2019, Number 3
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Cir Cir 2019; 87 (3)
Guidelines in the decision of surgical management in spine surgery
Jiménez-Ávila JM, Sánchez-García O, González-Cisneros AC
Language: Spanish
References: 15
Page: 299-307
PDF size: 610.09 Kb.
ABSTRACT
Introduction: The spine surgeon has knowledge and skills that allow him to make decisions when performing a surgical
procedure, based on the evidence and ethical values and expectations of the patient. Any surgical procedure will be preceded
by a diagnosis based on four fundamental pillars: traumatic, degenerative, vertebral destruction syndrome and deformities.
Once the lesion is categorized, the surgeon will use his knowledge to identify instability or neurological compromise. When
performing a surgical procedure, it should be kept in mind in the transoperative the four key objectives that will count, to
achieve a satisfactory management: decompress, implement, merge and correct the sagittal balance.
Objective: To analyze
the fundamental criteria in decision making, for conservative or surgical management in the spine.
Results: The assessment
scales and the most frequent and best practices in relation to spine surgery will be analyzed, as well as the applications that
will be applied and evaluated in each particular case, which will strengthen the diagnostic impression and the value forecast.
Conclusion: Implementing the culture of using patient outcome measurements as an assessment tool helps the spine surgeon
to decide on a treatment plan that can be adapted to the patient’s preferences and needs. We must base our clinical objective
on the stability and the neurological commitment of the patient, there being four diagnostic possibilities; which will be
corrected for four fundamental objectives.
REFERENCES
Jiménez-Ávila JM, Rubio-Flores EN, González-Cisneros AC, Guzmán-Pantoja JE, Gutiérrez-Román EA. Directrices en la aplicación de la guía de práctica clínica en la lumbalgia. Cir Cir. 2018;86:29-37.
De la Cruz-Álvarez S, Canales-Nájera JA, Hurtado-Padilla A, Guevara-Villazón F, Ledezma-Ledezma J. Corporectomía por acceso ú nico posterior con colocación de caja expandible y fijación transpedicular en fracturas toracolumbares. Acta Ortopédica Mexicana. 2017;31:82-5.
Ames CP, Justin SS, Smith JS, Shay B, Scheer JK, Bess S, et al. Impact of spinopelvic alignment on decision making in deformity surgery in adults. J Neurosurg Spine. 2012;16:547-64.
Vaccaro AR, Schroeder GD, Kepler CK, Oner FC, Vialle LR, Kandziora F, et al. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J. 2016;25:1087-94.
Feng Z, Liu Y, Yang G, Battié MC, Wang Y. Lumbar vertebral endplate defects on magnetic resonance images: classification, distribution patterns, and associations with modic changes and disc degeneration. Spine (Phila Pa 1976). 2018;43:919-27.
Urrutia J, Besa P, Campos M, Cikutovic P, Cabezón M, Molina M, et al. The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment. Eur Spine J. 2016;25:2728-33.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193-9.
Fisher CG. A novel classification system for spinal instability in neoplastic disease. An evidence-based approach and expert consensus from the spine oncology study group. Spine (Phila Pa 1976). 2010;35:E1221-9.
Jiménez-Ávila JM, Cahueque-Lemus MA, Cobar-Bustamante AE, Bregni-Duraes MC. Vertebral destruction syndrome: from knowledge to practica. J Spine. 2015:4:1-4.
Choi D, Crockard A, Tomita K. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J. 2010;19:215-22.
Sponseller P, Flynn JM, Newton PO, Marks MC, Bastrom TP, Petcharaporn M, et al. The association of patient characteristics and spinal curve parameters with Lenke classification types. Spine (Phila Pa 1976). 2012;37:1138-41.
Falavigna A, Dozza DC, Teles AR, Wong CC, Barbagallo G, Brodke D, et al. Current status of worldwide use of patient-reported outcome measures (PROMs) in spine care. World Neurosurg. 2017;108:328-35.
Kim GM, Yi CH, Cynn HS. Factors influencing disability due to low back pain using the Oswestry Disability Questionnaire and the Quebec Back Pain Disability Scale. Physiother Res Int. 2015;20:16-21.
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25:2940-52; discussion 2952.
Chiarotto A, Maxwell LJ, Terwee CB, Wells GA, Tugwell P, Ostelo RW. Roland-Morris Disability Questionnaire and Oswestry Disability Index: which has better measurement properties for measuring physical functioning in nonspecific low back pain? Systematic review and meta-analysis. Phys Ther. 2016;96:1620-37.