Hernia discal lumbar en el ámbito laboral. Resultado de un análisis retrospectivo de una serie de 189 pacientes consecutivos
Correspondencia: Dr. M.B. Royo Salvador. Clínica de la Columna Vertebral de Barcelona. Clínica Delfos. Avda. Hospital Militar, 151-153. E08023 Barcelona.
E-mail: 10389mrs@comb.es
Introduction. Owing to recent advances in the diagnosis and treatment of lumbar disc pathology, the functional results obtained have improved, although there are still certain factors which affect this. The results in the work place are particularly problematic. Objective. With the aim of finding an answer to the problem of relapse of the sciatica syndrome in patients operated on for hernia of the lumbar discs, we describe a study carried out in a consecutive group of patients who had had operations for hernias of lumbar discs whilst at work, within the context of revindication involved in this situation. Patients and methods. We describe the results obtained in a series of 189 patients who had been operated on for lumbar disc pathology. Conventional open surgery was performed in 105 cases. Percutaneous nucleotomy was done in the remainder. In 17.39%, operations were done at more than one level, making a total of 265 discs operated on. Results. These were considered good when the patient returned to his former work. Good results were obtained in 72% of the patients treated by open surgery and 68% of those treated by percutaneous nucleotomy. The re-operation rate was 8.57% for open surgery and 32.14% for percutaneous nucleotomy (p< 0.05). Conclusions. The main reason for re-operation was a recurrence of disc protrusion. Good results were obtained in 80% of those reoperated. All reoperations were done using open surgery techniques. Overall assessment of the cases, including initial and re-operations, gave good results, reaching 83.59% in the current series [REV NEUROL 1998; 27: 574-6].
Objetivo Con el propósito de dar respuesta a la problemática de la recidiva del síndrome ciatálgico en pacientes intervenidos de hernia discal lumbar, se expone un estudio realizado en un grupo consecutivo de pacientes intervenidos de hernia discal lumbar en el ámbito laboral, con el contexto reivindicativo que conlleva.
Pacientes y métodos Se describen los resultados obtenidos en una serie de 189 pacientes intervenidos por patología discal lumbar. En 105 casos se realizó cirugía abierta convencional y en los 84 casos restantes, una nucleotomía percutánea. En el 17,39% se practicaron intervenciones a más de un nivel, totalizando 265 discos intervenidos.
Resultados Se catalogaron como buenos cuando el paciente se reincorporó a su trabajo habitual, resultando que el 72% de los pacientes sujetos a cirugía abierta y el 68% de los sujetos sometidos a nucleotomía percutánea tuvieron un buen resultado. La tasa de reintervenciones fue del 8,57% para la cirugía abierta y del 32,14% para la nucleotomía percutánea (p< 0,05).
Conclusiones El principal motivo de reintervención fue la recurrencia de la protrusión discal. Se obtuvo un buen resultado en el 80% de las reintervenciones, que siempre se realizaron mediante cirugía abierta. Una valoración global de los casos, incluyendo cirugía primaria y reintervenciones, da una tasa de buenos resultados que alcanza el 83,59% en la presente serie
