| 51. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis
- 2015
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:4, s. E227-E233
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective cohort study.OBJECTIVE: This study investigates the results of long posterior instrumentation with regard to complications and survival.SUMMARY OF BACKGROUND DATA: Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing.METHODS: Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol.RESULTS: Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury.CONCLUSION: Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4.
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| 52. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Do biological disease-modifying antirheumatic drugs reduce the spinal fracture risk related to ankylosing spondylitis? : A longitudinal multiregistry matched cohort study
- 2017
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Ingår i: BMJ Open. - London, UK : BMJ Publishing Group Ltd. - 2044-6055. ; 7:12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Ankylosing spondylitis (AS) is associated with an increased spinal fracture risk due to the loss of elasticity in spinal motion segments. With the introduction of biological disease-modifying antirheumatic drug (bDMARD) treatment for AS, the individual course of the disease has been ameliorated. This study aims to examine the association of bDMARD treatment and risk of spinal fracture.Design: Longitudinal population-based multiregistry observational matched cohort study.Setting: Swedish Patient Registry 1987-2014 and Swedish Prescribed Drugs Registry 2005-2014.Participants: Included were patients ≥18 years of age receiving treatment at a healthcare facility for the primary diagnosis of AS. About 1352 patients received more than one prescription of bDMARD from 2005 to 2014. An untreated control group was created by propensity score matching for age, sex, comorbidity, antirheumatic prescriptions and years with AS (n=1352).Main Outcome Measures: Spinal fracture-free survival.Results: No bDMARD treatment-related effect on spinal fracture-free survival was observed in the matched cohorts. Male gender (HR=2.54, 95% CI 1.48 to 4.36) and Charlson Comorbidity Index score (HR=3.02, 95% CI 1.59 to 5.75) contributed significantly to spinal fracture risk.Conclusion: bDMARD had no medium-term effect on the spinal fracture-free survival in patients with AS.Trial Registration Number: NCT02840695
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| 53. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis
- 2018
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Ingår i: Global Spine Journal. - : SAGE Publications. - 2192-5682 .- 2192-5690. ; 8:6, s. 570-578
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Tidskriftsartikel (refereegranskat)abstract
- Background: Spinal fractures related to AS are often treated by long posterior stabilisation. The biomechanical rationale behind is the neutralisation of long lever arms in the ankylosed spine to avoid non-union or neurological deterioration. Despite the widespread application of long posterior instrumentation it has never been investigated in a biomechanical model. The objective of this study is to develop a finite element model for spinal fractures related to AS and to establish a biomechanical foundation for long posterior stabilisation of cervicothoracic fractures related to ankylosing spondylitis (AS).Methods: An existing finite element-model (consisting of two separately developed models) including the cervical and thoracic spine were adapted to the conditions of AS (all discs fused, C0-C1 and C1-C2 mobile) and a fracture at the level C6-C7 was simulated. Besides a normal spine (no AS, no fracture) and the uninstrumented fractured spine four different posterior transpedicular instrumentations were tested: 1. Fracture uninstrumented, 2. Short instrumentation C6-C7, 3. Medium instrumentation C5-T1, 4. Long instrumentation C3-T3, 5. Skipped level long instrumentation C3-C6-C7-T3.Three loads (1.5g, 3.0g, 4.5g) were applied according to a specific load curve. Kinematic data such as the gap distance in the fracture site were obtained. Furthermore the stresses in the ossified parts of the discs were evaluated.Findings: All posterior stabilisation methods could normalise the axial stability at the fracture site as measured with gap distance. With larger accelerations than 1.5g , it was seen that the longer instrumentations resulted in lesser maximal gap distance than the Short instrumentation. The maximum stress at the cranial instrumentation end (C3-C4) was slightly greater if every level was instrumented, than in the skipped level model. The skipped level instrumentation achieved similar rotatory stability as the long multilevel instrumentation.Interpretation: The FE model developed simulated a spinal fracture at C6-C7 level. Skipping instrumentation levels without giving up instrumentation length also reduces the stresses in the ossified tissue within the range of the instrumentation and does not decrease the stability in a finite element model of a cervicothoracic fracture related to AS. Considering the risks associated with every additional screw placed, the skipped level instrumentation has advantages with regard to patient safety. The effects of the degree of osteoporosis, screw placement and pre-existing kyphosis on the construct stability were not investigated in this study and should be a matter of further research.
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| 54. |
- Robinson, Yohan, et al.
(författare)
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Increased occurrence of spinal fractures related to ankylosing spondylitis : a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden.
- 2013
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Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ankylosing spondylitis (AS) is a rheumatoid disease leading to progressive ossification of the spinal column. Patients suffering from AS are highly susceptible to unstable vertebral fractures and often require surgical stabilisation due to long lever arms. Medical treatment of these patients improved during the last decades, but until now it is unknown whether the annual number of spinal fractures changed during the last years. Since the annual count of fracture is an effective measure for efficacy of injury prevention and patient safety in AS patients, the current recommendations of activity have to be revised accordingly.METHODS: Data for all patients with AS treated as inpatients between 01/01/1987 and 31/12/2008 were extracted from the Swedish National Hospital Discharge Registry (SNHDR). The data in the registry are collected prospectively, recording all inpatient admissions throughout Sweden. The SNHDR uses the codes for diagnoses at discharge according to the Swedish versions of the International Classification of Diseases (ICD-9 and ICD-10).RESULTS: During the years from 1987 to 2008 17,764 patients with AS were treated as inpatients; of these 724 patients were treated due to spinal fractures. The annual number of cervical, thoracic and lumbar fractures in the registry increased until 2008 (r = 0.94).CONCLUSIONS: Despite the improved treatment of AS the annual number of vertebral fractures requiring inpatient care increased during the last two decades. Possible explanations are population growth, greater awareness of fractures, improved diagnostics, improved emergency care reducing fatalities, and a higher activity level of patients receiving modern medical therapy. Obviously the improvement of medical treatment did not reduce the susceptibility of these patients to unstable fractures. Thus the restrictive injury prevention recommendations for patients with AS cannot be defused, but must be critically revised to improve patient safety.
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| 55. |
- Robinson, Yohan, 1977, et al.
(författare)
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Kyphoplasty in osteoporotic vertebral compression fractures--guidelines and technical considerations.
- 2011
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Ingår i: Journal of orthopaedic surgery and research. - 1749-799X. ; 6
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Forskningsöversikt (refereegranskat)abstract
- Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity. Besides conventional vertebral cement augmentation techniques balloon kyphoplasty has become a popular tool to address painful thoracic and lumbar compression fractures. It showed improved pain reduction and lower complication rates compared to standard vertebroplasty. Interestingly the results of two placebo-controlled vertebroplasty studies question the value of cement augmentation, if compared to a sham operation. Even though there exists now favourable data for kyphoplasty from one randomised controlled trial, the absence of a sham group leaves the placebo effect unaddressed. Technically kyphoplasty can be performed with a transpedicular or extrapedicular access. Polymethyl methacrylate (PMMA)-cement should be favoured, since calcium phosphate cement showed inferior biomechanical properties and less effect on pain reduction especially in less stable burst fractures. Common complications of kyphoplasty are cement leakage and adjacent segment fractures. Rare complications are toxic PMMA-monomer reactions, cement embolisation, and infection.
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| 56. |
- Robinson, Yohan, 1977-
(författare)
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Spinal fractures related to ankylosing spondylitis : Epidemiology, clinical outcome and biomechanics
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines.Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying anti-rheumatic drug (bDMARD) therapy on spinal fractures related to AS.Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS.Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved. It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS.Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no well-established cadaver models exist.Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.
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| 57. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Surgical Stabilization Improves Survival of Spinal Fractures Related to Ankylosing Spondylitis
- 2015
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:21, s. 1697-1702
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. National registry cohort study. Objective. The aim of this study was to investigate the effect of surgical stabilization on survival of spinal fractures related to ankylosing spondylitis (AS). Summary of Background Data. Spinal fractures related to AS are associated with considerable morbidity and mortality. Multiple studies suggest a beneficial effect of surgical stabilization in these patients. Methods. In the Swedish patient registry, all patients treated in an inpatient facility are registered with diagnosis and treatment codes. The Swedish mortality registry collects date and cause of death for all fatalities. Registry extracts of all patients with AS and spinal fractures including date of death and treatment were prepared and analyzed for epidemiological purposes. Results. Seventeen thousand two hundred ninety-seven individual patients with AS were admitted to treatment facilities in Sweden between 1987 and 2011. Nine hundred ninety patients with AS (age 66 +/- 14 years) had 1131 spinal fractures, of which 534 affected cervical, 352 thoracic, and 245 lumbar vertebrae. Thirteen percent had multiple levels of injuries during the observed period. Surgically treated patients had a greater survival than those treated nonsurgically [hazard ratio (HR) 0.79, P = 0.029]. Spinal cord injury was the major factor contributing to mortality in this cohort (HR 1.55, P< 0.001). The proportion of surgically treated spinal fractures increased linearly during the last decades (r = 0.92, P< 0.001) and was 64% throughout the observed years. Conclusions. Spinal cord injury threatened the survival of patients with spinal fractures related to AS. Even though surgical treatment is associated with a considerable complication rate, it improved the survival of spinal fractures related to AS.
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| 58. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly
- 2014
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2014, s. 231948-
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Forskningsöversikt (refereegranskat)abstract
- Odontoid fractures type II according to Anderson and d’Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.
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| 59. |
- Robinson, Yohan, 1977, et al.
(författare)
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Vertebroplasty and kyphoplasty--a systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy.
- 2012
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Ingår i: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 72:1, s. 42-9
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Forskningsöversikt (refereegranskat)abstract
- After more than two decades the treatment effect of cement augmentation of osteoporotic vertebral compression fractures (VCF) has now been questioned by two blinded randomised placebo-controlled trials. Thus many practitioners are uncertain on the recommendation for cement augmentation techniques in elderly patients with osteoporotic VCF. This systematic review analyses randomised controlled trials on vertebroplasty and kyphoplasty to provide an overview on the current evidence. From an electronic database research 8 studies could be identified meeting our inclusion criteria of osteoporotic VCF in elderly (age>60 years), treatment with vertebroplasty or kyphoplasty, controlled with placebo or standard medical therapy, quality of life, function, or pain as primary parameter, and randomisation. Only two studies were properly blinded using a sham-operation as control. The other studies were using a non-surgical treatment control group. Further possible bias may be caused by manufacturer involvement in financing of three published RCT. There is level Ib evidence that vertebroplasty is no better than placebo, which is conflicting with the available level IIb evidence that there is a positive short-term effect of cement augmentation compared to standard medical therapy with regard to QoL, function and pain. Kyphoplasty is not superior to vertebroplasty with regard to pain, but with regard to VCF reduction (evidence level IIb). Kyphoplasty is probably not cost-effective (evidence level IIb), and vertebroplasty has not more than short-term cost-effectiveness (evidence level IV). Vertebroplasty and kyphoplasty cannot be recommended as standard treatment for osteoporotic VCF. Ongoing sham-controlled trials may provide further evidence in this regard.
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| 60. |
- Rodriguez-Lorenzo, Andres, et al.
(författare)
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Fibula osteo-adipofascial flap for reconstruction of a cervical spine and posterior pharyngeal wall defect
- 2014
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 34:4, s. 314-318
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Tidskriftsartikel (refereegranskat)abstract
- When reconstructing combined defects of the cervical spine and the posterior pharyngeal wall the goals are bone stability along with continuity of the aerodigestive tract. We present a case of a patient with a cervical spine defect, including C1 to C3, associated with a posterior pharyngeal wall defect after excision of a chordoma and postoperative radiotherapy. The situation was successfully solved with a free fibula osteo-adipofascial flap. The reconstruction with a fibula osteo-adipofascial flap provided several benefits in comparison with a fibula osteo-cutaneous flap in our case, including an easier insetting of the soft tissue component at the pharyngeal level and less bulkiness of the flap allowing our patient to resume normal deglutition.
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