| 1. |
- Ahonen, Matti, et al.
(författare)
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Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis
- 2023
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 48:10, s. 665-671
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Tidskriftsartikel (refereegranskat)abstract
- Study Design.Comparative cohort study. Objective.The aim of the present study was to evaluate pain and health-related quality of life (HRQoL) in surgically managed patients with a minimum follow-up of 10 years compared with patients with untreated adolescent idiopathic scoliosis (AIS) and a healthy control group. Summary of Background Data.Posterior spinal fusion with pedicle screws is the standard treatment for AIS, although it remains unclear whether this procedure results in improved long-term HRQoL compared with untreated patients with AIS. Patients and Methods.Sixty-four consecutive patients at a minimum follow-up of 10 years, who underwent posterior pedicle screw instrumentation for AIS were prospectively enrolled. Fifty-three (83%) of these patients completed Scoliosis Research Society (SRS) 24 questionnaires, clinical examination, and standing spinal radiographs. Pain and HRQoL were compared with age and sex-matched patients with untreated AIS and healthy individuals. Results.The mean major curve was 57 degrees preoperatively and 15 degrees at the 10-year follow-up. SRS-24 self-image domain score showed a significant improvement from preoperative to 2 years and remained significantly better at the 10-year follow-up (P < 0.001). Patients fused to L3 or below had lower pain, satisfaction, and total score than patients fused to L2 or above (P < 0.05), but self-image, function, and activity scores did not differ between groups at 10-year follow-up. Pain, self-image, general activity, and total SRS domains were significantly better at 10-year follow-up in the surgically treated patients as compared with untreated patients (all P < 0.05). Healthy controls had significantly higher total scores than those surgically treated at 10-year follow-ups (P < 0.001). Conclusion.Patients undergoing segmental pedicle screw instrumentation for AIS maintain high-level HRQoL during a 10-year follow-up. Their HRQoL was significantly better than in the untreated patients with AIS, except for the function domain. However, HRQoL remained at a lower level than in healthy controls.
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| 2. |
- Diarbakerli, Elias, et al.
(författare)
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Quality of life in males and females with idiopathic scoliosis
- 2019
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 44:6, s. 404-410
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Cross-sectional.Objective. To describe quality of life in males and females with idiopathic scoliosis.Summary of Background Data. Idiopathic scoliosis is a three-dimensional deformity affecting the growing spine. The prevalence of larger curves, requiring treatment, is higher in females.Methods. This cross-sectional study comprised 1519 individuals with idiopathic scoliosis (211 males) with a mean (SD) age of 35.3 (14.9) years. They all answered the Scoliosis Research Society 22 revised (SRS-22r) questionnaire and EuroQol 5-dimension-index (EQ-5D). Five hundred twenty eight were surgically treated (78 males), 535 were brace treated (50 males), and 456 were untreated (83 males). The SRS-22r subscore (excluding the satisfaction domain), the SRS-22r domains and the EQ-5D index score were calculated. Subgroup analyses based on treatment and age were performed. Statistical comparisons were performed using analysis of covariance with adjustments for age and treatment. A P-value less than 0.05 was considered as statistical significant.Results. The mean (SD) SRS-22r subscore was 4.19 (0.61) in males and 4.05 (0.61) in females (P = 0.010). The males had higher scores on the SRS-22r domains function (4.56 vs. 4.42), pain (4.20 vs. 4.00), and mental health (4.14 vs. 3.92) (all P < 0.05). The mean (SD) EQ-5D index score was 0.85 (0.22) for males and 0.81 (0.21) for females (P = 0.10). There were minor differences when comparing males and females in treatment and age groups, but both treated and untreated groups had reduced quality of life compared with the national norms.Conclusion. When compared with females, males with idiopathic scoliosis tend to have slightly higher scores in the scoliosis specific SRS-22r but not in the generic quality of life measurement EQ-5D. Quality of life is overall similar between males and females in treatment and age groups, but reduced in comparison with the general population.Level of Evidence: 3
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| 3. |
- Gerdhem, Lovisa, et al.
(författare)
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Patient-reported Data as Predictors of Surgical Outcome in Patients With Degenerative Cervical Myelopathy : Analysis of a National Multicenter Dataset
- 2023
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 48:2, s. 113-119
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Retrospective study design on prospectively collected registry data.Objective: To investigate whether improvement after surgery for degenerative cervical myelopathy is associated with preoperative disease severity and to identify predictors of outcome.Summary of Background Data: Degenerative cervical myelopathy is the most common cause of spinal cord compromise in adults and surgery is often the treatment of choice. Identifying predictors may help to improve patient selection.Materials and Methods: This nationwide study from the Swedish spine registry included 901 patients treated surgically for degenerative cervical myelopathy. To investigate improvement in different disease severity groups, the individuals were divided into quartiles based on their preoperative European Myelopathy Scale (EMS) and EuroQol-5 Dimension (EQ-5D) index. Statistical analyses were made with analysis of variance, χ2, McNemar, and t tests. Multivariable linear or logistic regression was used to identify predictors for one-year improvement in EMS and EQ-5D index, and satisfaction at one year. In the regressions, the patient-reported outcome measures were dichotomized at their median, except improvement in EMS.Results: All patient-reported outcome measures improved from baseline to the one-year follow-up (P<0.001). Statistically significant outcome improvements were seen in all disease severity groups. Preoperative low EMS (β=−1.37, P<0.001), long walking distance (<500 vs. >500 m; β=0.44, P=0.030), and low NDI (β=−0.43, P=0.048) were independent predictors of improvement in EMS. R2 was 0.11 for the multivariable model. Preoperative low EQ-5D index (odds ratio=0.11; 95% confidence interval: 0.07–0.16) and low NDI (0.56; 0.36–0.88) were independent predictors of improvement in EQ-5D index. Preoperative high EMS (1.86; 1.20–2.90) and shorter arm pain duration [<12 vs. >12 months (0.54; 0.33–0.88)] were independent predictors of satisfaction.Conclusions: Postoperative improvement was seen over the whole range of disease severity. Disease severity, symptom duration, and walking distance were predictors of outcome in patients treated surgically for degenerative cervical myelopathy.
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| 4. |
- Grauers, A, et al.
(författare)
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Prevalence of Back Problems in 1069 Adults With Idiopathic Scoliosis and 158 Adults Without Scoliosis.
- 2014
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Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 39:11
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Multi-center case-control studyObjective. To investigate the prevalence of back problems in adults with idiopathic scoliosis.Summary of Background Data. Information on the prevalence of back problems in adults with idiopathic scoliosis is scarce, especially in untreated individuals, males and individuals with an age at onset of the scoliosis of less than 10 years.Methods. 1069 individuals with idiopathic scoliosis and 158 individuals without scoliosis, all aged 20-65 years, answered a questionnaire on back problems. Individuals with scoliosis were diagnosed between ages 4 and 20 years and any treatment was terminated before age 20. Logistic regression or ANCOVA was used for group comparisons.Results. Mean (SD) age at the time of investigation in individuals with scoliosis (123 men and 946 women) was 41 (9) years, and in individuals without scoliosis (75 men and 83 women) 45 (13) years. 374 individuals with scoliosis were untreated, 451 had been brace treated and 244 surgically treated. The mean prevalence of back problems was 64% in the individuals with scoliosis and 29% in the individuals without scoliosis (p<0.001). Among the untreated individuals with scoliosis, 69% reported back problems, among the brace treated 61%, and among the surgically treated 64% (p = 0.06). When comparing females and males with scoliosis, and individuals with juvenile and adolescent scoliosis, there were no statistically significant differences in the prevalence of back problems (p = 0.10 and p = 0.23, respectively).Conclusion. Adults with idiopathic scoliosis have a higher prevalence of back problems than individuals without scoliosis. Treatment, gender and juvenile or adolescent onset of diagnosis was not related to the prevalence of back problems in adulthood.
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| 5. |
- Singh, Aman, et al.
(författare)
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Outcome and Health-Related Quality of Life After Combined Anteroposterior Surgery Versus Anterior Surgery Alone in Subaxial Cervical Spine Fractures Analysis of a National Multicenter Data Set
- 2023
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 48:12, s. 853-858
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Tidskriftsartikel (refereegranskat)abstract
- Study design.Observational study on prospectively collected data. Objectives.To compare patient-reported outcomes and complications after anteroposterior surgery or anterior surgery in subaxial cervical spine fractures. Summary of Background Data.There is no consensus regarding the optimal surgical approach for subaxial cervical spine fractures. Although anterior surgery is often sufficient to restore stability, anteroposterior surgery is sometimes preferred in severe instability. The effects of a more extensive procedure on patient-reported outcomes have not been investigated. We hypothesized that patient-reported outcomes and complication rates were similar between these surgical approaches. Materials and Methods.Individuals treated with either a combined anteroposterior or anterior surgery alone between 2006 and 2016 and with at least 1-year follow-up were identified in the Swedish Spine Registry. Cases were matched 1:2 for age (+/- 5 y). Outcomes were Neck Disability Index (NDI), EQ-5D-3L index, satisfaction, reoperations, and surgeon-reported and patient-reported complications within 90 days. Mann-Whitney U-tests and chi(2) tests were used in statistical comparisons. Results.The median [interquartile range] number of instrumented vertebrae was 3 [2-5.5] in the anteroposterior group and 2 [2-3] in the anterior group (P<0.001). The mean +/- SD follow-up time was 3.5 +/- 2.3 years in the anteroposterior and 3.8 +/- 2.0 years in the anterior group (P=0.39), respectively. At follow-up, Neck Disability Index was 20 [6-37] in the anteroposterior group and 18 [3.5-40] in the anterior group (P=0.69), and the median EQ-5D-3L index was 0.73 [0.12-0.80] in the anteroposterior group and 0.75 [0.62-0.89] in the anterior group (P=0.27). Satisfaction with the treatment was reported by 90% in the anteroposterior group and by 87% in the anterior group (P=0.98). None of the individuals in the anteroposterior and 6 of the individuals in the anterior group were reoperated (P=0.18). Conclusion.Patients operated on with anteroposterior or anterior surgery for subaxial cervical spine fractures are equally satisfied and report similar health-related quality of life measures.
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| 6. |
- Strömqvist, Björn, et al.
(författare)
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X-Stop Versus Decompressive Surgery For Lumbar Neurogenic Intermittent Claudication: A Randomized Controlled Trial With 2 Years Follow-Up.
- 2013
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 38:17
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Study Design. Prospective randomized controlled study.Objective. To compare the outcome of indirect decompression by means of the X-Stop implant to conventional decompression in patients with neurogenic intermittent claudication due to lumbar spinal stenosis.Summary of Background Data. Decompression is the golden standard for lumbar spinal stenosis nowadays but afflicted with complications and a certain number of dissatisfied patients. Interspinous implants have been on the market for more than 10 years but no prospective study comparing its outcome to decompression has been performed.Methods. After power calculation 100 patients were included, 50 in X-Stop group and 50 in decompression group. Patients with symptomatic one- or two-level lumbar spinal stenosis and neurogenic claudication relieved on flexion were included. X-Stop operations were performed under local anaesthesia.Mean Patient Age. 69 (49-89) years, male/female distribution 56/44. Minimal dural sac area was in all cases except two ≤ 80 mm.Non-Inferiority Hypothesis. Six, 12, and 24 months follow-up. Intention-to-treat (ITT) as well as As-Treated (AT) analyses.Primary Outcome Measure. Zürich Claudication Questionnaire. Secondary outcome measures: VAS pain, SF-36, complications and re-operations.Results. Patients in both groups improved significantly regarding primary and secondary outcome measures. The results were similar at 6, 12 and 24 months and at no time point any statistical difference between the two types of surgery could be identified. Three patients (6%) in the decompression group had further surgery, compared to 13 patients (26%) in the X-Stop group (p = 0.04). Results were identical in ITT and AT analysis.Conclusion. For spinal stenosis with neurogenic claudication, decompressive surgery as well as X-Stop are rewarding procedures. Similar results were achieved in both groups, however, with a higher number of re-operations in the X-Stop group. Patients having X-Stop removal and decompression experienced results similar to those randomized to primary decompression.
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