O estreitamento do canal medular é chamado de estenose espinhal e aumenta a probabilidade de compressão da medula, mesmo sem qualquer fratura óssea. Tratamento cirúrgico da estenose degenerativa lombar: comorbidades e Palavras-Chave: Estenose espinhal/cirurgia; Claudicação intermitente; Hipertensão;. This Pin was discovered by IS Life Brasil. Discover (and save) your own Pins on Pinterest.
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Surgical treatment of degenerative lumbar stenosis: Retrospective review of medical records and radiographs of patients with degenerative lumbar estsnose treated surgically. Descriptive analysis of data was done with SAS 9. The most prevalent comorbidities were hypertension Patients with only one preoperative comorbidity showed similar complication rates compared to the population without comorbidities.
Comorbidities negatively influenced the outcome of surgical treatment of degenerative lumbar stenosis with higher rates of postoperative complications. Vertebral lumbar stenosis estehose the narrowing of the vertebral canal, lateral recess, or neural foramen. It generally occurs due to progressive degenerative hypertrophy of any osteocartilaginous and ligament structure, and can result in neurological or vascular compression at one or more lumbar levels.
The patient generally presents pain in the legs, whether due to neurogenic claudication or irradiated pain. Neurogenic claudication is characterized by pain in the legs without defined dermatome, dysesthesia, numbness, discomfort, pins and needles, and postural changes with anterior tilt of the trunk, associated with gait and orthostasis.
Surgical treatment of degenerative lumbar stenosis: comorbidities and complications
The vast majority of patients with degenerative lumbar stenosis DLS begin their treatment in conservative form, with surgical treatment being indicated based on clinical findings, such as refractory pain and claudication over short distances, associated with objective changes in the imaging exams. Factors such advanced age and obesity are related to higher susceptibility to diseases of the spine.
Patients with systemic arterial hypertension SAHinsulin intolerance or diabetes mellitus DMheart disease, and metabolic syndrome. This study was approved by the Research Ethics Committee of the institution. It consists of a quantitative and retrospective analysis of the patient records of patients admitted for surgical treatment for DLS between January and Decemberobtained through analysis of the surgical records of the Department of Spine Surgery of the hospital.
The parameters evaluated were the sex and age of the patients, non-surgical treatments received, the number of segments operated on, the persistence of complaints and need for new surgical intervention, associated comorbidities, and early and late complications. In all the patients operated on, pedicle screws and rods were used as the fixation system, to prevent instability caused by the main surgical procedure.
Intersomatic arthrodesis transforaminal lumbar interbody fusion, TLIFcombined with the main procedure, was performed in 10 patients. The criteria used in the indication for intersomatic arthrodesis was the presence of reduced disc height with mobility of the segment and foraminal stenosis due to an accentuated decrease in disc space.
Thus, the aim was to ensure indirect decompression of the foramen after insertion of the intersomatic device. For descriptive analysis of the data, we used the statistic Student’s t-test for the unpaired samples, and Fisher’s exact test for the categorical variables, with the aid of the program SAS 9.
In the distribution by sex, 47 The average age was The average age of the patients with comorbidities was approximately 6 years older than that of the patients without comorbidities However, when we analyzed patients with the presence of two or more comorbidities, the average age of this group was As treatment prior to the surgery, 38 patients received analgesic medication alone All the patients were submitted to pedicle screw fixation, posterolateral arthrodesis, and decompression of the segment with stenosis.
The most prevalent associated disease in this study was systemic arterial hypertension in 44 patients The presence of other comorbidities was observed in 13 patients Early postoperative complications diagnosed during admission to surgery found were: Late postoperative complications diagnosed after hospital discharge, during the outpatient visits were: The most frequent early complication was postoperative infection, found in seven patients 7.
Meanwhile, residual pain or recurrence of the symptoms and late infection were recorded in five patients each 5. Complications of surgical treatment of degenerative lumbar stenosis.
When analyzed in isolation, the various comorbidities are not related to either higher levels of complications, or to different types of complications from the one studied. The distribution by sex and age group found in our study population is in keeping with what is described in various epidemiological and review studies in the literature on the subject.
Patients with degenerative lumbar stenosis generally start with conservative treatment, with physiotherapy, analgesics, NSAIDs, epidural blocks and calcitonin.
In the series of patient records analyzed, we found a high incidence of comorbidities, probably because it is a tertiary reference center. Furthermore, as described by Kats et al.
Similarly, as demonstrated by other studies, patients with comorbidities present higher levels of complications as a result of surgical treatment for degenerative lumbar stenosis.
Although Athiviraham et al.
Espunhal, factors like age, lifestyle, expectation, and general state of health of the patients can contribute to the decision on surgical conduct. This study has some weak points, such as the absence of estfnose of the patients’ sagittal balance, and the presence of degenerative disease of the adjacent disc, which could influence the clinical result and consequently, the results of our study.
Furthermore, obesity, mood disorders, smoking, and assessments of expectations and satisfaction could have been included in our evaluation, providing more data on the patient’s response to the treatment used. We therefore believe that further studies, with the inclusion of these and other aspects, are important for responding to this study question.
The presence etenose two or more associated comorbidities had a negative influence on the result of the surgical treatment for degenerative lumbar stenosis, with higher levels of postoperative complications. Degenerative lumbar spinal stenosis: Arbit E, Panullo S. Clin Orthop Relat Res. Reversible prolongation of motor conduction time after transcranial magnetic brain stimulation after neurogenic claudication in spinal stenosis.
Spine Phila Pa Spinal stenosis and neurogenic claudication. Brandt RA, Wajchenberg M. Estenose do canal vertebral cervical e lombar. Estenose degenerativa da coluna lombar.
Estenose da Coluna
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Services on Demand Journal. Original Articles Surgical treatment of degenerative lumbar stenosis: Patients with systemic arterial hypertension SAHinsulin intolerance or diabetes mellitus DMheart disease, and metabolic syndrome associated with SAH, DM, dyslipidemia and obesity have higher levels of wound dehiscence, adjacent infection, and vascular complications.
Table 1 Table 1. Type of complication Total no. August 29, ; Accepted: How to cite this article.