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BACKGROUND: Continuous invasive monitoring of intracranial pressure (ICP) is essential in neurocritical care for surveillance and management of raised ICP. Fluid-based systems and strain gauge microsensors remain the current standard. In the past few decades, several studies with wireless monitoring were developed aiming to reduce invasiveness and complications. OBJECTIVE: To describe a novel Wi-Fi fiber-optic device for continuous ICP monitoring using smartphone in a swine model. METHODS: Two ICP sensors (wireless prototype and wire-based reference) were implanted in the cerebral parenchyma of a swine model for a total of 120 minutes of continuous monitoring. Every 5 minutes, jugular veins compression was performed to evaluate ICP changes. The experimentation was divided in 3 phases for comparison and analysis. RESULTS: Phase 1 showed agreement in ICP changes for both sensors during jugular compression and releasing, with a positive and strong Spearman correlation (r = 0.829, P < .001). Phase 2 started after inversion of the sensors in the burr holes; there was a positive and moderately weak Spearman correlation (r = 0.262, P < .001). For phase 3, the sensors were returned to the first burr holes; the prototype behaved similarly to the reference sensor, presenting a positive and moderately strong Spearman correlation (r = 0.669, P < .001). CONCLUSION: A Wi-Fi ICP monitoring system was demonstrated in a comprehensive and feasible way. It was possible to observe, using smartphone, an adequate correlation regarding ICP variations. Further adaptations are already being developed.
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Hipertensão Intracraniana , Pressão Intracraniana , Animais , Suínos , Crânio , Monitorização Fisiológica , Hipertensão Intracraniana/diagnóstico , TrepanaçãoRESUMO
BACKGROUND: Traumatic facet dislocations in the subaxial cervical spine, also known as locked facets, are commonly associated with neurological deficits. The fear of the presence of an associated traumatic disc herniation and consequent neurological worsening usually causes a delay in the spinal realignment. This study's aim is an analysis of safety and efficacy when treating acute cervical traumatic facet dislocations using cranial-cervical traction or posterior open reduction and fixation in the presence of disc herniations. METHODS: Inclusion criteria addressed the following patient groups: (1) MRI diagnosis of traumatic cervical facet dislocations with disc herniation, (2) intervention: either cranial-cervical traction or posterior open reduction and fixation, (4) neurological outcomes after treatment, (5) adult 18 plus years of age, (6) sample sizes greater than 20 patients, (7) English language publication. The following databases and search tools were analyzed: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and the clinical trial registries (ClinicalTrials.gov), October 2021. RESULTS: Six studies were found, 2 with posterior open reduction and fixation and 4 with cranial-cervical traction, totalizing 197 patients. Neurological worsening was reported only in 1 case (0.5%). CONCLUSIONS: Traumatic disc herniation in cervical facet dislocations is not an absolute contraindication of cranial-cervical traction or posterior open reduction. Early realignment of the spine could bring more neurological benefits than waiting for an MRI or surgical discectomy. However, caution is needed in this review's data interpretation until prospective and well-designed studies are performed.
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Deslocamento do Disco Intervertebral , Luxações Articulares , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Estudos ProspectivosRESUMO
INTRODUCTION: Intramedullary spinal cord tumors (IMSCT) account for about 2%-4% of all central nervous system tumors. Surgical resection is the main treatment step, but might cause damage to functional tissues. Intraoperative neuromonitoring (IONM) is an adopted measure to decrease surgical complications. Below, we describe the results of IMSCT submitted to surgery under IONM at a tertiary institution. METHODS: The sample consisted of consecutive patients with IMSCT admitted to the Neurological Institute of Curitiba from January 2007 to November 2016. A total of 47 patients were surgically treated. Twenty-three were male (48.9%) and 24 were female (51.1%). The mean age was 42.77 years. The mean follow-up time was 42.7 months. RESULTS: Neurological status improved in 29 patients (62%), stable in 6 (13%), and worse in 12 (25%). Patients who presented with motor symptoms at initial diagnosis had a worse outcome compared to patients with sensory impairment and pain (P = 0.026). Patients with a change in electromyography had worse neurological outcomes compared to patients who did not show changes in monitoring (P = 0.017). DISCUSSION AND CONCLUSION: No prospective randomized high evidence study has been performed to date to compare clinical evolution after surgery with or without monitoring. In our sample, surgical resection was well succeeded mainly in oligosymptomatic patients with low preoperative McCormick classification and no worsening of IONM during surgery. We believe that microsurgical resection of IMSCT with simultaneous IONM is the gold standard treatment and achieved with good results.
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PURPOSE: Symptomatic Chiari type I malformation (CM) is treated with posterior fossa decompression with/ without duroplasty. Few authors suggested cerebellar tonsil caudal migration due to a supposed "caudal traction" of cranial nerve structures in a so-called occult tethered cord syndrome. For these authors, filum terminale (FT) sectioning may improve CM symptoms. The objective of this review is to evaluate the effect of FT sectioning on the treatment of CM. METHODS: Using the PRISMA guidelines for systematic reviews, we reviewed studies to evaluate patient's outcomes with CM who underwent FT sectioning. The MINORS instrument was used for methodological quality assessment. The included studies' levels of evidence (LOE) were classified according to the Oxford Centre of Evidence-Based Medicine. RESULTS: Two studies from the same group of authors were included. We cannot assure if the cited cases in the first study were also included in their latter published study. The described results suggest that outcomes were not collected in a standardized fashion. Outcomes are described vaguely as a percentage of improvement. Case series samples were small and included not only patients with CM but also patients with scoliosis and syringomyelia. The MINORS score reported that both studies had low methodological quality. Both included studies were classified as level 4 of evidence. CONCLUSION: There is no scientific support for filum terminale sectioning in patients with CM without evidence of tethered cord. This procedure may be considered experimental and should be validated in a strict criterion of inclusion clinical trial comparing outcomes in posterior fossa decompression.
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Malformação de Arnold-Chiari/cirurgia , Cauda Equina/cirurgia , Defeitos do Tubo Neural/cirurgia , Siringomielia/cirurgia , Humanos , Procedimentos Neurocirúrgicos/métodos , Escoliose/cirurgiaRESUMO
SUMMARY
Assuntos
Humanos , Doenças da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Antibioticoprofilaxia , Antibacterianos/administração & dosagem , Pós/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
STUDY DESIGN: Systematic literature review and meta-analysis. OBJECTIVE: The objective of this systematic literature review was to evaluate if intraoperative neurophysiological monitoring (IONM) can prevent neurological injury during spinal operative surgical procedures. SUMMARY OF BACKGROUND DATA: IONM seems to have presumable positive effects in identifying neurological deficits. However, the role of IONM in the decrease of new neurological deficits remains unclear. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and Meta-analysis, we reviewed clinical comparative studies who evaluate the rate of new neurological events in patients who had a spinal surgery with and without IONM. Studies were then classified according to their level of evidence. Methodological quality was assessed according to methodological index for non-randomized studies instrument. RESULTS: Six studies were evaluated comparing neurological events with and without IONM use by the random effects model. There was a great statistical heterogeneity. The pooled odds ratio (OR) was 0.72 {0.71; 1.79}, Pâ=â0.4584. A specific analysis was done for two studies reporting the results of IONM for spinal surgery of intramedullary lesions. The OR was 0.1993 (0.0384; 1.0350), Pâ=â0.0550. CONCLUSION: IONM did not result into fewer neurological events with the obtained evidence of the included studies. For intramedullary lesions, there was a trend to fewer neurological events in patients who underwent surgery with IONM. Further prospective randomized studies are necessary to clarify the indications of IONM in spinal surgeries. LEVEL OF EVIDENCE: 2.
Assuntos
Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Doenças da Coluna Vertebral/cirurgia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/epidemiologiaRESUMO
According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.
Assuntos
Inibidores do Fator Xa/efeitos adversos , Hematoma Epidural Craniano/induzido quimicamente , Rivaroxabana/efeitos adversos , Adulto , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/cirurgia , Humanos , Masculino , Risco , Tomografia Computadorizada por Raios XRESUMO
Summary According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.
Resumo Segundo nossa pesquisa, descrevemos o primeiro caso na literatura de hematoma epidural intracraniano espontâneo secundário ao uso de Xareltor. Hematomas epidurais intracranianos espontâneos raramente são descritos na literatura, sendo comumente associados a doenças infecciosas cranianas, distúrbios de coagulação, malformações vasculares da dura-máter e metástases cranianas. A elaboração de relatórios de monitoramento em longo prazo de pós-comercialização e relatórios independentes provavelmente irá detectar o espectro completo de complicações hemorrágicas do uso desse medicamento.
Assuntos
Humanos , Masculino , Adulto , Inibidores do Fator Xa/efeitos adversos , Rivaroxabana/efeitos adversos , Hematoma Epidural Craniano/induzido quimicamente , Tomografia Computadorizada por Raios X , Risco , Hematoma Epidural Craniano/cirurgia , Hematoma Epidural Craniano/diagnóstico por imagemRESUMO
A instabilidade atlantoaxial possui múltiplas causas e muitas vezes requer tratamento cirúrgico. Várias técnicas estão disponíveis para realização da fixação atlantoaxial, todas elas com diferentes vantagens e desvantagens. Em 2004, Wrigth descreveu a técnica de fixação translaminar de C2, que oferece uma fixação rígida, porém sem a dificuldade técnica da colocação de parafusos na pars de C2 e com eliminação do risco de lesão da artéria vertebral. O objetivo deste estudo é revisar a técnica de fixação translaminar de C2, enfatizando detalhes técnicos, risco e benefícios em comparação com as outras técnicas de fixação atlantoaxial.
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Articulação Atlantoaxial , Fusão Vertebral , Coluna VertebralRESUMO
Introdução: Os estudos anatômicos realizados nas últimas décadas possibilitaram a emergência da técnica Free-handpara instrumentação da coluna tóraco-lombar baseada exclusivamente em parâmetros anatômicos. Entretanto, os riscos potenciais a ela associados levaram à necessidade de criação de modelos educacionais para o treinamento cirúrgico. Métodos: Após parceria multidisciplinar, foi realizada a instrumentação de dois espécimens cadavéricos, os quais foram, na sequencia, submetidos à Tomografia Computadorizada com cortex finos e posteriormente à descompressão do canal lombar para verificação da real posição dos parafusos pediculares tanto ao nível radiológico quanto anatômico. Resultados: Foram instrumentados ao total 28 níveis (T5-S1), totalizando 62 parafusos pediculares. Ao final, verificaram-se somente 4 violações críticas. O número de violações diminuiu de 32% para 25% do primeiro para o segundo especimen. Uma curva de aprendizado mais acentuada pôde ser observada considerando-se isoladamente a coluna torácica baixa(37,5% versus 12,5%). Conclusões: Os autores demonstraram que a incorporação do treinamento de instrumentação da coluna tóraco-lombar com parafusos pediculares no programa de residência médica é um método educacional com uma ótima relação custo-benefício, o qual possibilita que neurocirurgiões em treinamento desenvolvam suas habilidades antes de exercê-las na prática cirúrgica.
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Humanos , Artrodese , Parafusos Ósseos , Internato e Residência , Fusão VertebralRESUMO
Exames pós-operatórios de cirurgias intracranianas são difíceis de serem interpretados por apresentarem alterações morfológicas que simulam situações patológicas, como edema e tumores residuais. Com o advento de métodos de ressonância intraoperatória essa interpretação ganhou maior importância, pelo risco de re-intervenções desnecessárias. O presente estudo objetivou estabelecer as características de exames pós-operatórios normais após remoção de tumores hipofisários pela via transesfenoidal endonasal, bem como estabelecer parâmetros de remoção tumoral radical para otimização de exames intraoperatórios. Foram estudados 40 pacientes (22 microadenomas e 18 macroadenomas) operados consecutivamente no Instituto de Neurologia de Curitiba, portadores de adenomas hipofisários, pela via transesfenoidal endonasal, e que realizaram exame de ressonância magnética (RM) dinâmica no pré-operatório, pós-operatório imediato (primeiras 24horas após o término da cirurgia) e após três meses.Foram utilizadas sequências ponderadas em T1, com cortes coronais de 3mm antes da injeção de contraste (gadopentetato dimeglumina Gd-DTPA) e a cada 90 segundos após a injeção rápida do mesmo. Os achados de RM dinâmica no pós-operatório imediato foram analisados quanto ao deslocamento da haste hipofisária, presença de material hiperintenso intrasselar, deslocamento do diafragma selar superiormente (caracterizado pela classificação de Hardy para extensões suprasselares) e quanto ao padrão de captação de contraste na RM dinâmica. Os padrões de captação foram classificados como: 1. ausência de captação de contraste, 2. realce anelar periférico, 3. captação nodular e 4. padrão misto (periférico e nodular coexistentes). No exame pós-operatório tardio, ênfase foi dada na presença de tumor residual, confirmada por alteração hormonal ou re-operação com histopatologia.As alterações de imagem foram descritas em termos de prevalência de ocorrência (porcentagem), e correlacionadas com a existência...
Imaging after intracranial surgeries is difficult to evaluate because usual changes often simulates pathological findings, such as edema and residual tumors. Emerging technologies of intraoperative magnetic resonances lead to a greater interest on understanding usual findings, in order to avoid unnecessary revisions. The objective of this study was to establish normal postoperative findings on dynamic magnetic resonance imaging (dMRI) after resection of pituitary tumors through endonasal transsphenoidal approach, as well as determine parameters of radical resection, thus optimizing intraoperative images. Forty patients (22 microadenomas and 18 macroadenomas) operated on the Instituto de Neurologia de Curitiba for pituitary adenomas through endonasal transsphenoidal approach were evaluated by dMNRI before, within the first 24 hours and after three months of the surgery. T1-weighted images on coronal plane, 3mm slices were performed before and on every 90 seconds after rapid injection of the paramagnetic contrast (gadopentetate dimeglumine GdDTPA). Findings analyzed at early postoperative dMRI were: lateral displacement of the pituitary stalk, hyperintense intraselar material, position of the diafragma selae (as classified by Hardy, for supraselar extensions) and the pattern of contrast enhancement: 1. no enhancement, 2. peripheral ring, 3. nodular enhancement and 4. combined peripheral and nodular. At late postoperative MRI, the regression of early findings was noted, as well as the presence of a residual tumor. This late was confirmed by hormonal essay or hystopathological examination (reoperation). Findings were first described as prevalence (%), and then related to the presence or not of a residual tumor at late postoperative MRI. Displacement of the pituitary stalk was noted in 95% of cases (90,9% in microadenomas, and 100% in macroadenomas). Hyperintense intraselar material was found in 77,3% of microadenomas and 100% of macroadenomas (87,5% of all cases)...
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Humanos , Imageamento por Ressonância Magnética , Neoplasia Residual , Neoplasias Hipofisárias/cirurgia , Período Pós-Operatório , RecidivaRESUMO
BACKGROUND: Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. In this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis. METHOD: Forty consecutive patients were enrolled in a prospective study. All of them had operations in the lower lumbar disc in a single level for the first time. Three months after the operation they were submitted to clinical outcome evaluations and questionnaires, including Numeric Pain Rating scales (NPR) for lumbar and leg pain, the McGill Pain Questionnaire, The Quebec Back Pain Disability scale (QBPD) and Straight Leg Raising test. These data were correlated with the degree of fibrosis as revealed by Magnetic Resonance Imaging (MRI). FINDINGS: After 3 months, the NPR values for lumbar and leg pain ranged from 0 to 8 (mean 2.32 and 1.67 respectively). The values of the post-operative QBPD scale ranged from 1 to 71 (mean 25.9). Every patient showed a varied degree of fibrosis on MRI. However, statistical analysis depicted no significant correlation between fibrosis and a poorer clinical outcome for pain and disability. CONCLUSIONS: The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. The role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.
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Discotomia/efeitos adversos , Síndrome Pós-Laminectomia/epidemiologia , Fibrose/epidemiologia , Deslocamento do Disco Intervertebral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Canal Medular/cirurgia , Adulto , Idoso , Cicatriz/epidemiologia , Cicatriz/patologia , Cicatriz/fisiopatologia , Dura-Máter/patologia , Dura-Máter/fisiopatologia , Dura-Máter/cirurgia , Síndrome Pós-Laminectomia/patologia , Síndrome Pós-Laminectomia/fisiopatologia , Feminino , Fibrose/patologia , Fibrose/fisiopatologia , Humanos , Incidência , Deslocamento do Disco Intervertebral/patologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Medição da Dor , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Canal Medular/patologia , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/fisiopatologia , Raízes Nervosas Espinhais/cirurgia , Falha de Tratamento , Adulto JovemRESUMO
Filum terminale ependymomas are slow growing tumors of the cauda equina with a high incidence in young adults. Although a complete microsurgical resection can lead to a cure, recurrence is not uncommon. Sixteen cases of filum terminale ependymomas treated at the Instituto de Neurologia de Curitiba were analyzed. Eleven patients were females and 5 males, their age ranging from 7 to 84 years. Symptoms and signs included lumbar pain (31.25%), radicular pain (56.25%) and neurological deficits (12.5%). In three cases, patients had previously undergone surgery in other hospitals. All were tested through MRI and were operated on. Two underwent a laminoplasty and 14 a laminectomy. The last 8 patients of this series had neuro-physiological monitoring during surgery. In all patients a total microsurgical resection was achieved. Histologically, 2 cases were cellular ependymomas and 14 cases myxopapillary ependymomas. There was no recurrence during a 2 to 84 month follow-up period.
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Cauda Equina/cirurgia , Ependimoma/cirurgia , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cauda Equina/patologia , Criança , Ependimoma/patologia , Feminino , Seguimentos , Humanos , Laminectomia/métodos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/patologia , Adulto JovemRESUMO
Filum terminale ependymomas are slow growing tumors of the cauda equina with a high incidence in young adults. Although a complete microsurgical resection can lead to a cure, recurrence is not uncommon. Sixteen cases of filum terminale ependymomas treated at the Instituto de Neurologia de Curitiba were analyzed. Eleven patients were females and 5 males, their age ranging from 7 to 84 years. Symptoms and signs included lumbar pain (31.25 percent), radicular pain (56.25 percent) and neurological deficits (12.5 percent). In three cases, patients had previously undergone surgery in other hospitals. All were tested through MRI and were operated on. Two underwent a laminoplasty and 14 a laminectomy. The last 8 patients of this series had neuro-physiological monitoring during surgery. In all patients a total microsurgical resection was achieved. Histologically, 2 cases were cellular ependymomas and 14 cases myxopapillary ependymomas. There was no recurrence during a 2 to 84 month follow-up period.
Os ependimomas do filum teminale são tumores da cauda eqüina de crescimento lento com maior incidência em adultos jovens. A ressecção microcirúrgica total possibilita a cura da doença, recidivas, entretanto, apresentam sérias dificuldades no tratamento. Com o objetivo de estudar os aspectos clínicos, anatomopatológicos e do tratamento, analisaram-se 16 casos de ependimomas do filum teminale tratados no Instituto de Neurologia de Curitiba, 11 do sexo feminino e 5 do sexo masculino, com idade entre 7 e 84 anos, que apresentavam dor lombar (31,25 por cento), radiculopatia (56,25 por cento) e déficits neurológicos (12,5 por cento). Em 3 casos, os pacientes tinham sido operados em outro serviço anteriormente. Em todos os casos o diagnóstico foi confirmado pela ressonância magnética. Em 2 pacientes realizou-se laminoplastia e em 14 laminectomia. Nos últimos 8 pacientes empregou-se monitorização neurofisiológica. Em todos os casos a ressecção microcirúrgica foi total. Do ponto de vista histológico, demonstraram-se 2 casos de ependimoma celular e 14 casos mixopapilares. Não houve recidiva do tumor em um seguimento entre 2 e 84 meses.
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Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cauda Equina/cirurgia , Ependimoma/cirurgia , Neoplasias da Medula Espinal/cirurgia , Cauda Equina/patologia , Ependimoma/patologia , Seguimentos , Laminectomia/métodos , Imageamento por Ressonância Magnética , Neoplasias da Medula Espinal/patologia , Adulto JovemRESUMO
Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adaptation at work is one well-known cause of treatment failure. This study examines 350 patients on long-term follow-up after surgery for first-time LDH. The relationship was analyzed between occupation before surgery and outcome (maintenance of lumbar and leg pain, satisfaction with the surgical treatment and return to work). The preoperative occupation (employed in public or private services, autonomous, unemployed, housewife, retired or student) and the exertion at work were analyzed as prognostic factors for different clinical outcomes. Although unemployed people had higher numerical analog scale for lumbar pain and retired patients had a higher leg pain, this difference was not statistically significant. Retired people were significantly less satisfied with the surgical result. Higher exertion at work showed a statistically insignificant higher level of pain and lower degree of satisfaction. The authors conclude that preoperative occupation was not a statistically significant factor in this series of patients.
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Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Ocupações/estatística & dados numéricos , Ciática/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Estudos Retrospectivos , Ciática/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adaptation at work is one well-known cause of treatment failure. This study examines 350 patients on long-term follow-up after surgery for first-time LDH. The relationship was analyzed between occupation before surgery and outcome (maintenance of lumbar and leg pain, satisfaction with the surgical treatment and return to work). The preoperative occupation (employed in public or private services, autonomous, unemployed, housewife, retired or student) and the exertion at work were analyzed as prognostic factors for different clinical outcomes. Although unemployed people had higher numerical analog scale for lumbar pain and retired patients had a higher leg pain, this difference was not statistically significant. Retired people were significantly less satisfied with the surgical result. Higher exertion at work showed a statistically insignificant higher level of pain and lower degree of satisfaction. The authors conclude that preoperative occupation was not a statistically significant factor in this series of patients.
A hérnia de disco lombar (HDL) é uma causa comum de dor lombar e ciática. Quando o tratamento clínico não oferece melhora dos sintomas, a cirurgia pode ser proposta em casos selecionados. Apesar de ser efetiva, uma pequena, porém significativa parcela dos pacientes operados podem não melhorar. Diversos fatores podem influenciar tais resultados. A insatisfação no ambiente de trabalho é relacionada com um maior índice de maus resultados. Neste estudo, 350 pacientes no pós-operatório tardio da primeira cirurgia de HDL foram estudados, analisando a possível relação entre tipo de profissão antes da cirurgia e evolução clínica (persistência de dor lombar e em membro inferior, satisfação com a cirurgia e retorno ao trabalho). Os pacientes foram classificados quanto à profissão em empregados públicos, empregados em órgãos privados, autônomos, desempregados, donas de casa, aposentados e estudantes. Também o grau de esforço no ambiente de trabalho foi analisado como fator prognóstico. Os desempregados relataram índices de dor lombar maiores e os aposentados tiveram maiores índices de dor irradiada, apesar de que estatisticamente os valores não foram significativos. Os aposentados ficaram significativamente menos satisfeitos com o tratamento no longo prazo. Um maior esforço no ambiente de trabalho não se correlacionou estatisticamente com o grau de dor e satisfação. Concluimos que o tipo de profissão não foi fator estatisticamente significativo na evolução destes pacientes. Os aposentados tiveram menor grau de satisfação com o procedimento cirúrgico.