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Advisor(s)
Abstract(s)
Introdução: A síndrome da cirurgia lombar falhada (SCLF) caracteriza-se pela
persistência ou recidiva da dor ou aparecimento de novos sintomas após discectomia,
descompressão de canal estreito ou artrodese lombares. Objectivos: O objectivo deste
estudo foi descrever a abordagem em fisioterapia de um caso com Síndrome da Cirurgia
Lombar Falhada e avaliar os seus efeitos na funcionalidade e sintomatologia dolorosa neste
indivíduo. Metodologia: A amostra foi constituída por um sujeito com 41 anos,
trabalhador da construção civil, apresentando dor lombar com irradiação para o membro
inferior, após ter sido submetido a discectomia lombar e artrodese, que realizou sessões de
fisioterapia convencional antes e depois da cirurgia, e que apresentava sinais compatíveis
com compressão radicular. A intensidade da dor foi medida através da escala visual
analógica (EVA), as amplitudes com o goniómetro universal, a funcionalidade foi avaliada
utilizando o Questionário de Incapacidade Roland-Morris (RMDQ), o estado psicológico
foi avaliado através da “Escala de Desânimo Associado à Dor” e do “Inventário de
Convicções e Percepções Relacionadas com a Dor”. Resultados: A dor era inicialmente
em média de 5,5/10 EVA, sendo de 3,4/10 EVA no final do tratamento. Quanto à
funcionalidade (RMDQ) esta variou de 14/24 no início para 17/24 no final. De uma forma
geral, após a aplicação de técnicas para diminuir a tensão do piriforme, técnicas
neuurodinâmicas e um programa de exercícios para melhoria do controlo motor, o paciente
apresentou alívio das queixas de dor na nádega esquerda e anca, aumento da amplitude de
rotação medial da coxo-femoral, ausência das parestesias na face plantar do pé esquerdo e
melhoria das queixas de dor na face anterior e lateral da coxa. Verificamos que houve
diminuição dos índices de dor e melhorias dos níveis de funcionalidade. Conclusão: Neste
estudo de caso, foi salientado o processo de raciocínio clínico desenvolvido pelo
fisioterapeuta: a interpretação dos dados da história e levantamento das primeiras hipóteses
e a realização dos testes no exame objectivo, permitiram estabelecer um diagnóstico
funcional e elaborar um plano de intervenção através do qual o utente recuperou
parcialmente a sua funcionalidade e diminuiu os seus índices de dor.
Introduction: The failed back surgery syndrome (FBSS) is characterized by persistent or recurrent pain or onset of new symptoms after discectomy, decompression of lumbar arthrodesis or narrow channel. Objectives: The aim of this study was to describe the approach to therapy of a case with Failed back surgery syndrome and to assess their effects on function and pain symptoms in this individual. Methodology: The sample consisted of a man with 41 years, construction worker, with back pain radiating to the leg, after having undergone lumbar discectomy and arthrodesis, which held sessions of concentional physical therapy before and after surgery, and showed signs consistent with nerve root compression. Pain intensity was measured by visual analogue scale (VAS), the amplitudes with the universal goniometer, the functionality was assessed using the Questionnaire of Roland-Morris Disability (RMDQ), the psychological state was assessed using the "Pain Catastrophising Scale" and "Pain Beliefs and Perceptions Invetory". Results: The pain initially was on average 5.5/10 EVA and 3.4/10 EVA at the end of treatment. As for functionality (RMDQ) that ranged from 14/24 to 17/24 at the beginning and at the end. In general, after the application of techniques to reduce piriformis tension, neurodynamic techniques and an exercise program to improve motor control, the patient presented with complaints of pain relief in the left buttock and hip, increased range of internal rotation the hip joint, the absence of paresthesias on the plantar surface of the left foot and improvement of the complaints of pain in the anterior and lateral thigh. We found that decreased levels of pain and improved levels of functionality. Conclusion: In this case study was emphasized clinical reasoning process developed by the physiotherapist: data interpretation of history and survey of the first hypotesis in the testing and physical examination, the establishment of a functional diagnosis and development of a treatment plan through which the pacient has partially recovered its functionality and reduced their levels of pain.
Introduction: The failed back surgery syndrome (FBSS) is characterized by persistent or recurrent pain or onset of new symptoms after discectomy, decompression of lumbar arthrodesis or narrow channel. Objectives: The aim of this study was to describe the approach to therapy of a case with Failed back surgery syndrome and to assess their effects on function and pain symptoms in this individual. Methodology: The sample consisted of a man with 41 years, construction worker, with back pain radiating to the leg, after having undergone lumbar discectomy and arthrodesis, which held sessions of concentional physical therapy before and after surgery, and showed signs consistent with nerve root compression. Pain intensity was measured by visual analogue scale (VAS), the amplitudes with the universal goniometer, the functionality was assessed using the Questionnaire of Roland-Morris Disability (RMDQ), the psychological state was assessed using the "Pain Catastrophising Scale" and "Pain Beliefs and Perceptions Invetory". Results: The pain initially was on average 5.5/10 EVA and 3.4/10 EVA at the end of treatment. As for functionality (RMDQ) that ranged from 14/24 to 17/24 at the beginning and at the end. In general, after the application of techniques to reduce piriformis tension, neurodynamic techniques and an exercise program to improve motor control, the patient presented with complaints of pain relief in the left buttock and hip, increased range of internal rotation the hip joint, the absence of paresthesias on the plantar surface of the left foot and improvement of the complaints of pain in the anterior and lateral thigh. We found that decreased levels of pain and improved levels of functionality. Conclusion: In this case study was emphasized clinical reasoning process developed by the physiotherapist: data interpretation of history and survey of the first hypotesis in the testing and physical examination, the establishment of a functional diagnosis and development of a treatment plan through which the pacient has partially recovered its functionality and reduced their levels of pain.
Description
Keywords
Síndrome da Cirurgia Lombar Falhada (SCLF) Dor Funcionalidade Fisioterapia Failed back surgery syndrome (FBSS) Pain Function Physical therapy
Citation
Publisher
Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto