quarta-feira, 15 de maio de 2013

NAS HÉRNIAS DE DISCO LOMBARES, REALIZAÇÃO DE ESTABILIZAÇÃO DINÂMICA NÃO É UMA BOA OPÇÃO


Sequestrectomy With Additional Transpedicular Dynamic Stabilization for the Treatment of Lumbar Disc Herniation: No Clinical Benefit After 10 Years Follow-up.
Hoff, Eike MD; Strube, Patrick MD; Gross, Christian MD; Putzier, Michael MD
Miscellaneous Article

AB Study Design. Single-center prospective study. Objective. Clinical and radiological long-term evaluation of the effects of transpedicular dynamic stabilization after sequestrectomy. Summary of Background Data. Short- and mid-term investigations have shown that additional dynamic stabilization is appropriate to prevent progression of initial segment degeneration after sequestrectomy and associated with superior clinical outcome compared with sequestrectomy alone. Long-term data are missing. Methods. Eighty-four patients with symptomatic disc herniation and initial osteochondrosis (Modic = I[degrees]) of the lumbar spine underwent sequestrectomy. Additional dynamic stabilization was performed in 35 subjects (group D); the remaining 49 subjects were treated with sequestrectomy alone (group S). Clinical (Oswestry Low Back Pain Disability Questionnaire, Version 2.0; visual analogue scale) and radiological (plain and extension-flexion radiographs and magnetic resonance images) parameters were collected preoperatively, at 3 months postoperatively, as well as at a mean follow-up of 2.8 and 10.2 years. Results. Twenty-nine of 35 (83%, group D) and 38 of 49 (78%, group S) patients were available at the final follow-up. Reoperation rate in group D was 34% (10/29) due to implant failures or progression of degeneration at the index or the adjacent segments. In group S, 5 of 38 (13%) underwent further operation because of a reprolapse or progression of degeneration of the index level. In the remaining patients, clinical scores (Oswestry Low Back Pain Disability Questionnaire, Version 2.0; and visual analogue scale) improved significantly, with similar results in both groups at the final follow-up. The rate of progression of disc degeneration was lower when the patients were also dynamically stabilized than sequestrectomy alone, but the rate of adjacent segment degeneration superior to the operated segment was significantly higher in group D. Conclusion. Additional dynamic stabilization does not lead to a clinical benefit in patients with symptomatic disc herniation and initial segment degeneration compared with sequestrectomy alone after a long-term follow-up. Because of this and the high rate of necessary reoperations, we do not recommend this surgical strategy for this indication. Level of Evidence: 4 (C) 2013 Lippincott Williams & Wilkins, Inc.

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