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Sökning: WFRF:(Annertz Mårten)

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1.
  • Anderberg, Leif, et al. (författare)
  • Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography.
  • 2006
  • Ingår i: European Spine Journal. - : Springer. - 0940-6719. ; 15:10, s. 1465-1471
  • Tidskriftsartikel (refereegranskat)abstract
    • Transforaminal injections are sometimes used for the diagnosis and treatment of painful conditions in the lumbar and to a lesser degree in the cervical spine. The technique is most often used when investigating/treating radiculopathy caused by degenerative disease. But how selective are the nerve root blocks? What possible structures other than the intended nerve root are affected from such injections? This study was undertaken in order to try to answer these questions, as no study focusing on the possible spread from the transforaminal selective nerve root blocks in the cervical spine has been performed earlier. In three groups of patients, each group including three patients, we injected three different volumes (0.6, 1.1 and 1.7 ml) with a transforaminal technique in the cervical spine. In all the injections, a small amount of contrast media was added. The spread of the injections were then investigated using multi-slice computed tomography with reconstructions. The imaging revealed a possible effect on other nerve roots than the intended ones when a larger volume was used for the root blocks. The spread was related to the injected volume as well as to local anatomy (size of foraminal area). In this study, only 0.6-ml injections could be accepted for being selective enough for diagnostic investigations.
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4.
  • Anderberg, Leif, et al. (författare)
  • Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine.
  • 2006
  • Ingår i: European Spine Journal. - : Springer. - 0940-6719. ; 15:6, s. 794-801
  • Tidskriftsartikel (refereegranskat)abstract
    • In patients with radiculopathy due to degenerative disease in the cervical spine, surgical outcome is still presenting with moderate results. The preoperative investigations consist of clinical investigation, careful history and most often magnetic resonance imaging (MRI) of the cervical spine. When MRI shows multilevel degeneration, different strategies are used for indicating which nerve root/roots are affected. Some authors use selective diagnostic nerve root blocks (SNRB) for segregating pain mediating nerve roots from non-pain mediators in such patients. The aim of the present study is to assess the ability of transforaminal SNRB to correlate clinical symptoms with MRI findings in patients with cervical radiculopathy and a two-level MRI degeneration, on the same side as the radicular pain. Thirty consecutive patients with cervical radiculopathy and two levels MRI pathology on the same side as the radicular pain were studied with SNRBs at both levels. All patients underwent clinical investigation and neck and arm pain assessment with visual analogue scales (VAS) before and after the blocks. The results from the SNRBs were compared to the clinical findings from neurological investigation as well as the MRI pathology and treatment results. Correlation between SNRB results and the level with most severe degree of MRI degeneration were 60% and correlation between SNRB results and levels decided by neurological deficits/dermatome radicular pain distribution were 28%. Twenty-two of the 30 patients underwent treatment guided by the SNRB results and 18 reported good/excellent outcome results. We conclude that the degree of MRI pathology, neurological investigation and the pain distribution in the arm are not reliable parameters enough when deciding the affected nerve root/roots in patients with cervical radiculopathy and a two-level degenerative disease in the cervical spine. SNRB might be a helpful tool together with clinical findings/history and MRI of the cervical spine when performing preoperative investigations in patients with two or more level of degeneration presenting with radicular pain that can be attributed to the degenerative findings.
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5.
  • Anderberg, Leif, et al. (författare)
  • Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study.
  • 2007
  • Ingår i: European Spine Journal. - : Springer. - 0940-6719. ; 16:3, s. 321-328
  • Tidskriftsartikel (refereegranskat)abstract
    • Steroid injections are often employed as an alternative treatment for radicular pain in patients with degenerative spinal disorders. Prospective randomised studies of the lumbar spine reveal contradictory results and non-randomised and most often retrospective studies of the cervical spine indicate pain reduction from steroid injections. No prospective randomised study on transforaminal steroid injections for the treatment of radicular pain in the cervical spine focusing on short-term results has been performed. Forty consecutive patients were employed for the study. The inclusion criteria were one-sided cervical radiculopathy with radicular distribution of arm pain distal to the elbow and corresponding significant degenerative pathology of the cervical spine at one or two levels on the same side as the radicular pain and visualised by MRI. A transforaminal technique was used for all injections. A positive response to a diagnostic selective nerve root block at one or two nerve roots was mandatory for all patients. The patients were randomised for treatment with steroids/local anaesthetics or saline/local anaesthetic. Only the neuroradiologist performing the blocks was aware of the content of the injection; all other persons involved in the study were blinded. Follow up was made 3 weeks after the randomised treatment by a clinical investigation and with a questionnaire focusing on the subjective effects from the injections. At follow up, there were no differences in treatment results in the two patient groups. Statistical analysis of the results confirmed the lack of difference in treatment effect. Further studies have to be performed before excluding steroids in such treatment and for evaluating the influence of local anaesthetics on radiculopathy in transforaminal injections.
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6.
  • Annertz, Mårten, et al. (författare)
  • Contrast-enhanced MRI versus myelography and contrast-enhanced CT in postdiskectomy problems
  • Ingår i: European Spine Journal. - : Springer. - 0940-6719. ; 1:2, s. 84-88
  • Tidskriftsartikel (refereegranskat)abstract
    • The differentiation between scar tissue and disk herniation is essential in postdiskectomy problems of the lumbar spine, since reoperation on scar tissue alone is often unfavourable. Epidural scar is a vascularized tissue, and enhancement can be seen after intravenous contrast injection, allowing differentiation from avascular disk material. Ten patients who had previously undergone surgery for lumbar disk herniation and with recurrent symptoms severe enought to warrant repeat surgery were examined by myelography, magnetic resonance imaging (MRI), and computed tomography (CT) before reoperation. MRI was performed with T1- and T2-weighted sequences in sagittal and axial projections before and after intravenous contrast injection. CT scans were obtained before and during intravenous contrast infusion. Reoperation revealed scar tissue, alone or together with disk, in 9 of 10 patients. Enhancement of scar but not of disk material was observed on MRI in 8 cases, but in none on CT. No enhancement of disk was seen with either modality. The correct diagnosis was given by MRI in 9 of 10 patients and by CT in 3 of 10. CT was superior to MRI in only 1 patient, who had a bony stenosis. Myelography could not separate disk from scar in any case. In conclusion, contrast-enhanced MRI was superior to MRI without contrast, CT before and after contrast, as well as myelography in discriminating disk from scar tissue.
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7.
  • Annertz, Mårten, et al. (författare)
  • Isthmic lumbar spondylolisthesis with sciatica. MR imaging vs myelography
  • 1990
  • Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455. ; 31:5, s. 449-453
  • Tidskriftsartikel (refereegranskat)abstract
    • Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: normal nerve (n = 8); II: compressed nerve (n = 16); III: disappearance of fat, nerve not possible to identify (n = 9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information.
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8.
  • Annertz, Mårten, et al. (författare)
  • Ländryggsröntgen ger falsk säkerhet och ringa nytta för patienten : MRT och DT ger bättre och billigare resultat
  • 2017
  • Ingår i: Läkartidningen. - : Swedish Medical Association. - 0023-7205. ; 114:46, s. 1962-1962
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • In 2016 140 000 lumbar spine radiographies were performed in Sweden (14 000 per million inhabitants) to a cost of about 85 million SEK (≈8.5 million Euro) and a negligible value for the patients with low back pain. In the work-up of low back pain, when imaging is indicated, lumbar spine radiography should be replaced by limited magnetic resonance imaging including a whole lower body coronal STIR sequence or computed tomography with radiation dose adapted to indication and patient age. Indication for imaging should be restricted to 1) low back pain with more than 3-4 weeks duration in combination with at least one »red flag«, 2) radicular pain without improvement on conservative treatment, or 3) low back pain with more than 8 weeks duration in combination with »yellow flags«.
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9.
  • Annertz, Mårten, et al. (författare)
  • MR imaging as the primary modality for neuroradiologic evaluation of the lumbar spine. Effects on cost and number of examinations
  • 1996
  • Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455. ; 37:3 Pt 1, s. 373-380
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To evaluate the effects on cost, and number of primary and supplementary neuroradiologic examinations, after introducing MR imaging as the primary modality in the evaluation of the lumbar spine. MATERIAL AND METHODS: Two 5-month periods were compared: period 1--before MR; and period 2--after introduction of a 2nd MR device. In period 1, patients were examined with myelography and/or CT after referral from specialists only, whereas in period 2 both specialists and general practitioners could refer patients for MR imaging. The direct cost (neuroradiologic methods and hospitalization) and indirect cost (sick-leave and estimated loss of production caused by the diagnostic procedure) were estimated. RESULTS AND CONCLUSION: In period 1, investigations were started in 75 patients (62 myelographies and 13 CT examinations); in period 2, in 227 patients (198 MR, 21 CT, and 8 myelographies). The estimated total cost increased from SEK 825,000 to 1,265,000 (53%), the cost per investigated patient decreasing from 11,000 to 5565 (50%), and the cost of preoperative investigation per operated patient decreasing from 8616 to 5563 (35%). The number of supplementary examinations was unchanged.
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10.
  • Annertz, Mårten, et al. (författare)
  • 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
  • Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436. ; 20:4, s. 449-453
  • 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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