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Abstract(s)
Introdução: A ráquis cervical é a porção da coluna vertebral com mais graus de liberdade. É uma estrutura complexa, que garante o suporte da cabeça na posição ereta e os movimentos de flexão, extensão, rotação e inclinação lateral. A sua mobilidade é requerida para numerosas tarefas diárias relacionadas com a perceção do espaço envolvente, o autocuidado e com tarefas laborais. Além do mais, garante a proteção de importantes estruturas como é o caso das estruturas nervosas (medula espinhal, nervos cranianos e plexo braquial), vasculares, respiratórias e órgãos fonatórios e das estruturas digestivas. Pode ser afetada por patologias que se manifestam por diminuição da mobilidade cervical, por algias locais ou irradiadas e redução da sensibilidade ou da força muscular, devidas a compressão das estruturas nervosas. Daqui se depreende o forte impacto que patologias cervicais podem ter na qualidade de vida dos indivíduos por elas afetadas. A artrodese é um procedimento cirúrgico que consiste na fusão de dois ou mais segmentos vertebrais. É frequentemente realizada após procedimentos cirúrgicos que causam instabilidade vertebral, como a discectomia ou a corporectomia, pre-venindo as suas sequelas.
Objetivos: O presente trabalho tem como objetivo primário a realização de uma revisão sistemática sobre as alterações funcionais e clínicas resultantes da artrodese cervical.
Metodologia: Fez-se uma pesquisa na base de dados PUBMED, com as seguintes palavras-chave: cervical AND ("spinal fusion" OR arthrodesis) AND "range of motion". Selecionaram-se apenas os artigos que apresentavam resultados clínicos e funcionais. A análise realizada foi apenas qualitativa. Incluíram-se 12 estudos nesta revisão sistemática.
Conclusões: Na avaliação clínica, os estudos desta revisão sistemática demonstram uma melhoria na intensidade da dor no pós-operatório. A nível funcional, os artigos são concordantes quanto à diminuição da amplitude geral do movimento após artrodese. Ficam por esclarecer quais as alterações de movimento compensadoras dos segmentos adjacentes, bem como a sua repercussão ou impacto clínico no doente. São necessários mais estudos com maior nível de evidência, com amostras maiores e uniformização dos critérios de avaliação, para entender quais são os fatores que definem o sucesso clínico na perspetiva do doente, sendo que a gestão da dor, mais do que o movimento, parece ter o papel principal.
Background: The cervical rachis is the portion of the spine with more degrees of freedom. It is a complex structure, which guarantees the support of the head in the upright position and the movements of flexion, extension, rotation and lateral bending. Its mobility is required for numerous daily tasks related to the perception of the surrounding space, self-care and work tasks. Moreover, it ensures the protection of important structures such as nervous structures (spinal cord, cranial nerves and brachial plexus), vascular structures, respiratory and phonatory organs and digestive structures. It can be affected by pathologies manifested by reduc-tion of cervical mobility and by neuronal impairment with local or irradiated algias and re-duced sensitivity or muscular strength. Therefore, cervical pathologies can have a strong im-pact on the quality of life. Arthrodesis is a surgical procedure that involves the fusion of two or more vertebral segments. It is often performed after surgical procedures that cause verte-bral instability, such as discectomy or corpectomy, preventing its sequelae. Goals: The primary objective of the present work is to systematically review the functional and clinical changes resulting from cervical arthrodesis. Methods: A search was performed on the PUBMED database, with the following keywords: cervical AND ("spinal fusion" OR arthrodesis) AND "range of motion". Only studies with clinical and functional results were selected. The analysis was only qualitative. Twelve studies were included on the systematic review. Conclusions: In the clinical evaluation, the studies demonstrate an improvement in postoper-ative pain intensity. At functional level, the articles agree on the reduction of the overall range of motion after arthrodesis. It remains unclear the compensatory movement changes of the adjacent segments, as well as their repercussion or clinical impact on the patient. It is still necessary to understand what the true factos that define clinical success from the per-spective of the patient are. Pain management, rather than movement, seems to play the main role. We still need future studies with high level of evidence, larger samples, standardi-zation of evaluation criteria and integration of patient satisfaction criteria are required.
Background: The cervical rachis is the portion of the spine with more degrees of freedom. It is a complex structure, which guarantees the support of the head in the upright position and the movements of flexion, extension, rotation and lateral bending. Its mobility is required for numerous daily tasks related to the perception of the surrounding space, self-care and work tasks. Moreover, it ensures the protection of important structures such as nervous structures (spinal cord, cranial nerves and brachial plexus), vascular structures, respiratory and phonatory organs and digestive structures. It can be affected by pathologies manifested by reduc-tion of cervical mobility and by neuronal impairment with local or irradiated algias and re-duced sensitivity or muscular strength. Therefore, cervical pathologies can have a strong im-pact on the quality of life. Arthrodesis is a surgical procedure that involves the fusion of two or more vertebral segments. It is often performed after surgical procedures that cause verte-bral instability, such as discectomy or corpectomy, preventing its sequelae. Goals: The primary objective of the present work is to systematically review the functional and clinical changes resulting from cervical arthrodesis. Methods: A search was performed on the PUBMED database, with the following keywords: cervical AND ("spinal fusion" OR arthrodesis) AND "range of motion". Only studies with clinical and functional results were selected. The analysis was only qualitative. Twelve studies were included on the systematic review. Conclusions: In the clinical evaluation, the studies demonstrate an improvement in postoper-ative pain intensity. At functional level, the articles agree on the reduction of the overall range of motion after arthrodesis. It remains unclear the compensatory movement changes of the adjacent segments, as well as their repercussion or clinical impact on the patient. It is still necessary to understand what the true factos that define clinical success from the per-spective of the patient are. Pain management, rather than movement, seems to play the main role. We still need future studies with high level of evidence, larger samples, standardi-zation of evaluation criteria and integration of patient satisfaction criteria are required.
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Keywords
Amplitude de Movimento Artrodese Cervical Dor Resultados