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Hernia discal lumbar con déficit motor de moderado a severo: un estudio multicéntrico del mundo real
Henri d'Astorg1,2, Hadrien Giorgi3, Fahed Zairi4
1Ramsay santé, Hôpital Privé Jean Mermoz, Lyon, France.
Resumen
La intervención quirúrgica temprana y la mejora de la fuerza muscular el día 1 postoperatorio son clave para la recuperación motora en la hernia discal lumbar (HDL). La reducción del dolor radicular y la debilidad preoperatoria menos severa también mejoran los resultados.
Área de la Ciencia:
- Neurocirugía
- Cirugía Ortopédica
- Investigación de Resultados Clínicos
Sus antecedentes:
- La hernia discal lumbar (HDL) con déficit motor presenta un desafío clínico significativo.
- La intervención quirúrgica a menudo es necesaria para restaurar la función y aliviar los síntomas.
Objetivo del estudio:
- Determinar los resultados de los pacientes después del tratamiento quirúrgico para la HDL con déficit motor.
- Identificar los factores asociados con la recuperación motora completa después de la cirugía.
Principales métodos:
- Un estudio observacional prospectivo incluyó a 144 pacientes con HDL y déficit motor (puntuación MRC ≤3).
- Los pacientes fueron evaluados preoperatoriamente, el día 1 postoperatorio y a los 1-3 y 10-12 meses.
- La recuperación motora completa se definió como una puntuación MRC de 5.
Principales resultados:
- El 58 % (83/144) de los pacientes lograron una recuperación motora completa.
- El tratamiento más temprano (por cada aumento de 10 días), la debilidad preoperatoria menos severa, la resolución del dolor radicular en el día postoperatorio 1 y las ganancias en la fuerza muscular en el día 1 se asociaron de forma independiente con la recuperación.
- La recuperación motora completa también se relacionó con la recuperación sensorial.
Conclusiones:
- La mejora postoperatoria de la fuerza muscular el día 1 es el predictor más fuerte de recuperación motora completa.
- Factores como la reducción del dolor radicular, el menor tiempo hasta el tratamiento y una mayor fuerza muscular preoperatoria influyen en el pronóstico.
- Estos hallazgos ayudan a los médicos y pacientes a comprender los posibles resultados de la cirugía de HDL.
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