CASE REPORT

Fusão Intersomática Lombar Anterior (ALIF) 5 níveis (L1-S1) Associada a Artrodese Via Posterior T10-S1: relato de caso

Anterior Lumbar Interbody Fusion (ALIF) 5 levels (L1-S1) Plus Posterior Arthrodesis T10-S1: case report

  • Iracema Araújo Estevão (1)
  • Larissa Fantinati Zaia (2)
  • Guilherme Holtz Schuch (2)
  • Lorraine Martins Oliva (2)
  • Rafael Duarte de Souza Loduca (3)
  • Aécio Rubens Dias Pereira Filho (4)
  • Paulo Porto de Melo (5)
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Resumo

Relatamos o caso da paciente do sexo feminino, 55 anos, com queixa de lombalgia axial de longa duração associada a irradiação para membro inferior direito não relacionada a dermátomo específico, que piorava com esforço físico e deambulação. Foi admitida no Hospital Militar de Área de São Paulo, HMASP, e submetida a fusão intersomática lombar anterior (ALIF) 5 níveis (L1-S1) associada a artrodese via posterior T10-S1 em segundo tempo. A paciente apresentou melhora significativa da dor e parestesia no pós-operatório imediato, sendo demonstrada boa consolidação óssea nos estudos pós-operatórios por imagens. Realizamos pesquisa documental baseada em dados obtidos do prontuário médico e revisão de literatura nos bancos de dados Medline, Lilacs e Scielo. Este caso nos leva a concluir que apesar das dificuldades técnicas, este procedimento é seguro e passível de bom resultado pós-operatório quando realizado por equipe multidisciplinar composta por cirurgião vascular e neurocirurgião experientes. Devem ser rigorosamente selecionados pacientes com biotipo favorável, a fim de se evitar possíveis eventos adversos.

Palavras-chave

Palavras-Chave: Artrodese lombar; ALIF; Fusão intersomática lombar

Abstract

This is the case of a female patient, 55 years old, with long-lasting axial low back pain associated with irradiation to the right lower limb, not related to a specific dermatome, which worsened with physical exercise and walking. She was admitted to São Paulo Area Military Hospital, HMASP, and submitted to anterior lumbar interbody fusion (ALIF) on 5 levels (L1-S1) plus arthrodesis via posterior route T10-S1 in a second moment. Patient showed significant improvement in pain and paresthesia in the immediate postoperative period and good bone consolidation was shown in postoperative imaging studies. A documentary study based on data retrieved from medical records and literature review from Medline, Lilacs and Scielo databases was conducted. This cases indicates that despite technical challenges, this procedure is safe and likely to obtain improved postoperative results when performed by a multidisciplinary team, composed by experienced vascular surgeon and neurosurgeon. Proper patient selection, based on the biotype is crutial in order to avoid possible adverse events.

Keywords

Lumbar arthrodesis; ALIF; Lumbar interbody fusion

References

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1 MD, MR, Medical Residency in Neurosurgery, São Paulo Area Military Hospital – HMASP, São Paulo, SP, Brazil.
2 Medical Student, University “Nove de Julho”, São Paulo, SP, Brazil.
3 MD, Neurosurgeon, São Paulo Area Military Hospital – HMASP, São Paulo, SP, Brazil.
4 MD, Vascular Surgeon, Company “Clinart Medicina Ltda”, São Paulo, SP, Brazil.
5 MD, PhD, Head of Neurosurgery Department, São Paulo Area Military Hospital – HMASP, São Paulo, SP, Brazil.

 

Received Aug 29, 2021
Accepted Jan 25, 2022

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JBNC  Brazilian Journal of Neurosurgery

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