Espondilose cervical: valor prognóstico dos sinais e sintomas pré-operatórios

Cervical spondylosis: prognostic value of preoperative signs and symptoms

Cervical spondylosis. Prognostic value of preoperative signs and symptoms

Espondilose cervical: valor prognóstico dos sinais e sintomas pré-operatórios

Reynaldo A. Brandt^I; Charles A. Fager^II

^IDepartment of Neurosurgery, Lahey Clinic Foundation, Boston, Massachusetts, U.S.A.: Fellow

^IIDepartment of Neurosurgery, Lahey Clinic Foundation, Boston, Massachusetts, U.S.A.: Chairman

SUMMARY

One hundred and forty-one patients with cervical spondylosis were studied, looking for a possible prognostic value in preoperative signs and symptoms. Duration of symptoms lasting from one month to five years untill surgical treatment and spinal fluid protein level had no prognostic value in these patients. In those with radiculopathy, the degree of upper limb pareses, muscle atrophy, absent or diminished reflexes, sensory involvement, number of myelographic deffects and age had prognostic value. In those with myelopathy, the degree of lower limbs pareses and spasticity, sensory involvement, number of myelographic deffects and age had prognostic value. Surgery is a definite method of treatment for patients with progressive signs and symptoms due to cervical spondylosis; some of the preoperative signs and symptoms are valuable in establishing their prognosis.

RESUMO

Cento e quarenta e um pacientes com espondilose cervical foram estudados com o objetivo de se determinar um possível valor prognóstico nos sinais e sintomas pré-operatórios; 99 apresentaram radiculopatia, 19 mielopatia e 23 mielorradiculopatia. Nos pacientes com radiculopatia, recuperação completa foi 2,5 vezes mais frequente nos com paresia moderada dos membros superiores em relação aos com paresia intensa, 4,5 vezes mais frequente nos que não apresentaram atrofia muscular, 4,5 vezes mais frequente nos que não apresentaram distúrbios objetivos da sensibilidade, 4 vezes mais frequente nos que apresentaram defeitos mielográficos em menos do que dois níveis discais; pacientes com mais de 60 anos apresentaram maior proporção de comprometimento motor grave e também tiveram piores resultados com a cirurgia. Nos pacientes com mielopatia, nenhum com paresia intensa e nenhum com espasticidade intensa dos membros inferiores teve recuperação completa no primeiro ano após a cirurgia; resultados melhores foram observados nos que apresentaram paresia moderada nos membros inferiores. Melhores resultados foram vistos em pacientes com número maior de defeitos mielográficos. Comprometimento motor grave dos membros inferiores foi mais frequente nos pacientes com mais de 60 anos e estes apresentaram também piores resultados após a cirurgia em relação aos com menos de 60 anos. A cirurgia foi um marco na recuperação destes pacientes. Conclui-se que a padronização da avaliação destes sinais e sintomas pré-operatórios permite um prognóstico em relação à radiculopatia e à mielopatia consequentes à espondilose cervical.

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Reynaldo A. Brandt — Address: Praça Osvaldo Cruz 138, cj. 73 — 04747 São Paulo. SP — Brasil.

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Datas de Publicação

• Publicação nesta coleção
  27 Fev 2013
• Data do Fascículo
  Mar 1976