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| 2. |
- Andersson, Eleonor I., et al.
(författare)
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Performance Tests in People With Chronic Low Back Pain Responsiveness and Minimal Clinically Important Change
- 2010
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Ingår i: Spine. - : J B Lippincott Co. - 0362-2436 .- 1528-1159. ; 35:26, s. E1559-E1563
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Cohort study. Objective. To assess the responsiveness and minimal clinically important change (MCIC) of 6 commonly-used performance tests (5-minute walking, 50-ft walking, sit-to-stand, 1 minute stair climbing, loaded forward reach, Progressive Isoinertial Lifting Evaluation). Summary of Background Data. Performance tests are used to evaluate physical function in people with low back pain. Little is known about their clinimetric properties. Methods. Performance tests were administered in people with chronic nonspecific low back pain (n = 198) before and after 10 weeks of treatment. At 10 weeks, the global perceived effect scale was used to determine if participants judged themselves as worsened, unchanged, or improved. The mean change scores for each performance test were calculated. A performance test was considered responsive if the area under the receiver operating characteristic curve (AUC) was equal to or greater than 0.70. We used 2 methods to evaluate MCIC: the optimal cut-off point based on the receiver operating characteristic curve, which takes into account both sensitivity and specificity, and the minimal detectable change for improvement, which considers test specificity only. Results. In general, the mean change scores were the smallest in participants who judged themselves worsened and largest in those reporting to be improved. Sit-to-stand (AUC = 0.75) and stair climbing (AUC = 0.72) were the only performance tests that showed adequate responsiveness. For sit-to-stand, the MCIC ranged from 4.1 to 9.8 seconds (19%-45% of the mean baseline score). For stair climbing, the MCIC ranged from 14.5 to 23.9 steps (19%-31% of the mean baseline score). Conclusion. Only 2 of the 6 performance tests were responsive. Both had acceptable MCIC values. Developing individualized performance tests might partly overcome the general lack of responsiveness of performance tests. Future research should focus on the clinimetric testing of performance tests in subgroups.
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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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| 4. |
- 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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| 5. |
- Bergknut, Niklas, et al.
(författare)
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The Dog as an Animal Model for Intervertebral Disc Degeneration?
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37, s. 351-358
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective observational and analytic study.Objective. To investigate whether spontaneous intervertebral disc degeneration (IVDD) occurring in both chondrodystrophic (CD) and nonchondrodystrophic dogs (NCD) can be used as a valid translational model for human IVDD research.Summary of Background Data. Different animal models are used in IVDD research, but in most of these models IVDD is induced manually or chemically rather than occurring spontaneously.Methods. A total of 184 intervertebral discs (IVDs) from 19 dogs of different breeds were used. The extent of IVDD was evaluated by macroscopic grading, histopathology, glycosaminoglycan content, and matrix metalloproteinase 2 activity. Canine data were compared with human IVD data acquired in this study or from the literature.Results. Gross pathology of IVDD in both dog types (CD and NCD) and humans showed many similarities, but the cartilaginous endplates were significantly thicker and the subchondral cortices significantly thinner in humans than in dogs. Notochordal cells were still present in the IVDs of adult NCD but were not seen in the CD breeds or in humans. Signs of degeneration were seen in young dogs of CD breeds (<1 year of age), whereas this was only seen in older dogs of NCD breeds (5-7 years of age). The relative glycosaminoglycan content and metalloproteinase 2 activity in canine IVDD were similar to those in humans: metalloproteinase 2 activity increased and glycosaminoglycan content decreased with increasing severity of IVDD.Conclusion. IVDD is similar in humans and dogs. Both CD and NCD breeds may therefore serve as models of spontaneous IVDD for human research. However, as with all animal models, it is important to recognize interspecies differences and, indeed, the intraspecies differences between CD and NCD breeds (early vs. late onset of IVDD, respectively) to develop an optimal canine model of human IVDD.
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| 6. |
- Crnalic, Sead, et al.
(författare)
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Predicting survival for surgery of metastatic spinal cord compression in prostate cancer : a new score
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37:26, s. 2168-2176
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Study design. We retrospectively analyzed prognostic factors for survival in prostate cancer patients operated for metastatic spinal cord compression.Objective. The aim was to obtain a clinical score for prediction of survival after surgery.Summary of background data. Survival prognosis is important when deciding about treatment of patients with metastatic spinal cord compression. The criteria for identifying prostate cancer patients who may benefit from surgical treatment are unclear.Patients and methods The study comprised 68 consecutive patients with prostate cancer operated for metastatic spinal cord compression at Umeå University Hospital, Sweden. The indication for surgery was neurological deficit; 53 patients had hormone-refractory prostate cancer, and 15 patients had previously untreated, hormone-naïve prostate cancer. In 42 patients posterior decompression was performed and 26 patients were operated with posterior decompression and stabilization.Results A new score for prediction of survival was developed based on the results of survival analyses. The score includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The total scores ranged from 0 to 6. Three prognostic groups were formulated: group A (n = 32) with scores 0-1; group B (n = 23) with scores 2-4, and group C (n = 12) with scores 5-6. The median overall survival was 3 (0.3 - 20) months in group A, 16 (1.8 - 59) months in group B, and in group C more than half (7 of 12) of patients were still alive.Conclusion We present a new prognostic score for predicting survival of prostate cancer patients after surgery for metastatic spinal cord compression. The score is easy to apply in clinical practice and may be used as additional support when making decision about treatment.
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| 7. |
- Cuellar, Jason M., et al.
(författare)
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The Effects of Amicar and TXA on Lumbar Spine Fusion in an Animal Model
- 2014
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 39:19, s. E1132-E1137
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Animal model. Objective. To determine whether aminocaproic acid (Amicar) and tranexamic acid (TXA) inhibit spine fusion volume. Summary of Background Data. Amicar and TXA are antifibrinolytics used to reduce perioperative bleeding. Prior in vitro data showed that antifibrinolytics reduce osteoblast bone mineralization. This study tested whether antifibrinolytics Amicar and TXA inhibit spine fusion. Methods. Posterolateral L4-L6 fusion was performed in 50 mice, randomized into groups of 10, which received the following treatment before and after surgery: (1) saline; (2) TXA 100 mg/kg; (3) TXA 1000 mg/kg; (4) Amicar 100 mg/kg; and (5) Amicar 1000 mg/kg. High-resolution plane radiography was performed after 5 weeks and micro-CT (computed tomography) was performed at the end of the 12-week study. Radiographs were graded using the Lenke scale. Micro-CT was used to quantify fusion mass bone volume. One-way analysis of variance by ranks with Kruskal-Wallis testing was used to compare the radiographical scores. One-way analysis of variance with least significant difference post hoc testing was used to compare the micro-CT bone volume. Results. The average +/- standard deviation bone volume/total volume (%) measured in the saline, TXA 100 mg/kg, TXA 1000 mg/kg, Amicar 100 mg/kg, and Amicar 1000 mg/kg groups were 10.8 +/- 2.3%, 9.7 +/- 2.2%, 13.4 +/- 3.2%, 15.5 +/- 5.2%, and 17.9 +/- 3.5%, respectively. There was a significant difference in the Amicar 100 mg/kg (P < 0.05) and Amicar 1000 mg/kg (P < 0.001) groups compared with the saline group. There was greater bone volume in the Amicar groups compared with the TXA group (P < 0.001). There was more bone volume in the TXA 1000 mg/kg group compared with TXA 100 mg/kg (P < 0.05) but the bone volume in neither of the TXA groups was different to saline (P = 0.49). There were no between-group differences observed using plane radiographical scoring. Conclusion. Amicar significantly "enhanced" the fusion bone mass in a dose-dependent manner, whereas TXA did not have a significant effect on fusion compared with saline control. These data are in contrast to prior in vitro data that antifibrinolytics inhibit osteoblast bone mineralization.
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| 8. |
- 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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| 9. |
- Danielsson, Aina, 1953, et al.
(författare)
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Reliability and Validity of the Swedish Version of the Scoliosis Research Society-22 (SRS-22r) Patient Questionnaire for Idiopathic Scoliosis.
- 2013
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 38:21, s. 1875-1884
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Two quality of life questionnaires were completed, once or twice, by patients with idiopathic scoliosis from three centers for scoliosis care in Sweden. These patients were under observation, during brace treatment, or after treatment with either a brace or surgery.Objective: The aim of the study was to translate and validate the Scoliosis Research Society Questionnaire (SRS-22r) for use in Sweden.Summary of Background Data: In modern outcome research, the patient's own view of outcome is of great importance. The SRS-22 questionnaire has been specially designed to measure quality of life in patients with scoliosis and has been used in a number of recent studies. This questionnaire had not previously been used in Sweden.Methods: The SRS-22r was translated into Swedish according to accepted methods for the translation of quality of life questionnaires. 141 patients answered the questionnaire together with the SF-36. Statistical analyses were performed and revealed a somewhat low internal consistency (Cronbach's alpha) of the Function domain/SRS-22, which was found to originate in question no 18. After retranslation, another 52 patients completed the improved questionnaire. Analyses were repeated and the results improved. When suitable, all 193 patients were therefore analyzed together.Results: Descriptive statistics, distributions, test-retest and test for concurrent validity showed satisfactory results. After retranslation, the Cronbach's α for all domain scores was at least 0.72. Discriminant validity was only shown for self-image and management satisfaction/dissatisfaction.Conclusion: The SRS-22r questionnaire was found to be appropriate for use in our language. Further testing for discriminant validity will be performed.
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| 10. |
- Engquist, M., et al.
(författare)
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Surgery versus nonsurgical treatment of cervical radiculopathy : A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up
- 2013
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:20, s. 1715-1722
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN.: Prospective randomized controlled trial. OBJECTIVE.: To study the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program compared with the same physiotherapy program alone for patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA.: Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. METHODS.: Sixty-three patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with anterior cervical decompression and fusion. The physiotherapy program included general/specific exercises and pain-coping strategies. The outcome measures were disability (Neck Disability Index), neck and arm pain intensity (visual analogue scale), and the patient's global assessment. Patients were followed for 24 months. RESULTS.: The result from the repeated-measures analysis of variance showed no significant between-group difference for Neck Disability Index (P = 0.23). For neck pain intensity, the repeated-measures analysis of variance showed a significant between-group difference during the study period in favor of the surgical group (P = 0.039). For arm pain intensity, no significant between-group differences were found according to the repeated-measures analysis of variance (P = 0.580). Eighty-seven percent of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up compared with 62% in the nonsurgical group (P < 0.05). At 24 months, the corresponding figures were 81% and 69% (P = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group. Significant reduction in Neck Disability Index, neck pain, and arm pain compared with baseline was seen in both groups (P < 0.001). CONCLUSION.: In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years. Structured physiotherapy should be tried before surgery is chosen. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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