a0 rese\u00f1ar :<\/p>\n<p>1.- La\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/infiltracion-atlanto-axial-1\" target=\"_self\" rel=\"noopener\">Infiltraci\u00f3n atlanto-axial<\/a>\u00a0:\u00a0Hay\u00a0 bibliograf\u00eda\u00a0que\u00a0 afirma que la inyecciones de esteroides intraarticulares en las\u00a0 AA laterales alivian el dolor\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#8764821b-0154-ebcb-b8dd-cdde5060e8de\" name=\"entry-8764821b-0154-ebcb-b8dd-cdde5060e8de\" data-bibliography-uid=\"8764821b-0154-ebcb-b8dd-cdde5060e8de\">2<\/a>\u00a0,\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#79765979-0048-b01f-ab41-cbeefa5f6bf4\" name=\"entry-79765979-0048-b01f-ab41-cbeefa5f6bf4\" data-bibliography-uid=\"79765979-0048-b01f-ab41-cbeefa5f6bf4\">3<\/a>,\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#e0e48d81-d948-fea5-e4f4-f55ac9a4d5bb\" name=\"entry-e0e48d81-d948-fea5-e4f4-f55ac9a4d5bb\" data-bibliography-uid=\"e0e48d81-d948-fea5-e4f4-f55ac9a4d5bb\">4<\/a>. ,\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#d82ea389-e3ee-b848-4665-2284297cee13\" name=\"entry-d82ea389-e3ee-b848-4665-2284297cee13\" data-bibliography-uid=\"d82ea389-e3ee-b848-4665-2284297cee13\">5<\/a>. Desafortunadamente, \u00a0se\u00a0 considera\u00a0 \u00a0una\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/infiltraciones-articulares-en-el-cuello\" target=\"_self\" rel=\"noopener\">INFILTRACION\u00a0ARTICULAR\u00a0EN EL CUELLO<\/a>\u00a0con un beneficio-riesgo no muy claro\u00a0debido\u00a0al\u00a0potencial riesgo de complicaciones\u00a0debido a la proximidad del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/conducto-vertebral-y-contenido-del-conducto-vertebral\" target=\"_self\" rel=\"noopener\">saco dural\u00a0<\/a>, la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>,\u00a0\u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">arteria vertebral\u00a0<\/a>\u00a0y\u00a0 los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">ganglios dorsales de los nervios raqu\u00eddeos cervicales<\/a>\u00a0 , agravado\u00a0 a\u00fan m\u00e1s por la variabilidad fisiol\u00f3gica en la ubicaci\u00f3n y simetr\u00eda de las estructuras que rodean la articulaci\u00f3n\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#def780e2-a238-a137-58a9-d15672d1639b\" name=\"entry-def780e2-a238-a137-58a9-d15672d1639b\" data-bibliography-uid=\"def780e2-a238-a137-58a9-d15672d1639b\">6<\/a>. Como ejemplo\u00a0 , se ha\u00a0informado\u00a0 de\u00a0 complicaciones como el\u00a0\u00a0infarto de la m\u00e9dula espinal y accidente cerebrovascular en la circulaci\u00f3n posterior.<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#2e6c6bb9-f0fb-fc1e-728e-97e432560b69\" name=\"entry-2e6c6bb9-f0fb-fc1e-728e-97e432560b69\" data-bibliography-uid=\"2e6c6bb9-f0fb-fc1e-728e-97e432560b69\">7<\/a>\u00a0 \u00a0Es por ello\u00a0 que\u00a0 hay\u00a0 autores\u00a0 que\u00a0 recomiendan\u00a0 su no\u00a0 realizaci\u00f3n\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#b54d75cc-0cd6-f06f-610b-db86ab4c8c95\" name=\"entry-b54d75cc-0cd6-f06f-610b-db86ab4c8c95\" data-bibliography-uid=\"b54d75cc-0cd6-f06f-610b-db86ab4c8c95\">8<\/a>\u00a0 \u00a0. Lo\u00a0 que\u00a0 s\u00ed\u00a0 es\u00a0\u00a0muy\u00a0 recomendable\u00a0 \u00a0es\u00a0 evaluar\u00a0 \u00a0con t\u00e9cnicas de imagen\u00a0 \u00a0 la\u00a0 zona\u00a0 a\u00a0 pinchar preprocedimiento\u00a0\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#750fdd5c-b9e1-46d7-7a35-96f16be32c42\" name=\"entry-750fdd5c-b9e1-46d7-7a35-96f16be32c42\" data-bibliography-uid=\"750fdd5c-b9e1-46d7-7a35-96f16be32c42\">9<\/a><\/p>\n<p>2.-La\u00a0 realizaci\u00f3n\u00a0 de\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-radiculares-selectivos-de-las-raices-cervicales\" target=\"_self\" rel=\"noopener\">bloqueos\u00a0 radiculares\u00a0 selectivos\u00a0 de\u00a0 ra\u00edces\u00a0 cervicales\u00a0\u00a0<\/a>\u00a0 \u00a0(\u00a0\u00a0los\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios raqu\u00eddeos cervicales<\/a>\u00a0C1 , C2 y C3\u00a0 )<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#de363f1b-a3cf-2b57-450c-fcbe140714be\" name=\"entry-de363f1b-a3cf-2b57-450c-fcbe140714be\" data-bibliography-uid=\"de363f1b-a3cf-2b57-450c-fcbe140714be\">10<\/a>\u00a0,\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#1bcdec7a-c97c-2537-a9b3-34f98112367e\" name=\"entry-1bcdec7a-c97c-2537-a9b3-34f98112367e\" data-bibliography-uid=\"1bcdec7a-c97c-2537-a9b3-34f98112367e\">11<\/a><\/p>\n<p>&nbsp;<\/p>\n<h2 id=\"acItem_content\">Contenido del art\u00edculo<\/h2>\n<div class=\"editor-field\">\n<p>Es una\u00a0 articulaci\u00f3n\u00a0 formada\u00a0 entre\u00a0\u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a><\/p>\n<p>Es una\u00a0 articulaci\u00f3n \u00fanica\u00a0 por la presencia del\u00a0proceso\u00a0odontoide del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0( v\u00e9rtebra cervical\u00a0CII )\u00a0 ,\u00a0 que permite\u00a0 a la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0 (\u00a0 v\u00e9rtebra cervical CI )\u00a0\u00a0 rotar sobre \u00e9l\u00a0\u00a0mismo<\/p>\n<p><strong>Figura 1.Articulaci\u00f3n atlantoaxial\u00a0\u00a0<\/strong>.\u00a0\u00a0En su conjunto, la articulaci\u00f3n atlantoaxial presenta 3 ejes de movimiento con tres grados de libertad, aunque destaca su amplio rango de moci\u00f3n rotacional.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/rotacion_articulac_AA.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Esta\u00a0 articulaci\u00f3n\u00a0\u00a0 consta en realidad\u00a0 de\u00a0 3 articulaciones\u00a0 :<\/p>\n<p><strong><em>1) Dos\u00a0articulaci\u00f3nes atlantoaxiales laterales\u00a0<\/em><\/strong>(AA laterales)\u00a0 \u00a0(\u00a0 que\u00a0 contienen\u00a0 un menisco\u00a0 )\u00a0 :<\/p>\n<ul>\n<li>Forrmadas por las caras articulares inferiores de las masas laterales del atlas (convexas) que articulan bilateralmente con las caras articulares superiores del axis (convexas).<\/li>\n<li>Son articulaciones\u00a0 sinoviales planas\u00a0 tipo\u00a0 artrodia\u00a0(superficies opuestas, caras relativamente planas, aunque ligeramente convexas).<\/li>\n<\/ul>\n<p><strong><em>2) una\u00a0 articulaci\u00f3n central\u00a0 (atlantoaxial media o atlantoaxoidea media)\u00a0<\/em><\/strong><\/p>\n<ul>\n<li>Formada por la cara articular anterior del diente del axis (convexa) y la fosita del diente del atlas (c\u00f3ncava); y por la cara articular posterior del diente (c\u00f3ncava de arriba abajo y convexa transversalmente) y el ligamento transverso del atlas (arquea a trav\u00e9s del aro del atlas y mantiene el diente en contacto con la fosita del diente). Una cavidad articular y una c\u00e1psula sinovial pone en contacto el diente y la fosita. Entre el diente y el ligamento transverso no se encuentra c\u00e1psula sinovial sino tejido celuloadiposo.<\/li>\n<li>La articulaci\u00f3n atlantoaxial media se clasifica como diartrosis sinovial de tipo trocoide (de pivote). Es la que permite un gran rango de rotaci\u00f3n entre C1 y C2.<\/li>\n<\/ul>\n<p>El movimiento de las\u00a0 3 articulaciones atlantoaxoideas\u00a0 permiten\u00a0 girar la cabeza de lado a lado\u00a0\u00a0 &#8211; como cuando movemos la\u00a0 cabeza para hacer el\u00a0 movimiento\u00a0 de\u00a0 decir\u00a0 ? No\u00a0 ?\u00a0 . Durante\u00a0\u00a0 este movimiento\u00a0 , el\u00a0\u00a0 cr\u00e1neo y\u00a0 la v\u00e9rtebra CI\u00a0\u00a0 rotan\u00a0 en\u00a0\u00a0 C II\u00a0 como si fueran uno solo\u00a0 .\u00a0\u00a0 La ap\u00f3fisis\u00a0\u00a0odontoides de CII\u00a0 es e\u00a0 eje\u00a0 o pivote que se mantiene dentro\u00a0 de la\u00a0 cavidad o\u00a0 collar\u00a0 formado por\u00a0\u00a0 delante por\u00a0 el arco\u00a0 anterior\u00a0 del\u00a0 atlas\u00a0\u00a0 y por\u00a0 detr\u00e1s por el ligamento\u00a0\u00a0\u00a0 transverso\u00a0 del\u00a0 atlas<\/p>\n<p>&nbsp;<\/p>\n<p>Esta\u00a0 aticulaci\u00f3n\u00a0 :<\/p>\n<p>1) Est\u00e1\u00a0inervada\u00a0por los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios raqu\u00eddeos cervicales C1 Y C2<\/a>\u00a0\u00a0(\u00a0Es importante\u00a0 recordar\u00a0que ni\u00a0 el\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0ni\u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0 tienen\u00a0 un foramen\u00a0 intervertebral\u00a0\u00a0 para el paso\u00a0\u00a0 los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervios raqu\u00eddeos cervicales C1 Y C2<\/a>\u00a0)<\/p>\n<p><strong>Figura 2.\u00a0Rama\u00a0anterior\u00a0del\u00a0nervio\u00a0cervical\u00a0C2<\/strong>. El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">nervio\u00a0raqu\u00eddeo\u00a0cervical\u00a0C2<\/a><strong>\u00a0<\/strong>sale\u00a0por encima\u00a0 de\u00a0\u00a0la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical\u00a0CII ( axis )\u00a0<\/a>. Su\u00a0\u00a0<strong>rama anterior<\/strong>\u00a0es uno\u00a0 \u00a0de los\u00a0 componentes\u00a0 del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervical\u00a0\u00a0<\/a>\u00a0 .<strong><em>\u00a0Trayecto:\u00a0<\/em><\/strong>\u00a0La rama ventral corre horizontal y lateralmente\u00a0&#8220;adherida&#8221; a\u00a0la c\u00e1psula del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial lateral\u00a0<\/a>\u00a0 por la fascia\u00a0 de inversi\u00f3n\u00a0 . Lateralmente\u00a0 llega a la\u00a0 altura\u00a0 de la arteria vertebral y, sostenida cerca de ella por\u00a0 ila fascia de inversi\u00f3n , se dobla aproximadamente 90 grados anteriormente\u00a0 para\u00a0 \u00a0 unirse al \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervica .\u00a0<\/a>Esta rama es uno\u00a0 de los\u00a0 componentes\u00a0 \u00a0del\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-cervical\" target=\"_self\" rel=\"noopener\">plexo cervical\u00a0\u00a0<\/a>, contribuye a la inervaci\u00f3n de los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-anterior-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n anterior del cuello<\/a>\u00a0 .\u00a0 \u00a0Tambi\u00e9n\u00a0 \u00a0,\u00a0 \u00a0junto\u00a0 a los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">\u00a0nervios raqu\u00eddeos cervicales<\/a>\u00a0C1 y C3\u00a0 inerva\u00a0la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial<\/a>\u00a0medial y sus ligamentos y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/duramadre-espinal\" target=\"_self\" rel=\"noopener\">duramadre<\/a>\u00a0\u00a0que protege\u00a0 \u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal cervical superior<\/a>. Las ramas sinuvertebrales C1, C2 y C3 inervan la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/duramadre-espinal\" target=\"_self\" rel=\"noopener\">duramadre<\/a>\u00a0sobre el clivus en la fosa craneal posterior\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#155dc5ff-1752-34e6-6d97-347ae728ed28\" name=\"entry-155dc5ff-1752-34e6-6d97-347ae728ed28\" data-bibliography-uid=\"155dc5ff-1752-34e6-6d97-347ae728ed28\">12<\/a>\u00a0 \u00a0.\u00a0 \u00a0Es importante\u00a0 rese\u00f1ar\u00a0 \u00a0que \u00a0El nervio\u00a0 \u00a0est\u00e1\u00a0rodeado\u00a0de una fascia\u00a0 de inversi\u00f3n\u00a0\u00a0y un denso plexo de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/drenaje-venoso-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">venas<\/a>\u00a0que comunican\u00a0el plexo epidural y las venas\u00a0vertebrales .\u00a0 Esta\u00a0 fascia\u00a0 de\u00a0 inversi\u00f3n\u00a0 se continua medialmente\u00a0 con la membrana posterior atlanto-axial, lateralmente con la fascia que rodea la<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/irrigacion-arterial-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">\u00a0arteria vertebral<\/a>,\u00a0 ventralmente con la c\u00e1psula de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n atlantoaxial lateral\u00a0<\/a>, y dorsalmente est\u00e1 cubierto por el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-oblicuo-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0 oblicuo mayor\u00a0 de la cabeza<\/a><a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#be619a32-4a51-2736-7f37-36efd1942a5b\" name=\"entry-be619a32-4a51-2736-7f37-36efd1942a5b\" data-bibliography-uid=\"be619a32-4a51-2736-7f37-36efd1942a5b\">13<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/RAMA_ANTERIOR_C2_BUENA.JPG\" alt=\"\" \/><\/p>\n<p>2)\u00a0 No\u00a0 hay\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">discos intervertebrales\u00a0<\/a>\u00a0\u00a0entre el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas<\/a>\u00a0 (\u00a0 v\u00e9rtebra cervical CI )\u00a0 y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">axis<\/a>\u00a0( v\u00e9rtebra cervical\u00a0CII ).<\/p>\n<p>3)\u00a0 Se relaciona\u00a0con la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">\u00a0arteria vertebral\u00a0<\/a>:<\/p>\n<p><strong>Figura 3\u00a0. Localizaci\u00f3n de la\u00a0<\/strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">\u00a0arteria vertebral\u00a0<\/a><strong>\u00a0en su porci\u00f3n<\/strong><em><strong>\u00a0<\/strong><\/em><strong>suboccipital (atloidea)\u00a0\u00a0<\/strong>( modificado de<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial#e9a7b315-5443-a600-3590-3218df3a3ab0\" name=\"entry-e9a7b315-5443-a600-3590-3218df3a3ab0\" data-bibliography-uid=\"e9a7b315-5443-a600-3590-3218df3a3ab0\">14<\/a>\u00a0 )\u00a0<strong>.\u00a0<\/strong>Normalmente\u00a0la\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/arterias-vertebrales\" target=\"_self\" rel=\"noopener\">\u00a0arteria vertebral\u00a0<\/a>\u00a0 est\u00e1 localizada\u00a0en la cara posterior\u00a0y el\u00a0tercio lateral\u00a0 de la\u00a0\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-atlantoaxial\" target=\"_self\" rel=\"noopener\">articulaci\u00f3n\u00a0atlantoaxial<\/a><\/strong>\u00a0 &#8211; hay multiples variantes\u00a0 anat\u00f3micas\u00a0 &#8211;\u00a0\u00a0\u00a0\u00a0 y\u00a0\u00a0 se\u00a0 encuentra medial\u00a0 a las\u00a0\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-atlantooccipitales-1\" target=\"_self\" rel=\"noopener\">articulaciones atlantooccipitales<\/a><\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/arteria_vertebral_C1_C2.JPG\" alt=\"\" \/><\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>M\u00fasculos de la regi\u00f3n anterior del cuello<\/h1>\n<\/div>\n<div class=\"col-md-3\"><a class=\"popupLauncher btn btn-big btn-primary pull-right visible-lg visible-md\" href=\"https:\/\/dolopedia.com\/login\">\u00a0Solicitar nuevo art\u00edculo<\/a><\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>Una\u00a0 forma\u00a0 de clasificar\u00a0 los\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-del-cuello\" target=\"_self\" rel=\"noopener\">M\u00daSCULOS DEL CUELLO<\/a>\u00a0 \u00a0es\u00a0 tener\u00a0 en cuenta\u00a0\u00a0su posici\u00f3n\u00a0 \u00a0con\u00a0 respecto\u00a0 a los\u00a0 cuerpos vertebrales\u00a0 de las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales<\/a>\u00a0 . En funci\u00f3n\u00a0 de\u00a0 este criterio los m\u00fasculos\u00a0del cuello\u00a0\u00a0se\u00a0 clasifican en\u00a0 \u00a0<strong>m\u00fasculos\u00a0 de la\u00a0 regi\u00f3n anterior del cuello<\/strong>\u00a0 \u00a0y\u00a0 \u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n posterior del cuello o m\u00fasculos de la nuca<\/a><\/strong><\/p>\n<p>Este\u00a0 apartado\u00a0 se\u00a0 centra\u00a0 en el\u00a0 \u00a0estudio\u00a0 de los\u00a0<strong>M\u00daSCULOS\u00a0 DE LA\u00a0 REGI\u00d3N\u00a0 ANTERIOR\u00a0 DEL\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">\u00a0CUELLO<\/a><\/strong>\u00a0,\u00a0es\u00a0decir , los\u00a0\u00a0<ins>m\u00fasculos que\u00a0 se encuentran por delante de los\u00a0\u00a0cuerpos vertebrales\u00a0 de las\u00a0\u00a0<\/ins><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales .<\/a><\/p>\n<p><strong>Figura 1.\u00a0\u00a0M\u00fasculos de la regi\u00f3n anterior del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">\u00a0cuello<\/a>\u00a0(\u00a0 modificado\u00a0 de\u00a0\u00a0<\/strong>\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-anterior-del-cuello#68f5c540-99d3-5c5d-a6b9-c03b101e3a50\" name=\"entry-68f5c540-99d3-5c5d-a6b9-c03b101e3a50\" data-bibliography-uid=\"68f5c540-99d3-5c5d-a6b9-c03b101e3a50\">1<\/a>\u00a0)\u00a0<em><strong>Vista anteror<\/strong><\/em>\u00a0.\u00a0\u00a0Los m\u00fasculos prevertebrales\u00a0 (\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-muscular-profundo-medio-de-los-musculos-del-cuello\" target=\"_self\" rel=\"noopener\">grupo muscular profundo medio de los m\u00fasculos del cuello\u00a0<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-muscular-profundo-lateral-de-los-musculos-del-cuello\" target=\"_self\" rel=\"noopener\">grupo muscular profundo lateral de los m\u00fasculos del cuello<\/a>\u00a0 ) se encuentran a ambos lados de los cuerpos vertebrales de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna cervical<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">\u00a0columna tor\u00e1cica<\/a>\u00a0y est\u00e1n cubiertos por la l<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/fascia-cervical-profunda\" target=\"_self\" rel=\"noopener\">\u00e1mina prevertebral\u00a0de la fascia cervical<\/a>. Las partes anterolaterales del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">atlas (CI<\/a>\u00a0y el eje est\u00e1n unidas a trav\u00e9s del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-anterior-menor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto anterior menor de la cabeza<\/a>.\u00a0 Los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculos escalenos<\/a>\u00a0se insertan en las primeras<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">\u00a0costillas<\/a>\u00a0y forman una placa muscular de forma triangular en la regi\u00f3n lateral de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna cervical<\/a>. El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno\u00a0anterior<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno medio<\/a>, junto con el borde superior de la primera\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>\u00a0forman el hiato escaleno, a trav\u00e9s del cual pasan la A. subclavia y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-del-plexo-braquial\" target=\"_self\" rel=\"noopener\">plexo\u00a0braquial<\/a>\u00a0(no mostrado).\u00a0 Algunos autores distinguen entre un hiato escaleno anterior y uno posterior. El hiato escaleno anterior representa el curso de V. subclavia frente al\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno\u00a0anterior<\/a>\u00a0a trav\u00e9s de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>, mientras que el hiato escaleno posterior representa el paso de A. subclavia y Plexus braquial que discurren entre el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno anterior<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno medio<\/a>\u00a0sobre la primera\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>. Dado que el llamado hiato escaleno &#8220;anterior&#8221; no es una brecha real, s\u00f3lo se debe hacer referencia al espacio entre el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno anterior<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculo\u00a0escaleno medio<\/a>, como hiato escaleno.\u00a0<em><strong>Vista lateral.\u00a0<\/strong><\/em>\u00a0Se eliminaron todas las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/fascias-del-cuello\" target=\"_self\" rel=\"noopener\">fascias musculares<\/a>, el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-platisma-o-musculo-cutaneo-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculo platisma<\/a>\u00a0y la porci\u00f3n media de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternocleidomastoideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo esternocleidomastoideo<\/a>. De anterior a posterior se pueden ver las siguientes estructuras: los \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-infrahioideos\" target=\"_self\" rel=\"noopener\">m\u00fasculos infrahioideos<\/a>(\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternocleidohioideo\" target=\"_self\" rel=\"noopener\">M\u00fasculo esternocleidohioideo<\/a>,\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-omohioideo\" target=\"_self\" rel=\"noopener\">M\u00fasculo omohioideo<\/a>\u00a0-vientre\u00a0superior; el vientre inferior corre por encima de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/clavicula\" target=\"_self\" rel=\"noopener\">clav\u00edcula<\/a>\u00a0en el tri\u00e1ngulo lateral del cuello- ,\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-tirohioideo\" target=\"_self\" rel=\"noopener\">M\u00fasculo tirohioideo<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternotiroideo\" target=\"_self\" rel=\"noopener\">M\u00fasculo esternotiroideo<\/a>, )\u00a0 partes de los m\u00fasculos far\u00edngeos (m\u00fasculo constrictor inferior de la faringe) , los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">M\u00fasculos escalenos<\/a>, .\u00a0 \u00a0Asimismo\u00a0 ,\u00a0 son\u00a0 visibles\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">M\u00fasculos de la regi\u00f3n posterior del cuello o m\u00fasculos de la nuca<\/a>\u00a0como\u00a0 el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-elevador-de-la-escapula-1\" target=\"_self\" rel=\"noopener\">M\u00fasculo elevador de la esc\u00e1pula<\/a>\u00a0, el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esplenio\" target=\"_self\" rel=\"noopener\">M\u00fasculo esplenio de la cabeza\u00a0<\/a>\u00a0y\u00a0\u00a0el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculo-trapecio\" target=\"_self\" rel=\"noopener\">M\u00fasculo trapecio<\/a>\u00a0. Por encima del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/hueso-hioides\" target=\"_self\" rel=\"noopener\">hueso hioides<\/a>, se pueden ver tres\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-suprahioideos\" target=\"_self\" rel=\"noopener\">m\u00fasculos suprahioideos<\/a>\u00a0(<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-digastrico\" target=\"_self\" rel=\"noopener\">M\u00fasculo dig\u00e1strico<\/a>\u00a0con su vientre anterior y vientre\u00a0posterior, el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-milohioideo\" target=\"_self\" rel=\"noopener\">M\u00fasculo milohioideo<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-estilohioideo\" target=\"_self\" rel=\"noopener\">M\u00fasculo estilohioideo<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/musculos_region_anterior_cuello.JPG\" alt=\"\" \/><\/p>\n<p><strong>Figura\u00a0 2.\u00a0 Corte\u00a0 transversal\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>\u00a0 a la\u00a0 altura\u00a0 del\u00a0 cuerpo de\u00a0 la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical CVI<\/a>\u00a0\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/musculos_cuello_anterior_CVI.JPG\" alt=\"\" \/><\/p>\n<p><strong>Figura 3.\u00a0 Corte\u00a0transversal\u00a0del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>\u00a0a la\u00a0altura\u00a0del\u00a0 cuerpo de\u00a0 la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0cervical C IV<\/a>\u00a0\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/corte_CIV_plexo_cervical.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>Estos\u00a0m\u00fasculos son\u00a0 muy potentes y su funci\u00f3n es literalmente mantener la cabeza unida al\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">\u00a0CUELLO<\/a>\u00a0. Adem\u00e1s, permiten los movimientos de flexoextensi\u00f3n de la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna\u00a0 cervical\u00a0<\/a>l (inclinar la cabeza hacia adelante y hacia atr\u00e1s), inclinaci\u00f3n lateral y rotaci\u00f3n. Tambi\u00e9n\u00a0 es\u00a0 rese\u00f1able\u00a0 que\u00a0\u00a0a veces funcionan como m\u00fasculos accesorios de la respiraci\u00f3n, como el caso de los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculos escalenos<\/a>\u00a0cuando toman su punto fijo en las \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales<\/a>\u00a0y su punto m\u00f3vil en su inserci\u00f3n costal.<\/p>\n<p>Los m\u00fasculos de la regi\u00f3n anterior se dividen en varios subgrupos seg\u00fan su ubicaci\u00f3n y profundidad. Desde la profundidad a la superficie\u00a0 son\u00a0 \u00a0:<\/p>\n<p><strong>\u00a01.-<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-muscular-profundo-medio-de-los-musculos-del-cuello\" target=\"_self\" rel=\"noopener\">Grupo muscular profundo medio de los m\u00fasculos del cuello<\/a><\/strong><strong>\u00a0<\/strong>(en relaci\u00f3n directa con los cuerpos vertebrales).\u00a0 Son los m\u00fasculos m\u00e1s profundos del cuello y guardan relaci\u00f3n directa con los cuerpos vertebrales de las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales\u00a0<\/a>, apoy\u00e1ndose sobre su cara anterior. Son m\u00fasculos\u00a0 prevertebrales .\u00a0 Por delante de estos discurren de atr\u00e1s hacia adelante el es\u00f3fago y la tr\u00e1quea, adem\u00e1s de los grandes vasos del cuello.\u00a0 Este grupo est\u00e1 compuesto por tres m\u00fasculos principales:\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-largo-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculo largo del cuello<\/a><\/strong>,\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-anterior-menor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto anterior menor de la cabeza<\/a><\/strong>\u00a0y\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-anterior-mayor-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto anterior mayor de la cabeza<\/a><\/strong>, todos ellos flexores de la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna cervical<\/a>\u00a0(inclinan la cabeza hacia adelante).<\/p>\n<p><strong>2.-<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-muscular-profundo-lateral-de-los-musculos-del-cuello\" target=\"_self\" rel=\"noopener\">Grupo muscular profundo lateral de los m\u00fasculos del cuello<\/a>.<\/strong>\u00a0Guardan relaci\u00f3n directa con las ap\u00f3fisis transversas de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales<\/a>\u00a0y forman lo que podr\u00eda considerarse la pared lateral del cuello.\u00a0 Su funci\u00f3n es inclinar la cabeza hacia su lado (los m\u00fasculos derechos inclinan la cabeza hacia la derecha y viceversa), aunque si toman su punto fijo en las v\u00e9rtebras los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculos escalenos<\/a>\u00a0pueden funcionar como accesorios de la respiraci\u00f3n.\u00a0 A este grupo pertenecen: los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-escalenos\" target=\"_self\" rel=\"noopener\">m\u00fasculos escalenos<\/a>\u00a0(tres de cada lado), los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculos-intertransversos-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculos intertransversos del cuello<\/a>\u00a0, el\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-recto-lateral-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo recto lateral de la cabeza\u00a0<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-largo-de-la-cabeza\" target=\"_self\" rel=\"noopener\">m\u00fasculo largo de la cabeza<\/a>.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/llave.JPG\" alt=\"\" \/><\/p>\n<p>&#8211;&gt;Estos m\u00fasculos\u00a0 son\u00a0 los m\u00fasculos prevertebrales\u00a0 :<\/p>\n<ul>\n<li>\u00a0Sus inserciones\u00a0proximales est\u00e1n en la cara anterior del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/hueso-occipital\" target=\"_self\" rel=\"noopener\">hueso occipital<\/a>\u00a0y las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales<\/a>, y sus inserciones\u00a0distales\u00a0se hallan en la superficie anterior de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0 cervicales<\/a>\u00a0y tres primeras\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras tor\u00e1cicas<\/a>.<\/li>\n<\/ul>\n<p><strong>Figura 1.\u00a0 M\u00fasculos prevertebrales\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/musculos_prevertebrales.JPG\" alt=\"\" \/><\/p>\n<p><strong>3.-<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-infrahioideos\" target=\"_self\" rel=\"noopener\">M\u00fasculos infrahioideos<\/a>\u00a0(l\u00ednea media anterior).<\/strong>\u00a0Son m\u00e1s superficiales que los anteriores, se ubican en la l\u00ednea media de la cara anterior del cuello y discurren desde el hueso hioides hasta sus inserciones en el estern\u00f3n. Todos los m\u00fasculos infrahioideos trabajan de manera sin\u00e9rgica para abatir y descender el hueso hioides, de manera que se convierta en un punto de apoyo firme para el grupo suprahiodeo cuya funci\u00f3n es ayudar a abrir la boca y a deglutir. Los m\u00fasculos de este grupo se dividen en dos planos, uno profundo donde se ubican los\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternotiroideo\" target=\"_self\" rel=\"noopener\">m\u00fasculos esternotiroideos<\/a><\/strong>\u00a0y\u00a0los\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-tirohioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculos tirohioideos<\/a><\/strong>, mientras el plano superficial incluye los\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternocleidohioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculos esternocleidohioideos<\/a><\/strong>\u00a0y los\u00a0<strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-omohioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculos omohioideos<\/a><\/strong>.<\/p>\n<p><strong>4.-<\/strong>\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-suprahioideos\" target=\"_self\" rel=\"noopener\">M\u00fasculos suprahioideos<\/a>\u00a0(l\u00ednea media anterior).<\/strong>Son un grupo de m\u00fasculos que forman el piso de la boca y su funci\u00f3n principal es la apertura bucal, tomando como punto fijo sus inserciones en el hueso hioides. Estos m\u00fasculos se dividen en tres planos: \u00a0uno profundo constituido por el\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-genihioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo genihioideo<\/a><\/strong>, uno medio donde se encuentra el\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-milohioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo milohioideo<\/a><\/strong>\u00a0y uno superficial que incluye los\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-digastrico\" target=\"_self\" rel=\"noopener\">m\u00fasculo dig\u00e1strico<\/a><\/strong>\u00a0y\u00a0\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-estilohioideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo estilohioideo<\/a><\/strong><\/p>\n<p><strong>5.-\u00a0<\/strong>\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-de-los-musculos-anterolaterales-del-cuello\" target=\"_self\" rel=\"noopener\">Grupo de los m\u00fasculos anterolaterales del cuello<\/a>.<\/strong>\u00a0En este grupo se encuentra el m\u00fasculo m\u00e1s grande y conocido del cuello: el\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-esternocleidomastoideo\" target=\"_self\" rel=\"noopener\">m\u00fasculo esternocleidomastoideo<\/a><\/strong>.<\/p>\n<p><strong>6.-<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-supraponeuroticos-del-cuello\" target=\"_self\" rel=\"noopener\">M\u00fasculos supraponeur\u00f3ticos del cuello<\/a>\u00a0(los m\u00e1s superficiales).<\/strong>Este grupo est\u00e1 constituido por un solo m\u00fasculo conocido como\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-platisma-o-musculo-cutaneo-del-cuello\" target=\"_self\" rel=\"noopener\">m\u00fasculo platisma o m\u00fasculo cut\u00e1neo del cuello<\/a><\/strong>. Es el \u00fanico m\u00fasculo del cuello que no toma inserciones musculares, siendo su funci\u00f3n \u201crecubrir\u201d al resto de las estructuras a manera de funda. Se inserta en los planos profundos en la aponeurosis cervical y en los planos superficiales directo en la piel de la cual lo separa una delgada capa de grasa.<\/p>\n<p>Estos\u00a0 m\u00fasculos\u00a0 son susceptibles\u00a0 de\u00a0 \u00a0aplicaci\u00f3n de\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-musculos-para-el-alivio-del-dolor-en-cuello\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS SOBRE M\u00daSCULOS PARA EL ALIVIO DEL DOLOR EN CUELLO<\/a>\u00a0 y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-musculos-para-el-alivio-del-dolor-en-las-extremidades-superiores\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS SOBRE M\u00daSCULOS PARA EL ALIVIO DEL DOLOR EN LAS EXTREMIDADES SUPERIORES<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<h2 class=\"title title-small base-color\">Bibliograf\u00eda<\/h2>\n<ol class=\"strong\">\n<li><a name=\"68f5c540-99d3-5c5d-a6b9-c03b101e3a50\"><\/a><a href=\"https:\/\/tienda.elsevier.es\/sobotta-atlas-de-anatomia-humana-vol-3-9788491133681.html\" target=\"_blank\" rel=\"noopener\">Sobotta. Atlas de anatom\u00eda humana vol 3 , por Friedrich Paulsen &amp; Jens Waschke &amp; Friedrich Paulsen &amp; Jens Waschke en Editorial Elsevier , a\u00f1o 2018<\/a><\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5b16add1b5d90.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-muscular-profundo-medio-de-los-musculos-del-cuello\">Grupo muscular profundo medio de los m\u00fasculos del cuello<span class=\"page-count\">3<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno\u00a0 de los grupos de los\u00a0m\u00fasculos de la regi\u00f3n anterior del cuello\u00a0\u00a0es\u00a0 el\u00a0 denominado grupo muscular profundo&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5b16dd1d8ec28.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-muscular-profundo-lateral-de-los-musculos-del-cuello\">Grupo muscular profundo lateral de los m\u00fasculos del cuello<span class=\"page-count\">4<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno\u00a0 de los grupos de los\u00a0m\u00fasculos de la regi\u00f3n anterior del cuello\u00a0\u00a0es\u00a0 el\u00a0 denominado\u00a0grupo muscular profundo&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5b7ab407ca712.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-infrahioideos\">M\u00fasculos infrahioideos<span class=\"page-count\">4<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno\u00a0 de los grupos de los\u00a0m\u00fasculos de la regi\u00f3n anterior del cuello\u00a0\u00a0es\u00a0 el\u00a0constitu\u00eddo\u00a0por los\u00a0m\u00fasculos&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5b7bd9a5a0ba9.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-suprahioideos\">M\u00fasculos suprahioideos<span class=\"page-count\">5<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno\u00a0 de los grupos de los\u00a0m\u00fasculos de la regi\u00f3n anterior del cuello\u00a0\u00a0es\u00a0 el\u00a0 constitu\u00eddo\u00a0 por los\u00a0 m\u00fasculos&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5b7ec443c71d0.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/grupo-de-los-musculos-anterolaterales-del-cuello\">Grupo de los m\u00fasculos anterolaterales del cuello<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno\u00a0 de los grupos de los\u00a0m\u00fasculos de la regi\u00f3n anterior del cuello\u00a0\u00a0es\u00a0 el\u00a0denominado\u00a0grupo de los m\u00fasculos&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5b81903daaf1e.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-supraponeuroticos-del-cuello\">M\u00fasculos supraponeur\u00f3ticos del cuello<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Uno\u00a0 de los grupos de los\u00a0m\u00fasculos de la regi\u00f3n anterior del cuello\u00a0\u00a0es\u00a0 el\u00a0denominado\u00a0grupo de los m\u00fasculos&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0tor\u00e1cicas<\/a>\u00a0y las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras lumbares<\/a>\u00a0de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>.<\/p>\n<p><strong>Figura 1.Disco intervertebral.<\/strong>\u00a0El disco intervertebral\u00a0es una estructura cartilaginosa que act\u00faa como\u00a0almohadilla\u00a0y separa\u00a0las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>. \u00a0Se compone\u00a0de dos partes principales : 1)\u00a0el<strong><em>\u00a0<\/em><\/strong><em>n\u00facleo pulposo (NP)<\/em>\u00a0central\u00a0compuesto por gran cantidad de agua y mucopolisac\u00e1ridos (situados en una estructura de fibras col\u00e1genas que le confiere propiedades hidrodin\u00e1micas y electrost\u00e1ticas responsables de la turgencia del mismo), que\u00a0 permite que el movimiento se amolde a las tensiones de la columna vertebral \u00a0 \u00a0y 2)\u00a0 el\u00a0<em>anillo fibroso (AF)<\/em>\u00a0que lo rodea\u00a0compuesto\u00a0por fibras col\u00e1genas en forma de l\u00e1minas conc\u00e9ntricas orientadas oblicuamente con respecto a las de la l\u00e1mina inmediata \u00a0. Un tercer componente del disco intervertebral son los platillos de cart\u00edlago que cubren las superficies superior e inferior de cada disco llamados\u00a0<em>platillos vertebrales<\/em>.\u00a0Cada disco intervertebral\u00a0forma un amortiguamiento\u00a0cartilaginoso\u00a0que organiza y permite ligeros movimientos de las \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras<\/a>\u00a0y act\u00faa como un ligamento que las mantiene juntas.\u00a0<strong><em>Caracter\u00edsticas\u00a0 seg\u00fan ubicaci\u00f3n\u00a0<\/em><\/strong>\u00a0: Los discos intervertebrales presentan variaciones en el grosor\u00a0 seg\u00fan el nivel de la columna en el que est\u00e9n , lo que se correlaciona\u00a0con el\u00a0\u00a0movimiento asociado a la regi\u00f3n de la cpolumna en la que\u00a0 est\u00e9 ubicado:\u00a0 1)\u00a0 en la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna cervical<\/a>: es m\u00e1s estrecho, de 3 mm de grosor. Es el m\u00e1s m\u00f3vil con una relaci\u00f3n de disco-cuerpo de 2\/5.; 2) en la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">columna lumbar<\/a>: es el que tiene los discos m\u00e1s gruesos. Su altura es de 9 mm. Es un poco menos m\u00f3vil que el anterior, con una relaci\u00f3n disco-corp\u00f3rea de 1\/3.; 3)\u00a0 en la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">columna\u00a0 tor\u00e1cica<\/a>: mide 5 mm de grosor. Este es el menos m\u00f3vil de los tres. Su relaci\u00f3n disco-corp\u00f3rea es de 1\/5.\u00a0<strong>Vascularizaci\u00f3n de los\u00a0 discos intervertebrales<\/strong>\u00a0:\u00a0\u00a0Son estructuras avasculares \u2013se nutren a partir de los capilares sangu\u00edneos de los cart\u00edlagos de los platillos vertebrales\u2013 . Ello implica que factores como el tabaquismo, los a\u00f1os, la inmovilizaci\u00f3n, o estar sometido a vibraciones constantes alteren su composici\u00f3n\u00a0<strong>\u00a0Inervaci\u00f3n de los discos intervertebrales<\/strong>\u00a0:\u00a0 El disco intervertebral en condiciones fisiol\u00f3gicas est\u00e1 escasamente inervado y las fibras que contiene se limitan a las l\u00e1minas m\u00e1s externas del AF y parte central de los PC. El resto del AF y el NP carecen de inervaci\u00f3n. La inervaci\u00f3n del disco intervertebral deriva de ramas del nervio sinuvertebral &#8211;\u00a0 son\u00a0\u00a0brazos men\u00edngeos del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervio espinal<\/a>&#8211; , de nervios que tienen origen de los ramos ventrales de los \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/nervios-espinales-o-nervios-raquideos\" target=\"_self\" rel=\"noopener\">nervios espinales<\/a>\u00a0y de 2 densos plexos localizados en los l<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/ligamentos-de-la-columna-vertebral\" target=\"_self\" rel=\"noopener\">igamentos com\u00fan anterior y posterior<\/a>, los cuales se conectan formando un plexo lateral. El plexo anterior est\u00e1 formado por ramas de los<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/ganglios-del-grupo-vertebral-o-tronco-simpatico\" target=\"_self\" rel=\"noopener\">\u00a0troncos simp\u00e1ticos<\/a>\u00a0y de los ramos comunicantes grises, y el plexo posterior deriva de los nervios sinuvertebrales. Ambos plexos est\u00e1n conectados por un plexo lateral menos definido formado por ramas de los ramos comunicantes grises. Las fibras sensitivas que inervan el disco son principalmente nociceptivas y, en menor proporci\u00f3n, mecanoceptivas. Las fibras simp\u00e1ticas proceden de los ganglios de las cadenas simp\u00e1ticas laterovertebrales y, del mismo modo que el resto de las fibras, est\u00e1n confinadas en las capas m\u00e1s externas del AF. En los discos degenerados y, especialmente en aquellos que son dolorosos, se ha observado una neoinervaci\u00f3n que acompana\u02dc al tejido de granulaci\u00f3n reparativa en las fisuras radiales. La hiperinervaci\u00f3n en estos discos patol\u00f3gicos se extiende a regiones que fisiol\u00f3gicamente son aneurales como la parte interna del AF o el NP. El perfil inmunohistoqu\u00edmico de las fibras que inervan los discos dolorosos es similar a la de los discos normales, de tal manera que las diferencias en la inervaci\u00f3n con los discos patol\u00f3gicos es cuantitativa m\u00e1s que cualitativa<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/unidad_funcional_columna_vertebral.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>En relaci\u00f3n\u00a0 a\u00a0 estas\u00a0\u00a0 estructuras\u00a0anat\u00f3micas cabe rese\u00f1ar :<\/p>\n<p><strong>1.- Es una\u00a0 estructura\u00a0 anat\u00f3mica\u00a0 esencial \u00a0en la biomec\u00e1nica de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a><\/strong>\u00a0, pues act\u00faa como un cojinete cuya bola es el n\u00facleo pulposo (sincondrosis)..\u00a0 El n\u00facleo pulposo, compuesto por gran cantidad de agua y mucopolisac\u00e1ridos (situados en una estructura de fibras col\u00e1genas que le confiere propiedades hidrodin\u00e1micas y electrost\u00e1ticas responsables de la turgencia del mismo), permite que el movimiento se amolde a las tensiones de la columna vertebral. De ah\u00ed que cualquier variaci\u00f3n en la composici\u00f3n del contenido del n\u00facleo pulposo, cualquier alteraci\u00f3n de la regulaci\u00f3n del intercambio de fluidos, afecte a la funci\u00f3n biomec\u00e1nica que realiza.<\/p>\n<p><strong>1.- Conforme va pasando el tiempo\u00a0van perdiendo la superficie lisa perif\u00e9rica y van perdiendo altura<\/strong>. Para\u00a0 su\u00a0 estudio\u00a0 la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/resonancia-magnetica-rm-o-rmn-y-dolor\" target=\"_self\" rel=\"noopener\">RM\u00a0<\/a>\u00a0es la t\u00e9cnica indicada para\u00a0 su valoraci\u00f3n\u00a0\u00a0 (\u00a0 ejm :\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/resonancia-magnetica-rm-o-rmn-para-el-estudio-del-dolor-en-la-zona-lumbar-columna-lumbar-sacro-y-coccix\" target=\"_self\" rel=\"noopener\">RESONANCIA MAGN\u00c9TICA-RM O RMN- PARA EL ESTUDIO DEL DOLOR EN LA ZONA LUMBAR, COLUMNA LUMBAR, SACRO Y C\u00d3CCIX )\u00a0<\/a><\/p>\n<ul>\n<li>\u00a0<ins>La secuencia que mejor valora la patolog\u00eda es el sagital T2<\/ins>.\u00a0<strong><em>El disco normal<\/em><\/strong>\u00a0presenta una\u00a0<em>hiperintensidad central, que corresponde al n\u00facleo pulposo, y una periferia hipointensa que es el anillo fibroso.<\/em>\u00a0<strong><em>Seg\u00fan progresa la enfermedad\u00a0<\/em><\/strong>l<em>os discos intervertebrales se deshidratan, perdiendo las propiedades el\u00e1sticas, y pierden la se\u00f1al en T2\u00a0\u00a0hasta hacerse completamente hipointenso<\/em>.<strong>\u00a0<em>Otros\u00a0 cambios\u00a0 \u00a0rese\u00f1ables\u00a0 en\u00a0 \u00a0el proceso degenerativo<\/em><\/strong>, seg\u00fan avanza la deshidrataci\u00f3n discal :<em>\u00a0<\/em><em>1)\u00a0\u00a0los discos van perdiendo su altura<\/em>.\u00a0 \u00a0<em>2)\u00a0Puede\u00a0 \u00a0haber\u00a0\u00a0\u00a0rotura de anillos fibrosos<\/em>, que se describe como hiperintensidad en T2\u00a0en la regi\u00f3n posterior del disco o captaci\u00f3n focal de contraste-\u00a0\u00a0son la traducci\u00f3n anatomopatol\u00f3gica de material mucoide o liquido del n\u00facleo pulposo que se escapa del n\u00facleo central hacia la periferia m\u00e1s fibrosa. Existe gran controversia respecto la asociaci\u00f3n de rotura fibrosa y dolor lumbar ya que se ha observado que tambi\u00e9n\u00a0 existe hernias intravertebrales en pacientes asintom\u00e1ticos. Lo que si queda claro es que la\u00a0<strong>rotura anular<\/strong>\u00a0condiciona un endurecimiento del disco intervertebral y por tanto p\u00e9rdida de las propiedades el\u00e1sticas del mismo. En consecuencia, la rotura anular es ya un signo de degeneraci\u00f3n discal precoz pudiendo aparecer incluso antes de cambios de se\u00f1al en el n\u00facleo pulposo.\u00a0\u00a0<em>3)\u00a0 &#8211; Otros efectos degenerativos sobre el disco intervertebral son los fenomenos &#8220;exvacuo&#8221;\u00a0<\/em>consistente en la formaci\u00f3n de gas (nitr\u00f3geno) como producto de desecho degenerativo. En RM se observar\u00e1 como material hipointenso en T1<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Figura 2\u00a0.\u00a0 RM\u00a0 proyecci\u00f3n\u00a0 sagital , secuencias\u00a0 T2 (\u00a0\u00a0modificado de\u00a0\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales#132ef15f-782d-e72e-a84f-eaf53e8a7903\" name=\"entry-132ef15f-782d-e72e-a84f-eaf53e8a7903\" data-bibliography-uid=\"132ef15f-782d-e72e-a84f-eaf53e8a7903\">1<\/a><\/strong>)\u00a0<strong>.\u00a0<\/strong>Evolucion de la discopat\u00eda (aros rojos): 1 disco normal, 2 paulatinamente el disco pierde se\u00f1al en T2 y a continuaci\u00f3n comienza a perder altura 3, y en fases tard\u00edas 4 se pierda casi la totalidad del disco.<\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/discos_intervertebrales.JPG\" alt=\"\" \/><\/p>\n<p><strong>Tabla\u00a0 2 . Grado de discopat\u00eda\u00a0 .\u00a0 E<\/strong>n el proceso degenerativo, seg\u00fan avanza la deshidrataci\u00f3n discal, los discos van perdiendo su altura. Pearce et al clasificaron la degeneraci\u00f3n discal en T2 sagital. Esta clasificaci\u00f3n puede ser tediosa para la pr\u00e1ctica cl\u00ednica diaria, pero es una forma clara de ver la evoluci\u00f3n de la enfermedad discal. Lo interesante de la tabla es que la degeneraci\u00f3n discal y en consecuencia la enfermedad discal, comienza mucho antes de lo que com\u00fanmente\u00a0 se cree (hipointensidad completa del n\u00facleo pulposo).<\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"center\">\n<tbody>\n<tr>\n<td><strong>GRADO<\/strong><\/td>\n<td><strong>DIFERENCIACION NUCLEO PULPOSO-ANILLO<\/strong><\/td>\n<td><strong>INTENSIDAD NUCLEO PULPOSO<\/strong><\/td>\n<td><strong>ALTURA DISCAL<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>I<\/strong><\/td>\n<td>SI<\/td>\n<td>HOMOGENEO HIPERINTENSO<\/td>\n<td>NORMAL<\/td>\n<\/tr>\n<tr>\n<td>II<\/td>\n<td>SI<\/td>\n<td>HIPERINTENSO CON BANDAS HIPOINTENSAS HORIZONTALES<\/td>\n<td>NORMAL<\/td>\n<\/tr>\n<tr>\n<td>III<\/td>\n<td>BORROSO<\/td>\n<td>LEVE DISMINUCION DE SE\u00d1AL<\/td>\n<td>LEVE DISMINUCION<\/td>\n<\/tr>\n<tr>\n<td>IV<\/td>\n<td>PERDIDO<\/td>\n<td>MODERADA DISMINUCION DE SE\u00d1AL<\/td>\n<td>MODERADA DISMINUCION<\/td>\n<\/tr>\n<tr>\n<td>V<\/td>\n<td>PERDIDO<\/td>\n<td>HIPOINTENSO<\/td>\n<td>COLAPSO<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Figura 3.\u00a0Hernias discales\u00a0(\u00a0\u00a0modificado de\u00a0\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales#132ef15f-782d-e72e-a84f-eaf53e8a7903\" name=\"entry-132ef15f-782d-e72e-a84f-eaf53e8a7903\" data-bibliography-uid=\"132ef15f-782d-e72e-a84f-eaf53e8a7903\">2<\/a><\/strong>)\u00a0<strong>\u00a0.<\/strong>\u00a0En la progresi\u00f3n de la enfermedad los \u00a0discos intervertebrales\u00a0\u00a0van perdiendo la superficie lisa perif\u00e9rica y desarrollan bultos. De la terminolog\u00eda radiol\u00f3gica deber\u00eda desaparecer la palabra de &#8220;hernia&#8221; ya que esta palabra significa herniaci\u00f3n del n\u00facleo pulposo.\u00a0 Terminolog\u00eda\u00a0 que\u00a0 se\u00a0 recomienda utilizar :\u00a0<em>\u00a01)\u00a0<strong>Distensi\u00f3n discal o bulging<\/strong>:\u00a0\u00a0<\/em>aumento generalizado del disco m\u00e1s all\u00e1 del borde vertebral.<em>; 2)\u00a0<strong>Protrusi\u00f3n<\/strong>:<\/em>\u00a0la mayor distancia del disco fuera de su lugar, corresponde a la distancia lateral en la base. La lesi\u00f3n se puede subdividir en focal, si afecta a menos del 50% de la circunferencia o difusa si afecta a m\u00e1s del 50% en plano axial.<em>; 3)\u00a0<strong>Extrusi\u00f3n<\/strong>:\u00a0<\/em>la mayor distancia del disco deslocalizado es anteroposterior y no lateral en la base en plano axial.\u00a0 Cuando la extrusi\u00f3n es muy grande conviene valorar la lesi\u00f3n en proyecci\u00f3n sagital\u00a0\u00a0y si el disco excede la altura del disco intervertebral, tambi\u00e9n lo llamaremos extrusi\u00f3n.;\u00a0 4)\u00a0<strong>Migraci\u00f3n<\/strong>: desplazamiento del disco intervertebral\u00a0 por el espacio graso pretecal craneal o caudalmente permaneciendo en contacto con el disco originario.\u00a0;\u00a0 5)\u00a0<strong>Secuestro<\/strong>: cuando el disco desplazado pierde el nexo de uni\u00f3n con el disco intervertebral originario.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/hernias_discales.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>2.-\u00a0Son\u00a0 la\u00a0 fuente generadora\u00a0de diferentes\u00a0tipos\u00a0de dolor<\/strong>. As\u00ed\u00a0,\u00a0en\u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-lumbar\" target=\"_self\" rel=\"noopener\">dolor lumbar<\/a>\u00a0 el\u00a0 disco intervertebral\u00a0es\u00a0 responsable\u00a0 del\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/dolor-discogenico-lumbar\" target=\"_self\" rel=\"noopener\">dolor discog\u00e9nico lumbar<\/a>\u00a0 . Asimismo\u00a0 se relaciona\u00a0 con otros dolores lumbares con\u00a0 diferente patr\u00f3n\u00a0 cl\u00ednico\u00a0\u00a0como\u00a0 son\u00a0\u00a0 el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/dolor-radicular-lumbar\" target=\"_self\" rel=\"noopener\">dolor radicular lumbar<\/a>\u00a0 \u00a0y\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/dolor-lumbar-secundario-a-estenosis-de-canal-o-estenosis-espinal\" target=\"_self\" rel=\"noopener\">dolor lumbar secundario a estenosis de canal o estenosis espinal<\/a>\u00a0 . Para m\u00e1s informaci\u00f3n\u00a0 ver\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/el-disco-intervertebral-como-fuente-generadora-de-dolor-lumbar\" target=\"_self\" rel=\"noopener\">el disco intervertebral como fuente generadora de dolor lumbar<\/a><\/p>\n<p><strong>3.-.-Son\u00a0 la\u00a0 diana\u00a0 terap\u00e9utica\u00a0 de\u00a0 una\u00a0 serie\u00a0 de\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">t\u00e9cnicas intervencionistas para el tratamiento del dolor\u00a0<\/a>\u00a0 \u00a0como\u00a0 son\u00a0 las\u00a0 t\u00e9cnicas sobre los discos intervertebrales para el alivio\u00a0 del dolor\u00a0 (\u00a0 ejm\u00a0 :\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-sobre-los-discos-intervertebrales-para-el-alivio-del-dolor-en-la-zona-lumbar-columna-lumbar-sacro-y-coccix\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS SOBRE LOS DISCOS INTERVERTEBRALES PARA EL ALIVIO DEL DOLOR EN LA ZONA LUMBAR, COLUMNA LUMBAR, SACRO Y C\u00d3CCIX<\/a>)<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<h4><strong>Ligamentos de la columna cervical\u00a0<\/strong><\/h4>\n<ul>\n<li>Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">discos intervertebrales<\/a><\/li>\n<\/ul>\n<p><strong>M\u00fasculos de la columna cervical<\/strong><\/p>\n<ul>\n<li>Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-region-posterior-del-cuello-o-musculos-de-la-nuca\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la regi\u00f3n posterior del cuello o m\u00fasculos de la nuca<\/a><\/li>\n<\/ul>\n<h4><strong>Articulaciones de la columna vertebral cervical\u00a0<\/strong><\/h4>\n<ul>\n<li>Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-del-cuello\" target=\"_self\" rel=\"noopener\">articulaciones del cuello\u00a0<\/a><\/li>\n<\/ul>\n<h3>Contenido\u00a0 de la\u00a0 columna cervical<\/h3>\n<p><strong>Figura 2. . Contenido de la columna cervical\u00a0\u00a0<\/strong>(\u00a0 modificado de<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical#8e629b32-54b6-7baa-a814-889e06096ffa\" name=\"entry-8e629b32-54b6-7baa-a814-889e06096ffa\" data-bibliography-uid=\"8e629b32-54b6-7baa-a814-889e06096ffa\">1<\/a>\u00a0 )<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/contenido_columna_cervical.JPG\" alt=\"\" \/><\/p>\n<p><strong>1.- Elementos\u00a0 de protecci\u00f3n del\u00a0 sistema nervioso\u00a0 central\u00a0 \u00a0como\u00a0 son\u00a0\u00a0<\/strong><\/p>\n<p><strong>1) Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/meninges-espinales-y-espacios-meningeos-asociados\" target=\"_self\" rel=\"noopener\">meninges espinales\u00a0 y\u00a0 espacios men\u00edngeos\u00a0 asociados\u00a0<\/a><\/strong><\/p>\n<p><strong>2) El<\/strong><strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/liquido-cefalorraquideo\" target=\"_self\" rel=\"noopener\">l\u00edquido cefalorraqu\u00eddeo<\/a><\/strong><\/p>\n<p><strong>3) La\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/barrera-sangre-aracnoides\" target=\"_self\" rel=\"noopener\">barrera sangre-aracnoides<\/a><\/strong><\/p>\n<p><strong>2.- La\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a><\/strong><\/p>\n<p><strong>3.- Las ra\u00edces de los<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-cervicales-o-nervios-raquideos-cervicales\" target=\"_self\" rel=\"noopener\">\u00a0nervios raqu\u00eddeos cervicales<\/a><\/strong><\/p>\n<p><strong>4.-Estructuras\u00a0 vasculares\u00a0 como las arterias de la m\u00e9dula espinal\u00a0 \u00a0y las venas\u00a0 espinales\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<h3>T\u00e9cnicas de imagen para el\u00a0 estudio de la columna cervical<\/h3>\n<ul>\n<li>\n<h4>Ver\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-de-imagen-para-el-estudio-del-dolor-en-el-cuello\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS DE IMAGEN PARA EL ESTUDIO DEL DOLOR EN EL CUELLO<\/a><\/h4>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>2.-Tiene una forma alargada y levemente curva en algunas secciones\u00a0 dividi\u00e9ndose\u00a0 en cinco regiones<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">\u00a0columna cervical<\/a><\/strong>,\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">columna dorsal o tor\u00e1cica<\/a><\/strong>,<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">\u00a0columna lumbar<\/a><\/strong>,<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-del-sacro\" target=\"_self\" rel=\"noopener\">\u00a0sacro<\/a><\/strong>\u00a0y\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/coccix\" target=\"_self\" rel=\"noopener\">c\u00f3ccix<\/a>\u00a0 \u00a0<\/strong>. Las\u00a0\u00a0curvaturas normales\u00a0 son lordosis cervical y lumbar y la cifosis dorsal. Los puntos m\u00e1s acentuados de estas curvaturas son C5, T6 y L3 y la bisagra lumbosacra.<\/p>\n<p>3.-Delimita el denominado\u00a0canal raqu\u00eddeo\u00a0 por el que pasa la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula<\/a> <a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">espinal<\/a><\/p>\n<p>4.-Su longitud var\u00eda con la talla del individuo .\u00a0 Mide, en t\u00e9rmino medio ,\u00a0 unos\u00a0 73 a 75\u00a0 cm de media en el hombre y 60-654 cm en la mujer . Esta ongitud disminuye en la vejez , como consecuencia del aplastamiento de los<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\"><\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d1a20ebab4b.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/consideraciones-generales-relacionadas-con-la-columna-vertebral\">CONSIDERACIONES GENERALES RELACIONADAS CON LA COLUMNA VERTEBRAL<span class=\"page-count\">3<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El \u00a0conocimiento \u00a0de la \u00a0ANATOM\u00cdA DE LA COLUMNA VERTEBRAL\u00a0implica \u00a0tener \u00a0en cuenta una serie de consideraciones&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5c7e448107158.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/componentes-de-la-columna-vertebral\">COMPONENTES DE LA COLUMNA VERTEBRAL<span class=\"page-count\">3<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>La\u00a0 columna vertebral\u00a0 est\u00e1 constituida por piezas \u00f3seas superpuestas, , las v\u00e9rtebras, intercaladas por\u00a0 \u00a0unas\u00a0 estructuras\u00a0&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5e41af237936d.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/conducto-vertebral-y-contenido-del-conducto-vertebral\">CONDUCTO VERTEBRAL Y CONTENIDO DEL CONDUCTO VERTEBRAL<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>La\u00a0\u00a0columna vertebral\u00a0 \u00a0delimita\u00a0 un\u00a0 espacio estrecho\u00a0\u00a0denominado\u00a0 conducto\u00a0 vertebral\u00a0 &#8211;\u00a0tambi\u00e9n\u00a0se\u00a0puede llamar\u00a0conducto&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d1a1012c572.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p>ANATOM\u00cdA DE LA COLUMNA VERTEBRAL SEG\u00daN TOPOGRAF\u00cdA<span class=\"page-count\">5<\/span><\/p>\n<div class=\"link-card-info-content\">\n<p>El \u00a0conocimiento \u00a0de la \u00a0columna vertebral\u00a0\u00a0teniendo \u00a0en cuenta la topograf\u00eda \u00a0facilita \u00a0la realizaci\u00f3n de una serie de&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>A pesar que la columna vertebral debe ser considerada como un todo, para su estudio se suele dividiren las denominadas <a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/unidad-funcional-de-la-columna-vertebral\" target=\"_self\" rel=\"noopener\">unidades\u00a0funcionales de la columna vertebral<\/a>\u00a0:\u00a0 estas unidades est\u00e1n formadas\u00a0 por el disco intervertebral, el cuerpo vertebral, las facetas articulares y\u00a0 los ligamentos.<\/p>\n<p>Al igual que los huesos largos y planos, tiene una inervaci\u00f3n auton\u00f3mica y sensorial compleja<\/p>\n<p>Esta\u00a0 estructura : \u2022 Protege la m\u00e9dula espinal\u00a0y los\u00a0nervios raqu\u00eddeos. \u2022 Soporta el peso del cuerpo sobre el nivel de la pelvis. \u2022 Proporciona un eje, parcialmente r\u00edgido y flexible, para el cuerpo, y una base sobre la cual se sit\u00faa y gira la\u00a0cabeza.\u00a0\u2022 Desempe\u00f1a un importante papel en la postura y la locomoci\u00f3n (el desplazamiento de un lugar a otro).<\/p>\n<p>Su\u00a0 conocimiento\u00a0 es\u00a0 \u00a0 esencial\u00a0 a \u00a0la \u00a0hora \u00a0de \u00a0realizar\u00a0 \u00a0una\u00a0 serie\u00a0 de\u00a0 \u00a0T\u00c9CNICAS INTERVENCIONISTAS PARA EL TRATAMIENTO DEL DOLOR\u00a0 como\u00a0 son\u00a0 :\u00a0 1)\u00a0\u00a0los\u00a0BLOQUEOS NERVIOSOS PERIMEDULARES\u00a0 \u00a0, 2)\u00a0 los\u00a0\u00a0BLOQUEOS DE LAS RA\u00cdCES ESPINALES\u00a0\u00a0;\u00a0 3)\u00a0 los\u00a0\u00a0\u00a0BLOQUEOS PARAVERTEBRALES\u00a0, 4)\u00a0\u00a0BLOQUEOS FACIALES REALIZADOS EN LA PARED TOR\u00c1CICA POSTERIOR\u00a0 como\u00a0 \u00a0el\u00a0\u00a0BLOQUEO\u00a0 RETROLAMINAR\u00a0 \u00a0y\u00a0 el\u00a0\u00a0BLOQUEO EN EL PLANO DEL\u00a0 M\u00daSCULO ERECTOR DE LA COLUMNA. ESP &#8211; block )<\/p>\n<\/div>\n<\/div>\n<h2 id=\"acItem_content\">Contenido del art\u00edculo<\/h2>\n<div class=\"editor-field\">\n<p><strong>La columna\u00a0 tor\u00e1cica o\u00a0raquis tor\u00e1cico\u00a0<\/strong>\u00a0es la\u00a0porci\u00f3n m\u00e1s extensa de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>. M\u00e1s\u00a0 espec\u00edficamente,\u00a0 es\u00a0 una\u00a0 estructura \u00f3sea\u00a0 formada por la superposici\u00f3n de\u00a0doce\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/vertebras\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0<\/a>\u00a0que\u00a0se extiende desde la base del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-cuello\" target=\"_self\" rel=\"noopener\">cuello<\/a>\u00a0hasta el medio de la espalda.<\/p>\n<p><strong>Figura 1. Columna tor\u00e1cica .\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/columna_toracica_lateral.JPG\" alt=\"\" \/><\/p>\n<p>La columna tor\u00e1cica\u00a0 se caracteriza por una incurvaci\u00f3n fisiol\u00f3gica cif\u00f3tica, que viene determinada principalmente por la forma en cu\u00f1a de sus cuerpos vertebrales y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">discos intervertebrales\u00a0<\/a>, algo m\u00e1s altos en la parte posterior que en la anterior. El tama\u00f1o de los cuerpos aumenta progresivamente en las regiones caudales, donde son m\u00e1s frecuentes los cambios degenerativos, por estar sometidos a mayor carga.<\/p>\n<p><strong>Figura 2.\u00a0\u00a0Curvatura\u00a0 de la columna dorsal\u00a0<\/strong>\u00a0.\u00a0La columna dorsal tiene una curvatura c\u00f3ncava que se inicia en la mitad de la segunda v\u00e9rtebra y se extiende hasta las 12\u00aa dorsal. La curvatura se hace m\u00e1s profunda en la s\u00e9ptima v\u00e9rtebra dorsal, coincidiento con la prominencia de su ap\u00f3fisis espinosa. La D1 (primera v\u00e9rtebra dorsal), est\u00e1 conectada con la s\u00e9ptima cervical (C7). Las costilas que forman la caja tor\u00e1cica (articulaci\u00f3n de las costillas con el estern\u00f3n) del ser humano est\u00e1n conectadas a las 10 primeras v\u00e9rtebras dorsales, en las cuales se pueden observar las caras costales (lugar de uni\u00f3n.), mientras que la D11 y D12 (que son l\u00e1s \u00faltimas) conectan con las costillas flotantes (las que no se conectan al estern\u00f3n). El tama\u00f1o y las dimensiones de las v\u00e9rtebras dorsales est\u00e1 condicionado por el de las cervicales y lumabares. Las articulaciones de esta columna le permienten llevar a cabo los siguientes movimientos: flexi\u00f3n, flexi\u00f3n lateral, rotaci\u00f3n y extensi\u00f3n.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/COLUMNA_toracica_curvaturas.JPG\" alt=\"\" \/><\/p>\n<p>A los\u00a0 lados\u00a0 de la columna\u00a0 tor\u00e1cica\u00a0 se\u00a0 encuentra\u00a0 un espacio denominado\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-bloqueo-paravertebral\" target=\"_self\" rel=\"noopener\">\u00a0espacio paravertebral\u00a0 tor\u00e1cico<\/a>\u00a0de forma triangular a ambos lados de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">\u00a0columna dorsal o tor\u00e1cica<\/a>, delimitado en su cara medial por el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-bloqueo-epidural\" target=\"_self\" rel=\"noopener\">espacio epidural tor\u00e1cico\u00a0<\/a>\u00a0mediante los for\u00e1menes intervertebrales y en su cara lateral con el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-del-espacio-intercostal\" target=\"_self\" rel=\"noopener\">espacio intercostal<\/a>, tras su paso por la ap\u00f3fisis\u00a0transversa de las\u00a0v\u00e9rtebras\u00a0\u00a0tor\u00e1cicas.<\/p>\n<p><strong>Relaci\u00f3n\u00a0 de la columna vertebral tor\u00e1cica y\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal tor\u00e1cica<\/a><\/strong>\u00a0 :\u00a0 La m\u00e9dula tor\u00e1cica presenta doce segmentos tor\u00e1cicos. Sin embargo, dado que la<strong>\u00a0\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>\u00a0crece menos que la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>, no coinciden los niveles vertebrales con los niveles medulares. As\u00ed, existen dos niveles de diferencia en la regi\u00f3n tor\u00e1cica alta (por ejemplo, la v\u00e9rtebra TIII\u00a0\u00a0est\u00e1\u00a0 a la misma altura que el segmento T5), y tres niveles de diferencia en la zona dorsal baja (otro ejemplo, la v\u00e9rtebra TX\u00a0coincide con el segmento medular L1)\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica#1529d532-d25b-3050-f63a-f1d4e623998f\" name=\"entry-1529d532-d25b-3050-f63a-f1d4e623998f\" data-bibliography-uid=\"1529d532-d25b-3050-f63a-f1d4e623998f\">1<\/a><\/p>\n<h3>Componentes\u00a0 de la columna tor\u00e1cica<\/h3>\n<h4><strong>V\u00e9rtebras tor\u00e1cicas<\/strong><\/h4>\n<ul>\n<li>Las\u00a0v\u00e9rtebras tor\u00e1cicas\u00a0son un grupo de doce\u00a0huesos\u00a0peque\u00f1os que forman la columna tor\u00e1cica.\u00a0Las v\u00e9rtebras tor\u00e1cicas son \u00fanicas entre los huesos de la\u00a0columna vertebral\u00a0porque son las \u00fanicas v\u00e9rtebras que sostienen las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0y\u00a0 tienen procesos espinosos superpuestos<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica#3eaa9858-55b5-cd3d-6a2b-569a5683f6ab\" name=\"entry-3eaa9858-55b5-cd3d-6a2b-569a5683f6ab\" data-bibliography-uid=\"3eaa9858-55b5-cd3d-6a2b-569a5683f6ab\">2<\/a>.<\/li>\n<\/ul>\n<p><strong>Figura 3\u00a0.\u00a0 Anatom\u00eda\u00a0 de\u00a0 la\u00a0 v\u00e9rtebra tor\u00e1cica\u00a0\u00a0<\/strong>. La v\u00e9rtebra tor\u00e1cica\u00a0\u00a0est\u00e1 formada, desde anterior a posterior, por: 1)\u00a0\u00a0<strong><em>\u00a0un cuerpo vertebral,<\/em><\/strong>\u00a0que presenta 4 carillas articulares para la cabeza costal, dos superiores y dos inferiores, y que se articula en su superficie superior e inferior con los discos intervertebrales.;\u00a0 2)<em><strong>\u00a0\u00a0dos ped\u00edculos<\/strong><\/em>, uno a cada lado del cuerpo vertebral, que delimitan por su parte interna el canal vertebral, y por su parte superior e inferior el foramen intervertebral.;\u00a0 3)\u00a0<em><strong>\u00a0dos ap\u00f3fisis transversas<\/strong><\/em>, una a cada lado, con una carilla costal.;\u00a0 4)\u00a0<em><strong>\u00a0dos ap\u00f3fisis articulares superiores<\/strong><\/em>, que se articulan con las de la v\u00e9rtebra inmedatamente superior. 5)\u00a0<strong><em>\u00a0dos ap\u00f3fisis articulares inferiores<\/em><\/strong>, que se articulan con las de la v\u00e9rtebra inmediatamente inferior. 6 )\u00a0\u00a0<em><strong>dos l\u00e1minas<\/strong><\/em>, una a cada lado de la ap\u00f3fisis transversa, que se unen a la ap\u00f3fisis espinosa.\u00a0 7)\u00a0\u00a0una\u00a0<strong><em>ap\u00f3fisis espinosa<\/em><\/strong>, en la zona posterior.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/www.dolopedia.com\/uploads\/media\/194-encarnacion-maria-belen\/Anatomia%20vert%20torac.PNG\" alt=\"\" \/><\/p>\n<ul>\n<li>Cada v\u00e9rtebra tor\u00e1cica recibe su nombre por su posici\u00f3n dentro de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>, desde la primera v\u00e9rtebra tor\u00e1cica (TI) en el extremo superior hasta la duod\u00e9cima v\u00e9rtebra tor\u00e1cica (TXII) en el extremo inferior.<\/li>\n<li>Las v\u00e9rtebras tor\u00e1cicas son de tama\u00f1o mediano, m\u00e1s grandes y m\u00e1s gruesas que las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras cervicales<\/a>\u00a0por encima de ellas, pero m\u00e1s peque\u00f1as y delgadas que las\u00a0v\u00e9rtebras lumbares\u00a0inferiores.\u00a0La v\u00e9rtebra TI\u00a0es la m\u00e1s\u00a0peque\u00f1a\u00a0y se asemeja mucho a las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras cervicales<\/a>, mientras que la v\u00e9rtebra TXII\u00a0es la m\u00e1s grande y m\u00e1s similar a las\u00a0v\u00e9rtebras lumbares.\u00a0Todas las v\u00e9rtebras intermedias siguen la tendencia de aumentar el tama\u00f1o de superior a inferior como resultado del mayor peso corporal soportado por las v\u00e9rtebras inferiores.<\/li>\n<li>Las\u00a0 v\u00e9rtebras de la columna tor\u00e1cica son relativamente fijas pues constituyen un s\u00f3lido apoyo a las<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">\u00a0costillas<\/a>\u00a0y, por lo tanto , a los movimientos de la caja tor\u00e1cica<\/li>\n<li>Las v\u00e9rtebras est\u00e1n separadas por\u00a0discos intervertebrales\u00a0de fibrocart\u00edlago,\u00a0que son\u00a0discos de cart\u00edlago flexible ubicados entre los cuerpos de dos v\u00e9rtebras adyacentes que permiten el movimiento en la columna vertebral y tambi\u00e9n tienen una\u00a0funci\u00f3n\u00a0de amortiguaci\u00f3n .\u00a0Un\u00a0disco intervertebral\u00a0consiste en un\u00a0n\u00facleo pulposo\u00a0gelatinoso interno\u00a0rodeado por un anillo de fibrocart\u00edlago, el\u00a0anillo fibroso.<\/li>\n<li><strong>Caracter\u00edsticas generales de\u00a0 las\u00a0v\u00e9rtebras tor\u00e1cicas .\u00a0(<\/strong>son las\u00a0\u00a0caracter\u00edsticas generales de la segunda a la octava v\u00e9rtebra tor\u00e1cica.\u00a0La primera y la novena a la duod\u00e9cima v\u00e9rtebra contienen ciertas peculiaridades y se detallan\u00a0 posteriormente )<\/li>\n<\/ul>\n<table border=\"1\" cellspacing=\"1\" cellpadding=\"1\" align=\"center\">\n<tbody>\n<tr>\n<td>A\u00a0 diferencia de\u00a0 otras v\u00e9rtebras de la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a><\/p>\n<ol>\n<li><em><strong>Tienen carillas costales bilaterales<\/strong><\/em>\u00a0 (hemicarillas)\u00a0 en su cuerpo,\u00a0 frecuentemente\u00a0 en pares superiores\u00a0 e inferiores , para\u00a0 articularse\u00a0 con las\u00a0 cabezas de las costillas\u00a0 (\u00a0<strong>articulaciones costovertebrales<\/strong>\u00a0)<\/li>\n<li><strong><em>Tienen\u00a0carillas\u00a0 costales\u00a0en\u00a0 sus ap\u00f3fisis\u00a0transversas<\/em><\/strong>\u00a0para\u00a0 articularse\u00a0con los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">tub\u00e9rculos de las costillas<\/a>\u00a0 ,\u00a0 excepto para las\u00a0 2\u00a0 o\u00a0 3\u00a0\u00a0 v\u00e9rtebras tor\u00e1cicas\u00a0 inferiores (\u00a0<strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costotransversas\" target=\"_self\" rel=\"noopener\">articulaciones costotransversas<\/a><\/strong>)<\/li>\n<li><em><strong>Tienen ap\u00f3fisis\u00a0 epinosas\u00a0 largas inclinadas\u00a0 hacia\u00a0 abajo<\/strong><\/em><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Figura 4. V\u00e9rtebra\u00a0tor\u00e1cica\u00a0 con\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costovertebrales\" target=\"_self\" rel=\"noopener\">articulaciones costovertebrales<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costotransversas\" target=\"_self\" rel=\"noopener\">articulaciones costotransversas<\/a>\u00a0de una\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>\u00a0t\u00edpica.\u00a0<\/strong>\u00a0Son v\u00e9rtebras con un\u00a0cuerpo, un\u00a0arco vertebral y 7 ap\u00f3fisis para uniones musculares y articulares\u00a0.\u00a0<strong>\u00a0<\/strong>Las v\u00e9rtebras tor\u00e1cicas son m\u00e1s grandes que las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras cervicales<\/a>, tienen como caracter\u00edstica \u00fanica que el\u00a0<ins><em>c<\/em>uerpo es en forma de coraz\u00f3n<\/ins>; se encuentran en el cuerpo de estas v\u00e9rtebras una o dos fositas costales, las que se articulan con las\u00a0costillas para conformar la articulaci\u00f3n costovertebral.<\/p>\n<div class=\"row container-row container-right-column tabs-header-container\">\n<div class=\"col-md-12\">\n<h1>Costillas<\/h1>\n<div class=\"section\">\n<div class=\"user-badge separate-right pull-left\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"tab-content\">\n<div id=\"article-content\" class=\"tab-pane active\">\n<div id=\"article-body\" class=\"row container-row container-right-column\">\n<div class=\"col-md-12 pull-left\">\n<p><strong>Las costillas<\/strong> son\u00a0\u00a0huesos planos y curvos\u00a0\u00a0que ,\u00a0junto\u00a0 a otros\u00a0\u00a0HUESOS DE LA PARED TOR\u00c1CICA\u00a0,<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>HUESOS DE LA PARED TOR\u00c1CICA<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>El\u00a0 \u00a0esqueleto\u00a0 tor\u00e1cico\u00a0 \u00a0forma la\u00a0 caja tor\u00e1cica\u00a0 osteocartilaginosa\u00a0 de\u00a0 la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-la-pared-toracica\" target=\"_self\" rel=\"noopener\">\u00a0PARED TOR\u00c1CICA<\/a>\u00a0 \u00a0que protege la\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/generalidades-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">cavidad\u00a0tor\u00e1cica\u00a0<\/a><\/p>\n<p>Este esqueleto incluye\u00a0\u00a012 pares de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0que se articulan anteriormente con el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0y posteriormente con la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">columna dorsal o tor\u00e1cica<\/a>, . M\u00e1s\u00a0 espec\u00edficamente\u00a0 \u00a0consta\u00a0 de\u00a0 10 pares de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0verdaderas y dos pares de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0flotantes,\u00a0 en el que\u00a0 los cart\u00edlagos de las primeras 6\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0tienen cada uno su articulaci\u00f3n con el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>, no as\u00ed los cart\u00edlagos de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a07 a 10 que primero se fusionan formando el borde costal antes de su inserci\u00f3n en el extremo inferior de el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>. Completan esta estructura las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/clavicula\" target=\"_self\" rel=\"noopener\">clav\u00edculas<\/a>, la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">columna dorsal o tor\u00e1cica<\/a>,\u00a0 y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/escapula-omoplato\" target=\"_self\" rel=\"noopener\">esc\u00e1pulas\u00a0<\/a><\/p>\n<p>Figura\u00a0 1 .\u00a0<strong>Esqueleto\u00a0 tor\u00e1cico\u00a0\u00a0<\/strong>\u00a0:\u00a0 La\u00a0 caja\u00a0 tor\u00e1cica\u00a0 osteocartilaginosa\u00a0 incluye\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0, 12 pares de \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0y\u00a0 cart\u00edlagos costales y\u00a0 12\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">vertebras tor\u00e1cicas<\/a>\u00a0y discos intervertebrales\u00a0 .\u00a0 Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/clavicula\" target=\"_self\" rel=\"noopener\">clav\u00edculas<\/a>\u00a0 y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/escapula-omoplato\" target=\"_self\" rel=\"noopener\">esc\u00e1pulas<\/a>\u00a0forman parte de la cintura escapular.\u00a0 La\u00a0 l\u00ednea discontinua\u00a0 indica la posici\u00f3n del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-diafragma\" target=\"_self\" rel=\"noopener\">m\u00fasculo diafragma<\/a>\u00a0 , que separa las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/generalidades-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">cavidades tor\u00e1cica\u00a0\u00a0<\/a>\u00a0y\u00a0 \u00a0cavidad abdominal<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/esqueleto_%20pared_toracica.JPG\" alt=\"\" \/><\/p>\n<\/div>\n<\/div>\n<p>proporcionan\u00a0 la\u00a0 rigidez\u00a0 de\u00a0 la\u00a0PARED TOR\u00c1CICA<\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>ANATOM\u00cdA RELACIONADA CON LA PARED TOR\u00c1CICA<\/h1>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>A la hora de\u00a0 evaluar el\u00a0\u00a0dolor tor\u00e1cico\u00a0\u00a0o\u00a0\u00a0realizar\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-en-el-torax\" target=\"_self\" rel=\"noopener\">t\u00e9cnicas intervencionistas en el t\u00f3rax\u00a0<\/a>\u00a0 (\u00a0 como pueden\u00a0 \u00a0ser\u00a0 los \u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-nerviosos-perifericos-en-el-torax\" target=\"_self\" rel=\"noopener\">BLOQUEOS NERVIOSOS PERIF\u00c9RICOS EN EL T\u00d3RAX<\/a>\u00a0\u00a0 o\u00a0 las diferentes\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/posibilidades-de-infiltracion-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">POSIBILIDADES DE INFILTRACI\u00d3N DE LA PARED TOR\u00c1CICA<\/a>\u00a0 \u00a0)\u00a0\u00a0\u00a0 \u00a0es interesante \u00a0conocer \u00a0aspectos \u00a0anat\u00f3micos de la<strong>\u00a0PARED<\/strong><\/p>\n<p>Dolor tor\u00e1cico<span style=\"font-size: 36px; font-weight: 600;\">DOLOR TOR\u00c1CICO<\/span><\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-3\"><a class=\"popupLauncher btn btn-big btn-primary pull-right visible-lg visible-md\" href=\"https:\/\/dolopedia.com\/login\">\u00a0Solicitar nuevo art\u00edculo<\/a><\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>EL DOLOR \u00a0TOR\u00c1CICO\u00a0 es \u00a0un \u00a0 s\u00edndrome doloroso\u00a0que \u00a0se \u00a0debe\u00a0\u00a0tener en cuenta \u00a0 a la\u00a0hora de estudiar\u00a0\u00a0las\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-en-el-torax\" target=\"_self\" rel=\"noopener\">ENTIDADES CL\u00cdNICAS EN T\u00d3RAX<\/a><\/p>\n<p>Este \u00a0apartado describe\u00a0 este \u00a0\u00a0<a class=\"external-link\" href=\"https:\/\/dolopedia.com\/articulos\" target=\"_blank\" rel=\"noopener\" data-externallink-href=\"http:\/\/dolopedia.com\/articulos\">dolor<\/a>\u00a0\u00a0\u00a0 \u00a0y \u00a0 aporta informaci\u00f3n \u00a0 para una mayor precisi\u00f3n \u00a0en la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/valoracion-y-evaluacion-del-dolor\" target=\"_self\" rel=\"noopener\">valoraci\u00f3n\u00a0<\/a>\u00a0y \u00a0el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">tratamiento<\/a>\u00a0\u00a0 de las diferentes\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/entidades-clinicas-especificas-que-se-manifiestan-con-dolor-en-el-torax\" target=\"_self\" rel=\"noopener\">\u00a0entidades \u00a0cl\u00ednicas \u00a0que se \u00a0 manifiestan \u00a0con \u00a0DOLOR \u00a0TOR\u00c1CICO\u00a0 \u00a0<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d17e724d783.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/conceptos-a-tener-en-cuenta-a-la-hora-de-abordar-el-dolor-toracico\">CONCEPTOS A TENER EN CUENTA A LA HORA DE ABORDAR EL DOLOR TOR\u00c1CICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El\u00a0\u00a0DOLOR TOR\u00c1CICO\u00a0\u00a0se define como toda sensaci\u00f3n \u00e1lgica o dolorosa localizada en la zona comprendida entre&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d3e58d76a2d.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/epidemiologia-del-dolor-toracico\">EPIDEMIOLOG\u00cdA DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El\u00a0DOLOR TOR\u00c1CICOes \u00a0un\u00a0S\u00cdNDROME\u00a0DOLOROSOS EN EL T\u00d3RAX\u00a0\u00a0con gran impacto para la&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5c100c00eb863.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-torax\">ANATOM\u00cdA RELACIONADA CON EL T\u00d3RAX<span class=\"page-count\">2<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>A la hora de estudiar patolog\u00edas asociadas con\u00a0DOLOR EN EL T\u00d3RAX\u00a0o\u00a0realizar\u00a0T\u00c9CNICAS&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d3ead3222c7.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/etiopatogenia-del-dolor-toracico\">ETIOPATOGENIA DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">2<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El\u00a0DOLOR TOR\u00c1CICOes \u00a0un\u00a0S\u00cdNDROME\u00a0DOLOROSO LOCALIZADO\u00a0EN EL T\u00d3RAX. \u00a0No&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d40da85aaac.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/fisiopatologia-del-dolor-toracico\">FISIOPATOLOG\u00cdA DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>En el\u00a0\u00a0DOLOR TOR\u00c1CICOes necesario estudiar\u00a0los mecanismos por los cuales se origina\u00a0este tipo \u00a0de\u00a0dolor\u00a0, lo que permite&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d40e2bd4dcb.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/clasificacion-del-dolor-toracico\">CLASIFICACI\u00d3N DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">20<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Existen diferentes clasificaciones \u00a0del\u00a0DOLOR TOR\u00c1CICO.\u00a0A continuaci\u00f3n se\u00a0enumeran\u00a0diferentes\u00a0formas\u00a0de&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d40f0f9d0a4.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/clinica-del-dolor-toracico\">CL\u00cdNICA DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El proceso diagn\u00f3stico \u00a0del \u00a0DOLOR TOR\u00c1CICO\u00a0 debe incluir \u00a0el \u00a0reconocimiento de las\u00a0MANIFESTACIONES CL\u00cdNICAS&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d40f8e6f03a.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/complicaciones-asociadas-al-dolor-toracico\">COMPLICACIONES ASOCIADAS AL DOLOR TOR\u00c1CICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>A \u00a0la \u00a0hora \u00a0de \u00a0abordar \u00a0 el \u00a0DOLOR TOR\u00c1CICO\u00a0 \u00a0hemos \u00a0de \u00a0de conocer sus complicaciones.\u00a0 Este apartado \u00a0se centra&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d4108b42c92.png\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/valoracion-del-dolor-toracico\">VALORACI\u00d3N DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Cuando se\u00a0 vaya\u00a0a\u00a0realizar una \u00a0\u00a0EVALUACI\u00d3N DEL DOLORdel\u00a0DOLOR TOR\u00c1CICOdebe\u00a0\u00a0tenerse\u00a0 presente\u00a0 que&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d4110a58ec9.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/diagnostico-diferencial-del-dolor-toracico\">DIAGN\u00d3STICO DIFERENCIAL DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Aunque en la mayor\u00eda de las ocasiones el\u00a0DOLOR TOR\u00c1CICO\u00a0es inespec\u00edfico, es conveniente realizar un diagn\u00f3stico&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d41251de313.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/pronostico-del-dolor-toracico\">PRON\u00d3STICO DEL DOLOR TOR\u00c1CICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El\u00a0DOLOR TOR\u00c1CICO\u00a0\u00a0representa uno de los principales retos cl\u00ednicos, tanto por su prevalencia como por la trascendencia de&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/57d419cfd3d8d.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<div class=\"link-card-info-content\">\n<p>El TRATAMIENTO DEL DOLORdel \u00a0DOLOR TOR\u00c1CICO se debe sustentar \u00a0en \u00a0el \u00a0\u00a0TRATAMIENTO ETIOL\u00d3GICO DEL&#8230;<\/p>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\"><\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5aca87b673523.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/infiltraciones-musculares-en-el-torax-1\">INFILTRACIONES MUSCULARES EN EL T\u00d3RAX<span class=\"page-count\">24<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Una\u00a0 de las\u00a0POSIBILIDADES DE INFILTRACI\u00d3N DE LA PARED TOR\u00c1CICA\u00a0son las INFILTRACIONES&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5c9b709487895.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/infiltraciones-articulares-en-la-pared-toracica\">INFILTRACIONES ARTICULARES EN LA PARED TOR\u00c1CICA<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Ver\u00a0INFILTRACIONES ARTICULARES EN EL T\u00d3RAX<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5921b60a6f3ab.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p>BLOQUEO INTERPLEURAL<\/p>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>El bloqueo interpleural o intrapleural\u00a0\u00a0 es \u00a0una\u00a0\u00a0\u00a0INFILTRACI\u00d3N DE LA PARED TOR\u00c1CICA\u00a0que puede emplearse \u00a0dentro \u00a0de las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-control-del-dolor-agudo\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL CONTROL DEL <\/a>DOLOR<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-control-del-dolor-agudo\" target=\"_self\" rel=\"noopener\"> AGUDO<\/a>\u00a0 &#8211;\u00a0 y\u00a0las\u00a0ESTRATEGIAS ANALG\u00c9SICAS EN EL CONTROL DEL DOLOR CR\u00d3NICO\u00a0 \u00a0 como \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">T\u00c9CNICA\u00a0INTERVENCIONISTA\u00a0PARA EL TRATAMIENTO DEL DOLOR<\/a><\/p>\n<p>En \u00a0este \u00a0caso \u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/infiltraciones\" target=\"_self\" rel=\"noopener\">infiltraci\u00f3n<\/a>\u00a0se realiza\u00a0<strong>entre la pleura pariental y la pleura viscera<\/strong>l \u00a0con el fin de conseguir una analgesia \u00a0toracoabdominal uni o bilateral \u00a0 al \u00a0actuar \u00a0sobre<em>\u00a0m\u00faltiples\u00a0 nervios\u00a0 intercostales\u00a0 y\u00a0 la\u00a0 cadena\u00a0\u00a0 de ganglios\u00a0 simp\u00e1ticos\u00a0 tor\u00e1cicos<\/em><\/p>\n<p>Figura 1.-Abordaje \u00a0del BLOQUEO INTERPLEURAL. \u00a0 \u00a0El \u00a0 bloqueo interpleural\u00a0\u00a0se suele\u00a0 realizar \u00a0a \u00a0trav\u00e9s de un\u00a0espacio intercostal en la l\u00ednea axilar media \u00a0-generalmente se\u00a0 aborda\u00a0 uno\u00a0 el \u00a05\u00ba,\u00a0 6\u00ba,7\u00ba,8\u00ba \u00f3 9\u00ba- \u00a0con un \u00e1ngulo de aproximadamente 30\u00ba-40\u00ba rozando el borde\u00a0 superior\u00a0 de la\u00a0 costilla\u00a0 inferior\u00a0del\u00a0 espacio\u00a0 intercostal\u00a0 elegido\u00a0 (\u00a0 con\u00a0 el\u00a0 fin\u00a0 de\u00a0 evitar lesiones\u00a0\u00a0 en el paquete\u00a0 vasculonervioso\u00a0 que\u00a0 se\u00a0 encuentra\u00a0 en el\u00a0 borde\u00a0 inferior\u00a0 de la\u00a0 costilla\u00a0 superior )\u00a0 . Una \u00a0vez \u00a0se perfora \u00a0la membrana intercostal caudal se utiliza \u00a0t\u00e9cnca \u00a0de p\u00e9rdida \u00a0de resitencia \u00a0o \u00a0gota colgante \u00a0\u00a0.\u00a0 Al\u00a0 entrar\u00a0\u00a0 en\u00a0 la\u00a0 cavidad\u00a0 pleural\u00a0\u00a0\u00a0 se percibe \u00a0un click\u00a0 ctco\u00a0\u00a0 y \u00a0se nota la p\u00e9rdida \u00a0de resitencia \u00a0 y\/o el\u00a0 \u00e9mbolo\u00a0 es\u00a0 succionado\u00a0 unos\u00a0 2\u00a0 ml\u00a0 por\u00a0 efecto\u00a0 de la presi\u00f3n\u00a0 negativa intrapleural . Esta\u00a0 presi\u00f3n negativa\u00a0 aumenta\u00a0 con\u00a0 cada inspiraci\u00f3n se puede\u00a0 observar un\u00a0 desplazamiento\u00a0 del\u00a0 \u00e9mbolo\u00a0 hacia\u00a0 adentro\u00a0 acompa\u00f1ando\u00a0 cada\u00a0 inspiraci\u00f3n\u00a0 del paciente<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/bloqueo%20interpleural.JPG\" alt=\"\" \/><\/p>\n<p>Su \u00a0realizaci\u00f3n implica \u00a0conocer la \u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-la-pared-toracica\" target=\"_self\" rel=\"noopener\">ANATOM\u00cdA DE LA\u00a0PARED TOR\u00c1CICA<\/a><\/p>\n<p>Esta \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-en-el-torax\" target=\"_self\" rel=\"noopener\">T\u00c9CNICA\u00a0INTERVENCIONISTA\u00a0EN EL T\u00d3RAX<\/a>\u00a0 se ha \u00a0propuesto\u00a0como\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-control-del-dolor-agudo\" target=\"_self\" rel=\"noopener\">ESTRATEGIA\u00a0ANALG\u00c9SICA\u00a0EN EL CONTROL DEL DOLOR AGUDO<\/a>\u00a0y \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-control-del-dolor-cronico\" target=\"_self\" rel=\"noopener\">ESTRATEGIA ANALG\u00c9SICA\u00a0EN EL CONTROL DEL DOLOR CR\u00d3NICO<\/a>\u00a0 . Sin embargo , numerosos estudios han mostrado una gran variabilidad en su efecto analg\u00e9sico\u00a0.\u00a0\u00a0Como \u00a0ejemplo \u00a0citar \u00a0su uso \u00a0 en el \u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-del-dolor-postoperatorio\" target=\"_self\" rel=\"noopener\">TRATAMIENTO DEL DOLOR POSTOPERATORIO<\/a>\u00a0 &#8211; \u00a0se ha utilizado\u00a0en el\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-postoperatorio-en-cirugia-de-torax\" target=\"_self\" rel=\"noopener\">DOLOR POSTOPERATORIO EN CIRUG\u00cdA DE T\u00d3RAX<\/a>\u00a0 \u00a0&#8211; toracotom\u00edas\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#8857cbd7-b594-ee8c-a178-225cad6930f7\" name=\"entry-8857cbd7-b594-ee8c-a178-225cad6930f7\" data-bibliography-uid=\"8857cbd7-b594-ee8c-a178-225cad6930f7\">1<\/a>\u00a0, \u00a0cirug\u00eda \u00a0de mama<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#6bc98538-d7c4-8875-a0c1-93dc4b7121ab\" name=\"entry-6bc98538-d7c4-8875-a0c1-93dc4b7121ab\" data-bibliography-uid=\"6bc98538-d7c4-8875-a0c1-93dc4b7121ab\">2<\/a>\u00a0&#8211; \u00a0 , en el \u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/dolor-postoperatorio-tras-cirugia-de-columna\" target=\"_self\" rel=\"noopener\">Dolor postoperatorio tras cirug\u00eda de columna<\/a>\u00a0y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-postoperatorio-en-cirugia-de-abdomen-y-pelvis\" target=\"_self\" rel=\"noopener\">DOLOR POSTOPERATORIO EN CIRUG\u00cdA DE ABDOMEN Y PELVIS<\/a>\u00a0&#8211; \u00a0 colecistectom\u00eda<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#72276f8a-a770-e41f-c8b0-7d4a3b3af8f2\" name=\"entry-72276f8a-a770-e41f-c8b0-7d4a3b3af8f2\" data-bibliography-uid=\"72276f8a-a770-e41f-c8b0-7d4a3b3af8f2\">3<\/a>, \u00a0nefrectom\u00edas<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#407d89d7-617f-4bee-c1f6-9397dcde86ff\" name=\"entry-407d89d7-617f-4bee-c1f6-9397dcde86ff\" data-bibliography-uid=\"407d89d7-617f-4bee-c1f6-9397dcde86ff\">4<\/a>&#8211; \u00a0 . \u00a0 Tambi\u00e9n \u00a0existe bibliograf\u00eda de\u00a0 su uso en \u00a0fracturas costales<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#62537ae6-0944-2765-d712-b0bb1d469db6\" name=\"entry-62537ae6-0944-2765-d712-b0bb1d469db6\" data-bibliography-uid=\"62537ae6-0944-2765-d712-b0bb1d469db6\">5<\/a>\u00a0, traumatismos tor\u00e1cicos<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#59b79c8e-cb06-2746-a9df-8d9e9aa10223\" name=\"entry-59b79c8e-cb06-2746-a9df-8d9e9aa10223\" data-bibliography-uid=\"59b79c8e-cb06-2746-a9df-8d9e9aa10223\">6<\/a>\u00a0\u00a0y Herpes\u00a0 zoster\u00a0 en\u00a0 fase\u00a0 aguda.<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#3609e870-1f64-d36c-7d27-072cea413ad9\" name=\"entry-3609e870-1f64-d36c-7d27-072cea413ad9\" data-bibliography-uid=\"3609e870-1f64-d36c-7d27-072cea413ad9\">7<\/a>\u00a0\u00a0En \u00a0el \u00a0caso \u00a0utilizarse para el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-nerviosos-en-dolor-cronico\" target=\"_self\" rel=\"noopener\">BLOQUEOS NERVIOSOS EN DOLOR CR\u00d3NICO<\/a>\u00a0\u00a0 es \u00a0susceptible \u00a0de emplearse\u00a0 como una \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">T\u00c9CNICA\u00a0INTERVENCIONISTA\u00a0PARA EL TRATAMIENTO DEL DOLOR<\/a>\u00a0\u00a0 \u00a0dentro \u00a0de las\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-en-el-torax\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS INTERVENCIONISTAS EN EL T\u00d3RAX<\/a>\u00a0. \u00a0para el \u00a0alivio \u00a0del \u00a0dolor \u00a0cr\u00f3nico oncol\u00f3gico en diversos \u00a0 \u00a0 tumores que \u00a0cursaban con dolor referido \u00a0a las met\u00e1meras tor\u00e1cicas\u00a0<a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-interpleural#379b64a1-55a2-a8cc-9cd8-e4103cbb7a34\" name=\"entry-379b64a1-55a2-a8cc-9cd8-e4103cbb7a34\" data-bibliography-uid=\"379b64a1-55a2-a8cc-9cd8-e4103cbb7a34\">8<\/a><\/p>\n<p>Alternativas \u00a0a \u00a0este \u00a0procedimiento \u00a0son: \u00a0\u00a01 )\u00a0\u00a0 la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnica-epidural-toracica\" target=\"_self\" rel=\"noopener\">T\u00c9CNICA EPIDURAL TOR\u00c1CICA<\/a>\u00a0; \u00a02) el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-paravertebral-toracico-1\" target=\"_self\" rel=\"noopener\">BLOQUEO PARAVERTEBRAL TOR\u00c1CICO<\/a>; \u00a03) el \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueo-de-los-nervios-intercostales\" target=\"_self\" rel=\"noopener\">BLOQUEO DE LOS NERVIOS INTERCOSTALES<\/a>\u00a0; 4) \u00a0los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/bloqueos-fasciales-en-la-pared-toracica\" target=\"_self\" rel=\"noopener\">BLOQUEOS FASCIALES EN LA PARED TOR\u00c1CICA<\/a>\u00a0; 4) El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-radicular-selectivo-toracico-o-bloqueo-sobre-el-ganglio-de-la-raiz-dorsal-de-t1-t12\" target=\"_self\" rel=\"noopener\">BLOQUEO RADICULAR SELECTIVO TOR\u00c1CICO O\u00a0 BLOQUEO SOBRE EL GANGLIO DE LA RA\u00cdZ DORSAL DE\u00a0\u00a0de T1 &#8211; T12<\/a><\/p>\n<div class=\"row container-row content-header\">\n<div class=\"col-md-9\">\n<h1>ESTRATEGIAS ANALG\u00c9SICAS EN EL CONTROL DEL DOLOR AGUDO<\/h1>\n<\/div>\n<div class=\"col-md-3\"><a class=\"popupLauncher btn btn-big btn-primary pull-right visible-lg visible-md\" href=\"https:\/\/dolopedia.com\/login\">\u00a0Solicitar nuevo art\u00edculo<\/a><\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<p>Cuando\u00a0 se plantea\u00a0 realizar un<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">\u00a0tratamiento\u00a0 del dolor\u00a0<\/a>\u00a0 para un\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/dolor-agudo\" target=\"_self\" rel=\"noopener\">DOLOR AGUDO<\/a>\u00a0\u00a0 hay\u00a0 que\u00a0 rese\u00f1ar que lo m\u00e1s habitual\u00a0 es\u00a0 considerar un\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-farmacologico-del-dolor-agudo\" target=\"_self\" rel=\"noopener\">TRATAMIENTO FARMACOL\u00d3GICO\u00a0 DEL DOLOR AGUDO<\/a>\u00a0\u00a0\u00a0 aunque\u00a0 existen\u00a0 posibilidad\u00a0 de\u00a0\u00a0 considerar\u00a0 un \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tratamiento-no-farmacologico-del-dolor\" target=\"_self\" rel=\"noopener\">TRATAMIENTO NO FARMACOL\u00d3GICO DEL DOLOR<\/a><\/p>\n<p>A continuaci\u00f3n\u00a0\u00a0 se enumeran\u00a0 diferentes estrategias analg\u00e9sicas\u00a0\u00a0 ante diferentes\u00a0 tipos de dolor\u00a0 agudo\u00a0 como\u00a0 son\u00a0las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-dolor-agudo-postoperatorio\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL DOLOR AGUDO POSTOPERATORIO<\/a>\u00a0 , las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-dolor-obstetrico\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL DOLOR OBST\u00c9TRICO<\/a>, las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-paciente-politraumatizado\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL\u00a0 PACIENTE POLITRAUMATIZADO<\/a>, las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-paciente-gran-quemado\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN EL PACIENTE GRAN QUEMADO<\/a>\u00a0 y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-dolores-sintomaticos\" target=\"_self\" rel=\"noopener\">ESTRATEGIAS ANALG\u00c9SICAS EN DOLORES SINTOM\u00c1TICOS<\/a><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d3444769d59.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-dolor-agudo-postoperatorio\">ESTRATEGIAS ANALG\u00c9SICAS EN EL DOLOR AGUDO POSTOPERATORIO<span class=\"page-count\">75<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Dentro \u00a0de las \u00a0ESTRATEGIAS ANALG\u00c9SICAS EN EL CONTROL DEL DOLOR AGUDO\u00a0deben\u00a0considerarse las&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d344a565bfa.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-dolor-obstetrico\">ESTRATEGIAS ANALG\u00c9SICAS EN EL DOLOR OBST\u00c9TRICO<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Dentro \u00a0de las \u00a0ESTRATEGIAS ANALG\u00c9SICAS\u00a0 EN EL CONTROL DEL DOLOR AGUDO\u00a0se deben \u00a0considerar\u00a0\u00a0las&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d86ac87ef47.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-paciente-politraumatizado\">ESTRATEGIAS ANALG\u00c9SICAS EN EL PACIENTE POLITRAUMATIZADO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Dentro \u00a0de las \u00a0ESTRATEGIAS ANALG\u00c9SICAS\u00a0 EN EL CONTROL DEL DOLOR AGUDO\u00a0se deben \u00a0considerar\u00a0\u00a0las&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d344fe81536.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-el-paciente-gran-quemado\">ESTRATEGIAS ANALG\u00c9SICAS EN EL PACIENTE GRAN QUEMADO<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Dentro \u00a0de las \u00a0ESTRATEGIAS ANALG\u00c9SICAS\u00a0 EN EL CONTROL DEL DOLOR AGUDO\u00a0se deben \u00a0considerar\u00a0\u00a0las&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/56d3452e87fb3.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/estrategias-analgesicas-en-dolores-sintomaticos\">ESTRATEGIAS ANALG\u00c9SICAS EN DOLORES SINTOM\u00c1TICOS<span class=\"page-count\">0<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Dentro \u00a0de las \u00a0ESTRATEGIAS ANALG\u00c9SICAS\u00a0 EN EL CONTROL DEL DOLOR AGUDO\u00a0se deben \u00a0considerar\u00a0\u00a0las&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-12\">\n<h2 class=\"title title-small base-color\">Bibliograf\u00eda<\/h2>\n<ol class=\"strong\">\n<li><a name=\"8857cbd7-b594-ee8c-a178-225cad6930f7\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3674486\" target=\"_blank\" rel=\"noopener\">Continuous intrapleural infusion of bupivacaine for analgesia after thoracotomy , por Rosenberg PH, Scheinin BM, Lep\u00e4ntalo MJ, Lindfors O. en Anesthesiology. Vol. Nov;67(5) , en las p\u00e1ginas 811-3. , a\u00f1o 1987<\/a><\/li>\n<li><a name=\"6bc98538-d7c4-8875-a0c1-93dc4b7121ab\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16229706\" target=\"_blank\" rel=\"noopener\">Interpleural anaesthesia for mastectomy , por Higgins PC, Ravalia A. en Anaesthesia. Vol. Nov;60(11):\u00a1 , en las p\u00e1ginas 1150-1 , a\u00f1o 2005<\/a><\/li>\n<li><a name=\"72276f8a-a770-e41f-c8b0-7d4a3b3af8f2\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Postcholecistectomy+pain+relief+by+intrapleural+bupivacaine+in+patient+with+cystic+fibrosis+.\" target=\"_blank\" rel=\"noopener\">Postcholecystectomy pain relief by intrapleural bupivacaine in patients with cystic fibrosis. , por Bruce DL, Gerken MV, Lyon GD. en Anesth Analg. Vol. Nov;66(11) , en las p\u00e1ginas 1187-9. , a\u00f1o 1987<\/a><\/li>\n<li><a name=\"407d89d7-617f-4bee-c1f6-9397dcde86ff\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8009191\" target=\"_blank\" rel=\"noopener\">Interpleural analgesia for postoperative pain relief in renal surgery patients. , por Kaukinen S, Kaukinen L, Kataja J, K\u00e4rkk\u00e4inen S, Heikkinen A. en Scand J Urol Nephrol. Vol. Mar;28(1) , en las p\u00e1ginas 39-43. , a\u00f1o 1994<\/a><\/li>\n<li><a name=\"62537ae6-0944-2765-d712-b0bb1d469db6\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2006723\" target=\"_blank\" rel=\"noopener\">[Intrapleural catheter analgesia in patients with multiple rib fractures]. , por Wulf H, Jeckstr\u00f6m W, Maier C, Winckler K. en Anaesthesist. Vol. Jan;40(1) , en las p\u00e1ginas 19-24. , a\u00f1o 1991<\/a><\/li>\n<li><a name=\"59b79c8e-cb06-2746-a9df-8d9e9aa10223\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8651535\" target=\"_blank\" rel=\"noopener\">Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. , por Short K, Scheeres D, Mlakar J, Dean R. en Am Surg. Vol. Jun;62(6) , en las p\u00e1ginas 488-93. , a\u00f1o 1996<\/a><\/li>\n<li><a name=\"3609e870-1f64-d36c-7d27-072cea413ad9\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Interpleural+block+for+acute+combined+cervical+and+thoracic+herpes+zoste\" target=\"_blank\" rel=\"noopener\">Interpleural block for acute combined cervical and thoracic herpes zoster. , por Thwaites BK, Powell DR. en Reg Anesth. Vol. May-Jun;20(3) , en las p\u00e1ginas 255-6. , a\u00f1o 1995<\/a><\/li>\n<li><a name=\"379b64a1-55a2-a8cc-9cd8-e4103cbb7a34\"><\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7935235\" target=\"_blank\" rel=\"noopener\">Interpleural catheter analgesia for chronic pain treatment&#8211;a case report. , en Middle East J Anaesthesiol. Vol. Jun;12(5) , en las p\u00e1ginas 469-74. , a\u00f1o 1994<\/a><\/li>\n<\/ol>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"link-card-info\">\n<div class=\"link-card-info-content\">\n<p>El bloqueo interpleural o intrapleural\u00a0\u00a0 es \u00a0una\u00a0\u00a0\u00a0INFILTRACI\u00d3N DE LA PARED TOR\u00c1CICA\u00a0que puede emplearse \u00a0dentro&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/591c1efd822b5.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p>INFILTRACI\u00d3N DE LA HERIDA QUIR\u00daRGICA EN CIRUG\u00cdA TOR\u00c1CICA<span class=\"page-count\">1<\/span><\/p>\n<div class=\"link-card-info-content\">\n<p>La INFILTRACION DE LA HERIDA QUIR\u00daRGICA\u00a0es \u00a0un tipo de\u00a0\u00a0INFILTRACI\u00d3N EXTRAVASCULAR\u00a0&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><strong> TOR\u00c1CICA\u00a0<\/strong>\u00a0 .<\/p>\n<p>En\u00a0 este\u00a0 \u00a0apartado\u00a0 se\u00a0 proporciona informaci\u00f3n\u00a0 \u00a0sobre\u00a0\u00a0la\u00a0anatom\u00eda\u00a0 regional\u00a0 de\u00a0 la\u00a0 PARED TOR\u00c1CICA\u00a0 \u00a0que incluye\u00a0\u00a0el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/huesos-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">esqueleto tor\u00e1cico\u00a0<\/a>\u00a0, con\u00a0 los\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la pared tor\u00e1cica<\/a>\u00a0y el\u00a0 tejido conectivo\u00a0 que se les unen , as\u00ed como\u00a0por la piel, el tejido subcut\u00e1neo,y la\u00a0 grasa\u00a0 que lo cubren .\u00a0 Asimismo\u00a0 \u00a0,\u00a0 describe la\u00a0 \u00a0la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-superficie-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">configuraci\u00f3n\u00a0 de la\u00a0 superficie\u00a0 de la\u00a0 pared tor\u00e1cica\u00a0<\/a>\u00a0 con\u00a0 la finalidad\u00a0 de\u00a0 favorecer\u00a0 la\u00a0 realizaci\u00f3n\u00a0 de\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-intervencionistas-para-el-tratamiento-del-dolor\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS INTERVENCIONISTAS PARA EL TRATAMIENTO DEL DOLOR<\/a><\/p>\n<p>* Es interesante\u00a0 \u00a0rese\u00f1ar\u00a0 \u00a0 que\u00a0 las estructuras que cubren\u00a0 la cara posterior de la pared tor\u00e1cica\u00a0 se consideran pertenecientes al dorso.\u00a0 \u00a0Asimismo,\u00a0 las \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-la-glandula-mamaria\" target=\"_self\" rel=\"noopener\">gl\u00e1ndulas mamarias\u00a0<\/a>, a pesar\u00a0\u00a0de\u00a0 formar\u00a0parte del tejido subcut\u00e1neo de la pared tor\u00e1cica,\u00a0\u00a0se\u00a0 suelen\u00a0 \u00a0estudiar\u00a0 \u00a0de\u00a0 forma\u00a0 aislada<\/p>\n<p>* La\u00a0<strong>pared tor\u00e1cica<\/strong>\u00a0est\u00e1 formada por\u00a0un\u00a0esqueleto\u00a0constitu\u00eddo\u00a0por\u00a0atr\u00e1s por la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">columna vertebral tor\u00e1cica<\/a>, adelante por el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0y a cada lado por las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a><strong>\u00a0;<\/strong>\u00a0la pared es completada por los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-intercostales\" target=\"_self\" rel=\"noopener\">m\u00fasculos intercostales<\/a>\u00a0que ocupan el espacio entre dos\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0vecinas y adem\u00e1s se encargan de proteger estas cavidades.<\/p>\n<p>Figura\u00a0 1 .\u00a0<strong>Esqueleto\u00a0 tor\u00e1cico\u00a0\u00a0<\/strong>\u00a0:\u00a0 La\u00a0 caja\u00a0 tor\u00e1cica\u00a0 osteocartilaginosa\u00a0 incluye\u00a0 el\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0, 12 pares de\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0y\u00a0 cart\u00edlagos costales y\u00a0 12\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">vertebras tor\u00e1cicas<\/a>\u00a0y discos intervertebrales\u00a0 .\u00a0 Las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/clavicula\" target=\"_self\" rel=\"noopener\">clav\u00edculas<\/a>\u00a0 y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/escapula-omoplato\" target=\"_self\" rel=\"noopener\">esc\u00e1pulas\u00a0<\/a>\u00a0forman parte de la cintura escapular.\u00a0 La\u00a0 l\u00ednea discontinua\u00a0 indica la posici\u00f3n del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-diafragma\" target=\"_self\" rel=\"noopener\">m\u00fasculo diafragma<\/a>\u00a0 , que separa las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/cavidad-toracica\" target=\"_self\" rel=\"noopener\">cavidad tor\u00e1cica\u00a0<\/a>\u00a0y\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/cavidad-abdominal\" target=\"_self\" rel=\"noopener\">\u00a0cavidad abdominal<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/esqueleto_%20pared_toracica.JPG\" alt=\"\" \/><\/p>\n<p>Figura\u00a0 2\u00a0 .\u00a0<strong>M\u00fasculos de la pared tor\u00e1cica<\/strong>\u00a0.\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-pared-toracica-anterolateral\" target=\"_self\" rel=\"noopener\">M\u00daSCULOS DE LA PARED TOR\u00c1CICA ANTEROLATERAL<\/a><em>\u00a0 .\u00a0<\/em>El\u00a0 m\u00fasculo\u00a0 pectoral mayor ha sido retirado en el lado izquierdo para exponer el pectoral menor , el subclavio y los m\u00fasculos intercostales externos\u00a0 .\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-pared-toracica-posterior\" target=\"_self\" rel=\"noopener\">M\u00daSCULOS DE LA PARED TOR\u00c1CICA POSTERIOR<\/a><em>.\u00a0<\/em>Los m\u00fasculos iliocostal y long\u00edsimo\u00a0 (\u00a0 2\u00a0 de los 3\u00a0 componentes\u00a0 del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/bloqueo-en-el-plano-del-musculo-erector-de-la-columna-erector-spinae-plane-esp-block\" target=\"_self\" rel=\"noopener\">m\u00fasculo erector\u00a0 de la columna<\/a>\u00a0)\u00a0 han\u00a0 sido\u00a0 retirados para exponer los m\u00fasculos elevadores de las costillas . En los\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-del-espacio-intercostal\" target=\"_self\" rel=\"noopener\">espacios intercostales<\/a>\u00a08\u00ba y 10\u00ba , distintas partes de los m\u00fasculos intercostales externos han sido retiradas para exponer la membrana intercostal interna subyacente, que es continua con los m\u00fasculos intercostales internos .\u00a0 En el\u00a0 9\u00ba espacio intercostal , el elevador de la costilla ha sido retirado para exponer los vasos y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-los-nervios-intercostales-1\" target=\"_self\" rel=\"noopener\">\u00a0los nervios intercostales<\/a>.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/musculatura_pared_toracica.JPG\" alt=\"\" \/><\/p>\n<p>*Aunque\u00a0 los\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-hombro\" target=\"_self\" rel=\"noopener\">hombros\u00a0<\/a>\u00a0son\u00a0 claramente\u00a0 parte de los\u00a0 miembros\u00a0 superiores\u00a0 , los\u00a0 m\u00fasculos toracopaendiculares anterolaterales que cubren la caja tor\u00e1cica y forman el lecho\u00a0 del pecho\u00a0 \u00a0(\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-pectoral-mayor\" target=\"_self\" rel=\"noopener\">M\u00fasculo pectoral mayor<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-serrato-anterior-o-musculo-serrato-mayor\" target=\"_self\" rel=\"noopener\">m\u00fasculo serrato anterior o m\u00fasculo serrato mayor<\/a>\u00a0\u00a0 )\u00a0 \u00a0son\u00a0 considerados parte\u00a0 de la\u00a0 pared tor\u00e1cica\u00a0 &#8211;\u00a0 estos m\u00fasculos\u00a0 \u00a0tiene\u00a0 funci\u00f3n\u00a0 e inervaci\u00f3n\u00a0 diferente\u00a0 al\u00a0 de los miembros superiores &#8211;\u00a0 .<\/p>\n<p>*Los m\u00fasculos toracopendiculares posteriores\u00a0 (\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-trapecio\" target=\"_self\" rel=\"noopener\">m\u00fasculo trapecio<\/a>\u00a0y \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/musculo-dorsal-ancho\" target=\"_self\" rel=\"noopener\">m\u00fasculo dorsal ancho<\/a>)\u00a0 se consideran\u00a0 \u00a0m\u00fasculos superficiales de la espalda, a pesar que en\u00a0 t\u00e9rminos\u00a0 funcionales\u00a0 son\u00a0 claramente m\u00fasculos\u00a0 del miembro\u00a0 superior<\/p>\n<p>La pared tor\u00e1cica\u00a0 \u00a0protege\u00a0a la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/cavidad-toracica\" target=\"_self\" rel=\"noopener\">cavidad tor\u00e1cica<\/a>\u00a0 y\u00a0 a\u00a0 algunos \u00f3rganos\u00a0 abdominales\u00a0 alojados\u00a0 en la cavidad\u00a0 abdominal\u00a0 .\u00a0 Tambi\u00e9n\u00a0 da\u00a0 da soporte a\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-el-bloqueo-de-los-nervios-perifericos-en-las-extremidades-superiores\" target=\"_self\" rel=\"noopener\">estructuras del miembro superior\u00a0<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\">\n<h2 class=\"section-title\">SUBCATEGOR\u00cdAS<\/h2>\n<\/div>\n<\/div>\n<div class=\"row container-row section\">\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5a7f14f689a1e.jpg\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/generalidades-de-la-pared-toracica\">GENERALIDADES DE LA PARED TOR\u00c1CICA<span class=\"page-count\">1<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>A la hora de realizar\u00a0T\u00c9CNICAS INTERVENCIONISTAS EN EL T\u00d3RAX\u00a0 (\u00a0 como pueden\u00a0 \u00a0ser\u00a0 los \u00a0 \u00a0BLOQUEOS&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5a7f3f70d0f64.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/huesos-de-la-pared-toracica\">HUESOS DE LA PARED TOR\u00c1CICA<span class=\"page-count\">3<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>El\u00a0 \u00a0esqueleto\u00a0 tor\u00e1cico\u00a0 \u00a0forma la\u00a0 caja tor\u00e1cica\u00a0 osteocartilaginosa\u00a0 de\u00a0 la\u00a0\u00a0PARED TOR\u00c1CICA\u00a0 \u00a0que protege&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5a7f42be5ebac.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-pared-toracica\">M\u00daSCULOS DE LA PARED TOR\u00c1CICA<span class=\"page-count\">32<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>\u00a0 Los\u00a0 m\u00fasculos\u00a0 de\u00a0 \u00a0pared tor\u00e1cica \u00a0 \u00a0 son \u00a0 m\u00fasculos\u00a0 \u00a0que : 1)\u00a0 \u00a0participan en la formaci\u00f3n de la caja tor\u00e1cica\u00a0y est\u00e1n&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5c857f3664aff.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-de-la-pared-toracica\">ARTICULACIONES DE LA PARED TOR\u00c1CICA<span class=\"page-count\">10<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Las articulaciones de la \u00a0pared tor\u00e1cica\u00a0hacen referencia a\u00a0 diferentes\u00a0 articulaciones\u00a0 que\u00a0ocurren entre&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5a9852d987b9d.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/inervacion-de-la-pared-toracica\">INERVACI\u00d3N DE LA PARED TOR\u00c1CICA<span class=\"page-count\">3<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>Para\u00a0 conocer\u00a0 la INERVACI\u00d3N DE LA\u00a0\u00a0PARED TOR\u00c1CICA\u00a0 es\u00a0 interesante\u00a0\u00a0clasificar los nervios&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6 col-sm-6 block-card-width\">\n<div class=\"link-card link-card-md\">\n<div class=\"link-card-image\"><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/media\/cache\/category_large\/5a9a6403b24ef.JPG\" \/><\/div>\n<div class=\"link-card-info\">\n<p><a class=\"link-card-header\" href=\"https:\/\/dolopedia.com\/categoria\/vascularizacion-de-la-pared-toracica\">VASCULARIZACI\u00d3N DE LA PARED TOR\u00c1CICA<span class=\"page-count\">2<\/span><\/a><\/p>\n<div class=\"link-card-info-content\">\n<p>\u00a0 Los\u00a0 VASCULARIZACI\u00d3N\u00a0\u00a0ARTERIAL\u00a0 de la\u00a0\u00a0PARED TOR\u00c1CICA\u00a0 \u00a0 y su contenido se\u00a0 lleva\u00a0 a cabo por ramas de tres vasos\u00a0&#8230;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"row container-row section light-background\">\n<div class=\"col-md-12\"><\/div>\n<\/div>\n<p>Estos huesos\u00a0 poseen distintos nombre por su manera de articular con el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>. As\u00ed tenemos: \u00a07 pares de\u00a0<strong>costillas verdaderas:<\/strong>\u00a0 son\u00a0 las que poseen una superficie articular exclusiva para cada una con el estern\u00f3n;\u00a0 3 pares de\u00a0<strong>costillas falsas:\u00a0<\/strong>\u00a0 se unen en un gran cart\u00edlago costal com\u00fan para tomar inserci\u00f3n en el estern\u00f3n; \u00a02 pares de\u00a0<strong>costillas flotantes<\/strong>;:\u00a0no poseen articulaci\u00f3n con el estern\u00f3n ya que son muy cortas y nunca llegan a \u00e9l.<\/p>\n<p><strong>Figura 1. Costillas<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/costillas.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Las\u00a0costillas\u00a0se articulan en la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-la-pared-toracica\" target=\"_self\" rel=\"noopener\">pared tor\u00e1cica\u00a0<\/a>\u00a0 en\u00a0 diferentes\u00a0 puntos\u00a0 \u00a0As\u00ed\u00a0 \u00a0,\u00a0 \u00a0las\u00a0 costillas\u00a0 \u00a0pueden\u00a0 articularese\u00a0 con :\u00a0\u00a0<strong>\u00a0I)\u00a0 Con\u00a0las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras tor\u00e1cicas\u00a0<\/a>\u00a0 de\u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>\u00a0<\/strong>mediante dos articulaciones: \u00a01)\u00a0<strong><em>Las\u00a0\u00a0<\/em><\/strong><em><strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costovertebrales\" target=\"_self\" rel=\"noopener\">articulaciones costovertebrales<\/a><\/strong><\/em>: son las articulaciones entre las cabezas de las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costillas<\/a>\u00a0 y las\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0tor\u00e1cicas<\/a>\u00a0;\u00a0y<strong><em>\u00a02)\u00a0 Las\u00a0<\/em><\/strong><em><strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costotransversas\" target=\"_self\" rel=\"noopener\">articulaciones costotransversas<\/a><\/strong><\/em>\u00a0:\u00a0son las\u00a0articulaciones\u00a0entre\u00a0 el tub\u00e9rculo de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>\u00a0con el proceso transverso de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0tor\u00e1cica<\/a>\u00a0del mismo n\u00famero.<strong>\u00a0II) Con los cart\u00edlagos costales :\u00a0<\/strong>\u00a0<strong><em>Las\u00a0\u00a0<\/em><\/strong><em><strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costocondrales\" target=\"_self\" rel=\"noopener\">articulaciones costocondrales<\/a><\/strong><\/em><strong><em>\u00a0.\u00a0<\/em><\/strong>Son las articulaciones\u00a0entre el\u00a0 borde lateral del cart\u00edlago y el extremo esternal de la costilla.\u00a0\u00a0<strong>\u00a0III.- Con\u00a0los cart\u00edlagos costales<em>\u00a0:\u00a0 las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-intercondrales\" target=\"_self\" rel=\"noopener\">articulaciones intercondrales<\/a><\/em>\u00a0. IV.- Con\u00a0\u00a0el\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0:\u00a0 hay que considerar:\u00a0<strong>1) Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulacion-esternoclavicular\" target=\"_self\" rel=\"noopener\">articulaci\u00f3nes esternoclaviculares- o esternocostoclaviculares-<\/a><em>\u00a0<\/em>y<\/strong><strong>\u00a02)<em>\u00a0Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-esternocostales\" target=\"_self\" rel=\"noopener\">articulaciones esternocostales<\/a><\/em><\/strong><\/p>\n<p>Todas las costillas tienen elementos comunes: 1)\u00a0\u00a0la cabeza,\u00a0 2)\u00a0 el cuello, 3)\u00a0 el tub\u00e9rculo articular para la v\u00e9rtebra, 4)\u00a0 el cuerpo , 5) la\u00a0superficie articular para el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0(uni\u00f3n costocondral y cart\u00edlago costal)<\/p>\n<p><strong>Figura\u00a0 2\u00a0 . Partes de\u00a0 una costilla\u00a0<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/partes_costilla.JPG\" alt=\"\" \/><\/p>\n<p>Las costillas protegen los \u00f3rganos vitales (coraz\u00f3n\u00a0y los\u00a0pulmones) y permiten facilitar la respiraci\u00f3n acompa\u00f1ando a los movimientos de inspiraci\u00f3n \/ espiraci\u00f3n.<\/p>\n<p>&nbsp;<\/p>\n<h2 id=\"acItem_content\">Contenido del art\u00edculo<\/h2>\n<div class=\"editor-field\">\n<ul>\n<li>Se denominan costillas a doce pares de huesos, de forma alargada, que se articulan en su zona posterior con las v\u00e9rtebras de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral\u00a0<\/a>l y en su parte anterior, articulan mediante un cart\u00edlago, con el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/esternon\" target=\"_self\" rel=\"noopener\">estern\u00f3n<\/a>\u00a0 (excepto las costillas falsas). Las costillas se ubican a transversales en el t\u00f3rax, y su principal funci\u00f3n es proteger los pulmones.<\/li>\n<\/ul>\n<p>Figura\u00a0 1. Costillas<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/www.dolopedia.com\/uploads\/media\/194-encarnacion-maria-belen\/Anatomia%20vert%20torac%20y%20costilla.PNG\" alt=\"\" \/><\/p>\n<ul>\n<li>Las\u00a0costillas\u00a0se articulan en la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/anatomia-relacionada-con-la-pared-toracica\" target=\"_self\" rel=\"noopener\">pared tor\u00e1cica\u00a0<\/a>\u00a0 en\u00a0 diferentes\u00a0 puntos\u00a0 tal y\u00a0 como\u00a0 se\u00a0 explica\u00a0 en el\u00a0 apartado\u00a0\u00a0<strong><em><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-en-las-que-estan-involucradas-las-costillas\" target=\"_self\" rel=\"noopener\">ARTICULACIONES EN LAS QUE EST\u00c1N INVOLUCRADAS LAS COSTILLAS<\/a><\/em><\/strong><\/li>\n<\/ul>\n<p><span style=\"font-size: 36px; font-weight: 600;\">Articulaciones costovertebrales<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"tab-content\">\n<div id=\"article-content\" class=\"tab-pane active\">\n<div id=\"article-body\" class=\"row container-row container-right-column\">\n<div class=\"col-md-12 pull-left\">\n<p>\u00a0<strong>Las\u00a0articulaciones costovertebrales\u00a0<\/strong>\u00a0son\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-en-las-que-estan-involucradas-las-costillas\" target=\"_self\" rel=\"noopener\">articulaciones en las que est\u00e1n involucradas las costillas<\/a>\u00a0 \u00a0 \u00a0y las\u00a0 \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras tor\u00e1cicas\u00a0<\/a>\u00a0 de\u00a0la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/columna-vertebral\" target=\"_self\" rel=\"noopener\">columna vertebral<\/a>\u00a0\u00a0 .\u00a0 M\u00e1s espec\u00edficamente\u00a0 , las articulaciones costovertebrales son las articulaciones existentes entre\u00a0\u00a0la cabeza de la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>\u00a0con los dos cuerpos vertebrales\u00a0 de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras tor\u00e1cicas\u00a0<\/a>\u00a0adyacentes y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">disco intervertebral\u00a0<\/a>\u00a0que hay entre ellas,<\/p>\n<p><strong>Figura\u00a0 1 .\u00a0Articulaciones\u00a0costovertebrales\u00a0 de una\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0tor\u00e1cica<\/a>\u00a0t\u00edpica.\u00a0<\/strong>Las\u00a0\u00a0articulaciones\u00a0 costovertebrales\u00a0 son las articulaciones constitu\u00eddas\u00a0por la articulaci\u00f3n de la cabeza de la \u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>\u00a0con la\u00a0de los 2 cuerpos de las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0tor\u00e1cicas<\/a>\u00a0adyacentes\u00a0 y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">disco intervertebral\u00a0<\/a>\u00a0exstente entre ellos .\u00a0 En ellas hay\u00a0cart\u00edlago, c\u00e1psula articular y bolsa sinovial. Estas\u00a0 articulaciones son\u00a0 diferentes\u00a0 a\u00a0 las\u00a0\u00a0articulaciones\u00a0 costotransversas formadas\u00a0por la articulaci\u00f3n\u00a0 del tub\u00e9rculo de la \u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">costilla<\/a>\u00a0con la ap\u00f3fisis transversa de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebra\u00a0tor\u00e1cica<\/a>\u00a0. Particularidades :\u00a0 Las costillas 1\u00aa, 11\u00aa y 12\u00aa se articulan con su correspondiente v\u00e9rtebra, mientras que las articulaciones de la 2\u00aa a la 10\u00aa se articulan con su v\u00e9rtebra y con la superior.\u00a0 \u00a0Movimiento :\u00a0 La\u00a0 costilla se desplaza ( sube y baja ) alrededor de un eje que cruza la cabeza y el cuello de la costilla<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/articulac_costovertebral_2_buena.JPG\" alt=\"\" \/><\/p>\n<p>Estas articulaciones\u00a0 son la diana sobre las que se puede realizar la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/infiltracion-de-las-articulaciones-costovertebrales\" target=\"_self\" rel=\"noopener\">infiltraci\u00f3n de las articulaciones costovertebrales<\/a>\u00a0 \u00a0en\u00a0 caso\u00a0 del\u00a0dolor cr\u00f3nico psudovisceral\u00a0\u00a0\u00a0referidos\u00a0\u00a0al t\u00f3rax, abdomen, costados y regi\u00f3n paraespinal.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>El\u00a0<ins>agujero vertebra<\/ins>l es de forma circular y de menor tama\u00f1o que los de las v\u00e9rtebras cervicales y lumbares. Las<ins>\u00a0ap\u00f3fisis transversas<\/ins>\u00a0son largas y se extienden en forma posterolateral; las ap\u00f3fisis articulares tienen caras superiores dirigidas en sentido posterior y lateral, sus caras inferiores ubicadas a nivel anterior y medial. Las\u00a0<ins>ap\u00f3fisis espinosas<\/ins>\u00a0de esta regi\u00f3n son las m\u00e1s largas de toda la columna vertebral.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/vertebra_toracica.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><em>Cuerpo<\/em>\u00a0\u00a0<\/strong>: tiene forma de un cubo , con\u00a0 2\u00a0 carillas\u00a0 articulares , superior e inferior<\/li>\n<\/ul>\n<p>El\u00a0 cuerpo\u00a0es\u00a0 redondeado, m\u00e1s voluminoso cuanto mas abajo\u00a0 se considere . Los\u00a0cuerpos\u00a0en el medio de la regi\u00f3n tor\u00e1cica son en forma de\u00a0coraz\u00f3n, y tan anchos en la direcci\u00f3n anteroposterior como en la transversal.\u00a0En los extremos de la regi\u00f3n tor\u00e1cica se asemejan respectivamente a las de las v\u00e9rtebras cervicales y lumbares.<\/p>\n<p>Las caras laterales del cuerpo vertebral presentan un canal circunferencial y , por delante de los ped\u00edculos , 2 fositas costales, superior e inferior , cerca de los bordes\u00a0 del cuerpo . \u00c9stas forman, con las fositas hom\u00f3logas de las v\u00e9rtebras suprayacente y subyacente, un \u00e1ngulo entrante, cuyo v\u00e9rtice corresponde al disco intervertebral , en el que se aloja la cabeza costal\u00a0de las 12 pares de costillas con las 12 v\u00e9rtebras tor\u00e1cicas (\u00a0 articulacion costovertebral )<\/p>\n<p><strong>Figura 5\u00a0.\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costovertebrales\" target=\"_self\" rel=\"noopener\">Articulaciones costovertebrales<\/a>\u00a0y\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costotransversas\" target=\"_self\" rel=\"noopener\">articulaciones costotransversas<\/a>\u00a0de una v\u00e9rtebra tor\u00e1cica t\u00edpica<\/strong>\u00a0 Las\u00a0\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costovertebrales\" target=\"_self\" rel=\"noopener\">articulaciones costovertebrales<\/a><\/strong>\u00a0se forman por la articulaci\u00f3n\u00a0de la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">cabeza de la costilla<\/a>\u00a0\u00a0con la\u00a0de los 2 cuerpos adyacentes\u00a0 y el\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">disco\u00a0intervertebral<\/a>\u00a0existente entre ellos .\u00a0 Las\u00a0\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/articulaciones-costotransversas\" target=\"_self\" rel=\"noopener\">articulaciones costotransversas<\/a><\/strong>\u00a0se\u00a0 forman por la articulaci\u00f3n\u00a0 del\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/costillas\" target=\"_self\" rel=\"noopener\">tub\u00e9rculo de la costilla<\/a>\u00a0con la ap\u00f3fisis transversa de la v\u00e9rtebra . La\u00a0 costilla se\u00a0 desplaza (\u00a0 sube\u00a0 y\u00a0 baja )\u00a0 alrededor de un eje que\u00a0 cruza la cabeza y el cuello de la costilla<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/articulac_costotransversa_costovertebral.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li><strong><em>Ped\u00edculos\u00a0<\/em>:<\/strong>\u00a0unen\u00a0 el\u00a0 cuerpo vertebral\u00a0 a la masa \u00f3sea.<\/li>\n<\/ul>\n<p>Tienen un borde superior ligeramente c\u00f3ncavo, mientras que su borde inferior presenta una fuerte escotadura de acuerdo con la inclinaci\u00f3n de las l\u00e1minas y de las ap\u00f3fisis\u00a0 espinosas<\/p>\n<ul>\n<li><strong><em>L\u00e1minas\u00a0\u00a0<\/em>:<\/strong>\u00a0 son\u00a0 cuadril\u00e1teras,\u00a0 casi verticales<\/li>\n<li><strong><em>Ap\u00f3fisis\u00a0 \u00a0espinosa\u00a0<\/em>\u00a0:<\/strong>\u00a0Las\u00a0 ap\u00f3fisis\u00a0 espiosas\u00a0 que\u00a0 salen de los arcos vertebrales de las\u00a0 v\u00e9rtebras tor\u00e1cicas t\u00edpicas son largas y se inclinan hacia abajo y atr\u00e1s, alcanzando la v\u00e9tebra inferior .\u00a0 Forma prism\u00e1tica triangular no\u00a0 \u00a0bifurcada\u00a0. El borde superior es romo;\u00a0 el borde inferior,\u00a0 excavado en canal; sus caras laterales se estrechan hacia el v\u00e9rtice.\u00a0Cuben los\u00a0 intervalos\u00a0\u00a0 entre las l\u00e1minas\u00a0 de las\u00a0 v\u00e9rtebras\u00a0 adyacentes\u00a0\u00a0 para as\u00ed prevenir\u00a0 que\u00a0 objetos punzantes\u00a0 puedan\u00a0 penetrar en el\u00a0 conducto\u00a0 vertebral\u00a0 medular<\/li>\n<li><strong><em>Ap\u00f3fisis\u00a0 transversas<\/em>:\u00a0\u00a0<\/strong>\u00a0se separan ampliamente por detr\u00e1s\u00a0 del ped\u00edculo . En la\u00a0 cara anterior de su v\u00e9rtice presentan una fosita articular , la fosita costal de la ap\u00f3fisis transversa ,\u00a0 donde se articula el tub\u00e9rculo costal (\u00a0 articulaci\u00f3n costotransversa )<\/li>\n<li><strong><em>Ap\u00f3fisis articulares\u00a0<\/em>\u00a0\u00a0<\/strong>; las\u00a0 superiores , muy\u00a0 salientes , se elevan\u00a0 en sentido vertical . Las inferiores, por el contrario ,\u00a0 est\u00e1n\u00a0 reducidas\u00a0 a 2 carillas articulares , sobre la cara anterior de\u00a0 las l\u00e1minas, orientadas hacia adelante y lgo medialmente .<\/li>\n<li><strong>Agujero raqu\u00eddeo :<\/strong>\u00a0es\u00a0 casi\u00a0 circular y comparativamente peque\u00f1o .<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>\u00bfQu\u00e9 vertebras la\u00a0 componen\u00a0 ?\u00a0\u00a0<\/strong>De las 12\u00a0 v\u00e9rtebras tor\u00e1cicas\u00a0 \u00a0que\u00a0 componen la columna dorsal\u00a0 de la segunda a la octava v\u00e9rtebra tor\u00e1cica se\u00a0consideran t\u00edpicas.\u00a0La primera y la novena a la duod\u00e9cima v\u00e9rtebra contienen ciertas peculiaridades que\u00a0se detallan a continuaci\u00f3n.<\/li>\n<\/ul>\n<p><strong>&#8211; T1:\u00a0<\/strong>V\u00e9rtebra\u00a0 de transici\u00f3n entre las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-cervical\" target=\"_self\" rel=\"noopener\">columna\u00a0 cervical<\/a>\u00a0y tor\u00e1cica . La primera v\u00e9rtebra tor\u00e1cica tiene, a cada lado del\u00a0cuerpo, una faceta articular completa para la cabeza de la primera costilla, y una semiestructura para la mitad superior de la cabeza de la segunda costilla.. El cuerpo es como el de una v\u00e9rtebra cervical, siendo ancho, c\u00f3ncavo y con labios a cada lado.Las\u00a0superficies articulares superiores\u00a0se dirigen hacia arriba y hacia atr\u00e1s;\u00a0la\u00a0ap\u00f3fisis espinosa\u00a0es gruesa, larga y casi horizontal. Los\u00a0procesos transversales\u00a0son largos, y las muescas vertebrales superiores son m\u00e1s profundas que las de las otras v\u00e9rtebras tor\u00e1cicas. El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio espinal tor\u00e1cico<\/a>\u00a01\u00a0(T1) pasa por debajo de ella.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/t1.JPG\" alt=\"\" \/><\/p>\n<p>&#8211;\u00a0<strong>T2 a\u00a0 T8 :\u00a0\u00a0<\/strong>son v\u00e9rtebras tor\u00e1cicas t\u00edpicas .\u00a0\u00a0El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio espinal tor\u00e1cico<\/a>\u00a0\u00a0pasa por debajo de la v\u00e9rtebra en cuesti\u00f3n<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/T2-78.JPG\" alt=\"\" \/><\/p>\n<p><strong>&#8211; T9\u00a0 :<\/strong>La novena v\u00e9rtebra tor\u00e1cica\u00a0 se caracteriza por no presentar facetas articulares inferiores para la d\u00e9cima costilla de cada lado . El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio espinal tor\u00e1cico<\/a>\u00a09\u00a0(T9) pasa por debajo de ella.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/t9.JPG\" alt=\"\" \/><\/p>\n<p><strong>&#8211; T10 :\u00a0<\/strong>En\u00a0 ella\u00a0 comienzan a aparecer los\u00a0caracteres de transici\u00f3n\u00a0 hacia las lumbares\u00a0 .\u00a0 Existe\u00a0 s\u00f3lo una fosita articular costal\u00a0 \u00a0:\u00a0 la\u00a0 superior para la\u00a0 10\u00aa\u00a0 costilla (\u00a0 =\u00a0 no tiene\u00a0 facetas articulares inferiores para la d\u00e9cima\u00a0 costilla de cada lado\u00a0 )\u00a0\u00a0 . La ap\u00f3fisis\u00a0 espinosa\u00a0 es menos\u00a0 oblicua .\u00a0El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio espinal tor\u00e1cico<\/a>\u00a010\u00a0(T10) pasa por debajo de ella.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/t10.JPG\" alt=\"\" \/><\/p>\n<p><strong>-T11:\u00a0<\/strong>el cuerpo se asemeja al de las v\u00e9rtebras lumbares . Las facetas articulares\u00a0 para las costillas\u00a0 son\u00a0 de mayor tama\u00f1o que en las v\u00e9rtebras superiores .\u00a0 El cuerpo presenta una sola carilla\u00a0 articular para la 11\u00aa\u00a0 costilla\u00a0 ;\u00a0 su\u00a0 mitad\u00a0 anterior\u00a0 responde\u00a0 al\u00a0 cuerpo\u00a0 ,\u00a0 su mitad posterior , al ped\u00edculo\u00a0.\u00a0 Ap\u00f3fisis\u00a0 espinosa\u00a0 aplastada\u00a0 en\u00a0 sentido\u00a0 transversal\u00a0 o\u00a0 dirigida\u00a0 atr\u00e1s\u00a0 horizontalmente\u00a0 . Ap\u00f3fisis\u00a0 transversas\u00a0 :\u00a0 cortas\u00a0 y rugosas\u00a0 , sin\u00a0 carillas\u00a0 articulares\u00a0 .\u00a0 Ap\u00f3fisis\u00a0 articulares :\u00a0 comienzan\u00a0 a\u00a0 orientarse hacia\u00a0 afuera .\u00a0El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio espinal tor\u00e1cico<\/a>\u00a011\u00a0(T11) pasa por debajo de ella.<\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/t11.JPG\" alt=\"\" \/><\/p>\n<p><strong>-T12\u00a0<\/strong>: posee caracter\u00edsticas similares a la T11\u00a0 ,\u00a0 distingui\u00e9ndose de ella por\u00a0 sus superficies\u00a0 articulares inferiores , que son convexas y se dirigen hacia los lados para cuadrar con las de la primera v\u00e9rtebra lumbar . El\u00a0 \u00a0cuerpo\u00a0 presenta una\u00a0 carilla\u00a0 articular para la\u00a0 12\u00aa costilla, en la superficie\u00a0 exterior del ped\u00edculo\u00a0 . Las ap\u00f3fisis\u00a0transversas\u00a0 son m\u00e1s cortas\u00a0 que las de las v\u00e9rtebras precedentes\u00a0 y no\u00a0 tienen faceta\u00a0 articular\u00a0 .\u00a0El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">nervio espinal tor\u00e1cico<\/a>\u00a011\u00a0(T11) pasa por debajo de ella.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/t12.JPG\" alt=\"\" \/><\/p>\n<ul>\n<li><strong>Diferencias\u00a0 entre las\u00a0<\/strong><strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras lumbares<\/a>\u00a0y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0tor\u00e1cicas<\/a><\/strong><\/li>\n<\/ul>\n<p><strong>Figura\u00a0 6.\u00a0 Diferencias\u00a0 entre\u00a0las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-lumbar\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras lumbares<\/a>\u00a0y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica\" target=\"_self\" rel=\"noopener\">v\u00e9rtebras\u00a0tor\u00e1cicas<\/a><\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/diferencias_columna_lumbar_toracica_2.JPG\" alt=\"\" \/><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/diferencias_facetas_lumbar_toracica.JPG\" alt=\"\" \/><\/p>\n<p>3.-Se\u00a0 debe\u00a0 considerar\u00a0 la\u00a0 re<\/p>\n<h4>Discos intervertebrales<\/h4>\n<ul>\n<li>Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/discos-intervertebrales\" target=\"_self\" rel=\"noopener\">discos intervertebrales<\/a><\/li>\n<\/ul>\n<h4>Ligamentos\u00a0 de la\u00a0 columna\u00a0 tor\u00e1cica<\/h4>\n<ul>\n<li>Generalidades : Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/ligamentos-de-la-columna-vertebral\" target=\"_self\" rel=\"noopener\">ligamentos\u00a0 de la columna vertebral\u00a0<\/a><\/li>\n<li>Especificaciones :<\/li>\n<\/ul>\n<p><strong>Figura 7.\u00a0 Ligamentos\u00a0 relacionados con las\u00a0v\u00e9rtebras tor\u00e1cicas\u00a0.<\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/ligamentos_toracicos_2_bueno.JPG\" alt=\"\" \/><\/p>\n<h4>M\u00fasculos de la columna tor\u00e1cica<\/h4>\n<ul>\n<li>Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/musculos-de-la-pared-toracica-posterior\" target=\"_self\" rel=\"noopener\">m\u00fasculos de la pared tor\u00e1cica posterior\u00a0<\/a><\/li>\n<\/ul>\n<h4>Articulaciones de la columna vertebral tor\u00e1cica<\/h4>\n<ul>\n<li>Ver\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-de-la-pared-toracica\" target=\"_self\" rel=\"noopener\">Articulaciones de la pared tor\u00e1cica\u00a0<\/a><\/li>\n<li>Cabe diferenciar entre\u00a0\u00a0: 1)\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-entre-vertebras-toracicas\" target=\"_self\" rel=\"noopener\">ARTICULACIONES ENTRE V\u00c9RTEBRAS TOR\u00c1CICAS<\/a>\u00a0 ; 2)\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/articulaciones-en-las-que-estan-involucradas-las-costillas\" target=\"_self\" rel=\"noopener\">ARTICULACIONES EN LAS QUE EST\u00c1N INVOLUCRADAS LAS COSTILLAS<\/a><\/li>\n<\/ul>\n<h3>Contenido\u00a0 de la\u00a0 columna tor\u00e1cica<\/h3>\n<p>La superposici\u00f3n\u00a0 de\u00a0 \u00a0diversas\u00a0 v\u00e9rtebras tor\u00e1cicas\u00a0\u00a0delimitan\u00a0\u00a0 un espacio\u00a0 triangular\u00a0 denominado<em><strong>\u00a0canal vertebral\u00a0\u00a0tor\u00e1cico\u00a0<\/strong><\/em><\/p>\n<p><strong>Figura 8.\u00a0Canal\u00a0vertebral\u00a0tor\u00e1cico<\/strong>.\u00a0El\u00a0canal vertebral\u00a0es relativamente peque\u00f1o y de forma sensiblemente circular<strong>.<\/strong>\u00a0Los\u00a0<strong>\u00a0l\u00edmites del\u00a0 canal\u00a0espina<\/strong>l\u00a0son:\u00a01)<strong><em>\u00a0La pared anterior:\u00a0<\/em><\/strong>ligamento\u00a0vertebral longitudinal posterior\u00a0;\u00a0 2)\u00a0\u00a0<strong><em>La\u00a0 pared posterior<\/em><\/strong>: l\u00e1minas vertebrales y los ligamentos amarillos\u00a0 ;\u00a0 3)\u00a0<strong><em>\u00a0Las paredes laterales<\/em><\/strong>: ped\u00edculos vertebrales y agujeros de conjunci\u00f3n correspondientes.\u00a0 Este\u00a0 canal\u00a0se comunica directamente\u00a0 a trav\u00e9s\u00a0 de los\u00a0 agujeros intervertebrales\u00a0 \u00a0con el espacio paravertebral lumbar<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/foramen_intervertebral_dolopedia.JPG\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>En\u00a0 este conducto\u00a0se\u00a0encuentran\u00a0 diversos\u00a0 elementos\u00a0:<\/p>\n<p><strong>Figura\u00a0 9.\u00a0 Conducto\u00a0 tor\u00e1cico\u00a0 (\u00a0 modificado de<\/strong><a class=\"reference-link\" href=\"https:\/\/dolopedia.com\/articulo\/anatomia-de-la-columna-dorsal-o-toracica#a1357a2b-110e-3c9a-c6a3-8e397289cdf5\" name=\"entry-a1357a2b-110e-3c9a-c6a3-8e397289cdf5\" data-bibliography-uid=\"a1357a2b-110e-3c9a-c6a3-8e397289cdf5\">3<\/a>\u00a0 )\u00a0 \u00a0.\u00a0La columna vertebral tor\u00e1cico\u00a0 contiene la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>\u00a0y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">ra\u00edces de los nervios tor\u00e1cicos o nervios raqu\u00eddeos tor\u00e1cicos<\/a>\u00a0 \u00a0.\u00a0Asimismo ,\u00a0 hay\u00a0 elementos\u00a0 de protecci\u00f3n del\u00a0 sistema nervioso\u00a0 central\u00a0 \u00a0como\u00a0 son : 1) Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/meninges-espinales-y-espacios-meningeos-asociados\" target=\"_self\" rel=\"noopener\">meninges espinales\u00a0 y\u00a0 espacios men\u00edngeos\u00a0 asociados ; ;<\/a>\u00a02) El\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/liquido-cefalorraquideo\" target=\"_self\" rel=\"noopener\">l\u00edquido cefalorraqu\u00eddeo<\/a>\u00a0 y\u00a0 3) La\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/barrera-sangre-aracnoides\" target=\"_self\" rel=\"noopener\">barrera sangre-aracnoides<\/a>\u00a0Tambi\u00e9n\u00a0 es de\u00a0 rese\u00f1ar la presencia de\u00a0estructuras\u00a0 vasculares\u00a0 como las<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/irrigacion-arterial-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">\u00a0arterias de la m\u00e9dula espinal<\/a>\u00a0 y las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/drenaje-venoso-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">venas espinales<\/a><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/dolopedia.com\/uploads\/media\/3-antonio-jose\/contenido_columna_toracica.JPG\" alt=\"\" \/><\/p>\n<p><strong>1.- Elementos\u00a0 de protecci\u00f3n del\u00a0 sistema nervioso\u00a0 central\u00a0 \u00a0como\u00a0 son\u00a0\u00a0<\/strong><\/p>\n<p><strong>1) Las\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/meninges-espinales-y-espacios-meningeos-asociados\" target=\"_self\" rel=\"noopener\">meninges espinales\u00a0 y\u00a0 espacios men\u00edngeos\u00a0 asociados\u00a0<\/a><\/strong><\/p>\n<p><strong>2) El<\/strong><strong>\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/liquido-cefalorraquideo\" target=\"_self\" rel=\"noopener\">l\u00edquido cefalorraqu\u00eddeo<\/a><\/strong><\/p>\n<p><strong>3) La\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/barrera-sangre-aracnoides\" target=\"_self\" rel=\"noopener\">barrera sangre-aracnoides<\/a><\/strong><\/p>\n<p><strong>2.- La\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/medula-espinal-1\" target=\"_self\" rel=\"noopener\">m\u00e9dula espinal<\/a>\u00a0\u00a0<\/strong><\/p>\n<p><strong>3.- Las\u00a0\u00a0<\/strong>\u00a0<strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/nervios-toracicos-o-nervios-raquideos-toracicos\" target=\"_self\" rel=\"noopener\">ra\u00edces de los nervios tor\u00e1cicos o nervios raqu\u00eddeos tor\u00e1cicos<\/a><\/strong><\/p>\n<p><strong>4.-Estructuras\u00a0 vasculares\u00a0 como las<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/irrigacion-arterial-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">\u00a0arterias de la m\u00e9dula espinal<\/a><strong>\u00a0 y las\u00a0<\/strong><a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/drenaje-venoso-de-la-medula-espinal\" target=\"_self\" rel=\"noopener\">venas espinales<\/a><\/p>\n<h3>T\u00e9cnicas de imagen para el\u00a0 estudio de la columna tor\u00e1cica<\/h3>\n<ul>\n<li>Para\u00a0su\u00a0estudio\u00a0existen\u00a0diversas\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/tecnicas-de-imagen-para-el-estudio-del-dolor-en-la-zona-toracica\" target=\"_self\" rel=\"noopener\">T\u00c9CNICAS DE IMAGEN PARA EL ESTUDIO DEL DOLOR EN LA ZONA TOR\u00c1CICA<\/a>\u00a0 como la\u00a0\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/radiografia-convencional-para-el-estudio-del-dolor-en-la-zona-toracica\" target=\"_self\" rel=\"noopener\">radiograf\u00eda convencional\u00a0<\/a>\u00a0 ,\u00a0\u00a0la\u00a0\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/articulo\/ecografia-de-la-columna-vertebral-toracica\" target=\"_self\" rel=\"noopener\">ecograf\u00eda de la columna vertebral tor\u00e1cica<\/a>\u00a0\u00a0y la\u00a0<a class=\"internal-link\" href=\"https:\/\/dolopedia.com\/categoria\/resonancia-magnetica-rm-o-rmn-para-el-estudio-del-dolor-en-la-zona-toracica\" target=\"_self\" rel=\"noopener\">resonancia magn\u00e9tica\u00a0<\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h2><span style=\"color: #ff0000;\">Normal alineaci\u00f3n de la columna<\/span><\/h2>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2015\/09\/Photographer-Lars-van-De-Goor-LARVAN106-So-Full-JaccART.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:558\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2015\/09\/Photographer-Lars-van-De-Goor-LARVAN106-So-Full-JaccART.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2526\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:558\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2015\/09\/Photographer-Lars-van-De-Goor-LARVAN106-So-Full-JaccART.jpg\" alt=\"SoFull\" width=\"744\" height=\"558\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2526\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:558\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2015\/09\/Photographer-Lars-van-De-Goor-LARVAN106-So-Full-JaccART.jpg\" alt=\"SoFull\" width=\"744\" height=\"558\" \/></noscript><\/a><\/p>\n<p><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esqueleto-lateral1.png\"  decoding=\"async\" class=\" wp-image-1631 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esqueleto-lateral1.png\" alt=\"Esqueleto lateral\" width=\"110\" height=\"467\" \/><noscript><img decoding=\"async\" class=\" wp-image-1631 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esqueleto-lateral1.png\" alt=\"Esqueleto lateral\" width=\"110\" height=\"467\" \/></noscript><\/p>\n<p>Esta informaci\u00f3n se refiere a la alineaci\u00f3n normal de la columna vertebral. La columna vertebral es una serie de bloques de construcci\u00f3n llamados v\u00e9rtebras apiladas una encima de otra, separadas en la parte superior por los discos y en la parte posterior por las facetas. A partir de la vista frontal, la columna vertebral debe ser recta con el centro de la cabeza que se sienta en una l\u00ednea de plomada directamente sobre la pelvis. La vista lateral de la columna vertebral tiene varias curvas que cuando se suman tambi\u00e9n deben tener la cabeza sentado directamente sobre la pelvis.<\/p>\n<h4>En la vista lateral, hay 2 curvas (la columna tor\u00e1cica y el sacro) llamada <span style=\"color: #ff0000;\">cifosis<\/span> y dos curvas hacia atr\u00e1s (la cervical y\u00a0 lumbar) llamada <span style=\"color: #ff0000;\">lordosis<\/span>. Estas curvas laterales son como muelles y equilibran entre s\u00ed.<\/h4>\n<p>Las curvas de la columna vertebral se originan en las formas de los discos y las formas de los cuerpos vertebrales. En la columna cervical y lumbar, la v\u00e9rtebra son cuadrados y los discos son trapezoidal. Si se pudiera acoplar esta v\u00e9rtebra en la parte superior de uno al otro sin los discos, se tendr\u00eda una columna recta. Es la forma angular de los discos los que causan las curvas lord\u00f3tica o hacia atr\u00e1s que ocurren en el cuello y la espalda inferior.<br \/>\nLa columna tor\u00e1cica tiene una curva hacia adelante o cifosis. Esta curva es causada principalmente por la forma de los cuerpos vertebrales.<\/p>\n<p><span style=\"color: #000000;\">Estos hechos son importantes, como se puede ver algunos de los problemas que pueden ocurrir secundariamente con la alineaci\u00f3n y la degeneraci\u00f3n de los discos. <\/span>La p\u00e9rdida de altura del disco en la columna lumbar puede causar un s\u00edndrome de la espalda plana, donde el individuo se siente inclinado hacia adelante. La p\u00e9rdida de altura del disco en la columna tor\u00e1cica puede aumentar la curva\u00a0 (la cifosis) y de nuevo, el individuo se siente ca\u00eddo hacia delante.<\/p>\n<p><strong>Normal alineaci\u00f3n y equilibrio de la columna<\/strong> son muy importantes para el consumo de energ\u00eda para pararse y caminar. Si la cabeza est\u00e1 directamente sobre la pelvis, que es el centro del punto de gravedad para el cuerpo, habr\u00e1 poca necesidad para la contracci\u00f3n muscular para mantener la cabeza y el torso sobre este punto de equilibrio. El gasto de energ\u00eda necesario para caminar con un buen balance es muy m\u00ednima. Por el contrario, si hay una curva anormal y la cabeza est\u00e1 fuera de la l\u00ednea media, la cantidad de contracci\u00f3n del m\u00fasculo necesario caminar hace que esta cantidad de gasto de energ\u00eda sea muy fatigante.<br \/>\n<strong>La pelvis<\/strong> es una estructura de partes duras y blandas encargadas de unir el miembro inferior y el tronco. Forma la parte inferior de la pared abdominal, sirve de origen e inserci\u00f3n a los m\u00fasculos del miembro inferior y aloja a las v\u00edsceras abdominales.<br \/>\nEn la mujer la entrada superior es m\u00e1s ancha y corta, siendo la salida tambi\u00e9n m\u00e1s ancha. Esto hace que los \u00e1ngulos pelvianos est\u00e9n m\u00e1s abiertos y, en conjunto, ligeramente m\u00e1s inclinada hacia delante. Al ser m\u00e1s ancha le confiere la propiedad de aumentar la base de sustentaci\u00f3n con unos m\u00fasculos m\u00e1s gruesos.<br \/>\n<strong>Sus funciones son<\/strong>: estabilizar el centro de gravedad, favorecer las posiciones est\u00e1ticas y transmitir los impulsos cr\u00e1neo-caudal y caudal-cranealmente. Est\u00e1 compuesta por un cintur\u00f3n \u00f3seo, formado por el sacro en medio y el coxal a ambos lados, con forma de embudo y diferencias en base al g\u00e9nero.<br \/>\nLos movimientos de la pelvis inciden sobre las curvaturas sagitales del raquis en sentido opuesto. La pelvis unida al raquis lumbar por medio de la articulaci\u00f3n lumbosacra determina que todos los movimientos de la pelvis afectan al raquis y viceversa. Un aumento de la lordosis lumbar afecta al raquis dorsal aumentando la cifosis, para posicionar adecuadamente el centro de gravedad. Tambi\u00e9n las variaciones en la inclinaci\u00f3n p\u00e9lvica modifican la actividad de los m\u00fasculos que contribuyen a configurar la postura, afectando la est\u00e1tica del raquis.<br \/>\nEl movimiento por el cual la base superior de la pelvis se desplaza hacia delante se denomina anteversi\u00f3n p\u00e9lvica mientras que el movimiento contrario se denomina retroversi\u00f3n.<br \/>\n<strong>Los m\u00fasculos que producen la anteversi\u00f3n p\u00e9lvica son<\/strong>: Sacro Lumbar, Dorsal largo, Epiespinoso, Cuadrado lumbar, Psoas Il\u00edaco, Sartorio, Pect\u00edneo, Aductor menor y mediano, Recto anterior cu\u00e1driceps y Tensor de la fascia lata. El acortamiento de estos m\u00fasculos determina un desplazamiento anterior de la pelvis en direcci\u00f3n ventro-caudal, que acent\u00faa la lordosis lumbar.<br \/>\nPor el contrario, los m\u00fasculos retroversores son: Recto anterior del abdomen, Oblicuo mayor, Oblicuo menor, Transverso abdomen, Gl\u00fateos (mayor especialmente), Adductor mayor y Cuadrado crural.<br \/>\nResumen de la amplitud del movimiento del raquis<br \/>\n<span style=\"color: #ff0000;\">&#8220;Rangos de movimientos medios&#8221;<\/span><br \/>\n<span style=\"color: #ff0000;\">&#8220;Raquis cervical \u00a0\u00a0&#8220;Flexi\u00f3n&#8221;40-60\u00ba&#8221;Hiperextensi\u00f3n&#8221;40-75\u00ba&#8221;Flexi\u00f3n lateral &#8220;40-45\u00ba&#8221;Rotaci\u00f3n&#8221;50-80\u00ba&#8221;<\/span><br \/>\n<span style=\"color: #ff0000;\">&#8220;Raquis toracolumbar&#8221;Flexi\u00f3n&#8221;45-75\u00ba&#8221;Hiperextensi\u00f3n&#8221;20-35\u00ba&#8221; \u00a0Flexi\u00f3n lateral&#8221;25-35\u00ba&#8221;Rotaci\u00f3n&#8221;30-45\u00ba&#8221;<\/span><br \/>\nPostura correcta &#8220;toda aquella que no sobrecarga la columna ni a ning\u00fan otro elemento del\u00a0aparato locomotor&#8221;<\/p>\n<p>Postura viciosa &#8220;la que sobrecarga a las estructuras \u00f3seas, tendinosas, musculares, vasculares, etc, desgastando el organismo de manera permanente, en uno o varios de sus elementos, afectando sobre todo a la columna vertebral-<\/p>\n<p>Curvas m\u00e1s peque\u00f1as en\u00a0 muchos pacientes son s\u00f3lo una constataci\u00f3n sobre una placa de rayos X que no tiene relaci\u00f3n con el bienestar del paciente, se les denomina <span style=\"color: #00ffff;\">Actitud escoli\u00f3tica<\/span>. S\u00f3lo si la curva es grande requieren atenci\u00f3n.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>Funciones:<\/strong><\/span><\/p>\n<ul style=\"text-align: justify;\">\n<li><span style=\"color: #008000;\">Mantenimiento posici\u00f3n erecta<\/span><\/li>\n<li><span style=\"color: #008000;\">Absorci\u00f3n y distribuci\u00f3n de cargas<\/span><\/li>\n<li><span style=\"color: #008000;\">Flexibilidad y estabilidad del tronco<\/span><\/li>\n<li><span style=\"color: #008000;\">Protecci\u00f3n de la m\u00e9dula espinal<\/span><\/li>\n<li><span style=\"color: #008000;\">Inserci\u00f3n muscular y ligamentaria<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">La C.V. no es una estructura r\u00edgida por lo que tiene una serie de <span style=\"color: #ff0000;\"><strong>movimientos b\u00e1sicos<\/strong><\/span> definidos sobre planos estos movimientos son:<\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"color: #ff0000;\">CORONAL<\/span>: <\/strong>Movimiento que es posible realizar de lado a lado, dcha. a izda. y viceversa.<\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"color: #ff0000;\">SAGITA<\/span>L: <\/strong>Movimiento que se realiza de delante a tras y viceversa<\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"color: #ff0000;\">AXIAL<\/span>:<\/strong> Movimiento rotacional sobre el eje que imaginariamente nos atraviesa de\u00a0arriba abajo<\/p>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/columna-ver1.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/columna-ver1.jpg\"  decoding=\"async\" class=\"alignleft wp-image-1927\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/columna-ver1.jpg\" alt=\"columna ver1\" width=\"392\" height=\"796\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-1927\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/columna-ver1.jpg\" alt=\"columna ver1\" width=\"392\" height=\"796\" \/></noscript><\/a><\/p>\n<p><span style=\"color: #ff0000;\"><strong>Elementos de la columna vertebral<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\">Los elementos de la columna vertebral est\u00e1n dise\u00f1ados para proteger la m\u00e9dula espinal, apoyar el cuerpo y facilitar el movimiento<\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"color: #ff0000;\">1.-V\u00e9rtebras \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Las estructuras \u00f3seas de la columna vertebral se denominan v\u00e9rtebras.<\/strong><span style=\"font-size: 13px;\">\u00a0<\/span><\/p>\n<h3 style=\"text-align: justify;\"><span style=\"font-size: 13px;\">Estas soportan la mayor\u00eda del peso impuesto a la columna vertebral.\u00a0El cuerpo de cada v\u00e9rtebra est\u00e1 unido a un anillo \u00f3seo que consta de varias partes.\u00a0Una proyecci\u00f3n \u00f3sea a cada lado del cuerpo vertebral llamado el ped\u00edculo apoya el arco que protege el canal espinal.\u00a0Cada v\u00e9rtebra espinal tiene dos partes principales, una secci\u00f3n anterior s\u00f3lida llamada cuerpo vertebral y un arco posterior. Las l\u00e1minas son las partes de las v\u00e9rtebras que forman la parte posterior del arco \u00f3seo que rodea y cubre el canal espinal.\u00a0Hay un proceso transversal a cada lado del arco, donde algunos de los m\u00fasculos de la columna vertebral se adhieren a las v\u00e9rtebras.\u00a0La ap\u00f3fisis espinosa es la porci\u00f3n \u00f3sea del cuerpo vertebral que se puede sentir como una serie de protuberancias en el centro de cuello y la espalda de una persona.<\/span><\/h3>\n<p style=\"text-align: justify;\"><strong><span style=\"color: #ff0000;\">2.-Disco\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span> \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/strong><span style=\"color: #339966;\"><strong>Disco Intervertebral<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\">El espacio que hay entre dos cuerpos vertebrales contiguos est\u00e1 ocupado por una estructura fibrocartilaginosa densa, de forma lenticular biconvexa con bordes aplanados y adheridos a los cuerpos vertebrales llamada<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #00ff00;\"><strong>DISCO INTERVERTEBRAL<\/strong><\/span>.El disco es como un amortiguador que mantiene a las v\u00e9rtebras separadas y las previene de las cargas de la columna .<\/p>\n<p style=\"text-align: justify;\">El Disco Intervertebral consta de dos partes:<\/p>\n<ul>\n<li><span style=\"color: #ff0000;\">Una central<\/span> :<b>\u00a0 \u00a0 N\u00daCLEO PULPOSO<\/b><\/li>\n<li><span style=\"color: #ff0000;\">Una perif\u00e9rica<\/span>:<strong> ANILLO FIBROSO<\/strong><\/li>\n<\/ul>\n<h3 style=\"text-align: justify;\"><span style=\"color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px; display: inline !important; float: none; background-color: #ffffff;\">\u00a0Est\u00e1n dise\u00f1ados para absorber los esfuerzos realizados por la columna vertebral permitiendo al mismo tiempo a los cuerpos vertebrales para moverse con respecto a la otra.\u00a0Cada disco se compone de un fuerte anillo exterior de fibras llamadas del anillo fibroso, y un centro blando llamado n\u00facleo pulposo.\u00a0La capa exterior (anillo) ayuda a mantener el n\u00facleo interno del disco (n\u00facleo) intacta.\u00a0El anillo se compone de fibras muy fuertes que conectan cada v\u00e9rtebra juntos.\u00a0El n\u00facleo del disco tiene un muy alto contenido de agua, que ayuda a mantener su flexibilidad y propiedades de absorci\u00f3n de impactos.<\/span><\/h3>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>3.-Faceta articular<\/strong><\/span><\/p>\n<p>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Las articulaciones facetarias conectan los arcos \u00f3seos de cada uno de los cuerpos vertebrales.\u00a0Hay dos articulaciones facetarias entre cada par de v\u00e9rtebras, una a cada lado.\u00a0Las articulaciones facetarias conectan cada v\u00e9rtebra con los que est\u00e1n directamente por encima y por debajo de ella, y est\u00e1n dise\u00f1ados para permitir que los cuerpos vertebrales para girar con respecto a la otra.<\/p>\n<p><span style=\"color: #ffff00;\"><strong><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inervacion.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:134\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inervacion.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2170\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:134\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inervacion.jpg\" alt=\"Inervacion\" width=\"225\" height=\"504\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2170\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:134\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inervacion.jpg\" alt=\"Inervacion\" width=\"225\" height=\"504\" \/></noscript><\/a><span style=\"color: #ff0000;\">4.-Foramen Neural<\/span><\/strong><\/span><br \/>\nEl foramen neural es la abertura a trav\u00e9s de las ra\u00edces nerviosas que salen de la columna y viaja al resto del cuerpo.\u00a0Hay dos foramen neural situadas entre cada par de v\u00e9rtebras, una a cada lado.\u00a0El foramen crea un pasadizo de protecci\u00f3n para los nervios que llevan se\u00f1ales entre la m\u00e9dula espinal y el resto del cuerpo.<\/p>\n<p><span style=\"color: #ff0000;\"><strong>5.-M\u00e9dula espinal y nervios<\/strong><\/span><br \/>\nTodas las v\u00e9rtebras (excepto el coxis) tienen una apertura formada por el arco posterior. Se denomina <span style=\"color: #99cc00;\"><strong>CANAL ESPINAL<\/strong><\/span> y es por donde pasa la m\u00e9dula espinal.La m\u00e9dula espinal se extiende desde la base del cerebro a la zona entre la parte inferior de la primera v\u00e9rtebra lumbar y la parte superior de la segunda v\u00e9rtebra lumbar.\u00a0La m\u00e9dula espinal termina divergentes en los nervios individuales que viajan a la parte inferior del cuerpo y las piernas.\u00a0Debido a su apariencia, este grupo de nervios se llama la cola de caballo &#8211; el nombre latino de &#8220;cola de caballo&#8221;.\u00a0Los grupos nerviosos viajan a trav\u00e9s del canal espinal por una corta distancia antes de que salgan del agujero intervertebral.<\/p>\n<p>La m\u00e9dula espinal est\u00e1 cubierta por una membrana protectora llamada la duramadre, que forma un saco herm\u00e9tico alrededor de la m\u00e9dula espinal y los nervios.\u00a0Dentro de este saco es l\u00edquido cefalorraqu\u00eddeo, que rodea la m\u00e9dula espinal.<\/p>\n<p>Los nervios en cada \u00e1rea de la m\u00e9dula espinal est\u00e1n conectados a partes espec\u00edficas del cuerpo.\u00a0Los que est\u00e1n en la columna cervical, por ejemplo, se extienden a la parte superior del pecho y los brazos;\u00a0los de la columna lumbar las caderas, las nalgas y las piernas.\u00a0Los nervios tambi\u00e9n llevan se\u00f1ales el\u00e9ctricas en el cerebro, creando sensaciones.\u00a0El da\u00f1o a los nervios, las ra\u00edces nerviosas o la m\u00e9dula espinal puede causar s\u00edntomas tales como dolor, hormigueo, entumecimiento y debilidad, tanto en y alrededor del \u00e1rea da\u00f1ada y en las extremidades.<\/p>\n<h1><strong>Unidad funcional de la columna<\/strong><\/h1>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.5-e1411743542998.png\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:176\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.5-e1411743542998.png\"  decoding=\"async\" class=\"alignleft size-medium wp-image-1919\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:176\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.5-e1411743542998.png\" alt=\"Esq.5\" width=\"300\" height=\"176\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-1919\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:176\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Esq.5-e1411743542998.png\" alt=\"Esq.5\" width=\"300\" height=\"176\" \/></noscript><\/a>La Unidad Funcional est\u00e1 formada por dos cuerpos vertebrales que est\u00e1n separados por el disco intervertebral que es la parte de la columna que soporta peso, sostiene el cuerpo y permite los movimientos hacia adelante (flexi\u00f3n) y hacia atr\u00e1s (extensi\u00f3n), de inclinaci\u00f3n a los lados (torsi\u00f3n) y de giro a los lados (rotaci\u00f3n).El trabajo de cada unidad funcional se realiza de forma independiente y colectiva.La unidad funcional contiene tejidos sensibles que al lesionarse se irritan, lesionan, est\u00e1n sometidos a tensi\u00f3n y producen dolor. Para valorar las causas del dolor y descubrir de qu\u00e9 tejidos se trata es preciso entender las funciones de la unidad vertebral.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>La unidad funcional m\u00e1s peque\u00f1a de la columna est\u00e1 formada por:<\/strong><\/p>\n<p><span style=\"color: #ff0000;\"><strong>Dos v\u00e9rtebras<\/strong><\/span><\/p>\n<p><span style=\"color: #ff0000;\"><strong>Un disco Intervertebral<\/strong><\/span><\/p>\n<p><span style=\"color: #ff0000;\"><strong>Un foramen<\/strong><\/span><span style=\"color: #ccffcc;\">\u00a0a dicho segmento<\/span><\/p>\n<p><iframe src=\"https:\/\/www.youtube.com\/embed\/LSrDBI-Bxyg\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #ff0000;\"><strong>LA COLUMNA CERVICAL SANA. <\/strong><\/span><span style=\"color: #ff0000;\">Consideraciones generales<\/span><\/p>\n<p>La columna cervical (CC) es la conexi\u00f3n entre la cabeza y el cuerpo. Su movilidad permite el movimiento tridimensional de la cabeza, que al mismo tiempo hace posible la orientaci\u00f3n en las diferentes direcciones del espacio. Probablemente fue esta movilidad junto con la posici\u00f3n erecta y el desarrollo del cerebro lo que permiti\u00f3 a la humanidad luchar y defenderse eficazmente en los primeros tiempos de la evoluci\u00f3n.<\/p>\n<p>Los tejidos blandos del cuello est\u00e1n formados por elementos para transportar alimentos y aire que aportan la energ\u00eda b\u00e1sica al cuerpo y a los m\u00fasculos para controlar el movimiento mencionado. Los vasos sangu\u00edneos suministran ox\u00edgeno al cerebro. El sistema nervioso que circula por el canal vertebral cervical transporta informaci\u00f3n del cuerpo en funcionamiento hacia el cerebro y las se\u00f1ales del cerebro hacia la periferia.<\/p>\n<h4><span style=\"color: #ff0000;\">Anatom\u00eda de la columna cervical<\/span><\/h4>\n<p>La columna cervical est\u00e1 formada por siete v\u00e9rtebras, de las cuales cinco (C3-C7) siguen un esquema com\u00fan al resto de v\u00e9rtebras de la columna y dos (C1-C2) tienen un dise\u00f1o anat\u00f3mico distinto.<\/p>\n<p>Anatom\u00eda normal de la columna cervical<\/p>\n<p>El conjunto de v\u00e9rtebras cervicales forma la columna cervical y el soporte \u00f3seo del cuello. La movilidad se consigue con las uniones intervertebrales: discos, facetas articulares y ligamentos. La rotaci\u00f3n de la cabeza es posible gracias al dise\u00f1o anat\u00f3mico espec\u00edfico de las dos primeras v\u00e9rtebras (C1\/C2), denominadas atlas (C1) y axis (C2), mientras que columna cervical inferior es responsable de la flexi\u00f3n, la extensi\u00f3n y la inclinaci\u00f3n lateral.<\/p>\n<p><iframe src=\"https:\/\/www.youtube.com\/embed\/d2Hf0SD3ShY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<div>Flexi\u00f3n\/extensi\u00f3n<\/div>\n<p><strong>Rotaci\u00f3n C1\/2<\/strong><\/p>\n<div>Los arcos vertebrales, que est\u00e1n unidos por el ligamento amarillo, forman el canal vertebral cervical. Los cuerpos vertebrales en posici\u00f3n anterior y los discos intervertebrales forman un canal con agujeros laterales segmentarios o de conjunci\u00f3n. La m\u00e9dula espinal circula por este canal y las ra\u00edces nerviosas salen bilateralmente hacia las extremidades superiores.<\/div>\n<div>\n<p><span style=\"color: #ff0000;\"><span style=\"color: #ff0000;\"><strong>Dolor de espalda en los ancianos<\/strong><\/span><\/span><\/p>\n<h5><span class=\"titular\">El dolor de espalda supone una amenaza para la vida de los mayores<\/span><\/h5>\n<h5 class=\"subtitulo\">Las personas mayores que sufren dolor de cuello y espalda tienen un riesgo hasta un 13% superior de morir por cualquier causa<\/h5>\n<p>El dolor de espalda es una de las afecciones m\u00e1s comunes en todo el mundo. De hecho, a d\u00eda de hoy conviven en el planeta m\u00e1s de 700 millones de personas afectadas por esta dolencia que, sobre todo localizada en la zona lumbar, supone la primera causa de discapacidad global. Sin embargo, parece que este dolor de espalda no \u2018solo\u2019 compromete la calidad de vida de los pacientes, muy especialmente de los m\u00e1s longevos.\u00a0 Se trata, por tanto, de un hallazgo significativo dado que la mayor\u00eda de la poblaci\u00f3n piensa que el dolor de espalda no supone una amenaza para la vida\u00bb.<\/p>\n<h3 class=\"ladillo\">Esperanza de vida comprometida<\/h3>\n<p>Si bien hasta una tercera parte de la poblaci\u00f3n global padecer\u00e1 dolor de espalda en alg\u00fan momento de su vida, el n\u00famero de estudios desarrollados para evaluar el efecto de esta dolencia sobre la esperanza de vida en las personas mayores es ciertamente escaso. Todo ello a pesar de que, tal y como ocurre con este dolor, el envejecimiento poblacional es un proceso com\u00fan en muchas regiones del planeta.<\/p>\n<p>De ah\u00ed la importancia de esta nueva investigaci\u00f3n, llevada a <span class=\"texto-sumario\">El mejor tratamiento para el dolor de espalda es seguir un estilo de vida saludable que incluya el ejercicio f\u00edsico.<\/span><\/p>\n<p>As\u00ed, y con una poblaci\u00f3n sometida a un cada vez m\u00e1s acelerado proceso de envejecimiento, la salud de la espalda es un aspecto cr\u00edtico para mantener la independencia de las personas mayores\u00bb.<\/p>\n<h3 class=\"ladillo\">Hay que \u2018moverse\u2019<\/h3>\n<p>Los autores ya hab\u00edan demostrado en un estudio previo que las personas con depresi\u00f3n tienen un riesgo hasta un 60% mayor de padecer dolor de espalda en alg\u00fan momento de su vida. Tal es as\u00ed que el tratamiento de la depresi\u00f3n puede jugar un papel muy importante para prevenir esta dolencia y, por ende, no comprometer la esperanza de vida del afectado.<\/p>\n<p>Pero, una vez que aparece el dolor, \u00bfqu\u00e9 se puede hacer? Pues seg\u00fan el nuevo estudio, la soluci\u00f3n no se encuentra en los f\u00e1rmacos que la poblaci\u00f3n toma asiduamente para tratar de aliviarlo. Es decir,\u00a0<strong>ni en los antiinflamatorios no esteroideos (AINE) \u2013como el ibuprofeno o la aspirina\u2013 ni en el paracetamol, que adem\u00e1s de ser inefectivos provocan efectos secundarios muy molestos<\/strong> y, en algunos casos, incluso graves.<\/p>\n<div class=\"l-title\">\n<h1 class=\"page-title\"><span style=\"color: #ff0000;\">La lumbalgia en los adultos mayores<\/span><\/h1>\n<\/div>\n<div class=\"l-main\">\n<div class=\"l-content\">\n<article class=\"node node--article node--full node--article--full\" role=\"article\">\n<div class=\"node__content\">\n<div class=\"field field--name-body field--type-text-with-summary field--label-hidden\">\n<div class=\"field__items\">\n<div class=\"field__item even\">\n<p>Aunque los adultos mayores pueden experimentar los dolores relacionados con las afecciones que afectan tambi\u00e9n a adultos m\u00e1s j\u00f3venes, las personas mayores de 60 a\u00f1os de edad son m\u00e1s propensas a sufrir dolores relacionados con la degeneraci\u00f3n de las articulaciones de la columna vertebral. Dos de las causas m\u00e1s comunes de la lumbalgia en los adultos mayores son la artrosis y la estenosis vertebral.<\/p>\n<h2>S\u00edntomas: lumbalgia y entumecimiento que son m\u00e1s fuertes por la ma\u00f1ana y por la noche<\/h2>\n<p>Puede incluir cualquier combinaci\u00f3n de los siguientes s\u00edntomas:<\/p>\n<ul>\n<li>Dolores que interrumpen el sue\u00f1o<\/li>\n<li>Un dolor que es m\u00e1s pronunciado a primera hora de la ma\u00f1ana y otra vez al final del d\u00eda<\/li>\n<li>Un \u00e1rea localizada de la columna que es dolorosa con la palpaci\u00f3n<\/li>\n<li>Un dolor sordo, continuo o intermitente, en la parte inferior de la espalda que se agrava despu\u00e9s de hacer mucha actividad f\u00edsica<\/li>\n<li>Entumecimiento o una p\u00e9rdida de flexibilidad en la espalda (por ejemplo, una incapacidad para doblarse por la cintura con comodidad)<\/li>\n<\/ul>\n<h3><span style=\"color: #ff0000;\">Artrosis de las articulaciones facetarias<\/span><\/h3>\n<p>La artrosis de las articulaciones facetarias es una afecci\u00f3n degenerativa de evoluci\u00f3n lenta. El dolor es causado por la degeneraci\u00f3n del cart\u00edlago entre las articulaciones facetarias de la columna. Al principio, los s\u00edntomas pueden ser solo intermitentes, pero luego pueden convertirse en una lumbalgia m\u00e1s constante y, con el tiempo, pueden llegar a causar no solo una lumbalgia sino tambi\u00e9n la ci\u00e1tica.<\/p>\n<h2>S\u00edntoma: dolor de pierna que se siente principalmente al caminar y al estar de pie<\/h2>\n<p>Puede incluir cualquier combinaci\u00f3n de los siguientes s\u00edntomas:<\/p>\n<ul>\n<li>Incapacidad para caminar mucha distancia sin tener dolor en la pierna<\/li>\n<li>La lumbalgia se alivia pronto despu\u00e9s de sentarse<\/li>\n<li>Los s\u00edntomas a veces son graves y, otras veces, leves o inexistentes<\/li>\n<li>Los s\u00edntomas son de evoluci\u00f3n lenta<\/li>\n<li>Debilidad, adormecimiento y hormigueo que se irradian de la parte inferior de la espalda a las nalgas y las piernas (ci\u00e1tica)<\/li>\n<\/ul>\n<nav id=\"toc-container\" class=\"toc-container\" aria-label=\"In page table of contents for quick access to other pages in this article\">\n<div class=\"l-title\">\n<h1 class=\"page-title\"><span style=\"color: #ff0000;\">Hernia de disco, un pinzamiento de un nervio, un disco protuberante<\/span><\/h1>\n<\/div>\n<div class=\"l-main\">\n<div class=\"l-content\">\n<article class=\"node node--article node--full node--article--full\" role=\"article\">\n<div class=\"node__content\">\n<div class=\"field field--name-body field--type-text-with-summary field--label-hidden\">\n<div class=\"field__items\">\n<div class=\"field__item even\">\n<p>Existen muchos t\u00e9rminos distintos para describir la patolog\u00eda del disco vertebral y el dolor asociado, como &#8220;hernia de disco&#8221;, &#8220;pinzamiento de nervio&#8221;, y &#8220;disco protuberante&#8221; y los m\u00e9dicos utilizan todos estos t\u00e9rminos de manera diferente.<\/p>\n<div class=\"yt-embed-container\"><iframe src=\"https:\/\/www.youtube.com\/embed\/qm710xrxk_I\" allowfullscreen=\"allowfullscreen\" data-mce-fragment=\"1\"><\/iframe><\/div>\n<p>Lamentablemente, los profesionales de atenci\u00f3n de la salud no se ponen de acuerdo sobre una definici\u00f3n precisa de ninguno de estos t\u00e9rminos, y los pacientes pueden sentirse frustrados cuando escuchan distintos t\u00e9rminos para su diagn\u00f3stico. Una variedad de t\u00e9rminos intercambiables (disco roto, disco desgarrado, disco desplazado, disco colapsado, protrusi\u00f3n discal, enfermedad de disco, disco negro) pueden provocar a\u00fan m\u00e1s confusi\u00f3n.<\/p>\n<p>En lugar de preocuparse por qu\u00e9 t\u00e9rmino se usa, es m\u00e1s \u00fatil para los pacientes lograr comprender con claridad el diagn\u00f3stico m\u00e9dico preciso.<\/p>\n<p><em>El diagn\u00f3stico m\u00e9dico identifica la causa real del dolor de espalda, dolor de pierna y otros s\u00edntomas del paciente.<\/em>El profesional m\u00e9dico determina la causa del dolor del paciente a trav\u00e9s de una combinaci\u00f3n de:<\/p>\n<ul>\n<li>una revisi\u00f3n de la historia cl\u00ednica del paciente<\/li>\n<li>un examen f\u00edsico completo<\/li>\n<li>una o m\u00e1s pruebas diagn\u00f3sticas (si fuera necesario)<\/li>\n<\/ul>\n<h2><span style=\"color: #ff0000;\">Pinzamiento de disco frente a dolor discal<\/span><\/h2>\n<p>Al identificar la causa del dolor del paciente, existen dos tipos generales de problemas de disco intervertebral usados por los m\u00e9dicos<\/p>\n<div class=\" mb-component mb-component\">\n<div class=\"imageBox text-left\"><a data-toggle=\"modal\" data-target=\"#myModal_jcr5cdd9955-e2f3-4f4a-8bad-b9822c56b9ea\"><img decoding=\"async\" class=\"lazyload img-responsive img\" title=\"infografico-max-hernia-discal\" src=\"https:\/\/www.cun.es\/.imaging\/mte\/newstyle\/half\/dam\/cun\/infograficos\/cot\/infografico-min-hernia-discal\/jcr:content\/infografico-min-hernia-discal.jpg\" alt=\"\" width=\"975\" height=\"653\" data-src=\"\/.imaging\/mte\/newstyle\/half\/dam\/cun\/infograficos\/cot\/infografico-min-hernia-discal\/jcr:content\/infografico-min-hernia-discal.jpg\" \/><\/a><\/div>\n<div id=\"myModal_jcr5cdd9955-e2f3-4f4a-8bad-b9822c56b9ea\" class=\"modal fade show\" tabindex=\"-1\" role=\"dialog\" aria-labelledby=\"myModalLabel\" aria-modal=\"true\">\n<div class=\"modal-dialog modal-lg\">\n<div class=\"modal-content\">\n<div class=\"modal-body\"><img decoding=\"async\" class=\"lazyload img-responsive\" title=\"infografico-max-hernia-discal\" src=\"https:\/\/www.cun.es\/.imaging\/dmsChain\/dam\/cun\/infograficos\/cot\/infografico-max-hernia-discal.jpg\" alt=\"\" data-src=\"\/.imaging\/dmsChain\/dam\/cun\/infograficos\/cot\/infografico-max-hernia-discal.jpg\" \/><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h3><span style=\"color: #ff0000;\">Pinzamiento de nervio<\/span><\/h3>\n<p>Cuando un paciente tiene un disco herniado sintom\u00e1tico, el disco en s\u00ed mismo no es doloroso, sino que el desplazamiento del disco est\u00e1 pinzando un nervio. Esto produce un dolor llamado dolor radicular (dolor de la ra\u00edz del nervio) el cual puede trasladarse a otras partes del cuerpo, por ejemplo, puede descender desde la parte baja de la espalda a la pierna o desde el cuello al brazo. El dolor en la pierna de un pinzamiento de nervio generalmente se describe como\u00a0ci\u00e1tica.<\/p>\n<ul>\n<li>\n<div class=\"l-main\">\n<div class=\"l-content\">\n<article class=\"node node--article node--full node--article--full\" role=\"article\">\n<header><\/header>\n<div class=\"node__content\">\n<div class=\"field field--name-body field--type-text-with-summary field--label-hidden\">\n<div class=\"field__items\">\n<div class=\"field__item even\">\n<p>Si bien el t\u00e9rmino &#8220;estenosis&#8221; proviene del griego y significa &#8220;estrangular&#8221;, la estenosis raqu\u00eddea tiene poco en com\u00fan con estrangular. Entonces, \u00bfqu\u00e9 es la estenosis raqu\u00eddea?<\/p>\n<p>Existen dos tipos de estenosis raqu\u00eddea:\u00a0estenosis lumbar y estenosis cervical. Si bien la estenosis raqu\u00eddea lumbar es m\u00e1s com\u00fan, la estenosis raqu\u00eddea cervical es con frecuencia m\u00e1s peligrosa porque implica la compresi\u00f3n de la m\u00e9dula espinal, como se explica en forma m\u00e1s detallada a continuaci\u00f3n.<\/p>\n<div class=\"l-title\">\n<h1 class=\"page-title\">Lo que usted debe saber sobre la ci\u00e1tica<\/h1>\n<div id=\"share-container\">\u00a0El t\u00e9rmino ci\u00e1tica describe los s\u00edntomas de dolor de pierna (y posiblemente de hormigueo, adormecimiento o debilidad) que empiezan en la parte inferior de la espalda y pasan por los gl\u00fateos y el nervio ci\u00e1tico mayor en la parte posterior de la pierna.<\/div>\n<\/div>\n<div class=\"l-main\">\n<div class=\"l-content\">\n<article class=\"node node--article node--full node--article--full\" role=\"article\">\n<div class=\"node__content\">\n<div class=\"field field--name-body field--type-text-with-summary field--label-hidden\">\n<div class=\"field__items\">\n<div class=\"field__item even\">\n<div class=\"l-main\">\n<div class=\"l-content\">\n<div class=\"block--vh-video-content-jwplayer\">\n<div class=\"block-inner clearfix\">\n<div>\n<div id=\"jwplayer-container-1\" class=\"video-wrapper-16-9\">\n<div id=\"jwPlayer-stage-1\" class=\"jwplayer jw-reset jw-state-idle jw-stretch-uniform jw-flag-aspect-mode jw-breakpoint-4 jw-floating-dismissible jw-flag-user-inactive\" tabindex=\"0\" role=\"application\" aria-label=\"Video Player\">\n<div class=\"jw-wrapper jw-reset\">\n<div class=\"jw-title jw-reset-text\" dir=\"auto\">La ci\u00e1tica es un t\u00e9rmino que describe los s\u00edntomas de dolor, entumecimiento y\/o debilidad que se irradian a lo largo del nervio ci\u00e1tico desde la parte baja de la espalda hasta las nalgas y las piernas. El t\u00e9rmino m\u00e9dico para la ci\u00e1tica es radiculopat\u00eda lumbar. La gran mayor\u00eda de los s\u00edntomas de la ci\u00e1tica se producen por trastornos en la parte baja de la espalda entre L4 y S1, que presionan la ra\u00edz de un nervio lumbar o la irritan. Com\u00fanmente, la ci\u00e1tica se debe a un problema de disco, como una hernia de disco que presiona la ra\u00edz de un nervio. Tambi\u00e9n se puede producir cuando un disco se degenera y libera prote\u00ednas inflamatorias que irritan un nervio adyacente.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h2>La ci\u00e1tica<\/h2>\n<p>La ci\u00e1tica con frecuencia es caracterizada por la presencia de uno o m\u00e1s de los siguientes s\u00edntomas:<\/p>\n<ul>\n<li>Dolor constante en una nalga o en una sola pierna (rara vez puede presentarse en ambas piernas)<\/li>\n<li>Dolor que se agudiza al sentarse<\/li>\n<li>Quemaz\u00f3n o hormigueo que bajan por la pierna (en vez de un dolor sordo)<\/li>\n<li>Debilidad, adormecimiento o dificultad para mover la pierna o el pie<\/li>\n<li>Dolor constante en una nalga<\/li>\n<li>Dolor punzante que pueda hacer dif\u00edcil ponerse de pie o caminar<\/li>\n<\/ul>\n<p>El dolor de la ci\u00e1tica puede variar desde infrecuente e irritante hasta constante y debilitador. Los s\u00edntomas espec\u00edficos de la ci\u00e1tica tambi\u00e9n var\u00edan mucho en cuanto al tipo de s\u00edntoma, el lugar afectado y su gravedad; todo depende de la afecci\u00f3n causante de la ci\u00e1tica. Aunque los s\u00edntomas pueden ser muy dolorosos, rara vez producen da\u00f1os permanentes (da\u00f1o tisular) en el nervio ci\u00e1tico.<\/p>\n<h2>El nervio ci\u00e1tico y la ci\u00e1tica<\/h2>\n<p>Los s\u00edntomas de la ci\u00e1tica son producidos por la irritaci\u00f3n del nervio ci\u00e1tico mayor. El nervio ci\u00e1tico es el m\u00e1s grande de los nervios del cuerpo y est\u00e1 compuesto por ra\u00edces individuales que surgen de varias partes de la columna vertebral para luego juntarse y formar el &#8220;nervio ci\u00e1tico&#8221;.<\/p>\n<ul>\n<li>El nervio ci\u00e1tico empieza en la parte inferior de la espalda en el segmento lumbar n\u00famero 3 (L3).<\/li>\n<li>De cada nivel de la parte inferior de la espalda sale una ra\u00edz nerviosa de dentro de la columna y, luego, estas ra\u00edces se juntan para formar el nervio ci\u00e1tico mayor.<\/li>\n<li>El nervio ci\u00e1tico va desde la parte inferior de la espalda hasta la parte posterior de cada pierna.<\/li>\n<li>En cada pierna porciones del nervio ci\u00e1tico se ramifican para proveer de nervios a ciertas partes de la pierna; por ejemplo, la nalga, el muslo, la pantorrilla, el pie y los dedos del pie.<\/li>\n<\/ul>\n<nav id=\"toc-container\" class=\"toc-container\" aria-label=\"In page table of contents for quick access to other pages in this article\"><\/nav>\n<p>Los s\u00edntomas de la ci\u00e1tica (por ejemplo, dolor de pierna, adormecimiento, hormigueo, debilidad y posiblemente dolor de pie) son diferentes seg\u00fan la parte del nervio comprimida. Por ejemplo, una compresi\u00f3n del nervio en el quinto segmento lumbar (L5) puede ocasionar una debilidad en la extensi\u00f3n del dedo gordo del pie y potencialmente en el tobillo (marcha en estepaje).<\/p>\n<div class=\"short-ad\"><\/div>\n<h2>La evoluci\u00f3n de la ci\u00e1tica<\/h2>\n<p>La prevalencia de la ci\u00e1tica aumenta en las personas de mediana edad. Es rara su aparici\u00f3n antes de los 20 a\u00f1os. La probabilidad de experimentar la ci\u00e1tica aumenta por los cincuenta a\u00f1os y luego se disminuye.<\/p>\n<p>En general, la ci\u00e1tica no es causada por un evento o una lesi\u00f3n aislados, sino que suele ir desarroll\u00e1ndose con el tiempo.<\/p>\n<p>La gran mayor\u00eda de las personas que experimentan la ci\u00e1tica se curan dentro de unas semanas o meses y consiguen aliviar el dolor con tratamientos no quir\u00fargicos. Sin embargo, otras sufren una ci\u00e1tica fuerte y debilitante debido a la compresi\u00f3n del nervio ci\u00e1tico.<\/p>\n<p>Existen unos pocos s\u00edntomas que puedan requerir de una intervenci\u00f3n m\u00e9dica (y posiblemente quir\u00fargica) inmediata, tales como s\u00edntomas neurol\u00f3gicos progresivos (por ejemplo, debilidad de la pierna) o una disfunci\u00f3n intestinal o vesical.<\/p>\n<p>Como la ci\u00e1tica es provocada por una afecci\u00f3n m\u00e9dica de fondo, su tratamiento se centra en el alivio de las causas subyacentes de los s\u00edntomas. Generalmente el tratamiento consta de cuidados personales o tratamientos no quir\u00fargicos, pero para casos graves o resistentes al tratamiento, puede ser una opci\u00f3n una cirug\u00eda.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<h2><span style=\"color: #ff0000;\">Estenosis raqu\u00eddea lumbar frente a estenosis raqu\u00eddea cervical<\/span><\/h2>\n<ul>\n<li>En la estenosis lumbar, las ra\u00edces de los nervios espinales en la parte baja de la espalda quedan comprimidas, o estranguladas, y esto puede producir\u00a0<a href=\"https:\/\/www.spine-health.com\/espanol\/ciatica\/sintomas-de-la-ciatica\">S\u00edntomas de la ci\u00e1tica<\/a>: hormigueo, debilidad o entumecimiento que irradia de la parte inferior de la espalda hacia las nalgas y piernas, especialmente con la actividad.<\/li>\n<li>El dolor en el cuello por la estenosis raqu\u00eddea (estenosis raqu\u00eddea cervical) puede ser mucho m\u00e1s peligroso por comprimir la m\u00e9dula espinal. La estenosis de m\u00e9dula espinal puede causar s\u00edntomas graves, incluso debilidad corporal importante o hasta par\u00e1lisis. Sin embargo, este tipo de s\u00edntomas por estenosis raqu\u00eddea grave son pr\u00e1cticamente imposibles en la columna lumbar ya que no hay m\u00e9dula espinal en la columna lumbar.En Spine-health.com, este dolor de la ra\u00edz nerviosa se llama hernia de disco. (Otras causas comunes de un pinzamiento de un nervio pueden incluir la estenosis raqu\u00eddea y espolones \u00f3seos por artritis de la columna).\n<div class=\"l-title\">\n<h1 class=\"page-title\"><span style=\"color: #ff0000;\">Estenosis raqu\u00eddea<\/span>?<\/h1>\n<\/div>\n<\/li>\n<\/ul>\n<p>En casos poco frecuentes, la estenosis lumbar puede llegar a producir un dolor incapacitante persistente e incluso debilidad en las piernas. Sin embargo, la mayor\u00eda de los casos de estenosis en la columna lumbar presentan dolor que irradia a la(s) pierna(s) al caminar, y el dolor se alivia al sentarse. Esto se llama claudicaci\u00f3n, que tambi\u00e9n puede ser causado por problemas circulatorios en las piernas, como se analiza m\u00e1s adelante en este art\u00edculo.<\/p>\n<nav id=\"toc-container\" class=\"toc-container\" aria-label=\"In page table of contents for quick access to other pages in this article\"><\/nav>\n<p>La estenosis raqu\u00eddea est\u00e1 relacionada con la degeneraci\u00f3n en la columna y por lo general se torna importante a partir de los 50 a\u00f1os y se extiende en cada grupo etario siguiente. La mayor\u00eda de los pacientes consultan al m\u00e9dico con s\u00edntomas de estenosis raqu\u00eddea cuando tienen alrededor de 60 a\u00f1os. Los pacientes solo necesitan buscar tratamiento para la estenosis raqu\u00eddea lumbar si ya no desean vivir con limitaciones significativas en las actividades, como dolor de piernas y\/o dificultad para caminar.<\/p>\n<p>La estenosis raqu\u00eddea puede ocurrir en una variedad de formas en la columna. Aproximadamente el 75% de los casos de estenosis raqu\u00eddea ocurren en la columna lumbar (parte baja de la espalda), llamada estenosis raqu\u00eddea lumbar, y la mayor\u00eda afectar\u00e1 el nervio ci\u00e1tico que recorre la parte posterior de la pierna. Cuando esto sucede, se denomina com\u00fanmente ci\u00e1tica<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<h3>Dolor discal<\/h3>\n<p>Cuando un paciente tiene un disco degenerado sintom\u00e1tico (que causa lumbalgia o dolor en la pierna), el espacio discal es lo que causa dolor y es doloroso. Este tipo de dolor generalmente se llama dolor axial.<\/p>\n<nav id=\"toc-container\" class=\"toc-container\" aria-label=\"In page table of contents for quick access to other pages in this article\">\n<div class=\"view view-toc view-id-toc view-display-id-block view-dom-id-970658519bbf539e45735e45a41f9824\">\n<div class=\"view-content\">\n<ul>\n<li class=\"views-row-even\">Diagn\u00f3stico de problemas de disco<\/li>\n<li class=\"views-row-odd\">Tratamientos para la hernia de disco frente a tratamientos para la enfermedad degenerativa de disco<\/li>\n<li class=\"views-row-even views-row-last\">Video sobre hernia de disco<br \/>\n<h1 class=\"content-title\">\u00bfQu\u00e9 es una hernia de disco, un pinzamiento de un nervio, un disco protuberante?<\/h1>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/nav>\n<p>Cualquiera de las afecciones mencionadas anteriormente pueden ocurrir en la columna cervical, dorsal o lumbar. Tienden a ser m\u00e1s frecuentes en la parte baja de la espalda porque esta parte soporta la mayor rotaci\u00f3n y fuerza todos los d\u00edas.<\/p>\n<p>Se debe recordar que todos los t\u00e9rminos: hernia de disco, pinzamiento de nervio, disco protuberante, disco desplazado, disco roto, etc., se refieren a hallazgos radiogr\u00e1ficos observados en una tomograf\u00eda computarizada o resonancia magn\u00e9tica. Si bien estos resultados son importantes, no son tan significativos para determinar la causa del dolor como los s\u00edntomas espec\u00edficos del paciente y los resultados del examen f\u00edsico del m\u00e9dico.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<div class=\"view view-toc view-id-toc view-display-id-block view-dom-id-e5fe7fc72ef2daf13abf54eba1d1d2a7\">\n<div class=\"view-content\">\n<ul>\n<li class=\"views-row-odd views-row-first\">S\u00edntomas, diagn\u00f3stico y tratamiento de la lumbalgia<\/li>\n<li class=\"views-row-even\">S\u00edntomas y causas de la lumbalgia<\/li>\n<li class=\"views-row-odd\">La lumbalgia en los adultos mayores<\/li>\n<li class=\"views-row-even\">Diagn\u00f3stico de la lumbalgia<\/li>\n<li class=\"views-row-odd views-row-last\">Tratamiento de la lumbalgia<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/nav>\n<h3><span style=\"color: #ff0000;\">Estenosis del canal lumbar o espondilolistesis degenerativa<\/span><\/h3>\n<p>Tanto la estenosis vertebral como la espondilolistesis degenerativa pueden comprimir los nervios donde estos salen de la columna vertebral. Cuando uno est\u00e1 de pie, por ejemplo cuando est\u00e1 caminando normalmente, esto aumenta la compresi\u00f3n del nervio, causando el dolor de pierna.<\/p>\n<h2><span style=\"color: #ff0000;\">Dolor de espalda de aparici\u00f3n repentina, p\u00e9rdida de flexibilidad y p\u00e9rdida de estatura<\/span><\/h2>\n<p>Puede incluir cualquiera de los siguientes s\u00edntomas:<\/p>\n<ul>\n<li>Dolor de espalda de aparici\u00f3n repentina<\/li>\n<li>Al estar de pie o al caminar generalmente empeora el dolor<\/li>\n<li>Al recostarse boca arriba el dolor se pone menos intenso<\/li>\n<li>P\u00e9rdida de estatura<\/li>\n<li>Flexibilidad limitada de la columna<\/li>\n<li>Deformidad y discapacidad<\/li>\n<\/ul>\n<a href=\"https:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2022\/01\/Clasificacio\u0301n-de-las-lesiones-trauma\u0301ticas-vertebrales.pdf\" class=\"pdfemb-viewer\" style=\"\" data-width=\"max\" data-height=\"max\" data-toolbar=\"bottom\" data-toolbar-fixed=\"off\">Clasificacio\u0301n de las lesiones trauma\u0301ticas vertebrales<\/a>\n<div class=\"header-title text-left show\">\n<div class=\"title-wrap\">\n<div class=\"content\">\n<div class=\"page-container\">\n<div class=\"wrap-container\">\n<h1 class=\"page-title no-transition\">Descubre la clasificaci\u00f3n de las fracturas vertebrales t\u00f3raco-lumbares<\/h1>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"page-container without-breadcrumbs\">\n<div class=\"page-content with-right-sidebar\">\n<div id=\"primary\" class=\"content-area\">\n<p>&nbsp;<\/p>\n<article id=\"post-507942\" class=\"post-507942 post type-post status-publish format-standard has-post-thumbnail hentry category-columna\">\n<div class=\"entry-content\">\n<section class=\"wpb-content-wrapper\">\n<section class=\"vc_section\">\n<div class=\"vc_row wpb_row vc_row-fluid\">\n<div class=\"wpb_column vc_column_container vc_col-sm-12\">\n<div class=\"vc_column-inner\">\n<div class=\"wpb_wrapper\">\n<div id=\"norebro-custom-645457d51b34e\" class=\"norebro-text-sc \">\n<p><i><a href=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/12\/Captura-de-Pantalla-2021-05-17-a-les-13.20.14.png\"><img decoding=\"async\" class=\"wp-image-507963 alignleft\" src=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/12\/Captura-de-Pantalla-2021-05-17-a-les-13.20.14.png\" alt=\"\" width=\"301\" height=\"206\" \/><\/a><\/i><i>Las fracturas toraco-lumbares, son fracturas tremendamente frecuentes en nuestro medio. Es importante saber identificarlas y tratarlas, de lo contrario pueden haber muchas secuelas. Es por eso que, tanto por su frecuencia como por su potencial gravedad, que cualquier especialista debe tener las nociones m\u00ednimas de como identificarlas y tratarlas.<\/i><\/p>\n<p><i>La anatom\u00eda es b\u00e1sica en cualquier tipo de fractura, y el raquis no es una excepci\u00f3n.<\/i><\/p>\n<p><i>En este caso, cada nivel (v\u00e9rtebra-disco-v\u00e9rtebra) de la columna vertebral tiene caracter\u00edsticas concretas. Conocer la anatom\u00eda, lo que es normal o anormal, es clave para el abordaje de estas fracturas.<\/i><\/p>\n<p>&nbsp;<\/p>\n<p>La gran mayor\u00eda de fracturas t\u00f3raco-lumbares suelen ser por ca\u00eddas banales en personas osetopor\u00f3ticas que no tienen un gran potencial de lesi\u00f3n neurol\u00f3gica. Sin embargo, son esos pacientes j\u00f3venes que sufren accidentes de alta energ\u00eda, como accidentes de tr\u00e1fico o ca\u00eddas de gran altura, los que presentan, en el momento de la llegada a urgencias, alg\u00fan d\u00e9ficit neurol\u00f3gico a la exploraci\u00f3n.<\/p>\n<p>Hay que ser muy cuidadoso con la exploraci\u00f3n neurol\u00f3gica desde un inicio.<\/p>\n<h3 id=\"yui_3_17_2_1_1621248594284_21\">Clasificaci\u00f3n seg\u00fan Denis.<\/h3>\n<p>Dennis, postulaba que hab\u00eda 3 modelos de columna<\/p>\n<ul>\n<li><strong>COLUMNA ANTERIOR.<\/strong><\/li>\n<\/ul>\n<p>Parte anterior del cuerpo vertebral, fuertemente unidos unos a otros por la banda longitudinal de ligamento vertebral com\u00fan anterior y por la parte anterior del anillo fibroso del disco intervertebral, fuertemente adherido a las caras superior e inferior de las v\u00e9rtebras adyacentes, as\u00ed como al cuerpo del ligamento vertebral com\u00fan anterior.<\/p>\n<ul>\n<li><strong>COLUMNA MEDIA.<\/strong><\/li>\n<\/ul>\n<p>Formada por la parte posterior del cuerpo vertebral, unido y s\u00f3lidamente fijado al ligamento vertebral longitudinal com\u00fan posterior y al anillo fibroso posterior.<\/p>\n<ul>\n<li><strong>COLUMNA POSTERIOR.<\/strong><\/li>\n<\/ul>\n<p>Formada por el arco \u00f3seo posterior: ped\u00edculos, l\u00e1minas, ap\u00f3fisis transversas articulares y espinosas y, adem\u00e1s, el complejo ligamentario posterior; ligamento interespinoso, amarillo, c\u00e1psulas y ligamentos articulares.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/12\/Captura-de-Pantalla-2021-05-17-a-les-12.52.14-1.png\"><img decoding=\"async\" class=\"aligncenter wp-image-507949\" src=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/12\/Captura-de-Pantalla-2021-05-17-a-les-12.52.14-1.png\" alt=\"\" width=\"401\" height=\"196\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>Cuando una fractura afecta a un nivel en 2 columnas o m\u00e1s, podemos plantearnos una cirug\u00eda.<\/p>\n<p>No obstante, exiten m\u00e1s clasificaciones a considerar.<\/p>\n<\/div>\n<div class=\"vc_empty_space\"><\/div>\n<section class=\"vc_cta3-container\">\n<div class=\"vc_general vc_cta3 vc_cta3-style-classic vc_cta3-shape-rounded vc_cta3-align-center vc_cta3-color-classic vc_cta3-icon-size-md\">\n<div class=\"vc_cta3_content-container\">\n<div class=\"vc_cta3-content\">\n<header class=\"vc_cta3-content-header\">\n<h2>Clasificaci\u00f3n de las fracturas toraco-lumbares\u2018<\/h2>\n<\/header>\n<p align=\"center\"><i>\u201cLas fracturas toraco-lumbares, son fracturas tremendamente frecuentes en nuestro medio. Es importante saber identificarlas y tratarlas, de lo contrario pueden haber muchas secuelas. Es por eso que, tanto por su frecuencia como por su potencial gravedad, que cualquier especialista debe tener las nociones m\u00ednimas de como identificarlas y tratarlas.\u201d<\/i><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<div id=\"norebro-custom-645457d51bddc\" class=\"norebro-text-sc \">\n<div class=\"h5p-column-content h5p-advanced-text\">\n<h3 id=\"yui_3_17_2_1_1621250303770_21\">Clasificaci\u00f3n propuesta por la AOSpine.<\/h3>\n<p>Hace unos a\u00f1os, la AO presento un estudio donde divid\u00edan las fracturas en letras y n\u00fameros. Las letras corresponden al mecanismo de la lesi\u00f3n, el n\u00famero corresponde a la severidad.<\/p>\n<\/div>\n<p><a href=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/12\/Captura-de-Pantalla-2021-05-17-a-les-13.06.44.png\"><img decoding=\"async\" class=\"alignright wp-image-507955\" src=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/12\/Captura-de-Pantalla-2021-05-17-a-les-13.06.44.png\" alt=\"\" width=\"300\" height=\"225\" \/><\/a>En el caso de las letras son tres, A,B y C correspondi\u00e9ndose a \u00a0fracturas por mecanismo de compresi\u00f3n axial, fracturas por distracci\u00f3n y fracturas por traslaci\u00f3n.<\/p>\n<p>Una vez a\u00f1adimos los n\u00fameros la clasificaci\u00f3n se desarrollaria de esta manera.<\/p>\n<div class=\"h5p-column-content h5p-advanced-text\">\n<p><b>A = fracturas por mecanismo de compresi\u00f3n axial.<\/b><\/p>\n<ul>\n<li>A0, fracturas de elementos que no comprometen la estabilidad de la v\u00e9rtebra<\/li>\n<li>A1, platillos<\/li>\n<li>A2, fracturas tipo split<\/li>\n<li>A3, Estallido parcial<\/li>\n<li>A4, Estallido completo.<\/li>\n<\/ul>\n<p><b>B =\u00a0fracturas por distracci\u00f3n.<\/b><\/p>\n<ul>\n<li>B1, fractura por flexi\u00f3n. Afectados elementos \u00f3seos.<\/li>\n<li>B2, fractura por flexi\u00f3n. Se afectan componentes no \u00f3seos<\/li>\n<li>B3, fractura por extensi\u00f3n.<\/li>\n<\/ul>\n<p><b>C = fracturas por traslaci\u00f3n;<\/b>\u00a0(gran inestabilidad y probabilidad de asociar cl\u00ednica neurol\u00f3gica).<\/p>\n<\/div>\n<p>Me pueden servir estas clasificaciones a la hora de proponerle un tratamiento a un paciente? Nos va a guiar a la hora de decidir si opararla o no?<\/p>\n<h3>El TLICS<\/h3>\n<p>El mismo grupo propuso utilizando est\u00e1 clasificaci\u00f3n el TLICS, una orientaci\u00f3n, basandose en tres elementos, para saber si esas fracturas hay que tratarlas quir\u00fargicamente o no.<\/p>\n<p>&nbsp;<\/p>\n<p>Los tres elementos son morfolog\u00edade la fractura (tipo de fractura), el da\u00f1o neurol\u00f3gico asociado, cuanto m\u00e1s severo, m\u00e1s puntuaba esta fractura y la lesi\u00f3n del complejo ligamentoso posterior, cuanto m\u00e1s da\u00f1ado, m\u00e1s puntuaba esta fractura.<\/p>\n<p>En un principio era interesante para ayudarnos en las fracturas que no sab\u00edamos si hay que tratar quir\u00fargicamente o no. No obstante, existe una gran limitaci\u00f3n en esta propuesta, ya que en las fracturas en estallido sin lesi\u00f3n neurol\u00f3gica y con CLP (complejo ligamentoso posterior), obten\u00edamos 4 puntos y el score no nos indicaba hacia tratamiento conservador o quir\u00fargico.<\/p>\n<p>Como resultado, para las fracturas m\u00e1s dudosas, nos complicaba la decisi\u00f3n.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/section>\n<\/div>\n<\/article>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span style=\"color: #ff0000;\">Aplastamiento vertebral<\/span> (p.ej., por osteoporosis)<\/h3>\n<p>Como regla general debe considerarse la posibilidad de un aplastamiento vertebral<\/p>\n<h1 class=\"titulo_enfermedad\">Aplastamiento vertebral<\/h1>\n<div id=\"bloque_1\" class=\"\">\n<p><img decoding=\"async\" class=\"contenido-imagen-centro\" title=\"Imagen de distintos tipos de columna vertebral\" src=\"https:\/\/www.redaccionmedica.com\/images\/enfermedades\/aplastamiento-vertebral.jpg\" alt=\"\u00bfPueden prevenirse la osteoporosis y las fracturas?\" \/><\/p>\n<div class=\"enfermedad_texto\">\n<p>Un\u00a0<strong>aplastamiento o fractura vertebral es la rotura de una v\u00e9rtebra.<\/strong>\u00a0Se produce como consecuencia de traumatismos o de forma espont\u00e1nea en personas con descalcificaci\u00f3n de los huesos (osteoporosis).<\/p>\n<h2>\u00bfCu\u00e1les son las causas del aplastamiento vertebral?<\/h2>\n<p>Los aplastamientos vertebrales pueden ser debidos a un\u00a0<strong>traumatismo<\/strong>\u00a0(generalmente ca\u00eddas, saltos o accidentes de tr\u00e1fico), tras un\u00a0<strong>estornudo en personas predispuestas,<\/strong>\u00a0tras hacer un gran esfuerzo (por ejemplo al cargar con un peso o levantarlo) o pueden producirse\u00a0<strong>de forma espont\u00e1nea.<\/strong>\u00a0Los aplastamientos son mucho\u00a0<strong>mas frecuentes<\/strong>\u00a0en personas con\u00a0<strong>osteoporosis<\/strong>.<\/p>\n<h2>S\u00edntomas de la fractura vertebral<\/h2>\n<p>Un aplastamiento suele producir un\u00a0<strong>dolor intenso localizado en el lugar de la fractura<\/strong>\u00a0que habitualmente cede de forma espont\u00e1nea transcurridas varias semanas. Hasta entonces precisar\u00e1 medicinas para reducir el dolor (analg\u00e9sicos y\/o anti-inflamatorios).<\/p>\n<hr width=\"131\" \/>\n<table width=\"10\" cellspacing=\"0\" cellpadding=\"0\" align=\"right\">\n<tbody>\n<tr>\n<td>Suele producir un dolor intenso localizado en el lugar de la fractura que habitualmente cede transcurridas varias semanas<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<hr width=\"131\" \/>\n<p>En muchas ocasiones, por el contrario, no producen ninguna sintomatolog\u00eda y las fracturas son descubiertas de forma casual al realizar una\u00a0<strong>radiograf\u00eda.<\/strong><\/p>\n<p>Los aplastamientos, si son m\u00faltiples, pueden<strong>\u00a0reducir la estatura,<\/strong>\u00a0producir una\u00a0<strong>curvatura de la espalda hacia delante (cifosis),<\/strong>\u00a0<strong>disminuir la capacidad pulmonar y producir dolores cr\u00f3nicos de espalda.<\/strong><\/p>\n<h2>\u00bfPueden prevenirse la osteoporosis y las fracturas?<\/h2>\n<p>La osteoporosis puede prevenirse evitando los factores de riesgo previamente referidos:<\/p>\n<ul>\n<li><strong>Dieta.<\/strong>\u00a0El consumo de\u00a0<strong>calcio y vitamina D\u00a0<\/strong>a lo largo de la vida adulta se asocia con el riesgo de desarrollar osteoporosis a edades avanzadas, de ah\u00ed la importancia de mantener una alimentaci\u00f3n rica en calcio a lo largo de toda la vida. Se recomienda un consumo de calcio de 1000 o 1200 mg diarios, bien en forma de alimentos o como suplementos. No es aconsejable realizar consumo superiores a 2000 mg al d\u00eda. El calcio se encuentra fundamentalmente en la leche y sus derivados y en vegetales de hoja verde. Se recomienda consumir diariamente un m\u00ednimo de 800 UI de vitamina D. Esta vitamina se encuentra en el aceite de h\u00edgado, yema de huevo, queso y pescados azules. Si su consumo no fuera suficiente, deben utilizarse suplementos vitam\u00ednicos.<\/li>\n<li><strong>Exposici\u00f3n al sol.\u00a0<\/strong>La piel produce vitamina D activa tras exponerse al sol sin protecci\u00f3n. Es conveniente ponerse al sol con frecuencia y dejando superficie corporal expuesta, si bien hay que evitar la sobreexposici\u00f3n que se asociar\u00eda a quemaduras solares o mayor riesgo de c\u00e1ncer de piel.<\/li>\n<li><strong>Ejercicio<\/strong>. El ejercicio aumenta la cantidad de hueso y reduce el riesgo de ca\u00eddas. Debe hacerse ejercicio f\u00edsico un m\u00ednimo de 30 minutos diarios, 3 veces a la semana. El beneficio del ejercicio desaparece poco tiempo despu\u00e9s de haberlo abandonado, por lo que se debe ser constante en su realizaci\u00f3n.<\/li>\n<li><strong>Tabaco.<\/strong>\u00a0El tabaco favorece el desarrollo de osteoporosis, por lo que debe abandonarse.<\/li>\n<li><strong>Medicamentos.\u00a0<\/strong>Se debe evitar el uso prolongado de medicaciones que puedan reducir la cantidad de hueso, como los corticoides, la heparina y algunos antiepil\u00e9pticos.<\/li>\n<li><strong>Prevenci\u00f3n de ca\u00eddas.<\/strong>\u00a0Se deben de evitar aquellas circunstancias que puedan favorecer las ca\u00eddas:<\/li>\n<\/ul>\n<blockquote>\n<ul>\n<li>Retirar las alfombras de la casa que se muevan con facilidad.<\/li>\n<li>Retirar los cables que puedan favorecer el tropiezo.<\/li>\n<li>Mantener un adecuado alumbrado de la casa y del acceso a la misma.<\/li>\n<li>Evitar caminar por superficies resbaladizas como zonas reci\u00e9n enceradas, zonas con hielo o reci\u00e9n mojadas.<\/li>\n<li>Evitar caminar solo por zonas donde no se est\u00e9 familiarizado.<\/li>\n<li>Evitar los medicamentos que puedan producir somnolencia o torpor mental.<\/li>\n<li>Hacer revisiones oftalmol\u00f3gicas peri\u00f3dicas para mantener una adecuada capacidad visual.<\/li>\n<\/ul>\n<\/blockquote>\n<h2>Tratamiento de los aplastamientos vertebrales<\/h2>\n<p>El\u00a0<strong>tratamiento agudo<\/strong>\u00a0de un aplastamiento suele consistir en:<\/p>\n<ul>\n<li>La administraci\u00f3n de\u00a0<strong>analg\u00e9sicos o anti-inflamatorios.<\/strong><\/li>\n<li>En ocasiones, la\u00a0<strong>utilizaci\u00f3n de un cors\u00e9<\/strong>\u00a0que inmovilice la zona.<\/li>\n<li><strong>Calor<\/strong>\u00a0para aliviar las contracturas musculares asociadas.<\/li>\n<li>El tratamiento con\u00a0<strong>calcitonina<\/strong>\u00a0tambi\u00e9n ha demostrado ser eficaz para reducir el dolor y se puede usar cuando el dolor no cede con la analgesia habitual.<\/li>\n<li>La inyecci\u00f3n a trav\u00e9s de la piel de un cemento en el lugar donde se encuentra la v\u00e9rtebra comprimida<strong>\u00a0(vertebroplastia o cifoplastia),<\/strong>\u00a0suele producir alivio inmediato en la mayor\u00eda de los pacientes, si bien se desconocen sus efectos a largo plazo. Es la t\u00e9cnica de elecci\u00f3n si no se logra controlar el dolor con medicamentos.<\/li>\n<li>Si bien se suele recomendar reposo los primeros d\u00edas, se debe intentar la movilizaci\u00f3n lo antes posible para frenar la descalcificaci\u00f3n (p\u00e9rdida de masa \u00f3sea) que habitualmente ocurre en personas que se mueven poco.<\/li>\n<\/ul>\n<p><strong>De forma cr\u00f3nica<\/strong>\u00a0los aplastamientos vertebrales pueden asociarse con dolor, el cual requiere:<\/p>\n<ul>\n<li><strong>Analg\u00e9sicos y ejercicios<\/strong>\u00a0para fortalecer la musculatura de la espalda.<\/li>\n<li><strong>La utilizaci\u00f3n de calor, TENS\u00a0<\/strong>(estimulaci\u00f3n nerviosa transcut\u00e1nea) o\u00a0<strong>ultrasonidos<\/strong>\u00a0pueden ser eficaces en algunos pacientes.<\/li>\n<\/ul>\n<p>En todo paciente con un aplastamiento vertebral se recomienda\u00a0<strong>evaluar si tiene osteoporosis<\/strong>\u00a0y, en ese caso, poner un tratamiento espec\u00edfico para reducir el riesgo de futuras fracturas.<\/p>\n<\/div>\n<\/div>\n<p>luego de cualquier aparici\u00f3n repentina de dolor de espalda en adultos mayores de 50 a\u00f1os, especialmente en mujeres posmenop\u00e1usicas con osteoporosis y en hombres y mujeres luego del uso prolongado de corticoesteroides. En una persona con osteoporosis, hasta una fuerza peque\u00f1a ejercida sobre la columna, como por un estornudo, puede ocasionar un aplastamiento vertebral.<\/p>\n<p>El principal s\u00edntoma de una\u00a0<strong>fractura vertebral grave<\/strong>\u00a0es el dolor, que puede ser muy intenso y adem\u00e1s empeora con el movimiento. Adem\u00e1s, si la m\u00e9dula espinal resulta afectada tambi\u00e9n puede aparecer entumecimiento y debilidad, que puede extenderse a los brazos y piernas.<\/p>\n<p>Dependiendo de la gravedad de la fractura pueden causar par\u00e1lisis o reflejos anormales.<\/p>\n<p>A causa de ese dolor, se limita la movilidad y se adoptan posturas defensivas, lo que puede provocar contracturas musculares. A ello se une que el estr\u00e9s que genera en la columna puede provocar fracturas en las v\u00e9rtebras vecinas. Entonces sentimos que nos falta capacidad para respirar. Y complica poder realizar actividades diarias sencillas.<\/p>\n<h2><span id=\"Fractura_vertebral_grave_tratamiento_del_aplastamiento_vertebral\">Fractura vertebral grave: tratamiento del aplastamiento vertebral<\/span><\/h2>\n<p>Aunque la mayor\u00eda de los casos de una\u00a0<strong>fractura vertebral grave<\/strong>\u00a0suelen ser debido a la osteoporosis, tambi\u00e9n pueden aparecer por un\u00a0<strong>aplastamiento vertebral<\/strong>\u00a0o por un tumor. En el caso de la osteoporosis, el reposo, los analg\u00e9sicos y el uso de un cors\u00e9 suelen ser suficientes. Adem\u00e1s, los medicamentos para tratar la osteoporosis pueden ayudar a prevenir fracturas futuras. Cuando la causa es un tumor, hay que recurrir a la cirug\u00eda.<\/p>\n<p>En el caso de una\u00a0<strong>fractura por aplastamiento,<\/strong>\u00a0el\u00a0<strong>tratamiento<\/strong>\u00a0debe comenzar con el alivio del dolor, reposo y la estabilizaci\u00f3n de la columna para evitar una lesi\u00f3n mayor.<\/p>\n<p>La mayor\u00eda de los casos de una\u00a0<strong>fractura vertebral grave<\/strong>\u00a0se pueden tratar con\u00a0<strong>productos ortop\u00e9dicos<\/strong>\u00a0durante unas semanas (entre 6 y 12 dependiendo de la gravedad). As\u00ed se consigue mantener la alineaci\u00f3n de la columna, adem\u00e1s de inmovilizarla y controlar el dolor. Gradualmente hay que ir aumentando la actividad f\u00edsica y cuando el especialista lo indique iniciar la rehabilitaci\u00f3n. Si no se produce curaci\u00f3n o mejora hay que plantearse la opci\u00f3n de la\u00a0cirug\u00eda.<\/p>\n<h3><span id=\"Productos_ortopedicos_para_una_fractura_vertebral_grave\">Productos ortop\u00e9dicos para una fractura vertebral grave<\/span><\/h3>\n<p><img decoding=\"async\" class=\"alignright wp-image-10446 size-medium\" title=\"\" src=\"https:\/\/www.orliman.com\/wp-content\/uploads\/J001G-D1-1-300x300.jpg\" sizes=\"(max-width: 300px) 100vw, 300px\" srcset=\"https:\/\/www.orliman.com\/wp-content\/uploads\/J001G-D1-1-300x300.jpg 300w, https:\/\/www.orliman.com\/wp-content\/uploads\/J001G-D1-1-150x150.jpg 150w, https:\/\/www.orliman.com\/wp-content\/uploads\/J001G-D1-1.jpg 720w\" alt=\"\" width=\"300\" height=\"300\" \/>En el caso de los\u00a0<strong>productos ortop\u00e9dicos<\/strong>\u00a0que se pueden utilizar, en Orliman recomendamos el\u00a0Marco de hiper-extensi\u00f3n Jewett con adaptaci\u00f3n esternal tridimensional. En su versi\u00f3n\u00a0normal\u00a0o\u00a0corto. Este producto ayuda en el\u00a0<strong>tratamiento<\/strong>\u00a0de la\u00a0<strong>fractura vertebral grave<\/strong>\u00a0estabilizando y restringiendo los movimientos de la columna vertebral. Adem\u00e1s, gracias al sistema de tres puntos de apoyo (suprap\u00fabico, dorsolumbar y esternal) permite la hiperextensi\u00f3n de la columna vertebral. A ello se une el alivio del dolor y la descarga mec\u00e1nica de los cuerpos vertebrales de la zona tor\u00e1cica baja y lumbar alta.<\/p>\n<p>El marco de hiper-extensi\u00f3n Jewett de Orliman se adapta al cuerpo del paciente, minimizando los impactos dolorosos que este tipo de\u00a0<strong>productos ortop\u00e9dicos<\/strong>\u00a0suelen causar. As\u00ed se evita que el paciente no siga correctamente el\u00a0<strong>tratamiento<\/strong>\u00a0prescrito. Por ejemplo, para una sedestaci\u00f3n m\u00e1s c\u00f3moda, el marco cuenta con un apoyo p\u00e9lvico basculante. Todas las protecciones superiores est\u00e1n confeccionadas en un tejido foamizado y termoconformado para ofrecer un mayor confort. Y es f\u00e1cil de utilizar y colocar, gracias a su sistema de cierres y fijaci\u00f3n en microgancho.<\/p>\n<p>Un diagn\u00f3stico temprano es el m\u00e9todo m\u00e1s efectivo para tratar una\u00a0<strong>fractura vertebral grave<\/strong>. Por ello, informa de inmediato a tu m\u00e9dico acerca de cualquier dolor de espalda nuevo o inusual.<\/p>\n<div class=\"tablebox tablebox--headings\">\n<div class=\"tablebox__cell tablebox__cell--headings\">\n<div class=\"topic__headings\">\n<div class=\"topic__header--container\">\n<div class=\"topic__authors topic__authors--container\">\n<h1 class=\"topic__header__headermodify--title topic__header__headermodify--title--animate\">Fracturas vertebrales por compresi\u00f3n<\/h1>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"topic__accordion\">\n<div class=\"para\">\n<div class=\"topic__explanation\">La mayor\u00eda de las fracturas vertebrales por compresi\u00f3n son una consecuencia de la osteoporosis, son asintom\u00e1ticos o m\u00ednimamente sintom\u00e1ticas, y se producen con o sin un traumatismo m\u00ednimo.<\/div>\n<\/div>\n<div class=\"para\">\n<p><span style=\"font-size: 1em;\">Las fracturas por compresi\u00f3n vertebral debido a<\/span><\/p>\n<div class=\"tablebox tablebox--headings\">\n<div class=\"tablebox__cell tablebox__cell--headings\">\n<div class=\"topic__headings\">\n<div class=\"topic__header--container\">\n<div class=\"topic__authors topic__authors--container\">\n<h1 class=\"topic__header__headermodify--title topic__header__headermodify--title--animate\"><span style=\"color: #ff0000;\">Osteoporosis<\/span><\/h1>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"topic__accordion\">\n<div class=\"para\">\n<div class=\"topic__explanation\">La osteoporosis es una enfermedad \u00f3sea metab\u00f3lica progresiva que disminuye la densidad \u00f3sea (masa \u00f3sea por unidad de volumen), con deterioro de la estructura del hueso. La debilidad esquel\u00e9tica produce fracturas por traumatismos m\u00ednimos o inaparentes, en especial en la columna tor\u00e1cica y lumbar, la mu\u00f1eca y la cadera (fracturas por fragilidad). El diagn\u00f3stico se realiza por absorciometr\u00eda dual de rayos X (DXA) o mediante la confirmaci\u00f3n de una fractura por fragilidad. La prevenci\u00f3n y el tratamiento incluyen la modificaci\u00f3n de los factores de riesgo, suplementos de calcio y vitamina D, ejercicios para maximizar la fuerza \u00f3sea y muscular, mejorar el equilibrio y minimizar el riesgo de ca\u00eddas, y f\u00e1rmacos que preservan la masa \u00f3sea o estimulan la formaci\u00f3n de hueso nuevo.<\/div>\n<\/div>\n<section id=\"v906751_es\" class=\"topic__section FHead\">\n<h2 id=\"Pathophysiology\" class=\"topic__header--section\">Fisiopatolog\u00eda<\/h2>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>El hueso se forma y se reabsorbe en forma continua. Normalmente, la formaci\u00f3n y resorci\u00f3n \u00f3seas est\u00e1n equilibradas. Los osteoblastos (c\u00e9lulas que forman la matriz org\u00e1nica del hueso y su mineralizaci\u00f3n) y los osteoclastos (c\u00e9lulas que resorben el hueso) son regulados por la hormona paratiroidea (PTH), la\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">calcitonina<\/span>, los\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span>, la vitamina D, diversas citocinas y otros factores locales como las prostaglandinas.<\/p>\n<\/div>\n<div class=\"para\">\n<p>El pico de masa \u00f3sea en hombres y mujeres se produce alrededor de los 30 a\u00f1os. Las personas de raza negra alcanzan una masa \u00f3sea m\u00e1xima que los de raza blanca y los asi\u00e1ticos, mientras que los latinos tienen valores intermedios. Los hombres tienen mayor masa \u00f3sea que las mujeres. Una vez alcanzado un pico, la masa \u00f3sea se mantiene estable durante 10 a\u00f1os, durante los cuales la formaci\u00f3n \u00f3sea es similar a la resorci\u00f3n \u00f3sea. Luego, comienza a haber una p\u00e9rdida \u00f3sea de 0,3 a 0,5% por a\u00f1o. A partir de la menopausia, esta p\u00e9rdida se acelera en las mujeres a un 3 a 5% por a\u00f1o durante 5 a 7 a\u00f1os y luego disminuye la velocidad de p\u00e9rdida \u00f3sea.<\/p>\n<\/div>\n<div class=\"para\">\n<p>La p\u00e9rdida de hueso osteopor\u00f3tica afecta al hueso cortical y trabecular (esponjoso). El grosor cortical y el n\u00famero y tama\u00f1o de las trab\u00e9culas disminuye, lo que aumenta la porosidad. Las trab\u00e9culas pueden romperse o estar ausentes. La p\u00e9rdida de hueso trabecular es m\u00e1s r\u00e1pida que la de hueso cortical, debido a que el hueso trabecular es m\u00e1s poroso y tiene mayor recambio. Sin embargo, la p\u00e9rdida de ambos tipos contribuye a la fragilidad esquel\u00e9tica.<\/p>\n<\/div>\n<section id=\"v7821313_es\" class=\"topic__section GHead\">\n<h3 id=\"\" class=\"topic__header--subsection\"><span style=\"color: #ff0000;\">Fracturas por fragilidad<\/span><\/h3>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Una fractura por fragilidad se produce por un traumatismo menor que el que podr\u00eda esperarse para fracturar un hueso normal. Las ca\u00eddas desde la posici\u00f3n de pie o desde menor altura, incluyendo ca\u00eddas de la cama, se consideran fracturas por fragilidad. Los sitios m\u00e1s comunes de fracturas por fragilidad son los siguientes:<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Columna vertebral (fracturas por compresi\u00f3n vertebral: fractura m\u00e1s com\u00fan relacionada con la osteoporosis)<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/section>\n<section id=\"v906762_es\" class=\"topic__section FHead\">\n<h2 id=\"Classification\" class=\"topic__header--section\">Clasificaci\u00f3n<\/h2>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>La osteoporosis puede ser primaria o secundaria a otros factores. Los sitios de fractura son similares en la osteoporosis primaria y secundaria.<\/p>\n<\/div>\n<section id=\"v906765_es\" class=\"topic__section GHead\">\n<h3 id=\"\" class=\"topic__header--subsection\">Osteoporosis primaria<a id=\"v906767_es\" class=\"anchor\"><\/a><\/h3>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>M\u00e1s del 95% de los casos de osteoporosis en mujeres, y alrededor del 80% en hombres son primarios. La mayor\u00eda de los casos ocurren en mujeres posmenop\u00e1usicas y en hombres mayores. La insuficiencia gonadal es un factor importante en hombres y mujeres. Otros factores que podr\u00edan acelerar la p\u00e9rdida \u00f3sea en pacientes con osteoporosis primaria incluyen una baja ingesta de calcio, bajos niveles de vitamina D, algunos f\u00e1rmacos e\u00a0hiperparatiroidismo. Algunos pacientes tienen una ingesta inadecuada de calcio durante los a\u00f1os de crecimiento de los huesos de la adolescencia y por lo tanto nunca alcanzan la masa \u00f3sea m\u00e1xima.<\/p>\n<\/div>\n<div class=\"para\">\n<p>El principal mecanismo de p\u00e9rdida \u00f3sea es el aumento de la resorci\u00f3n \u00f3sea, que produce una disminuci\u00f3n de la masa \u00f3sea con deterioro de la microarquitectura del hueso. Pero en algunos casos puede haber una alteraci\u00f3n en la formaci\u00f3n del hueso. Los mecanismos de p\u00e9rdida \u00f3sea incluyen los siguientes:<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Cambios locales en la producci\u00f3n de citocinas de resorci\u00f3n \u00f3sea, como un aumento en citocinas que estimulan la resorci\u00f3n \u00f3sea<\/p>\n<\/div>\n<div class=\"para\">\n<p>Alteraci\u00f3n de la respuesta de formaci\u00f3n durante la remodelaci\u00f3n \u00f3sea (probablemente debida a una reducci\u00f3n en el n\u00famero y actividad de los osteoblastos relacionada con la edad)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Otros factores como una disminuci\u00f3n de los factores de crecimiento locales y sist\u00e9micos<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Las fracturas por fragilidad ocurren raramente en ni\u00f1os, adolescentes, mujeres premenop\u00e1usicas, u hombres &lt; 50 a\u00f1os con funci\u00f3n gonadal normal y sin causa secundaria detectable, incluso en aquellos con baja masa \u00f3sea (baja puntuaci\u00f3n Z en la absorciometr\u00eda de energ\u00eda dual de rayos X [DXA]). Estos casos raros se consideran osteoporosis idiop\u00e1tica.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/section>\n<section id=\"v906778_es\" class=\"topic__section GHead\">\n<h2 class=\"topic__header--section\"><span style=\"color: #ff0000;\">Osteoporosis secundaria<\/span><a id=\"v906781_es\" class=\"anchor\"><\/a><\/h2>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>La osteoporosis secundaria representa\u00a0<span class=\"symbol\">&lt;<\/span>\u00a05% de los casos de osteoporosis en mujeres y alrededor del 20% en hombres. Las causas (ver\u00a0Causas de osteoporosis secundaria) tambi\u00e9n pueden acelerar la p\u00e9rdida \u00f3sea y aumentar el riesgo de fracturas en pacientes con osteoporosis primaria.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los pacientes con\u00a0enfermedad renal cr\u00f3nica\u00a0pueden tener varias razones para una baja masa \u00f3sea, incluyendo\u00a0hiperparatiroidismo secundario, hiperfosfatemia, deficiencia de\u00a0<span class=\"disabledResolvedDrug\">calcitriol<\/span>, alteraciones de la calcemia y la concentraci\u00f3n s\u00e9rica de vitamina D, osteomalacia y trastornos por bajo recambio \u00f3seo (enfermedad del hueso adin\u00e1mico).<\/p>\n<\/div>\n<div class=\"inlinebox--right inlinebox--table inlinebox--clickable\" data-mmanualobjecttype=\"illustrativeMaterial\">\n<div id=\"v906787_es\" class=\"inlinebox__wrapper\">\n<div class=\"inlinebox__header\">TABLA<\/div>\n<div class=\"inlinebox__content\">\n<div class=\"multimedia__link\" data-bind=\"component: { name: 'multimedia-link-text', params: $data }\"><span style=\"color: #000000;\"><a class=\"multimedia__link--text\" style=\"color: #000000;\" data-bind=\"shortClick: showPlayer, html: linkText, css: cssClass\">Causas de osteoporosis secundaria<\/a><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v906825_es\" class=\"topic__section FHead\">\n<h2 id=\"RiskFactors\" class=\"topic__header--section\">Factores de riesgo<\/h2>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Dado que la presi\u00f3n, incluido el apoyo del peso, es necesaria para el crecimiento del hueso, la inmovilizaci\u00f3n o los per\u00edodos sedentarios prolongados producen p\u00e9rdida \u00f3sea. Un \u00edndice de masa corporal bajo predispone a la p\u00e9rdida de masa \u00f3sea. Ciertos grupos \u00e9tnicos, entre ellos los blancos y los asi\u00e1ticos, tienen un mayor riesgo de osteoporosis. Una ingesta insuficiente de calcio, f\u00f3sforo, magnesio y vitamina D en la dieta predispone a la disminuci\u00f3n de masa \u00f3sea, al igual que la acidosis end\u00f3gena. El tabaquismo y el alcohol tambi\u00e9n afectan en forma adversa a la masa \u00f3sea. Un antecedente familiar de osteoporosis, en especial fractura de cadera en uno de los padres, tambi\u00e9n aumenta el riesgo. Los pacientes que han sufrido una fractura por fragilidad tienen mayor riesgo de sufrir otras fracturas cl\u00ednicas (sintom\u00e1ticas) y fracturas vertebrales por compresi\u00f3n asintom\u00e1ticas.<a id=\"v906829_es\" style=\"font-size: 18px;\"><\/a><\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v906828_es\" class=\"topic__section FHead\">\n<h2 id=\"SymptomsAndSigns\" class=\"topic__header--section\">Signos y s\u00edntomas<a id=\"v906830_es\" class=\"anchor\"><\/a><\/h2>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Los pacientes con osteoporosis son asintom\u00e1ticos a menos que se haya producido una fractura. Las fracturas no vertebrales son t\u00edpicamente sintom\u00e1ticas, pero cerca de dos tercios de las fracturas vertebrales por compresi\u00f3n son asintom\u00e1ticas (aunque los pacientes pueden tener dolor de espalda cr\u00f3nico subyacente debido a otras causas, como la artrosis). Una fractura por compresi\u00f3n vertebral sintom\u00e1tica comienza con dolor agudo que no irradia y es agravado en la posici\u00f3n de pie, puede acompa\u00f1arse de dolor espinal puntiforme y suele ceder luego de 1 semana. Sin embargo, puede quedar dolor residual durante meses o ser constante.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Las fracturas tor\u00e1cicas por compresi\u00f3n m\u00faltiples producen cifosis dorsal, con exageraci\u00f3n de la lordosis cervical (joroba de viuda). La sobrecarga anormal sobre los m\u00fasculos y ligamentos de la columna puede causar dolor cr\u00f3nico sordo y continuo, en especial en la parte inferior de la espalda. Los pacientes pueden tener dificultad para respirar debido a la disminuci\u00f3n del volumen intrator\u00e1cico o a saciedad precoz a la compresi\u00f3n de la cavidad abdominal dado que la caja tor\u00e1cica se aproxima a la pelvis.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v906836_es\" class=\"topic__section FHead\">\n<h2 id=\"Diagnosis\" class=\"topic__header--section\">Diagn\u00f3stico<\/h2>\n<div class=\"topic__content\">\n<div class=\"list\">\n<div class=\"para\">\n<p>Absorciometr\u00eda radiol\u00f3gica con energ\u00eda dual<\/p>\n<\/div>\n<div class=\"para\">\n<p>Radiograf\u00edas simples (suelen indicarse, pero no son diagn\u00f3sticas)<\/p>\n<\/div>\n<\/div>\n<section id=\"v33013133_es\" class=\"topic__section GHead\">\n<h3 id=\"\" class=\"topic__header--subsection\">Absorciometr\u00eda radiol\u00f3gica con energ\u00eda dual (DEXA)<a id=\"v33013135_es\" class=\"anchor\"><\/a><\/h3>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>La densidad \u00f3sea se debe medir usando DXA para detectar personas en riesgo, para obtener una medida cuantitativa de la p\u00e9rdida \u00f3sea y para controlar a aquellos bajo tratamiento (<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/trastornos-de-los-tejidos-musculoesquel%C3%A9tico-y-conectivo\/osteoporosis\/osteoporosis#v33013169_es\">1<\/a>).<\/p>\n<\/div>\n<div class=\"inlinemedia-component\" data-ko-rebind=\"v34402304_es\" data-bind=\"component: {name: 'inlinemedia-photo', params: $data}\">\n<div class=\"inlinemedia--image inlinemedia--right\" data-bind=\"css: componentClasses()\">\n<div class=\"inlinemedia__wrapper\">\n<div class=\"inlinemedia__header\">\n<div class=\"inlinemedia__title\" data-bind=\"html: Title\">\n<div>DXA<\/div>\n<\/div>\n<div class=\"inlinemedia__open hide-on-print\"><\/div>\n<\/div>\n<div class=\"inlinemedia__content\">\n<div class=\"inlinemedia__subtitle\" data-bind=\"html: Credits\">IMAGEN CORTES\u00cdA DE MARCY BOLSTER, MD.<\/div>\n<\/div>\n<div class=\"multimedia__link\" data-bind=\"component: { name: multimediaLinkComponentName, params: multimediaLinkModel }\">Se recomienda una prueba DEXA para los siguientes pacientes:<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Todas las mujeres \u2265 65 a\u00f1os<\/p>\n<\/div>\n<div class=\"para\">\n<p>Mujeres entre la menopausia y los 65 a\u00f1os que tienen factores de riesgo, incluyendo un antecedente familiar de osteoporosis, un \u00edndice de masa corporal bajo (p. ej., previamente definido como un peso corporal &lt; 57 kg [127 libras]), y el uso de tabaco o drogas con un alto riesgo de p\u00e9rdida de masa \u00f3sea (p. ej., glucocorticoides)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pacientes (hombres y mujeres) de cualquier edad que han tenido fracturas por fragilidad.<\/p>\n<p>Pacientes (hombres y mujeres) de cualquier edad que han sidos tratados con Corticoterapia por COVID<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pacientes con evidencias en los estudios de diagn\u00f3stico por im\u00e1genes de disminuci\u00f3n de la densidad \u00f3sea o de fracturas por compresi\u00f3n vertebral asintom\u00e1ticas detectadas en forma incidental<\/p>\n<\/div>\n<ul class=\"topic__list\" data-mmanualobjecttype=\"List\">\n<li class=\"topic__listitem\">\n<div class=\"para\">\n<p>Pacientes en riesgo de osteoporosis secundaria<\/p>\n<\/div>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Si la columna vertebral o la cadera no est\u00e1 disponible para su estudio (p. ej., a causa de la presencia de una artroplastia total de cadera previa), se puede estudiar el radio distal (denominado &#8220;1\/3&#8221; del radio<\/p>\n<p>en el informe de la prueba DXA) . El radio distal tambi\u00e9n debe ser escaneado en un paciente con hiperparatiroidismo porque este es el sitio m\u00e1s com\u00fan de p\u00e9rdida de masa \u00f3sea en esta patolog\u00eda.<\/p>\n<div class=\"para\" style=\"font-size: 1em;\">\n<p>El puntaje Z corresponde al n\u00famero de desviaciones est\u00e1ndar en qu\u00e9 difiere la densidad mineral \u00f3sea del valor normal para una persona de la misma edad y sexo, y se utiliza en ni\u00f1os, mujeres premenop\u00e1usicas, u hombres menores de 50 a\u00f1os. Si el puntaje Z es \u2264 \u20132, la densidad \u00f3sea es baja para la edad del paciente, y deben considerarse causas secundarias.<\/p>\n<\/div>\n<div class=\"para\" style=\"font-size: 1em;\">\n<p>Los sistemas actuales de DEXA central tambi\u00e9n permiten evaluar deformidades vertebrales en la columna tor\u00e1cica inferior y lumbar, un procedimiento denominado an\u00e1lisis de fractura vertebral (VFA). Las deformidades vertebrales no asociadas con traumatismos, incluso las que no tienen manifestaciones cl\u00ednicas, son diagn\u00f3sticas de osteoporosis y predicen un mayor riesgo de fracturas en el futuro. El an\u00e1lisis de fractura vertebral es m\u00e1s \u00fatil en pacientes con p\u00e9rdida de \u2265 3 cm de altura. Si los resultados de la morfometr\u00eda vertebral revelan probables anomal\u00edas, se deben realizar radiograf\u00edas simples para confirmar el diagn\u00f3stico.<\/p>\n<\/div>\n<div class=\"para\" style=\"font-size: 1em;\">\n<p>La necesidad de terapia farmacol\u00f3gica se basa en la probabilidad de fractura, que depende de los resultados de DXA, as\u00ed como de otros factores. La\u00a0<b>puntuaci\u00f3n de la evaluaci\u00f3n del riesgo de fractura (FRAX)<\/b>\u00a0(WHO Risk Assessment Tool) predice la probabilidad a 10 a\u00f1os de fractura osteopor\u00f3tica mayor (cadera, columna vertebral, antebrazo o h\u00famero) o de cadera en pacientes no tratados. La puntuaci\u00f3n representa factores de riesgo significativos para la p\u00e9rdida \u00f3sea y fracturas. Si la puntuaci\u00f3n FRAX est\u00e1 por encima de ciertos umbrales (en los EE.UU., \u2265 20% de probabilidad de fractura osteopor\u00f3tica mayor o 3% de probabilidad de fractura de cadera), se recomienda el tratamiento farmacol\u00f3gico.<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Para controlar la p\u00e9rdida \u00f3sea o la respuesta al tratamiento, se debe utilizar la misma m\u00e1quina DXA, y la comparaci\u00f3n debe basarse en la densidad mineral \u00f3sea real (g\/cm<sup>2<\/sup>) en lugar del puntaje T. En pacientes con osteopenia, DXA debe repetirse peri\u00f3dicamente para determinar si hay p\u00e9rdida \u00f3sea continua o desarrollo de osteoporosis franca que requiera tratamiento. La frecuencia del DXA de seguimiento var\u00eda de paciente a paciente. La DXA a menudo se realiza cada 2 a 3 a\u00f1os, pero a veces se puede hacer con menor frecuencia, por ejemplo, si la densidad \u00f3sea es normal y el riesgo de fractura es bajo. En los pacientes que reciben tratamiento para la osteoporosis, se debe repetir la DXA, por lo general alrededor de cada 2 a 3 a\u00f1os, pero a veces con mayor frecuencia en pacientes que toman glucocorticoides. Una densidad mineral \u00f3sea estable o mejorada predice un menor riesgo de fractura y muestra mayor respuesta al tratamiento. La monitorizaci\u00f3n de la densidad \u00f3sea con otra DXA puede ayudar a identificar a los pacientes con mayor riesgo de fracturas debido a una respuesta sub\u00f3ptima al tratamiento de la osteoporosis (<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/trastornos-de-los-tejidos-musculoesquel%C3%A9tico-y-conectivo\/osteoporosis\/osteoporosis#v33013169_es\">1<\/a>). Los pacientes que reciben tratamiento para osteoporosis que tienen una densidad mineral \u00f3sea significativamente disminuida en los ex\u00e1menes DXA seriados (&gt; 3% de disminuci\u00f3n cuando se eval\u00faa con el mismo equipo) se debe evaluar el cumplimiento del tratamiento y causas secundarias de p\u00e9rdida \u00f3sea.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<h3 class=\"topic__section GHead\"><span style=\"color: #000000;\">Radiograf\u00eda <span style=\"background-color: #d5d5d5;\">simple<\/span><\/span><\/h3>\n<div class=\"topic__content\">\n<div class=\"para\">\n<h6>Una osteoporosis inducida por corticoides tiene m\u00e1s probabilidades de causar fracturas vertebrales por compresi\u00f3n pero tambi\u00e9n puede causar fracturas en otros sitios en los que son frecuentes las fracturas por osteoporosis. El hiperparatiroidismo puede diferenciarse porque causa resorci\u00f3n subperi\u00f3stica o lesiones \u00f3seas qu\u00edsticas (raras veces). La osteomalacia puede causar anormalidades en los estudios por la imagen similares a las de la osteoporosis.<\/h6>\n<\/div>\n<div class=\"inlinebox--right inlinebox--sidebar\" data-mmanualobjecttype=\"illustrativeMaterial\">\n<div class=\"inlinebox__wrapper\">\n<div class=\"inlinebox__content\">\n<div class=\"table-box\" data-mmanualobjecttype=\"Table\">\n<div id=\"v7821335_es\" class=\"SidebarHalfPage\">\n<h3 class=\"title\"><span style=\"color: #ff0000;\">Osteopenia: diferenciaci\u00f3n entre osteoporosis y osteomalacia<\/span><\/h3>\n<table>\n<thead><\/thead>\n<tbody>\n<tr class=\"odd \">\n<td>\n<div class=\"para\">\n<p>La osteopenia es la disminuci\u00f3n de la masa \u00f3sea. Existen 2 enfermedades metab\u00f3licas del hueso que pueden disminuir la masa \u00f3sea: osteoporosis y osteomalacia.<\/p>\n<\/div>\n<div class=\"para\">\n<p>En la\u00a0<b>osteoporosis<\/b>, disminuye la masa \u00f3sea, pero la relaci\u00f3n entre el mineral \u00f3seo y la matriz \u00f3sea es normal.<\/p>\n<\/div>\n<div class=\"para\">\n<p>En la\u00a0<b>osteomalacia<\/b>, la relaci\u00f3n entre el mineral \u00f3seo y la matriz \u00f3sea es m\u00e1s baja.<\/p>\n<\/div>\n<div class=\"para\">\n<p>La osteoporosis se produce por una combinaci\u00f3n entre una masa \u00f3sea pico baja, un aumento de la resorci\u00f3n \u00f3sea y una alteraci\u00f3n en la formaci\u00f3n del hueso. La osteomalacia se debe a una alteraci\u00f3n en la mineralizaci\u00f3n, generalmente debida a una deficiencia grave de vitamina D o a una alteraci\u00f3n del metabolismo de la vitamina D (v\u00e9ase\u00a0<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/trastornos-nutricionales\/deficiencia-dependencia-e-intoxicaci%C3%B3n-vitam%C3%ADnica\/deficiencia-y-dependencia-de-vitamina-d\" data-preview-itemid=\"076828c8e3864ba9879a3bd617b5e45e\">Vitamina D<\/a>). La osteomalacia puede ser causada por trastornos que interfieren con la absorci\u00f3n de vitamina D (p. ej.,\u00a0enfermedad cel\u00edaca) y por ciertos medicamentos (p. ej., anticonvulsivos). La osteoporosis es mucho m\u00e1s frecuente que la osteomalacia en los Estados Unidos. Ambas afecciones pueden coexistir, y su expresi\u00f3n cl\u00ednica es similar; adem\u00e1s, en una osteoporosis puede identificarse una deficiencia leve a moderada de vitamina D.<\/p>\n<\/div>\n<div class=\"para\">\n<p>La osteomalacia se debe sospechar si el nivel de vitamina D es muy bajo en forma constante. Para diferenciar definitivamente entre los dos trastornos, el m\u00e9dico puede hacer una biopsia \u00f3sea marcada con tetraciclina, pero rara vez se justifica.<\/p>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<section id=\"v906876_es\" class=\"topic__section GHead\">\n<h3 id=\"\" class=\"topic__header--subsection\">Otras pruebas<\/h3>\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Se debe considerar una evaluaci\u00f3n de las causas secundarias de p\u00e9rdida \u00f3sea en un paciente con un puntaje Z \u2264 \u20132 o si se sospecha una causa de p\u00e9rdida \u00f3sea secundaria. Los estudios de laboratorio suelen incluir los siguientes:<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Calcio, magnesio y f\u00f3sforo s\u00e9ricos<\/p>\n<\/div>\n<div class=\"para\">\n<p>Nivel de 25-hidroxi vitamina D<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pruebas hep\u00e1ticas, incluyendo evaluaci\u00f3n debido a fosfatasa alcalina baja (hipofosfatasia)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Nivel de PTH intacto (hiperparatiroidismo)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Nivel de <span class=\"genericDrug\" data-showrollover=\"false\">testosterona<\/span>\u00a0en suero en hombres (hipogonadismo)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Estudio de calcio y creatinina en orina de 24 horas (hipercalciuria)<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Seg\u00fan las manifestaciones cl\u00ednicas, se deben considerar otros estudios como concentraci\u00f3n de hormona estimulante de la tiroides o tiroxina libre para descartar\u00a0hipertiroidismo, medici\u00f3n de\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">cortisol<\/span>\u00a0libre en orina, y hemograma y otros estudios para descartar neoplasia, en especial\u00a0mieloma (p. ej., electroforesis de prote\u00ednas en suero y orina).<\/p>\n<\/div>\n<div class=\"para\">\n<p>En pacientes con p\u00e9rdida de peso, deben investigarse afecciones gastrointestinales (p. ej.,\u00a0malabsorci\u00f3n,\u00a0enfermedad cel\u00edaca,\u00a0enfermedad intestinal inflamatoria) y c\u00e1ncer. La biopsia de hueso se reserva para casos excepcionales (p. ej., pacientes j\u00f3venes con fracturas por fragilidad y sin causa aparente, pacientes con enfermedad renal cr\u00f3nica que puede tener otros trastornos de los huesos, pacientes con niveles de vitamina D persistentemente bajos con sospecha de osteomalacia).<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los niveles de enlaces covalentes de C-telop\u00e9ptido (CTX) en suero en ayunas o de N-telop\u00e9ptido en orina (NTX) reflejan un incremento de la resorci\u00f3n \u00f3sea. Aunque la fiabilidad var\u00eda para el uso cl\u00ednico de rutina, CTX y NTX pueden ser \u00fatiles para monitorizar la respuesta al tratamiento o el tiempo de interrupci\u00f3n del mismo.<a id=\"v33013169_es\" style=\"font-size: 16px;\"><\/a><\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v33013168_es\" class=\"topic__section GHead\">\n<h3 id=\"\" class=\"topic__header--subsection\">Referencia del diagn\u00f3stico<\/h3>\n<\/section>\n<\/div>\n<\/section>\n<section id=\"v906887_es\" class=\"topic__section FHead\">\n<h2 id=\"Treatment\" class=\"topic__header--section\">Tratamiento<\/h2>\n<div class=\"topic__content\">\n<div class=\"list\">\n<div class=\"para\">\n<p>Modificaci\u00f3n de los factores de riesgo<\/p>\n<\/div>\n<div class=\"para\">\n<p>Suplementos de calcio y vitamina D<\/p>\n<\/div>\n<div class=\"para\">\n<p>F\u00e1rmacos antirresortivos (p. ej., bifosfonatos, terapia de reemplazo hormonal, moduladores selectivos del receptor de <span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span>, inhibidores del receptor activador del ligando del factor nuclear kappa-B [RANKL] [<span class=\"disabledResolvedDrug\">denosumab<\/span>])<\/p>\n<\/div>\n<div class=\"para\">\n<p>Esteroides anab\u00f3licos<a id=\"v906897_es\" class=\"anchor\" style=\"font-size: 1em;\"><\/a><\/p>\n<div class=\"para\" style=\"font-size: 1em;\">\n<p>Los objetivos del tratamiento de la osteoporosis son preservar la masa \u00f3sea, prevenir fracturas, disminuir el dolor y mantener la funci\u00f3n.<\/p>\n<\/div>\n<section id=\"v906898_es\" class=\"topic__section GHead\" style=\"font-size: 1em;\">\n<h3 id=\"\" class=\"topic__header--subsection\">Preservaci\u00f3n de la masa \u00f3sea<\/h3>\n<\/section>\n<\/div>\n<\/div>\n<section id=\"v906898_es\" class=\"topic__section GHead\">\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>La tasa de p\u00e9rdida \u00f3sea puede disminuirse con el uso de f\u00e1rmacos. Los niveles adecuados de calcio y vitamina D y la actividad f\u00edsica son fundamentales para lograr una densidad \u00f3sea \u00f3ptima. Los factores de riesgo modificables tambi\u00e9n deben abordarse.<\/p>\n<\/div>\n<div class=\"para\">\n<p>La modificaci\u00f3n de los factores de riesgo incluye mantener un peso adecuado, aumentar los ejercicios aer\u00f3bicos en bipedestaci\u00f3n, minimizar el consumo de cafe\u00edna y alcohol y evitar el cigarrillo. No se ha establecido la cantidad \u00f3ptima de ejercicios aer\u00f3bicos, pero se recomienda un promedio de 30 min\/d\u00eda. Un fisioterapeuta puede desarrollar un programa de ejercicios seguro y demostrar c\u00f3mo realizar de forma segura las actividades diarias para reducir al m\u00ednimo el riesgo de ca\u00eddas y fracturas de la columna vertebral.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Tanto hombres como mujeres deben consumir al menos 1.000 mg de calcio elemental por d\u00eda. Se recomienda una ingesta de 1.200 a 1.500 mg\/d\u00eda (incluyendo el consumo en la dieta) para mujeres posmenop\u00e1usicas y hombres ancianos y para per\u00edodos de mayor requerimiento, como en la pubertad, el embarazo y la lactancia. La ingesta de calcio debe proceder idealmente de fuentes diet\u00e9ticas, con suplementos si el aporte diet\u00e9tico es insuficiente. Se toman suplementos de calcio, con mayor frecuencia en forma de carbonato de calcio o citrato de calcio. El citrato de calcio se absorbe mejor en pacientes con aclorhidria; ambas formas se absorben bien con las comidas. Los pacientes que toman inhibidores de la bomba de protones o los que han tenido una cirug\u00eda de bypass g\u00e1strico deben tomar citrato de calcio para asegurar la absorci\u00f3n m\u00e1xima. El calcio debe tomarse en dosis divididas de 500 a 600 mg dos o 3 veces al d\u00eda.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Se recomiendan\u00a0<b>suplementos de vitamina D<\/b>\u00a0se recomienda con 800 a 1000 unidades\/d\u00eda. Los pacientes con deficiencia de vitamina D pueden requerir dosis a\u00fan m\u00e1s altas. Los suplementos de vitamina D suelen darse como colecalciferol, la forma natural de la vitamina D, aunque tambi\u00e9n se puede dar la forma sint\u00e9tica derivada de vegetales, el\u00a0<span class=\"disabledResolvedDrug\">ergocalciferol<\/span>. El nivel de 25-hidroxivitamina D debe ser \u2265 30 ng\/mL.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los\u00a0<b>bisfosfonatos<\/b> son el tratamiento m\u00e9dico de elecci\u00f3n. A trav\u00e9s de la inhibici\u00f3n de la resorci\u00f3n \u00f3sea, los bifosfonatos ayudan a preservar la masa \u00f3sea, lo que disminuye el riesgo de fracturas vertebrales y de cadera en hasta un 50%. El recambio \u00f3seo se reduce despu\u00e9s de 3 meses de tratamiento con bisfosfonatos y la reducci\u00f3n del riesgo de fractura es evidente tan pronto como 1 a\u00f1o despu\u00e9s del inicio de la terapia. Cuando la DXA se realiza en serie para monitorizar la respuesta al tratamiento, en general no necesita realizarse a intervalos &lt; 2 a\u00f1os. Los bifosfonatos pueden administrarse por v\u00eda oral o IV. Los bifosfonatos incluyen los siguientes:<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Alendronato (10 mg 1 vez al d\u00eda o 70 mg 1 vez\/semana por v\u00eda oral)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Risedronato (5 mg por v\u00eda oral 1 vez al d\u00eda, 35 mg por v\u00eda oral 1 vez\/semana, o 150 mg por v\u00eda oral 1 vez\/mes)<\/p>\n<\/div>\n<div class=\"para\">\n<p>\u00c1cido zoledr\u00f3nico (5 mg 1 vez\/a\u00f1o IV)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Ibandronato por v\u00eda oral (150 mg una vez al mes) o IV (3 mg una vez cada 3 meses)<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Los bisfosfonatos orales deben tomarse con el est\u00f3mago vac\u00edo con un vaso de agua lleno (250 mL, 8 oz), y el paciente debe permanecer en posici\u00f3n erguida al menos durante 30 min (60 min para el ibandronato) sin ingerir nada por v\u00eda oral durante este per\u00edodo. Este f\u00e1rmaco puede utilizarse en forma segura en pacientes con depuraci\u00f3n de creatinina &gt; 35 mL\/min. Los bifosfonatos pueden producir irritaci\u00f3n esof\u00e1gica. Una afecci\u00f3n esof\u00e1gica que disminuye el tiempo de tr\u00e1nsito o s\u00edntomas de afecci\u00f3n en el tubo digestivo superior son contraindicaciones relativas a los bisfosfonatos orales. Se indican bifosfonatos IV si el paciente es incapaz de tolerarlos por v\u00eda oral o no cumple con el tratamiento.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Rara vez se ha informado\u00a0osteonecrosis de la mand\u00edbula\u00a0y fracturas femorales at\u00edpicas en pacientes que reciben terapia antirresortiva con bifosfonatos o\u00a0<span class=\"disabledResolvedDrug\">denosumab<\/span> (v\u00e9ase m\u00e1s abajo). Los factores de riesgo incluyen procedimientos dentales invasivos, el uso de bifosfonato IV y neoplasias. Los beneficios de la reducci\u00f3n de las fracturas relacionadas con la osteoporosis son muy superiores a este peque\u00f1o riesgo.<\/p>\n<\/div>\n<div class=\"para\">\n<p>El uso de bisfosfonatos a largo plazo puede aumentar el riesgo de fracturas de f\u00e9mur at\u00edpicas. Estas fracturas ocurren en la mitad de la di\u00e1fisis del f\u00e9mur con un traumatismo m\u00ednimo o nulo y pueden ser precedidos por dolor en el muslo durante semanas o meses. Las fracturas tambi\u00e9n pueden ser bilaterales. Para reducir al m\u00ednimo la incidencia de fracturas, se debe considerar la interrupci\u00f3n de los bifosfonatos (un descanso de bifosfonatos) despu\u00e9s de aproximadamente<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>3 a 5 a\u00f1os de uso en pacientes con osteoporosis (por DXA), pero pocos o ning\u00fan otro factor de riesgo de p\u00e9rdida \u00f3sea (3 a\u00f1os para el \u00e1cido zoledr\u00f3nico por v\u00eda IV y 5 a\u00f1os para los bifosfonatos por v\u00eda oral)<\/p>\n<\/div>\n<div class=\"para\">\n<p>5 a 10 a\u00f1os de uso en pacientes con osteoporosis (por DXA) y m\u00e1s factores de riesgo<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>El inicio y la duraci\u00f3n del tratamiento con bifosfonatos, as\u00ed como el cese intermitente (vacaciones del medicamento) dependen de los factores de riesgo del paciente, como la edad, las comorbilidades, el historial previo de fracturas, los resultados de la exploraci\u00f3n con DEXA y el riesgo de ca\u00eddas. La evidencia apoya la duraci\u00f3n del tratamiento con alendronato por v\u00eda oral durante 5 o 10 a\u00f1os o con \u00e1cido zoledr\u00f3nico IV durante 3 o 6 a\u00f1os (<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/trastornos-de-los-tejidos-musculoesquel%C3%A9tico-y-conectivo\/osteoporosis\/osteoporosis#v39824493_es\">1<\/a>). Las vacaciones del medicamento duran 1 a\u00f1o o m\u00e1s. Los pacientes que descansan de los bifosfonatos deben ser estrechamente monitorizados para detectar una nueva fractura o una p\u00e9rdida \u00f3sea acelerada evidente en un DXA. Durante la terapia con un f\u00e1rmaco antirresortivo, como un bisfosfonato, el recambio \u00f3seo se suprime como se evidencia por el bajo nivel de enlaces cruzados de N-telop\u00e9ptido (&lt; 40 nmol\/L) o de C-telop\u00e9ptido. Estos marcadores pueden permanecer bajos durante \u2265 2 a\u00f1os de un descanso de los medicamentos.<\/p>\n<\/div>\n<div class=\"para\">\n<p>En los pacientes no tratados, un aumento de los niveles de los marcadores de recambio \u00f3seo indica un mayor riesgo de fractura. Sin embargo, no est\u00e1 claro si los niveles de los marcadores de recambio \u00f3seo deben utilizarse como criterio para definir cu\u00e1ndo comenzar o terminar un descanso de los medicamentos.<\/p>\n<\/div>\n<div class=\"para\">\n<p>La calcitonina de salm\u00f3n intranasal no debe utilizarse en forma habitual para el tratamiento de la osteoporosis. La calcitonina de salm\u00f3n puede brindar analgesia a corto plazo en fracturas agudas, como una fractura vertebral dolorosa, por un efecto endorf\u00ednico. No se ha demostrado que ayude a reducir las fracturas.<\/p>\n<\/div>\n<div class=\"para\">\n<p>El <b>estr\u00f3geno<\/b>\u00a0puede preservar la densidad \u00f3sea y prevenir fracturas. El\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3geno<\/span>\u00a0es m\u00e1s eficaz si se comienza dentro de los 4 a 6 a\u00f1os de la menopausia, se administra por v\u00eda oral y disminuye la velocidad de p\u00e9rdida \u00f3sea y el riesgo de fracturas, incluso si se comienza mucho m\u00e1s tarde. El uso de\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span> aumenta el riesgo de tromboembolia y c\u00e1ncer de endometrio, y puede aumentar el riesgo de c\u00e1ncer de mama. El riesgo de c\u00e1ncer de endometrio puede reducirse en mujeres con \u00fatero intacto mediante la toma de progest\u00e1genos con\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span>\u00a0(v\u00e9ase\u00a0Hormonoterapia). Sin embargo, la combinaci\u00f3n de progest\u00e1genos y\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span>\u00a0puede aumentar el riesgo de c\u00e1ncer de mama, enfermedad coronaria, accidente cerebrovascular y enfermedad biliar. Debido a estos riesgos y a la disponibilidad de otros tratamientos para la osteoporosis, los da\u00f1os potenciales del tratamiento con\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3geno<\/span> para la osteoporosis son mayores que sus beneficios potenciales para la mayor\u00eda de las mujeres; cuando se inicia el tratamiento, se debe considerar un curso corto con una vigilancia estrecha.<\/p>\n<\/div>\n<div class=\"para\">\n<p><b>El raloxifeno<\/b>\u00a0es un modulador selectivo de los receptores de\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span>\u00a0(MSRE) que puede ser apropiado para el tratamiento de la osteoporosis en mujeres que no pueden tomar bisfosfonatos. Se administra por v\u00eda oral y reduce las fracturas vertebrales en un 50%, aunque no se ha demostrado una reducci\u00f3n de las fracturas de cadera. El raloxifeno no estimula el \u00fatero y antagoniza los efectos de los\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3genos<\/span> en las mamas. Se ha demostrado que reduce el riesgo de c\u00e1ncer de mama invasor. El raloxifeno se asoci\u00f3 con un mayor riesgo de tromboembolia.<\/p>\n<\/div>\n<div class=\"para\">\n<p><b><span class=\"disabledResolvedDrug\">Denosumab<\/span><\/b>\u00a0es un anticuerpo monoclonal contra RANKL (activador del receptor del ligando factor nuclear kappa-B) y reduce la resorci\u00f3n \u00f3sea por los osteoclastos.\u00a0<span class=\"disabledResolvedDrug\">Denosumab<\/span>\u00a0puede ser \u00fatil en pacientes que no toleran o no responden a otras terapias o en pacientes con insuficiencia renal. Se ha encontrado que este medicamento tiene un buen perfil de seguridad a los 10 a\u00f1os de tratamiento. El\u00a0<span class=\"disabledResolvedDrug\">denosumab<\/span>\u00a0est\u00e1 contraindicado en pacientes con hipocalcemia porque puede causar cambios de calcio que dan como resultado una hipocalcemia profunda y efectos adversos como la tetania.\u00a0Osteonecrosis de la mand\u00edbula\u00a0y las fracturas femorales at\u00edpicas se han reportado raramente en pacientes que toman\u00a0<span class=\"disabledResolvedDrug\">denosumab<\/span>.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los pacientes que toman\u00a0<span class=\"disabledResolvedDrug\">denosumab<\/span>\u00a0no deben someterse a un receso de medicamentos porque suspender este medicamento puede causar una p\u00e9rdida en la densidad mineral \u00f3sea y, lo que es m\u00e1s importante, aumentar el riesgo de fracturas, especialmente vertebrales.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los\u00a0<b>agentes anab\u00f3licos<\/b> pueden administrarse durante un total de 2 a\u00f1os en toda la vida del paciente. La teriparatida (PTH sint\u00e9tica [PTH1-34]) y la abaloparatida (un an\u00e1logo de la PTH humana que se une al receptor de PTH tipo 1) se administran diariamente mediante inyecci\u00f3n subcut\u00e1nea para aumentar la masa \u00f3sea, estimular la formaci\u00f3n de hueso nuevo y reducir el riesgo de fracturas. Los pacientes que toman un agente anab\u00f3lico deben tener una depuraci\u00f3n de creatinina &gt; 35 mL\/min.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los agentes anab\u00f3licos se suelen indicar para los pacientes con las siguientes caracter\u00edsticas:<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Pacientes que no pueden tolerar los agentes antiresortivos o tienen contraindicaciones para su uso<\/p>\n<\/div>\n<div class=\"para\">\n<p>Falta de respuesta (es decir, desarrollo de nuevas fracturas o p\u00e9rdida de la densidad mineral \u00f3sea) a los f\u00e1rmacos antirresortivos, as\u00ed como al calcio, la vitamina D y el ejercicio<\/p>\n<\/div>\n<div class=\"para\">\n<p>Posible osteoporosis grave (p. ej., T score <span class=\"symbol\">&lt;<\/span>\u00a0-3,5) o m\u00faltiples fracturas vertebrales por fragilidad<\/p>\n<\/div>\n<div class=\"para\">\n<p>Tienen osteoporosis inducida por glucocorticoides<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Los agentes anab\u00f3licos pueden considerarse para su uso durante un feriado de bifosfonato.<\/p>\n<\/div>\n<div class=\"para\">\n<p>El inicio inmediato de la terapia con agentes antirresortivos despu\u00e9s de una fractura osteopor\u00f3tica es controvertido porque estos agentes pueden impedir la curaci\u00f3n del hueso. Muchos cirujanos ortop\u00e9dicos prefieren esperar 6 semanas despu\u00e9s de la fractura para asegurar una curaci\u00f3n adecuada. En pacientes con riesgo particularmente alto de fractura o en quienes no se puede garantizar el inicio de la terapia ambulatoria para la osteoporosis, puede ser preferible iniciar el tratamiento durante la hospitalizaci\u00f3n. Los agentes anab\u00f3licos se pueden iniciar en forma segura en cualquier momento despu\u00e9s de la fractura. No est\u00e1 claro si el uso temprano de agentes anab\u00f3licos despu\u00e9s de la fractura acelera la curaci\u00f3n \u00f3sea.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v39824492_es\" class=\"topic__section GHead\">\n<h3 id=\"\" class=\"topic__header--subsection\">Referencia del tratamiento<\/h3>\n<\/section>\n<section id=\"v906941_es\" class=\"topic__section GHead\">\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Muchos pacientes mayores tienen riesgo de ca\u00eddas por falta de coordinaci\u00f3n, mala visi\u00f3n, debilidad muscular, confusi\u00f3n y por uso de agentes que producen hipotensi\u00f3n postural o alteran la sensibilidad. Los ejercicios de fortalecimiento central pueden aumentar la estabilidad. Es importante educar al paciente acerca del riesgo de ca\u00eddas y fracturas, tomar medidas de seguridad en la vivienda, y desarrollar programas individuales para aumentar la estabilidad f\u00edsica y atenuar el riesgo para prevenir fracturas.<\/p>\n<p>T<span style=\"font-size: 16px;\">ratamiento del dolor y mantenimiento de la funci\u00f3n<span style=\"color: #21759b;\"><span style=\"background-color: #d5d5d5;\">.<\/span><\/span><\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v906945_es\" class=\"topic__section GHead\">\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>El dolor de espalda agudo provocado por una fractura vertebral por compresi\u00f3n debe tratarse con soporte ortop\u00e9dico, analg\u00e9sicos y (si hay espasmo muscular importante),\u00a0calor h\u00famedo\u00a0y\u00a0masajes. Los ejercicios de fortalecimiento central son \u00fatiles para los pacientes que tienen dolor de espalda y una fractura vertebral previa ya curada. El dolor cr\u00f3nico puede aliviarse mediante un dispositivo ortop\u00e9dico y ejercicios para fortalecer los m\u00fasculos paravertebrales. Debe evitarse levantar cosas pesadas. El reposo en cama debe ser m\u00ednimo y debe incentivarse la realizaci\u00f3n de ejercicios en bipedestaci\u00f3n cuidadosamente dise\u00f1ados para el paciente.<\/p>\n<\/div>\n<div class=\"para\">\n<p>En algunos casos, se puede indicar vertebroplastia o cifoplastia para aliviar el dolor intenso debido a una nueva fractura por fragilidad vertebral; sin embargo, las evidencias que avalan la eficacia no son concluyentes. En la vertebroplastia, se inyecta metacrilato de metilo en el cuerpo vertebral. En la cifoplastia, se expande el cuerpo vertebral con un bal\u00f3n y luego se inyecta metil metacrilato. Estos procedimientos pueden reducir la deformidad en las v\u00e9rtebras tratadas, pero no reducen el riesgo de fracturas en v\u00e9rtebras adyacentes, e incluso pueden aumentarlo. Otros riesgos pueden incluir fracturas costales, filtraci\u00f3n del cemento, embolia pulmonar o infarto de miocardio. Se deben hacer nuevos estudios para determinar las indicaciones para estos procedimientos.<\/p>\n<p><span style=\"font-size: 18px;\">Prevenci\u00f3n<\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/section>\n<section id=\"v906953_es\" class=\"topic__section FHead\">\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Los objetivos de la prevenci\u00f3n son dobles: preservar la masa \u00f3sea y prevenir fracturas. Las medidas preventivas est\u00e1n indicadas en las siguientes condiciones:<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>Mujeres posmenop\u00e1usicas<\/p>\n<\/div>\n<div class=\"para\">\n<p>Hombres mayores<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pacientes que tienen osteopenia<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pacientes que reciben corticosteroides sist\u00e9micos en altas dosis y\/o durante largos per\u00edodos<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pacientes con osteoporosis<\/p>\n<\/div>\n<div class=\"para\">\n<p>Pacientes con causas secundarias de p\u00e9rdida \u00f3sea<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Las medidas preventivas para todos estos pacientes incluyen la ingesta adecuada de vitamina D y calcio, ejercicios en bipedestaci\u00f3n, prevenci\u00f3n de ca\u00eddas, y otras formas de reducir el riesgo (p. ej., evitar el tabaco y limitar el alcohol). Adem\u00e1s, se indica tratamiento farmacol\u00f3gico a pacientes que tienen osteoporosis o que tienen osteopenia si presentan un mayor riesgo de fractura, como los que tienen un una alta puntuaci\u00f3n FRAX y los que consumen glucocorticoides. La terapia con medicamentos incluye las mismos f\u00e1rmacos utilizados para el tratamiento de la osteoporosis. Es de suma importancia educar a los pacientes y la comunidad acerca de la importancia de la salud \u00f3sea.<a id=\"v23349556_es\" style=\"font-size: 18px;\"><\/a><\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v23349555_es\" class=\"topic__section topic__section--keypoints FHead\">\n<h2 id=\"KeyPoints\" class=\"topic__header--section\">Conceptos clave<\/h2>\n<div class=\"topic__content--keypoints\">\n<div class=\"list\">\n<div class=\"para\">\n<p>El hueso se pierde a una velocidad de aproximadamente 0,3 a 0,5%\/a\u00f1o despu\u00e9s de los 40 a\u00f1os, con aceleraci\u00f3n despu\u00e9s de la menopausia en las mujeres de aproximadamente 3-5%\/a\u00f1o durante aproximadamente 5 a 7 a\u00f1os.<\/p>\n<\/div>\n<div class=\"para\">\n<p>M\u00e1s del 95% de los casos de osteoporosis en mujeres, y alrededor del 80% en hombres son primarios.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Se sospecha osteoporosis en pacientes que tienen fracturas causadas por una fuerza inesperadamente escasa (fracturas por fragilidad) de la columna vertebral, el radio distal o la cadera.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Utilizar DXA para medir la densidad \u00f3sea en mujeres \u2265 65 a\u00f1os; las mujeres entre la menopausia y la edad de 65 a\u00f1os que tienen factores de riesgo (p. ej., antecedentes familiares de osteoporosis, un \u00edndice de masa corporal bajo, y uso de tabaco y\/o drogas con un alto riesgo de p\u00e9rdida de masa \u00f3sea [incluyendo glucocorticoides]); hombres y mujeres de cualquier edad que tienen fracturas por fragilidad; evidencias en los estudios de diagn\u00f3stico por im\u00e1genes de disminuci\u00f3n de la densidad \u00f3sea o fracturas vertebrales por compresi\u00f3n asintom\u00e1ticas; y pacientes en riesgo de osteoporosis secundaria.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Se debe considerar una evaluaci\u00f3n de las causas secundarias de p\u00e9rdida \u00f3sea si el puntaje Z es \u2264 \u20132 o si se sospecha una causa de p\u00e9rdida \u00f3sea secundaria.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Para el tratamiento y la prevenci\u00f3n, asegurar una ingesta adecuada de calcio y vitamina D, el uso de suplementos cuando sea necesario, y modificar los factores de riesgo para ayudar a preservar la masa \u00f3sea (p. ej., con levantamiento de peso y reduciendo al m\u00ednimo el consumo de cafe\u00edna, alcohol y tabaco).<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los tratamientos incluyen f\u00e1rmacos antirresortivos (p. ej., bifosfonatos, un modulador selectivo del receptor de\u00a0<span class=\"genericDrug\" data-showrollover=\"false\">estr\u00f3geno<\/span>, activador del receptor del inhibidor del ligando factor nuclear kappa-B [RANKL], un f\u00e1rmaco utilizado para la terapia de reposici\u00f3n hormonal) o un agente anab\u00f3lico.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<p><span style=\"font-size: 1em;\">\u00a0son comunes en la columna tor\u00e1cica (por lo general por debajo de T6) y la columna lumbar, sobre todo cerca de la uni\u00f3n T12-L1. Puede que no haya antecedentes de un trauma o solo uno m\u00ednimo (p. ej., una ca\u00edda menor, flexi\u00f3n s\u00fabita, elevaci\u00f3n, tos). Los pacientes que hayan tenido una fractura vertebral osteopor\u00f3tica tienen mayor riesgo de otras fracturas vertebrales y no vertebrales.<\/span><\/p>\n<\/div>\n<div class=\"para\">\n<p>De vez en cuando, la compresi\u00f3n u otras fracturas vertebrales son el resultado de una fuerza significativa (p. ej., un accidente automovil\u00edstico, una ca\u00edda desde una altura, una herida de bala). En tales casos, tambi\u00e9n se suele identificar una\u00a0<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/lesiones-y-envenenamientos\/traumatismos-de-columna\/traumatismos-de-columna\" data-preview-itemid=\"121991838cdd43a9a0f89a518fc7d31b\">lesi\u00f3n de <\/a>la<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/lesiones-y-envenenamientos\/traumatismos-de-columna\/traumatismos-de-columna\" data-preview-itemid=\"121991838cdd43a9a0f89a518fc7d31b\"> m\u00e9dula espinal<\/a>, y la columna vertebral puede fracturarse en m\u00e1s de 1 lugar. Si la causa fue una ca\u00edda o un salto desde una altura, uno o ambos talones tambi\u00e9n pueden fracturarse; el 10% de todos los pacientes con\u00a0<a href=\"https:\/\/www.msdmanuals.com\/es-es\/professional\/lesiones-y-envenenamientos\/fracturas\/fracturas-de-calc%C3%A1neo\" data-preview-itemid=\"5d8694436238472aa6bee60c63798c91\">fractura del <\/a>calc\u00e1neo tambi\u00e9n tiene una fractura toracolumbar (a causa de la carga axial al esqueleto al aterrizar sobre los talones)<span style=\"color: #21759b;\"><span style=\"font-size: 18px; background-color: #d5d5d5;\">.<\/span><\/span><\/p>\n<p><span style=\"font-size: 18px;\">Signos y\u00a0s\u00edntomas<\/span><\/p>\n<\/div>\n<section id=\"v13387281_es\" class=\"topic__section FHead\">\n<div class=\"topic__content\">\n<div class=\"para\">\n<p>Las\u00a0<b>fracturas vertebrales osteopor\u00f3ticas<\/b>\u00a0son asintom\u00e1ticas o causan \u00fanicamente p\u00e9rdida de altura o cifosis en cerca de dos tercios de los pacientes. En otros pacientes, el dolor puede desarrollarse inmediatamente o m\u00e1s tarde. El dolor puede irradiarse al abdomen. El dolor, la debilidad y las anomal\u00edas en los reflejos o los esf\u00ednteres son poco comunes. El dolor por lo general disminuye despu\u00e9s de aproximadamente 4 semanas y se resuelve despu\u00e9s de aproximadamente 12 semanas.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Las\u00a0<b>fracturas vertebrales por compresi\u00f3n no osteopor\u00f3ticas<\/b> causan dolor agudo, hipersensibilidad \u00f3sea en el sitio de la fractura, y por lo general espasmo muscular.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v13387285_es\" class=\"topic__section FHead\">\n<h2 id=\"Diagnosis\" class=\"topic__header--section\">Diagn\u00f3stico<\/h2>\n<div class=\"topic__content\">\n<div class=\"list\">\n<div class=\"para\">\n<p>Radiograf\u00eda<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p><b>Las fracturas osteopor\u00f3ticas<\/b> por lo general se diagnostican mediante radiograf\u00edas. Los resultados son por lo general<\/p>\n<\/div>\n<div class=\"list\">\n<div class=\"para\">\n<p>P\u00e9rdida de la altura vertebral (especialmente &gt; 6 cm o m\u00e1s de la mitad de la altura del cuerpo vertebral)<\/p>\n<\/div>\n<div class=\"para\">\n<p>Radiodensidad disminuida<\/p>\n<\/div>\n<div class=\"para\">\n<p>P\u00e9rdida de la estructura trabecular<\/p>\n<\/div>\n<div class=\"para\">\n<p>Acu\u00f1amiento anterior<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Las fracturas osteopor\u00f3ticas vertebrales se diagnostican com\u00fanmente como hallazgos incidentales. Si los pacientes no tienen factores de riesgo para la osteoporosis (p. ej., la edad avanzada), estas fracturas son poco probables.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Las fracturas solitarias por encima de T4 sugieren c\u00e1ncer en lugar de osteoporosis. Si no se conoce que los pacientes tengan osteoporosis, se debe hacer radioabsorciometr\u00eda de doble energ\u00eda (DXA). Si la osteoporosis est\u00e1 reci\u00e9n diagnosticada, los pacientes deben ser\u00a0evaluados para detectar causas de osteoporosis secundaria.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Si\u00a0<b>se ha producido un traumatismo significativo<\/b>, la TC se hace para evaluar toda la columna vertebral, y si hay d\u00e9ficits neurol\u00f3gicos o s\u00edntomas, se obtiene una resonancia magn\u00e9tica de la secci\u00f3n correspondiente de la m\u00e9dula espinal.<\/p>\n<\/div>\n<div class=\"inlinemedia inlinemedia--full inlinemedia--slider\" data-slide-count=\"4\">\n<div class=\"inlinemedia__wrapper\">\n<div class=\"inlinemedia__header\">\n<div class=\"inlinemedia__title\">\n<div>Im\u00e1genes de fracturas por compresi\u00f3n<\/div>\n<\/div>\n<\/div>\n<div class=\"tablebox inlinemedia__container\">\n<div class=\"tablebox__cell inlinemedia__content\">\n<div class=\"inlinemedia__slides slick-initialized slick-slider\">\n<div class=\"slick-list draggable\">\n<div class=\"slick-track\">\n<figure class=\"inlinemedia__figure js-carousel-slide slick-slide slick-current slick-active\" tabindex=\"0\" data-slick-index=\"0\" aria-hidden=\"false\">\n<div class=\"multimedia__link\" data-bind=\"component: { name: 'multimedia-link-block', params: $data }\">Esta fractura por compresi\u00f3n de la segunda v\u00e9rtebra lumbar es visible como una p\u00e9rdida de la altura del cuerpo vertebral tanto en la vista anteroposterior como en la lateral.<\/div><figcaption class=\"inlinemedia__copyright\"><\/figcaption><\/figure>\n<figure class=\"inlinemedia__figure js-carousel-slide slick-slide\" tabindex=\"-1\" data-slick-index=\"1\" aria-hidden=\"true\"><figcaption class=\"inlinemedia__description\">\n<div class=\"para\">\n<p>Esta fractura por compresi\u00f3n de la primera v\u00e9rtebra lumbar es visible en la vista anteroposterior como una p\u00e9rdida importante de altura y un aumento de la radiodensidad.<\/p>\n<\/div>\n<\/figcaption><\/figure>\n<figure class=\"inlinemedia__figure js-carousel-slide slick-slide\" tabindex=\"-1\" data-slick-index=\"2\" aria-hidden=\"true\"><figcaption class=\"inlinemedia__description\">\n<div class=\"para\">\n<p>Esta radiograf\u00eda de columna lateral muestra la p\u00e9rdida de altura y acu\u00f1amiento anterior debido a una fractura de compresi\u00f3n vertebral.<\/p>\n<\/div>\n<\/figcaption><\/figure>\n<figure class=\"inlinemedia__figure js-carousel-slide slick-slide\" tabindex=\"-1\" data-slick-index=\"3\" aria-hidden=\"true\"><figcaption class=\"inlinemedia__description\">\n<div class=\"para\">\n<p>Esta tomograf\u00eda computarizada (vista sagital) muestra una notable fractura por compresi\u00f3n de T12 con enfermedad degenerativa leve (p. ej. osteofitos del cuerpo vertebral anterior) en otro lugar.<\/p>\n<\/div>\n<\/figcaption><\/figure>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>Si la causa fue una ca\u00edda o salto desde una altura, los m\u00e9dicos deben buscar fracturas de calc\u00e1neo y vertebrales adicionales. Si se sospecha o se expresa una ideaci\u00f3n suicida, se debe consultar a un psiquiatra.<a id=\"v13387308_es\" style=\"font-size: 18px;\"><\/a><\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v13387307_es\" class=\"topic__section FHead\">\n<h2 id=\"Treatment\" class=\"topic__header--section\">Tratamiento<\/h2>\n<div class=\"topic__content\">\n<div class=\"list\">\n<div class=\"para\">\n<p>Analg\u00e9sicos<\/p>\n<\/div>\n<div class=\"para\">\n<p>Inmovilizaci\u00f3n temprana y fisioterapia<\/p>\n<\/div>\n<\/div>\n<div class=\"para\">\n<p>El tratamiento de las fracturas vertebrales se centra en el alivio del dolor y la movilizaci\u00f3n temprana. Se administran analg\u00e9sicos. La pronta reanudaci\u00f3n de la actividad normal ayuda a limitar la p\u00e9rdida \u00f3sea y la discapacidad<\/p>\n<\/div>\n<div class=\"para\">\n<p>Los fisioterapeutas pueden ayudar mediante la ense\u00f1anza de t\u00e9cnicas de elevaci\u00f3n correctas y la prescripci\u00f3n de ejercicios para fortalecer los m\u00fasculos paravertebrales, pero la terapia puede tener que retrasarse hasta que se controle el dolor.<\/p>\n<\/div>\n<div class=\"para\">\n<p>La\u00a0osteoporosis, si est\u00e1 presente, debe ser ratada (p. ej., con un bifosfonato). La calcitonina tambi\u00e9n puede ser utilizada y puede ayudar a aliviar el dolor y aumentar la densidad \u00f3sea.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Es com\u00fan que se recete la colocaci\u00f3n de una ortesis, pero su eficacia no est\u00e1 clara.<\/p>\n<\/div>\n<div class=\"para\">\n<p>En algunos casos, la vertebroplastia, a veces precedida por cifoplastia, puede aliviar un dolor intenso. En la vertebroplastia, se inyecta metacrilato de metilo en el cuerpo vertebral. En la cifoplastia, se expande el cuerpo vertebral con un bal\u00f3n.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Estos procedimientos pueden reducir la deformidad en las v\u00e9rtebras tratadas, pero no reducen el riesgo de fracturas en v\u00e9rtebras adyacentes, e incluso pueden aumentarlo. Otros riesgos son las fracturas costales, filtraci\u00f3n del cemento y edema pulmonar o infarto de miocardio.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Si las fracturas son producto de un traumatismo significativo, la columna vertebral se inmoviliza inmediatamente, y la TC o RM se realiza para evaluar la estabilidad de las fracturas. Las\u00a0lesiones de la m\u00e9dula espinal, si est\u00e1n presentes, se tratan con prontitud, y se proporciona tratamiento sintom\u00e1tico (p. ej., analg\u00e9sicos, movilizaci\u00f3n temprana).<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"v13387325_es\" class=\"topic__section topic__section--keypoints FHead\">\n<h2 id=\"KeyPoints\" class=\"topic__header--section\">Conceptos clave<\/h2>\n<div class=\"topic__content--keypoints\">\n<div class=\"list\">\n<div class=\"para\">\n<p>La mayor\u00eda de las fracturas vertebrales se deben a osteoporosis.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Alrededor de dos tercios de las fracturas osteopor\u00f3ticas vertebrales son asintom\u00e1ticas o causan solo p\u00e9rdida de altura o cifosis.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Se sospecha c\u00e1ncer si los pacientes tienen una fractura solitaria por encima de la T4.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Si no se sabe si los pacientes tienen osteoporosis realizar una radioabsorciometr\u00eda de doble energ\u00eda.<\/p>\n<\/div>\n<div class=\"para\">\n<p>Fomentar la movilizaci\u00f3n precoz.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<h2><span style=\"color: #ff0000;\">Causas menos frecuentes de la lumbalgia<\/span><\/h2>\n<p>Aunque son menos frecuentes que las afecciones enumeradas arriba, existen varias otras afecciones que tambi\u00e9n pueden causar la lumbalgia, entre ellas:<\/p>\n<div class=\"l-main\">\n<div class=\"l-content\">\n<article class=\"node node--article node--full node--article--full\" role=\"article\">\n<header><\/header>\n<div class=\"node__content\">\n<div class=\"field field--name-body field--type-text-with-summary field--label-hidden\">\n<div class=\"field__items\">\n<div class=\"field__item even\">\n<div class=\"callout-video-box\"><a title=\"Video sobre la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca\" href=\"https:\/\/www.spine-health.com\/video\/video-sobre-la-disfuncion-de-la-articulacion-sacroiliaca\"><img decoding=\"async\" title=\"Video sobre la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca\" src=\"https:\/\/embed.widencdn.net\/img\/veritas\/xogye4zz4g\/100x80px\/sacroiliac-joint-pain-areas.jpeg?u=at8tiu&amp;use=idsla&amp;k=c\" alt=\"la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca\" \/><br \/>\n<\/a><\/div>\n<p>El diagn\u00f3stico preciso de la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca puede ser dif\u00edcil porque los s\u00edntomas son similares a los de otras afecciones frecuentes, incluidas otras condiciones mec\u00e1nicas de dolor de espalda, como s\u00edndrome facetario, como tambi\u00e9n otras afecciones de la columna lumbar incluida la\u00a0hernia de disco\u00a0y la radiculopat\u00eda (dolor a lo largo del nervio ci\u00e1tico que irradia hacia abajo por la pierna).<\/p>\n<p>Normalmente se llega a un diagn\u00f3stico a trav\u00e9s del examen f\u00edsico (eliminaci\u00f3n de otras causas) o mediante una inyecci\u00f3n (que se usa para bloquear el dolor).<\/p>\n<h2>Examen f\u00edsico para determinar la fuente de dolor<\/h2>\n<p>En un examen f\u00edsico, el m\u00e9dico puede intentar determinar si la articulaci\u00f3n sacroil\u00edaca es la causa del dolor a trav\u00e9s del movimiento de la articulaci\u00f3n. Si el movimiento recrea el dolor del paciente, y no existe otra causa que pueda explicar el dolor y los s\u00edntomas (como una hernia de disco en una resonancia magn\u00e9tica), la articulaci\u00f3n sacroil\u00edaca podr\u00eda ser la causa del dolor.<\/p>\n<p>Existen varias pruebas de provocaci\u00f3n ortop\u00e9dica que pueden usarse para intentar reproducir los s\u00edntomas asociados con la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca. Como regla, varias pruebas positivas que reproducen el dolor espec\u00edficamente ubicado en la articulaci\u00f3n sacroil\u00edaca mejoran la probabilidad del diagn\u00f3stico de disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca.<\/p>\n<p>Por ejemplo, un examen f\u00edsico puede incluir:<\/p>\n<ul>\n<li>El paciente puede acostarse boca arriba sobre el borde de una camilla con la pierna del lado afectado colgando del costado de la camilla hacia el piso o apoyada sobre una banqueta de manera tal que la articulaci\u00f3n sacroil\u00edaca quede sobre el borde de la camilla.<\/li>\n<li>La rodilla opuesta puede llevarse hacia el pecho para aislar todav\u00eda m\u00e1s la articulaci\u00f3n SI sobre el lado de la pierna que est\u00e1 colgando. En esta posici\u00f3n, no hay apoyo para la articulaci\u00f3n de la cadera, y presionar sobre la cresta il\u00edaca (pelvis) o la parte superior del muslo puede reproducir el dolor del paciente.<\/li>\n<li>Se debe tener cuidado de ubicar el dolor directamente sobre la articulaci\u00f3n SI ya que otras estructuras de la columna lumbar y la pelvis tambi\u00e9n sufren estr\u00e9s en esta posici\u00f3n.Disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca\n<div class=\"l-title\">\n<h1 class=\"page-title\">Diagn\u00f3stico preciso de la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca<\/h1>\n<\/div>\n<\/li>\n<\/ul>\n<nav id=\"toc-container\" class=\"toc-container\" aria-label=\"In page table of contents for quick access to other pages in this article\">\n<div class=\"view view-toc view-id-toc view-display-id-block view-dom-id-6e8703f8721f8034316cfc039bec2e97\">\n<div class=\"view-content\">\n<ul>\n<li class=\"views-row-odd views-row-first\">Disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca (dolor en la articulaci\u00f3n SI)<\/li>\n<li class=\"views-row-even\">Diagn\u00f3stico preciso de la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca<\/li>\n<li class=\"views-row-odd\">Opciones de tratamiento para la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca<\/li>\n<li class=\"views-row-even views-row-last\">Video sobre la disfunci\u00f3n de la articulaci\u00f3n sacroil\u00edaca<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/nav>\n<h2>Inyecciones para determinar la fuente de dolor<\/h2>\n<p>Una inyecci\u00f3n en la articulaci\u00f3n sacroil\u00edaca, a veces denominada un\u00a0bloqueo de la articulaci\u00f3n sacroil\u00edaca, puede ser una prueba diagn\u00f3stica \u00fatil. El m\u00e9dico debe tener amplia experiencia y mucha habilidad para insertar una aguja en la parte correcta de la articulaci\u00f3n sacroil\u00edaca. Por este motivo, la inyecci\u00f3n se gu\u00eda generalmente con rayos X para asegurarse de que se inyecta correctamente en la articulaci\u00f3n. En algunas ocasiones, se inyecta un tinte para visualizar mejor la articulaci\u00f3n. Esto se llama artrograf\u00eda.<\/p>\n<p>En esta prueba, un m\u00e9dico usa una gu\u00eda fluorosc\u00f3pica (radiograf\u00edas en vivo) e inserta una aguja en la articulaci\u00f3n sacroil\u00edaca para inyectar lidoca\u00edna (una soluci\u00f3n anest\u00e9sica). Si la inyecci\u00f3n alivia el dolor del paciente, se puede inferir que la articulaci\u00f3n sacroil\u00edaca es la causa del dolor. Generalmente, se inyecta al mismo tiempo una soluci\u00f3n de esteroides para disminuir la inflamaci\u00f3n en la articulaci\u00f3n sacroil\u00edaca y reducir el dolor.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<ul>\n<li><span style=\"color: #ff0000;\"><span style=\"color: #ff0000;\">S\u00edndrome piriforme<\/span><\/span>\n<div class=\"page-info\">\n<div class=\"page-title\">\n<h1 class=\"with-also\">S\u00edndrome piriforme<\/h1>\n<\/div>\n<\/div>\n<div class=\"main\">\n<div id=\"ency_summary\">\n<p>El s\u00edndrome piriforme es dolor y adormecimiento en los gl\u00fateos y hacia la parte trasera de su pierna. Esto ocurre cuando el m\u00fasculo piriforme presiona el nervio ci\u00e1tico.<\/p>\n<p>El s\u00edndrome, que afecta m\u00e1s a las mujeres que a los hombres, es poco com\u00fan. Pero cuando ocurre, puede causar\u00a0ci\u00e1tica.<\/p>\n<\/div>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>Causas<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-2\" class=\"section-body\">\n<p>El m\u00fasculo piriforme participa en casi todos los movimientos que realiza con la parte inferior del cuerpo, desde caminar hasta cambiar el peso de un pie al otro. Por debajo del m\u00fasculo se encuentra el nervio ci\u00e1tico. Este nervio va de la parte inferior de su columna vertebral completamente hacia abajo en la parte trasera de su pierna hasta su pie.<\/p>\n<p>Lesionar o irritar el m\u00fasculo piriforme puede causar espasmos musculares. El m\u00fasculo tambi\u00e9n podr\u00eda inflamarse o tensarse a causa de los espasmos. Esto pone presi\u00f3n en el nervio que pasa por debajo, causando dolor.<\/p>\n<p>El uso excesivo puede inflamar o lesionar el m\u00fasculo. Los espasmos musculares pueden venir de:<\/p>\n<ul>\n<li>Sentarse durante per\u00edodos prolongados<\/li>\n<li>Hacer demasiado ejercicio<\/li>\n<li>Correr, caminar o hacer otras actividades repetitivas<\/li>\n<li>Practicar deportes<\/li>\n<li>Subir escaleras<\/li>\n<li>Levantar objetos pesados<\/li>\n<\/ul>\n<p>El traumatismo tambi\u00e9n puede causar irritaci\u00f3n y da\u00f1o muscular. Esto puede ser ocasionado por:<\/p>\n<ul>\n<li>Accidentes automovil\u00edsticos<\/li>\n<li>Ca\u00eddas<\/li>\n<li>Giros repentinos de la cadera<\/li>\n<li>Heridas penetrantes<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>S\u00edntomas<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-3\" class=\"section-body\">\n<p>La ci\u00e1tica es el s\u00edntoma principal del s\u00edndrome piriforme. Otros s\u00edntomas incluyen:<\/p>\n<ul>\n<li>Sensibilidad o un dolor breve en el gl\u00fateo<\/li>\n<li>Adormecimiento u hormigueo en el gl\u00fateo a lo largo de la parte trasera de la pierna<\/li>\n<li>Dificultad para sentarse<\/li>\n<li>Dolor al sentarse que empeora si contin\u00faa sentado<\/li>\n<li>Dolor que empeora con la actividad<\/li>\n<li>Dolor en la parte inferior del cuerpo que es tan intenso que lo deja incapacitado<\/li>\n<\/ul>\n<p>El dolor usualmente afecta solo un lado de la parte inferior del cuerpo. Pero tambi\u00e9n puede ocurrir en ambos lados al mismo tiempo.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>Ex\u00e1menes y pruebas<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-4\" class=\"section-body\">\n<p>Su proveedor de atenci\u00f3n m\u00e9dica:<\/p>\n<ul>\n<li>Har\u00e1 un examen f\u00edsico<\/li>\n<li>Preguntar\u00e1 sus s\u00edntomas y actividades recientes<\/li>\n<li>Tomar\u00e1 su historial m\u00e9dico<\/li>\n<\/ul>\n<p>Durante el examen, su proveedor podr\u00eda pedirle que haga un rango de movimientos. El punto es ver si le causan dolor y d\u00f3nde.<\/p>\n<p>Otros problemas pueden causar ci\u00e1tica. Por ejemplo, un\u00a0disco movido\u00a0o artritis de la columna vertebral pueden poner presi\u00f3n en el nervio ci\u00e1tico. Para descartar otras causas, puede realizarse una\u00a0resonancia magn\u00e9tica\u00a0o una\u00a0tomograf\u00eda computarizada.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>Tratamiento<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-5\" class=\"section-body\">\n<p>En algunos casos, es posible que no necesite tratamiento m\u00e9dico. Su proveedor puede recomendar los siguientes consejos de cuidados personales para ayudarle a aliviar el dolor.<\/p>\n<ul>\n<li>Evite realizar actividades que causan dolor, como montar bicicleta o correr. Puede reanudar estas actividades despu\u00e9s de que se haya quitado el dolor.<\/li>\n<li>Aseg\u00farese de utilizar la forma y el equipo correctos al practicar deportes u otras actividades f\u00edsicas.<\/li>\n<li>Tome medicamentos para el dolor como ibuprofeno (Motrin, Advil), naproxeno (Aleve, Naprosyn) o acetaminof\u00e9n (Tylenol).<\/li>\n<li>Pruebe el hielo y el calor. Utilice hielo por 15 a 20 minutos cada pocas horas. Envuelva el hielo en una toalla para proteger su piel. Alterne el hielo con una almohadilla t\u00e9rmica en temperatura baja. No utilice una almohadilla t\u00e9rmica por m\u00e1s de 20 minutos a la vez.<\/li>\n<li>Siga las instrucciones de su proveedor para hacer estiramientos especiales. Los estiramientos y el ejercicio pueden relajar y fortalecer el m\u00fasculo piriforme.<\/li>\n<li>Utilice una postura correcta al sentarse, pararse o conducir. Si\u00e9ntese derecho y no se encorve.<\/li>\n<\/ul>\n<p>Su proveedor podr\u00eda recetarle relajantes musculares. Esto relajar\u00e1 el m\u00fasculo para que pueda hacer ejercicio y estirarlo. Las inyecciones de medicamentos esteroides en el \u00e1rea tambi\u00e9n pueden ayudar.<\/p>\n<p>Para el dolor m\u00e1s intenso, su proveedor podr\u00eda recomendarle electroterapia como TENS. Este tratamiento utiliza estimulaci\u00f3n para reducir el dolor y detener los espasmos musculares.<\/p>\n<p>Como \u00faltimo recurso, su proveedor podr\u00eda recomendarle una cirug\u00eda para cortar el m\u00fasculo y aliviar la presi\u00f3n sobre el nervio.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>Prevenci\u00f3n<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-6\" class=\"section-body\">\n<p>Para prevenir dolor futuro:<\/p>\n<ul>\n<li>Practique ejercicio de manera regular.<\/li>\n<li>Evite correr o ejercitarse en colinas o superficies desniveladas.<\/li>\n<li>Haga calentamiento y estiramiento antes de hacer ejercicio. Luego aumente gradualmente la intensidad de su actividad.<\/li>\n<li>Si algo le causa dolor, deje de hacerlo. No se esfuerce demasiado si tiene dolor. Descanse hasta que pase el dolor.<\/li>\n<li>No se siente ni se acueste por per\u00edodos prolongados en posiciones que ponen m\u00e1s presi\u00f3n en sus caderas.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>Cu\u00e1ndo debe llamar al m\u00e9dico<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-7\" class=\"section-body\">\n<p>Llame a su proveedor si tiene:<\/p>\n<ul>\n<li>Dolor que dura m\u00e1s que algunas semanas<\/li>\n<li>Dolor que empieza despu\u00e9s de que se ha lastimado en un accidente<\/li>\n<\/ul>\n<p>Busque ayuda m\u00e9dica de inmediato si:<\/p>\n<ul>\n<li>Tiene dolor intenso repentino en la parte inferior de su espalda o piernas, junto con debilidad o adormecimiento<\/li>\n<li>Tiene dificultad para controlar sus pies y se tropieza al caminar<\/li>\n<li>No puede controlar sus movimientos intestinales o su vejiga<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<div class=\"section\">\n<div class=\"section-header\">\n<div class=\"section-title\">\n<h2>Nombres alternativos<\/h2>\n<\/div>\n<\/div>\n<div id=\"section-Nom\" class=\"section-body\">\n<p>Pseudoci\u00e1tica; Ci\u00e1tica de la billetera; Neuropat\u00eda de la cavidad de la cadera; S\u00edndrome de salida; Dolor de espalda baja &#8211; piriforme<\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/li>\n<li>\n<h4><span style=\"color: #ff0000;\"><span style=\"color: #ff0000;\">Infecci\u00f3n Vertebral<\/span><\/span><\/h4>\n<section class=\"section pt-0 pb-0\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"column col-12 col-sm-12 col-md-8 align-self-start\">\n<section class=\"textImageComponent textImageComponent\">La i<strong>nfecci\u00f3n vertebra<\/strong>l sucede cuando un microorganismo invade la columna vertebral.<\/p>\n<ul>\n<li>Empiema epidural o subdural. Un empiema es una infecci\u00f3n localizada en un espacio de una cavidad. En este caso puede estar en el espacio epidural o en el espacio subdural.<\/li>\n<li>Osteomielitis vertebral o espondilitis infecciosa. Un absceso es una infecci\u00f3n organizada en un tejido. Cuando afecta al hueso, es decir, a la v\u00e9rtebra, se denomina osteomielitis vertebral o espondilitis infecciosa.<\/li>\n<\/ul>\n<p>Sin la infecci\u00f3n afecta exclusivamente al disco intervertebral se denomina discitis infecciosa. Si es mixta (disco y v\u00e9rtebra) se hablar\u00e1 de espondilodiscitis infecciosa.<\/p>\n<p>Si la infecci\u00f3n llega a afectar las membranas que recubren el sistema nervioso se desarrollar\u00e1 una meningitis.<\/p>\n<p>El nivel tor\u00e1cico es el m\u00e1s frecuentemente afectado (50%) seguido del lumbar (35%) y cervical (15%). A menudo coexisten empiemas y discitis u osteomielitis.<\/p>\n<\/section>\n<\/div>\n<div class=\"column col-12 col-sm-12 col-md-4 align-self-start\">\n<section class=\"\"><\/section>\n<section id=\"section1614467137724\" class=\"section pt-0 pb-0 \">\n<div class=\"container\"><\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<section id=\"section1614467137733\" class=\"section pb-0 \">\n<div class=\"container\">\n<div class=\"row rowTitle\">\n<div class=\"col-12\">\n<h2>\u00bfCu\u00e1les son los s\u00edntomas de una infecci\u00f3n vertebral?<\/h2>\n<\/div>\n<\/div>\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<div class=\"column-detail shadow bg-white\">\n<section id=\"section1614467137745\" class=\"section pt-0 \">\n<div class=\"container\">\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-6 col-lg-6 col-xl-6\">\n<section class=\"textImageComponent textImageComponent \">La infecci\u00f3n vertebral\u00a0aparece por tres v\u00edas de diseminaci\u00f3n de los microorganismos: v\u00eda hemat\u00f3gena, inoculaci\u00f3n externa directa y por contig\u00fcidad a partir de tejidos vecinos.La infecci\u00f3n de la columna vertebral puede provocar un dolor constante, que empeora por la noche y con los cambios de posici\u00f3n, la deambulaci\u00f3n y realizaci\u00f3n de actividades.Este dolor puede irradiarse al t\u00f3rax o al abdomen.Cuando afecta a espacios cervicales puede provocar disfagia y\/o tort\u00edcolis.Si existe d\u00e9ficit neurol\u00f3gico puede aparecer hipoestesia (disminuci\u00f3n de la sensibilidad), adormecimiento y calambres en la extremidad afectada.<\/section>\n<\/div>\n<div class=\"column col-12 col-sm-12 col-md-6 col-lg-6 col-xl-6\">\n<section class=\"textImageComponent textImageComponent \"><strong>Los s\u00edntomas m\u00e1s habituales son:<\/strong><\/p>\n<ul>\n<li>Dolor local, inespec\u00edfico y moderado.<\/li>\n<li>Fiebre.<\/li>\n<li>Malestar general y cansancio generalizado.<\/li>\n<li>Alteraciones neurol\u00f3gicas.<\/li>\n<\/ul>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<div class=\"containerBg bg-light \">\n<section id=\"section1614467137759\" class=\"section \">\n<div class=\"container\">\n<div class=\"row rowTitle\">\n<div class=\"col-12\">\n<h2>\u00bfTiene alguno de estos s\u00edntomas?<\/h2>\n<p>Puede que padezca una infecci\u00f3n vertebral<\/p>\n<\/div>\n<\/div>\n<div class=\"row align-items-start\">\n<div class=\"column mt-0 col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12 align-self-start\">\n<div class=\"linkComponent text-center\"><span style=\"font-size: 28px; font-weight: 600;\">\u00bfCu\u00e1les son las causas de una infecci\u00f3n vertebral?<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<div class=\"containerBg bg-white \">\n<section id=\"section1614467137772\" class=\"section \">\n<div class=\"container\">\n<div class=\"row \">\n<div class=\"column col-12 col-sm-12 col-md-6 col-lg-6 col-xl-6\">\n<section class=\"textImageComponent textImageComponent \">El origen de la infecci\u00f3n puede ser iatrog\u00e9nico (cirug\u00edas o pinchazos) o por diseminaci\u00f3n hemat\u00f3gena y en algunas ocasiones incluso resulta imposible discernir la procedencia del pat\u00f3geno (Hasta un 50% en algunas series).Hoy en d\u00eda cada vez son menos frecuentes ya que los avances en la asepsia quir\u00fargica y en la antibioterapia han reducido significativamente estas infecciones.El Staphylococcus aureus es el germen que se observa con mayor frecuencia (&gt;50%). La tuberculosis (Enfermedad de Pott) e infecciones f\u00fangicas, muy infrecuentes en individuos inmunocompetentes se han de sospechar en pacientes inmunodeprimidos o pacientes adictos a drogas por v\u00eda parenteral (ADVP).<\/section>\n<\/div>\n<div class=\"column col-12 col-sm-12 col-md-6 col-lg-6 col-xl-6\">\n<section class=\"textImageComponent textImageComponent \">\n<h3>\u00bfCu\u00e1les son los factores de riesgo?<\/h3>\n<p>Existen algunos factores que puede favorecer la aparici\u00f3n de una infecci\u00f3n vertebral:<\/p>\n<p>Diabetes mellitus, alcoholismo, traumatismo penetrante, procedimiento quir\u00fargico previo, edad avanzada, obesidad, desnutrici\u00f3n, inmunodepresi\u00f3n o inmunodulaci\u00f3n (corticoterapia, VIH\/SIDA, trasplantados etc.), drogadicci\u00f3n, comorbilidad m\u00e9dica importante, mal estado del paciente, hemodi\u00e1lisis etc.<\/p>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"section1614467137787\" class=\"section pb-0 \">\n<div class=\"container\">\n<div class=\"row rowTitle\">\n<div class=\"col-12\">\n<h2>\u00bfC\u00f3mo se diagnostica una infecci\u00f3n vertebral?<\/h2>\n<\/div>\n<\/div>\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<div class=\"column-detail shadow bg-white\">\n<section id=\"section1614467137798\" class=\"section pt-0 pb-0 \">\n<div class=\"container\">\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<section class=\"textImageComponent textImageComponent \"><img decoding=\"async\" class=\"lazyload img-responsive img-thumbnail pull-right\" title=\"destacado-pet-tac\" src=\"https:\/\/www.cun.es\/.imaging\/mte\/newstyle\/half\/dam\/cun\/imagen\/departamentos\/medicina-nuclear\/destacado-pet-tac\/jcr:content\/destacado-pet-tac.jpg\" alt=\"Imagen del PET-TAC. Cl\u00ednica Universidad de Navarra\" data-src=\"\/.imaging\/mte\/newstyle\/half\/dam\/cun\/imagen\/departamentos\/medicina-nuclear\/destacado-pet-tac\/jcr:content\/destacado-pet-tac.jpg\" \/>Las pruebas de laboratorio (velocidad de sedimentaci\u00f3n globular (VSG), prote\u00edna-C reactiva (PCR), procalcitonina, f\u00f3rmula leucocitaria etc. Son par\u00e1metros indispensables para el control de este tipo de enfermedad.El estudio radiol\u00f3gico simple aporta informaci\u00f3n de los cambios cronol\u00f3gicos en el hueso, pero no es suficiente para una valoraci\u00f3n de la fase aguda-subaguda de la enfermedad; no obstante, una Rx din\u00e1micas para valorar la estabilidad vertebral seg\u00fan cu\u00e1nto haya afectado a las v\u00e9rtebras tambi\u00e9n son de gran importancia.La resonancia magn\u00e9tica (partes blandas) y el esc\u00e1ner o TC (elementos \u00f3seos) son las pruebas de referencia para un estudio adecuado y eficaz de la infecci\u00f3n.Tambi\u00e9n puede servir de ayuda ante casos dudosos las pruebas de medicina nuclear, \u00e9stas son la gammagraf\u00eda con leucocitos marcados o con Galio\/Tecnecio, el SPECT-TC y el PET-TC.El estudio definitivo diagn\u00f3stico de una infecci\u00f3n es una toma de biopsia con el que se obtienen muestras para cultivo del pat\u00f3geno a tratar. Puede llevarse a cabo en un acto quir\u00fargico o de manera percut\u00e1nea guiada con TC.<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"section1614467137811\" class=\"section pb-0 \">\n<div class=\"container\">\n<div class=\"row rowTitle\">\n<div class=\"col-12\">\n<h2>\u00bfC\u00f3mo se trata una infecci\u00f3n vertebral?<\/h2>\n<\/div>\n<\/div>\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<div class=\"column-detail shadow bg-white\">\n<section class=\"responsive-tab tabs-left r-tabs\">\n<ul class=\"nav nav-tabs r-tabs-nav\" role=\"tablist\">\n<li class=\"nav-item r-tabs-tab r-tabs-state-active\" role=\"presentation\"><span class=\"tab-title \"><span class=\"text\">Tratamiento<\/span><\/span><\/li>\n<\/ul>\n<div class=\"tab-content\">\n<div id=\"tab16144671378260\" class=\"tab-pane fade in active show r-tabs-panel r-tabs-state-active\" role=\"tabpanel\">\n<section id=\"section1614467137831\" class=\"section pt-0 pb-0 \">\n<div class=\"container\">\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<section class=\"textImageComponent textImageComponent \">El tratamiento de cualquiera de estas infecciones es la antibioterapia intravenosa. Si conocemos el pat\u00f3geno que ha provocado la infecci\u00f3n se le administra antibioterapia dirigida. Si a\u00fan se ignora el origen de la infecci\u00f3n se implementar\u00e1 antibioterapia de amplio espectro.Si el empiema o el absceso produce una compresi\u00f3n patente sobre estructuras nerviosas, la cirug\u00eda est\u00e1 indicada para aliviar la presi\u00f3n en la zona afectada.Si debido a la destrucci\u00f3n \u00f3sea, presenta una inestabilidad vertebral, se puede indicar una cirug\u00eda de estabilizaci\u00f3n, ya que a menudo esta consecuencia de la infecci\u00f3n, acarrea mayores problemas de dolor al paciente.En una discitis infecciosa post-quir\u00fargica, el tratamiento habitual es antibioterapia intravenosa emp\u00edrica, reposo y una ortesis lumbar o dorso-lumbar.<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<div class=\"clearfix\"><\/div>\n<\/div>\n<\/section>\n<div class=\"clearfix\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"section1614467137848\" class=\"section pb-0 \">\n<div class=\"container\">\n<div class=\"row rowTitle\">\n<div class=\"col-12\">\n<h2>\u00bfD\u00f3nde la tratamos?<\/h2>\n<\/div>\n<\/div>\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<div class=\"column-detail shadow bg-white\">\n<section id=\"section1614467137864\" class=\"section antetitulo \">\n<div class=\"container\">\n<div class=\"row rowTitle\">\n<div class=\"col-12\">\n<h2>Especialistas del Departamento de Neurocirug\u00eda<\/h2>\n<\/div>\n<\/div>\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-6 col-lg-7 col-xl-8\">\n<section class=\"textImageComponent textImageComponent \">El Departamento de Neurocirug\u00eda cuenta con especialistas con una gran experiencia asistencial e investigadora y de la tecnolog\u00eda m\u00e1s avanzada.Somos el \u00fanico centro espa\u00f1ol en incorporar Resonancia Magn\u00e9tica intraoperatoria de alto campo (3T). Esto permite la \u00a0m\u00e1xima precisi\u00f3n y control en la cirug\u00eda craneal.<\/section>\n<section id=\"section1614467137873\" class=\"section pt-0 pb-0 \">\n<div class=\"container\">\n<div class=\"row align-items-start\">\n<div class=\"column col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12\">\n<section class=\"textImageComponent textImageComponent \"><strong>Tratamientos que realizamos<\/strong><\/p>\n<ul>\n<li>\n<h6>Alteraciones de la circulaci\u00f3n del l\u00edquido cefalorraqu\u00eddeo<\/h6>\n<\/li>\n<li>\n<h6>Bombas de infusi\u00f3n<\/h6>\n<\/li>\n<li>\n<h6><strong>Cirug\u00eda de la epilepsia<\/strong><\/h6>\n<\/li>\n<li>\n<h6><strong>Estimulaci\u00f3n cerebral profunda<\/strong><\/h6>\n<\/li>\n<li>\n<h6><strong>HIFU, ultrasonidos de alta intensidad<\/strong><\/h6>\n<\/li>\n<li>\n<h6>Neuralgia del trig\u00e9mino<\/h6>\n<\/li>\n<li>\n<h6>Neurocirug\u00eda pedi\u00e1trica<\/h6>\n<\/li>\n<li>\n<h6><strong>Patolog\u00eda de la columna<\/strong><\/h6>\n<\/li>\n<li>\n<h6><strong>Tumores cerebrales<\/strong><\/h6>\n<\/li>\n<li>\n<h6>Tumores hipofisarios<\/h6>\n<\/li>\n<\/ul>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>Extradurales<\/strong>: estos son m\u00e1s de la mitad de los tumores. Se originan en los cuerpos vertebrales o en el espacio epidural, lo que significa que aparecen fuera de la m\u00e9dula y en la duramadre (la cubierta). La mayor parte de los tumores localizados en esta zona son metast\u00e1sicos, por lo que su origen se encuentra en un tumor primitivo y maligno de otra parte del cuerpo. Los m\u00e1s frecuentes son el linfoma, el pulm\u00f3n, la mama y la pr\u00f3stata. En estos casos, el pron\u00f3stico depende de que se pueda aplicar un tratamiento resolutivo del proceso primitivo.<\/span><\/span><\/span><\/li>\n<li><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>Intradurales \u2013 extramedulares:<\/strong>\u00a0estos son menos de la mitad, que se engendran en la leptomeninge o en las ra\u00edces nerviosas. En gran parte son meningiomas y neurinomas, ambos benignos y que pueden curarse si se extirpan en su totalidad.<\/span><\/span><\/span><\/li>\n<li><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>Intramedulares<\/strong>: estos se dan en menos de uno de cada diez casos y tienen origen en el propio tejido nervioso de la m\u00e9dula. Los m\u00e1s frecuentes son los astrocitomas, que suelen localizarse en la parte m\u00e1s exc\u00e9ntrica y los ependimomas, que se ocupan del lugar m\u00e1s central en el tejido medular.<\/span><\/span><\/span><br \/>\n<h6>Tumor medular<\/h6>\n<header>\n<h1>Tumores de columna y de m\u00e9dula espinal<\/h1>\n<\/header>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">Uno de cada diez tumores primarios del Sistema Nervioso Central son intrarraqu\u00eddeos. La mayor\u00eda de estos tumores primarios espinales son benignos, algo que no se cumple entre los tumores intracraneales.<\/span><\/span><\/span><\/p>\n<h2><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>Tipos de tumores raqu\u00eddeos e intraraqu\u00eddeos<\/strong><\/span><\/span><\/span><\/h2>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">Hay tres grupos de tumores raqu\u00eddeos e intraraqu\u00eddeos, clasificados:<\/span><\/span><\/span><\/p>\n<p>&nbsp;<\/li>\n<\/ul>\n<div>\n<figure class=\"image\"><img decoding=\"async\" src=\"https:\/\/www.topdoctors.es\/files\/Image\/large\/5a5495c1-f75c-476d-96b1-66888ac97da0.jpg\" alt=\"\" \/><figcaption><em>Uno de cada diez tumores primarios del Sistema Nervioso Central son intrarraqu\u00eddeos<\/em><\/figcaption><\/figure>\n<\/div>\n<h2><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>S\u00edntomas de tumores de columna y m\u00e9dula espinal<\/strong><\/span><\/span><\/span><\/h2>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">Los pacientes que muestran esta patolog\u00eda pueden tener\u00a0<strong>s\u00edntomas distintos<\/strong>. C\u00f3mo m\u00e1s frecuente se presenta el dolor, que puede ser local en la zona afectada o irradiado a otra parte en forma de radiculopat\u00eda. Otro s\u00edntoma que puede darse es la p\u00e9rdida de fuerza o de sensibilidad en el tronco y las extremidades, as\u00ed como las dificultades en la micci\u00f3n o en la deposici\u00f3n por da\u00f1os en el esf\u00ednter vesical y rectal.<\/span><\/span><\/span><\/p>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">Estos s\u00edntomas pueden ser tan graves que pueden acabar condenando al paciente a una silla de ruedas y con incontinencia total de heces y orina.<\/span><\/span><\/span><\/p>\n<h2><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>C\u00f3mo diagnosticar los tumores de columna y m\u00e9dula espinal<\/strong><\/span><\/span><\/span><\/h2>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">La\u00a0<strong>prueba m\u00e1s importante\u00a0<\/strong>en el diagn\u00f3stico de procesos raqu\u00eddeos e intraraqu\u00eddeos es la resonancia nuclear magn\u00e9tica de columna.<\/span><\/span><\/span><\/p>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">Si se trata de un tumor extradural se ver\u00e1 una afecci\u00f3n en las v\u00e9rtebras y\/o del espacio extradural y la posible comprensi\u00f3n sobre la m\u00e9dula. Si se trata de un tumor intradural-extramedular se ver\u00e1 una masa homog\u00e9nea y regular que desplaza la m\u00e9dula espinal dentro de la duramadre o cubierta men\u00edngea que la envuelve. Si el tumor es intramedular, lo que se observar\u00e1 es una lesi\u00f3n intr\u00ednseca de la m\u00e9dula, no tan homog\u00e9nea o regular como las del apartado anterior.<\/span><\/span><\/span><\/p>\n<h2><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>Tratamiento para los tumores de columna y m\u00e9dula espinal<\/strong><\/span><\/span><\/span><\/h2>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">El tratamiento que m\u00e1s se usa en este campo es el quir\u00fargico, que se considera de urgencia cuando haya una p\u00e9rdida de fuerza considerable en las extremidades, as\u00ed como alteraci\u00f3n de los esf\u00ednteres vesical o rectal.<\/span><\/span><\/span><\/p>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">En la intervenci\u00f3n se usa el\u00a0<strong>microscopio quir\u00fargico<\/strong> para tener una buena iluminaci\u00f3n y ampliaci\u00f3n del campo, lo cual facilita las maniobras y permite actuar con m\u00e1s precisi\u00f3n. As\u00ed, se evita causar da\u00f1os innecesarios en el hueso o las estructuras nerviosas. El aspirador ultras\u00f3nico se usa para hacer extirpaci\u00f3n del tumor en muchos casos, ya que permite fragmentar mediante ultrasonido y aspirarlo sin tironear de las estructuras nerviosas.<\/span><\/span><\/span><\/p>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">La radioterapia y quimioterapia se usar\u00e1 en todos aquellos tumores que sean sensibles a estas modalidades de tratamiento, ya sea como terapia inicial, en el caso que la cirug\u00eda se haya desestimado, o ya sea como terapias complementarias.<\/span><\/span><\/span><\/p>\n<h2><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\"><strong>Pron\u00f3stico en tumores de columna y de m\u00e9dula espinal<\/strong><\/span><\/span><\/span><\/h2>\n<p><span class=\"margen_abj\"><span class=\"margen_der\"><span class=\"margen_todo\">El pron\u00f3stico en los pacientes con tumores raqu\u00eddeos e intrarraqu\u00eddeos, dada la amplia variedad de procesos que pueden encontrarse en este campo, va a depender de la naturaleza histol\u00f3gica de estos y del grado de resecci\u00f3n alcanzado del proceso tumoral. Normalmente, los tumores benignos bien localizados y con extirpaci\u00f3n quir\u00fargica total tienen un pron\u00f3stico excelente. Los tumores malignos, que son difusos y tienen extirpaci\u00f3n quir\u00fargica parcial, tendr\u00e1n un pron\u00f3stico pobre con expectativa de vida corta y secuelas importantes e invalidantes.<\/span><\/span><\/span><\/p>\n<div class=\"row\">\n<div class=\"content\">\n<div>\n<h2>Descripci\u00f3n general<\/h2>\n<p>La enfermedad \u00f3sea de Paget interfiere en el proceso natural de reciclaje del cuerpo, por el cual el tejido \u00f3seo viejo se reemplaza gradualmente por tejido \u00f3seo nuevo. Con el tiempo, la enfermedad puede hacer que los huesos afectados se vuelvan fr\u00e1giles y se deformen. La enfermedad \u00f3sea de Paget suele afectar la pelvis, el cr\u00e1neo, la columna vertebral y las piernas.<\/p>\n<p>El riesgo de contraer la enfermedad \u00f3sea de Paget aumenta con la edad. El riesgo tambi\u00e9n aumenta si alg\u00fan integrante de tu familia padece este trastorno. Algunas de las complicaciones de la enfermedad \u00f3sea de Paget son: fracturas, p\u00e9rdida de la audici\u00f3n y pinzamiento de los nervios de la columna vertebral.<\/p>\n<p>El pilar del tratamiento son los bifosfonatos; medicamentos que tambi\u00e9n se usan para fortalecer los huesos debilitados por la osteoporosis. En el caso de los pacientes que tienen complicaciones, puede ser necesario realizar una cirug\u00eda.<\/p>\n<h2>S\u00edntomas<\/h2>\n<p>La mayor\u00eda de las personas con enfermedad \u00f3sea de Paget no presentan s\u00edntomas. Cuando se manifiestan s\u00edntomas, la queja m\u00e1s frecuente es por dolor de huesos.<\/p>\n<p>C\u00f3mo esta enfermedad hace que el cuerpo cree huesos nuevos m\u00e1s r\u00e1pido que lo normal, la remodelaci\u00f3n r\u00e1pida genera huesos m\u00e1s blandos y d\u00e9biles que los normales, lo que puede derivar en dolor de huesos, deformidades y fracturas.<\/p>\n<p>La enfermedad puede afectar solamente a una o dos zonas del cuerpo, o puede ser generalizada. Los signos y s\u00edntomas que se manifiesten, si es que hay alguno,<\/p>\n<article id=\"main-content\">\n<div class=\"row\">\n<div class=\"content\">\n<h2>Descripci\u00f3n general<\/h2>\n<p>La enfermedad \u00f3sea de Paget interfiere en el proceso natural de reciclaje del cuerpo, por el cual el tejido \u00f3seo viejo se reemplaza gradualmente por tejido \u00f3seo nuevo. Con el tiempo, la enfermedad puede hacer que los huesos afectados se vuelvan fr\u00e1giles y se deformen. La enfermedad \u00f3sea de Paget suele afectar la pelvis, el cr\u00e1neo, la columna vertebral y las piernas.<\/p>\n<p>El riesgo de contraer la enfermedad \u00f3sea de Paget aumenta con la edad. El riesgo tambi\u00e9n aumenta si alg\u00fan integrante de tu familia padece este trastorno. Algunas de las complicaciones de la enfermedad \u00f3sea de Paget son: fracturas, p\u00e9rdida de la audici\u00f3n y pinzamiento de los nervios de la columna vertebral.<\/p>\n<p>El pilar del tratamiento son los bisfosfonatos; medicamentos que tambi\u00e9n se usan para fortalecer los huesos debilitados por la osteoporosis. En el caso de los pacientes que tienen complicaciones, puede ser necesario realizar una cirug\u00eda.<\/p>\n<h2>S\u00edntomas<\/h2>\n<p>La mayor\u00eda de las personas con enfermedad \u00f3sea de Paget no presentan s\u00edntomas. Cuando se manifiestan s\u00edntomas, la queja m\u00e1s frecuente es por dolor de huesos.<\/p>\n<p>C\u00f3mo esta enfermedad hace que el cuerpo cree huesos nuevos m\u00e1s r\u00e1pido que lo normal, la remodelaci\u00f3n r\u00e1pida genera huesos m\u00e1s blandos y d\u00e9biles que los normales, lo que puede derivar en dolor de huesos, deformidades y fracturas.<\/p>\n<p>La enfermedad puede afectar solamente a una o dos zonas del cuerpo, o puede ser generalizada. Los signos y s\u00edntomas que se manifiesten, si es que hay alguno, depender\u00e1 de cu\u00e1l sea la zona afectada.<\/p>\n<ul>\n<li><strong>Pelvis.<\/strong>\u00a0La enfermedad \u00f3sea de Paget en la pelvis puede ocasionar dolor de cadera.<\/li>\n<li><strong>Cr\u00e1neo.<\/strong>\u00a0Una excrecencia \u00f3sea en el cr\u00e1neo puede ocasionar p\u00e9rdida de la audici\u00f3n o dolores de cabeza.<\/li>\n<li><strong>Columna vertebral.<\/strong>\u00a0Si se ve afectada la columna vertebral, las ra\u00edces nerviosas pueden terminar comprimidas. Esto puede provocar dolor, hormigueo y entumecimiento de un brazo o una pierna.<\/li>\n<li><strong>Pierna.<\/strong>\u00a0A medida que los huesos se debilitan, pueden arquearse, lo que deriva en una postura de estevado. Los huesos alargados y deformados de las piernas pueden agregar presi\u00f3n adicional en las articulaciones cercanas, lo que puede terminar provocando artrosis en la rodilla o la cadera.<\/li>\n<\/ul>\n<h3>Cu\u00e1ndo consultar al m\u00e9dico<\/h3>\n<p>Habla con tu m\u00e9dico si tienes algo de lo siguiente:<\/p>\n<ul>\n<li>Dolor en los huesos y las articulaciones<\/li>\n<li>Hormigueo y debilidad en una de las extremidades<\/li>\n<li>Deformidades en los huesos<\/li>\n<li>Sordera inexplicable, especialmente si es de un solo lado<br \/>\n<header>\n<div class=\"row\">\n<h1><span style=\"color: #ff0000;\"><a style=\"color: #ff0000;\" href=\"https:\/\/www.mayoclinic.org\/es-es\/diseases-conditions\/pagets-disease-of-bone\/symptoms-causes\/syc-20350811\">Enfermedad \u00f3sea de Paget<\/a><\/span><\/h1>\n<\/div>\n<\/header>\n<nav class=\"mobile-nav-container\">\n<div class=\"row\">\n<div id=\"access-nav\">\n<ul role=\"menubar\">\n<li role=\"menuitem\">S\u00edntomas y causas<\/li>\n<li role=\"menuitem\">Diagn\u00f3stico y tratamiento<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/nav>\n<\/li>\n<\/ul>\n<h2>Causas<\/h2>\n<p>La causa de la enfermedad \u00f3sea de Paget se desconoce. Los cient\u00edficos creen que existe una combinaci\u00f3n de factores ambientales y gen\u00e9ticos que contribuyen a causar esta enfermedad. Hay varios genes que parecen estar relacionados con la enfermedad.<\/p>\n<p>Algunos cient\u00edficos consideran que la enfermedad \u00f3sea de Paget se relaciona con una infecci\u00f3n viral en las c\u00e9lulas \u00f3seas, aunque esta teor\u00eda es controvertida.<\/p>\n<h2>Factores de riesgo<\/h2>\n<p>Los factores que pueden aumentar el riesgo de sufrir la enfermedad \u00f3sea de Paget comprenden los siguientes:<\/p>\n<ul>\n<li><strong>La edad.<\/strong>\u00a0Las personas mayores de 40 a\u00f1os tienen m\u00e1s probabilidades de desarrollar la enfermedad \u00f3sea de Paget.<\/li>\n<li><strong>Sexo.<\/strong>\u00a0Los hombres tienen mayor probabilidad de contraer esta enfermedad que las mujeres.<\/li>\n<li><strong>Origen nacional.<\/strong>\u00a0La enfermedad \u00f3sea de Paget es m\u00e1s frecuente en Inglaterra, Escocia, Europa Central y Grecia, as\u00ed como en pa\u00edses donde se establecieron los inmigrantes europeos. Es poco frecuente en Escandinavia y en Asia.<\/li>\n<li><strong>Antecedentes familiares.<\/strong>\u00a0Si tienes un pariente que tiene la enfermedad \u00f3sea de Paget, es m\u00e1s probable que desarrolles dicha afecci\u00f3n.<\/li>\n<\/ul>\n<h2>Complicaciones<\/h2>\n<p>En la mayor\u00eda de los casos, la enfermedad \u00f3sea de Paget avanza lentamente. La enfermedad se puede controlar de manera eficaz en casi todas las personas. Algunas de las posibles complicaciones son las siguientes:<\/p>\n<ul>\n<li><strong>Fracturas y deformidades.<\/strong>\u00a0Los huesos afectados se rompen con m\u00e1s facilidad. Estos huesos deformados tienen vasos sangu\u00edneos adicionales, por lo que probablemente sangren m\u00e1s durante la reparaci\u00f3n quir\u00fargica. Los huesos de la pierna se pueden arquear, lo que puede afectar la capacidad de caminar.<\/li>\n<li><strong>Artrosis.<\/strong>\u00a0Los huesos deformados pueden provocar que las articulaciones cercanas tengan que hacer m\u00e1s esfuerzo, lo que puede derivar en artrosis.<\/li>\n<li><strong>Problemas neurol\u00f3gicos.<\/strong>\u00a0Cuando la enfermedad \u00f3sea de Paget ocurre en un \u00e1rea donde los nervios pasan a trav\u00e9s del hueso, como la columna vertebral y el cr\u00e1neo, el crecimiento excesivo del hueso puede comprimir y da\u00f1ar el nervio, causando dolor, debilidad u hormigueo en un brazo o pierna, o sordera.<\/li>\n<li><strong>Insuficiencia card\u00edaca.<\/strong>\u00a0La enfermedad \u00f3sea de Paget extendida puede provocar que el coraz\u00f3n tenga que esforzarse m\u00e1s para bombear sangre a las zonas afectadas del cuerpo. A veces, este esfuerzo adicional puede derivar en una insuficiencia card\u00edaca.<\/li>\n<li><strong>C\u00e1ncer de huesos.<\/strong>\u00a0El c\u00e1ncer de huesos afecta a alrededor del 1\u00a0por ciento de las personas con enfermedad \u00f3sea de Paget.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/article>\n<h5><span style=\"color: #ff0000;\">Dolor de espalda en los ni\u00f1os<\/span><\/h5>\n<\/div>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<\/div>\n<div>Descripci\u00f3n<\/div>\n<div>El dolor de espalda en los ni\u00f1os no es como el dolor de espalda en los adultos. En comparaci\u00f3n con un adulto, un ni\u00f1o con un dolor de espalda es m\u00e1s probable que tenga un trastorno subyacente grave. Esto es especialmente cierto si el ni\u00f1o tiene 4 a\u00f1os de edad o menos o si un ni\u00f1o de cualquier edad tiene dolor de espalda acompa\u00f1ada de:<\/div>\n<div>\n<ul>\n<li>La fiebre o p\u00e9rdida de peso<\/li>\n<li>Debilidad o entumecimiento<\/li>\n<li>Dificultad para caminar<\/li>\n<li>Dolor que se irradia hacia abajo una o ambas piernas<\/li>\n<li>Problemas intestinales o de la vejiga<\/li>\n<li>Dolor que impide que el ni\u00f1o duerme<\/li>\n<\/ul>\n<p>Las causas m\u00e1s graves de dolor de espalda necesita una identificaci\u00f3n precoz y el tratamiento o pueden empeorar.\u00a0Siempre consulte a un m\u00e9dico si el dolor de su ni\u00f1o de vuelta tiene una duraci\u00f3n de m\u00e1s de varios d\u00edas o empeora progresivamente.<\/p>\n<h5><span style=\"color: #000000;\"><strong>Examen M\u00e9dico<\/strong><\/span><\/h5>\n<p>Su m\u00e9dico comenzar\u00e1 por aprender sobre c\u00f3mo el problema desarrollado.\u00a0A continuaci\u00f3n, se le realizar\u00e1 un examen f\u00edsico de su hijo.<\/p>\n<div>\n<h4><span style=\"color: #000000;\">Historial M\u00e9dico \/ S\u00edntomas<\/span><\/h4>\n<p>Su m\u00e9dico le har\u00e1 preguntas generales sobre la salud general de su hijo y preguntas m\u00e1s espec\u00edficas sobre el dolor.\u00a0Las preguntas y el examen f\u00edsico le permitir\u00e1 a su m\u00e9dico para determinar cu\u00e1l de una serie de condiciones es la responsable del dolor de espalda de su hijo.<\/p>\n<p>Su m\u00e9dico querr\u00e1 saber cuando comienza el dolor, si estaba asociada con una lesi\u00f3n o una actividad exigente, y si ha mejorado o empeorado.\u00a0\u00c9l o ella le preguntar\u00e1 si hay algo que lo hace peor, y lo que hace su hijo para que sea menos doloroso.\u00a0Ser\u00e1 importante que su m\u00e9dico sepa exactamente d\u00f3nde est\u00e1 el dolor se siente, qu\u00e9 tan grave es, y lo mucho que interfiere con la escolarizaci\u00f3n del ni\u00f1o y actividades.\u00a0Si el dolor se dispara en una pierna que podr\u00eda significar que hay una presi\u00f3n sobre un nervio.<\/p>\n<\/div>\n<div>\n<h4><span style=\"color: #000000;\">Examen f\u00edsico<\/span><\/h4>\n<p>Durante el examen f\u00edsico de su hijo, el m\u00e9dico examina cuidadosamente los m\u00fasculos, huesos y nervios.\u00a0Su m\u00e9dico controlar\u00e1 lo siguiente:<\/p>\n<p><span style=\"color: #800000;\"><strong>La espina dorsal.<\/strong><\/span>\u00a0Su m\u00e9dico palpa cada v\u00e9rtebra y busca deformidades en la alineaci\u00f3n y la movilidad de la columna vertebral.\u00a0El aumento de la redondez de la espalda o una curva hacia un lado podr\u00eda ser importante.\u00a0Su m\u00e9dico revisar\u00e1 la postura y la marcha a pie, la capacidad de agacharse para tocar los dedos de los pies, y doblar a la derecha y la izquierda.Dificultad con el movimiento puede indicar que hay un problema con las articulaciones de la columna vertebral.<\/p>\n<p><span style=\"color: #ffff00;\"><strong><span style=\"color: #800000;\">Los nervios de la espalda.<\/span><\/strong><\/span><\/p>\n<p>Problemas de disco pueden causar presi\u00f3n en los nervios que salen de la columna vertebral, por lo que su m\u00e9dico le realizar\u00e1 pruebas espec\u00edficas para ello.Con su ni\u00f1o acostado boca arriba, su m\u00e9dico elevar las piernas (levantar la pierna recta de prueba) y tambi\u00e9n puede elevar las piernas con su ni\u00f1o acostado boca abajo (pierna recta inversa prueba de elevaci\u00f3n). Prueba de reflejos y sensibilidad en las piernas se llevar\u00e1 a cabo por la misma raz\u00f3n.<\/p>\n<p><span style=\"color: #800000;\"><strong>M\u00fasculos.<\/strong><\/span><\/p>\n<p><span style=\"color: #800000;\">\u00a0<\/span>Los m\u00fasculos de la espalda y las piernas se ponen a prueba.\u00a0Opresi\u00f3n de los m\u00fasculos de la espalda o los m\u00fasculos isquiotibiales en la parte posterior del muslo mostrar\u00e1 que su hijo est\u00e1 tratando de protegerse a s\u00ed mismo de los movimientos y las posiciones que pueden ser dolorosas.\u00a0Sensibilidad de los m\u00fasculos indicar\u00e1 una lesi\u00f3n muscular, tal como una cepa.<\/p>\n<p><strong><span style=\"color: #800000;\">Equilibrio, flexibilidad, coordinaci\u00f3n y fuerza muscular<\/span>.<\/strong><\/p>\n<p>Otros ex\u00e1menes que se har\u00e1n para asegurarse de que el dolor de espalda no es parte de un cuadro m\u00e1s grande.<\/p>\n<p><strong>Investigaciones \/ Pruebas<\/strong><\/p>\n<p>Pruebas con im\u00e1genes<\/p>\n<\/div>\n<div>\n<p>El m\u00e9dico puede usar las herramientas de diagn\u00f3stico de una o varias im\u00e1genes para ver el interior del cuerpo.<\/p>\n<p><strong>Rayos-X.<\/strong>\u00a0Las radiograf\u00edas de la columna mostrar\u00e1 los huesos y puede mostrar fracturas, desplazamientos u otros problemas en los huesos.<\/p>\n<p><b>Las gammagraf\u00eda \u00f3<\/b><strong>seas.<\/strong><\/p>\n<p>Esta prueba consiste en inyectar una sustancia en una vena y luego usando una c\u00e1mara especial para ver donde se recoge.\u00a0Se puede identificar la inflamaci\u00f3n, infecciones, tumores y fracturas.\u00a0Dado que la anatom\u00eda de la columna vertebral es muy complicado y puesto que estos procesos no son siempre visibles en la radiograf\u00eda, la gammagraf\u00eda \u00f3sea puede ser muy \u00fatil.<\/p>\n<p><strong>La tomograf\u00eda computarizada (TC).<\/strong><\/p>\n<p>Este es un especial de radiograf\u00eda computarizada t\u00e9cnica que proporciona una imagen tridimensional y permite al m\u00e9dico ver las cosas que no son visibles en dos dimensiones radiograf\u00edas.\u00a0Es particularmente \u00fatil en la columna vertebral para entender la compleja anatom\u00eda.<\/p>\n<p><strong>La resonancia magn\u00e9tica (MRI).<\/strong><\/p>\n<p>Esta t\u00e9cnica es muy valioso ya que muestra tejidos diferentes al hueso.\u00a0Se puede utilizar para ver la m\u00e9dula espinal, las ra\u00edces nerviosas, discos, u otros tejidos blandos que puede ser muy importante en el dolor de espalda.<\/p>\n<\/div>\n<div>\n<h1>Pruebas de laboratorio<\/h1>\n<p>Ex\u00e1menes de sangre, incluyendo la completa conteo sangu\u00edneo (CSC), velocidad de sedimentaci\u00f3n globular (VSG) y la prote\u00edna C-reactiva (CRP), todo puede cambiar en presencia de inflamaci\u00f3n o infecci\u00f3n.<\/p>\n<p>Condiciones comunes del dolor de espalda en los ni\u00f1os<\/p>\n<\/div>\n<div>\n<h3>Tensiones del M\u00fasculo \u00a0y desequilibrios<\/h3>\n<p>Tensi\u00f3n musculoesquel\u00e9tica es m\u00e1s a menudo responsables de dolor de espalda en ni\u00f1os y adolescentes. Este tipo de dolor frecuentemente responde al reposo, medicamentos antiinflamatorios, y un programa de ejercicios.<\/p>\n<p>Muchos adolescentes pueden tener dolor de espalda m\u00e1s persistente.\u00a0Esto a menudo se relaciona con los m\u00fasculos posteriores del muslo y la debilidad de los m\u00fasculos abdominales. Estos ni\u00f1os parecen mejorar con un programa de terapia f\u00edsica que hace hincapi\u00e9 en los m\u00fasculos isquiotibiales estiramiento y fortalecimiento abdominal.<\/p>\n<\/div>\n<h3><span style=\"color: #ff0000;\">Cifosis<\/span><\/h3>\n<p>En adolescentes, espalda redonda, tambi\u00e9n llamada cifosis de Scheuermann, es una causa com\u00fan de dolor en el medio de la espalda (la columna tor\u00e1cica). Las v\u00e9rtebras quedar atrapado, causando un redondeado o inclinado, atr\u00e1s. La parte curva de la espalda puede doler y el dolor puede empeorar con la actividad.<\/p>\n<div class=\"rich-text\" lang=\"en\">\n<section>La cifosis es un trastorno de la columna vertebral en el que una curvatura excesiva de la columna da como resultado un redondeo anormal de la parte superior de la espalda.\u00a0La condici\u00f3n a veces se conoce como espalda redonda o, en el caso de una curva pronunciada, como jorobado.\u00a0La cifosis puede ocurrir a cualquier edad, pero es com\u00fan durante la adolescencia.En la mayor\u00eda de los casos, la cifosis causa pocos problemas y no requiere tratamiento.\u00a0Ocasionalmente, un paciente puede necesitar usar un aparato ortop\u00e9dico para la espalda o hacer ejercicios para mejorar su postura y fortalecer la columna vertebral.\u00a0Sin embargo, en casos severos, la cifosis puede ser dolorosa, causar una deformidad significativa de la columna y provocar problemas respiratorios.\u00a0Los pacientes con cifosis grave pueden necesitar cirug\u00eda para ayudar a reducir la curvatura excesiva de la columna y mejorar sus s\u00edntomas.<\/section>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">Anatom\u00eda<\/h2>\n<div class=\"accordion-content\">\n<p>Su columna vertebral se compone de tres segmentos.\u00a0Cuando se ven desde un lado, estos segmentos forman tres curvas naturales.<\/p>\n<ul>\n<li>Las curvas en forma de C del cuello (columna cervical) y la parte inferior de la espalda (columna lumbar) se denominan lordosis.<\/li>\n<li>La curva en forma de C inversa del t\u00f3rax (columna tor\u00e1cica) se denomina cifosis.<\/li>\n<\/ul>\n<p>Esta curvatura natural de la columna vertebral es importante para el equilibrio y nos ayuda a mantenernos erguidos.\u00a0Si alguna de las curvas se vuelve demasiado grande o demasiado peque\u00f1a, se vuelve dif\u00edcil mantenerse erguido y nuestra postura parece anormal.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption\" data-widthoverrideside=\"30\">\n<div class=\"fullscreen-button\"><\/div>\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Vista lateral de la columna vertebral\" src=\"https:\/\/orthoinfo.aaos.org\/globalassets\/figures\/a00423f01.jpg\" alt=\"Vista lateral de la columna vertebral\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<p>Cuando se ve de lado, una columna vertebral normal tiene tres curvas suaves.<\/p>\n<\/div>\n<\/div>\n<p>Los segmentos m\u00e1s peque\u00f1os de su columna incluyen:<\/p>\n<p><strong>v\u00e9rtebras.\u00a0<\/strong>La columna vertebral generalmente se compone de 24 peque\u00f1os huesos de forma rectangular, llamados v\u00e9rtebras, que se apilan uno encima del otro.\u00a0Estos huesos crean las curvas naturales de la espalda y se conectan para crear un canal que protege la m\u00e9dula espinal.<\/p>\n<div class=\"embedded-media embedded-photo inline-image-right\">\n<div class=\"fullscreen-button\"><\/div>\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"V\u00e9rtebras y discos intervertebrales\" src=\"https:\/\/orthoinfo.aaos.org\/globalassets\/figures\/a00423f08.jpg\" alt=\"V\u00e9rtebras y discos intervertebrales\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<p>V\u00e9rtebras y discos intervertebrales en una columna sana.<\/p>\n<\/div>\n<\/div>\n<p><strong>Discos intervertebrales.\u00a0<\/strong>Entre las v\u00e9rtebras hay discos intervertebrales flexibles.\u00a0Son planas y redondas y de aproximadamente media pulgada de grosor.\u00a0Los discos intervertebrales amortiguan las v\u00e9rtebras y act\u00faan como amortiguadores cuando caminas o corres.<\/p>\n<\/div>\n<\/section>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">Descripci\u00f3n<\/h2>\n<div class=\"accordion-content\">\n<p>Aunque la columna tor\u00e1cica debe tener una cifosis natural de 20 a 45 grados, las anomal\u00edas posturales o estructurales pueden dar como resultado una curva que est\u00e1 fuera de este rango normal.\u00a0Aunque el t\u00e9rmino m\u00e9dico para una curva que es m\u00e1s grande de lo normal (m\u00e1s de 50 grados) es en realidad hipercifosis, los m\u00e9dicos usan com\u00fanmente el t\u00e9rmino cifosis para referirse a la condici\u00f3n cl\u00ednica de curvatura excesiva en la columna tor\u00e1cica que conduce a una parte superior de la espalda redondeada. .<\/p>\n<p>La cifosis puede variar en severidad.\u00a0En general, cuanto mayor es la curva, m\u00e1s grave es la afecci\u00f3n.\u00a0Las curvas m\u00e1s leves pueden causar dolor de espalda leve o ning\u00fan s\u00edntoma.\u00a0Las curvas m\u00e1s severas pueden causar una deformidad significativa de la columna y resultar en una joroba visible en la espalda del paciente.<\/p>\n<\/div>\n<\/section>\n<div class=\"related-articles\">\n<p class=\"related-articles-header\">Art\u00edculos relacionados<\/p>\n<h6 class=\"related-articles-item-tag theme-brand-a\">ENFERMEDADES Y CONDICIONES<\/h6>\n<div class=\"related-articles-item-title\">\n<p>Dolor de espalda en ni\u00f1os<\/p>\n<\/div>\n<h6 class=\"related-articles-item-tag theme-brand-b\">TRATAMIENTO<\/h6>\n<div class=\"related-articles-item-title\">\n<p>Fusi\u00f3n espinal<\/p>\n<\/div>\n<h6 class=\"related-articles-item-tag theme-brand-a\">ENFERMEDADES Y CONDICIONES<\/h6>\n<div class=\"related-articles-item-title\">\n<p>Fundamentos de la columna vertebral<\/p>\n<\/div>\n<\/div>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">Tipos de cifosis<\/h2>\n<div class=\"accordion-content\">\n<p>Hay varios tipos de cifosis.\u00a0Los tres que m\u00e1s com\u00fanmente afectan a los ni\u00f1os y adolescentes son:<\/p>\n<ul>\n<li>cifosis postural<\/li>\n<li>cifosis de Scheuermann<\/li>\n<li>Cifosis cong\u00e9nita<\/li>\n<\/ul>\n<section>\n<h3><em>cifosis postural<\/em><\/h3>\n<p>La cifosis postural, el tipo m\u00e1s com\u00fan de cifosis, generalmente se vuelve notoria durante la adolescencia.\u00a0Se nota cl\u00ednicamente como mala postura o encorvamiento, pero no se asocia con anomal\u00edas estructurales graves de la columna.<\/p>\n<p>La curva causada por la cifosis postural suele ser redonda y suave y, a menudo, el paciente puede corregirla cuando se le pide que se ponga de pie.<\/p>\n<p>La cifosis postural es m\u00e1s com\u00fan en ni\u00f1as que en ni\u00f1os.\u00a0Rara vez es doloroso y, debido a que la curvatura no progresa, no suele generar problemas en la vida adulta.<\/p>\n<\/section>\n<section>\n<h3><em>Cifosis de Scheuermann<\/em><\/h3>\n<p>La cifosis de Scheuermann lleva el nombre del radi\u00f3logo dan\u00e9s que describi\u00f3 por primera vez la afecci\u00f3n.<\/p>\n<p>Al igual que la cifosis postural, la cifosis de Scheuermann suele manifestarse durante la adolescencia.\u00a0Sin embargo, la cifosis de Scheuermann puede resultar en una deformidad m\u00e1s severa que la cifosis postural.<\/p>\n<p>La cifosis de Scheuermann es causada por una anomal\u00eda estructural en la columna vertebral.\u00a0En un paciente con cifosis de Scheuermann, una radiograf\u00eda lateral mostrar\u00e1 que, en lugar de la forma rectangular normal, tres o m\u00e1s v\u00e9rtebras consecutivas tienen una forma m\u00e1s triangular.\u00a0Esta forma irregular hace que las v\u00e9rtebras se acu\u00f1en hacia el frente de la columna, disminuyendo el espacio normal del disco y creando una curvatura exagerada hacia adelante en la parte superior de la espalda.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption-right\" data-widthoverrideside=\"40\">\n<div class=\"fullscreen-button\"><\/div>\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Ilustraci\u00f3n y radiograf\u00eda de acu\u00f1amiento vertebral\" src=\"https:\/\/orthoinfo.aaos.org\/globalassets\/figures\/a00423f02.jpg\" alt=\"Ilustraci\u00f3n y radiograf\u00eda de acu\u00f1amiento vertebral\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<div>La ilustraci\u00f3n y la radiograf\u00eda muestran el acu\u00f1amiento vertebral que ocurre en pacientes con cifosis de Scheuermann.<\/div>\n<div><em><strong>(Derecha) Reproducido de JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, Academia Estadounidense de Cirujanos Ortop\u00e9dicos, 2010<\/strong><\/em><\/div>\n<\/div>\n<\/div>\n<p>La curva causada por la cifosis de Scheuermann suele ser aguda y angular.\u00a0Tambi\u00e9n es r\u00edgido y r\u00edgido.\u00a0A diferencia de un paciente con cifosis postural, un paciente con cifosis de Scheuermann no puede corregir la curva simplemente par\u00e1ndose derecho.<\/p>\n<p>La cifosis de Scheuermann generalmente afecta la columna tor\u00e1cica, pero ocasionalmente se desarrolla en la columna lumbar.\u00a0La condici\u00f3n es m\u00e1s com\u00fan en ni\u00f1os que en ni\u00f1as y deja de progresar una vez que se completa el crecimiento.<\/p>\n<p>La cifosis de Scheuermann a veces puede ser dolorosa.\u00a0Si hay dolor, por lo general se siente en la parte m\u00e1s prominente, o v\u00e9rtice, de la curva.\u00a0El paciente tambi\u00e9n puede sentir dolor en la espalda baja.\u00a0Esto puede suceder cuando la columna trata de compensar la parte superior de la espalda redondeada aumentando la curva natural hacia adentro de la parte inferior de la espalda.\u00a0La actividad puede empeorar el dolor, al igual que estar de pie o sentado durante largos per\u00edodos.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption\">\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Fotos cl\u00ednicas de un ni\u00f1o con cifosis severa\" src=\"https:\/\/orthoinfo.aaos.org\/link\/fe6bb083290245309958c6f1853c43fa.aspx\" alt=\"Fotos cl\u00ednicas de un ni\u00f1o con cifosis severa\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<div>Las fotograf\u00edas cl\u00ednicas de un adolescente masculino muestran una parte superior de la espalda anormalmente redondeada.\u00a0Su cifosis severa es m\u00e1s obvia cuando se inclina hacia adelante.<\/div>\n<div><em><strong>Cortes\u00eda de Texas Scottish Rite Hospital for Children<\/strong><\/em><\/div>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<h3><em>Cifosis cong\u00e9nita<\/em><\/h3>\n<p>La cifosis cong\u00e9nita est\u00e1 presente al nacer.\u00a0Ocurre cuando la columna vertebral no se desarrolla normalmente mientras el beb\u00e9 est\u00e1 en el \u00fatero.\u00a0Es posible que los huesos no se formen como deber\u00edan, o que varias v\u00e9rtebras se fusionen.\u00a0La cifosis cong\u00e9nita suele empeorar a medida que el ni\u00f1o crece.<\/p>\n<p>Los pacientes con cifosis cong\u00e9nita a menudo necesitan tratamiento quir\u00fargico a una edad muy temprana para detener la progresi\u00f3n de la curva.\u00a0Muchas veces, estos pacientes tendr\u00e1n defectos de nacimiento adicionales que afectar\u00e1n otras partes del cuerpo, como el coraz\u00f3n y los ri\u00f1ones.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption\">\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Foto cl\u00ednica y resonancia magn\u00e9tica de un ni\u00f1o con cifosis cong\u00e9nita\" src=\"https:\/\/orthoinfo.aaos.org\/link\/2958351da7c84d87841c850a6901f7fd.aspx\" alt=\"Foto cl\u00ednica y resonancia magn\u00e9tica de un ni\u00f1o con cifosis cong\u00e9nita\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<div>(\u00a0<strong>Izquierda<\/strong>\u00a0) Fotograf\u00eda cl\u00ednica de un ni\u00f1o con cifosis cong\u00e9nita en la columna tor\u00e1cica.\u00a0(\u00a0<strong>Derecha<\/strong>\u00a0) Una resonancia magn\u00e9tica nuclear (RMN) de su columna vertebral muestra compresi\u00f3n de la m\u00e9dula espinal.\u00a0Esto puede provocar s\u00edntomas neurol\u00f3gicos como debilidad y entumecimiento en las piernas.<\/div>\n<div><em><strong>Cortes\u00eda de Texas Scottish Rite Hospital for Children<\/strong><\/em><\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/section>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">S\u00edntomas<\/h2>\n<div class=\"accordion-content\">\n<p>Los signos y s\u00edntomas de la cifosis var\u00edan seg\u00fan la causa y la gravedad de la curva.\u00a0Estos pueden incluir:<\/p>\n<ul>\n<li>Hombros redondeados<\/li>\n<li>Una joroba visible en la espalda.<\/li>\n<li>dolor de espalda leve<\/li>\n<li>Fatiga<\/li>\n<li>rigidez de la columna<\/li>\n<li>Isquiotibiales apretados (los m\u00fasculos en la parte posterior del muslo)<\/li>\n<\/ul>\n<p>En raras ocasiones, con el tiempo, las curvas progresivas pueden conducir a:<\/p>\n<ul>\n<li>Debilidad, entumecimiento u hormigueo en las piernas<\/li>\n<li>Perdida de la sensibilidad<\/li>\n<li>Cambios en los h\u00e1bitos intestinales o vesicales<\/li>\n<li>Dificultad para respirar u otras dificultades respiratorias<\/li>\n<\/ul>\n<\/div>\n<\/section>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">Examen m\u00e9dico<\/h2>\n<div class=\"accordion-content\">\n<p>La cifosis leve a menudo pasa desapercibida hasta que una prueba de detecci\u00f3n de escoliosis en la escuela solicita una visita al m\u00e9dico.\u00a0Sin embargo, si se notan cambios en la espalda del paciente, suele ser bastante preocupante tanto para los padres como para el ni\u00f1o.\u00a0La preocupaci\u00f3n por el aspecto cosm\u00e9tico de la espalda del ni\u00f1o es a menudo lo que lleva a la familia a buscar ayuda m\u00e9dica.<\/p>\n<section>\n<h3><em>Examen f\u00edsico<\/em><\/h3>\n<p>Su m\u00e9dico comenzar\u00e1 tomando un historial m\u00e9dico y preguntando sobre la salud general y los s\u00edntomas de su hijo.\u00a0Luego examinar\u00e1n la espalda de su hijo, presionando la columna para determinar si hay \u00e1reas de sensibilidad.<\/p>\n<p>Durante el examen, el m\u00e9dico le pedir\u00e1 a su hijo que se incline hacia adelante con ambos pies juntos, las rodillas rectas y los brazos colgando.\u00a0Esta prueba, que se llama prueba de flexi\u00f3n hacia adelante de Adam, le permite a su m\u00e9dico ver mejor la inclinaci\u00f3n de la columna y observar cualquier deformidad de la columna.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption-right\" data-widthoverrideside=\"30\">\n<div class=\"fullscreen-button\"><\/div>\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Foto cl\u00ednica de la prueba de flexi\u00f3n hacia adelante de Adam\" src=\"https:\/\/orthoinfo.aaos.org\/globalassets\/figures\/a00423f05.jpg\" alt=\"Foto cl\u00ednica de la prueba de flexi\u00f3n hacia adelante de Adam\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<div>Para evaluar una curva, su m\u00e9dico le pedir\u00e1 a su hijo que se incline hacia adelante por la cintura.<\/div>\n<\/div>\n<\/div>\n<p>El m\u00e9dico tambi\u00e9n puede pedirle a su hijo que se acueste para ver si esto endereza la curva, una se\u00f1al de que la curva es flexible y puede ser representativa de una cifosis postural.<\/p>\n<\/section>\n<section>\n<h3><em>Pruebas<\/em><\/h3>\n<p><strong>Rayos X.\u00a0<\/strong>\u00a0Los rayos X proporcionan im\u00e1genes de estructuras densas, como los huesos.\u00a0El m\u00e9dico de su hijo puede solicitar radiograf\u00edas desde diferentes \u00e1ngulos para determinar si hay cambios en las v\u00e9rtebras o cualquier otra anomal\u00eda \u00f3sea.<\/p>\n<p>Los rayos X tambi\u00e9n ayudar\u00e1n a medir el grado de la curva cif\u00f3tica.\u00a0Una curva mayor de 50 grados se considera anormal;\u00a0sin embargo, no indica necesariamente la necesidad de tratamientos invasivos.<\/p>\n<p><strong>Pruebas de funci\u00f3n pulmonar.\u00a0<\/strong>Si la curva es severa, el m\u00e9dico puede ordenar pruebas de funci\u00f3n pulmonar.\u00a0Estas pruebas ayudar\u00e1n a determinar si la respiraci\u00f3n de su hijo est\u00e1 restringida debido a la disminuci\u00f3n del espacio tor\u00e1cico.<\/p>\n<p><strong>Otras pruebas.\u00a0<\/strong>En pacientes con cifosis cong\u00e9nita, las curvas progresivas pueden provocar s\u00edntomas de compresi\u00f3n de la m\u00e9dula espinal, como dolor, hormigueo, entumecimiento o debilidad en la parte inferior del cuerpo.\u00a0Si su hijo experimenta cualquiera de estos s\u00edntomas, o si la curva cambia r\u00e1pidamente con el tiempo, el m\u00e9dico de su hijo puede solicitar pruebas neurol\u00f3gicas o una resonancia magn\u00e9tica nuclear (RMN).<\/p>\n<\/section>\n<\/div>\n<\/section>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">Tratamiento<\/h2>\n<div class=\"accordion-content\">\n<p>El objetivo del tratamiento es detener la progresi\u00f3n de la curva y prevenir la deformidad.\u00a0El m\u00e9dico de su hijo tendr\u00e1 en cuenta varias cosas al determinar el tratamiento para la cifosis, entre ellas:<\/p>\n<ul>\n<li>La edad y el estado general de salud de su hijo<\/li>\n<li>El n\u00famero de a\u00f1os de crecimiento restantes<\/li>\n<li>El tipo de cifosis<\/li>\n<li>La severidad de la curva.<\/li>\n<\/ul>\n<section>\n<h3><em>Tratamiento no quir\u00fargico<\/em><\/h3>\n<p>Se recomienda el tratamiento no quir\u00fargico para pacientes con cifosis postural.\u00a0Tambi\u00e9n se recomienda para pacientes con cifosis de Scheuermann que tienen curvas de menos de 70 a 75 grados.<\/p>\n<p>El tratamiento no quir\u00fargico puede incluir:<\/p>\n<p><strong>Observaci\u00f3n.\u00a0<\/strong>\u00a0El m\u00e9dico puede recomendar simplemente monitorear la curva para asegurarse de que no empeore.\u00a0Es posible que se le pida a su hijo que regrese para visitas peri\u00f3dicas y radiograf\u00edas hasta que crezca por completo.<\/p>\n<p>A menos que la curva empeore o se vuelva dolorosa, es posible que su hijo no necesite ning\u00fan otro tratamiento.<\/p>\n<p><strong>Terapia f\u00edsica.\u00a0<\/strong>Los ejercicios espec\u00edficos pueden ayudar a aliviar el dolor de espalda y mejorar la postura al fortalecer los m\u00fasculos del abdomen y la espalda.\u00a0Ciertos ejercicios tambi\u00e9n pueden ayudar a estirar los isquiotibiales tensos y fortalecer las \u00e1reas del cuerpo que pueden verse afectadas por la desalineaci\u00f3n de la columna.<\/p>\n<p><strong>Medicamentos antiinflamatorios no esteroideos (AINE).\u00a0<\/strong>Los AINE, como la aspirina, el ibuprofeno y el naproxeno, pueden ayudar a aliviar el dolor de espalda.<\/p>\n<p><strong>Vigorizante.\u00a0<\/strong>Se pueden recomendar aparatos ortop\u00e9dicos para pacientes con cifosis de Scheuermann que a\u00fan est\u00e1n creciendo. El tipo espec\u00edfico de aparato ortop\u00e9dico y la cantidad de horas por d\u00eda que se debe usar depender\u00e1n de la gravedad de la curva. El m\u00e9dico ajustar\u00e1 el cors\u00e9 regularmente a medida que mejore la curva. Por lo general, el ni\u00f1o usa el aparato ortop\u00e9dico hasta que alcanza la madurez esquel\u00e9tica y deja de crecer.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption-right\" data-widthoverrideside=\"35\">\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Radiograf\u00edas de una curva espinal cif\u00f3tica antes y despu\u00e9s del cors\u00e9\" src=\"https:\/\/orthoinfo.aaos.org\/globalassets\/figures\/a00423f06.jpg\" alt=\"Radiograf\u00edas de una curva espinal cif\u00f3tica antes y despu\u00e9s del cors\u00e9\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<div>(\u00a0<strong>Izquierda<\/strong>\u00a0) Este paciente tiene una curva de 65 grados en la columna tor\u00e1cica.\u00a0(\u00a0<strong>Derecha<\/strong>\u00a0) Aunque no se puede ver en la radiograf\u00eda, el paciente ahora usa un aparato ortop\u00e9dico en la espalda que ha ayudado a reducir la curvatura excesiva.<\/div>\n<div><\/div>\n<\/div>\n<\/div>\n<\/section>\n<section>\n<h3><em>Tratamiento quir\u00fargico<\/em><\/h3>\n<p>La cirug\u00eda a menudo se recomienda para pacientes con cifosis cong\u00e9nita.<\/p>\n<p>Tambi\u00e9n se puede recomendar la cirug\u00eda para pacientes con cifosis de Scheuermann que tienen curvas de m\u00e1s de 70 a 75 grados o aquellos con dolor de espalda severo.\u00a0Los pacientes con cifosis en la parte inferior de la espalda (curvas toracolumbar) pueden requerir cirug\u00eda para curvas m\u00e1s peque\u00f1as de m\u00e1s de 25 a 30 grados.<\/p>\n<p>La fusi\u00f3n espinal es el procedimiento quir\u00fargico m\u00e1s com\u00fanmente utilizado para tratar la cifosis.<\/p>\n<p>Los objetivos de la fusi\u00f3n espinal son:<\/p>\n<ul>\n<li>Reducir el grado de la curva.<\/li>\n<li>Evitar una mayor progresi\u00f3n de la curva<\/li>\n<li>Mantener la mejora en el tiempo<\/li>\n<li>Aliviar el dolor de espalda significativo, si est\u00e1 presente<\/li>\n<\/ul>\n<section>\n<h4>Procedimiento quir\u00fargico<\/h4>\n<p>La fusi\u00f3n espinal es esencialmente un proceso de soldadura.\u00a0La idea b\u00e1sica es fusionar las v\u00e9rtebras afectadas para que cicatricen en un solo hueso s\u00f3lido.\u00a0Fusionar las v\u00e9rtebras reducir\u00e1 el grado de la curva y, debido a que elimina el movimiento entre las v\u00e9rtebras afectadas, tambi\u00e9n puede ayudar a aliviar el dolor de espalda.<\/p>\n<p>Durante el procedimiento, el m\u00e9dico generalmente usar\u00e1 tornillos y varillas de metal para ayudar a colocar las v\u00e9rtebras en una mejor alineaci\u00f3n.\u00a0A menudo, el objetivo es una correcci\u00f3n parcial segura: hacer que la curva sea m\u00e1s peque\u00f1a pero no siempre normal.\u00a0Idealmente, la curva se reducir\u00e1 en un 50% de su magnitud inicial.\u00a0Una vez que las v\u00e9rtebras est\u00e1n mejor alineadas, se colocan peque\u00f1os trozos de hueso, llamados injertos \u00f3seos, en los espacios entre las v\u00e9rtebras que se van a fusionar.\u00a0Con el tiempo, los huesos crecen juntos, de forma similar a como sana un hueso roto.<\/p>\n<p>La extensi\u00f3n exacta de la columna vertebral depende del tama\u00f1o de la curvatura de su hijo.\u00a0Solo las v\u00e9rtebras curvas est\u00e1n fusionadas.\u00a0Los otros huesos de la columna a\u00fan pueden moverse y ayudar a doblarse, enderezarse y rotar.\u00a0Las curvas m\u00e1s grandes a menudo requieren que se fusionen m\u00e1s v\u00e9rtebras, lo que significa que quedan menos v\u00e9rtebras m\u00f3viles para permitir la flexi\u00f3n y torsi\u00f3n de la columna.<\/p>\n<div class=\"embedded-media embedded-photo sidecaption-right\" data-widthoverrideside=\"30\">\n<div class=\"fullscreen-button\"><\/div>\n<p><img decoding=\"async\" class=\"embedded-photo-img\" title=\"Radiograf\u00edas de una curva cif\u00f3tica antes y despu\u00e9s de la fusi\u00f3n espinal\" src=\"https:\/\/orthoinfo.aaos.org\/globalassets\/figures\/a00423f07.jpg\" alt=\"Radiograf\u00edas de una curva cif\u00f3tica antes y despu\u00e9s de la fusi\u00f3n espinal\" \/><\/p>\n<div class=\"embedded-media-caption\">\n<div>(\u00a0<strong>Izquierda<\/strong>\u00a0) Radiograf\u00eda preoperatoria de un ni\u00f1o de 17 a\u00f1os con una dolorosa curva de 80 grados causada por cifosis de Scheuermann.\u00a0(\u00a0<strong>Derecha<\/strong>\u00a0) Despu\u00e9s de la fusi\u00f3n espinal y la estabilizaci\u00f3n con placas y tornillos, la curvatura se redujo a 38 grados.<\/div>\n<div><\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/section>\n<\/div>\n<\/section>\n<section class=\"accordion\">\n<h2 class=\"accordion-header\">Resultados a largo plazo<\/h2>\n<div class=\"accordion-content\">\n<p>Si la cifosis se diagnostica temprano, muchos pacientes pueden ser tratados con \u00e9xito sin cirug\u00eda y llevar una vida activa y saludable. Sin embargo, la progresi\u00f3n de la curva podr\u00eda generar problemas durante la edad adulta. Los pacientes con cifosis necesitan un seguimiento regular del estado y control de la progresi\u00f3n de la curva, tanto si se trata con cirug\u00eda como si no.<\/p>\n<div class=\"header-title text-left show\">\n<div class=\"title-wrap\">\n<div class=\"content\">\n<div class=\"page-container\">\n<div class=\"wrap-container\">\n<h1 class=\"page-title no-transition\">Tipos de osteotom\u00edas de columna vertebral<\/h1>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"page-container without-breadcrumbs\">\n<div class=\"page-content with-right-sidebar\">\n<div id=\"primary\" class=\"content-area\">\n<p>&nbsp;<\/p>\n<article id=\"post-497630\" class=\"post-497630 post type-post status-publish format-standard has-post-thumbnail hentry category-columna\">\n<div class=\"entry-content\">\n<section class=\"wpb-content-wrapper\">\n<section class=\"vc_section\">\n<div class=\"vc_row wpb_row vc_row-fluid\">\n<div class=\"wpb_column vc_column_container vc_col-sm-12\">\n<div class=\"vc_column-inner\">\n<div class=\"wpb_wrapper\">\n<div id=\"norebro-custom-64545591925eb\" class=\"norebro-text-sc \"><\/div>\n<div id=\"norebro-custom-64545591926cf\" class=\"norebro-text-sc \">\n<p><a href=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/02\/Spine.jpg\"><img decoding=\"async\" class=\"alignleft wp-image-497699\" src=\"https:\/\/aware.doctor\/wp-content\/uploads\/2021\/02\/Spine.jpg\" alt=\"\" width=\"250\" height=\"500\" \/><\/a>Las deformidades vertebrales plantean numerosos desaf\u00edos al cirujano de columna. Se requiere una revisi\u00f3n detallada de las principales osteotom\u00edas vertebrales para comprender mejor las ventajas y desventajas de cada t\u00e9cnica, y para determinar qu\u00e9 osteotom\u00eda es la mejor para una deformidad particular, con el fin de mejorar el conocimiento sobre la importancia de restablecer la alineaci\u00f3n normal de la columna\u2026<\/p>\n<p>&nbsp;<\/p>\n<p>Cada vez se tiende a hacer menos cirug\u00edas complejas, ya que hay muchas complicaciones derivadas de la misma. Lo fundamental es ajustar la indicaci\u00f3n para afinar en que casos hay que hacer cirug\u00eda compleja y en cuales no. Saber muy bien cuales son las complicaciones que se pueden tener, tanto en adultos como en ni\u00f1os.<\/p>\n<p>&nbsp;<\/p>\n<p>La\u00a0osteotom\u00eda vertebral\u00a0se puede indicar en diferentes condiciones, se pueden corregir deformidades tanto en el plano sagital como en el plano coronal. Es importante saber\u00a0diferenciar una deformidad larga de una deformidad angular y se debe tener en cuenta que no son cirug\u00edas sencillas y se pueden tener importantes\u00a0complicaciones mec\u00e1nicas y neurol\u00f3gicas.<\/p>\n<p>&nbsp;<\/p>\n<h3>Tipos de osteotom\u00edas<\/h3>\n<p>Podr\u00edamos enumerar 6 tipos de osteotom\u00edas seg\u00fan la resecci\u00f3n.<\/p>\n<ul>\n<li><b>Tipo 1<\/b>\u00a0con resecci\u00f3n parcial de las facetas.<\/li>\n<li><b>Tipo 2<\/b>\u00a0con resecci\u00f3n completa de las facetas.<\/li>\n<li><b>Tipo 3<\/b>\u00a0con resecci\u00f3n del ped\u00edculo y parcial del cuerpo.<\/li>\n<li><b>Tipo 4<\/b>\u00a0con resecci\u00f3n del ped\u00edculo y parcial del cuerpo y del disco.<\/li>\n<li><b>Tipo 5 \u00f3 6<\/b>\u00a0con resecci\u00f3n completa de v\u00e9rtebra y discos.<\/li>\n<\/ul>\n<h3 id=\"yui_3_17_2_1_1610536411726_21\">Elecci\u00f3n de osteotom\u00edas<\/h3>\n<p>En el momento de la elecci\u00f3n de las osteotom\u00edas debemos tener presente que cada deformidad es \u00fanica, deberemos realizar m\u00faltiples osteotom\u00edas peque\u00f1as para curvas largas y amplias y para deformidades focales o angulares deberemos realizar osteotom\u00edas grandes (tipo 4, 5 o 6).<\/p>\n<p>La osteotom\u00eda para deformidades largas no angulares ser\u00e1 de Ponte o tipo 2 y para deformidades angulares deben realizarse osteotom\u00edas grandes ya que m\u00faltiples osteotom\u00edas son ineficientes.<\/p>\n<\/div>\n<section class=\"vc_cta3-container\">\n<div class=\"vc_general vc_cta3 vc_cta3-style-classic vc_cta3-shape-rounded vc_cta3-align-center vc_cta3-color-classic vc_cta3-icon-size-md\">\n<div class=\"vc_cta3_content-container\">\n<div class=\"vc_cta3-content\">\n<header class=\"vc_cta3-content-header\">\n<h2>Osteotom\u00edas de columna vertebral<\/h2>\n<h4>en adultos y adolescentes<\/h4>\n<\/header>\n<p align=\"center\"><i>\u2018\u2018Las deformidades vertebrales plantean numerosos desaf\u00edos al cirujano de columna. Se requiere una revisi\u00f3n detallada de las principales osteotom\u00edas vertebrales para comprender mejor las ventajas y desventajas de cada t\u00e9cnica, y para determinar qu\u00e9 osteotom\u00eda es la mejor para una deformidad particular, con el fin de mejorar el conocimiento sobre la importancia de restablecer la alineaci\u00f3n normal de la columna..<\/i><i>.<\/i><i>\u2019\u2019<\/i><\/p>\n<p align=\"center\"><span style=\"font-size: 28px; font-weight: 600;\">Resecci\u00f3n vertebral compleja o completa<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<div id=\"norebro-custom-6454559193794\" class=\"norebro-text-sc \">\n<p><b>Paso a paso de Resecci\u00f3n vertebral posterior (Osteotom\u00eda VCR).<\/b><\/p>\n<ol>\n<li>Inserci\u00f3n\u00a0tornillos pediculares\u00a0segmentariamente,\u00a0excepto niveles resecados.<\/li>\n<li>Resecci\u00f3n de arcos neurales posteriores + cuerpo vertebral + discos\u00a0de un lado tras fijaci\u00f3n con barra temporal en lado contralateral. (Para evitar la movilidad de la columna).<\/li>\n<li>Barra temporal\u00a0en lado contralateral + resecci\u00f3n lado contrario.<\/li>\n<li>Correcci\u00f3n gradual\u00a0de deformidad mediante compresi\u00f3n + flexi\u00f3n in situ + cambio alterno de barras temporales.<\/li>\n<li>En algunos casos colocar caja mallada en regi\u00f3n anterior para\u00a0evitar exceso de acortamiento\u00a0de columna vertebral.<\/li>\n<li>Aloinjerto\u00a0para cubrir la zona de la osteotom\u00eda.<\/li>\n<\/ol>\n<h3 id=\"yui_3_17_2_1_1610536590545_21\">Osteotom\u00edas peque\u00f1as<\/h3>\n<p>La Osteotom\u00eda de Ponte estar\u00e1 indicada en casos con curvas tor\u00e1cicas largas suaves y con desequilibrio leve, en casos de Scheuermann y de Cifosis postraum\u00e1ticas.<\/p>\n<div class=\"h5p-column-content h5p-advanced-text\">\n<h3>Osteotom\u00edas grandes (tipos 3 \u00f3 4)<\/h3>\n<p>Las indicaciones en estos casos ser\u00e1n con deformidad severa en general lumbar, desequilibrio sagital grave y no movilidad en los discos.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/section>\n<\/div>\n<\/article>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<h4>Se presenta en adolescentes varones con espalda redonda \u00a0localizada en la columna tor\u00e1cica.\u00a0La cifosis severa es m\u00e1s evidente cuando se inclina hacia delante.<\/h4>\n<div>\n<h2><span style=\"color: #ff0000;\">Fracturas Columna Vertebral<\/span><\/h2>\n<p><span style=\"line-height: 1.5;\">La espondilolisis fractura, o el estr\u00e9s, pueden causar dolor de espalda en los adolescentes.Las fracturas por estr\u00e9s pueden ocurrir durante las etapas de crecimiento en la adolescencia o en los deportes que en repetidas ocasiones se retuercen y hiper-extensi\u00f3n de la columna vertebral, como la gimnasia, buceo y f\u00fatbol.<\/span><\/p>\n<p>El dolor suele ser leve y puede irradiar a los gl\u00fateos y las piernas.\u00a0El dolor se siente peor con la actividad y mejora con el descanso.\u00a0Un ni\u00f1o con espondilolisis puede caminar con un paso patas tiesas y s\u00f3lo ser capaz de efectuar pasos cortos.<\/p>\n<p>Para obtener m\u00e1s informaci\u00f3n acerca de las fracturas por estr\u00e9s espinal:\u00a0<a href=\"http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00053\" target=\"_blank\" rel=\"noopener noreferrer\">La <\/a>espondilolisis<a href=\"http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00053\" target=\"_blank\" rel=\"noopener noreferrer\"> y <\/a>espondilolistesis<\/p>\n<\/div>\n<div>\n<h4><span style=\"color: #ff0000;\">V\u00e9rtebra desplazada<\/span><\/h4>\n<p class=\"p1\"><strong><span style=\"color: #ff0000;\">Espondilolistesis\u00a0y Espondilolisis<\/span><\/strong><\/p>\n<p>Se conoce como espondilolistesis al deslizamiento de una v\u00e9rtebra sobre otra, en\u00a0cualquier direcci\u00f3n. La palabra espondilolistesis deriva del griego esp\u00f3ndilos\u00a0(v\u00e9rtebra) y olisthesis (deslizar). La primera descripci\u00f3n de dicha entidad de la que\u00a0se tiene conocimiento fue en 1782 cuando el ginec\u00f3logo belga Herbiniaux la\u00a0describe en una de sus pacientes con dificultades en el momento del parto; Killian,\u00a0tambi\u00e9n belga y de profesi\u00f3n obstetra, se refiere a dicha patolog\u00eda como entidad\u00a0en 1854. Robert en 1855 realiz\u00f3 una gran contribuci\u00f3n cuando describi\u00f3 que la\u00a0lesi\u00f3n principal de dicha patolog\u00eda es en el arco posterior; este autor realiz\u00f3,\u00a0adem\u00e1s, otros trabajos que se pueden catalogar como precursores de los estudios\u00a0biomec\u00e1nicos de hoy.<\/p>\n<p>La primera referencia del t\u00e9rmino espondilolisis se debe a Neugebauer, en 1882,\u00a0quien adem\u00e1s, estableci\u00f3 una clasificaci\u00f3n para este tipo de entidad que ha tenido\u00a0pocas modificaciones en el tiempo. Las clasificaciones mas usadas actualmente son\u00a0las de Meyerding, Wiltse, Newman y MacNab.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\">Intervenci\u00f3n quir\u00fargica<\/span><\/p>\n<p>Criterios de inclusi\u00f3n<\/p>\n<p>\u2022 Pacientes portadores de espondilolistesis sintom\u00e1tica que no responden al\u00a0tratamiento conservador por un periodo de 6 meses o m\u00e1s<\/p>\n<p>\u2022 Pacientes que tengan controladas las enfermedades de riesgo<\/p>\n<p>\u2022 Consentimiento informado de los riesgos de de tratamiento quir\u00fargico.<\/p>\n<p>\u2022 Equilibrio psicol\u00f3gico demostrado en consultas peri\u00f3dicas o en determinados\u00a0casos por \u00ednter consultas con el especialista de Psicolog\u00eda.<\/p>\n<p>Criterios de exclusi\u00f3n<\/p>\n<p>\u2022 Enfermedades de riesgo descompensadas<\/p>\n<p>\u2022 Trastornos psiqui\u00e1tricos severos<\/p>\n<p>\u2022 Exceso de peso corporal que ponga en riesgo la instrumentaci\u00f3n<\/p>\n<p>Diagn\u00f3stico<\/p>\n<p>Diagn\u00f3stico cl\u00ednico<\/p>\n<p>\u2022 El s\u00edntoma fundamental es el dolor en la regi\u00f3n lumbar, de intensidad \u00a0\u00a0variable, que se puede acompa\u00f1ar de ci\u00e1tica, sobre todo de ra\u00edz L5,\u00a0claudicaci\u00f3n neur\u00f3gena, y deformidad cl\u00ednica caracter\u00edstica, determinada por\u00a0la contractura de la musculatura de las rodillas, que provoca una marcha\u00a0muy espec\u00edfica en estos pacientes.<\/p>\n<p>Existen variaciones en el cuadro cl\u00ednico del ni\u00f1o y el adulto porque, aunque\u00a0en ambos el s\u00edntoma fundamental es el dolor, en el ni\u00f1o predomina la contractura\u00a0y la deformidad y en el adulto el dolor y la claudicaci\u00f3n neur\u00f3gena<\/p>\n<p>Diagn\u00f3stico imagenol\u00f3gico<\/p>\n<p>\u2022 Rx de columna lumbar, AP y lateral (bipedestaci\u00f3n), para determinar el\u00a0grado de deslizamiento de la v\u00e9rtebra problema.<\/p>\n<p>\u2022 Radiograf\u00edas din\u00e1micas en flexi\u00f3n m\u00e1xima y extensi\u00f3n m\u00e1xima\u00a0(bipedestaci\u00f3n) para demostrar el grado de inestabilidad del segmento\u00a0afectado.<\/p>\n<p>\u2022 TC, RMN o mielograf\u00eda: para estudiar el canal y las ra\u00edces nerviosas, y\u00a0descartar las compresiones.<\/p>\n<p>Tipos de espondilolistesis<\/p>\n<p>Clasificaci\u00f3n radiogr\u00e1fica (usamos la clasificaci\u00f3n de Wiltse y McNab)<\/p>\n<p>\u2022 Displ\u00e1stica<\/p>\n<p>\u2022 \u00cdstmica (elongativa, traum\u00e1tica y fractura aguda)<\/p>\n<p>\u2022 Degenerativa<\/p>\n<p>\u2022 Traum\u00e1tica<\/p>\n<p>\u2022 Patol\u00f3gica<\/p>\n<p>\u2022 Iatrog\u00e9nica<\/p>\n<p>Mediciones m\u00e1s usadas<\/p>\n<p>(Disponer de l\u00e1piz cristalogr\u00e1fico, goni\u00f3metro y cirujano entrenado en cirug\u00eda espinal)<\/p>\n<p>\u2022 Grado de desplazamiento (Meyerding): se logra mediante la divisi\u00f3n\u00a0del borde superior de S1 en cuatro partes iguales:<\/p>\n<p>Grado % de desplazamiento<\/p>\n<p>1 25 %<\/p>\n<p>2 50 %<\/p>\n<p>3 75 %<\/p>\n<p>4 100 %<\/p>\n<p>5 Si espondiloptosis o luxaci\u00f3n total\u00a0de la v\u00e9rtebra<\/p>\n<p>\u2022 \u00c1ngulo de deslizamiento<\/p>\n<p>\u2022 Tangente al borde superior de S1 y<\/p>\n<p>\u2022 Tangente al borde inferior de L5*<\/p>\n<p>\u00c1ngulo sacro horizontal \u2022 Tangente al borde posterior de S1 y<\/p>\n<p>\u2022 Una l\u00ednea paralela a la horizontal<\/p>\n<p>\u00c1ngulo de inclinaci\u00f3n sacra<\/p>\n<p>\u2022 Tangente al borde posterior de S1 y<\/p>\n<p>\u2022 La vertical<\/p>\n<p>\u00c1ngulo de Ferguson<\/p>\n<p>(\u00e1ngulo lumbo sacro)<\/p>\n<p>\u2022 Tangente al borde posterior de S1 y<\/p>\n<p>\u2022 Tangente al borde superior de L5<\/p>\n<p>(*) Si borde superior de S1 tiene forma de domo, tomar como referencia la perpendicular<\/p>\n<p>a la tangente al borde posterior de S1)<\/p>\n<p>Conducta a seguir<\/p>\n<p>En el ni\u00f1o<\/p>\n<p>\u2022 Tratamiento conservador<\/p>\n<p>En el adulto<\/p>\n<p>La pr\u00f3xima generaci\u00f3n de la fusi\u00f3n lumbosacra ha llegado! AxiaLIF Plus<br \/>\n\/AxiaLIF\u00ae e iO-Flex\u00ae<\/p>\n\n<!-- GDE Error: No se ha podido cargar el perfil solicitado. -->\n\n<p class=\"p2\">La espondilolistesis se define como el desplazamiento de una v\u00e9rtebra con respecto a la adyacente. Aunque en ocasiones se aprecia desplazamiento\u00a0vertebral posterior (retrolistesis), la espondilolistesis suele considerarse\u00a0equivalente a desplazamiento hacia anterior (anterolistesis).<\/p>\n<p class=\"p2\">Se\u00a0reconocen varios <strong>tipos de espondilolistesis<\/strong> :<\/p>\n<p class=\"p3\">Displ\u00e1sica (d\u00e9ficit cong\u00e9nito facetario).<\/p>\n<p class=\"p3\">\u00cdstmica (por espondilolisis).<\/p>\n<p class=\"p3\">Degenerativa (inestabilidad).<\/p>\n<p class=\"p3\">Traum\u00e1tica (fracturas sin espondilolistesis).<\/p>\n<p class=\"p3\">Patol\u00f3gica (Paget, osteoporosis).<\/p>\n<div>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLH1a.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLH1a.jpg\"  decoding=\"async\" class=\"alignnone wp-image-1908\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLH1a.jpg\" alt=\"Inf-JCLH1a\" width=\"227\" height=\"345\" \/><noscript><img decoding=\"async\" class=\"alignnone wp-image-1908\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLH1a.jpg\" alt=\"Inf-JCLH1a\" width=\"227\" height=\"345\" \/></noscript><\/a> <a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLHa.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLHa.jpg\"  decoding=\"async\" class=\"alignnone wp-image-1909\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLHa.jpg\" alt=\"Inf-JCLHa\" width=\"243\" height=\"346\" \/><noscript><img decoding=\"async\" class=\"alignnone wp-image-1909\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JCLHa.jpg\" alt=\"Inf-JCLHa\" width=\"243\" height=\"346\" \/></noscript><\/a><\/p>\n<p>&nbsp;<\/p>\n<div>En este dibujo de espondilolistesis, una v\u00e9rtebra lumbar se ha desplazado hacia delante.<\/div>\n<\/div>\n<p>Una v\u00e9rtebra desplazada, o espondilolistesis ocurre cuando una v\u00e9rtebra se desliza hacia adelante sobre la v\u00e9rtebra siguiente directamente debajo.\u00a0Por lo general, se produce en la base de la columna vertebral (articulaci\u00f3n lumbosacra).<\/p>\n<p><iframe src=\"https:\/\/www.youtube.com\/embed\/nRg3TGQ9wmo\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<h6><span style=\"color: #000000;\"><em><strong>En casos severos, el hueso se estrecha el canal espinal, que presiona sobre los nervios.<\/strong><\/em><\/span><\/h6>\n<h6 class=\"topicTitle\"><span style=\"color: #000000;\"><em><strong><span class=\"goog-text-highlight\">La causa m\u00e1s com\u00fan de dolor de espalda baja en atletas adolescentes que se puede ver en los rayos X es una fractura por estr\u00e9s en uno de los huesos (v\u00e9rtebras) que forman la columna vertebral. <\/span>T\u00e9cnicamente, esta condici\u00f3n se llama espondilolisis. Por lo general, afecta a la quinta v\u00e9rtebra lumbar en la espalda baja y, con mucha menor frecuencia, la cuarta v\u00e9rtebra lumbar.<\/strong><\/em><\/span><\/h6>\n<h6><span style=\"color: #000000;\"><em><strong>Si la fractura por estr\u00e9s debilita el hueso tanto que es incapaz de mantener su posici\u00f3n correcta, la v\u00e9rtebra puede empezar a desplazar fuera de lugar. Esta condici\u00f3n se llama espondilolistesis. Si se presenta demasiado deslizamiento, los huesos pueden comenzar a ejercer presi\u00f3n sobre los nervios y la cirug\u00eda puede ser necesaria para corregirla.<\/strong><\/em><\/span><\/h6>\n<p><span style=\"color: #000000;\">Causas<\/span><\/p>\n<div>\n<h4>Gen\u00e9tica<\/h4>\n<p>Puede haber un aspecto hereditario de espondilolisis. Una persona puede nacer con hueso delgado vertebral y por lo tanto pueden ser vulnerables a esta condici\u00f3n. Per\u00edodos significativos de r\u00e1pido crecimiento pueden estimular el deslizamiento.<\/p>\n<\/div>\n<div>\n<h4>El uso excesivo<\/h4>\n<p>Algunos deportes, como la gimnasia, levantamiento de pesas y el f\u00fatbol americano ponen mucha tensi\u00f3n sobre los huesos en la espalda baja. Tambi\u00e9n requieren que el atleta constantemente estirar demasiado (extienda) demasiado la columna vertebral. En cualquier caso, el resultado es una fractura por estr\u00e9s en uno o ambos lados de la v\u00e9rtebra.<\/p>\n<ul>\n<li>En muchas personas, la espondilolisis y espondilolistesis est\u00e1n presentes, pero sin ning\u00fan s\u00edntoma aparente.<\/li>\n<li>El dolor generalmente se propaga a trav\u00e9s de la espalda baja y se puede sentir como una distensi\u00f3n muscular.<\/li>\n<li>La espondilolistesis puede causar espasmos que endurecen la espalda y contraen los m\u00fasculos isquiotibiales, dando lugar a cambios en la postura y la marcha. Si el da\u00f1o es significativo, puede comenzar a comprimir los nervios y estrechar el canal espinal.<\/li>\n<\/ul>\n<\/div>\n<div class=\"pageTop\"><strong>Diagn\u00f3stico<\/strong><\/div>\n<h6>Las radiograf\u00edas de la (lumbar) columna lumbar mostrar\u00e1n la posici\u00f3n de la v\u00e9rtebra.<\/h6>\n<h6>La porci\u00f3n interarticular es una porci\u00f3n de la columna lumbar. Se une las articulaciones superior e inferior. La pars es normal en la gran mayor\u00eda de los ni\u00f1os.<\/h6>\n<div>Si la pars &#8220;grietas&#8221; o fracturas, se llama espondilolisis. La radiograf\u00eda confirma la anomal\u00eda \u00f3sea.<\/div>\n<div class=\"figure\"><\/div>\n<div>Esta radiograf\u00eda lateral de la columna lumbosacra demuestra el desplazamiento hacia delante en la quinta v\u00e9rtebra lumbar en el sacro (Espondilolistesis L5-S1).<\/div>\n<h6>Si el espacio de la fractura en la pars se ensancha y la v\u00e9rtebra se desliza hacia adelante, entonces se llama espondilolistesis. Por lo general, la quinta v\u00e9rtebra lumbar se desplaza hacia delante sobre la parte del hueso de la pelvis llamada el sacro. Las medidas m\u00e9dicas de rayos X de la columna lateral de pie, determina la cantidad de deslizamiento hacia delante.<\/h6>\n<h6>Si la v\u00e9rtebra est\u00e1 presionando los nervios, una tomograf\u00eda computarizada o una resonancia magn\u00e9tica puede ser necesaria antes de iniciar el tratamiento para evaluar a\u00fan m\u00e1s la anormalidad.<\/h6>\n<div class=\"pageTop\"><span style=\"color: #339966;\"><strong>Tratamiento<\/strong><\/span><\/div>\n<div>\n<h4>Tratamiento no quir\u00fargico<\/h4>\n<p>El tratamiento inicial para la espondilolisis es siempre quir\u00fargico. La persona debe tomar un descanso de las actividades hasta que los s\u00edntomas desaparezcan, como sucede con frecuencia.Los medicamentos antiinflamatorios, como el ibuprofeno, pueden ayudar a reducir el dolor de espalda.<\/p>\n<p>De vez en cuando, se puede recomendar un soporte en la espalda y la terapia f\u00edsica. En la mayor\u00eda de los casos, las actividades se pueden reanudar poco a poco y habr\u00e1 pocas complicaciones o recurrencias. El estiramiento y ejercicios de fortalecimiento para la espalda y los m\u00fasculos abdominales pueden ayudar a prevenir futuras recurrencias de dolor.<\/p>\n<p>Las radiograf\u00edas peri\u00f3dicas mostrar\u00e1n si la v\u00e9rtebra est\u00e1 cambiando de posici\u00f3n.<\/p>\n<\/div>\n<div>\n<h4>Tratamiento quir\u00fargico<\/h4>\n<p>La cirug\u00eda puede ser necesaria si el deslizamiento empeora progresivamente o si el dolor de espalda no responde al tratamiento no quir\u00fargico y comienza a interferir con las actividades de la vida diaria. Una fusi\u00f3n espinal se realiza entre la v\u00e9rtebra lumbar y el sacro. A veces, una abrazadera interna de tornillos y barras as se utiliza para mantener unida la v\u00e9rtebra a medida que cicatriza de fusi\u00f3n.<\/p>\n<\/div>\n<\/div>\n<div>\n<h4><span style=\"color: #ff0000;\">Infecci\u00f3n<\/span><\/h4>\n<p>En los ni\u00f1os peque\u00f1os, la infecci\u00f3n en un espacio de disco (discitis) puede conducir al dolor de espalda. Afecta t\u00edpicamente a ni\u00f1os entre las edades de 1 y 5 a\u00f1os, a pesar de que los ni\u00f1os mayores y adolescentes tambi\u00e9n pueden verse afectados.<\/p>\n<p>Un ni\u00f1o con discitis pueden tener los siguientes s\u00edntomas.<\/p>\n<ul>\n<li>Dolor en la espalda baja o abdomen y la rigidez de la columna vertebral<\/li>\n<li>El caminar con una cojera, o simplemente se niega a caminar<\/li>\n<li>En cuclillas con la espalda recta cuando trate de alcanzar algo en el suelo, en lugar de doblar la cintura<\/li>\n<\/ul>\n<\/div>\n<div>\n<h4><span style=\"color: #ff0000;\">Tumor<\/span><\/h4>\n<p class=\"p1\"><span style=\"color: #000000;\">Hemangioma vertebral<\/span><\/p>\n<p class=\"p1\">El hemangioma vertebral es una displasia vascular generalmente\u00a0benigna, cuya incidencia en la poblaci\u00f3n general\u00a0es elevada.<\/p>\n<p class=\"p1\">Suelen cursar de forma asintom\u00e1tica, y en la\u00a0actualidad se diagnostican con mayor frecuencia, generalmente\u00a0de forma accidental, al realizar pruebas de imagen (Resonancia Magn\u00e9tica).<\/p>\n<p class=\"p1\">En aquellos casos que produzcan dolor o s\u00edntomas neurol\u00f3gicos\u00a0se emplea la cirug\u00eda, radioterapia, embolizaci\u00f3n\u00a0o una combinaci\u00f3n de ellos.<\/p>\n<p class=\"p1\">Cuando el \u00fanico s\u00edntoma es el dolor el tratamiento inicial suelen ser los analg\u00e9sicos, y la radioterapia. En el caso de que haya s\u00edntomas neurol\u00f3gicos la cirug\u00eda es la t\u00e9cnica m\u00e1s utilizada, bien sola o precedida de embolizaci\u00f3n preoperatoria, t\u00e9cnica que mediante la cateterizaci\u00f3n de arterias intercostales o lumbares permite embolizar con part\u00edculas la vascularizaci\u00f3n patol\u00f3gica del cuerpo vertebral consiguiendo\u00a0as\u00ed una reducci\u00f3n del tama\u00f1o del tumor y un menor\u00a0sangrado quir\u00fargico.<\/p>\n<p class=\"p1\">Si hay deterioro neurol\u00f3gico r\u00e1pido hay que realizar una descompresi\u00f3n quir\u00fargica. Si se afectan \u00fanicamente los elementos vertebrales posteriores suele ser suficiente una laminectom\u00eda, pero si se afecta s\u00f3lo el cuerpo de la v\u00e9rtebra\u00a0hay que realizar una escisi\u00f3n vertebral total.<\/p>\n<p class=\"p1\">En raras ocasiones, el osteoma osteoide, pueden ser responsables del dolor de espalda.\u00a0Cuando se producen, tumores de la columna se encuentran m\u00e1s frecuentemente en la espalda media o inferior.\u00a0El dolor es constante y por lo general empeora con el tiempo.\u00a0Este dolor es progresivo, sino que est\u00e1 relacionado con la actividad y \/ o sucede en la noche.<\/p>\n<p><span class=\"goog-text-highlight\">Estos tumores se han curado al contraerse por s\u00ed solos, sin intervenci\u00f3n quir\u00fargica lo largo de varios a\u00f1os. <\/span>Pero el paciente o la familia pueden no estar dispuestos a esperar por el dolor asociado.<\/p>\n<div>\n<h4>Opciones de tratamiento quir\u00fargico:<\/h4>\n<p>El tratamiento est\u00e1ndar para el osteoma osteoide es extirpar quir\u00fargicamente todo el tumor, particularmente el n\u00facleo central, para un buen resultado. De lo contrario, el tumor puede reaparecer. Este tipo de cirug\u00eda es muy exitosa. Sin embargo, la cirug\u00eda conlleva riesgos: la anestesia general, infecci\u00f3n, sangrado y posible da\u00f1o a los tejidos circundantes. Una opci\u00f3n de tratamiento m\u00e1s reciente es quitar el n\u00facleo central con t\u00e9cnicas m\u00ednimamente invasivas.<\/p>\n<p>Eliminaci\u00f3n de radiofrecuencia guiada por tomograf\u00eda computarizada del nido ha sido utilizada con \u00e9xito con pocas recurrencias y poca complicaci\u00f3n. Esta es una cirug\u00eda menor que se puede realizar bajo anestesia general o un bloque regional con sedaci\u00f3n. El procedimiento se realiza de forma rutinaria en forma ambulatoria, ya sea por un radi\u00f3logo intervencionista o un cirujano ortop\u00e9dico.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<h2><span style=\"color: #ff0000;\"><span style=\"color: #ff0000;\"><a href=\"http:\/\/www.apex-spine.com\/neck-pain-2.html\">Dolor en el cuello<\/a><\/span><\/span><\/h2>\n<div>\n<div id=\"toclikebox\">\n<div id=\"specialtoc\">\n<h4>INFORMACI\u00d3N R\u00c1PIDA<\/h4>\n<ol>\n<li>S\u00edntomas frecuentes<\/li>\n<li>\u00bfC\u00f3mo se trata?<\/li>\n<li>Reemplazo de disco artificial<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<table style=\"height: 24px;\" border=\"0\" width=\"790\">\n<tbody>\n<tr>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table border=\"0\">\n<tbody>\n<tr>\n<td>\n<h6><span class=\"goog-text-highlight\">No s\u00f3lo por el aumento de las condiciones est\u00e1ticas lugar de trabajo, tales como sentarse y trabajar en la computadora, sino tambi\u00e9n lesiones por latigazo cervical de la columna cervical es un aumento significativo de las quejas relacionadas con el desgaste en la regi\u00f3n del cuello registrado.<\/span>El dolor de cuello puede ser aliviado muy bien con la terapia manual y la terapia f\u00edsica en las primeras etapas y el fortalecimiento de la terapia a menudo dirigida. Incluso puede prevenir la progresi\u00f3n de los procesos de desgaste.<\/h6>\n<h6>Las quejas m\u00e1s comunes del dolor de cuello<\/h6>\n<ul>\n<li>El dolor de cuello, que se extienden en la regi\u00f3n de la cabeza y \/ o el hombro<\/li>\n<li>Dolor, adormecimiento o sensaci\u00f3n de debilidad, tire del cuello en los brazos, dorso de las manos y \/ o dedos<\/li>\n<li>El dolor de hombro con adormecimiento en la regi\u00f3n deltoidea y \/ o una debilidad o par\u00e1lisis de la elevaci\u00f3n lateral del brazo.<\/li>\n<\/ul>\n<p>El cuadro cl\u00ednico individual depende principalmente despu\u00e9s de que la secci\u00f3n se ve afectada la columna cervical o si y en qu\u00e9 medida los nervios vecinos queden atrapados por una hernia de disco.<\/p>\n<h6>S\u00edntomas frecuentes<\/h6>\n<ul>\n<li>\u00a0\u00a0El dolor de cuello que se puede sentir en la cabeza (dolor de cabeza) o el hombro y \/ o<\/li>\n<li>\u00a0\u00a0Dolor &#8211; entumecimiento o debilidad que se extiende desde el cuello hasta los brazos, dorso de las manos y \/ o los dedos<\/li>\n<li>\u00a0\u00a0Dolor en el hombro con el entumecimiento en la regi\u00f3n del m\u00fasculo deltoides y \/ o una sensaci\u00f3n de debilidad o paresia al levantar el brazo hacia un lado.<\/li>\n<\/ul>\n<p>El cuadro cl\u00ednico individual depende principalmente de lo que la secci\u00f3n de la columna cervical se ve afectada y si y en qu\u00e9 medida los nervios adyacentes se comprimen por la hernia de disco.<\/p>\n<p><span style=\"color: #000000; font-size: 13px;\">DOLOR DISCOG\u00c9NICO<\/span><\/p>\n<p>El dolor de uno o varios discos de la columna cervical puede causar un dolor axial insoportable en el cuello. El mecanismo de dolor procedente de un disco cervical a\u00fan no se conoce del todo. Se cree que un traumatismo, la degeneraci\u00f3n u otros factores adversos que influyen en la integridad del disco pueden causar el s\u00edndrome de dolor en el cuello.<\/p>\n<div>\n<p>Diagn\u00f3stico: el diagn\u00f3stico se hace mediante el examen cl\u00ednico, el diagn\u00f3stico por im\u00e1genes (principalmente RMN) y la discograf\u00eda.<br \/>\nTratamiento: el procedimiento habitual para tratar el dolor discog\u00e9nico es la inmovilizaci\u00f3n del segmento que causa dolor. La fusi\u00f3n se realiza normalmente con un abordaje anterior, retirando y sustituyendo el disco que causa dolor por un espaciador biocompatible, con o sin fijaci\u00f3n de una placa.<\/p>\n<\/div>\n<div>\n<div>\n<p><span style=\"color: #000000;\">S\u00edndrome facetario<\/span><\/p>\n<\/div>\n<\/div>\n<div>\n<p>Este s\u00edndrome se caracteriza por un dolor principalmente axial causado por la artrosis de las articulaciones intervertebrales (facetas articulares) La existencia de un &#8220;s\u00edndrome facetario&#8221; como entidad patol\u00f3gica es un tema de debate. Diagn\u00f3stico: esta afectaci\u00f3n puede diagnosticarse mediante la exploraci\u00f3n cl\u00ednica, el diagn\u00f3stico por im\u00e1genes (cambios degenerativos de las facetas articulares) y la infiltraci\u00f3n local en las facetas articulares.<\/p>\n<p><span style=\"color: #000000;\">Diagn\u00f3stico invasivo\u00a0<\/span><\/p>\n<\/div>\n<div><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Infiltraciones-de-prueba.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:146\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Infiltraciones-de-prueba.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2009\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:146\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Infiltraciones-de-prueba.jpg\" alt=\"Infiltraciones de prueba\" width=\"372\" height=\"181\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2009\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:146\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Infiltraciones-de-prueba.jpg\" alt=\"Infiltraciones de prueba\" width=\"372\" height=\"181\" \/></noscript><\/a><\/div>\n<p>COMPRESI\u00d3N NERVIOSA EN LA COLUMNA CERVICAL<\/p>\n<p>Los discos cervicales pueden herniarse o protruir igual que los discos lumbares. Adem\u00e1s, con el tiempo pueden formarse osteofitos (aposiciones \u00f3seas) a causa de los cambios degenerativos en determinadas zonas de la columna cervical. Ambas situaciones pueden aumentar la presi\u00f3n en el nervio raqu\u00eddeo o la m\u00e9dula espinal. En funci\u00f3n del lugar de compresi\u00f3n, los s\u00edntomas y signos cl\u00ednicos ser\u00e1n radiculares (nervio raqu\u00eddeo) o mielop\u00e1ticos (m\u00e9dula espinal). La compresi\u00f3n causada \u00fanicamente por material discal extruido (normalmente aguda) se llama hernia blanda, mientras que la compresi\u00f3n por osteofitos (o combinada con material discal) normalmente es cr\u00f3nica y se denomina hernia discal dura.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>HERNIAS DISCALES EN LA COLUMNA CERVICAL<a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Hernia-discal.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:143\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Hernia-discal.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2010\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:143\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Hernia-discal.jpg\" alt=\"Hernia discal\" width=\"485\" height=\"231\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2010\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:143\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Hernia-discal.jpg\" alt=\"Hernia discal\" width=\"485\" height=\"231\" \/></noscript><\/a><\/p>\n<p>&nbsp;<\/p>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div>Resonancia magn\u00e9tica de una hernia discal media en la columna cervical<\/div>\n<p><iframe src=\"https:\/\/www.youtube.com\/embed\/nJfxPOkeUIU\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000;\">S\u00cdNTOMAS RADICULARES<\/span><\/p>\n<p>S\u00edntomas radiculares causados por el material discal u osteofitos<\/p>\n<div>\n<p>En funci\u00f3n de la ra\u00edz nerviosa implicada aparece dolor, alteraciones sensoriales o debilidad muscular en el segmento correspondiente.<\/p>\n<\/div>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Raices-nerviosas1.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:195\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Raices-nerviosas1.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2011\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:195\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Raices-nerviosas1.jpg\" alt=\"Raices nerviosas1\" width=\"480\" height=\"312\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2011\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:195\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Raices-nerviosas1.jpg\" alt=\"Raices nerviosas1\" width=\"480\" height=\"312\" \/></noscript><\/a>Diagn\u00f3stico: los s\u00edntomas radiculares pueden diagnosticarse con la evaluaci\u00f3n de la historia cl\u00ednica, la exploraci\u00f3n cl\u00ednica, el diagn\u00f3stico por im\u00e1genes (TC y RMN) y las encuestas neurol\u00f3gicas.Tratamiento: el objetivo del tratamiento quir\u00fargico es eliminar la presi\u00f3n sobre la ra\u00edz nerviosa extirpando el material protruido del disco o el hueso. El tratamiento conservador con antiinflamatorios y ejercicios musculares puede ser eficaz.<\/p>\n<p>La opini\u00f3n del especialista:<\/p>\n<div>\n<div><\/div>\n<div><span style=\"color: #ff0000;\">COMPRESI\u00d3N DE LA M\u00c9DULA ESPINAL CON MIELOPAT\u00cdA (ESTENOSIS DEL CANAL VERTEBRAL CERVICAL)<\/span><\/div>\n<\/div>\n<div>\n<p>El canal vertebral puede estrecharse por los tejidos adyacentes que crean una compresi\u00f3n de la m\u00e9dula espinal. Si no ocurre como consecuencia de una lesi\u00f3n traum\u00e1tica, este proceso es cr\u00f3nico y los s\u00edntomas se van desarrollando lentamente. A veces el paciente no se da cuenta de los primeros s\u00edntomas y solamente el dolor en el cuello o el diagn\u00f3stico por im\u00e1genes con otro fin revelan la estenosis y la compresi\u00f3n. Ello hace que la elecci\u00f3n del tratamiento sea dif\u00edcil. El tratamiento quir\u00fargico que incluye el ensanchamiento del canal vertebral adquiere un car\u00e1cter profil\u00e1ctico en estas situaciones. En fases avanzadas, la m\u00e9dula espinal est\u00e1 seriamente da\u00f1ada y los s\u00edntomas de mielopat\u00eda son obvios para el paciente y el m\u00e9dico.<\/p>\n<p><span style=\"color: #000000;\">Estenosis del canal vertebral cervical <\/span>(secci\u00f3n transversal)<\/p>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Corpectomía.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:153\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Corpectomía.jpg\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2012\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:153\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Corpectomía.jpg\" alt=\"Corpectom\u00eda\" width=\"300\" height=\"153\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2012\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:153\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Corpectomía.jpg\" alt=\"Corpectom\u00eda\" width=\"300\" height=\"153\" \/></noscript><\/a><\/p>\n<\/div>\n\n<!-- GDE Error: No se ha podido cargar el perfil solicitado. -->\n\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000;\">Columna cervical: descompresi\u00f3n del canal vertebral<\/span><\/p>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Estenosis-canal.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:223\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Estenosis-canal.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2013\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:223\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Estenosis-canal.jpg\" alt=\"Estenosis canal\" width=\"451\" height=\"335\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2013\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:223\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Estenosis-canal.jpg\" alt=\"Estenosis canal\" width=\"451\" height=\"335\" \/></noscript><\/a><\/p>\n<div>Diagn\u00f3stico: El canal vertebral estrecho o<strong> estenosis espinal <\/strong>se diagnostica y confirma con el diagn\u00f3stico por im\u00e1genes (TC y RMN), pero no es concluyente para el diagn\u00f3stico de la mielopat\u00eda, que b\u00e1sicamente es un diagn\u00f3stico cl\u00ednico o neurofisiol\u00f3gico. La elecci\u00f3n del tratamiento adecuado debe tener en cuenta dos factores: los s\u00edntomas cl\u00ednicos y hallazgos en el diagn\u00f3stico por im\u00e1genes. La decisi\u00f3n de intervenir quir\u00fargicamente tambi\u00e9n depende del n\u00famero de segmentos esten\u00f3ticos.<\/div>\n<div>Tratamiento: un factor importante para los procedimientos de descompresi\u00f3n es el tiempo.<\/div>\n<div><\/div>\n<div><strong>Diagn\u00f3stico \/ indicaci\u00f3n<\/strong><\/div>\n<p>Comprobaci\u00f3n de diagn\u00f3stico de la enfermedad es posible a trav\u00e9s de las radiograf\u00edas o resonancia magn\u00e9tica-Im\u00e1genes y discograf\u00eda adicional.<\/p>\n<p>Diagn\u00f3stico a fondo &#8211; requisito previo para el \u00e9xito del tratamiento!<\/p>\n<p>Para el \u00e9xito del tratamiento de los s\u00edntomas deben ser directamente correlacionados con los resultados de las t\u00e9cnicas de diagn\u00f3stico por imagen.\u00a0Un examen cl\u00ednico completo en combinaci\u00f3n con m\u00e9todos de imagen como la tomograf\u00eda computarizada o resonancia magn\u00e9tica tomograf\u00eda (TC y RM) son por lo tanto, esencial para un tratamiento con \u00e9xito de su enfermedad de la columna.<\/p>\n<p>Enfermedad degenerativa del disco en la columna cervical a resolver todo de, dolor de cuello severo constante y \/ o dolor de cabeza. La prueba de tal enfermedad se hace primero radiol\u00f3gicamente con las radiograf\u00edas y las im\u00e1genes de resonancia magn\u00e9tica y se complementa con una discograf\u00eda.<\/p>\n<p><strong>Diagn\u00f3stico cuidadoso &#8211; el requisito m\u00e1s importante para el \u00e9xito del tratamiento<\/strong><\/p>\n<p>Con el fin de tratar su dolor de cuello prometedor, dolor de cuello se debe describir con precisi\u00f3n debido al segmento operativo. Por tanto, un cuidadoso examen cl\u00ednico en combinaci\u00f3n con t\u00e9cnicas de imagen como la tomograf\u00eda computarizada o una resonancia magn\u00e9tica es el elemento vital de un tratamiento exitoso de la enfermedad del disco.<\/p>\n<h4>\u00bfC\u00f3mo se trata?<\/h4>\n<ul>\n<li><strong>El tratamiento conservador<\/strong><\/li>\n<\/ul>\n<p>Una hernia de disco de la columna cervical sin par\u00e1lisis es primero por lo general tratados de forma conservadora con analg\u00e9sicos y conservaci\u00f3n; medidas complementarias, como el calor o la electroterapia y fisioterapia a instrucciones fisioterapeuta puede proporcionar alivio.<\/p>\n<p><span style=\"color: #000000;\">Infiltraciones ra\u00edz nerviosa<\/span><\/p>\n<p>Si la ra\u00edz de un nervio est\u00e1 irritado o inflamado la mayor\u00eda se puede detectar mediante resonancia magn\u00e9tica. Los pacientes por lo general sufren de dolor intenso y radiante. En estos casos, una o dos inyecciones espec\u00edficas con corticosteroides puede hacer maravillas . Bajo anestesia local y de la vista de control de una fina c\u00e1nula se enviar\u00e1 directamente a la ra\u00edz nerviosa afectada . El remojo de la ra\u00edz nerviosa con corticosteroides 2cc llevar\u00e1 a aliviar el dolor inmediato . En casos raros se debe repetir el tratamiento .<\/p>\n<p>Si despu\u00e9s de 6 a 8 semanas no hay un alivio significativo de los s\u00edntomas,\u00a0debe considerarse un tratamiento quir\u00fargico.<\/p>\n<p><strong>El tratamiento quir\u00fargico &#8211; \u00bfCu\u00e1les son las opciones?<\/strong><\/p>\n<p>Un objetivo principal \u00a0es la nucleotom\u00eda percut\u00e1nea (discectom\u00eda) de la columna cervical.<\/p>\n<p>A diferencia de otros procedimientos quir\u00fargicos comunes, donde se extrae todo el disco y se sustituye por un marcador de posici\u00f3n (Jaula o reemplazo artificial), con este m\u00e9todo especial s\u00f3lo el material herniado se elimina bajo anestesia local.\u00a0Se mantiene la movilidad natural y la estabilidad de la columna cervical.<\/p>\n<p>De hecho, este procedimiento quir\u00fargico es an\u00e1loga a la discectom\u00eda lumbar de la columna vertebral donde tambi\u00e9n s\u00f3lo el tejido herniado se retira y no todo el disco reemplazado por un marcador de posici\u00f3n artificial.<\/p>\n<ul>\n<li>\u00a0Tratamiento:<\/li>\n<\/ul>\n<div>\n<div>\n<h2><span style=\"color: #000000;\">Cervical<\/span><\/h2>\n<p><span style=\"color: #000000;\"><strong>Sistemas de no fusi\u00f3n por v\u00eda anterior:<\/strong><\/span><\/p>\n<ul>\n<li>Pr\u00f3tesis de disco cervical<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div>\n<ul>\n<li>\n<div>\n<div id=\"toclikebox\">\n<div id=\"specialtoc\">\n<h4>INFORMACI\u00d3N R\u00c1PIDA<\/h4>\n<ol>\n<li>Ventajas de un vistazo<\/li>\n<li>\u00bfC\u00f3mo se realiza la cirug\u00eda?<\/li>\n<li>Los cuidados postoperatorios<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<h6>A veces un reemplazo de disco artificial puede parecer indicado para ayudar al paciente.<\/h6>\n<p>Gracias a los avances en el desarrollo moderno reemplazos de disco artificial implantes est\u00e1n equipados ideal para la configuraci\u00f3n funcional de la columna cervical y permiten el movimiento natural &#8211; preservando por este medio la movilidad del cuello.\u00a0Adem\u00e1s su elasticidad permite que funcionen como amortiguadores al igual que sus contrapartes naturales. Esto ayuda a evitar que las secciones adyacentes de la columna vertebral de las tensiones indebidas.<\/p>\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td rowspan=\"3\" valign=\"top\">\n<h4><a name=\"surgery\"><\/a>\u00bfC\u00f3mo se realiza la cirug\u00eda?<\/h4>\n<p>La inserci\u00f3n de un reemplazo de disco artificial se realiza a trav\u00e9s de una peque\u00f1a incisi\u00f3n en el cuello.\u00a0Despu\u00e9s de la retirada del disco prolapsado la sustituci\u00f3n del disco artificial se ajusta entre las v\u00e9rtebras.\u00a0Se fija con dos placas de titanio que permiten una adherencia \u00f3ptima del implante en el hueso de manera que un aflojamiento se mitiga.\u00a0Entre las dos placas de titanio hay un n\u00facleo polim\u00e9rico (polietileno) y otro pol\u00edmero (poliuretano) se utiliza para revestir la pr\u00f3tesis y para sellarlo los tejidos circundantes.<\/p>\n<p>La intervenci\u00f3n se realiza bajo anestesia general y dura aproximadamente una hora.\u00a0Ya dos horas despu\u00e9s de la cirug\u00eda se puede caminar por s\u00ed mismo, y dos d\u00edas m\u00e1s tarde se pueden volver a casa de nuevo.<\/p>\n<p>S\u00f3lo en raras ocasiones una pr\u00f3tesis no se puede utilizar.\u00a0Este es el caso de la osteoporosis, tumores, mielopat\u00eda (cambios de la m\u00e9dula espinal) o si la degeneraci\u00f3n del disco y las articulaciones facetarias es demasiado grave.\u00a0En tales casos, una fusi\u00f3n se realiza despu\u00e9s de la descompresi\u00f3n a fondo.\u00a0Para este prop\u00f3sito se utiliza una jaula hecha de PEEK (un material sint\u00e9tico que es altamente biocompatible).<\/p>\n<p>La intervenci\u00f3n se realiza bajo anestesia general y dura aproximadamente una hora.\u00a0Ya dos horas despu\u00e9s de la cirug\u00eda se puede caminar por s\u00ed mismo, y dos d\u00edas m\u00e1s tarde se pueden volver a casa de nuevo.<\/td>\n<td><img decoding=\"async\" src=\"http:\/\/www.apex-spine.com\/images\/stories\/contentPics\/fotos\/contarticles\/bandschop_hws1.jpg\" alt=\"bandschop_hws1\" width=\"136\" height=\"148\" \/><\/td>\n<\/tr>\n<tr>\n<td><img decoding=\"async\" src=\"http:\/\/www.apex-spine.com\/images\/stories\/contentPics\/fotos\/contarticles\/bandschop_hws2.jpg\" alt=\"bandschop_hws2\" width=\"136\" height=\"148\" \/><\/td>\n<\/tr>\n<tr>\n<td>Artificial disco de repuesto columna cervical (vista lateral \/ frontal)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000;\"><strong>Sistemas de fusi\u00f3n por v\u00eda anterior:<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Sistemas de fusi\u00f3n intersom\u00e1tica<\/span>\n<ul>\n<li>T\u00e9cnica de implantaci\u00f3n sencilla y segura.<\/li>\n<li>Alta estabilidad primaria.<\/li>\n<li>Dise\u00f1o \u00f3ptimo para facilitar la fusi\u00f3n \u00f3sea.<\/li>\n<li>Reducci\u00f3n del riesgo de \u201chundimiento\u201d y mayor estabilidad a la inclinaci\u00f3n.<\/li>\n<li>Buen diagn\u00f3stico post-operatorio.<\/li>\n<li>Buena estabilidad a largo plazo por una \u00f3ptima carga \u00f3sea.<\/li>\n<li>Radiolucencia con marcadores de titanio.<\/li>\n<li>Mejor fijaci\u00f3n primaria con las ranuras en los bordes del implante.<\/li>\n<li>Bioelasticidad similar a la de hueso.<\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000;\">Sistema de placa cervical\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li><strong>Principales caracter\u00edsticas: \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/strong>\n<ul>\n<li>Permite al cirujano escoger entre tres tipos de montaje: constre\u00f1ido, semi-constre\u00f1ido y no constre\u00f1ido.<\/li>\n<li>Las placas son pre-contorneadas con una curvatura de 8\u00ba.<\/li>\n<li>El dise\u00f1o silueteado de la placa, las ranuras y su perfil reducido<\/li>\n<li>Amplia gama de tornillos autoterrajantes.<\/li>\n<li>La inserci\u00f3n de los tornillos puede realizarse con un \u00e1ngulo c\u00e9falo-caudal de hasta 20\u00ba.<\/li>\n<li>Se utilizan placas de bloqueo superior que evitan el retroceso de los tornillos.<\/li>\n<li>La inserci\u00f3n de los tornillos con un \u00e1ngulo medial de 6\u00ba reduce la posibilidad de arrancamiento. Disponibles tornillos de un di\u00e1metro superior para procedimientos de revisi\u00f3n.<\/li>\n<\/ul>\n<p><strong>Indicaciones:\u00a0<\/strong><\/p>\n<ul>\n<li>Enfermedades degenerativas del disco<\/li>\n<li>Espondilolistesis<\/li>\n<li>Estenosis vertebral<\/li>\n<li>Tumores<\/li>\n<li>Pseudoartrosis<\/li>\n<li>Deformidades<\/li>\n<li>Traumatismos<\/li>\n<li>Revisiones de cirug\u00edas previas; y otorgando al cirujano la mayor versatilidad en el manejo de la placa.<\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000;\">Malla cervical<\/span><\/li>\n<li>El sistema de malla quir\u00fargica NGage proporciona una amplia cobertura de la placa terminal, una fijaci\u00f3n firme y una gran variedad de opciones de implante para usted\u00a0 y sus pacientes.<strong>\u00a0<\/strong><strong>El implante se puede personalizar para lograr un preciso ajuste anat\u00f3mico.<\/strong>Se adapta a la anatom\u00eda del paciente:-\u00a0 Cuerpo de la malla fabricado con titanio puro comercial de 1 mm de espesor.<\/li>\n<\/ul>\n<p><span style=\"color: #000000;\"><strong>Sistemas de no fusi\u00f3n por v\u00eda posterior:<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Sistema de laminoplastia<\/span><\/li>\n<li>La laminoplastia cervical es una alternativa quir\u00fargica a la laminectom\u00eda o a la corpectom\u00eda y fusi\u00f3n cervical anterior en m\u00faltiples niveles para los pacientes con estenosis cervical sintom\u00e1tica. Es, a menudo, el tratamiento de elecci\u00f3n en los pacientes con estenosis cong\u00e9nita o adquirida que afecta a varios niveles de C3 a T3.<\/li>\n<li>El <img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:359\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2020\/09\/Captura-de-pantalla-2020-09-12-a-las-1.49.22.png\"  decoding=\"async\" class=\"alignleft size-medium wp-image-3092\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:359\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2020\/09\/Captura-de-pantalla-2020-09-12-a-las-1.49.22.png\" alt=\"\" width=\"744\" height=\"359\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-3092\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:359\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2020\/09\/Captura-de-pantalla-2020-09-12-a-las-1.49.22.png\" alt=\"\" width=\"744\" height=\"359\" \/></noscript>\u00a0se desarroll\u00f3 como una alternativa a las t\u00e9cnicas de<\/li>\n<li><\/li>\n<li><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:326\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2020\/09\/Captura-de-pantalla-2020-09-12-a-las-1.48.59.png\"  decoding=\"async\" class=\"alignleft size-medium wp-image-3093\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:326\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2020\/09\/Captura-de-pantalla-2020-09-12-a-las-1.48.59.png\" alt=\"\" width=\"744\" height=\"326\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-3093\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:744\/h:326\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2020\/09\/Captura-de-pantalla-2020-09-12-a-las-1.48.59.png\" alt=\"\" width=\"744\" height=\"326\" \/></noscript>fijaci\u00f3n para mantener la expansi\u00f3n abierta de la l\u00e1mina, proporcionando un refuerzo superior, a la par que expande el conducto vertebral y conserva los elementos posteriores.<\/li>\n<li><strong>Caracter\u00edsticas especiales del producto<\/strong>\n<ul>\n<li>Incorpora una leng\u00fceta en cada una de las placas, que se apoya sobre los bordes laminares para reforzar la fijaci\u00f3n.<\/li>\n<li>El dise\u00f1o de los dientes de la placa ayuda a mantener la posici\u00f3n de la misma durante la implantaci\u00f3n.<\/li>\n<li>Incorpora 3 tama\u00f1os de placas, con diferentes ranuras para ajustar la inserci\u00f3n de los tornillos en el hueso remanente, para ajustarse a la anatom\u00eda de cualquier paciente<\/li>\n<li>Los diferentes tama\u00f1os de tornillos tanto para la l\u00e1mina como para la masa lateral, permiten su utilizaci\u00f3n en los diferentes niveles desde C3 a T3.<\/li>\n<\/ul>\n<p><strong>Indicaciones<\/strong><\/p>\n<ul>\n<li>Estenosis mayor de 3 niveles o extirpaci\u00f3n de lesiones que comprometan m\u00e1s de 3 niveles.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000;\"><strong>Sistemas de fusi\u00f3n por v\u00eda posterior:<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Sistema Occ\u00edpito-C\u00e9rvico-Tor\u00e1cico<\/span>\n<ul>\n<li>El dise\u00f1o de los tornillos multiaxiales permite hasta 66\u00ba de variabilidad de ajuste.<\/li>\n<li>Todos los implantes son de apriete\/carga superior para garantizar su bloqueo sencillo y seguro.<\/li>\n<li>Los conectores laterales de dise\u00f1o abierto proporcionan una mayor variabilidad adicional.<\/li>\n<li>Los conectores transversales multiaxiales tienen una capacidad de ajuste \u00fanica en m\u00faltiples planos proporcionan adaptabilidad en traslaci\u00f3n, rotaci\u00f3n y angulaci\u00f3n.<\/li>\n<li>Disponibilidad de barras precurvadas de diferentes longitudes, barras occipitales reforzadas y pre-curvadas<\/li>\n<li>Posibilidad de conectar con una barra de 5,5mm para alargar los montajes a la columna tor\u00e1cica.<\/li>\n<li>Gu\u00eda de broca con tope regulable que ayuda a perforar los orificios para los tornillos con la trayectoria y la profundidad deseadas.<\/li>\n<\/ul>\n<p><strong>Indicaciones:<\/strong><\/p>\n<ul>\n<li>traumatismos<\/li>\n<li>tumores<\/li>\n<li>malformaciones<\/li>\n<li>deformidades<\/li>\n<li>artritis reumatoide y condiciones asociadas<\/li>\n<li>inestabilidades secundarias a laminectom\u00eda<\/li>\n<li>condiciones degenerativas del raquis cervical.<\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000;\">Cable sublaminar<\/span><\/li>\n<\/ul>\n<ul>\n<li>El Sistema de Cable Songer ha sido desarrollado como una alternativa al alambre de monofilamento para su utilizaci\u00f3n en procedimientos de fijaci\u00f3n vertebral debidos a una lesi\u00f3n traum\u00e1tica y\/o degenerativa, as\u00ed como para el tratamiento de la escoliosis. El Sistema de Cable Songer consta de un cable (de acero inoxidable o titanio) que se tensa y se asegura mediante el uso de un Instrumento de Tensi\u00f3n\/Cierre. El Sistema ofrece multitud de ventajas sobre el alambre de monofilamento, incluyendo menor riesgo de lesi\u00f3n neurol\u00f3gica, facilidad de uso, flexibilidad, resistencia y consistencia.<\/li>\n<\/ul>\n<\/div>\n<h1><strong>La pr\u00f3tesis (implante)<\/strong><\/h1>\n<p><strong>Indicaciones<\/strong><\/p>\n<ul>\n<li>Hernia de disco de C3-C4 a C7-T1.<\/li>\n<li>Espondilosis cervical.<\/li>\n<li>Radiculopat\u00eda cervical.<\/li>\n<li>Enfermedad discal cervical degenerativa.<\/li>\n<li>Mielopat\u00eda cervical.<\/li>\n<li>Compresi\u00f3n mec\u00e1nica sobre elementos neurol\u00f3gicos probada mediante RMN.<\/li>\n<li>Compresi\u00f3n del canal medular en 1, 2 \u00f3 3 niveles, desde C3-C4 a C7-T1.<\/li>\n<li>Nivel adyacente a una artrodesis cervical (en caso de enfermedad en un segmento adyacente, utilice un implante PCM\u00ae con pesta\u00f1as).<\/li>\n<\/ul>\n<div>\n<div>\n<h1><strong>Reemplazo de disco artificial<\/strong><\/h1>\n<p>El dolor de cuello y dolores de cabeza no pueden ser controlados por la terapia conservadora, una sustituci\u00f3n del disco artificial, sobre todo es la \u00fanica alternativa a la rigidez de las v\u00e9rtebras cervicales.\u00a0La sustituci\u00f3n del disco artificial, seguro y f\u00e1cilmente manejable ofrece muchas ventajas para el paciente en comparaci\u00f3n con la cirug\u00eda de fusi\u00f3n convencional de las v\u00e9rtebras adyacentes.\u00a0Es una t\u00e9cnica relativamente nueva que ha conseguido f\u00e1cilmente una gran aceptaci\u00f3n en todo el mundo durante los \u00faltimos a\u00f1os.<\/p>\n<p>Despu\u00e9s de probar con \u00e9xito varios discos artificiales diferentes elegimos<\/p>\n<\/div>\n<\/div>\n<div>\n<h6 class=\"stand-description-title\">Pr\u00f3tesis de disco de cervicales\u00a0BAGUERA\u00aeC y\u00a0pr\u00f3tesis de disco (Mobi-C) como producto est\u00e1ndar para nuestras operaciones.<\/h6>\n<h6 class=\"stand-description-title\">Est\u00e1n disponibles en una gran variedad de tama\u00f1os y los pacientes se benefician de una movilidad sin restricciones, sin embargo, que se empareja con una alta estabilidad.<\/h6>\n<\/div>\n<div>\n<h4 class=\"stand-description-title\"><iframe title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/30685827\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/h4>\n<\/div>\n<p><iframe title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/30686196\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<div>\n<p>No puede ser aliviado, el incremento en el dolor de cuello y dolores de cabeza por medio de terapias conservadoras, un reemplazo de disco (pr\u00f3tesis de disco o implante) es por lo general la \u00fanica soluci\u00f3n si se quiere evitar la rigidez de las v\u00e9rtebras del cuello. Esta t\u00e9cnica relativamente nueva se ha consolidado r\u00e1pidamente a un verdadero ganador. Debido al f\u00e1cil manejo seguro y muchos beneficios para los pacientes que sustituyen en muchos lugares la cirug\u00eda de fusi\u00f3n tradicional.<\/p>\n<p>&nbsp;<\/p>\n<div>\n<ul>\n<li><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:140\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Técnica-fusión.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2015\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:140\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Técnica-fusión.jpg\" alt=\"T\u00e9cnica fusi\u00f3n\" width=\"362\" height=\"169\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2015\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:140\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Técnica-fusión.jpg\" alt=\"T\u00e9cnica fusi\u00f3n\" width=\"362\" height=\"169\" \/></noscript><span style=\"font-family: inherit; font-size: inherit;\">Fijaci\u00f3n de las v\u00e9rtebras C1\/C2 (atlas-axis): tornillos<\/span><\/li>\n<\/ul>\n<\/div>\n<div><span style=\"color: #000000;\">Endoscopia y\u00a0cirug\u00eda microsc\u00f3pica:<\/span><\/div>\n<div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><iframe title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/30685983\" width=\"640\" height=\"368\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>Todas las ventajas de un vistazo:<\/p>\n<p><iframe title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/30686345\" width=\"640\" height=\"426\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>La intervenci\u00f3n se puede realizar bajo anestesia local &#8211; no se requiere anestesia general!<br \/>\nComo casi no hay da\u00f1o en el tejido , la intervenci\u00f3n es mucho menos engorrosa y el riesgo de complicaciones es muy baja<br \/>\nNo inestabilidad , ya que las estructuras que estabilizan la columna vertebral &#8211; los ligamentos y articulaciones &#8211; permanecen ilesos.<\/p>\n<p>Esta es una diferencia principal con la t\u00e9cnica de la cirug\u00eda microsc\u00f3pica .<\/p>\n<p>Menos dolor de curaci\u00f3n de heridas , as\u00ed como una mayor estabilidad<br \/>\nPoco riesgo de infecci\u00f3n , ya que el acceso es a trav\u00e9s de una peque\u00f1a incisi\u00f3n cut\u00e1nea ( 5mm )<br \/>\nMenos formaci\u00f3n de cicatrices en la regi\u00f3n de las ra\u00edces de los nervios<br \/>\nYa dos horas despu\u00e9s de la intervenci\u00f3n ser\u00e1 capaz de caminar sin dolor<br \/>\nCorta estancia hospitalaria : se puede ir a casa el d\u00eda despu\u00e9s de la intervenci\u00f3n<br \/>\nYa despu\u00e9s de unos d\u00edas podr\u00e1 retomar sus actividades diarias habituales<br \/>\nTiempos de recuperaci\u00f3n m\u00e1s corto:<\/p>\n<p>Despu\u00e9s de una o dos semanas se puede volver a trabajar , despu\u00e9s de 6 semanas podr\u00e1 retomar sus actividades deportivas habituales.<br \/>\nPocas cicatrices<\/p>\n<\/div>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<p><img decoding=\"async\" style=\"font-size: 13px;\" title=\"\" src=\"http:\/\/www.eurospine.org\/img\/space.gif\" alt=\"\" width=\"1\" height=\"12\" \/><\/p>\n<div>\n<p><span style=\"color: #ff0000;\">COLUMNA LUMBAR SANA<\/span><\/p>\n<\/div>\n<ul>\n<li>La columna lumbar sana<\/li>\n<li>Cambios degenerativos de la columna lumbar<\/li>\n<li>Procedimientos de diagn\u00f3stico<\/li>\n<li>Tratamiento<\/li>\n<li>T\u00e9cnicas quir\u00fargicas<\/li>\n<\/ul>\n<div>La columna lumbar (CL) est\u00e1 formada por cinco v\u00e9rtebras lumbares (en aproximadamente el 8-12% de la poblaci\u00f3n existe una variaci\u00f3n anat\u00f3mica de cuatro o seis v\u00e9rtebras lumbares) y cinco discos intervertebrales. La forma normal de la columna lumbar tiene una ligera curvatura (lordosis). La magnitud de esta curva est\u00e1 determinada por las curvaturas adyacentes de la columna vertebral y la posici\u00f3n de la pelvis. Es b\u00e1sica para el equilibrio de toda la columna vertebral.<\/div>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-2.png\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-2.png\"  decoding=\"async\" class=\"alignleft size-full wp-image-2274\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-2.png\" alt=\"Fig-2\" width=\"410\" height=\"457\" \/><noscript><img decoding=\"async\" class=\"alignleft size-full wp-image-2274\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-2.png\" alt=\"Fig-2\" width=\"410\" height=\"457\" \/></noscript><\/a><\/p>\n<div>El movimiento es posible entre dos v\u00e9rtebras adyacentes. El disco intervertebral en la parte frontal, dos articulaciones facetarias (peque\u00f1as articulaciones que unen dos v\u00e9rtebras) posteriores y diversos ligamentos y m\u00fasculos forman una unidad funcional de la columna vertebral (UFC). La columna lumbar tiene cinco UFC que garantizan la estabilidad y permiten el movimiento en la columna lumbar.La amplitud media de movimiento de una UFC lumbar es de unos 10 grados de flexi\u00f3n, 5 grados de extensi\u00f3n, 5 grados de flexi\u00f3n lateral y unos 3 grados de rotaci\u00f3n. La suma de estas amplitudes de movimiento permite la flexibilidad de toda esta estructura anat\u00f3mica.<\/div>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-3.png\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-3.png\"  decoding=\"async\" class=\"alignleft size-full wp-image-2276\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-3.png\" alt=\"Fig-3\" width=\"534\" height=\"322\" \/><noscript><img decoding=\"async\" class=\"alignleft size-full wp-image-2276\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Fig-3.png\" alt=\"Fig-3\" width=\"534\" height=\"322\" \/></noscript><\/a><\/p>\n<div>La limitaci\u00f3n del movimiento segmentario de estos diferentes componentes est\u00e1 determinada por las caracter\u00edsticas (capacidad de compresi\u00f3n, elasticidad) del disco intervertebral, las articulaciones facetarias y los ligamentos del interior y alrededor de la UFC.Los nervios raqu\u00eddeos discurren por el canal vertebral, formado por las partes posteriores de las v\u00e9rtebras. De cada nivel salen un par de nervios raqu\u00eddeos del canal vertebral que descienden hasta las piernas.<strong><span style=\"color: #ff0000;\">CAMBIOS <\/span><\/strong><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><strong><span style=\"color: #ff0000;\">DEGENERATIVOS DE LA COLUMNA LUMBAR<\/span><\/strong><\/div>\n<div>\n<p>Aspectos generales<\/p>\n<p>El movimiento y la carga generan cambios en la adaptaci\u00f3n de los tejidos a lo largo de la vida. Estos cambios incluyen la p\u00e9rdida de elasticidad de los tejidos, la formaci\u00f3n de osteofitos y la calcificaci\u00f3n de los ligamentos. El movimiento en una UFC cambia a consecuencia de este proceso degenerativo de envejecimiento de la columna y puede disminuir o aumentar su movilidad.<\/p>\n<\/div>\n<p>Disco intervertebral<\/p>\n<div>\n<p>El disco intervertebral y las articulaciones facetarias (las estructuras m\u00e1s expuestas a las cargas) determinan el grado de degeneraci\u00f3n de la columna vertebral.<\/p>\n<p><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:145\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Degeneración-del-disco.jpg\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2007\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:145\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Degeneración-del-disco.jpg\" alt=\"Degeneraci\u00f3n del disco\" width=\"300\" height=\"145\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2007\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:145\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Degeneración-del-disco.jpg\" alt=\"Degeneraci\u00f3n del disco\" width=\"300\" height=\"145\" \/></noscript>El disco intervertebral es el \u00f3rgano m\u00e1s grande que contiene tejido fibroso del cuerpo humano. Tiene un anillo exterior (anillo fibroso hecho de fibras resistentes de col\u00e1geno que unen el disco a los cuerpos vertebrales adyacentes) y un n\u00facleo interior (n\u00facleo pulposo). \u00c9ste est\u00e1 formado por un tejido cartilaginoso blando que contiene c\u00e9lulas (condrocitos) que forman la denominada matriz (sustancia fundamental), hecha de sustancias de alto peso molecular (proteoglucanos como el sulfato de condroitin). Estas sustancias tienen una gran capacidad para retener el agua (contenido h\u00eddrico de los discos lumbares: 75\u201390%). Puesto que el disco no est\u00e1 directamente conectado al sistema vascular del cuerpo, su nutrici\u00f3n s\u00f3lo est\u00e1 asegurada por perfusi\u00f3n a trav\u00e9s de las superficies cartilaginosas y \u00f3seas de los cuerpos vertebrales adyacentes. Esto hace que el disco pueda degenerarse.<\/p>\n<\/div>\n<div>La degeneraci\u00f3n del disco est\u00e1 caracterizada por una p\u00e9rdida cuantitativa y\/o disminuci\u00f3n de la calidad de la sustancia de base. La cantidad de agua y la altura del disco disminuyen. La carga continua sobre<a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Colapso-discal.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:221\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Colapso-discal.jpg\"  decoding=\"async\" class=\"alignleft wp-image-2006\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:221\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Colapso-discal.jpg\" alt=\"Colapso discal\" width=\"398\" height=\"293\" \/><noscript><img decoding=\"async\" class=\"alignleft wp-image-2006\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:300\/h:221\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Colapso-discal.jpg\" alt=\"Colapso discal\" width=\"398\" height=\"293\" \/></noscript><\/a>\u00a0el anillo fibroso aumentando el \u00edndice de fisuras, lo cual debilita su resistencia mec\u00e1nica. Esto puede causar una protrusi\u00f3n del disco en el canal vertebral y la compresi\u00f3n de las ra\u00edces nerviosas. La p\u00e9rdida de altura del disco hace aumentar la carga en las carillas articulares y acelera los cambios relacionados con la artrosis. As\u00ed pues, el patr\u00f3n de movimiento de la UCF est\u00e1 sometido a cambios importantes.<\/div>\n<div><\/div>\n<div><span style=\"color: #ff0000;\"><strong>Las articulaciones facetarias<\/strong><\/span><\/div>\n<div>\n<p>Los cambios degenerativos mencionados anteriormente tambi\u00e9n afectan las carillas articulares. Igual que otras articulaciones del cuerpo, las carillas articulares est\u00e1n recubiertas de una capa de cart\u00edlago que garantiza el movimiento arm\u00f3nico e indoloro entre las dos masas articulares \u00f3seas. La carga continua y el movimiento causan la erosi\u00f3n de este cart\u00edlago, generando un contacto directo \u00f3seo y finalmente provocan el desarrollo de una artrosis dolorosa.<\/p>\n<\/div>\n<div>\n<div><span style=\"color: #800000;\">PROCEDIMIENTOS DE DIAGN\u00d3STICO<\/span><\/div>\n<p>El procedimiento b\u00e1sico de diagn\u00f3stico para los cambios degenerativos de la columna lumbar incluye una evaluaci\u00f3n cuidadosa de la historia del paciente y un examen cl\u00ednico. Las pruebas complementarias indispensables para el diagn\u00f3stico son las pruebas de diagn\u00f3stico por im\u00e1genes de la columna vertebral y las infiltraciones.<\/p>\n<p><strong>Radiograf\u00edas convencionales:<\/strong> las radiograf\u00edas convencionales proporcionan una excelente visi\u00f3n de las estructuras \u00f3seas y permiten una orientaci\u00f3n anat\u00f3mica de la columna vertebral. Se puede obtener informaci\u00f3n sobre la densidad \u00f3sea y los cambios en la forma y el tama\u00f1o de los cuerpos vertebrales. Tambi\u00e9n pueden observarse cambios degenerativos como la formaci\u00f3n de osteofitos o la retracci\u00f3n del espacio discal. Puesto que las radiograf\u00edas s\u00f3lo muestran las estructuras que contienen calcio, los tejidos blandos no pueden verse directamente.<\/p>\n<p><strong>Tomograf\u00eda computadorizada (CT), resonancia magn\u00e9tica nuclear (RMN):<\/strong> estas t\u00e9cnicas m\u00e1s nuevas son los m\u00e9todos de diagn\u00f3stico por im\u00e1genes est\u00e1ndares de la columna vertebral. Permiten visualizar y analizar los cambios en las estructuras \u00f3seas y en el tejido blando.<\/p>\n<p>Interpretar el significado cl\u00ednico de las im\u00e1genes de los diferentes cambios degenerativos puede ser dif\u00edcil puesto que no todos los cambios que se observan en las radiograf\u00edas, la TC o la RMN producen dolor.<\/p>\n<p><strong>Infiltraciones:<\/strong> se pueden inyectar medios de contraste y\/o agentes anest\u00e9sicos a los discos y las carillas articulares. La provocaci\u00f3n o eliminaci\u00f3n del dolor puede confirmar que un cambio degenerativo identificado en el diagn\u00f3stico por im\u00e1genes es la fuente de dolor. Estas infiltraciones se practican de forma rutinaria con el control del diagn\u00f3stico por im\u00e1genes.<\/p>\n<p>La sensibilidad y la especificidad de este procedimiento de diagn\u00f3stico son controvertidas por el alto \u00edndice de resultados falsamente positivos.<\/p>\n<\/div>\n<p><strong><span style=\"color: #ff0000;\">TRATAMIENTO<\/span><\/strong><\/p>\n<div>\n<p>La degeneraci\u00f3n de la columna lumbar es un proceso normal de envejecimiento y normalmente es asintom\u00e1tico. El tratamiento conservador no quir\u00fargico est\u00e1 indicado en caso de dolor ligero y moderado. La cirug\u00eda de la columna vertebral s\u00f3lo debe considerarse en caso de dolor insoportable y resistente al tratamiento conservador con dolor en una estructura de la columna vertebral bien identificada.<\/p>\n<p><strong>8 ejercicios muy efectivos en la prevenci\u00f3n de la radiculitis. Te quedar\u00e1s impresionado por el resultado<\/strong><\/p>\n<h6>De acuerdo a las estad\u00edsticas, alrededor del 40% de la poblaci\u00f3n mundial sufren con frecuencia del dolor en el nervio ci\u00e1tico o se convierten en v\u00edctimas de sacrolumbalgia. \u00bfEs mucho o poco? Sea cual sea tu respuesta, Quepasada.cc no desea que caigas en este 40%, y ha preparado para ti un complejo de ejercicios especiales. Con la ayuda de ellos, podr\u00e1s fortalecer la parte lumbar de tu columna y prevenir (o detener) la inflamaci\u00f3n de nervio ci\u00e1tico. Haz estos ejercicios todos los d\u00edas, \u00a1y el dolor de espalda no te molestar\u00e1 m\u00e1s!<br \/>\n<strong><br \/>\nEjercicio \u2116 1<br \/>\nP\u00e1rate frente al asiento de la silla. Dobla la pierna derecha y ponla en el asiento, de forma que el muslo quede paralelo al suelo, y la rodilla est\u00e9 justo sobre el tobillo. Pon tu mano izquierda en la parte externa de la rodilla derecha, y sin deslizar el pie derecho, gira el cuerpo hacia la derecha. Toma varias respiraciones profundas y mantente en esta posici\u00f3n durante 30 segundos. Repite el ejercicio con la pierna izquierda<\/strong><\/h6>\n<h6><strong>Ejercicio \u2116 2<br \/>\nEn posici\u00f3n acostado sobre su espalda, comprime una rodilla hacia el pecho, manteniendo la otra pierna recta. Toma varias respiraciones profundas. Cuida que los hombros est\u00e9n pegados al suelo. Repite durante 30 segundos, para cada pie.<\/strong><\/h6>\n<h6><strong>Ejercicio \u2116 3<br \/>\nLa posici\u00f3n inicial es la misma. Estira los brazos a los lados, conformando la letra T. Sin levantar los hombros del piso, gira ambas rodillas a la vez, a la derecha, luego a la izquierda. Respira profunda y libremente. Repite el ejercicio durante un minuto por cada lado.<\/strong><\/h6>\n<h6><strong>Ejercicio \u2116 4<br \/>\nAcu\u00e9state sobre la espalda, forma con el cuerpo la letra T (pies juntos, los brazos a los lados). Mant\u00e9n una pierna recta, la otra doblada en un \u00e1ngulo de 90\u00b0, poniendo la mano opuesta sobre la rodilla. Vira la cara, para mirar hacia tu mano extendida. Ambos hombros deben mantenerse sin separarlos del suelo. Respira profunda y libremente, dem\u00f3rate un minuto por cada lado.<\/strong><\/h6>\n<h6>Ejercicio \u2116 5<br \/>\nP\u00e1rate derecho y da un paso adelante con la pierna derecha, dobla la rodilla. La pierna izquierda debe quedar estirada. Gira el torso hacia la pierna doblada, conecta tus manos en el centro del pecho de forma tal que el codo toque la parte externa de la rodilla doblada. Trata de mantenerte en esta posici\u00f3n durante 30 segundos.<\/h6>\n<h6>Ejercicio \u2116 6<br \/>\nSi\u00e9ntate en el suelo. Dobla la pierna derecha y p\u00e1sala por encima del muslo izquierdo. Pon tu mano derecha en el suelo, detr\u00e1s de ti, y el codo izquierdo \u2014 tocando la parte externa de la rodilla doblada (la derecha). Gira el torso en direcci\u00f3n del brazo derecho, tratando de mantener los pies en la posici\u00f3n inicial. Si lo logras \u2014 trata de permanecer en esta posici\u00f3n durante 30 a 60 segundos. Luego, cambia los pies.<\/h6>\n<h6>Ejercicio \u2116 7<br \/>\nPonte de rodillas, con las palmas de las manos apoyadas en el suelo. Arquea la espalda hacia abajo, levanta el pecho. Siente como se estiran los m\u00fasculos de los hombros. Respira tranquilamente durante unos 10 segundos. Luego, arquea la espalda hacia arriba, manteniendo la barbilla pegada al pecho. Mant\u00e9n esta posici\u00f3n durante 10 segundos y vuelve a la posici\u00f3n inicial. Haz los ejercicios de uno a dos minutos.<\/h6>\n<h6><b>Ejercicio \u2116 8<\/b><br \/>\n<b>Es la posici\u00f3n m\u00e1s f\u00e1cil de este complejo de ejercicios. Si\u00e9ntate sobre los talones, rodillas ligeramente separadas a los lados. La frente pegada al suelo, estira los brazos hacia delante y rel\u00e1jate. Trata de respirar profundamente y con calma. En esta posici\u00f3n, pueden quedarse todo el tiempo que quieras. Lo importante es no quedarse dormido. De lo contrario, tus pies no te lo perdonar\u00e1n.<\/b><\/h6>\n<h6><strong>Si trabajas en una oficina y llevas un estilo de vida sedentario, o empiezas a notar un dolor de espalda ocasional \u2014 estos ejercicios no solo ser\u00e1n un excelente preventivo, sino tambi\u00e9n ayudar\u00e1n a deshacerte de los problemas ya existentes. Cu\u00e9ntales a tus amigos sobre estos ejercicios. Recuerda que \u00a1la mejor manera de mantener la salud \u2014 es la prevenci\u00f3n!<\/strong><\/h6>\n<h2>Inyecciones epidurales contraindicados en la estenosis espinal<\/h2>\n<div>\n<div>Muchos pacientes de edad avanzada, sufren de dolor de espalda debido a una estenosis espinal. Con bastante frecuencia los pacientes son tratados con inyecciones epidural (PRIT = peridural terapia radicular infiltraci\u00f3n, Ra\u00edz-cat\u00e9ter, etc)<\/div>\n<\/div>\n<div>\n<p>Un grupo de investigaci\u00f3n de Filadelfia, EE.UU. ahora descubierto, que un grupo de pacientes que hab\u00edan sido tratados con PRIT antes de una cirug\u00eda de la estenosis, ten\u00eda un resultado mucho peor en comparaci\u00f3n con el grupo de pacientes que nunca hab\u00edan recibido terapia con infiltraci\u00f3n epidural.<\/p>\n<\/div>\n<h2><span style=\"color: #ff0000;\">Tratamiento quir\u00fargico<\/span><\/h2>\n<p>Durante muchos a\u00f1os el tratamiento de los cambios degenerativos de la columna lumbar ha sido la fusi\u00f3n. La estrategia de esta intervenci\u00f3n quir\u00fargica es la extirpaci\u00f3n o eliminaci\u00f3n de la estructura que causa dolor (p. ej. un disco) y el restablecimiento de una curvatura y anatom\u00eda normales.<\/p>\n<\/div>\n<p>Aunque esta t\u00e9cnica ha sido eficaz y ha dado resultados aceptables en numerosas ocasiones hay algunas desventajas asociadas a la intervenci\u00f3n quir\u00fargica:<\/p>\n<div>\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td>\n<ul>\n<li>cambios &#8220;anormales&#8221; del patr\u00f3n de movimiento por la inmovilizaci\u00f3n<\/li>\n<li>mayor frecuencia de degeneraci\u00f3n de los segmentos adyacentes<\/li>\n<li>hipermovilidad de compensaci\u00f3n de los segmentos adyacentes<\/li>\n<li>mayor \u00edndice de espondil\u00f3lisis (inestabilidad) de los segmentos adyacentes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>A ra\u00edz de ello se han desarrollado nuevos m\u00e9todos para conseguir los principales objetivos de la cirug\u00eda de fusi\u00f3n (eliminaci\u00f3n del dolor, restauraci\u00f3n de una curvatura y anatom\u00eda normales) pero conservando el movimiento. Actualmente los implantes m\u00e1s frecuentemente utilizados son la pr\u00f3tesis total (o parcial) de disco, la estabilizaci\u00f3n posterior din\u00e1mica y los espaciadores interespinosos.<\/p>\n<p>La experiencia cl\u00ednica ganada en estos \u00faltimos a\u00f1os parece demostrar que la pr\u00f3tesis total del disco puede ser una alternativa a la fusi\u00f3n. La fijaci\u00f3n posterior din\u00e1mica y los espaciadores interespinosos parecen ser el futuro<\/p>\n<p>La opini\u00f3n del especialista:<\/p>\n<\/div>\n<div>\n<div>Las t\u00e9cnicas de preservaci\u00f3n del movimiento son un nuevo concepto de tratamiento. No todos los implantes disponen de datos cl\u00ednicos y experiencia cl\u00ednica suficiente. Eval\u00fae la relevancia y la fiabilidad de los datos disponibles en la literatura m\u00e9dica sobre los siguientes implantes (0=sin experiencia cl\u00ednica, experimental; 100=experiencia cl\u00ednica relevante, antecedentes s\u00f3lidos)<\/div>\n<div><\/div>\n<div>\n<div id=\"page-top\">\n<h1 class=\"title\">Palabras del inventor de la fijaci\u00f3n din\u00e1mica intervertebral: sobre los dispositivos interespinosos<\/h1>\n<\/div>\n<div id=\"left\">\n<article id=\"post-283810\" class=\"post-283810 post type-post status-publish format-standard has-post-thumbnail hentry category-orthopedic tag-advanced-concepts-in-lumbar-degenerative-disk-disease pmpro-has-access\">\n<div class=\"post-full single\">\n<article id=\"post-283810\" class=\"post-283810 post type-post status-publish format-standard has-post-thumbnail hentry category-orthopedic tag-advanced-concepts-in-lumbar-degenerative-disk-disease pmpro-has-access\">\n<div class=\"Caption\" xml:lang=\"en\">\n<div class=\"CaptionContent\">\n<div class=\"SimplePara\">Dispositivo Wallis de primera generaci\u00f3n<\/div>\n<\/div>\n<\/div>\n<div><\/div>\n<div id=\"Fig2\" class=\"Figure\">\n<div id=\"MO2\" class=\"MediaObject\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/https:\/\/i1.wp.com\/musculoskeletalkey.com\/wp-content\/uploads\/2017\/05\/A314055_1_En_44_Fig2_HTML.gif\"  class=\"optimole-lazy-only\"  decoding=\"async\" src=\"data:image/svg+xml,%3Csvg%20viewBox%3D%220%200%20100%%20100%%22%20width%3D%22100%%22%20height%3D%22100%%22%20xmlns%3D%22http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%22%3E%3C%2Fsvg%3E?w=960\" alt=\"A314055_1_Es_44_Fig2_HTML.gif\" width=\"326\" height=\"440\" \/><noscript><img decoding=\"async\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/https:\/\/i1.wp.com\/musculoskeletalkey.com\/wp-content\/uploads\/2017\/05\/A314055_1_En_44_Fig2_HTML.gif?w=960\" alt=\"A314055_1_Es_44_Fig2_HTML.gif\" width=\"326\" height=\"440\" \/></noscript><\/div>\n<div class=\"Caption\" xml:lang=\"en\">\n<div class=\"CaptionContent\">\n<p><span class=\"CaptionNumber\">Figura 44.2<\/span><\/p>\n<div class=\"SimplePara\">Implante de Wallis<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"Fig3\" class=\"Figure\">\n<div id=\"MO3\" class=\"MediaObject\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/https:\/\/i1.wp.com\/musculoskeletalkey.com\/wp-content\/uploads\/2017\/05\/A314055_1_En_44_Fig3_HTML.gif\"  class=\"optimole-lazy-only\"  decoding=\"async\" src=\"data:image/svg+xml,%3Csvg%20viewBox%3D%220%200%20100%%20100%%22%20width%3D%22100%%22%20height%3D%22100%%22%20xmlns%3D%22http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%22%3E%3C%2Fsvg%3E?w=960\" alt=\"A314055_1_Es_44_Fig3_HTML.gif\" width=\"327\" height=\"523\" \/><noscript><img decoding=\"async\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/https:\/\/i1.wp.com\/musculoskeletalkey.com\/wp-content\/uploads\/2017\/05\/A314055_1_En_44_Fig3_HTML.gif?w=960\" alt=\"A314055_1_Es_44_Fig3_HTML.gif\" width=\"327\" height=\"523\" \/></noscript><\/div>\n<div class=\"Caption\" xml:lang=\"en\">\n<div class=\"CaptionContent\">\n<div class=\"SimplePara\">Implante UniWallis<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div><\/div>\n<div id=\"Par6\" class=\"Para\">\n<div id=\"Tab1\" class=\"Table\">\n<div class=\"Caption\" xml:lang=\"en\">\n<div class=\"CaptionContent\">\n<p><span class=\"CaptionNumber\">Tabla 44.1<\/span><\/p>\n<div class=\"SimplePara\">La estabilizaci\u00f3n din\u00e1mica interespinosa est\u00e1 indicada para lesiones degenerativas con inestabilidad potencial o reducible (menos de 2 mm en radiograf\u00edas din\u00e1micas)<\/div>\n<\/div>\n<\/div>\n<table border=\"1\">\n<colgroup><\/colgroup>\n<colgroup>\n<col align=\"left\" \/><\/colgroup>\n<colgroup>\n<col align=\"left\" \/><\/colgroup>\n<tbody>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">1.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Despu\u00e9s de la cirug\u00eda de disco, especialmente hernia de disco masiva, disco de transici\u00f3n L4-L5 si hay sacralizaci\u00f3n de L5 y hernia de disco recurrente<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">2.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Lumbalgia cr\u00f3nica con degeneraci\u00f3n discal y\/o artrosis facetaria, o cambios Modic I refractarios al tratamiento conservador<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">3.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Despu\u00e9s de laminotom\u00eda descompresiva por estenosis central<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">4.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Para estenosis foraminal din\u00e1mica con retrolistesis en radiograf\u00edas din\u00e1micas debido al colapso del disco posterior<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">5.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Estabilizaci\u00f3n de uno o dos niveles apicales sintom\u00e1ticos en la escoliosis degenerativa lumbar en pacientes de edad avanzada (alternativa a las correcciones de deformidades con construcciones de fusi\u00f3n extensas)<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">6.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Inestabilidad adyacente a una fusi\u00f3n lumbar previa<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">7.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">&#8220;Relleno&#8221; para un segmento adyacente degenerado por encima de la fusi\u00f3n lumbar o reemplazo total del disco<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div id=\"Tab2\" class=\"Table\">\n<div class=\"Caption\" xml:lang=\"en\">\n<div class=\"CaptionContent\">\n<p><span class=\"CaptionNumber\">Tabla 44.2<\/span><\/p>\n<div class=\"SimplePara\">Las contraindicaciones para la estabilizaci\u00f3n din\u00e1mica interespinosa incluyen<\/div>\n<\/div>\n<\/div>\n<table border=\"1\">\n<colgroup><\/colgroup>\n<colgroup>\n<col align=\"left\" \/><\/colgroup>\n<colgroup>\n<col align=\"left\" \/><\/colgroup>\n<tbody>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">1.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Espondilolistesis de cualquier grado y retrolistesis no reducible<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">2.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Deformidades de la columna vertebral de ni\u00f1os y adultos j\u00f3venes<\/div>\n<\/td>\n<\/tr>\n<tr class=\"noclass\">\n<td align=\"left\">\n<div class=\"SimplePara\">3.<\/div>\n<\/td>\n<td align=\"left\">\n<div class=\"SimplePara\">Problemas psicol\u00f3gicos, sociales y profesionales.<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<div id=\"Par7\" class=\"Para\">Al mismo tiempo que se lanzaba nuestro implante de estabilizaci\u00f3n din\u00e1mica interespinosa de segunda generaci\u00f3n, se desarroll\u00f3 el implante interespinoso X-Stop\u00a0<span class=\"EmphasisTypeItalic\">por una raz\u00f3n completamente diferente<\/span>\u00a0,\u00a0<span class=\"EmphasisTypeItalic\">para distraer el espacio interespinoso a fin de aliviar la claudicaci\u00f3n neurog\u00e9nica sin usar laminectom\u00eda o laminotom\u00eda en pacientes con estenosis del\u00a0canal lumbar<\/span>.<\/div>\n<div id=\"Par8\" class=\"Para\">Los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa que desarrollamos fueron seguidos por otros dispositivos interespinosos que tambi\u00e9n estaban destinados a la estabilizaci\u00f3n din\u00e1mica, no a la distracci\u00f3n.\u00a0Entre los primeros de ellos estaban el Interspinous U (que luego se convirti\u00f3 en el Coflex) \u00a0y el DIAM, pero muchos otros han aparecido a lo largo de los a\u00f1os: LumiFlex\u00a0, In-Space, Ligamento Vertebral de Renfort, BacJak y Viking , Dallos, InSWing ,\u00a0<cite><\/cite> y Locker. Asimismo, hubo una proliferaci\u00f3n de dispositivos destinados a la distracci\u00f3n interespinosa en lugar de la estabilizaci\u00f3n din\u00e1mica que se comercializaron despu\u00e9s de la aparici\u00f3n de X-Stop: Aperius, un dispositivo sin nombre de Kinoshita Giken Corporation, Jap\u00f3n, In-Space, Superior , SMID y ExtenSure .<\/div>\n<div class=\"Para\">Esta diferencia fundamental en las indicaciones (estabilizaci\u00f3n din\u00e1mica frente a distracci\u00f3n) no siempre es percibida por los autores que informan sobre dispositivos interespinosos en la literatura. Adem\u00e1s, algunos autores \u00a0utilizan dispositivos como In-Space para la estabilizaci\u00f3n din\u00e1mica, algunos para la distracci\u00f3n \u00a0y otros para ambos. Un estudio incluso compar\u00f3 la eficacia cl\u00ednica de la distracci\u00f3n sola para la estenosis del canal con Wallis, Coflex y X-Stop, sin descompresi\u00f3n quir\u00fargica asociada: como era de esperar, las mejoras en la puntuaci\u00f3n de dolor VAS fueron deficientes para los tres dispositivos utilizados en esta indicaci\u00f3n. Aunque el principio de distracci\u00f3n mejora los s\u00edntomas de la estenosis del canal lumbar m\u00e1s que el tratamiento conservador, est\u00e1 bien documentado que la distracci\u00f3n es menos eficaz que la descompresi\u00f3n quir\u00fargica, excepto en un metan\u00e1lisis, que se bas\u00f3 en una comparaci\u00f3n indirecta de estas t\u00e9cnicas . Adem\u00e1s, se han informado otras desventajas en pacientes tratados por estenosis del canal con distracci\u00f3n interespinosa en lugar de descompresi\u00f3n quir\u00fargica. Los revisores que creen que todos los dispositivos interespinosos se usan para la distracci\u00f3n han concluido que la &#8220;tecnolog\u00eda interespinosa&#8221; no est\u00e1 probada y no es confiable o que los riesgos superan los beneficios. Tamburelli et al. bien lo expresa, concluyendo que \u201ccomo suele ocurrir con toda t\u00e9cnica nueva, el entusiasmo contagioso temprano \u2014resultado en un uso excesivo y en ocasiones incorrecto del dispositivo\u2014 se ha traducido en un n\u00famero creciente de fracasos y en una consideraci\u00f3n cr\u00edtica sobre las indicaciones y la verdaderas ventajas de la t\u00e9cnica.\u201d Esta situaci\u00f3n se complica a\u00fan m\u00e1s por los revisores que consideran que los \u00fanicos sistemas de estabilizaci\u00f3n din\u00e1mica posterior son los dispositivos basados \u200b\u200ben tornillos pediculares, lo que parece ignorar por completo la existencia de la estabilizaci\u00f3n din\u00e1mica interespinosa.<\/div>\n<div id=\"Par9\" class=\"Para\">Teniendo en cuenta esta confusi\u00f3n de la estabilizaci\u00f3n din\u00e1mica interespinosa con la distracci\u00f3n interespinosa, una revisi\u00f3n de la evidencia disponible sobre los implantes interespinosos destinados \u00fanicamente a las indicaciones de estabilizaci\u00f3n din\u00e1mica es muy esclarecedora, aunque sigue siendo una tarea compleja.\u00a0Primero, la experimentaci\u00f3n biomec\u00e1nica var\u00eda con las diferentes concepciones de c\u00f3mo deber\u00eda funcionar la estabilizaci\u00f3n din\u00e1mica.\u00a0En cuanto a los resultados cl\u00ednicos, tambi\u00e9n hay una variedad de hip\u00f3tesis y explicaciones para la acci\u00f3n terap\u00e9utica de los dispositivos y, en general, buenos resultados para los pacientes.\u00a0Por \u00faltimo, entre los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa disponibles, existen diferencias fundamentales que complican a\u00fan m\u00e1s el panorama, principalmente si existe o no un sistema de banda de tensi\u00f3n limitador de flexi\u00f3n junto con un espaciador limitador de extensi\u00f3n.\u00a0En los \u00faltimos a\u00f1os, ha habido una explosi\u00f3n de evidencia en la literatura sobre la estabilizaci\u00f3n din\u00e1mica interespinosa, particularmente de Asia.\u00a0Este cap\u00edtulo representa, seg\u00fan mi leal saber y entender, una revisi\u00f3n exhaustiva de todos los art\u00edculos revisados \u200b\u200bpor pares relacionados con la estabilizaci\u00f3n din\u00e1mica interespinosa que han aparecido en los \u00faltimos 5 a\u00f1os.<\/div>\n<div>\n<h1 class=\"blogTitle\">T\u00e9cnica de la inserci\u00f3n de dispositivos interespinoso<\/h1>\n<h6 class=\"blogTitle\"><a href=\"https:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2023\/03\/Dispositivos_Interespinosos.pdf\" class=\"pdfemb-viewer\" style=\"\" data-width=\"max\" data-height=\"max\" data-toolbar=\"bottom\" data-toolbar-fixed=\"off\">Dispositivos_Interespinosos<\/a><\/h6>\n<div class=\"entryDescription\">\n<p class=\"cmParagraph cmAligncenter\"><span class=\"cmEmbedImage cmEmbedImageUnaligned\"><img decoding=\"async\" src=\"https:\/\/www.quironsalud.es\/blogs\/es\/pasa-cerebro\/tecnica-insercion-dispositivos-interespinosos.ficheros\/2256709-dispositivos_interespinosos.jpg?width=600&amp;height=600&amp;aspectRatio=true\" srcset=\"\/blogs\/es\/pasa-cerebro\/tecnica-insercion-dispositivos-interespinosos.ficheros\/2256709-dispositivos_interespinosos.jpg?width=1200&amp;height=1200&amp;aspectRatio=true 2x\" alt=\"dispositivos_interespinosos\" width=\"600\" height=\"600\" \/><\/span><\/p>\n<a href=\"https:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2023\/03\/dispositivos-interespinosos-indicaciones.pdf\" class=\"pdfemb-viewer\" style=\"\" data-width=\"max\" data-height=\"max\" data-toolbar=\"bottom\" data-toolbar-fixed=\"off\">dispositivos-interespinosos-indicaciones<\/a>\n<h5 class=\"style-scope ytd-watch-metadata\">Separador Interespinoso DIAM<\/h5>\n<p><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/VX5c8ylOdcc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<\/div>\n<div id=\"Sec2\" class=\"Section1 RenderAsSection1 SectionTypeResults\">\n<h2 class=\"Heading\">Resultados de investigaciones biomec\u00e1nicas in vitro<\/h2>\n<div id=\"Par10\" class=\"Para\">\n<div class=\"UnorderedList\">\n<ul class=\"UnorderedListMarkBullet\">\n<li>\n<div id=\"Par11\" class=\"Para ParaOneEmphasisChild\"><span class=\"EmphasisTypeItalic\">Estabilizaci\u00f3n en t\u00e9rminos de rango de movimiento reducido y mayor rigidez<\/span>\u00a0,<\/div>\n<\/li>\n<li>\n<div id=\"Par12\" class=\"Para ParaOneEmphasisChild\"><span class=\"EmphasisTypeItalic\">Descarga del disco<\/span><\/div>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div id=\"Par13\" class=\"Para\">Los tama\u00f1os disponibles de los espaciadores interespinosos corresponden a las medidas de los espacios interespinosos publicados en dos estudios [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR59\">59<\/a><\/cite>\u00a0,\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR60\">60<\/a><\/cite>\u00a0].\u00a0Estos estudios sugieren que los espaciadores deben colocarse anteriormente en el espacio interespinoso, donde la corteza es m\u00e1s gruesa y la distancia del proceso interespinoso es mayor [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR60\">60<\/a><\/cite>\u00a0].\u00a0Un estudio radiogr\u00e1fico in vivo encontr\u00f3 espacios interespinosos m\u00e1s peque\u00f1os, lo que sugiere que el recorte \u00f3seo suele ser necesario para evitar la creaci\u00f3n de cambios cif\u00f3ticos no deseados en los segmentos tratados con estabilizaci\u00f3n din\u00e1mica interespinosa , lo que confirma nuestra propia experiencia.<\/div>\n<div id=\"Par14\" class=\"Para\">Mantener la lordosis segmentaria es capital y amerita una breve digresi\u00f3n sobre varios aspectos importantes de la operaci\u00f3n y el postoperatorio: primero, para seleccionar un tama\u00f1o de espaciador que no induzca cifosis, el paciente debe ser operado en posici\u00f3n prona, no en la posici\u00f3n genupectoral.\u00a0Para insertar el Wallis o el UniWallis cuando el paciente est\u00e1 en dec\u00fabito prono, se puede utilizar un distractor. Si el dispositivo se ajusta con fuerza cuando el paciente est\u00e1 en la posici\u00f3n genu pectoral, las bandas se aflojan\u00a0cuando el paciente est\u00e9 de pie.\u00a0\u00a1Esto ciertamente no contribuir\u00e1 a restaurar la rigidez segmentaria!\u00a0El espaciador debe empujarse contra la fricci\u00f3n, pero no debe ser lo suficientemente grande como para inducir cifosis.\u00a0Tambi\u00e9n es importante utilizar un espaciador que no sea demasiado peque\u00f1o.\u00a0Si es demasiado peque\u00f1o, existe el riesgo de un movimiento excesivo que podr\u00eda rasgu\u00f1ar las ap\u00f3fisis espinosas.\u00a0Otro punto operativo se refiere al ligamento supraespinoso, cuyo extremo distal es L4 en la mayor\u00eda de los sujetos.\u00a0Siempre pens\u00e9 que era importante desinsertar la fascia de los m\u00fasculos paraespinales de las ap\u00f3fisis espinosas despu\u00e9s de la incisi\u00f3n inicial y luego, al final del procedimiento de implante de Wallis, volver a unirlos con una sutura a trav\u00e9s de un peque\u00f1o orificio en la punta de la ap\u00f3fisis espinosa. .\u00a0Tambi\u00e9n es importante insistir en que el paciente debe usar un cors\u00e9 lumbar durante 1 mes despu\u00e9s de la operaci\u00f3n para optimizar el desarrollo del tejido cicatricial alrededor del implante.\u00a0Finalmente, tal como se debe hacer al seleccionar pacientes para fusi\u00f3n, los cirujanos deben tener en cuenta aspectos psicol\u00f3gicos, sociales o relacionados con la compensaci\u00f3n laboral al decidir qu\u00e9 pacientes se beneficiar\u00edan m\u00e1s de la estabilizaci\u00f3n din\u00e1mica (fin de la digresi\u00f3n).<\/div>\n<div id=\"Par15\" class=\"Para\">En los implantes de estabilizaci\u00f3n din\u00e1mica interespinosa que no tienen bandas limitadoras de la flexi\u00f3n, existe evidencia biomec\u00e1nica contradictoria.\u00a0En un estudio con precarga axial aplicada a espec\u00edmenes de cad\u00e1veres de la columna lumbar, Coflex, In-Space y Aperius redujeron el rango de movimiento (ROM) del segmento implantado tanto en extensi\u00f3n como en flexi\u00f3n, aunque se extrajo el ligamento supraespinoso para colocar el Coflex.\u00a0En un estudio similar con precarga, In-Space redujo el ROM en extensi\u00f3n, pero no en flexi\u00f3n, flexi\u00f3n lateral o rotaci\u00f3n axial;\u00a0reducci\u00f3n de la presi\u00f3n del disco del segmento operado, con pocos efectos sobre la ROM o la presi\u00f3n del disco en los segmentos adyacentes ;\u00a0y descargaron las articulaciones facetarias cuando se cargaron en extensi\u00f3n.\u00a0Por el contrario, los estudios de cad\u00e1veres de espaciadores solos (sin bandas de tensi\u00f3n) sin precarga axial muestran una limitaci\u00f3n significativa del ROM en extensi\u00f3n, pero no en flexi\u00f3n, as\u00ed como ninguna influencia en la rotaci\u00f3n axial o la flexi\u00f3n lateral.\u00a0Esto se aplicar\u00eda menos si los dispositivos de estabilizaci\u00f3n pudieran implantarse sin lesionar la fascia toracolumbar, la fascia de los m\u00fasculos long\u00edsimos del t\u00f3rax o la fascia de los m\u00fasculos mult\u00edfidos, aunque es dif\u00edcil evitar estas lesiones cuando se descomprime el canal lumbar.\u00a0En cuanto a los segmentos adyacentes a la implantaci\u00f3n de un espaciador solo, Hartmann et al.\u00a0informaron que el ROM de flexi\u00f3n-extensi\u00f3n por encima y por debajo se increment\u00f3 en la mayor\u00eda de sus espec\u00edmenes de cad\u00e1veres con y sin una carga de seguidor de 400 N.\u00a0Mao et al.\u00a0inform\u00f3 un aumento del ROM solo en extensi\u00f3n en L2-L3 con un Coflex en L3-L4, que limit\u00f3 el ROM de flexi\u00f3n-extensi\u00f3n all\u00ed con poco efecto sobre la rotaci\u00f3n axial o la flexi\u00f3n lateral, adyacente a L4-L5 con fijaci\u00f3n de tornillo pedicular r\u00edgido.\u00a0Un estudio radiogr\u00e1fico in vivo ha informado que la limitaci\u00f3n de la flexi\u00f3n por parte del dispositivo Coflex es posible en caso de sobrecrecimiento \u00f3seo en el dispositivo, pero generalmente no se espera.\u00a0Coflex se puede utilizar para limitar fuertemente la flexi\u00f3n, pero la soluci\u00f3n requiere remaches a trav\u00e9s de las ap\u00f3fisis espinosas, con un alto riesgo de fractura de la ap\u00f3fisis espinosa, especialmente en L5 y en pacientes con hueso de mala calidad [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR72\">72<\/a><\/cite>\u00a0].<\/div>\n<div id=\"Par16\" class=\"Para\">En un modelo ovino, Gunzburg et al.\u00a0mostr\u00f3 que un espaciador interespinoso redujo el ROM segmentario total en flexi\u00f3n-extensi\u00f3n en solo un 17 % y que la combinaci\u00f3n de un espaciador m\u00e1s una banda de tensi\u00f3n alrededor de las ap\u00f3fisis espinosas redujo el ROM en un 46 %.\u00a0A diferencia de algunos dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa, las tres generaciones de nuestros dispositivos de estabilizaci\u00f3n interespinosa tienen un cord\u00f3n o banda resistente que limita la flexi\u00f3n.\u00a0Un estudio cadav\u00e9rico reciente con la aplicaci\u00f3n de precargas de compresi\u00f3n que imitan la acci\u00f3n estabilizadora de la musculatura axial demostr\u00f3 que las alteraciones anat\u00f3micas correspondientes a lesiones degenerativas e iatrog\u00e9nicas resultan en una disminuci\u00f3n de la rigidez segmentaria.\u00a0Esta p\u00e9rdida de rigidez fue menos susceptible de compensaci\u00f3n por la actividad muscular axial en flexi\u00f3n que en extensi\u00f3n, lo que sugiere a los autores la utilidad potencial de los implantes quir\u00fargicos que aumentan espec\u00edficamente la rigidez en flexi\u00f3n y limitan el ROM de flexi\u00f3n para contrarrestar la inestabilidad iatrog\u00e9nica resultante de la descompresi\u00f3n quir\u00fargica [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR4\">4 ].<\/a><\/cite>].\u00a0Sin precarga, otros estudios en cad\u00e1veres han demostrado que el sistema de Wallis restaur\u00f3 el ROM al de la muestra intacta tanto en flexi\u00f3n como en extensi\u00f3n, mientras que Coflex y DIAM restablecieron el ROM solo en extensi\u00f3n, pero no en flexi\u00f3n;\u00a0los tres sistemas redujeron la flexi\u00f3n lateral en un 10 % y la rotaci\u00f3n axial en un 20 %.\u00a0En un ensayo aleatorizado de pacientes operados en L4-L5 por hernias discales o estenosis del canal mediante PLIF o estabilizaci\u00f3n din\u00e1mica de Wallis, Li et al.\u00a0midi\u00f3 la rigidez del segmento L4-L5 degenerado.\u00a0La rigidez de L4-L5 antes de la descompresi\u00f3n era de 37 Nm;\u00a0despu\u00e9s de la descompresi\u00f3n, cay\u00f3 a 26 Nm, y despu\u00e9s de la estabilizaci\u00f3n de Wallis, se restaur\u00f3 a 46 Nm.\u00a0La rigidez del segmento adyacente suprayacente intacto (L3-L4) fue significativamente mayor por encima del Wallis que por encima del PLIF aumentado con tornillos pediculares (46 Nm frente a 35 Nm;\u00a0<span class=\"EmphasisTypeItalic\">p<\/span> \u2009&lt; 0,05), lo que confirma sus propios estudios experimentales en cad\u00e1veres.\u00a0Otros estudios en cad\u00e1veres de Wallis de segunda generaci\u00f3n han mostrado una reducci\u00f3n del 14 % en el ROM de flexi\u00f3n-extensi\u00f3n del segmento L3-L4 estabilizado, con peque\u00f1os aumentos en el ROM en los segmentos L2-L3 y L4-L5 no instrumentados del 7 % y 3,5 %. , respectivamente, y poca influencia en la flexi\u00f3n lateral y la rotaci\u00f3n axial.\u00a0Se han encontrado resultados biomec\u00e1nicos similares en cad\u00e1veres con otro dispositivo que tiene un espaciador y una banda de tensi\u00f3n, dispositivo que tambi\u00e9n demostr\u00f3 reducir las presiones en el anillo posterior y el n\u00facleo central.\u00a0Al comparar Wallis con un sistema de estabilizaci\u00f3n din\u00e1mica basado en tornillos pediculares, Schulte et al.\u00a0inform\u00f3 que el implante de Wallis redujo la extensi\u00f3n en un 69 % y la flexi\u00f3n en un 62 %, casi sin acci\u00f3n sobre la flexi\u00f3n lateral o la rotaci\u00f3n axial.<\/div>\n<div id=\"Par17\" class=\"Para\">Un estudio de la distancia entre los procesos espinosos mostr\u00f3 que las variaciones en la distancia del proceso interespinoso (ISPD) son mayores en pacientes con enfermedad degenerativa del disco que en sujetos sanos, lo que demuestra el riesgo de dislocaci\u00f3n del implante para dispositivos interespinosos que no limitan ISPD durante la flexi\u00f3n. De hecho, entre los dispositivos de estabilizaci\u00f3n din\u00e1mica que no limitan fuertemente la flexi\u00f3n, se ha informado de dislocaci\u00f3n para Coflex en varios estudios. En este sentido, el dispositivo DIAM parece ser una excepci\u00f3n. Aunque los estudios de cad\u00e1veres muestran que no logra limitar la flexi\u00f3n, los cordones de sujeci\u00f3n probablemente explican la falta de dislocaciones postoperatorias informadas. Adem\u00e1s del sistema de Wallis, se han desarrollado otros dispositivos de estabilizaci\u00f3n interespinosos con fuertes bandas limitadoras de la flexi\u00f3n para restaurar la rigidez segmentaria de manera m\u00e1s consistente, incluido el Ligamento Vertebral de Renfort, Dallos, InSWing \u00a0y Locker. En un estudio porcino, se observ\u00f3 que el ligamento supraespinoso (SSL) y los cordones de DIAM ten\u00edan un papel mec\u00e1nico, lo que llev\u00f3 a los autores a recomendar la preservaci\u00f3n del SSL y el uso de cordones, que tambi\u00e9n se pensaba que preven\u00edan la dislocaci\u00f3n posoperatoria. ]. El dispositivo LimiFlex tiene bandas que limitan la flexi\u00f3n, pero no un espaciador interespinoso.<\/div>\n<\/div>\n<div id=\"Sec3\" class=\"Section1 RenderAsSection1\">\n<h2 class=\"Heading\">Revisi\u00f3n de hallazgos cl\u00ednicos y radiol\u00f3gicos<\/h2>\n<div id=\"Par18\" class=\"Para\">En contraste con la poca eficacia asociada con la distracci\u00f3n interespinosa (ver arriba), durante los \u00faltimos 5 a\u00f1os, 29 estudios cl\u00ednicos de dispositivos interespinosos utilizados para la estabilizaci\u00f3n din\u00e1mica han informado una mejora del estado cl\u00ednico y la persistencia de la mejora independientemente del dispositivo: Wallis , Coflex , DIAM, In-Space, Ligament Vertebral de Renfort \u00a0o Dallos.<\/div>\n<div id=\"Par19\" class=\"Para\">Al utilizar dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa para descomprimir las ra\u00edces nerviosas y descargar los discos y las articulaciones facetarias, muchos autores informan datos radiol\u00f3gicos que muestran un aumento de las dimensiones foraminales, la altura del disco o ambos , a excepci\u00f3n de DIAM, que tiene un espaciador de silicona .\u00a0Aunque estos mecanismos de acci\u00f3n indudablemente contribuyen a la eficacia de los dispositivos de estabilizaci\u00f3n din\u00e1mica , desarrollamos la l\u00ednea de implantes Wallis principalmente para aliviar el dolor lumbar cr\u00f3nico asociado con la p\u00e9rdida de rigidez intersegmentaria.\u00a0Otros autores coinciden en que la acci\u00f3n cl\u00ednica de los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa se debe te\u00f3ricamente a la descarga de las articulaciones facetarias, la restauraci\u00f3n de la altura foraminal y\/o el aumento de la estabilidad intervertebral.\u00a0Como se indic\u00f3 anteriormente, la prueba experimental in vivo en pacientes demuestra que el dispositivo de Wallis de hecho restaura la rigidez fisiol\u00f3gica del segmento tratado sin afectar negativamente la rigidez de los segmentos adyacentes.\u00a0Sin embargo, debido a que la medici\u00f3n directa de la rigidez en los pacientes no es pr\u00e1ctica, para medir la estabilizaci\u00f3n los autores informan en su lugar las restricciones radiol\u00f3gicas del ROM de flexi\u00f3n-extensi\u00f3n logradas y mantenidas por los dispositivos de estabilizaci\u00f3n din\u00e1mica en comparaci\u00f3n con el ROM preoperatorio.\u00a0El ROM general de flexi\u00f3n-extensi\u00f3n, que aumenta con la enfermedad degenerativa intervertebral y aumenta a\u00fan m\u00e1s con los procedimientos de descompresi\u00f3n, mejora constantemente con la colocaci\u00f3n de un espaciador interespinoso, incluso si el espaciador no tiene conexiones que limiten la flexi\u00f3n.\u00a0Cuando el implante no tiene nada que limite la flexi\u00f3n, las adherencias postoperatorias entre las ap\u00f3fisis espinosas y la fascia medial de los m\u00fasculos paraespinales pueden limitar la flexi\u00f3n del segmento implantado despu\u00e9s de varias semanas.\u00a0En cualquier caso, debido a que los espaciadores reducen la extensi\u00f3n, esto reduce autom\u00e1ticamente el ROM general de flexi\u00f3n-extensi\u00f3n.\u00a0Otros han informado casi ning\u00fan cambio entre el ROM preoperatorio y el ROM al final del seguimiento.\u00a0sol et al.\u00a0comunicaron una mayor restricci\u00f3n del ROM de flexi\u00f3n-extensi\u00f3n lograda con Wallis (10\u00b0) con su banda limitadora de flexi\u00f3n que con Coflex (13\u00b0) (<span class=\"EmphasisTypeItalic\">\u00a0p<\/span> \u2009= 0,019), y Chao et al.\u00a0mostr\u00f3 que el ROM en extensi\u00f3n disminuy\u00f3, pero que el ROM en flexi\u00f3n aument\u00f3 en los segmentos lumbares implantados con Coflex.<\/div>\n<div id=\"Par20\" class=\"Para\">El ROM de los segmentos intervertebrales adyacentes a los segmentos tratados es igualmente importante.\u00a0Por encima de un segmento lumbar fusionado, aumenta el ROM del segmento adyacente, lo que se cree que acelera la enfermedad del segmento adyacente .\u00a0Desarrollamos dispositivos de estabilizaci\u00f3n din\u00e1mica que endurecer\u00edan el segmento tratado sin eliminar por completo la flexi\u00f3n y la extensi\u00f3n para preservar el funcionamiento fisiol\u00f3gico en los segmentos adyacentes.\u00a0Idealmente, el ROM de flexi\u00f3n-extensi\u00f3n en los segmentos sanos adyacentes no deber\u00eda verse afectado por la colocaci\u00f3n de un estabilizador din\u00e1mico interespinoso.\u00a0Todos los autores que han medido el ROM del segmento adyacente informan que no hubo un aumento no deseado en ese ROM durante el seguimiento de los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa que utilizan.\u00a0En un estudio de 60 pacientes que se sometieron a descompresi\u00f3n de L4\/L5 por estenosis degenerativa del canal, Liu et al.\u00a0informaron que el ROM de seguimiento de L3\/L4 aument\u00f3 y la altura del disco de L3\/L4 disminuy\u00f3 significativamente m\u00e1s en los 31 pacientes que ten\u00edan una fusi\u00f3n de 360\u00b0 de L4\/L5 en comparaci\u00f3n con los 29 pacientes estabilizados en L4\/L5 mediante una dispositivo de estabilizaci\u00f3n din\u00e1mica interespinosa (<span class=\"EmphasisTypeItalic\">\u00a0p<\/span> \u2009&lt; 0,05), lo que lleva a esos autores a concluir que la estabilizaci\u00f3n din\u00e1mica retrasar\u00eda la degeneraci\u00f3n de L3\/L4.<\/div>\n<div id=\"Par21\" class=\"Para\">En un estudio, el an\u00e1lisis de Kaplan-Meier de supervivencia por falla mostr\u00f3 que la descompresi\u00f3n por laminotom\u00eda y flavectom\u00eda estabilizada por fusi\u00f3n fue del 76 % a los 5 a\u00f1os, con todas las fallas causadas por cirug\u00eda adicional para el s\u00edndrome del nivel adyacente.\u00a0En ese estudio, entre los pacientes que se sometieron a la misma operaci\u00f3n sin fusi\u00f3n, la supervivencia a los 5 a\u00f1os del fracaso fue del 92 %, con ambos fracasos en el nivel \u00edndice.\u00a0En pacientes sometidos a cirug\u00eda descompresiva lumbar, Hong et al.\u00a0compararon 18 pacientes que no ten\u00edan estabilizaci\u00f3n con 23 que ten\u00edan estabilizaci\u00f3n interespinosa din\u00e1mica, recurriendo a la revisi\u00f3n por fusi\u00f3n por inestabilidad sintom\u00e1tica en 1 de los 23 pacientes (4 %) en el grupo estabilizado y en 5 de los 18 pacientes (28 %) en el grupo estabilizado. grupo no estabilizado.\u00a0En un estudio comparativo retrospectivo emparejado, Liu et al.\u00a0informaron que, en comparaci\u00f3n con PLIF aislado de L5-S1, PLIF en L5-S1 combinado con estabilizaci\u00f3n din\u00e1mica Wallis o Coflex en L4-L5 restringe el ROM de L4-L5 en extensi\u00f3n y previene la olistesis excesiva de L4 tanto en extensi\u00f3n como en flexi\u00f3n.\u00a0Con base en estos hallazgos y evidencia convincente de IRM de diferencias en la degeneraci\u00f3n del disco L4-L5 y cambios de Modic, concluyeron que el seguimiento de sus pacientes durante m\u00e1s de 24 meses podr\u00eda mostrar que la estabilizaci\u00f3n din\u00e1mica interespinosa reduce los cambios degenerativos adyacentes a la fusi\u00f3n.\u00a0Incluso el dispositivo DIAM, que limita menos la flexi\u00f3n y la extensi\u00f3n que el sistema de Wallis, se ha informado que ralentiza el desarrollo de la degeneraci\u00f3n radiol\u00f3gica del segmento adyacente por encima de un PLIF (\u00a0<span class=\"EmphasisTypeItalic\">p<\/span> \u2009= 0,03), aunque no se observ\u00f3 una diferencia significativa en la cirug\u00eda adicional en el segmento rostral al PLIF en esa cohorte.\u00a0En un estudio controlado aleatorizado de estabilizaci\u00f3n din\u00e1mica de Wallis por encima de los procedimientos de osteos\u00edntesis lumbar, Korovessis et al.\u00a0han proporcionado la mejor evidencia de que estos dispositivos pueden retrasar la enfermedad sintom\u00e1tica del segmento adyacente: el ROM en flexi\u00f3n y extensi\u00f3n de los segmentos adyacentes protegidos por un implante de Wallis se mantuvo estable despu\u00e9s de la operaci\u00f3n, mientras que hubo un aumento significativo progresivo (\u00a0<span class=\"EmphasisTypeItalic\">p<\/span>\u2009&lt; 0,02) en el ROM del segmento adyacente de los pacientes control que no ten\u00edan protecci\u00f3n por encima de la fusi\u00f3n;\u00a0esto se asoci\u00f3 con mejores puntuaciones de ODI en el grupo de Wallis (\u00a0<span class=\"EmphasisTypeItalic\">p<\/span> \u2009&lt; 0,05) y m\u00e1s operaciones de revisi\u00f3n de segmentos adyacentes en el grupo de control (14 % frente a ninguna).<\/div>\n<div id=\"Par22\" class=\"Para\">En un estudio de pacientes que se sometieron a cirug\u00eda de revisi\u00f3n por enfermedad degenerativa del segmento adyacente a la fusi\u00f3n previa, Cho et al.\u00a0recomend\u00f3 el tratamiento mediante descompresi\u00f3n y un dispositivo de estabilizaci\u00f3n din\u00e1mica interespinosa en lugar de extender la fusi\u00f3n, porque los resultados cl\u00ednicos fueron igualmente buenos y la estabilizaci\u00f3n din\u00e1mica preserva la integridad del complejo posterior.<\/div>\n<div id=\"Par23\" class=\"Para\">Como hemos recomendado para nuestro sistema, los autores que usan otros sistemas tambi\u00e9n preservan el ligamento supraespinoso, que contribuye a la estabilidad segmentaria , env\u00eda informaci\u00f3n propioceptiva a la musculatura paraespinal \u00a0y previene el aumento del ROM en flexi\u00f3n y extensi\u00f3n en los segmentos adyacentes.<\/div>\n<div id=\"Par24\" class=\"Para\">Algunos autores han informado resultados menos favorables para los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa o resultados no superiores a los grupos de control.\u00a0En cada uno de estos informes, los resultados menos favorables pueden atribuirse al uso de los dispositivos en indicaciones controvertidas o a una duraci\u00f3n insuficiente del seguimiento.\u00a0Debido a que los dispositivos de estabilizaci\u00f3n din\u00e1mica est\u00e1n destinados a aliviar el dolor relacionado con la inestabilidad, pueden ser necesarios muchos meses antes de que aparezcan diferencias en el dolor lumbar entre pacientes descomprimidos con y sin estabilizaci\u00f3n.\u00a0En un estudio con 24 meses de seguimiento, no se encontr\u00f3 diferencia en el resultado cl\u00ednico, que fue bueno, entre pacientes con o sin estabilizaci\u00f3n Coflex despu\u00e9s de la descompresi\u00f3n de la estenosis del canal (con espondilolistesis en la mitad de los pacientes).\u00a0En un ensayo controlado aleatorio a\u00fan no publicado presentado por Mahir y Marsh en el Congreso Anual 2012 de la Asociaci\u00f3n Ortop\u00e9dica Brit\u00e1nica en 2012, ambos grupos (30 pacientes tratados solo con descompresi\u00f3n en comparaci\u00f3n con 30 pacientes tratados con descompresi\u00f3n y estabilizaci\u00f3n din\u00e1mica de Wallis), los resultados cl\u00ednicos postoperatorios fueron bueno, pr\u00e1cticamente id\u00e9ntico y estable en los dos grupos a 1 y 2 a\u00f1os, pero el grupo no estabilizado empeor\u00f3 a los 3 a\u00f1os mientras que los mismos buenos resultados persistieron en el grupo estabilizado por Wallis.\u00a0Los resultados cl\u00ednicos con respecto a la enfermedad sintom\u00e1tica del segmento adyacente tambi\u00e9n dependen del tiempo, siendo necesarios m\u00e1s de 2 a\u00f1os de seguimiento para demostrar la superioridad de la estabilizaci\u00f3n din\u00e1mica interespinosa sobre la artrodesis en t\u00e9rminos de cirug\u00eda de revisi\u00f3n para el s\u00edndrome del nivel adyacente.<\/div>\n<div id=\"Par25\" class=\"Para\">En dos ejemplos de resultados menos favorables con indicaciones controvertidas, Mayer et al.\u00a0informaron cirug\u00eda de revisi\u00f3n dentro de los 34 meses en 8 de 32 pacientes en los que usaron In-Space para el dolor lumbar artrog\u00e9nico y, usando el dispositivo Coflex para la distracci\u00f3n en 20 pacientes que tambi\u00e9n ten\u00edan dolor en las articulaciones facetarias aislado, Cabraja et al.\u00a0informaron una reducci\u00f3n del 50 % en la puntuaci\u00f3n de dolor VAS en solo 7 pacientes (35 %) despu\u00e9s de 2 a\u00f1os.\u00a0Esto sugiere que descargar las articulaciones facetarias con un espaciador interespinoso para el dolor aislado de las articulaciones facetarias puede ser una mala indicaci\u00f3n.\u00a0Sin embargo, estos malos resultados pueden atribuirse al uso de demasiada distracci\u00f3n de los segmentos tratados (L4-L5), con una p\u00e9rdida de lordosis demostrada radiogr\u00e1ficamente all\u00ed, (\u00a0<span class=\"EmphasisTypeItalic\">p .<\/span>\u2009&lt; 0,001) y aumento de la lordosis en L3-L4 (\u00a0<span class=\"EmphasisTypeItalic\">p<\/span>\u00a0\u2009&lt; 0,032).\u00a0Estos cambios inducidos en el perfil sagital pueden haber contribuido a una mayor degeneraci\u00f3n de las articulaciones facetarias, posiblemente explicando por qu\u00e9 el resultado cl\u00ednico de estos pacientes fue mejor en el seguimiento de 1 a\u00f1o que en el seguimiento final.<\/div>\n<div id=\"Par26\" class=\"Para\">En pacientes con espondilolistesis degenerativa de grado I, que, en mi opini\u00f3n, es ciertamente una contraindicaci\u00f3n, los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa no han logrado evitar un mayor deslizamiento y, en un estudio, se lograron buenos resultados cl\u00ednicos en solo dos tercios de los pacientes [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR16\">16<\/a><\/cite>\u00a0].\u00a0Un estudio de 6 a\u00f1os de 23 pacientes estabilizados con un dispositivo din\u00e1mico interespinoso para la espondilolistesis degenerativa de grado I en comparaci\u00f3n con 22 pacientes tratados por la misma indicaci\u00f3n con PLIF aumentado con tornillos pediculares proporciona una confirmaci\u00f3n a\u00fan m\u00e1s convincente de que la estabilizaci\u00f3n din\u00e1mica interespinosa no debe usarse para la espondilolistesis.<\/div>\n<\/div>\n<div id=\"Sec4\" class=\"Section1 RenderAsSection1\">\n<h2 class=\"Heading\">Complicaciones de los dispositivos de estabilizaci\u00f3n din\u00e1mica interespinosa<\/h2>\n<div id=\"Par27\" class=\"Para\">Las tasas de complicaciones informadas son generalmente m\u00e1s bajas en los estudios de dura din\u00e1mica interespinosa que en los informes de pacientes con enfermedad degenerativa tratados con fusi\u00f3n.\u00a0En 131 pacientes tratados con Coflex, Xu et al.\u00a0informaci\u00f3n solo tres complicaciones relacionadas con el implante (aflojamiento, rotura del ala y fractura de la ap\u00f3fisis espinosa), junto con otras cinco complicaciones que requirieron cirug\u00eda adicional (hernia de disco recurrente en el nivel tratado en dos, una hernia de disco residual en uno , hematoma del canal espinal en un paciente que toma anticoagulantes y descompresi\u00f3n incompleta en uno).\u00a0Zang et al.\u00a0informaci\u00f3n un total de solo 13 complicaciones entre 133 pacientes.\u00a0Nachakian et al.\u00a0Actualiz\u00f3 un procedimiento de revisi\u00f3n (para la recurrencia de los s\u00edntomas neurol\u00f3gicos) entre 134 pacientes.\u00a0En un estudio de una sola unidad de complicaciones en 168 pacientes que llegaron r\u00e1pidamente din\u00e1mica de Wallis o Coflex, la tasa general de complicaciones fue del 10,7 % (18\/168), 6,2 % (8\/130) en el grupo de Wallis y 26,3 % (10\/168).\u00a038) en el grupo Coflex (\u00a0<span class=\"EmphasisTypeItalic\">p<\/span>\u00a0\u2009&lt; 0,01) [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR128\">128<\/a><\/cite>\u00a0].\u00a0Xu et al.\u00a0informado que ninguno de sus 96 pacientes tuvo complicaciones relacionadas con la din\u00e1mica definida de Wallis.\u00a0En 48 pacientes de Wallis, Liu et al.\u00a0no complicaciones intraoperatorias [\u00a0<cite><a href=\"https:\/\/musculoskeletalkey.com\/a-word-from-the-inventor-of-intervertebral-dynamic-fixation-on-interspinous-devices\/#CR87\">87<\/a><\/cite>].\u00a0Otros estudios tampoco han registrado complicaciones relacionadas con el implante con Wallis (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/20), (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/15), (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/25), Coflex (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0 \/20), (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/29) , (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/21) , DIAM (\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/8),(\u00a0<span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/16) \u00a0( <span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/68) \u00a0y Taquilla ( <span class=\"EmphasisTypeItalic\">n<\/span> \u2009= 0\/23).<\/div>\n<div id=\"Par28\" class=\"Para\">Entre las complicaciones de los dispositivos de seguridad interespinosa, la lumbalgia no resulta no es un problema grave, porque estos sistemas respetan la anatom\u00eda vertebral;\u00a0no excluyen ni complican significativamente el tratamiento posterior con un procedimiento m\u00e1s definitivo (es decir, fusi\u00f3n).\u00a0Algunos informes de la din\u00e1mica interespinosa incluyen algunos casos de extracci\u00f3n directa y reemplazo por fusi\u00f3n.La complicaci\u00f3n que naturalmente a nivel del \u00edndice m\u00e1s a menudo despu\u00e9s de cualquier tipo de determinaci\u00f3n din\u00e1mica que ocurre despu\u00e9s de la fusi\u00f3n es la hernia de disco, porque la certeza din\u00e1mica conserva la funci\u00f3n del disco, la fusi\u00f3n posterolateral reduce la funci\u00f3n del disco y la fusi\u00f3n intersom\u00e1tica lumbar elimina el disco.\u00a0Como muestran Floman et al.\u00a0la frecuencia de la recurrencia del disco depende del procedimiento de discectom\u00eda m\u00e1s que de la t\u00e9cnica de din\u00e1mica determinada.\u00a0Despu\u00e9s de un procedimiento de Wallis, Liu et al.\u00a0Actualiz\u00f3 un disco recurrente en 6 de 48 pacientes, 3 de los cuales fueron tratados de forma conservadora y 3 simplemente mediante extracci\u00f3n y fusi\u00f3n.En un estudio que compar\u00f3 Wallis en 25 pacientes con Coflex en 27 pacientes, Sun et al.\u00a0inform\u00f3 4 discos recurrentes en los pacientes Coflex y ninguno con Wallis.\u00a0En otra serie de 68 pacientes tratados mediante una fuerte din\u00e1mica interespinosa, Li et al.\u00a0informaci\u00f3n 2 casos de discoteca recurrente.\u00a0Hrabalek et al.\u00a0inform\u00f3 que no hubo discos recurrentes entre 68 pacientes.<\/div>\n<div id=\"Par29\" class=\"Para\">\n<p>La tasa de fracturas de la ap\u00f3fisis espinosa intraoperatorias y posoperatorias que complican los dispositivos de determinada din\u00e1mica interespinosa es bastante baja seg\u00fan mi experiencia con la t\u00e9cnica, pero siempre utilic\u00e9 espaciadores de tama\u00f1o peque\u00f1o para evitar la distracci\u00f3n y preservar la lordosis segmentaria. Esto contrasta con la alta incidencia de fracturas de la ap\u00f3fisis espinosa cuando se utilizan espaciadores interespinosos para la distracci\u00f3n para tratar la estenosis del canal sin socavar, porque se utilizan espaciadores m\u00e1s grandes para obtener cifosis segmentaria en lugar de preservaci\u00f3n la lordosis segmentaria como recomendamos en la consistencia din\u00e1mica para evitar el dolor en las articulaciones facetarias.Un informe de Fabrizi et al. ilustra el aspecto dependiente de la indicacion de esta complicacion de los dispositivos interespinosos. Entre 1315 pacientes en los que utilizaron un dispositivo interespinoso para la determinaci\u00f3n din\u00e1mica despu\u00e9s de la descompresi\u00f3n, observaron 7 fracturas de ap\u00f3fisis espinosa (0,5 %), mientras que entre 260 pacientes en los que los mismos cirujanos utilizaron un dispositivo interespinoso para la distracci\u00f3n en pacientes de edad avanzada para evitar la descompresi\u00f3n quir\u00fargica y anestesia general, reportaron 3 fracturas de ap\u00f3fisis espinosa (1,2 %).Los espaciadores interespinosos y las bandas blandas de poli\u00e9ster de nuestro sistema pueden ser menos agresivos para la ap\u00f3fisis espinosa que los sistemas met\u00e1licos de alta din\u00e1mica interespinosa. Se han informado fracturas de la ap\u00f3fisis espinosa con el uso de Coflex. En una serie de 133 pacientes que tuvieron previamente Coflex din\u00e1mica, 3 tuvieron una fractura de ap\u00f3fisis espinosa intraoperatoria y 2 una fractura de ap\u00f3fisis espinosa posoperatoria. Sin embargo, en un estudio de Sun et al.de complicaciones de la din\u00e1mica interespinosa en 168 pacientes con Wallis o Coflex, no se inform\u00f3 fractura de la ap\u00f3fisis espinosa. Utilizando un espaciador interespinoso blando en 65 pacientes, Lee et al. inform\u00f3 que ninguno de los pacientes ten\u00eda una fractura de ap\u00f3fisis espinosa. El an\u00e1lisis radiogr\u00e1fico in vivo en 176 pacientes muestra que las cargas promedio ejercidas por un espaciador de durabilidad interespinosa sobre la ap\u00f3fisis espinosa y la l\u00e1mina se estiman en solo el 11 % y el 7 % de sus respectivas cargas est\u00e1ticas de falla, lo que ayudar\u00eda a explicar las bajas tasas observadas de fracturas postoperatorias.<\/p>\n<div id=\"info-item\" class=\"margin\">\n<div class=\"principal\">\n<div class=\"cabecera\">\n<section>\n<div class=\"elsevierItemTitulo\">Sistema pedicular de estabilizaci\u00f3n din\u00e1mica. Resultados funcionales y complicaciones del implante en pacientes con enfermedad degenerativa discal lumbar, tras un seguimiento m\u00ednimo de 4 a\u00f1os<\/div>\n<\/section>\n<section>\n<div class=\"elsevierItemTitulosAlternativos\"><\/div>\n<\/section>\n<\/div>\n<h5 class=\"clear\"><strong>El sistema de estabilizaci\u00f3n Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0<\/strong>es un sistema pedicular de estabilizaci\u00f3n din\u00e1mica sin fusi\u00f3n. El objetivo de nuestro estudio es evaluar los resultados cl\u00ednicos en pacientes con enfermedad degenerativa discal y\/o estenosis, as\u00ed como medir la prevalencia de aflojamiento de tornillos tras 4 a\u00f1os de seguimiento.<\/h5>\n<\/div>\n<\/div>\n<div class=\"fondo\">\n<div class=\"contenido\">\n<div id=\"item\" class=\"margin\">\n<article>\n<section id=\"resumen\">\n<div class=\"elsevierItemsResumenesPalabras\">\n<div id=\"resumen_es\" class=\"elsevierItemsResumenPalabras\">\n<div class=\"elsevierItemResumenPalabrasResumenTexto\">\n<p><span id=\"sect0015\" class=\"elsevierStyleSectionTitle\">Material y m\u00e9todos<\/span><\/p>\n<p id=\"spar0010\" class=\"elsevierStyleSimplePara elsevierViewall\">Se trata de un estudio de serie de casos retrospectivo donde fueron incluidos todos los pacientes intervenidos desde enero a diciembre de 2008 con Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>. Se indic\u00f3 la cirug\u00eda si presentaban dolor lumbar de m\u00e1s de 6 meses de evoluci\u00f3n y una RM positiva para enfermedad degenerativa discal y\/o estenosis.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"texto-completo\">\n<div class=\"elSevierItemTextoCompleto\">\n<div class=\"elsevierItemTextoCompletoTitulo\">TEXTO COMPLETO<\/div>\n<div class=\"elsevierItemTextoCompletoTexto\">\n<p><span class=\"elsevierStyleSections\"><span class=\"elsevierStyleSection elsevierViewall\"><span id=\"sect0065\" class=\"elsevierStyleSectionTitle\">Introducci\u00f3n<\/span><\/span><\/span><\/p>\n<p id=\"par0005\" class=\"elsevierStylePara elsevierViewall\">Las enfermedades degenerativas de columna producen gran impacto en la capacidad funcional y el dolor. Entre ellas se encuentra la enfermedad degenerativa discal asociada o no a estenosis de canal. Tradicionalmente, el tratamiento quir\u00fargico aceptado para este tipo de enfermedades ha sido la descompresi\u00f3n asociada a fusi\u00f3n<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0005\"><span class=\"elsevierStyleSup\">1<\/span><\/a>. Dicho tratamiento se ha asociado a complicaciones como el aflojamiento de tornillos, rotura de barras, hipermovilidad del segmento adyacente o ausencia de consolidaci\u00f3n del segmento instrumentado, que en muchos casos son responsables de cirug\u00eda de revisi\u00f3n. Con la idea de evitar estos efectos indeseados se han desarrollado sistemas de estabilizaci\u00f3n din\u00e1micos como el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0(Zimmer, Inc., Warsaw, Indiana, EE. UU.). El sistema de estabilizaci\u00f3n din\u00e1mico Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0fue presentado por el Dr. Gilles Dubois y se utiliz\u00f3 por primera vez en Francia en 1994<a class=\"elsevierStyleCrossRefs\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0015\"><span class=\"elsevierStyleSup\">3,4<\/span><\/a>. Se introdujo en la pr\u00e1ctica cl\u00ednica en Europa en el a\u00f1o 2000 y fue aprobado en EE. UU. en 2009 para proporcionar estabilizaci\u00f3n espinal a los pacientes con enfermedades degenerativas de columna causantes de dolor lumbar y radicular<a class=\"elsevierStyleCrossRefs\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0025\"><span class=\"elsevierStyleSup\">5,6<\/span><\/a>. El sistema sustituye las barras de fusi\u00f3n r\u00edgidas por tornillos pediculares fabricados con Ti-Al-Nb unidos entre s\u00ed mediante cuerdas de tereftalato de polietileno (Sulene-PET<span class=\"elsevierStyleSup\">\u00ae<\/span>) que discurren por el centro de un espaciador cil\u00edndrico hecho de policarbonato-uretano (Sulene-PCU<span class=\"elsevierStyleSup\">\u00ae<\/span>) permitiendo cierto grado de flexibilidad del segmento instrumentado<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0035\"><span class=\"elsevierStyleSup\">7<\/span><\/a>\u00a0(<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#fig0005\">fig. 1<\/a>). Existe poca bibliograf\u00eda que valore los resultados funcionales y complicaciones del implante a largo plazo en los pacientes con enfermedad degenerativa discal, y en nuestro pa\u00eds un \u00fanico estudio ha sido publicado<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0040\"><span class=\"elsevierStyleSup\">8<\/span><\/a>. El objetivo de nuestro estudio es evaluar los resultados funcionales y de dolor lumbar en estos pacientes, y tambi\u00e9n conocer las complicaciones del material midiendo la prevalencia de rotura y aflojamientos de tornillos a los 4 a\u00f1os de seguimiento.<\/p>\n<div class=\"elsevierItemMultimedia\">\n<div class=\"elsevierItemMultimediaFloat\">\n<p><a class=\"imagen\" href=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/S1888441513002014:gr1.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w997EogCnBdOOD93cPFbanNdV4B9vwZQjgKcZv3MP4Cds3qiLBpJmV7qW2dfcCTNKQPEGbA3\/75i9IKpZfJyJ4Cqpw\/z74sjKiWj4anaOSBcDpLqiDYdbWG8auecmykcDOvNqvbyJumHziG0OBM0mVXbzlrO59T1ubDdANtsTh4gDlDml6lKjkAZ8azpX3\/czV8X1DEfUbBmXlN\/S3vb5tqDnSwvJQZjaJdBaFyd+IX3oPK8kaGpQE4q859RMrUHl2Uk1+dVWLhxwXESb4m04Ir3UX9MMo9sI6IsCbpAqCDhB\" data-fancybox=\"imagen\" data-caption=\"Figura 1 Sistema de estabilizaci\u00f3n din\u00e1mica Dynesys\u00ae.\"><img decoding=\"async\" title=\"Sistema de estabilizaci\u00f3n din\u00e1mica Dynesys\u00ae.\" src=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/thumbnail\/S1888441513002014:gr1.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w96p5LBcBpyJTqfwgorxm+Ow=\" alt=\"Sistema de estabilizaci\u00f3n din\u00e1mica Dynesys\u00ae.\" \/><\/a><\/p>\n<div class=\"elsevierItemMultimediaFigura\">\n<div class=\"elsevierItemMultimediaFiguraDescripcion\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionIdiomas\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionTexto\">\n<p>Figura 1.<\/p>\n<p id=\"spar0045\" class=\"elsevierStyleSimplePara elsevierViewall\">Sistema de estabilizaci\u00f3n din\u00e1mica Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<ul id=\"lis0005\" class=\"elsevierStyleList\">\n<li id=\"lsti0010\" class=\"elsevierStyleListItem\">\n<div class=\"elsevierItemMultimedia\">\n<div class=\"elsevierItemMultimediaFloat\">\n<div class=\"elsevierItemMultimediaFigura\">\n<div class=\"elsevierItemMultimediaFiguraFigura\"><a class=\"imagen\" href=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/S1888441513002014:gr2v3.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w997EogCnBdOOD93cPFbanNdV4B9vwZQjgKcZv3MP4Cds3qiLBpJmV7qW2dfcCTNKQPEGbA3\/75i9IKpZfJyJ4Cqpw\/z74sjKiWj4anaOSBcDpLqiDYdbWG8auecmykcDOvNqvbyJumHziG0OBM0mVXbzlrO59T1ubDdANtsTh4gDlDml6lKjkAZ8azpX3\/czV8X1DEfUbBmXlN\/S3vb5tqDnSwvJQZjaJdBaFyd+IX3oPK8kaGpQE4q859RMrUHl2Uk1+dVWLhxwXESb4m04Ir3UX9MMo9sI6IsCbpAqCDhB\" data-fancybox=\"imagen\" data-caption=\"Figuras 2 y 3 Paciente con enfermedad degenerativa discal Pfirrmann 3 y 4 en segmentos L2-L3-L4, estabilizada con Dynesys\u00ae. V\u00e9ase la RM antes (arriba) y despu\u00e9s (abajo) con reabsorci\u00f3n de peque\u00f1a protusi\u00f3n discal L2-L3 (flechas blancas).\"><img decoding=\"async\" title=\"Paciente con enfermedad degenerativa discal Pfirrmann 3 y 4 en segmentos L2-L3-L4, estabilizada con Dynesys\u00ae. V\u00e9ase la RM antes (arriba) y despu\u00e9s (abajo) con reabsorci\u00f3n de peque\u00f1a protusi\u00f3n discal L2-L3 (flechas blancas).\" src=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/thumbnail\/S1888441513002014:gr2v3.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w96p5LBcBpyJTqfwgorxm+Ow=\" alt=\"Paciente con enfermedad degenerativa discal Pfirrmann 3 y 4 en segmentos L2-L3-L4, estabilizada con Dynesys\u00ae. V\u00e9ase la RM antes (arriba) y despu\u00e9s (abajo) con reabsorci\u00f3n de peque\u00f1a protusi\u00f3n discal L2-L3 (flechas blancas).\" \/><\/a><\/div>\n<div class=\"elsevierItemMultimediaFiguraDescripcion\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionIdiomas\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionTexto\">\n<p>Figuras 2 y 3.<\/p>\n<p id=\"spar0050\" class=\"elsevierStyleSimplePara elsevierViewall\">Paciente con enfermedad degenerativa discal Pfirrmann 3 y 4 en segmentos L2-L3-L4, estabilizada con Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>. V\u00e9ase la RM antes (arriba) y despu\u00e9s (abajo) con reabsorci\u00f3n de peque\u00f1a protusi\u00f3n discal L2-L3 (flechas blancas).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<p><span class=\"elsevierStyleSections\"><span class=\"elsevierStyleSection elsevierViewall\"><span id=\"sec0025\" class=\"elsevierStyleSection elsevierViewall\"><\/span><span id=\"sect0090\" class=\"elsevierStyleSectionTitle\">Procedimiento quir\u00fargico<\/span><\/span><\/span><\/p>\n<p id=\"par0080\" class=\"elsevierStylePara elsevierViewall\">Todas las cirug\u00edas fueron realizadas por el mismo cirujano (D.F-S) mediante abordaje paramedial de Wiltse. Los tornillos de titanio fueron anclados en el ped\u00edculo y cuerpo vertebral preservando las articulaciones facetarias, bajo control radiogr\u00e1fico intraoperatorio. Tras la colocaci\u00f3n de los tornillos pediculares se midi\u00f3 la distancia interpedicular con el comp\u00e1s dinamom\u00e9trico incluido en el instrumental, se realiz\u00f3 distracci\u00f3n hasta la marca n\u00famero 1 de las 3 marcas preestablecidas en dicho instrumento. Acto seguido se cort\u00f3 el cilindro de Sulene-PCU<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0a la medida resultante y se introdujo mediante la cuerda de Sulene-PET<span class=\"elsevierStyleSup\">\u00ae<\/span> . En los casos en los que fue necesario asociar una descompresi\u00f3n de la ra\u00edz nerviosa esta se realiz\u00f3 mediante una incisi\u00f3n en la l\u00ednea media y laminotom\u00eda uni o bilateral conservando las ap\u00f3fisis espinosas y el ligamento supra e interespinoso.<\/p>\n<div class=\"elsevierItemMultimedia\">\n<div class=\"elsevierItemMultimediaFloat\">\n<p><a name=\"fig0015\"><\/a><\/p>\n<div class=\"elsevierItemMultimediaFigura\">\n<div class=\"elsevierItemMultimediaFiguraFigura\"><a class=\"imagen\" href=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/S1888441513002014:gr4.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w997EogCnBdOOD93cPFbanNdV4B9vwZQjgKcZv3MP4Cds3qiLBpJmV7qW2dfcCTNKQPEGbA3\/75i9IKpZfJyJ4Cqpw\/z74sjKiWj4anaOSBcDpLqiDYdbWG8auecmykcDOvNqvbyJumHziG0OBM0mVXbzlrO59T1ubDdANtsTh4gDlDml6lKjkAZ8azpX3\/czV8X1DEfUbBmXlN\/S3vb5tqDnSwvJQZjaJdBaFyd+IX3oPK8kaGpQE4q859RMrUHl2Uk1+dVWLhxwXESb4m04Ir3UX9MMo9sI6IsCbpAqCDhB\" data-fancybox=\"imagen\" data-caption=\"Figura 4 Comp\u00e1s dinamom\u00e9trico utilizado para medir la longitud del cilindro espaciador interpedicular (en el c\u00edrculo se pueden ver las 3 marcas o niveles de fuerza de distracci\u00f3n, a mayor fuerza, mayor distracci\u00f3n y, por lo tanto, mayor ser\u00e1 la longitud del cilindro espaciador).\"><img decoding=\"async\" title=\"Comp\u00e1s dinamom\u00e9trico utilizado para medir la longitud del cilindro espaciador interpedicular (en el c\u00edrculo se pueden ver las 3 marcas o niveles de fuerza de distracci\u00f3n, a mayor fuerza, mayor distracci\u00f3n y, por lo tanto, mayor ser\u00e1 la longitud del cilindro espaciador).\" src=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/thumbnail\/S1888441513002014:gr4.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w96p5LBcBpyJTqfwgorxm+Ow=\" alt=\"Comp\u00e1s dinamom\u00e9trico utilizado para medir la longitud del cilindro espaciador interpedicular (en el c\u00edrculo se pueden ver las 3 marcas o niveles de fuerza de distracci\u00f3n, a mayor fuerza, mayor distracci\u00f3n y, por lo tanto, mayor ser\u00e1 la longitud del cilindro espaciador).\" \/><\/a><\/div>\n<div class=\"elsevierItemMultimediaFiguraDescripcion\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionIdiomas\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionTexto\">\n<p id=\"spar0055\" class=\"elsevierStyleSimplePara elsevierViewall\">Comp\u00e1s dinamom\u00e9trico utilizado para medir la longitud del cilindro espaciador interpedicular (en el c\u00edrculo se pueden ver las 3 marcas o niveles de fuerza de distracci\u00f3n, a mayor fuerza, mayor distracci\u00f3n y, por lo tanto, mayor ser\u00e1 la longitud del cilindro espaciador).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p id=\"par0085\" class=\"elsevierStylePara elsevierViewall\">Se permiti\u00f3 la sedestaci\u00f3n y deambulaci\u00f3n al d\u00eda siguiente de la cirug\u00eda sin ortesis lumbar ni limitaciones de las actividades de la vida diaria.<\/p>\n<p id=\"par0090\" class=\"elsevierStylePara elsevierViewall\">Las variables cl\u00ednicas y radiogr\u00e1ficas fueron recogidas de la historia cl\u00ednica de los pacientes y de entrevista personal en la \u00faltima visita a consultas externas.<\/p>\n<p><span class=\"elsevierStyleSections\"><span class=\"elsevierStyleSection elsevierViewall\"><span id=\"sec0030\" class=\"elsevierStyleSection elsevierViewall\"><\/span><span id=\"sect0095\" class=\"elsevierStyleSectionTitle\">Evaluaci\u00f3n cl\u00ednica<\/span><\/span><\/span><\/p>\n<p id=\"par0095\" class=\"elsevierStylePara elsevierViewall\">Los resultados funcionales fueron medidos mediante la escala de discapacidad de Oswestry en su versi\u00f3n espa\u00f1ola (ODI), mientras que el dolor de espalda y piernas fue recogido mediante la escala visual anal\u00f3gica (EVA)<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0055\"><span class=\"elsevierStyleSup\">11<\/span><\/a>. El ODI se representa en una escala de 0 a 100%, donde valores altos describen mayor limitaci\u00f3n funcional. Entre 0-20%: limitaci\u00f3n funcional m\u00ednima; 20-40%: moderada; 40-60%: severa; 60-80%: discapacidad, y por encima del 80%: limitaci\u00f3n funcional m\u00e1xima.<\/p>\n<p><span class=\"elsevierStyleSections\"><span class=\"elsevierStyleSection elsevierViewall\"><span id=\"sec0035\" class=\"elsevierStyleSection elsevierViewall\"><\/span><span id=\"sect0100\" class=\"elsevierStyleSectionTitle\">Evaluaci\u00f3n radiogr\u00e1fica<\/span><\/span><\/span><\/p>\n<p id=\"par0100\" class=\"elsevierStylePara elsevierViewall\">Radiograf\u00edas lumbares en proyecci\u00f3n anteroposterior y lateral fueron obtenidas del sistema digitalizado Risolution<span class=\"elsevierStyleSup\"><span class=\"elsevierStyleBold\">\u00ae<\/span><\/span>\u00a0(MediAlfa Corp. Miami, Fl, EE. UU.), cada imagen fue magnificada y el contraste ajustado para obtener la mejor visualizaci\u00f3n posible. Un cirujano ortop\u00e9dico (M.S-T), revis\u00f3 la presencia de rotura y aflojamiento de tornillos, considerando como positivo la presencia, en ambas proyecciones, de una circunferencia radiotransparente alrededor del tornillo de 1mm o m\u00e1s rodeada de una l\u00ednea radiopaca de hueso de mayor densidad\u00a0<span class=\"elsevierStyleItalic\">\u00abDouble halo sign\u00bb<\/span>.<\/p>\n<div class=\"elsevierItemMultimedia\">\n<div class=\"elsevierItemMultimediaFloat\">\n<p><a class=\"imagen\" href=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/S1888441513002014:gr5.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w997EogCnBdOOD93cPFbanNdV4B9vwZQjgKcZv3MP4Cds3qiLBpJmV7qW2dfcCTNKQPEGbA3\/75i9IKpZfJyJ4Cqpw\/z74sjKiWj4anaOSBcDpLqiDYdbWG8auecmykcDOvNqvbyJumHziG0OBM0mVXbzlrO59T1ubDdANtsTh4gDlDml6lKjkAZ8azpX3\/czV8X1DEfUbBmXlN\/S3vb5tqDnSwvJQZjaJdBaFyd+IX3oPK8kaGpQE4q859RMrUHl2Uk1+dVWLhxwXESb4m04Ir3UX9MMo9sI6IsCbpAqCDhB\" data-fancybox=\"imagen\" data-caption=\"Figura 5 Tornillos L4 derecho con \u00abDouble halo sign\u00bb (l\u00ednea radiotransparente rodeada de otra l\u00ednea radiopaca de hueso de mayor densidad).\"><img decoding=\"async\" title=\"Tornillos L4 derecho con \u00abDouble halo sign\u00bb (l\u00ednea radiotransparente rodeada de otra l\u00ednea radiopaca de hueso de mayor densidad).\" src=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/thumbnail\/S1888441513002014:gr5.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w96p5LBcBpyJTqfwgorxm+Ow=\" alt=\"Tornillos L4 derecho con \u00abDouble halo sign\u00bb (l\u00ednea radiotransparente rodeada de otra l\u00ednea radiopaca de hueso de mayor densidad).\" \/><\/a><\/p>\n<div class=\"elsevierItemMultimediaFigura\">\n<div class=\"elsevierItemMultimediaFiguraDescripcion\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionIdiomas\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionTexto\">\n<p id=\"spar0060\" class=\"elsevierStyleSimplePara elsevierViewall\">Tornillos L4 derecho con\u00a0<span class=\"elsevierStyleItalic\">\u00abDouble halo sign\u00bb<\/span>\u00a0(l\u00ednea radiotransparente rodeada de otra l\u00ednea radiopaca de hueso de mayor densidad).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"elsevierItemMultimedia\"><\/div>\n<div class=\"elsevierItemMultimedia\">\n<div class=\"elsevierItemMultimediaFloat\">\n<div class=\"elsevierItemMultimediaFigura\">\n<div class=\"elsevierItemMultimediaFiguraFigura\"><a class=\"imagen\" href=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/S1888441513002014:gr6v7.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w997EogCnBdOOD93cPFbanNdV4B9vwZQjgKcZv3MP4Cds3qiLBpJmV7qW2dfcCTNKQPEGbA3\/75i9IKpZfJyJ4Cqpw\/z74sjKiWj4anaOSBcDpLqiDYdbWG8auecmykcDOvNqvbyJumHziG0OBM0mVXbzlrO59T1ubDdANtsTh4gDlDml6lKjkAZ8azpX3\/czV8X1DEfUbBmXlN\/S3vb5tqDnSwvJQZjaJdBaFyd+IX3oPK8kaGpQE4q859RMrUHl2Uk1+dVWLhxwXESb4m04Ir3UX9MMo9sI6IsCbpAqCDhB\" data-fancybox=\"imagen\" data-caption=\"Figuras 6 y 7 Rotura de tornillo L5 derecho del sistema de estabilizaci\u00f3n din\u00e1mica Dynesys\u00ae.\"><img decoding=\"async\" title=\"Rotura de tornillo L5 derecho del sistema de estabilizaci\u00f3n din\u00e1mica Dynesys\u00ae.\" src=\"https:\/\/multimedia.elsevier.es\/PublicationsMultimediaV1\/item\/multimedia\/thumbnail\/S1888441513002014:gr6v7.jpeg?xkr=ue\/ImdikoIMrsJoerZ+w96p5LBcBpyJTqfwgorxm+Ow=\" alt=\"Rotura de tornillo L5 derecho del sistema de estabilizaci\u00f3n din\u00e1mica Dynesys\u00ae.\" \/><\/a><\/div>\n<div class=\"elsevierItemMultimediaFiguraDescripcion\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionIdiomas\">\n<div class=\"elsevierItemMultimediaFiguraDescripcionTexto\">\n<p id=\"spar0065\" class=\"elsevierStyleSimplePara elsevierViewall\">Rotura de tornillo L5 derecho del sistema de estabilizaci\u00f3n din\u00e1mica Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p id=\"par0145\" class=\"elsevierStylePara elsevierViewall\">Este estudio observacional retrospectivo presenta la experiencia de los autores con el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>. Seg\u00fan el estudio publicado por Ostelo et al. (donde se establece en 10 puntos en el ODI y 1,5 puntos en la escala EVA, la diferencia m\u00ednima relevante) los pacientes incluidos en nuestro estudio consiguieron una reducci\u00f3n cl\u00ednicamente relevante del dolor y la discapacidad tras la cirug\u00eda. Cuando comparamos nuestros resultados con los resultados obtenidos en otras series de casos publicadas, vemos que el margen de mejor\u00eda en nuestros pacientes no es tan amplio como el que se ha publicado en otros estudios. En este sentido, Lee et al. publican la mayor disminuci\u00f3n del ODI registrada hasta la fecha, con una variaci\u00f3n de 57,43%, de 79,58- 22,17% (p&lt;0,001), en 19 pacientes con espondilolistesis y estenosis lumbar. Sapkas et al.tambi\u00e9n obtuvieron resultados superiores a los de nuestro estudio con una variaci\u00f3n del 35% en el ODI en 114 pacientes con enfermedad degenerativa discal y estenosis de canal, recientemente Fay et al, en pacientes de similares caracter\u00edsticas a los anteriores, han publicado una disminuci\u00f3n de 4,1 puntos en la escala EVA (p&lt;0,001) y de 23,3% en el ODI (p&lt;0,001). Estas diferencias entre los estudios anteriormente citados y el nuestro, suponiendo que los pacientes fueran comparables, podr\u00edan deberse al hecho de que en los primeros se asoci\u00f3 una descompresi\u00f3n en el 100% de los pacientes, mientras que en nuestro estudio solo 2 (9%) pacientes de pacientes recibi\u00f3 descompresi\u00f3n junto al dispositivo Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>. Es evidente que en los casos en los que se asocia una maniobra descompresiva esta podr\u00eda estar actuando como factor de confusi\u00f3n y como consecuencia resulta imposible aislar el efecto del Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span><span class=\"elsevierStyleItalic\">per se<\/span>. En este sentido, nuestro estudio en el que el 91% de los pacientes no recibi\u00f3 descompresi\u00f3n, aporta una referencia aproximada en la mejor\u00eda funcional que puede obtenerse utilizando el dispositivo Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0solamente.<\/p>\n<p><span class=\"elsevierStyleSections\"><span class=\"elsevierStyleSection elsevierViewall\"><span id=\"sect0130\" class=\"elsevierStyleSectionTitle\">Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0frente a fusi\u00f3n<\/span><\/span><\/span><\/p>\n<p id=\"par0155\" class=\"elsevierStylePara elsevierViewall\">El sistema Dyensys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0no ha demostrado superioridad en los resultados funcionales frente a la fusi\u00f3n, en este sentido, Yu\u00a0no encontr\u00f3 diferencias significativas en el ODI cuando compar\u00f3 pacientes tratados con el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>, frente a aquellos tratados con fusi\u00f3n intersom\u00e1tica posterior (p=0,254). Por otra parte, en el ensayo cl\u00ednico realizado para la aprobaci\u00f3n del sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>, por parte de la FDA en Estados Unidos en el a\u00f1o 2009, el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0fue comparado frente a la fusi\u00f3n r\u00edgida posterolateral, sin que la diferencia en los resultados funcionales sea estad\u00edsticamente significativa a los 2 a\u00f1os de seguimiento (p=0,34). Si bien hay que mencionar que algunos autores defienden que a igualdad de resultados, el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0aporta otros beneficios ya que no es necesaria la extracci\u00f3n de injerto de cresta il\u00edaca y se ahorra tiempo quir\u00fargico.<\/p>\n<p id=\"par0160\" class=\"elsevierStylePara elsevierViewall\">En el \u00e1mbito espa\u00f1ol un estudio ha sido publicado, obteniendo resultados positivos en la mejor\u00eda de la discapacidad, a los 2 a\u00f1os de seguimiento, sin embargo dicho estudio no especifica si estas diferencias fueron estad\u00edsticamente significativas ni tampoco el porcentaje de pacientes que recibi\u00f3 descompresi\u00f3n junto al sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span><a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0050\"><span class=\"elsevierStyleSup\">10<\/span><\/a>. En el \u00e1mbito internacional, solo 4 estudios han publicado resultados con el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0con m\u00e1s de 4 a\u00f1os de seguimiento. En este sentido los resultados a largo plazo todav\u00eda son inciertos, teniendo Hoppe<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0110\"><span class=\"elsevierStyleSup\">22<\/span><\/a>\u00a0el mayor registro publicado hasta la fecha con 7,1 a\u00f1os de seguimiento.<\/p>\n<p id=\"par0165\" class=\"elsevierStylePara elsevierViewall\">En el an\u00e1lisis del aflojamiento de tornillos, obtuvimos un porcentaje similar a lo publicado por otros autores con esta t\u00e9cnica, en este sentido Wu et al.<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0120\"><span class=\"elsevierStyleSup\">24<\/span><\/a>\u00a0en 126 pacientes intervenidos con esta t\u00e9cnica, encontraron un 19,8% de pacientes con signos radiol\u00f3gicos de aflojamiento. Algunos autores sostienen que el porcentaje de aflojamiento de los tornillos del sistema din\u00e1mico podr\u00edan ser menores que los sistemas r\u00edgidos, debido a que las barras flexibles permitir\u00edan cierto grado de movilidad, descargando el tornillo pedicular<a class=\"elsevierStyleCrossRef\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0115\"><span class=\"elsevierStyleSup\">23<\/span><\/a>, sin embargo en los estudios de Yu et al.<a class=\"elsevierStyleCrossRefs\" href=\"https:\/\/www.elsevier.es\/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-sistema-pedicular-estabilizacion-dinamica-resultados-S1888441513002014#bib0100\"><span class=\"elsevierStyleSup\">20,25<\/span><\/a>, se compararon estos 2 sistemas, obteniendo un porcentaje de aflojamiento de tornillos similar en el sistema Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>, frente al sistema de fusi\u00f3n r\u00edgida, siendo de un 14,3 frente a un 20% de pacientes respectivamente (p=0,728).<\/p>\n<p><span class=\"elsevierStyleSections\"><span class=\"elsevierStyleSection elsevierViewall\"><span id=\"sect0135\" class=\"elsevierStyleSectionTitle\">Limitaciones<\/span><\/span><\/span><\/p>\n<p id=\"par0170\" class=\"elsevierStylePara elsevierViewall\">Dentro de la enfermedad degenerativa discal existen varios, nosotros presentamos la experiencia en casos de degeneraci\u00f3n discal leve estadios Pfirrmann 2, 3 y 4 con facetas articulares sanas, donde la mayor\u00eda de casos (91%) fue tratada con el dispositivo Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span> de manera aislada. En nuestra pr\u00e1ctica cl\u00ednica, en los casos en los que existe un estadio m\u00e1s avanzado de degeneraci\u00f3n discal y\/o artrosis facetaria optamos por una cirug\u00eda de fusi\u00f3n y\/o descompresi\u00f3n. Debido a esto debemos ser prudentes a la hora de comparar nuestros resultados con otras poblaciones en diferentes estadios de enfermedad discal, y con intervenciones que combinan la estabilizaci\u00f3n din\u00e1mica tras la descompresi\u00f3n.<\/p>\n<p id=\"par0175\" class=\"elsevierStylePara elsevierViewall\">La cirug\u00eda con Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0muestra resultados cl\u00ednicos favorables a largo plazo en pacientes con enfermedad degenerativa discal lumbar, sin embargo, el rango de mejor\u00eda en nuestra serie es menor a los comunicados en otros estudios. Esto puede deberse a la diferencia en el porcentaje de descompresi\u00f3n asociada a Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span>\u00a0en los resultados aportados por otros autores. Estudios comparativos entre Dynesys<span class=\"elsevierStyleSup\">\u00ae<\/span> y descompresi\u00f3n deber\u00edan realizarse para poder aislar el beneficio de la estabilizaci\u00f3n din\u00e1mica del obtenido por la descompresi\u00f3n. Las complicaciones relacionadas con el aflojamiento de material no son infrecuentes<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/article>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<div>\n<h2><span style=\"color: #ff0000;\">Procedimientos anteriores: Cirug\u00eda del disco<\/span><\/h2>\n<h2>La cirug\u00eda de disco ENDOSC\u00d3PICO &#8211; columna lumbar<\/h2>\n<div class=\"section section-post-header\">\n<div class=\"section_wrapper clearfix\">\n<div class=\"column one single-photo-wrapper image\">\n<div class=\"image_frame scale-with-grid disabled\">\n<div class=\"image_wrapper\">\n<div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"post-wrapper-content\">\n<div class=\"section the_content has_content\">\n<div class=\"section_wrapper\">\n<div class=\"the_content_wrapper\">\n<h1>La cirug\u00eda endosc\u00f3pica de columna se enfoca en la aplicaci\u00f3n de los mismos principios de la cirug\u00eda abierta, pero ocasionando un menor da\u00f1o al paciente.<\/h1>\n<p>Por sus numerosas ventajas, este tipo de\u00a0<strong>cirug\u00eda m\u00ednimamente invasiva<\/strong>\u00a0est\u00e1 destinada a convertirse en el\u00a0<strong>procedimiento habitual<\/strong>\u00a0a la hora de abordar el tratamiento de una serie de patolog\u00edas como la\u00a0<strong><a href=\"https:\/\/neurocirugiatorres.com\/articulos-y-consejos\/sintomas-y-tratamiento-de-la-hernia-discal\/\">hernia discal<\/a>\u00a0<\/strong>y la\u00a0<strong>estenosis de canal.<\/strong><\/p>\n<h2>\u00bfQu\u00e9 es la endoscopia de columna?<\/h2>\n<p>Se trata de una\u00a0<strong>t\u00e9cnica quir\u00fargica<\/strong>\u00a0centrada en la\u00a0<strong>exploraci\u00f3n del canal espinal<\/strong>\u00a0mediante una c\u00e1mara que cuenta con un sistema \u00f3ptico como fuente de luz, conectada a su vez a una pantalla de alta definici\u00f3n.<\/p>\n<blockquote><p>En constante evoluci\u00f3n durante los \u00faltimos 20 a\u00f1os, la cirug\u00eda endosc\u00f3pica busca proporcionar\u00a0<strong>nuevos m\u00e9todos y v\u00edas de acceso<\/strong>\u00a0a la hora de abordar la\u00a0<strong>columna vertebral.<\/strong><\/p><\/blockquote>\n<h2>\u00bfEn qu\u00e9 consiste el procedimiento?<\/h2>\n<p>La\u00a0<strong>cirug\u00eda endosc\u00f3pica<\/strong>\u00a0de la columna vertebral se desarrolla en\u00a0<strong>dos fases:<\/strong><\/p>\n<p>La primera de ellas requiere de unos 30 minutos en los que se anestesia al paciente y se le coloca en\u00a0<strong>posici\u00f3n dec\u00fabito prono<\/strong>\u00a0con almohadillas en el t\u00f3rax y en la regi\u00f3n p\u00e9lvica. Adem\u00e1s, se establece basculaci\u00f3n en flexi\u00f3n de las extremidades inferiores. Para identificar el\u00a0<strong>tipo de abordaje<\/strong>\u00a0y la entrada de la c\u00e1mara \u00f3ptica se emplean\u00a0<strong>proyecciones anteroposteriores y laterales de rayos X\u00a0<\/strong>que se realizan en la misma sala gracias a la tecnolog\u00eda que hoy en d\u00eda nos acompa\u00f1a en los quir\u00f3fanos h\u00edbridos.<\/p>\n<p>La segunda fase dura aproximadamente 45 minutos. A trav\u00e9s de una\u00a0<strong>incisi\u00f3n de apenas 2 cent\u00edmetros<\/strong>\u00a0en la piel se coloca una c\u00e1nula en cuyo interior se introduce la \u00f3ptica que permite ampliar el campo de trabajo. Con ello se\u00a0<strong>elimina<\/strong>\u00a0<strong>la necesidad de llevar a cabo grandes disecciones<\/strong>\u00a0para acceder a la columna del paciente. Una vez dentro del canal espinal, se realiza la separaci\u00f3n de la ra\u00edz comprimida para extraer el fragmento herniado.<\/p>\n<blockquote><p>Tanto en la\u00a0<strong>cirug\u00eda discal<\/strong>\u00a0como en la\u00a0<strong>cirug\u00eda de estenosis de canal,<\/strong>\u00a0el paciente permanece\u00a0<strong>un solo d\u00eda ingresado;<\/strong>\u00a0teniendo que acudir transcurridas dos semanas para quitarle los puntos que se le hayan realizado.<\/p><\/blockquote>\n<p>Aunque es posible hacer\u00a0<strong>vida normal desde el momento en que se abandona el hospital,\u00a0<\/strong>la experiencia del equipo de\u00a0<a class=\"glossaryLink \" style=\"box-sizing: inherit; -webkit-font-smoothing: antialiased; margin: 0px; padding: 0px; border-width: 0px 0px 1px; border-color: initial; border-image: initial; font: inherit; vertical-align: baseline; text-decoration: none !important; outline: 0px; color: #0061ff; border-style: initial initial dotted initial;\" href=\"https:\/\/neurocirugiatorres.com\/wikineuro\/neurocirugia\/\" target=\"_blank\" rel=\"noopener\" data-cmtooltip=\"Neurocirug\u00eda&lt;hr \/&gt;Es la &lt;strong&gt;especialidad m\u00e9dica&lt;\/strong&gt; que se encarga del &lt;strong&gt;manejo quir\u00fargico y del tratamiento&lt;\/strong&gt; no quir\u00fargico y estereot\u00e1ctico de determinados procesos patol\u00f3gicos que puedan modificar la actividad del &lt;strong&gt;sistema nervioso central, perif\u00e9rico y vegetativo&lt;\/strong&gt;, incluyendo sus estructuras vasculares.\">Neurocirug\u00eda<\/a>\u00a0Torres nos dice que el tiempo de recuperaci\u00f3n completa oscila entre uno y dos meses. Tras ese periodo, el paciente podr\u00e1 reanudar su actividad deportiva y reincorporarse al trabajo, en caso de que este le exija esfuerzo f\u00edsico.<\/p>\n<h2>Ventajas frente a la cirug\u00eda abierta<\/h2>\n<ul>\n<li><strong>Reducci\u00f3n del traumatismo de los tejidos musculares<\/strong>\u00a0al realizar una incisi\u00f3n de menor tama\u00f1o.<\/li>\n<li><strong>Disminuci\u00f3n de la tasa de infecciones.<\/strong><\/li>\n<li><strong>M\u00ednimo dolor postquir\u00fargico,<\/strong>\u00a0con la consiguiente reducci\u00f3n del consumo de analg\u00e9sicos.<\/li>\n<li><strong>R\u00e1pida incorporaci\u00f3n a la actividad laboral.<\/strong><\/li>\n<li><strong>Mejor resultado est\u00e9tico,<\/strong>\u00a0ya que la cicatriz no supera los 2 cent\u00edmetros.<br \/>\n<hr \/>\n<\/li>\n<\/ul>\n<h2>Recomendaciones ante los primeros s\u00edntomas<\/h2>\n<p>En Asturias, el 90% de las personas que sufren dolor de espalda a causa de una hernia discal mejoran de forma considerable a base de reposo, analg\u00e9sicos y fisioterapia. Dado que\u00a0<strong>solo un 10% de los casos precisa intervenci\u00f3n quir\u00fargica,\u00a0<\/strong>desde\u00a0<a href=\"https:\/\/neurocirugiatorres.com\/contacto\/\">Neurocirug\u00eda Torres<\/a>, servicio de\u00a0<a class=\"glossaryLink \" style=\"box-sizing: inherit; -webkit-font-smoothing: antialiased; margin: 0px; padding: 0px; border-width: 0px 0px 1px; border-color: initial; border-image: initial; font: inherit; vertical-align: baseline; text-decoration: none !important; outline: 0px; color: #0061ff; border-style: initial initial dotted initial;\" href=\"https:\/\/neurocirugiatorres.com\/wikineuro\/neurocirugia\/\" target=\"_blank\" rel=\"noopener\" data-cmtooltip=\"Neurocirug\u00eda&lt;hr \/&gt;Es la &lt;strong&gt;especialidad m\u00e9dica&lt;\/strong&gt; que se encarga del &lt;strong&gt;manejo quir\u00fargico y del tratamiento&lt;\/strong&gt; no quir\u00fargico y estereot\u00e1ctico de determinados procesos patol\u00f3gicos que puedan modificar la actividad del &lt;strong&gt;sistema nervioso central, perif\u00e9rico y vegetativo&lt;\/strong&gt;, incluyendo sus estructuras vasculares.\">Neurocirug\u00eda<\/a>\u00a0del\u00a0<strong>Centro M\u00e9dico de Asturias,<\/strong>\u00a0recordamos la importancia de<strong>\u00a0acudir al especialista<\/strong>\u00a0para que eval\u00fae el alcance de la lesi\u00f3n mediante pruebas diagn\u00f3sticas como la\u00a0<a href=\"https:\/\/neurocirugiatorres.com\/wikineuro\/resonancia-magnetica\/\"><strong>resonancia magn\u00e9tica<\/strong>\u00a0<\/a>o la\u00a0<strong><a href=\"https:\/\/neurocirugiatorres.com\/?s=ELECTROMIOGRAMA\">electromiograf\u00eda<\/a>.<\/strong>\u00a0Su valoraci\u00f3n determinar\u00e1 la necesidad de someterse a una intervenci\u00f3n o bien recurrir a un tratamiento m\u00e1s conservador.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<div id=\"toclikebox\">\n<div id=\"specialtoc\">\n<h4>INFORMACI\u00d3N R\u00c1PIDA<\/h4>\n<ol>\n<li>Ventajas de un vistazo<\/li>\n<li>Tratamiento m\u00ednimamente invasivo<\/li>\n<li>\u00bfC\u00f3mo se realiza la cirug\u00eda?<\/li>\n<li>Los cuidados postoperatorios<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<h6>Discectom\u00eda lumbar Endosc\u00f3pica\u00a0!\u00a0Mayor\u00eda de los tejidos del mundo preservando la cirug\u00eda de disco!<\/h6>\n<p>Si el dolor grave y s\u00edntomas neurol\u00f3gicos no pueden ser controlados por el tratamiento conservador ser\u00e1 necesaria una intervenci\u00f3n quir\u00fargica.Objetivo de la discectom\u00eda es eliminar el tejido del disco extruido y descomprimir o para establecer completamente libre del nervio oprimido.<\/p>\n<p>(Consulte tambi\u00e9n\u00a0<a href=\"http:\/\/www.apex-spine.com\/news-archiv.html\">NEWS<\/a>\u00a0).<\/p>\n<p>No precisa una gran incisi\u00f3n o abertura del canal espinal no es necesario con este procedimiento.\u00a0Es por lo tanto una alternativa, preservando a la cirug\u00eda convencional &#8220;abierta&#8221;.\u00a0Como casi no hay destrucci\u00f3n de tejidos, riesgo de cicatrizaci\u00f3n es muy bajo.Adem\u00e1s de que la intervenci\u00f3n es mucho menos engorrosa.\u00a0En total, el proceso de curaci\u00f3n se acelera y el tiempo de recuperaci\u00f3n es mucho m\u00e1s corto.<\/p>\n<p>M\u00ednimamente invasivo = suave y seguro<\/p>\n<p>La nueva t\u00e9cnica de discectom\u00eda endosc\u00f3pica nos permite tratar una hernia de disco con mayor seguridad y de una manera m\u00e1s conservantes de tejidos que nunca.\u00a0La diferencia m\u00e1s importante para un procedimiento endosc\u00f3pico convencional es el acceso lateral a trav\u00e9s del agujero en comparaci\u00f3n con el acceso dorsal tradicional.\u00a0Por este medio, los nervios que corren a trav\u00e9s del canal espinal permanecen completamente intactas y las lesiones, las adherencias y otras complicaciones son por lo tanto evitarse.\u00a0Tambi\u00e9n los ligamentos intervertebrales que estabilizan la columna vertebral permanecen intactos.<\/p>\n<p>Bajo anestesia local un endoscopio \u00f3ptica se inserta a trav\u00e9s de una peque\u00f1a incisi\u00f3n en la piel.\u00a0Est\u00e1 equipado con peque\u00f1as c\u00e1nulas de trabajo y cuidadosamente se empuja hacia delante al sitio del prolapso de disco.\u00a0El tejido de disco extruido se puede quitar bajo control la vista.\u00a0Restos sobresalientes se eliminan por medio de un nucleolyser l\u00e1ser especial.\u00a0En ciertos casos, el n\u00facleo de tipo gel del disco intervertebral se shrinked con la ayuda de la quimopapa\u00edna &#8211; una enzima especial de clivaje de prote\u00edna.<\/p>\n<p>Esto ayuda a desembarazarse del anillo fibroso para apoyar el proceso de curaci\u00f3n posterior.\u00a0Para la revitalizaci\u00f3n del disco de la columna, a la abrasi\u00f3n del hueso vertebral calcificada mediante instrumentos minuto se hace.<\/p>\n<p>Esto conduce a un mejor suministro de sangre en el tejido de disco y un anillo firme y estable fibrosa puede desarrollar.<\/p>\n<p>La intervenci\u00f3n dura entre 30 a 45 minutos.<\/p>\n<p>El video animaci\u00f3n muestra c\u00f3mo se realiza la cirug\u00eda endosc\u00f3pica de disco.<\/p>\n<p>La intervenci\u00f3n dura entre 30 a 45 minutos.\u00a0El punto de entrada es as\u00e9ptica cubierto con un peque\u00f1o parche.<\/p>\n<p>Los pacientes son controlados posteriormente durante 2 horas en la sala de recuperaci\u00f3n.\u00a0Con una buena cirug\u00eda ambulatoria estado general es posible.<\/p>\n<p>Al d\u00eda siguiente, y de nuevo despu\u00e9s de tres meses no habr\u00e1 ex\u00e1menes de seguimiento.<\/p>\n<p><strong>\u00a0No todas las cirug\u00edas endosc\u00f3picas son lo mismo!<\/strong><\/p>\n<p>La gran diferencia entre nuestra t\u00e9cnica de cirug\u00eda y otras cirug\u00edas endosc\u00f3picas &#8211; que es tambi\u00e9n su principal ventaja &#8211; es el punto de entrada.\u00a0Mientras que en nuestra cl\u00ednica se accede al disco herniado lateralmente otras t\u00e9cnicas entran por la parte de atr\u00e1s.\u00a0El acceso transforaminal lateral es mucho m\u00e1s tejido de preservaci\u00f3n que el acceso dorsal, ya que deja los nervios y ligamentos ilesos y se puede realizar bajo anestesia local.\u00a0\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1 !\u00a0El resultado depende en gran medida de la experiencia del cirujano \u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1\u00a1!<\/p>\n<p>La mayor\u00eda de otras t\u00e9cnicas de cirug\u00eda endosc\u00f3pica de disco tambi\u00e9n utilizan el acceso transforaminal (abertura lateral para la salida del nervio), sin embargo, el objetivo principal es el propio disco.\u00a0Al eliminar el tejido sano del disco se crea una p\u00e9rdida de volumen (vac\u00edo).\u00a0Esto dar\u00e1 lugar a una retracci\u00f3n de la parte posterior del tejido prolapsado en el espacio en disco con una descompresi\u00f3n asociada del nervio espinal pellizcado.\u00a0En muchos casos, esto es exitosa.\u00a0Los procedimientos con una filosof\u00eda similar son, por ejemplo, la contracci\u00f3n del tejido con l\u00e1ser, chomucleolysis, las inyecciones de alcohol o aspiraci\u00f3n de tejido del disco.\u00a0Las tasas de \u00e9xito de estos procedimientos son m\u00e1s bien baja y se asocia con un riesgo para la degeneraci\u00f3n acelerada y la inestabilidad.<\/p>\n<p>La t\u00e9cnica utilizada por el Dr. Schubert en el centro COLUMNA APEX pretende eliminar directamente y de forma segura la hernia que pinza el nervio &#8211; independientemente de su localizaci\u00f3n o tama\u00f1o.\u00a0La condici\u00f3n natural del disco, as\u00ed como la movilidad y la estabilidad del segmento espinal se conserva completamente.<\/p>\n<p>Con el punto de entrada dorsal siempre el ligamento amarillo debe ser &#8220;sacrificado&#8221; y los nervios debe retraerse a un lado.Esto se asocia con un riesgo considerable de lesi\u00f3n.\u00a0Adem\u00e1s, la intervenci\u00f3n tiene que ser llevado a cabo bajo anestesia general &#8211; de lo contrario los pacientes no pod\u00edan tolerar el dolor.<a name=\"care\"><\/a><\/p>\n<h6>\u00bfQu\u00e9 cuidado postoperatorio es necesario?<\/h6>\n<p>Habr\u00e1 un examen de seguimiento al d\u00eda siguiente de la intervenci\u00f3n.\u00a0Adem\u00e1s, un fisioterapeuta le explicar\u00e1 un programa de rehabilitaci\u00f3n dirigido individualmente.\u00a0Durante las primeras dos semanas, tendr\u00e1 que poner en un cors\u00e9 pl\u00e1stico especialmente equipada, que sostiene la espalda y pronto permitir\u00e1 reanudar las actividades diarias.\u00a0Se recomienda comenzar una fisioterapia supervisado profesionalmente despu\u00e9s de una semana.\u00a0Despu\u00e9s de 6 semanas, los ejercicios de fortalecimiento para la espalda y los m\u00fasculos abdominales deben iniciarse.\u00a0Al mismo tiempo es posible reanudar gradualmente sus actividades deportivas.<\/p>\n<p>Para leer m\u00e1s sobre el cuidado postoperatorio despu\u00e9s de una discectom\u00eda es posible que desee para descargar nuestro folleto &#8221;\u00a0<a href=\"http:\/\/www.apex-spine.com\/downloads.html\">cuidado postoperatorio<\/a>\u00a0&#8220;.<\/p>\n<h6>\u00bfCu\u00e1ndo puedo volver a mis actividades deportivas despu\u00e9s de mi discectom\u00eda endosc\u00f3pica?<\/h6>\n<p>Despu\u00e9s de tres semanas que tiene que ser capaz de ir a nadar o andar en bicicleta.\u00a0Tu puede retomar sus actividades deportivas habituales despu\u00e9s de 6 semanas.<\/p>\n<h6>\u00bfCu\u00e1ndo puedo volver al trabajo despu\u00e9s de mi discectom\u00eda endosc\u00f3pica?<\/h6>\n<p>Despu\u00e9s de una o dos semanas puede reanudar el trabajo de oficina simple y ligero trabajo f\u00edsico.\u00a0Usted no debe hacer ning\u00fan trabajo f\u00edsico duro durante las primeras 6 semanas y luego aumentar de forma gradual.<\/p>\n<h6>\u00bfCu\u00e1l es la tasa de \u00e9xito de la discectom\u00eda endosc\u00f3pica?<\/h6>\n<p>Las tasas de \u00e9xito dependen en gran medida de la experiencia del cirujano. I En las tasas de \u00e9xito de la literatura cient\u00edfica internacional de alrededor del 90% est\u00e1n presupuestados. En nuestras propias evaluaciones stastical para discectom\u00eda endosc\u00f3pic<\/p>\n<div>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td colspan=\"3\" valign=\"top\"><b>Los hechos m\u00e1s importantes de un vistazo para su conveniencia<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><\/td>\n<td valign=\"top\"><b>Cirug\u00eda de disco abierta convencional<\/b><\/td>\n<td valign=\"top\"><b>Cirug\u00eda de disco endosc\u00f3pica<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Anestesia<\/b><\/td>\n<td valign=\"top\">El paciente est\u00e1 en la anestesia total.\u00a0\u00a1Peligro de da\u00f1os en los nervios de la cirug\u00eda.<\/td>\n<td valign=\"top\">La cirug\u00eda se lleva a cabo en la anestesia local y sedaci\u00f3n concomitante.\u00a0El paciente se encuentra bajo vigilancia constante.\u00a0Da\u00f1os nerviosos se por lo tanto, pr\u00e1cticamente excluidos.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Posicionamiento<\/b><\/td>\n<td valign=\"top\">El paciente est\u00e1 en posici\u00f3n prona y la cirug\u00eda se realiza a trav\u00e9s de una incisi\u00f3n de 4-8 cm en la parte posterior.<\/td>\n<td valign=\"top\">Paciente se acuesta sobre su lado.\u00a0La cirug\u00eda endosc\u00f3pica se lleva a cabo a trav\u00e9s de una amplia incisi\u00f3n en la piel de 7 mm en la parte posterior lateral.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Riesgos<\/b><\/td>\n<td valign=\"top\">El riesgo de recurrencia es de aproximadamente el 10 al 17%.\u00a0Hay una alta probabilidad de formaci\u00f3n de cicatrices alrededor de los nervios.\u00a0Tambi\u00e9n hay un alto riesgo de que el tejido sano disco est\u00e1 da\u00f1ado o eliminado.<\/td>\n<td valign=\"top\">S\u00f3lo hay muy poco crecimiento de tejido cicatrizal.\u00a0S\u00f3lo se elimina el tejido hernia discal.\u00a0El riesgo de recurrencia es de aproximadamente el 4%.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Dolor<\/b><\/td>\n<td valign=\"top\">El dolor es relativamente grave despu\u00e9s de la cirug\u00eda.<\/td>\n<td valign=\"top\">No hay, o s\u00f3lo muy poco de dolor despu\u00e9s de la cirug\u00eda.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Despu\u00e9s de la intervenci\u00f3n<\/b><\/td>\n<td valign=\"top\">Como una declaraci\u00f3n de estado a la actividad completa dura 6 semanas.<\/td>\n<td valign=\"top\">Dos horas despu\u00e9s de la cirug\u00eda puede dejar la unidad de recuperaci\u00f3n por su cuenta.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>La estancia hospitalaria<\/b><\/td>\n<td valign=\"top\">1 a 3 semanas.\u00a0Con el tiempo de hospitalizaci\u00f3n se requiere ya antes de la cirug\u00eda.<\/td>\n<td valign=\"top\">1-2 d\u00edas.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Cirug\u00eda<\/b><\/td>\n<td valign=\"top\">Volver musculatura tiene que ser separado de los huesos en el segmento afectado, las partes del hueso, as\u00ed como los ligamentos que debe ser eliminado o reducido &#8211; la p\u00e9rdida de la estabilidad y el trauma conduce entonces a un dolor continuo.<\/td>\n<td valign=\"top\">El cirujano s\u00f3lo elimina el tejido del disco inquietante sin da\u00f1ar o eliminar las estructuras circundantes, como los huesos, ligamentos o m\u00fasculos.\u00a0Por lo tanto se evita una inestabilidad o el crecimiento de tejido cicatricial alrededor del nervio.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Deportes<\/b><\/td>\n<td valign=\"top\">Reanudaci\u00f3n de los deportes es posible s\u00f3lo despu\u00e9s de 4 a 6 semanas.<\/td>\n<td valign=\"top\">Reanudaci\u00f3n de los deportes es posible que ya despu\u00e9s de 2 semanas.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\"><b>Horarios<\/b><\/td>\n<td valign=\"top\">Los largos tiempos de espera no son inusuales.<\/td>\n<td valign=\"top\">En casos extremos, puede ser operado en 48 horas.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>\u00a1\u00a1\u00a1\u00a0La movilidad y la funci\u00f3n de la columna vertebral estan completamente conservadas despu\u00e9s de discectom\u00eda endosc\u00f3pica!<\/p>\n<h3><span style=\"color: #ff0000;\">\u00a0<span style=\"font-size: 0.75em;\">Todas las ventajas de la discectom\u00eda endosc\u00f3pica de un vistazo:<\/span><\/span><\/h3>\n<div>\n<ul>\n<li>\u00a0Alta tasa de \u00e9xito&gt; 95%<\/li>\n<li>\u00a0Baja tasa de infecci\u00f3n &lt;0,01%<\/li>\n<li>\u00a0La intervenci\u00f3n se puede realizar bajo anestesia local &#8211; no se requiere anestesia general!<\/li>\n<li>\u00a0En la mayor\u00eda de los casos los pacientes est\u00e1n libres de dolor inmediatamente despu\u00e9s de la cirug\u00eda!<\/li>\n<li>\u00a0Como casi no hay da\u00f1o en el tejido, la intervenci\u00f3n es mucho menos engorroso y el riesgo de complicaciones es muy baja<\/li>\n<li>\u00a0No inestabilidad, ya que las estructuras que estabilizan la columna vertebral &#8211; los ligamentos y articulaciones &#8211; permanecen ilesos.\u00a0Esta es una diferencia principal con la t\u00e9cnica de la cirug\u00eda microsc\u00f3pica.<\/li>\n<li>\u00a0Menos dolor de curaci\u00f3n de heridas, as\u00ed como una mayor estabilidad, como m\u00fasculos de la espalda no se cortan o se desgarran.<\/li>\n<li>\u00a0Poco riesgo de infecci\u00f3n, ya que el acceso es a trav\u00e9s de una peque\u00f1a incisi\u00f3n cut\u00e1nea (5 mm).<\/li>\n<li>\u00a0Menos formaci\u00f3n de cicatrices en la regi\u00f3n de las ra\u00edces de los nervios!<\/li>\n<li>\u00a0Ya dos horas despu\u00e9s de la intervenci\u00f3n que ser\u00e1 capaz de caminar sin dolor.<\/li>\n<li>\u00a0Corta estancia hospitalaria: se puede ir a casa el d\u00eda despu\u00e9s de la intervenci\u00f3n<\/li>\n<li>\u00a0Ya despu\u00e9s de unos d\u00edas podr\u00e1 retomar sus actividades diarias habituales.<\/li>\n<li>\u00a0Tiempos de recuperaci\u00f3n m\u00e1s corto: Despu\u00e9s de una o dos semanas se puede volver a trabajar, despu\u00e9s de 6 semanas podr\u00e1 retomar sus actividades deportivas habituales.<\/li>\n<li>\u00a0Poco cicatrices<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<div><\/div>\n<div><a href=\"http:\/\/youtu.be\/vKVGipY5H84\" target=\"_blank\" rel=\"noopener noreferrer\"><iframe src=\"https:\/\/www.youtube.com\/embed\/vKVGipY5H84\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/a><\/div>\n<p>Para eliminar el dolor de origen discal se puede implantar una <span style=\"color: #ff0000;\">pr\u00f3tesis de disco total o parcial.<\/span><\/p>\n<\/div>\n<p><a name=\"el31002226\"><\/a> <img decoding=\"async\" title=\"Fig 11\" src=\"http:\/\/www.eurospine.org\/cm_data\/motion_Fig11_esp.jpg\" alt=\"Fig 11\" width=\"571\" height=\"369\" \/><\/p>\n<div>\n<div><span style=\"color: #ff0000;\"><strong>T\u00c9CNICAS QUIR\u00daRGICAS<\/strong><\/span><\/div>\n<p><strong><span style=\"color: #99cc00;\">Pr\u00f3tesis discal total<\/span>:<\/strong> el abordaje quir\u00fargico de la columna se efect\u00faa por la v\u00eda anterior con una incisi\u00f3n en el abdomen. Despu\u00e9s de disecar la pared abdominal, el peritoneo y los intestinos se pueden movilizar y separar lateralmente. Tras una retracci\u00f3n cuidadosa de los grandes vasos aparece la parte anterior de la columna vertebral. A continuaci\u00f3n se puede extraer el disco y limpiar las superficies de los cuerpos vertebrales. La pr\u00f3tesis discal se coloca entre los dos cuerpos vertebrales mediante una cuidadosa distracci\u00f3n y despu\u00e9s de liberarla la pr\u00f3tesis se fija en el lugar adecuado.<\/p>\n<p><strong><span style=\"color: #99cc00;\">Pr\u00f3tesis parcial<\/span>:<\/strong> las t\u00e9cnicas m\u00e1s nuevas intentan sustituir \u00fanicamente el n\u00facleo (la parte interior del disco). Este procedimiento es menos invasivo y normalmente se realiza con un abordaje posterior. Algunos implantes permiten realizar una intervenci\u00f3n percut\u00e1nea. Hasta hoy existe poca experiencia con la pr\u00f3tesis parcial de disco y este procedimiento s\u00f3lo se efect\u00faa en algunos centros especializados en la columna vertebral.<\/p>\n<p>Procedimientos posteriores: ligamentos, carillas articulares<\/p>\n<\/div>\n<div>\n<p>De manera similar a los discos intervertebrales, los elementos posteriores (principalmente las carillas articulares) pueden sufrir cambios degenerativos y convertirse en potenciales fuentes de dolor. Con la introducci\u00f3n de las t\u00e9cnicas de preservaci\u00f3n del movimiento este proceso puede detenerse o incluso invertirse. Actualmente la fijaci\u00f3n din\u00e1mica con tornillos pediculares se practica cl\u00ednicamente. Se intenta reducir el dolor modificando el movimiento y descargando las carillas articulares. Se dispone de pocos datos sobre la eficacia y el mecanismo de alivio del dolor. Actualmente se est\u00e1 investigando la viabilidad de una pr\u00f3tesis de las articulaciones facetarias.<\/p>\n<\/div>\n<p><img decoding=\"async\" title=\"Fig 12\" src=\"http:\/\/www.eurospine.org\/cm_data\/motion_Fig12_esp.jpg\" alt=\"Fig 12\" width=\"571\" height=\"426\" \/><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>Fracturas<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\">Una fractura es una lesi\u00f3n del hueso, con o sin desplazamiento de los fragmentos producida por flexi\u00f3n, extensi\u00f3n, o compresi\u00f3n.<\/p>\n<p style=\"text-align: justify;\">Las fracturas de columna vertebral presentan diferentes caracter\u00edsticas, dependiendo del segmento afectado. La gravedad se debe tanto a la posible repercusi\u00f3n funcional sobre la estabilidad y movilidad como al riesgo de lesi\u00f3n medular, de consecuencias irreparables. La secci\u00f3n medular se produce por el desplazamiento de los cuerpos vertebrales fracturados, y dependiendo de la altura de la lesi\u00f3n (cuanto m\u00e1s cerca del cr\u00e1neo mayor gravedad) se puede originar desde la muerte inmediata hasta la par\u00e1lisis de cualquier miembro.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\">FRACTURAS POR COMPRESION DE CUERPOS VERTEBRALES<\/span><\/p>\n<p style=\"text-align: justify;\">Hasta hace poco tiempo, los cuidados paliativos para el tratamiento de dolor se han considerado el tratamiento est\u00e1ndar para las fracturas por compresi\u00f3n de cuerpos vertebrales, considerando que la fractura sanar\u00eda por si sola, dejando la columna deformada. . Sin embargo, actualmente, est\u00e1n disponibles nuevas t\u00e9cnicas y tratamientos<\/p>\n<p style=\"text-align: justify;\">La Cifoplastia y\/o Vesselplastia es una t\u00e9cnica para el tratamiento de este tipo de pacientes. Este procedimiento minimamente invasivo reduce la fractura y corrige la deformidad y, por consiguiente, frena la degeneraci\u00f3n que empieza con la primera fractura por compresi\u00f3n de cuerpo vertebral. Adem\u00e1s, estos pacientes experimentan un alivio de dolor mas que significativo despu\u00e9s de la utilizaci\u00f3n de la Cifoplastia y la Vesselplastia.<\/p>\n<p style=\"text-align: justify;\"><strong> Una fractura por compresi\u00f3n del cuerpo vertebral ocurre cuando el hueso dentro del soma pierde densidad y eventualmente puede aplastarse o fracturarse. Como resultado, los platillos vertebrales se deprimen, la columna se acorta y se inclina hacia delante, causando graves consecuencias fisiol\u00f3gicas al paciente. <\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Estas fracturas dolorosas pueden producirse por las siguientes causas: <\/strong><\/p>\n<ul>\n<li>Qu\u00e9 es la osteoporosis?<\/li>\n<li>Diagn\u00f3stico<\/li>\n<li>Tratamiento<\/li>\n<li>Estabilizaci\u00f3n intravertebral<\/li>\n<li>Estabilizaci\u00f3n segmentaria<\/li>\n<\/ul>\n<div><\/div>\n<p><strong style=\"color: #ff0000; text-align: justify; font-size: 14px; line-height: 1.5em;\">Tumores<\/strong><\/p>\n<p style=\"text-align: justify;\">Los tumores de la columna afectan normalmente al cuerpo vertebral, esto Pueden ser intradurales (en el canal espinal), extradurales (en los huesos y tejidos que rodean al canal) y fuera de la columna.<\/p>\n<p style=\"text-align: justify;\">Los tumores de columna primarios (neoplasma) son relativamente raros.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>La Artrosis<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\">Degenerativo es un t\u00e9rmino muy general que abarca un amplio rango de cambios degenerativos que pueden estar unidos a un n\u00famero de patolog\u00edas. Estos cambios normalmente estan asociados con dolor severo. T\u00edpicamente afectan a la columna lumbar, pero pueden afectar a toda la columna o solo a la columna cervical.<\/p>\n<p style=\"text-align: justify;\">A medida que el cuerpo envejece, los discos intervertebrales pierden elasticidad y se deshidratan, el espacio discal se estrecha, y la formaci\u00f3n de hueso hipertr\u00f3fico (osteofitos), llega a ser evidente en la uni\u00f3n del anillo y el cuerpo vertebral.<\/p>\n<p style=\"text-align: justify;\"><a href=\"http:\/\/doctorlinares.com\/trauma\/?page_id=410\"><strong>Estenosis de Canal<\/strong><\/a><\/p>\n<p style=\"text-align: justify;\">La estenosis es cualquier condici\u00f3n que estrecha el canal medular o los for\u00e1menes intervertebrales.<\/p>\n<p style=\"text-align: justify;\">Existen varias causas de la estenosis:<\/p>\n<p style=\"text-align: justify;\"><a href=\"http:\/\/www.spineview.com\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>La Ci\u00e1tica <\/strong><\/a><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>Hernia Discal<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\">A partir de los 30 a\u00f1os se producen cambios degenerativos en el disco que conducen a una p\u00e9rdida de resistencia del mismo. El anillo fibroso puede hacerse incompetente y el n\u00facleo puede desplazarse posteriormente (protrusi\u00f3n discal) o incluso romperse, de forma que el n\u00facleo se desplace m\u00e1s. Esto es lo que se conoce como hernia de disco y puede producir s\u00edntomas por compresi\u00f3n de ra\u00edces nerviosas o incluso por compresi\u00f3n medular, en casos severos.<\/p>\n<p style=\"text-align: justify;\">Las hernias de disco son m\u00e1s frecuentes a nivel cervical y lumbar, por ser estos los segmentos con mayor movilidad de la columna<\/p>\n<p style=\"text-align: justify;\"><a href=\"http:\/\/youtu.be\/o5UmZ_gBrN8\"><iframe src=\"https:\/\/www.youtube.com\/embed\/o5UmZ_gBrN8\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #ff0000;\"><strong>Estabilizaci\u00f3n Din\u00e1mica<\/strong><\/span><\/p>\n<p>El concepto relativamente nuevo de estabilizaci\u00f3n din\u00e1mica en columna vertebral.<\/p>\n<p>La edad, la gen\u00e9tica y el desgaste de las rutinas diarias, con el tiempo pueden contribuir al da\u00f1o y a la degeneraci\u00f3n de los discos que amortiguan los huesos de la columna (v\u00e9rtebras).<\/p>\n<p>Para tratar la enfermedad degenerativa del disco, en general se comienza con tratamientos m\u00e9dicos conservadores (sin cirug\u00eda).<\/p>\n<p>Cuando la terapia conservadora falla, otros enfoques, tal vez la cirug\u00eda, se pueden recomendar.<br \/>\nEn algunas enfermedades degenerativas de la columna, como las expuestas en los cap\u00edtulos anteriores, puede ser necesaria la aplicaci\u00f3n de alguna t\u00e9cnica de fijaci\u00f3n o fusi\u00f3n de columna.<\/p>\n<p>Sin embargo, la fusi\u00f3n de la columna tiene desventajas potenciales que se conocen bien y son:<\/p>\n<p>\u00b7 P\u00e9rdida de movimiento y flexibilidad: cuando realizamos la fusion tradicional, le quitamos la movilidad que normalmente posee ese segmento de la columna, lo que acarrea alteraciones funcionales que pueden producir problemas en los discos adyacentes, proceso llamado s\u00edndrome del espacio transicional, que consiste en que los discos y dem\u00e1s estructuras ubicados por encima y por debajo de la fijaci\u00f3n quedar\u00e1n expuestos a un estr\u00e9s din\u00e1mico mayor por el hecho que entre ellos hay un segmento inm\u00f3vil (fijado).<br \/>\n\u00b7 Alteraciones en las caracter\u00edsticas del movimiento y biomec\u00e1nicas de forma permanente.<br \/>\n\u00b7 Complicaciones m\u00e9dicas de las cirug\u00edas varias veces por sobre las correspondientes a procedimientos sin fijaci\u00f3n instrumentada.<br \/>\n\u00b7 Encarecimiento significativo de los costos de los procedimientos quir\u00fargicos.<\/p>\n<p>Una acelerada y potencial degeneraci\u00f3n de los discos arriba y debajo del nivel fusionado pueden provocar m\u00e1s dolor y la necesidad de m\u00e1s cirug\u00edas.<\/p>\n<h4>Estabilizaci\u00f3n din\u00e1mica de la columna lumbar<\/h4>\n<div class=\"pm-column-title-divider\"><img decoding=\"async\" src=\"http:\/\/neurocirugiaferrer.com\/wp-content\/uploads\/2015\/11\/cerebro-sin-bandas-favicon.png\" alt=\"icon\" width=\"29\" height=\"29\" \/><\/div>\n<p><a href=\"http:\/\/neurocirugiaferrer.com\/wp-content\/uploads\/2015\/11\/columna-0.jpg\"><img decoding=\"async\" class=\"alignleft wp-image-1508\" src=\"http:\/\/neurocirugiaferrer.com\/wp-content\/uploads\/2015\/11\/columna-0.jpg\" sizes=\"(max-width: 211px) 100vw, 211px\" srcset=\"https:\/\/neurocirugiaferrer.com\/wp-content\/uploads\/2015\/11\/columna-0.jpg 300w, https:\/\/neurocirugiaferrer.com\/wp-content\/uploads\/2015\/11\/columna-0-150x150.jpg 150w\" alt=\"\" width=\"211\" height=\"211\" \/><\/a><\/p>\n<p>Mientras que tradicionalmente se ha considerado que el movimiento excesivo de la columna lumbar ha llevado al dolor lumbar (lumbalgia), en determinados casos se considera que restringir controladamente los movimientos de la columna lumbar puede llevar a eliminar el dolor por una parte y por otra parte a no inmovilizar la columna lumbar, que es el tratamiento propuesto tradicionalmente (fusi\u00f3n lumbar).<\/p>\n<p>Por ello han surgido una serie de implantes que limitan de manera controlada el movimiento, impidiendo que sea exagerado pero sin anularlo, de tal manera que parece lo m\u00e1s congruente biomec\u00e1nicamente.<\/p>\n<p>La estabilizaci\u00f3n din\u00e1mica de la columna lumbar puede realizarse principalmente aunque no exclusivamente, de dos maneras:<\/p>\n<p>Mediante tornillos transpediculares a los que unimos una barra din\u00e1mica (permite movimiento).<br \/>\nMediante la colocaci\u00f3n de un elemento posterior interespinoso, que limita pero no anula el movimiento.<br \/>\nLa indicaci\u00f3n de cada uno de ellos debe ser individualizada y depender\u00e1 de las caracter\u00edsticas de la lesi\u00f3n del paciente y de la experiencia del cirujano.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"ngg-gallery-1988-1507\" class=\"ngg-galleryoverview ngg-template-caption\">\n<div id=\"ngg-image-23\" class=\"ngg-gallery-thumbnail-box\">\n<div class=\"ngg-gallery-thumbnail\"><a class=\"ngg-fancybox\" title=\" \" href=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/columna-1.jpg\" rel=\"1988\" data-image-id=\"23\" data-src=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/columna-1.jpg\" data-thumbnail=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/dynamic\/columna-1.jpg-nggid0223-ngg0dyn-350x350x100-00f0w010c011r110f110r010t010.jpg\" data-title=\"columna-1\" data-description=\" \"><img decoding=\"async\" title=\"columna-1\" src=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/dynamic\/columna-1.jpg-nggid0223-ngg0dyn-350x350x100-00f0w010c011r110f110r010t010.jpg\" alt=\"columna-1\" width=\"350\" height=\"350\" \/><\/a><\/div>\n<\/div>\n<div id=\"ngg-image-24\" class=\"ngg-gallery-thumbnail-box\">\n<div class=\"ngg-gallery-thumbnail\"><a class=\"ngg-fancybox\" title=\" \" href=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/columna-2.jpg\" rel=\"1988\" data-image-id=\"24\" data-src=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/columna-2.jpg\" data-thumbnail=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/dynamic\/columna-2.jpg-nggid0224-ngg0dyn-350x350x100-00f0w010c011r110f110r010t010.jpg\" data-title=\"columna-2\" data-description=\" \"><img decoding=\"async\" title=\"columna-2\" src=\"https:\/\/neurocirugiaferrer.com\/wp-content\/gallery\/columna\/dynamic\/columna-2.jpg-nggid0224-ngg0dyn-350x350x100-00f0w010c011r110f110r010t010.jpg\" alt=\"columna-2\" width=\"350\" height=\"350\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<div id=\"ngg-image-25\" class=\"ngg-gallery-thumbnail-box\"><\/div>\n<\/div>\n<p><span style=\"color: #00ffff;\">\u00bfExisten alternativas a la fijaci\u00f3n de columna?<\/span><\/p>\n<p>Como expusimos en las secciones anteriores, s\u00f3lo se necesita una fijaci\u00f3n de columna para enfermedades degenerativas en una m\u00ednima fracci\u00f3n de los casos. Las indicaciones aumentan en el caso de enfermedades traum\u00e1ticas y tumorales.<br \/>\nCuando en un cuadro degenerativo, como hernias discales, estenorraquis o espondilolistesis, se hace necesaria la instrumentaci\u00f3n porque se ha evidenciado una inestabilidad o se supone fuertemente ella tras la operaci\u00f3n, existe la posibilidad de realizar una estabilizaci\u00f3n din\u00e1mica, la que tiende a conservar al menos parcialmente el movimiento normal del segmento a estabilizar, a diferencia de las fusiones o fijaciones cl\u00e1sicas.<br \/>\n<span style=\"color: #ff0000;\">\u00bfCu\u00e1les t\u00e9cnicas de fijaci\u00f3n din\u00e1mica existen?<\/span><br \/>\nExisten varios tipos de intervenciones es este sentido, enfocadas a diferentes entidades patol\u00f3gicas.<br \/>\nNombraremos las m\u00e1s importantes:<\/p>\n<p>\u00b7<span style=\"color: #00ffff;\"> Disco artificial:<br \/>\n<\/span><\/p>\n<p><a href=\"http:\/\/youtu.be\/vKVGipY5H84\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/vKVGipY5H84\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/a><br \/>\n<iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/kHuWTFQ_KxM\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Tras una resecci\u00f3n del disco intervertebral por la presencia una hernia, por ejemplo, el espacio que queda vac\u00edo entre ambas v\u00e9rtebras puede quedar sin relleno, puede adicionarse un cage o un trozo de hueso del paciente para lograr una fusion a mediano plazo, quedando ese segmento sin movilidad. Una alternativa a este procedimiento es la incorporaci\u00f3n de un disco artificial en este espacio. Este disco es un dispositivo de material sint\u00e9ticos que permite conservar la movilidad del segmento afectado, al menos en determinados planos y en ciertos rangos, por un tiempo variable. La principal desventaja de este sistema es su alto costo, pese alo cual ha ido ganando r\u00e1pidamente popularidad por sus buenos resultados m\u00e9dicos y relativas bajas complicaciones. Existen discos artificiales para columna cervical y lumbar, aunque los cervicales son los m\u00e1s usados.<\/p>\n<p>&nbsp;<\/p>\n<p><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Protesis-Disco-lumbar-.jpg\"  decoding=\"async\" class=\"alignnone size-full wp-image-1100\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Protesis-Disco-lumbar-.jpg\" alt=\"Protesis Disco lumbar\" width=\"195\" height=\"318\" \/><noscript><img decoding=\"async\" class=\"alignnone size-full wp-image-1100\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Protesis-Disco-lumbar-.jpg\" alt=\"Protesis Disco lumbar\" width=\"195\" height=\"318\" \/></noscript><\/p>\n<div>Los implantes interespinosos son espaciadores de titanio o PEEK que se colocan entre las ap\u00f3fisis espinosas de dos v\u00e9rtebras adyacentes. Una ligera distracci\u00f3n segmentaria abre el espacio para la salida de la ra\u00edz nerviosa y extiende los ligamentos del canal vertebral, proporcionando as\u00ed m\u00e1s espacio para los nervios raqu\u00eddeos. Esta t\u00e9cnica est\u00e1 indicada para la estenosis espinal leve.<\/div>\n<p><img decoding=\"async\" title=\"Fig 13\" src=\"http:\/\/www.eurospine.org\/cm_data\/motion_Fig13_esp.jpg\" alt=\"Fig 13\" width=\"571\" height=\"304\" \/><a name=\"el31002235\"><\/a><\/p>\n<p>Las t\u00e9cnicas de preservaci\u00f3n del movimiento han ganado un amplio reconocimiento entre los profesionales y pacientes. La idea de evitar la fijaci\u00f3n r\u00edgida es evidentemente atractiva. El futuro dir\u00e1 si estas innovaciones son m\u00e1s eficaces que los procedimientos &#8220;tradicionales&#8221; y en qu\u00e9 casos se convertir\u00e1n en procedimientos est\u00e1ndares.<\/p>\n<p>\u00b7 <span style=\"color: #00ffff;\">Dispositivos inter-espinosos<\/span>: consisten en elementos de diversos materiales que se instalan entre las ap\u00f3fisis espinosas de 2 v\u00e9rtebras contiguas (para un recuerdo anat\u00f3mico dir\u00edjase a la secci\u00f3n de generalidades). Estos elementos act\u00faan como un pivote y un espaciador que regula la motricidad anormalmente alta a la vez que permite descomprimir algunas estructuras neurales, manteniendo cierto grado de movilidad en el segmento afectado.<br \/>\n<span style=\"color: #ff0000;\">Estabilizaci\u00f3n Din\u00e1mica<\/span><\/p>\n<h1>Estabilizaci\u00f3n din\u00e1mica lumbar<\/h1>\n<h2>En qu\u00e9 consiste?<\/h2>\n<p>La estabilizaci\u00f3n din\u00e1mica consiste en colocar un dispositivo, usualmente transpedicular, que limita la movilidad de la columna pero que no la suprime totalmente como es el caso de la fusi\u00f3n lumbar. Por tanto, si objetivo es restringir controladamente los movimientos de la columna lumbar lo que lleva a eliminar el dolor por una parte y por otra parte a no inmovilizar la columna lumbar, con sus consecuentes complicaciones.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/guillemsalo.cat\/wp-content\/uploads\/2015\/09\/Tratamientos.-estabilizaci%C3%B3n-din%C3%A1mica.jpg\"><img decoding=\"async\" class=\"aligncenter wp-image-159\" src=\"https:\/\/guillemsalo.cat\/wp-content\/uploads\/2015\/09\/Tratamientos.-estabilizaci%C3%B3n-din%C3%A1mica.jpg\" sizes=\"(max-width: 650px) 100vw, 650px\" srcset=\"https:\/\/guillemsalo.cat\/wp-content\/uploads\/2015\/09\/Tratamientos.-estabilizaci\u00f3n-din\u00e1mica.jpg 795w, https:\/\/guillemsalo.cat\/wp-content\/uploads\/2015\/09\/Tratamientos.-estabilizaci\u00f3n-din\u00e1mica-300x91.jpg 300w\" alt=\"Tratamientos.-estabilizaci\u00f3n-din\u00e1mica\" width=\"650\" height=\"198\" \/><\/a><\/p>\n<h2>\u00bfA qu\u00e9 pacientes va dirigido?<\/h2>\n<p>La Estabilizaci\u00f3n din\u00e1mica lumbar esta indicada en pacientes j\u00f3venes con degeneraci\u00f3n inicial del disco intervertebral (discopat\u00eda degenerativa lumbar) o inestabilidad de un disco intervertebral (hipermovilidad). Estos sistemas de estabilizaci\u00f3n din\u00e1mica est\u00e1n en pleno desarrollo, por lo que hace falta una visi\u00f3n m\u00e1s a largo plazo para determinar su efectividad. No se debe perder la perspectiva que las fusiones son el tratamiento cl\u00e1sico y que las estabilizaciones din\u00e1micas en la columna con enfermedad degenerativa se reservan para casos puntuales y no son en absoluto un est\u00e1ndar de la t\u00e9cnica para la generalidad de los pacientes.<\/p>\n<h2>\u00bfC\u00f3mo se realiza?<\/h2>\n<p>B\u00e1sicamente existen dos tipos de t\u00e9cnicas para conseguir la estabilizaci\u00f3n din\u00e1mica de la columna.<\/p>\n<p>En primer lugar existen los dispositivos interespinosos, que es un implante m\u00ednimamente invasivo que se asienta entre dos procesos interespinosos en la parte inferior de la columna vertebral. La movilidad se limita m\u00ednimamente.<\/p>\n<p>El segundo tipo de estabilizaci\u00f3n din\u00e1mica se basa en la instrumentaci\u00f3n transpedicular. Consiste en colocar unos tornillos por v\u00eda posterior en los ped\u00edculos de las v\u00e9rtebras, los cuales se unen entre s\u00ed mediante unas barras o dispositivos el\u00e1sticos. Aqu\u00ed no se usa injerto dado que lo que se pretende es estabilizar, no fusionar.<\/p>\n<h2>\u00bfC\u00f3mo es el postoperatorio?<\/h2>\n<p>Habitualmente los pacientes permanecen 24 horas en reposo en cama despu\u00e9s de la cirug\u00eda, retir\u00e1ndose los drenajes a las 48 horas despu\u00e9s de la intervenci\u00f3n. Al segundo d\u00eda inician la deambulaci\u00f3n asistida y la rehabilitaci\u00f3n y al quinto d\u00eda pueden ser dados de alta del hospital siendo aut\u00f3nomos para las actividades de la vida diaria. Se recomienda una faja u ortesis lumbar de confort durante el primer mes. Las grapas o puntos se retiran entre los 10-14 d\u00edas y el paciente sigue la rehabilitaci\u00f3n de forma ambulatoria. El paciente puede volver a realizar una vida normal alrededor de los tres meses en funci\u00f3n de la patolog\u00eda. Los tiempos de recuperaci\u00f3n suelen acortarse en caso de cirug\u00eda m\u00ednimamente invasiva.<\/p>\n<h2>\u00bfQu\u00e9 complicaciones presenta?<\/h2>\n<p>Las complicaciones difieren seg\u00fan la v\u00eda de abordaje. En general, para los abordajes posteriores las complicaciones suponen el 4% de las cirug\u00edas y consisten en infecci\u00f3n (2%), d\u00e9ficit neurol\u00f3gico radicular (1%) y malposici\u00f3n de los implantes, todos ellos reversibles con tratamiento adecuado. Finalmente, en algunos casos puede producirse p\u00e9rdidas hem\u00e1ticas suficientes para que se requiera una transfusi\u00f3n. Las complicaciones a largo plazo son desconocidas, pero podr\u00edan pasar por el aflojamiento del material o la rotura del mismo.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>Ligamentoplastia<\/strong><\/span><\/p>\n<h2><\/h2>\n<p><strong>ESTABILIZACI\u00d3N INTERESPINOSA \u00d3SEA<\/strong><\/p>\n<p>La estabilizaci\u00f3n interespinosa de la columna lumbar es una alternativa que se encuentra entre el tratamiento conservador fallido y una laminectom\u00eda completa o incluso una fusi\u00f3n.<br \/>\nFlexis<\/p>\n<p>Esta alternativa quir\u00fargica permite:<\/p>\n<ul>\n<li>Disminuir la presi\u00f3n de las facetas interarticulares y el espacio intervertebral incrementando la tensi\u00f3n de los tejidos adyacentes.<\/li>\n<li>Aliviar el dolor recuperando la estabilidad.<\/li>\n<li>Preservar futuras opciones quir\u00fargicas para una ulterior fusi\u00f3n vertebral si fuera necesario.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">El Wallis es un sistema estabilizador din\u00e1mico posterior que permite el tratamiento de las lumbalgias asociadas con lesiones degenerativas. Permite tratar los dolores, preserva la movilidad, la anatom\u00eda y la estabilidad del segmento.<\/p>\n<p style=\"text-align: justify;\">Esta indicado en:<\/p>\n<p style=\"text-align: justify;\">HDL \u2013 Hernias discales voluminosas, recidivantes o multiples<\/p>\n<p style=\"text-align: justify;\">DDD- Enfermedad degenerativa discal<\/p>\n<p style=\"text-align: justify;\">Lesiones degenerativas<\/p>\n<p style=\"text-align: justify;\">Estenosis de Canal<\/p>\n<p style=\"text-align: justify;\">El Wallis esta dise\u00f1ado para colocarse solo en la columna lumbar (L1-L5)<\/p>\n\n<!-- GDE Error: No se ha podido cargar el perfil solicitado. -->\n\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong>Descripci\u00f3n del implante Yoda<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><strong><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Yoda.png\"  decoding=\"async\" class=\"alignleft size-full wp-image-260\" title=\"Yoda\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Yoda.png\" alt=\"Yoda\" width=\"268\" height=\"268\" \/><noscript><img decoding=\"async\" class=\"alignleft size-full wp-image-260\" title=\"Yoda\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Yoda.png\" alt=\"Yoda\" width=\"268\" height=\"268\" \/></noscript><\/strong><\/p>\n<p style=\"text-align: justify;\">Tiene un<strong> dise\u00f1o anat\u00f3mico <\/strong>que se adapta perfectamente a las ap\u00f3fisis espinosas. Las bandas laterales planas de poli\u00e9ster optimizan la superficie de contacto y la caja y las fijaciones de PEEK proporcionan al implante una elasticidad y unas propiedades mec\u00e1nicas comparables a las del hueso.<\/p>\n<p style=\"text-align: justify;\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JRFC.png\"  decoding=\"async\" class=\"alignnone size-full wp-image-1103\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JRFC.png\" alt=\"Inf-JRFC\" width=\"425\" height=\"319\" \/><noscript><img decoding=\"async\" class=\"alignnone size-full wp-image-1103\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Inf-JRFC.png\" alt=\"Inf-JRFC\" width=\"425\" height=\"319\" \/></noscript> <img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/IMG_0594.png\"  decoding=\"async\" class=\"alignnone wp-image-1101\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/IMG_0594.png\" alt=\"IMG_0594\" width=\"328\" height=\"328\" \/><noscript><img decoding=\"async\" class=\"alignnone wp-image-1101\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/IMG_0594.png\" alt=\"IMG_0594\" width=\"328\" height=\"328\" \/></noscript><\/p>\n<ul>\n<li><span style=\"color: #ff0000;\">Sistemas de barras din\u00e1micas o flexibles<\/span>: se trata de sistemas en general adicionados a tornillos transpediculares que tienen la particularidad de no ser r\u00edgidos y permitir cierto grado de flexion y extension controlada.<\/li>\n<\/ul>\n<p>Los sistemas de estabilizaci\u00f3n din\u00e1mica est\u00e1n en pleno desarrollo, por lo que esta secci\u00f3n sera\u00e1permanentemente actualizada. No se debe perder la perspectiva que las fusiones y estabilizaciones en la columna con enfermedad degenerativa se reservan para casos puntuales y no son en absolute un est\u00e1ndar de la t\u00e9cnica para la generalidad de los pacientes.<br \/>\n<iframe src=\"http:\/\/www.youtube.com\/embed\/91krOjmv8pY\" width=\"640\" height=\"480\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<h3 class=\"post-title entry-title\"><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/6.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/6.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2132 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/6.jpg\" alt=\"6\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2132 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/6.jpg\" alt=\"6\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/7.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/7.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2133 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/7.jpg\" alt=\"7\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2133 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/7.jpg\" alt=\"7\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/8.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/8.jpg\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2134\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/8.jpg\" alt=\"8\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2134\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/8.jpg\" alt=\"8\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/9.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/9.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2135 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/9.jpg\" alt=\"9\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2135 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/9.jpg\" alt=\"9\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/10.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/10.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2136 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/10.jpg\" alt=\"10\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2136 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/10.jpg\" alt=\"10\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/11.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/11.jpg\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2137\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/11.jpg\" alt=\"11\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2137\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/11.jpg\" alt=\"11\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/13.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/13.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2138 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/13.jpg\" alt=\"13\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2138 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/13.jpg\" alt=\"13\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/14.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/14.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2139 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/14.jpg\" alt=\"14\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2139 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/14.jpg\" alt=\"14\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/15.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/15.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2140 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/15.jpg\" alt=\"15\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2140 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/15.jpg\" alt=\"15\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/16.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/16.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2141 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/16.jpg\" alt=\"16\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2141 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/16.jpg\" alt=\"16\" width=\"210\" height=\"300\" \/></noscript><\/a><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/17.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/17.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2142 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/17.jpg\" alt=\"17\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2142 alignleft\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/17.jpg\" alt=\"17\" width=\"210\" height=\"300\" \/></noscript><\/a><\/h3>\n<p>&nbsp;<\/p>\n<p><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/18.jpg\"  decoding=\"async\" class=\"size-medium wp-image-2143 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/18.jpg\" alt=\"18\" width=\"210\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"size-medium wp-image-2143 alignright\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:210\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/18.jpg\" alt=\"18\" width=\"210\" height=\"300\" \/></noscript><\/p>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<p>&lt;<\/p>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<div><b>Para trabajar los m\u00fasculos del tren superior, tronco y piernas en casa, se pueden realizar las siguientes actividades:<\/b><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><\/div>\n<ul>\n<li><b>Gemelos:\u00a0<\/b>Utilizando unas escaleras, hacemos ejercicios de multisaltos con ellas:\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-0SatnJDdKPg\/UpOgBSNOmbI\/AAAAAAAAACQ\/SeqZkyGhD1M\/s1600\/gemelos.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-0SatnJDdKPg\/UpOgBSNOmbI\/AAAAAAAAACQ\/SeqZkyGhD1M\/s320\/gemelos.jpg\" width=\"195\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<\/li>\n<li>\n<div class=\"separator\"><b>Cu\u00e1driceps:\u00a0<\/b>Sentadillas.<\/div>\n<\/li>\n<\/ul>\n<div><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-c-SrFdyuo8o\/UpOg6YCkEjI\/AAAAAAAAACY\/hzzIzijHpTk\/s1600\/ejercicios-cuadriceps.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-c-SrFdyuo8o\/UpOg6YCkEjI\/AAAAAAAAACY\/hzzIzijHpTk\/s1600\/ejercicios-cuadriceps.jpg\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<ul>\n<li><b>Gl\u00fateos:\u00a0<\/b>Sentadillas en V.\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-qALSTTtEbmo\/UpOijEer_JI\/AAAAAAAAACk\/5gcs75n_Kps\/s1600\/5_Sentadilla_en_V.jpg\"><img decoding=\"async\" src=\"http:\/\/2.bp.blogspot.com\/-qALSTTtEbmo\/UpOijEer_JI\/AAAAAAAAACk\/5gcs75n_Kps\/s1600\/5_Sentadilla_en_V.jpg\" border=\"0\" \/><\/a><\/div>\n<\/li>\n<li><b>Abdominales:<\/b><\/li>\n<\/ul>\n<div><b>\u00a0<\/b><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-Myi6OX88BZk\/UpOjQ_lGyiI\/AAAAAAAAACs\/PN7msIfmGnw\/s1600\/Entrenamiento-de-Abdominales-en-casa.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-Myi6OX88BZk\/UpOjQ_lGyiI\/AAAAAAAAACs\/PN7msIfmGnw\/s320\/Entrenamiento-de-Abdominales-en-casa.jpg\" width=\"196\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div>\n<ul>\n<li><b>Lumbares:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/1.bp.blogspot.com\/-x_mglmSitKM\/UpOjsfAALzI\/AAAAAAAAAC0\/4cM9f94_pd8\/s1600\/ejercicio_lumbar.jpg\"><img decoding=\"async\" src=\"http:\/\/1.bp.blogspot.com\/-x_mglmSitKM\/UpOjsfAALzI\/AAAAAAAAAC0\/4cM9f94_pd8\/s320\/ejercicio_lumbar.jpg\" width=\"320\" height=\"227\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Pectorales:\u00a0<\/b>Apoy\u00e1ndonos en una o m\u00e1s sillas, procedemos a hacer flexiones.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-AfVFhkPk9sc\/UpOkWhN2yfI\/AAAAAAAAAC8\/24tdwli5Rag\/s1600\/120-pectorales-en-casa1_thumb_a.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-AfVFhkPk9sc\/UpOkWhN2yfI\/AAAAAAAAAC8\/24tdwli5Rag\/s1600\/120-pectorales-en-casa1_thumb_a.jpg\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Dorsales:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-eBpkzxvmZic\/UpOk5n1tZGI\/AAAAAAAAADE\/B6YwJuSpAwk\/s1600\/Ejercicios-Espalda-dorsales-l.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-eBpkzxvmZic\/UpOk5n1tZGI\/AAAAAAAAADE\/B6YwJuSpAwk\/s320\/Ejercicios-Espalda-dorsales-l.jpg\" width=\"320\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div><b>\u00a0<\/b><\/div>\n<div>\n<ul>\n<li><b>B\u00edceps:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-I-gsjSGlH9o\/UpOlqJi3wMI\/AAAAAAAAADM\/TamRDQi6cnY\/s1600\/biceps-74724.jpg\"><img decoding=\"async\" src=\"http:\/\/2.bp.blogspot.com\/-I-gsjSGlH9o\/UpOlqJi3wMI\/AAAAAAAAADM\/TamRDQi6cnY\/s320\/biceps-74724.jpg\" width=\"295\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Tr\u00edceps:<\/b><\/li>\n<\/ul>\n<\/div>\n<h3 class=\"post-title entry-title\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-czBGPj2i2FI\/UpOl-rNj-zI\/AAAAAAAAADU\/Ivy9k6gQeOc\/s320\/triceps.jpg\" \/><\/h3>\n<h3 class=\"post-title entry-title\">ME PONGO EN FORMA EN CASA<\/h3>\n<div><u>UNIDAD 1<\/u>: Actividad F\u00edsica y Salud.<\/div>\n<div><\/div>\n<div><b>1. H\u00e1bitos saludables.<\/b><\/div>\n<div>Aquellas conductas de nuestra vida cotidiana que inciden en nuestro bienestar f\u00edsico, mental y social.<\/div>\n<div><\/div>\n<ul>\n<li>Ayudan a prevenir enfermedades y lesiones.<\/li>\n<li>Nos garantizan m\u00e1s energ\u00eda.<\/li>\n<li>Mayor autoestima y satisfacci\u00f3n personal.<\/li>\n<\/ul>\n<div><u>La alimentaci\u00f3n:<\/u><\/div>\n<div><\/div>\n<ul>\n<li>Comer despacio y masticando bien.<\/li>\n<li>Realizar cuatro o cinco comidas al d\u00eda, bien distribuidas.<\/li>\n<li>Mantener un horario regular de comidas.<\/li>\n<li>El desayuno debe ser la comida m\u00e1s importante del d\u00eda.<\/li>\n<li>La cena debe ser ligera.<\/li>\n<li>Evitar ejercicios f\u00edsicos pesados despu\u00e9s de comer.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-3P5Y5VkhDz0\/UpOrzNAP0QI\/AAAAAAAAADk\/ogGhp4uC29Y\/s1600\/Pir%C3%A1mide-de-alimentaci%C3%B3n-saludable-SENC-2004.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-3P5Y5VkhDz0\/UpOrzNAP0QI\/AAAAAAAAADk\/ogGhp4uC29Y\/s320\/Pir%C3%A1mide-de-alimentaci%C3%B3n-saludable-SENC-2004.jpg\" width=\"307\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><u>El descanso:<\/u><\/div>\n<div>\n<ul>\n<li>Dormir un n\u00famero suficiente de horas (unas 8 horas).<\/li>\n<li>La cama debe ser firme.<\/li>\n<li>Evitar acostarse justo despu\u00e9s de comer.<\/li>\n<li>No acostarse justo despu\u00e9s de hacer ejercicio f\u00edsico.<\/li>\n<li>Dedicar unos minutos a dormir o descansar a lo largo del d\u00eda.<\/li>\n<li>Cuidar las condiciones de descanso.<\/li>\n<li>Prepararse para el descanso.<\/li>\n<\/ul>\n<div><u>La higiene corporal:<\/u><\/div>\n<\/div>\n<div>\n<ul>\n<li>Utilizar vestimenta espec\u00edfica.<\/li>\n<li>Evitar el uso repetido de la vestimenta para hacer ejercicio f\u00edsico.<\/li>\n<li>Utilizar un buen calzado.<\/li>\n<li>Ducharse despu\u00e9s de hacer ejercicio f\u00edsico.<\/li>\n<li>No andar descalzo en vestuarios p\u00fablicos.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-I4RBpa7PZTE\/UpOtu1XTLhI\/AAAAAAAAADw\/udkOaSYrmi0\/s1600\/H%C3%81BITOS+SALUDABLES+4%C2%BA.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-I4RBpa7PZTE\/UpOtu1XTLhI\/AAAAAAAAADw\/udkOaSYrmi0\/s400\/H%C3%81BITOS+SALUDABLES+4%C2%BA.jpg\" width=\"400\" height=\"161\" border=\"0\" \/><\/a><\/div>\n<div><b>2. H\u00e1bitos saludables relacionados con la actividad f\u00edsica.<\/b><\/div>\n<\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><u>Antes del ejercicio:<\/u><\/div>\n<div>\n<ul>\n<li>Vestimenta c\u00f3moda y transpirable. Zapatillas bien atadas.<\/li>\n<li>Realizar un calentamiento correcto antes de realizar actividad f\u00edsica.<\/li>\n<li>Evitar los cortes de digesti\u00f3n.<\/li>\n<\/ul>\n<div><u>Durante el ejercicio:<\/u><\/div>\n<\/div>\n<div>\n<ul>\n<li>Iniciar la actividad de forma suave y progresiva.<\/li>\n<li>Beber abundante l\u00edquido.<\/li>\n<li>Dosificar el esfuerzo. Controla la intensidad en funci\u00f3n de tu estado f\u00edsico y el ejercicio.<\/li>\n<li>Respirar adecuadamente.<\/li>\n<\/ul>\n<div><u>Despu\u00e9s del ejercicio:<\/u><\/div>\n<\/div>\n<div>\n<ul>\n<li>Abrigarse si hace fr\u00edo.<\/li>\n<li>Realizar ejercicios de estiramiento, relajaci\u00f3n o respiratorios.<\/li>\n<li>Beber l\u00edquidos para recuperar fluidos.<\/li>\n<li>Si la actividad ha sido muy intensa, procura comer hidratos de carbono.<\/li>\n<\/ul>\n<div><b>3. Dec\u00e1logo para una vida sana.<\/b><\/div>\n<\/div>\n<div>\n<ul>\n<li>Reflexiona sobre tus h\u00e1bitos.<\/li>\n<li>Mejor prevenir que curar.<\/li>\n<li>El ejercicio f\u00edsico es un seguro de vida.<\/li>\n<li>Descansa lo suficiente.<\/li>\n<li>Cuida tu alimentaci\u00f3n.<\/li>\n<li>Cuida tu actitud postural.<\/li>\n<li>Evita el alcohol y el tabaco.<\/li>\n<li>Procura trasladar tus h\u00e1bitos saludables a tu familia.<\/li>\n<li>Acude al m\u00e9dico cuando notes que algo no va bien.<\/li>\n<li>Mant\u00e9n una actitud positiva.<\/li>\n<\/ul>\n<div><b>4. Factores perjudiciales para la salud.<\/b><\/div>\n<\/div>\n<div>\n<p>Factores prejudiciales para la salud si los convertimos en h\u00e1bitos.<\/p>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-wPt-TPlYFi8\/UpOyk72kjdI\/AAAAAAAAAEA\/Eqwx1wwZzzc\/s1600\/image001.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-wPt-TPlYFi8\/UpOyk72kjdI\/AAAAAAAAAEA\/Eqwx1wwZzzc\/s400\/image001.jpg\" width=\"400\" height=\"290\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><b>5. Actividad f\u00edsica y sobrepeso.<\/b><\/div>\n<div class=\"separator\">Factores influyentes en el aumento de la obesidad de la poblaci\u00f3n:<\/div>\n<div class=\"separator\"><\/div>\n<ul>\n<li>Falta de ejercicio f\u00edsico regular (sedentarismo).<\/li>\n<li>Dieta desequilibrada y aporte cal\u00f3rico excesivo.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-uTGf4xE5QWE\/UpPIJhXgK1I\/AAAAAAAAAEQ\/Z9O5xCzZyPE\/s1600\/obesidad.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-uTGf4xE5QWE\/UpPIJhXgK1I\/AAAAAAAAAEQ\/Z9O5xCzZyPE\/s320\/obesidad.jpg\" width=\"224\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div><\/div>\n<div><u>Consejos:<\/u><\/div>\n<div>\n<ul>\n<li>Cuidado con las modas.<\/li>\n<li>Lo importante es que est\u00e9s a gusto contigo mismo.<\/li>\n<li>Cuando realizas un ejercicio f\u00edsico, puede ocurrir que ganes peso por aumentar tu masas muscular.<\/li>\n<li>No existen las llamadas &#8220;Dietas milagrosas&#8221; para perder peso.<\/li>\n<li>Mant\u00e9n una dieta equilibrada.<\/li>\n<li>Distribuye las comidas.<\/li>\n<li>Practica ejercicio f\u00edsico con regularidad.<\/li>\n<\/ul>\n<div><\/div>\n<\/div>\n<div class=\"separator\"><b>6. Actividad f\u00edsica y anorexia.<\/b><\/div>\n<\/div>\n<div><u>S\u00edntomas de anorexia:<\/u><\/div>\n<div>\n<ul>\n<li>Dejar de comer voluntariamente o alimentaci\u00f3n deficiente.<\/li>\n<li>Obsesi\u00f3n por la delgadez.<\/li>\n<li>Alteraciones en la menstruaci\u00f3n (mujeres).<\/li>\n<li>Estado irascible y nervioso.<\/li>\n<li>Obsesi\u00f3n por el ejercicio f\u00edsico constante.<\/li>\n<li>Depresiones y problemas en relaciones afectivas.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/1.bp.blogspot.com\/-z0nw8AhKSfw\/UpPLqqy-0DI\/AAAAAAAAAEc\/2vClQEQmB2k\/s1600\/anorexia01_0.jpg\"><img decoding=\"async\" src=\"http:\/\/1.bp.blogspot.com\/-z0nw8AhKSfw\/UpPLqqy-0DI\/AAAAAAAAAEc\/2vClQEQmB2k\/s320\/anorexia01_0.jpg\" width=\"320\" height=\"180\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<div><b>7. Actividad f\u00edsica: asma y alergias.<\/b><\/div>\n<div><u>El asma:<\/u><\/div>\n<div>\n<ul>\n<li>Episodios ocasionales de dificultad respiratoria.<\/li>\n<li>Es frecuente en los ni\u00f1os y j\u00f3venes.<\/li>\n<li>Causas:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Hereditarias.<\/li>\n<li>Al\u00e9rgicas.<\/li>\n<li>Emocionales.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p><u>Consejos y recomendaciones:<\/u><\/p>\n<\/div>\n<div>\n<ul>\n<li>No es una enfermedad grave, y el ejercicio f\u00edsico ayuda a su mejor\u00eda y prevenci\u00f3n.<\/li>\n<li>El m\u00e9dico especificar\u00e1 las causas del asma y prescribir\u00e1 un tratamiento.<\/li>\n<li>Se deben desarrollar al m\u00e1ximo las v\u00edas respiratorias, por lo que el deporte es un buen aliado.<\/li>\n<li>Ejercicios aer\u00f3bicos moderados (nataci\u00f3n y carrera).<\/li>\n<li>Actividades al aire libre.<\/li>\n<li>Deportes de equipo (esfuerzos breves y poco intensos).<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-9Ov1pdB2pKc\/UpPObIaQPgI\/AAAAAAAAAEo\/bZeHo0g24ns\/s1600\/Patol+asma.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-9Ov1pdB2pKc\/UpPObIaQPgI\/AAAAAAAAAEo\/bZeHo0g24ns\/s320\/Patol+asma.jpg\" width=\"320\" height=\"210\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<div><b>8. Actividad f\u00edsica y dolores de espalda.<\/b><\/div>\n<div><\/div>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-33LNvTprTqE\/UpPPZqly2XI\/AAAAAAAAAE0\/Uj9-ptb_giA\/s1600\/escoliosis2.gif\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-33LNvTprTqE\/UpPPZqly2XI\/AAAAAAAAAE0\/Uj9-ptb_giA\/s320\/escoliosis2.gif\" width=\"320\" height=\"272\" border=\"0\" \/><\/a><\/div>\n<p>&nbsp;<\/p>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-kll_qLxVD30\/UpPPZoC4lTI\/AAAAAAAAAEw\/kX7GAP6xlRk\/s1600\/escoliosis5.gif\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-kll_qLxVD30\/UpPPZoC4lTI\/AAAAAAAAAEw\/kX7GAP6xlRk\/s320\/escoliosis5.gif\" width=\"320\" height=\"181\" border=\"0\" \/><\/a><\/div>\n<div><u>\u00bfQu\u00e9 hacer?<\/u><\/div>\n<div>\n<ul>\n<li>Seguir las indicaciones del m\u00e9dico y profesores.<\/li>\n<li>Fortalecer los m\u00fasculos del tronco.<\/li>\n<li>Realizar ejercicios de estiramiento en piernas y espalda para liberar tensi\u00f3n.<\/li>\n<li>Dormir sobre una superficie dura y lo m\u00e1s recta posible.<\/li>\n<li>Tener cuidado con las malas posturas y levantamientos de pesos.<\/li>\n<li>Nataci\u00f3n (crol y espalda).<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-d71_imiS7eY\/UpPRj861gPI\/AAAAAAAAAFE\/-t5fArhsn3E\/s1600\/lumbalgia+SCANNER+1++A.jpg\"><img decoding=\"async\" class=\"\" src=\"http:\/\/4.bp.blogspot.com\/-d71_imiS7eY\/UpPRj861gPI\/AAAAAAAAAFE\/-t5fArhsn3E\/s400\/lumbalgia+SCANNER+1++A.jpg\" width=\"530\" height=\"609\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-lWLspfuPLvE\/UpPRkrlcPfI\/AAAAAAAAAFM\/pdsel84ojqw\/s1600\/lumbalgia.jpg\"><img decoding=\"async\" class=\"\" src=\"http:\/\/3.bp.blogspot.com\/-lWLspfuPLvE\/UpPRkrlcPfI\/AAAAAAAAAFM\/pdsel84ojqw\/s400\/lumbalgia.jpg\" width=\"522\" height=\"696\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-wZaQFaRTfqk\/UpPRkEFz1vI\/AAAAAAAAAFI\/_AzjSOJdfbo\/s1600\/Lumbalgia_Imagen1.jpg\"><img decoding=\"async\" class=\"\" src=\"http:\/\/2.bp.blogspot.com\/-wZaQFaRTfqk\/UpPRkEFz1vI\/AAAAAAAAAFI\/_AzjSOJdfbo\/s400\/Lumbalgia_Imagen1.jpg\" width=\"529\" height=\"340\" border=\"0\" \/><\/a><\/div>\n<div><b>9. La relajaci\u00f3n.<\/b><\/div>\n<\/div>\n<div>Busca conseguir la liberaci\u00f3n de tensiones y un mayor estado de bienestar general.<\/div>\n<div><\/div>\n<div><u>Condiciones:<\/u><\/div>\n<div>\n<ul>\n<li>Temperatura agradable.<\/li>\n<li>Posici\u00f3n c\u00f3moda.<\/li>\n<li>Poco ruido.<\/li>\n<li>Sin prisa.<\/li>\n<li>Prendas c\u00f3modas.<\/li>\n<li>Pesar en algo positivo.<\/li>\n<\/ul>\n<div><u>Beneficios:<\/u><\/div>\n<\/div>\n<div>\n<ul>\n<li>Disminuyen tensiones y dolores musculares.<\/li>\n<li>No hay gasto de energ\u00eda innecesario.<\/li>\n<li>Mayor rendimiento en situaciones de concentraci\u00f3n.<\/li>\n<li>Mejora del estado de \u00e1nimo.<\/li>\n<li>Mejora nuestra relaci\u00f3n con los dem\u00e1s.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-QlOvh4l2oh0\/UpPULnhdBkI\/AAAAAAAAAFg\/TOWSBcjNH6g\/s1600\/rutina.estres.jpg\"><img decoding=\"async\" class=\"\" src=\"http:\/\/2.bp.blogspot.com\/-QlOvh4l2oh0\/UpPULnhdBkI\/AAAAAAAAAFg\/TOWSBcjNH6g\/s320\/rutina.estres.jpg\" width=\"433\" height=\"410\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-KphkitVNTNU\/UpPUQnIeeNI\/AAAAAAAAAFo\/TOlfY7_Yogk\/s1600\/Ejercicios_relajacion.jpg\"><img decoding=\"async\" class=\"\" src=\"http:\/\/4.bp.blogspot.com\/-KphkitVNTNU\/UpPUQnIeeNI\/AAAAAAAAAFo\/TOlfY7_Yogk\/s400\/Ejercicios_relajacion.jpg\" width=\"363\" height=\"516\" border=\"0\" \/><\/a><\/div>\n<div>\n<div class=\"separator\"><\/div>\n<\/div>\n<\/div>\n<div class=\"post-header\">\n<div class=\"post-header-line-1\"><\/div>\n<\/div>\n<div id=\"post-body-7542778605065193043\" class=\"post-body entry-content\">\n<div><b>\u00a0<\/b><\/div>\n<div><b>Para trabajar los m\u00fasculos del tren superior, tronco y piernas en casa, se pueden realizar las siguientes actividades:<\/b><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><\/div>\n<ul>\n<li><b>Gemelos:\u00a0<\/b>Utilizando unas escaleras, hacemos ejercicios de multisaltos con ellas:\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-0SatnJDdKPg\/UpOgBSNOmbI\/AAAAAAAAACQ\/SeqZkyGhD1M\/s1600\/gemelos.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-0SatnJDdKPg\/UpOgBSNOmbI\/AAAAAAAAACQ\/SeqZkyGhD1M\/s320\/gemelos.jpg\" width=\"195\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<\/li>\n<li>\n<div class=\"separator\"><b>Cu\u00e1driceps:\u00a0<\/b>Sentadillas.<\/div>\n<\/li>\n<\/ul>\n<div><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-c-SrFdyuo8o\/UpOg6YCkEjI\/AAAAAAAAACY\/hzzIzijHpTk\/s1600\/ejercicios-cuadriceps.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-c-SrFdyuo8o\/UpOg6YCkEjI\/AAAAAAAAACY\/hzzIzijHpTk\/s1600\/ejercicios-cuadriceps.jpg\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<ul>\n<li><b>Gl\u00fateos:\u00a0<\/b>Sentadillas en V.\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-qALSTTtEbmo\/UpOijEer_JI\/AAAAAAAAACk\/5gcs75n_Kps\/s1600\/5_Sentadilla_en_V.jpg\"><img decoding=\"async\" src=\"http:\/\/2.bp.blogspot.com\/-qALSTTtEbmo\/UpOijEer_JI\/AAAAAAAAACk\/5gcs75n_Kps\/s1600\/5_Sentadilla_en_V.jpg\" border=\"0\" \/><\/a><\/div>\n<\/li>\n<li><b>Abdominales:<\/b><\/li>\n<\/ul>\n<div><b>\u00a0<\/b><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-Myi6OX88BZk\/UpOjQ_lGyiI\/AAAAAAAAACs\/PN7msIfmGnw\/s1600\/Entrenamiento-de-Abdominales-en-casa.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-Myi6OX88BZk\/UpOjQ_lGyiI\/AAAAAAAAACs\/PN7msIfmGnw\/s320\/Entrenamiento-de-Abdominales-en-casa.jpg\" width=\"196\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div>\n<ul>\n<li><b>Lumbares:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/1.bp.blogspot.com\/-x_mglmSitKM\/UpOjsfAALzI\/AAAAAAAAAC0\/4cM9f94_pd8\/s1600\/ejercicio_lumbar.jpg\"><img decoding=\"async\" src=\"http:\/\/1.bp.blogspot.com\/-x_mglmSitKM\/UpOjsfAALzI\/AAAAAAAAAC0\/4cM9f94_pd8\/s320\/ejercicio_lumbar.jpg\" width=\"320\" height=\"227\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Pectorales:\u00a0<\/b>Apoy\u00e1ndonos en una o m\u00e1s sillas, procedemos a hacer flexiones.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-AfVFhkPk9sc\/UpOkWhN2yfI\/AAAAAAAAAC8\/24tdwli5Rag\/s1600\/120-pectorales-en-casa1_thumb_a.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-AfVFhkPk9sc\/UpOkWhN2yfI\/AAAAAAAAAC8\/24tdwli5Rag\/s1600\/120-pectorales-en-casa1_thumb_a.jpg\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Dorsales:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-eBpkzxvmZic\/UpOk5n1tZGI\/AAAAAAAAADE\/B6YwJuSpAwk\/s1600\/Ejercicios-Espalda-dorsales-l.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-eBpkzxvmZic\/UpOk5n1tZGI\/AAAAAAAAADE\/B6YwJuSpAwk\/s320\/Ejercicios-Espalda-dorsales-l.jpg\" width=\"320\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div><b>\u00a0<\/b><\/div>\n<div>\n<ul>\n<li><b>B\u00edceps:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-I-gsjSGlH9o\/UpOlqJi3wMI\/AAAAAAAAADM\/TamRDQi6cnY\/s1600\/biceps-74724.jpg\"><img decoding=\"async\" src=\"http:\/\/2.bp.blogspot.com\/-I-gsjSGlH9o\/UpOlqJi3wMI\/AAAAAAAAADM\/TamRDQi6cnY\/s320\/biceps-74724.jpg\" width=\"295\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Tr\u00edceps:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-czBGPj2i2FI\/UpOl-rNj-zI\/AAAAAAAAADU\/Ivy9k6gQeOc\/s1600\/triceps.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-czBGPj2i2FI\/UpOl-rNj-zI\/AAAAAAAAADU\/Ivy9k6gQeOc\/s320\/triceps.jpg\" width=\"310\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div>\n<h3><u>Pruebas realizadas en clase para medir nuestra condici\u00f3n f\u00edsica:<\/u><\/h3>\n<ul>\n<li><b>Fuerza:<\/b><\/li>\n<\/ul>\n<p><a href=\"http:\/\/4.bp.blogspot.com\/-CIW91QZKm4M\/UnvmeZbSyNI\/AAAAAAAAABE\/dAUOlcon4E0\/s1600\/salto+horizontal+dibujo.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-CIW91QZKm4M\/UnvmeZbSyNI\/AAAAAAAAABE\/dAUOlcon4E0\/s320\/salto+horizontal+dibujo.jpg\" width=\"320\" height=\"182\" border=\"0\" \/><\/a>-Salto horizontal.\u00a0Consiste en saltar hacia delante desde una posici\u00f3n inm\u00f3vil y con los pies juntos, tratando de llegar lo m\u00e1s lejos posible. Necesitaremos un metro, y nos colocaremos justo en el comienzo del mismo.\u00a0La distancia realizada se medir\u00e1 desde el comienzo del salto hasta la parte del cuerpo que ha aterrizado m\u00e1s cerca (normalmente, los talones). Si al realizar el salto, nos caemos, el salto ser\u00e1 nulo.<\/p>\n<div>\n<div><\/div>\n<div>-Lanzamiento bal\u00f3n medicinal.Consiste en lanzar un bal\u00f3n medicinal desde una posici\u00f3n inm\u00f3vil, sin saltar, con los dos brazos, desde atr\u00e1s. Necesitaremos dicho bal\u00f3n medicinal y un metro, con el que se medir\u00e1 la distancia que ha realizado el bal\u00f3n hasta su primer contacto con el suelo.<\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-jHvJr7Y53s8\/UnvoE6c0szI\/AAAAAAAAABQ\/zGNIC_ZOIJs\/s1600\/Balon+medicinal.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-jHvJr7Y53s8\/UnvoE6c0szI\/AAAAAAAAABQ\/zGNIC_ZOIJs\/s200\/Balon+medicinal.jpg\" width=\"200\" height=\"142\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div>\n<ul>\n<li><b>Resistencia:<\/b><\/li>\n<\/ul>\n<\/div>\n<div>-Test de Course Navette.\u00a0\u00a0Consiste en recorrer la distancia de 20 metros ininterrumpidamente, al ritmo que marca una grabaci\u00f3n con el registro del protocolo correspondiente. Se pondr\u00e1 en marcha el CD\/casete y al o\u00edr la se\u00f1al de salida el ejecutante, tendr\u00e1 que desplazarse hasta la l\u00ednea contraria (20 metros) y pisarla esperando o\u00edr la siguiente se\u00f1al. Se ha de intentar seguir el ritmo del CD que progresivamente ira aumentando el ritmo de carrera. Se repetir\u00e1 constantemente este ciclo hasta que no pueda pisar la l\u00ednea en el momento en el que suene la se\u00f1al. Cada periodo r\u00edtmico se denomina &#8220;palier&#8221; o &#8220;periodo&#8221; y tiene una duraci\u00f3n de 1 minuto. Necesitaremos una pista de 20 metros de ancho y el casete con la grabaci\u00f3n del protocolo del Test de Course Navette. Mediremos nuestra resistencia respecto al periodo en el que hemos dejado de seguir el ritmo de la se\u00f1al.<\/div>\n<div><\/div>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-4dAgk5ynIdc\/UnvsKX086zI\/AAAAAAAAABc\/y9ERQT44d4M\/s1600\/course+navette.gif\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-4dAgk5ynIdc\/UnvsKX086zI\/AAAAAAAAABc\/y9ERQT44d4M\/s320\/course+navette.gif\" width=\"320\" height=\"242\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div>\n<ul>\n<li><b>Velocidad:<\/b><\/li>\n<\/ul>\n<\/div>\n<div>-Test de velocidad de 40 metros.\u00a0Correr 20m hasta llegar a una l\u00ednea, en la que entrar\u00e1 en m\u00e1xima velocidad, empezando a contar el tiempo hasta que recorra los 40m. Necesitaremos un cron\u00f3metro para medir en segundos el tiempo que se ha tardado en recorrer la distancia propuesta.<\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-q5JLvOPutSs\/UnvtggWASHI\/AAAAAAAAABo\/GBNvdb5mL3s\/s1600\/VELOCIDAD1.JPG\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-q5JLvOPutSs\/UnvtggWASHI\/AAAAAAAAABo\/GBNvdb5mL3s\/s400\/VELOCIDAD1.JPG\" width=\"400\" height=\"160\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div>\n<ul>\n<li><b>Flexibilidad:<\/b><\/li>\n<\/ul>\n<div>&#8211; Prueba de Sit and Reach.\u00a0Necesitaremos un banco o una estructura parecida, un metro y un objeto m\u00f3vil. Para realizar esta prueba, nos sentaremos a uno de los lados del banco, con los pies apoyados totalmente en las patas de este y las piernas completamente estiradas, sin doblar las rodillas. Marcamos con la ayuda de un metro las distancias con el 0 en el punto de contacto de los pies con el banco. A continuaci\u00f3n, colocamos un objeto en el borde del banco. Para medir nuestra flexibilidad, nos colocamos en la posici\u00f3n descrita anteriormente, e intentamos mover el objeto con nuestros dedos lo m\u00e1s lejos posible. Este movimiento mediante el cual movemos el objeto, debe ser lento, sin cambios bruscos de velocidad. Nuestra flexibilidad se medir\u00e1 en funci\u00f3n de la distancia que hemos conseguido desplazar el objeto sobre el banco. Nota: La distancia puede ser negativa.<\/div>\n<\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-IdaDg-lHdCE\/UnvxKg3942I\/AAAAAAAAAB0\/yAVFfVPkiw4\/s1600\/sit-and-reach-flex.gif\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-IdaDg-lHdCE\/UnvxKg3942I\/AAAAAAAAAB0\/yAVFfVPkiw4\/s400\/sit-and-reach-flex.gif\" width=\"400\" height=\"178\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h3 class=\"post-title entry-title\"><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda1.png\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:632\/h:889\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda1.png\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2257\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:632\/h:889\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda1.png\" alt=\"Ejercicios espalda1\" width=\"632\" height=\"889\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2257\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:632\/h:889\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda1.png\" alt=\"Ejercicios espalda1\" width=\"632\" height=\"889\" \/></noscript><\/a><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda.png\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:632\/h:842\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda.png\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2256\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:632\/h:842\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda.png\" alt=\"Ejercicios espalda\" width=\"632\" height=\"842\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2256\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:632\/h:842\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/Ejercicios-espalda.png\" alt=\"Ejercicios espalda\" width=\"632\" height=\"842\" \/></noscript><\/a><\/p>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><\/h3>\n<h3 class=\"post-title entry-title\"><a href=\"http:\/\/manuel-angeles-santiago.blogspot.com.es\/2013\/11\/me-pongo-en-forma-en-casa.html\">ME PONGO EN FORMA EN CASA<\/a><\/h3>\n<div class=\"post-header\"><\/div>\n<div class=\"post-header\"><b style=\"line-height: 1.5;\">\u00a0<\/b><\/div>\n<div id=\"post-body-7542778605065193043\" class=\"post-body entry-content\">\n<div><b>Para trabajar los m\u00fasculos del miembro superior, tronco y piernas en casa, se pueden realizar las siguientes actividades:<\/b><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><\/div>\n<ul>\n<li><b>Gemelos: <\/b>Utilizando unas escaleras, hacemos ejercicios de multisaltos con ellas:\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-0SatnJDdKPg\/UpOgBSNOmbI\/AAAAAAAAACQ\/SeqZkyGhD1M\/s1600\/gemelos.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-0SatnJDdKPg\/UpOgBSNOmbI\/AAAAAAAAACQ\/SeqZkyGhD1M\/s320\/gemelos.jpg\" alt=\"\" width=\"195\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<\/li>\n<li>\n<div class=\"separator\"><b>Cu\u00e1driceps: <\/b>Sentadillas.<\/div>\n<\/li>\n<\/ul>\n<div><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-c-SrFdyuo8o\/UpOg6YCkEjI\/AAAAAAAAACY\/hzzIzijHpTk\/s1600\/ejercicios-cuadriceps.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-c-SrFdyuo8o\/UpOg6YCkEjI\/AAAAAAAAACY\/hzzIzijHpTk\/s1600\/ejercicios-cuadriceps.jpg\" alt=\"\" border=\"0\" \/><\/a><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<div class=\"separator\"><\/div>\n<ul>\n<li><b>Gl\u00fateos: <\/b>Sentadillas en V.\n<div class=\"separator\"><a href=\"http:\/\/2.bp.blogspot.com\/-qALSTTtEbmo\/UpOijEer_JI\/AAAAAAAAACk\/5gcs75n_Kps\/s1600\/5_Sentadilla_en_V.jpg\"><img decoding=\"async\" src=\"http:\/\/2.bp.blogspot.com\/-qALSTTtEbmo\/UpOijEer_JI\/AAAAAAAAACk\/5gcs75n_Kps\/s1600\/5_Sentadilla_en_V.jpg\" alt=\"\" border=\"0\" \/><\/a><\/div>\n<\/li>\n<li><b>Abdominales:<\/b><\/li>\n<\/ul>\n<div><b>\u00a0<\/b><\/div>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-Myi6OX88BZk\/UpOjQ_lGyiI\/AAAAAAAAACs\/PN7msIfmGnw\/s1600\/Entrenamiento-de-Abdominales-en-casa.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-Myi6OX88BZk\/UpOjQ_lGyiI\/AAAAAAAAACs\/PN7msIfmGnw\/s320\/Entrenamiento-de-Abdominales-en-casa.jpg\" alt=\"\" width=\"196\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div>\n<ul>\n<li><b>Lumbares:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/1.bp.blogspot.com\/-x_mglmSitKM\/UpOjsfAALzI\/AAAAAAAAAC0\/4cM9f94_pd8\/s1600\/ejercicio_lumbar.jpg\"><img decoding=\"async\" src=\"http:\/\/1.bp.blogspot.com\/-x_mglmSitKM\/UpOjsfAALzI\/AAAAAAAAAC0\/4cM9f94_pd8\/s320\/ejercicio_lumbar.jpg\" alt=\"\" width=\"320\" height=\"227\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Pectorales: <\/b>Apoy\u00e1ndonos en una o m\u00e1s sillas, procedemos a hacer flexiones.<\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-AfVFhkPk9sc\/UpOkWhN2yfI\/AAAAAAAAAC8\/24tdwli5Rag\/s1600\/120-pectorales-en-casa1_thumb_a.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-AfVFhkPk9sc\/UpOkWhN2yfI\/AAAAAAAAAC8\/24tdwli5Rag\/s1600\/120-pectorales-en-casa1_thumb_a.jpg\" alt=\"\" border=\"0\" \/><\/a><\/div>\n<div><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Dorsales:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/4.bp.blogspot.com\/-eBpkzxvmZic\/UpOk5n1tZGI\/AAAAAAAAADE\/B6YwJuSpAwk\/s1600\/Ejercicios-Espalda-dorsales-l.jpg\"><img decoding=\"async\" src=\"http:\/\/4.bp.blogspot.com\/-eBpkzxvmZic\/UpOk5n1tZGI\/AAAAAAAAADE\/B6YwJuSpAwk\/s320\/Ejercicios-Espalda-dorsales-l.jpg\" alt=\"\" width=\"320\" height=\"320\" border=\"0\" \/><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<\/div>\n<div><b>\u00a0<\/b><\/div>\n<div>\n<ul>\n<li><b>B\u00edceps:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:auto\/h:auto\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/biceps.jpg\"><img data-opt-src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:278\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/biceps.jpg\"  decoding=\"async\" class=\"alignleft size-medium wp-image-2150\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:278\/h:300\/q:eco\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/biceps.jpg\" alt=\"biceps\" width=\"278\" height=\"300\" \/><noscript><img decoding=\"async\" class=\"alignleft size-medium wp-image-2150\" src=\"https:\/\/mldvd8hsxxw8.i.optimole.com\/w:278\/h:300\/q:mauto\/f:avif\/http:\/\/doctorlinares.com\/trauma\/wp-content\/uploads\/2012\/04\/biceps.jpg\" alt=\"biceps\" width=\"278\" height=\"300\" \/></noscript><\/a><\/div>\n<div><b>\u00a0<\/b><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<\/div>\n<div>\n<ul>\n<li><b>Tr\u00edceps:<\/b><\/li>\n<\/ul>\n<div class=\"separator\"><a href=\"http:\/\/3.bp.blogspot.com\/-czBGPj2i2FI\/UpOl-rNj-zI\/AAAAAAAAADU\/Ivy9k6gQeOc\/s1600\/triceps.jpg\"><img decoding=\"async\" src=\"http:\/\/3.bp.blogspot.com\/-czBGPj2i2FI\/UpOl-rNj-zI\/AAAAAAAAADU\/Ivy9k6gQeOc\/s320\/triceps.jpg\" alt=\"\" width=\"310\" height=\"320\" border=\"0\" \/><\/a><a 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