| 1. |
- Möller, Anders, et al.
(author)
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A vertebral fracture in childhood is not a risk factor for disc degeneration but for Schmorl's nodes: a mean 40-year observational study.
- 2007
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In: Spine. - 0362-2436. ; 32:22, s. 2487-2492
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Journal article (peer-reviewed)abstract
- STUDY DESIGN: Observational cohort study. OBJECTIVE: To evaluate by MRI whether a vertebral fracture during childhood is a risk factor for degeneration of adjacent discs. SUMMARY OF BACKGROUND DATA: Several studies infer that trauma is a major cause of disc degeneration. Only 1 study has by magnetic resonance imaging (MRI) evaluated disc degeneration in children with a former thoracic or lumbar vertebral fracture. That study reported a 50% prevalence of degenerative disc changes 4 years after the fracture. However, due to the sparse literature, it is still unclear whether a vertebral fracture in childhood represents a risk factor for disc degeneration in a long-term perspective. METHOD: Nine boys and 11 girls with a mean age of 12 years (range, 7-16 years) when sustaining a lumbar or thoracic vertebral fracture without neurologic deficits were examined at a mean of 40 years (range, 33-53 years) after the injury. Eighteen of the subjects had 1-column compression fractures, and 2 had Denis Type B burst fractures. All were mobilized without brace or surgery directly after being injured. A favorable long-term clinical and plain radiographic outcome has previously been reported for this cohort. In the present study, the intervertebral discs were evaluated with MRI by applying the Oner classification scheme. Degenerative disc changes were defined as loss of signal intensity on T2-weighted images with or without disc height reduction. RESULTS: Degenerative changes were not more prevalent in discs adjacent to the previously fractured vertebrae than in discs at a distance from those segments. However, there were more Schmorl's nodes at the disc levels adjacent to the earlier fractures. CONCLUSION: Stable vertebral fractures in childhood with no neurologic deficits at injury do not render more degenerative changes than can be expected according to age, but they are associated with more Schmorl's nodes at adjacent disc levels.
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| 2. |
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| 3. |
- Karlsson, Magnus, et al.
(author)
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A modeling capacity of vertebral fractures exists during growth - an up to 47-year follow-up
- 2003
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In: Spine. - 0362-2436. ; 28:18, s. 2087-2092
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Journal article (peer-reviewed)abstract
- Study Design. The study is an observational cohort study. Objectives. To determine the incidence and the long-term outcome of thoracic or lumbar vertebral fractures in children. Summary of Background Data. The incidence of vertebral fractures in children is described as rare and the outcome as favorable. However, no studies evaluate the clinical and radiographic long-term outcome and if a fractured vertebra could be rebuilt during growth. Method. The incidence of vertebral fractures in children was evaluated through the radiographic archives. Twelve boys and 12 girls, aged 7-16 when sustaining the fracture, 21 one-column compression fractures and 3 burst fractures Denis type B, all without neurologic deficits, attended the follow-up. Primary treatment consisted of immediate mobilization without brace. Clinical and radiographic examination were performed 27-47 years after the injury. Results. The annual incidence of thoracic and lumbar vertebral body fractures in individuals below age 16 was 0.07%. Twenty-one individuals had, at follow-up. no subjective complaints, 3 had occasional back pain (Oswestry Scores, 8, 22, and 26), 23 were classified as Frankel E, and 1 as Frankel D. The radiographic ratio anterior height/posterior height of the fractured vertebral body increased from 0.75 after injury to 0.87 at follow-up (P<0.001). The posttraumatic kyphosis in the fracture region decreased in 8 individuals (33%), all aged 13 or less at fracture. No increased disc degeneration was observed. Conclusion. Thoracolumbar vertebral fractures without neurologic deficits, sustained during growth, have a favorable long-term outcome. A modeling capacity, reducing the fracture deformity exists at least in the youngest patients.
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| 5. |
- Malmvik, J, et al.
(author)
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Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up
- 2003
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In: Journal of Pediatric Orthopedics. Part B. - 1473-5865. ; 12:1, s. 63-68
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Journal article (peer-reviewed)abstract
- Twenty-four individuals, who were 16 years of age or younger when they sustained a fracture of the radial head or neck, were examined at a mean of 19 years (range 14-25 years) after injury. The 12 girls and 12 boys were a mean age of 11 years (range 5-16 years) when the fracture was sustained. Two were excluded due to late resection of the radial head following persisting pain. The fractures, which were of Mason type II in 19 and type III in three cases, were treated by mobilization in eight cases, plaster in eight, open reduction and internal fixation in three and closed reduction and plaster in three. At the follow-up examination, 19 (86%) had no complaints, while three (14%) had occasional pain. Flexion was decreased in the formerly injured compared with the uninjured elbow (139 + 8degrees versus 142+/-5degrees; P<0.05). None had developed elbow osteoarthritis. Isolated, closed fracture of the radial head and neck during growth has a favourable, long-term outcome.
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| 6. |
- Möller, Anders, et al.
(author)
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Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23-to 41-year follow-up
- 2007
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In: The Spine Journal. - : Elsevier BV. - 1878-1632 .- 1529-9430. ; 7:6, s. 701-707
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Journal article (peer-reviewed)abstract
- BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type 13, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p <.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs. (c) 2007 Elsevier Inc. All rights reserved.
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| 7. |
- Ohlin, Acke, et al.
(author)
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Complications after transpedicular stabilization of the spine. A survivorship analysis of 163 cases
- 1994
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In: Spine. - 0362-2436. ; 19:24, s. 2774-2779
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Journal article (peer-reviewed)abstract
- OBJECTIVES. The authors studied complications of transpedicular stabilization methods. SUMMARY OF BACKGROUND DATA. One hundred and sixty-three consecutive transpedicular stabilization procedures were performed between January 1987 and December 1991. The indications for stabilization were trauma (33 cases), metastatic spinal disorder (30 cases), spinal stenosis (33 cases), spondylolisthesis (27 cases), ankylosing spondylitis (6 cases), low back pain (22 cases), and miscellaneous (12 cases). METHODS. Patients records and the entire series of radiographs for each case were scrutinized by independent observers. All per- and postoperative complications, including implant loosening and fatigue, were recorded. Clinical and radiographic survivorship analyses of the implants were performed. RESULTS. Early complications were unusual and none were associated with permanent morbidity. The probability of not having the implant removed in the first postoperative year was 85%. There was a 40% risk of radiographic failure, defined as loosening or implant fatigue, at 6 months. The outcome was more favorable in cases in which anterior vertebral interbody fusion was also performed. CONCLUSIONS. Transpedicular fixation is a safe procedure with a low incidence of serious per- and early postoperative complications. The mechanical durability of transpedicular fixators used alone is a cause for concern.
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| 8. |
- Hasserius, Ralph
(author)
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Vertebral Deformity and Vertebral Fracture in the Elderly
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Osteoporosis is a systemic, skeletal disease with the consequence of an increased risk of sustaining a fracture, one of the most common fractures being a vertebral fracture. The lifetime risk of sustaining a clinically diagnosed vertebral fracture from age 50 years onward is 8% in men and 15% in women. These fractures are followed by increased morbidity and mortality as well as an increased risk of sustaining future fragility fractures, a fact that emphasizes the need of preventing the disease. Individuals with a clinically diagnosed vertebral fracture are, however, only a subset of all individuals with vertebral fractures, revealed if a generalized radiological screening is performed. Furthermore, the changes in the shape of the vertebral body, visible on lateral spine radiographs, do not always represent fractures. As a consequence, changes in the shape of the vertebral body are, in epidemiological studies, referred to as vertebral deformities instead of vertebral fractures. This thesis evaluates the occurrence as well as the consequences of prevalent vertebral deformities and clinically diagnosed vertebral fractures in Swedish men and women, aged 50 years or more. In a cross-sectional study the prevalence of vertebral deformity in 343 men and 454 women, age 50-86 years, from two different, population-based cohorts from southwest Sweden, was evaluated using a morphometric method. Thirty-three percent of the men and 39% of the women had vertebral deformities. More women than men had vertebral deformities, and in both genders the prevalence increased with age. The vertebrae most commonly deformed were L1, Th12 and Th11. The European Vertebral Osteoporosis Study (EVOS) was a multi-centre study evaluating the prevalence of vertebral deformity in 19 European countries. The individuals who were invited but declined to participate in the Malmö part of the EVOS study were analyzed regarding risk factors for vertebral deformities and were compared with age- and gender-matched participants. The “true” prevalence of subjects with vertebral deformity in the whole male Malmö population at risk was probably underestimated in the EVOS study. Whether this is also the case for women was not so clearly indicated. In the population-based cohort of 298 men and 300 women, age 50-80 years, in the Malmö part of the EVOS study, men and women with a prevalent vertebral deformity had a 2.4- and 2.3-fold, respectively, increased risk of dying during a 10-year follow-up period, compared with individuals without a prevalent vertebral deformity. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. The presence of a vertebral deformity predicted also future fractures of any type in both genders and future fragility fractures in women. The prevalence of vertebral deformities among 196 hip fracture patients was higher than among reference subjects from two population-based cohorts. This difference was most pronounced among individuals less than 80 years old. The result suggests that a prevalent vertebral deformity possibly indicates an increased risk of sustaining a hip fracture. There was no difference in the prevalence of vertebral deformity between patients with a per- or subtrochanteric hip fracture and patients with a cervical hip fracture. Among individuals over 50 years of age, in the Swedish city of Malmö, 1.8 out of 1000 men and 3.6 out of 1000 women sustained a clinically diagnosed vertebral fracture during 1979. Among the women, there were more individuals who, at a follow-up examination 12 years later, had back pain and an impaired health status compared with women from a population-based cohort. Both men and women with a clinically diagnosed vertebral fracture had an increased mortality during the 22 years following the diagnosis compared with the population at risk.
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| 9. |
- Akesson, T, et al.
(author)
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Displaced fractures of the neck of the radius in adults - An excellent long-term outcome
- 2006
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In: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 88B:5, s. 642-644
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Journal article (peer-reviewed)abstract
- We have reviewed 20 women and three men aged 22 to 73 years, who had sustained a Mason type-lib fracture of the neck of the radius 14 to 25 years earlier. There were 19 patients with displacement of the fractures of 2 mm to 4 mm, of whom 13 had been subjected to early mobilisation and six had been treated in plaster for one to four weeks. Of four patients with displacement of 4 mm to 8 mm, three had undergone excision and one an open reduction of the head of radius. A total of 21 patients had no subjective complaints at follow-up, but two had slight impairment and occasional elbow pain. The mean range of movement and strength of the elbow were not impaired. The elbows had a higher prevalence of degenerative changes than the opposite side, but no greater reduction of joint space. Mason type-lib fractures have an excellent long-term outcome if operation is undertaken when the displacement of the fracture exceeds 4 mm.
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| 10. |
- Ghanei, Iman, et al.
(author)
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The prevalence and severity of low back pain and associated symptoms in 3,009 old men
- 2014
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In: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 23:4, s. 814-820
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Journal article (peer-reviewed)abstract
- The aim of this study is to evaluate the prevalence and severity of low back pain (LBP) and the influence of sciatica and neurological deficits in old men. Mister osteoporosis Sweden includes 3,014 community-dwelling men aged 69-81 years. At study start 3,009 participants answered questions on LBP, low back pain and sciatica (LBP + SCI) or low back pain and sciatica with associated neurological deficits (LBP + SCI + NEU) during the preceding 12 months. Data are presented as proportions or medians with mid-quartile ranges. Differences between groups were tested by chi(2) test and Kruskall-Wallis test. 24 % had experienced LBP without SCI, 8 % LBP + SCI and 14 % LBP + SCI + NEU. 10 % of the men with LBP, 22 % of those with LBP + SCI, and 36 % of those with LBP + SCI + NEU rated the pain as severe (p < 0.001). 23 % of the men with LBP, 31 % of those with LBP + SCI and 50 % of those with LBP + SCI + NEU reported limitation in activity of daily living (ADL) (p < 0.001). Men with only LBP had to restrict their activities for 7 days (3-14), those with LBP + SCI 6 days (2-14) and those with LBP + SCI + NEU 10 days (3-30) (p < 0.05). The 1-year prevalence of LBP in community living men aged 69-81 years was close to 50 % but for individuals with LBP or LBP + SCI the morbidity was low with more than two-thirds having no limitations in ADL. In men with LBP + SCI + NEU more than one-third rated the pain as severe and close to half had limitations in ADL.
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