IMPACTO DE LA CIRUGÍA MÍNIMAMENTE INVASIVA EN CIRUGÍA DE COLUMNA
Palabras clave:
cirugía, cirugía de columna, cirugía mínimamente invasiva, economía, resultados, impactosResumen
Introducción: La tecnología ha cambiado el estilo de vida de la humanidad llegando a impactar incluso nuestra expectativa de vida. Al vivir más, los seres humanos enfrentan mayores problemas relacionados con la edad, entre ellos, las enfermedades degenerativas. De la misma forma, la Medicina se ha visto impactada de manera positiva con esos avances tecnológicos y ha desarrollado nuevas maneras de tratar patologías complejas. Las técnicas mínimamente invasivas se basan en el principio: “primum non nocere”, minimizando la lesión iatrogénica inherente de la cirugía. El propósito de este documento es analizar qué tan relevante y positivo ha sido el impacto de la cirugía mínimamente invasiva de columna en el manejo del dolor de cuello y espalda. Desarrollo: Los autores agruparon el tipo de impacto desde cuatro perspectivas: los resultados y desenlaces quirúrgicos, la relación costo-beneficio, beneficios para los pacientes para con estas técnicas y, por último, el impacto sobre los especialistas y las especialidades. Conclusiones: Las técnicas MISS han tenido una serie de impactos positivos frente al tratamiento de la patología de columna. Sus excelentes resultados clínicos, su alta satisfacción en los pacientes y su adecuada relación costo-beneficio, deben estimular a los cirujanos para enfrentar los nuevos retos que se plantean con el fin de ofrecer estos beneficios a los pacientes y al sistema de salud en general.
Biografía del autor/a
Jorge Felipe Ramírez León, Centro de Cirugía de Mínima Invasión, Cecimin. Clínica Reina Sofía
MD. Ortopedista Cirujano de Columna. Director Centro de Columna – Cirugía Mínima Invasiva. Presidente Sociedad Iberolatinomericana de Cirujanos de Columna. Centro de Cirugía de Mínima Invasión, Cecimin. Clínica Reina Sofía. Bogotá, Colombia.
Gabriel Oswaldo Alonso Cuéllar, Centro de Columna – Cirugía Mínima Invasiva
MD. Veterinario, Zootecnista. Magíster en Docencia e Investigación Universitaria. Director de Educación e Investigación Centro de Columna – Cirugía Mínima Invasiva. Bogotá, Colombia.
Carolina Ramírez Martínez, Centro de Cirugía de Mínima Invasión, Cecimin. Clínica Reina Sofía
MD. Ortopedista Cirujana de Columna. Centro de Cirugía de Mínima Invasión, Cecimin. Clínica Reina Sofía. Bogotá, Colombia.
José Gabriel Rugeles Ortíz, Centro de Cirugía de Mínima Invasión, Cecimin. Clínica Reina Sofía
MD. Ortopedista Cirujano de Columna. Centro de Cirugía de Mínima Invasión, Cecimin. Clínica Reina Sofía. Bogotá, Colombia
Referencias bibliográficas
1. Solbes J, Vilches A. Papel de las relaciones entre ciencia, tecnología, sociedad y ambiente en la formación ciudadana. Enseñanza de las ciencias. 2004; 22(3): 337–48.
2. Sieverink F, Kelders S, Poel M, van Gemert-Pijnen L. Opening the black box of electronic health: collecting, analyzing, and interpreting log data. JMIR Res Protoc. 2017 Aug 7; 6(8):e156.
3. van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, et al. A holistic framework to improve the uptake and impact of health technologies. J Med Internet Res. 2011 Dec 5; 13(4):e111.
4. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific allcause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Jan 10; 385(9963):117-71.
5. Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018 Feb 26. doi: 10.1007/s00586-017-5432-9. [Epub ahead of print]
6. Craig A Blum, David B Adams. Who did the first laparoscopic cholecystectomy? J Minim Access Surg. 2011 Jul-Sep; 7(3): 165–8.
7. Van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007 Oct;9 Suppl 2:25-34
8. Snyder LA, O’Toole J, Eichholz KM, Perez-Cruet MJ, Fessler R. The technological development of minimally invasive spine surgery. Biomed Res Int. 2014; 2014:293582.
9. Osorio E, Ramírez J, Rugeles J, Alonso G. Endoscopy and thermodiscoplasty: a minimally invasive surgical treatment for lumbar pain. In: Ramina, R et al, editors. Samii’s Essentials in Neurosurgery, 2nd edn. Berlin: Springer; 2014.p. 103-15.
10. Alonso GO, Rugeles JG. Endoscopic interlaminar discectomy. Use of swine cadavers as a training model. Coluna/Columna. 2017;16(2):116-20
11. Ramírez JF, Fonseca E, Rugeles JG, Ramírez C, Alonso GO. Clinical outcomes of thermodiscoplasty. En: Lewandrowski KU, Schubert M, Ramirez JF, Fessler R (Eds) Minimally Invasive Spinal Surgery: Evidence-based Practice. Jayppe Medical. London. 2018. 83-88p
12. Choi G, Pophale CS, Patel B, Uniyal P. Endoscopic Spine Surgery. J Korean Neurosurg Soc. 2017 Sep;60(5):485- 97
13. Ramírez JF, Rugeles JG, Osorio E, Ramírez C, Alonso GO. Radiofrequency neurolysis for lumbar pain using a variation of the original technique. Pain Physician. 2016 Mar; 19(3):155-61.
14. Fu TS, Li YD. Fluoroscopy-guided percutaneous vertebroplasty for symptomatic loosened pedicle screw and instrumentation-associated vertebral fracture: an evaluation of initial experiences and technical note. J Neurosurg Spine. 2018 Jan 12:1-8. [Epub ahead of print]
15. McAnany SJ, Overley SC, Anwar MA, Cutler HS, Guzman JZ, Kim JS, et al. Comparing the incidence of index level fusion following minimally invasive versus open lumbar microdiscectomy. Global Spine J. 2018 Feb; 8(1):11-6.
16. Tapp SJ, Martin BI, Tosteson TD, Lurie JD, Weinstein MC, Deyo RA, et al. Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices. Spine J. 2017 Aug 25. Pii: S1529-9430(17)30944-0.
17. Kamper SJ, Ostelo RW, Rubinstein SM, Nellensteijn JM, Peul WC, Arts MP, et al. Minimally invasive surgery for lumbar disc herniation: a systematic review and metaanalysis. Eur Spine J. 2014 May; 23(5):1021-43.
18. Dasenbrock HH, Juraschek SP, Schultz LR, Witham TF, Sciubba DM, Wolinsky JP, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine. 2012 May; 16(5):452-62.
19. Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J. 2010 Feb; 19(2):181- 204.
20. Imada A, Huynh T, Drazin D. Minimally invasive versus open laminectomy/discectomy, transforaminal lumbar, and posterior lumbar interbody fusions: a systematic review. Cureus. 2017 Jul 18; 9(7):e1488.
21. Archavlis E, Carvi y Nievas M. Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with highgrade facet joint osteoarthritis. Eur Spine J. 2013 Aug; 22(8):1731-40.
22. Bach K, Ahmadian A, Deukmedjian A, Uribe JS. Minimally invasive surgical techniques in adult degenerative spinal deformity: a systematic review. Clin Orthop Relat Res. 2014 Jun; 472(6):1749-61.
23. Hussain NS, Perez-Cruet MJ. Complication management with minimally invasive spine procedures. Neurosurg Focus. 2011 Oct; 31(4):E2.
24. Xie T, Qian J, Lu Y, Chen B, Jiang Y, Luo C. Biomechanical comparison of laminectomy, hemilaminectomy and a new minimally invasive approach in the surgical treatment of multilevel cervical intradural tumour: a finite element analysis. Eur Spine J. 2013 Dec; 22(12):2719- 30.
25. Cizik AM, Lee MJ, Martin BI, Bransford RJ, Bellabarba C, Chapman JR, et al.Using the spine surgical invasiveness index to identify risk of surgical site infection: a multivariate analysis. J Bone Joint Surg Am. 2012 Feb 15; 94(4):335-42
26. Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KM, Broadstone PA, et al. Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine. 2011 Apr 1; 36(7):556-63.
27. Ee WW, Lau WL, Yeo W, Von Bing Y, Yue WM. Does minimally invasive surgery have a lower risk of surgical site infections compared with open spinal surgery? Clin Orthop Relat Res. 2014 Jun; 472(6):1718-24.
28. Perez-Cruet MJ, Hussain NS, White GZ, Begun EM, Collins RA, Fahim DK, et al. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine. 2014 Feb 1;39(3):E191-8
29. Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Kazakos K. Comparison of quality of life between men and women who underwent transforaminal percutaneous endoscopic discectomy for lumbar disc herniation. Int J Spine Surg. 2017 Nov 28; 11:28. doi: 10.14444/4028
30. Kapetanakis S, Charitoudis G, Thomaidis T, Theodosiadis P, Papathanasiou J, Giatroudakis K. Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation. J Craniovertebr Junction Spine. 2017 JanMar; 8(1):44-49.
31. Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017 Jun 27; 17(1):446.
32. Allen RT, Garfin SR. The economics of minimally invasive spine surgery: the value perspective. Spine. 2010 Dec 15; 35(26 Suppl):S375-82.
33. Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012 Aug; 25(6):324-8. 34. Hofstetter CP, Hofer AS, Wang MY. Economic impact of minimally invasive lumbar surgery. World J Orthop. 2015 Mar 18;6(2):190-201
35. Al-Khouja LT, Baron EM, Johnson JP, Kim TT, Drazin D. Cost-effectiveness analysis in minimally invasive spine surgery. Neurosurg Focus. 2014 Jun; 36(6):E4.
36. Lucio JC, Vanconia RB, Deluzio KJ, Lehmen JA, Rodgers JA, Rodgers W. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy. 2012; 5:65-74.
37. Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012 Aug; 25(6):324-8.
38. Voyadzis J. The learning curve in minimally invasive spine surgery. Seminars in Spine Surgery. 2011; 23(1):9-13.
39. Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J. 2013 Apr; 22(4):727-33.
40. Sclafani JA, Kim CW.Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res. 2014 Jun; 472(6):1711-7.
41. Ramírez JF, Alonso GO, Rugeles JG, Ramírez C. Multispecialty and multilanguage training in spine surgery: A Latin-American experience. Educación Médica, 2016; 17. 61-6.
42. Kukreja S, Haydel J, Nanda A, Sin AH. Impact of body habitus on fluoroscopic radiation emission during minimally invasive spine surgery. J Neurosurg Spine. 2015 Feb; 22(2):211-8.
43. Ropper AE, Chi JH. Maximal radiation exposure during minimally invasive spine surgery? Neurosurgery. 2011 Apr; 68(4):N23-4.
44. Yu E, Khan SN. Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res. 2014 Jun; 472(6):1738-48.
45. Srinivasan D, Than KD, Wang AC, La Marca F, Wang PI, Schermerhorn TC, et al. Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg. 2014 Dec; 82(6):1337-43.
46. Webb J, Gottschalk L, Lee YP, Garfin S, Kim C. Surgeon Perceptions of Minimally Invasive Spine Surgery. SAS J. 2008 Sep 1; 2(3):145.
2. Sieverink F, Kelders S, Poel M, van Gemert-Pijnen L. Opening the black box of electronic health: collecting, analyzing, and interpreting log data. JMIR Res Protoc. 2017 Aug 7; 6(8):e156.
3. van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, et al. A holistic framework to improve the uptake and impact of health technologies. J Med Internet Res. 2011 Dec 5; 13(4):e111.
4. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific allcause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Jan 10; 385(9963):117-71.
5. Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018 Feb 26. doi: 10.1007/s00586-017-5432-9. [Epub ahead of print]
6. Craig A Blum, David B Adams. Who did the first laparoscopic cholecystectomy? J Minim Access Surg. 2011 Jul-Sep; 7(3): 165–8.
7. Van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007 Oct;9 Suppl 2:25-34
8. Snyder LA, O’Toole J, Eichholz KM, Perez-Cruet MJ, Fessler R. The technological development of minimally invasive spine surgery. Biomed Res Int. 2014; 2014:293582.
9. Osorio E, Ramírez J, Rugeles J, Alonso G. Endoscopy and thermodiscoplasty: a minimally invasive surgical treatment for lumbar pain. In: Ramina, R et al, editors. Samii’s Essentials in Neurosurgery, 2nd edn. Berlin: Springer; 2014.p. 103-15.
10. Alonso GO, Rugeles JG. Endoscopic interlaminar discectomy. Use of swine cadavers as a training model. Coluna/Columna. 2017;16(2):116-20
11. Ramírez JF, Fonseca E, Rugeles JG, Ramírez C, Alonso GO. Clinical outcomes of thermodiscoplasty. En: Lewandrowski KU, Schubert M, Ramirez JF, Fessler R (Eds) Minimally Invasive Spinal Surgery: Evidence-based Practice. Jayppe Medical. London. 2018. 83-88p
12. Choi G, Pophale CS, Patel B, Uniyal P. Endoscopic Spine Surgery. J Korean Neurosurg Soc. 2017 Sep;60(5):485- 97
13. Ramírez JF, Rugeles JG, Osorio E, Ramírez C, Alonso GO. Radiofrequency neurolysis for lumbar pain using a variation of the original technique. Pain Physician. 2016 Mar; 19(3):155-61.
14. Fu TS, Li YD. Fluoroscopy-guided percutaneous vertebroplasty for symptomatic loosened pedicle screw and instrumentation-associated vertebral fracture: an evaluation of initial experiences and technical note. J Neurosurg Spine. 2018 Jan 12:1-8. [Epub ahead of print]
15. McAnany SJ, Overley SC, Anwar MA, Cutler HS, Guzman JZ, Kim JS, et al. Comparing the incidence of index level fusion following minimally invasive versus open lumbar microdiscectomy. Global Spine J. 2018 Feb; 8(1):11-6.
16. Tapp SJ, Martin BI, Tosteson TD, Lurie JD, Weinstein MC, Deyo RA, et al. Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices. Spine J. 2017 Aug 25. Pii: S1529-9430(17)30944-0.
17. Kamper SJ, Ostelo RW, Rubinstein SM, Nellensteijn JM, Peul WC, Arts MP, et al. Minimally invasive surgery for lumbar disc herniation: a systematic review and metaanalysis. Eur Spine J. 2014 May; 23(5):1021-43.
18. Dasenbrock HH, Juraschek SP, Schultz LR, Witham TF, Sciubba DM, Wolinsky JP, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine. 2012 May; 16(5):452-62.
19. Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J. 2010 Feb; 19(2):181- 204.
20. Imada A, Huynh T, Drazin D. Minimally invasive versus open laminectomy/discectomy, transforaminal lumbar, and posterior lumbar interbody fusions: a systematic review. Cureus. 2017 Jul 18; 9(7):e1488.
21. Archavlis E, Carvi y Nievas M. Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with highgrade facet joint osteoarthritis. Eur Spine J. 2013 Aug; 22(8):1731-40.
22. Bach K, Ahmadian A, Deukmedjian A, Uribe JS. Minimally invasive surgical techniques in adult degenerative spinal deformity: a systematic review. Clin Orthop Relat Res. 2014 Jun; 472(6):1749-61.
23. Hussain NS, Perez-Cruet MJ. Complication management with minimally invasive spine procedures. Neurosurg Focus. 2011 Oct; 31(4):E2.
24. Xie T, Qian J, Lu Y, Chen B, Jiang Y, Luo C. Biomechanical comparison of laminectomy, hemilaminectomy and a new minimally invasive approach in the surgical treatment of multilevel cervical intradural tumour: a finite element analysis. Eur Spine J. 2013 Dec; 22(12):2719- 30.
25. Cizik AM, Lee MJ, Martin BI, Bransford RJ, Bellabarba C, Chapman JR, et al.Using the spine surgical invasiveness index to identify risk of surgical site infection: a multivariate analysis. J Bone Joint Surg Am. 2012 Feb 15; 94(4):335-42
26. Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KM, Broadstone PA, et al. Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine. 2011 Apr 1; 36(7):556-63.
27. Ee WW, Lau WL, Yeo W, Von Bing Y, Yue WM. Does minimally invasive surgery have a lower risk of surgical site infections compared with open spinal surgery? Clin Orthop Relat Res. 2014 Jun; 472(6):1718-24.
28. Perez-Cruet MJ, Hussain NS, White GZ, Begun EM, Collins RA, Fahim DK, et al. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine. 2014 Feb 1;39(3):E191-8
29. Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Kazakos K. Comparison of quality of life between men and women who underwent transforaminal percutaneous endoscopic discectomy for lumbar disc herniation. Int J Spine Surg. 2017 Nov 28; 11:28. doi: 10.14444/4028
30. Kapetanakis S, Charitoudis G, Thomaidis T, Theodosiadis P, Papathanasiou J, Giatroudakis K. Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation. J Craniovertebr Junction Spine. 2017 JanMar; 8(1):44-49.
31. Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017 Jun 27; 17(1):446.
32. Allen RT, Garfin SR. The economics of minimally invasive spine surgery: the value perspective. Spine. 2010 Dec 15; 35(26 Suppl):S375-82.
33. Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012 Aug; 25(6):324-8. 34. Hofstetter CP, Hofer AS, Wang MY. Economic impact of minimally invasive lumbar surgery. World J Orthop. 2015 Mar 18;6(2):190-201
35. Al-Khouja LT, Baron EM, Johnson JP, Kim TT, Drazin D. Cost-effectiveness analysis in minimally invasive spine surgery. Neurosurg Focus. 2014 Jun; 36(6):E4.
36. Lucio JC, Vanconia RB, Deluzio KJ, Lehmen JA, Rodgers JA, Rodgers W. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy. 2012; 5:65-74.
37. Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012 Aug; 25(6):324-8.
38. Voyadzis J. The learning curve in minimally invasive spine surgery. Seminars in Spine Surgery. 2011; 23(1):9-13.
39. Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J. 2013 Apr; 22(4):727-33.
40. Sclafani JA, Kim CW.Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res. 2014 Jun; 472(6):1711-7.
41. Ramírez JF, Alonso GO, Rugeles JG, Ramírez C. Multispecialty and multilanguage training in spine surgery: A Latin-American experience. Educación Médica, 2016; 17. 61-6.
42. Kukreja S, Haydel J, Nanda A, Sin AH. Impact of body habitus on fluoroscopic radiation emission during minimally invasive spine surgery. J Neurosurg Spine. 2015 Feb; 22(2):211-8.
43. Ropper AE, Chi JH. Maximal radiation exposure during minimally invasive spine surgery? Neurosurgery. 2011 Apr; 68(4):N23-4.
44. Yu E, Khan SN. Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res. 2014 Jun; 472(6):1738-48.
45. Srinivasan D, Than KD, Wang AC, La Marca F, Wang PI, Schermerhorn TC, et al. Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg. 2014 Dec; 82(6):1337-43.
46. Webb J, Gottschalk L, Lee YP, Garfin S, Kim C. Surgeon Perceptions of Minimally Invasive Spine Surgery. SAS J. 2008 Sep 1; 2(3):145.
Cómo citar
[1]
Ramírez León, J.F. et al. 2019. IMPACTO DE LA CIRUGÍA MÍNIMAMENTE INVASIVA EN CIRUGÍA DE COLUMNA. Medicina. 41, 2 (jul. 2019), 145–155.
Descargas
Los datos de descargas todavía no están disponibles.
Publicado
2019-07-05
Número
Sección
Artículos de Revisión
Licencia
Copyright
ANM de Colombia
Los autores deben declarar revisión, validación y aprobación para publicación del manuscrito, además de la cesión de los derechos patrimoniales de publicación, mediante un documento que debe ser enviado antes de la aparición del escrito. Puede solicitar el formato a través del correo revistamedicina@anmdecolombia.org.co o descargarlo directamente Documento Garantías y cesión de derechos.docx
Copyright
ANM de Colombia
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent.
