Operarse de columna, ¿posible en la tercera edad?

Operarse de columna, ¿posible en la tercera edad?

Publicado en Topdoctors

Los problemas de columna son frecuentes en mayores de 65 años. El dolor puede localizarse solo a nivel lumbar o irradiarse a las piernas como ciática, impidiendo caminar al paciente.

A partir de los 65 años el envejecimiento afecta de forma importante a la columna. Hay dos lesiones muy habituales: las fracturas vertebrales osteoporóticas y la estenosis de canal medular. En el caso de las mujeres, la columna envejece peor que en los hombres. Esto se debe, principalmente, a la osteoporosis, que supone que el hueso de las vértebras de las mujeres es más frágil y se rompe con más facilidad, tras esfuerzos o incluso al toser o estornudar fuerte.

Hay determinadas fracturas vertebrales que pueden no dar síntomas y detectarse en una radiografía rutinaria, aunque en la mayoría de los casos aparece un dolor súbito e intenso a nivel de la columna dorsal o lumbar que, en ocasiones, no permite que el paciente permanezca en pie.

En la estenosis de canal vertebral, el principal síntoma es la claudicación neurógena, es decir, el paciente empieza a caminar y en un momento dado tiene que pararse porque las piernas no le responden o le duelen, pudiendo tener asociado o no dolor lumbar. A la hora de decidir el tratamiento para estas patologías existen diferentes opciones.

Los problemas de columna aumentan a partir de los 65 años.

En las fracturas vertebrales por osteoporosis lo habitual es comenzar con reposo, analgésicos y el uso de un corsé. En aquellos casos en los que tras seis semanas de tratamiento conservador el dolor no mejora, puede realizarse una cirugía mínimamente invasiva y con anestesia local que se denomina vertebroplastia o cifoplastia. Esta técnica consiste en inyectar de forma percutánea, un cemento acrílico especial para el hueso dentro de la vértebra.

Se realiza con una incisión de 3 milímetros y a través de un trócar, cuya posición controlamos por radiología intraoperatoria se inyecta el cemento. El paciente se va a casa sin dolor el mismo día de la cirugía.

En el caso de la estenosis de canal, en la que el paciente ya no puede casi caminar por el dolor de la pierna, los tratamientos con medicamentos o las infiltraciones tienen un efecto temporal, por lo que el tratamiento más efectivo y duradero es la cirugía.

Es una enfermedad que no se cura sola. Puede permanecer estable o empeorar, pero no mejorar. Por lo tanto, es absurdo retrasar la cirugía por miedo, ya que mientras más mayor se sea, más enfermedades asociadas se suelen tener.

Si se quiere mejorar, hay que operarse o resignarse a no volver a caminar distancias medias o largas. Es fundamental la valoración preparatoria por parte del anestesista, debido a la edad del paciente.

Este tipo de cirugía se realiza con técnicas poco invasivas, que van a permitir solucionar el problema con la menor agresividad, aumentando la seguridad y disminuyendo las complicaciones y el tiempo de recuperación. Con una buena coordinación entre cirujanos y anestesista operamos de forma habitual pacientes de más de 80 años.

En la Unidad de Columna del Policlínico HM IMI Toledo realizan las intervenciones de forma conjunta traumatólogos y neurocirujanos aportando lo mejor de ambas especialidades.

Dr. Andres Barriga

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