Tratamiento quirúrgico en las cifosis congénitas: Revisión de 14 pacientes

Los autores efectúan una revisión de 14 pacientes con cifosis congénita, intervenidos entre los años 1979-1989, con un seguimiento medio de 7 años. La edad media preoperatoria fue de 11 años (todos ellos mayores de 5 años), con una cifosis media de 7 9 . En 6 casos se realizó una artrodesis posterior y en 8 una anterior combinada con una fusión posterior. Inicialmente obtuvieron una corrección media de la curva de 18° con la artrodesis posterior y 20° con la artrodesis combinada. La pérdida postoperatoria final fue de 10° y 8° respectivamente. En un caso, se produjo una pseudoartrosis por fusión corta. Como complicaciones postoperatorias en 5 pacientes, una radiculopatía, una infección superficial y cuatro protusiones de material que requirieron su extracción. Los autores analizan los factores que han podido influir en los resultados obtenidos, comparándolos posteriormente con los conseguidos por otros centros hospitalarios importantes.Fourteen patients with congenital kyphosis treated surgically between 1979- 1989 were reviewed. All had a follow-up of 2 years or more, with an average follow-up of 7 years. The average age at surgery was 11 and the average kyphosis was 79°. Six cases had posterior fusion only and eigth had combined anterior and posterior fusion. The results showed an average correction of the curve at surgery of 18° with posterior arthrodesis and 20° with combined arthrodesis. There was thus an average loss of 10° and 8° respectively from the time of surgery in both types of treatment. Pseudoarthrosis by short fusion ocurred in one case. Other complications after surgery were 1 radiculopathy, one wound infection and four rod protusion (six patients). The factors that have influence in this results were analysed. A comparison from the results of treatment at other medical centers was also carried out

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of “disc herniation”, less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results