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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(06): 766-771
DOI: 10.1055/s-0041-1724083
Artigo Original
Coluna

Descompressão lombar versus fusão espinhal em ambiente ambulatorial privado: Um estudo retrospectivo com três anos de acompanhamento[*]

Article in several languages: português | English
Isadora Orlando de Oliveira 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
2   Instituto Wilson Mello, Campinas, SP, Brasil
,
Mario Lenza 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Eliane Antonioli 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Mario Ferretti 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Resumo

Objetivo Comparar a dor, a função, a qualidade de vida e os eventos adversos da descompressão lombar e da fusão espinhal em pacientes com patologias degenerativas da coluna vertebral que participaram de um programa de segunda opinião para cirurgias de coluna com acompanhamento de 36 meses.

Métodos Os dados desta coorte retrospectiva foram obtidos de um sistema de saúde privado entre junho de 2011 e janeiro de 2014. A amostra do estudo foi composta por 71 pacientes encaminhados para cirurgia de coluna lombar. Os desfechos para comparações entre a descompressão lombar e a fusão espinhal foram qualidade de vida (avaliada pelo questionário EuroQoL 5D), dor (medida pela Escala Numérica de Classificação de Dor) e função (avaliada pelo Questionário de Incapacidade de Roland Morris) no início do estudo e aos 12 e 36 meses de acompanhamento pós-cirúrgico. As definições de recuperação foram estabelecidas pela diferença mínima clinicamente importante (DMCI). As diferenças basais entre os grupos foram analisadas por teste t não pareado, e as diferenças nas pontuações dos instrumentos entre os momentos, por modelos mistos generalizados. Os resultados foram apresentados como valores médios ajustados pelos modelos e intervalos de confiança de 95%.

Resultados No total, 22 pacientes foram submetidos à artrodese, e 49 pacientes, à descompressão lombar. Quanto às comparações de achados antes e depois das intervenções cirúrgicas, a DMCI foi alcançada em todos os desfechos de qualidade de vida, dor e função nos dois pontos de acompanhamento em relação aos escores basais Em relação às complicações, apenas a descompressão lombar apresentou 4% (n = 3) de taxa cirúrgica de recidiva da hérnia de disco lombar.

Conclusão Pacientes com patologias espinhais degenerativas apresentam melhoras nos desfechos de dor, função e qualidade de vida em longo prazo que são clinicamente significativas e independentes da intervenção cirúrgica.

Palavras-chave

avaliação de resultados em cuidados de saúde - doenças musculoesqueléticas - dor nas costas - coluna vertebral - intervenções cirúrgicas

Contribuições dos Autores

Todos os autores conceberam o estudo. IOO escolheu o delineamento experimental, e ML, EA e MF contribuíram para a versão final deste manuscrito. IOO e EA participaram da análise estatística. Todos os autores contribuíram para o refinamento do estudo e aprovaram o manuscrito final.


Suporte Financeiro

Não houve suporte financeiro de fontes públicas, comerciais, ou sem fins lucrativos.


* Estudo desenvolvido no Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.




Publication History

Received: 24 July 2020

Accepted: 17 September 2020

Article published online:
11 September 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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