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- Hansson, Elisabeth K, 1954, et al.
(författare)
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Utility of spine surgery: a comparison of common elective orthopaedic surgical procedures.
- 2008
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Ingår i: Spine. - 0362-2436. ; 33:25, s. 2819-30
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A 1-year prospective observational cohort study. OBJECTIVE: To compare the utility before and 1 year after elective spine surgery with some other common orthopaedic surgical procedures. SUMMARY OF BACKGROUND DATA: By using global measures like EQ-5D and SF-36 for the determination of the utility, the changes in quality of life, quality of life (QoL) after an intervention different diagnoses, and treatments can be compared. Total hip replacement (THR) has become almost golden standard in this respect. METHODS: Seven hundred seventy-seven subjects with different common orthopaedic diagnoses scheduled for elective surgery were just before surgery and 1 year after surgery answering both EQ-5D and SF-36. Four groups with different spine diagnoses and procedures were formed and compared with 8 other diagnoses and treatment groups. RESULTS: Before surgery, subjects with spine diagnoses reported the lowest QoL of all diagnoses compared. Surgery for spinal stenosis, spondylolisthesis, and instability meant the largest improvement of all surgical interventions. Surgery for NHP gave a moderately good improvement, whereas surgery for CLBP only marginally improved those operated. Particularly THR but also TKR more or less completely normalized QoL but made it from a relatively high preoperative level. The greatest improvements after spine surgery, other surgical procedures, and different diagnoses were in the pain/discomfort domain. CONCLUSION: Spinal surgery in spinal stenosis, spondylolisthesis, and instability had in comparison to other types of elective orthopaedic surgery an outstanding better ability to improve the operated subject's health-related quality of life than other types of elective orthopaedic surgery. The utility of HNP surgery was somewhat lower and was rather marginal for those operated for nonspecific CLBP.
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| 2. |
- Hansson, Tommy H., 1943, et al.
(författare)
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The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: A prospective 2-year cohort study in six countries.
- 2000
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Ingår i: Spine. - 0362-2436. ; 25:23, s. 3055-64
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Tidskriftsartikel (refereegranskat)abstract
- A prospective cohort study with identical questionnaires and inclusion criteria was performed.To compare in six different countries the frequencies and effects of the common medical interventions used for patients with low back pain who are work incapacitated.Low back pain is a huge problem with increasing costs for health care, industry, and society.Cohorts of employed men and women ages 18 to 59 years who had been sick-listed (100%) for a minimum of 90 days because of low back pain were recruited in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. The subjects received three separate questionnaires with identical questions after 90 days, 1 year, and 2 years. The questionnaires included separate questions about background factors, treatment, and the like, as well as validated scales such as the Hannover Activities of Daily Living, von Korff pain score, Short Form-36, and Karasek-Theorell. Working status was obtained from registers. Main outcome measures were working/not working, back function, and pain.All three questionnaires were completed by 2080 subjects in the six countries. With few exceptions, there were great similarities in the appointments, examinations, and treatments in the different countries. Considerable differences were found between the back surgery rates, which ranged from 6% in Sweden to 32% in the United States during the first 90 days of the study. Very few of the interventions had any noticeable positive effects on work resumption, pain, or back function. Back surgery in Sweden was a striking exception, positively affecting all three outcome measures. The frequencies of work resumption within the first year ranged from 73% in the Netherlands to 32% in Denmark.Almost none of the commonly occurring and frequently practiced medical interventions for patients who are sick-listed because of low back pain had any positive effects on either the recorded health measures or work resumption.
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| 4. |
- Hebelka, Hanna, 1977, et al.
(författare)
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The transfer of disc pressure to adjacent discs in discography: a specificity problem?
- 2010
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Ingår i: Spine. - 0362-2436. ; 35:20, s. E1025-E1029
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: In vivo experimental study. OBJECTIVE: The primary objective of the study was to investigate pressure transmission to adjacent discs during discography. A secondary objective was to quantify the transmitted pressure, both in contrast injected and noninjected porcine intervertebral discs. SUMMARY OF BACKGROUND DATA: Discography is used to before surgery identify painful discs. A pain response during discography that is concordant with the patient's experienced back pain is regarded as an indication that the injected disc is the source of pain. However, the sensitivity and specificity of discography are matters of debate. Pressure-controlled discographies have been reported to reduce the number of false-positive discs using low pressure criteria. Preliminary data indicated a transfer of pressure from an injected to an adjacent disc during discography. Pressure transmission in vivo during lumbar discography, not reported before might, if clinically present, contribute to a false-positive diagnosis. METHODS: Thirty-six lumbar discs in 9 adolescent pigs were investigated. Intradiscal pressure was recorded during contrast injection, using a 0.36/0.25 mm fiber-optic pressure transducer inserted into the nucleus pulposus via a 22 G needle. The pressure was measured simultaneously in 2 adjacent discs during contrast injection into 1 of the discs at pressures up to 8 bar. Transmitted pressure was recorded both in noninjected discs and in discs that were prefilled with contrast. RESULTS: Thirty-three discs were successfully examined. During contrast injection, there was an intradiscal pressure rise in the adjacent disc with a median value of 16.0% (range, 3.2-37.0) over baseline pressure. There was no significant difference in pressure increase between the noninjected and prefilled discs (P < 0.68). CONCLUSION: Discography of porcine discs induces a pressure increase in adjacent discs. A similar pressure transfer during human clinical discography might elicit false-positive pain reactions.
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| 6. |
- Kaigle Holm, Allison, 1964, et al.
(författare)
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Experimental instability in the lumbar spine.
- 1995
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Ingår i: Spine. - 0362-2436. ; 20:4, s. 421-30
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Tidskriftsartikel (refereegranskat)abstract
- An in vivo animal model of lumbar segmental instability, involving both passive and active stabilizing components of the spine, was developed.
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