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| 2. |
- Engquist, M., et al.
(författare)
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A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone
- 2017
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Ingår i: Journal of Neurosurgery-Spine. - : Journal of Neurosurgery Publishing Group (JNSPG). - 1547-5654. ; 26:1, s. 19-27
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.
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| 3. |
- Engquist, Markus, et al.
(författare)
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Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy
- 2015
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Ingår i: Spine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0362-2436 .- 1528-1159. ; 40:20, s. 1553-1563
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective randomized controlled trial. Objective. To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy. Summary of Background Data. An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out. Methods. 60 patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at 1 year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress and Risk Assessment Method), self-efficacy (Self-Efficacy Scale) health status (EQ-5D), and magnetic resonance imaging findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/neck pain intensity and NDI. Results. Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain less than 12 months (P = 0.007), duration of arm pain less than 12 months (P = 0.01) and female sex (P = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, P = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, P = 0.02 and NDI, P = 0.02), low Self-Efficacy Scale score (P = 0.05), and high Distress and Risk Assessment Method score (P = 0.04) (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone. Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self-efficacy, and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.
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| 4. |
- Engquist, M., et al.
(författare)
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Surgery versus nonsurgical treatment of cervical radiculopathy : A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up
- 2013
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:20, s. 1715-1722
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN.: Prospective randomized controlled trial. OBJECTIVE.: To study the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program compared with the same physiotherapy program alone for patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA.: Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. METHODS.: Sixty-three patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with anterior cervical decompression and fusion. The physiotherapy program included general/specific exercises and pain-coping strategies. The outcome measures were disability (Neck Disability Index), neck and arm pain intensity (visual analogue scale), and the patient's global assessment. Patients were followed for 24 months. RESULTS.: The result from the repeated-measures analysis of variance showed no significant between-group difference for Neck Disability Index (P = 0.23). For neck pain intensity, the repeated-measures analysis of variance showed a significant between-group difference during the study period in favor of the surgical group (P = 0.039). For arm pain intensity, no significant between-group differences were found according to the repeated-measures analysis of variance (P = 0.580). Eighty-seven percent of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up compared with 62% in the nonsurgical group (P < 0.05). At 24 months, the corresponding figures were 81% and 69% (P = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group. Significant reduction in Neck Disability Index, neck pain, and arm pain compared with baseline was seen in both groups (P < 0.001). CONCLUSION.: In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years. Structured physiotherapy should be tried before surgery is chosen. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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| 5. |
- Halldin, Klas, 1967, et al.
(författare)
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Clinical application of a new three-dimensional radiological classification of lumbar disc herniations
- 2005
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Ingår i: Ups J Med Sci. - 0300-9734. ; 110:2, s. 159-65
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Tidskriftsartikel (refereegranskat)abstract
- The results after lumbar discectomy are usually satisfactory. However, there is a group of patients with less favorable result. The predictive factors affecting the result are not fully understood. In this paper a new radiological classification for lumbar disc herniations has been used in order to study the predictive value of the type and location of the herniation for the postoperative result. 142 patients operated with standard lumbar discectomy were included in the study. The preoperative CT-scans were used to classify the disc herniations in the transverse, sagittal and longitudinal directions and the size of the herniations were calculated. At a mean of 7.7 years postoperatively a patient administrated questionnaire was used to compare the clinical results to the radiological findings. A significantly smaller size of the lumbar disc herniation was found with increasing age, which could reflect the increased degeneration of the disc. Patients with a wide transverse distribution of the herniation seem to have a less favorable postoperative outcome in terms of higher rate of repeat surgery (p = 0.056). No other correlations were found.
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| 6. |
- Halldin, Klas, 1967, et al.
(författare)
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Is increased segmental motion early after lumbar discectomy related to poor clinical outcome 5 years later?
- 2005
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Ingår i: Int Orthop. - : Springer Science and Business Media LLC. - 0341-2695. ; 29:4, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to compare segmental motion in the early postoperative phase after lumbar discectomy to the outcome 5 years postoperatively. The study population had radiologically verified symptomatic L4-L5 or L5-S1 lumbar disc herniation and was referred with an indication for lumbar discectomy. Radiostereometry was performed in the supine and standing positions. The L4-L5 and L5-S1 segments were analysed separately. L4-L5 segments adjacent to the operated L5-S1 segment constituted a reference segment for the operated L4-L5 and vice versa. Twenty-one patients were available for the follow-up at 5 years. Outcome was classified as functionally good or poor. Repeated or planned repeat surgery at the same level during follow-up was considered as poor outcome. The L4-L5 segments in the poor group showed different direction of sagittal rotation (anterior versus posterior) of L4 on L5 compared with the good group (p<0.01). On the L5-S1 segment, patients with poor outcome displayed an increased anterior translation of about 1 mm (p<0.01) compared with the reference segments. Our study suggests that increased inducible vertebral displacement in the early postoperative phase after discectomy is associated with a poor clinical outcome.
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| 7. |
- Halldin, Klas, 1967, et al.
(författare)
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The effect of standard lumbar discectomy on segmental motion: 5-year follow-up using radiostereometry
- 2005
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Ingår i: Int Orthop. - : Springer Science and Business Media LLC. - 0341-2695. ; 29:2, s. 83-7
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Tidskriftsartikel (refereegranskat)abstract
- We measured the effects of lumbar discectomy on segmental motion over a period of 5 years. Twenty-four patients with lumbar disc herniation were treated by standard lumbar discectomy at the L4-L5 or L5-S1 level. Peroperatively, tantalum markers were inserted into L4, L5, and the sacrum. Radiostereometric analysis was performed at discharge from hospital and 5 years postoperatively. The treated level was compared with the corresponding untreated level. Thus, patients who had discectomy at the L4-L5 level served as controls for patients with L5-S1 lesions and vice versa. The relative rotation and translation in relation to the three cardinal axes were calculated. Inducible displacements over the two discs were calculated between the supine and standing positions. At the L4-L5 level, there were no differences in inducible displacements between the operated and control levels at discharge or 5 years postoperatively. At the L5-S1 level we found decreasing inducible movement in the sagittal plane over time for discectomy patients. The reason for decreasing mobility over time after discectomy at the L5-S1 but not at the L4-L5 level is unknown. Mechanical factors caused by the more vertical orientation of the L5-S1 disc in combination with degenerative changes could be one explanation.
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| 8. |
- Halldin, Klas, 1967, et al.
(författare)
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Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome
- 2009
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 33:3, s. 725-30
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Tidskriftsartikel (refereegranskat)abstract
- Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome.
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| 9. |
- Janssen, T., et al.
(författare)
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Publication rate of paper and podium presentations from the European Section of the Cervical Spine Research Society Annual Meeting
- 2016
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 25:7, s. 2311-2316
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Tidskriftsartikel (refereegranskat)abstract
- The Cervical Spine Research Society Europe (CSRS-E) actively promotes scientific activities, the annual meeting being the most evident of them. The publication rate of oral and poster presentations at the annual meeting could be a measure for the success of the promotional activities. The publication rates of abstracts presented at the annual European meetings of the CSRS are unknown. The quality of the abstracts presented at a conference is reflected by the publication rate. A high publication rate is usually interpreted as representative of high scientific value of the conference. Poster and podium presentations from the 2007 to 2012 annual meetings were identified. Pubmed was used to search for the abstract title and/or the combination of authors to verify whether the data were published in a peer-reviewed journal. Abstracts were considered published if the data presented at the meeting were identical to that in the publication. The journals in which the data were published were identified, as well as the origin of the research centre. From 2007 to 2012 826 abstracts were featured at the CSRS Europe annual meetings. There were 236 podium presentations and 590 poster presentations. 42 % of the podium presentations resulted in a publication, and 28 % of the poster presentations led to a publication. Overall, 32 % of accepted abstracts effectuated a publication in a peer-reviewed scientific journal. Abstracts from European research groups had a publication rate of 29 % compared to 34 % for abstracts from non-European research groups. Spine, European Spine Journal, Journal of Spinal Disorders and Techniques and J Neurosurgery Spine were the most common publication journals for the abstracts. The mean impact factor of the journals in which was published was 2.2. 42 % of the abstracts that were accepted for podium presentation at the CSRS Europe resulted in a publication in peer-reviewed MEDLINE indexed journals. Publication rates are at the high end of the publication rate spectrum of abstracts accepted for European scientific meetings.
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