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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se analiza de forma retrospectiva el resultado cl&#237;nico de una serie consecutiva de 53 pacientes afectos de mielopat&#237;a o mielorradiculopat&#237;a cervical que fueron intervenidos mediante discectom&#237;a cervical y artrodesis por v&#237;a anterior utilizando la t&#233;cnica de Cloward&#44; con un seguimiento medio de 3 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El 64&#46;2&#37; de los pacientes se benefici&#243; del tratamiento quir&#250;rgico&#44; mejorando en uno o m&#225;s grados en la escala de Nurick&#46; No se produjo mortalidad&#44; aunque apareci&#243; deterioro neurol&#243;gico en el 9&#46;4&#37; de los casos&#46; Se objetiv&#243; una correcta fusi&#243;n de los segmentos intervenidos en el 92&#46;5&#37; de las cirug&#237;as&#44; desarrollando un 9&#46;4&#37; de los enfermos cifosis postquir&#250;rgica&#46; En el an&#225;lisis multivariante se identificaron como factores relacionados con el resultado cl&#237;nico&#58; edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#44; presencia de factores de riesgo vascular &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; duraci&#243;n de la cl&#237;nica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; estado neurol&#243;gico prequir&#250;rgico &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; diagn&#243;stico neurorradiol&#243;gico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#44; presencia de hiperse&#241;al intramedular en las secuencias de resonancia magn&#233;tica potenciadas en T2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#44; alteraci&#243;n de la conducci&#243;n medular en el estudio neurofisiol&#243;gico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; y desarrollo de complicaciones quir&#250;rgicas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dadas las discrepancias existentes en la actualidad&#44; la optimizaci&#243;n del tratamiento de estos pacientes pasa por una valoraci&#243;n individualizada&#44; y por la realizaci&#243;n de estudios prospectivos y randomizados que respondan a las preguntas cu&#225;ndo y c&#243;mo operar&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We perform a retrospective analysis of clinical results in 53 consecutive patients surgically treated for cervical myelopathy or myelo-radiculopathy with anterior cervical discectomy and interbody fusi&#243;n by means of the Cloward procedure&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">64&#46;2&#37; of the patients had good outcome as measured by the improvement in one or more grades in the Nurick&#39;s scale&#46; No mortality related to the surgical procedure was noted&#44; although 9&#46;4&#37; of the cases suffered neurological deterioration&#46; Correct fusi&#243;n was achieved in 92&#46;5&#37; of the patients&#44; with a rate of post-surgical kyphosis of 9&#46;4&#37;&#46; Multivariate analysis identified as factors related to the clinical outcome&#58; age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#44; vascular risk factors &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; duration of symptoms &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; pre-surgical neurological status &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; neuroradiological diagnosis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#44; intramedullary high signal intensity changes in T2-weighted images &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#44; prolongation of the central somatosensory or motor conduction times &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; and neurologic complications &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Treatment optimisation of the patient suffering cervical spondylotic myelopathy requires individualised evaluation&#46; Prospective randomised studies are needed to answer the questions when and how to op&#233;rate&#46;</p>"
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Vol. 16. Núm. 3.
Páginas 235-255 (enero 2004)
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Vol. 16. Núm. 3.
Páginas 235-255 (enero 2004)
Mielopatía cervical: análisis retrospectivo de los resultados quirúrgicos de 54 pacientes tratados mediante discectomía y fusión intersomática por vía anterior
Cervical myelopathy: Retrospective analysis of surgical results in 53 cases treated by anterior cervical discectomy and interbody fusión
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2477
R. Martín
, J.R. Carda, F. Montiaga, J.I. Pinto, F. Sanz, B. Paternina, F. Trigueros, J.M. Izquierdo, A. Vázquez-Barquero
Servicio de Neurocirugía. Hospital Universitario Marqués de Valdecilla. Santander
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Pacientes y métodos

Se analiza de forma retrospectiva el resultado clínico de una serie consecutiva de 53 pacientes afectos de mielopatía o mielorradiculopatía cervical que fueron intervenidos mediante discectomía cervical y artrodesis por vía anterior utilizando la técnica de Cloward, con un seguimiento medio de 3 años.

Resultados

El 64.2% de los pacientes se benefició del tratamiento quirúrgico, mejorando en uno o más grados en la escala de Nurick. No se produjo mortalidad, aunque apareció deterioro neurológico en el 9.4% de los casos. Se objetivó una correcta fusión de los segmentos intervenidos en el 92.5% de las cirugías, desarrollando un 9.4% de los enfermos cifosis postquirúrgica. En el análisis multivariante se identificaron como factores relacionados con el resultado clínico: edad (p=0.008), presencia de factores de riesgo vascular (p=0.031), duración de la clínica (p=0.002), estado neurológico prequirúrgico (p<0.001), diagnóstico neurorradiológico (p=0.014), presencia de hiperseñal intramedular en las secuencias de resonancia magnética potenciadas en T2 (p=0.008), alteración de la conducción medular en el estudio neurofisiológico (p=0.004) y desarrollo de complicaciones quirúrgicas (p=0.012).

Conclusiones

Dadas las discrepancias existentes en la actualidad, la optimización del tratamiento de estos pacientes pasa por una valoración individualizada, y por la realización de estudios prospectivos y randomizados que respondan a las preguntas cuándo y cómo operar.

Palabras clave:
Artrodesis intersomática
Discectomía cervical
Hernia discal cervical
Mielopatía cervical
Radiculopatía cervical
Abstract
Patients and methods

We perform a retrospective analysis of clinical results in 53 consecutive patients surgically treated for cervical myelopathy or myelo-radiculopathy with anterior cervical discectomy and interbody fusión by means of the Cloward procedure.

Results

64.2% of the patients had good outcome as measured by the improvement in one or more grades in the Nurick's scale. No mortality related to the surgical procedure was noted, although 9.4% of the cases suffered neurological deterioration. Correct fusión was achieved in 92.5% of the patients, with a rate of post-surgical kyphosis of 9.4%. Multivariate analysis identified as factors related to the clinical outcome: age (p=0.008), vascular risk factors (p=0.031), duration of symptoms (p=0.002), pre-surgical neurological status (p<0.001), neuroradiological diagnosis (p=0.014), intramedullary high signal intensity changes in T2-weighted images (p=0.008), prolongation of the central somatosensory or motor conduction times (p=0.004) and neurologic complications (p=0.012)

Conclusions

Treatment optimisation of the patient suffering cervical spondylotic myelopathy requires individualised evaluation. Prospective randomised studies are needed to answer the questions when and how to opérate.

Key words:
Cervical discectomy
Cervical disc herniation
Cervical myelopathy
Interbody fusión

Artículo

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