Factores relacionados con la cirugía fallida de hernia discal lumbar
Related factors with the failed surgery of herniated lumbar disc
J. Rodríguez-García
, A. Sánchez-Gastaldo, T. Ibáñez-Campos, C. Vázquez-Sousa, M. Cantador-Hornero, J.A. Expósito-Tirado, A. Cayuela-Domínguez, C. Echevarría-Ruiz de Vargas
Servicio de Rehabilitación. Hospitales Universitarios Virgen del Rocío. Sevilla
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"apellidos" => "Rodríguez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Gastaldo" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ibáñez-Campos" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Vázquez-Sousa" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Cantador-Hornero" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "Expósito-Tirado" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Cayuela-Domínguez" ] 7 => array:2 [ "nombre" => "C." "apellidos" => "Echevarría-Ruiz de Vargas" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Rehabilitación. Hospitales Universitarios Virgen del Rocío. Sevilla" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Avd/ De las Ciencias n° 10, Blq. 7, 6° D. 41020. Sevilla." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Related factors with the failed surgery of herniated lumbar disc" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-08-18" "fechaAceptado" => "2005-02-01" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159091" "palabras" => array:4 [ 0 => "Hernia discal lumbar" 1 => "Cirugía fallida" 2 => "Reincorporación laboral" 3 => "Calidad de vida" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159089" "palabras" => array:2 [ 0 => "FBSS" 1 => "SCRF" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159090" "palabras" => array:4 [ 0 => "Herniated disc surgery" 1 => "Failed surgery" 2 => "Return to work" 3 => "Quality of life" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La cirugía descompresiva de hernia discal es la intervención quirúrgica más frecuente a nivel de la columna lumbar. La cirugía fallida oscila entre un 10 y un 40% de los casos, constituyendo el denominado Síndrome de la Cirugía Raquídea Fracasada (SCRF). La reincorporación laboral a medio plazo tras la cirugía se sitúa en torno al 70–85%, y existen pocos estudios que analicen la calidad de vida tras la intervención. Los objetivos de este estudio son conocer la incidencia de cirugía fallida de hernia discal lumbar en nuestro medio, identificando aquellos factores que puedan influir en su aparición; y estudiar factores ambientales como la reincorporación laboral y la calidad de vida a medio plazo tras esta cirugía, así como su relación con el éxito o fracaso quirúrgico.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo transversal de 117 pacientes intervenidos de hernia discal lumbar durante el primer semestre del 2003 en nuestro hospital. Para valorar la incidencia de cirugía fallida y factores relacionados se han recogido datos clínicos de la Historia Clínica de los pacientes de la muestra. Y, asimismo, se ha entrevistado telefónicamente a 91 de ellos -los que contestaron- para valorar factores no clínicos relacionados con el SCRF, tales como reincorporación laboral, satisfacción con la cirugía, realización de tratamiento rehabilitador y calidad de vida a través del Cuestionario de Salud SF-36. Para el análisis de resultados se ha empleado el programa estadístico SPSS 11.01.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En una muestra en la que la proporción ente ambos sexos es de 1/1 y la edad media de 45 [35–54] años, con una clínica más frecuente de ciática derecha, de más de 6 meses de evolución, correlacionada con el hallazgo radiológico de hernia L5-S1, un 37,9% ha presentado el SCRF. Aunque es escaso el número de pacientes que en nuestra serie afrontan una reintervención, se ha observado en ellos una incidencia del SCRF notablemente superior (52,2%) a los que se someten a una primera cirugía (32%). Los factores clínicos predictivos de resultados desfavorables en pacientes sometidos a primera cirugía han sido la clínica precirugía de ciática bilateral, el hallazgo de estenosis de canal asociada a hernia discal y la comorbilidad; mientras que los sociolaborales han sido pacientes sin estudios y aquellos que trabajan en los sectores de la conducción, construcción y hostelería. La reincorporación laboral se produjo en el 64% de los trabajadores activos previamente. Sólo en torno al 10% se encuentran insatisfechos con la opción quirúrgica, relacionándose significativamente tanto esto como las dimensiones de función física, dolor, vitalidad y rol emocional en el SF-36 con el SCRF.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Uno de cada 3 pacientes intervenidos de hernia discal lumbar en nuestro medio presenta cirugía fallida, reincorporándose laboralmente 2 de cada 3 pacientes previamente activos.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El paciente con cirugía fallida se encuentra afectado por dolor, hasta el punto de repercutir y limitar las actividades del hogar y las laborales. Además presenta frecuentemente sensación de cansancio o agotamiento, y problemas emocionales que interfieren tanto en las actividades de la vida diaria como en el trabajo.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Return to work after surgery occurs in 70–85% of the cases. There are a few studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. For the statistical analysis of the results, we used the program SPSS 11.01.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In a sample in which the proportion between both sexes was 1/1, and the middle age was over 45 years [35–54], in which the most frequent clinical symptom was right sciatica, lasting more than 6 months, correlated to disc herniation at L5-S1 level, 37’9% of the patients presented FBSS. Although there were a few patients with reoperation in our study, the incidence of FBSS in these patients was higher (52,9%) than in patients who suffered this surgery for first time (32%). The predictive clinical factors of an unfavourable result in patients operated on for first time were bilateral sciatica, the presence of stenosis associated to herniated disc and comorbidity factors. On the other hand the sociolabor factors identified were a low culture level and those working as drivers, building and service sectors. Return to work occurred in the 64% of the active workers before surgery. Only around 10% of patients were dissatisfied with surgical result and there was a significant relationship between this and the physical function, pain, vitality and emotional status in the SF-36 with the FBSS.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labor and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Rodríguez-García, J.; Sánchez-Gastaldo, A.; Ibáñez-Campos, T.; Vázquez-Sousa, C.; Cantador-Hornero, M.; Expósito- Tirado, J.A.; Cayuela-Domínguez, A.; Echevarría-Ruiz de Vargas, C.: Factores relacionados con la cirugía fallida de hernia discal lumbar. Neurocirugía 2005; 16: 507–517.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Abril | 1 | 0 | 1 |
| 2023 Marzo | 4 | 1 | 5 |
| 2018 Febrero | 14 | 7 | 21 |
| 2018 Enero | 17 | 44 | 61 |
| 2017 Diciembre | 13 | 11 | 24 |
| 2017 Noviembre | 39 | 40 | 79 |
| 2017 Octubre | 6 | 9 | 15 |
| 2017 Septiembre | 6 | 9 | 15 |
| 2017 Agosto | 12 | 13 | 25 |
| 2017 Julio | 6 | 7 | 13 |
| 2017 Junio | 17 | 7 | 24 |
| 2017 Mayo | 17 | 8 | 25 |
| 2017 Abril | 26 | 16 | 42 |
| 2017 Marzo | 4 | 5 | 9 |
| 2017 Febrero | 3 | 7 | 10 |
| 2017 Enero | 10 | 4 | 14 |
| 2016 Diciembre | 23 | 19 | 42 |
| 2016 Noviembre | 25 | 17 | 42 |
| 2016 Octubre | 34 | 19 | 53 |
| 2016 Septiembre | 35 | 23 | 58 |
| 2016 Agosto | 33 | 14 | 47 |
| 2016 Julio | 19 | 9 | 28 |
| 2016 Mayo | 1 | 0 | 1 |
| 2016 Abril | 1 | 0 | 1 |
| 2016 Marzo | 3 | 0 | 3 |
| 2016 Febrero | 1 | 0 | 1 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Septiembre | 1 | 0 | 1 |
| 2015 Julio | 1 | 5 | 6 |
| 2015 Junio | 17 | 12 | 29 |
| 2015 Mayo | 19 | 18 | 37 |
| 2015 Abril | 18 | 16 | 34 |
| 2015 Marzo | 23 | 13 | 36 |
| 2015 Febrero | 16 | 19 | 35 |
| 2015 Enero | 22 | 23 | 45 |
| 2014 Diciembre | 23 | 24 | 47 |
| 2014 Noviembre | 12 | 16 | 28 |
| 2014 Octubre | 19 | 26 | 45 |
| 2014 Septiembre | 15 | 22 | 37 |
| 2014 Agosto | 15 | 33 | 48 |
| 2014 Julio | 14 | 16 | 30 |
| 2014 Junio | 34 | 54 | 88 |
| 2014 Mayo | 24 | 29 | 53 |
| 2014 Abril | 24 | 21 | 45 |
| 2014 Marzo | 22 | 19 | 41 |
| 2014 Febrero | 24 | 29 | 53 |
| 2014 Enero | 17 | 54 | 71 |
| 2013 Diciembre | 18 | 31 | 49 |
| 2013 Noviembre | 20 | 35 | 55 |
| 2013 Octubre | 25 | 35 | 60 |
| 2013 Septiembre | 23 | 33 | 56 |
| 2013 Agosto | 29 | 45 | 74 |
| 2013 Julio | 23 | 27 | 50 |
| 2013 Junio | 18 | 23 | 41 |
| 2013 Mayo | 9 | 39 | 48 |
| 2013 Abril | 13 | 29 | 42 |
| 2013 Marzo | 13 | 26 | 39 |
| 2013 Febrero | 20 | 21 | 41 |
| 2013 Enero | 11 | 21 | 32 |
| 2012 Diciembre | 9 | 27 | 36 |
| 2012 Noviembre | 1 | 7 | 8 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Enero | 16 | 0 | 16 |
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