Community Care Administration of Spinal Deformities in the Brazilian Public Health System.

OBJECTIVE:: Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system. METHODS:: A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system. RESULTS:: Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available. CONCLUSION:: The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.

Community Care Administration of Spinal Deformities in the Brazilian Public Health System

OBJECTIVE: Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system. METHODS: A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system. RESULTS: Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available. CONCLUSION: The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.

Health-related quality of life and expectations of spinal stenosis patients towards the surgical treatment / Calidad de vida relacionada a la salud y expectativas del tratamiento quirúrgico de pacientes con estenosis espinal / Qualidade de vida relacionada à saúde e expectativas com o tratamento cirúrgico de pacientes com estenose espinhal

ABSTRACT The objective of this cross-sectional analytical study was to compare health-related quality of life, presence of anxiety and depression symptoms, and functional limitation according to the location of the spinal stenosis; and to describe patients' expectations toward the surgical treatment. Thirty-two patients with lumbar stenosis and 22 with cervical stenosis participated in the study. Comparison of health-related quality of life showed statistically significant differences in pain and functional capacity dimensions. There were no statistically significant differences regarding anxiety and depression symptoms. The mean functional limitation was 53.2% (SD=11.9%) for the group with lumbar stenosis and 40.2% (SD=17.5%) for the group with cervical stenosis. Most participants expected great improvement of the symptoms after the surgical treatment. In the preoperative period, expectations of improvement are high and should be discussed with the health staff, since in clinical practice, this improvement is not always achieved with the surgical treatment.

RESUMEN Estudio analítico, trasversal para comparar la calidad de vida relacionada a la salud, presencia de síntomas de ansiedad y depresión y limitación funcional según el local de la estenosis espinal; y describir las expectativas de los pacientes ante el tratamiento quirúrgico. Participaron 32 pacientes con estenosis lumbar y 22 con estenosis cervical. En la comparación de la calidad de vida relacionada a la salud, constatamos diferencias estadísticamente significantes en los dominios Dolor y Capacidad funcional. No fueron encontradas diferencias estadísticamente significantes en los síntomas de ansiedad y depresión. El promedio de la limitación funcional fue 53,2% (DE=11,9%) para el grupo con estenosis lumbar y 40,2% (DE=17,5%) para estenosis cervical. La mayoría esperaba gran mejora de los síntomas después del tratamiento quirúrgico. En el preoperatorio, las expectativas de mejora son altas y deben ser discutidas con el equipo de salud, ya que esa mejora ni siempre es alcanzada en la clínica con el tratamiento quirúrgico.

RESUMO Estudo analítico, de corte transversal com objetivos de comparar a qualidade de vida relacionada à saúde, presença de sintomas de ansiedade e depressão e limitação funcional, segundo o local da estenose espinhal; e descrever as expectativas dos pacientes frente ao tratamento cirúrgico. Participaram 32 pacientes com estenose lombar e 22 com estenose cervical. Na comparação da qualidade de vida relacionada à saúde, constatamos diferenças estatisticamente significantes nos domínios Dor e Capacidade funcional. Não houve diferenças estatisticamente significantes quanto aos sintomas de ansiedade e depressão. A média da limitação funcional foi 53,2% (DP=11,9%) para o grupo com estenose lombar e 40,2% (DP=17,5%) para estenose cervical. A maioria dos participantes tinha expectativa de muita melhora dos sintomas após o tratamento cirúrgico. No pré-operatório, as expectativas de melhora são elevadas e devem ser discutidas com a equipe de saúde, uma vez que, na clínica, essa melhora nem sempre é obtida com o tratamento cirúrgico.

Results of kyphoplasty in the minimally invasive treatment of vertebral metastasis / Resultado da cifoplastia no tratamento minimamente invasivo das metástases vertebrais / Resultado de la cifoplastia en el tratamiento mínimamente invasivo de las metástasis vertebrales

OBJECTIVE: To evaluate the clinical and radiological outcome of minimally invasive surgical treatment of vertebral metastases using the technique of kyphoplasty. METHODS: This was a prospective observational study of patients with the diagnosis of spinal metastasis who underwent minimally invasive surgical treatment by filling the vertebral body with balloon kyphoplasty technique. Clinical evaluation included patient age at surgery, diagnosis of the tumor, biopsy results, data of the surgical procedure performed, visual pain scale (VAS) and complications related to surgery. Radiological evaluation involved the study of radiographic procedures in the anteroposterior and lateral incidences, with the analysis of vertebral body kyphosis and the occurrence of extravasation of cement. RESULTS: 22 patients with spinal metastases who were treated by balloon kyphoplasty, 8 (36%) males and 14 (64%) females were studied. The average age was 56.05 years and the mean follow-up was 8.5 months. The mean preoperative VAS was 8.73, 1.73 in the initial postoperative period, and 1.92 in the late postoperative period. CONCLUSION: Kyphoplasty proved to be a safe and effective technique for symptomatic treatment of vertebral metastases. .

OBJETIVO: Avaliar o resultado clínico e radiológico do tratamento cirúrgico minimamente invasivo das metástases vertebrais por meio da técnica de cifoplastia. MÉTODOS: Este é um estudo observacional prospectivo de pacientes com diagnóstico de metástase vertebral, que foram submetidos ao tratamento cirúrgico minimamente invasivo por meio de preenchimento do corpo vertebral com a técnica de cifoplastia com balão. A avaliação clínica incluiu a idade do paciente no momento da cirurgia, o diagnóstico do tumor, os resultados das biópsias, os dados do procedimento cirúrgico realizado, a escala visual de dor (EVA) e as complicações relacionadas à cirurgia. A avaliação radiológica envolveu o estudo dos exames radiográficos nas incidências anteroposterior e lateral, com a análise da cifose do corpo vertebral e a ocorrência de extravasamento do cimento. RESULTADOS: Foram estudados 22 pacientes portadores de metástase vertebral que foram tratados por meio de cifoplastia com balão, sendo 8 (36%) do sexo masculino e 14 (64%) do sexo feminino. A média de idade foi de 56,05 anos e o tempo médio de seguimento, 8,5 meses. A média da EVA pré-operatória foi de 8,73, no pós-operatório inicial, de 1,73 e no pós-operatório tardio, de 1,92. CONCLUSÃO: a cifoplastia mostrou-se uma técnica segura e efetiva para o tratamento sintomático das metástases vertebrais. .

OBJETIVO: Evaluar el resultado clínico y radiológico del tratamiento quirúrgico mínimamente invasivo de las metástasis vertebrales utilizando la técnica de cifoplastia. MÉTODOS: Se trata de un estudio observacional prospectivo de los pacientes con el diagnóstico de metástasis vertebral que se sometieron a tratamiento quirúrgico mínimamente invasivo mediante el llenado del cuerpo vertebral con la técnica de cifoplastia con balón. La evaluación clínica incluyó la edad del paciente en la cirugía, el diagnóstico del tumor, los resultados de la biopsia, los datos del procedimiento quirúrgico realizado, la escala visual de dolor (EVA) y las complicaciones relacionadas con la cirugía. La evaluación radiológica implicó el estudio de exámenes radiográficos en las incidencias anteroposterior y lateral, con el análisis de la cifosis del cuerpo vertebral y la ocurrencia de la extravasación del cemento. RESULTADOS: 22 pacientes con metástasis vertebrales que fueron tratados con cifoplastia con balón, siendo 8 (36%) hombres y 14 (64%) mujeres. La edad promedio fue de 56,05 años y la media de seguimiento fue de 8,5 meses. La media preoperatoria de la EVA fue 8,73, la postoperatoria inicial fue de 1,73 y la postoperatoria tardía fue 1,92. CONCLUSIÓN: La cifoplastia ha demostrado ser una técnica segura y eficaz para el tratamiento sintomático de las metástasis vertebrales. .

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis / Qualidade de vida relacionada saúde e expectativas de pacientes antes do tratamento cirúrgico da estenose lombar / Calidad de vida relacionada con la salud y expectativas de los pacientes antes del tratamiento quirúrgico de la estenosis lumbar

OBJECTIVE: To evaluate the expectations of patients awaiting surgical treatment of lumbar canal stenosis and the association of Health-Related Quality of Life (HRQoL) with symptoms of anxiety and depression. METHODS: The sample included 49 patients from a university hospital. HRQoL was assessed by the Oswestry Disability Index (ODI) and 36-item Medical Outcomes Survey Short Form (SF-36) and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Expectations were investigated by means of questions used in international studies. Data were analyzed descriptively and by Student's t test. RESULTS: The mean time of disease progression was 34.5 months, the mean age was 58.8 years and 55.1% of the patients were women. Most patients had the expectation of improving with surgical treatment and 46.9% expected to be "much better" with regard to leg pain, walking ability, independence in activities and mental well being. The scores of anxiety and depression were respectively, 34.7% and 12.2%. We observed statistically significant differences between the groups with and without anxiety in the domains: General Health, Mental Health, and Vitality. Between the groups with and without depression there were statistically significant differences in the General Health and Mental Health domains. CONCLUSION: Patients showed great expectation to surgical treatment and the symptoms of anxiety and depression were related to some domains of HRQoL. Thus, the study contributes to broaden our knowledge and we can therefore guide the patients as to their expectations with respect to the real possibilities arising from surgery. .

OBJETIVO: Avaliar as expectativas de pacientes que aguardavam o tratamento cirúrgico da estenose do canal lombar e a associação da qualidade de vida relacionada à saúde (QVRS) aos sintomas de ansiedade e depressão. MÉTODOS: Amostra de 49 pacientes de um hospital universitário. A QVRS foi avaliada pelo questionário Oswestry (ODI) e pelo SF-36, e os sintomas de ansiedade e depressão, por meio das subescalas Hospital Anxiety and Depression Scale (HADS). As expectativas foram investigadas por meio de questões usadas em estudos internacionais. Os dados foram analisados descritivamente e pelo teste t de Student. RESULTADOS: O tempo médio de evolução da doença foi de 34,5 meses, a média de idade foi 58,8 anos e 55,1% eram mulheres. A maioria dos pacientes tinha a expectativa de melhorar com o tratamento cirúrgico e 46,9% esperavam ficar "muito melhores" com relação à dor nas pernas, capacidade de caminhar, independência nas atividades e bem estar mental. Os escores de sintomas de ansiedade e depressão foram respectivamente de 34,7% e 12,2%. Observamos diferenças estatisticamente significantes entre os grupos com e sem ansiedade nos domínios: estado geral de saúde, saúde mental e vitalidade. Entre os grupos com e sem depressão as diferenças foram estatisticamente significantes no domínio de estado geral de saúde e saúde mental. CONCLUSÃO: Os pacientes apresentaram grande expectativa frente ao tratamento cirúrgico e os sintomas de ansiedade e depressão eram relacionados com alguns domínios do QVRS. Desta forma, o estudo contribui para ampliarmos o nosso conhecimento e podermos, assim, orientar os pacientes quanto às suas expectativas com relação às reais possibilidades advindas da cirurgia. .

OBJETIVOS: Evaluar las expectativas de los pacientes en espera de tratamiento quirúrgico de la estenosis del canal lumbar y la asociación de la calidad de vida relacionada con salud (CVRS) con síntomas de ansiedad y depresión. MÉTODOS: La muestra incluyó a 49 pacientes de un hospital universitario. La CVRS se evaluó mediante el cuestionario de Oswestry (ODI) y SF-36 y los síntomas de ansiedad y depresión por la Hospital Anxiety and Depression Scale (HADS). Las expectativas fueron investigadas por medio de preguntas utilizadas en estudios internacionales. Los datos se analizaron de forma descriptiva y mediante la prueba t de Student. RESULTADOS: El tiempo promedio de la progresión de la enfermedad fue de 34,5 meses, la edad media fue 58,8 años y el 55,1% eran mujeres. La mayoría de los pacientes tenían la expectativa de mejorar con el tratamiento quirúrgico y el 46,9% esperan quedarse "mucho mejor" en materia de dolor en las piernas, capacidad de caminar, independencia en las actividades y el bienestar mental. Las puntuaciones de ansiedad y depresión fueron respectivamente, 34,7% y 12,2%. Se observaron diferencias estadísticamente significativas entre los grupos con y sin ansiedad en los dominios Salud General, Salud Mental y Vitalidad. Entre los grupos con y sin depresión se constataran diferencias significativas en los dominios de Salud General y Salud Mental. CONCLUSIÓN: Los pacientes mostraron gran expectativa con relación al tratamiento quirúrgico y los síntomas de ansiedad y depresión se relacionaron con algunos dominios de la CVRS. Así, el estudio contribuye a ampliar nuestros conocimientos y podemos así guiar a los pacientes en cuanto a sus expectativas frente a las posibilidades reales que surgen de la cirugía. .