<?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>2306-4102</journal-id>
<journal-title><![CDATA[Acta ortopédica mexicana]]></journal-title>
<abbrev-journal-title><![CDATA[Acta ortop. mex]]></abbrev-journal-title>
<issn>2306-4102</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Ortopedia y Traumatología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2306-41022020000500293</article-id>
<article-id pub-id-type="doi">10.35366/97991</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[A management algorithm for vertebral destruction syndrome by multiple myeloma and metastatic spinal cord compression]]></article-title>
<article-title xml:lang="es"><![CDATA[Algoritmo de manejo para el síndrome de destrucción vertebral por mieloma múltiple y compresión metastásica de la médula espinal]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mireles-Cano]]></surname>
<given-names><![CDATA[JN]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Escoto-Venegas]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-González]]></surname>
<given-names><![CDATA[OG]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Miranda-González]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Ramírez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández-Sepúlveda]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez-Pérez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Guanajuato  ]]></institution>
<addr-line><![CDATA[León ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2020</year>
</pub-date>
<volume>34</volume>
<numero>5</numero>
<fpage>293</fpage>
<lpage>297</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2306-41022020000500293&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2306-41022020000500293&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2306-41022020000500293&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Multiple myeloma represents 1% of all cancers and 10% of hematological cancers. Up to 80-90% of cases will have skeletal involvement and the spine is the most frequently involved site. Any intervention must be aimed to improve the patient&#8217;s functional prognosis and will impact their quality of life.  Objective:  To describe the clinical presentation of vertebral destruction syndrome due to multiple myeloma and to present the management algorithm used for the study and decision-making in treatment.  Material and methods: Study design: Retrospective cross-sectional. A search was made in the hospital&#8217;s clinical file in search of patients with a histological diagnosis of multiple myeloma attended by the Spinal Surgery Service. Clinical characteristics of the initial presentation were obtained such as: presence of pain, ASIA scale and it was categorized according to the Durie-Salmon classification at diagnosis; the levels involved and type of surgery were described.  Results:  The study included ten patients with an average age of 61.4 years, 70% were male subjects. All patients were approach according to the modified protocol for vertebral destruction syndrome and fluoroscopy-guided percutaneous biopsy. Most had pain at diagnosis, after neurologic examination only 30% were classified as ASIA A. Most of the patients were staged III according to Durie Salomon. The most frequently vertebral segment involved was thoracic. In only one patient more than two vertebrae were involved. After diagnosis of multiple myeloma, nine patients were managed according to a NOMS framework. In the majority they were treated with fusion by posterior approach, six of them were augmented with vertebroplasty. Only one patient of the total, was treated with vertebroplasty alone.  Conclusions:  The use of systematized management algorithms will allow better decisions to be made in conjunction with a multidisciplinary group for the care of multiple myeloma with vertebral involvement.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  El mieloma múltiple representa 1% de todos los tipos de cáncer y 10% de los cánceres hematológicos. Hasta en 80-90% de los casos se involucrará el sistema esquelético, siendo la columna el sitio más frecuentemente afectado. Cualquier intervención planeada deberá ser dirigida a mejorar el pronóstico funcional del paciente e impactará en su calidad de vida.  Objetivo:  Describir la presentación clínica del síndrome de destrucción vertebral por mieloma múltiple y presentar el algoritmo de manejo empleado para el estudio y la toma de decisiones en el tratamiento.  Material y métodos: Diseño de estudio: Retrospectivo, transversal. Se realizó una búsqueda en el archivo clínico del hospital en búsqueda de pacientes con diagnóstico histológico de mieloma múltiple atendidos por el Servicio de Cirugía de Columna. Se obtuvieron características clínicas de la presentación inicial como: presencia de dolor, escala de ASIA y se categorizó de acuerdo con la clasificación de Durie-Salmon al diagnóstico; se describen los niveles involucrados y tipo de cirugía.  Resultados:  El estudio incluyó 10 pacientes con una edad promedio de 61.4 años, 70% de los cuales fueron varones. Todos los pacientes se abordaron de acuerdo al protocolo de síndrome de destrucción vertebral y con biopsia percutánea guiada por fluoroscopía. La mayoría de los pacientes tenían dolor al diagnóstico, tras la exploración neurológica sólo el 30% fueron clasificados como ASIA A. La mayoría de los pacientes se estadificaron como III de acuerdo con Durie-Salmon. El segmento vertebral más comúnmente afectado fue el torácico. En sólo un paciente se involucraba más de dos vértebras. Tras el diagnóstico de mieloma múltiple, nueve pacientes fueron manejados de acuerdo con el marco de trabajo NOMS. La mayoría fueron tratados con fusión por un abordaje posterior, seis de ellos con aumentación con vertebroplastía. Sólo un paciente del total, fue tratado sólo con vertebroplastía.  Conclusiones:  El empleo de algoritmos de tratamiento sistematizado permitirá la toma de mejores decisiones en conjunto con un grupo multidisciplinario para el tratamiento de mieloma múltiple con afección vertebral.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Multiple myeloma]]></kwd>
<kwd lng="en"><![CDATA[metastatic spinal cord compression]]></kwd>
<kwd lng="en"><![CDATA[vertebral destruction syndrome]]></kwd>
<kwd lng="es"><![CDATA[Mieloma múltiple]]></kwd>
<kwd lng="es"><![CDATA[compresión metastásica de la médula espinal]]></kwd>
<kwd lng="es"><![CDATA[síndrome de destrucción vertebral]]></kwd>
</kwd-group>
</article-meta>
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