Identificación de los factores de riesgo en la aparición de síndrome de cirugía de espalda fallida (SCEF)

Zusammenfassung

INTRODUCTION: The Failed Back Surgery Syndrome (FBSS) can be defined as the final surgical phase after one or more procedures in the lumbar spine, indicated to relieve axial or radicular pain -or the combination of both-, without a positive effect. It must be approached as a chronic pathology with a high prevalence, which also affects public health and entails a great economic impact due to a high use of health resources. HYPOTHESIS AND OBJECTIVES: It would be possible to identify some clinical, care and sociodemographic variables that allow us to predict the appearance of FBSS and to develop a risk minimisation protocol to increase the patient&apos;s safety. MATERIAL AND METHODS: A retrospective, descriptive and inferential study on back surgeries performed on 278 patients. The data were collected from the medical records, and consisted of sociodemographic, diagnostic, presurgical and postsurgical variables, as well as medical histories. SPSS software was used to perform the statistical analysis and a p<0.05 was considered statistically significant. RESULTS: The final sample of the study is made up of 278 patients, 49.3% (n = 137) of whom are women and 50.7% (n = 141) are men, aged between 32 and 86 years, with a mean age of 54.4 (SD = 12.1). According to the procedure results, in 49.3% of the cases, the patients were diagnosed with FBSS, while in 50.7% of the cases, the surgery was successful and, consequently, the patient improved. The risk profile of our sample is a young, dyslipidaemic male who smokes and suffers from anxiety and/or depression. He takes NSAIDs before the surgery, but not opioids, and has a low level of pre-surgical haemoglobin and an evolution time for surgery greater than or equal to two years. Plain X-rays and MRIs were the tests chosen for the diagnosis. The most frequent diagnosis was degenerative disc disease (DDD), a risk factor that increases the probabilities of having FBSS. The most frequent surgery was discectomy. The most prescribed postsurgical treatment in patients with FBSS was analgesia and mild opioids. 40.2% of the cases required one or more additional surgeries. The most frequent surgery (78.1%) was single-level arthrodesis. Myofascial low back pain was the postsurgical effect our patients presented the most. 72.2% also had mainly bilateral sciatica. 39.3% of the patients in the FBSS group had postsurgical complications - the most frequent one was depressive disorder secondary to surgery. CONCLUSIONS: Managing FBSS is complex and should be assessed from a multidisciplinary approach. We think that, due to limitations and the repercussions in the quality of life of the patients that suffer from it, the best treatment is preventing its appearance.