Abstract
OBJETIVO: Procuramos avaliar a eficácia terapêutica de estabilizadores interespinosos na doença degenerativa lombar, e a evolução do índice de depressão e somatização de sintomas preexistentes nesses pacientes. MÉTODOS: Estudamos 20 pacientes com estenose de canal lombar. Considerados diversos critérios de inclusão, os pacientes concordaram em participar do estudo assinando o consentimento livre e esclarecido. Na avaliação clínica e psicossomática utilizamos: Escore Euroqol (EQ-5D); escala visual analógica (EVA) lombar e dos membros inferiores; Oswestry Disability Index versão 2.0 e Modified Somatic Perception Questionnaire (MSPQ) e Zung Self-Rating Depression Scale (ZDS). A análise estatística foi realizada com os testes de Friedman e Wilcoxon, sendo o nível de significância 0,05. RESULTADOS: Existiu uma melhoria em EQ-5D (p<0,001), EVA lombar e dos membros inferiores (p<0,001), ODI (p<0,001), sem alterações significativas no MSPQ (p=0,197). CONCLUSÃO: Em pacientes com doença degenerativa lombar (grau 2 e 3 de Benzel e 3 e 4 de Pfirmann), estáveis em termos psicossomáticos, o uso de estabilizadores interespinosos revelou-se eficaz considerando a evolução clínica e o índice de depressão preexistente relacionado com a patologia diagnosticada.
Highlights
When the degenerative cascade reaches high levels of progression, the therapy solution usually proposed is direct decompression, often associated with arthrodesis
The quality of life measured by the EQ-5D was 0.339 ± 0.235 preoperatively and this value changed to 0.849 ± 0.070 after the first year, with p < 0.001
The value obtained for visual analog scale of pain (VAS) in the lumbar region on average and standard deviation preoperatively was 6.60 ± 2.25, constituting a 1.00 ± 0.77 improvement in the first year, with p < 0.001
Summary
When the degenerative cascade reaches high levels of progression, the therapy solution usually proposed is direct decompression, often associated with arthrodesis. This approach has been validated by various publications[1,2,3,4] and by our clinical practice. When degenerative changes are only moderate, the selection of an appropriate therapy is never linear.[5,6] As for arthrodesis, it always somewhat restricts the mobility of the intervened segment, changing the local biomechanics[7,8,9] in a way that often seems disproportionate to the pathology we are seeking to.
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