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- Annertz, Mårten, et al.
(författare)
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No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients
- 1995
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Ingår i: Spine. - 0362-2436. ; 20:4, s. 449-453
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN. Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES. To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA. Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS. The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS. Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION. No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned.
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- Sigmundsson, Freyr Gauti, 1972-, et al.
(författare)
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Impact of pain on function and health related quality of life in lumbar spinal stenosis. A register study of 14,821 patients
- 2013
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:15, s. E937-45
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Descriptive register study.OBJECTIVE: To describe preoperative levels of leg and back pain in patients operated for lumbar spinal stenosis, and to obtain information on how 3 different pain constellations (back pain < leg pain, back pain > leg pain, back pain = leg pain) correlate to health related quality of life (HRQoL) and function in different morphological types of stenosis.SUMMARY OF BACKGROUND DATA: Degenerative lumbar spinal stenosis is considered a poorly defined clinical syndrome and knowledge of what uniquely characterizes the different morphological types of stenosis is lacking.METHODS: Using the Swedish Spine Register, we studied (1) the pain characteristics of patients with central spinal stenosis (CSS), lateral recess stenosis, and spinal stenosis with spondylolisthesis (2) how HRQoL and function correlate to leg and back pain.RESULTS: Grading leg pain higher than back pain was the most common pain constellation (49%) followed by grading back pain more than leg pain (39%). Twelve percent had the same intensity of leg and back pain. The type of stenosis grading the highest burden of back pain was spinal stenosis with spondylolisthesis (ratio = 0.93; [95% confidence interval, CI] = 0.92-0.95), followed by central spinal stenosis (ratio = 0.88; [95% CI] = 0.88-0.89). Lateral recess stenosis had the lowest burden of back pain (ratio = 0.85; [95% CI] = 0.83-0.87). The lowest HRQoL and function was found in spinal stenosis with spondylolisthesis (back pain = leg pain group) where 55% ([95% CI] = 50-59) of patients could not walk more than 100 m. Patients with lateral recess stenosis had better self-estimated walking distance.CONCLUSION: Back pain is generally experienced to a high extent by patients scheduled for spinal stenosis surgery. HRQoL and function are low preoperatively irrespective of whether back or leg pain is predominant. In this large patient material patients who grade their back and leg pain as likeworthy have significantly lower values for HRQoL and function compared to patients reporting predominant leg or back pain but the difference is not clinically relevant.
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| 4. |
- Sigmundsson, Freyr Gauti, et al.
(författare)
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Preoperative Pain Pattern Predicts Surgical Outcome more than Type of Surgery in Patients With Central Spinal Stenosis Without Concomitant Spondylolisthesis: A Register Study of 9,051 Patients.
- 2014
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 39:3, s. 199-210
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A register cohort study.Objective. To evaluate outcome of surgery for lumbar spinal stenosis without concomitant degenerative spondylolisthesis according to predominance of pain and to analyze the role of spinal fusion in conjunction with decompression in patients with predominant back or leg pain.Summary of Background Data. Predominance of back pain is associated with inferior outcome of surgery for central spinal stenosis (CSS). It is unknown if adding spinal fusion improves outcomes.Methods. In a register study of 9,051 patients we studied outcome of surgery in terms of back and leg pain (VAS), function (the Oswestry disability index and self-estimated walking distance), health-related quality of life (SF-36 and EQ-5D), and patient satisfaction. Outcome was analyzed for 4 groups at 1 and 2 year follow up; preop back pain ≥ leg pain and decompression, preop back pain ≥ leg pain and decompression and fusion, preop back pain < leg pain and decompression, preop back pain < decompression and fusion.Results. Patients with concomitant fusion were younger and had higher back pain and ODI scores and lower preoperative EQ-5D. Predominant back pain was associated with inferior outcome in terms of pain, health-related quality of life and function. Patients most often satisfied (69%) were patients with back pain < leg pain treated with decompression and fusion and the least satisfied group was patients with back pain ≥ leg pain treated with decompression (54%). Fusion was associated with higher EQ-5D at 1-year follow up for patients with predominant back pain up but was also associated with increased leg pain at 2- year follow up in patients with predominant leg pain. Patients with predominant back pain experienced small gains in the physical component summary with fusion.Conclusion. Predominance of back pain is associated with inferior outcome. Adding spinal fusion improves unadjusted outcome but the benefit is small and not clinically significant and generally disappears in the adjusted analysis.
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