| 11. |
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| 12. |
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| 13. |
- Eskilsson, Karin, et al.
(författare)
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Pedicle subtraction osteotomy: a comprehensive analysis in 104 patients. Does the cause of deformity influence the outcome?
- 2017
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Ingår i: Journal of Neurosurgery-Spine. - : Journal of Neurosurgery Publishing Group (JNSPG). - 1547-5654. ; 27:1, s. 56-62
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE The clinical outcomes and complications of patients who underwent pedicle subtraction osteotomy (PSO) for various diagnoses were compared. More specifically, the purpose was to identify if outcomes differed between patients with flat-back syndrome after lumbar fusion (FBS-LF) versus patients who underwent surgery for adult spinal deformity (ASD). METHODS A retrospective analysis of 104 patients who underwent a PSO for sagittal plane imbalance was performed. There were 28 patients with FBS-LF and 76 patients with various forms of ASD. Outcome was measured using visual analog scale (VAS)-back, VAS-leg, Oswestry Disability Index (ODI) (range 0-100 for all scales), and EQ-5D scores (range 0-1). Patients also rated their global outcomes as much better, better, unchanged, or worse at follow-up. The minimum follow-up was 1 year (range 1-4 years). Clinical outcomes and complications were compared between the 2 groups of patients. RESULTS The most common level of PSO was L-3 and L-2; 100 single and 4 double PSOs were performed. The average local correction by PSO itself was 27.2 degrees. The sagittal vertical axis (SVA) improved from a mean preoperative value of 74 +/- 23 mm to 49 +/- 20 mm at the final follow-up. The VAS -back, ODI, and EQ:5D scores improved significantly for the entire group by 33, 16, and 0.31 points, respectively. In total, 57% of patients reported that they were "much better" or "better" than before surgery. Preoperatively, as well as postoperatively, the FBS-LF patients reported significantly worse VAS scores.. According to VAS -back results, the ASD group improved by 34 points compared with 29 points in FBS-LF patients. ODI scores were similar between the 2 groups preoperatively but improved significantly more in the ASD group (18 points) compared with the FBS-LF group (13 points). The EQ-5D scores improved from 0.07 to 0.35 in FBS-LF patients, and from 0.21 to 0.56 on average in ASD patients. Similarly, a "much better" or "better" outcome compared with before surgery was reported by 72% of patients in the ASD group compared with 24% of patients in the FBS-LF group (p < 0.001). The overall reoperation rate was 31%: 46% of patients in the FBS-LF group compared with 25% of patients in the ASD group. There were 19 (18%) dural tears, 14 (13.5%) surgical site infections, 12 (11.5%) instances of pseudarthrosis, 15 (14%) proximal junctional failures, and 2 distal junctional failures. The 12 (11%) neurological complications were dominated by partial weakness of hip flexion and knee extension, and all but 2 of these were temporary. CONCLUSIONS PSO is a safe and effective method for correcting sagittal plane imbalance due to multiple etiologies. The authors found patient satisfaction to be high, and health-related quality of life was greatly improved by the procedure in patients with ASD. In contrast, in FBS-LF patients, a suboptimal outcome was observed and the cautious use of PSO seems warranted in this subset of patients.
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| 14. |
- Eskilsson, Karin, et al.
(författare)
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The impact of spinopelvic morphology on the short-term outcome of pedicle subtraction osteotomy in 104 patients
- 2017
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Ingår i: Journal of Neurosurgery-Spine. - : Journal of Neurosurgery Publishing Group (JNSPG). - 1547-5654. ; 27:1, s. 74-80
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Pedicle subtraction osteotomy (PSO) is commonly performed for correction of spinal sagittal plane deformities. The PSO results in complex, multiple changes of the spinopelvic alignment. The influence of the variability of individual pelvic morphology has not been fully analyzed in previous outcome studies of sagittal imbalance. The aim of this study was to define radiological variables affecting the outcome after PSO in adult spinal deformities, with special emphasis on the variability of pelvic morphology. METHODS Clinical and radiographic outcomes were analyzed in a retrospective analysis of 104 patients who underwent a PSO at a single center. The radiographic variables studied were sagittal vertical axis (SVA), T1SPI (T-1 spinopelvic inclination), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). To control for the individual variation of pelvic morphology, the LL/PI, PT/PI, and SS/PI ratios were calculated. Clinical outcome was assessed using the visual analog scale for pain, Oswestry Disability Index, and EQ-5D preoperatively and at a minimum 1 -year follow-up. Correlation coefficients were calculated between each individual radiographic variable and the outcome measures. The importance of LL mismatch to TK, reflecting the importance of a harmonious spine, was analyzed by comparing the outcome of patients with a TK+LL+PI 5 45 to those with a sum > 45. RESULTS SVA and T1SPI demonstrated the strongest correlation with the clinical outcome scores (r = 0.4-0.5, p < 0.001). LL correlated weakly with the clinical outcome (r = 0.2-0.3, p < 0.003). Mismatch of LL to PI, however, did not correlate significantly with the outcome. Similarly, only weak and inconsistent correlation was observed between PT, SS, PT/PI, SS/PI, and functional outcome. Patients with a TK+LL+PI _5 45 had a significantly lower ODI score (33 vs 44) and a significantly higher EQ-5D score (0.64 vs 0.40) than patients with a sum > 45 (LL is a negative value). CONCLUSIONS PSO resulted in a substantial correction of sagittal imbalance and improved outcome in most patients in this study. Correction of the global sagittal balance appears to be a necessary precondition for a good outcome. A harmonious spine with a TK and an LL of similar magnitude seems to add to a positive outcome.
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| 15. |
- Grunnesjö, Marie
(författare)
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Low Back Pain : With Special Reference to Manual Therapy, Outcome and its Prognosis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work. Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work. Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56). Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.
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| 16. |
- Hermansen, Anna, et al.
(författare)
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A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study
- 2011
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Ingår i: SPINE. - : J B Lippincott Co. - 0362-2436 .- 1528-1159. ; 36:12, s. 919-925
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Ten- to 13-year follow-up of a prospective randomized study. Objective. To compare the 10- to 13-year outcomes of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC), and the Cloward procedure (CP) using a broad clinical and patient-centered assessment. Summary of Background Data. There are few prospective studies and none with a follow-up of 10 years or more. Methods. Patient questionnaires completed 10 years or more after ACDF. Seventy-three patients (77%) responded. Radiographs were obtained at 2 years. Results. Apart from greater fulfillment of preoperative expectation (P = 0.01) and less headache (P = 0.005) in the CIFC group compared with the CP group, there were no significant differences in the outcomes of the two surgical methods. Pain intensity improved in comparison with preoperative levels in both the CIFC and CP groups (P andlt; 0.0001), but the Neck Disability Index (NDI) only improved in the CIFC group (P = 0.04). Only those with a healed fusion benefited from an improved NDI (P = 0.02). There was no deterioration in pain intensity or NDI after the 2-year follow-up. Conclusion. The outcomes of the two surgical methods, with a few exceptions, were equal at 10- to 13-year follow-up, and there was no deterioration in outcome after the 2-year follow-up. Pain intensity improved more than disability, which may indicate that further improvement of physical function requires early more extensive postoperative rehabilitation. Despite persisting disability, repeat surgery was relatively uncommon.
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| 17. |
- Hermansen, Anna, et al.
(författare)
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A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques
- 2023
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Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFollow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20 years after ACDF surgery using different techniques. The purpose of this study was to describe pain and functioning more than 20 years after anterior cervical decompression and fusion surgery, and to compare outcomes between the Cloward Procedure and the carbon fiber fusion cage (CIFC).MethodsThis study is a 20 to 24-year follow-up of a randomized controlled trial. Questionnaires were sent to 64 individuals, at least 20 years after ACDF due to cervical radiculopathy. Fifty individuals (mean age 69, 60% women, 55% CIFC) completed questionnaires. Mean time since surgery was 22.4 years (range 20,5-24). Primary outcomes were neck pain and neck disability index (NDI). Secondary outcomes were frequency and intensity of neck and arm pain, headache, dizziness, self-efficacy, health related quality of life or global outcome. Clinically relevant improvements were defined as 30 mm decrease in pain and a decrease in disability of 20 percentage units. Between-group differences over time were analyzed with mixed design ANOVA and relationships between main outcomes and psychosocial factors were analyzed by Spearman s rho.ResultsNeck pain and NDI score significantly improved over time (p < .001), with no group differences in primary or secondary outcomes. Eighty-eight per cent of participants experienced improvements or full recovery, 71% (pain) and 41% (NDI) had clinically relevant improvements. Pain and NDI were correlated with lower self-efficacy and quality of life.ConclusionThe results from this study do not support the idea that fusion technique affects long-term outcome of ACDF. Pain and disability improved substantially over time, irrespective of surgical technique. However, the majority of participants reported residual disability not to a negligible extent. Pain and disability were correlated to lower self-efficacy and quality of life.
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| 18. |
- Hermansen, Anna, 1974-, et al.
(författare)
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Balance problems and dizziness after neck surgery–associations with pain and health-related quality of life
- 2020
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10–13years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients’ descriptions of these problems are in line with common symptoms of cervicogenic dizziness. © 2019, © 2019 The Author(s). Published by Taylor & Francis.
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| 19. |
- Hermansen, Anna, et al.
(författare)
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Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article
- 2013
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Ingår i: Journal of Neurosurgery. - : American Association of Neurological Surgeons. - 1547-5654 .- 1547-5646. ; 19:4, s. 403-411
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Tidskriftsartikel (refereegranskat)abstract
- Object. The main purpose of this 10- to 13-year follow-up of a prospective randomized study was to identify preoperative factors that predicted good long-term outcome after anterior cervical decompression and fusion (ACDF) with the Cloward procedure or the cervical intervertebral fusion cage. A second purpose was to investigate subgroup differences at the 10-year follow-up between patients with and without clinically relevant improvement (CRI) and between men and women. less thanbrgreater than less thanbrgreater thanMethods. To evaluate clinically meaningful outcomes, good outcome was defined as CRI in neck-related pain intensity (andgt;= 30-mm improvement on a visual analog scale), and CRI in neck-specific disability (andgt;= 20% improvement in the neck disability index [NUT]) from preoperative measurements to the 10-year follow-up. A total of 73 patients (77% of the original study sample) completed questionnaires at least 10 years after ACDF. less thanbrgreater than less thanbrgreater thanResults. High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of CRI in neck-related pain intensity, and male sex was a predictor of CRI in neck-specific disability; however, no additional predictive factors were identified for good outcome after ACDF. The surgical procedure, number of operated levels, and radiological factors such as healing status did not influence the prediction models. Individuals without CRI in neck-specific disability (75%) and pain intensity (43%) reported a worse outcome for several psychosocial outcome variables compared with those with CRI. At the 10-year follow-up, women reported significantly greater neck- and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. Women reported CRI on the NDI less frequently than men (p = 0.01). less thanbrgreater than less thanbrgreater thanConclusions. Preoperative predictive factors of good outcome 10-13 years after ACDF included initial high neck-related pain intensity, nonsmoking status at the time of surgery, and male sex. There were greater improvements in pain intensity than in neck-specific disability, and the latter showed a greater association with psychosocial factors. These results suggest the need for multimodal postoperative rehabilitation for patients who do not have a satisfactory outcome after ACDF.
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| 20. |
- Iderberg, Hanna, et al.
(författare)
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Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden : a multi-register evaluation
- 2019
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 28:6, s. 1423-1432
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Lumbar spinal stenosis (LSS) can be surgically treated, with variable outcome. Studies have linked socioeconomic factors to outcome, but no nation-wide studies have been performed. This register-based study, including all patients surgically treated for LSS during 2008-2012 in Sweden, aimed to determine predictive factors for the outcome of surgery.Methods: Clinical and socioeconomic factors with impact on outcome in LSS surgery were identified in several high-coverage registers, e.g., the national quality registry for spine surgery (Swespine, FU-rate 70-90%). Multivariate regression analyses were conducted to assess their effect on outcome. Two patient-reported outcome measures, Global Assessment of leg pain (GA) and the Oswestry Disability Index (ODI), as well as length of sick leave after surgery were analyzed.Results: Clinical and socioeconomic factors significantly affected health outcome (both GA and ODI). Some predictors of a good outcome (ODI) were: being born in the EU, reporting no back pain at baseline, a high disposable income and a high educational level. Some factors predicting a worse outcome were previous surgery, having had back pain more than 2years, having comorbidities, being a smoker, being on social welfare and being unemployed.Conclusions: The study highlights the relevance of adding socioeconomic factors to clinical factors for analysis of patient-reported outcomes, although the causal pathway of most predictors' impact is unknown. These findings should be further investigated in the perspective of treatment selection for individual LSS patients. The study also presents a foundation of case mix algorithms for predicting outcome of surgery for LSS.
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