¿Dónde estamos?

La consulta del Dr. Manuel Malillos se encuentra en:

  • Hospital Viamed Los Manzanos

C/ Hermanos Maristas, s/n. 26140 Lardero.

           

                  Teléfono 941 499 490

 

 

Dr. Manuel Malillos Torán

Tratamiento quirúrgico de las fracturas osteoporóticas vertebrales

Las fracturas vertebrales osteoporóticas o "aplastamientos" vertebrales son una causa muy frecuente de dolor dorsal y lumbar en el anciano. Habitualmente se tratan de forma conservadora mediante el empleo de analgésicos asociados a ortesis toracolumbares. Sin embargo, en ocasiones es necesario recurrir a la cirugía. Las tecnicas quirúrgicas más habituales para este tipo de fracturas son tecnicas mínimamente invasivas y consisten en rellenar con cemento el cuerpo vertebral, dotandolo de mayor capacidad para soportar la carga de peso. Cuando solo pretendemos rellenar el cuerpo vertebral, empleamos una vertebroplastia. Cuando por el contrario intentamos "levantar" los platillos vertebrales para devolver a la vertebra la forma que tenía antes de fracturarse empleamos la cifoplastia. Son técnicas muy seguras, y que eliminan el dolor no siendo necesario emplear ortesis.

"Doctor, ¿es necesario recurrir a la cirugía cuando me duele la espalda?

La respuesta es: a veces.

En la gran mayoría de lo casos, los dolores de espalda se manejan o "se controlan" con tratamientos conservadores (tratamiento rehabilitador, medicación analgésica, unidad del dolor etc.). Las cervicalgias, dorsalgias y lumbalgias evolucionan, de forma general, hacia la resolución espontánea. Los diferentes tratamientos conservadores tienen como objetivo aliviar los periodos de dolor y mejorar nuestra calidad de vida (medicación analgesíca, fisioterapia, etc.) pero en ningún caso curan el problema.

Sólo estaría indicada la cirugía si se dan estas circunstancias:

  • que exista una lesión subyacente tratable con cirugía (hernia de disco, estenosis de canal, discopatia, radiculopatía que cause ciática, etc.)  
  • y que se hayan agotado todos los tratamientos no quirúrgicos.
  • y que la calidad de vida de los pacientes este severamente afectada.

No existe ninguna regla universal sobre el momento ideal para operar. Lo razonable es esperar un tiempo prudencial de varios meses con tratamientos conservadores (no quirúrgicos) para dar tiempo a que el dolor mejore. Si tras el periodo de tratamiento conservador la calidad de vida del paciente continúa muy limitada podemos indicar la cirugía.

En definitiva el principal propósito de una cirugía de columna suele ser corregir una lesión anatómica en personas que no han logrado mejorar con tratamientos no quirúrgicos.

Dentro las opciones quirúrgicas, existen técnicas con diferentes periodos de convalecencia. Las técnicas mínimamete invasivas, como la microdiscectomia para el tratamiento de las hernias discales, permiten una rápida recuperación funcional, en algunos casos sin ingreso hospitalario. Si por el contrario es necesario realizar una artrodesis o fusion vertebral, la recuperación es mas lenta. En este último caso, con el desarrollo de las técnicas minimamente invasivas para la artrodesis vertebral, hemos conseguido disminuir el dolor postoperatorio y acortar los periodos de ingreso a uno o dos dias. 

"Doctor, tengo una hernia de disco.¿Me tendría que operar?"



Aunque hay que individualiar el tratamiento de cada paciente, podemos contestar que hasta un 90% de las hernias de disco sintomáticas mejoran en el plazo de 8 a 12 semanas y por lo tanto no es necesario operar. Solamente un 10% de los pacientes no mejoran con los tratamientos conservadores y en este grupo podría estar indicada la intervención quirúrgica.

La indicación quirúrgica de las hernia de disco sería el dolor incontrolado con tratamientos conservadores ( hasta un 10% de las hernias de disco), la pérdida de fuerza o parálisis de algun miembro, la anestesia o hipostesia en silla de montar y las alteraciones esfinterianas.

¿Qué ejercicios son buenos para la espalda?

Las tres reglas esenciales para tener una espalda sana son:

  1. realizar ejercicio físico de forma regular
  2. no coger pesos
  3. evitar el sobrepeso

¿Cuándo se opera la estenosis de canal?

Most patients with spinal stenosis respond well to non-surgical treatments (such as medication), so you may not have to have surgery. However, there are situations when you may want to go ahead with spine surgery.

  • You've tried non-surgical treatments and they haven't been successful.
  • You've been in severe pain for a lengthy period of time.
  • You're experiencing radiculopathy, which is a medical term used to describe pain, numbness, and tingling in the arms or legs.
  • You've lost sensation in your arms or legs.
  • You have decreased motor strength in your arms or legs.
  • You've lost bowel or bladder control.

One main goal of spinal stenosis surgery is to free up area for your spinal cord and/or the nerve roots. That's called decompression. By giving your spinal cord and nerve roots more space to pass through, your spine surgeon hopes to decrease your pain from nerve inflammation.

Another goal of spinal stenosis surgery is to increase your motor strength in your arms or legs. If you've lost sensation in your arms or legs, your surgeon also hopes to restore that.

Non-surgical Spinal Stenosis Treatments to Try Before Surgery

Typically, surgeons use 2 surgical techniques for spinal stenosis surgery.

  • Decompression: The surgeon will remove tissue pressing against a nerve structure, which makes more room in the spinal canal (for the spinal cord) or in the foramen (for the nerve roots).
  • Stabilization: The surgeon works to limit motion between vertebrae.

Decompression Surgery for Spinal Stenosis

To remove the tissue that's pressing on a nerve, your spine surgeon may perform one of the following types of surgery.

  • Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
  • Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on your nerve, so the surgeon may make more room for the nerves using a laminotomy.
  • Laminectomy: Sometimes, a laminotomy is not sufficient. The surgeon may need to remove all or part of the lamina, and this procedure is called a laminectomy.  This can often be done at many levels without any harmful effects.

Indirect decompression is a variation of decompression surgery where pressure is relieved by spreading the bones apart instead of removing bone. This can be done with instrumentation (hardware), such as interspinous process devices or interbody cages. Even artificial discs can accomplish some indirect decompression by restoring the height between adjacent vertebrae.

Stabilization Surgery for Spinal Stenosis

Not everyone who has surgery for spinal stenosis will need stabilization, which is also known as spinal fusion. It's especially helpful in cases where one or more vertebrae has slipped out of the correct position, which makes your spine unstable (and painful). In these cases, the bones slipping can pinch nerves. The need for stabilization also depends on how many vertebrae your surgeon needs to work on. For example, if he or she needs to remove the lamina (using a laminectomy) in multiple vertebrae, your spine may be unstable without those structures. You'll need to have spinal fusion to help stabilize your spine.

Spine stabilization surgery has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.

Open Spine Surgery or Minimally Invasive Spine Surgery?

If your surgery is performed through a relatively large incision in your back, that's called open surgery. Another option is minimally invasive surgery, which is done through several small incisions. The surgeon may use a microscope, endoscope, or tiny camera and very small surgical instruments.

However, minimally invasive surgery is not for everyone. If your surgeon needs to work on many vertebrae, you'll probably need to have open surgery.

Be Aware of These Surgical Risks

As with any operation, there are risks involved with surgery for spinal stenosis. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

  • general risks of anesthesia
  • injury to your spinal cord or nerves
  • non-healing of the bony fusion (pseudoarthrosis)
  • failure to improve
  • instrumentation breakage/failure
  • infection and/or bone graft site pain

Recovery from Spinal Stenosis Surgery

After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you'll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: In general, don't do anything that moves your spine too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection-to your doctor right away.

You should always take good care of your body and practice healthy habits, but you should be especially healthy following surgery. You should:

  • follow your doctor's treatment plan
  • sit and stand properly
  • learn to lift correctly
  • exercise regularly (low-impact aerobic exercise is especially good, but check with your doctor first)
  • use proper sports equipment
  • attain and maintain a healthy body weight
  • eat healthy foods (a well-balanced, low-fat diet rich in fruits and vegetables) and get enough calcium
  • stop smoking
  • avoid excessive use of alcohol

And take heart: The results with surgery to correct spinal stenosis are usually good. Generally, 80% to 90% of patients have relief from their pain after surgery.