Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data / Impacto da cirurgia na dor, incapacidade e qualidade de vida de portadores de doença degenerativa lombar: dados brasileiros

ABSTRACT Objective: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). Methods: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. Results: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. Conclusions: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

RESUMO Objetivo: Descrever o impacto da cirurgia na dor, incapacidade, qualidade de vida e a satisfação global do paciente numa amostra unificada de pacientes portadores de DDL. Métodos: Análise retrospectiva de dados colhidos prospectivamente em pacientes operados no período de janeiro de 2014 a março de 2017, que tivessem avaliação pré-operatória e pelo menos uma avaliação pós-operatória entre 6 e 12 meses com os questionários de ODI, SF-36 e o ISP. Resultados: Um total 216 pacientes preenchia os critérios de inclusão. Houve melhora no escore médio de dor (201,2%), incapacidade (39,7%), qualidade de vida física (42%) e mental (37,8%). Da amostra, 57,7% alcançaram o MCID de dor, 59,7% de ODI, 59,7% 50,5% de PCS e 50,5% de MCS; 82,5% dos pacientes se consideraram "Satisfeitos". Conclusões: O efeito da cirurgia foi amplamente favorável na dor, incapacidade e qualidade de vida dos pacientes portadores de DDL. Estes dados podem servir de guia para aconselhamento pré-operatório quanto às perspectivas de sucesso.

Inflammatory biomarkers in sera of patients with intervertebral disc degeneration / Biomarcadores inflamatórios no plasma de pacientes com degeneração do disco intervertebral

ABSTRACT Objective: To evaluate intervertebral disc levels of inflammatory factor (interleukin 6) and proteinase activity (cathepsin B) in patients with a degenerative disease and serum levels of interleukin 6, serum cathepsin B activity and hyaluronic acid biomarkers. Methods: We conducted immunohistochemistry studies of intervertebral discs to analyze interleukin 6 and cathepsin B levels of patients with degenerative disease and spine fracture (Control Group) and to measure hyaluronic acid, interleukin 6 and cathepsin B activity from sera of intervertebral disc degeneration patients, fracture patients, and healthy individuals. Results: Interleukin 6 and cathepsin B seem to be related with physiopathology of intervertebral disc degeneration, since the levels of both were higher in discs of patients with intervertebral disc degeneration. Interleukin 6 and cathepsin B do not represent good biomarkers of degenerative intervertebral disc disease, since the level of such compounds is increased in the plasma of patients with fractures. Conclusion: Hyaluronic acid can be a biomarker for intervertebral disc degeneration, because hyaluronic acid levels were higher only in sera of patients with intervertebral disc degeneration.

RESUMO Objetivo: Avaliar os níveis de fatores inflamatórios nos discos intervertebrais (interleucina 6) e proteinase (catepsina B) em pacientes com doença degenerativa de disco intervertebral, além de verificar os níveis séricos de interleucina 6, ácido hialurônico e atividade sérica da catepsina B. Métodos: Foi realizado exame imuno-histoquímica dos discos intervertebrais de pacientes com doença degenerativa e fratura da coluna (Grupo Controle) e análise do plasma de pacientes com doença degenerativa de disco intervertebral. Como controle, foram utilizados plasma de pacientes com fraturas, além de indivíduos saudáveis. Resultados: Interleucina 6 e catepsina B sugerem relação com a fisiopatologia da doença degenerativa de disco intervertebral, uma vez que os níveis de ambos foram maiores nos discos de pacientes com doença degenerativa de disco intervertebral. Interleucina 6 e catepsina B não representam bons biomarcadores da doença degenerativa do disco intervertebral, já que também encontram níveis aumentados em plasma de pacientes com fratura. Conclusão: O ácido hialurônico é um possível biomarcador de doença degenerativa de disco intervertebral, porque os níveis de ácido hialurônico foram maiores apenas em plasma de pacientes com doença degenerativa de disco intervertebral.

Relación entre la degeneración discal, el dolor y la estabilidad lumbar: dolor / Relationship between disc degeneration, lumbar pain and stability: pain

INTRODUCCIÓN: el dolor lumbar clasifica como uno de los trastornos musculoesqueléticos más comunes, la degeneración del disco intervertebral es aceptada como la mayor causa de dicho dolor, el conocimiento de la fisiopatología de la degeneración del disco intervertebral y el dolor asociado a ella, representan una de las mayores prioridades de las investigaciones biomédicas. OBJETIVO: revisar y discutir los mecanismos directos e indirectos, relativos a la degeneración, que pueden ser causa de dolor lumbar. MÉTODOS: se realizó una revisión acerca de los mecanismos a través de los cuales, la degeneración del disco intervertebral, puede producir dolor, analizando aquellos que por vía mecánica o anatómica actúan indirectamente; y los que, a través de cambios biológicos y bioquímicos, pueden producir dolor de forma directa. RESULTADOS: de forma indirecta, la degeneración discal puede producir dolor al afectar de manera anatómica y funcional estructuras cercanas que están inervadas, no está claro que la degeneración discal provoque inestabilidad. Al interior del disco patológico ocurren cambios biológicos y bioquímicos con liberación de mediadores de inflamación que llevan a la neoinervación discal y a dolor. CONCLUSIONES: el dolor como consecuencia de la degeneración discal, se produce por mecanismos directos e indirectos, no está demostrado que la degeneración del disco provoque inestabilidad. Al interior del disco ocurre crecimiento de nervios nociceptivos que explican el dolor directo discógeno.

INTRODUCTION: LBP ranks as one of the most common musculoskeletal disorders, degeneration of the intervertebral disc is accepted as the major cause of pain, the pathophysiology knowledge of intervertebral disc degeneration and pain associated therewith, represent a of the highest priorities of biomedical research. OBJECTIVE: review and discuss the direct and indirect mechanisms relating to this degeneration, which can cause back pain. METHOD: a review was performed on the mechanisms through which the degeneration of the intervertebral disc can cause pain, by analyzing those that mechanical or anatomical indirectly act; and those that can directly cause pain through biological and biochemical changes. RESULTS: indirectly, disc degeneration can cause pain by affecting nearby innervated structures anatomically and functionally. it is unclear that disc degeneration causes instability. Biological and biochemical changes occur with release of inflammation mediators leading to pain and disc neo-innervation within the pathological disc.CONCLUSIONS: the pain from disc degeneration occurs by direct and indirect mechanisms. Disc degeneration is not proved to cause instability. Within the disc nociceptive nerve growth occurs explaining direct discogenic pain.

Escoliosis degenerativa del adulto / Degenerative adult scoliosis

La escoliosis del adulto es una deformidad rotacional compleja tridimensional de la columna, resultado de la degeneración progresiva de los elementos vertebrales en la edad madura, en una columna previamente recta; con un ángulo de Cobb mayor de 10º en el plano coronal, que además altera los planos sagital y axial. Se origina de una enfermedad degenerativa, asimétrica del disco y las facetas articulares, creando cargas asimétricas y posteriormente deformidad. El síntoma principal es dolor axial, radicular y déficit neurológico. El tratamiento conservador incluye fármacos y terapia física. Las infiltraciones epidurales y facetarias para bloqueo selectivo de raíces nerviosas mejora el dolor a corto plazo. El tratamiento quirúrgico se reserva para pacientes con dolor intratable, radiculopatía y/o déficit neurológico. No existe un consenso para las indicaciones quirúrgicas, sin embargo, se debe tener un entendimiento claro de los síntomas y signos clínicos. La meta de la cirugía es la descompresión de elementos neurales con restauración, modificación de la deformidad en forma tridimensional y estabilización del balance coronal y sagital.

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10º in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and / or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.