Başarısız Bel Cerrahisi Sendromlu Hastalarda Özürlülük, Anksiyete ve Depresyon Arasındaki ilişki

Abstract

Bu çalışmanın amacı; Başarısız Bel Cerrahisi Sendromu (BBCS) tanısı alan hastaların demografik ve klinik özelliklerini belirleyip, özürlülük, anksiyete ve depresyon düzeyleri açısından karşılaştırmaktı. Çalışmaya 35 hasta (25 kadın, 10 erkek) dahil edildi. Hastalara; sosyodemografik özellikleri sorgulayan yarı yapılandırılmış form, Görsel Analog Skala (GAS), Hastane Anksiyete-Depres-yon ölçeği (HAD-A, HAD-D) ve Oswestry Disabilite Ölçeği (ODÖ) uygulandı. Ayrıca tüm hastaların lomber bölge manyetik rezonans görüntüleri değerlendirildi. Cinsiyetler arasında GAS, ODÖ, HAD-A ve HAD-D skorları açısından istatistiksel fark yoktu (p>0.05). Birden fazla operasyon geçiren hastalarda operasyon sayısı ile disabilite arasında pozitif korelasyon saptandı (p<0.05). Ağrı süresi ve şiddeti ortalama değerlerin üstündeki olgularda, ağrı şiddeti depresyonla korele bulundu. Bu çalışmayla BBCS hastaların tanı ve değerlendirilmelerindeki zorluklar bir kez daha ortaya çıkmıştır. Tüm hastalara; multidisipliner yaklaşımla ağrı şiddetleri, özürlülük, anksiyete ve depresyonları göz önünde bulundurularak tedavi planlanmalıdır. / Relationships of the Disability, Anxiety and Depression in Patients with Failed Back Surgery Syndrome The aim of this study is to determine the demographic and clinical features and compare them according to disability, anxiety and depression in patients with Failed Back Surgery Syndrome (FBSS). There were 35 patients (25 female, 10 male) in the study. To evaluate the social and demographic features of the patients, a semi structured form was used analysing Visual Analog Scala (VAS), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scala (HAD). In all of the patients, lumbar magnetic resonans imagings were evaluated. There were no statistical differences between male and females according to VAS, ODI, HAD-A and HAD-D (p>0.05). There was a positive correlation between number of the operations and disability (p<0.05). In patients who had a more than mean pain score their depression and degree of pain were correlated.As a conclusion, we observed many difficulties for the diagnosis and evaluation of the patients with FBSS. We suggest that the planning of the treatment for the patient with FBSS should be made regarding their degree of pain, disability, anxiety and depression.

Keywords

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References

1. Loeser JD, Volinn E. Epidemiology of low back pain. Neur Surg Clin N Am 1991; 2: 713–718.
2. Berker E Baflar›s›z Bel Cerrahisi Sendromu. Bel a¤r›s› tan› ve tedavi. Nobel Kitabevi 2002; 7: 319–324.
3. Schofferman J, Reynolds J, Herzog R, Covington E, Dreyfuss P, O’Neill C. Failed back surgery: etiology and diagnostic evaluation. The Spine Journal 2003; 3: 400–403.
4. Bruton CV, Kirkaldy-Willis WH, Yang-Hing K. Causes of failure of surgery on lumbar spine. Clin Orthop 1981; 152: 191–199.
5. Waguespack A, Schofferman J, Slosar P, Reynolds J et al. Etiology of long-term failures of lumbar spine surgery. Pain Med 2002; 3: 18–22.
6. Slipman CW, Shin CCH, Patel RK, Isaac Z, Huston CW, Lipetz JS et al. Etiologies of failed back surgery syndrome. Pain Med 2002; 3: 200–214.
7. Turk DC, Rudy TE. A cognitive-behavioral perspective on chronic pain: Beyond the scalpel and syringe. In: Tollison CD. (ed) Hand-book of chronic pain management, Baltimore, Williams&Wilkins, 1989; 222–236.
8. Ketenci A. Kronik mekanik bel a¤r›s› bir hastal›k m›d›r? Türkiye Fiziksel T›p ve Rehabilitasyon Dergisi, Özel Say›, 1998; 25–32.

9. Zigmond AS, Sanith PR. The hospital anxiety and depression scale, Acta Psychiatr Scand 1983; 67: 361–70.
10. Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane anksiyete ve depresyon ölçe¤i Türkçe formunun geçerlilik ve güvenilirli¤i. Türk Psikiatri Dergisi 1997; 8: 280–287.
11. Prince DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17: 45–56.
12. Hudson-Cook N, Tomes Nicholson K, Breen A. A revised Oswestry disability questionnaire. In: Roland MO. Jenner JR. eds. Back pain. Manchester, Manchester University, 1989; 187–204.
13. Aydin Y, Ziyal IM, Duman H, Turkmen CS, Baflak M, Sahin Y. Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique. Surg Neurol 2002; 57: 5–13.
14. Onesti TS. Failed back syndrome. The Neurologist 2004; 10: 5: 259–264.
15. Pearce JMS. Aspects of the failed back syndrome: role of litigation. Spinal Cord 2000; 38: 63–70.
16. Goethem JW, Parizel PM, Jinkins JR. Review article: MRI of the postoperative lumbar spine. Neuroradiology. 2002; 44: 723–739.
17. Doan BD, Wadden N. Relationships between depressive symptoms and descriptions of chronic pain. Pain 1989; 36: 75–84.
18. Dickens C, Jayson M, Creed F. Psychological correlation pain behavior in patients with chronic low back pain. Psychosomatics 2002; 43: 42–8.
19. Kjellby-Wendt G, Styf J, Carlsson SG. Early active rehabilitation after surgery for lumbar disc herniation: a prospective, randomized study of psychometric assesment in 50 patients. Acta Ortop Scand 2001; 72: 518–527.
20. Hakkinen A, Yinen J, Kautiainen H, et al. Lomber disk cerrahisinin ard›ndan a¤r›, gövde kaslar›n›n gücü, omurga mobilitesi ve engellilik. Türkiye Klinikleri J PM&R 2004; 4: 64–72.
21. Y›lmaz F, Y›lmaz A, Merdol F ve ark. Dinamik lomber stabilizasyon egzersizinin lomber mikrodiskektomide etkinli¤i. Türkiye Klinikleri J PM&R 2004; 4: 73–80.
22. Çoflkun E, Süzer T, Topuz O, Zencir M, Pakdemirli E, Tahta K. Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery. Eur Spine J 2000; 9: 218–223.