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| 3. |
- Baranto, Adad, 1966, et al.
(författare)
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Acute injury of an intervertebral disc in an elite tennis player: a case report.
- 2010
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Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 35:6, s. E223-7
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Tidskriftsartikel (refereegranskat)abstract
- A case report.To present a previously not described rare case of intradiscal hematoma due to acute trauma in an elite tennis player.Several studies have demonstrated a high frequency of radiological changes in the spine of athletes, especially in sports with high loads on the back. Signs of disc degeneration without disc herniation have frequently been found in magnetic resonance imaging (MRI) studies of the spine of athletes. It has also been shown that radiological abnormalities of the spine in young athletes are correlated to back pain.An elite male tennis player experienced pain in the right buttock after a backhand stroke. He was successfully treated for hip problems and started to play competitive tennis, 2 weeks later. After few games, a backhand stroke again resulted in intense pain projected in the os coccyx region. At examination, there were no neurologic disturbances. At palpation over the spinal processes (Springing test) of L1-L2, the patient experienced intense pain projected to the os coccyx region.MRI examination showed an injured L1-L2 disc with fluid inside the disc with a signal similar to blood. Four additional MRI examinations were performed 2 weeks and 2 years after the injury until disc degeneration is formed. Radiograph examination before and 2 years after the injury is available.In conclusion, trauma in athletes can cause intradiscal hematoma, which probably is a new etiology for disc degeneration. Also that sudden onset of pain in the hip or the gluteal region may be caused by referred pain due to a disc lesion. Intradiscal hematoma can be visualized using MRI.
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- Barreto Henriksson, Helena, et al.
(författare)
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Identification of Cell Proliferation Zones, Progenitor Cells and a Potential Stem Cell Niche in the Intervertebral Disc Region: A Study in Four Species.
- 2009
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Ingår i: SPINE. - 0362-2436. ; 34:21, s. 2278-2287
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN.: Descriptive experimental study in 4 different mammals. OBJECTIVE.: To investigate cell proliferation/regeneration and localize stem cells/progenitor cells within the intervertebral disc (IVD). SUMMARY OF BACKGROUND DATA.: Disc degeneration (DD) is believed to play a major role in patients with chronic lumbar pain. Lately, biologic treatment options for DD have gained increasing interest. Normal regeneration processes within the IVD and have previously been sparsely described and therefore it is of great interest to increase the knowledge about these processes. METHODS.: Detection of cell proliferations zones and label-retaining cells were done by in vivo 5-bromo-2-deoxyuridine (BrdU) labeling in 18 rabbits, killed after 4, 6, 10, 14, 28, or 56 days. Results were visualized with immunohistochemistry and fluorescence/confocal microscopy. Localization of progenitor cell were further investigated by immunohistochemistry using antibodies towards Notch1, Delta4, Jagged1, C-KIT, KI67, and Stro-1 in normal IVD from rabbits (n = 3), rats (n = 2), minipigs (n = 2), and in human degenerated IVD (n = 4). Further, flowcytometry analysis using progenitor markers were performed on additional human IVD cells (n = 3). RESULTS.: BrdU positive cells were found in comparable numbers at early and late time points in most regions of the anulus fibrosus (AF) and nucleus pulposus demonstrating slow ongoing cell proliferation. In the AF border to ligament zone (AFo) and the perichondriumregion (P) a stem cell niche-like pattern was determined (a high number of BrdU positive cells at early time points vs. only a few label retaining cells at later time points). In normal and DD tissue from the 4 investigated species progenitor cell markers were detected. CONCLUSION.: The IVD is a tissue with ongoing slow cell proliferation both in the AF and the nucleus pulposus. The stem cell niche pattern detected in AFo and P can be suggested to play a role for IVD morphology and function. These findings may be of importance for the development of biologic treatment strategies. PMID: 19755937 [PubMed - as supplied by publisher]
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- Barreto Henriksson, Helena, et al.
(författare)
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Support of Concept that Migrating Progenitor Cells from Stem Cell Niches Contribute to Normal Regeneration of the Adult Mammal Intervertebral Disc: A Descriptive study in the New Zeeland white Rabbit.
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37:9
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Study Design. Descriptive experimental study performed in rabbits of two age groups.Objective. To study and investigate presence of prechondrocytic cells and cell migration routes in the IVD region, to gain knowledge about the normal IVD regeneration pattern.Summary of Background Data. Disc degeneration is believed to play a major role in patients with chronic lumbar pain. Regeneration processes and cell migration within the intervertebral disc (IVD) have been sparsely described. Therefore it is of interest to increase knowledge of these processes in order to understand pathological conditions of the IVD.Methods. 5-bromo-2-deoxyuridine (BrdU) in vivo labelling was performed in two groups of rabbits, 3 and 9 months old at the beginning of the experiment, in total 27 rabbits. BrdU is incorporated into DNA during mitosis and then it is gradually diluted with each cell division until it finally disappears. Incorporation of BrdU was then visualized by immunohistochemistry (IHC) at different time points providing cell division pattern and presence of slow-cycling cells in the IVD region. IVD tissue was investigated by IHC for: Growth- and differentiation-factor-5 (GDF5), SOX9 (chondrogenic lineage markers), SNAIL homolog1 (SNAI1), SNAIL homolog2 (SLUG)(migration markers) and β1-INTEGRIN (cellular adhesion marker). In addition, GDF5, SOX9 and BMPRIB expression were investigated on genetic level.Results. BrdU+ cells were observed in early time points in the IVD niche, adjacent to the epiphyseal plate, at later time points mainly in outer region of the annulus fibrosus (AF) for both age groups of rabbits, indicating a gradual migration of cells. The presence of SLUG, SNAI1, GDF5, SOX9 and β1-INTEGRIN were found in same regions.Conclusion. The results suggest a cellular migration route from the IVD stem cell niche toward the AF and the inner parts of the IVD. These findings may be of importance for understanding IVD regenerative mechanisms and for future development of biological treatment strategies.
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- Carrwik, Christian, et al.
(författare)
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Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease : A Retrospective Study of 315 Patients in Sweden
- 2020
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 45:6, s. 414-419
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective cohort study.OBJECTIVE: To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.SUMMARY OF BACKGROUND DATA: Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.METHODS: Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.RESULTS: The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6-14.2) and median 5.9 months (confidence interval 4.5-7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.CONCLUSION: Predictive scores underestimate survival for the patients which might affect important clinical decisions.LEVEL OF EVIDENCE: 3.
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- Danielsson, Aina, 1953, et al.
(författare)
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A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity
- 2007
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Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 32:20, s. 2198-207
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: The Swedish patients included in the previous SRS brace study were invited to take part in a long-term follow-up. OBJECTIVE: To investigate the rate of scoliosis surgery and progression of curves from baseline as well as after maturity. SUMMARY OF BACKGROUND DATA: Brace treatment was shown to be superior to electrical muscle stimulation, as well as observation alone, in the original SRS brace study. Few other studies have shown that brace treatment is effective in the treatment of scoliosis. METHODS: Of 106 patients, 41 in Malmo (all Boston brace treatment) and 65 in Goteborg (observation alone as the intention to treat), 87% attended the follow-up, including radiography and chart review. All radiographs were (re)measured for curve size (Cobb method) by an unbiased examiner. Searching in the mandatory national database for performed surgery identified patients who had undergone surgery after maturity. RESULTS: The mean follow-up time was 16 years and the mean age at follow-up was 32 years The 2 treatment groups had equal curve size at inclusion. The curve size of patients who were treated with a brace from the start was reduced by 6 degrees during treatment, but the curve size returned to the same level during the follow-up period. No patients who were primarily braced went on to undergo surgery. In patients with observation alone as the intention to treat, 20% were braced during adolescence due to progression and another 10% underwent surgery. Seventy percent were only observed and increased by 6 degrees from inclusion until now. No patients underwent surgery after maturity. Progression was related to premenarchal status. CONCLUSION: The curves of patients with adolescent idiopathic scoliosis with a moderate or smaller size at maturity did not deteriorate beyond their original curve size at the 16-year follow-up. No patients treated primarily with a brace went on to undergo surgery, whereas 6 patients (10%) in the observation group required surgery during adolescence compared with none after maturity. Curve progression was related to immaturity.
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- Danielsson, Aina, 1953, et al.
(författare)
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Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: A case-control study - Part I
- 2003
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Ingår i: Spine. - 0362-2436. ; 28, s. 2078-2085
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A consecutive series of patients with adolescent idiopathic scoliosis and brace-treated (BT) between 1968 and 1977 before age 21 years (BT: n = 127; 122 females and 5 males) were followed-up at least 20 years after completion of the treatment. Objectives. To determine the long-term outcome in terms of back pain and function in patients BT for adolescent idiopathic scoliosis. Summary of Background Data. Few reports on long-term outcome of back pain and function have previously been presented for consecutive groups of these patients. Materials and Methods. One hundred ten (87%) BT patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination, evaluation of curve size (Cobb method), and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality-of-life aspects as well as present back and pain symptoms were used. One hundred nine had complete follow-up. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. Results. The deterioration of the curves was a mean of 7.9 degrees for all curves, excluding the only patient who underwent operation after 4 years (increase = 27 degrees). The patients had significantly more degenerative disc changes than the controls. Lumbar and thoracic back pain, although mild (2.7 on visual analogue scale), was significantly more frequent among the patients than the controls (75 vs. 47%, P = 0.0050 and 35.8 vs. 22.0%, P = 0.033, respectively). Only 24% of the patients admitted daily pain and analgesics were sparsely used. The patients had a slightly, but significantly, worse back function as measured by the Oswestry Disability Index (9.2 vs. 4.8, P = 0.0012) and general function score (7.7 vs. 4.2, P = 0.0006), but general health-related quality of life was not affected. No differences could be seen in sociodemographic variables between the groups, except for having ever been on sick leave because of the back (38% vs. 19%, P = 0.0036). Furthermore, no differences could be found between patients with different curve types (single thoracic, n = 50; lumbar, n = 19; double curves, n = 40). No correlation could be found between pain and its localization and curve size, an increase of at least 10 degrees since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, body mass index, or smoking. Conclusions. More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls. Compared with surgically treated patients with a mean end result similar to this group, no significant differences were found except that BT patients experience more affective components of their pain.
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| 9. |
- Danielsson, Aina, 1953, et al.
(författare)
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Body Appearance and Quality of Life in Adult Patients with Adolescent Idiopathic Scoliosis Treated with a Brace or Under Observation Alone During Adolescence.
- 2011
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Ingår i: Spine. - 1528-1159. ; 37:9
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Study Design. The SRS brace study (JBJS-A, 1995) was comprised of patients with adolescent idiopathic scoliosis with moderate curve sizes (25-35°). Forty observed and 37 braced patients (77% of the original group) attended a follow-up a mean of 16 years after onset of maturity.Objectives. To analyze whether the subjectively evaluated present body appearance affects outcome as measured by quality of life in adult patients, previously treated by observation alone (non-braced) or with a brace during adolescence.Summary of Background Data. Few reports exist where validated outcome measures for body appearance have been used.Methods. Two quality of life questionnaires (SRS-22 and SF-36) were answered. The patient's opinion on body appearance was evaluated pictorially (i.e. sketches) using the Spinal Appearance Questionnaire, in which seven aspects of asymmetry are graded. These scores were compared with curve sizes, scoliometer measurements for grading trunk asymmetry and quality of life measures.Results. At follow-up, both groups were similar in terms of age (mean 32 years) and curve size (mean 35°). Distortion was inversely related to SRS-22 total score and satisfaction/dissatisfaction with management subscore, but not related to the SRS-22 function subscore. No difference was found between the groups in terms of trunk rotation, where the means were 10.7° and 10.8° for the non-braced and braced patients, respectively. The non-braced patients estimated that their body appearance was significantly less distorted than the braced patients (mean 12.9 and 15.0, respectively; p = 0.0028).Conclusions. Patients who experienced less body asymmetry were more satisfied with treatment and had a better quality of life. In spite of similar curve sizes and trunk rotation in both groups, the non-braced patients felt that their body appearance was less distorted than the braced patients.
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- Danielsson, Aina, 1953, et al.
(författare)
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Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study.
- 2001
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Ingår i: Spine. - 0362-2436. ; 26:13, s. 1449-56
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Tidskriftsartikel (refereegranskat)abstract
- A consecutive series of female patients with adolescent idiopathic scoliosis treated between 1968 and 1977, either with distraction and fusion using Harrington rods (n = 145) or with a brace (n = 122), were followed for at least 20 years after completion of the treatment.To determine the long-term outcomes of childbearing and sexual life in women treated for adolescent idiopathic scoliosis, as compared with matched control subjects who did not have scoliosis.The effect of pregnancy on curve progression is not established, and results are contradictory. Few reports exist on the social life (marriage, childbearing, and sexual function) of formerly treated individuals with scoliosis.In this study, 136 surgically treated women (94%) and 111 brace-treated women (91%) completed the Scoliosis Research Society (SRS)/MODEM's questionnaire concerning childbearing and sexual life as a part of an unbiased personal follow-up examination. Of these, 129 surgically treated and 105 brace-treated women also underwent a radiographic examination. The Cobb method was used to measure curve size in present and earlier examinations. An age-matched control group of 90 women was randomly selected and subjected to the same examinations.The mean age for all the groups was 40 years. Of the surgically treated and brace-treated women, 85% were or had been married, as compared with 82% of the control women. In the total cohort, 628 pregnancies had occurred. No significant mean difference existed between the groups in the number of children born (1.8 for the surgically treated, 1.9 for the brace-treated, and 2 for the control women) (P = 0.25). The patients in the brace-treated group had a significantly higher mean age at first pregnancy (28 years) than the control subjects (25.9 years) (P = 0.011), whereas the age for the surgically treated women (26.6 years) did not differ significantly from that for the brace-treated women. There were no significant differences between the groups in rates for low back pain (35% for the surgically treated, 43% for the brace-treated, and 28% for the control group) or for cesarean section (19% for the surgically treated, 14% for the brace-treated, and 18% for the control group) during the first pregnancy. The rate of vacuum extractions was higher in the surgically treated group (16%) than in the control group (5%) (P = 0.036) or the brace-treated group(8%). Limitation of sexual function from the back was admitted by 33% of the surgically treated, 28% of the brace-treated, and 15% of the control women: surgically treated vs control subjects (P = 0.0042), brace-treated vs control subjects (P = 0.026), and brace-treated vs surgically treated subjects (P = 0.57, a nonsignificant difference). These limitations were largely because of difficulties participating physically in activities or self-consciousness about appearance. Pain was a minor reason for limitation. There was no correlation between progression of the major or lumbar curve and number of pregnancies, or between curve progression and age at first pregnancy.Patients treated for adolescent idiopathic scoliosis appeared to function well with regard to marital status and number of children. The scoliotic curve did not seem to increase as a result of childbearing. Minor problems occurred during pregnancy and delivery. Some patients, however, experienced a slight negative effect in their sexual life.
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