| 71. |
- Skeppholm, Martin, et al.
(författare)
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The Discover artificial disc replacement versus fusion in cervical radiculopathy-a randomized controlled outcome trial with 2-year follow-up
- 2015
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Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 15:6, s. 1284-1294
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND CONTEXT: Several previous studies comparing artificial disc replacement (ADR) and fusion have been conducted with cautiously positive results in favor of ADR. This study is not, in contrast to most previous studies, an investigational device exemption study required by the Food and Drug Administration for approval to market the product in the United States. This study was partially funded with unrestricted institutional research grants by the company marketing the artificial disc used in this study. PURPOSE: To compare outcomes between the concepts of an artificial disc to treatment with anterior cervical decompression and fusion (ACDF) and to register complications associated to the two treatments during a follow-up time of 2 years. STUDY DESIGN/SETTING: This is a randomized controlled multicenter trial, including three spine centers in Sweden. PATIENT SAMPLE: The study included patients seeking care for cervical radiculopathy who fulfilled inclusion criteria. In total, 153 patients were included. OUTCOME MEASURES: Self-assessment with Neck Disability Index (NDI) as a primary outcome variable and EQ-5D and visual analog scale as secondary outcome variables. METHODS: Patients were randomly allocated to either treatment with the Depuy Discover artificial disc or fusion with iliac crest bone graft and plating. Randomization was blinded to both patient and caregivers until time for implantation. Adverse events, complications, and revision surgery were registered as well as loss of follow-up. RESULTS: Data were available in 137 (91%) of the included and initially treated patients. Both groups improved significantly after surgery. NDI changed from 63.1 to 39.8 in an intention-to-treat analysis. No statistically significant difference between the ADR and the ACDF groups could be demonstrated with NDI values of 39.1 and 40.1, respectively. Nor in secondary outcome measures (EQ-5D and visual analog scale) could any statistically significant differences be demonstrated between the groups. Nine patients in the ADR group and three in the fusion group underwent secondary surgery because of various reasons. Two patients in each group underwent secondary surgery because of adjacent segment pathology. Complication rates were not statistically significant between groups. CONCLUSIONS: Artificial disc replacement did not result in better outcome compared to fusion measured with NDI 2 years after surgery.
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| 72. |
- Skeppholm, Martin, et al.
(författare)
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The Dysphagia Short Questionnaire : An Instrument for Evaluation of Dysphagia: A Validation Study With 12 Months' Follow-up After Anterior Cervical Spine Surgery
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37:11, s. 996-1002
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective clinical validation study of questionnaire to assess dysphagia. Objective. To test validity and reliability of Dysphagia Short Questionnaire (DSQ), and also to determine levels of dysphagia over time after anterior cervical spine surgery (ACSS). Summary of Background Data. Dysphagia is common after ACSS but reports on the incidence vary widely between 1% and 79%, indicating an evaluation problem. Several tools for evaluation of dysphagia exist but common features are that they are cumbersome to use and usually are designed for patients with neurological or malignant diseases in the neck region. Others are not validated, for example, the Bazaz score. There is, thus, a need for a more adapted tool to evaluate dysphagia in patients undergoing ACSS. Methods. The DSQ was constructed in collaboration with a group of ear-nose-and-throat specialists. In a first validation study, 45 patients with stationary dysphagia for various reasons completed the DSQ twice 2 weeks apart, the M. D. Anderson Dysphagia Inventory (MDADI), the Bazaz score, and a quality-of-life score, the EQ-5D. To evaluate the utility of the DSQ, a second validation study was performed, where 111 subjects undergoing ACSS for degenerative disk disease completed the form preoperatively and at 4 weeks, 3 months, and 1 year after surgery. Results. In the first study, the DSQ correlated to MDADI (r = 0.59) and showed good reproducibility. The Bazaz score did not correlate to the DSQ, the MDADI, or the EQ-5 D. In the second study, dysphagia was present in a few patients already preoperatively. At 4 weeks, 85% of the patients reported dysphagia. The level had dropped significantly at 3 months and had returned to baseline levels at 1 year. Conclusion. We consider the DSQ to be a validated tool for the assessment of dysphagia in ACSS patients. Dysphagia after ACSS for cervical spondylosis is common but the symptoms on a group level are not very severe and are also temporary.
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| 73. |
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| 74. |
- Söderman, Tomas, et al.
(författare)
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Static and dynamic CT imaging of the cervical spine in patients with rheumatoid arthritis
- 2015
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Ingår i: Skeletal Radiology. - : Springer Science and Business Media LLC. - 0364-2348 .- 1432-2161. ; 44:2, s. 241-248
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To compare CR with CT (static and dynamic) to evaluate upper spine instability and to determine if CT in flexion adds value compared to MR imaging in neutral position to assess compression of the subarachnoid space and of the spinal cord.MATERIALS AND METHODS:Twenty-one consecutive patients with atlantoaxial subluxation due to rheumatoid arthritis planned for atlantoaxial fusion were included. CT and MRI were performed with the neck in the neutral position and CT also in flexion. CR in neutral position and flexion were obtained in all patients except for one subject who underwent examination in flexion and extension.RESULTS:CR and CT measurements of atlantoaxial subluxation correlated but were larger by CR than CT in flexion, however, the degree of vertical dislocation was similar with both techniques irrespective of the position of the neck. Cervical motion was larger at CR than at CT. The spinal cord compression was significantly worse at CT obtained in the flexed position as compared to MR imaging in the neutral position.CONCLUSIONS:Functional CR remains the primary imaging method but CT in the flexed position might be useful in the preoperative imaging work-up, as subarachnoid space involvement may be an indicator for the development of neurologic dysfunction.
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| 75. |
- Tominaga, Hiroyuki, et al.
(författare)
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Surgical treatment of the severely damaged atlantoaxial joint with C1-C2 facet spacers Three case reports
- 2019
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Ingår i: Medicine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0025-7974 .- 1536-5964. ; 98:22
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Atlantoaxial subluxation (AAS), caused by congenital factors, inflammation such as rheumatoid arthritis, infection, neoplasia, or trauma, is rare and severely erodes and subluxates atlantoaxial (AA) joints. For these patients, surgical reduction, and stabilization are difficult. Surgery, including anterior transoral decompression and posterior fixation, anterior endonasal decompression and fixation, and posterior decompression with AA or occipitocervical fixation, is often the only treatment available. However, there have only been 2 reports of C1-C2 facet spacer use in treating AAS. Here, we report the case histories of 3 patients with severely damaged and subluxated AA joints and symptomatic basilar invagination (BI), malalignment, or C2 root compression. Patient concerns: The cases included 2 women with rheumatoid arthritis and 1 man with spondyloarthropathy secondary to ulcerative colitis. Diagnosis: Radiographic imaging revealed severely damaged and subluxated AA joints. Their symptoms included worsening pain in the neck or occiput with or without myelopathy and neuralgia. Interventions: After realignment with C1-C2 spacers and posterior C1-C2 screw fixation, the patient symptoms were resolved. Outcomes: Of note, 2 of the 3 patients were healed without complications. One patient who underwent secondary revision surgery because of rod breakage and obvious nonunion at C0-C2 was determined to be healed at 1-year follow-up after the revision surgery. Lessons: We confirmed that C1-C2 facet spacers both reduced BI and occipitocervical coronal malalignment as well as releasing C2 root compression. Therefore, surgical restoration and fixation should be a required treatment in this very rare group of patients.
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