[Minimally-invasive circumferential lumbar arthrodesis. Functionality and complications]. / Artrodesis lumbar circunferencial mínima invasiva. funcionalidad y complicaciones.

OBJECTIVE: Report the experience of the authors with the treatment of degenerative disc disease using minimally-invasive circumferential arthrodesis and considering the functional results, healing and complications. MATERIAL AND METHODS: Circumferential arthrodesis was performed with an anterior approach using an interbody spacer, and with a posterior approach using translaminar facet screws in 36 patients. All of them had disc degeneration with some type of contraindication for lumbar arthroplasty, with a history of conservative treatment for at least 6 months. They were evaluated before and after surgery with the visual analogue pain scale and the Oswestry scale, as well as a treatment satisfaction scale (0 to 10 points). RESULTS: The pain scale went from 9.1 preoperatively to 23 postoperatively, and the Oswestry disability scale went from 47% to 21%. The satisfaction rate at the two-year follow-up was 9.2. All patients were found to have interbody healing at the 6-month follow-up and there were 2 complications: one vascular injury and one case of transient retrograde ejaculation. CONCLUSION: Circumferential arthrodesis using minimally-invasive methods leads to interbody healing and good functional recovery rates and low complication rates.

LUMBAR DISC HERNIATION.

Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term.

Hérnia discal lombar / Lumbar disc herniation

A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3 por cento da população) e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas). O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo.

Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3 percent of the population), and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks). Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less), where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence in the long term.

Estudo epidemiológico de fraturas de femur proximal em idosos / Epidemiologic study of proximal femur fractures in the elderly

De 1984 até 1994 foram analisados os casos de 1.250 pacientes portadores de fratura de fêmur proximal acima de 60 anos de idade. Houve predominância das fraturas mulheres (65,0 por cento) e a faixa etária mais acometida foi a de 60 a 69 anos de idade. Oitenta e seis por cento das fraturas foram conseqüentes a traumas leves; a maioria das quedas ocorreu em casa. Cada paciente apresentava uma média de três patologias associadas. Este estudo teve como objetivo analisar fatores relacionados Ós etiologias das fraturas, tanto do ponto de vista etiológicos como de alteraçöes diversas que possam agir como fatores pré-disponentes.