<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-054X</journal-id>
<journal-title><![CDATA[Cirugía y cirujanos]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. cir.]]></abbrev-journal-title>
<issn>2444-054X</issn>
<publisher>
<publisher-name><![CDATA[Academia Mexicana de Cirugía A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-054X2019000300299</article-id>
<article-id pub-id-type="doi">10.24875/ciru.19000583</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Directrices en la decisión del manejo quirúrgico en la cirugía de columna vertebral]]></article-title>
<article-title xml:lang="en"><![CDATA[Guidelines in the decision of surgical management in spine surgery]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jiménez-Ávila]]></surname>
<given-names><![CDATA[José María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez-García]]></surname>
<given-names><![CDATA[Omar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Cisneros]]></surname>
<given-names><![CDATA[Arelhi C.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente Clínica de Columna]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Militar Regional de Especialidades  ]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Tecnológico y de Estudios Superiores de Monterrey Escuela de Medicina ]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2019</year>
</pub-date>
<volume>87</volume>
<numero>3</numero>
<fpage>299</fpage>
<lpage>307</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-054X2019000300299&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-054X2019000300299&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-054X2019000300299&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: El cirujano de columna cuenta con conocimientos y habilidades que le permiten tomar decisiones al momento de realizar un procedimiento quirúrgico, basado en la evidencia, en valores éticos y en las expectativas del paciente. Cualquier procedimiento quirúrgico será precedido por el diagnóstico basado en cuatro pilares fundamentales: traumático, degenerativo, síndrome de destrucción vertebral y deformidades. Una vez categorizada la lesión, el cirujano utilizará sus conocimientos para identificar la inestabilidad o el compromiso neurológico. Al realizar un procedimiento quirúrgico, en el transoperatorio deberán tenerse en mente los cuatro objetivos fundamentales con los que contará para lograr un manejo satisfactorio: descomprimir, instrumentar, fusionar y corregir el balance sagital.  Objetivo: Analizar los criterios fundamentales en la toma de decisión para el manejo conservador o quirúrgico en la columna vertebral.  Resultados: Se analizaron las escalas de medición y de evaluación más frecuentes y mayormente efectivas en relación a la cirugía de columna, mismos que obligadamente tienen que ser aplicadas y evaluadas en cada caso particular, lo cual permite fortalecer la impresión diagnóstica y el valor pronóstico.  Conclusión: Implementar la cultura del uso de mediciones de resultados de pacientes como instrumento de evaluación ayuda al cirujano de columna a decidir un plan de tratamiento que pueda adecuarse a las preferencias y las necesidades del paciente. Debemos fundamentar nuestro objetivo clínico en la estabilidad y el compromiso neurológico del paciente, existiendo cuatro posibilidades diagnósticas, que se corregirán para cuatro objetivos fundamentales.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: The spine surgeon has knowledge and skills that allow him to make decisions when performing a surgical procedure, based on the evidence and ethical values and expectations of the patient. Any surgical procedure will be preceded by a diagnosis based on four fundamental pillars: traumatic, degenerative, vertebral destruction syndrome and deformities. Once the lesion is categorized, the surgeon will use his knowledge to identify instability or neurological compromise. When performing a surgical procedure, it should be kept in mind in the transoperative the four key objectives that will count, to achieve a satisfactory management: decompress, implement, merge and correct the sagittal balance.  Objective: To analyze the fundamental criteria in decision making, for conservative or surgical management in the spine.  Results: The assessment scales and the most frequent and best practices in relation to spine surgery will be analyzed, as well as the applications that will be applied and evaluated in each particular case, which will strengthen the diagnostic impression and the value forecast.  Conclusion: Implementing the culture of using patient outcome measurements as an assessment tool helps the spine surgeon to decide on a treatment plan that can be adapted to the patient's preferences and needs. We must base our clinical objective on the stability and the neurological commitment of the patient, there being four diagnostic possibilities; which will be corrected for four fundamental objectives.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Cirugía]]></kwd>
<kwd lng="es"><![CDATA[Columna]]></kwd>
<kwd lng="es"><![CDATA[Guías de práctica clínica]]></kwd>
<kwd lng="es"><![CDATA[Indicaciones]]></kwd>
<kwd lng="es"><![CDATA[Vertebral]]></kwd>
<kwd lng="en"><![CDATA[Clinical practice guidelines]]></kwd>
<kwd lng="en"><![CDATA[Indications]]></kwd>
<kwd lng="en"><![CDATA[Spine]]></kwd>
<kwd lng="en"><![CDATA[Surgery]]></kwd>
<kwd lng="en"><![CDATA[Vertebral]]></kwd>
</kwd-group>
</article-meta>
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