Journal Information
Vol. 31. Issue 1.
Pages 37-41 (January - February 2020)
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Vol. 31. Issue 1.
Pages 37-41 (January - February 2020)
Artículo de opinión
Técnicas abandonadas en cirugía de columna
Abandoned techniques in spine surgery
Pedro David Delgado-López
Corresponding author
pedrodl@yahoo.com

Autor para correspondencia.
, Antonio Rodríguez-Salazar
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España
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Tabla 1. Técnicas y dispositivos cuyo empleo se ha abandonado o se encuentra en franco declive
Resumen

En cirugía de columna, ciertos dispositivos y algunas técnicas quirúrgicas han sido abandonados por completo o se hallan en franco declive. Aunque empleados en miles de pacientes, dichos tratamientos no han demostrado una efectividad sólida y duradera y, ocasionalmente, asocian morbilidades inaceptables. Ejemplos de abandono son la quimionucleólisis, la discectomía percutánea, la discectomía por láser o los geles antifibrosis. Otras técnicas se encuentran en marcado retroceso como los dispositivos interespinosos o las prótesis discales lumbares. Generalmente una técnica se abandona por falta de efectividad, morbilidad excesiva, sustitución por otra técnica más eficaz y menos agresiva, por falta de comercialización o por prohibición de su uso. En las últimas décadas, la enorme presión comercial y una creciente demanda social han conseguido convencer a muchos cirujanos de columna para que empleen tratamientos no suficientemente sustentados por estudios sólidos ni avalados por el paso del tiempo, muchos de los cuales eventualmente se abandonan.

Palabras clave:
Técnica quirúrgica
Dispositivo
Discectomía
Industria farmacéutica
Morbilidad
Lumbalgia
Abstract

In spine surgery, certain surgical techniques and devices are currently in marked decline or have been completely abandoned. Although used in thousands of patients, such treatments failed to demonstrate durable and sound effectiveness, and sometimes associate inacceptable morbidity. Chemopapain injections, percutaneous discectomy, laser discectomy or antiadhesion gels are examples of abandoned therapies. Some other techniques are in frank decline like implantation of interspinous devices or lumbar disc prosthesis. In general, a technique is abandoned due to inefficacy, excessive associated morbidity, substituted by another more efficacious and less aggressive technique, end of commercialization, or usage prohibition. In the last decades, a great commercial pressure plus an increasing social demand have managed to convince many spine surgeons to indicate treatments not sufficiently supported by scientific evidence nor consolidated over time, many of which are eventually abandoned.

Keywords:
Surgical technique
Device
Discectomy
Pharmaceutical industry
Morbidity
Low back pain

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